If you’ve been told to “just do Kegels” during pregnancy, you’re not alone. It’s one of the most common pieces of pelvic floor advice out there.
The problem? The way most people are taught to do them may actually work against you, especially when it comes to preparing for the unique demands of pregnancy and childbirth. There’s a better way to train your pelvic floor for everything pregnancy and delivery demand of it.
In this article, you’ll learn how to train your pelvic floor muscles to support the added weight placed on them during pregnancy, and to guide your baby out during birth.
Read on to learn:
- What your pelvic floor muscles are and what they do
- How to perform effective pelvic floor exercises during pregnancy, step by step
- Why we don’t recommend Kegels (as they’re traditionally described)
Quick Answer: The pelvic floor muscles span the entire base of your core, with attachment points in the front, back, and sides of your pelvis, and training them effectively during pregnancy means working all four points through a full range of motion. During pregnancy, these muscles need to develop both strength and length: strength to support the added demands of a growing belly, and length to help guide your baby out during delivery. Pelvic Floor Activations (PFAs) train both qualities by incorporating a full contraction and a complete release — the lengthening phase that the traditional Kegel cue leaves out.
What Are Your Pelvic Floor Muscles and What Do They Do?
Many people think of their pelvic floor muscles as just those “pee-stopping” muscles, but actually, that is just the front of your pelvic floor. As you can see in the image below, the pelvic floor muscles span the entire base of your core. There are three layers of 14 muscles in total, with attachment points on the front, back, and sides of your pelvis.
Together, the pelvic floor muscles are responsible for:
- Supporting your pelvic organs: uterus, bladder, rectum
- Helping to stabilize your spine and pelvic-hip region
- Controlling continence (making sure you pee when you want to, and don’t pee when you don’t want to)
- Aiding in sexual response and satisfaction
- Assisting in guiding the baby out during delivery
How to Perform Effective Pelvic Floor Exercises for Pregnancy
During pregnancy, we want the pelvic floor muscles to develop:
- Strength: The pelvic floor muscles must be strong enough to withstand the added stresses of weight gain, alignment shifts, increased intra-abdominal pressure, and decreased pelvic stability from the hormonal changes of pregnancy.
- Length: These muscles also need to know how to fully lengthen to help guide your baby out during childbirth, which is key to reducing the risk of tearing during delivery.
We accomplish both of these objectives with exercises we call PFAs (Pelvic Floor Activations).
Follow the four steps below to first find your pelvic floor muscles and then learn how to perform the two PFA variations: PFAs-Slow and PFAs-Fast. You can also watch the video demonstration that follows the steps.
1. Find your pelvic floor muscles
The first step is to actually find (and feel) your four pelvic floor attachment points.
- Find the Front: Imagine you are peeing. Try to stop the flow of urine, and then let it go. That’s the front of your pelvic floor.
- Find the Back: Imagine you are trying to stop yourself from passing gas, and then let it go. That’s the back of your pelvic floor. NOTE: The glutes shouldn’t squeeze to achieve this action (they remain relaxed when done right). It’s a deeper, more internal feeling. You may need to lean back a bit to feel this.
- Find the Sides: Sit on your hands with your palms facing up. Feel the two bony prominences of your “sits” bones with your fingertips and try to bring them closer together. Then, release them back. Those are the sides of your pelvic floor.
You may find that some parts of the PF are easier to access than others. This is quite common. Just practice consistently and experiment with different positions (i.e. supine or quadruped).
2. Practice lifting and lowering through a full range of motion
Now that you’ve located all 4 pelvic floor attachment points, it’s time to practice lifting and lowering them together in a coordinated fashion.
- Straddling the corner of your chair (so that you are sitting directly on top of your pelvic floor muscles), imagine the 4 attachment points are corners of a tissue.
- Then, think of pulling that tissue up from the center — feeling all 4 points lifting and coming together
- Finally, fully release the muscles—feeling them contact the chair (as if you were spreading that tissue flat on the table).
- Practice this a few times—lifting and bringing the muscles together, then fully relaxing and lengthening.
Another potential cue you could use is to imagine picking up a blueberry with your muscles, then lowering it all the way back down.
3. Coordinate the movement with your 360° Breathing (PFA-Slow)
Now that you’ve practiced lifting and lowering, the next step is to connect this movement with your 360° Breath. This is a PFA-Slow.
