Birth: Optimizing your Pelvic Bones and Muscles for Birth

Updated: Sep 28

Hello! I thought I would share with you guys a little about the pelvis: the bones and the muscles and the process of birth. When you go into labor, your baby first descends into the “pelvic inlet” and the sacrum, pubic symphysis and ilial bones widen. Then, as your baby’s head moves farther down and reaches the pelvic floor muscles, the “pelvic inlet” closes a bit and the “pelvic outlet” widens. The tailbone has about 30 degrees of extension (or tail moving towards the feet) and it needs every ounce of that to pass your baby’s head. The seatbones (ischiums) spread and the pubic symphysis widens. The pelvic floor muscles stretch 3 to 5 times their length to get out of the way of the baby’s passing body, which is amazing! Levator ani tears or avulsions occur in 10-30% of women who have had a baby. Factors that increase the risk of levator ani tears are a prolonged pushing stage, use of forceps, episiotomy, anal sphincter tears and large baby head. A woman’s body is wonderfully designed to birth and there are some things you can do to optimize this space:

  1. Get your baby "occiput anterior!" Babies fit in and out of the pelvis best when they are “occiput anterior” or head down and the back of the head towards mama's belly. How can you promote this optimal position? Standing, hands and knees positions, walking and swimming are activities that help the baby’s heavy butt move to the front of the belly! Reclining in chairs or the couch are positions that you may want to limit because they encourage the baby’s heavy butt to move to the spine (wrong way!). When you do sit (and of course you will!), be sure to sit like a "happy dog" rather than a "sad dog." When a happy dog sits, it's tail is upright and happy! Avoid sitting like a sad dog, or with your tail under or slouched. Sitting "happy dog" or with good posture helps optimize your baby's position.

  2. Keep your pelvis happy in pregnancy so that the bones and muscles are “happy,” can open for birth and at optimal position. If you have pelvic girdle pain (pain at the bone in the front below your baby or pain in the dimple areas in the low, low back on the left or the right or both sides), get help from women's health physical therapist! If you are in Richmond, give us a call to schedule a free phone or telehealth consultation. If you are not in the area, find a Board-Certified Pelvic Health specialist in your area.

  3. Think outside of the box with regards to delivery positions. When you are laying on your back, the pelvis is limited in its full range of expansion. Think about hands and knees or laying on your side!

  4. Once your baby is in the head down and occiput anterior position (ask your provider or check out, help engage your baby into the pelvic "inlet" with deep squats, upright exercise and activity.

  5. If you have any indicators of pelvic floor dysfunction, see a pelvic health specialist in pregnancy. Those muscles need to stretch and "get out of the way" to make room for your baby, so you want those muscle to have good flexibility. Take the quiz below (Cozean Screening Questionnaire) to see if you may have pelvic floor dysfunction.

  6. Pushing: In birth, you will use your breath and your body's intuition to push your baby out. If you have diastasis, this can be a little more difficult, but we have a few tricks that can help such as using a sheet to support your abdominal wall to help support your muscles. At the end of pregnancy, we will assess your ability to gently bear down and make sure you are relaxing your pelvic floor (as opposed to contracting, which is not what we want in birth) and make sure your abdominal wall has the support it needs for pushing.

As pelvic floor physical therapy specialists, Dr. Laura and Dr. Kelley have a combined 30 years of experience and countless advanced trainings to help birthing people optimize their births and recover postpartum. Postpartum, we help incontinence, pelvic pain, painful sex, helping moms get out of the "open birthing position", cesarean scar healing, diastasis rectus (abdominal separation) and help guide birthing people back to doing the things they love!

In Richmond, Virginia? We are Richmond's most experienced team of pelvic health physical therapy specialists offering house calls! Book your patient appointment or free phone or telehealth consult online at or call us at 804-372-0291

Share this important information with a few friends. Remember that pain and leaking are common but NOT normal. Help is out there! To find a Board Certified Pelvic Health specialist in your area, go to

Cozean Pelvic Dysfunction Screening Protocol Instructions:

Instructions: Check all that apply

1. I sometimes have pelvic pain (in genitals, perineum, pubic or bladder area, or pain with urination) that exceeds a ‘3’ on a 1-10 pain scale, with 10 being the worst pain imaginable.

2. I can remember falling onto my tailbone, lower back, or buttocks (even in childhood)

3. I sometimes experience one or more of the following urinary symptoms

-Accidental loss of urine

-Feeling unable to completely empty my bladder

-Having to void within a few minutes of a previous void

-Pain or burning with urination

-Difficulty starting or frequent stopping/starting of urine stream

4. I often, or occasionally, have to get up to urinate two or more times at night

5. I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic organs slipping down or falling out

6. I have a history of pain in my low back, hip, groin, or tailbone or have had sciatica

7. I sometimes experience one or more of the following bowel symptoms

-Loss of bowel control

-Feeling unable to completely empty my bowels

-Straining or pain with a bowel movement

-Difficulty initiating a bowel movement

8. I sometimes experience pain or discomfort with sexual activity or intercourse

9. Sexual activity increases one or more of my other symptoms

10. Prolonged sitting increases my symptoms

If you answered yes to 3 or more questions then pelvic floor dysfunction is likely and you should book a physical therapy evaluation or a free phone consultation. This applies to all genders, not just women.

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