This is the messaging I have been receiving in my emails lately.

Women more than ever are starting to become their own health care advocates in regards to their pelvic health concerns.

This is awesome. I love seeing this initiative, as for way too long the pregnant and postpartum Mom’s needs have not always been addressed as it should.

Not to mention there still tends to be outdated advice out there as to what pregnant Moms should and should not be doing throughout their pregnancy.

This can lead to fear and confusion. Since many Moms wish to stay active throughout their pregnancy, this lack of knowledge can result in Moms exercising very little, or not exercising at all. While fatigue can also play a factor, sometimes pain can be part of the picture as well.

  • The pelvic floor and core to help with safe exercise throughout pregnancy
  • Pain relief strategies such as helping with back or hip pain as well as other issues such as pubic symphysis dysfunction
  • How to prepare for labor and delivery

Seeing a pelvic floor physical therapist can help Moms understand their options and give them the guidance so they are empowered throughout their pregnancy and into postpartum.

Here are the top 3 reasons every pregnant mama needs a pelvic floor physical therapist in their life.

Guidance for exercise during pregnancy

The American College of Obstetricians and Gynecologists has recommended that all pregnant women receive 150 minutes of moderate-intensity physical activity each week, spread over three or more days. This includes strength training plus aerobic activity.

Benefits of strength training include:

  • Decreased risk of gestational diabetes
  • Decreased risk of urinary incontinence
  • Decreased risk of preeclampsia
  • Decreased risk of low back pain
  • Decreased postpartum recovery time
  • Maintenance of physical fitness

Of course you always want to check with your doctor to make sure there are no contraindications when it comes to exercise.

In the past it was recommended not to have your heart rate go above 140 beats per minute during exercise. However that is not the case anymore. If you were performing certain activities or exercises before you became pregnant, it is believed you can continue to do so as long as OK with your doctor.

PRE, also known as Perceived Rate Exertion, can be used instead as a way to measure how intensely you’re working based on how you feel. 1 on the scale is considered little or no activity, 4-6 is moderate activity where breathing is heavy and harder to carry a conversation, while 10 is considered maximal activity, where you can hardly breathe or speak at all.

You can start to exercise including strength training during pregnancy if you never have before, as long as you keep the intensity around a 3 on the PRE to start. Then as you gain more experience and stamina, you can increase it to a 6. It is thought that most pregnant Moms should stay around a 6 throughout their pregnancy. Only exception is an elite athlete. They are used to their heart rate getting exceptionally high while their perceived effort can remain low or moderate. In this case using a heart monitor may be helpful, keeping the heart rate below 85-90% of their max as to not overly exert themselves

As your pregnancy progresses, there will be a time when you will want to ramp down your intensity and start to modify your exercises. As your belly continues to grow, exercises such as planks for example will need to be modified from a full plank on hands and toes to an upright incline plank position.

If you lift weight with a bar as with a clean and snatch, you may want to switch to free weights instead as to avoid hitting your belly with the bar.  Some Pilates moves such as with jack knifes for example, will need to be modified to avoid too much strain on the low back as well as on the belly.

This leads to a discussion of Diastasis Recti. This is when there is a separation of the rectus abdominus muscles, also known as the “6 pack muscles” to allow space for baby to grow. Research shows mostly all pregnant women will have a diastasis by the end of their pregnancy.

Unfortunately there is a lot of fear mongering on social media about having a diastasis recti. Some online influencers claim they are able to “prevent” a diastasis during pregnancy. This is simply not true. While there are ways to support the core during pregnancy to help decrease the amount of intra-abdominal pressure present during exercise, diastasis is a naturally occurring process our body goes through. The goal should be learning ways to minimize this pressure along the Diastasis by tweaking exercises we are doing.

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Learning how to engage the pelvic floor and core during not just exercises, but activities throughout your day as well, can potentially help minimize your chance of worsening a diastasis. By letting a pelvic floor physical therapist assess your movements and exercise patterns, we can tweak your exercises to help encourage safe core and pelvic floor muscle engagement.

You also want to look for the “3 P’s” during exercises as a guide when you are exercising.

Pressure, Pain or Peeing.

Pressure includes vaginal pressure or doming along the abs as with a Diastasis. Pain as in low back pain or pubic pain either during exercises or afterward. Peeing your pants while jumping, squatting or running may also happen due to strain along the pelvic floor, or could be as a result of breath holding. If you notice any of the 3 P’s when you are exercising, then it means you should tweak what you are doing to avoid these.

That being said, Moms are strong, and we should not be fearful of movement. Our bodies are strong and capable. However understanding how our bodies are changing and what to look for, can be very empowering and give us the confidence to keep moving.

Learning how to engage the pelvic floor and core while pregnant will help carry over into your postpartum recovery. Pregnancy is not the time to push yourself with max lifting or excessive workouts. Thinking of more intention with your movements, versus flying through the movement, will serve you in the run. Pregnancy is just a season, there will be time to regain strength and return to your baseline activities later on as you recover.

How to Resolve Pain Issues During Pregnancy

Hopefully you will have a pain free pregnancy and feel good most of the time. However, there is a chance that you may have periods of discomfort due to strain on the back from a growing baby in the front, or ligament laxity in the body. This laxity serves the purpose of making room for baby as the baby continues to grow. You may experience low back pain, hip pain, pelvic pain and pain along the pubic area, also known as pubic symphysis dysfunction.

Certain exercises may help to relieve back pain, such as stretches to address low back or hip tightness. Prenatal yoga may be good to include, as well as strength training to help strengthen the glut or butt muscles. It is believed that by keeping the glut muscles strong, that it can help provide the pelvis and the growing belly support to minimize pain.