- Inhale through your nose and lengthen your PF muscles downward while your rib cage expands 360°. Envision your Core Canister expanding and lengthening.
- Then exhale through pursed lips, drawing your PF muscles in and up as your navel draws in. Envision your Core Canister contracting and tightening. It should feel like a “wrapping” in your lower core.
- Continue to practice this – inhaling and expanding the space in your Core Canister, exhaling and contracting that space. This is a PFA-Slow (lifting and lowering coordinated with your breath).
4. Increase Speed (PFA-Fast)
In step 3, you performed a PFA-Slow. Now, in step 4, you’ll perform the same pelvic floor movement, but increase the tempo for a PFA-Fast. Because you are lifting and lowering your PF muscles more quickly, a PFA-Fast is not coordinated with your breath. Just breathe comfortably as you lift and lower your PF muscles. NOTE: Even though these are faster than PFAs-Slow, they are not “fast.” It should take about 1-2 seconds per rep.
Watch the Video Demonstration
Why Practice Both PFA Variations?
Practice both PFAs-Slow and PFAs-Fast because they target different muscle fibers:
- PFAs-Slow target the slow-twitch fibers that are responsible for supporting the pelvic organs and stabilizing the pelvic region
- PFAs-Fast target the fast-twitch fibers that help to resist unwanted leakage (urinary or fecal) – especially during sudden movements like coughing, laughing, sneezing, or impact exercise.
There is no set number of reps to hit each day. The goal is to practice enough that you feel confident and in control through the full range of motion. As a starting point, one set might look like 3-5 PFAs-Slow, followed by 8-10 PFAs Fast. Perform 2-3 sets per day.
Pelvic floor training during pregnancy is not just about squeezing harder or doing more reps. It’s about learning how to access the full pelvic floor and train for both strength and length. When your pelvic floor muscles can move through their full range of motion, they are better prepared to support your body through pregnancy and assist during birth.
Why Not Just Do Kegels?
“Kegel” has become a tricky term. Today it’s largely synonymous with “squeezing the muscles used to stop the flow of urine.” However, this description has two problems:
- Your “pee-stopping” muscles are only the front of your pelvic floor
- Focusing on contraction only — without the release — can create complications during delivery and contribute to other pelvic floor dysfunction. Like any other muscle in your body, your pelvic floor muscles need to be worked through a full range of motion.
Frequently Asked Questions About Pelvic Floor Training
Are Kegels the best pelvic floor exercises during pregnancy?
Not the way they are traditionally described (“squeeze the muscles you’d use to stop the flow of urine”). This description has two problems. It only targets the front of your pelvic floor and focuses entirely on contraction. Effective pelvic floor training during pregnancy requires activating all four attachment points (front, back, and sides) and working through a full range of motion, including the release. That lengthening component is especially critical for preparing the pelvic floor to guide your baby out during delivery.
When should I start pelvic floor exercises during pregnancy?
Pelvic floor training can begin at any point during pregnancy, but the sooner you start, the more time you have to develop both the strength and the full range of motion your pelvic floor needs to support the demands ahead. If you or your client are new to pelvic floor work, starting in the first trimester gives you the most time to build awareness and control before the later stages of pregnancy increase the load on these muscles.
How do I know if I’m doing pelvic floor exercises correctly?
Pelvic floor training is uniquely challenging because you can’t see the muscles working. A few signs you’re on the right track: you can feel distinct activation at all four attachment points (front, back, and sides), you can fully release the muscles after each contraction, and there’s no gripping in your glutes or inner thighs. If you’re unsure, working with a pelvic floor physical therapist — even for one session — can be a helpful way to confirm your technique.
Can your pelvic floor be too tight during pregnancy?
Yes, and it’s more common than many people realize. A tight muscle is not a strong muscle. When the pelvic floor muscles are weak or overwhelmed, they may compensate by overacting to support the pelvic organs or prevent accidental leakage. This excessive recruitment of the PF muscles can lead to tightness. Over time, this tension can reduce the muscles’ ability to respond when it matters most — such as during sudden movements or delivery. This is why training the pelvic floor through a full range of motion, including the lengthening phase, is so important during pregnancy. If you’re experiencing pelvic pressure, discomfort, or tension, a pelvic floor physical therapist can help assess what’s happening and guide your training.