The MamasteFit Podcast Episode 130 – Comprehensive Birth Preparation: Physical, Emotional, and Mental Readiness

Gina: Welcome to The MamasteFit Podcast. In this episode, we’re going to be talking about all of the things that you can be thinking about when it comes to birth preparation. What are some focuses that you can do physically to help prepare your body for birth, and then also emotionally and mentally to help prepare your mind for birth?

Welcome to The MamasteFit Podcast. Today I have Hayley Kava here who is our in-house pelvic floor PT to talk all about birth preparation. And we’re going to be talking about what are some of the main goals that we have when it comes to the physical preparation for birth, but also we’re going to spend some time talking about the mental preparation as well, ’cause there is a lot involved with how safe and supported you feel and how that can impact your physical preparation, and the release and the relaxation portion when it comes to birth.

And so let’s start with the physical preparation and then we’re going to end more with the mental aspect, ’cause that one will actually probably take a little bit more time.

Hayley: Okay.

Gina: So when it comes to physically preparing for birth, the main goals that we have is, one, can we support our baby’s position? And this doesn’t mean forcing baby into a specific position, but rather creating the opportunity for them to find their best position when labor begins.

The second thing that we’re going to be thinking about is, can we improve pelvic mobility and the opportunity to create more space in the pelvis, based on where baby is at when labor begins? So how well can you create space in the top of your pelvis, the middle part of your pelvis, and then the bottom of your pelvis? And we’re not necessarily, again, trying to force baby into any position, but rather we want that movement capability to be there.

And then the last portion is going to be how can we release tension, specifically within the pelvic floor. Now when it comes to releasing tension within the pelvic floor, it’s not just all of the stretches and all of the releases, there’s also a huge mental aspect when it comes to the pelvic floor that we’re going to touch on towards the second half of this episode.

So to start with baby’s position, you may have been told that you need to force your baby into an OA position or LOA, those are usually the two like key positions that you get told try to put your baby into during pregnancy, and if they’re not in that position either labor won’t begin, or labor will be awful. And this is not true. Your baby can be in any position during pregnancy and it does not impact when you go into labor, and it does not impact the length of your labor either. Your baby can be posterior, where the back of their head is to the back of your body, they can be on the right side, they can be towards the front, they can be towards the left, and it really doesn’t matter. And your baby also will probably change positions.

Hayley: Yeah. And I would argue that we want them to change positions.

Gina: Yeah.

Hayley: Like, you don’t, if your baby is even in LOA, if they’re in LOA all the time, like they’re always on the left, they’re going to be, when they come out, they might be a little tight.

Gina: Yeah.

Hayley: On the left, ’cause they’ve been stuck there. We want our body to be able to move in all the ways and how our body moves is going to influence how they are able to rotate and move. And yeah, movement is good for them too.

Gina: Yeah. So they will probably, if you did all the things to force them into LOA and you’re like, “They’re in the perfect position for birth,” they’re just going to move. Like, you got them there, and then they just rotate! And that’s totally normal and it’s going to happen. And so I would really, I’m just begging you to not be super fixated on forcing my baby into one specific position or else, because that is, one, really just going to stress you out, which can increase tension within your pelvic floor. But two, also just not going to be helpful because your baby’s just going to wiggle and move around.

Hayley: Yeah.

Gina: What we can focus on, rather than trying to force our baby wherever they need to be, is ensure that the muscles around their path are relatively clear of restrictions and like obstacles for them. So can we clear their path to rotate? And when I say that, we’re thinking about uterine ligaments. So we have different kind of bands that attach the uterus to your body, and if we have a little bit more tension in some of those bands, it could create like little speed bumps for your baby. So we have our round ligaments that are vertical, and maybe can make like the horizontal rotation of baby a little bit harder ’cause we’ve got some bands that are speed bumping them that way. The bra ligament runs horizontally across your body, and so sometimes that can make it a little bit harder for baby to move down if that ligament is fairly tight. And so we can think about releasing tension in the uterine ligaments. This can help baby’s ability to rotate and to move when labor begins, to be a little bit easier.

And then we can think about the next layer of muscles that are helping to support. So, the abdominal wall, the sides, your back.

Hayley: Yeah.

Gina: Your pelvic floor.

Hayley: Your rib cage, right?

Gina: Yeah, rib cage mobility. And so we’re thinking about like the whole torso. Can we release tension within that? Can we improve rib cage mobility? And so we don’t always have to think specifically on force my baby- or we should never think about forcing baby into one specific position- but rather we want to think about the different layers that could be impacting baby’s position.

Hayley: And I find, clinically, that when mom can move well in all directions through their rib cage, through all of it, that then baby is moving around more, and then mom tends to be more comfortable.

