Services We Offer for Postpartum Recovery

Postpartum Pelvic Health Recovery Should Start Day 1.

Here are some tips to help you get your postpartum pelvic health (and general health) back on track:

This article focuses on 5 key techniques you can use to improve postpartum pelvic health. It covers diaphragmatic breathing to activate core muscles and kickstart lymphatic drainage, pelvic floor muscle coordination, posture, and the benefits of a pelvic floor evaluation by a physical therapist to begin improving postpartum pelvic health on day 1. It also provides detailed instructions and references scientific studies to provide further research.

Are You Thinking of Returning to Running Postpartum?

There is not a magic time frame as each person recovers differently and the most important thing is to listen to your body.

For healthy uncomplicated pregnancies and deliveries the American College of Obstetricians and Gynecologists (ACOG) recommends women return to low-moderate intensity exercise at six weeks postpartum and eight weeks postpartum for cesarean.

After your OBGYN or midwife has cleared you to return to exercise, if you haven’t started with a Pelvic Floor Physical Therapist yet, now is a good time.

What is babywearing? 

Babywearing is the practice of transporting a baby or child in a sling or carrier that is worn on the body - a practice that has existed for generations, and has been observed across many different cultures.

What are the benefits of babywearing?

In the first few months of an infant's life, it is required of caregivers to perform many hours of carrying, a task that may be daunting if there are other children in their household that need caring for, or other responsibilities within the home that need tending to. Of course babywearing allows caregivers to be physically close to the baby while remaining hands free, but not only this, babywearing has also been shown to have emotional, physical and psychological benefits for both infant and mother. For the infant, maternal carrying of the offspring has been shown to trigger a calming response demonstrated by central, motor and cardiac signals in distressed infants.¹ There is also research to support that can improve length and success of breastfeeding, improve infant temperature regulation, and sleep apnea.

During pregnancy, the body goes through tremendous changes that can significantly impact strength, endurance, and ability to absorb ground reaction forces that are required to safely return to running. Your growing belly changes your posture, your hormones are making your joints more flexible, and some amount of deconditioning is expected and normal as pregnancy progresses. 

For most postpartum runners, their return to running following birth can be intimidating and overwhelming. 

Are You Wondering "Can A Vaginal Birth Ruin Your Sex Life?"

Medically, the answer is a resounding ‘no’… but postpartum sex is still an understandable concern for most pregnant women, especially in a digital age where whispered rumors have given way to detailed stories of difficult birth experiences splashed across social media pages.

In the greater debate over vaginal birth vs. C-section, the real issue on the minds of many expectant mothers is often whether one mode of delivery is somehow better than the other. It’s a complex question; but a group of researchers in Ontario, Canada recently attempted to answer the ‘sex after baby’ part of it. What they found out surprised even them; and shed some important light on the bigger question as well.

Researchers Studying the Impact of Vaginal Childbirth versus Cesarean on Postpartum Sex Find...

Learn To Do Cesarean Section Early Recovery Exercises

It’s Cesarean Section Awareness Month!

Trauma to the body is something all who give birth to a baby experience. With those who deliver via cesarean (c-section), there is the added trauma of an abdominal surgery in addition to the trauma of labor and delivery.

Today we will talk about post-delivery rehabilitation, with an emphasis for those who have had a cesarean. This information is all about self care to recover birth and is useful for ALL new mothers, whether delivering via the vaginal canal or a cesarean section.

In an upcoming blog post this month, we will discuss body mechanics of picking up a baby, breastfeeding, and the like after a C-Section.

Many women experience lower libido, vaginal dryness, sore muscles, and tender skin in the genital area after childbirth.

These issues can make sex uncomfortable, or even unappealing.  

Many women are not comfortable bringing up their sex lives to their doctors and midwives, thinking that it “will get better with time.” However, if you find your sexual health impacted for more than a few months after childbirth, you might start to wonder when you’ll be feeling back to normal.

What's the Link Between Urinary Incontinence and Postpartum Depression?

Postpartum Depression is a medical illness that negatively affects how you feel, the way you think, and how you act.

