For decades, when we thought about the pelvic floor, we thought about Kegels. But the medical community has come to understand that when it comes to pelvic floor exercises—and pregnancy pelvic floor exercises in particular—relaxation is just as essential as contraction.

“The pelvic floor has to get the heck out of the way to get the baby out,” says physical therapist Carrie Pagliano, DPT, who specializes in pelvic health.

Unless we’ve previously dealt with incontinence or pelvic pain, most of us ignore our pelvic floor muscles until we get pregnant. So we might not be quite sure of the difference between contracting and bulging, or how to get these muscles to relax. Pregnancy pelvic floor exercises can help you understand how to engage the area correctly when the big day arrives.

How pregnancy pelvic floor exercises can help

Although pregnancy hormones like relaxin will help loosen up the pelvic joints and increase soft tissue flexibility, if your pelvic floor muscles are too short, tight, or overactive, they will cause more pain during a vaginal delivery.

“Prepping those muscles to down train, or relax or let go, is really an essential part of any birth prep program,” says pelvic floor physical therapist Heather Jeffcoat, DPT, founder of Fusion Wellness PT in Los Angeles. “[That’s] because it’s hard to push something out through a lot of tension.”

How do you know if you need to work on pelvic floor flexibility? “If you have any sort of pre-pregnancy history of pain with sex, pelvic pain, constipation, leakage,” says Dr. Pagliano. Even very active athletes can sometimes have trouble relaxing their pelvic floor, she adds. Dr. Jeffcoat says her office often helps patients manually stretch the muscles by teaching them how to use a medical dilator intravaginally. There are also some pregnancy pelvic floor exercises you can do at home to help open up the area.

Just keep in mind that no amount of exercises—or any other birth prep—can 100 percent prevent a C-section. “You can have the best pelvic floor in the world. You can have all the prep right,” says Dr. Pagliano. But if something medical happens, your birth team will need to get the baby out in whatever is the safest way possible.

7 pregnancy pelvic floor exercises

Working on the pelvic floor isn’t only about the pelvic floor itself—it also includes opening up the muscles and joints nearby.

“There’s a functional relationship¹ between the pelvic floor and the glutes, so doing glute strengthening can help with pelvic floor strengthening,” says Dr. Jeffcoat. Dr. Pagliano adds that we also have deep hip rotator muscles adjacent to the pelvic floor muscles, and they need to be able to move through bigger ranges of motion to open up the pelvis and get into the positions required for giving birth.

Exercises that pelvic floor therapists recommend include a mix of moves targeting the pelvic floor muscles specifically, and some that work the hips and pelvis in general.

During any of these exercises, nothing should be painful—if it is, stop immediately and check with your provider to make sure that you’re doing them correctly, and that they’re safe for you.

1. Contract, relax, bulge

This pelvic floor exercise will help you develop the coordination you need for the active pushing phase of labor. If you’re not sure whether you’re doing it correctly, you can set up a mirror underneath you to see if your holes are opening and closing on command, says Dr. Jeffcoat Once you get the hang of it, practice this in any positions that you plan to use during delivery, whether that’s squatting or lying on your side.

1. 1.
   Start with a pelvic floor muscle contraction, as though you’re doing a Kegel. “Can you isolate that muscle group? What does it feel like to close the openings of the anus and vagina, and coordinate that lift? Do you feel that tension?” asks Dr. Jeffcoat.
2. 2.
   Let it go and relax, feeling the heaviness and softening.
3. 3.
   Finally, try to bulge, or bear down on your pelvic floor muscles as you aim to spread your sit bones. “Can you create more space in those openings in that front hole and back hole? Can you feel a downward pressure? That’s going to be the position that you need to be able to access during childbirth to help ease that baby coming down the canal,” says Dr. Jeffcoat.

2. Lower belly breathing

The pelvic floor is a “helper breathing” muscle, says Dr. Pagliano. “When you take a breath in, your lungs fill with air and the diaphragm elongates to make room. If there’s a little pressure that pushes downward, the pelvic floor accepts that pressure and elongates just a couple millimeters. And then when you exhale, the pelvic floor rises.” That means deep inhales can be helpful when you’re trying to get the pelvic floor to elongate and relax.

