September 30, 2025
The Pelvic Floor Connection Prior to Birth: Podcast Episode #310
Kristin Revere and Brittney Ellers discuss the pelvic floor connection pre-conception in the latest episode of Ask the Doulas Podcast. She also discusses when to begin pelvic floor physical therapy and describes what that would look like in pregnancy, postpartum, and pre-conception. Brittney is a Holistic Pelvic Physical Therapist and owner of Being Better.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am thrilled to chat with my new friend Brittney Ellers. She has so many titles: PT, DPT, RYT. She is a holistic pelvic embodiment guide and physical therapy specialist focusing on the well-being of women throughout all of the stages of our lives.
Brittney has spent the last eight years dedicated to working with women and has had extensive training and experience in physical and energetic well-being, movement modalities, and traditional healing and embodiment practices from across the world.
She is committed to orienting women to their own inner authority and intuition as they thrive, fully aware of their potential, their vibrant health, their sexual power, and creativity.
Her practice, Being Better, seeks to guide women to reclaim their womb wisdom and honor the sacredness of their bodies and cyclical nature.
Welcome, Brittney! That is so fascinating, and we were chatting before we started recording about your own personal experience with all of the different paths that physical therapists can take and that you decided to focus on women’s health and the pelvic floor specifically.
Yes, exactly. Thanks for having me, Kristin. I’m so happy to be here. And yeah, absolutely, I feel like it’s a lot of people’s pathway sometime, even before they get into PT school, that they experience maybe some kind of injury as an athlete or something like that, and that’s what gets them into school. That was not the case for me. My initiation wasn’t until I was already a physical therapist. I was treating outpatient ortho, and one of the pieces of my story was that I experienced some pelvic pain that came through more as urge incontinence. And I already had a hypertonic or tight pelvic floor. I didn’t know this at the time. But it was kind of triggered by use of a vibrator right before work. And I was actually super lucky at the time when this happened. I went into work and had this feeling, this awful pain, and every time I would try to go to the bathroom, nothing would come out. I was actually already working with a pelvic physical therapist. She was my patient at the time. I had a resource right there at my fingertips, and I just called her and asked her, after telling her what happened – what do you think I should do? And it was amazing. She basically just reeducated me on stuff I already knew, but applying it to this really small area of the body called the pelvic floor, with the outcome of relieving that pain within the day, and it never came back again. It came back one other time, but I was at that point so aware of it that I knew how to handle it after that. And for me, it’s a lot of stress that triggers that pain, and so I’ve only experienced that twice in my life. But it was one of the kickstarters into getting into pelvic health and really understanding my body. Not just so that I could be out of pain, but to actually live the life I want to live, which is active and vibrant and full, and I want to be a mother one day. I treat and work with mothers all the time, so it felt very aligned to get into this work.
Absolutely. What a gift. I do feel like pelvic floor physical therapy is having its moment. I mentioned on your own podcast when I guested that it is now something that even OBs are bringing up to patients. When I was a new doula over 12 years ago, it was not anything that was discussed as a resource in that six-week appointment, and we would bring it up as doulas and have a lot of connections with local physical therapists and pelvic floor physical therapists. So we talked to our clients, but they didn’t have a pathway from their provider at the time. And now, things have changed for the better, and I’m very thankful for the awareness and even those insurance referrals and so on.
Right. I was actually just thinking about this this morning. Thank God for the awareness. I feel like for the most part, the people I come into contact with that end up working with me – they’re very much aware, and the same thing with the referrals and OBs here. I feel like they’re aware that it’s here and it’s a resource for women, but there’s still this gap of actually embodying and working with your pelvic health space sometimes. I don’t know if you find this a lot of the time, but it’s not always an easy step to take, to take care of your pelvic floor. And I would hope that resources and encouragement from doulas and any other kind of provider that women are seeing leading up to a birth and/or closely thereafter leads them to really acknowledging this part of them. It’s important, and it’s huge, and I can’t stress it enough.
Agreed. And it oftentimes is only brought up if there’s some sort of trauma at the birth – tearing or a surgical birth and healing that’s needed. Or of course the leaking. And I work with a lot of athletes as doula clients, and they want to get back to their next marathon or swimming, whatever their sport is. They certainly already work with physical therapists and know about pelvic floor physical therapy and don’t want any sort of discomfort or leaking when they’re approved by their provider to get back to physical activity.
Right. But that’s also the hard part right there, and I think part of the education now is not that people know that they can see their pelvic floor PT once they’ve gotten a referral. Ideally, actually, I try to educate my clients and people in my world – actually, you can see a pelvic physical therapist before your six month. I’m out of pocket, so that’s a difference for sure that you have to keep in mind. I would love to see someone as soon as they feel comfortable after giving birth because there’s so many little things that lead to the six-week checkup where they then give you approval to go do your exercise. But it’s like, are you actually going to start running that day? No. A lot of women are really missing that key point where there are obvious steps that lead to then getting back to a marathon. And it’s not like going back into your general training that you did before you gave birth.
