As a physical therapist, my role in supporting labor and delivery is to help the client avoid birth injuries like perineal tear or pelvic organ prolapse, protect pre-existing injuries like herniated disc or hip impingement, and prepare for early postpartum recovery. No one likes to think of these things happening, but the potential is real, and the potential to minimize the risk of injury is also real. After all, birth is a normal bodily process, and knowing more about that process allows a person to cope better and to be able to wisely choose their options for their birth plan. PT can offer pain management strategies, techniques for pelvic mobility to promote the baby’s descent, strategies to help avoid perineal tearing, safe pushing techniques, and pelvic floor fitness.
While I can offer all of these clinical strategies, one of the most important pieces of guidance I can give you to protect against injury is to be confident and fearless once labor starts - in other words, to LET GO and go with the flow. Letting go comes from a place of feeling confident and fearless. This results in a decrease of the ‘fight or flight’ response, which is driven by the Sympathetic Nervous System. The ‘fight or flight’ response is important for meeting deadlines, competitive sports, running from danger, and multi-tasking. But too much of this nervous system state can be counter-productive to pooping, libido, childbirth, and pain management. WHY? Well, pooping, libido, childbirth, and pain reduction all depend on the ability to relax and let go of muscular tension and stress. This “rest and digest” function belongs to the Parasympathetic Nervous System. The pelvic floor specifically must remain relaxed and be stretched gradually to allow the baby to pass through the birth canal. It's been observed that a cervix will un-dilate if an unfamiliar person walks in the room or if the mother feels threatened or nervous. It’s also been observed that the cervix and/or birth canal relaxes and opens using good mental imagery and/or a positive mantra, like “I’m beautiful; I’m going to open up; my baby and body are working together; my body knows what to do”. A good analogy to setting yourself up for childbirth relaxation is to set up your environment the way you would if you were going to take a poop - maybe a bit more privacy, low lights, deep breathing… Merely sitting on the toilet during labor often helps labor progress. Whatever it takes to allow natural body relaxation should also help labor.
Your labor preparations and birth team play a pivotal role in making it safe to turn down your sympathetic nervous system. A great childbirth education class, respectful OBGYN or midwife, and hands-on birth partner and/or doula can all help you to feel safe, strong, and capable. PT is an excellent complement to childbirth education because a good PT can help you manage pregnancy symptoms, prepare the pelvic floor for delivery, and set you up for postpartum recovery! And also to bolster your own sense of empowerment and security.
In conclusion, I highly recommend each pregnant person invest resources in detailed birth prep to whatever level is necessary to feel confident at your birth. Aim to be fully and well-roundedly prepared. Then, once labor starts, trust in the process, trust in your body, trust in your team, trust in your resources, trust in your preparation, and LET GO.
By Melissa Stendahl, DPT
Dr. Melissa Stendahl is a Physical Therapist specializing in pelvic health and manual therapy. A lifelong athlete and military veteran, Dr. Stendahl is unique in her empathetic teamwork approach with clients, promoting preventative care in addition to rehabilitation. She encourages active participation from patients, placing great emphasis on education so that each person understands their diagnosis and treatment plan, and feels empowered in their ability to achieve wellness. Dr. Stendahl has specialty certificates in the areas of prenatal and postpartum physical therapy, and interventions from preconception through early childhood aimed at chronic disease prevention. Dr. Stendahl provides holistic support to individuals throughout the lifespan, and is proud to aid clients towards optimization of human development and performance.