In this post, I hope to shed some light on the aspects of postpartum care, what aspects are missing, and what pelvic floor physical therapy can provide.
What is the 6 week check-up?
The 6 week check-up is the comprehensive postpartum assessment a woman has with her OB/GYN following childbirth. It is often referred to as the “6 week check-up” as it is commonly (but not always) performed 6 weeks after delivery. Currently, the American College of Obstetricians and Gynecologists or ACOG have the following guidelines for postpartum care assessment*
1) Care should be an ongoing process, rather than a single encounter.
2) All women should ideally have contact with a maternal care provider within the first 3 weeks postpartum, followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.
3) The timing of the comprehensive postpartum visit should be individualized and woman centered.
4) The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being.
*These guidelines have been summarized for the purpose of this blog post. The complete list of guidelines can be found here.
From the OB/GYNs Perspective:
During these postpartum (and prenatal) visits, the provider has a large list of tasks to accomplish:
● They are looking out for the mother’s emotional well-being, screening for signs of postpartum depression and ensuring mother and baby have a stable support system.
● They are also checking on feeding schedules and addressing lactation/breastfeeding issues that may arise.
● They are accounting for complications during pregnancy or chronic pre-existing conditions and monitoring the new mother’s symptoms as well as counseling her regarding long-term risks and creating a plan for maintenance as indicated.
● They are assessing the physical healing that has occurred since delivery and integrating their findings in to recommendations for resumption of intercourse and exercise.
● They are screening for common postpartum conditions such as incontinence and pain and referring to other providers as necessary.
● They are discussing future pregnancy plans with their patients to help with contraception planning.
From the Patient Perspective:
New moms at this time are entering the “fourth trimester”. If they are first-time moms, they enter into an experience they have never known. Trying to manage their appointments, their infants appointments, their healing, their infants care, sleep schedules, household tasks, and for some return to work and navigating childcare. Her body may be feeling like a very foreign place after delivery and she may be unsure of whether or not what she is feeling is “normal”. She may even be hearing from well-intentioned but poorly informed friends and relatives that this is her new normal after having a child and she needs to get used to it. Additionally, she may go to her check-up and be medically cleared for intercourse and exercise despite feeling that those are the last things she wants to do at this time.
What is Missing:
Our current maternal healthcare system is generally great at providing education and support for pregnant women. There is so much planning and preparation going into healthy pregnancies and deliveries, but often little is brought up regarding what to expect for her body after delivery. This is where pelvic floor physical therapy comes in.
A pelvic floor physical therapy (PFPT) exam looks at the musculoskeletal health of your pelvic floor and core muscles, assessing for pain, weakness, muscle tone, issues with control, scar tissue adhesions, and body mechanics among other things. PFPT can treat the urinary, bowel, sexual, and orthopedic dysfunction related to pregnancy and postpartum. It is important to note that a pelvic floor physical therapy examination DOES NOT take the place of a 6 week check-up with an OB/GYN.
What can you do:
If you are experiencing ANYTHING that you find concerning or troubling, remember to bring it up to your doctor. Keep a list on your phone if you have a hard time recalling things during your appointments. If your OB does not know what is troubling you they can not make the connection to the right treatment or person to help you.
You may be a good candidate for pelvic floor PT, even if you were not given a referral by your OB/GYN. As mentioned above, your physician is assessing for a lot of medical red flags as well as creating a comprehensive care plan for you. They may not refer you to PT for a few reasons:
1) They are human beings and in the midst of everything they are juggling they may simply not make the connection.
2) If your symptoms are not medically urgent or if they do not seem to be having a major impact on your life they may not think referral to a specialist is necessary
3) They may not know that pelvic floor physical therapy exists, or they may not know the full scope of what pelvic floor physical therapy can treat.
In most states (including Vermont) a referral from a doctor is not necessary for pelvic floor physical therapy unless the patient has Medicare or Medicaid insurance. In states known as “direct access” a patient can schedule an appointment with a pelvic floor physical therapist without a physician referral.
If you are unsure if this applies to you we are happy to help! Simply call All Wellness (802-863-9900) and our front desk can assist you.
As always, I am happy to speak with you. Fee free to email me firstname.lastname@example.org!
~Karen Bumpus, DPT & Pelvic Floor Specialist