A Comprehensive Guide to Childbirth Education
If you’re looking to prepare for childbirth and learn how to make informed decisions during your pregnancy journey, our childbirth education course is the perfect solution.
Our expert instructors will guide you through every step of the childbirth process, from prenatal care to postpartum recovery. With our comprehensive curriculum, you’ll gain the knowledge and confidence you need to have a safe and positive childbirth experience.
Enroll now in our childbirth education course to take the first step towards a healthy and happy pregnancy. Click here to learn more and register.
Podcast Episode Transcript with Videos and Images:
Prenatal Fitness for Birth Preparation
In this episode, we will be discussing how prenatal fitness for birth preparation can help you open the pelvis for an easier labor and potentially prevent labor stalls.
In today’s episode, we’re going to be breaking down how we can use our prenatal fitness workouts to not only maintain our strength throughout pregnancy, to stay comfortable throughout pregnancy but how we can use them to actually prepare for birth, to have easier labor, and to prevent those labor stalls.
ACOG, the governing body of Obstetrics and Gynecology, and the CDC, both recommend 150 minutes of moderate-intensity exercise per week.
Now, I would say moderate intensity is anywhere from 60% to 80% effort level.
- If you’re doing cardio, you should be able to speak in a short sentence before you get winded.
- If you’re doing strength training, you should feel like you can do a few more reps, but you couldn’t do too much more than that.
So it’s still a challenging level of workout. It’s not just like stretching and really passive yoga by any means. You can still have really hard workouts during your pregnancy, but we do want to keep it around that moderate intensity level.
ACOG also recommends strength training throughout pregnancy as well, or resistance training. And there are definitely a lot of concerns as to whether or not lifting throughout your pregnancy is safe, but [lifting] can be done very safely and there could be tons of benefits for both you and for your baby.
The Benefits of Prenatal Exercise
The benefits of prenatal fitness are:
- Enhanced your prenatal comfort and function,
- Improved your birth outcomes,
- Increased support of your postpartum recovery.
The maternal physiologic adaptations are enhanced with exercise to include:
- 10 to 15% higher blood volume and cardiac output,
- Improved metabolic functioning,
- Improved respiratory function, and
- Increased volume and functional capacity of the placenta.
And there are a lot of benefits for your baby as well if you exercise throughout your pregnancy.
So after birth, hormone levels that were secreted from the kidneys demonstrating low oxygen levels, red blood cell percentage, and acid accumulation in the blood were lower in the babies. That demonstrated that they were better able to tolerate the stresses of late pregnancy and labor.
So all of those levels were a lot lower, demonstrating that they were handling stress better.
Benefits of Exercise for Your Baby:
- There’s a lower occurrence of meconium at birth, which is indicating that there’s less stress,
- There’s better regulation of body temperature,
- They regain their birth weight a lot quicker,
- They’re also leaner at birth and
- They maintain appropriate blood glucose levels after birth as well.
There are lots of benefits for not only you but for your baby.
Why Prenatal Fitness Makes Labor Faster: The Positive Feedback Loop
If we’re exercising throughout pregnancy, another highly advertised benefit of exercising throughout your pregnancy is that your labor will be faster. But exercising throughout pregnancy doesn’t just make you better at labor. That’s not why the labor tends to be faster, it actually has to do with the positive feedback loop of labor.
The Mamastefit podcast is sponsored by:
Use code MAMASTEPOD for 20% off
Use code MAMASTEFIT for 20% off
The positive feedback loop is what is sustaining labor naturally, using the hormones oxytocin and prostaglandins, we don’t know which one starts labor. It could be different for everybody’s body. Roxanne is a firm believer that it is the prostaglandins. Gina is a firm believer that is the oxytocin. We’ll fight about it probably till the day that we retire and maybe longer, but we’ll pretend that it’s the oxytocin for Gina’s sake. So when oxytocin is released by our brain, this causes contractions in our uterus.
The uterus then is pushing the baby down onto the cervix. This is applying pressure to the cervix, which then causes our body to release prostaglandins. The prostaglandins then tell our brain to continue releasing more oxytocin and then the cycle continues until a baby is born. The number of prostaglandins and oxytocin will change throughout the entire labor just based on this positive feedback loop.
When we’re in a more upright position, this is enhancing this positive feedback loop because it is applying even more pressure onto the cervix from just being upright because gravity is pulling that baby just down naturally onto that cervix to release more of that prostaglandin, who just enhances this feedback loop to potentially cause shorter labor.
And this is why they say that this positive feedback loop could be affected when someone gets an epidural because they are not able to maintain that upright position as easily as someone who is unmedicated in upright birthing positions. But that doesn’t mean that if you get an epidural, your positive feedback loop is ruined.
