Prenatal Care

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The postpartum time frame is typically described as the time from delivery of a newborn to anywhere from 6 to 12 weeks after birth. The American College of Obstetricians and Gynecologists (ACOG) refers to this as "the 4th trimester." In this wide range of time, women experience a variety of physical, chemical, and psychological changes. Anyone who has experienced this knows first hand how overwhelming all of these changes can be on mom, baby, and the rest of the members of their support system. Far too often, the focus of postpartum care tends to shift primarily to the newborn once the arbitrary 4 to 6 week postpartum doctor visit is performed. This visit also serves to clear a new mother for return to exercise and sexual intercourse. This is where the healthcare system is woefully lacking and missing the opportunity to provide essential, and quite frankly, vital care to mothers to allow them to optimize their postpartum  recovery!

ACOG recognizes that there is a need for ongoing follow up care beyond the initial postpartum visit for new mothers. Women are concerned about more than just when to return to having sex or which form of contraceptive they should be starting (not that these are not very important topics to discuss).  However, follow up care does not always include a multidisciplinary approach to addressing issues like postpartum incontinence, pelvic pain, breastfeeding support, etc. There needs to be more of an emphasis on comprehensive total body rehabilitation for new moms. It is important to ensure that things like getting out of bed after a c-section or getting up from the toilet after a traumatic vaginal delivery are not so difficult for women to go home and do, all while caring for a newborn baby! 

Here is where the pelvic floor physical therapist comes swooping to the rescue! As a women's health specialist, I am profoundly passionate about the need for better 4th trimester care. This is why I have created a "Bringing Home Baby" program through my practice which consists of a one-time in home visit that is recommended to be done within 2-4 weeks of your delivery. At this visit, I am able to evaluate and assess your strength, posture, body mechanics, and wound healing. All of this information is then used to develop an individualized rehabilitation plan for you to help navigate the remaining weeks of the 4th trimester while minimizing pain and optimizing your healing. Of course we have some fun along the way; I always enjoy the opportunity to build my community of new mamas who often teach me as much as I teach them in many ways! Establishing new relationships that extend beyond the 4th trimester (because remember, postpartum is FOREVER) is an immeasurable bonus that is taken away from these sessions.  

When women experience symptoms of pain in the lower abdominal and pelvic area, there are numerous possible sources of the pain to consider. Is the problem related to the uterus? Bladder? Bowel? Intestines? The list goes on and on. Many times, primary care providers order lab testing or imaging studies to determine the source of the problem along with considering other diagnostic factors. But what happens when all of these tests come back as normal or with no significant findings to explain the pain? Usually the next step taken is to trial medication for pain relief. But what if there were a system that was overlooked? What if the musculoskeletal component of the problem was ignored? 

Chronic pelvic pain diagnoses such as endometriosis, irritable bowel syndrome, chronic constipation, and interstitial cystitis are just a few of the common conditions that can be managed with incorporating pelvic floor physical therapy into the course of treatment. When women are experiencing pelvic pain for long periods of time, the muscles of the abdominal wall, hips, spine, and pelvic floor tend to become tense and over active. When this occurs, the muscle and connective tissue tension creates additional pain and even can refer pain to the organs that are being effected. Physical therapy treatments such as soft tissue mobilization, muscle control training, therapeutic ultrasound application, and other interventions have been shown to be valuable components of the pain management plan in these cases. 

In order to treat these chronic pain symptoms, I use the information I get from the initial assessment of the muscle system to develop a targeted plan. Research has shown that we have to retrain our brains and our nervous system in the case of chronic pain; therefore, restoring pain free movement patterns, addressing muscle imbalances, and teaching patients effective ways to manage muscle tension are all skills that result in pain reduction. These strategies also equip patients with the tools needed to have long term pain relief which is always the ultimate goal!

While there is a systemic lack of education on proper pelvic health care for women, the void is even larger when it comes to pediatric pelvic health. During well child visits, pediatricians are following up on the health of the bowel and bladder of infants; however, after the first year exam, most pelvic care in children is left up to parents to manage through potty training. There are a multiple schools of thought and strategies surrounding this sometimes controversial topic of potty training. As a pelvic floor specialist, my goal is to assist parents and their children in navigating this challenging time in development. After all, kids have pelvic floors too and as the famous book says, "Everybody Poops!" 

With my pediatric pelvic health clients, I perform comprehensive assessments of gross motor development and assess their current neurological developmental status. Evaluation also includes dietary assessment and education to address issues such as constipation which tends to arise during the transitional time to potty training. Determining a child's baseline strength of the hips, back, core, and pelvic floor is critical to identify any imbalances and treat them with appropriate exercises. I work to educate families on proper toileting mechanics, develop voiding schedules, and provide ongoing support during the course of the potty training process. Being able to perform these assessments in the comfort of the child's home environment improves the effectiveness of the training as well. There is no one-size-fits-all approach to toilet training, so a collaborative approach between parents and children yields the best results. I strive to make potty training FUN and remove some of the stress and pressure that can set in when trying to meet this milestone.