Prep for push

The pushing stage of labour occurs after the cervix is fully dilated and the baby begins descending through the birth canal.

Your uterus is doing much of the work through contractions. Your breathing, abdominal pressure, pelvic position and pelvic floor can then contribute to the process.

Current maternity guidelines recognize that position and pushing approach should be individualized. NICE advises supporting comfortable birth positions and notes that spontaneous pushing may be beneficial for people without epidural analgesia, while recommendations differ when an epidural is present. ACOG recommends beginning pushing at complete cervical dilation, with management individualized to labour progress and clinical circumstances.

This is why prenatal physiotherapy should not teach:
“This is exactly how you must push.”
Your maternity team will guide the actual pushing stage based on what is happening during labour.

Instead, we help you understand your options.

Many people spend pregnancy learning how to tighten the pelvic floor.
But preparing for vaginal birth also requires learning the opposite skill.
Imagine making a fist with your hand.
You can squeeze strongly.

But if you cannot completely open your hand afterward, strength alone is not very useful.

The same principle applies to the pelvic floor.

During prenatal physiotherapy, we may help you recognize the sensation of contraction and then practise intentionally releasing and lengthening the muscles while breathing.

The goal is not to create an unusually “loose” pelvic floor.
It is to develop control in both directions.

There is no single birth position that is correct for everyone.

Depending on your comfort, epidural use, baby's position, fetal monitoring and other clinical circumstances, labour positions may include side-lying, kneeling, hands-and-knees, supported squatting or upright positions.

NICE recommends supporting the position a labouring person finds comfortable and notes benefits to mobility and upright positions for some people without epidural analgesia.

During physiotherapy, we can practise different positions before labour so that you understand how they feel in your hips, pelvis and pelvic floor.

But labour is dynamic.
You may love a position in the clinic and dislike it completely while giving birth.
That is okay.
Preparation is about creating options—not rules.

As the baby's head crowns during vaginal birth, the tissues around the vaginal opening and perineum need to stretch significantly.

Antenatal perineal massage is a technique used during the final weeks of pregnancy to gently familiarize these tissues with stretching.

RCOG recommends that people may choose to begin perineal massage from around 35 weeks of pregnancy.

A Cochrane review involving 2,497 women found that antenatal perineal massage reduced trauma requiring suturing and reduced episiotomy, particularly among people who had not previously had a vaginal birth. It did not eliminate the possibility of tearing or clearly reduce severe third- or fourth-degree tears.

This distinction matters.
Perineal massage is preparation.
It is not a guarantee.

When appropriate for your pregnancy, the technique generally involves comfortable positioning, clean hands and gentle pressure to the lower portion of the vaginal opening until a stretching sensation is felt.

The goal should be a gentle stretch—not sharp pain.

RCOG describes holding gentle stretching pressure and using a U-shaped massage through the lower vaginal tissues for a few minutes.

At Peloraa, we can teach the technique, discuss comfortable positions and help you coordinate the stretch with breathing and pelvic floor relaxation.

Some people perform it themselves.
Others choose to involve their partner.
Others decide not to do it at all.
All are valid choices.

If your maternity provider has advised you to avoid vaginal insertion or sexual activity, or if you have pregnancy complications, discuss perineal massage with your maternity provider before beginning.