Should All New Birthing Parents See a Pelvic Floor Therapist?

Doing postpartum pelvic floor physical therapy can address short-term concerns and preempt long-term issues.

Woman doing a hip bridge

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After giving birth, the birthing parent is often told they'll be able to get back to regular activity quickly. The American College of Obstetricians and Gynecologists (ACOG) says those who had a healthy pregnancy and a normal vaginal delivery should be able to start exercising again "a few days after giving birth—or as soon as you feel ready." They recommend those who had C-sections talk to their healthcare provider about what's best for them.

At the same time, the first six weeks after giving birth can also be marked by physical changes and symptoms you might not be used to, from perineal soreness to afterbirth pains and breast engorgement. Yet most six-week check-ups focus on a quick uterine exam, questions about mental health, and a strong focus on the newborn. The exam often fails to address real physical changes a new parent is experiencing in the short term that could shape their health down the road. It's for that reason that new parents may want to consider seeing a pelvic floor physical therapist.

Benefits of Seeing a Pelvic Floor Physical Therapist

In France, pelvic physical therapy is the standard postpartum care, and OB-GYNs prescribe postpartum people 10-20 sessions of pelvic physical rehab. Bonus: It's covered as part of the country's government health care plan. While it's still considered a new practice in the U.S.—one that may only be covered on an out-of-network basis—American experts believe pelvic PT can benefit all new parents.

Tami Kent, MSPT, a physical therapist in Portland, Oregon, and author of the books Wild Feminine and Mothering From Your Center, says she never wants pregnant people to feel worried about childbirth in general, as it is natural. The birth process though can take a certain physical toll, leaving behind bruised, inflamed, or scarred tissue. But pelvic floor PT "accentuates the natural healing capacity of the body." The sooner you can see a therapist, the better, as issues left unaddressed can "become greater imbalances later," Kent notes.

Ann Udofia, PT, DPT, co-founder of Body Connect Health & Wellness in Washington, D.C. says many postpartum people come in with complaints of "anything from neck and back pain, sciatica, pelvic pain, tailbone pain, a lot of which can be the result of the postural changes that come with nursing, carrying your baby, wearing your baby." She also has new parents note that they're experiencing urinary incontinence when sneezing, jumping, or jumping, or perhaps they're suffering from pelvic organ prolapse.

Still, not all patients have a definitive, physical concern. "They could just be aware of not feeling like themselves in their bodies anymore," Udofia notes. "They just feel weaker, they're having problems connecting with their pelvic floor muscles, and they want to get a sense of what they need to be doing to reintegrate that."

But she agrees that even if someone isn't experiencing immediate concerns, they would do well to check in with a pelvic floor physical therapist after giving birth. "It doesn't necessarily mean they need extensive therapy done, but pregnancy, the birthing experience, postpartum recovery, it's really just a powerful, transformative experience in any person's life," Udofia says. "Being empowered about the changes that are happening in your pregnancy—especially when it's a first-time pregnancy—understanding how to safely and effectively take care of yourself and understanding the resources you have available to you are important, as well."

What To Expect With Pelvic Floor Physical Therapy

Udofia shares that whenever she meets a new patient, she does an extensive intake, in which she learns about their symptoms, their level of physical activity prior to pregnancy, their birth experience, and, quite importantly, what they are aiming to accomplish. "I want to show them I'm aware of their goals, that I understand where they're coming from," she says. Then, she and the patient will set up a game plan together.

In Kent's practice, she often sees patients six weeks postpartum and strives to offer them "a lot of education on self-care and what that looks like."

There are two types of pelvic floor physical therapy: external and internal. Patients can expect a typical pelvic floor physical therapy session to be similar to an OB or midwifery appointment, Udofia notes. "There's an expectation of your therapist working very gently to examine what's going on," she explains, noting that could include looking at scar tissue around a C-section scar or the vulva.

"There are some women who are just not comfortable with [internal work] in the beginning," she acknowledges. "But there's no pressure that that has to be done the first time that you see a pelvic PT."

Udofia uses a pelvic floor model to explain the anatomy of the pelvis and the pelvic floor muscles. She'll then use hands-on treatment techniques, like treating trigger points or releasing the myofascial tissue. Those are the tough membranes that wrap, connect, and support your muscles. A session may also include work on the spine, hips, rib cage, and lower or upper body. Imbalances in these areas can throw pelvic alignment off.

Another important focus of treatment will be on core strengthening and pelvic stabilization. "If I'm finding that a patient's breathing mechanics are off, that can change how they're stabilizing through their core and pelvic floor muscles," Udofia shares. "Just improving how you breathe is an important part of treatment. A lot of behavioral modification goes into the education we do."

In addition to breathwork, Udofia may go over the best techniques for everyday tasks. That includes reaching into the crib to pick up the baby or even going to the bathroom. For instance, hovering over the toilet can exacerbate bladder issues.

"You're actually not allowing your pelvic floor muscles to relax all the way," she explains. "You're using your glutes to keep you hovering over the toilet. And if your pelvic floor muscles are not relaxing all the way, you're not allowing your bladder to completely empty, and you're storing urine." That could lead to more frequent bathroom visits, simply feeling like you have to go again soon thereafter, or chronic urinary tract infections.

If there are no acute issues, postpartum people might come in for anywhere from one or two sessions to more frequent visits. If there are extensive injuries or a high level of pain or dysfunction, Udofia may recommend several months of PT.

The Bottom Line

"A lot of [new parents] are working and juggling a lot of things," Kent notes. But ultimately, she wants them to remember that they are the most important piece of this puzzle. "Think of how you're going to put back the energy that you're putting out," she says

In an ideal world, birthing people would be more supported in the days, weeks, and months following birth and have the opportunity to rest and recover with the aid of their tribe or village. But as that isn't so much the case these days, Kent reminds people to prioritize their rest and their own physical recovery and care, especially in the first few months. Pelvic floor PT is one major way to do just that, offering a bevy of benefits—in both the short- and long-term.

If you are looking for a pelvic floor physical therapist, your OB/GYN, midwife, or other healthcare provider is a great place to start. The Academy of Pelvic Health Physical Therapy also has a locator tool on its website to help find a therapist in your area.

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