Birth Prep For Active Moms

You can train hard, lift heavy, and still feel blindsided by labor. A lot of the internet messaging aimed at “fit pregnancies” skips the messy middle: contractions still hurt, pushing is still hard, and sometimes the biggest challenge is navigating the gap between what you hoped for and what actually happens.

I walk through a comprehensive birth prep plan for the active mom-to-be from my perspective as a pelvic floor physical therapist, researcher in exercise and pregnancy, and strength athlete. We talk about what pelvic PT birth prep looks like in real life, why coordination matters as much as strength, and how to practice pelvic floor relaxation so you are not accidentally tightening during the pushing phase. I also unpack the common myth that fitness guarantees an easy vaginal delivery, using a more honest, evidence-informed lens: activity may improve odds and endurance, but it cannot control breech presentation, medical complications, or the need to pivot.

We dig into perineal massage with a nuanced take on the research and the “ring of fire,” framing it as exposure to stretching sensation and learning not to flinch, not a promise to prevent tearing. Then we zoom out to the paths labor can take, including induction (cervical ripening, mechanical options, Pitocin), epidural choices, and what it helps to know about cesarean birth before you are exhausted and making fast decisions. I also share a favorite resource that supports calm, informed preparation.

If you found this helpful, subscribe, share it with a pregnant training partner, and leave a review so more active moms can find these conversations. What part of birth prep do you want us to go deeper on next?

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Transcript

SPEAKER_00 0:07

Hello

Welcome And Quick Disclaimer

SPEAKER_00 0:08

everyone and welcome to the Farabell Momless Podcast. My name is Christina Friday. I'm a public school physical therapist, a researcher in exercise and pregnancy, and a mom of two who has competed in constant powerlifting or weightlifting, pregnant post-partum, or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise. Whether you're a recreational exerciser or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey. We're gonna talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual. While I am a public floor physical therapist, I am not your public floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together. And I can't wait to get to it.

Why Birth Prep Still Feels Scary

SPEAKER_00 1:11

In today's episode, I am wanting to do a very comprehensive overview of birth prep for the active mom to be. I am hoping that with this episode, you will feel like you have a really good understanding of labor and delivery, what might happen if you're going to see a pelvic PT for birth prep, things that I talk about with my patients that you are going into your D-Day, your delivery day with as much knowledge and education as possible. When we look at our social media spaces and you are pregnant, you are probably getting lots of information from doors, pelvic PTs, midwives, and OVs who are putting information out there about labor and delivery. Even with all of that information, birth can still be really scary. I think, particularly for the first-time mom or the mom who had a really traumatic first birth experience, there can be a lot of nerves and uncertainty about what birth is going to be like, um, what your birth is gonna be like. And sometimes the information on the internet helps, but sometimes the information does not. I remember when I was pregnant with my daughter, my first pregnancy. I acutely remember this that I was teaching a postnatal fitness class. That's kind of what got me into Palma PT in the first place. And so many moms were talking to me about their birth stories. And one of them said, Yeah, the last time I actually threw up, I think we asked a question of the day, like when's the last time you had the flu, or when's the last time you threw up, like something random? And so many of the moms in the room had said, when I was in labor. And I didn't know at that moment that you could throw up in labor. What do you mean I'm throwing up in labor? And it just made me feel very aware as somebody who was pregnant and who was in that uh pelvic space, how much of like the nuance of labor delivery and all the different directions that labor and delivery could go that I wasn't aware of at the same time. I didn't want all of the worst case scenarios because it scared me more. So that I always feel like there's just this fine balance when talking about labor and delivery. And it's such a transformative time, right? Because it's that transition into motherhood or transition into motherhood again. And so when I am working with my clients, I try and kind of stick to the facts and then allow their emotions in the session to kind of guide where and how we talk about different things and in how much detail. So if

