Comprehensive Guide to Preparing for Vaginal Birth
Not sure how to prepare for a vaginal birth? No worries, I’ve got you covered.
I’ve said it once and I’m here to say it again – birth is an endurance event and should be trained for as such. Pregnancy is a 40-ish week marathon with a sprint finish. Want to run a marathon? You’d probably do a lot of running to prepare your body for it. But how do you prepare your body and mind for a vaginal birth?
Consider this your comprehensive guide to do exactly that. I’ll cover:
Physical preparation
Mental preparation
Labor stages
Postpartum recovery
Physical Preparation
A. Pelvic Floor Muscles
How important are strong pelvic floor muscles when it comes to pushing a baby out? Turns out you actually want coordinated and mobile pelvic floor muscles.
Remember, the uterus (balloon in the photo below) pushes the baby out.
You see, your pelvic floor muscles surround the vaginal canal and when contracted, contract around the baby’s escape route. You actually want these muscles to get out of the way (or relax) instead of contracting during birth. Doing so allows for a smoother exit for baby and (likely) less birth related injury for mama.
But which muscles do you want to strengthen for pushing purposes?
Your abdominal muscles - specifically the deep core (hands in the photo above). Transverse abdominus, I’m looking at you!
Your deep core muscles wrap around the uterus and can therefore give external force to help the uterus out.
So, if you’re going to invest time into physically preparing your muscles for a vaginal birth, invest your time into pelvic floor relaxation and core strengthening.
B. Perineal Massage
Perineal tears are common during a vaginal birth, and sometimes require stitches to heal. Perineal tears can be graded 1-4 with grade 1 being the least severe and grade 4 being most severe.
Grade 1 tears: tearing of the perineal skin
Grade 2 tears: tearing of the perineal skin & muscle
Grade 3 tears: tearing of the perineal skin & muscle - this is a tear TO the external anal sphincter
Grade 4 tears: tearing of the perineal skin & muscle - this is a tear THROUGH the external anal sphincter
What can you do about it?
Research shows perineal massage reduces the likelihood of grade 3-4 tears which is great news as those are the most severe.
Perineal scar tissue typically heals within the first 6 weeks following birth, but can lead to pain with intercourse (among other pelvic floor symptoms), so addressing the scar tissue can help eliminate those symptoms/dysfunction.
C. Breathing Techniques
Breathing exercises are one of the single most important things you can do to prepare your body for a vaginal birth (and postpartum). Did you know your diaphragm is the roof of your core? And can work with your transverse abdominus muscles to help your uterus out?
Oh, and if you aren’t wanting an epidural and looking for other pain management strategies, breathing techniques can help with pain management too!
And my favorite – not holding your breath during birth decreases birth related injuries like prolapse and diastasis by not funneling pressure down into your pelvic floor or increasing the pressure in the front of your core chamber.
Why is this hard during birth?
Because your musculoskeletal system changes so much during pregnancy to accommodate for a growing fetus. One of those major changes is widened lower ribs, which flattens the diaphragm. Consequently, most pregnant women begin breathing with their upper traps and scalenes (accessory breathing muscles) and not their diaphragm.
So one way to be sure you are breathing with your diaphragm is to place your hands on your lower ribs to be sure they are expanding with each breath rather than your upper ribs.
D. Stretching Routines
As mentioned above, you want your pelvic floor muscles and the muscles surrounding your pelvis to be more mobile than strong when it comes to birth. Strengthening the muscles around the pelvis will help the pelvic floor muscles not be overactive, and mobility routines for the pelvic floor and adductors will help your muscles be mobile.
Specific stretches and mobility movements I often recommend include:
Child’s pose
Happy baby
Deep squatting (pictured below - specifically beginning at 37 weeks)
Cat cow
Thread the needle
E. Hydration
I am sure you’ve heard of Braxton-Hicks contractions– warm up contractions, if you will. These begin happening later in pregnancy and can actually be a sign of dehydration. A good way to differentiate Braxton-Hicks from true contractions is the amount of the abdomen that is contracting.
With a true contraction the entire abdomen will contract, while with a Braxton-Hicks contraction ~25% of the abdomen will contract.
Remember, a contraction is the muscular layer of the uterus contracting. Staying hydrated limits the number of Braxton-Hicks contractions so consider increasing your water intake to 80-100 oz water/day if you are experiencing these frequently.
Mental Preparation
A. Birth Plan Creation
It can be super beneficial to have a plan going into birth, but important to remember it’s just that— a plan. It’s not concrete. Things can change quite quickly so having back up plans for your back up plans is just as important.
And I would argue that practicing and preparing for the preferences in your birth plan is just as important as the creation of your plan itself.
