Getting your body, especially your midsection and pelvic floor, ready for labour, delivery, and recovery. It suits any pregnancy, whether you're planning a vaginal or caesarean birth.
Birth preparation (antenatal) physiotherapy is all about getting your body, particularly your midsection and pelvic floor, ready for labour, delivery, and the recovery (puerperal and postpartum) periods that follow. As your body changes size and shape through pregnancy, the load increases on the stomach, intestines, bladder, pelvic floor, abdominal wall, and lower back, and on all the muscles and slings that hold the uterus and other organs in place. These muscles need to keep doing their job while also relaxing and lengthening, both to give the baby room to grow and to let the baby pass through during a vaginal birth (and even if you opt for a caesarean, there are still some considerations to make).
Preparing for birth as early as week 20 (and sometimes earlier if there have been previous birth complications, or you think there may be anatomical or body-process considerations that could make birth more difficult) can help make labour and delivery more bearable, and can help reduce your risk of perineal tearing (though some variables that arise in labour can increase the risk, such as a breech baby or a twisted umbilical cord requiring a more intensive delivery).
Birth preparation is useful for anyone who is pregnant, whether it's your first baby or your fourth, and whether you're planning a vaginal or caesarean delivery. First-time mothers are often eager to learn but also inundated with conflicting and sometimes unhelpful information about what to expect, and at the end of the day just want to deliver a happy, healthy baby while minimising the trauma their body goes through. Those who have had a difficult or traumatic birth before want to go in more prepared and confident. Antenatal physiotherapy usually starts midway through the second trimester after your scans, which gives you enough time through the rest of pregnancy to build awareness of your body and pelvic floor, address any factors that might change the birth plan (vaginismus, excessive muscle spasm, extensive scar tissue, for example), get everything working and relaxing the way it should, and massage and prepare the area in the weeks leading up to delivery.
During your first visit, I'll go through your pregnancy so far, along with any previous pregnancies and births, including any that did not make it to full term. I'll ask what your main concerns about pregnancy are and what you want to achieve through antenatal physiotherapy, whether that's optimising labour and delivery and minimising the risk of tearing, preparing your pelvic floor, understanding what you need to do for delivery, or a combination. I'll also ask about your bladder and bowel habits, which change through pregnancy, and any symptoms you're currently getting, including lower back, pelvic or hip pain, leakage, pelvic heaviness, or anything else that doesn't feel right.
To get the best picture of what your body is going through, I'll perform a transperineal ultrasound in the session to view the pelvic floor muscles, bladder, urethra, and base of the uterus. I'm not a sonographer or OBGYN, so I can't give you details about your foetus beyond, at most, the position they're facing if they can be seen well, as that falls outside my scope. I'll also perform an external and, with your consent and after discussing the benefits, an internal examination of the pelvic floor muscles, vulva, and vagina. This lets me see and feel the muscles engaging and relaxing, guide you through breathing with the pelvic floor and relaxing and lengthening (bearing down) without bracing or breath-holding, and work out whether there are any anatomical obstacles worth addressing, such as tightness or pain.
Treatment is very variable and depends on both your goals and what I find in the examination. In most cases there will be exercises and positions to practise at home that I'll guide you through, to help with pelvic floor awareness and co-ordination, lower back and hip mobility, and any strategies for factors we identify. You won't have too much to do all at once - there are staggered goals as you progress through pregnancy, with the focus changing as you get closer to your due date.
All of this is packaged into a plan to continue at home between sessions, where I monitor progress and change and progress the plan as needed.
Consent is ongoing, specific, and yours to withdraw at any time.
Antenatal physiotherapy is best done as part of a multidisciplinary team, including your GP, an OBGYN, midwife, and/or doula. I recommend having your second-trimester evaluation with your primary care specialist, who will identify any issues or concerns beyond the scope of physiotherapy.
Seek urgent care: if you notice spotting or bleeding, any significant change in pain, or numbness into the genitals and inner thighs (which may come with difficulty going to the bathroom), present to your local emergency department, as these can indicate medical emergencies that lie outside the physiotherapy scope of practice.
There is no universally agreed time to start, but midway through the second trimester is when you tend to notice more of the changes, bladder and bowel changes, lower back or hip pain, and the shift in body shape that makes you more aware of what is happening. Starting then also gives you around 12 to 15 weeks to prepare your body and plenty of time to address any concerns.
Perineal massage is a technique of gently stretching the muscles and soft tissue at and around the vaginal opening and perineum (the area between the vagina and anus) in the weeks before birth, to improve how it stretches and conforms to the stresses of delivery. You don't need to start too early, but having a good awareness of the vaginal opening and local muscles, and noticing any tightness, sensitivity or pain early on, gives you time to address it before delivery. Perineal massage can help soften and improve the pliability of the tissue in and around the vulva, which can reduce the degree of tearing during delivery and, ideally, the risk of needing an episiotomy (though some factors that arise during delivery may still make an assisted delivery necessary).
It can help, though nothing can guarantee you won't tear. A combination of learning to relax and lengthen the pelvic floor, perineal massage in the final weeks, good pushing and breathing technique, and practising all of it in various birthing positions that open the pelvis (which I'll show you, and which may change depending on your baby's position) has been shown to reduce the risk of significant (third and fourth-degree) tears, particularly for first-time mothers. The overall aim is to give you the best possible preparation for labour and delivery and to quash any concerns you have.
Not sure if I'm who you need? Ask me and I'll let you know if physiotherapy is the right fit, or point you to who is.