Pelvic Floor PT After Childbirth

So you just had a baby? Congratulations! Or maybe you're pregnant. Or maybe you have a friend or family member who just had a baby. Or maybe you're just curious how pelvic floor physical therapy could help a woman after childbirth. Whatever your reason for finding your way to this blog, I hope I convince you of the importance of pelvic floor PT after childbirth.

Postpartum care for women in this country is a JOKE. Some form of pelvic floor physical therapy or rehab is standard in many countries throughout the world. In France, women are automatically prescribed 10 pelvic floor PT sessions regardless of delivery type or symptom presentation. The thing is, most women don't know what they don't know. What's normal? What's not normal? When can I start exercising again? Why do I still look 6 months pregnant at my 6 week check up? Any of this sound familiar?

Ever given birth? It is 100% an athletic event. No matter the baby's exit strategy (vaginal or cesarean delivery), a woman's body goes to hell and back to bring this beautiful life into the world. Physical therapy is the standard of care after major musculoskeletal surgeries or injuries. Why should childbirth be any different?

I have a follow up with my doctor. Won't they tell me if I need physical therapy?

Mamas get one follow up visit (2 if you're lucky) during the first year after childbirth. Most often this occurs at 6 weeks. You know how many that baby gets in that same year? 6!! Mamas go from once a week appointments in the last month of pregnancy, to one total in the year following delivery. The focus of that appointment is typically to discuss birth control and screen for postpartum depression. If you have a great OB or midwife, they'll actually do a muscle assessment. But most do not. Once you are 6 week post-partum, you're just supposed to magically be ready to have sex, train for a 5K, or get back to CrossFit?

Absolutely not! The latest research shows that women should not return to running until 12 weeks at the earliest. There is actually a check list of smaller milestones to master without leakage, pain, or pressure before transitioning to running. Your physical therapist can help you through this list to ensure your body is ready.

I had a c-section. Shouldn't my pelvic floor be fine?

FALSE. Pregnancy and carrying a child alone, can cause changes to the pelvic floor, hips, and low back. Straining from constipation can also affect your pelvic floor. Larger breasts larger from breastfeeding can lead to upper back pain. Muscle imbalances in the pelvic floor or scar tissue from vaginal tearing can lead to painful sex.

You get the idea. Pregnancy and delivery can have a profound impact on your body. Click here to read a previous blog with details on the postpartum phase including how hormones affect a woman's body, how a vaginal or cesarean delivery occurs, postpartum body mechanics, returning to sex, returning to exercise, and other tips.

What does a pelvic floor PT assessment after childbirth look like?

• Lots and lots and LOTS of questions (medical history, what concerns you have, what your goals are, etc)

• Looking at your abdominal muscles to see if they've come back together (they frequently separate during pregnancy to make room for baby)

• Looking at scar tissue from c-section or vaginal tearing

• Hip and core strength testing

• Pelvic floor muscle assessment (best completed vaginally as long as you're ok with it). This will include looking at the strength and endurance of the muscles. It is also important that the muscles can relax and lengthen/bulge.

• Bring the baby if you want/need to. We can work on different way to feed, carry, or change your baby

What I can do between birth and your 6 week assessment?

1. SLEEP! Seriously. Your body needs rest to heal. And let's be real, I have NEVER heard a mom say they got too much sleep with a newborn.

2. Breathe. More specifically diaphragmatic/belly breathing.

   • HOW: Sit down or lie on your back. Place one hand on your belly and one hand on your chest. Take a big inhale in and do not allow your chest to rise. Your belly should get big with the inhale. This is your diaphragm descending and your abdominal organs moving. This helps your pelvic floor move up and down with your breath.

   • WHY: This breathing ensures the pelvic floor can move both directions, helps get oxygen to healing tissue, helps massage and stimulate your bowels, helps decrease anxiety, and helps lower your sympathetic (fight or flight) nervous system. I am a HUGE fan of diaphragmatic breathing. Maybe I will do a separate blog on it in the future.

3. Pelvic floor contractions. Anytime you are feeding your baby, try to pick up a blueberry with your vagina. Make sure to set the blueberry back down. Do this 5-10 times with each feeding, as long as you are not having pain. If you had a grade 3-4 vaginal tear, you might want to wait a week or so before attempting this.

4. Engage your tummy muscles anytime you are carrying or lifting your baby.

5. Use proper body mechanics to minimize strain on your stretched out tissues.

   • Roll over onto your side before getting out of bed, or off the couch. Your abdominals are stretched out and probably weak from pregnancy. Your organs are trying to remember where they're supposed to go. Do your body a favor and don't ask them to work this hard yet.

   • Keep your rib cage stacked over your pelvis whenever baby wearing, carrying your baby, or pushing the stroller.

   • Bring the baby to you instead of slouching when feeding the baby (either bottle or breast feeding).

   • Drink LOTS of water (this helps with milk production, helps keep stool hydrated, and helps restore blood volume). We frequently lose a lot of blood during childbirth.

Better yet, see a pelvic floor PT when you're pregnant to get a personalized postpartum plan.

My hope and prayer is that by the time I retire, pelvic floor PT will be the norm after childbirth. For now, I will settle for trying to educate the world from my keyboard.

Til next time... Dr. Jen.