“Is there anything I can actually do to make labor go more smoothly?” The honest answer is that birth is unpredictable, and no amount of preparation guarantees a specific outcome, but there is real, physical-therapy-backed groundwork you can lay in the weeks leading up to labor that can help your body work with the process instead of against it.
Why Movement and Positioning Matter
Labor is, at its core, a biomechanical event. Your baby needs to navigate through your pelvis, and your pelvis isn’t a fixed, symmetrical opening. It shifts and opens more in some positions than others. Staying mobile and using strategic positions during labor can help create more room, encourage favorable fetal positioning, and take pressure off your lower back.
Being flat on your back for labor is a relatively modern default, largely a product of hospital convenience and monitoring. Not necessarily what’s most functional for your anatomy.
Positions Worth Practicing Ahead of Time
You don’t want the first time you try these to be during active labor. Practicing beforehand builds strength, familiarity, and confidence.
- Hands and knees (all-fours): Takes pressure off the lower back, encourages the baby to move downward, and is easy to shift into during contractions.
- Deep squat: Opens the pelvic outlet more than almost any other position. Practicing a supported squat (holding a stable surface, or using a birth ball or squat bar) builds the leg and hip strength you’ll need in the moment.
- Side-lying with a peanut ball: Great for rest periods between active pushing, especially useful with an epidural
- Standing and swaying, or leaning over a support: Uses gravity to your advantage and allows the pelvis to move freely.
Practicing transitions between these positions matters too. Labor isn’t static, and being able to move fluidly from one position to another (rather than feeling stuck) is important.
Breathing: Technique and Regulation
A lot of patients come in having heard about specific breathing “methods” and feel pressure to master one.
A few practices worth working on now:
- Slow diaphragmatic breathing: long inhale through the nose, longer exhale through the mouth. This activates your parasympathetic nervous system and can help interrupt the fear-tension-pain cycle
- Low, open-mouth vocalization on the exhale: sounds unusual to practice ahead of time, but a relaxed jaw is linked to a more relaxed pelvic floor. Clenching your jaw during contractions often mirrors clenching in the pelvis.
- Exhale-focused pushing (when the time comes) rather than prolonged breath-holding: increasingly supported as a gentler approach
Pelvic Floor Prep: It’s Not Just Kegels
This is where I probably differ most from generic prenatal advice. Kegels are not the primary goal in late pregnancy, pelvic floor relaxation and lengthening is.
A pelvic floor that’s overly tight or unable to release is not more protective, it can actually make it harder for the baby to descend. In the weeks leading up to labor, I focus patients on:
- Perineal massage, typically starting around 34-35 weeks
- Deep squatting and hip-opening stretches to build tissue mobility
- Learning to actively bear down and release the pelvic floor on cue, rather than only learning to contract it
If you’re not sure whether your pelvic floor is coordinated well for this, meaning it can both engage and fully let go on command, that’s exactly the kind of thing a pelvic floor PT evaluation can assess.
None of this needs to be overwhelming. In sessions, we typically build a simple, personalized “labor toolkit”: two or three positions you feel strong and confident in, a breathing rhythm that calms you rather than one more thing to think about, and pelvic floor work that prepares your body to open rather than clench.
Birth is unpredictable, and that’s okay. But walking in with a body that’s practiced these positions, breathing patterns, and pelvic floor skills gives you tools to reach for, and that preparation itself can make a real difference in how supported and capable you feel.
If you’re in your third trimester and want a personalized birth prep session, we’d love to help you build your own toolkit before your due date.
Dr. Rachel Atufunwa PT, DPT