Why All Postpartum Women Need Pelvic Floor Physical Therapy

Image permission via Cosmopolitan

By Stephanie Prendergast

The Facts

21% of women undergoing vaginal delivery had levator ani avulsion¹

29% of women undergoing vaginal deliveries had pubic bone fractures²

 60% of postpartum women reported Stress Urinary Incontinence (SUI)³

64.3% of women reported sexual dysfunction in the first year following childbirth⁴

77% of women had low back pain that interfered with daily tasks⁵

Last month, Cosmo published an article titled “Millions of women are injured during childbirth, why aren’t doctors diagnosing them?”. The article had over 50,000 shares on Facebook and thousands of comments from suffering postpartum women grateful to hear that they were not alone. The article was unique and truthful, featuring mom and baby in diapers. The article refreshingly and openly discussed the staggering high prevalence of embarrassing problems that women silently deal with following childbirth.

As a pelvic floor physical therapist I am well aware of the musculoskeletal consequences of pregnancy and delivery. It is mind blowing to pelvic floor PTs that pelvic floor care for new moms is erroneously and ineffectively compartmentalized to ‘do your kegels’. I was interviewed for the Cosmo article and it was no surprise to me that there was confusion about the lack of postpartum medical care and why so many women were suffering.

Cosmo asked the question, WHY aren’t doctors diagnosing these problems? The short answer is musculoskeletal health is not technically the OBGYN’s responsibility. The standard of insurance-covered medical care in the United States includes one postpartum checkup at 6 weeks. This examination includes a depression screening, discussion around contraception and breast feeding, and checking the health of the cervix and uterus. This visit does not routinely include evaluation of musculoskeletal structures. Urinary, bowel and sexual function spans many medical disciplines, but a primary owner lies in the hands of a pelvic floor physical therapist who has undergone specific training to evaluate pelvic floor and girdle function and biomechanics. Since pelvic floor physical therapy is not automatically part of a women’s medical care in the US,  treatable impairments are often left unidentified and treated. As a result women suffer unnecessarily with incontinence, sexual dysfunction, and pain. The symptoms are not life-threatening.  However, one look at the comments on the recent media articles reflect the significant impact the symptoms have on the mother’s quality of life, relationships, and ability to care for her baby.

There is no need for women to suffer. A University of Michigan study described childbirth as  event more traumatic than the most aggressive combat sports. I do not think any sane person would disagree with this. Therefore, it should be no surprise that postpartum rehabilitation is a hell of a lot more sophisticated than doing a few kegels, and that every new mom needs it.

Since the current standard of maternal care does not automatically include a referral to a pelvic floor physical therapist, many women find us on their own. Once they do, they’re understandably upset that this type of service exists and that they were not told about it. We understand this frustration, but it is often misplaced on the physician. The insurance company and our broken healthcare system is the true problem. It is impossible for doctors to address all postpartum concerns in the limited time they have with their patients and this is as frustrating for them as it is for the patient. With that said, we want to share some information and tips to help you work with your OBGYN to get the postpartum care you need, and have it covered by your insurance.

1. At your 6-week postpartum visit or anytime thereafter, ask your OBGYN if he or she works with a pelvic floor physical therapist and if they can recommend someone for you. They may already be working with someone they trust that they can recommend.
2. Many states have direct access policies to physical therapy, which includes pelvic floor physical therapy. This means women can legally go to a pelvic floor physical therapist without a referral from a physician. If your OBGYN cannot recommend someone for you, women can use the ‘find a provider’ section on our blog homepage to find a qualified person in their local area.
3. While it is legal to see a physical therapist without a prescription, your insurance company may require a prescription to cover services to the physical therapist or to reimburse you for your expenses. In many cases, the physical therapy office you choose to go to will have systems in place to help you navigate the process of getting your care covered.
4. You may choose to ask your OBGYN or your primary care physician for a prescription for physical therapy to be evaluated and treated for pelvic floor dysfunction.

Once you find a pelvic floor physical therapist, you can expect that your unanswered questions and concerns will be addressed. Many women are embarrassed and worried about their symptoms, don’t be. As pelvic floor physical therapists we have seen and heard it all and are here and ready to help!

For more information on what a postpartum physical therapy evaluation entails, please click here.

References

1. Van Delft et al. Levator ani muscle avulsion during childbirth: a risk prediction model. BJOG 2014 August; 121(9):1155-63.
2. Miller et al. Evaluating maternal recovery from labor and delivery: bone and levator ani injuries. AJOG 2015 August; 213:188e.1-11).
3. Mannion et al. The influence of back pain and urinary incontinence on daily tasks of mothers at 12 months postpartum. PLoS One 10(6):e0129615.
4. Kajehi M et al. Prevalence and risk factors of postpartum sexual dysfunction in Australian women. J Sex Med. 2015 Jun;12(6):1415-26. doi: 10.1111/jsm.12901. Epub 2015 May 11.
5. Mannion et al. The influence of back pain and urinary incontinence on daily tasks of mothers at 12 months postpartum. PLoS One 10(6):e0129615.