My sister is pregnant. Four of the fire wives on my husband’s shift are pregnant. Multiple people I follow on social media are pregnant. I’m pregnant!!! But because I’m not the biggest fan of unsolicited advice, you won’t find me telling these women that pelvic floor physical therapy during pregnancy should be on their to-do list. If they ask, you better believe I’ll climb up on my soapbox and share my two cents, but it’s not my place to tell a woman (who knows her body and baby better than I ever will) how to navigate pregnancy.
But if you found my little ol’ blog in the pages of the massive world wide web, clicked the link, landed here, and are scrolling through these very sentences, then 1) hey friend!…I’m so glad you’re here, and 2) the advice has now been solicited and ya girl is pulling out said soapbox as you read.
Perhaps you’re pregnant and learning more about the importance of pelvic health? Maybe you want to be pregnant and are planning ahead? It’s possible that you’re in the same boat as me and are looking for a subtle way to tell a pregnant woman you love about the power of pelvic floor physical therapy during pregnancy? No matter where you are on your motherhood journey or what role you’re currently playing in supporting someone who is, [this] is your one-stop-shop for allllllll the reasons pelvic health should be towards the tippity-top of a pregnant mama’s totem pole.
So many women plan for baby – the crib, the clothes, the carrier, the car seat – but they forget to prepare their bodies for the pregnancy, birth, and postpartum that will immensely impact them and their baby’s first experiences together. And while I fully support the tips picked up from scrolling social or chatting with friends and the informational & inspirational books and blog posts, nothing (in my humble opinion) beats the personalized, full-body approach that pelvic rehab provides during pregnancy.
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If you’re already convinced that pelvic floor physical therapy during pregnancy is worth your precious time and energy, then stop what you’re doing and book an appointment with yours truly or start searching for a pelvic rehab therapist near you. You can come back to this blog post and thank me later *wink wink*. But if you’re the kind of person who needs the full scoop before moving forward (same girl…same), then keep reading for all the reasons you shouldn’t wait until postpartum to prioritize your pelvic floor health.
Allllll the benefits of pelvic floor physical therapy during pregnancy
Every time I meet with my business coach, she tells me I need to narrow down my ideal client…but I can’t! I get so much joy and satisfaction from working with athletes, pregnant women, postpartum women, peri- and post-menopausal women, proactive women, and even men. I could never (and probably will never) just choose one type of person to work with. But if I had to choose one patient population who would benefit the most from pelvic floor physical therapy, pregnant women would hands-down be at the top of the list.
While pregnancy always has its challenges, I personally look back on my experiences of that period with nothing but fondness, and I believe that can be the case for more women than not with a little proactivity in the pelvic health department. So many of the pains & problems & apprehensions associated with pregnancy are considered “normal”, but “common” and “normal” are two very different words that need to be differentiated in this season.
A growing belly? Normal. The back pain associated with it? Common.
Increased pressure on the pelvic floor? Normal. Leakage, urgency, and prolapse because of it? Common.
Questions about pregnancy, birth, and postpartum? Normal. Fear and uncertainty? Common.
Not to toot my own profession’s horn (ok…toot! toot!), but pelvic rehab therapists are theeeeee subject experts when it comes to a woman’s body in these first stages of motherhood, and having someone in your corner who can help, prepare, or even prevent current, upcoming, or expected issues is beyond invaluable. I’m so, so excited to share everything that pelvic floor physical therapy during pregnancy can do.
LESS ACHES & PAINS
Low back pain…round ligament tightness….leg cramps….lightning crotch…feeling like your pelvis is going to split in two…I could go on. So many changes take place in the female body during pregnancy, and we shouldn’t be surprised that with a growing belly and surge in ligament laxity often come aches and pains. While we might not be able to mitigate those changes, we can minimize the negative effects associated with them.
Relaxing the pelvic floor, keeping the core and hips strong, and maintaining proper pelvic alignment are all pieces of the puzzle when it comes to avoiding discomfort during pregnancy, aaaaaaand all covered in pelvic floor physical therapy. While pain meds, sacroiliac joint belts, or “just taking it easy” might work in the moment (or for a moment), there are more reliable and lasting solutions that can and should be taken advantage of.
