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Why Pelvic Physical Therapy Should Be A Standard Of Care Before, During, and After Birth

In this country, if you received a surgery for your hip, knee, or any major joint in your body, the assumption is that you would, of course, rehabilitate that joint.

Why? Because that part of your body underwent a major trauma, tissue was cut through, muscles atrophy, and scar tissue forms. You risk loosing proper function of that part of your body without rehabilitation.

In this country, when a person gives birth, the assumption is that person can return to “normal” after 6 weeks. Without rehabilitation. Even though that person’s pelvic floor also underwent trauma, tissue may have been cut through, and key muscles of the deep core have become de-conditioned or at the very least uncoordinated in way that can lead to prolonged pain and dysfunction.

When you look at most European countries’ healthcare for birthing people, the standard of care is to have postpartum physical therapy. In France, any person who delivers a baby is given 10 free physical therapy sessions that focus on pelvic floor health to prevent issues such as prolapse, incontinence, and pain.

It is no surprise that healthcare for people with vulvas is severely lacking in this country. So while we wait for major systemic and policy changes, it is our job as healthcare providers to educate the public and model what should be the standard for postpartum care.

As a pelvic physical therapist, I have seen significant increases in successful outcomes for people who did pelvic physical therapy immediately after their birth. And yes, I said immediately because pelvic physical therapists are absolutely competent to see patients right away after delivery (and in fact this is better for outcomes). Pelvic physical therapists will not do an internal assessment until the 6 week mark with clearance from your MD, however pelvic physical therapists do so much more than just the internal assessment.

Pelvic physical therapists specialize in the whole deep core system, which includes the abdomen, diaphragm, and even some deep back muscles. This means that right after delivery, topics such as breathing techniques and pressure management, as well as scar tissue management can be addressed right away to prevent worsening or development of dysfunction.

Once a pelvic assessment is indicated, this can be essential for rehabilitating the pelvic floor muscles which play a key role in alleviating urinary and fecal incontinence, preventing prolapse, and allowing for pain free sex.

Having pelvic physical therapy after birth should be the bare minimum at this point in our healthcare. However, if we are to truly strive for the best outcomes for birthing people, we cannot stop there. Pelvic physical therapy during, and even before, your pregnancy can improve the outcomes of your birth and decrease dysfunction profoundly.

At the beginning of a pregnancy, the body starts to subtly make changes in posture and how muscles function that can add up in signifiant ways. Working with a pelvic physical therapist for even just a few sessions in order to develop awareness of postural changes and how to safely adapt to them, as well as how to engage your deep core properly can set you up to have a more pain-free pregnancy and better outcomes with delivery.

Throughout the pregnancy, you may notice small signs of changes such as mild low back pain or occasional urinary incontinence. Although this is often brushed off as “normal” or told to patients that “it will pass after the pregnancy”, this is often the body’s first cue that something is not functioning optimally. Getting ahead of these symptoms with a few sessions of physical therapy can prevent the symptoms from worsening after delivery. It is also often much easier to address these changes earlier on as symptoms get better quicker, saving you time, money, and energy down the road.

It is unfortunate we live in a culture that has not established this type of care as standard. It is frustrating that birthing people must take that extra step, alongside many others, in order to ensure a safe and healthy birthing journey. As a pelvic physical therapist, I aim to make that step easier and more accessible. Being aware that this type of care exists, and the importance of it, is the first step. As a collective, pelvic physical therapists are bringing a stronger voice to the value of this work and changing the quality of life for countless individuals. It is a privilege to be both of service and a witness to the profound life event that is birth. Such an event is stronger in community, and pelvic physical therapists are eagerly ready to be a part of that community, if you so choose to have them from a place of feeling informed and empowered.

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