It typically arises due to a combination of hormonal changes, psychological adjustment to motherhood, and fatigue. Postpartum depression is said to affect between 5-20% of mothers depending on variable socioeconomic factors. Many people associate urinary incontinence as a common postpartum symptom. Prevalence of postpartum urinary incontinence figures vary due to diverse study formats, however it is predicted that bladder leakage is experienced in a quarter to half of all postpartum women.

In recent years, studies have concluded there is a strong link between both postpartum depression and urinary incontinence postpartum.

What is DRA?

Diastasis rectus abdominis (DRA, sometimes referred to as Diastasis Recti) is a distortion or thinning of the linea alba which is the midline of the abdomen that connects left and right rectus abdominis muscles together.

Although DRA can be found in both genders, it is more commonly found in females, and more common during pregnancy (66-100% of women have DRA during their third trimester) and can persist through their postpartum periods. About 33% of women continue to have a DRA a year postpartum. It can look like a gap in the midline, “doming” in the midline, or it can even appear as a “pooch,” in the lower abdomen. 

Why Do We Care?

The abdominal muscles and linea alba assist in trunk movement, posture, lumbopelvic stability, breathing, and abdominal organ support. As you can imagine, it can affect those functions when a DRA is present. As movement specialists, we want to make sure you are engaging the muscles and tensing up the fascia of the linea alba appropriately to help prevent low back pain, pelvic girdle pain, and activity-related injuries. 

Self Care After Cesarean Section, With an Emphasis on Baby Care Ergonomics

Today we talk about ergonomics with baby care after a cesarean section. It’s important for all new parents to conserve energy and protect their own bodies while adjusting to the care of a new baby, especially those who have had a cesarean. Today we will discuss body mechanics of picking up a baby, breastfeeding, and the like after a C-Section.

Lifting Restrictions

As a cesarean section is an abdominal surgery, your doctor will likely advise you to not lift anything over 8-10 lbs, depending on the doctor as well as the details regarding your cesarean and your personal health. Lifting restrictions typically last anywhere from 6-8 weeks. This may prevent you from lifting household items heavier than a gallon of milk… That means no carrying baskets of laundry or heavy bags of groceries.

A healthy lifestyle includes getting back to exercise postpartum

Exercise has shown to be beneficial in all stages of life, and the postpartum period is no exception.

Some of the benefits of postpartum exercise are:

• Strengthen and tone abdominal muscles
• Boosts energy
• May help prevent postpartum depression
• Promotes better sleep
• Relieves stress
• Can help you lose the extra weight that you may have gained during pregnancy
  (ACOG, July 2019).

Even with all these benefits, research shows that most mothers stop participating in exercise programs which leads to increased weight gain and obesity (Minig et al., and O’Toole et al., 2003). There are many adjustments that have to be made when becoming a new mother and the information on the internet regarding postpartum exercise can be misguided and overwhelming. Let's break down what the literature says about guidelines for returning to exercise postpartum.

Proper Postpartum Care is Crucial to Prevent "Ghostpartum"

Today we are addressing “Ghostpartum,” which may sound like a Halloween ghoul or goblin, but is actually a term used to describe the postpartum period where many do not receive appropriate care as they transition from pregnancy to parenthood. In fact, according to the American College of OB/GYN (ACOG), up to 40 percent of postpartum folks do not even seek proper postpartum care.

Physical therapy can help women across their lifespan. This includes support with orthopedic considerations related to breastfeeding, as well as other breastfeeding care with clogged milked ducts and noninfectious mastitis.

Symptoms & Causes of Clogged Milk Ducts and Mastitis

Breastfeeding can be a joyous time for some, but unfortunately it can be painful for others. Clogged milk ducts can be extremely uncomfortable and painful. It often arises due to not being able to drain fully, causing a back-up of milk along the mammillary ducts. It can occur when feeding sessions are interrupted or skipped, as well as when mom is under stress. One may experience symptoms such as a painful lump in the breast tissue, pain during breastfeeding that subsides after, and/or decreased milk supply from the blockage. Sometimes if unresolved, it can lead to mastitis, or infection of the breast tissue. Monitor for symptoms such as fever, swelling of breast tissue, redness of breast tissue, and escalation of pain/breast tenderness. If you start to experience these aforementioned symptoms, give your doctor a call as soon as possible.

