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Perinatal Wellness: Combining the Worlds of Physical Therapy and Doula Support

Updated: Nov 24, 2023

Physical Therapy; Pelvic Floor Therapy;  Prenatal Care; Postpartum Care; Doula; Pregnancy related pain; Labor preparation; Postpartum recovery; scarring; Pain or difficulty with intercourse; Incontinence (leaking); Constipation; Bladder and bowel urgency; Genital pain; Pelvic organ prolapse; Sciatic and pudendal nerve irritation; Pubic symphysis dysfunction; Interstitial Cystitis; Polycystic Ovarian Syndrome; Endometriosis; Neck pain; Shoulder/ arm pain; Thoracic/ mid back pain; Lumbar/ low back pain; Pelvis/ sacroiliac joint pain; Hip pain; Knee pain; Ankle Pain

In high school, I was torn between becoming an OBGYN or a physical therapist. I had an affinity for moms because they do so much for their families and the community that I wanted to give back. However, I was not a fan of the idea of being “on call” and the stressors associated with being an obstetrician. I loved the idea of helping people who are in pain regain their functional movement just as much as helping moms and decided to go down the exercise science and physical therapy road. As I started my career, I was elated to find out that I could make a huge impact on the lives of pregnant and postpartum moms as a doctor of physical therapy and trained doula.

Combining the worlds of physical therapy and doula education can give new and recurring moms the ultimate knowledge and preparation to have a more successful birthing experience. Here is how:

Finding your muscle strength deficits and addressing them ahead of time is the key to preventing injury to the core, hips, and spine.

One of the top fears I hear from my patients is about the abdominal gapping or “diastasis recti” after the baby is born. Everyone who is pregnant has a diastasis recti, it is just a matter of the abdominals being strong and resilient enough to “close the gap” postpartum. With proper activation and training of the transverse abdominis (deep core), obliques, rectus abdominis (six pack muscles) and spinal stabilizers, this can be achieved sooner rather than later!

Another common birth injury is a hip labral tear. The labrum is a “bowl” of cartilage that sits in the socket of the hip so the “ball” can move freely and smoothly. Strength of the core, as well as, hip abductors, extensors, and rotators can greatly affect the stability of the joint and probability of injury to this tissue. Another thing to consider is the position in which you are giving birth and the stress being put on your hips, which can be troubleshooted with the help of a pelvic floor therapist.

The last component to consider is any pre-existing orthopedic problems you have before going into birth. Changing progesterone and estrogen levels in the body (along with the notorious relaxin hormone) contribute to soft tissue laxity which naturally makes the joints a little more unstable. It is important to strengthen and stabilize the already vulnerable joints especially before the third trimester and to speed up recovery postpartum. Also, if you have a spine or hip condition before birth, you can learn ways to work with your body via positioning, whether it is flexion, extension, or side bending biased!

Pelvic floor lengthening, not necessarily strengthening!

Yes, you read that correctly! The uterus is what pushes the baby out, not the pelvic floor. In fact, the pelvic floor needs to be able to stretch and recoil as the baby descends through the vaginal canal. Ideally, the pelvic floor can do this without tearing! Some ways to do this are targeted stretches of the pelvic floor, working on hip mobility in all planes of movement, performing external pelvic floor releases, and internal perineal massage if the patient and provider are comfortable.

Working with your pelvis biomechanics as birth progresses!

There are three parts of the pelvis that we train to open and close with specific movement; the pelvic inlet, mid pelvis, and pelvic outlet. The inlet is the top, “butterfly” part of the pelvis that is best opened and mobilized by performing movements that involve feet in, knees out movements. The mid pelvis can be worked with asymmetrical movements. Lastly, the pelvic outlet, bottom and pelvic floor region, can be mobilized with knees in and feet out motions. Doulas can work with you during labor by suggesting positions during each phase of baby descent and providing counter pressure to the pelvis as an added pain relief technique.

Becoming more informed about the processes and your choices during your birth experience.

Nothing breaks my heart more than hearing a postpartum patient tell me how scared they were during birth or upset they were with their provider for not asking informed consent before performing a procedure. Consent is EVERYTHING and knowledge is power. Doulas and pelvic floor therapists can be excellent resources in educating what procedures can be done and when they are necessary. If you do not have a doula to support you during birth, I highly recommend having a birth plan not only for the fact that your partner can advocate for you but to have more information to transparently discuss with your provider.

The world of obstetrics is changing in a positive direction and I am excited to be a part of the revolution!

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