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Thinking this is too good to be true? Take a peek at what one of my patients had to say – “I decided to see Dr. Amanda Davis due to some pubic pain in the late second trimester of pregnancy with twins. I was surprised by the amount of relief I have found by practicing the techniques she has taught me. I am already moving so much better, and on top of that, experiencing significantly less low back pain and cramping, which I thought was just a given during pregnancy and didn’t realize that I had any ability to improve it.”
^^That^^ could be you, friend. And I only saw her for five appointments! And did you catch that she was pregnant with twins!? I and my patients are living proof that you can be active & happy & actually appreciate & even adore pregnancy…it’s just wayyyyy easier when your body feels good too. Please don’t let something that’s completely correctable stop you from having the pregnancy of your dreams.
STAY STRONGER…LONGER
I’m currently pregnant with my second baby, which means this time around there’s the added need to keep up with a five-year-old while also growing a human. Picture less naps and more noise, endless games of tag instead of nice long baths, aaaaaand a few more years tacked onto my (ever increasing) age. Whether you too are keeping up with parenthood while pregnant or have a profession, passion, or project to pursue, for many of us it’s important to stay as strong as possible in this season.
Exercises to maintain strength and strategies to reduce pain all taught by someone who understands the implications and limitations of the pregnant body are key to sustaining everything essential & exciting until baby is born. While there is importance in a little extra R&R as our bodies juggle pregnancy with all of life’s other obligations and goals, we overall still want to be functional and ideally flourishing members of our family and community.
Forget surviving…let’s aim for thriving during pregnancy, and I believe even just a few visits pelvic floor physical therapy visits can get you there. The 40-week countdown can and should be out of pure excitement to meet your baby, not because you want pregnancy over as soon as possible. If this sounds too good to be true, then you’ve never talked to someone who prioritized their pelvic health during pregnancy.
BIRTH PREP
I don’t know about you, friend, but I’m kiiiiiiinda a control freak. And while nothing (& I mean nothing) can guarantee the outcome of anyone’s pregnancy, there are steps we can take to prepare as best as possible to keep labor and birth safe & smooth & supported & stress-free. This isn’t about what’s in your hospital bag, whether you have the perfect playlist, or even creating an air-tight birth plan. This is about taking the time and energy to practice for one of the hardest things the female body will ever go through.
Nowadays you can find a lot of beautiful information about preparing your body for birth between Lamaze classes, scrolling socials, and reading books & blogs. But relaxing the pelvic floor, opening the hips, pain management during labor, and breathwork and positioning during birth are so much more effective & efficient when personalized. And when this is done by a pelvic floor physical therapist, the internal assessment and real-time feedback for all of the above make it even more practical & productive.
This level of birth prep means more confidence and less fear. It’s easier to trust your body when you know it intimately and have been working with it intently for the last nine months. Does going to pelvic floor physical therapy during pregnancy guarantee a pain-free, tear-free, complication-free birth? Sorry…no. But when patients repeatedly say things like “I had an incredible birth experience with my second after a traumatic experience with my first and I do believe it was the information and work that I gained from working with Amanda”, I can’t help but believe it makes a difference.
AN EASIER POSTPARTUM
I can vividly remember leaving my girl for one of the first times after she was born to go to a postpartum pelvic floor physical therapy visit (yes…even we need help) and pumping in the parking lot beforehand. And I also remember being sooooooo grateful that I only had to do it a handful of times because I had put in the pelvic health work during pregnancy, which meant an easier and faster postpartum recovery, even with a nearly fourth-degree tear, prolapse, and leakage.
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When I see patients for pelvic floor physical therapy during pregnancy, we practice techniques and activities to avoid things like tearing, prolapse, diastasis, and pain (aaaaaaand I am living proof that sometimes it doesn’t work). But no matter the outcome, we also discuss strategies that mothers can implement starting in those first postpartum hours to begin the healing process, which means those first six weeks women usually waste just waiting for their follow-up are spent recovering & remedying & restoring function, control, and strength instead.
