Strong Isn't the Goal: Rethinking Pelvic Floor Prep for Birth
- Lorie Michaels, CD(DONA), PMH-C, CLC, EBB Inst.
- Jul 5
- 7 min read
A primer for birth workers and the clients you support
If you're new to birth work, you've probably already spent time thinking about the perineum, that word that comes up in every birth story, every tearing conversation, every discussion about what recovery looks like. Even if you haven't attended a birth yet, you likely know it matters. But how often do you think about the pelvic floor itself, not just the perineum, but the whole living system underneath, and what it's been doing for the nine months before labor even begins?
That's what this post is about.
On Saturday, July 11, Lauren Ohayon, founder of Restore Your Core®, and one of the most respected voices in functional movement and pelvic floor health, is joining our Full Spectrum Doula Training cohort for an hour-long conversation on proactive prenatal pelvic floor preparation. Before she does, I want to give you enough foundation to show up ready to go deeper.
What the Pelvic Floor Actually Is
The pelvic floor is commonly described as a hammock of muscles at the base of the pelvis, and that image does some useful work. It helps people locate the structure and understand that it provides support. But it stops short of capturing what this system actually does.
The pelvic floor is not a passive sling. It is dynamic tissue that moves, responds, and adapts. It has connections throughout the body: to the diaphragm above it, to the abdominal wall, the spine, the sacrum, and the hips. It responds to how you breathe, how you stand, how you move, and how your nervous system is doing on any given day. It participates in the pressure changes created by every cough, every lift, every contraction.
Think of it less as a floor and more as an active participant in almost everything your body does.
That reframe matters enormously for how we approach birth preparation, because it means we are not training a single muscle. We are supporting a whole interconnected system to be ready for one of the most demanding physical events of a person's life.
Pressure: An Underappreciated Part of the Picture
One of the less commonly discussed aspects of pelvic floor birth preparation is pressure management, and it's worth understanding before Sunday.
Every movement, every breath, every physical effort creates forces that travel through the body. The pelvic floor is part of how the body absorbs and responds to those forces. In a non-pregnant body this is already a continuous, demanding job. In pregnancy it becomes significantly more so.
The growing uterus raises the baseline pressure inside the abdominal cavity before your client has done anything at all. Every cough, sneeze, or exertion adds to that. The pelvic floor is managing more load, more often, for longer than it ever has before.
During birth, what the pelvic floor is asked to do shifts in the opposite direction. Instead of absorbing and containing force, it needs to release and yield. A system that has spent months bracing and holding may not switch easily into opening.
This is why preparation during pregnancy matters so much, and why it looks different than simply building strength. A pelvic floor that can adapt, respond, and let go when asked is better prepared for birth than one that is simply strong.
The Tightness That Deserves More Attention
The conversation around pelvic floor health in pregnancy has leaned heavily toward strengthening, and that's understandable. It's what most guidance has offered. Kegels for a strong pelvic floor for birth.
But many pregnant people arrive at labor not with a weak pelvic floor, but with a tight one.
Hypertonicity, or chronically elevated pelvic floor tone, is far more common in pregnancy than the mainstream conversation reflects. Stress, anxiety about labor, trauma history, the bracing patterns that develop in response to a changing body, and yes, too many Kegels on a floor that was already holding, all contribute. A floor that cannot fully release does not open easily in labor. It resists rather than yields. And that resistance can have real consequences: longer pushing phases, more significant tearing, and a harder recovery. This isn't a reason to worry about past preparation. It's a reason to add something to it going forward.
The most important pelvic floor skill for birth may not be contraction. It may be the ability to fully, consciously let go.
Breath is one of the most powerful pathways to that release. A slow, exhale-extended breath, taking a full inhale and then letting the exhale be long and complete, allows the pelvic floor to lengthen and soften. It is also a nervous system regulation tool, shifting the body toward the parasympathetic state that makes yielding possible. This is something your clients can practice every single day of their pregnancy, and it costs nothing.
What the Research Says About Tearing
Between 31% and 93% of people giving birth vaginally experience some degree of tearing or laceration, with the wide range reflecting differences in provider, setting, and how tears are documented and reported. A 2024 review in the American Journal of Obstetrics and Gynecology found that approximately nine in ten people are affected by some form of perineal trauma after vaginal birth, with second-degree tears occurring in roughly 40% of first-time births.
The consequences extend well beyond the immediate postpartum period. Research shows that 55% of people with tears reported moderate to severe pain at hospital discharge. Painful sex affects around 60% of people at three months postpartum. Fecal incontinence affects 17% of all birthing people. Post-partum depression and stress markers are significantly higher in those experiencing second-degree or greater tears.
Several factors influence tearing outcomes, and while some of them sit firmly in provider or clinical scope, birth workers play a meaningful role in others.