What Pelvic PT Birth Prep Is

SPEAKER_00 3:45

you are coming in to see a pelvic PT for birth prep, first and foremost, this is going to feel different than if you are doing a birth prep session with an obstetrical provider. So I know a lot of doulas and midwives have kind of labor prep and parenting prep sessions. And oftentimes that is those are classes that are helping to demystify labor, what labor is gonna look like. Many times partners and couples will do um sessions together. I've had a spouse come with me or come with their client to a session with me or their partner. Um, and they also talk about things like newborn care. My brother did a birth ref session, and it was like the first time he had really worked on um putting a diaper on and swaddling a kiddo. So there there are some differences between where pelvic PTs may be prioritizing or the main tenant of their education versus somebody like a midwife or a doula. In the pelvic PT world, uh, birth prep is often talking about preparing your pelvic floor and understanding the mechanics of delivery. Now, I'm kind of speaking in generalizations. What I really want you all to be aware of is that every clinician you go to, their expertise is going to be slightly different. How they tackle these sessions are gonna be different, and all of that variation is wonderful. Um, everyone's kind of come into those sessions from a different lens. But we are really focusing in on like the pelvic floor, laboring positions, preparing for the act of pushing baby out and pain management on the lead up to the active pushing phase of labor. So when you are coming in to see me, I love getting my moms in earlier in pregnancy, but earlier in pregnancy, we're making sure there's no aches, pains, muscle hurts, like all those things. We are looking at exercise modification and building resiliency in the pregnant body. So making sure that we are prioritizing core training and we're modifying away from exercise that isn't feeling good once we've coached and made sure that the reason why it's not feeling good isn't because of a drift in positions. As you kind of get into this third trimester, I'm not seeing you super often if you are not having any pain that we're trying to actively manage, but maybe every six or eight weeks, and then we start seeing you every four weeks in the third trimester, so that we can start talking about what your thoughts and feelings are around birth, what your questions are about different aspects of labor and delivery. And there's a ton of education that kind of happens in that third trimester as the reality that this baby is coming soon becomes a little bit more front of mind. So if you're coming to see me between 28 and 34 weeks, my first session with the birth considerations is tell me what your hopes, desires, how strong you have those hopes and desires around your labor and delivery. And everybody's gonna be different, right? Some people are going for a home birth that's unmedicated, some people are gonna try and do a VBAC, a vaginal birth after cesarean, some people are opting for an elective C-section, some people are scheduling inductions, some people want to go without any pain medications, somebody doesn't want to feel a single contraction, then they want to have an epidural. Like there's all these ways that birth can go, and there's all these preferences, and all of them are okay. When

Exercise Myths And Real Labor Odds

SPEAKER_00 7:27

I'm kind of thinking about the prep from the body side of things, there's two kind of buckets that I think are important to talk about. There's the exercise management side of things, or the beliefs around being active in pregnancy and labor and delivery. And then there's the exercises and interventions we are actively doing to try and prepare your body for delivery. I have a lot of active moms that I see on my schedule. The joke in my clinical practice is that you're either pregnant postpartum or over the age of 70. That's the those are the the two big groups of people that are on my schedule. And so I see a lot of moms who are told in pregnancy, oh, you are so fit, this baby is gonna go right out. Like you are gonna have no problem at all when you are thinking about your labor. This in some ways is true, but it really misses the nuance that that we need and we need to kind of filter through when we're thinking about labor and delivery. When we are looking at our research on physical activity and labor, what we see is that first stage of labor may be slightly shorter, and there's less less often is baby flipping to cesarean when we look at those who were active in their pregnancy versus those that weren't. The reason why I think that is is because there are um circumstances where mom's fatigue and mom's um ability to have a strength of push that they need to for the length of time that they need to can be a struggle and can lead to conversations around flipping to cesarean. When you have somebody who's really active, they may have better endurance for the long demand of labor, right? The first stage of labor is like a marathon, right? Where it can be a lot longer than you think. And then the second stage is a bit more like a 5K where intensity goes up, duration goes down, but requires still a lot of endurance from you. And so it does not matter how active you were, birth is a challenging time. Like contractions hurt, pushing is hard, whether you have an epidural or you don't have an epidural, though the sensations are different, obviously, depending on the med management. And so sometimes the messaging gets misconstrued that handling labor well is the same as labor being easy. And it's not. Less likely doesn't mean a guaranteed vaginal delivery. And that is where, and this is kind of true for a lot of things, where when people think, oh, I was really active, I'm not gonna have this bad thing happen, and then a bad or adverse health outcome occurs, then they're like, what the heck? Or people use the exception, right? Of, you know, this person didn't do any activity at all and had easy vaginal deliveries, right? Like we're looking at statistics and averages. So you're trying to stack the deck for the outcome that you are interested in that you want by doing the activities or factors that are inside your control. But in labor and delivery, in many aspects of life, there are these other buckets that are not inside your control. An example is a breach presentation and risk for C section. You cannot control if your baby is breach, right? Baby flip-flops are evidence on spinning babies. We have one retrospective study that showed an effect and one prospective study that didn't. The prospective study from a research perspective is a higher level of evidence than the retrospective study. And so we can try and stack the deck. There's nothing bad with doing inversions to try and flip baby, but I'm not, I can't make you a promise that if you do inversions, your baby's gonna flip. So we're we're trying to give ourselves the best odds and then just know that there are a lot of factors at play in labor and delivery, some of which are not inside of our control that can change the the way that your labor and delivery goes. And so I'm often talking about the nuance around physical activity and labor and delivery to just set the appropriate expectation, because then I don't want you postpartum to feel like, you know, everybody told me that this would be easy for me. And I feel like my birth was really long and really scary and really traumatic, and it didn't go the way that I wanted. How did I fail? And the answer is you didn't, right? And and sometimes you were just responding to the way things went versus being able to truly change the outcome. And I think having that nuanced conversation and setting expectations on the right path is really important. So we kind of have this discussion around exercise and its influence on labor, exercise throughout pregnancy.