There are different ways that we can enhance it. So that’s why exercising throughout pregnancy could make your labor faster, because we tend to be able to maintain an upright position longer during labor.
And I tend to see this trend with my doula clients as well as the ones who have been exercising throughout their pregnancies are moving a lot longer in their labors before they get overly fatigued, especially for those long labors.
While my clients who didn’t really work out very much during their pregnancy are in more reclined and like restorative positions a lot earlier in the labor process, which can also make your labor just a little bit longer.
What Should We Include in a Prenatal Fitness Program?
We can use our prenatal fitness to stay comfortable throughout our pregnancy, gain that stamina for labor, and then we can also prepare to open the pelvis for birth. And so our prenatal fitness program should be more than just pregnancy-safe exercises.
#1 Goal: Increase Strength to Adapt to the Physiologic Changes of Pregnancy
Usually, I’ll see these prenatal fitness programs that are just like a bunch of random exercises to make you tired that exclude sit-ups and crunches or jumping.
These programs are not made for pregnancy, and they’re typically modified from a general population program. So, what should a prenatal fitness program actually include? So, one, we need some strength and conditioning exercises.
We need to be stronger during pregnancy to counter the shift in the center of gravity. So as the belly is growing, our center of gravity, which is primarily in our hips, moves out. So towards the front and then also up.
And so we really need to emphasize strengthening the posterior chain or the back side of our body: our back muscles, our glute muscles, and our hamstring muscles.
In addition, we’re also gaining weight during our pregnancies; the baby weighs something; our uterus weighs something; all the extra fluid that we’re retaining weighs something. And so we just have more of a load that we have to move. And so being stronger is going to help to support our comfort with a heavier load.
#2 Goal: Stay Pain-Free Throughout Your Pregnancy with Prenatal Fitness
In addition, we want to ensure that our prenatal fitness programs are focusing on keeping us comfortable throughout our pregnancies.
Our prenatal fitness programs include a lot of pelvic stability focus exercises. These are movements that are focusing on the myofascial slings.
We have various slings like fascial slings across our body that support functional movement. They connect the upper body to the lower body, crossing the pelvis, and they allow us to do like, rotational movement. They support us walking, they support like, functional lifts, things like that.
It’s important that we incorporate these myofascial slings to help stabilize the pelvic girdle.
Your prenatal fitness program should be including exercises that are going to minimize or alleviate pelvic pain, which is something that a lot of us are experiencing throughout our pregnancies.
Gina's Experience with SI Joint, Back Pelvic Pain
So for my own pregnancies, I tend to have more SI joint pain. This is probably from an injury that I sustained when I was in the Army, and then it just kind of gets worse only during my pregnancies because there’s just so much extra movement happening within the joints of the body during pregnancy, thanks to the hormone relaxin.
But I’ve been able to manage it pretty well throughout my last two pregnancies.
My first pregnancy, I didn’t know as much as I know now, and so I was kind of suffering for a month or two. I went to my doctor, and I said, “hey, I’m having tons of pelvic pain in the back. It’s preventing me from being able to squat. Like, walking is super painful.”
And really the only advice that I was given was, you just need to give birth, and when you give birth, the pain will go away. And that just seemed really unhelpful and based on research, is also not accurate. Like, there’s a lot that we can do during our pregnancies to support pelvic girdle comfort.
Roxanne's Experience with SPD, Front Pelvic Girdle Pain
In Roxanne’s pregnancy, she had really bad SPD pain, which is a pain in the front pubic bone that started really early in her pregnancy, probably around 20 weeks. She started having pain that just progressively got worse and worse and worse. And we did not have a ton of pelvic stability in the program at the time, so we were just kind of like formulating what to do with it.
Roxanne: I do remember as a nurse myself, I would always be like, oh, you just deal with this. And when the baby is out, then it goes away, which is not always the truth. It doesn’t go away immediately when the baby’s out. So with my first, I just kind of like suffered through until I had a baby and then hoped it would go away when it didn’t.
Then I started seeking pelvic floor PT during my postpartum, not just for SPD pain, but for other reasons as well.
And then when we got pregnant the second time, I was like, I do not want to deal with that pain again. So we did have a way more involved pelvic stability program, but we also know that we can see pelvic floor PT during pregnancy to prevent all of these pelvic pains, hopefully.
So I worked with a pelvic floor PT during starting on week ten pregnant, I think until we PCS (military permanent change of station or moving locations) from Fort Bragg to California. And then I just kind of continued with my own exercises at home once we were in California and I had no SPD except if I moved quickly, which was really, really nice to not have that issue.