Things to practice and plan for from a physical therapy perspective include:
Who you want in the room
Your pain management plan (plan A, B, and C for this)
Techniques for pushing (ideally begin practicing this at 30ish weeks)
Positions that feel good (to you) for the first stage of labor
Position(s) you would like to push in
What you want your support partners in the room to be doing if anything
A playlist if you want one
B. Stress Management
For stress management surrounding birth, several of my patients have benefited greatly from:
Aromatherapy in the birthing room (lavender, eucalyptus, etc)
Calming playlist playing while in labor
Physical touch from support partners in the room
Meditative breathing while in labor
Low lighting
Ultimately, this comes down to personal preference and what feels calming to you. Personally, I don’t prefer physical touch, therefore I would probably go with several of the other options instead. I believe it’s important to take an introspective look inward to find what feels coming to you and replicate those things in your birthing experience.
C. Visualization Techniques
Visualization is a great tool that I often used during my sports years and plan on using visualization techniques for my own birth experience(s) as well. Vaginal birth can be hard to visualize if you’ve never experienced it, however, physically positioning yourself in the positions that feel good to you and are beneficial for the birthing process and practicing the breathing techniques previously mentioned repetitively can build a positive body-brain connection.
D. Partner Support
Support partners can play a crucial role during a vaginal birth. Not only do they emotionally and mentally support you, they can physically support you by applying counterpressure to various parts of the pelvis to open things up during each stage of labor and other parts of the body for pain management. In my birth prep sessions with patients, I always recommend having a support partner in the room so they are equipped and educated as well and know what to do for my patient during birth as labor isn’t exactly an optimal time for recall.
Labor and Delivery Preparation
A. Signs of Labor
Common signs of going into labor include:
Uterine contractions (full abdomen compared to Braxton-Hicks ~25% of the abdomen)
Back pain
Water breaking (gush OR trickle) as the amniotic sac breaks
Bloody show: small amount of pink discharge as the mucus plug is lost. This can happen a few days before labor or at the beginning, but not everyone experiences this.
Loose joints around the pelvic region – we like this
Everyone has a different experience when their body goes into labor. Most of my patients have been shocked to find out that it usually doesn’t happen in real life like the movies portray it to – a huge gush of water, though it can.
It is important to talk to your maternal provider regarding when they want you to come in during labor, but most recommend to go in when your contractions are more than one minute, 3-5 minutes apart for an hour-long period. It’s also important to note the distance you are from the place you’ll be delivering at when making this decision.
B. Stages of Labor
There are three stages of labor. I like to keep it simple when teaching these.
The first stage is from 37 weeks until you start pushing.
The second stage is actively pushing the fetus out.
And the third stage is pushing the placenta out.
During the first stage you want to open the top of the pelvis (pelvic inlet) to allow the baby to be positioned head down. Think about a really deep squat (pictured below) for this stage.
During the second stage (actively pushing) you want to open the bottom of the pelvis (pelvic outlet) to allow the baby to come through the pelvis. Think about the cow portion of a cat-cow (pictured below) for this.
C. Pain Management Options
Outside of the obvious epidural, there are many strategies for pain management during labor. One of my favorites is a TENS unit with adhesive patches applied to the low back. I do believe it’s important to apply this and use it prior to pressure to know if this is something you like, and tolerate prior to going into labor.
Some hospitals offer nitrous oxide (laughing gas) for pain management now, however you typically only find this at the larger hospitals and more metropolitan areas.
There are several areas of the body that appreciate counterpressure as a form of pain management, including the pelvis, knees, and forehead. This can be applied by support partners in the room, and again should be tested prior to going to labor to see if this is something you appreciate and tolerate.
Lastly, breathing techniques are a great way to manage pain during labor. Specifically, emphasizing your exhale and exhaling with painful contractions longer than you inhale. A good example of this is inhaling for four seconds and exhaling for eight seconds. This can be quite challenging so practicing prior to birth is beneficial.
D. Hospital Bag Essentials
Keep in mind, this is from a pelvic PT perspective but inspired by many patients. But here’s a list of things to include in your hospital bag that your pelvic floor* will thank you for later.
Comfy PJs
Robe
Nursing bra(s)
House shoes or socks
Chapstick
Aromatherapy
Snacks
Long phone charger
Pillow and blanket
Shampoo
Book
Hair ties
Fan
Peppermint essential oil (to sprinkle in your toilet for your first postpartum pee)*
Lotion
E. Postpartum Recovery from a Pelvic PT
Initially following a vaginal delivery, you can expect to have swelling for a couple of weeks, bleeding for a while, some pain with urination and defecation (though a squatty potty, hydration, and magnesium help with this), pain around any lacerations if tearing occurred, and other symptoms like urinary leakage or pain with sitting can occur. The latter two symptoms should not persist, so if they do then consider reaching out to your local pelvic floor PT for help.
If you see a pelvic floor PT during pregnancy (highly recommend) then consider asking them for gentle core exercises you can begin postpartum. Generally this starts with re-training breathing mechanics as your ribs and diaphragm change so much during pregnancy.
I do recommend staying off of your feet as much as you can the first two weeks to let your body heal. Remember, birth is a marathon – train and recover as such.
Annnndddd….
If you’ve made it this far, you’re dedicated and I believe in you. You are going to rock the birthing process. You’re right on time and you’ve got this mama!
You are prepared for a vaginal birth.
If you’re looking for more in depth information to prepare for birth check out the articles below.