Learning Pelvic Floor Relaxation Skills

SPEAKER_00 13:23

And then we have these active interventions to try and prepare your body for delivery. And so the first is is your pelvic floor able to relax in order to facilitate a vaginal delivery? And that would be obviously in individuals who are not opting for an elective C-section. And then the conversation around perennial massage. When it comes to the relaxation piece, this is where I will do an internal exam. I actually don't have to do a like an actual internal, like my finger does not have to go into the vaginal canal for this section. Um, because I can externally, like if I am just looking at the inside of your vagina from the outside, I do an external check. I can kind of see, are you contracting when you are saying you're contracting and are you relaxing? Am I seeing a drop of your tissues when you are saying that you are relaxing and bearing down? And so I will get people to, I'll do a check in the third trimester, an internal exam, if that person is comfortable with it, to make sure you are doing the right thing at the right time. That coordination of birth is really important. When we are in the pushing phase of labor, our uterus is what is contracting, our pelvic floor is relaxing. And you are using this headlift and this inner abdominal pressure to help facilitate that uterus contraction to allow baby to go down into the birth canal. And baby's gonna come up and down and wiggle in waves, which I always try and tell my moms about because if you think I push and then I stop pushing and baby's head comes up, then that means that I need to just never rest. That's not true. Like, just like your contractions in your first stage of labor came in waves, those waves got stronger and closer together as you got closer to pushing. In your second stage of labor, they come in waves as well. And so there's contract, relax, recover, contract, relax, recover. And the goal is that with every contraction, you're getting further down without a complete reversal. And that means that by the time, you know, hopefully like 30, 60, 90 minutes, two hours, hopefully not two hours, two hours is tough. Um, but you know, what by the time, like you're you're making steady progress, even if that progress isn't as fast as you want it to be on the way down. So when it comes to my active clients, that relaxation can sometimes be very challenging. And that is because my active, my people who are doing exercise, whenever you are doing effortful movement, right? Running, jumping, lifting, your pelvic floor is contracting to increase pressure in your belly to perform that effort. We just did a bracing podcast about that inner abdominal pressure. That pressure increases not just with lifting, but from going from slow to fast. Anytime we add speed to the system, there's a co-contraction of our core canister that increases in our abdominal pressure that allows us to exert force from our midline. It's why our abs are sore when we do a sprint track workout and they're not as sore when we're doing a slow jog, right? Because we see this ramp up in our co-contraction, which means that for barbell athletes and for endurance athletes, understanding this ability for our pelvic floor to control or relax rather, is going to be really important. And what we see in labor and clinically, what I have recognized in my active women is that levator and co-contraction in the second stage of labor. So instead of pelvic floor relaxing with the push, you're contracting with the push can make your pushing phase longer. So we are working on this relaxation. And then I facilitate that at home by getting people to do some practice pushes and work on understanding where their pelvic floor is in space. When we go into a lengthened position of the pelvic floor, that is when we're in posterior pelvic tilt. And so a deep supported squat where you're kind of relaxing into it. Child's pose and happy baby are the three positions where we're really kind of in this posterior tilt. And it can sometimes feel easier to feel that relaxing of our pelvic floor. So I'll get people to do a Kegel to a five-second relaxation so that they really feel that drop and spread of their pelvic floors. And we'll even practice, you know, some pushing with uh holding your breath and without, because often in the act of labor, you end up doing both, flipping both, even if you you practice only breathing with your pushes. You're gonna at least transiently hold your breath. So I want you to be able to relax your pelvic floor in a breathing condition where you're pushing with uh or uh any type of coordinated breathing strategy, or you are holding your breath and trying to push down. Now you're not trying to do a max wear down. We're gonna save that for the delivery room, but understanding and feeling that. And for some of my clients who are having a tough time on the relaxation piece, the the contract to relax and then try and do a little push, that change in feeling can really help to wire what they're supposed to be experiencing when they're in that labor and delivery room. So that relaxation is a really important part of the birth prep process. The second

