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  • Writer's pictureDr. Kelly Sammis, PT, CLT

Birth Prep: What's All The Fuss?

Updated: Mar 19, 2023

Are you pregnant and currently prepping for your upcoming birth marathon?! Have you heard other mamas talk about their own personal 'birth prep' and you're wondering what the heck they're referring to?!

As a pelvic PT, mama, and advocate for all things pelvic health that empower women, I wanted to take a moment to discuss the birth prep strategies that I often review with my clients.

Breath Strategies

I typically recommend three different breath strategies for my mamas:

1) diaphragmatic breathing

2) phased breathing

3) active core breath

The diaphragmatic breath is your surrendering breath. It promotes calming and relaxation of the body by getting us back into our parasympathetic nervous system. It also works with the pelvic floor muscles by promoting lengthening.

Phased breathing should be used during exercise and movement and will be paired with what phase of the activity you are in, the relaxation/lengthening phase or the exertion/shortening phase. This is also referred to as the belly pump. You will pair an inhalation belly breath with the relaxation or lengthening phase of your activity and you will pair an exhalation abdominal wrap with the exertion or shortening phase of your activity. This can be utilized with ANY movement, inclusive of common activities like getting up out of a chair all the way to lifting weights or exercise.

Active core breath should be utilized when your activity or exercise involves a longer core hold, in that you don’t want to lose your stability or engagement throughout the movement. For example, while in a plank position. For this breath pattern you will inhale and perform a diaphragmatic breath prior to beginning the activity, exhale and wrap your abdominals to engage in the activity and then continue with short chest/lateral inhalations (keeping your abdominal wrap) and exhalations to re-wrap what you lost from your inhale. This can be used for longer duration exertion exercises that require continual engagement from your core.

Diaphragmatic Breathing

This is key throughout any phase in life, but extra important during pregnancy, birth and postpartum! If mamas only chose ONE exercise to perform during their pregnancy, I would always encourage this one! Performing diaphragmatic breathing in multiple positions, especially in different birthing positions, is key. This helps you integrate the breath during labor and delivery.

With it’s ability to promote lengthening of the pelvic floor, this will be integral during the push phases of delivery. Pushing against a contracted pelvic floor is not only extremely difficult, but it can put you at risk for perineal tearing, pelvic organ prolapse and prolonged push phases. Relaxation, surrendering to these muscles and promoting length is crucial.

Transverse Abdominis Facilitation/Abdominal Wrap

This exercise is your foundational exercise. It should be the driver behind all movements and task execution. The more you engage this muscle during daily tasks, the more it becomes part of your reactive core. This will be crucial for pregnancy and postpartum (and really any stage of life)! Contraction of this muscle helps to regulate intra-abdominal pressure and helps to prevent a dysfunctional diastasis (AKA abdominal separation).

There are some exercise platforms that I absolutely love for my pregnancy and postpartum clients, shoot me a message if you'd like some recommendations!

Regulation of Intra-Abdominal Pressure/Prevention of Dysfunctional Diastasis

When you are performing an exercise or movement in any phase of life, it’s important to recognize the signs of poor regulation of intra-abdominal pressure (IAP). If your body is over-exerting or if an exercise is too challenging for your stage of healing or your current level of function you may see the following:

1) presence of visible tenting/doming/gapping of the abdominals during movement or exercise

2) sensation of pelvic pressure/bulge/dragging in the vagina or pelvic area during movement or exercise

3) presence of pelvic, low back, deep hip or other pain during movement or exercise

4) presence of urinary or fecal incontinence during movement or exercise

It’s important that you either (a) discontinue the exercise or movement (b) modify the movement or exercise to ensure that you’re able to engage the transverse abdominis throughout the execution of the move or (c) re-establish a proper connection with your core and then attempt to execute the move again.

If you continue to push through and ignore these signs of poor IAP regulation you can put yourself at risk for the development of a dysfunctional diastasis, pelvic organ prolapse, incontinence or other pelvic floor dysfunctions.

Regarding diastasis, there is always a natural amount of separation that occurs during pregnancy to accommodate the growing babe. This is a separation along the linea alba which is made up of mostly collagen connective tissue. Genetics plays a big role in our connective tissue make up, so some are prone to larger degrees of separation secondary to their genes. You can always consider adding a collagen supplement to help support this structure.

Perineal Support

Performing perineal massage and stretching can be a fabulous adjunct to birth prep. I typically recommend beginning this around 32 weeks gestation and starting with 1-2x/week. You can then increase the frequency to 3-4x/week as you approach your delivery date! This is also something that can be implemented in late stage labor and during delivery to help prevent perineal tearing.

Proper Pushing

Proper pushing strategies should include the following:

1) Choosing an effective birth position for your body

2) Implementing proper breath strategies ( the traditional cue of holding your breath during pushing may not be the answer)

3) Implementing appropriate perineal support measures

Postpartum: What’s Normal Versus Abnormal

While there is a WHOLE LOTTA new stuff going on with your postpartum body, there are some things that are common, but definitely not normal.

If you have persistent pain, persistent pain with intercourse, persistent presence of incontinence, persistent changes in your bowel/bladder habits from your pre-pregnancy norm, a dysfunctional or non-healing diastasis, or simply aren't feeling yourself postpartum....please know that we are here to help you! These are not conditions that you “have to live with because you had a baby”. There are treatment options and a community of support available throughout every stage!

To health + wellness for your pelvis,


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