Pregnancy and Postpartum Care

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.  

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. 

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.

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!

Your therapist and doula can help come up with a birthing plan with you.  For instance, if you have orthopedic injuries such as hip pain, your therapist can help instruct your team on how make you feel most comfortable. At 36 weeks gestation, you can start perineal massage to improve the elasticity and prepare the muscle for stretch. You can also discuss crib and lactation ergonomics to plan for optimal posture and improve comfort after the delivery of your baby.  It is recommend to have at least 3 sessions prior to 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 2-3 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.

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.