After delivery, newborns are closely followed by a pediatrician every few weeks to make sure they are developing well and are healthy. The mother’s body’s job is largely considered completed when the maternity-ward bracelets come off. All energy and focus shifts to the infant who (surprising to no one) is far more demanding outside the womb than inside. What about the body that carried, grew and nurtured this being for months? What about the incubator draped in maternity fashion that endured months of stretching and aching, only to be topped off with a grand finale of exhausting hours of labor and delivery? The mother’s body is left to heal on its own, amidst the sleep-deprived zombie months that follow.
By the time a woman realizes that her body may not be returning back to its pre-baby functioning level, as she had anticipated, she is knee deep in diapers and likely back to balancing work and the demands of other children or responsibilities. Her own well-being may be low on her endless “to-do list” as long as she can put one foot in front of the other reasonably well enough to reach the closest pot of coffee.
Issues that seem to be “small inconveniences” like, oh, say, leaking with sneezing and jumping, abdominal wall separation and weakness or pain, are delegated to the “deal with later” list, the “kept meaning to get to that…” list that self-generates in her brain at 2 a.m., or gets lost in the “notes” section of her phone.
In France, postpartum women are routinely prescribed “la re-education perineale,” 10–20 visits of physical therapy designed to retrain the pelvic floor muscles, to be followed by “abdominal re-education” after the pelvic floor sessions are completed, if necessary.
“La reeducation perineale” has been subsidized by French Social Security since 1985. The French state health system subsidizes 60–100 percent of the cost; private insurance typically covers the rest. France is one of the only countries to sponsor such a program for women postpartum.
The good news is that one does not need to move to France to receive expert postpartum physical therapy care. In the US, women’s health/pelvic floor physical therapists provide evaluation and treatment for women both prenatally and postpartum. While the body undergoes a natural healing process after childbirth, some issues may not resolve on their own. Even in the best-case scenario of an easy delivery and recovery, a woman may be left with issues beyond the six-week checkup. Pregnancy and delivery may lead to common but potentially permanent changes that result from changes in uterus size, adaptations in connective tissue and pelvic floor changes. Caring for young children and carrying heavy toddlers can further exacerbate these underlying issues. It is important for women to address any issues or concerns that arise postpartum with their OB/GYN.
Pelvic floor physical therapists assess a woman’s pelvic function by providing treatment aimed at faster healing and return to pre-pregnancy strength and function. They routinely address pelvic floor–related problems that may occur, such as pelvic organ prolapse (POP), management and treatment of pelvic and low back pain, urgency, abdominal wall weakness and muscle separation (diastasis recti) and urinary incontinence.
The adage “Once postpartum, always postpartum,” is often evident when women in their 60s suffer from pelvic floor issues that may have originated with childbirth 30 years prior that were never resolved. It is no wonder that incontinence products are a large and growing market in the United States. Consulting with a pelvic floor physical therapist postpartum can be key in empowering women to be, as Beyonce says, “Strong enough to bear the children, then get back to business.”
Rivki Chudnoff PT, MSPT is a NY/ NJ licensed physical therapist with over 15 years of experience working in both pediatrics and women’s health rehabilitation. Rivki is the owner of Hamakom Physical Therapy with offices in both Teaneck, NJ and Monsey, NY. Her practice addresses the needs of women related to urinary incontinence, bladder and bowel conditions, pregnancy and postpartum issues, sacroiliac joint, coccyx, hip and pelvic pain.Through her treatment, she strives to help women improve their quality of life at every stage.
By Rivki Chudnoff PT, MSPT