Physical therapy during the postpartum period is key in restoring the physical health of the postpartum mother and reducing the risk of orthopedic or pelvic floor injury.  Often during the postpartum phase, the emphasis is on the care of the newborn baby, with not enough emphasis on the recovery of the mother.  This is especially true with such short hospital stays, and little support for the family in the early postpartum period.  Often, women are not evaluated adequately for pelvic floor dysfunction, flexibility and resiliency of perineal tears, extent of any prolapse that may have occurred, or the status or integrity of abdominal muscles in the early postpartum period.  Even if they are evaluated, they are often not sent for appropriate treatment.  This is one of the most challenging times for new mothers and their families, and they do not have enough instruction in care of the mother and to the return of sexual intimacy between partners.

When to refer:

1.    Any significant trauma during delivery, such as prolonged second stage, 3rd and 4th degree tears, forceps or vacuum deliveries, hematomas, large hemorrhoids, and incidence of prolapsed.

2.    Poor ability to contract or isolate pelvic floor muscles.

3.    Unresolved incontinence by six week follow-up.

4.    Painful intercourse or unwillingness to attempt intercourse due to fear of injury or pain by six week follow-up.

5.    Pubic pain, coccyx pain/injury, low back pain/sciatica, sacroiliac joint pain, upper back/neck/wrist pain often due to breastfeeding and carrying of newborn.

6.    Continuation or exacerbation of pre-existing orthopedic problems.

7.    Unresolved DRAM by six week follow-up.  Also “jelly belly” where there has been significant connective tissue stretching and diminished tone in abdominal muscles.

Tracking the postpartum client with a questionnaire at 3 or 6 months would be beneficial.

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