By Christi Springfield, PT, DPT
Pelvic health physical therapy is first and foremost about health! Pelvic PT prioritizes the health of perinatal people whose bodies experience profound changes during pregnancy. The metamorphosis then continues postpartum.
During pregnancy, Pelvic PT helps navigate the new normal of having a growing, moving being that is wreaking tiny, slow havoc on mom’s body from the inside-out: pushing up on the rib cage and diaphragm progressively, out against abdominal wall muscles, down onto the pelvic bowl of muscles and that doesn’t even start to address what’s happening at the pregnant low back! Through pregnancy, the body must constantly adjust to hormonal fluctuations, fluid volume changes, digestive challenges, ligamentous laxity, and maybe even urinary leakage for the first time ever. It’s a confusing time and the information might be overwhelming or inaccurate as to how to manage the wide variety of changes that are normal for a pregnant body. It may be hard to know what to do to even manage challenges, much less actually thrive in pregnancy.
Pelvic PT focuses on the whole pregnant person. For instance, sleep position and overall sleep quality can affect how a pregnant person moves and feels, including how well pain is managed and food is digested during the day. Understanding the forces that are acting on pregnant bodies helps us to understand the symptoms that may be experienced and quickly incorporate strategies to help manage discomfort as it arises (or beforehand, if possible). Some simple behavioral modifications, such as sleeping with support between the knees is a great tactic for helping manage pelvic girdle pain. Applying a towel or pillow-shelf to a pregnant belly in sidelying, during sleep, helps prevent a lot of twisting motion at the low back, which can save SI joints some strain. If the SI joint or pubic symphysis gets strained after all, pelvic physical therapists can recommend a belt to support and stabilize joints or a maternity cradle to lift and support a pregnant belly that might be bearing down heavily on the joints.
Just as pregnancy hormones impact most body systems and often contribute to connective tissue laxity, they can also work to make the GI system more sluggish and slower to digest food. Constipation is a common complaint in pregnancy. Food aversions can also contribute GI issues, and many find themselves struggling to find the balance of fiber and fluid and movement that is ideal for minimizing constipation. Pelvic PT can help provide solutions to the discomfort by giving practical recommendations for proper hydration, optimal fiber intake, and suggestions for safe and comfortable exercise and breathing practices that supports healthy digestive function.
First time-moms are often experiencing urinary leakage for the first time and are told that this is a normal part of pregnancy. This is the best opportunity to learn one’s own pelvic anatomy, especially as it changes through the pregnancy process. Identifying pelvic floor muscles and how to control them helps to manage bladder symptoms, including leakage, urgency, and frequency. Pelvic PTs help teach pregnant moms how to activate and strengthen their pelvic floors to control leakage. Additionally, it’s an optimal time to teach proper pelvic floor lengthening techniques including how to bear down, with proper breath support, to allow for better preparation and practice going into vaginal delivery.
Pelvic PTs educated pregnant people and their partners on comfortable and feasible positions for labor to allow for greater freedom of movement and familiarity with alternatives to flat on the back as a labor position, if desired. Pelvic PTs are also often the only providers to help pregnant moms become familiar with their anatomy well enough to provide instruction and hands-on techniques to prepare the perineal area for the flexibility needed to accomplish vaginal delivery with the minimum amount of trauma to perineal tissues.
The critical time immediately postpartum is confusing, hectic, and often focused on newborn care if left solely to exhausted moms who have just gone through the physically- demanding process of delivering their babies. Pelvic PTs can help prepare new moms before delivery with instructional materials on how to safely mobilize after delivery and also care for their healing tissues— whether one experiences a vaginal delivery or a surgical one. Since the immediate postpartum phase is full of activity, pelvic physical therapists emphasize early mobility after delivery to minimize complications and negative impact to the abdominal wall, pelvic floor, especially if a new mom has sustained perineal trauma or a surgical delivery.
Given that C-sections are the number one most common surgery out of all surgeries, of any type, in the United States, delivering moms need accurate information about how to mobilize, move their C-section scars, gently activate the core system, and comfortably hold and feed their newborns. Brand new moms are often very focused on the appointments and checkups needed to ensure optimal health for newborns, but their own abdominopelvic recovery is often left on the back burner. Pelvic physical therapists teach new moms before they deliver that returning for pelvic physical therapy assessment and customized pelvic care postpartum is an important part of recovering their own wellness. Pelvic PTs teach postpartum moms how to manage pain and progress through safe return to the activities that they love.