Pelvic floor exercises during pregnancy: what works, what's overrated, and what to actually do

Walk into any OB office and the pelvic floor advice during pregnancy is one sentence: "Do your kegels." Walk out, do them in the parking lot, repeat for 40 weeks, and apparently you're good.

Two problems with that. First, most people doing kegels do them wrong. Second, even done correctly, a kegel is one of many things the pelvic floor needs — and for some pregnant women, doing more kegels actively makes things worse.

What the pelvic floor actually is

Your pelvic floor is a hammock of muscles slung across the bottom of your pelvis. It supports your bladder, uterus, and rectum. During pregnancy, it's holding up an increasingly heavy load (baby + placenta + extra blood volume). During labor, it has to coordinate one of the most complex muscular events the body ever performs: letting the baby through.

The pelvic floor doesn't just need to be stronger. It needs to know how to engage when you need to, release when you need to, and coordinate with your breath, deep core, and glutes under load.

Why "more kegels" isn't the answer for everyone

There's a real population of pregnant women whose pelvic floor is already over-gripping — sometimes from anxiety, postural compensation, or holding tension you don't even feel. For them, doing more kegels reinforces a problem and can contribute to longer labors, painful intercourse, and pelvic floor dysfunction postpartum.

The honest pelvic floor question isn't "are you strong enough?" It's "can you coordinate?" Engaging on demand is one skill. Releasing on demand is a different skill — and the under-trained one for most pregnant women preparing for labor.

The four things to actually do

1. Diaphragmatic breathing (the foundation)

Lie down, knees bent, one hand on chest, one hand on belly. Inhale through your nose — your belly should rise, side ribs should expand, even your lower back should subtly press into the floor. On the exhale, gently engage the deep core (transverse abdominis) without forcing your belly button down.

• ✓What it trains: The breath-pelvic-floor connection. As you inhale and the diaphragm descends, your pelvic floor lengthens and releases. As you exhale, it gently lifts.
• ✓Reps/sets: 5 minutes a day. That's it. Standing version once you've mastered lying down.
• ✓Why it matters for labor: Pushing is largely about releasing the pelvic floor, not gripping it. Diaphragmatic breathing trains exactly that release.

2. The down-train (release on demand)

Lie on your back, knees bent. Inhale deeply, focus on letting the pelvic floor fall away — like dropping a hammock. Imagine a flower opening, or releasing a fist you didn't know was clenched. Hold the release for the full inhale, then let the pelvic floor passively return on the exhale.

• ✓What it trains: Coordinated relaxation — the skill that matters most for the pushing stage.
• ✓Reps/sets: 10 slow breaths, twice a day. Especially good in the last 6-8 weeks of pregnancy.
• ✓Common pitfall: Most women have never deliberately released the pelvic floor. It feels weird at first. That's the point.

3. Coordinated kegels (still useful — when done right)

On an exhale, gently lift the pelvic floor (think of stopping the flow of urine, but lighter). Hold for 3-5 seconds. Inhale and fully release. The exhale-engage / inhale-release pattern matters more than the count.

• ✓What it trains: Quick engagement for moments you need it (sneezing, jumping, lifting).
• ✓Reps/sets: 10 reps, 2-3x/day. Skip if you tend to hold tension — focus on release work first.
• ✓Common pitfall: Holding your breath, clenching glutes/inner thighs, or never fully releasing between reps. All of those defeat the purpose.

4. Deep squat holds + hip mobility

Bodyweight deep squat (feet shoulder-width, toes slightly out, drop into a deep squat, elbows pressing knees out gently). Hold for 30-60 seconds at a time, breathing deeply. Add hip rocks, side-to-side weight shifts, ankle circles.

• ✓What it trains: The exact position your body needs for labor. Opens the pelvic outlet, builds hip mobility, lengthens the pelvic floor under gentle load.
• ✓Reps/sets: 2-3 minutes total per day, accumulated. Great while brushing teeth or watching TV.
• ✓Common pitfall: Going too deep too fast in the third trimester. Use a support (wall, doorway, partner) if you need it.

When to skip the trainer and see a pelvic floor PT

• ✓Pelvic or perineum pain during pregnancy
• ✓Heaviness or pressure that doesn't resolve with rest
• ✓Pain with intercourse
• ✓Any sense of bulging or prolapse
• ✓Previous pelvic floor injury (high-grade tear, prolapse, fistula)

How this fits into a full prenatal program

Pelvic floor work is built into every prenatal session I run — it's not a separate "chore" on the side. We coordinate it with strength, mobility, and breath work. See prenatal training, or send me a DM with questions about where you are.