BIRTH AS A MOTOR SKILL: Applying Exercise Physiology to Labor Preparation for Improved Outcomes

NOTE: This is the first in a series of posts that derive from a presentation authored by DTP Director Ann Cowlin for the 2018 Normal Birth Research Conference. Remaining posts will be added each week on Wednesdays for the next several weeks.

When a person desires to run a marathon, she trains, doing those things that enable the person to achieve the goal. When an exercise physiologist views labor and birth as an athletic event, she sees specific challenges and seeks to train pregnant women in ways that produce a healthy labor, birth, mother and newborn.

Designing a program to specifically address improved outcomes is tricky. Many existing prenatal fitness programs address some of the areas required, others focus on one skill as a magic bullet. The reality, as so often is the case, is the necessity of doing all those things that are effective and avoiding the so-called junk workouts. So, what does an effective program look like? This presentation offers some possibilities.

The well-established principles in exercise physiology that are emphasized here are training specificity, overload, muscle bonding, and flow (or zone). They are defined and explicated, and intersections of these principles with the physiology of labor and birth are enumerated. Childbirth literature is clear that physically fit women, with skills to prevent oxygen debt and muscle fatigue, with confidence, and who have continuous support in labor, are less likely to require intervention to give birth.


The successful preparation for any intense physical challenge includes practices shown to improve outcomes for participants because these practices enhance the physiologic systems or skills required during the activity or event. Identifying physical challenges of an activity or event permits design and testing of an evidence-based best practices model of physiologic preparation.

Childbirth and exercise physiology literature are clear that

  1. Pre/postnatal Exercise is generally safe and can be effective in helping produce birth and health outcomes that are beneficial for pregnant women and their offspring [1,2,3].
  2. Physically fit women, with skills and the capacity to prevent oxygen debt and muscle fatigue, with confidence in their bodies, and who have continuous support in labor, are less likely than sedentary women to require intervention to give birth [4] and may have shorter labors [5].


Labor and birth are intense physical challenges that require endurance and stamina over an extended period of time, the ability to cope with high intensity intervals and quick recovery, strength, mobility, emotional support, and the ability to enter a parasympathetic or alpha brain wave driven state. These factors point to a physical preparation based on evidence of exercise principles that produce progress in these areas.

These well-established principles in exercise physiology – listed below – help us meet these needs. Note these are physiological principles, not methods. Some validated methods of achieving outcomes derived from applying these principles are given as examples in the discussion that follows.

  • Training Specificity (discussed in this post)
  • Overload and Progression
  • Muscle Bonding
  • Flow (or The Zone)


“Specificity is the principle of training that states that sports trainingshould be relevant and appropriate to the sport for which the individual is training in order to produce a training effect. Training must also progress from general conditioning to specific training and skills for the sport or activity. You must perform the skill in order to get better at it.” 5/27/18

Two important relevant points are contained in this definition:

  1. An underlying general fitness precedes more detailed training and skill acquisition.
  2. The event or sport activity dictates the type of underlying fitness that is needed.

Stamina.By definition labor and birth are ultra distance endurance events. Thus, cardiovascular conditioning (a.k.a., cardiorespiratory or aerobic conditioning) is the underlying type of fitness base needed. Without this base, skill acquisition may be futile, especially if skills require mental attention. The discomfort of oxygen debt intrudes on the effort to “go with the flow” or move in response to bodily sensations. By contrast, stamina permits the mind to focus on resolving emergent needs.

What methods of cardiovascular conditioning might be most appropriate for labor and birth?Vertical, weight-bearing movement– jogging, aerobic dancing, and elliptical equipment – are ideal. See Figure 1.

Fig 1: Aerobic Dancing is a fun method for cardiovascular conditioning.

These forms mimic labor activities that elicit gate-control of pain and gravity-assist. Almost any safe aerobic activity helps the body learn to use and replace oxygen in the utero/placental environment, affected by hypoxic tendencies during contractions [5].


High Intensity Interval Training (HIT or HIIT).Repeated bouts of high intensity activity, alternated with a recovery phase, also characterize labor, particularly first stage active labor/transition and second stage. HIIT – the associated training strategy – raises anaerobic threshold, reduces stress on cardiac reserve, and enhances metabolism [6]. HIIT in cardiovascular and strength training regimens produce beneficial outcomes [7,8]. Practicing HIIT sequences develops muscle memory, freeing the mind to focus on response to the body’s needs.Cross-fit or boot camp training are examples. Are they safe in pregnancy? If appropriate.


Strength and Mobility.To achieve positions and movements that allow the body to release rather than resist the cathartic demands of birth depends on body trust– the accomplishment of successful experiences that develop strength and flexibility, enhance kinesthesia and improve confidence in one’s body.

Fig. 2: Developing kinesthesia of the vaginal birth area.
1) kinesthesia aids 2) motor control, which leads to
3) accomplishment, implementing 4) body trust.

An example of this is learning to open the pelvis through various strength, release and bulge practices. To identify the birth target area,moms-to-be can sit upright on the ischial tuberosities (sitbones) with iliofemoral flexion, shown in Figure 2.

Focusing on the vaginal opening between the sitsbones, they locate the outlet, and develop kinesthesia and a mental grasp of this area as an exit. Practicing the muscular actions (tighten, release and bulge) that control the outlet permits the pregnant women to learn the difference between a restricted and released birth target. Additional exercises to develop skeletal muscles surrounding the pelvis, help prevent postural fatigue during second stage in various positions.


References for Post #1:

  1. ACOG Committee Opinion 650. Physical Activity and Exercise During Pregnancy and the Postpartum Period.2015.
  2. Barakat R, et al. Exercise Throughout Pregnancy Does Not Cause Preterm Delivery. A Randomized, Controlled Trial. J Phys Act Health.2014 Jul;11(5):1012-7. doi:10.1123/jpah.2012-0344. Epub 2013 May 10
  3. Blaize AN, Pearson KJ, Newcomer SC. Impact of maternal exercise during pregnancy on offspring chronic disease susceptibility. Exerc Sport Sci Rev. 2015;43(4):198-203.
  4. Owe KM et al. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study. Am J Obstet Gynecol. 2016 Dec;215(6):791.e1-791.e13. doi: 10.1016/j.ajog.2016.08.014. Epub 2016 Aug 23.
  5. Barakat R et al. Exercise during pregnancy is associated with a shorter duration of labor. A randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018 224:33–40.
  6. Dobierzewska A et al. NFAT5 Is Up-Regulated by Hypoxia: Possible Implications in Preeclampsia and Intrauterine Growth Restriction, Biol Reprod.2015 Jul;93(1):14. doi: 10.1095/biolreprod.114.124644. Epub 2015 May 20. 
  7. Laursen PB, Jenkins DG. The scientific basis for high-intensity interval training. Sports Med2002;32(1):53-73.
  8. Schubert MM, Clarbe HE, Seav RF, Spain KK. Impact of 4 weeks of interval training on resting metabolic rate, fitness, and health-related outcomes. Appl Physiol Nutr Metab. 2017, Oct;42(10):1073-1081. doi:10.1139/1pnm-2017-0268. Epub 2017 Jun 20.

#Birth #PregnancyFitness #FitnessForBirth #DancingThruPregnancy #BirthOutcomes #BirthAsAMotorSkill

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