Gina: Yeah.

Hayley: Like your body’s going to feel… you’re going to feel less sore, you’re going to feel less rib pain, you’re going to feel less restriction in those uterine ligaments or broad ligaments, because your body can just move in all the different ways.

Gina: So I would definitely recommend lots of thoracic mobility, so learning how to twist through your spine. Also, the lateral extension and bending- which I think a lot of people forget about when it comes to thoracic mobility- and then the front to back like cat/cow type movements are all going to be super helpful to improve your baby’s position. And then we can think about inversions are usually pretty easy to do to help release some uterine ligaments. We can do some kind of like belly tucks, or like where you pull your belly up to help release tension on the broad ligament can be really helpful. If you’re having a lot of discomfort with baby’s movements, like their kicks and stuff are like really painful, it could be that the broad ligament is a little bit on the tighter side, and like even just wearing a belly band can sometimes help to release some of that tension as well. So can we add a little bit more support to the belly? That can help to release tension there.

So when it comes to baby’s position, it’s not force them into one specific position, but rather, can we clear their path to rotate so when labor begins, and we have our strong contractions, our body is going to be able to help baby rotate into whatever their best position is. Because even within the different pelvic levels, baby’s best position is different, depending on how they’re rotating through. And so we’re going to think about, can I release tension in the uterine ligaments so that baby’s movements feel comfortable for me? Like, me moving my body feels really comfortable. Can we improve thoracic or rib cage mobility? This is where getting like massages, can be really nice.

Hayley: Yeah. Just chill out.

Gina: Just to help release tension as well, which again, will also really help with the mental aspect of birth preparation.

So when it comes to supporting baby’s position, it’s more about releasing tension so that they can rotate more easily as opposed to forcing them into any specific position. And we have a whole YouTube video that has some example exercises that you could do to help support that. The next place that we’re thinking about is how can we improve pelvic mobility? How well can we improve our ability to open the top of the pelvis, the middle of the pelvis, and then the bottom of the pelvis? ‘Cause they all open in a different way, different muscles pull to change positions of the pelvis, but also different muscles have to release to allow that opening to happen. And so it’s not just, do a bunch of deep squats and butterfly poses and all these wide leg positions to prep for birth. We also have to think about, how well is the rib cage moving, ’cause that can really influence how well your pelvis can move. We have to think about, can we find more internally rotated positions to create more space in the bottom part of the pelvis, and those asymmetrical positions as well to create more space in the middle part of the pelvis.

So for me, the four like main types of movements that I would be doing as a part of my birth preparation is going to be- specific to just the hip, so this isn’t thinking about like the rib cage portion, which is a whole other thing- with just the hips, we’re thinking both legs are wider, so we have ankles in knees out. So we have that external rotation with the abduction is going to be helping to create a little bit more space on the top part of the pelvis. And then there’s some ribcage mobility that helps to improve that space as well, but thinking about just the hips, wider legs. So this is going to be our deep squat, it’s our butterfly pose, pretty standard birth prep. If you type in “birth prep,” in Google that is what’s opening the top part of your pelvis.

Then we’re thinking about one-sided movements, and so this is what’s going to create more space in the middle part of the pelvis. And so we need asymmetrical hip mobility, so external internal hip mobility. And then we need asymmetrical pelvic mobility. So internal and external pelvic mobility to help create space in the middle part of the pelvis. And both of those are just, they’re similar, but they’re a little bit different. So hip mobility is going to, or that internal external hip mobility is thinking about what is the anchor point? The anchor point is the pelvis and the hips and the legs are moving on that pelvis, while pelvic mobility, the anchor point is the femur and the pelvis is moving on the femur. So they’re similar, they’re just like a little bit different, and so incorporating both of those can be super helpful. And then the last part, we’re thinking about more knees in, ankles out, so we have more of that internal hip rotation. So things like heroes pose or even things like deadlifts are like incredibly helpful to creating space in the bottom part of the pelvis. It’s not all just releases, it’s also a combination of strengthening exercises with mobility.

Hayley: Yeah, I would say one of my favorite things to hear from clients when, after they give birth, is they’ll say, “Hayley, I didn’t use any of the things that we talked about,” which is probably not what you’d expect to want to hear from your client. You want to think, you think, “Oh, we’re trying all these different movements, like, hopefully they’ll use them.” But I would say when you’ve prepared with these movements, it means that you have access to those movements readily. And so then you’re able to move more intuitively with you and your baby, and you may or may not need to do more extreme movement in labor. But if you do need it, we know you can do it because we’ve practiced it in pregnancy. And if you don’t need it, and you’re just vibing, and baby just is born, then, beautiful!

