Pelvic Floor Care in Pregnancy and Birth 🩷 From Your Homesteading Doula 🌻🌼

As your baby grows, the pressure on your pelvic floor increases. This group of muscles, ligaments, and tissues sits at the base of your pelvis and supports the bladder, bowel, and uterus. It carries more and more weight as pregnancy progresses — and that can lead to discomfort, leaking, or weakness if not supported with awareness and care.

Understanding how your baby rests in the womb helps explain why many women feel constant pressure on their bladder or bowels in the later months. The baby's head often settles low into the pelvis, pressing on these organs and stretching the pelvic floor. (See the image below for a visual of how closely baby’s position interacts with the pelvic organs.)

This is why pelvic floor health matters — not just in pregnancy, but especially during labor and birth. Many women are told to “push hard” or hold their breath during contractions, but this can actually put more strain on the pelvic floor. Forceful, breath-holding pushes (known as purple pushing) can tire the body, stress the muscles, and increase the chance of tearing.

Instead, one of the most powerful tools in labor is the pause. Waiting. Breathing. Letting the body guide the rhythm rather than forcing a baby out with willpower. The pause allows the tissues to stretch slowly. It gives the pelvic floor time to open with less trauma. It gives the baby a gentler entrance.

And here’s something important: birth often moves like two steps forward and one step back. You may feel the baby’s head crown, then slip back in slightly. This isn’t failure — it’s wisdom. It gives the perineum a chance to slowly stretch, reducing the chance of tearing. Rushing past that rhythm — especially with directed, breath-holding pushes — can interrupt the body’s natural unfolding.

There’s even a way babies are born with no active pushing at all.
In some births — especially undisturbed ones — the body initiates what's called the fetal ejection reflex. This is a powerful, involuntary series of contractions that expel the baby without conscious effort. There’s no bearing down, no coached pushing — just the body doing exactly what it knows how to do. It can feel overwhelming, fast, and wild… but it’s instinctive and effective.

Not every birth includes this reflex, but it reminds us: your body is wise. You don’t always have to push. Sometimes your only job is to get out of your own way.

Position also matters. Lying flat on your back during pushing puts extra pressure on the tailbone and pelvic floor. Studies show that this position may increase the risk of tearing, especially when paired with coached pushing. Upright, side-lying, or hands-and-knees positions often help the pelvis open more freely and allow gravity to assist, rather than resist, the baby’s descent.

There’s also a common belief that an episiotomy — a surgical cut to the perineum — protects the pelvic floor. But research doesn’t support this. In fact, routine episiotomy is associated with increased risk of deeper tears, longer healing times, and pelvic floor dysfunction postpartum. Protecting the pelvic floor is less about cutting and more about listening — to your body, your rhythm, and the slow stretch of soft tissues doing exactly what they were made to do.

📚 Evidence note:
– A Cochrane Review (2017) concluded that restrictive use of episiotomy results in better outcomes than routine use, with fewer severe perineal traumas.
– A 2020 review in Birth journal found that spontaneous pushing (vs. directed pushing) was associated with less pelvic floor trauma and better maternal satisfaction.
– Upright birthing positions have been shown to decrease the length of the second stage of labor and reduce the need for assisted deliveries (Gupta et al., 2017).
– Michel Odent and other physiological birth researchers have documented the fetal ejection reflex as a natural, undisturbed process of birth requiring no conscious effort by the birthing woman.

Your pelvic floor is capable. It is meant to stretch and recover. But it deserves support, patience, and space to do what it’s made to do. Whether you breathe your baby down, push gently in rhythm, or experience the spontaneous force of the fetal ejection reflex — know that your body knows.

Slowing down is not stalling — it’s strength.
Trust the unfolding. Trust your design. Trust your birth.