1. 1.
   In a comfortable position, take a moment to notice where you typically breathe. “Are you an upper chest breather, diaphragm breather, lower belly breather?” asks Dr. Pagliano. “Obviously, that’s going to get harder as you have a baby stuffed up in your diaphragm.”
2. 2.
   Focus on dropping more of your breath down into your lower belly. If you’re not sure if it’s working, you can put a hand on your perineum to feel the motion.
3. 3.
   Think about relaxing your pelvic floor on the inhale, and activating it on the exhale.

3. Open glottis breathing

The glottis is the part of your throat that includes your vocal cords, and during labor, you want to keep it open enough to make a sound like a hum or vocal exhale—not the stereotypical pushing where you close it off, stop breathing, and turn purple.

1. 1.
   Take a deep inhale.
2. 2.
   Exhale slowly, blowing through pursed lips and thinking about keeping the area around your vocal cords open. Try to see if you can feel your pelvic floor activate as you breathe out.

4. Spinal mobility on a birthing ball

These moves work on accessing different planes of motion in the lumbar spine, says Dr. Jeffcoat.

1. 1.
   Sit on a large stability ball with your feet planted out wide to either side, and place your hands on your hips.
2. 2.
   Do a few pelvic circles counterclockwise “like you’re belly dancing,” says Dr. Jeffcoat.
3. 3.
   Go in the opposite direction for a few clockwise circles.
4. 4.
   Then, try pelvic tilts: Keeping your spine tall, tuck and release your pelvis.

5. Modified child’s pose

Child’s pose is a great move to open up the hips, glutes, and lower back, and also serve as a self-assessment to check whether you’re tighter on one side, says Dr. Jeffcoat.

1. 1.
   Starting on hands and knees, spread your legs out wide to make enough space for your belly, and draw your feet together.
2. 2.
   Sit your hips back toward your heels while your arms stretch forward.
3. 3.
   Walk your hands to the left to open up the right side of your body. Hold for a few breaths.
4. 4.
   Walk your hands to the right to open up the left side of your body. Hold for a few breaths.

6. Happy baby

Happy baby is a great pelvic floor stretch for the hip muscles (and feel great on a cranky lower back).

1. 1.
   Lying on your back, bend your knees at 90 degrees and bring them knees up to either side of your chest.
2. 2.
   Grab the outside of each foot with each hand, and gently pull down toward the ground, keeping your knees at 90 degrees and your back flat on the floor.
3. 3.
   Hold for one to three minutes.

7. Butterfly stretch

If your hips are tight, butterfly stretch will help increase the flexibility of your inner thighs, glutes, and lower back, says Dr. Jeffcoat.

1. 1.
   Sit on the floor with the bottoms of your feet touching together and your knees bent and splayed out wide on either side.
2. 2.
   Gently lean forward until you feel a stretch.
3. 3.
   Hold for about 30 seconds.

When to do pregnancy pelvic floor exercises

Dr. Jeffcoat suggests starting to do these exercises by your 32nd week of pregnancy. That hopefully gives you at least a month to work on opening up the muscles, even if you end up delivering a little early.

How often you do them just depends on what you have time for (without getting stressed out about it). If you can fit them in once or twice a week, that’s great. If you can do them once or twice a day, even better. Just remember that something’s better than nothing.

Doing prenatal yoga or Pilates? Some of these exercises will likely be integrated into the class.

The benefits of pregnancy pelvic floor exercises after birth

Working on your pelvic floor during pregnancy can be helpful beyond the delivery room, too. After having a baby, your pelvic floor might feel a bit foreign, says Dr. Jeffcoat. “Your center has changed, and so how your muscles activate is going to feel different.”

Developing the awareness of your pelvic floor muscles and learning how to coordinate them before birth will assist your healing process after labor because you’re more in touch with what your pelvic floor normally feels like.