Gina: Yeah. During my last labor, with Zoe, was probably like the most connected and like informed I felt about my own body. And during my labor it was all like really subtle movements and I’m wondering if it was the same for you, where I wasn’t doing these like really extreme elevated lunges or deep squats. It was just really, subtle shifts, like, back and forth, like really small little movements. But it was my fastest labor by far! Half the time, when it comes to active labor. And I think a lot of it was, I had more preparation like physically within my body. I also mentally just felt a little bit more like at peace with the experience and I felt like I had surrendered more to whatever needs to happen can happen. So there was definitely a lot of that mental aspect that really helped with the release. But because I had that movement capability already prepared within my body, she was already able to find a really good position, and I think things just progressed really quick from there. I did notice myself doing some like very mild like hip shifts as she was getting lower. But it’s really hard to teach somebody, in the moment, a brand new movement.

Hayley: Right. Exactly.

Gina: So even if I am, like, I’m supporting a birth as a doula and I know that the baby is really low in the pelvis and we just need some help with rotation and then that baby will come out, it’s really hard to teach somebody how to hip shift the middle of labor.

Hayley: Between contractions.

Gina: In between contractions. I’m like, yeah, that’s not going to happen. I’m not even going to try to entertain that. And so I have to figure out really subtle ways to help them find that position without it being like…

Hayley: Intrusive.

Gina: Too much.

Hayley: Or like messing with their flow state.

Gina: Yeah. But if they knew. What a hip shift was from prenatal, if I was like, “Hey, why don’t you find a little bit of a hip shift?” they’re like, “Okay,” and it’s super easy for them to find it. And then we usually see some progression really quick- if we needed it. We don’t always need to interrupt somebody’s labor.

Hayley: And yeah, and I think that’s where it’s been really cool to work with doulas and midwives, now being back in person, where we can do sessions at the end of pregnancy with the pregnant person and at least communicate with the doula, if not the doulas around, and we can say, “Okay, what we found through their course of PT is that this part is a little bit tighter,” when we’re labor, we’re not going to be overthinking that, right? We don’t want that in our head too much.

Gina: Yeah.

Hayley: But it might mean something as simple as, oh, we’re going to put a block underneath this foot ’cause that helps encourage better shifting to that side. Or they can, as the doula, can encourage a staggered stance position. And again, hopefully we don’t even need that because they’ve worked on that work throughout pregnancy. But then, yeah, then our choices or the way that we add support is a lot more subtle and also more effective and yeah, less intrusive.

Gina: Yeah, it’s really hard to teach in the moment, and it’s just not necessary, also.

And so when it comes to pelvic mobility, how can we improve, how well the pelvis can move and the capability to do that? Because again, we’re not trying to like force baby into a specific position by any means, we want to ensure their path to rotate is clear. And then if it comes to pelvic mobility, we’re not necessarily just focusing on exactly where baby is at when it comes to birth preparation. We’re thinking about the pelvis as a whole, and recognizing that different types of movements help to create different types of space within the pelvis. And so we want to make sure that we can do all four of those type of movements- we can spread our knees wide and have more abduction with external rotation, we can have internal and external hip and pelvic rotation, that we can find more internal hip rotation, or knees in ankles out, to create more space in the bottom part of the pelvis. And all of those are going to relate to different muscles pulling and other muscles releasing as well. And it gets a little bit more complicated as we start diving into what all those are. But, if you generally find squat movements, so that’s generally going to open the top part of the pelvis. If we’re finding more like one-legged or like split stance movements and we’re finding open to close hip positions, that’s really going to take care of the middle two. And then if we think more hinge type motion, so like deadlifts, that’s really going to help take care of the final one. And then you just gotta think about, okay, what are the opposing muscles that I probably have to release to help support opening all of that?

And we incorporate all of that within our prenatal fitness programs just to make it really easy for you as well.

Hayley: You don’t have think too hard!

Gina: You don’t hard have to think about it at all! And we do have some free YouTube videos as well that have like examples of different exercises that you could do to help create space throughout the entirety of the pelvis, and our free birth prep circuit that has some release exercises as well. So lots of resources to help support you so that you do not need to reinvent the wheel by any means. And then professionals, we are diving into birth prep all next month, or this month, within our professional community as well, so you can always check that out.

