My first child was a stubborn labor and delivery; perhaps due to my inability to breathe and be “easy and relaxed”, perhaps due to going to the hospital too soon and being plopped into bed with limited walking and movement (it was 30 years ago), or perhaps simply due to her positioning, size, and my pelvis. No matter, after 24 hours and 3 hours at 8 cm without progress, we delivered a beautiful baby by caesarean. Postpartum care and instructions: rest, take it easy, don’t lift. No driving. Scar mobilization? Nope…no one suggested it. Core and abdominal work? Well, I was working as a PT, gardening and active, and caring for a baby to toddler…didn’t even think of it.
Fast forward 3 years to my 2nd pregnancy and birth. My OB had assured me that there was a 50/50 chance that I could deliver vaginally, if that was the course I wanted to go, he was game, and that my post-partum recovery would be quicker and “easier” (that word again!). I had no desire for another C-sect, so that was the plan. We knew that I was carrying a fairly large baby, but remember, 27 years ago, ultrasound to assess size later in pregnancy was not a typical course of action. I went into labor on a Thursday, and a friend and her daughter came over to walk, spend time, and to keep me company, allowing labor to progress. The next day, off to the hospital, and 5 hours after admission to the birthing suite, my 10# baby was born, "naturally" and VBAC. That 10# child had broad shoulders, and caused several grade 4 tears. Off to the delivery room for anesthesia and surgical repair of the tears (for which I remain forever grateful to my OB! Especially for the anesthesia).
Now remember, at the time, I was a “musculoskeletal/ortho” PT. I took care of women, but did not even begin to consider the pelvic floor, the abdominals and changes that occurred during pregnancy, and the post-partum recovery of the musculoskeletal and core system…that came several years later. I did not know amazing terms and instructions like “blow as you go” or “exhale with exertion,” and I certainly was not being proactive in my care! I had Pelvic Floor pain with or without lifting the baby, walking, or moving, and all I could think to do was to keep going, because isn’t that what new moms are supposed to do (and to care for the toddler at home?).
Imagine your core as a pressure system, from the jaw down to the pelvis, front, back, and sides, and including the organs and the diaphragm. I did not understand that my pressure system had essentially lost its support and cork when I birthed my little guy, and I had no stability in my pelvic floor and in my abdominals (oh, and the diaphragm? He had been pushing up into it and I had bruising and pain…it was not working too well). The long and short of it: I developed a shoulder and rotator cuff tendonitis. At the time I thought “of course, I am lifting and carrying a 10# baby.” In retrospect, and with 24 years of working with pelvic floor, core, and moms, I would say “of course, you were using the shoulder and shoulder girdle to do all of the work that the lower core/abdominals/pelvic floor could not support and sustain.”
Did I see a therapist for help with my shoulder, my core, or my pelvic floor? Of course not! I was a young mom, I could do it all, AND NO ONE suggested it might be helpful! Within 2 weeks, I had significantly less pain, and within 6 weeks or so, I THOUGHT that I was back to normal. 10 weeks after birth, back to work, and 2 years later, birthed a third (and final) child…7# this time, and easy-peasy delivery and recovery.
Or was it? Would I have benefitted from some expert eyes, evaluation, and direction earlier on after any or all of my births? I am continent, no leakage, and don’t need to run to the bathroom at the drop of a hat. I have no back pain, and can lift during my activities and do the things that I want to do. But possibly I would not still have density and limitations in my scar, my diastasis (DRA) might be a little less, and I might have less, or no, pelvic organ prolapse. As a therapist specializing in core and pelvic floor health (for women, men, and kids), I practice what I preach, and have spent the last years changing muscular and breath patterns so as to correct or at the very least to not worsen, my DRA and my prolapse, and I now continue to do scar mobilization. I have the ability to check in on myself, to use the Real Time Ultrasound at Embody to assess, and to monitor myself in the classes I teach and while working with my clients. I am fortunate…I live, breathe, and teach what I need to do, and what I teach my clients to do.
So what is a mom-to be or a new (or not new mom) to do?
**Ask us!! Or ask other PTs working with ante and postpartum moms (resources below).
** Advocate for yourself, and if you are told that you are “fine” but you are not sure that you really are, ask us!!
**Leakage is NOT NORMAL!! Diapers and pads are ok for babies but not for moms.
** DRAs are present in EVERY mom who goes to term…it’s what we do with them after that matters, and that is a part of the pressure system that we want to assess and retrain.
**Pain immediately after birth, with or without episiotomy or tearing, is common and “normal”…after all, the body has undergone some pretty incredible changes for birth. Pain that persists is NOT NORMAL, and is treatable. ASK!
**Back, mid back, shoulder, neck pain…all treatable (and BTW, you DO NOT need to see us 2 or 3 times/week!! ). Don’t live with it!
**Each mom, and each pregnancy and delivery is different, and needs after birth vary. Be patient with yourself. Ask for and accept assistance.
**Sleep whenever you can. Read to the baby, sing, laugh.
**When in doubt, breathe out!
And when should I seek advice, help, evaluation? We love to see moms early in pregnancy to begin to discuss breath, anatomy, changes, and answer any questions they have. If moms have pain or pelvic ring pain, we want to see you then to address it sooner than later; remember, it’s common but not normal! Seeing moms in the last trimester is great because we can give some ideas, tips, and instruction for early postpartum days. When to see you after the baby is born is up to you; if issues or concerns, sooner than later is the key (and call and ask!). If you want to begin to work on recovery and restoration, 6-8 weeks has been traditional, but it varies from mom to mom and her goals. One size does not fit all!
Whether you have one baby or more, a 10+#, or a peanut, you deserve and benefit from care to help you regain confidence in your body. A strong mom is a strong family!
Wishing you much health and wellness during your pregnancy and after! Rebecca
“Being a mother is not about what you gave up to have a child, but what you’ve gained from having one”….Sunny Gupta
Finding a PT in your area: Section on Women's Health PT Locator
APTA (American Physical Therapy Association) Find PT, Use "Women's Health" to Filter Results
Talking to your Care Provider: About Pelvic Floor Dysfunction
About "The Fourth Trimester" and ACOG Guidelines