Considerations of Musculoskeletal Harm Reduction During Labor and Birth

In Pregnancy/Postpartum by Molly Bachmann1 Comment

By Molly Bachmann PT, DPT, PHRC San Francisco

When you reflect on major athletic moments or professional accomplishments in your life, you likely remember the days, weeks, months or maybe even years of training your body and mind for that event. The evaluations from medical professionals and coaches helped you identify which drills to run, what food to consume, and provided you with the motivation necessary to score that winning goal or complete that one additional pirouette that leaves the audience in “awe.” You may remember the extra course work you learned from on the side while working 40 hours a week to boost your resume to get your seat at the table you’ve always dreamed of sitting at. All of those hours of preparation and building the right community helped you to succeed.


When it comes to labor and birth, we should be thinking of preparation as a necessity for not only nesting and adjusting to the idea of bringing in a new family member, but also for our bodies. Just as we emphasize injury prevention on the field or burn out prevention in the workplace, we should be emphasizing injury prevention in labor and birth, rehabilitation in early postpartum and community centered care for new parents to reduce stress and poor health outcomes. Physical therapy can play a huge role in helping you prepare. 


In thinking about birth through a biomechanics lens, it is essential that we have a conversation about birthing positions. In the United States, most pregnant people who give birth in hospital settings will do so lying on their backs with legs up in the air. This is called the dorsal lithotomy position. According to research, this may not be the most appropriate position for all pregnant people especially when thinking about the musculoskeletal system.


Laboring and birthing in the dorsal lithotomy position demonstrated:

  1. Increased need for perineal sutures
  2. Increase patient reports of severe pain
  3. Increased rate of episiotomies
  4. Higher rates of instrument assisted deliveries
  5. Increased risk of extremity nerve injuries due to prolonged positioning at end range
  6. May prohibit sacral nutation which is required for opening the pelvic outlet


When compared with the dorsal lithotomy position, side-lying showed: 

  1. Least likely to cause perineal tearing
  2. 66% of pregnant people gave birth to an intact perineum
  3. Avoids compression to joints reducing pain
  4. Helpful for patients pregnant for the first time and for those with larger newborns
  5. May slow a precipitous labor


Birth in a quadruped (on hands and knees) position showed:

  1. Less need for perineal suturing as opposed to dorsal Lithotomy
  2. 61% birthed with an intact perineum
  3. May be helpful in reducing orthopedic pain


Lastly, squatting can help to:

  1. Shorten the 2nd stage of labor
  2. Reduce need for oxytocin to stimulate labor
  3. Reduce rate of episiotomies and severity of perineal lacerations


If we can use effective and personalized exercise/therapeutic programs to prepare people for more positive outcomes prior to a total knee replacement, we can do the same in birth spaces. Having a good understanding of how to breathe properly during birth, how to lengthen your pelvic floor muscles, appropriate hip flexibility and strength, can all help to reduce musculoskeletal injury. Preparation as well as critical analysis of which positions are best for you can help to achieve healthier outcomes for you and the baby. As you prepare for birth, it’s important to consult with your birth work team and physical therapist as they can help you to identify an appropriate individualized program as well as which positions may be best for you and your body.




AL;, De Jonge A;Teunissen TA;Lagro-Janssen. “Supine Position Compared to Other Positions during the Second Stage of Labor: a Meta-Analytic Review.” Journal of Psychosomatic Obstetrics and Gynaecology, U.S. National Library of Medicine, 

B;, Shorten A;Donsante J;Shorten. “Birth Position, Accoucheur, and Perineal Outcomes: Informing Women about Choices for Vaginal Birth.” Birth (Berkeley, Calif.), U.S. National Library of Medicine, 

Golay, Jane, et al. “The Squatting Position for the Second Stage of Labor: Effects on Labor and on Maternal and Fetal Well‐Being.” Wiley Online Library, John Wiley & Sons, Ltd, 2 Apr. 2007, 

Simarro, María, et al. “A Prospective Randomized Trial of Postural Changes vs Passive Supine Lying during the Second Stage of Labor under Epidural Analgesia.” Medical Sciences (Basel, Switzerland), MDPI, 8 Mar. 2017, 

Soong, Barbara, and Margaret Barnes. “Maternal Position at Midwife-Attended Birth and Perineal Trauma: Is There an Association?” Birth, vol. 32, no. 3, 2005, pp. 164–169., doi:10.1111/j.0730-7659.2005.00365.x. 

Walker C;Rodríguez T;Herranz A;Espinosa JA;Sánchez E;Espuña-Pons M; “Alternative Model of Birth to Reduce the Risk of Assisted Vaginal Delivery and Perineal Trauma.” International Urogynecology Journal, U.S. National Library of Medicine, 

Wong CA;Scavone BM;Dugan S;Smith JC;Prather H;Ganchiff JN;McCarthy RJ; “Incidence of Postpartum Lumbosacral Spine and Lower Extremity Nerve Injuries.” Obstetrics and Gynecology, U.S. National Library of Medicine, 



Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $85.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

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