Now the last thing that we’re thinking about when it comes to, or one of the last things that we’re thinking about when it comes to birth preparation, ’cause there’s obviously a whole bunch of other stuff that we can do, is the release portion. And a lot of us think specifically like pelvic floor. “I need to learn how to release my pelvic floor for birth,” ’cause your pelvic floor does not push your baby out. I’m just going to go ahead and debunk that. If that is, if that was something that somebody was believing, ’cause you may have been told do all the Kegels so that your pelvic floor is really strong so you could push your baby out. It would be like tightening the tube of your toothpaste tighter to squeeze your toothpaste out. That’s not, don’t do that, don’t do that. Your pelvic floor really just needs to let go and release to allow the baby to pass through. it’s not tightening and pushing the baby by any means. Your uterus is what pushes your baby out.

Now there is some value with your pelvic floor having the ability to find some tension to help support your baby’s position, but it still needs to be able to release and to let go. And now when it comes to the pelvic floor, usually what I get asked is, “What is the best stretch for my pelvic floor? If you don’t want me to do Kegels, which is what I’ve believed to be the best for my pelvic floor, okay. What stretch do I need to do? What is the best stretch that I can do?” And remember that your pelvic floor attaches to the pelvis, so there’s no one best stretch either, just to make that really fun for everybody.

Hayley: Yeah. Our pelvic floor has four quadrants, and what’s going on in each quadrant is going to be dependent upon the position of the pelvis. And so we can apply lengthening in different parts of the pelvic floor in different positions, and then we can also improve activation or lift in the pelvic floor with something else. And really, we need both, right? And we need it to be able to move in all the ways. And I think really it’s also acknowledging that the pelvic floor is not exclusively an orthopedic muscle. So our pelvic floor is really a part of our lower digestive system, it’s also part of our sort of nervous system, and so how our pelvic floor responds to stress, how our pelvic floor responds to worry, can cause it to react in different ways, regardless of where pelvis is at. So you could be in the perfect knees in, ankles out position for pushing, and that pelvic floor could still be like, “Absolutely not,” like, “we’re not yielding, we’re not letting go,” even if we’re putting it in the best- quote unquote “best”- position for pushing. That ability to go to that place mentally, where we’re able to yield and we’re able to let go and feel safe then also is what allows that pelvic floor to let go, too.

Gina: So there’s a lot to that. So to touch, quickly touch on like the physical stretches, the pelvic floor attaches to the pelvis, so all of those hip movements that we were doing to open the pelvis are also going to be all the movements you should do to stretch your pelvic floor.

Hayley: They’re all pelvic floor.

Gina: But, like Hayley’s saying, there’s so much more than just what position are you in, it’s about how you feel in the moment too. And so I’ll have like doula clients that have a provider that they do not feel comfortable with, that I know when it comes to pushing, they’re going to want you to be in a specific position, you’re probably going to have a lot of people talking to you at the same time. I had one client who- and this was more recent and it was something that I hadn’t quite like put together for myself, ’cause I’ve given birth at home for the past three, so I, did, I guess I just forgot about it- where she was asking, “Oh, so how many people are going to be in the room when I’m pushing?” And I was like, “Oh yeah, that’s a good thing to know. A lot. There’s going to be a lot of people in the room, a lot of strangers that you’ve never met, and they will likely not introduce themselves, ’cause they’re going to be like a random person and they don’t want to interrupt you.” And I’m like, “You’ll have your midwife or your provider, or the OB provider. You’ll also have a nurse for you, and there’ll be one or two nurses for a baby. There’ll be a tech for the provider. And then if it’s shift change, just double all of that. If there was anything where they were concerned, like if they had meconium or baby had any sort of decels, there’ll be NICU in the room as well. It could be like 10 people just like loitering in this room.” And I was like, “So that’ll probably be a lot to just be spread eagle while all these strangers are staring at your vagina.” ‘Cause it was a lot for me during my first birth!

Hayley: Yeah! Oh yeah.

Gina: Where I like, at one point, like in between pushing, I looked at my nurse and I was like, “Who are all these people?!”

Hayley: “Get out!”

Gina: “Who is this guy?” And she’s like, “Oh, that’s your midwife, her name is Susan, and….” I actually don’t remember what her name was, “that is the cord blood banking lady, that is the attending provider, those are two residents that are just witnessing this experience. Those are your nurses,” like, and she was just like listing all these people. She’s like, “I don’t know why that person’s in here.” And I’m like, “I don’t know who any of these people are,” and like they’ve all got their little side chats going on. Like the attending was like talking to the midwife and he was like, “Oh, maybe we need a vacuum,” and I’m like, “What is a vacuum?!”

Hayley: Yeah.

Gina: And I’m like, “I can hear you guys, like, I’m here!” And my husband reflects on it and he’s like, “I felt like I was watching a fight in like high school, and I was like on the outskirts trying to see what was happening ’cause there was like, there were so many people around you.”

