First of all, I want to clarify that this blog is not meant to speak negatively of any person or profession. Your doctors, whether it be your OB/GYN or your primary care physician, are likely wonderful human beings with a very specialized set of knowledge. Your OB/GYN is trained to handle many complex conditions as well as save your life in emergency situations during birth. In terms of postpartum care, your doctor will likely screen you for depression, discuss birth control, and ensure that the cervix is healing properly. Their specialty, for the most part, does not include assessment of the musculoskeletal system. That’s where pelvic floor physical therapy comes in.
There are a few reasons your doctor may not be referring you to pelvic floor physical therapy after having a baby. The most common is that they truly don’t know this service exists. I have heard from countless practitioners they were not told about these services in school. While pelvic floor therapy is definitely a growing field, there are still many areas of the country where access to pelvic floor rehabilitation is lacking . While pelvic floor PT is the standard of care in many parts of Europe, it was practically unheard of just a generation ago in the United States. Even then, pelvic PT was typically reserved for post-menopausal women with severe incontinence, as a last resort, often after several surgical interventions.
Additionally, there are providers who have heard of pelvic floor PT but don’t fully understand our scope and what we do. Some practitioners have a misconception that pelvic floor training is all about kegels and biofeedback. It has become popular to have a biofeedback technician in many offices who will put electrodes on women and ask them to squeeze to strengthen and tighten the pelvic floor. There is no comparison to seeing a trained pelvic floor physical therapist versus completing 6 sessions of biofeedback from a technician. Pelvic floor PT involves one-on-one care, with manual therapy as needed for scars and tissue adhesions. There is extensive education and guidance as to what exercises to perform and which to avoid to promote proper healing. We teach breathing techniques and pressure management to avoid damaging the pelvic organs. We are, first and foremost, orthopedic therapists and take posture, alignment and musculoskeletal systems into account. Pelvic floor PTs aid in injury prevention as it may relate to lifting, caring for baby and breastfeeding. We teach re-coordination of the pelvic floor muscles so women are continent and able to return to meaningful exercise after birth. While we are not sex therapists, we discuss sexual practices and are able to improve tissue extensibility and PFM coordination as it relates to penetration, pleasure and acheiving orgasm.
Statistics show that 77% of women will have low back pain that interferes with daily tasks after childbirth. 64% will have sexual dysfunction in the first year, 60% will have stress urinary incontinence and 29% will have pubic bone fracture. Physical therapists are musculoskeletal experts; we are not trained in delivering babies and your doctor is not trained to assess or heal the pelvic floor muscles. The body heals when we treat it as a whole and take posture, coordination, alignment, strength, stress, prior function and personal factors into account.
This profession exists, in part, so women do not have to live with these dysfunctions. We all need to stop using the verbiage “new norm” when it comes to bodily changes after childbirth. Change is definitely happening, and more people and providers are being informed every day of this care. If you are a woman who is or has had any of the above issues mentioned, I urge you to consult with your doctor and ask to be referred to a pelvic health PT. Many states also have direct access where you can see a physical therapist without a referral from an MD for a certain amount of time. If you are having trouble finding a provider in your area, feel free to e-mail us and we would be happy to help you.
To greater community and self love,
Dr Katie and Dr Carly
Mannion, C. A., Vinturache, A. E., McDonald, S. W., & Tough, S. C. (2015). The Influence of Back Pain and Urinary Incontinence on Daily Tasks of Mothers at 12 Months Postpartum. PloS one, 10(6), e0129615. https://doi.org/10.1371/journal.pone.0129615