I love to tell people I am a pelvic floor therapist. I often get a lot of funny looks, plenty of questions, and a few jokes. I hear things like "pelvic floor, what is that?" or “You talk about what?!” or "My aunt had pelvic floor PT, and loved it". My favorite question is "I had a baby a couple months ago, should I go to pelvic floor physical therapy?"   That's the easy question for me because it's always YES. Seeing a pelvic floor PT during postpartum can be so helpful even if it is just to get evaluated by an expert in postpartum care.  Think about it, during pregnancy a woman will see their gynecologist every couple weeks to check in on the baby. Yet as soon as baby is born moms are often only given one 6 week follow up and a suggestion to "work on your kegels." Come on guys, we can do better! Let's talk about postpartum care 

What is PostPartum Care 

Insurance is hard. I would like to go in depth on what insurance and the medical field deems necessary when looking at healthcare across the pregnancy continuum. Honestly, this all depends on the insurance plan and benefits you make through a job or your spouse. So to generalize it according to the Associations of Women's Healthcare, "If your pregnancy is free of complications and your overall health is normal, you’re likely to have about 15 prenatal visits during your pregnancy". So generally you see your physician regularly for 6-9 months as you progress through pregnancy to discuss health changes and overall concerns. During postpartum, there is ONE 6 week follow up with the OBGYN who then "gives you the clear".  To really drive that home it's 15 visits prenatally and 1 visit postpartum. When we compare the level of care between the two it seems ludicrous. Things seem to be changing though. Recently the American College of Obstetricians and Gynecologists (ACOG)  put out the recommendation for "moms to connect with their ob-gyns several times during the 12 weeks after birth". Your OBGYN cant handle everything and may not even have the availability for multiple follow ups. That's where a pelvic floor physical therapist can help fill the gap in care.

 The Gap in Care

What is covered at the 6 week check up anyway? Really this can vary depending on the physician, the type of labor/delivery, and health status of mom and baby. Generally, the OBGYN will perform a pelvic exam to check healing of tissues. They should also address concerns over urinary  continence, pelvic pain, abdominal pain, and cesarean healing. They often also screen for depression, discuss concerns with feeding, and monitor baby's growth. These are all great and important things to check! However, say there is urinary incontinence or pain with sex. What then? Who do you see about that? Vice versa, your OBGYN tells you that everything is "healed" and you're cleared. Internally you may be panicking because you still cannot sit up out of bed without using your hands or help from your spouse. They say it's okay to be sexually active and return to exercise and to “listen to your body”. That can be daunting and scary for moms who already have the stress of a new baby. Many women want to return to exercise but don't know when or how. As a pelvic floor physical therapist I hear this all the time. "I want to go back to running, but I leak urine when I try" or "I want to go back to Crossfit, but I don't want to hurt my back". These are very valid and important questions and concerns that a lot of new moms have. New moms are getting bombarded by family, friends, and social media on the importance of "healing" and "bouncing back" after having a baby. Yet, no one is giving them guidelines or information on how to go about it.

Postpartum Expectations

How important is this 6 week window? I often get this question from both new moms and moms that have had multiple pregnancies. My answer? It's my opinion that 6 weeks doesn't really mean that much on its own. We have to consider the whole picture! This includes the pregnancy, labor/delivery, and postpartum status. Was pregnancy really difficult? Was there an emergency C-section, do we have to consider postpartum depression? There is so much more that can affect how we are progressing through the postpartum period rather than giving it a couple of weeks. In general this is what I have been taught/ seen in the clinic. 

Given a "normal and non-eventful" pregnancy/delivery new moms should expect to spend 1 year on average for their strength to return to prenatal levels. Did you hear me world?! ONE YEAR POSTPARTUM TO RETURN TO PRENATAL STRENGTH LEVELS! 

Of course, this is a general statement that isn't written in stone. Some women feel that their strength returns quicker than that...but in some cases it's more than a year. Again, we should consider the demands baby 1, baby 2, or baby 7 can put on the body and that things can look different with each pregnancy. I am treating a mom in the clinic that is on baby number 7. That's right folks, baby number 7. We have discussed expectations and a gradual return to Crossfit that is fitting her needs. She has told me that every postpartum experience has been different.  So let's push the norms on care and be better for our moms.

Expect More

Bottom line, moms deserve more postpartum care to meet the demands of everyday life as well as their individual goals of returning to exercise and quality movement. As a pelvic floor therapist, we discuss urinary leakage, abdominal wall separation, back pain, hip pain, pain with sex, and return to sport. Then together we make a personalized plan postpartum to protect tissues that are still healing, improve body awareness, regain muscle strength and endurance, normalize bowel/bladder habits, and decrease/eliminate pain with sex. Expect more in your healthcare journey and make an appointment with a pelvic floor physical therapist if you're a new mom. Maybe you don't feel like you need a ton of things, but it's a great place to start. 

References

Tiffany Athey, MSN, WHCNP-BC. (n.d.). How often should I see my doctor during pregnancy?: The Association for Women’s Health Care: OB/GYNs. https://www.chicagoobgyn.com/blog/how-often-should-i-see-my-doctor-during-pregnancy#:~:text=Most%20women%20have%20a%20schedule,weeks%2036%2D40%20of%20pregnancy

What to Expect at a Postpartum Checkup—And Why the visit matters. (n.d.). ACOG. https://www.acog.org/womens-health/experts-and-stories/the-latest/what-to-expect-at-a-postpartum-checkup-and-why-the-visit-matters

Selman R, Early K, Battles B, Seidenburg M, Wendel E, Westerlund S. Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport. Int J Sports Phys Ther. 2022 Oct 1;17(6):1170-1183. doi: 10.26603/001c.37863. PMID: 36237644; PMCID: PMC9528725.