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Medical

What OBGYNs Don't Tell You About the 4th Trimester

by Ashley Rawlins, DPT

With so much to cover and so little time to spend with each patient, it’s impossible for OBGYNs to go over every detail of delivery and beyond. Inevitably, essential tips on how to take care of your body are rushed through or left out altogether. According to research, a prime example of this is how little information you’re likely to get about your pelvic floor. After vaginal delivery, pelvic floor problems like bladder and stool leakage, pelvic organ prolapse (vaginal heaviness), and vulvar or vaginal pain are incredibly common. Yet many new moms head into postpartum, aka the 4th trimester, completely unaware of them.

As a pelvic floor physical therapist at Origin, a practice that specializes in physical therapy for women and mothers, nothing makes me happier than educating my patients about their pelvic floor. Understanding what it is, what it does, and how it can be impacted by labor and delivery helps you recognize when something is wrong and empowers you to communicate confidently with your doctor.

And once you know that physical therapy can help you strengthen and heal your pelvic floor throughout pregnancy, postpartum, and beyond, you can schedule a visit as soon as you need one.

Say hello to your pelvic floor

As you know, the pelvis is the ring of bones at the base of your spine that safely houses your bladder, bowels, vagina, and uterus. At the bottom of your pelvis is the pelvic floor — a bowl-shaped group of muscles, nerves, and connective tissues.

Your pelvic floor muscles have multiple jobs to do. They support your internal organs, stabilize your pelvic bones, and keep your urethra, vagina, and rectum closed. Your perineal body — the intersection of muscles located between the vaginal and anal openings — further supports the vagina and rectum and, if you have a vaginal birth, plays a major role in pushing out your baby.

That’s not all. Your pelvic floor also aids in respiration by coordinating with your diaphragm, functions like a pump to circulate blood and lymphatic fluid, and supports sexual function and satisfaction by optimizing sensation and arousal.

Your pelvic floor on delivery day

During a vaginal delivery, the muscles, nerves, and connective tissues of your pelvic floor endure massive strain — your muscles have to stretch to several times their normal length to accommodate a baby’s head. While they are absolutely up for the task, they do have their limits.

The combined forces of the baby’s weight, those powerful uterine contractions, and your heroic pushing put your pelvic floor at serious risk for injury. When vacuum or forceps are required to assist in delivery, that risk — and your odds of developing the above-mentioned bladder and stool leakage, organ prolapse, and/or vulvar and vaginal pain — can be even greater.

How to take care of your pelvic floor

Overwhelmingly, pelvic floor symptoms during the postpartum period are not given the attention and care that they deserve, but physical therapy can almost always help. Physical therapy has been shown to be effective in reducing urinary incontinence and alleviating symptoms associated with pelvic organ prolapse. Physical therapy is also recommended as an important treatment component for sexual pain.

On average, your baby will be seen by their pediatrician 6 times, before you meet with your obstetrician to check in even once. Take care of your pelvic floor postpartum by seeing a pelvic health physical therapist as soon as possible. At your first visit, we’ll go over your medical history, any symptoms you’re having, and all of your questions and concerns. After assessing your needs and the best way to meet them, we’ll create a personalized plan together. At Origin, we devote a full hour to this process, which makes all the difference. And we also offer virtual visits so you don’t have to leave home to get care.

If you’re able to see a pelvic physical therapist before you give birth, that’s even better — there are several ways we can work with you to prepare for smooth delivery and reduce the likelihood of injury. (Read more on the benefits of physical therapy during pregnancy here.) But, even if you wait until after childbirth, there’s so much that can be done to minimize your symptoms and improve how you feel, so don’t hesitate to start physical therapy at any point in your birth journey.

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Learn more about pregnancy and pelvic floor health in Rosy's new Class: Mind, Body, Pregnancy! Take this Class for FREE through 9/30.

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References:

Ashton-Miller JA, DeLancey JOL. On biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng. 2009; 11: 163-176.

Geynisman-Tan, J. M., Taubel, D., & Asfaw, T. S. (2018). Is Something Missing From Antenatal Education? A Survey of Pregnant Women's Knowledge of Pelvic Floor Disorders. Female pelvic medicine & reconstructive surgery, 24(6), 440-443.

Woodley SJ, Boyle R, Hay-Smith EJ, Cody JD, & Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. 2012;10. doi: 10.1002/14651858.CD007471.pub2

Wu YM, McInnes N, Leong Y. Pelvic floor muscle training versus watchful waiting and pelvic floor disorders in postpartum women: a systematic review and meta-analysis. Female Pelvic Med Reconsr Surg. 2018;24(2):142-149. Doi: 10.1097/SPV.0000000000000513.

Ghaderi F, Bastani P, Hejebrahimi S, Jafarabadi MA, Berghmans B. Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial. Int urogynecol J. 2019; 30:1849-1855.



Ashley Rawlins is a doctor of physical therapy (DPT) with advanced certification in the treatment of Pelvic Health and Obstetric Health (CAPP-Pelvic, CAPP-OB). She practices at Origin Physical Therapy for Women & Mothers, where she specializes in treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. Ashley is a passionate educator and author in the field of women's health physiotherapy.