Have you ever heard of an athlete getting back on the field after a major injury WITHOUT a period of rest followed by intense rehab? Of course not! But somehow the expectation for women after their pregnancy is to mysteriously “bounce back” to normal activity, appearance, and function without any guidance. Most mamas even attempt to do this while caring for one or more very adorable, yet extremely needy human beings.
Thankfully our society is beginning to recognize the fact that child-rearing is hard work and calling in reinforcements for recovery is acceptable and often necessary. I would like to propose that Women’s Health Physical Therapists should be considered another essential part of the postpartum team. As Physical Therapists we can pursue specialization in obstetrics, pelvic health or both to learn more about the ways that pregnancy and childbirth affect the function of the pelvic floor in connection with the entire musculoskeletal system. Pelvic Health Physical Therapists, specifically, have training in assessing the pelvic floor’s strength and function from an external as well as an internal perspective.
The following are common questions that moms are asking that we as Physical Therapists can answer best.
Should moms wait to exercise until their 6 week postpartum follow-up appointment with their Ob-Gyn or midwife?
Who knows exercise better than Physical Therapists? Women are fed all sorts of exercise advice within facebook groups and mommy blogs, but is it reliable? As experts in movement, we can give healthy recommendations on this topic when we have the right training. Women need a strong foundation of core and pelvic floor muscles in order to progress effectively when cleared by their provider at the 6 week postpartum appointment. Even after this appointment, it is wise to progress SLOWLY back into the exercises they know and love. Nothing magical happens after 6 weeks of rest that suddenly allows a woman’s body to jump back into her Zumba classes. Women need to be educated on breathing, body mechanics, and safe progressions, and that’s where we come in.
Is it normal for sex to be painful after having a baby?
Pain with intercourse otherwise known as dyspareunia after childbirth is common; however, not normal. If it’s been months or even years since a woman has had her baby and she is still experiencing pain with sex, the pain is probably not going to go away without treatment. A study from 2015 found that at 6 months postpartum 94% of women had started having intercourse again, but 43% of them were still experiencing pain! Scar tissue, muscle tightness, and birth trauma are a few common causes of pain with sex. Women’s Health or Pelvic Health Physical Therapists can guide women through the recovery process by teaching pelvic floor relaxation, stretching, manual techniques, and educating on the use of tools like dilators to reach their goals through home exercise programs.
How do women repair diastasis recti?
Physical Therapists and researchers are constantly asking this question as we look for the best way to address diastasis recti. Diastasis recti is simply the separation of abdominal muscles. It is commonly found in women during and after pregnancy. This abdominal separation can often be closed with education and exercise. When a woman’s goal is to strengthen her core and close the gap in her abdominal muscles, we start with education on breathing and deep core activation and end with safe progressions back to the workouts she enjoys most by incorporating the basics into every single exercise and activity she does. As Physical Therapists, we can apply the fundamentals that we have learned regarding exercise and core strength and apply it to the goals of a mom.
Will a woman’s vagina ever be the same after perineal trauma?
After perineal tearing or incisions from episiotomies, women often notice changes to their vulva, vagina, and perineum. This is both an emotional and physical problem for women. Some of the most common changes that occur after perineal injury are pelvic floor weakness, incoordination, incontinence, and pain. Typical treatment for pelvic floor weakness includes diaphragmatic breathing, improving coordination and strength of the pelvic floor muscles, and adding progressive loads to the pelvic floor. If pelvic floor dysfunction and pain are not addressed, women will likely experience incontinence and/or prolapse in the future. Think about recovery after knee replacement. Typical protocol is to mobilize the scar, strengthen injured muscles, and improve coordination and proprioception. These same familiar concepts can be applied to the pelvic floor after perineal trauma.
In addition to addressing the above mentioned postpartum questions, Women’s Health Physical Therapists mobilize cesarean scars, teach mechanics for protecting the pelvic floor during bowel movements, offer solutions for the various kinds of incontinence, alleviate symptoms associated with prolapse, teach body mechanics for lifting baby gear and children, educate on breastfeeding positions, assist with strengthening and home modifications when nerve injuries happen during delivery, and more. It may be surprising to learn that it is beneficial for Orthopedic Physical Therapists to acknowledge the pelvic floor as well because cesarean scars and pelvic floor dysfunction could be contributing to your female patient’s back pain.
Postpartum Physical Therapy services can be introduced immediately following birth while at the hospital, completed at an outpatient clinic, or even provided as an in-home service. Unfortunately, therapists are not automatically included in postpartum care in the United States, but thankfully they are often accessible and sometimes even covered by insurance depending on location.
Not all therapists have an interest or expertise in Obstetric Physical Therapy; however, knowing what services these therapists provide can improve the quality of life for many women. Commonly women say that nobody ever asked about their incontinence or pelvic pain or even worse a provider told them it was normal because they have had children. Learning about and becoming comfortable screening women for pelvic health concerns will allow you to be a bridge that empowers women to heal completely after child birth. Mamas do incredible things and they deserve to have the resources they need to stay happy and healthy.
Dr. Nicole Bringer, DPT
Owner of Mamas & Misses, LLC
Creator of Online Postpartum Recovery Course
Website: www.mamasandmisses.com
Email: nicole@mamasandmisses.com
- McDonald, E. A., Gartland, D., Small, R., & Brown, S. J. (2015). Dyspareunia and childbirth: A prospective cohort study. British Journal of Obstetrics & Gynaecology, 122(5), 672-679.
