Navigating Labor with Confidence: Breathing Techniques to Support the Pelvic Floor and Minimize Perineal Trauma

As a pelvic floor therapist, I’ve had the privilege of walking alongside many women as they prepare for one of life’s most transformative experiences: childbirth. One of the most empowering tools we can offer expecting mothers is knowledge—knowledge of their body, of the birthing process, and of how intentional preparation can promote a smoother labor and recovery. In this post, I’ll walk you through the stages of labor, with special attention to the second stage, and share evidence-informed strategies like spontaneous (open-glottis) breathing to help reduce the incidence and severity of perineal trauma.

Understanding the Stages of Labor

Labor is typically divided into three stages:

Stage 1: Dilation
This stage begins with the onset of regular contractions and ends when the cervix is fully dilated to 10 centimeters. It’s further divided into:

  • Early labor: Contractions are mild and irregular but gradually become more consistent.
  • Active labor: Contractions are stronger, longer, and closer together.
  • Transition: The final and most intense part of dilation, leading up to full cervical dilation.

Stage 2: Pushing and Birth
This stage begins when the cervix is fully dilated and ends with the birth of the baby. It’s during this stage that the pelvic floor is most challenged.

Stage 3: Delivery of the Placenta
After your baby is born, contractions continue until the placenta is delivered.

The Second Stage and Perineal Protection

During the second stage of labor, many women are encouraged to push with each contraction using a closed-glottis technique—essentially holding the breath and bearing down, similar to straining during a bowel movement. However, research and clinical observation increasingly support the use of spontaneous, or open-glottis breathing, which involves exhaling slowly and steadily while bearing down, as if blowing through a straw or sighing with effort.

This breathing method allows for a more gradual descent of the baby through the birth canal, which may reduce the stress placed on the perineum and pelvic floor. Open-glottis pushing aligns with the body’s natural rhythm and helps avoid excessive intra-abdominal pressure that can contribute to pelvic floor dysfunction postpartum.

Key Benefits of Open-Glottis Breathing in Second Stage:

  • Promotes better oxygen exchange for mother and baby
  • Encourages gentle, controlled descent of the baby
  • Reduces likelihood of severe perineal tearing
  • May result in fewer interventions (forceps, vacuum)

Training the Body and Mind for Labor

Just as athletes train for a big event, preparing for birth requires mental and physical readiness. One effective technique I recommend in my practice is ice holds. This practice helps condition your nervous system to remain calm during intense sensations like contractions and reinforces relaxation strategies that are essential during labor.

How to Try It:

  1. Hold an ice cube in your hand for 60-90 seconds—approximately the length of a contraction.
  2. As you feel the intense cold, practice consciously relaxing your face, shoulders, jaw, and pelvic floor.
  3. Breathe slowly and deeply, avoiding breath-holding. Try open-glottis exhalation with a gentle sound like “hahhhh” or “oooo.”
  4. Repeat this frequently and try to reduce the amount of tension in your body, especially as you approach your due date.

This exercise is not about “toughing it out,” but about training your mind and body to stay soft, open, and responsive—even in the presence of intensity. Over time, you’ll develop a sense of confidence and control that you can carry into your birth experience.

Additional Tips for Perineal Preparation

  • Perineal Massage: Starting around 34–36 weeks, gently massaging the perineum can increase tissue elasticity.
  • Upright or Side-Lying Birth Positions: These positions reduce pressure on the perineum compared to lithotomy (flat on back) positions.
  • Stay Mobile in Early Labor: Movement promotes optimal fetal positioning and can shorten labor.
  • Hydrate and Nourish: Keep your body fueled with water and light snacks to maintain energy and tissue integrity.

In Summary

Every labor is unique, but the way we breathe, move, and prepare can have a profound impact on our experience. As a pelvic floor therapist, my goal is to empower you with tools that support your body’s natural rhythms and promote long-term pelvic health. Incorporating open-glottis breathing and practicing intentional relaxation strategies, like the ice cube technique, can help you approach birth with greater ease and resilience.

If you’re expecting, consider working with a pelvic floor therapist to create a personalized birth preparation plan. Your body is wise, your instincts are strong, and with the right preparation, you can meet labor with confidence and grace.

