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Birth: Preparing for a Natural Birth with Body Balance

Updated: Mar 1

the pelvic inlet anatomy for birth
Our physical therapist shows the pelvic bones and muscles that the baby moves through for birth

Hello! Let's talk about birth-- one of my favorite subjects! In labor, your job is to dilate and your baby's job is to rotate through the pelvis (credit: spinning babies). In order to dilate and for your baby to have an easier time rotating through the pelvis, balanced- not too tight, not to loose and not too twisted- tissues help your baby get in position for their best birth.

When you go into labor, your baby first descends into the “pelvic inlet” and the sacrum, pubic symphysis and ilial bones widen. Having good mobility of these bones to open is essential. Pelvic health physical therapy, prenatal yoga, Webster-trained chiropractic care and exercise can ensure great mobility of the pelvic joints.

As labor continues and your uterus contracts to help your baby's head move farther down, the baby reaches the level of the pelvic floor muscles. At this point in labor, the “pelvic inlet” closes a bit and the “pelvic outlet” widens. The urge to push begins. 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! This is why birthing on your hands and knees is shown to have reduced risk of severe perineal tears. Positioning on hands and knees and sidelying give the pelvis and pelvic floor more space to widen evenly, which reduces the risk of severe tearing.

Levator ani tears or avulsions occur in 10-30% of women who have had a baby (these are tears of the deep pelvic floor). 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! Our physical therapy team helps with internal and external balance of the pelvic floor bones and muscles. Our massage therapy team helps with external balance of the abdominal wall and hips/ pelvis.

  3. Keep your belly "happy," too! Old cesarean scars, appendectomy scars or sports trauma can cause restrictions in your tissues. These restrictions can limit your baby's ability to get "locked and loaded" in the head down position. We, at RVA Holistic PT, have taken courses to learn how to release the belly to make it "happy" to optimize your baby's position. Another issue can be diastasis recti (or abominal separation). If you have a very wide diastasis, your baby might not get engaged behind the pubic bone and have difficulty moving down into the pelvic bowl.

  4. 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!

  5. 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. We can give you special exercises to help your baby find this optimal position.

  6. 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.

  7. Pushing: In birth, you will use your breath and your body's intuition to ease your baby out. Feel how it feels to hold your breath and push forcefully. Do you feel the tension in your jaw? That same tension is in your pelvic floor (not what we want!). Now feel how it feels to take a deep breath and then do a deep guttoral HUM. How does that feel in your jaw? Nice and soft, right? This is one of many tricks to try out and make sure that your pelvic floor is lengthening as you ease your baby out.

  8. If you have diastasis, pushing 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.

What about breech and transverse baby positions? We use movement, gravity and balancing of the belly, buttocks, pelvic floor and back to create space for the baby to move on their own to the head down position. This is NOT an external cephalic version. Our physical therapy team is trained in internal and external body balancing techniques and our massage therapy team is trained in external-only body balancing techniques.

Below is a picture of before/ after a body balancing session. The mother is 36 weeks pregnant and at visit 1 presented breech (at 35.5 weeks). We did a total of 3 sessions in 7 days to create space in her body where she was tight, which allowed her baby room to move to head down and head centered. Ultrasound confirmed her baby was now head down after session 3.

body balance for breech, transverse and oblique positioned baby
A before and after photo of a baby initially oblique positioned that left the session head down and centered

As pelvic floor physical therapy specialists, we have love to help birthing people optimize their births and recover postpartum. In pregnancy, we help optimize the pelvic bones and muscles and abdominal wall to help "encourage" your baby engage in an optimal position.

We see pregnant people throughout their pregnancy for pain or dysfunction, but we recommend EVERY mom see us around 36 weeks for a Body Balancing for birth session. In this session, we work on making sure all the bones and muscles have great mobility for a faster and easier delivery. Bonus: our clients love these sessions! They feel great and are a great way to feel more prepared and confident for a better birth. Book a 90-minute clinic visit with us for a birth prep session. Is your baby breech after 32 weeks? Book as soon as you can for a Breech Body Balancing session with our massage or physical therapy team.

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!

anatomy of the pelvic outlet for birth
Our physical therapist shows the pelvic outlet anatomy

We want all moms to feel their absolute best - before, during or even after their pregnancy journey. That's why we recommend using a maternity support band that is comfortable to wear and keeps your back and belly supported. This also provides relief to any pressure and pain related to pregnancy.


In Richmond, Virginia? Book your birth prep visit at or call us at 804-372-0291

Want to learn in your own time? We have an online school for that. Check it out here


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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