Hayley: Yeah. During my first birth, I locked myself in the bathroom and I wouldn’t, like, they were knocking the door, and I refused to open it. And I think I might’ve, I had gotten in the tub or I was in the shower or something, and they really wanted to come in and I really did not want that.

Gina: You will not come in here.

Hayley: And then I did come out, but, it’s… Penny Simkin talks about a lot- RIP, Penny Simkin is a PT, but birth worker doula, who’s really like foundational to a lot of birth work info that’s out there. And she talks about sphincter law and she was like, when she would teach like group birth classes, she’d put a bucket on the floor and she’d tell all the spouses, “I’ll give a hundred dollars to anyone who will shit in that bucket.” I don’t know if I’m allowed to say shit… And of course our sphincters, which are emotional, are not going to, we’re not going to feel good about crapping in a bucket in front of the whole room of people. And if our goal, if our plan is to birth in the hospital and we know that there’s going to be a lot of people around, I would argue, as weird as this might sound, is part of your birth preparation being poop with the door open.

Gina: Yeah.

Hayley: With your partner, with your kids, and that’s because we want to practice, like, practice these things. And so if we have a lot of anxiety or fear about pooping or farting or bodily functions in front of people, and we know that’s what it’s going to be like when we give birth, having some reps with that, I don’t think, is that wild of a thing to say.

Gina: I actually had one client who had never farted or pooped in front of her husband and it was definitely like impeding pushing.

Hayley: Yeah!

Gina: ‘Cause she like could not let go.

Hayley: Yeah.

Gina: And I was like, “I’m so sorry that that’s never happened for you before. Like, I know that it’s like really anxiety producing, but I promise you that he does not care. I promise you that he could not care less, but I know that it’s… you just gotta let it happen,” and she farted and he did not respond. Like he was like, “Whatever,” and like she was finally able to be like, “Okay, I can could do this.” But once she told me that, I was like, “Oh, that’s why!”

Hayley: Of course, ’cause now you’re holding in.

Gina: Yeah!

Hayley: During this thing where the whole goal is to just let her…

Gina: Yeah.

Hayley: Let it go. And yeah, I think people don’t talk that about that kind of stuff that much when we’re talking about like birth preparation.

Gina: Yeah.

Hayley: I’d say other types of birth preparation is, yeah, how do you respond in a stressful situation, learning about yourself, how do you, where do you hold tension in your body when you’re stressed? And that might not be the exact same as when you’re in labor, but, start, like starting to think about that, right?

I, this last pregnancy, I’d get a ton of cramps in my calves at night, it’s like, the summer in North Carolina, and it was like, yeah, as much as they suck, it’s good practice.

Gina: That’s what I did during my third, whenever I had a charlie horse I’m like, “I’m practicing for labor!”

Hayley: Practice yielding instead of tightening and making it way worse, can I go against it? Can I soften? Can I let go? And so using those opportunities to practice preparing for what that’s like- I think especially for people who haven’t had a baby before, who, while that sensation of a charlie horse is not the exact same sensation of yielding with your pelvic floor, it’s, it helps with some of the like mental piece of it.

And I think I feel the same way about that with perineal stretching, right? I don’t believe that perineal stretching is actually changing the tissue of the perineum, but I do believe it is a mental preparation technique that the research tells us is most effective for preventing tears in first time moms. But, I think it’s most effective in first time moms because it allows that mom to learn what it feels like to feel a little bit of discomfort in the pelvic floor, feel that sensation of a little bit of stretch, and not freak. And to be able to like, “Okay, I have to go with this. I have to get through this,” versus pulling away from it, and yeah, I think that’s huge as well.

Gina: Other things that folks have told me that they didn’t realize was going to be something that was stressing them out was all the noises.

Hayley: Yeah.

Gina: So like I had never been in, well I’ve been in hospitals before, but I had never been there as like a patient before my first. And even as a doula, like I’m more aware of all the noises and I know how to turn the volume down on things, but sometimes there’s just like all these beepings and like the heart rate monitors going, and then if something is like being alerted, there’s like a little alert that’s going on, and so there’s all of these like extra bings and stuff that are happening. And so learning how to turn all that stuff off, not turn it off, but turn the volume off can be really helpful. Learning how, or asking your nurse to show you, “How can I silence the alarms on things until like you come in and check on it?” can be really helpful, too. ‘Cause that’s something that sometimes we don’t realize, is there’s going to be a lot of noise, like extra noises, and there’s going to be a lot of that extra traffic in the room, even before pushing. ‘Cause your nurse will come in, like the person that takes your blood will come in at some point. There’s just going to be like this traffic through the room that you can’t always control.

