Why Post-partum Physical Therapy Should Be The New Standard of Care

So… you had a baby. Congratulations!

You got pregnant and watched your body go through these AMAZING changes over a period of 9 months. There were even changes that you did not see. These included:
– the stretching of the linea alba as the abdominal muscles and connective tissues stretches to accommodate your growing stomach
– the relaxation of pelvic ligaments to accommodate for growth of the baby by also labor
– stretching of muscles to accommodate for the above
– slight separation of your pubic bones, up to which 2-4mm is considered normal, to accommodate for passage of the baby during labor
– orthopedic issues including SI jt dysfunction, lumbosacral, thoracolumbar and even sometimes cervical issues due to postural changes.
– decreased muscle tone based on your ability to remain active throughout your pregnancy. Remember not everyone is able to actively participate in some type of fitness although it is highly recommended. There are women on bedrest with precautions and there are many more who don’t have access to or know where to find good instruction for safe activity during pregnancy and as a result opt to “be safe rather than sorry” and not do anything. Then there are those who continue their sedentary lifestyle throughout.

Now depending on the type of birth you might have had, whether you labored for a long time, whether you had a vaginal or a cesarean, there might have been even more changes. These may include: tearing of your perineum (the area between the vaginal entry/ introitus and the anus; disruption of pelvic floor muscles depending on forcefulness, speed of birth and length of labor; disruption of connective tissues if a cesarean and sometimes even with a vaginal birth.

So how does one check at 6 weeks help?!!?!?!?! A peek at the uterus and a papsmear. Maybe you had a physician who asked about breast feeding and or asked a few questions to screen for post-partum depression (or maybe you didn’t). It all seems insufficient as far as postpartum care goes. Somehow the focus post birth seems to be on the baby… and don’t get me wrong, it should… but you know the saying “If momma ain’t happy, ain’t nobody happy!” and I think that has never been truer. If moms are in pain, unable to move and function, have diastasis recti, have abdominal pain, adhesions due to scarring, unable to control urine and feces, unable to have sex, fractures of tailbones and so on, we are not only talking about physical implications, but we are now talking about a lot of psychosocial issues that impact this female and by extension her family and can as a result have an impact of her ability to function optimally even as a mom in some cases.

Research has shown that approximately 50% of women have diastasis recti after giving birth which goes unresolved after 8 weeks. Among American women, about 1 in every 4 have some type of pelvic floor dysfunction. Among new mothers, 58% of moms who delivered vaginally have a pelvic floor dysfunction, as well as 42% of those who have delivered via cesarean.

So, talk to your OB/GYN today. In many states in the US physical therapists (PT) have direct access which means that they can evaluate you and even treat you for a specific period of time without a prescription from your MD. In some states direct access is such that there is no time restriction. Find a PT near you that specializes in pregnancy, post-partum and women’s health that can help you address any issues you may be having as a result of pregnancy.

Let’s take care of ‘momma’!

Take a look at this article from an American living in France with access to post-partum therapy. In France, as a part of their care, women get 10-20 customary post-partum visits with a therapist to ensure that they can address any issues they may have.

http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.single.html

References:
Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1-8.

Sahakian J, Woodward S. Stress incontinence and pelvic floor excercises in pregnancy. Br J Nurs. 2012;21(18):S10-S15.

Yamaguchi M, Morino S. Comparison of Pelvic Alignment among Never-Pregnant Women,Pregnant Women, and Postpartum Women (Pelvic Alignment and Pregnancy). J Women’s Health Care. 2016;05(01). doi:10.4172/2167-0420.1000294.

Madill S. Differences in pelvic floor muscle activation and functional output between women with and without stress urinary incontinence. September 2009.

Miller JM, Low LK, Zielinski R, Smith AR, DeLancey JOL, Brandon C. Evaluating maternal recovery from labor and delivery: bone and levator ani injuries. Am J Obstet Gynecol. 2015;213(2):188–e11. doi:10.1016/j.ajog.2015.05.001.

Larson-Meyer E. The effects of regular postpartum exercise on mother and child: review article. Int SportMed J. 2003;4(6):1-14.

Norman E, Sherburn M, Osborne RH. An Exercise and Education Program Improves Well-Being of New Mothers: A Randomized Controlled Trial. Phys Ther. 2010;90(3):348-355.

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