Prenatal care can be pretty thorough – you’re seen pretty regularly (even moreso if you are considered high risk, had IVF, or have a medical condition that requires extra monitoring) and I’d say overall most important topics are covered (depending on your provider). I am not saying it is perfect – because really, there are a lot of gaps in the current prenatal care model as well. However, it is certainly much more supportive than postpartum care.

*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*

Before I get into talking about my pelvic physio experience, I want to talk briefly about postpartum. Right now, the general model of care (and I say general because some situations are different, like my own) is:

• Discharge mom and baby from hospital
• See mom and baby at 6 weeks postpartum for follow-up

Now, the model of care I experienced was a bit different because I saw Ontario midwives. I was therefore seen much more frequently in postpartum – several times in my home, then in clinic as well closer to the end (when I would be discharged and we would from there forward see our GP). I think this is important to mention because I really feel I got an excellent postpartum care experience to begin with, in comparison to many women who are left to sort of “figure it out on their own” until their 6 week visit.

I have also had many moms tell me they felt that their 6 week follow up was not adequate in meeting their needs. For example, I’ve heard from multiple women that they were never asked how they were feeling. Many did not have an internal exam afterwards, to say – check on healing of suturing or anything. I’ve heard many other complaints about just not feeling prepared for postpartum, and this of course more a failure of prenatal care, but is not helped by a lack of postpartum support.

Now with that covered, lets talk about pelvic physiotherapy. I’ll briefly talk about what it is (though I do have a more detailed post on this, courtesy of Marla Maislin who is a pelvic PT), my experiences with it in both prenatal & postpartum, and then I’ll explain why my experiences have made me demand better support for postpartum women (and if you know me – you know this is already a topic I am extremely passionate about, but I don’t often put it into words outside of Twitter).

What is pelvic physio?

Now if you’re wondering what the pelvic floor is and why it’s so important, please see my previous post with Marla.

Pelvic physio is physiotherapy support for – you guessed it – the pelvic floor! But it’s also much more than that. Pelvic physiotherapy can be helpful to prepare for labour, ease the pains and discomforts of pregnancy (which is what I initially went for) and help with a variety of postpartum issues such as vaginal tearing, C-section scarring and Diastasis Recti. It can also be helpful for any bladder or bowel issues, low back pain, dyspareunia (pain during intercourse), and more. Again, please refer to my previous post for a deeper exploration of these services.

About my pelvic physio experiences

So, as I mentioned above, I first sought pelvic physio for support during pregnancy. I was actually in a car accident at 28 weeks pregnant – both Maggie and I were fine, however it did cause me some residual pelvic discomfort (which was 100% muscular and probably also related to the anxiety that the accident caused for me – aka, tensing my muscles). I had also had pretty persistent hip pain throughout my first and into my second trimester, so it actually seemed like a perfect “excuse” to address both issues.

I knew little about pelvic physio at the time. I just knew enough to know that it might be good for me since my discomfort was in my pelvis, so I self-referred and went to a clinic near me that exclusively did pelvic PT. The experience was great – it was like any physio appointment really with a full assessment of my posture, mobility and so on at the beginning (after an in-depth history about myself, past injuries, my pregnancy). Then we went into assessing my specific limitations (primarily my hips) through an external examination that was adapted in many ways to accommodate my pregnant belly.

What was different about pelvic physio was of course the internal examination (done at your comfort of course, but it’s definitely beneficial). To assess the same things really as externally – muscle strengths, weaknesses and so on, but in regards to the internal anatomy. I have to admit – I hate pap smears (I don’t find them painful but I just like don’t like it – which I think is pretty status quo?), which I know is a totally different thing but that made me a bit nervous for this part, especially because I was pregnant. But I knew it would benefit me, and the physiotherapist did explain the benefit of the exam. It was a quick assessment and it was free of discomfort. We quickly discovered I had external issues with my hips and a bit of internal weakness on the same side.

I attended physio for several sessions, until I honestly was getting too tired to go on my lunch breaks at work. I wish I had stuck it out because I would have loved to do the labor and delivery prep portion (and I fully intend to do this for my next pregnancy) but I still found I benefited from many of the stretches and exercises I learned during pregnancy and even when it came to pushing.

After I gave birth, I had wanted to return to pelvic PT so badly! I just wanted to know if I had DR (I knew I didn’t have it significantly but that everyone usually has it to some degree after pregnancy), and how my stitches healed; if there was anything I needed to work on in advance of any future pregnancies. Unfortunately – cue COVID-19 pandemic. So I waited. I felt pretty good so after I was approved for exercise, I just got myself back into a routine and did lots of walking.

As Maggie nears her first birthday, I have to be honest I’ve been thinking about the future a bit. Siblings. And then I remembered – I haven’t been to physio! So coincidentally after I had booked an in-person visit at a different clinic closer to home, I saw someone post on a mom Facebook group about in-home pelvic physio. I instantly cancelled my other appointment and arranged an appointment with this physiotherapist. I had actually seen two people I trust recommend this person, so that made me more confident in my decision.

And let me tell you I was not disappointed. The physiotherapist came to my home and followed full COVID-19 precautions as advised by our local public health unit. Did the same types of assessments as I had in my previous experience but in my home. Did an internal examination but in the comfort of my home. Anything that was brought in my the PT was left at my home (any extra material, etc.) to follow precautions. I got a full hour appointment and I didn’t have to leave my house!!! I also didn’t have to factor driving time in to my work day – I was able to do this all on my lunch break. Amazing.

So what’s wrong with postpartum care?

