Prenatal and Postpartum Physical Therapy

Are you living with the “normal” issues of pregnancy or postpartum, like back pain or urinary leaking? However common, these symptoms are NOT normal and can lead to long term issues if they go unaddressed!

Much can be done to support the pregnant and postpartum woman. You do not have to live with pain just because you are pregnant. And you do not have to live with bladder leaking or weakness just because you had a baby. These are not normal conditions for anyone, whether or not you’ve had a baby. Physical therapy can provide successful interventions to address pain and disability specifically related to pregnancy and childbirth. It is important to find a therapist who has trained and specialized in pelvic health, preferably with experience in maternal care (prenatal, postpartum, and labor & delivery). These professionals, like myself, are especially prepared to help optimize your pregnancy and postpartum lifestyle, as well as childbirth outcomes (less injury, better function), and can be a valuable part of your maternal healthcare team. I believe that prenatal and postpartum physical therapy should be a routine part of our covered and standardized maternal healthcare structure. Here’s why, and how:

PREGNANCY:

Common issues experienced during pregnancy include: back pain, pubic symphysis pain, round ligament pain, urinary leaking, and constipation. Sometimes issues can continue from pre-pregnancy into pregnancy, and treatment should also continue! Some examples of pre-existing issues that can get worse during pregnancy due to changing hormones, weight gain, and a shifting center of gravity are: painful intercourse, tight pelvic floor muscles, and joint pain. It is important to get pain and disability addressed DURING pregnancy so that they do not get worse with time or become injuries during childbirth. It is also helpful to learn what positions you should use and avoid during labor and delivery that would work best for your body, especially if you have existing or prior joint pain or injury of the back, hips, pelvis, or knees, like a herniated disc, hip impingement, or meniscus tear.

If you do not have any regular issues during pregnancy, I recommend that you schedule a prenatal evaluation to learn preventative strategies to maintain your fitness and comfort, to prepare for labor & delivery, and to prepare an early postpartum plan for return to your normal level of activity. Areas assessed include: posture, alignment, balance, mobility, stability, coordination, and pelvic floor fitness (do you know how to kegel correctly and how to push correctly?).

POSTPARTUM:

Common issues that women experience after childbirth include back pain, diastasis recti abdominis (separation of the 6-pack muscles vertically along midline), incontinence, pelvic organ prolapse, and scar tissue pain or tightness. Scar tissue can be numb or painful, and the muscles underneath can be weak or tight, resulting in incoordination - the inability to do their job correctly. This can occur on the abdomen from a Cesarean section or at the perineum from an episiotomy or tear. Weakness and incoordination often result in poor control of pressure within the abdominal cavity, which can weaken the necessary tension of our connective tissue that supports safe movement and handles load, like picking up a child, pulling open a heavy door, getting up from the floor, and lifting weights. Lingering weakness of the abdominal wall can contribute to a hernia, and lingering weakness of the pelvic floor can contribute to bowel & bladder incontinence and/or pelvic organ prolapse. It is certainly not guaranteed that you will develop these issues if the core remains weak, but predisposition to it is important to address as early as possible to minimize risk of injury.

CONCLUSION

Every pregnant woman deserves a musculoskeletal assessment and personalized preparation for childbirth. I highly recommend that every pregnant woman receive prenatal physical therapy, regardless of symptoms, to address predisposing factors to pain or injury during pregnancy and childbirth (such as poor posture, herniated discs, hip impingement, constipation, etc.), to prepare for labor and delivery to minimize risk of injury to the pelvic floor, and to prepare an early postpartum recovery plan for the time spent at home (yes, you can exercise right away, if you know the appropriate activities). Additionally, every woman deserves consistent and continual postpartum rehab care beyond the first six weeks. Rehab during the first several months offers the opportunity for return to stable and normal function with reduced risk of future issues. Here is what the minimum plan of care looks like with me at Stendahl PT (may include more visits if addressing specific pain or disability):

First Prenatal Visit:

• Musculoskeletal assessment – posture, alignment, mobility, strength, stability

• Pelvic floor assessment – kegel strength, ability to contract and relax the muscles, ability to bear down properly (pelvic floor assessment depends on trimester)

• Breathing patterns and breath coordination during exercise and functional movements, including diaphragmatic breathing

• Technique for getting out of bed, lifting, squatting, etc. to avoid injury to abdomen and pelvic floor

• Sleep positions

• Core strengthening exercises

• Toilet management - reducing constipation or leaking (as needed)

• Rehab exercises (as needed) for pain management and function

Second Prenatal Visit: (encouraged to bring partner to this visit)

• Labor and delivery positions to avoid injury, specific to your body and any pre-existing pain or injury

• Labor pain management techniques

• Postpartum scar tissue management plan

Third Prenatal Visit: (at least 36 weeks pregnant)

• Perineal massage

• Push prep

• Review of labor & delivery positions to avoid injury, specific to your body and any pre-existing pain or injury

• Early postpartum exercise plan

Postpartum Visits:

• A series of appointments covering at least 4-6 months postpartum

• First visit recommended within the first 2 months postpartum and/or after your 6-week checkup

• Will address pain, injury, scar tissue, general fitness, pelvic floor recovery, diastasis recti (abdominal wall), and return to exercise programming

• If returning to higher intensity activities or running, the PT care may span longer or include more frequent visits to ensure safe progression to these activities