Pregnancy, Birth & Your Pelvic Floor: Things Nobody Puts in the Baby Book

Pregnancy is an incredible time, but it can also bring aches, pains and pelvic floor changes 

Questions you weren’t expecting.

Can I keep exercising? Why does my back or pelvis hurt? Is leaking urine during pregnancy normal? Should I be doing pelvic floor exercises? How can I prepare my body for birth? And what should I do after my baby arrives?

A pelvic health physiotherapist can help answer these questions and support you throughout pregnancy, birth preparation and recovery.

Rather than waiting until something goes wrong, seeing a pelvic health physiotherapist during pregnancy — or even before you become pregnant — can help you understand your changing body, stay active, manage discomfort and feel more confident about what’s ahead.

You don’t have to wait until you’re in pain

Many women think physiotherapy is something they need only when they have an injury or a problem that won’t go away. But pregnancy is actually an ideal time to seek advice and learn how to look after your changing body.

As your baby grows, your centre of gravity changes and your posture and movement patterns naturally adapt. Your muscles and joints are also dealing with different demands, while hormonal changes affect the ligaments and tissues supporting your pelvis.

This can contribute to:

• Lower back pain
• Pelvic or pelvic girdle pain
• Hip pain
• Pubic bone pain
• Rib or upper back discomfort
• Sciatica-type symptoms
• Pelvic heaviness or pressure
• Bladder leakage
• Difficulty exercising comfortably

While some discomfort is common during pregnancy, persistent or worsening pain shouldn’t simply be accepted as something you have to endure because you’re pregnant. A pelvic health physiotherapist can assess what’s contributing to your symptoms and give you practical strategies to keep moving and manage your discomfort as your pregnancy progresses.

Staying active during pregnancy

Pregnancy doesn’t mean you need to put your exercise routine on hold. For women with healthy, uncomplicated pregnancies, staying physically active can support physical and mental wellbeing, help maintain strength and fitness, reduce some pregnancy-related discomfort and help prepare your body for the physical demands of birth and caring for a baby.

But knowing exactly what exercise is appropriate for you isn’t always easy.

Perhaps you were a regular runner before pregnancy. Maybe you enjoy Pilates, swimming or strength training. Or perhaps exercise hasn’t been a big part of your life and you’re now wondering how to become more active safely. The answer isn’t necessarily to exercise harder. It’s about finding the right type and level of activity for your body, your pregnancy and your goals.

A pelvic health physiotherapist can help modify your existing exercise program or develop a safe, realistic program if you’re starting from scratch. They can also help you understand how your exercise needs may change as your pregnancy progresses.

The goal is to help you stay strong, mobile and confident — not to make pregnancy feel like another fitness challenge.

Your pelvic floor does more than stop you leaking

You’ve probably heard that you should “do your pelvic floor exercises” during pregnancy. But the pelvic floor is much more complicated than simply squeezing and holding. Your pelvic floor is a group of muscles at the base of your pelvis that helps support your bladder, bowel and uterus. It also plays an important role in bladder and bowel control and sexual function. During pregnancy, these muscles are working under increased load as your baby grows.

This is why learning how to strengthen your pelvic floor can be important. But there’s another side to pelvic floor health that is often overlooked.

Your pelvic floor also needs to be able to relax.

During birth, the pelvic floor needs to lengthen and relax to allow your baby’s head to move through the birth canal. If you’re constantly thinking about tightening your pelvic floor, you may not be learning the relaxation and coordination that can also be important during labour. A pelvic health physiotherapist can assess how your pelvic floor is working and teach you how to contract it correctly, relax it fully and coordinate it with your breathing and movement.

And importantly, not every woman needs the same pelvic floor exercises. Some women have weakness, while others have muscles that are already very tight or difficult to relax. An individual assessment can help determine what your body actually needs.

Preparing for birth is more than pelvic floor exercises

When people think about preparing for birth, they often think about antenatal classes, hospital bags and choosing a name. But preparing your body for birth is important too. A pelvic health physiotherapist can help you understand how your body may move and respond during labour and give you practical strategies to help you feel more prepared.

This can include learning breathing techniques and pelvic floor relaxation, practising different labour and birth positions, using movement to stay comfortable during labour and understanding how to coordinate your breathing, abdominal muscles and pelvic floor during pushing. You can also learn about perineal massage, which may help reduce the likelihood of significant perineal trauma and episiotomy, particularly for women having their first vaginal birth.

The advantage of learning these techniques before labour is that they aren’t completely new to you when the big day arrives. Birth doesn’t always go according to plan, and there is no single “perfect” way to give birth. Your physiotherapist isn’t there to tell you how you should give birth. Instead, the aim is to give you knowledge, practical strategies and options, so you can feel more confident about your choices.