And what you did with hiding in the bathroom, I think is like a great place for people to go if they’re like, “There’s too much happening here.” Like, most people will not follow you if you’re like, “I’m going to go poop.” They might follow you in labor, just ’cause that usually means baby’s coming, but if you’re in the bathroom, usually I find that people just leave you there. Or if you’re in the shower, they tend to just leave you to give you that privacy. So if you are, if there’s a lot happening in your room, and you have the ability to do so, I would go in the bathroom and like chill in there.

I also find that if you turn the lights off in the room or you dim them, people enter that vibe and they are quieter, for some reason. ‘Cause it’s dark and they’re like, “Oh, I have to, I’m supposed to be quiet. They want me to be quiet.” As opposed to if all the lights are really on, and you have the TV going like, they’re going to respond with the same type of energy. And so setting the vibe in the room can really help.

Hayley: Yeah, yup.

Gina: Like, with the energy levels of people that are trafficking in.

Hayley: Or if you, like, have a pair of noise canceling headphones you like, or you like to sleep with an eye mask, or things that feel familiar, that helps with some of that sensory… blocking out of some of those sensory inputs, that are going to allow you to stay in that sort of flow state that you need, right? Because when our sympathetic nervous system is activated by a dinging bell or strangers, our uterine contractions are also going to change and could be maybe less efficient, or space out, because our old lizard brain is like, “Oh, we need to move from this place because it’s not ideal.” And so we know rationally that’s not true, right? But our body doesn’t necessarily know that. And so can we be prepared? In our prep for birth, can we be prepared for the reality of that, depending on what our birth location is?

Gina: Yeah. And I would say that there is a lot of value in where you choose to give birth as well- acknowledging that some of us may not have a ton of options as well. So like for my first birth, I did not have any other option, like it was give birth at this specific hospital, just based on like my insurance, and like I was an active duty service member and I had to give birth at the military hospital. Now, I know that I could have potentially scrambled to find a midwife to give birth at home, but it would’ve been all out of pocket, and the availability of home birth midwives where we live is not very high. So I was not going to find somebody in my third trimester. I wasn’t going to give birth by myself. So I did not have a ton of options for my first birth, but if you do have some options, I would, especially if you live like near a big city and your insurance allows you to choose from several hospitals, know that there are usually multiple clinics that can support the same hospital. There’s usually a lot of options. So for folks that are like our local area, there’s one hospital and now there’s only one clinic that supports it, but an hour away, there’s five hospitals that you can choose from. So sometimes it’s not like in your immediate area, too.

So if you are at your prenatal appointments and you don’t feel good when you leave your appointments, you don’t feel that the provider is taking time, or as much as they can, to answer your questions. So if you’re leaving your appointments feeling really uneasy, that’s a red flag to me. Like maybe we need to look at a different provider. If you cannot choose a different provider, we need to potentially look at investing and having somebody else there with us, like a doula or if you have a family member or a friend that’s like really well versed in birth, can they be there with you to help advocate for you?

If you do have the option to go somewhere else and you’re not sure where to go, ’cause it, you can’t interview 20 clinics, you can ask local doulas, “Hey, this is my plan for my birth. This is what I’m wanting. Is there a place that you’d recommend?”

Hayley: Yeah, the doulas know. The doulas know.

Gina: They’ll be honest with you. I’ll be honest. Anybody that asks me for like my honest opinion on things, I’ll give it to them.

Hayley: Yeah.

Gina: Now, if you are telling me that you love your provider and it’s a provider that I’m like, “Eh,” I’m not going to say that. I’m going to be like, “Oh, that’s great, I’m glad that you are having a really good experience!” ‘Cause people do have good experiences with providers that I don’t like. I don’t have to give birth with them, but if other people want to, that’s fine, and they could still have a good experience. So if you tell me that, “I love this provider so much, they’re the best.” I’m like, “That’s awesome.”

Hayley: Yeah. Great.

Gina: “I’m so glad for you.” I’m not going to be like, “Actually they suck.”

Hayley: Yeah.

Gina: ‘Cause that’s not my place. But if you ask me, “Hey, I want to give birth at a place that I feel like I’m going to be respected.” “This is where you should go. It’s a little bit further, yeah. That’s where you should go.”

Hayley: I think something that used to play back for me was, a friend of mine who’s a midwife, at the very end of my pregnancy with my first, I went in with my evidence-based birth sheets that I printed out.

Gina: They’re really helpful!

Hayley: And I ask my provider, the provider that I saw at that appointment, “Oh, what are your thoughts on episiotomies versus tearing naturally? What are your thoughts on delayed eye ointment?” Like not necessarily hugely controversial questions.

Gina: Yeah.

