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Serving Westchester, Rockland, Putnam Counties and beyond
Hudson Valley Logo
Serving Westchester, Rockland, Putnam Counties and beyond

Happy New Year! We hope you’ve settled into 2024 nicely and wish you all the best for a healthy and happy year ahead.

Are you expecting in 2024? Last month, we took you through holiday relaxation for your pelvic floor including positions specifically to prepare your pelvic floor for labor and delivery. Keep reading on to learn how to work with your pelvis and pelvic floor to optimize your delivery experience.

For our purposes, the pelvis can be divided up into five segments: the ilium (X2), the ischium (X2), the pubis, the sacrum, and the coccyx or tailbone.

If you place your hands on your waist and slide down, you will find your iliac crests. The top part of the pelvis  is called the ilium. The two ilia join together at the pubic symphysis, a strong and relatively stiff joint in the front of the pelvis, and the sacrum in the back of the pelvis. 

These bones form the top of your pelvis or “the pelvic inlet.” During the first part of labor, we want to make it easy for baby’s head to move down into the pelvic inlet to make contact with the cervix. This action of pressure on the cervix helps the progression of labor.

The “pelvic outlet” is comprised of the ischium joined at the sacrum and pubic bone. Sit on your hands, you will feel two knobby bones called the ischial tuberosities at the bottom of the ischium. 

When it comes to the pushing stage of labor, we want to open the pelvic outlet to create more space for baby to pass through and ensure your pelvic floor is at an ideal length. 

The pelvis creates the scaffolding that your pelvic floor muscles suspend from. 

How to improve opening of the pelvic inlet with examples

As we mentioned above, the key in the first part of labor is to open up the top of the pelvis to allow your baby’s head to contact your cervix. 

Before going into some specific positions we love, here is a quick “cheat sheet” for opening up the top of the pelvis. 

  • Movement is good, change position every 20-30 minutes
  • Upright is good, let gravity help baby descend into the pelvis
  • Hip external rotation and posterior pelvic tilt help open up the inlet

Supported cat, cow

We love this position over the birth ball for many reasons. You can also do this leaning forward on the couch or in the hospital bed. 

Start on hands and knees. 

Rest your upper body on the ball, couch, etc. 

Bring your knees wider than your hips. This is hip external rotation. 

Add a little movement in by rounding your pelvis, posterior tilt, and the return to neutral.

*note, this position can also be great when you have back labor. 

Deep supported squat

Hold onto a ball or surface for this position.

You want to keep the lower back rounded so this support is essential.

From a standing position, rotate your feet outward and drop down into a deep squat.

Ensure that your comfortable and able to keep your low back rounded in this position. 

We wouldn’t recommend holding this deep squat for a whole 20-30 minutes, so you can alternate between standing and squatting which is a great way to use gravity to your advantage.


Gentle, easy walks are great to help your baby move into the pelvis. 

Without having to think about it, each step forward changes the diameters of the pelvis and uses gravity to help your baby make that journey closer to birth.

How to improve opening the pelvic outlet with examples

Again, here is a little “cheat sheet” on how to work with your pelvis to make more space for pushing.

  • Allow the sacrum and tailbone to move out of the way
  • Keep hips in neutral or slight internal rotation
  • Avoid end range movements ie the limits of how far you can bring your hips up. This can put a ton of pressure on your joints, nerves, and tissue.
  • Anterior pelvic tilt, or arching the lower back, is helpful

Hands and knees

Like the previous example on hands and knees, it may be more comfortable to give your upper body some support via the birth ball, couch, bed etc.

Bring your feet slightly wider than your knees to move into hip internal rotation.

Allow your lower back to arch slightly or move between cow pose and neutral to create anterior pelvic tilt. 

Side lying

Lie on your side. Generally your provider will recommend the left.

Your top leg will be supported by your partner, medical professionals, or your doula. 

Support on the lower part of the leg keeps your hips in a neutral or slight internal rotation position. Just make sure you feel completely supported here. The last thing you want is to feel like you’re expending extra energy to suspend your leg.

On back

This is the “traditional” delivery position in the US. Your medical provider during delivery may instruct you to push on your back for a variety of reasons and that is okay. 

There are a few ways to make this position a bit friendlier for your pelvic floor. 

Use a small towel rolled up into a U shape. This helps lift the sacrum and coccyx off the bed so it can move slightly backward and allow your baby some extra space to pass through and your pelvic floor to get some extra length. 

Instruct whoever is holding your legs to keep  them relatively close to your body instead of pushed all the way up and spread super wide. This goes back to really protecting your hip, muscles, and nerves from unnecessary compression and stretch. 

History of increased pelvic floor tension, low back pain, hip pain etc.? Our team of pelvic floor physical therapists can work with you and your partner to prepare you, your pelvis, and your pelvic floor for labor and delivery on an individualized basis. We hope these basic tips help you and your birth team create  a positive birthing experience.

  • note: Always consult with your medical provider before attempting any of the positions above
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