What about bladder leakage?

A small leak when you cough, sneeze, laugh or exercise can become something women simply accept during pregnancy. But while bladder leakage is common, you don’t have to consider it an unavoidable part of becoming a mother. Pregnancy places additional demands on the pelvic floor, and pelvic floor muscle training can help improve pelvic floor strength and bladder control. However, the right approach isn’t necessarily the same for everyone.

A pelvic health physiotherapist can assess how your pelvic floor is functioning and determine whether you need strengthening, relaxation, coordination or simply some changes to the way you’re exercising. They can also help with other pelvic floor symptoms such as urinary urgency, difficulty controlling your bladder or bowel, and feelings of pelvic pressure or heaviness.

What if you feel pressure or heaviness?

Some women describe a feeling that something is “heavy” in their pelvis or that something is “dropping”. Others notice pressure after walking, exercising or standing for long periods. These symptoms shouldn’t simply be dismissed as something you have to tolerate because you’re pregnant.

A pelvic health physiotherapist can assess your symptoms and help you understand what may be contributing to them. They can also provide strategies for exercise, lifting, everyday activities and managing pressure through your abdomen and pelvis.

Don’t forget about the fourth trimester

It’s easy to spend nine months thinking about pregnancy and birth and forget that your body still has a significant recovery job to do afterwards. Pregnancy and birth can place considerable demands on your pelvic floor, abdominal muscles, back and pelvis. Whether you’ve had a vaginal birth, caesarean, stitches, tearing or an assisted birth, your recovery is individual. And then there’s the small matter of suddenly being responsible for a tiny human who needs to be lifted, carried, fed and settled — often while you’re running on very little sleep!

Your postnatal recovery may include gradually rebuilding:

• Pelvic floor strength and coordination
• Abdominal strength
• General fitness
• Core and trunk control
• Confidence with lifting and carrying
• Comfort with walking and exercise
• Comfortable movement around the house
• Your return to the activities you enjoy

A pelvic health physiotherapist can help you develop a graded return to exercise, rather than expecting your body to immediately return to what it could do before pregnancy. If you experience ongoing pelvic or back pain, bladder or bowel problems, pelvic heaviness, painful sex, abdominal concerns or difficulty returning to exercise after birth, you don’t simply have to wait and hope it gets better.

When should you see a pelvic health physiotherapist?

There isn’t one “right” time.

If you’re planning a pregnancy, an appointment can be a great opportunity to identify and address existing pelvic floor, back or pelvic problems and establish good exercise habits before pregnancy begins.

During pregnancy, you may seek help because you’re experiencing pain, bladder leakage, pelvic pressure or difficulty exercising. Or you may simply want professional advice about staying active and looking after your pelvic floor. As you approach the later stages of pregnancy, a session can focus more specifically on birth preparation, including pelvic floor relaxation, breathing, perineal massage, movement and birth positions.

And after your baby arrives, a postnatal assessment can help you understand your recovery and plan your return to exercise and everyday activities.

You don’t need to know what’s wrong Perhaps you’ve noticed something doesn’t feel quite right, but you’re not sure whether it’s something a physiotherapist can help with. Maybe you’re leaking during exercise. Perhaps your pelvis feels uncomfortable when you walk. Maybe you’re nervous about birth and want to know how you can physically prepare. Or perhaps you’ve simply been told you “should be doing pelvic floor exercises” but aren’t sure whether you’re doing them correctly.

You don’t need to have all the answers before you make an appointment.

That’s what your pelvic health physiotherapist is there for.

They can listen to your concerns, assess what’s happening and explain your options in a way that makes sense to you.

Preparing your body. Building your confidence.

Pregnancy and birth are major physical events, but they don’t have to leave you feeling frightened or unprepared. Understanding your changing body, staying active, managing pregnancy pain and learning how your pelvic floor works can help you approach pregnancy, birth and recovery with greater confidence.

At Hindmarsh Physiotherapy & Sports Injury Clinic, our Women’s Health Physiotherapy service supports women through pregnancy, birth preparation and the transition into motherhood.

Whether you’re planning a pregnancy, currently pregnant, preparing for birth or recovering after having your baby, we’d love to help you understand your body and feel more confident about what’s ahead. You don’t have to wait until something is wrong. Preparing early can be one of the best things you do for yourself.

Book an appointment with our Women’s Health Physiotherapist at Hindmarsh Physio to discuss your pregnancy, birth preparation or postnatal recovery.