That postpartum period is so important for you and your baby – it’s your first motherhood experience, formative days, weeks, and months for your rapidly developing baby, and (not to be dramatic, but…) sets the tone for the rest of your lifetime together. There’s no book, blog post, or bestie that can prepare you for those first messy & magical months…you kinda have to live it yourself. There is, however, a pelvic rehab therapist out there who is able & excited to help you heal before you even get there.
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A SECOND OPINION, SOUNDING BOARD, & SUPPORT PERSON
I have never met a pregnant woman who said “I could use a little less support”. Have you? Pregnancy, birth, and motherhood change us physically, mentally, emotionally, and spiritually, and the more people we have in our corner to share concerns, ask questions, and get clear, customized, cut-the-fluff kinda counsel the better.
Pelvic rehab therapists are musculoskeletal experts who specialize in the female body, and specifically the pelvic floor. But even if your doubts & dilemmas go beyond what’s going on “down there”, many of us have worked with hundreds of pregnant women (& possibly been pregnant a time or two ourselves) to be able to guide you through things like tough conversations with your significant other, alternative takes on tests & treatment options, and even those should I be feeling this way? thoughts.
All the benefits of pelvic floor physical therapy during pregnancy that we’ve listed so far are invaluable, but for some women, simply having someone who knows their story and is [there] every step of the way is the most pivotal part. Not everyone has a mom, sister, or friend they can turn to, and I’m sorry, but 15-minute OB appointments once a month just aren’t enough. This is a season that benefits from as much support as possible, why not get it from someone who can give insight on it all?
Still have some reservations? I get it…let’s work through them together.
I get it, friend…there are a million things pulling for your attention during pregnancy. And if you don’t feel great, are going at it alone, or have just got other extenuating circumstances taking up your bandwidth, brainpower, or bank account, the feasibility of pelvic floor physical therapy in this season might seem slim. So let’s see if we can’t work through some of the most common excuses explanations for skipping pelvic floor physical therapy during pregnancy together. I’d like to think that a little extra creativity and clarity is all it might take to make pelvic rehab a reality.
THE COST
Let’s address one of the bigger obstacles first, because most pelvic health clinics (including mine) don’t accept medical insurance. I often see women for four to eight visits during pregnancy, and in my practice that would cost anywhere from $725 to $1350, amounts that can admittedly make many of our eyes go wide.
But what if you asked everyone attending your shower to contribute to a pelvic health fund instead of buying another set of onesies that your baby will only wear once? Is it possible to postpone or pass on the purchase of that fancy stroller? Could you save up a couple hundred dollars in each month of the first and second trimester?
They say you can’t buy happiness, but (to an extent) I believe you can buy health. And when you put stock in your wellbeing, not only are you proving to yourself that you’re worthy, but the reward outweighs the risk every time. Believe me when I say the cost of these appointments will pay for themselves in preparedness, peace of mind, and prevention of managing more expensive medical issues down the road.
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THE LOGISTICS
We’re all stressed and stretched to our limits (in some ways literally during pregnancy), and I know the thought of finding a provider, setting aside time in your schedule, tracking down childcare, potential travel, and completing the prescribed exercises and techniques is enough to make you throw in the towel before you even start. While pelvic rehab is becoming more popular, finding a therapist who fits with your location, calendar, and goals is not always easy.
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Step one is clicking here to find the closest provider to you. If there isn’t one within a reasonable distance, consider working with someone virtually as this is far better than nothing and will be more personalized than an online course, app, book, or blog post. When it comes to finding time in your schedule, an hour-long appointment once a week for four to eight weeks is typical (but definitely not required), and you can ultimately choose the frequency that works best for you. Some clinics (like mine!) allow kids, but if yours doesn’t, consider asking for childcare during pelvic floor physical therapy as a baby shower gift, trade time away with a fellow mama, or recruit your significant other as much as possible.
All of that *waves arms wildly* is easier said than done, I know. But it’s like Jim Rohn said, “If you really want to do something, you’ll find a way. If you don’t, you’ll find an excuse.” And after watching hundreds of pregnant women prioritize their pelvic health despite all the things making it feel impossible, I can attest that this is true.
