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The Femina Physical Therapy Blog

Featuring original articles by our staff about current events and trends

With emphasis on vaginismus, pregnancy and postpartum best practices, treatments for incontinence, and other topics related to the health of your pelvic floor.

Featured From the Blog:

Details: Written by: Debbie Dy, PT, DPT; Published: 09 November 2023; Last Updated: 14 November 2023; 1864 Views

Safe Exercise During Pregnancy: ACOG Backed Guidelines — Safe Pregnancy Exercise | Image Courtesy of Lucas Favre via Unsplash

Dr. Debbie Dy, PT, DPT

Orthopedic Clinical Specialist/Pelvic Health Physical Therapist

Once the exciting news of a new pregnancy is shared, it is common to get flooded with misinformation and “advice” from concerned family members regarding the safety of exercise during their pregnancy. Historically, it is common for people to be told to “take it easy” during their pregnancy or spend more time in bed. What we know is that exercise during pregnancy is safe and beneficial for both birthing parent and baby.

ACOG Updated Guidelines on Exercise During Pregnancy

The American College of Obstetrics and Gynecology (ACOG) in 2020 released updated guidelines regarding exercise in pregnancy which states that “exercise is both safe and desirable for birthing people in the absence of obstetric or medical complications or contraindications.” Not only is regular exercise safe for most pregnancies, exercising has immense physical and mental health benefits for not only the birthing person, but for the growing fetus as well. Birthing people who engage in regular exercise during their pregnancies have been shown to have decreased rates of gestational diabetes, hypertension, cesarean births, operative vaginal births and postpartum recovery time. It can also be preventative for the development of depressive disorders in the postpartum period.

Underreported Pregnancy Related Lumbopelvic Pain:

A common condition that most healthcare providers are missing and how physical therapy can help

Being pregnant comes with lots of changes to an expecting mother’s body. Hormonal and physical changes to the body, as well as vascular and neural factors can cause pregnancy-related lumbopelvic pain (PLPP). About 63% of pregnant women in the U.S. experience it at some point during gestation. A recent survey study involving 538 pregnant women with pregnancy-related lumbar and pelvic pain (henceforth termed lumbopelvic pain) found that only 43% reported it, and of those, only 22% received any treatment!¹ Physical therapy through the use of manual treatments, therapeutic exercises, muscle re-education, and functional activity training (lifting mechanics, proper sitting and standing posture) have been proven effective at reducing pregnancy-related lumbopelvic pain and improving quality of life.^2,3,4 Pregnancy-related lumbopelvic pain can interfere with quality of life, physical function, inability to perform daily activities, sleep disturbances, and can contribute to mood disorders such as anxiety and depression.^1,2

What Are Some of the Best Labor Positions For Vaginal Birth?

Read on to find out why not all labor positions are created equal

If you have been pregnant for many months now, it is most likely time to get ready for the upcoming birth! Similar to a marathon, we need to train for childbirth to prepare the muscles and body for the upcoming event. For this reason, it is a good idea to start practicing being in different positions either with movement or holding a position for a long time. The first stage of labor involves contractions to dilate and open the cervix. Once the c

ervix is fully dilated, the second stage includes the passive and active phases of the baby crowning and coming out of the vaginal canal. The third stage involves the delivery of the placenta. We will go over each stage and how to best support our bodies throughout the childbirth journey.

Learn About Pelvic Floor Physical Therapy as Treatment for Levator Ani Avulsion

The pelvic floor is a group of muscles positioned like a hammock along our saddle region. The group of muscles attach from our pubic bone on the inside and then to our lateral walls with a bundle of collagen fibers called the levator arch, and attach to the ischial spines and tailbone on the back side.

During vaginal childbirth, the pubococcygeus muscle, a group of pelvic floor muscles, stretches 3.26 times more than its normal length to make room for the coming baby in the vaginal canal! As you can imagine, this can result in some perineal tearing and/or levator ani avulsion. Levator ani avulsion occurs when muscle fibers of the puborectalis (the most innermost muscle of the pubococcygeus group) are detached from its insertion on the pubic bone. About 20% of women experience an avulsion during their first vaginal childbirth. Risk factors include instrumental-assisted delivery (forceps higher risk than vacuum), older age at vaginal birth, second stage lasting longer than 2 hours, baby weighing over 8 pounds and 13 ounces, and those who underwent a grade 4 perineal tear.

Are You Thinking of Working with a Doula?

Here are some of the benefits

Being a pelvic floor physical therapist, I work with pregnant and postpartum women almost daily. Not having birthed any children yet and currently pregnant, I was curious about the doula process both professionally and personally. So, I attended a wonderful birth doula training program and learned a ton about what working with a doula is all about.

Details: Written by: Staff; Published: 25 April 2022; Last Updated: 17 June 2022; 4443 Views

Laboring Positions and Pelvic Floor Stretches for Childbirth — "Positions for Laboring Out of Bed" by joel telling is licensed under CC BY 2.0

All About the Importance of Pelvic Floor Stretches for Childbirth

**Talk to your physical therapist and healthcare team about specific guidelines for you**

Are you ready for the big day? Have you thought about how you will prep for your upcoming delivery? In this article, we’ll review four pelvic floor stretches for childbirth that may be appropriate, but recommend you consult with your childbirth healthcare professional to confirm if these are right for you.

Details: Written by: Staff; Published: 15 March 2022; Last Updated: 07 April 2022; 3050 Views

How to Manage Urinary Incontinence After Childbirth | Image Courtesy of Engin Aykurt via Unsplash

Postpartum Recovery Series Part 5

Managing Urinary Incontinence After Childbirth

Urinary incontinence is the unwanted leakage of urine, also known as accidental bladder leakage. There are a few main types. Stress urinary incontinence is leakage associated with activities, such as lifting, exercising, coughing, sneezing, or laughing. Urge urinary incontinence is leakage associated with the urge and people often experience leaking on the way to the toilet. There is also mixed incontinence which is a combination of the two types. Continence is managed by the complex interaction of bladder physiology, central nervous system, and the pelvic floor muscles. When there is dysfunction in any part of the three systems, incontinence may occur.