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Guest Post: Dr. Katherine Uttech on Physical Therapy in Pregnancy

Updated: Mar 20

Doulas and Physical Therapists go together like PB&J. Looking for an easier labor? You want us both on your team. Our services compliment each other perfectly, which is why I'm so excited that Dr. Katherine Uttech, a physical therapist from New Journey Physical Therapy, who specializes in perinatal care is sharing tips. If you are experiencing pregnancy discomfort or are worried about pushing, this article is for you! Dr. Kate writes:


Physical therapy for pain in general is a common practice these days (injuries, surgeries, or pain of unknown presentation). Physical therapy for pregnancy related pain is becoming more common, and I love that. I love helping people in pain, and I love knowing that people are accessing the care that can help them feel better. Physical therapy is so much more than treating pain. We also treat non-painful dysfunctions of movement, and we can prevent pain! Late in pregnancy, my goal is to treat any pain that is present, but I am often more focused on wellness.


Here are my top 5 reasons to receive physical therapy in late pregnancy, even if you are feeling great!


Optimize pelvic and uterine alignment

Pelvic releases can be performed at any time, but uterine ligament releases are performed only after 37 weeks.

  • Improve baby’s position: These techniques help babies rotate, stretch and move. This makes it easier for babies to get into a better position, and having babies in a better position makes labor easier. Sometimes breech babies are able to move to a head down position after mobilizations. Typically, people feel better and looser. Doulas and medical providers agree that labors seem easier after these techniques are performed.

  • Better breathing capacity: By completing uterine ligament releases, we can increase your breathing capacity. Oxygen is needed by the human body, and reducing lung capacity makes physical exertion much harder. Many past clients have commented on how much more easily they can breathe after a session. This makes it easier to workout, finish preparing the home for the baby, lift and carry objects, walk, sleep, and do just about anything you can think of.

  • Less pain: Increased and/or asymmetrical movement of the pelvis is a frequent cause of pelvic and low back pain. Pelvic releases that balance the bony structures can be helpful in resolving this pain and allow for an easier passage through the birth canal.

Know your preferred labor and delivery positions

Based on your unique movements patterns, previous injuries, and any pain you have experienced in pregnancy you may have movement restrictions. Knowing what movement restrictions or preferences exist for YOU helps you to prepare for labor and to manage labor better. Without this knowledge, you may end up in a position where you aggravate a previous injury, cause a recurrence of pain, and make labor more painful and more difficult. Some people should avoid bending forward through their spine, some people should avoid lunges or squats, some people should keep their legs in symmetrical positions, and some do not have any restrictions. A set of customized recommendations is very helpful to be sure you have the easiest labor and delivery you can.


Learn and practice physiological pushing

We have all seen a ton of TV and movie births. For the most part, birth is presented as a scary and painful event, where the birthing person spends a lot of time in bed and alone, and then pushes the baby out while a nurse yells push and counts to 10. There are a lot of problems with this representation of birth. One big problem is that 10 count pushes, while holding your breath, and someone yelling at you is not the only way, and it is definitely not the best way. Instead, it is better for the birthing person and baby to utilize physiological pushing. Physiological pushing is the name we use for the pushing pattern used by people who feel and follow a fetal ejection reflex to push.


We know that people who birth vaginally without an epidural have a strong urge to push when the fetal ejection reflex kicks in. The fetal ejection reflex starts when the cervix and baby’s head have descended together deep in the pelvis and applied pressure to the pelvic floor. Then, and only then, will pushing by the birthing person be productive. When people birth without an epidural, we know they do not hold their breath and push for 10 seconds. Instead, they push for about 5-7 seconds, 2-3 times per contraction, with 2-3 full inhales and exhales in between pushes. We call this pushing pattern physiological pushing. Pushing this way is associated with lower risk of tearing, is gentler on baby and your body (giving you the endurance to keep going and reducing the likelihood that your baby goes into distress).


There are two big takeaways that I want to highlight:

  1. Do not push until the baby reaches the pelvic floor (the cervical station measures where the baby’s head is in relation to the pelvic floor, +2 station means baby has reached the pelvic floor and your body is ready to push).

  2. Use physiological pushing when the time comes

Using physiological pushing is easy if you do not get an epidural, but if you think you might get one (or you understand that birth is unpredictable) then practicing is a great idea. In the last few weeks of pregnancy, a perinatal physical therapist can test how well you connect to your pelvic floor in varying positions and teach you to use physiological pushing. I recommend practicing physiological pushing in a position where you relax your pelvic floor well every day from 35 weeks on. Then you will have some muscle memory for the process prior to labor.


Practice pelvic floor contractions

Did you know 80% of people do not do a pelvic floor contraction correctly without education by a skilled provider? Conscious activation and contraction of the pelvic floor is not how we typically use the pelvic floor, but it is really useful postpartum. Whether you have a vaginal delivery or cesarean delivery, your pelvic floor will benefit from physical therapy postpartum. The pregnancy itself causes most of the symptoms that we see. This is separate from performing pelvic floor contractions in the early postpartum period.


Throughout the body muscle contractions aide in circulating blood to all tissues. During healing, new blood is continually needed to push dead cells away from an area and bring in new cells for the next stage in healing. Pumping blood with active muscle contraction is a huge benefit for healing whether you had a cesarean with cut abdominal muscles and stretched pelvic floor muscles, or a vaginal birth with stretched abdominal muscles and stretched and/or torn pelvic floor muscles.


Best practice is to see a pelvic floor therapist during pregnancy, learn to correctly perform pelvic floor contractions, and then practice during the last few weeks of pregnancy. This allows you to form muscle memory so that postpartum you can be confident that you are performing contractions effectively.


Muscle releases to feel better

It is a well known fact that many people feel muscular discomfort near the end of pregnancy. This general discomfort does not severely limit someone’s function, otherwise we would call it pain. Feeling tight, sore, and achy does make it harder to get through the day and people usually feel fatigued by it. Generally, being sore and fatigued can both make labor more difficult and make the end of pregnancy harder.


Get scheduled with your local perinatal physical therapist today to feel your best and help you rock you labor!


Looking for a doula who understands and supports your PT journey? My services are listed here. You can find out more about Dr. Uttech on her website www.newjourneypt.com.

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