THE TIMING
Let’s be honest…if you’re 40 weeks pregnant you’re probably a little too late. But even starting halfway through the third trimester (if you can find a clinic that has immediate openings) gives you enough time to experience all the benefits listed above. Even a few appointments can make a world of a difference in how you manage pain during pregnancy, “push” out your baby, and recover postpartum.
Because an internal vaginal exam is often not performed until the second trimester, I recommend patients call their pelvic floor physical therapist of choice as soon as they find out they’re pregnant and schedule appointments to start once they are in their thirteenth week. This not only ensures they will have plenty of time for all the visits they could possibly need, but also makes certain that they are experiencing the maximum benefits.
Unless you’re literally ready to pop any minute, allow me to enlighten you that it’s not too late. Depending on when you’re due, the provider will know the best way to spend your time whether you have two or 26 weeks left. So many of us tend to think that if we didn’t have the time to do it “right” there’s no point in doing it at all, but that couldn’t be further from the truth. Some is always better than none in this case.
THE FEAR
“I’m nervous about the internal work”. “I don’t know what to expect”. “It sounds uncomfortable”. These are common and legitimate thoughts regarding pelvic floor physical therapy during pregnancy, and I’d like to honor them while also gently challenging them too. Precautions are taken, your OB’s or midwife’s permission is always obtained, and 99.9% of the time those reservations regarding the appointment turn into “that wasn’t so bad” or “why didn’t I do this sooner?!”. Here’s why…
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Yes, quality pelvic floor rehab involves an internal component, but with just one finger (far less invasive than a speculum, ultrasound wand, or…um…penis), and at the hands of a skilled, consent-driven therapist who does everything possible to make sure it doesn’t feel violating, painful, or rushed. As far as what to expect, most pelvic floor physical therapists have a “what happens at your first visit” section on their website or are able to answer your questions by phone or email beforehand. Take the time to do your research, because more information often always means less apprehension.
More often than not, the unease of starting pelvic floor physical therapy is far worse than the reality, and there’s nothing that can prepare you for how rewarding and encouraging it feels to have a provider who truly understands your anatomy and how to work with it in this season. Don’t let an overall pointless fear prevent you from having a more comfortable and confident pregnancy, birth, and postpartum.
THE LIMITING BELIEFS
Sometimes I find that the concerns around cost, trepidations over timing, and reluctance to figure out logistics ultimately stem from one underlying belief – I’m not worthy. As women, so many of us are conditioned to push our needs to the side and care for everyone but ourselves, so the spotlight that’s put on us during pregnancy can feel unnecessary and even uncomfortable.
Maybe in your head (or even out loud) you’ve called pelvic floor PT during pregnancy “selfish”, “not really that important”, or even “a waste”. I once heard it said that you can’t believe everything you think, and based on allllllll the information above, we both know those thoughts aren’t quite true. You and…um…your baby deserve the best possible pregnancy, birth, and postpartum experience, and I encourage you not to let yourself or anyone else convince you otherwise.
A few fast (& fun) facts about pelvic floor physical therapy during pregnancy
I’ve been a pelvic rehab therapist for about 13 years now, and when someone reaches out regarding pelvic floor physical therapy during pregnancy, they all inevitably ask the same handful of questions. So let’s answer them here (and if I missed anything, please let me know)! Nowadays there’s too much information at our fingertips to let fear of the unknown prevent us from seeking the care we need, so let’s kick the apprehensions and arguments to the curb once and for all, eh?
WHEN IS THE BEST TIME TO START?
There’s no “wrong” time to start pelvic floor physical therapy during pregnancy, but an internal exam and treatment are contraindicated during the first trimester of pregnancy for everyone involved. That being said, I often encourage women to reach out to their pelvic rehab therapist of choice as soon as they find out they’re pregnant (many have a multi-month waitlist) and schedule their initial evaluation for once they’re in the second trimester, or 13th week of pregnancy.
DOES PELVIC FLOOR PT DURING PREGNANCY INCLUDE INTERNAL WORK? IS THAT SAFE?
