What Happens at a Prenatal Pelvic Floor Assessment at Balanced

Most women planning a vaginal birth know they should think about their pelvic floor during pregnancy. Fewer know that there's a specific assessment designed to look at how it's tracking — and what that means for birth.

During a vaginal birth, the pelvic floor stretches to accommodate the baby passing through. Whether it has the flexibility to do that — and the coordination to relax at the right moment — can influence how the second stage of labour progresses. We've written more about what the research shows on pelvic floor function and birth. The short version: some pelvic floor patterns are worth identifying and addressing during pregnancy, when there's time to do something about them.

The assessment is designed to identify patterns that can increase the risk of pelvic floor trauma during birth — reduced tissue flexibility, poor coordination when pushing, or elevated resting tone — and to address them during pregnancy, while there's time to make a difference.

What we assess — and why each measure matters

Pelvic floor strength and coordination

We assess how well the pelvic floor contracts. But strength is only one part of the picture. We're looking for coordinated function: the ability to switch on when needed and let go when it counts.

The ability to push

We assess your ability to bear down. What we're looking for is whether the pelvic floor relaxes and opens with that effort — or tightens against it.

Some women subconsciously tighten their pelvic floor when they bear down. This pattern, called paradoxical contraction, is more common than most women expect. When it's present, it can make the second stage of labour harder. It's something we can identify during pregnancy, and with the right approach, retrain.

Pelvic floor opening and flexibility

We take specific measurements of the pelvic floor opening — at rest and during bearing down.

The difference between those two measurements tells us how much the pelvic floor opens under load. A restricted opening that doesn't change much between rest and bearing down suggests there's less flexibility in the tissues.

Restricted flexibility is often associated with higher resting tone. If you have symptoms like urgency, pain during intercourse, constipation, or a history of pelvic pain such as endometriosis, elevated tone is worth screening for.

Your birth preferences

We talk through your birth plan, any concerns you have, and what matters most to you. This shapes what we prioritise in the assessment and the program we build from it.

Why we assess twice — and when

First assessment — around 20 weeks

The first appointment is scheduled after the 18-week morphology ultrasound. The reason for this timing is to first identify any factors that would affect how we conduct the examination.

At around 20 weeks, we establish your pelvic floor profile: baseline strength, tone, flexibility, and coordination. This is the starting point everything else is measured against.

Reassessment — around 34 weeks

In the third trimester, oestrogen levels rise. This hormonal shift softens pelvic floor tissues — it's the body's own preparation for birth. At 34 weeks, we can assess how those tissues are responding: whether flexibility has improved, whether tone has shifted, and whether the pelvic floor is tracking well for labour.

What we do with what we find

After each appointment, you'll have a specific plan based on your measurements — not a generic program.

For some women that's targeted pelvic floor strengthening. For others it's downtraining: learning to release and relax rather than contract. Some women need extra work on tissue flexibility, or some practice on how to push effectively.

Book a prenatal pelvic floor assessment

Assessments are available at our Vincentia clinic from around 20 weeks. No GP referral required.