And then with my current pregnancy, I’m going to kind of start doing more of the pelvic stability program worked into my Prenatal Fitness work and then see probably a pelvic floor PT in the next couple of weeks.
Our prenatal fitness program should include:
- Strength and conditioning training to keep us strong throughout pregnancy because there’s just extra load that we have to move.
- Myofascial sling exercises to help stabilize the pelvic girdle to keep us pain-free throughout our pregnancy because pain is not a requirement of pregnancy.
- And prepare us to open the pelvis for birth.
Preparing for Birth: Using Our Workouts to Support Birth Preparation
The pelvis has three main levels and each of these levels opens in a different way. There’s not just one movement that’s going to open the entire pelvis.
If anyone tells you: “squats are the best labor position, just do them the whole time and your baby will be born,” they are probably not super educated on pelvic mechanics because squats do open a level of the pelvis, but they don’t open the entire pelvis.
And so as you labor, you may find that you prefer different types of movements as your labor progresses, which is really normal and a really cool way to assess kind of where baby is within your pelvis.
The Pelvic Levels: Understand How to Open Each Pelvic Level
We have the inlet. This is where baby is going to enter or engage into the pelvis.
We have the mid pelvis, which is the bony structure of the pelvis. This is where baby is going to rotate through.
And then we have the pelvic outlet. This is the bottom of the pelvis where baby is going to extend underneath the pubic arch to be born.
There are a number of ways that we can tell what pelvic level baby is at because it’s important to know where baby is within the pelvis in order to know what type of pelvic movements, we should be doing to open which pelvic level.
Because if baby’s in the top of the pelvis, we don’t necessarily want to open the bottom of the pelvis. We want to open the pelvic level that baby is currently navigating.
And so there are a number of ways that we can tell where baby is within the pelvis. The first is going to be a cervical exam. So, your provider or your nurse can do a cervical exam. They’re feeling for these bony protrusions on your pelvis that are called the ischial spines.
When they feel the ischial spines when they’re doing a cervical exam, that is zero station.
If your baby’s head is at those ischial spines, that means baby is at 0 station, well engaged into the pelvis.
So if baby’s head is above, there’s like so much space above, it’ll be like -1, -2, -3.
If baby’s head is below those ischial spines, then they go from +1, +2, +3, until, like, baby is out.
So during a contraction, you just tend to move in a way that creates more space within your pelvis without even thinking about it.
And so what I’ll find for my Doula clients is if baby is still trying to engage into the pelvis, they favor movements that are primarily opening the top of the pelvis.
And then when baby is getting a lot lower, they start favoring movements that open the corresponding pelvic level. So it’s a really cool thing to have observed, and it tends to be pretty accurate.
Now, it does kind of go away if you get an epidural. Like you don’t have the same intuitive movement pattern. And I find the more interventions that are being introduced, the more this intuitiveness goes away. But in general, you’re going to move in a way to open your pelvis. And so that can be a good clue as to where baby is within your pelvis.
Prepare to Open Each Pelvic Level
Now, how does each pelvic level open? And we break this down with videos and pictures and stuff like on our Instagram page and in our labor biomechanics and childbirth education courses. So if you’re not getting a good visual of what we mean by speaking about it, just know that you can watch videos in those two places.
The Top of the Pelvis
So the top of the pelvis or the inlet is going to open more with external rotation of the femur. So, the knees going outward. So, think like squat type movements. So that is going to open the space more side to side.
In addition, a pelvic tilting type motion is going to help open the space more front to back.
So, tucking the butt underneath for more of that posterior pelvic tilt is going to move the sacral promontory, which is the junction between the lumbar spine or the lower spine and the sacrum.
It’s going to move that backwards and create more space front to back in the pelvis. So posterior pelvic tilt creates more space front to back.
Now an anterior pelvic tilt where you’re pushing the pelvis forward or like arching in your back more, is going to change the pelvic angle, which can make it easier for baby to enter into the pelvis. And it also makes it easier for us to find external rotation.
And so the top of the pelvis is going to be open more with external rotation of the femurs or like wide knee type movements, in addition to pelvic tilting,
The Midpelvis
The next level of the pelvis is going to be the mid pelvis. And this is that bony structure of the pelvis. The pelvis has two halves.
And so when we do asymmetrical type movement where one leg is doing something different than the other, we’re actually causing this slight torque within the pelvis, which is going to open it more like diagonally.
And so when we shift our weight from side to side, this is going to open the mid pelvis more diagonally to support baby’s rotation through it.
And then we have an upper mid pelvis and a lower mid pelvis. So each half kind of creates space a little bit different of an opening in the top of the pelvis versus the bottom of the pelvis.
