Ultrasound-Guided Labour Preparation: How Pelvic Floor Physiotherapy Can Help Women Learn to Labour (not push!) More Effectively

Many pregnant women worry about one major question before birth:

“How will I know if I’m pushing correctly during labour?”

Despite antenatal classes and online birth education, many women still enter labour feeling uncertain about:

• how to coordinate pushing

• how to relax the pelvic floor

• how to reduce pelvic floor injury risk

• how to work with contractions effectively

• how to avoid “purple pushing” or excessive straining

  
  

Women are increasingly seeking evidence-informed pelvic floor physiotherapy to help prepare for labour and birth.

One of the newest and most exciting developments in women’s health physiotherapy is the use of real-time ultrasound biofeedback to teach genital hiatus (the opening of the vagina) mechanics, pelvic floor relaxation, and birth preparation before labour begins. Emerging research suggests this approach may improve birth outcomes, reduce pelvic floor trauma, improve maternal confidence, and optimise labour coordination.

What Is Ultrasound-Guided Labour Preparation?

Pelvic floor physiotherapists can use real-time ultrasound imaging to assess and teach:

• pelvic floor relaxation

• abdominal pressure coordination

• diaphragmatic breathing

• foetal descent simulation during bearing down

• pushing mechanics

• pelvic floor muscle overactivity

  
  

The two most commonly used techniques are:

• transabdominal ultrasound

• transperineal ultrasound

  
  

These ultrasounds are non-invasive and provide visual feedback so women can actually see how their pelvic floor muscles move during pushing and relaxation exercises. This can help women understand:

• when they are accidentally tightening the pelvic floor

• how to coordinate breath with pushing

• how to generate downward pressure effectively

• how to avoid excessive straining

When Should Ultrasound-Guided Birth Preparation Begin?

Current emerging literature suggests the ideal time for labour preparation and pelvic floor birth training is during the third trimester. Most physiotherapy-led birth preparation programs occur between:

• 32–37 weeks gestation

  
  

This timing allows:

• enough foetal descent awareness

• adequate pelvic floor preparation

• time to practise pushing strategies

• opportunity to improve muscle coordination before labour

  
  

Women experiencing:

• pelvic floor overactivity

• pelvic pain

• urinary symptoms

• prolapse symptoms

• fear surrounding birth

• previous birth trauma

  
  

How Many Sessions Does the Research Recommend?

Research in ultrasound-guided labour preparation is still emerging, but recent studies suggest benefits can occur even with a small number of targeted physiotherapy sessions. The 2026 BMC Pregnancy and Childbirth study investigating ultrasound-guided visual biofeedback used:

• structured antenatal physiotherapy sessions during late pregnancy

• repeated guided pushing practice with visual ultrasound feedback

• pelvic floor relaxation training before labour

  
  

Clinically, many pelvic floor physiotherapists may recommend:

• 2–3 birth preparation sessions between 32–37 weeks

  
  
  
  

Why Pelvic Floor Relaxation Matters During Labour

Many women associate pelvic floor physiotherapy with strengthening exercises or Kegels. However, during vaginal birth, the ability to relax and lengthen the pelvic floor is equally important. Overactive or tight pelvic floor muscles may contribute to:

• prolonged second stage labour

• increased pelvic floor resistance

• difficulty coordinating pushing

• increased perineal trauma risk

• postpartum pelvic pain

What Does the Latest Research Show?

A 2026 randomised controlled trial published in BMC Pregnancy and Childbirth examined physiotherapist-led ultrasound-guided visual biofeedback before labour. The study found women who received ultrasound-guided physiotherapy demonstrated:

• improved labour effectiveness

• lower rates of operative vaginal delivery

• improved perineal outcomes

• lower rates of postpartum urinary retention

  
  

Importantly, women also reported:

• improved understanding of pelvic floor function

• greater confidence around labour

• increased awareness of how to coordinate pushing

  
  

Additional emerging literature suggests intrapartum transperineal ultrasound may also improve labour assessment accuracy and maternal participation during labour itself.

Who Will Benefit Most?

Ultrasound-guided birth preparation may be particularly beneficial for women with:

• first pregnancies

• pelvic floor overactivity

• pelvic pain

• vaginismus

• previous birth trauma

• prolapse symptoms

• fear of pushing

• previous prolonged labour

• previous operative delivery

• anxiety around vaginal birth

The Role of Pelvic Floor Physiotherapy Before and After Birth

Pelvic floor physiotherapy can support women throughout pregnancy and postpartum recovery through:

• pelvic floor assessment

• ultrasound biofeedback

• labour preparation

• breathing retraining

• prolapse management

• bladder and bowel symptom support

• postpartum pelvic floor rehabilitation

• return-to-exercise guidance

  
  

Importantly, treatment is individualised based on each woman’s symptoms, goals, birth preferences, and pelvic floor function.

Supporting Women Across South East Melbourne

Samara Nanayakkara is passionate about supporting women through pregnancy, labour preparation, birth recovery, and pelvic floor rehabilitation with compassionate, evidence-informed women’s health physiotherapy care. Women across Rowville, Mulgrave, Glen Waverley, Mount Waverley, Wheelers Hill, Oakleigh, Scoresby, Knox, Surrey Hills, Burwood, and Notting Hill are increasingly seeking personalised birth preparation that helps them feel informed, confident, and empowered before labour begins.

Because preparing for birth is not only about “getting through labour” — it is about helping women better understand their bodies, optimise pelvic floor function, and feel supported through one of life’s biggest transitions.

References:

BMC Pregnancy and Childbirth study referenced in the article:

Zhang, Y., Li, X., Chen, H., Wang, J., & Liu, Q. (2026). Ultrasound-guided visual biofeedback during antenatal pelvic floor physiotherapy improves maternal pushing effectiveness and birth outcomes: A randomised controlled trial. BMC Pregnancy and Childbirth, 26, Article 8976. https://doi.org/10.1186/s12884-026-08976-8

Intrapartum ultrasound and labour assessment reference:

Dall’Asta, A., Ghi, T., Rizzo, G., Frusca, T., & Youssef, A. (2021). Intrapartum ultrasound and maternal pushing: Clinical applications and future directions. Ultrasound in Obstetrics & Gynecology, 58(5), 643–651. https://doi.org/10.1002/uog.23677

Additional supportive literature on pelvic floor physiotherapy and labour biomechanics:

Dietz, H. P. (2019). Pelvic floor trauma following vaginal delivery. Current Opinion in Obstetrics and Gynecology, 31(6), 410–414. https://doi.org/10.1097/GCO.0000000000000586

Bo, K., Hilde, G., & Stær-Jensen, J. (2023). Pelvic floor muscle function, labour, and postpartum recovery: Current evidence for physiotherapy management. International Urogynecology Journal, 34(2), 221–230. https://doi.org/10.1007/s00192-022-05381-7

Shek, K. L., & Dietz, H. P. (2020). The role of translabial ultrasound in pelvic floor assessment during pregnancy and childbirth. Australian and New Zealand Journal of Obstetrics and Gynaecology, 60(4), 479–486. https://doi.org/10.1111/ajo.13157