I’ve been passionate about physical therapy for as long as I can remember, but helping moms feel capable and strong in their own bodies is truly the job of my dreams. We often talk about how bringing a child into the world is empowering and incredible, and it is. Birthing my daughter was an experience unlike anything else. But as a first time mom-to-be, I would be lying if I said I didn’t have some anxious moments leading up to my due date — even as a pelvic floor physical therapist.
If you have questions, concerns, or anxious moments about childbirth, know that you’re not alone. It’s completely normal to feel fear about such a big event! But my goal is to help you understand the challenges your body may face during childbirth— and hopefully, as you learn, those things become less scary. When you understand the way your body works, you can feel empowered to make choices throughout pregnancy, labor, delivery, and postpartum that feel best for you. That’s the ultimate win!
So today, let’s tackle one of those “scary” unknowns — what is prolapse? Can it happen during pregnancy? What about childbirth? And most importantly, can you avoid it?
Pelvic organ prolapse, commonly referred to as POP, is extremely common. It affects nearly half of all women in the course of their lifetime! This condition is not confined to pregnancy or labor, but those are common times for women to experience it.
I wrote an entire blog post about prolapse (you can read the deep dive here!) but I want to provide a quick overview here: POP occurs when one of your pelvic organs drops out of position due to a weakened pelvic floor and increased intraabdominal pressure. Obviously, your internal organs and pelvic floor are already experiencing increased pressure as your baby grows, so POP can happen during pregnancy, especially in the third trimester. But whether you’re already experiencing prolapse or not when you walk into your birthing suite, there is a possibility that it can occur during labor and delivery.
Prolapse can occur during childbirth for a couple of reasons. First, the use of forceps in delivery has been linked to a much higher risk of POP. To reduce your likelihood of requiring this medical intervention, involve other helpful tools like a peanut ball. Even without forceps, however, studies have shown that remaining in stage 2 of labor, the pushing stage, elevates your risk of prolapse. The pushing stage is, of course, inevitable — but the way you approach it and how long you remain in it could help you reduce your prolapse risk significantly.
The Valsalva maneuver is taught in countless childbirth classes. Also known as “purple pushing,” this method of breathing involves holding your breath and bearing down or pushing for 6-10 seconds at a time. I believe this technique is taught because it’s “easier” in the moment — but in reality, it comes with a higher risk of damage. Adding additional pressure and strain on your pelvic floor can lead to perineal tearing and pelvic organ prolapse.
Instead of holding your breath, try a different, less forceful method. Open glottis breathing means simply exhaling with control while you bear down and push. This feels unfamiliar to some childbirth professionals, so they don’t teach it — but in my opinion (and experience!), the benefits should not be ignored. In fact, I teach open glottis breathing to every patient who sees me for a labor prep appointment. You’ll also find a module on this in the Movement Through Labor and Delivery course that I teach with a friend and certified nurse midwife, Skyler Jacobs.
Practice open glottis breathing prior to birth so that it feels natural and comfortable. Holding your breath might seem easier at first, but once you master this, you’ll be able to control both your breathing and your pelvic pressure as you push.
When you push in the supine position, you have an increased risk of use of forceps or vacuum. These medical interventions can increase your prolapse risk. Pushing on your back can also leave you in the pushing stage for longer, which can cause excessive stress on your pelvic floor. Thankfully, there are plenty of optimal pushing positions available to you, depending on your labor stage and baby’s position. Try side-lying, all fours, or squatting — and if you want to lay supine for a while, use a towel roll to optimize your pelvic positioning.
I’m not against provider-directed pushing — it can be very helpful when you’ve lost sensitivity due to an epidural or you’re feeling too overwhelmed to read your body’s cues. A great provider will partner with you, helping you when you need direction and allowing you to take the wheel when you’re ready.
With self-directed pushing, you go with your body’s natural cues, pushing when you feel the urge instead on a specific timed schedule. This often leads to slower controlled pushing, which is needed for crowning. Trust your body, mama – she knows what to do!
As we’ve already discussed, prolonging stage 2 of labor is associated with higher risk of prolapse. Instead, try to “labor down.” You’ve probably heard that once you’re 10cm dilated and fully effaced, it’s time to push — but that isn’t always the case!
Laboring down allows your body to push spontaneously as needed, getting baby lower into the pelvis and ready for active pushing. By following these spontaneous cues, you decrease your active time in the pushing phase, which is easier on your pelvic floor, especially if you’re already pushing with a prolapse from earlier in your pregnancy. It will also preserve your energy for the final stage of labor, and trust me, you’ll want it!
This seems counterintuitive, but in most moments during labor, you should focus on relaxing your pelvic floor muscles rather than pushing or straining. Pushing against a pelvic floor that’s already under a lot of tension can require more force, which can put more strain on the pelvic floor, and so the spiral continues.
During labor, you actually want your pelvic floor to be as relaxed as possible. This allows the fetal ejection reflex to take hold and simply push your baby out for you with little to no assistance. This goes hand in hand with laboring down!
If you’re not sure how to relax your pelvic floor, the Movement Through Labor and Delivery course is going to be your most valuable tool. In it, you’ll find movements designed to help release tension in your pelvic floor and surrounding musculature. You get access to educational modules from me, a pelvic floor physical therapist, and Skyler, a certified nurse midwife! In the course, you’ll find pushing positions, hospital checklists, education on all labor stages, a guide to provider conversations, and so much more that will help you walk into any birthing suite with confidence.
Movement Through Labor and Delivery is HERE! I hope this brand new course helps you walk into childbirth with confidence.