Hayley: But just, it was really the only time where I was like, “You know what? I’m going to go in with my questions and I’m going to ask them.” And the provider was just really dismissive and was just like, really was not open to having conversation, was like, “Our standard is not to do episiotomies. You get eye ointment.” And I just remember leaving being like, “Oh, I probably was going to choose eye ointment, and I probably was fine with whatever they said about episiotomies, but I just wanted to Talk about it.

Gina: Yeah.

Hayley: And I remember leaving that and talking to my friend who’s a midwife, and she was like, “It’s not too late.” And I was like, heavily pregnant, I was like heavily into my third trimester. And I definitely have a bit of regret about that because that was the provider who ended up delivering my son, which, perfect! But that it’s not too late, I think is big. And although that will create, maybe create some, like I thought it was too big of a stressor to transfer care somewhere else, in hindsight, I think I would have listened to that gut instinct that I had, that I didn’t feel trusting of that clinic, period, but of that particular provider. I didn’t know if she was going to be the one who was going to be there or not, but the fact that was the vibe..

Gina: Yeah, that’s not a good vibe.

Hayley: It should have been my red flag. And knowing all the things that I know now, sure, could I have made a different decision at that time? Probably. But again, we are just making the best decisions with what we know.

Gina: Yeah. I’ve had people switch the day they were in labor, like to a new hospital. ‘Cause they were like, “You know what? I didn’t feel supported in that environment. I’m going to go somewhere else.” And I’m like, “Okay, cool, let’s go.” So you can switch the day of. Like in America, if you show up at a hospital in labor, they can’t turn you away.

Hayley: For now.

Gina: For now they can’t turn you away. So that, so I’ve had people that did not have care established, which, I don’t recommend, but they did not have care established with the clinics in the hospital and they showed up in labor ’cause they knew that it was going to be a better experience for them and they had a better experience which was all that really matters. Just feeling supported in this experience. So yeah, it’s definitely not too late, even if you’re in labor. I guess if you’re already checked into one hospital, you could always leave. Sometimes I think about that, I’m like, “What if I was just like, ‘goodbye, like I’m going to go home and I’ll come back when my baby’s falling out.'” Which I don’t think is always like… it’s not necessarily like bad to show up when your baby’s falling out of you, but it can be a little bit more stressful. I don’t know, I guess you did that.

Hayley: Yeah, I could say that. But it was what I, honestly, it’s what I had envisioned, like, that, mentally, I had prepared. That’s what I had been preparing for was, “I want to roll up and drop the baby at the hospital,” with my second. I had rehearsed that in my mind, and I believe that our mind’s really powerful. So what we rehearse in our mind really holds a lot of power. And yeah, that was what I had been rehearsing in my mind, and so while it was intense in the moment to be like pushing as you’re running in, I felt like cool about it because my brain and nervous system was like, felt ready for that. Yeah.

Gina: So choosing a supportive team is incredibly important, because that’s what’s really going to help to support you to be able to release and to relax during labor. So you can do all the stretches, again, during pregnancy to relax your pelvic floor, to release tension within your pelvic floor, but if you show up at labor in a place that you don’t feel supported or you don’t feel safe, it’s going to be really hard for that pelvic floor to yield and for the rest of your body to yield as well. And so if you can’t choose a different place and you don’t feel supported where you are now, looking to add on that additional advocacy with a doula can be really helpful, or even just family members that are well versed in birth and they feel confident and comfortable advocating for you. Maybe your partner is somebody that feels really confident in being able to advocate for you, which would be wonderful. Sometimes it’s a completely new experience for them too, and so they feel uncomfortable advocating, which was the case for us during my first. My husband had no experience with birth and he didn’t know what would interfere with my care by him asking questions. And so he was like, “I don’t know what to do ’cause I’m not familiar with this.” And so having a doula or somebody that is familiar with birth can be really helpful, especially if that person feels confident in being able to speak up for you, if needed. If needed.

For me, as a doula, the things that I do to really help empower my client is I ask them questions about what they’re, what I know that they’re wanting. So if somebody’s pushing and I know that they feel comfortable in the position they’re in, and maybe there’s a nurse that’s like, “You need to get on your back for the provider.” I’ll just ask my client like, “Do you feel comfortable where you’re at?” And if they’re like, “Yeah,” I’m like, “She’s good here,” and I’ll just let them know that she’s not going to move. Now if my client’s like, “I don’t care, I’ll move on my back, that’s fine,” then I’m like, “All right, cool. If you want to move on your back, that’s totally fine, if that feels comfortable for you,” but I give them the opportunity to tell me what they want, so that I can then let everyone else know, this is what she’s going to be doing.

