Preparing pregnant athletes for labor

May 22, 2021

The anxiety and stress about birth can be intense; it seems like every mom you know wants to tell you their horror story. You may have read posts in various forums and mom groups, and this can make the stress worse! Have you been thinking about being a pregnant athlete and vaginal birth? This article will help break down the stages of vaginal birth and provide you with some tips for labor.

Myth: Labor is a cinch for pregnant athletes

Moms who exercise may be told that labor will be a cinch; that it’ll be no problem at all because you’re fit.

But this is a myth, labor is not a cinch. This is often said with good intentions, and sometimes true… but not always! Your birth story is unique to you and your experiences.

Fitness helps you with endurance, but there are circumstances in labor where it doesn’t matter how fit you are. Birth can be a very crazy and somewhat complicated experience with so many possible scenarios. We never want a mama to feel like they’ve failed in their labor.

So how can pregnant athletes (or any mama) prepare for their labor? First, we think it’s super important that you know what’s going to happen. Next, we’ll give you five tips for how to cope with it the best that you can!

Stages of labor

There are three stages of labor. For most people, the first two stages are what matters the most. When people tell you they were in labor for 6 hours, 26 hours, or 48 hours, they’re telling you the amount of time from start to finish. This isn’t the time they were in active “OMG this hurts so much that I can’t stop swearing!” pain. This is really important and this knowledge can help ease the fear for a lot of expecting mamas.

The first stage of labor

Contractions will begin in the first stage of labor. They’re usually less intense, further apart, and don’t last long. You’re considered to be in the first stage of labor from 0 cm dilated up to 6 cm dilated. This is the phase that lasts the longest; it can be anywhere from 8 to 36 hours. Typically during this phase, you’re at home and can (try to) relax.

Generally, the rule of thumb for going to the hospital is when your contractions become less than 5 minutes apart and last for a minute for a period of 1 hour. This is called the 5-1-1 rule. If you have any bleeding or concerns, go to your medical centre and/or make sure you keep in contact with your midwife.

The contractions come every 5 minutes, lasting 1 minute each, for at least 1 hour.

The 5-1-1 Rule Tweet

The second stage of labor

The second stage of labor is when you’re pushing. This is when your baby has descended further into your pelvic and is trying to come through the birth canal. What many mamas may not know, is that this comes in waves too. People can often think this is where athletes thrive- there can be the assumption that it would take athletes two pushes and you’ve got your baby out! This doesn’t always happen, and sometimes maybe shouldn’t.

This is when you should listen to your body. Let yourself wait in between contractions, and relax your pelvic floor although it may seem impossible to even think of doing that. Once you’ve delivered the shoulders, the rest of the baby falls out and you listen for their first cry.

We often advocate for early skin-to-skin contact and delayed cord clamping when possible. Early skin-to-skin contact is where the newborn baby is placed naked on the mother’s bare chest right at birth or shortly thereafter. This is when it’s also possible to try to breastfeed. There’s some thought that this can help lessen issues with breastfeeding later on.

Delayed cord clamping is the prolonged time between the delivery of a newborn and the clamping of the umbilical cord. There’s a lot of nutrient rich fluids going to the baby and can help with their immune system.

In the second stage, there can sometimes be issues with the baby progressing. If your pelvic floor is too tight, or if you’re having trouble relaxing, pushing can last longer because the baby can’t descend. This is often called “failure to progress”. During this time, the baby will often be monitored for signs of distress. A C-section may be required due to a complication or an issue with the baby.

This stage of labor can last anywhere from 20 minutes to 3 hours. Longer times are normal, especially for first-time mothers. It’s also important to know that if you have an epidural, your pushing phase will likely be longer… and that’s normal too!

If you're looking to learn more about the failure to progress, Evidence Based Birth has a great podcast on this subject that you can listen to!

CHRISTINA's RECOMMENDATION Listen to this podcast

The third stage of labor

The third stage of labor is the shortest and often the most forgotten about – it’s the delivering of the placenta! This can last anywhere from 15-45 minutes. This stage of labor is still very important, as having your placenta or a piece of your placenta not getting delivered can be dangerous. Your healthcare team will be there to make sure everything’s okay.

The fourth stage of labor

What happens after birth? The baby’s with you and then you’re just… done?

Your midwife or OB-GYN will assess you for any tearing of the perineum, which is the skin and muscle from the bottom of your vagina to the top of your anus. If you’ve had tearing, which is very common, you may need to get stitched up. If you’ve had an unmedicated birth, this would require freezing, compared to if you had an epidural where this area would already be frozen.

