Birth: Preparing for a Natural Birth with Body Balance
- Kelley Ryan
- Aug 13, 2020
- 7 min read
How to Prepare Your Body for Your Best Birth
In labor, your job is to dilate. Your baby's job is to rotate through the pelvis. And the tissues of your body — the bones, muscles, and connective tissue of your pelvis — either help that process or... stay in the way.
That's not a scary thing. It's a useful one. Because so much of what sets the stage for a faster, easier delivery is something you can actually influence.
Here's what's happening inside your body during labor, and what you can do before you get there.
What Your Pelvis Is Actually Doing During Labor
When labor begins, your baby descends into what's called the pelvic inlet. The sacrum, pubic symphysis, and ilial bones all need to widen to let your baby through. Good mobility in these joints is essential — and it's something pelvic PT, prenatal yoga, Webster-trained chiropractic care, and exercise can all support. This is a huge focus at RVA Holistic PT in our prenatal physical therapy and massage therapy care for our clients.
As contractions continue and your baby's head moves deeper, the dynamic shifts. The pelvic inlet closes slightly while the pelvic outlet opens. The tailbone needs up to 30 degrees of extension. The seatbones spread. The pubic symphysis widens. And your pelvic floor muscles — incredible as they are — stretch three to five times their resting length to make room for your baby.
This is exactly why birthing positions matter. When you're on your back, your pelvis is limited in how fully it can open. Hands-and-knees and side-lying positions give those bones and muscles more room to widen evenly, which research shows reduces the risk of severe perineal tears.
Levator ani tears (deep pelvic floor tears) occur in an estimated 10-30% of vaginal births. Factors that increase that risk include a prolonged pushing stage, forceps use, episiotomy, anal sphincter tears, and large fetal head size. That's significant. And it's part of why we believe every pregnant person deserves hands-on support before they ever step foot in a delivery room.
The Things You Can Control
Get Your Baby "Occiput Anterior"
Babies navigate the pelvis most efficiently when they're occiput anterior — head down, with the back of their head toward your belly. Gravity and movement are your best tools for encouraging this.
Standing, hands-and-knees positions, walking, and swimming all help your baby's heavier bottom swing forward. Reclining in chairs or on the couch tends to do the opposite, encouraging the baby's back toward your spine.
When you do sit, think about the difference between a happy dog and a sad dog. A happy dog sits with its tail upright. A sad dog tucks its tail under. Sit like the happy dog. Upright posture with a neutral pelvis — not slouched, not tucked — keeps your baby in the best possible position to engage.
Maintain balance in the "Four Corners of the Womb": the ribcage, pelvic floor, abdominal wall and sacrum.
Keep Your Pelvis Balanced
Pelvic girdle pain (pain at the front of your pelvis below the baby, or in the dimples of your low back on one or both sides) is a signal that something is off in how your pelvic bones and muscles are working together. It's not something you have to push through. A pelvic health PT can work on both the internal and external balance of your pelvic floor, bones, and muscles. Our massage therapy team can support the external balance of your abdominal wall, hips, and pelvis.
Keep Your Belly Happy, Too
Scar tissue from a prior cesarean, appendectomy, or abdominal surgery can restrict the soft tissue around your uterus and limit your baby's ability to settle into an optimal position. Diastasis recti (abdominal separation) can also affect how well your baby engages behind the pubic bone.
Our team is trained in both internal and external techniques to release restrictions in the abdominal wall and create more space for your baby to move. This isn't an external cephalic version — it's whole-body balancing that makes room for your baby to find their own way into the best position.
What to Do About a Breech or Transverse Baby
If your baby is breech or transverse after 32 weeks, book as soon as you can. We use movement, gravity, and targeted work on the belly, buttocks, pelvic floor, and back to create space for the baby to move on their own. Our physical therapy team works internally and externally. Our massage therapy team uses external-only techniques.
One example from our practice: a client at 36 weeks presented breech at her first visit. Over three sessions in seven days, we created space where her tissues were restricted. By session three, ultrasound confirmed her baby had moved head down. Her body did the work. We made room for it.
How to Push Well
Most people hold their breath and bear down forcefully when they push. Try it for a second. Feel what that does to your jaw? That same tension travels directly to your pelvic floor — which is the last place you want tension when your baby is trying to come through.
Now try this: take a slow breath in, then exhale in a deep, guttural hum. Notice how soft your jaw is? That's what we want in your pelvic floor. Your breath and your body's own instincts are powerful tools — and they're trainable before you ever go into labor.
The 32-Week Session We Recommend for Every Client
We recommend every pregnant client come in around 32 weeks for a body balancing for birth session. In this visit, we work through the mobility of your pelvic bones and muscles and abdominal wall to help set everything up for a faster, more comfortable delivery.
Our clients consistently tell us these sessions make them feel more prepared, more confident, and more in tune with their bodies heading into labor. That matters. Birth is demanding, and walking in feeling ready is a very different experience than walking in hoping for the best.
If your baby is breech after 32 weeks, don't wait for 36 weeks. Book your Breech Body Balancing session as soon as possible — with our massage therapy team for external work or our physical therapy team for internal and external.
We're Here Before, During, and After
In pregnancy, we help with pain, pelvic girdle dysfunction, diastasis recti, breech positioning, and birth preparation. Postpartum, we help with incontinence, pelvic pain, painful sex, cesarean scar healing, diastasis recti recovery, clogged ducts and returning to the activities and sports you love.
We want every birthing person to feel their absolute best at every stage of this journey.
Ready to prepare your body for your best birth? Book a 60-minute birth prep session at our Fan location (1917 W Cary St) or West End location (3711 Westerre Pkwy, Unit C). Book here.
Questions? Reach out to our team — we'd love to help.
Frequently Asked Questions
When should I start pelvic PT during pregnancy? You can start at any point in pregnancy — and we see clients with pain, dysfunction, or positioning concerns at all stages. For birth preparation specifically, we recommend coming in around 32 weeks. If your baby is breech after 30-32 weeks, book right away.
Is it safe to have internal pelvic floor work done during pregnancy? Yes. Internal pelvic floor assessment and treatment is safe throughout pregnancy when performed by a trained pelvic health PT. Your therapist will always explain what they're doing and adjust the session to your comfort level. There are instances where we may decide to use external-only techniques in pregnancy as well.
What does a birth prep session include? A 60-minute session working through pelvic joint mobility, muscle balance, abdominal wall assessment, and positioning support. We'll also walk you through breathing and pushing strategies you can practice at home before labor begins. Many times, we do 2 one-hour sessions for birth prep.
What's the difference between a breech body balancing session and an external cephalic version (ECV)? An ECV is a medical procedure performed by an OB or midwife to manually turn the baby. Breech body balancing is not that. We use movement, gravity, and soft tissue work to release restrictions and create space — giving your baby room to turn on their own. We cannot guarantee repositioning, but we're seeing great results.
Do I need a referral to book? No referral needed. You can book directly online or by phone. Virginia allows direct access to physical therapy, so you can schedule with us anytime.
Do you see clients for both the Fan and West End locations? Yes. Both locations offer pelvic therapy and massage therapy. Our shockwave therapy services are available at the West End location.
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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