A Journey to Dry Days: Successful Pediatric Pelvic Therapy for a 6-Year-Old Girl with Encopresis and Incontinence

When six-year-old “Emma” (name changed for privacy) first came to our clinic, she was struggling with a trio of distressing symptoms: encopresis (fecal incontinence), daytime urinary incontinence, and nighttime bedwetting (enuresis). Her parents were overwhelmed, unsure of how to support her, and Emma herself was growing more withdrawn and anxious. She avoided playdates, was hesitant to participate in school activities, and had begun expressing embarrassment about accidents. Her story is one we hear often—but her transformation over the course of just 10 therapy sessions is one we’re proud to share.

Initial Evaluation

Emma’s initial evaluation revealed a classic pattern often seen in pediatric pelvic floor dysfunction. Her toileting history included frequent urinary leaks during the day, nighttime bedwetting nearly every night, and frequent soiling of her underwear despite bathroom visits. Her parents reported that she had been toilet trained at age 3, occasionally had nighttime accidents but the majority of symptoms arose when she was 5.

A bowel and bladder diary showed irregular voiding patterns, a tendency to “hold it” for long periods, and signs of chronic constipation. Emma was avoiding bowel movements due to fear of discomfort, contributing to a cycle of retained stool and frequent accidents. These physical issues were compounded by emotional distress: Emma was becoming self-conscious, avoiding sleepovers, and increasingly frustrated.

Treatment Plan

Our team developed an individualized treatment plan focused on three core areas:

  1. Pelvic Floor Muscle Training
    Using age-appropriate biofeedback tools and play-based exercises, Emma learned how to coordinate and strengthen her pelvic floor muscles. At first, she had difficulty identifying these muscles, but with feedback and encouragement, she began to recognize when she was clenching or relaxing.
  2. Bowel and Bladder Retraining
    We established a timed voiding schedule to encourage regular bathroom visits and reduce holding behaviors. We also educated Emma and her parents on the importance of hydration and fiber-rich nutrition to improve stool consistency and reduce constipation.
  3. Parental Education and Support
    Perhaps just as important as the physical therapy itself was the empowerment of Emma’s caregivers. We spent time in each session educating them about the bowel-bladder connection, the physiology of encopresis, and how to support toileting without shame or pressure. They learned how to use positive reinforcement and to frame progress in a celebratory, child-friendly way.

Progress Over 10 Visits

Emma attended therapy weekly for 10 sessions over a 3-month span. Early sessions focused on building rapport, body awareness, and establishing new habits. Her parents consistently reported that the structure and support helped reduce their anxiety, which in turn created a more positive environment for Emma.

By session 4, Emma was having fewer urinary leaks during the day and had begun to recognize when she needed to use the bathroom. Her confidence grew as she realized she had some control over her body. We introduced playful pelvic floor and core exercises using games and interactive tools, helping her remain engaged throughout each session.

By session 7, the soiling had significantly decreased. With improved bowel regularity and pelvic floor control, Emma no longer experienced daily accidents. She began initiating trips to the bathroom on her own and proudly reported her progress to the therapist each week.

By the end of her 10th session, Emma’s nighttime accidents had also improved. While occasional bedwetting remained, the frequency was reduced, and she had gained tools to manage it. Most importantly, Emma’s confidence had soared. She began attending sleepovers, and her parents shared that she was more cheerful and less anxious overall.

Family Reflections

Emma’s parents expressed immense gratitude for the education, empathy, and holistic care provided throughout her treatment. “We finally felt like we weren’t alone,” her mother shared. “Before therapy, we thought she was just being stubborn. Now we understand her body better, and we know how to help her.”

The family also appreciated how therapy incorporated Emma’s voice and experience, helping her feel empowered rather than ashamed. The transformation wasn’t just in symptom reduction—it was in quality of life, confidence, and connection.

Final Thoughts

Emma’s case is a beautiful reminder that pediatric pelvic therapy can be life-changing. With a supportive team, evidence-based strategies, and a family-centered approach, even children with persistent symptoms can experience meaningful recovery.

