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  • Jenni Davies

Pre-Natal Physio - Part 1: Pelvic Floor Muscle Training

We now have excellent evidence that all women should be doing pelvic floor muscle training during pregnancy (see references below) to decrease the risk of severe perineal tears and shorten the second stage of labour, thus improving birth outcomes with less post-natal pelvic floor dysfunction.

The evidence is irrefutable now but what programme do you need to be doing?

This is the golden question as no two pelvic floors are the same. They vary as much as our faces vary. Some are long and weak, some are short and tight and there's every variation in between. So, whilst kegels are a generic place to start, they aren't necessarily appropriate for you, and since pelvic floor exercises are really not very exciting to do, why waste your time doing something that may not be appropriate, and may, if your pelvic floor muscles are already tight, make it even harder to give birth?

The best solution to this conundrum is to have an assessment with a Pelvic Health Physio early in your second trimester, to ascertain what you personally need from a programme. We can then tailor your exercises to your specific needs and keep the time spent doing the exercises to a minimum with maximum benefit.

There are 3 more parts to this series to follow on with other aspects of Pre-Natal Physio, so stay tuned to learn more!

As ever, if you have any questions, please get in touch, we're always happy to help.


1. Meyer R, Rottenstreich A, Zamir M, Ilan H, Ram E, Alcalay M, Levin G. Sonographic fetal head circumference

and the risk of obstetric anal sphincter injury following vaginal delivery. Int Urogynecol J. 2020

Nov;31(11):2285-2290. doi: 10.1007/s00192-020-04296-3.

2. Stairs J, Brown MM, Smith A, Woolcott C. Association between second stage of labour length and risk of

obstetrical anal sphincter injury in nulliparous women: a population-based retrospective cohort study. Int

Urogynecol J. 2022 Jun;33(6):1583-1590. doi: 10.1007/s00192-021-05070-9.

3. Levin G, Friedman T, Shai D, Alcalay M, Ram E, Meyer R. The association between vacuum-assisted vaginal

delivery and anal sphincter injury. Int Urogynecol J. 2021 Jul;32(7):1771-1777. doi: 10.1007/s00192-020-


4. Pardo E, Rotem R, Glinter H, Erenberg M, Yahav L, Yohay Z, Yohay D, Weintraub AY. Recovery from pelvic

floor dysfuncÄon symptoms in the postpartum is associated with the duration of the second stage of labor.

Arch Gynecol Obstet. 2019 Jul;300(1):127-133. doi: 10.1007/s00404-019-05173-1.

5. Friedman T, Eslick GD, Dietz HP. Delivery mode and the risk of levator muscle avulsion: a meta-analysis. Int

Urogynecol J. 2019 Jun;30(6):901-907. doi:10.1007/s00192-018-3827-8.

6. Model A, Shek K, Dietz HP. Levator defects are associated with prolapse after pelvic floor surgery. European

Journal of Obstetrics & Gynaecology and Reproductive Biology. 2010; 153(2): 220-223.

7. Volloyhaug I, Morkved S, Salveson K, Salveson A. Forceps delivery is associated with increased risk of pelvic

organ prolapse and muscle trauma: a cross-sectional study 16–24 years after first delivery. Ultrasound in

Obstetricx & Gynecology. 2015 April; 46(4):487-495

8. Sobhgol SS, Smith CA, Dahlen HG. The effect of antenatal pelvic floor muscle exercises on labour and birth

outcomes: a systematic review and metaanalysis.Int Urogynecol J. 2020 Nov;31(11):2189-2203. doi:


9. Lanzarone V, Dietz HP. Three-dimensional ultrasound imaging of the levator hiatus in late pregnancy and

associations with delivery outcomes.Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):176-80. doi: 10.1111/j.1479-


10. Siafarikas F, St.r-Jensen J, Hilde G, B. K, Ellstr.m Engh M. Levator hiatus dimensions in late pregnancy and

the process of labor: a 3- and 4-dimensional transperineal ultrasound study. Am J Obstet Gynecol. 2014

May;210(5):484.e1-7. doi: 10.1016/j.ajog.2014.02.021

11. Chan, Cheung, Yiu, Lee, Chung (2016). Antenatal pelvic floor biometry is related to levator ani muscle injury.

Ultrasound Obstet Gynaecol (2016); 49: 520 – 525

12. Youssef A, Montaguti E, Dodaro MG, Kamel R, Rizzo N, Pilu G. Levator ani muscle coactivation at term is

associated with longer second stage of labor in nulliparous women. Ultrasound in Obstetrics & Gynecology.

2019 May;53(5):686-92.


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