The Outlet: The Bottom of the Pelvis
And then the final level of the pelvis is the outlet or the bottom of the pelvis.
This is where baby is going to be born from. And this space opens more with internal rotation of the femurs or a knees in, ankles out type position.
And this causes the issue tuberosities or your sitz bones to move apart.
So, if you put your hands on your butt and you feel those bones, those are your sits bones. They actually move further apart to the side when you bring your knees in and your ankles go out.
In addition, we want to make sure there’s space for that sacrum to move. So not necessarily like pelvic tilting at this point, because there’s no sacral promontory to move out of the way.
But ensuring that the sacrum has freedom to move is really beneficial to opening the pelvic outlet.
Preparing to Open the Pelvis for Birth
Now why does opening each pelvic level even matter? Why should this be a focus during our prenatal fitness workouts? Why should I care about ensuring that I can do external rotation and internal rotation and move my pelvis?
The biggest reason is it can help prevent labor stalls.
And so labor stalls are when labor has paused for whatever reason. And there are some normal pauses within labor, like usually when you’re transitioning between different phases of labor. So, from early to active labor, from active labor to transition, sometimes there’s like little lulls depending on if you’re fatigued or if you’re hungry.
Now there can be labor stalls that involve like labor progress has paused or rested for a period of time, which could be a problem. And there’s different things that can contribute towards a labor stall. The first is going to be the passage or the actual path that baby is moving through. And this involves the pelvis and how we can open the pelvis.
This also includes the pelvic floor and the tension that we can release within the pelvic floor. So if we’re having a hard time opening the pelvis, particularly the bottom half, we may experience a labor stall due to the passage.
Now there are some other stalls related to baby’s position and also the strength of the contractions.
But for this episode, we’re going to primarily focus on the passage and how we can do movements during pregnancy to ensure that we can potentially avoid a passage-related stall.
We can open the pelvis enough and we can release tension in the pelvic floor enough to where baby’s path in navigating through the pelvis is easier.
In my experience with just labor stalls in general, a large majority of them are either because of the baby’s position or due to just tension within that passage. Some sort of tension, whether it is related to just like tension you’re holding due to the contraction pain, or if there is prior tension like you’re not able to release in certain portions.
So, when we do cervical exams, we can feel different parts of the pelvic floor and then also like the opening of the pelvis, we can kind of feel like oh, there seems like there is a lot of room, or like oh, it’s like really tight in certain spots.
Usually, if there is some tension within that pelvic floor, sometimes even just doing a cervical exam can be very uncomfortable for you, but is also very hard to even check some people because of that tension that they’re just not able to relax that pelvic floor to be able to open it, to allow the baby to come through.
It’s not necessarily like the entire pelvic floor is tight. It’s like certain portions are just not able to release and allow the baby to come through.
Sometimes we can offer a massage of certain areas that will almost feel like bands in the vagina when we’re doing the cervical exams. It will feel almost like multiple rubber bands as we’re doing our cervical exam.
Then we can again offer to see if we can get those muscles to release with just a little bit of tension applied to it.
Sometimes getting an epidural for those people that just hold on to all of that tension in certain parts of the pelvic floor, I’ve seen those be really beneficial if you do have a lot of tension, you’re not able to release and relax in certain portions of your pelvic floor.
Getting that epidural if you’re having a stall makes it a lot easier for those muscles to then relax. Because it’s like, oh, I can’t really feel it. Sometimes the pelvic floor then just is able to relax, and the baby can come through. So that passage stall can sometimes be resolved by just getting an epidural.
But sometimes you could get a pelvic floor massage, if your nurse or provider is able to provide that. But that is why pelvic floor PT during pregnancy can be so helpful.
Because if, you know, you have certain movement patterns and certain tension within your pelvic floor, it’s not necessarily that having a tight pelvic floor is bad. It’s just that you don’t have the range of motion, you don’t have the ability to have that range of motion where you’re able to fully relax it at certain points that kind of creates that tension within that pelvic floor. So then the baby is not able to move through
So, when it comes to the passage stall, it’s typically the inability or limited or restricted movement to internal rotation.
So, external rotation and extension are really common postural tendencies for pretty much everybody, but especially during pregnancy. So we have this extra load on the front that’s kind of pulling us forward.
And with this more extended and externally rotated position, it’s really easy to open the top of the pelvis. And in most situations, it’s pretty easy to open the inlet.
Like we don’t have tons of issues with external rotation during pregnancy, but when baby starts navigating into the pelvis and needing to rotate through the pelvis, if we can’t find internal rotation, which is the opposite of external rotation, so instead of knees wide, it’s more knees coming towards midline or a closed hip position.
