Do female athletes find it harder to give birth?
There’s a common perception that physically fit women, particularly athletes, have more difficult births due to stronger pelvic floor muscles that might resist stretching during delivery. The reasoning seems logical on the surface – if athletes have stronger, tighter muscles throughout their bodies, wouldn’t those same qualities in the pelvic floor potentially hinder the birthing process? Let’s examine what the research actually tells us about female athletes and childbirth.
The physiology of an athletic pelvic floor
Research has shown that female athletes do indeed have some notable differences in their pelvic floor structure and function compared to non-athletes. Kruger et al. (2005) found that elite nulliparous athletes showed alterations in levator ani morphology, one of the key muscle groups of the pelvic floor. Another study by Kruger, Dietz, and Murphy (2007) confirmed that elite athletes demonstrated different pelvic floor functional characteristics than non-athletes.
These physiological differences have led to the hypothesis that athletes might experience more resistance during the second stage of labor when the baby passes through the birth canal. Theoretically, a stronger pelvic floor might not relax and stretch as readily, potentially prolonging labor or increasing the risk of perineal tears.
HOWEVER….the research also paints a much more nuanced picture.
Birth outcomes in female athletes
A case-control study by Sigurdardottir et al. (2019) specifically addressed whether elite athletes experience more complicated childbirths. Contrary to popular belief, the study found that elite athletes were not more likely to have complicated deliveries compared to non-athletes. In fact, the researchers found no significant differences in the duration of labour, rates of instrumental deliveries, or cesarean sections between elite athletes and control groups.
Duration of labour
A common concern is that athletic pelvic floors might prolong labor. However, Salvesen et al. (2014) conducted a secondary analysis of a randomized controlled trial and found that regular exercise during pregnancy did not negatively influence the duration of labour. Some studies even suggest a potential benefit: physically fit women may have better stamina and core strength to effectively push during the second stage of labour.
Mode of delivery
Barakat et al. (2009) demonstrated in a randomized controlled trial that light resistance and toning exercise training during pregnancy did not affect the type of delivery. This suggests that maintaining muscle tone through pregnancy doesn’t increase the likelihood of interventions during birth.
Pelvic floor opening
Bø et al. (2015) used 3D/4D ultrasound to study the pelvic floor “opening” from mid-pregnancy to childbirth in nulliparous pregnant women. They found that general exercise training before and during pregnancy did not negatively influence the pelvic floor’s ability to accommodate childbirth.
The benefits of training for birth
Rather than hindering birth, fitness may actually provide several advantages:
- Enhanced muscular control: Athletes often have better body awareness and voluntary muscle control, potentially allowing them to more effectively coordinate pushing efforts during labor (Parente et al., 2010).
- Better endurance: The stamina developed through athletic training can be beneficial during the sustained physical effort required during labour.
- Faster recovery: The American College of Obstetricians and Gynecologists (2020) notes that physically active women often experience faster postpartum recovery.
- Understanding the balance: As Bø and Nygaard (2020) point out in their narrative review, physical activity offers numerous benefits for women’s health, while the potential negative effects on the pelvic floor must be considered within a broader context of overall health benefits (mental and physical).
The complexity of birth outcomes
It’s important to recognize that birth outcomes are influenced by numerous factors beyond just pelvic floor strength:
- Baby’s size and position
- Maternal pelvic dimensions
- Efficiency of uterine contractions
- Psychological factors and stress levels
- Medical interventions and birth environment
- Individual anatomical variations
The research by Li et al. (2008), which modeled childbirth comparing athlete and non-athlete pelvic floor mechanics, acknowledges this complexity and suggests that the biomechanics of birth involve much more than just pelvic floor strength
Perception versus reality
An interesting aspect of this topic is the disconnect between perception and clinical reality. Kruger, Murphy, and Thompson (2006) studied the perceptions of obstetric caregivers regarding childbirth in sportswomen. They found that many healthcare providers held preconceived notions about athletes having more difficult births, despite the lack of substantial evidence supporting this belief.
These perceptions may influence how care is provided to athletic women and could potentially create unnecessary anxiety about the birthing process.
Anecdotally, I hear this all the time from providers who generalise about birth and athletic females.
Preparing the athletic pelvic floor for birth
For athletes concerned about potential birth complications, the following considerations may be helpful:
- Pelvic floor awareness: Learning to both contract AND relax the pelvic floor muscles is crucial. Many athletes excel at strengthening but may need to practice relaxation techniques.
- Balanced training: As suggested by Clapp and Cram (2012) in “Exercising Through Your Pregnancy,” maintaining a balanced exercise program that includes appropriate modifications as pregnancy progresses is beneficial.
- Expert guidance: The IOC expert group meeting (Bø et al., 2016) provides evidence-based recommendations for exercise during pregnancy for both recreational and elite athletes.
The available research does not support the notion that athletes have more difficult births due to their physical conditioning. While athletes may have differences in pelvic floor structure and function, these differences do not appear to translate to poorer birth outcomes. In fact, physical fitness may offer advantages during labour and delivery.
The perception that athletes have more difficult births appears to be largely a myth rather than a medical reality. As with all aspects of pregnancy and birth, individual experiences vary widely, and numerous factors beyond athletic status influence birth outcomes.
For athletes approaching childbirth, understanding the actual evidence can help alleviate unnecessary anxiety. Working with healthcare providers who understand the specific needs and concerns of athletic women, while maintaining fitness through appropriate prenatal exercise, appears to be the most beneficial approach for optimising birth outcomes.
Ready to train for birth and beyond?
If you’re an active female or athlete navigating pregnancy or preparing for postpartum return to activity, my specialised “From Bump to Barbell” coaching and classes are designed specifically for you.
These evidence-based programs combine my expertise in strength training with specialised knowledge of the pregnant and postpartum body, helping you:
- Maintain appropriate strength throughout pregnancy
- Learn techniques for optimal pelvic floor function during birth
- Build back strength strategically during the postpartum period
- Return to your athletic pursuits with confidence and safety
Beth Davies is a highly experienced personal trainer and coach with over 10 years experience in coaching pregnant, post-natal, or female pelvic health clients. Her programmes educate, empower and support women back to training or their active life, eliminating symptoms and building strength and confidence. She has been featured in women’s lifestyle magazines and websites, including Stylist, Metro, Woman & Home and Marie Claire UK
Beth’s training and coaching for women with pelvic organ prolapse or who are pregnant or post-natal, provides face-to-face personal training in Leamington Spa, Warwickshire, and online across the UK and Europe.