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Prepping for Labour...A Physio's Guide

After a lifetime spent preparing for job interviews, sporting events, first dates and other major milestones, I am still surprised at how little time I devoted to physically preparing my body for labour day.

Most women have some form of birth plan in place detailing scents, sounds and sensations that would be preferred in their birthing space. Hopefully the mother is well educated about pain relief options and medical interventions and have informed their birth team of their wishes and intentions.

In the lead up to labour day, the mother should be surrounded by a team of professionals whose role it is to support the family's emotional, mental and medical needs. The expertise of a Women's Health Physiotherapist lies in the weeks leading up to birth. There are scientifically proven physical preparations that can be made in this time that facilitate a faster labour and recovery. Unfortunately for me, my specialisation in Women's Health came post pregnancy and birth of my 2 children. Here are my 3 top tips for physically preparing for birth I wish I had known then that I know now.

  1. Perineal Massage

Research has shown that women experiencing their first vaginal birth who practice perineal massage from 35 weeks of pregnancy, have a lower risk of serious tearing or episiotomy and ongoing perineal pain at three months post-delivery.

The reason for the effectiveness of perineal massage is unknown but it is likely to provide desensitisation to the uncomfortable burning associated with crowning of the baby's head. It can also help body awareness and can be used effectively in association with mindfulness and breathing strategies.

It is recommended that perineal massage be commenced from 35 weeks of pregnancy. research shows benefit is seen when practiced once or twice per week. Performing perineal massage more frequently than this recommendation may decrease the protective effect.

Before starting the massage wash hands, be in a comfortable and relaxed position, a warm bath or shower can be helpful to soften the tissue and a mirror can be used initially to familiarise yourself with the perineal area.

Use a natural lubricant such as or coconut oil.

Use 2 thumbs inside the vagina to the depth of the first knuckle and gently pull down towards the anus and outward until an uncomfortable burning sensation is felt.

Alternatively one thumb or finger can be used in a sweeping motion from one side of the vagina to the other.

This is a great time to practice breathing and meditation techniques as in 'Calmbirth' and 'Hypnobirthing' programs.

Do not perform perineal massage:

  • prior to 34 weeks of pregnancy.

  • if you have placenta praevia (a low–lying placenta) or any other condition where there is bleeding from the vagina during the second half of pregnancy.

  • if you are suffering from vaginal herpes, thrush or any other vaginal infection, as massage could spread the infection and worsen the condition.

2. Pelvic Floor Exercises

The benefits of strengthening the pelvic floor to prevent pelvic health issues such as incontinence and prolapse are well documented. Conscious relaxation of the pelvic floor muscles and downtraining an overactive pelvic region are also incredibly important from 35 weeks of pregnancy.

It has long been hypothosised that tight pelvic floor muscles may impair the progress of labour and new research supports this theory. A correlation between high vaginal resting pressure (indicating high tone pelvic floor muscles) and prolonged or obstructed second stage of labour has been shown. It should be noted that high tone is not the same as strong. It is very possible to have normal pelvic floor muscle strength and be able to achieve full relaxation of the muscle complex. There is no link between high tone pelvic floor muscles and caesarian delivery or perineal tear.

To facilitate a speedy second stage of labour practice pelvic floor relaxation from 35 weeks onwards. This can be done by focusing on the descent and opening of the vagina on each deep inhale of breath. Belly breathing, mindfullness and meditation practices can all also be helpful. My guided meditation for pelvic floor relaxation can be found here:

3. Prenatal Positioning

Consideration should be made from 35 weeks of pregnancy to the mother's posture and positioning. A posterior position of the baby, when the baby's head is against the mother's spine may affect the length and intensity of contractions. Contractions in early labour will largely be devoted to turning the baby into a more optimal position.

As the spine and head of the baby is the heaviest, gravity can be utilised during the last weeks of labour to encourage to baby into the optimal anterior position. Wherever possible avoid slouched sitting especially car seats and couches. A back support or wedge cushion can be helpful at work or in the car to facilitate the natural curve if the lower back in sitting and tilt the hips forward. Sitting on a large swiss ball can also be helpful especially when used in conjunction with pelvic tilting exercises. Walking, water based exercise, yoga, pilates and home exercises on all 4's are all great ways to encourage baby into a head down, spine out position.

For more information on how to physically prepare for labour book for an individualised assessment and plan with your local Women's Health Physiotherapist!

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