Episiotomy avoidance. The research tells a consistent story here. A landmark randomized controlled trial found that routine episiotomy not only failed to prevent severe tears. It caused the opposite. Spontaneous tears were less painful and had better outcomes than episiotomies. Birth workers can help clients understand this evidence, include episiotomy avoidance in their birth preferences, and hold space for an unhurried second stage.
Warm compresses during pushing. Research shows that warm, moist compresses applied to the perineum during second stage can reduce third and fourth-degree tears by half, and are also associated with less pain during birth and postpartum. Applying compresses is in the hands of the provider or midwife, not the doula. But birth workers can absolutely make sure their clients know this option exists, talk about it prenatally, and include it in their birth preferences so the care team knows it matters.
Birth position. The flat-on-the-back lithotomy position is associated with higher rates of tearing. Upright positions, side-lying, and hands-and-knees give the perineum more room and reduce compressive forces. Helping clients explore and advocate for their preferred birthing position is one of the most evidence-supported things a doula can do.
Provider practices and pace. Research on midwives with consistently high intact perineum rates points to a consistent theme: calm, unhurried birth. Slow, controlled crowning.
Patience. One of the most valuable things a doula can do in the pushing phase is hold that energy: supporting the client to breathe rather than push-push-push, creating space for the baby to emerge slowly, and advocating for the room to take its time.
What This Means for Your Practice
You don't need to be a movement specialist to bring pelvic floor awareness into your prenatal doula work. You need to be curious, informed, and willing to bring these conversations into your prenatal visits.
Talk about the pelvic floor as something your clients can get to know. Encourage curiosity about it, not just effort. A pelvic floor that a person can feel, release, and breathe into is better prepared for birth than one that has simply been squeezed on command. Encourage them to notice it. To feel it respond to a deep inhale and a slow exhale. To sense what it feels like to release it, not just contract it.
Recommend a pelvic PT visit before 36 weeks. This is one of the highest-value referrals in your toolkit. A pelvic floor physical therapist can assess tone, identify hypertonicity, and give your client targeted preparation specific to their body. If they can only make one extra prenatal appointment in the third trimester, this is the one.
Teach the release breath. Inhale slowly, let the breath fill the body. Then exhale: long, slow, complete. This is a pelvic floor practice. It is a nervous system practice. It is something your client can do at 34 weeks while sitting in traffic, and it will matter on the day they give birth.
Advocate at the birth. For upright positions. For unhurried crowning. For birth preferences that include the evidence on episiotomy and warm compresses so the care team knows what your client wants.
For the Learners in the Room
If you want to go deeper before Sunday, here are some resources worth your time.
Evidence Based Birth has a five-episode podcast series called "Protecting the Perineum" , episodes 206, 210, 216, 218, and 221, which covers the research in detail and is free to access. Episode 206 is the best place to start. It lays the groundwork for everything else in the series.
For a visual understanding of pelvic floor anatomy, these YouTube resources are worth bookmarking. The Catalyst University videos are the most comprehensive and use Kenhub visuals that make the anatomy genuinely accessible:
Anatomy of the Perineum , Geeky Medics :
Pelvic Floor Part 1: The Pelvic Diaphragm , AnatomyZone :
Muscles of the Pelvic Floor Part 1 , Catalyst University (recommended) :
Muscles of the Pelvic Floor Part 2 , Catalyst University (recommended) :
Muscles of the Pelvic Floor Quick Anatomy , Kenhub :
Muscles of the Pelvic Walls Quick Anatomy , Kenhub :
For more than 25 years, Lauren Ohayon has been teaching people how their core and pelvic floor actually work – through pregnancy, birth, postpartum and beyond. Her method, Restore Your Core®, looks at the pelvic floor as part of a whole system: breath, ribs, pressure, gait, the nervous system, neural pathways and habitual movement patterns.
That same approach to the core and pelvic floor is what she brought to teaching in-person prenatal childbirth education classes in New York, to guiding thousands of women to prepare and heal their bodies throughout their pregnancy, birth and recovery journeys, to co-founding One Strong Mama (now Body Ready Method®), and sits at the foundation of how her work prepares the body for birth. In the years since, Lauren has refined her own approach further into the RYC® prenatal pelvic floor tools and the proactive pelvic floor prep these tools come from. Today she trains doulas in her professional training and as a guest teacher for doula training, midwives, physiotherapists, and movement professionals around the world to replace hopelessness with body literacy and agency.
Lauren has been working and training her pros through a bio-psycho-social lens for decades with incredible results.
Her trainings are known for going deep into the why. Practitioners learn to feel the work in their own bodies first, and then guide their clients there. RYC® Professionals describe it as the missing piece from their original trainings.She is bringing her expertise directly to our community this Saturday. Come ready to learn.
