What is the role of Physical Therapy in postpartum care?
If you follow us on social media, you know I am recovering from having my son on November 14th. The last 3 weeks have been a total whirlwind. Like most new moms, my focus 99% of the day (and night) is on taking care of my baby. It is challenging for new moms to take time to focus on their own recovery. Like babies, every pregnancy and delivery is unique and your recovery and rehab process should be individualized to your needs. Whether you had a cesarean or vaginal delivery, Physical Therapy can play a huge role in helping you recover and get back to both daily activities and exercise safely and without complications. Pregnancy and delivery cause major changes in your body, and like any other surgery or injury, require healing and proper rehab.
Unfortunately, many women (and even many physicians) don't realize how important Physical Therapy is for postpartum women. I've had many patients who have told me they have incontinence after having kids (many have been experiencing this for YEARS), and they accept that it is normal. Incontinence after having a baby is common, it is not normal and doesn't have to be accepted. The same goes for painful intercourse, pelvic organ prolapse, pain or limitations in c-section scars, and more.
For the active mom who loves to run, lift weights, or participate in group fitness, working with a Physical Therapist is key to returning safely to these activities. Many women see their OB at 6 weeks and are told they can "start getting back to exercising". They are encouraged to "ease back into it" and "listen to their body", but what the heck does that mean!? Should you just be doing Kegel's!? What signs and symptoms tell you this is "too much" or "not enough"!?
First thing is first - understand that just like physicians, Physical Therapists often specialize. I am a Board Certified Specialist in Orthopedics, and have done additional training in postpartum exercise and pelvic floor exercise. However, there are some Physical Therapists who are pelvic floor specialists and do internal exams and treatment as needed. Simply doing Kegel's is not the answer. It is important to be able to both contract and relax the pelvic floor, and these therapists can do a thorough examination with you to make sure you are able to do just that. I have had friends tell me that the idea of seeing a pelvic floor Physical Therapist is intimidating or uncomfortable. I completely understand, however, these providers are trained to make you comfortable and to educate you to manage your pelvic floor, which plays such a huge role in your mobility and function. If you are unsure, call and speak to a pelvic floor PT before scheduling an appointment to learn more about their assessment and treatment process.
From there, find a provider who can help you reach your goals. Maybe you just want to be able to lift the car seat and push the stroller, or maybe you want to run a marathon or return to CrossFit. Either way, understand that pregnancy and delivery cause major changes (and trauma) to your body. Like any other major surgery or injury, you will need time to heal. You will need to learn how to engage all of the muscles involved in your "core". You should start with relearning proper breathing patterns, then move into abdominal engagement and control. It sounds simple, but this process should be individualized for your needs in order to properly progress and also to work toward your specific goals.
So when should you see a Physical Therapist after having a baby? This depends on the provider's recommendation, as well as how you are feeling. Personally, I took the first 2 1/2 weeks of my recovery to rest. I took a few short walks, but I knew I needed to allow my body to heal (especially since I was getting less than the ideal amount of sleep!). I've started this week with some gentle mobility exercises, simple breathing and abdominal engagement exercises, as well as some hip strengthening. I am also nursing my son, so I've been adding in postural neck and upper back exercises to counteract discomfort from sitting and holding him. I am scheduled to see a pelvic floor specialist for an assessment 6 weeks after my delivery date. This internal exam is important as I mentioned above to be sure I can both engage and relax my pelvic floor, but due to the healing process, I need to wait until 6 weeks to see her for that exam. All of this to say - it depends, but the best thing you can do is speak with a Physical Therapist about your personal situation and get a recommendation on when you should schedule an appointment.
The other major factor for most mom's is time. We feel like we are nursing our babies every 5 minutes (at least that's how I feel!), and there just isn't much time to fit in another appointment. I am putting together a 6 week, "reconnect to your core" program for postpartum women who want to return to an active lifestyle. This program will be individualized to your goals, and will provide safe exercise recommendations and progressions to get you back to the activities you love. The exercises can be designed to be performed at home or at the gym, with or without equipment. I am accepting 10 clients for this program beginning January 1, 2020! Reach out to reserve your spot at firstname.lastname@example.org.