That’s where we’re typically going to see those issues with a labor stall. If you’re someone who really emphasizes external rotation, you’re decreasing the space in the pelvic outlet and like the back half of the pelvis. And so the posterior pelvic floor is going to have more tension to it and have a harder time releasing.
The actual bony opening of the pelvis is going to be decreased in the pelvic outlet and lower mid pelvis. We may see a harder time for baby to finish their rotation to get underneath the pubic bone. So maybe you’re like 8, you’ve been stalled there for a really long time, or maybe you’ve been pushing for a really long time and baby is just not finishing that rotation.
It could be related to the limited ability to find internal rotation. Emphasizing this a lot in our prenatal fitness program can be super beneficial to kind of minimizing labor stalls.
Quick summary:
If you have a passage-related stall, you could:
- Release the tension by either finding more comfort measures to relax
- Create more space in the pelvis
- Release the tension with pelvic floor internal massage by your provider
- Get an epidural to relax
So what can we do to prepare to open each pelvic level?
The Inlet: The Top of the Pelvis
The top of the pelvis or the inlet, goal is to help baby enter or engage into the pelvis.
We primarily are going to open this pelvic space with:
- External rotation of the femurs or those wide knees
- In addition to pelvic tilting front to back.
- So that anterior pelvic tilt where we’re arching more in the back
- Posterior pelvic tilt where we’re tucking the butt underneath.
And so remembering that external rotation and that anterior pelvic tilt or that extended position are common postural tendencies, you’re going to understand that that posterior pelvic tilt is probably going to be what you’re going to want to focus on more when preparing to open the inlet.
And so with the external rotation and the anterior pelvic tilt, those are going to be movements like squats. Anything, where you’re lowering down with wider knees and then standing up and extending, is going to be an inlet opening type of movement.
Now, for the posterior pelvic tilt, we need to think about what is going to pull the pelvis more forward and then focus on releasing those muscles.
So if the pelvis is being pulled more forward, the muscles that are going to be tighter or pulling, because your muscles only have the ability to pull, not push, are going to be the muscles on the front side of your legs.
So these are going to be things like your hip flexors and quads. So releasing those muscles can be really beneficial to helping you pull your pelvis back into a more posterior or tucked position.
In addition, our lats are probably going to be on the tight side because it’s pulling the pelvis up from the back to tilt it more forward. With that more anterior pelvic tilt, we tend to have a tighter front side of the legs and a tighter back.
The first thing that we want to do to help support finding this posterior pelvic tilt or this tucked position is we want to focus on releasing the hip flexors and quads and also releasing the lats. Incorporating those type of mobility exercises can be really beneficial.
The other thing that we want to remember is that muscles have the ability to pull. So just releasing the muscles doesn’t pull the pelvis back into that posterior pelvic tilt. We want to focus on strengthening the glutes and the hamstrings. They’re going to help pull that pelvis into that more posterior position.
Doing movements like deadlifts or like a hamstring curl can help strengthen the hamstrings, which can help us pull more into that posterior pelvic tilt. Examples of like inlet opening exercises or preparation exercises that I would be doing or that we incorporate within our prenatal fitness programs are going to include movements like:
- Squats
- Forward step ups
- Lunges
We’re also going to incorporate a lot of mobility work to help with that posterior pelvic tilt, such as:
- Hip flexor or quad releases,
- Lat releases,
- and then we’re also going to include lots of pelvic tilting from front to back.
- And so we like to do some like hip shifted pelvic tilting, but you can also do it seated on a ball as well.
The Middle of the Pelvis
The next level of the pelvis is the mid-pelvis. And so movements that we can do to help prepare to open the mid pelvis are going to emphasize a lot of like, unilateral and asymmetrical type movement patterns.
The goal of the mid-pelvis is rotation. So baby is rotating through the mid pelvis to go from the top all the way to the bottom when we begin to start pushing.
The mid-pelvis can be divided into two levels. We have our upper mid pelvis and then the lower mid pelvis. Remembering that the mid pelvis or the pelvic bone is two halves that can kind of torque with one another. And now the torque is not super extreme.
It’s really subtle, but it’s more during pregnancy than any other time during our lives.
When we shift our weight into one leg, that leg tends to find more internal rotation. That pelvic half is shifting back, the leg that we don’t have weight on is going to be more externally rotated, so it’s going to be shifted more forward.
When we walk, the two halves of our pelvis are going to be kind of shifting front to back in kind of opposite of each other.
When we have movement compensations or we have postural tendencies that really emphasize external rotation, what we tend to find is that we have a harder time shifting our weight into the leg and finding that internal rotation.