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. 

Mommy tummy aka diastasis recti abdominis (DRA) is a prevalent issue.

One in three American moms have DRA that persists greater than a year.

So what is a diastasis recti? It is the stretching of the linea alba, a connective tissue that runs down the midline of the abdomen and connects the abdominal muscles. The stretching happens during pregnancy in almost 100% of mothers to make room for a growing baby. Many of these moms are told this is a normal part of pregnancy, even by their healthcare providers.

DRA is not just about appearance, it is also connected to pelvic floor dysfunctions as well as pelvic and low back pain. In a study by Kari Bo et al., they found that mothers in the US with DRA were also more likely to have the following:

How Postpartum Exercise Guidelines are Changing and Why

We're not saying "Don't exercise at all!"

In the article Sydni describes the evolution of standard practice for exercising postpartum - with recommendations increasing from six weeks to twelve weeks before any strenuous activity - but with added emphasis on easing into exercise at the six week mark, all the while building to a full regimen at the twelve week mark. 

She begins:

Many women can’t wait to start exercising again after pregnancy. For others, sweet baby snuggles tend to win out over exercising for the first few weeks. Once you catch up on sleep and start to gain more energy, you may be ready to do Pilates or go for a jog again—but it might not be safe to jump back in with the same intensity level in your postpartum exercise as in your pre-pregnancy routines.

...It turns out, new research backs waiting until 12 weeks postpartum to do high-intensity workouts, and many OBGYNs have adjusted their postpartum exercise recommendations acccordingly.

Wondering When To Start Exercising Postpartum? Exercise Guidelines Are Changing

Here’s Why Some Obgyns Recommend Waiting 12 Weeks After Birth To Workout

If you’ve just had a baby, you may be wondering when to start exercising postpartum. There is so much to keep up with when you have a newborn that it's only natural that exercise is often the last thing on your mind right after giving birth.

But once a little bit of a routine has set in, your body will (hopefully) give you some signs that it's time to step it up a bit:

We are excited to announce the addition of the NormaTec PULSE Series to our treatment options!

NormaTec is the ultimate recovery device. The technology can increase circulation and improve mobility for those who work out regularly, are training for a competition or race, experience swollen legs from traveling frequently, stand for long hours on the job, or suffer from inflammation, sore muscles, or other circulatory issues.

NormaTec is used extensively in professional athletics and is utilized for both rehab and recovery by 97% of pro teams, as well as Olympic and elite athletes across a broad spectrum of sports. Plus, our pregnant and post-operative patients love the way they feel after a session!

Levator Ani Avulsion: Understand your pelvic anatomy to better understand your injury

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 pelvic walls with a bundle of collagen fibers called the levator arch, and attach to the ischial spines (the inside of the sit bones) 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 may result in some perineal tearing and/or levator ani avulsion.

What Pelvic Floor Physical Therapy after Cesarean Section Can Do For You

Physical therapy after cesarean section can help you in your recovery by giving you skills to regain optimal body function and help you get back on your feet, doing the activities you value in addition to taking care of your new little one. In this article we review some ways that a therapist at Femina Physical Therapy can help you through your recovery. You can see a trained therapist as soon as you have the energy to do so.

Scar management and desensitization

Pelvic floor physical therapists are trained in soft tissue mobilization techniques to help soften and flatten scar tissue after your cesarean incision is healed. As a part of your treatment, your therapist will teach you techniques such as scar massage to help prevent scar tissue build up and puckering. Check out our full article on scar tissue management here.

What are Pelvic Organ Prolapse and Urinary Incontinence?

What is the biggest risk factor for both conditions? And how can you tell if you have them?

Not sure? You’re not alone. In fact, one research study found women actually know more about erectile dysfunction than they do about pelvic organ prolapse! While pharmaceutical company advertising bias may be to blame for part of that equation, one of the largest surveys of pregnant women and new moms ever conducted on the subject (by a team of medical experts in New England) reveals women’s healthcare providers consistently miss their biggest window of opportunity to educate patients about these conditions and offer treatment strategies that work.