And it’s even that breath work while you’re nursing, healing, resting. There’s so many different techniques, and the mindfulness that you bring into your own holistic practice – it is so much more than your typical pelvic floor appointment.
Right. I love to actually – if they don’t have this at any point before they see me, I would love to just debrief about those last few days of pregnancy and then what their actual birth process looked like, if there are any lingering emotions with that. I’ve been really lucky where these women are open to sharing about all the little pieces, because some births can be really, really beautiful, and they say that. And then there are these other little pieces that maybe don’t get named, but that’s literally where the healing can be is just in naming the thing, letting it be witnessed, whether it was just a confrontation with a nurse or this thing was said and that’s not what they wanted and they didn’t feel heard. Or they were in a position for just a little too long and they were kind of just in regret or discomfort. Or maybe there were bigger things to name, but obviously, every process is very different, and then every outcome can be different. And then across multiple pregnancies, for example, for each woman. Yeah, the first session that I get to have after they’ve given birth can be a whole span of things. So giving them space to name that while we’re working with the tissues, working with their body and noting what the energy feels like, if there is anything kind of trapped in there that needs to be expressed and/or witnessed – it’s so important. And then of course, we’re going to go into the biomechanics and see what your connection looks like, see how the tissues are healing if you had any tearing and you were stitched up. And if you had a Cesarean and you were stitched up, how are acclimating with that scar and everywhere else that’s connected to it, because it doesn’t matter which type of birth you have. There’s always some tending that needs to be done around the body and around those areas. Yeah, I do let people know that I’ll see someone before that six-week checkup, which sometimes doesn’t even happen at six weeks; another thing, too. Some providers are so booked out and it takes them eight weeks or longer. So who are these women getting to see beforehand? They might get to see someone like me, which would be great, and we can do external work while I still can see and visibly work with the pelvic floor and help them connect back to their entire core so that they’re not just starting from square one whenever that clearance is happening.
And certainly I have clients that work with a pelvic floor physical therapist in pregnancy, and there’s so much that be done to prepare. You talked about some of that past trauma from prior births and preparing the body, and there’s so much that can be done if there’s a fear of tearing or there’s an issue with the hip and different positions that they might want to birth in, to avoid any discomfort. You mentioned long labors and processing that with someone. That’s one thing about birth and postpartum doulas. We love to be that safe space to process any trauma or hear the birth story, whether it was amazing or had some hurdles. And it is important to be a witness, as you are, to your patients and those who work with you in your programs that you offer.
Exactly. I love that you name that. Honestly, as long as she has that safe space to share, I think that’s golden. And then going back to what you were naming about seeing someone in pregnancy – of course, ideally, if I were going to have the perfect client experience, if you will, it would actually start in preconception. How do I want to phrase this? I mean, there are women who haven’t given birth – such as me, right? – who have pelvic floor issues before giving birth. And whether or not you want children, if you have issues at whatever age, and if you even want to tie it all the way back to maybe your period, when you first get that, and maybe when you’re first becoming sexually active – those are great times to connect with maybe a provider like myself to actually understand your body or know your body, even if it’s not a one on thing. It could be a group class or a class offered online where you actually learn about your anatomy and your physiology in a way that helps you feel empowered about it in all kinds of scenarios, whether that is school or at work and you’re getting your period and/or you’re in a romantic relationship and/or you are – yeah, maybe one day getting into a preconception journey and looking to really connect to these parts of you that you know are going to be in transformation throughout that process of becoming pregnant and then becoming a mother.
Exactly. And I feel like there’s such a fear of tearing with my birth clients or the students in my childbirth classes. So how do you address that, whether it’s preconception or early pregnancy? How can they work with you or another pelvic floor physical therapist?
I mean, number one, naming, like you just said. Sometimes just holding space for the fear, noting it and tracking it in the body. Where is that actually landing? It’d be curious to know, is that more so in your head and your neck or even in your shoulders and your heart? Are there birth stories and lineage stories that have been attached to you and you’re carrying something that’s maybe not even your fear? It’s just a fear that lives in you from your lineage? And/or friends, people in your own community.
And then I’d say there’s a huge piece for education here. Depending on even the position that you’re giving birth in, that can have a huge impact on where most women do tear, which is around the perineum. Maybe not directly in the center, but typically, it’s off to one side. And it’s at different depths, of course, but this is where I think the breathing biomechanics and understanding your body and knowing where tissues should be able to stretch and where tissue should stay strong. Perineal massage is a huge piece right there. I think a lot of women are afraid to do that for themselves, and/or you get so big that you can’t reach from the front. But guess what, guys? You can reach from behind, right?
