Physical Therapy for Pregnancy and Beyond: Q&A with Cami Hatch, DPT

Photo by:  Rawpixel  on  Unsplash

Photo by: Rawpixel on Unsplash

Ever wonder whether to see a physical therapist during and after pregnancy? Folks at Therapydia Denver sat down to ask their in-house pelvic physical therapist (Cami Hatch, DPT) about treatment for pregnant and postpartum women.

Check out their guest post below to learn more about when to get treatment, how to prepare for common postpartum issues, what treatment can look like, and more!

Cami Hatch, pelvic physical therapist at Therapydia Denver. Photo courtesy of author.

Cami Hatch, pelvic physical therapist at Therapydia Denver. Photo courtesy of author.

Should I see a Physical Therapist (PT) during pregnancy?

Everything in the body is changing during pregnancy, PT can be very helpful to strengthen muscles and normalize tissues. It’s quite common to experience low back pain, neck pain, pelvic pain or hip pain, all of which can be addressed with physical therapy. That being said, it is not 100% necessary to see a PT during pregnancy if you aren’t having any pain or issues, though it can be very beneficial for the postpartum recovery process.

Why should I see a PT during pregnancy? Isn’t my body all out of whack already?

This is exactly why seeing a PT can be helpful! Working on things like normalizing muscle tissue with stretches and exercises can prevent issues as your pregnancy progresses. Physical therapy can be especially helpful for women who have a history of pelvic floor issues or pain. If the issue is tightness, your physical therapist can work on relaxing muscles prior to delivery. Alternatively, if the issue is weakness or incontinence, your treatment will focus on strengthening the pelvic floor muscles while maintaining muscle extensibility to avoid tightness prior to delivery.

Should all pregnant women see a PT?

Not necessarily. Sometimes exercise isn’t recommended with high-risk pregnancies. These women can still benefit from some manual and soft tissue work but physical therapy may not always be appropriate. If you have concerns, this can be a good thing to discuss with your OB.

Can I prevent tearing/diastasis recti/prolapse/other common issues?

While these issues are not always preventable, you can definitely prepare in the best way possible by learning how to use the deep core muscles and pelvic floor. This usually starts with the same exercises you perform after delivery. We will teach you how to keep the spine and pelvis stable and neutral while the extremities are moving. Exercises start with easy positions, like lying on your back, and progress to harder things such as squats and single leg activities. After delivery, all of these muscles will feel weak again and the exercises will start over but with a good understanding of anatomy and the musculature, you will be more prepared to treat potential postpartum issues.

Will I harm my baby or myself if I do physical therapy or exercise while pregnant?
Absolutely not. All physical therapists are trained on what is/isn’t safe during pregnancy. If you ever feel like something is not right, speak up! Your PT should always be able to explain their reasoning for every aspect of treatment and no treatment should make you feel worse. When I work with my patients, I make sure to constantly check-in and ask how everything feels both during and after each session.  

Do I need clearance or a referral from my OBGYN in order to see a physical therapist?

For internal pelvic floor work, yes, but in all other cases, no. Even PTs who are not trained in Women’s Health specifically should know which treatments are appropriate and which are not. The process is similar to any other physical therapy treatment: Your PT locates the issue or cause of pain and addresses it with various treatment options. That said, every pregnancy is different. While clearance is not necessary for non-complicated pregnancies, women who have any sort of high-risk conditions should definitely get clearance from an OB prior to beginning a physical therapy or exercise program.

When should I see a PT after giving birth?

This is something that EVERY woman should do and I recommend coming in six weeks after delivery. The benefit of seeing a PT prior to delivery is that you can discuss which exercises and activities are safe during those first six weeks. For most women, tissues have healed after six weeks and it is safe to begin an exercise program. I believe a visit about six weeks after birth is necessary for every woman to at least get an internal health assessment.

Waiting six weeks to see a PT doesn’t mean that you should do nothing in the meantime. Physicians will typically tell women to rest but realistically, this isn’t happening. The birth of your baby brings about a number of new motherly tasks: lifting, carrying and bending among them. While these actions may be unavoidable, they can also cause a variety of problems.

What does treatment look like?

With postpartum patients, I like to focus on the body as a whole. Usually the early sessions focus on regaining core strength. I also like to conduct an internal assessment to check on the healing tissue and to make sure there are no prolapses. Ideally, all is fine and we can provide exercises to help you focus on getting back to your pre-pregnancy lifestyle.

If you experienced a trauma in any other context, your physician would immediately send you to a physical therapist. In the case of pregnancy, it is important to remember that even though women’s bodies are designed for it, childbirth is also a trauma that forces you to endure many changes. Despite common beliefs that women’s bodies just “bounce back” after giving birth, this is not always the case.

How different will my recovery be if I have a Cesarean section compared to a vaginal birth?

Women who deliver vaginally often have to work on pelvic floor strengthening, whereas, women who deliver with C-section experience more issues around general core weakness. Either way, it is important come in for an appointment after delivery. I utilize a lot of manual techniques to work on the C-section scar to ensure there aren’t any organ or scar tissue issues. Buildup of tissue that is not mobile can cause pain, bladder issues, core weakness, etc.

Any final thoughts?

Yes. As a postpartum patient, you should not feel nervous or apprehensive about advocating for yourself. Occasionally I’ll hear about something unusual told to a new mother by her OBGYN or physician). If you are having an issue, don’t be afraid to speak up and do some of your own research. You shouldn’t feel like you have to take medications or have surgery. Speak with other providers and get a second opinion when needed.

Childbirth is a big part of a woman’s life and it can cause a lot of stress and anxiety, making medical decisions tough. In the end, this is your body and if you have an activity you want to get back to (ie: CrossFit after a prolapse) then you should be able to!

Cami Hatch, DPT, is a Women’s Health Physical Therapist at Therapydia Denver. Therapydia is a national network of physical therapy and wellness clinics that emphasize longer, one-on-one treatments with a physical therapist. Therapydia clinics take a special interest in Women’s Health Physical Therapy, specifically providing services for pre and postpartum women. Learn more about Therapydia’s treatment for pelvic floor dysfunction here.