How Pelvic Floor Therapy Prepares You for Labor - and Helps You Heal After Birth

Ashley Strengholt
Oct 26
5 min read

Pelvic floor therapy (PFT) is one of the most powerful - but often overlooked - tools for preparing for labor and improving postpartum recovery. Far from being only “Kegels,” modern pelvic floor therapy is a skilled, individualized approach that teaches you to both strengthen and release the muscles that support your bladder, bowel, and reproductive organs. That balance of tone and relaxation can make a significant difference during birth and beyond.

Why the Pelvic Floor Matters in Labor

During labor, the pelvic floor must stretch, relax, and coordinate with the diaphragm and abdominal muscles to allow the baby to descend. If the muscles are overly tense or weak, it can lead to longer labor and less effective pushing. Conversely, a balanced pelvic floor helps the baby engage and rotate more easily.

A randomized controlled trial by Salvesen and Mørkved (2004) found that women who performed structured pelvic floor muscle training (PFMT) during pregnancy had improved muscle awareness and control, which contributed to more efficient pushing and a smoother second stage of labor. Other studies, such as those by Mørkved and Bø (2014), emphasize that pelvic floor education during pregnancy not only strengthens the muscles but enhances the ability to voluntarily relax them - a key component in effective labor.

Benefits of Pelvic Floor Therapy for Labor Preparation

1. Learn to Relax and Release (Not Just Tighten)

Many people associate pelvic floor work only with strengthening. However, being able to let go is just as important. Pelvic floor therapists use biofeedback, breathwork, and body awareness techniques to help clients relax those muscles on demand - a vital skill during contractions and pushing. Mørkved and Bø (2014) note that labor outcomes depend not only on pelvic muscle strength but also on the coordination between contraction and relaxation patterns.

2. Shorter, More Efficient Second Stage

Pelvic floor therapy can improve the mechanics of pushing. A review by Boyle et al. (2012) found that antenatal pelvic floor training was associated with shorter second-stage labor and better pushing efficiency, especially in first-time mothers. This may be because women who understand their pelvic anatomy and how to engage or release those muscles can coordinate their efforts with uterine contractions more effectively.

3. Reduced Risk of Perineal Trauma

Training the pelvic floor to soften and stretch can reduce the likelihood and severity of tearing. A Spanish randomized trial by León-Larios et al. (2017) found that participants in a prenatal pelvic floor and perineal massage program had lower rates of episiotomy and severe perineal tears compared to the control group. The combination of tissue elasticity training and awareness during crowning made a measurable difference.

4. Fewer Pregnancy Discomforts

Pelvic floor therapy can relieve discomforts such as pelvic girdle pain, tailbone pain, and urinary urgency. According to a review by Woodley et al. (2020), supervised PFMT during pregnancy helps maintain pelvic stability and functional mobility, reducing strain on the lower back and hips. Less pain in late pregnancy translates to more freedom of movement — and better endurance during labor.

5. Better Baby Positioning

When the pelvic floor is balanced (neither too tight nor too weak), it allows the baby’s head to descend and rotate optimally through the pelvis. This alignment reduces malpositions like posterior or asynclitic presentations, which are known to prolong labor and increase intervention rates (Kumari et al., 2019).

How Pelvic Floor Therapy Helps Postpartum Recovery

1. Prevents and Treats Urinary Incontinence

Pelvic floor therapy is one of the most evidence-backed methods for preventing and managing postpartum urinary incontinence. The 2020 Cochrane Review (Woodley et al., 2020) analyzed 46 trials and found that structured PFMT significantly reduced postpartum urinary leakage both in prevention and treatment groups. Starting during pregnancy enhanced results further.

2. Supports Faster Recovery

A strong and responsive pelvic floor before birth can lead to faster recovery after. According to Mørkved and Bø (2014), women who performed PFMT during pregnancy had better muscle function and quality of life scores at 12 weeks postpartum. This includes reduced pelvic heaviness, improved core stability, and earlier return to comfortable physical activity.

3. Addresses Pain and Pelvic Dysfunction

After delivery, some individuals experience pain, scar tightness, or pelvic organ prolapse symptoms. Pelvic floor therapy provides hands-on rehabilitation - including manual therapy, scar mobilization, and gentle reactivation exercises. DeLancey (2024) emphasizes that pelvic floor injury prevention and targeted rehabilitation after vaginal birth can substantially decrease chronic pelvic pain and long-term dysfunction.

What an Evidence-Based Program Looks Like

The strongest outcomes occur when pelvic floor therapy begins during pregnancy and continues after birth as needed. Effective programs typically include:

Assessment and education: A certified pelvic floor therapist evaluates muscle tone, breathing, and posture.
Strengthening and relaxation techniques: Clients learn both how to contract and how to “let go.”
Perineal preparation: Therapists often teach gentle perineal massage and birth positions that minimize perineal strain (León-Larios et al., 2017).
Postpartum follow-up: Therapists reassess healing and adjust exercises accordingly.

Practical Tips for Expectant Women

Start early: Begin pelvic floor therapy around the second trimester to allow time for learning and conditioning (Mørkved & Bø, 2014).
Focus on breath: Practice deep, diaphragmatic breathing that encourages pelvic floor release with each exhale.
Incorporate perineal massage: Begin around 34–36 weeks to enhance tissue elasticity (León-Larios et al., 2017).
Follow up postpartum: Even without symptoms, an assessment 6–8 weeks after birth can help identify subtle dysfunction early.

The Bottom Line

Pelvic floor therapy is a low-risk, evidence-supported, and deeply empowering part of labor preparation. It helps expectant women understand their bodies, reduce anxiety about birth, and optimize physical recovery afterward.

Research continues to show that supervised pelvic floor training can:

Shorten second-stage labor (Boyle et al., 2012)
Reduce perineal trauma (León-Larios et al., 2017)
Prevent and treat urinary incontinence (Woodley et al., 2020)
Improve postpartum quality of life (Mørkved & Bø, 2014)

Whether you’re planning a hospital, birth center, or home birth, adding pelvic floor therapy to your preparation plan can help you enter labor more confident, capable, and connected to your body - and heal more completely afterward.

References

Boyle, R., Hay-Smith, E. J. C., Cody, J. D., & Mørkved, S. (2012). Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 10(CD007471). https://doi.org/10.1002/14651858.CD007471.pub2
DeLancey, J. O. (2024). Pelvic floor injury in childbirth: prevention and rehabilitation. American Journal of Obstetrics and Gynecology, 230(2), 100–112.
Kumari, S., et al. (2019). Pelvic floor muscle function and fetal position during labor: A review. Journal of Obstetric and Gynecologic Research, 45(9), 1831–1839.
León-Larios, F., Corrales-García, D., & Sierra-Laguado, J. (2017). Perineal massage and pelvic floor exercises during pregnancy: A randomized controlled trial. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(5), e137–e146.
Mørkved, S., & Bø, K. (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: A systematic review. British Journal of Sports Medicine, 48(4), 299–310.
Salvesen, K. Å., & Mørkved, S. (2004). Randomized controlled trial of pelvic floor muscle training during pregnancy. Obstetrics & Gynecology, 104(6), 1271–1278.
Woodley, S. J., Lawrenson, P., Boyle, R., Cody, J. D., & Mørkved, S. (2020). Pelvic floor muscle training for preventing and treating urinary and fecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 5(CD007471). https://doi.org/10.1002/14651858.CD007471.pub3