Pregnancy and babies just throw you right in the middle of the ring so here is a stepwise guide to how physical therapy, both obstetric and pelvic floor, can help through the various stages of pregnancy and postpartum.
Step 1: I’m Pregnant!
From the first pee on the stick to the first positive test, a woman prepares. Prepares for possibilities, prepares financially, prepares mentally, prepares emotionally. But preparing physically may not always be at the forefront of her mind. As a fit woman prior to pregnancy, I did not even think twice about my post baby body. I had an idea of what it looked like objectively to be pregnant but postpartum was a nebulous “body back” concept I knew nothing about firsthand. But I digress, pee on the stick, positive test, wave of emotions: check. Now what do you do? Listen to your body? (What is it saying? I want to sleep, give me potato chips, I am going to exercise to my most challenging effort because I can and I did prior to pregnancy, I should slow down and rest, I should alternate between the two extremes every other day because I have no guidance on what to do.) This is where guidance–not a generic program, not a social media group, but specialized guidance–can help you through whatever type of pregnancy you are experiencing. There is no one size fits all approach to activity while pregnant. Pregnancy is dynamic and a training program should mimic this life altering event. It is well researched that exercising while pregnant is safe and healthy for mom and baby. Pregnancy and Postpartum athleticism coaches like myself can help a woman create that program which should include graded activity, posture modification, breathing techniques, cardio, weight training, and core stabilization to name a few. So what does that mean? Let’s say for example you love barbell training. After a thorough one on one evaluation, we find that in your first trimester you feel fine exercising at a submax but challenging weight where you can maintain good form. Great! In your second trimester, we switch to EMOMs (Every Minute On the Minute workouts) with the barbell to afford you a nice work to rest ratio which decreases intensity and we further decrease the percentage of max load. In the third trimester, we switch to dumbbells. Not necessarily because a mom shouldn’t use barbells in pregnancy but the growing belly could be impacting your bar path and affect your form. Also there’s the whole risk versus reward conversation that could be a whole other blog post. More on that in the future. Should there be any pain or abnormal responses involved in any of these activities or even just walking, that’s where a women’s health focused physical therapist, also like me, would come in. Obstetric and Pelvic floor physical therapists have specialized training in treating a pregnant woman. They know how to screen for dysfunction in the bony pelvis, pelvic floor, low back or with the urinary or bowel tracts, modify exercises, and recognize the hormonal, physiological and physical changes a woman’s body undergoes during pregnancy.
Step 2: Delivery
I’m going to state this from the get-go: Any type of delivery is beautiful and brings an adorable newborn into the world. That being said, there are different considerations in treating different types of deliveries. I am a firm believer that every delivery, uncomplicated to profoundly complex, is a trauma to a woman’s pelvic floor. Think about it: any other body part that has approximately 25 extra pounds resting on it for 9+ months along with added pressure that equates to a 50mph wind gust just going from sitting to standing (unscientific simile but backed by facts. Contact me for sources) needs a bunch of extra TLC when (on average) a 7 pound beautiful bundle busts through an incision or a 10cm opening. Obstetric physical therapy can guide a woman and her birthing partner through various positions for laboring and birthing to promote as much comfort as possible and assist in the descent of the baby. Laying on your side with pillows supporting your legs, or kneeling on a bed using a headboard for support or incorporating a physioball with pelvic tilts can all be beneficial as you prepare to meet your little guy or girl. Post delivery, regardless of how, us PTs can also offer healing techniques and guidance to a recovering mother.
Step 3: Postpartum
This one really hits home for me. As I mentioned earlier, I was a fit woman going into my first pregnancy. Postpartum was a loud emotional, mental, physical cacophony of baby cries, mama cries, and attempts at working out between feedings and naps. Oh, and maybe sleeping an hour or two at a time. A woman postpartum rarely has enough support to take care of herself and her baby and juggle her home and her partner and her job. Postpartum care for mama falls through the cracks. This is where obstetric/pelvic floor physical therapy are vital to the rehabilitation of a woman. No one would ever expect someone after open heart surgery to run a race with no coaching one week later or someone after shoulder surgery to be able to complete every daily task without waiting for the shoulder to heal. But somehow it’s ok to tell a mama she can’t lift more than 10 pounds when she has a 25 pound toddler running to her waiting to be hugged and cuddled after she comes home with a newborn baby. Physical therapy aims to do just this: rehab a mom from the trauma and changes post pregnancy and birth by focusing on her pelvic floor, her core and her breath coordination to promote optimal functioning post birth. Not only is it continuous sessions lasting 30-60 minutes focusing only on mom’s symptoms, but it also addresses the rebuilding and rehabilitation phase in order to recover. Spoiler alert: this takes way more than 6 weeks, especially if you are having pain, dysfunction, mental health difficulties and, yes, taking care of a newborn and/or a variety of other children at home.
Having a baby is beautiful, life changing and transcendent but it’s also downright hard to do by yourself. Women are strong and resilient but this should not read: We don’t need help. It should read: I want to be guided through the proper way to heal and rehab post a really long and really transformative process of growing and delivering a human. And that is why physical therapy is so vital during pregnancy and the postpartum period.
Corinna Lau is an experienced senior physical therapist at New York Presbyterian-Columbia University Irving Medical Center and small business owner of Perspectives Physical Therapy as well as a Pregnancy and Postpartum Athleticism Coach. She is in the process of completing her Obstetric Physical Therapy certificate and specialization in Pelvic Floor Physical Therapy. You can follow her on Instagram @activemotherhooddpt, email her at [email protected] or call her at (516)243-7041 with any questions or interest in working together.
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