Physical Preparation for Birth

A recent research article on birth positioning [1] and a policy paper on reducing interventions in labor [2] reinforced my thinking that how we prepare women for labor and birth needs updating. As we learn more and more about the physiology of labor and birth [3], we are learning which practices are productive for a healthy birth and which practices work against birth.

Augmenting our knowledge and skills, as well as encouraging exercise components that improve outcomes truly prepare women for the intense challenges of giving birth. So here are some up and coming tips:

Hands and knees is mechanically efficient for mom’s body to “cradle” the fetus.

Why is this pregnant woman on her hands and knees?

Hands & knees can help low back pain in pregnancy & labor. It also reduces risk of injury to the pelvic floor during birth [1].

This position innervates transverse abdominal support of the abdomen. It opens SI joint via knee press effect. Practicing breathing, pelvic tilts, and modified planks in this position improves hands and knees endurance.

Why are these pregnant women squatting with partner support?

The most common reason given for practicing squats is that this action “opens the pelvic outlet.” This is true. But knowing how valuable kinesthesia is in executing challenging actions, I find that I must first teach women (and their partners) to sense where the target outlet is – between the sitsbones! This helps them learn to release the pelvic floor muscles and know where to focus their pushing efforts.

Also, having the support partner understand what is happening, as well as learning to support this action, is equally valuable to mom. It creates an important bonding and trusting activity. Explaining, illustrating with charts, and then teaching the ability to release, then bulge or distend the pelvic floor in the target area turns out to be one of the activities for which both partners are most grateful.

Why is this woman taking big strides and really moving out?

Aerobic fitness helps provide endurance in labor

Moving is a complicated neurological phenomenon and requires large afferent fiber pathways. The gate-control theory of pain states that movement deters other sensations that must travel up smaller pathways to reach our attention. Example: When you hit your elbow funny bone, you are likely to move around and rub the area, NOT sit and focus on the discomfort.

Labor is an endurance event, so if a mom is going to use movement (and gravity – another big helper) for 10 or 12 hours in labor, endurance fitness is a key preparation. Whether she jogs, swims, spins or dances, cardiovascular activity is possibly the most valuable exercise component she can acquire.

Some Quick Tips, based on recent research:

  • Encourage moms in early labor to stay out of the hospital as long as they can, unless they are given a significant medical reason to go in by their care provider. Once in the hospital, try to minimize the procedures that she must undergo [2]. The hospital or birthing center where she gives birth can, itself, be a factor in how she births [4].
  • If this is a healthy pregnancy, encourage her to eat in early labor and maintain her fluid intake throughout labor [5]. Endurance drinks can be useful to help maintain electrolyte balance during this long event.
  • Let her know she can ask to have hands-on support of her pelvic floor as the baby descends in pushing. Have her discuss this ahead of time with her care provider. This is another method that has been shown to reduce injury [6].
  • She can also ask to “labor down” rather than push for a few contractions after she is fully dilated, if she feels she needs to regroup once the head is through the cervix [7].
  • A good resource for positioning for birth and for recovery exercise is a Physical Therapist who has a PT certification in women’s health. For more information, go to or their Physiquality Blog.


These references are worthy reading on our changing concepts of pregnancy, labor and birth practice. All of us who work with pregnant women are important influences in helping them gain skills and confidence to cope with this intensely physical, challenging experience.

  1. Zhang H et al. A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China. Midwifery July 2017 50:117-124.
  2. ACOG. Approaches to Limit Intervention During Labor and Birth. Committee Opinion Number 687, February 2017.
  3. Buckley SJ. Hormonal Physiology of Childbearing: Evidence and implications for Women, Babies, and Maternity Care. Childbirth Connection, 2015. PDF:
  4. Shah NT. System Complexity and the Challenge of Too Much Medicine, Annual Meeting ACOG 2017.
  5. ASA Press Release. Most healthy women would benefit from light meal during labor. Nov. 6, 2015.
  6. Leenskjold S, Hoi L, Pirhonen J. Manual protection of the perineum reduces the risk of obstetric anal sphincter ruptures. Dan Med J May 2015; 62(5). pii: A5075.
  7. Brancato (Ozovek) RM, Church S, Stone PW. A Meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor, JOGNN 2008; 37(1):4-12.

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