In other countries, like France and Ireland, postpartum women are referred to pelvic physical therapy immediately at 6 weeks postpartum! Yes, we are still catching up to the times here in the good ole’ USA, but small changes in South Jersey are happening! More recently, we have pushed the envelope to being seeing newly postpartum moms less than 6 weeks postpartum! Most women are previous clients we supported during their pregnancy, who trust in our care and see the opportunity to ask questions, be proactive and supported in this intimate transitional time. This opportunity allows women from day 1 postpartum, a safe and educational space for women to vocalize their concerns.
Calling the OB office feels like a dead-end with the never-ending answer, “Oh, its ok. You had a baby” or “That’s normal”. But we know as pelvis specialists, you want to be seen and encouraged to know what the road ahead looks like. It is our duty to assess, educate and care for any change to the musculoskeletal system either birth related or sports injury related!
What is happening day 1
A typical hospital birth, both vaginal and cesarean, mom and baby stay in the hospital for 1-3 days depending on health and readiness to return home. But let’s be honest, what rest or what hands on care are you really receiving in a hospital setting? There is a revolving door of specialists checking in from nursing care, lactation to cardiologist to neonatologist, so sleep is not happening! The goal of the hospital system is to maintain a safe medical status for both mom and baby. The goal is to ensure your blood pressure is stable, bleeding has stopped and you can pee or poop before you leave the hospital.
Few times does someone ask:
Do you feel comfortable walking to the bathroom?
Do you have any pain in your back or legs?
Do you feel confident to leave the hospital and care for yourself and the baby?
Is there someone who is going to help you at home?
Do you feel confident and understand how to care for your perineum and/or c-section healing?
No, these questions are not asked by hospital staff. It's not their direct line of care because they want to make sure you are medically safe.
Understand that medically safe and stable is not the same as secure and seen.
But you know who asks these questions on other floors, outside of the Mom/Baby floors? Physical and occupation therapists ask these simple questions to people who have had heart surgeries, joint replacements, and bronchitis. So why not ask new moms? Because most women who are birthing are “young, healthy, do not look ill”, a consultation for PT and/or OT is almost never prescribed. We are missing a huge opportunity to create confidence, optimize function and safety for postpartum momma. Because a lot can happen after you leave the hospital. And no, the answer is not, “you just had a baby”.
At Home waiting until 6 week postpartum OB visit
Clients who see us prenatally feel comfortable texting in the middle of the night asking for help. Albeit we do not answer in the middle of night, their concerns, pain, discomfort or frustration to understand the new changes are answered in the morning! This new chapter brings both physical and emotional excitement and fear, all wrapped up in the sexiest postpartum diaper and crowned with a high pony messy bun. The guidance and support for new moms in the time leaving the hospital to the 6-8 week postpartum visit is poor.
Let’s review some things you need to be vigilant about during the first 6 weeks:
During the first six weeks there is an increased risk of 42% risk of hemorrhage and significant fluctuations in blood pressure (both high and low). During labor, women may have experienced preeclampsia, hypertensive episodes, pitocin or magnesium drips during a very long birthing process. Once you are safe to be discharged home, there is little education. We recommend to perform daily blood pressure, heart rate and breathing monitoring, as well as checking your hemoglobin again in a few weeks via bloodwork. Purchase a blood pressure cuff and a pulsox from Amazon and get tracking!
Here are some parameters to start tracking at home and when to talk with your doctor.
Perineal injury healing
Shortly before birth, a hormone called relaxin, from the placenta increases causing the collagen fibers of your pelvic muscles and ligaments by 95% allowing for the fetal head to stretch against the pelvic muscles.
Prolonged second stage labor may exceed stretch limits of the soft tissue causing an obstetric perineal injury. Perineal trauma like a perineal tear (grade 1-4) or episiotomy. After birth, regardless of vaginal or cesarean delivery, the collagen in the muscles, fascia and ligaments begin to strengthen within the first 6-8 weeks. We can support this physiological change, by utilizing belly bands, compression shorts/pants and exhaling on efforts to lift baby and roll out of bed. To learn more on how to minimize pressure to your perineum, download our guide.
Cesarean section healing
Research shows that the C-sections are the largest operative inpatient procedure done in the US. The second is circumcision and the third joint replacements. Scar protection and listening to the lifting restrictions is a must! But did you know you can assist in healing by supporting your lymphatic system? Your lymphatic system is like the waste management system. It takes out the trash and keeps the body from backing up with piles of junk like swelling and infection.
To keep the system moving:
Gentle compression from a belly band or high waisted yoga pants can assist with moving blood flow from your legs back to your heart
Manual lymphatic massage by a therapist or by yourself can keep things moving
Drinking healthy fluids like water and or coconut water to stay hydrated. Stay away from fatty foods with higher saturated fat contents like steak or fried foods can slow down the lymphatic system in the first few weeks.
Move your body gently with upper body stretching, walking small laps around your bed and breathing.
One of the best outcomes for women who have given birth is to truly give yourself 40 days of rest. That doesn't mean becoming a veggie on the couch, but to respect your body and ask for help from your loved ones and support system. Resting, cat naps, kitten naps (Dr. Amanda’s infamous 20 min midday naps) are all good! You are not lazy, but you are recovering! There is a lot going on in the body from changing hormones, shifting fluids in the body, milk production, and the biggie, brain stimulation to learn a new little human.
As you are starting to heal, simple movements like breathing to gentle activation of your core are healthy for you! Of course, to your tolerance and done without pain, increased bleeding or swelling. Research shows those who have a perineal injury who started gentle breathing and core activity as prescribed by a pelvic therapist at 2 weeks had significant improvement in pelvic function and bother of symptoms compared to those who started at 6 weeks postpartum. How awesome! Follow along with Dr. Becca for some simple, movements to facilitate healing at week 1 postpartum.
Its never too early to start
I always joke about how happy French women seem to be, so glamorous and relaxed like an episode of Emily in Paris. The one reason they experience such glamor is because pelvic therapy is a normal part of postpartum rehabilitation. Many postpartum women see a pelvic therapist six to eight times after having a baby to encourage optimal pelvic health. So find your own Mindy Chen aka Pelvic Physical Therapist to advocate for optimal postpartum healing.
Want more? Learn what is or is not normal with Dr. Amanda's Postpartum Healing workshop. Get instant access now and start your path to pelvic wellness.
Dr. Amanda Heritage, PT, DPT, PRPC is the owner of Breathe Life Physical Therapy & Wellness, LLC located in Collingswood, NJ. She has been practicing physical therapy for 11 years with a strong focus on pelvic health. She enjoys encouraging women about pelvic therapy as a treatment option for those suffering with pelvic pain, incontinence or constipation.