So, I got chatting with my PT about why they offered in-home services. I hadn’t seen it before so I was curious. They said they had been doing it since before COVID-19 hit. The reason? Moms found it challenging to get out of the house with a newborn or young baby.

THIS!! It is challenging. It’s not even just with a newborn or young baby, but also with a baby in general when you don’t have childcare or support during the day (or, during a pandemic where your normal avenues for these things are no longer an option).

This got me thinking about: 1) how amazing this service was for moms who need PT support – and I’d say most postpartum moms would benefit from it honestly because a lot of the issues we think are normal are certainly common but shouldn’t necessarily be happening (like having to pee through the night several months postpartum); and 2) why weren’t more postpartum support services offered in home?!

This has been something I’ve thought about frequently since I found out midwives in Ontario did home visits postpartum. I was like wait a second – this isn’t even a thing for OB patients in our province (although there are some home visit services being offered in TO as a result of the pandemic currently). You’re telling me I got multiple, in-home visits postpartum that were, I should add, very thorough (covering not just my BABY’S health but also my health and all aspects of it) yet some mamas just get seen once in what is often a busy clinic at 6 weeks postpartum!?

I know some in the healthcare system would argue that moms are given all these community resources at discharge from the hospital. What I ask those people is – Have you been a postpartum mom? Your brain is just a bit foggy in the postpartum period because you just birthed a human and you now have to care for them 24 hours a day, and in the early weeks that often isn’t an exaggeration. You handed me a bunch of papers at discharge – did you go through them? I’m sure some people do, but certainly not everyone. Even if you did, there are other barriers to accessing community resources and I say that within a non-pandemic environment, let alone now.

Example – you can go to this lactation clinic, but you have to get there. Accessibility issue. You can come into such and such clinic, but it’s full of people. Maybe mom has some anxiety about bringing their newborn to a busy place? Oh just come on in to this clinic setting, right after you had major abdominal surgery! Do you see the issues here?! And this is in no ways exhaustive – there are so many other issues that aren’t covered here that may prevent someone from accessing a community resource.

On the flip side, there are many situations where people are just given paperwork and no explanation. Oh there are some numbers there you can call if this happens. Ehh.. thanks? What if English is not someone’s first language? What if there are literacy barriers? What if it’s a support that only mom needs and they don’t have anyone to watch the baby? What if… I could go on, but I think you get the point.

The current postpartum care model, in many places in North America, is – like many birth practices, tools, and care models – set up to accommodate the people providing the service and not necessarily the mother.

Beyond sometimes leaving mom often without support or resources that are accessible, mom sometimes isn’t seen by any medical professional until 6 weeks after their birth. What are the risks of that? Well, between 72 hours and 1 week postpartum: endometritis, hypertensive disorders, and postpartum psychosis are just a few issues that can arise for mom. From week 2 to week 6, issues that can arise include delayed postpartum hemorrhage; thromboembolism or pulmonary embolism; various infections including mastitis; and postpartum depression. I recommend checking out this excellent review by the Association of Ontario Midwives if you’re curious for more information.

Does this mean these issues are a risk for everyone? No, of course not. Many women are often physically okay leading up to their 6 week follow up. Would they benefit from additional visits? I’d guess yes. I am far from an expert, and I’m just speaking from my own personal experiences, but I was very grateful for the visits I received – I was of course even more grateful that they were offered in my home, but just having them offered at all would be excellent. There are probably a lot of women who slip through the cracks – especially when it comes to postpartum mental health, because they just aren’t checked in on enough.

I’ve also heard from many women that they weren’t even asked how they were in regards to their mental health at their 6 week visit. I would like to think that isn’t common place, but who knows right? Similarly, Marla (who I spoke about earlier) does lots of polls on her Instagram which have repeatedly revealed that many women do not have a vaginal exam at their 6 week follow up. She always says – how can you know if you’re healing OK (or that you healed ok) without an exam?! I totally agree with this.

Another thing Marla mentions frequently on her Instagram (which BTW, is @bloomphysio) is about how there are PT services offered to pretty much all post-op patients either in-hospital or as an arranged follow up service, yet this is not offered to mothers. Sure, pregnancy is not a health issue, I know that. However, it is still a physical challenge, whether you birth vaginally or have a C-section. If anything, PT should at the very least be offered to women who are post-C section because that actually is abdominal surgery!

Home care is also far from a new concept. Many people of all ages receive home care, and in Ontario, a lot of these services can be covered by the provincial health plan. So why are we not thinking of women’s needs and how we can better meet them? Why isn’t this is a priority? Focusing on women’s health and wellbeing in pregnancy and postpartum can prevent a lot of longer term health issues down the road that our system will need to support, related to mental health and physical health issues. One big one that comes to mind is prolapse. PT for example, could be extremely helpful during pregnancy and postpartum to help either prevent (through proper labor & delivery prep) or correct lesser prolapses. Some will still require surgery, but I wonder how many prolapse cases could have been helped at an earlier stage (postpartum) instead of leaving the issue for years and years and allowing it to worsen? Just food for thought.

I could ramble on and on about this, and I probably will in future posts but for now, lets just say – there is a lot of room for improvement in our current system. Things could be better. We could be supporting women more efficiently, and this might prevent issues in the long-run for the woman and their family (because things like PPD can impact a family).

Please advocate for more complete postpartum care! Whether it be in your workplace as a healthcare professional, or for yourself as a woman (or for your loved one). And if you are a woman who is pregnant or postpartum (or even just having any bowel, bladder, or pelvic health issues) talk to a pelvic PT near you! Their services are vast and if you’re having an issue or a discomfort that doesn’t feel right – maybe they can help to address it. As always, thanks for reading!