This program is a blend of evaluation for diastasis rectus abdominus, postural dysfunctions and pelvic floor muslce status. Treatments may include pelvic floor muscle biofeedback, specific strengthening exercises and an educational program, all custom tailored to your specific situation. We want to help you get back to all of the activities you were doing before baby!

What is Anal Incontinence?

Anal Incontinence is defined as the complaint of involuntary loss of liquid or solid stool or the involuntary loss of gas.

It is supposedly an underreported condition because of its stigmatizing nature. It occurs in approximately 50% of women at long-term follow-up after anal sphincter injuries (Gommesen et al., 2019; Haylen et al., 2010; Damon et al., 2006; Cotterill, 2008).

Pelvic pain during the postpartum period is common, even for those who had a “perfect and easy” pregnancy, labor and delivery. Often times, healthcare providers will tell women that the pain “will get better with time,” however it's important to advocate for yourself and seek out care if you feel like you need it. Read my previous article about advocating for your postpartum care here.

Common types of postpartum pelvic pain and what you can do at home:

Vaginal Dryness

After delivery, your estrogen levels drop and progesterone levels stay high, especially if your are breastfeeding.

What you can do:

A simple solution can be drinking more water and using a water-based lubricant, read my previous blog on choosing the right lubricant for you.

We can help with a large range of pregnancy and post-partum related disorders. We also offer a post-hysterectomy recovery program and many other pregnancy and non-pregnancy related services.

Customized One-on-One Prenatal and Postpartum Exercise Programs

Learn SAFE and EFFECTIVE exercises to keep your body strong, flexible and painfree throughout your pregnancy and after delivery from a licensed Physical Therapist and certified Pilates instructor.

Redefining Postpartum Care in the “Fourth Trimester” by Utilizing Pelvic Floor Physical Therapy

Last month the American College of Obstetricians and Gynecologists (ACOG) updated their position on postpartum care in the “fourth trimester” - the first 12 weeks after your baby is born. This is such a huge step for better healthcare and support for women after delivery. In other countries (France, Belgium, Northern Ireland and other European countries), postpartum physical therapy is a routine referral for women both in the hospital and for ongoing support when they are discharged.

The statement updates the previous recommendation of a 6 week visit, and instead supports a paradigm shift of postpartum care that not only adds contact with their Ob-Gyns within the first 3 weeks of delivery, but also address the need for ongoing care:

Restless Legs Syndrome (or RLS)

Restless legs syndrome (or RLS) is a condition where there are uncontrollable urges to move limbs (mostly in the legs, but sometimes in the arms) that follows a circadian pattern, namely evenings/overnight when resting.

The urges usually come with unpleasant sensations such as tingling, burning, itching, or otherwise pain. Usually, it can be alleviated by movement, but as you can imagine, it can be debilitating and impair sleep, and thus the quality of life. It is common to experience mood swings, anxiety, and depression.

It is estimated that about 3.9-14.3% of the general population suffers from RLS. It is the most common movement disorder in pregnant women. There is either primary (idiopathic) RLS, or secondary (acquired) RLS due to pregnancy, renal pathologies, diabetes, hypertension, and other metabolic conditions. The two most common risk factors for RLS are iron deficiency and kidney disease. 

Safely Returning to Activity and Sport Postpartum

Postpartum Recovery Part 1

Most women get the clearance after their 6 week check-up for sex and exercise, YAY! But, really? How? What does that mean? There are no guidelines on how to return to activity in a safe, leak-free and pain-free manner.

Between 6 and 31% of postpartum women experience urinary incontinence. In addition, 66% of those who experience urinary incontinence during pregnancy and/or their first 3 months of postpartum continued to experience incontinence even at 12 years after birth! As you can see, it may be common, but it is certainly not normal!

Tips For Scar Management and Desensitization After C-Section

Also After Hysterectomy and Other Laparoscopic Procedures

After delivery via cesarean section, hysterectomy or other laparoscopic procedure, there will be an incision site that you will have to manage according to the directions of your doctors and nurses to keep the site from becoming infected. Although the incision site will close after about 2-3 weeks, scar tissue will continue to form. It is important to begin scar massage and desensitization techniques to help prevent scar tissue build up, puckering, and ongoing pain.