If you were unmedicated during delivery, once you’ve been stitched up you’ll be able to get up and move around, or wheeled to recovery. Some women are able to get up very shortly after delivery, but for others it may take some time. You’ll continue to be monitored for anywhere from a couple of hours to days depending on your circumstances. They’ll start to make sure that the size of your uterus starts to go down by touching your stomach, which can feel a bit uncomfortable. They’re looking to see that your body is going into recovery mode.

What happens if you’ve had an epidural?

If you decide to get an epidural, the catheter will need to be removed and the medication will have to wear off before you can move anywhere. Before you’re able to go home, your healthcare team will want to know that you’ve been able to go to the bathroom. Some women will experience soreness around the needle’s injection site for the epidural. If you experience this, it typically subsides after a couple days.

5 things pregnant athletes should know leading up to labor

It’s important to be able to relax your pelvic floor muscles. When we’re pushing, we need to think about relaxing. It’s easier said than done. When the baby is trying to get into the birth canal, you need to let them! If we tighten up, our pelvic floor can prevent the baby from getting lower and it can make us push for longer… which is something that no one wants to do.
You’re fit, but you don’t need to train for birth. Often your fitness has nothing to do with your birth story. Fitness can help you during labor and delivery; there’s some research that shows we recover a bit faster if we’re more active compared to if we weren’t. However, during active labor, this may not be 100% accurate. We’ve seen mamas who have given birth by C-section, or had longer labor times and they feel like they failed in some way. They may have thought their fitness would prevent these things. Although it can help, there are so many twists and turns along the way that we can’t control.
Try to breathe through pushing and your contractions. As barbell athletes, we’re used to tightening our pelvic floors as we hold our breath. We do it all the time when we lift heavy weights. This is the opposite of what we want to do during active labor! Before you go into labor, really practice this technique. When you’re in pain, it can be hard to think about anything else. We usually recommend trying to relax your pelvic floor or to do some relaxation exercises after you lift weights during your pregnancy. This is when you tend to be used to flexing, and it may feel hard for you to relax. This makes it the perfect time to practice! Check our our Instagram post on three exercises to relax your pelvic floor.
A faster labor does not mean you are more or less fit. Your baby dictates the length of labor, not your fitness. It can almost be a badge of honor if you only push for 30 minutes, but we want to tell you that’s not the goal you always want! You want to listen to your body:

– Contractions always comes in waves
– The signal to your body to push also comes in waves

Relaxing when the baby’s head is right at the edge of your vagina is tough, but it can give your body time to stretch. Trying to be in active labor “for time” can make things progress too quickly and might lead to tearing. Let your tissues stretch and move, and push when your body is signalling for you to do it. You’ll thank us later. But… you might not thank us at the time!
Have a support team that knows how you want your birth to go, and let them be your advocates. When you’re in the middle of a long labor, it can be hard to even listen to those around you, let alone to think clearly. So when a member of your healthcare team is presenting options to you or telling you about what’s going to happen next, it can feel like a blue. This can be hard, because women may not feel in control of their birth experience. Let your support person or team that’s in the room with you, know what you want. This includes the birth plan, letting them know if you’re open to an episiotomy or not, what you think about birth positions, if you want medications, etc. Let them be your advocate. Getting a doula either virtually or in-person is another great option, as they support your birth. They know the ins and outs of the process, and are there to support you and help you feel like you’ve had some control over your experience. Feeling out of control can put a negative spin on your birth story, if you weren’t ready for it.

Christina's Bonus Tip: Make your birth plan flexible. The saying is "have a birth plan, don't laminate it!"

Birth never goes according to plan, and it doesn’t happen like in the movies. It can be complicated and confusing, or last longer or shorter than we expected. Knowing a general idea of what you want is important, but being rigid and thinking it has to go a certain way can make any small changes seem like big ones. Think of your birth plan as a general outline that has some flexibility.

Birth is a wonderful experience that often doesn’t go according to plan. It’s important to have a good understanding of what to expect. Knowing what to expect in each stage, and having a rough idea of the decisions you’re comfortable with will help you feel more prepared. Finally, you’ll rely on your fitness during your labor journey, but remember that it doesn’t prevent complications! No matter how your baby enters this world, you did not fail. Labor is hard, but you’ve got this, mama!

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Christina Prevett, MSCPT, CSCS, PHD (CANDIDATE)

Christina Prevett is a pelvic floor physiotherapist who has a passion for helping women with different life transitions, including postpartum care and menopause.