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A Pelvic Floor Physiotherapist's Tips For Vaginal Birth

Anne Stone is a pelvic health Physiotherapist and mother. During her pregnancy and vaginal birth, she did some very specific “tricks” which helped to reduce her risk of birth injury, and improved her and baby’s overall health. 

Here she shares what she believes helped her achieve the birth that she was aiming for.

Knowing no pregnancy is the same and everyone has different preferences, Anne started by filtering through the most up to date evidence to guide her decisions, using good quality studies to map out her pregnancy and vaginal birth plan.

1. Pelvic floor physiotherapist check

Anne prioritised an assessment with a pelvic floor physiotherapist colleague to see if a vaginal birth was even possible. In her case, she was worried that her pelvic floor may have been “too tight” and unable to relax to allow the baby to pass through the birth canal. It turned out that her pelvic floor was “tighter” on one side. This meant doing her pelvic floor exercises side-lying with the weaker side down so that it had to work harder against gravity as well as some lower belly breathing exercises to release tightness and muscle spasm. She was also doing some specific functional pelvic floor exercises for running.

She then checked in with her pelvic floor physiotherapist to ensure that her technique was still okay given 60% of women do not do their pelvic floor exercises correctly and well, frankly it can be quite hard to know without someone qualified to check.


2. Manage constipation

Importantly, Anne also managed any constipation during pregnancy by eating regular fruit and vegetables (2 x kiwifruit per day keeps the constipation at bay), staying hydrated with approximately 2-3L of water per day, and supplementing with Movicol (a popular stool softener).

Constipation is common in pregnant women, particularly those who take an iron supplement or multivitamin with iron included. With the added weight of placenta, baby, etc on the pelvic fascia and pelvic floor during this time, constipation can in-itself lead to prolapse, haemorrhoids and general downward drag on the pelvic floor. Constipation can also sometimes be a sign of an overactive pelvic floor.

Anne was that person having Movicol and hydrolyte, right up until labour, as she wanted to do everything she could to reduce her risk of birth injury, and make the commonly feared “first post partum poo” a breeze.

In conjunction with this, Anne introduced a footstool to help improve the anorectal angle for opening bowels, a simple yet effective way to decrease downward pressure.


3. Perineal massage from week 34 of gestation

The major “trick” that Anne did to reduce her risk factor for tearing during birth by 64%, was perineal massage from 34 weeks of pregnancy.  With these she was targeting primarily the “tighter” side of her pelvic floor to ensure that it could be flexible for birth and therefore reduce the risk of tearing. Anne did this daily for approximately 3-5 minutes and found standing in the shower with one foot on a block was the easiest position for her with her growing belly. 


4. Targeted Exercise

Throughout her pregnancy, Anne tried her best to follow minimum exercise guidelines. Sadly most women do not reach the WHO and RANZCOG guidelines for exercise during pregnancy, however Anne knew that if she didn’t adhere to these, her risk of fetal macrosomia, insulin resistance (diabetes) and preeclampsia would increase. She did her best to achieve 2.5 to 5 hours of moderate physical activity each week throughout her entire pregnancy. She also knew that it would help maintain her bone density and assist in her postnatal recovery.



5. Wear appropriate support garments

Compression garments were also helpful in supporting Anne’s pelvic floor and abdominals during pregnancy. Anne had been recommending compression garments to her clients for years, however now that she was pregnant herself, she wanted to really put them to the test. It was important to Anne to choose garments that supported not only her growing belly, but even more importantly, her pelvic floor. It was also important that these compression garments were seamless in the saddle area, so that any swelling could be dispelled smoothly, instead of having seams which could pool and even increase swelling.
She ended up purchasing multiple sizes of the baremum support briefs to take her through to the end of her pregnancy and then wore them again post partum as her belly shrank down.

While no birth is the same and genetics can play a huge factor, Anne truly believes the above evidence based steps helped her, and many of her patients reduce their risk of tearing during childbirth, and improved her recovery dramatically.


Hatch is a practice based in East Melbourne with a focus on pregnancy and postpartum physiotherapy. The team work closely with you to optimise birth outcomes and promote the best possible recovery postpartum.They work alongside your obstetric team at Epworth Freemasons Hospital to support you through pregnancy, birth, and beyond.