Prenatal Care

Prenatal physiotherapy is the assessment and management of the musculoskeletal and pelvic floor changes that occur during pregnancy. As the uterus enlarges, mechanical load on the spine, pelvis, and pelvic floor increases, and the hormone relaxin increases the laxity of ligaments and connective tissue across the pelvic girdle. These adaptations support the demands of pregnancy and birth, but they also alter joint stability and muscle function, which can contribute to pain and reduced tolerance for daily activity.

Common presentations in pregnancy

Pelvic girdle pain is common in pregnancy and is typically reported at the front of the pelvis, over the sacroiliac joints, or across the low back. Low back pain also occurs frequently. Presentation varies — pain may be provoked by walking, stair climbing, standing on one leg, turning in bed, or getting in and out of a vehicle. These symptoms reflect changes in load distribution and joint mechanics rather than tissue damage, and they are generally responsive to physiotherapy.

The role of physiotherapy

Prenatal physiotherapy addresses these presentations through individualized, activity-specific management. For pelvic girdle and low back pain, treatment commonly includes manual therapy to reduce joint irritation, targeted exercise to improve the capacity of the muscles supporting the pelvis and trunk, and advice on positioning and movement strategies for provoking activities. The aim is to reduce pain and support continued function and activity through pregnancy. Care is adapted to the trimester, the reported symptoms, and individual tolerance.

Pelvic floor and birth preparation

The pelvic floor muscles are directly involved in vaginal birth, during which the fetus descends and rotates through the pelvis. Both the ability to contract and the ability to relax these muscles are relevant to labour. Pelvic floor muscle training during pregnancy is associated with a reduced risk and severity of urinary incontinence in the postpartum period. Prenatal physiotherapy includes assessment of pelvic floor function and instruction in both activation and controlled relaxation, so the muscles can be coordinated appropriately during pushing rather than working against the descent of the fetus.

• Breathing during pushing — exhaling steadily while bearing down, rather than sustained breath-holding, reduces strain on the pelvic floor.
• Labour positioning — upright, side-lying, and hands-and-knees positions are associated with less perineal trauma than supine positions.
• Perineal massage — a self-managed technique practised in the weeks before the due date.

Perineal massage

Perineal massage from approximately 35 weeks is associated with a reduced risk of perineal trauma and instrumental intervention, particularly in a first vaginal birth. The technique involves applying a sustained, mild stretch to the posterior tissue of the vaginal opening using clean hands and a suitable oil, performed for a short period several times per week. Because technique and timing affect whether the practice is comfortable and appropriate, a physiotherapist can review the method and confirm suitability during a prenatal visit.

Safety and coordination of care

For most pregnancies, pelvic health physiotherapy is a low-risk, non-invasive intervention. Whether it is appropriate in an individual case is determined during assessment, and any internal examination is undertaken only with explicit consent. Prenatal physiotherapy is intended to work alongside the care provided by your OB or midwife, not to replace it. Where a pregnancy involves factors that require a different approach, physiotherapy is coordinated with your existing maternity team.