Exactly, and it can be a great way to have intimacy as a couple. Partners can feel so involved. It gets that oxytocin going and that’s a benefit in so many different ways.
Exactly. Like I said, I love working with women in the preconception stage, and this is where they really hopefully start to get comfortable with their own body in that way, whether it’s with their own hand or with a pelvic wand.
And then going through their early pregnancy – like, bless, we’re pregnant. Okay. So we’re not going to do any hands-on perineal stretching for birth prep until a little later. Let’s hold off until maybe towards the end of the third trimester. But if you’re someone who is consistently not hands on or you’re not feeling sexual during your pregnancy, and you’re not getting that natural expansion and juiciness that does happen when you have sex when you’re pregnant, or if you’re unable to be super active during your pregnancy for whatever reason – then this is where connecting with the tissue, even just by placing two hands over your pelvic floor, your vulva, cupping that, and breathing with her. You don’t have to do any direct hands-on tissue touching, but rather use your breath. Your breath is going to be the biggest and best friend during the whole entire process. So I would recommend staying super connected to your breathing during all types of daily activities. Hopefully, that includes pooping. But typically in pregnancy, people are constipated, right?
Exactly. It’s the whole fear, tension, pain in childbirth. And if you focus on the deep meditative yogic breathing, then you’re less likely to hyperventilate or to have that discomfort. So being one, as you mentioned, with your entire body and your mind is very important. But as doulas, a lot of our focus – of course, we do hip squeezes and counter pressure, but it is reminding our clients how to breathe properly in all of the stages of labor, including the pushing stage. In HypnoBirthing, we call it a birth breath, and it’s a little bit different. They don’t like to use some of the same terminology and it’s viewed a little bit differently.
I feel like there’s an interesting shift, maybe even in the language around pushing these days, right? At least the way I would teach it or talk about it is – I mean, it’s so funny. All the different experiences I’ve had with women in their postpartum – it absolutely depends on, of course, how their birth was, what was said, who was coaching them, who was there, what language did they use. I had a woman one time – this was a while back, and she was coming in for a postpartum pelvic floor assessment and treatment, and during part of my eval, I wanted to see her do a contraction, like a Kegel and a pull up, and what did it look like to come back to neutral, and then what did it look like to, I said, bear down. And she was like, oh, my God, that phrase, it’s so triggering for me. And I was like, oh, that’s really interesting. I’m sorry. Another way to say it is can you lengthen down; can you open up? Let’s see what that movement looks like. Can you do it on a exhale, or does it only happen on an inhale? Or does it happen on a breath hold? Sometimes that pushing and/or bearing down language brings them right back to that moment of giving birth where maybe something happened that they didn’t want to happen, or it happened so fast and it’s just a lot to process and it’s overstimulating. Death, rebirth of the woman you were and the woman that you now are. It’s everything. It’s a lot. So even in these postpartum sessions, I try to be a little careful or give an assortment of language that they can maybe connect to or even a visualization. But if I’m working with someone in preconception or pregnancy, I will talk them through that lengthening. But I usually will call it a lengthening and not a bearing down or a push.
That’s so beautiful because when you think of bearing down, it’s that image you see in movies where the woman is screaming and everything is an emergency. People are running around. And that is not how I see it. I see all types of births, but I usually am not around women screaming. Unless there’s a medical emergency, the staff is not panicking the way they show in TV and movies.
Why do you think that they do that? Because birth is not looking like that these days.
I mean, drama reasons. But if that’s all you know and you’ve never witnessed a woman giving birth, then that is the image that you have in your own mind for your birth. Or as you mentioned earlier, hearing stories from family or well-meaning friends that are, again, this traumatic emergency, surgical birth, or any sort of challenge that you then get stuck in your mind on repeat. It can affect your own experience.
Right. That’s part of the work that I do, too, in pregnancy. I’ll walk someone through all of these different positions, letting them realize and feel not only what feels the most comfortable, but where do they feel the most connected to their pelvic floor and their belly and their breath all in one? For some of them, it’s on their back still because that’s the way that they practice, which is fine. That does put a little pressure on the posterior pelvic floor. But some of them are like, I love this lunge, this half-lunge position. I can imagine myself picking up my baby. And I’m like, amazing. So cool! And then there are some who are like, I need to be on all fours, knees in, feet wide. I can connect there. And I’m like, okay, great. For others, it’s a squat. It can be so many different things, of course.
It’s very primal and listening to your body and moving. For me, I loved hands and knees until the crowning stage, and then I flipped. But I felt so connected and like it was making so much more progress in the hands and knees. And laboring while using all of the squats and lunges. I call it labor Olympics in my childbirth class because you’re trying everything. Even some things that can be a little bit uncomfortable, like toilet sitting can be so effective to bring baby down, and your body is used to opening up on the toilet. But because that perineum is not protected the way it would be if you were sitting on the birth ball, so it can cause a bit more discomfort, but make so much more progress.