If your child is struggling with bowel or bladder issues, know that help is available—and progress is possible. Every child deserves the chance to feel dry, confident, and in control.

Understanding Stress Urinary Incontinence in Children: How Pediatric PT Differs From Adult Care

As a pediatric pelvic floor physical therapist, one of the more surprising and often misunderstood conditions I treat is stress urinary incontinence (SUI) in children. While most people associate SUI with adults—especially postpartum women or older individuals—it’s important to know that kids can experience it too. And although there are similarities in how we approach treatment for children and adults, there are key differences—particularly in the type of therapy we use.

What is Stress Urinary Incontinence?

Stress urinary incontinence is the involuntary leakage of urine during physical exertion—think coughing, laughing, jumping, running, or sports activities. In adults, it’s often linked to pelvic floor dysfunction, commonly from childbirth, surgery, or aging. In children, however, the causes are more nuanced and often involve delayed pelvic floor muscle coordination, core instability, and high intra-abdominal pressure strategies during movement.

Children with SUI may not be able to describe what’s happening clearly. Parents might notice their child leaking during sports or coming home from school with damp underwear, and it’s often brushed off as “just an accident” or something they’ll grow out of. But when leakage is persistent, it’s a sign that their bodies need some support.

Treatment Approaches: Pediatric vs. Adult

While the underlying principles of pelvic floor physical therapy are consistent across age groups, the methods and techniques we use vary significantly.

Internal vs. External Therapy

One of the biggest differences in treating SUI in children is that we do not perform internal pelvic exams or internal pelvic floor muscle work. This is a cornerstone of adult pelvic PT—where internal assessments help us evaluate pelvic floor tone, strength, and coordination directly. But in pediatric care, we rely on external observation, movement analysis, and child-appropriate biofeedback tools to assess function.

Instead of internal work, we focus on global movement patterns that support the pelvic floor indirectly. This includes working on postural control, breathing mechanics, and core strength—what we call the “pressure system.”

Pressure Management and Breath Mechanics

Managing intra-abdominal pressure (IAP) is crucial in treating SUI in both adults and children. Often, kids with SUI are unknowingly bearing down or breath-holding during physical activity, creating downward pressure on the bladder and pelvic floor.

In therapy, we teach kids how to coordinate their diaphragm, core, and pelvic floor muscles through age-appropriate breathwork, games, and movement drills. We might play with blowing bubbles, pinwheels or kazoos, or animal breathing exercises to make the work fun and relatable. In adults, we still coach diaphragmatic breathing, but the language, tools, and feedback methods are more mature.

Force Absorption and Movement Re-Training

Running, jumping, and high-impact sports place a demand on the body’s ability to absorb force efficiently. In both kids and adults, poor force absorption (think: stiff landings or poor alignment) can overload the pelvic floor. But again, the way we train these mechanics looks different.

With children, we often address:

  • Jump and landing mechanics using visual cues or play-based drills
  • Core and hip strength through obstacle courses or coordination games
  • Balance and proprioception through fun challenges (e.g., hopping on one leg, animal walks)

Adults might perform similar drills, but with resistance, repetition tracking, and goal-specific modifications. With kids, we keep things engaging while subtly targeting the neuromuscular patterns that support continence.

Return to Sport and Confidence Building

Just like with adults, returning to sport or exercise confidently is a major goal. A child who leaks during soccer or gymnastics might feel embarrassed, anxious, or even withdraw from activities they love. Our job as pediatric pelvic PTs is not only to improve their muscle function but also to rebuild confidence and body trust.

We do this by:

  • Creating gradual return-to-play programs that support continence
  • Teaching pre-activity strategies, like timed voiding or diaphragmatic breathing before sport
  • Using positive reinforcement and normalization to reduce shame

In adults, confidence building is still part of the process, but we’re often undoing years of movement habits or postnatal changes. With kids, we’re teaching these skills early, setting them up for long-term success.

Final Thoughts

Stress urinary incontinence in children is more common than many realize—and absolutely treatable. The key is recognizing that even though children’s bodies are different from adults’, they still benefit from the foundational principles of pelvic floor care: pressure management, force absorption, and functional training.