For the mid pelvis, we want to be focusing on one-sided external rotated exercises. So think like Cossack lunges or side lunges. We want to emphasize external rotation just on one leg. We can do mobility exercises like adductor releases or inner thigh releases to make it easier to find external rotation in addition to the strengthening exercises to find more of the external rotation, thinking like glute strengtheners.
the lower half of the mid pelvis is going to be the lower mid pelvis, and this portion of the pelvis is going to open more with internal rotation.
If the upper mid pelvis is more open hip type position, so leg going out, the lower mid pelvis is going to be more internal rotation, which is going to be more closed hip positions.
Or if you think about your pelvis and then you think about your femur, I’m taking my pelvis and I’m rotating the opposite hip towards the opposite knee.
If my right leg was forward with my pelvis, I’m going to bring my left hip towards my right knee, and that’s going to be finding that internal rotation or that closed hip position. So bringing the leg towards midline is going to be internal rotation.
Now, internal rotation is a huge aspect of just like, how our hips should move. It’s a part of the hip range of motion and it’s a part of our glutes range of motion as well. So if you want to just strengthen your glute more. Finding more internal rotation is going to bring more of that full range of motion to the glute, and you’re going to find more strength.
We can find more of that internal rotation with single-leg or unilateral focus exercises. So step-ups, lunges, staggered stance RDLs, really any single leg type movement, we could really emphasize internal rotation, which in my opinion is a hugely neglected aspect of birth preparation.
So you’ll see tons of stuff on like, do 300 squats and do all these squats to prepare for birth. Everything’s externally rotated, squat, squat, squat. But really what we should be super emphasizing is the internal rotation aspect.
For step-ups, when you put your foot up onto the box, so let’s say you put your right foot on top of a box, we want to think the left hip is rotating or shifting towards that right knee. So that’s going to be that internally rotated position at the bottom.
As you step up onto the box, you face forward. And then as you lower down, we’re finding more of that internal rotation.
So moving the hip through its full range of motion. Same thing with lunges at the bottom of the lunge.
We’re finding more of that internal rotation thing, bringing the opposite hip towards the forward knee when we do the stagger stance RDLs, this is more of that hinge type motion.
Hips are going to the wall behind us as opposed to the floor below us, and then again, finding more of that internal rotation. It’s easiest to emphasize internal rotation with single leg or asymmetrical type movements. But if single leg movements hurt, then there’s some things that we can do to make it more accessible to you physically. Because one, we don’t want to be in pain with our workouts. It’s not mandatory by any means.
In Episode 5 of the MamasteFit Podcast, we’re going to be breaking down pelvic girdle pain and the kind of things you can do to resolve it.
And we also have all these exercises incorporated within our prenatal fitness programs. But the general approach to modifying if you have single leg pain is going to be one, decrease overall movement.
If you’re doing a walking or a reverse lunge, we can decrease how much the feet are moving. If you’re doing that walking lunge, you can do a reverse lunge where only one foot is moving all the way to a split squat, where no feet are moving. The feet are still asymmetrical, but they’re not moving around, and this makes it a lot easier to stabilize.
If you’re doing step-ups, for example, instead of stepping both feet up onto the box and then both feet down, you can just keep 1ft on top of the box. And so only one foot is moving up and down, and that’s going to decrease the overall movement to make it easier for you to stabilize.
One thing that was super helpful for Roxanne was to add support. Holding onto rings or even doing banded rows, so giving your upper body the opportunity to kind of take over a little bit from your legs can really help manage pelvic girdle pain as well with those single leg movements.
If you’re finding that those asymmetrical stances are still causing pain, even with these modifications, we can then even the stance. Both feet are going to be together, and then we can unilaterally load it.
Holding a weight on one side or maybe even just putting a resistance band around one leg.
For example, if single leg movements hurt, we also want to focus on trying to resolve pelvic pain. And so in episode 5, we’re going to be discussing pelvic stability and pelvic girdle pain.
The Pelvic Outlet: the Bottom of the Pelvis
Now, for the bottom of the pelvis or the pelvic outlet, the goal of the outlet is extension.
We’re typically focusing on opening this pelvic level when we’re pushing after baby has rotated underneath the pubic bone, it’s usually pretty close to when they’re crowning.
And so with the pelvic outlet, we want to focus on internal rotation of the femurs or knees in, ankles out.
And so again, this is where that internal rotation is really important because this is kind of the last point where baby is going to be vacating the premise.
And so with internal rotation, it’s also easier to find internal rotation with a posterior pelvic tilt or tucking the butt underneath. But we want like a really slight posterior pelvic tilt. You’re not totally tucking the butt underneath, but just a slight rounding can be really helpful to make it easier for us to find that internal rotation.