Safely incorporating the core and pelvic floor muscles may help minimize strain with exercises. Understanding and being shown how to contract as well as relaxing those muscles, can help provide support. However while we always think of strengthening or contracting our muscles to help with pain, sometimes too much tension can be a contributing factor to ongoing discomfort. Massage or even breathing strategies may be needed to connect with our bodies and give awareness of habitual holding patterns that may contribute to pain.

Pubic symphysis dysfunction is pain in the front of the pubic bone with activities such as prolonged walking including up and down steps, lunges, separating your legs wide as with stepping over a baby gate or stepping inside your car, or with even rolling side to side in bed. Exercises to help promote strength and balance in the pelvis can help to alleviate pain, decreasing your stride by taking smaller steps, and wearing a belly support belt can help reduce pain by lifting pressure off the pubic symphysis.

There are different types of belts out there to give support, and this is where a pelvic floor therapist can help assess the type that you need. One brand that has been helpful with my patients is called the CABEA Baby Belly Band. 

photo courtesy Cabea Baby Belly Band

By establishing a relationship with a pelvic floor physical therapist early in your pregnancy, you have someone to reach out for help if pain does present itself.

Here is a sign up link for a free e-book if you are currently pregnant and experiencing pain or discomfort. These tips go into more detail and provide exercises which may be helpful.

Tips to Ease Pregnancy Pain

How to Prepare for Labor and Delivery

There is a growing interest out there for pregnant Moms to learn how to prepare for labor and delivery.

The last trimester is a good time to

  • Learn strategies on decreasing risk of tearing during delivery
  • Practice different positions during labor to help baby move through the pelvis
  • How to breathe and push effectively during delivery.

There has been a shift in some labor and delivery rooms, instead of keeping mom in bed while laboring and pushing while on their back, to encouraging them to keep mobile as possible to help give the baby more opportunity to move in the pelvis.

The goal is to decrease labor time, decrease pain while also helping to prevent perineal tearing. The perineum is the tissue between the vaginal opening and the rectum.

Perineal massage is one technique that is being taught to pregnant Moms as a way to help prevent tearing. This is when you apply pressure down and outward along the bottom of the vaginal opening, by using your thumbs, finger or a pelvic wand. The concept is you are helping to prep the tissue by increasing the “stretchiness” to help decrease your chance of tearing.

The research however is limited in supporting the direct effect of performing perineal massage and decreasing risk of tearing. However if you want to try it, as long as there are no contraindications such as infection or your water has broken, you can perform it starting the 34th week of your pregnancy. You will want to clear it with your doctor.

The greatest benefit of performing perineal massage may be learning how to keep the pelvic floor muscles relaxed while doing the massage, as this simulates the pressure of the baby’s head coming out.

Understanding what the pelvic floor is doing during labor can be helpful. The baby has to go through the pelvic floor to make its way out of the pelvis. Sometimes when Moms are given cues to push the baby out, their instinct can be to contract the pelvic floor muscles instead. The pelvic floor muscles have to totally relax and stretch to allow baby’s head to move down.

Chantal Traub is a doula in New York and has great info on her website including a course called Pushing Power. She also has free resources to download. Check her out here.

Biofeedback can be done with a pelvic floor physical therapist to help give you a visual as to the coordination of the pelvic floor. Sometimes the Mom will try biofeedback in different positions such as sitting, sideline or hands and knees to see which position she feels more relaxed. You can practice this at home to help prep for labor, and this can be carried over to perform on the big day.

There is research that supports how birthing positions such as upright or on your side can prevent risk of tearing.

Upright positions such as on all fours, or with helps of props, can help with labor due to

  • Gravity helping to assist baby position in the pelvis
  • The uterus contracts more strongly here versus lying on your back
  • The pelvic outlet becomes bigger when knees are positioned inward which gives baby more room to move
  • Has been shown to cause decrease pain versus laboring on your back.

To show how positioning can help with providing more space for baby, try this trick. In a seated position place your hands under your butt. You will feel 2 hard bones called your sit bones. Now keeping your hands under these bones, turn your knees out to the side. You should feel the bones coming closer together. Now turn your knees in toward each other. You should feel the bones going away from each other. This is why having your knees more turned it while pushing baby out, ( versus out which is a common way Moms are  shown during delivery) can give your baby more room to exit, which could result in less techniques from the doctor to help get baby out, such as an episiotomy.

Lying on your side during labor has also been shown to be an effective way to reduce tearing. Even with an epidural, lying on your side would be a great option as you can still position the top knee in, and this position also keeps the sacrum off the bed. When lying on your back, the sacrum may not have as much flexibility to move out of the way for baby as it could be for side line or upright.

photo courtesy

Chantal Traub is a doula in New York and has great info on her website including a course called Pushing Power. She also has free resources to download. Check her out here.

Certain stretches can help prepare you for labor as well such as hip flexor stretches, hamstring stretches, cat camels, figure 8’s on hands and knees and sitting on an exercise ball while working on pelvic tilts and circles. Movement on the ball would be great after your labor has started, as that would be a way to remain upright and keep moving while baby is starting its’ decent into the pelvis.

The more Moms are empowered throughout their pregnancy and into postpartum, the more confidence they will have to make the right decisions for their body.

If you would like to learn more about how pelvic floor therapy can help you during your pregnancy, please give me a call at 317-689-0073 or email I would love to help you!


Owner of Indy Women Physical Therapy