How to Exercise Your Pelvic Floor in Pregnancy & Postpartum

You’ve probably heard all about the benefits of exercising before and after childbirth, but it never hurts to be reminded how good movement is for your body: Regular exercise in pregnancy has been tied to reduced risk of gestational diabetes and hypertension, reduced weight gain in pregnancy, reduced incontinence and lumbopelvic pain in pregnancy, as well as reduced prenatal and postpartum depression and anxiety. Research also suggests regular exercise can reduce rates of cesarean and operative vaginal deliveries and can reduce recovery time postpartum. There are so many benefits to regular movement, the American College of Obstetricians and Gynecologists recommends that all pregnant people begin or continue exercise in pregnancy as long as no medical complications or contraindications are present. 

What’s less well known are the benefits of exercising your pelvic floor muscles both before and after you have a baby. As a pelvic floor physical therapist who specializes in maternity care, I love to teach birthing people about their pelvic floor, which is made up of an intricately woven network of muscles and connective tissues that form a kind of hammock at the base of your pelvis. This incredible area of your body helps hold up your pelvic organs (your vagina, uterus, rectum, and bladder) and supports healthy bladder, bowel, and sexual function. 

When your pelvic floor muscles are weak, tight, or uncoordinated, simple things like holding in pee or poop, being able to walk to the bathroom (instead of sprinting), or having pain-free sex become challenging or impossible. Tight and uncoordinated pelvic floor muscles can also make it harder to push out a baby. After childbirth, rehabilitating your pelvic floor is a key part of recovery, whether you had a vaginal or Cesarean birth.

Ideally, everyone would receive individualized care from a pelvic floor PT throughout pregnancy and postpartum. (If you haven’t already, consider asking for a referral from your doctor.) But we realize that isn’t always possible, so we’ve put together a few simple exercise routines that can support your pelvic floor, core, and whole body at every stage in your birthing journey.   

As always, before you do these or any other exercises, talk to your primary care provider or OBGYN about whether physical activity is safe for you. 

FIRST TRIMESTER EXERCISES (1-14 weeks pregnant)

Often the first trimester is marked by fatigue, nausea or vomiting. For many people, exercising can seem nearly impossible during these first weeks of pregnancy. Be kind to yourself and do what you can. Here are a few exercises that would be worth attempting whenever you have the energy and ability.

Belly lift

Start on your hands and knees with your hands under your shoulders and knees under your hips.

1. 1. Inhale, filling your belly with air and relaxing it towards the ground.

2. Exhale, drawing your belly button up and in towards your spine. Tip: Keep your back flat and still for the duration of the movement. Your belly should be the only part of your body that moves.

3. Continue this motion for several breaths.

*Where you’ll feel it: In your back and deep in your core- the transversus abdominus muscle.

Cat cow

Start on your hands and knees with your hands under your shoulders and knees under your hips.

1.  Inhale, allowing your belly to drop towards the floor.

2.  Draw your shoulders away from your ears as you bring your gaze up towards the ceiling and lift your tailbone, arching your back.

3.  Exhale, drawing your belly up towards your spine.

4.  Push through your palms as though trying to touch the ceiling with your mid back, tuck your tailbone and bring your chin to your chest, rounding your back upwards. Tip: Feel free to hold either position for a few breaths before moving forward.

5.  Return to the starting position.

*Where you’ll feel it: This is a mobilization movement, you may feel a stretch along your spine.

Walking program

Wearing comfortable shoes, head outside for a daily walk.

2. 1.  Start small.
3. 2.  Try walking for 5 minutes (avoiding hills, if possible) 1-3 times a day.
4. 3.  If you do not have symptoms during or after your walks, try to increase your walking time or frequency a little each day (consider increasing to four 5-minute walks a day or maybe two 8-minute walks, for example).
5. 4.  Continue to gradually increase your distance or time walking until you are able to walk up to 30 minutes in a row 1-2 times a day without any symptoms.

SECOND TRIMESTER EXERCISES (14-27 weeks pregnant)

For many people, the second trimester brings newfound energy. Take advantage of this time to build strength and endurance throughout your body.

Sit to stands

Sit upright in a chair with your knees hip width apart and your ankles directly under your knees.

1. 1.  Pull your belly toward your spine to engage your core and keep your core engaged as you move.
2. 2.  Lean your shoulders forward then squeeze your glutes, as you straighten your knees to stand. Tip: For an increased challenge, try not to use your arms.

1. 3.  Push your hips back and lean your shoulders forward as you bend your knees to slowly lower back into the chair.

Bird dog

Start on your hands and knees with your hands under your shoulders and knees under your hips.

1. 1.  Draw your belly button in toward your spine to engage your core.
2. 2. Try to keep your pelvis level as you kick one leg straight behind you. Try to keep your shoulders level as you reach the opposite arm straight in front of you.
3. 3.  Hold this pose before slowly lowering your arm and leg back to the starting position.
4. 4.  Alternate arms and legs as you repeat this motion.

