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Your New Pre/Postpartum Team Member: A Pelvic Health Physical Therapist

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by Dr. Rachael Elizabeth Miller, Dr. Rachael Elizabeth

I remember after my first baby having no clue that my body would be so sore, and it would be difficult to even transition from sitting to standing. It took effort to get to the bathroom on time, and then sitting on the toilet and trying to use the potty was not fun. As time went on I felt a bit better. At my 6-8 week postpartum check up, I was told by my physician I was good to run and return to sport.

Well that doesn’t seem right, why does it hurt to exercise now? Why does it hurt to pick up my baby from the crib, or much less try to get him in and out of the car seat? This can not be my new normal.

It became my mission, 2 postpartum later, to discover who will help us mamas prepare and who will help us recover postpartum? It can not be normal to be in pain or feel disconnected from the activities mamas love to do. At that time I realized that I had the capability to help mamas thrive using the skills I had in rehabilitation as a physical therapist! I then pursued continuing education to specialize working with mamas!

Hello! I am Dr. Rachael Elizabeth Miller physical therapist and women’s health coach. I help mamas move and nourish their bodies so that they are prepared for birth, recovery, and return to fitness postpartum. Today I am going to touch on postpartum recovery and how a pelvic health physical therapist can help you, whether you delivered your baby by vaginal or Caesarean birth.

But first what are a few physical changes that happen in pregnancy to your beautiful body?

  • Your spine will become more mobile.
  • Your rib cage will increase 10-15 cm in circumference, and your lower ribs will flare laterally.
  • Your diaphragm will elevate up to 4 cm due to the growing uterus. While the lungs decrease in capacity by 4-5% causing some women to experience shortness of breath in later stages.
  • Your gait may change, later in pregnancy, as you shift backward on heels to compensate for the growing uterus. This relaxes the abdominals and you may begin to walk with feet pointed outward (aka: The Waddle).
  • Your pelvis will tip forward which will shorten the hip flexors and back muscles.
  • Your tummy muscles will stretch causing a separation between the rectus abdominis, often referred to as a diastasis recti.
  • Greater rotation in the pelvis occurs due to the ligaments laxity. The ligaments of the pelvic girdle then have to weight bear more, but this also allows for changes in the pelvic diameter for birth.

Sweet mama, when you have baby these changes do not immediately return to pre baby state! It can take 1-2 years after baby to heal! However, in some mamas the changes in pregnancy and the impact of labor and birth of any type can continue to persist if not addressed.

After vaginal or Caesarean births mamas will often times report to me that they experienced the following common but NOT normal conditions:

  • Pain in pelvis or low back
  • Tailbone pain
  • Heaviness or pressure in the vagina or pelvic organ prolapse
  • Pain in lady parts
  • Diastasis recti-sometimes referred to as mommy pooch
  • Sex is not the same or painful
  • Lack of connection with their core or pelvic floor
  • Difficulty caring for baby or doing daily activities or the activities they love
  • Urinary, gas, or fecal leaking (incontinence)
  • Hemorrhoids
  • Vaginal tearing, episiotomy, forceps delivery, stitches (vaginal births)
  • Pain over the Caesarean section scar, unable to touch belly or the Caesarean scar, disconnection from belly (Caesarean births)
  • Loss of sensation over belly, in the vagina, or in legs
  • Groin, hip, or other joint pain
  • Birth trauma and disconnection from body
  • Desire to return to an exercise routine safely and without fear of movement.

These symptoms if still continuing beyond the early weeks postpartum may continue to persist in many women. In fact I have seen women months to years after baby with complaints of these symptoms. As stated above the 6-8 week mark is the green light from the mama’s care team to
return to sport! Some women may not even have symptoms, be given the green light, and then begin to experience one of the above listed symptoms.

This list is not meant to scare you mama, but make you aware that there is help for you or those you love that may experience any of these symptoms. As a physical therapist I work with mamas to reduce pain and enjoy life through manual skills such as soft tissue massage, fascial release work, scar tissue massage, joint mobilizations, functional movement routines, connecting the breath with the core and pelvic floor, internal pelvic floor exams and/or treatments as needed with consent, nutritional strategies, and much more.

What does a check up look like with a pelvic health physical therapist?

This check up can be immediately after baby or at your 6-8 week follow up. I want to address your pain and give you strategies as soon as possible.

First, I always have an in depth conversation with you to hear your story, and your goals for care. I then spend one on one time with you only to address your concerns. My evaluation will typically involve assessing your whole body and what movements-such as walking, squatting, and/or how picking up your baby affects your symptoms or function. I will proceed to feel how your tissues move, release, and affect your area of concern. As I am evaluating I am also treating your body with release work to your tissues and joints. Finally we will develop a home program that you will do to aide in healing. This may include release work, functional tasks such as how to properly lift baby, and exercises or stretches to aide in recovery. It is very important to me that you are an active component in this rehab. I will provide you with the tools you need to recover that are simple and appropriate for your body. We will then devise a plan for follow up care to advance your program and for me to aide in healing through manual work.

Do I have to have a pelvic floor exam?

I want to elaborate a bit more specifically on the performing a pelvic floor exam. This exam is always done with written and verbal consent. Although we can address the pelvic floor immediately after baby, an internal only exam is best performed at 6-8 weeks postpartum and with clearance from your care team. It can be performed on mamas that have had a Caesarean birth, as this delivery and mama’s pregnancy can also affect the pelvic floor as well.

Every movement performed is explained and I will tell you what area of the pelvic floor I am assessing. This is a thorough eval assessing the pelvic organs, the 3 different layers of the pelvic floor muscles mobility, the range of motion, and strength. This exam is also completely optional, however it is very beneficial to have a full understanding of how your body is recovering. Often times, pain in the back or hip can be referred from the pelvic floor muscles, which is then confirmed by performing a pelvic floor exam-I see this frequently. Again every step of an exam is individualized and only done with your consent.

If you would like to learn more please join my facebook group “Core Defined™” to watch a video on me explaining a PF exam.

Final Thoughts

Postpartum is a beautiful time of bonding with your baby as well as getting to see how your body heals. Having grace to let it heal over time will aide in your lovely body’s recovery. I believe that having a physical therapist on your team pre/postpartum is a must and should become the new norm for mamas. This will enable you to feel confident in your movements and while you recover.

Want some tips postpartum you can start immediately after baby? Check out my ebook: Secrets to Healing in your 4th Trimester: A Simple Guide to Building Your Mama Nest

Thank you, Dr. Rachael, for sharing  your personal and professional experiences. (This content has been voluntarily provided by Rachael Miller. Local businesses supporting one another.)
Images used with permission from Dr. Rachael Elizabeth Miller.