Birth Preferences

Dr. Rebecca, PT, DPT • September 10, 2025

Birth Preparation Holly Springs, NC

birth preparation pelvic floor physical therapy Holly Springs, NC


If you are expecting, then you have probably heard about making a birth plan. Although I don’t love the word “plan” when thinking about labor and delivery, I do think there is great value in taking time to understand the possible interventions during childbirth and early newborn care so that you can develop a list of “birth preferences.” 


I encourage patients to make a Vaginal Birth Preferences list as well as an Unplanned C-Section Preferences list. As we prepare at the end of pregnancy for what we hope will happen during the birth of our baby, we have to realize that childbirth is an unpredictable experience that can very quickly move outside of our control. Whether it is your first birth or sixth, each pregnancy, labor, delivery, and postpartum experience is unique. Creating a hierarchy of interventions that you prefer is often a helpful way to adapt to the unexpected situations that may arise. For example, imagine that you are a first-time mom and your goal is to have an unmedicated vaginal delivery. You end up having a very long first phase of labor, are getting very fatigued, and are starting to feel overwhelmed by the pain and lack of dilation progress despite staying moving, changing positions, and using the labor tub. In this situation, you may need to discuss with your medical team what interventions may assist with pain management to allow you to rest so that you have energy to push and achieve your overall goal of a vaginal delivery. 


To clarify, I don’t believe that there are births that are superior to others. Whether it is vaginal or abdominal, medicated or unmedicated, no one birth is better or more legitimate than another. The hierarchy that I am referring to is reserved exclusively for your preferences and priorities. There are so many options available to you that can be started low and slow, reduced, or completely stopped if they are not working well for you or your baby. If you are unsure about certain interventions and early newborn care decisions, Evidence-Based Birth is a phenomenal free resource for you and your partner to educate yourselves in advance: https://evidencebasedbirth.com/signature-article-directory/ (they also have a podcast if you prefer listening vs reading). 


In pelvic floor physical therapy birth prep sessions, we provide education on the first and second stages of labor by helping you understand the physiologic process of birth, your pelvic floor anatomy, stretches and positions to help with labor progress, and how to effectively push to reduce your risk of severe perineal tearing. Our goal is that you go into birth with the tools you need to make empowered decisions to improve your outcome. Let us know if you would like a free consultation on what our birth prep package includes!


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By Dr. Molly Pierson, PT, DPT • September 3, 2025
Typically, once people get into their 3rd trimester of pregnancy, they focus on winding down, resting, and focusing more on stretching. While stretching is helpful, there is more you can do in your 3rd trimester to better prepare for labor, delivery, and recovery after childbirth. Birth prep physical therapy during the third trimester (weeks 28–40) focuses on helping the body prepare for labor and delivery, relieve discomfort, and support postpartum recovery. Here's what it typically includes: Optimize Pelvic Alignment & Mobility Encourages smoother fetal positioning and reduces chances restrictions from your pelvis and surrounding structures. This can include incorporating different positions to help open up different areas of the pelvis, which allow for a smooth transition as the baby moves through the pelvis. Reduce Pain & Discomfort Targets low back pain, pelvic girdle pain, sciatica, and round ligament pain as the baby continues to grow. Diaphragmatic breathing to help manage labor pain and regulate intra-abdominal pressure Prepare Muscles & Tissues for Labor Pelvic floor coordination and perineal mobility can ease labor and reduce tearing risk. Learning to engage abdominal muscles to assist with pushing. Gentle core exercises for transverse abdominis support. Empowerment Through Education Helps you understand pushing mechanics, breathing techniques, and labor positions. This can include: Pelvic Floor Work Focus is on coordination between diaphragm, pelvic floor muscles, and abdominal Learning how to relax the pelvic floor (just as important as contracting it). Gentle perineal massage techniques (usually after 34 weeks). Postural Adjustments & Alignment Body mechanics for daily life (getting out of bed, lifting other children, etc.). Pelvic tilts, cat-cow, and modified squats to maintain mobility. Laboring positions and strategies for fetal positioning Practice labor positions using birth balls, stools, or partner-assisted techniques. Learn strategies for optimal fetal positioning (like Spinning Babies techniques). Manual Therapy Myofascial release, sacral mobilization, and soft tissue work to relieve tension. Addressing hip or SI joint pain. Ultimately, birth prep is tailored to the needs of the mother and her goals when it comes to her birthing experience. The items listed above are just a snapshot of techniques that can be incorporated into sessions to help one become more educated and aware of what the birth experience may encompass, as well as address aches and pains along the way.

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Hypermobility = More Responsibility

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There are three primary categories to classify joint mobility: normal mobility, hypermobile, or hypomobile. Hypermobile joints are classified as those that exceed the normative range of motion values. While being extra flexible sounds advantageous, it also requires increased strength and coordination through a larger than usual range of motion. When considering the stability of a joint, there are passive structures such as the shape of the bones, ligaments, joint capsules, labrum and bursa which help the joint maintain its alignment without muscular activation. Dynamic stability of a joint comes from the nervous system working together with our muscles to create smooth and efficient movements. With hypermobile joints, we can work to protect them by improving their dynamic stability through their large range of motion to help reduce risk of injury. Joint hypermobility is also a common presentation in patients with genetic connective tissue disorders such as Ehlers-Danlos Syndromes. Some patients with EDS may experience frequent subluxations, sprains and dislocations due to the instability of their joints. Because of the compromise to their passive stabilizers, sometimes patients with EDS will present with complaints of muscular tightness that truly are stemming from decreased muscular flexibility, as the muscles have been essentially working double time to create stability. A common complaint I often hear from patients is “feeling tight.” But when we check their active and passive range of motion and muscular flexibility, their mobility is above average. Instead, their symptoms of tightness are often caused by muscular weakness, poor endurance, or suboptimal coordination. One treatment strategy I like to try is dry needling with electrical stimulation for pain modulation and improved activation of the targeted muscle’s motor unit, followed by neuromuscular stabilization and strengthening activities to provide long term benefits. Although joint manipulations and stretching feel good at the moment, these treatments are essentially reinforcing excessive mobility in already hyper flexible joints. As Uncle Ben warned Peter Parker (aka Spider Man), “With great power comes great responsibility.” If you have the superpower of being extra bendy, then take into consideration the increased demand on your neuromuscular system to keep your joints stable, and train accordingly! Dr. Rebecca Acevedo, PT, DPT - Holly Springs, NC Physical Therapy