By Molly Bachmann PT, DPT, PHRC San Francisco
Virtual appointments are now available for those who are pregnant and postpartum! We are excited to offer this service to birthing people around the world. Whether you are pregnant and are interested in learning more about how to prepare your body for birth or need help developing a birth plan and want support in navigating the birthing world, or postpartum and experiencing symptoms of pain or dysfunction and are not sure what to do, this service is for you.
The 4th Trimester
“The pelvic floor and pelvic girdle muscles undergo significant changes during pregnancy, labor and birth. Optimal pelvic health during pregnancy can help reduce musculoskeletal pain and dysfunction, ease labor and birth, and help reduce postpartum complications. In 2018 the American College of Obstetrics and Gynecology issued a statement acknowledging that postpartum care in the United States needs to be improved, suggesting the term “4th Trimester” should be used for the immediate postpartum period and that postpartum people/women need more care than what is currently being offered. All pregnant and postpartum people can benefit from pelvic floor physical therapy given the crucial role these muscles play during birth and how prevalent dysfunction is after birth. With new research emerging regularly, it has been shown time and time again that pelvic floor physical therapy reduces the risk of pelvic organ prolapse, urinary, bowel, and sexual dysfunction and pelvic pain. Research also shows the same for postpartum. But let’s be clear, there is no “one-size-fits-all” program. Programs should be tailored to the individual needs of each birthing person. This service aims to address just that.”
About Molly Bachmann, PT, DPT
Molly Bachmann PT, DPT is a Pelvic Health Physical Therapist and a Birth Doula. She also has taken advanced course work in fundamentals, advanced topics and intrapartum topics of Obstetrics through the American Physical Therapy Associations Academy of Pelvic Health. With this background, she is able to combine advanced knowledge of the musculoskeletal changes that occur during pregnancy and the postpartum period and an in-depth understanding of the physiology of birth to facilitate injury risk reduction and optimize rehabilitation after birth.
FAQs
Take a look at these FAQs to get further insight into what a virtual session may look like:
- I am pregnant and not experiencing any symptoms but want to be better informed about the birthing process and how I can prepare my body for birth. What things might we work on in a virtual session?
- I am a firm believer that knowledge is power and empowering. Birth preparation will look different for each individual. Typically we start with education about anatomy and function of the pelvic musculature. During a virtual appointment, it is possible to screen for flexibility and mobility deficits that may make birthing more challenging. This helps us tailor a movement plan to your body’s needs. Additionally, we discuss available resources that may include additional in-person providers, online resources, and therapeutic props that may be particularly helpful while birthing.
- I’ve had an abdominal birth via cesarean section and my provider has told me that “I am cleared” but I still have pain, discomfort and feel unprepared to return to my previous level of activity. What can I do?
- Just like physical therapists are specialists in the musculoskeletal system and exercise science, physicians and midwives are specialists in making sure that both the birthing parent and baby have a safe birth and immediate recovery. When a provider states that one is “cleared,” all that really means is that red flags for immediate harm have been addressed and are no longer a concern. However we all know that healing is not linear and that just because an incision is closed or active bleeding has ceased you may not feel ready to return to activity or know where to begin. In virtual sessions, we discuss the healing process, screen for appropriateness for physical therapy or other rehabilitation providers, and offer resources that will help guide you and feel more confident in your recovery.
- I’ve never had a baby before and am really nervous because I don’t know what to expect. Can you help me?
- Absolutely! Birth can feel really overwhelming if you’ve never experienced it before. Sometimes it feels like there is no information available about what it is really like and other times it feels like everyone has an opinion making it difficult to sort through all the information. In the virtual session, we discuss expectations versus reality, your options in creating an effective team and plan, and resources for additional support.
- I’ve just had my 4th child and never had any issues with the first three, but now I’m experiencing vaginal pain with intercourse and urinary urge incontinence. I feel helpless and unable to integrate with my new family in ways that I want to. How do I know if PT is right for me?
- Every pregnancy and every birth is different, even if you feel they all went similarly. Physical therapy is right for anyone experiencing symptoms that are prohibiting them from engaging in activities and environments that are important to them. Let’s be clear, intercourse should never be painful unless you want it to be. Urinary leakage is common, but never normal. Unfortunately, this has been normalized for many postpartum people/women. If the symptoms you experience are distressing to any degree, seeking the help of a qualified physical therapist is a great first step. Knowing how to identify a qualified provider for your specific needs, what to expect from a session, what questions to ask, and more, are the kinds of things we can discuss in virtual sessions.
- I’m pregnant for the 3rd time, and experience pain in my pubic bone, outer hip and some urinary leakage. Many people have told me that this is normal for pregnancy. Is it really?
- Similar to dysfunction and pain postpartum, this can be common during pregnancy but should not be normalized. Each of these components can and should be addressed with specificity. We are committed to helping you get through your pregnancy with as little pain and dysfunction as possible. Similar to postpartum, knowing where to begin and who to work with is challenging. Let us help you figure out the right recovery path for you.
Resources:
Pregnancy Awareness Month- Pregnancy & Postpartum Services (educational videos, pregnancy/postpartum blogs, plus more!)
Considerations of Musculoskeletal Harm Reduction During Labor and Birth
The 4th Trimester: Postpartum Pelvic Pain is Common but Not Normal
The 4th Trimester: Postpartum Pain is Common but not Normal, Part 2
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.