And so when preparing to open the bottom of the pelvis, we want to be focusing on the posterior chain because the hamstrings are going to pull the pelvis a little bit more posteriorly. The adductors and hamstrings help pull us into more internal rotation.
Then we also need to release the lats, because the lats are going to be pulling us more anterior. We need to release that tension to allow the pelvis to move into that slight posterior tilt.
But the lats are also a huge component of pushing. Typically, we’re holding on to something with our upper body as we’re pushing our babies. So, you’re holding onto your legs, you’re holding onto your partner, holding onto something nearby, because lat tension can help kind of pull that sacrum out of the way a little bit.
When we’re preparing to open the pelvic outlet, we want to focus on the posterior chain so the hamstrings, glutes and then the lats, because the lats are important to pushing. Strengthening the posterior chain is going to help to support internal rotation in that slight posterior pelvic tilt in addition to supporting the physical act of pushing with our lats. And so those are big things that are going to help us open the bottom of the pelvis.
There are three pelvic levels. We have the inlet, the mid pelvis and the outlet.
The inlet is the top of the pelvis, which is going to open more with external rotation of the femurs or knees out in addition to pelvic tilting. So, tucking the butt underneath and then also arching the back and letting the hips kind of fall forward.
Things that we can do to help open the top of the pelvis more are going to be movements that emphasize external rotation such as squats forward, step-ups, forward lunges, and things like that.
And then we also want to focus on being able to release so that we can come into more of that posterior pelvic tilt, which is going to increase that pelvic diameter front to back, so releasing the hip flexors and quads and releasing the lats and then strengthening the hamstrings so we can find more of that posterior pelvic tilt.
As we move into the mid-pelvis, we’re focusing more on those asymmetrical type movement patterns. So, we want to be able to find open-hip and closed-hip position. So external rotation and internal rotation are only on one side.
There’s probably more of an emphasis on internal rotation that needs to happen because external rotation is overly emphasized throughout pregnancy as a common postural tendency. And so, we want to be able to find more of that internal rotation of the femurs on one side and then as we make it to the outlet, be able to find it on both sides.
And so, movements like step-ups, lunges, stagger stance RDLs, really any single leg movement can be made into an internal rotated focused exercise. Know that we already include that all for you in our prenatal fitness programs.
As we make it to the pelvic outlet, we’re focusing more on that slight posterior pelvic tilt and internal rotation of the fevers in addition to ensuring the lats are released but also can pull as needed.
So we want the lats to have that full range of motion. And so for the outlet, we’re focusing on exercises that are going to strengthen the posterior chain. So, hamstring-focused exercises such as deadlifts, are going to be both lats and hamstrings and glutes.
We want to be able to release the lat. So mobility work for the lats in addition to movements like rowing, because we want to be able to strengthen the lat so that we have strong lats to support us while we’re pushing.
And so you can see that there are a lot of things that we can incorporate within our prenatal fitness workouts to ensure that we can open the various pelvic levels, particularly the lower mid pelvis and the outlet.
If you want more of a breakdown of WHAT to do throughout your prenatal workouts, check out our prenatal fitness programs! We offer it in two formats:
- 40-Week Prenatal Strength in the Teambuildr App (traditional delivery format)
- Full Version: Workouts 45-75 minutes in length, designed for the athlete with gym access or a home gym set up
- Mini Version: Workouts 15-20 minutes in length, designed for the busy person!
- Prenatal On-Demand with full-length workout videos that you follow along as you workout
Another thing that you could include within your prenatal fitness workouts to help you prepare for birth will be a labor preparation workout.
Labor preparation workouts were something that we developed near the beginning of the creation of MamasteFit for our prenatal fitness clients to help prepare them for birth.
What a labor preparation workout is, is we incorporate exercise-induced stress, then we have to relax during it. So it created this kind of rehearsal for birth. So it’d be 15 to 20 seconds of some sort of cardio effort. You get your heart rate up, get your respiration rate up, and then the actual focus of the workout was the in-between.
For one to two minutes, you would choose a labor position and would focus on relaxing and trying to get your heart rate down, get the respiration rate down, try to recover from this exercise, and do stress.
We would try different labor positions so that you can experiment with which ones felt easiest for you to relax into and which ones felt harder for you to find some relief.
For some of our clients, they found, like, sitting on a ball was most restorative for them, while others found that they preferred to be in standing positions, as that helped them relax the most.
Then we would also incorporate a comfort measure. We had cool washcloths that we had at the gym.
