If you are pregnant, or even thinking about becoming pregnant, it is never too early to get your body in shape to minimize the physical effects of carrying a child.

Kegel exercises, also known as pelvic floor muscle exercises, can decrease incontinence, and your first pregnancy is one of the best times to learn about them. Not only because the need is so great—up to 70% of women have some leakage during or after pregnancy—but the muscles have not suffered the trauma of birth.

Another helpful activity is called the Perineal massage.  It involves gentle stretching of the vaginal opening, and may decrease the risk of birth injury and pain afterwards.

Several aspects of childbirth that may seem inevitable are, in fact, choices to be considered. While easy to say but hard to enact, staying as relaxed as possible for as long as possible can greatly reduce pain of delivery. When stress hormones kick in and pelvic floor tension rises, pain or anxiety increases. The results can directly impact incontinence in the coming days and even for years to come.

Along with a relaxation strategy, there are other things you can explore to make childbirth less stressful on you and your child. There is no avoiding the fact that labor pushing introduces tremendous strain on the pelvic floor.

While there is no one ‘best’ method of pushing, you should know your options.

• Which position? Although lying down on your back (lithotomy) is most common, alternatives include squatting, sitting, sidelying, and standing. Certain positions might influence the risk of pelvic or perineal injury, such as back lying with legs strapped in stirrups.

• When to begin? Recent studies indicate by allowing the fetus to ‘passively’ descend through the birth canal with gentle pushing reduces the risk of difficult deliveries, forceps, and perineal injury.

• For how long? Prolonged pushing may sometimes increase the risk of pelvic nerve injury, fecal incontinence, and bladder dysfunction. You may wish to discuss reasonable limits for pushing ahead of time with your doctor or nurse midwife.

Other childbirth issues include surgical techniques such as episiotomy. This refers to the intentional cutting of the perineum during childbirth. Today it’s known that episiotomies are rarely of benefit in terms of preventing injuries to the pelvic area. However, ‘selective’ episiotomy remains an important tool and can benefit the immediate health of mother and child.

Obviously, big babies are associated with more severe perineal, rectal and pudendal nerve injuries, and incontinence. If you are carrying a macrosomic (9 pounds or more) baby, be sure to understand these issues.

While the use of a vacuum may be associated with less pelvic floor trauma, forceps delivery carries an increased risk for urinary incontinence and injuries to the anal sphincter and pelvic floor compared with spontaneous vaginal birth.

The ‘Cesarean by Choice’ debate is surrounded by complex medical, economic, and social questions. In parts of South America, cesarean rates exceed 90%, whereas trends in Europe have favored vaginal birth whenever possible, even if it entails a long or difficult labor.

Determining the right policy will require more research. In the meantime, know the facts.

• Consider the risks. Although a c-section is safer today than at any time in the past, it still carries potentially serious risks for mother and baby.

• Consider the benefits. Urinary incontinence, anal injuries, and pelvic prolapse are less common after cesarean. C-sections with the lowest incidence of injury appear to be those performed in the first pregnancy, before labor begins.

• Individualize your choice. Most obstetricians and midwives share the goal of a vaginal birth whenever the benefits outweigh the risks. In some cases, a difficult vaginal delivery may be more physically traumatic than a cesarean. For others, the exact opposite will be true.