Preparing for Pregnancy: Pelvic Health Therapy While Expecting and After Birth

You’re pregnant. As you think about arranging all the things needed for your newborn’s arrival, your body is preparing itself to stretch and shift, to carry the weight and strain as baby grows from the size of a poppy seed to a watermelon.

Regardless of fitness level or shape prior to baby being conceived, you can expect your body to go through significant changes. Those changes are all related to your pelvic floor — the muscles, ligaments, connective tissues and nerves that sit like a bowl in the pelvis. These muscles play a vital role in bowel and bladder function, sexual function and core stability. Anything that touches the pelvis (back, abdomen, hips) can benefit from the expertise of a pelvic health therapist.

Planning for pregnancy – reaping pelvic health therapy benefits early

Enlisting the expertise of a pelvic health therapist early on in pregnancy can garner huge results. Rather than accepting the likely consequences as the body accommodates a growing baby, moms can proactively build strength and posture to better withstand the added pressure and weight their bodies will carry.

In the prenatal stages, pelvic health therapists can help you:

• Prepare for labor: Learn how to engage and relax pelvic floor muscles properly prior to going into labor leading to a smoother, more efficient labor process. Understanding how the body works and how proper breathing can influence body function can aid in reduced tearing and complications of vaginal birth and give you more control during birth.
• Reduce pregnancy discomfort: Discomfort during pregnancy is common and expected. With pelvic healthy therapy, expectant moms can do strengthening exercises before the body undergoes huge changes. These targeted pelvic floor muscle movements can help relieve back pain, hip pain, sciatica, pelvic pressure and pubic symphysis pain.
• Create core stability: A therapist can assess for diastasis recti (potential stretching of abdomen muscles to accommodate fetus growth) and provide exercises that will help reduce abdominal separation and improve stability.
• Build strength for recovery: The ability to relax and contract the muscles at the base of the pelvis in a coordinated manner improves overall pelvic health. Doing purposeful pelvic floor exercises during pregnancy can prevent or alleviate urinary incontinence (leakage), pelvic organ prolapses and sexual dysfunction as pregnancy moves to late stages and post-birth.
• Prepare for the postpartum experience: Starting with a pelvic floor specialist before birth and continuing through postpartum builds a trusted patient-provider relationship and brings a continuity to care.

An extension of OB/GYN care

As a standard, moms follow-up with their OB/GYN as a check-in at the six-week mark. In this regular visit, your OB/GYN provider may recommend pelvic floor physical therapy. If they don’t refer, you can schedule pelvic health therapy on your own through direct access.

This therapy can be looked at as an extension of the care that enhances the excellent care already provided by your OB/GYN. With the availability of longer appointments and a strict focus on issues related to women’s health and the pelvic floor, seeing a pelvic health specialist can be a vital part of adjusting to life after baby and feeling your best.

Postpartum – Going in reverse

Postpartum, commonly called the fourth trimester, is the phase following birth up to six-eight weeks where your body is recovering from a full nine months of changes. As the body works to return to pre-pregnancy state, postpartum is marked by physical and emotional adjustments as life with a newborn takes shape.

Carrying a baby is a testament to the power and mechanics the female body can endure. It is not surprising that there will be some latent or lasting effects.

Let’s review some common conditions or issues that can be addressed with a pelvic health therapist as your body works in reverse to return to pre-pregnancy shape and function.

• Urinary incontinence: Leaking urine, especially when coughing, sneezing or laughing.
• Fecal incontinence: Difficulty controlling bowel movements.
• Pelvic organ prolapses: The descent of pelvic organs (bladder, uterus, etc.) into the vagina.
• Painful intercourse: Pain during sexual activity.
• Pelvic pain: Aches and pains in the pelvic region.
• Diastasis recti: Separation of the abdominal (six-pack) muscles. Naturally happens in the third trimester as baby reaches peak size.
• Clogged milk duct: When a clogged duct that brings milk to the nipple for breastfeeding gets clogged and prevents the flow of milk.
• Scar management: Healing and desensitization of scaring related to C-section births.