Right, that’s so true. That just connects a lot of people to the psychology of their pelvic floor. Like you just named, it’s something familiar where hopefully this is how you go to the bathroom. You are relaxed. There’s not a rush and there’s just an easeful, downward motion. I don’t even want to say pressure. It’s just a downward motion that happens. And you’re totally right. The perineum can have a lot of pressure on it in that moment, but that’s where a lovely compress can come into play. If you turn around on the toilet and you face the tank.
Yes, I have my clients take a pillow and turn backward, yeah. You can even get in for hip squeezes. There’s something about the bathroom space, and I like to get LED candles and line the ledge of the tub in a hospital or the sink and turn out the lights. Again, it’s very primal and can be a way to get progress if you’re feeling like everything has been tried and baby just is not moving through the canal the way you’d like. I love that toilet sitting, as you mentioned, but turning backwards.
With a little hot compress on the perineum so things do soften up.
I’m a big fan of that, especially in pushing.
Oh, yeah, absolutely. Anything that’s going to help soften the tissue in an appropriate way. I love the idea of that. I think tuning out a lot of the noise so that you can then tune in to your inner authority, like you said. Especially if you’ve done a bunch of practice, like you’ve been through a childbirth education course and you actually implemented not just the positions but even the nervous system training. I think that’s really fascinating. I know there are some people in my world who will expand their pelvic floor muscles leading up to their birth, kind of like the perineal stretching, but instead of focusing on – if you want to think about your pelvic floor opening at the vagina as a clock, your perineum being at 6:00 – so typically working between the 4:00 to 8:00 regions at different depths – I know people who are working on the full circumferential dilation and they’re using different sized pelvic wands or actual dildos, almost like a dilator system where you’re practicing and feeling, not for the first time at your birth, but leading up to it, you’re expanding and noticing what it does to your breath, your body, your nervous system. Can you stay present with it and breathe through it?
Yes. Again, it’s all about breath and understanding our anatomy and not shying away from the beauty of childbirth and the empowerment, no matter how birth unfolds or how you choose to give birth or where you choose to give birth. I love everything, including your name, Being Better. I’d love to hear more about the different programs and how our listeners can work with you, Brittney.
Of course! You can head to my website. I have a few different resources for women, especially if you are planning on becoming a mother and/or are already on your path to getting there and you want more on what we just spoke about. If you want some details, I have two different freebies, actually. One is Maiden To Mother and it’s about honoring the preconception and the postpartum stages. The other freebie is called Held, and that is a PDF guide that actually comes along with quite a few videos where I describe a lot of these mechanics that I really want every woman, every woman, to know about their bodies. All of these different breathing practices, knowing when you’re supposed to do what, can make a huge difference in your experience. So those exist on my website.
And then I have my own podcast, the Pelvic Pulse Podcast, where I talk to experts like you. Kristin, you were on there not too long ago.
So amazing!
Yeah, it was such a good conversation. If you are curious about Kristin’s story from her own mouth, come on and listen. There’s a YouTube channel that’s connected to that, too, for this past season. I’ve got quite a few meditations, as well, if you are someone who is on a journey like I am. Like, I’m in a preconception journey right now, so it feels really relevant to me and my system to really hone in on the energetics. And then of course, the physical aspects of preparing my body for this transformation. So I have a few of those meditations on the podcast, as well. And then you can work with me online or in person. I’m in Carlsbad, California. That’s Northern San Diego, if you’re familiar. And I work with people online more so in the pelvic health coaching space, but I can’t turn my PT brain off. I do have another course that’s a little more holistic in the sense of we touch on all different aspects of your pelvic health, and that includes pleasure and it includes trauma healing. It includes lineage and birth story healing. That is called Vaginal Alchemy, and that is a self-paced course with a couple different options for VIP experience where you get to work with me one on one.
Amazing! So many options, no matter what stage of life you’re in – preconception, postnatal, and even the crone stage.
Yes, 100%! I’ve had quite a few crones in my office lately. I’ve had quite a few women in their preconception years, and I feel so blessed. There’s the bell curve, but the bell curve is kind of softening.
Thankfully, yes!
It’s so cool.
Any final tips for our listeners, Brittney?
Final tips – I guess I would just say that to listen to yourself is probably the biggest piece of advice I could give. There are so many experts out there. There are experts like us and women who just want to help and beyond that, I think that most of us, you and I included, I think, see it like this: we’re really just here to point you back to yourself and what feels best to yourself. So learn how to trust that and just be confident in the things that feel right to you and good to you.
Beautiful! We’ll have to have you on again, but I enjoyed this conversation. Thank you for all the resources!
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