Perineal Massage And The Flinch

SPEAKER_00 19:18

big bucket of conversation that we chat about is perennial massage. There is a lot of um confidence for people when we talk about perennial massage that everybody needs it between 34 and 36 weeks. Where I have really changed my mind is one, the strength of our evidence isn't as strong as many people online would make us believe. And I think mechanistically, we didn't really hit the right note when we're talking about perennial massage. Discussions around perennial massage can be in preparation for delivery. So doing it after 34 weeks-ish in delivery at home. The second conversation around perennial massage is when you are in the rest phase of your pushing, the midwife or OB may do some perennial massage to prep for the head and shoulders being delivered. Our data is actually stronger on the in-pushing perennial massage than it is on the prepped, like prep for perennial massage. I used to say or believe that the idea was to basically prime the perennium for the stretch of vaginal delivery. So the perennium being the tissue from the bottom of the vagina to the top of the butthole, which is a common area where tearing happens during vaginal birth. And it's like you're kind of pre-stretching it, was the belief. I don't really believe that anymore. Um, I will prioritize perennial massage in first-time moms and moms who are really thinking that they want to try for an unmedicated delivery. Because my belief is more that the effectiveness of perennial massage is to fight the flinch on the big stretch sensation of the perennium during labor. When we are in birth, we can feel, right? When we're in pain, our body wants to tense up. When you are delivering without an epidural, there is a uh a moment where the head is coming through, that the the pelvic floor and perennium are at its most stretched, that you experience something called the ring of fire. And it feels like if you take both hands on your arm on somebody. And you turn them in opposite direction, you feel that burning sensation across your skin. Kids do it all the time to each other. It's actually really mean. It hurts. It's that sensation when you are going unmedicated on a vaginal delivery. And you can create a less intense version of that sensation with perennial massage. And the goal then is to learn to not flinch around and you know start slow and then build to a more intense stretching sensation and still feel like your pelvic floor is able to relax into that sensation. And it is a skill because our body wants to protect itself. If I have somebody who, you know, has had multiple deliveries in the past, so has understood that experience, or is somebody who's like, give me an epidural as soon as I get admitted, then, or, you know, is maybe going to think they're doing a trial of labor after cesarean. So maybe they're going to do an epidural in case they do have to flip to C-section based on their indications and risk profiles. It's less of a priority for me. We can absolutely have the conversation about it, but I am very hesitant to say, like, this is going to promise that you don't have a perennial tear, right? I I talk about, you know, why we may um we may leverage it, which also goes into my dose response. Like I'm not thinking that I'm trying to prescribe three sets of a 45-second hold because I'm not trying to stretch tissue. I'm trying to give exposure. And so that means that for some people, you know, if they're really worried about that flinch, maybe they're gonna do it more often. For somebody who isn't, maybe they're just gonna try it a couple of times. And if they feel like they can relax, then they're not gonna prioritize the perennial massage over other things when they're thinking about their preparation for labor and delivery. When

