The Importance of Pelvic Floor Physical Therapy For All Birthing People
Molli at 39 weeks pregnant
We need to normalize and set the expectation of pelvic floor physical therapy for all pregnant and birthing people.
Pregnancy and birth are enormously transformative processes, emotionally, spiritually, and physically. Societally, we have come a long way in addressing a birthing person’s emotional and spiritual well-being, but we still find ourselves woefully lacking when it comes to physical care. Not only are we lacking, but maternal health outcomes in the U.S. have actually worsened in the last 20 years. Unfortunately, the U.S. has some of the worst maternal health outcomes of any developed country, and most of these undesirable outcomes are preventable.
Our parents, our friends, our care providers (maybe ourselves) tend to perpetuate misinformation that negatively impacts a birthing person’s prenatal health and wellness which in turn, negatively impacts their postpartum health and wellness and extends to their ability to care for their newborn child.
Some examples of misinformation we often see and hear:
Peeing when you sneeze is normal.
Don’t work your abs during pregnancy.
Pregnancy is just uncomfortable and you won’t be able to sleep at the end.
You need to tone down your exercise in pregnancy. Walking is safer.
Intercourse after baby will be painful.
I (Molli) remember being 16 weeks pregnant, standing outside of the 9:30 club waiting to see The Band Camino, and peeing a little as I sneezed. I looked to my husband and sister-in-law, and said cheerfully, “I just had my first peeze!” My mind flashed to pregnant ladies on Instagram holding felt letter boards saying “Peeze (n.): peeing a little when you sneeze,” and I felt as if I’d hit a pregnancy milestone (I hadn’t), and not as if I’d just received a pelvic floor red flag (which I, in fact, had).
So many of the aches and pains and peezes during pregnancy and postpartum are common, yes, but normal? NO! And they are not only treatable, but many are preventable.
Maternal morbidities, a term used to describe short and long-term health problems resulting from pregnancy and/or birth, affect between 50,000 and 60,000 birthing people a year, and again, most of these morbidities are preventable!
Examples of maternal morbidities specifically related to the pelvic floor:
Incontinence (fecal or urinary)---this includes the urge to use the restroom more frequently than is necessary
Pelvic organ prolapse (uterine, bladder, or rectal)
Pelvic girdle pain
Speaking for myself (Molli), that peeze at 16 weeks pregnant was really the first sign of a weak pelvic floor that would have increasingly more pressure weighing down on it with each passing week as both baby and placenta grew and fluid increased. This increasing pressure over a sustained period of time (AKA pregnancy), most likely led to a bladder prolapse that my midwife would alert me to at my two-week check-up (yes, my amazing care team at Loudoun Homebirth and Healthcare check-in on the mother at 24 hours postpartum, 48 hours, 2 weeks, and 6 weeks, AND they’re available for texts and calls in between to answer your questions).
The pressure I felt in my pelvic floor postpartum when I went for little walks or stood for long periods of time was so intense, I felt like my vagina had been weight-lifting. I thought it was just another one of those postpartum quirks you don’t know about until they’re happening. I thought I was just really sore from my 14 hour powerhouse homebirth with a beautiful and big-headed babe. I didn’t realize it was pressure from my prolapsed bladder.
I also didn’t realize that something that often accompanies pelvic floor weakness, which I had, is pelvic floor tightness. The muscles can be so tight and tense and lead to all kinds of pelvic health issues.
One such pelvic health issue for me, aside from leaking when I tried to run or jump, was pain with intercourse. The first time my husband and I had sex after Jamie, I felt like daggers were peircing me, and I also had a little bleeding after which is indicative of tearing during sex.
I remember texting a girlfriend and saying “Wow, you did not overhype how uncomfortable sex is the first time after baby!” But it wasn’t just the first time, and it wasn’t just uncomfortable, it was painful. I confided in my husband and shared I didn’t know what to do. He told me to ask my midwives, but before I did that, a nurse friend of mine suggested kegels, which I tried, and which made the pain worse. Trust me, kegels are really never the answer. So I finally called my midwives and they told me pain with sex is NOT normal after baby and that I needed to go to pelvic floor PT. Hilary, the midwife who delivered Jamie, sent me a link for OrthoPelvic Physical Therapy, and I started working with Dr. Kelly as a patient in July of 2020.
OrthoPelvic Physical Therapy was just Dr. Kelly at the time and she was a mobile PT, so she came to my house and for one magical hour a week, we laughed, I cried, and I learned a ton about my pelvic floor and the importance of pelvic floor physical therapy.
In January of 2021, I resigned from teaching high school English in Fairfax County and joined OrthoPelvic PT as Dr. Kelly’s first hire and office admin. Now, only a year later, Dr. Kelly has brought on 3 more amazing physical therapists and 2 more office admins, and we are always trying to find ways to expand our reach and help as many people as we can. I love this work because it is so incredibly important, and I know how much getting pelvic floor PT changed my life and my perspective on pregnancy and postpartum.
Yes, birthing people are strong and incredible, but they do not need to prove it by weathering painful experiences that negatively impact their daily function and often worsen over time.
As pelvic floor specialists, OrthoPelvic PT’s physical therapists are in the best position to care for birthing people throughout pregnancy and into postpartum to help them both treat and PREVENT so many maternal morbidities that can cause lasting issues.
If you are pregnant, know that pregnancy and birth are a sprint whereas postpartum is a marathon. Postpartum is forever, we say at OrthoPelvic. Now is the time to get your body in a place of the best possible function to give you a better birth and a better postpartum.
If you are postpartum, whether 20 days or 20 years, we can help you. It is never too early and never too late to address the issues and pain you experience post-childbirth. At OrthoPelvic, we don’t wait for the 6-week check-up. We start working with birthing people to regain strength, function, and RELAX their majorly taxed muscles starting at 3 weeks postpartum. And remember, we consider you post-childbirth forever 🙂
If anything I’ve said resonates with you, book a FREE 10-minute consult call today. At OrthoPelvic PT, working with birthing people means so much to us because we know that we are truly equipped to give them the best, specialized care. This is what we do and this is what we love. Give us a call today ✨
Be empowered in education,
Molli Atallah, Clinic Manager and Dr. Kelly Alhooie, founder of OrthoPelvic Physical Therapy
Dr. Kelly Alhooie and Molli Atallah at OrthoPelvic Physical Therapy Clinic in Sterling, Virginia