Managing Scar Tissue

A trained physical therapist can perform soft tissue mobilization and other modalities such as cold laser over the scar site. As a part of your treatment, your therapist will teach you skills to manage the scars at home for the following benefits:

You counted down the weeks until your baby’s arrival…

now you and your partner are counting down the days until your doctor gives you the green light to have sex again.

That’s a good thing; intimacy is an important factor in your relationship and your own well-being. But whether this is your first baby, or you’re sure it’s your last, your anticipation might be tinged with some anxiety. After all, your body has been through a lot since that positive pregnancy test result.

Sleepless nights, fluctuating hormones, and breastfeeding challenges can take a toll. Perhaps you’re still healing from a C-section or a physically challenging delivery. Even if giving birth was a breeze, and this is your easiest baby yet, you may worry that your expectations aren’t in sync with your partner’s.

When it comes to your postpartum sex life, what’s the new normal? And how soon can you get there?

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Let's Look at the Effects of Pelvic Floor Muscle Strength on Orgasm

Hint: strong pelvic floor muscles = strong orgasm 

The world is learning more and more about the pelvic floor and the many ways that it can be treated. At Femina Physical Therapy, we have spoken about pelvic rehab for urinary, bowel, birth, pregnancy, bladder, erectile issues, and many more. But we all know the question that everyone wants answered: Does pelvic floor strength affect orgasm?

Well reader, you came to the right place.  

Therapeutic Breast Massage in Lactation Can Help Make Breastfeeding Less Painful

Breastfeeding is widely accepted as the normal standard for providing nutrition to newborns, however, many women who do not reach their breastfeeding goals. US national data stated that breast pain was a commonly reported reason for women weaning less than 1 month postpartum. Within that segment, 29% of women who participated in the study stated that “breastfeeding was too painful” to continue.

In the same study, 24% of women reported “breasts feel(ing) too full or engorged” as another reason to discontinue breastfeeding prior to 1 month postpartum.¹ Currently, The American Academy of Pediatrics recommends exclusive breastfeeding of infants for the first six months of life. As physical therapists who treat patients with postpartum conditions, we are well positioned to make a big impact on patients with breastfeeding related pain and reduce barriers to continued breastfeeding!

Third Stage of Childbirth: Delivery of the Placenta

You made it!

Now, at this point you have delivered your baby and your body’s hormones have shifted tremendously! You may feel overwhelming emotions of joy and exhaustion at the same time. Oxytocin, the bonding hormone, rises sharply to compensate for the drastic drop in estrogen and progesterone. You may find yourself shivering, and this is normal immediately post-giving birth and can last up to one hour.

Delivery of the Placenta

If you’re looking for specific diastasis recti exercises, we can help you get back into a fitness groove after pregnancy and childbirth and help heal and strengthen the deep core muscles.

What is Diastasis Recti?

Diastasis recti happens when the two muscle bellies of the rectus abdominis separate. The separation between the right and left sides of this muscle can happen during pregnancy when the linea alba, or the tissue between the rectus abdominis muscles, stretches to allow the body room for your baby.

Your OB/GYN or physical therapist can determine if the separation you have is considered wide enough to be diastasis recti. In general, separation of more than two centimeters at one or more points of the linea alba meets the criteria for diastasis recti.1

Wondering How Long After Pregnancy Can You Have Sex?

By Sara Lindberg, M.Ed

Your world changes drastically after having a baby. Feeling in the mood for sex may take some time for both you and your partner. And whether you’re dealing with a lack of sleep, hormonal ups and downs, painful recovery, postpartum depression, trouble connecting with your partner, or all of the above, trying to rush an intimate relationship can cause more trouble than its worth.

That’s why it’s important to ease back into this part of your life and educate yourself on what to expect. Here, we go over the recommended wait time, reasons why you might be experiencing painful sex, why it’s normal to not want to have sex right away, and tips for when you are ready.