Seeing a Pelvic Physical Therapist After Giving Birth Should be Our “New Normal”

Going to a physical therapist (PT) after pregnancy and childbirth isn’t standardized care in America, but it absolutely should be.

 Marisa Alonso (MSPT) physical therapist and co-founder of Body Connect Health & Wellness

Marisa Alonso (MSPT) physical therapist and co-founder of Body Connect Health & Wellness

I sat down with three therapists at Body Connect Health & Wellness (where I get treatment) to learn more about why every mom should check in with a pelvic PT at least once after childbirth.

...they didn’t rehab their core well, and so their bodies are still in this postpartum state for 30 years...
— Alonso

“[Pregnancy] is one of the most normal phases of dysfunction. Your ligaments are going to be ‘laxed, your posture is going to be off," says Lauren Collins. The uterus grows exponentially, organs are pushed aside, our center of gravity shifts outward, we rapidly gain weight, and someone literally kicks us from the inside.

Returning our bodies to normal function and alignment is also a long-term investment.

Marisa Alonso, co-founder of Body Connect, says she sees a lot of postmenopausal prolapse. “…they already had a dysfunction growing, maybe because they didn’t rehab their core well, and so their bodies are still in this postpartum state for 30 years, after they had their kids…[T]hen they go move furniture and get prolapse because their bodies haven’t come back to a healthy position postpartum.”

There’s also the wonderment of delivery.

Regardless of how we deliver, something quite large is coming out of our bodies through a relatively small hole or layers of abdominal tissue. Pregnancy and childbirth inevitably take a toll on our bodies.

A brief six-week checkup, a peek at the uterus, and a battery of feeding and depression questions seem entirely insufficient as our postpartum care. Culturally, we’ve come to accept that once the baby is born, the focus should be on the baby. This paradigm makes any sort of additional maternal care seem like a luxury.

But the physical struggles after pregnancy and childbirth are very real.

 Hannah Schoonover (PT, DPT) Body Connect physical therapist

Hannah Schoonover (PT, DPT) Body Connect physical therapist

Hannah Schoonover explains, “They all feed into a generalized core breakdown where if one thing isn’t working correctly, then everything that has to work around it or with it basically doesn’t work well either."

Typical culprits of such breakdown can include leakage (fecal and urinary), back pain, rectal pain, lingering issues from difficult deliveries, pain with sex, and organ prolapse. “So, if you have no back support or you have back pain, that can lead to or exacerbate a prolapse,” says Schoonover.

Some moms check-in with Body Connect therapists simply as a wellness visit. These women have no symptoms and are looking to safely resume normal activities.

On the more severe end of the spectrum, Alonso recalls working with a woman who fractured her tailbone during delivery from coccyx mobilization, “…so [doctors] take their thumb rectally and pull down on the coccyx…to create more space for the [baby’s] head.” Collins chimes in and adds, “Fecal incontinence as a result of stage four tears or episiotomies, those are pretty serious too.”

 Lauren Collins (MPT) Body Connect physical therapist

Lauren Collins (MPT) Body Connect physical therapist

As for me, I checked into Body Connect to see about my third-degree tear that was scarring strangely, vaginal heaviness, and incontinence, among other issues. The good news is that these symptoms are among some of the most common and treatable. The bad news is that so few women get help or too quickly opt for surgery, which is sometimes necessary but has its own complications.

Can we approach pelvic rehabilitation like rehabbing a dislocated shoulder or knee injury?

In some ways, yes.

When Schoonover discusses pelvic physical therapy to patients, she often equates it to a more relatable injury, like a hamstring pull. “I put it on a level that is not intimidating, frightening, or weird…It really is just another part of the body,” she says.

The similarities tend to end there.

Everything flows out of our pelvis, so if it’s out of whack it’s going to affect something else, at some point, somewhere…it’s where our center of gravity is.
— Collins

“With your bicep, you can see that working. You can see your arm working, but you can’t really see what’s happening with your pelvic floor on a regular basis,” says Alonso. Our pelvic floor also moves differently from other muscle groups, which for the Body Connect therapists makes it more interesting and challenging to rehabilitate.

“[B]eing that the shape of the pelvic floor is conical, you get telescoping motions. So you get the squeeze, you get the lift, and you get the contraction…It does more things than just one muscle pulling shorter that another one,” says Schoonover. Collins adds that our pelvis is the basis of our stability, “Everything flows out of our pelvis, so if it’s out of whack it’s going to affect something else, at some point, somewhere…it’s where our center of gravity is.”

Pelvic physical therapy can also be quite intimate, especially vaginal and rectal work. Good communication is crucial.

 Hannah Schoonover doing external manual therapy before moving onto internal work.

Hannah Schoonover doing external manual therapy before moving onto internal work.

“We’re very descriptive… I’m always informing my patients of what I’m going to do, letting them know, ‘This is what’s going to happen, this is where I’m placing my hand,’” says Collins.

Alonso adds, “We don’t push anyone to go beyond where they’re comfortable going. We have all our models, we describe everything, we try to inform people as much as possible…I’ve rehabbed postpartum moms without doing any internal work because some people felt uncomfortable with it, and that’s fine. There’s a lot of different ways we can start to access the pelvic floor or work the structures around the pelvic floor.”

“And another thing that’s specific to the internal work is that there’s never going to be something we do to a patient that we haven't had done on ourselves. We’ve felt everything that we do,” says Schoonover.

You may have heard about pelvic PT recently, especially how it’s standard postpartum care in France (yet another way that country supports mothers better than America). French OBGYNs prescribe postpartum women 10-20 sessions of pelvic physical rehab, and it’s covered as part of the country’s government health care plan.

In America, pelvic physical therapy is still relatively new and it's typically an out of network service. Many moms and OBGYNs either don’t know this help exists or the extent to which it can help.

Alonso, who has been working in this field for over decade, says she used to get European patients who had to fight with their U.S. doctors to get a prescription to see her. It’s not as difficult to get a prescription or recommendation anymore, but patients still need to ask.

In America, pelvic physical therapy is still relatively new and it’s typically an out of network service.

While we’re a far cry from having pelvic physical therapy as part of standardized postpartum care, PTs like Alonso, Collins, and Schoonover exist in our communities.

Seek them out. Ask your OGBYN, midwives, and doulas to help you with that search.

Pelvic pain, pain with sex, weird scarring, peeing when you laugh shouldn’t be any woman’s “new normal,” especially for those of us who’ve had the privilege and responsibility of ushering new life into this world.