We can also apply counterpressure techniques. You can try heat, you can try TENS. And so this is your opportunity to kind of experiment with your counter-pressure techniques for you and your partner to figure out which ones you like best.
It ends up kind of being like a rehearsal for the big day. So you can practice labor positions, and you can also practice comfort measures to make sure that you and your partner know which ones feel best for you, which ones you know, you can relax in easiest into which ones you know are accessible to you.
Because you may find that certain positions don’t feel good for you. They are really challenging to get in and out of. And so those may not be positions that you want to do during your own labor.
The labor preparation workouts, we tend to emphasize more in the last two months of pregnancy. So starting around week 32, we incorporate them once a week into our 40-week prenatal fitness program. And our prenatal on-demand programs in the third trimester.
But you could also do these workouts on your own if you have an understanding of labor positions and comfort measures.
So there are a lot of benefits to exercising throughout pregnancy, both for you and for your baby. And we want to ensure that our prenatal fitness programs are going to, one, help you stay strong throughout your pregnancy to counter kind of the increased mass and shift in your center of gravity to keep you comfortable.
We also want to ensure that our prenatal fitness programs are incorporating exercises to manage pelvic girdle pain. Like we don’t want to be in pain throughout our pregnancies.
Then we want to ensure that our prenatal fitness programs are incorporating exercises with the focus to prepare us for birth, particularly the internal rotation aspect of birth preparation. We could also incorporate pelvic floor relaxation exercises within our prenatal fitness programs.
There tends to be an overemphasis on clenching the pelvic floor and kegels, but like spoiler alert, our pelvic floor just needs to move out of the way as our uterus pushes our baby out. And so, while we do want to have pelvic floor activation as a part of our pelvic floor’s range of motion, it’s probably more important, especially towards the end of pregnancy, to have the ability to lengthen and to relax the pelvic floor. And so, if you’re unsure on what is going on with your pelvic floor or what is a pelvic floor, because for my first birth I had no idea that there was a pelvic floor, it could be really helpful to connect with a pelvic floor physical therapist and you can see one throughout your pregnancy as well. It’s not exclusive to early postpartum.
And so, if you just want someone to kind of walk you through what the mind body connection is to your pelvic floor or to identify if there’s any sort of issues with your pelvic floor, I would definitely recommend trying to connect with one in your local area. If you don’t have a PT in your local area or you aren’t able to find one that you really vibe with, then we have pelvic floor physical therapists that we can recommend that do virtual consults.
So, you can probably see that there’s a lot of things that should be incorporated into a quality prenatal fitness program. Fortunately for you, we already do this for you.
With our prenatal fitness programs, we have different options depending on how you like your workouts delivered to you.
The first is going to be our 40-week prenatal fitness program which is going to be delivered in the team builder app.
This app is going to provide the exercises as a list of exercises with shorter demo videos. And then we have two versions of this, the long version and the short version.
Feel strong and move comfortably throughout your entire pregnancy. Our program syncs to your current week of pregnancy, so you can start at any time!
- 5 Workouts Per Week
- Labor Prep Workouts
- Teambuildr App Access
The longer version is going to be 45 to 75 minutes long workouts. Ideally for somebody who’s going to be working out in a gym setting and prefers a traditional workout delivery.
And then we also have the mini version, which is going to be 15 to 20 minutes long workouts. For those of us that are just like more fatigued during pregnancy, we have a busier lifestyle and maybe we don’t have access to a full gym.
The 40 week prenatal fitness programs sync to your current week of pregnancy so you can start them at any time.
So if you’re 20 weeks, you’ll start at week 20 of our program. And so it’s going to correlate to kind of what you’re needing at each point of pregnancy.
Stay strong with our shorter prenatal workouts! Workouts are 15-20 minutes long, including a warm up, strength workout, and mobility cool down! This program includes pelvic stability and pelvic opening workouts too!
- 5 Workouts Per Week
- 20 Min Workout
- Labor Prep Workouts
- Teambuildr App Access
But if you prefer to follow a video as you work out at the same time, we have our prenatal on demand programs.
We have the prenatal on-demand fitness program, which is going to be lifting weights and using bands, and then we have our prenatal yoga program.
These programs have full-length workout videos for you to follow along with as you workout at the same time.
Those programs are going to be synced to your current trimester and you can start them at any time.
Thank you for listening to this week’s episode on how we can use our prenatal fitness workouts to not only maintain a strong pregnancy, a comfortable pregnancy, but prepare for birth.
We discussed what the different pelvic levels were in different types of movements that we can do during our prenatal workouts to prepare to open each pelvic level so that we can have an easier labor and then also hopefully prevent late labor stalls, particularly the ones that are limited by internal rotation of the femurs.