The most overlooked benefit of taking part in pelvic health therapy is the opportunity to have a trusted provider where all questions are good questions. You can privately, safely share any issues you may be have regarding women’s health and any changes you are noting in your body and the way it is working.

Those conversations allow you to focus on your goals, whether it be returning to fitness or to work, or simply getting through life in general with as little disruption as possible.

A look inside pelvic health appointments

Let’s take the mystery out of what pelvic health appointments will include. Communication is key. You are in control of your treatment and we accommodate you the best we can. Come in comfortable clothing that allows for easy movement, as we will be doing exercises.

• Assessment and goal setting – The getting to know you stage. We’ll take a full, hard look at your medical history, have a discussion about how you are currently functioning, issues you may be having, how you’re coping with changes and questions you may have as your body goes through birthing changes.
• Internal and external exams – These exams can happen at the first visit or in follow-up visits based on your level of comfort. We can perform exams internally, externally or neither depending on symptoms, comfort of you as the patient and where you are in the timeline of your postpartum experience. That decision is yours as the patient. The exams help us to determine your current pelvic floor strength, mobility, coordination and if there is any pain or tightness of the muscles we need to address.
• Education – Sometimes the greatest treatment is having the knowledge needed to be empowered to improve health. Our sessions are full of useful information you can carry with you. We help you visualize and understand how your body is working as you go about your day. Recognizing how to make changes in movement to build strength gives you the power to make purposeful changes.
• Personalized treatment plan – When you meet with us, you are uniquely you, and we create a treatment plan that takes into consideration your life and your needs. Using our expertise, we adapt and create plans with not only useful exercises but a complete plan that accommodates your lifestyle and needs to make completing the plan achievable. The plan may include manual therapy, behavioral strategies and other modalities.
• Home exercise plan and follow-up – After your initial evaluation and with a full understanding of your goals, childcare situation, maternity leave including return-to-work date or work schedule, we will determine the best frequency of follow-up for you. In addition, we’ll provide simple-to-follow activities you can do at home to keep positive progress between visits.
• Full privacy – Pelvic health therapy is done in a private treatment room with you and the therapist. You can bring a trusted friend or family member with you if that provides you with a better sense of comfort and safety. You will not be with other patients as we discuss the intimate details of your health.

No babysitter? No problem.

Many new moms are finding ways to juggle the new responsibilities and pressures on time that come into play with a newborn in the house. We encourage you to make your health a priority and pelvic health therapy can help you be your best self as you take on your days.

Not having a babysitter is not a barrier to taking advantage of pelvic health therapy appointments. We encourage you to bring baby with you if needed. In fact, we can practice how to properly pick-up baby and carry baby, using the best posture and strengthening tools, while focusing on how the pelvic floor muscles engage and help with these tasks.

No issues – no need for a therapist, right?

At six-weeks after birth, you may be saying, “I don’t really have any issues, so I don’t need pelvic health therapy.” Our answer is you can still benefit from scheduling a rehabilitation session with a pelvic health expert.

Your body just did an incredible thing growing and birthing a baby and it can take quite a toll on your body and pelvic floor. An initial visit allows us to ensure you have no residual tightness or pain and that the strength of your pelvic floor is good to prevent possible future concerns.

A visit also establishes an existing relationship and support system if you develop issues or concerns much later in the recovery process.

More than just physical

When you put your trust in a pelvic health specialist for your prenatal and postpartum needs, you’re investing in more than just your physical health. Sessions are catered to the needs of moms. It’s a safe space to talk about all concerns, not just pelvic health.

While working with a therapist, you have the opportunity to ask any and all questions. If you’re feeling down, mentally or physically, our experts can address your concerns directly or provide you resources for your needs.

As a mom of a newborn, you’re likely going to be experiencing ups and downs as your body and hormone levels go through the effort of returning to normal.

Having someone to confide in who has medical expertise can be the step you need to be supported. Don’t wait, upgrade your prenatal and postpartum experience today.

Clinical contribution to this blog provided by Women’s Pelvic Health Physical Therapist Kenzie Pratt.