Induction Epidurals And C-Section Talk

SPEAKER_00 24:07

we are in these discussions, we talk about all the different directions that labor can go. We have our preferences, and our preferences are placed at the highest priority. And then we recognize that there's many times where our birth plan takes a hard right turn, and all of a sudden we are in a position where we are not having the experience we thought we would have. You wanted to go into labor on your own and you're starting to so show signs of pre-eclampsia, and they're inducing you at 38 and a half weeks. You thought that you were gonna uh go into labor on your own and your water broke early. It's been 48 hours, you haven't started contracting, you got to kick the Pitocin into the conversation, or we got to put the Pitocin into the conversation because of risk of infection. Right? Like there's just a lot of you know ways that things can drift and deviate. And so in these sessions, I am talking about okay, here is what happens if you go into labor on your own. Here's the expectation for the first stage of labor, here's the second stage of labor, here is what would happen if you got induced. Here's the way that we would start with cervical ripening to soften and start to um have early dilation of your cervix before pitocin comes in. And we talk about mechanical fully catheters versus prostaglandins, and we go through that cervical ripening to induction process and how that might feel different than a beginning of labor without facilitation. We talk about epidurals versus not epidurals. We talk about other pain management strategies. And for every single person, even if your risk of cesarean is low and it is not something that you want, we go into a full conversation of what a cesarean entails. Because trying to get an understanding of a C-section for the first time when you're 36 hours into a vaginal delivery, it is a hard moment to fully take in all of that information. And we talk about how C-sections can be emergent where this isn't going as well as we want to. We're starting to hum and ha around like, do we need to flip versus an emergency? And now all of a sudden you are in distress or baby is in distress and we need to flip to a C-section immediately. And the amount of time for discussion is very different in those two scenarios. So having an understanding of what that looks like and then what your options are to maintain some of the things that are important to you, like the vibe of your birth space, right? With things like can we put music on in the C-section suite? Understanding that it's going to feel cold, like and sterile in a C-section, because we are not in a vaginal delivery, we are in a surgical field, um, and understanding the why so that you know why that transition feels so stark and sudden. All of those things are really important because the the trauma can happen in a lot of ways in labor and delivery, but one of them is feeling like you weren't being listened to, you weren't being advocated for, things are happening to your body and things are happening to you without you being a part of that informed consent process.

Favorite Resource And Closing Thoughts

SPEAKER_00 27:42

This is usually also where recently, because I just read this book and it's wonderful, um, I will recommend that people listen or read Birth Vibes by Jen Hamilton. She is a labor and delivery nurse out of North Carolina. If you are an audiobook listener, I highly recommend the audiobook because she writes or she reads it. And she just has such a calm way of explaining even the scary stuff in labor and delivery. And it is just such a good overview of all the different areas that's going to help support what we are talking about in session. So I often also give that resource. I have a book that I have in my office and I give it to my moms, and I I'm trying to get them to sign it. So I have a whole list of people who have have read it, who have been in my care. That's just something that I think will be fun. Um, and so having that additional resource to really deep dive into different areas. And she even says, like, if there are certain things that you are not ready to for, or you do not want to discuss or do not want to process just yet, just skip chapters. And so I thought that was really she just did a such a wonderful job around that. And it was such a good supplement to some of the things that we talk about in session. That is a very large overview. I could go into individual sessions on every single one of those things. Um, we are prepping some um resources for you too for birth prep for the active mom over on the barbell mama side of things. So stay tuned for that. But this is the the start of the these conversations and finding someone that you can really have these strong conversations with from a public PT side. And then, you know, having these conversations with your birth provider to supplement or understand what the process is at the hospital that you are working with is going to be really important. And that's a whole other discussion around advocating for yourself during labor and delivery and having um expectations or known expectations going into your labor and delivery. So um stay tuned for more episodes on that. Um, because this is a very big conversation and it it deserves more than one episode. If you have any other questions, please let me know. Um as I said, we have really been thinking about this a lot over on the barbell mama side of things around how to help support our active uh moms as they kind of prepare for their labor and delivery. Um, and really excited to keep having these conversations. Have a wonderful rest of your week, everybody, and we'll see you all next time.