As pediatric pelvic floor therapists, we bring a child-centered lens to treatment—one that honors their development, curiosity, and need for movement-based, non-invasive care. If your child is experiencing stress incontinence, know that you’re not alone—and there are gentle, effective ways to help them move, play, and thrive without fear of leaking.

Why It’s Important to Talk to Your Kids About Bowel and Bladder Health

As parents and caregivers, we teach our children how to brush their teeth, eat healthy foods, and wash their hands. But there’s one essential topic that often gets left out of regular conversation—bowel and bladder health.

Once children gain the skills to use the bathroom independently, many families stop talking about what happens behind that closed door. But just because kids can go to the bathroom on their own doesn’t mean they always know what’s happening with their bodies—or whether what they’re experiencing is normal.

The truth is, open conversations about bowel and bladder health are a cornerstone of physical and mental wellness for children. When kids feel safe and supported to talk about these topics, they are better equipped to recognize potential problems, advocate for themselves, and build a foundation for lifelong pelvic health.

The Problem With Staying Silent

Many pelvic floor issues in children—like constipation, urinary urgency, or bedwetting—develop gradually. Children may not understand what’s happening or may assume their symptoms are normal. If they’ve learned that “potty talk” is inappropriate or embarrassing, they may keep their discomfort to themselves for months or even years.

This silence can delay necessary care. A child might endure chronic abdominal pain, accidents, or bathroom anxiety simply because they don’t know how to explain what they’re feeling—or feel like they shouldn’t.

Talking about these issues doesn’t just reduce stigma—it can lead to earlier detection and better outcomes.

What’s “Normal,” Anyway?

Many children aren’t aware of what’s expected when it comes to bathroom habits. For example:

  • Bowel movements should generally happen every day or every other day, be soft and easy to pass, and not cause pain.
  • Urination should occur roughly 5-8 times per day, without strong urgency, dribbling, or leaking.
  • Accidents after potty training (especially with poop) are not something to brush off as laziness or a behavioral issue—they’re a red flag for a deeper issue.

When kids don’t know this, they may not recognize signs of constipation, bladder dysfunction, or pelvic floor issues. And if parents aren’t checking in regularly, these symptoms can worsen before anyone realizes there’s a problem.

The Physical and Mental Health Impact

Pelvic health issues don’t exist in a vacuum. Chronic constipation, urinary incontinence, and encopresis (poop accidents) can lead to:

  • Pain and discomfort
  • Avoidance of social situations, like sleepovers or school events
  • Embarrassment or shame
  • Low self-esteem
  • Behavioral concerns, like irritability or withdrawal

When children know they can talk to their caregivers about these challenges, they’re more likely to get help early. Physical therapy, dietary changes, and education can make a world of difference in resolving symptoms and restoring confidence.

How to Start the Conversation

You don’t have to be a medical expert to support your child’s pelvic health. You just need to make the topic safe and approachable. Here are some ways to start:

  • Normalize the conversation. Talk openly about how often everyone should be peeing and pooping. Use proper terms when possible, and avoid words that suggest these topics are gross or shameful.
  • Ask check-in questions regularly. “Did you have a good poop today?” or “Have you been needing to pee a lot lately?” can help you stay informed without making it awkward.
  • Validate their experience. If your child shares that something hurts or feels strange, take it seriously. Don’t dismiss their discomfort or chalk it up to drama.
  • Educate with kid-friendly language. Explain how the digestive and urinary systems work in a way your child can understand. There are wonderful books and resources that make these lessons fun and engaging.
  • Work with professionals. Pediatric pelvic floor physical therapists are specially trained to help kids with bowel and bladder dysfunction. If your child is struggling, you’re not alone—and help is available.

Making Space for Honest Talk

As a pelvic floor physical therapist, I work with many children and families who feel isolated or confused when facing bowel and bladder issues. But once the conversation opens up, it’s amazing to see how quickly things can improve. Kids begin to understand their bodies better. Parents gain tools to support their child’s health. And, most importantly, shame gets replaced with confidence.

So let’s change the narrative. Let’s raise kids who can talk openly about their poop and pee—not because it’s funny, but because it’s a vital part of their health.

Start the conversation today. You might be surprised by what your child has been waiting to tell you.