*Where you’ll feel it: This is a stability exercise. You may feel it in your core, low back, glutes, and arms.

Modified Side Plank

Lie on your side with your knees bent, then prop yourself up onto your bottom elbow. Your elbow should be directly underneath your shoulder with the hand and forearm resting on the floor. Tip: Try to keep your shoulders, hips and knees in a straight line.

1. 1.  Pull your belly button in towards your spine. Keeping your core engaged, squeeze your glutes to lift your hips up off of the floor. Tip: For sustained holds, try to keep your bottom hip at the same elevated height throughout by squeezing your bottom glute.

1. 2.  Slowly lower your hips back down to the floor. 

*Where you’ll feel it: In your glutes of the bottom leg.

THIRD TRIMESTER (27-40+ weeks pregnant)

As you approach labor and delivery, prepare by addressing your flexibility with a series of pelvic and hip opening stretches and exercises.

Hip flexor stretch

Stand with your hands resting on a wall or the back of a chair for support.

1. 1.  Step one foot back, keeping your toes pointed slightly outward and your heel on the ground.
2. 2.  With your back tall and shoulders relaxed, bend your front knee towards the wall. Tip: It’s ok for the back knee to bend a little and for your heel to come up off the floor if needed.

1. 3.  Hold this position and breathe. 

*Where you’ll feel it: In the front hip of your back leg.

Piriformis stretch

Sit in a chair with your feet flat on the floor.

2. 1.  Lift one foot off the floor and rest it on top of your opposite knee.
3. 2.  Keeping your back straight, lean your trunk forward, hinging at the hip.
4. 3.  Apply gentle pressure downwards into your bent knee for a deeper stretch.
5. 4.  Hold this position before sitting upright and returning your foot to the floor.

*Where you’ll feel it: In the outer hip of your top leg.

Ball circles

Sit on a stability ball with both feet planted on the ground in a wide stance.

Tip: Perform this movement near a wall so you can hold onto it for support.

1. 1.  Move your hips to one side, as though trying to touch your shoulder with your hip, feeling your side crunch while the other side stretches.
2. 2.  Move your hips backward and relax your belly, feeling your back arch as your tailbone lifts off the ball.
3. 3.  Move your hips toward your other side, once again trying to touch your shoulder with your hip and feeling your side crunch as the other stretches.
4. 4.  Move your hips forward, feeling your back low back form a “C” shape, with your tailbone tucked beneath you. Tip: Try to keep your shoulders and mid back still and upright throughout the motion.

1. 5.  Practice these motions clockwise, then counterclockwise.

FOURTH TRIMESTER (<8 weeks postpartum)

While giving yourself time and space for healing and recovery, these exercises can be a gentle way to restore function following a vaginal or cesarean birth.

Kegel 

Sit in a chair with feet flat on the floor and hip distance apart.

1. 1.  Inhale deeply, allowing air to fill the bottom of your lungs. Feel your lower abdomen, your low back and your pelvic floor gently stretch outwards with your breatH. Tip: Squeeze as though trying to stop the flow of urine midstream or as though trying to lift a blueberry with your vulva.
2. 2.  As you exhale, contract your pelvic floor muscles in a kegel, feeling your pelvic floor lift up and in and your belly button move towards your spine.
3. 3.  Relax your pelvic floor fully during the next inhale. Tip: Once this feels easy, try to contract and relax your pelvic floor muscles while breathing normally.

Diaphragmatic breathing

Lie flat on your back in a comfortable position.

1. 1.  Place your hands beneath your ribs and on the sides of your belly.
2. 2.  Inhale, feeling your abdomen expand outward and into your hands, your pelvis and your back as your lungs fill with air. Tip: With each inhale, imagine your pelvic floor lengthening like the bottom of a balloon as it inflates with air.

1. 3.  Exhale, allowing your abdomen to gently recoil back towards your spine. Tip: Try to keep your chest still- place a hand on your chest to help you see how much movement is happening there throughout this exercise.

Wall angels

Stand with your back and heels against a wall.

1. 1.  Bring your elbows to your side and rest your forearms and the backs of your hands against the wall forming the letter “W.”
2. 2.  Try to keep your hands in contact with the wall as you slide your arms up towards your head, and then back to your sides. Tip: Keep your shoulders relaxed and away from your ears for the duration of the movement.

*Where you’ll feel it: This is a mobilizing movement focused on increasing the range of motion in your chest and shoulders.

REMEMBER: If you are pregnant and experience vaginal bleeding, abdominal pain, regular uterine contractions, amniotic fluid leakage, persistent excessive shortness of breath, dizziness, headache, severe chest pain, muscle weakness, calf pain or swelling, stop exercise and immediately reach out to your healthcare provider. If you are postpartum and experience increased vaginal bleeding, pain, incontinence, heaviness, or pelvic pressure, stop exercise and reach out to your healthcare provider.