Pregnancy and Postpartum Care
Is Physical therapy safe during pregnancy?
As long as you are not on bed rest, you can still receive treatment. If you are in pain, your physical therapist can determine if this is from the musculoskeletal system. Many women experience pregnancy related low back pain or pelvic girdle pain that should be addressed at any trimester.
What is the difference between Pregnancy related low back pain Pelvic Girdle pain?
During pregnancy, either low back pain, pelvic pain, or a combination of both can occur. Low back pain typically occurs in the second trimester (due to weight and postural changes) and pelvic girdle pain typically occurs in the first trimester (due to hormonal changes). To ensure appropriate diagnosis, your therapist will perform a cluster of orthopedic tests during your evaluation.
is it safe to have an internal exam?
Depending on your needs and reasons for coming to therapy, your therapist may recommend a pelvic floor muscle exam. During the first trimester, your increased risk for miscarriage is the highest. Some facilities do not recommend internal exam, at this time, due to the increased risk of miscarriage. However, there is no evidence linking internal exams to miscarriage. If you are cleared and safe to have intercourse, you can opt into an internal exam. If you choose to opt out of an internal exam, you can still be seen.
what are some safety guidelines for exercise?
Each pregnancy varies and everyone responds differently. The safest way to exercise involves listening to your own body. Because your vital signs can be altered during pregnancy, rate your difficulty based off of your perceived rate of exertion: 0 to 10 how difficult was it for you to complete this activity. Research shows that moderate activities (<80% effort) are safe to continue doing. Strengthening is still encouraged. Confidently set yourself up for success to lift a baby and a carrier!
When and how often should I receive birthing preparation?
If you do not have pain, it is recommended to come in for at least 3 sessions prior to birth.
Here are some optimal times to come in if you don't have pain beforehand:
- At 20 weeks, your therapist can take a look at low back, hip mobility, and pelvic boney structure and mobility. You will get exercises to ensure you have mobility for the pelvic inlet and outlet, so fetal movement will progress smoothly.
- At 32-34 weeks gestation, you can start perineal massage to improve the elasticity and prepare for stretch through this area to occur to avoid tearing. As long as cleared by OB/gyn, releasing pelvic floor muscles and the endopelvic fascia will ensure that your baby can extend and rotate their head during delivery.
- At weeks 33-36, your baby will hit a growth spurt and this is the optimal time to ensure your body is allowing space for your baby to shift into position needed for birth. It is recommended to come in at this time. Your therapist is trained to help encourage fetal positioning by very gently encouraging motility to the uteral ligaments. Once this has been addressed, you will receive exercises to encourage opening of the pelvic inlet or outlet through a method from spinning babies to optimize likelihood of low medical intervention birth.
Other services that are offered include planning a hospital bag for tools used to make labor more comfortable, and for postpartum items to help with healing and pain management.
When do I receive physical therapy after delivery?
Most people are cleared at 6 weeks to see their therapist. At this time, internal assessment is usually cleared. However, we recommend you have 1 follow up at 1-2 weeks postpartum to ensure appropriate healing, success with gentle core activation, and postural education. Some research even recommends very gentle scar massage (above or below the incision) can be started as early as 2 weeks postpartum.
Having your baby is just the beginning, reviewing body mechanics with lifting your little one and lactation ergonomics is recommended. Your therapist will help you retrain muscles involved in core, pelvic floor, and breathing to help bridge the gap between postpartum and return to exercises.
When should I expect "return to normal"?
Everyone has a different end goal in mind, and a different experience giving birth. The American College of Obstetricians and Gynecologists (ACOG) recommends you have your last follow up with your OB/Gyn at 12 weeks. At this time frame, they will typically see a return to function or they are recommending resources like physical therapy to help meet any challenges you may still be facing. Remember, it takes time for tissue healing to occur. For instance, if you have a grade 1-2 muscle tear, recovery can take up to 3 months. If you have a grade 3 muscle tear, recovery can take up to 6 months. Laceration to tendons also take 6 months to heal, and ligament can take up to 1 year to completely heal. If you have considered PT and incontinence or low back pain has not resolved, you should consider physical therapy services to reach your goals.