Hayley: Yeah.

Gina: Right now.

Hayley: Yeah.

Gina: And you’re just not going to… And then that usually kind of eases people off where they’re like, “Oh, okay, yeah, we’re… we’ll just ease off.”

Hayley: And I feel like in general, doulas do a really good job at that, just by nature of their experiences and their training. Something that I see a lot in the clinical PT, OT, pelvic health space is that PTs or OTs will offer like birth prep sessions, right? And it’s maybe slightly longer, or maybe it’s just one hour or however long they have and to assume that you can learn all the things about how to prepare your body for birth in one session with a PT, I think is a bit of a stretch. I think if you have time for one that’s better than zero.

Gina: Yeah.

Hayley: If you have access to one, it’s better than zero. But I think from my perspective as I’ve evolved and seen more clients through their pregnancies and beyond, is the building that relationship and being able to have conversations about advocacy, being able to have conversations about your choices and your options and, movement and options for how to push and moving those pushing efficiency is all important when you’re talking about birth preparation as a therapist for someone. But I think sometimes these sessions end up being very orthopedically based, right? Where it’s like, “This position helps inlet, this position helps mid pelvis, this position helps outlet,” and it becomes very formulaic without creating space for some of this nuance of how is your partner going to respond to you? How do you like to be supported? All of those types of things as well.

Gina: Yeah, there’s definitely a lot more to birth preparation than just the physical, which is really easy. It’s really easy for me to just give somebody like six exercises, just do these exercises.

Hayley: And that’s good.

Gina: I just, I think it’s a good, it’s a good step, but then there’s always that room for a little bit more, and this is where having a very supportive team is really helpful. ‘Cause I got a lot of that, “Okay, what do you think you want support-wise during your birth?” from my midwife. Where she was like, “Where do you think you want to labor? What kind of snacks do you want to eat?” And she was asking all those like extra questions to have a better idea of like how I want her to be supported during my birth. But I gave birth at home and so my prenatal appointments were all an hour long, and I had 12 of those during my pregnancy. A little bit different than if you’re giving birth in like a hospital, or like a clinical setting or I guess it’s still clinical, but at home, where your appointments are usually a little bit more rushed. And so maybe this is where a doula is helping you to understand all that background stuff. Maybe you have more sessions throughout your pregnancy with a PT, ’cause you don’t have to wait until your postpartum to see a physical therapist. And maybe this is something that a physical therapist or an OT is weaving into their sessions with their prenatal clients. So like asking those little bit extra questions if they have the opportunity to. I know some PTs have really short appointments and stuff as well.

And so this is where all of the different people on a team can think about, how can we support this person in this very like unique experience, or it’s not unique as in nobody else experiences it, but for them this is like maybe the one or up to however many times they’re going to have in their life. How can we help support them in this experience, any in an all encompassing way with the physical preparation, which is obviously very important, the mental preparation and then also helping them emotionally to prepare for this whole experience.

Hayley: This big change. Yeah.

Gina: Yeah. If you want more support throughout your pregnancy, we got a lot for you.

So we have our prenatal fitness programs, which obviously is going to be the physical preparation for birth. In our prenatal fitness programs we have strength training exercises, we have cardio exercises in addition to the release movements. And we weave in tons of birth preparation exercises, tons of pelvic floor exercises within the programming as well, so we have that really well-rounded program to help support you. So it’s not just pregnancy safe exercises or a general fitness program without sit-ups, we have a lot of movements within it that are specific to that birth preparation- supporting your baby’s position, creating space within your pelvis, releasing tension within your pelvic floor. In addition to our full program, which is just daily workouts that you can do, we also have a free birth prep circuit if you just want some exercises to add on to your current workout routine.

If you are a professional, you can join our professional mentorship community where we’re talking all about birth preparation for the month of September. And now if it is well beyond September, and you are listening to this podcast episode, never fear, all of the content from this month is going to be available for the length and the duration of the community. So as long as the community exists, you’ll be able to find the birth preparation content. And we’re going to be diving really deep this month, where it’s not just going to be the physical preparation, we will dive deep into the physical preparation, but we’re also going to be talking about the mental and emotional preparation and how we can better support our clients as a full person, not just a person with a bunch of muscles within their body. ‘Cause there’s so much more to preparation for birth than just the physical prep.

And then back to the people that are pregnant- if you want more of the educational preparation, we do have a childbirth education course where we break down what to expect during birth. And when we understand what is happening and what our options are, this can really help to support us emotionally and mentally as we prepare for our birth.

And you can check out all of our online offerings at our website at mamastefit.com and use code STORY10 to get 10% off any of our online offerings.