Yes, quality pelvic floor rehab during pregnancy often involves an internal component, which is considered safe once in the second trimester. This is always done with patient consent, midwife or OB clearance, and just one finger (far less invasive than a speculum, ultrasound wand, or…um…penis). I personally wouldn’t trust a knee doctor who didn’t look at or feel my knee before diagnosing and treating me, therefore I believe quality pelvic floor PT requires internal assessment of the muscles.
WHAT DO THE EXAM & TREATMENTS INCLUDE?
Every therapist’s evaluations and treatment plans are different, and even the same therapist will utilize variable techniques depending on the patient in front of them. This is what a typical (please read that word typical…just because something is right for a majority of my patients doesn’t mean it’s right for you – you are always in control in my clinic) exam and treatments during pregnancy look like in my clinic.
Medical history review. This includes past injuries and surgeries, pregnancy/birth story, hormone & menstrual cycle experience, an overview of bladder, bowel & sexual health, current pregnancy, birth, & postpartum goals, and anything else you feel is important.
Musculoskeletal exam. This looks a lot like when you go to a “regular” physical therapist. I assess your body’s alignment, strength, range of motion, and flexibility.
External pelvic exam. This involves assessing the vulva tissue color and quality, watching the pelvic floor muscles move to determine coordination & control, then externally palpating the pelvic floor muscles in both the urogenital and anal triangles to check muscle tension.
Internal pelvic exam. This does not involve a speculum or stirrups. I insert one gloved finger with water-based lubricant into the vagina (or rectum when indicated). There are three layers of muscles in the pelvic floor and I work superficial to deep going layer by layer, muscle by muscle to further evaluate pelvic floor tone and length. At the end I assess for a pelvic organ prolapse by having you push while I watch where your bladder, uterus, and rectum start and stop.
Typical treatments. This can vary depending on patient complaints and goals, but typical pelvic floor physical therapy treatments during pregnancy includes teaching how to relax the pelvic floor, positioning and “pushing” techniques for labor and birth, core and hip strengthening, pain management, strategies for bladder control and bowel consistency, and tips for postpartum recovery.
SHOULD I GO EVEN IF I’M HAVING A C-SECTION?
A c-section birth, planned or not, does not impact the changes that happen during pregnancy or the healing necessary postpartum. In fact, research shows the overall risk of maternal complications is three times higher after c-section compared to vaginal delivery. Long story short…no matter how you plan to birth your baby, you will still likely need and definitely receive all the benefits of pelvic floor physical therapy during pregnancy listed above.
CAN I BRING A SUPPORT PERSON?
This may vary from practice to practice, but in my clinic, the answer is a heck yes! I’ve had patients bring in their significant other, mother or sister, doula, and even best friend. I especially encourage this during the last visit or two when we go over positioning & “pushing” techniques for labor and birth and postpartum recovery – the more people who understand and are on board with your plan, the better.
HOW MANY APPOINTMENTS WILL I NEED?
Again, this is different for each patient, but the average pregnancy treatment plan is about eight visits long. There’s the initial evaluation, two(ish) appointments for learning to relax the pelvic floor, one focused on positioning and “pushing”, and four more for everything else – keeping the core and hips strong, maintaining bladder and bowel health, pain management, and anything else that might come up.
I kiiiiiinda think this could change your life
Most of the time I finish a blog post and think, “well that was fun”. But every once in a while I write that last sentence and can’t help but have a hunch (& hope) that the words above will change someone’s life. It’s a little dramatic, I know, but something tells me this one falls in that second category. I believe a stronger pregnancy, smoother birth, and easier postpartum are some of the first building blocks to the rest of your days as a mother, and the fact that something as simple and accessible as pelvic floor physical therapy can get you there is a fact I can’t help but share.
Amanda
Disclaimer: The content provided here does not constitute medical advice, nor is it a substitute for personalized healthcare. I’m a doctor, but I’m not your doctor. If you have concerns about a medical condition, diagnosis, or treatment, you should consult with a licensed healthcare professional.
Disclosure: Some of the links above are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase. No pressure, but I have a feeling you’re gonna like what I’ve taken the time to put my recommendation behind.
