The Postpartum Exam That None of Us Had But Should

The Postpartum Exam That None of Us Had But Should

March 1, 2018

When it comes to the modern woman’s postpartum journey, there is usually a lot lacking in the care and support department.  If you are reading this and feeling that this does not describe your experience, then count yourself in the minority.

When it comes to the medical care and guidance, the usual 4-6 week postpartum checkup is usually the most glaring example of this.  We are often not really assessed and if we do even disrobe for a pelvic exam, its usually a quick visual exam of the state of our stitches or swelling.  The problem here is that there are actually MANY other things that should be assessed.  ESPECIALLY if they plan on telling us that we are fine to resume sex and exercise activity.

Before I go further, I would like to say that I absolutely adore the doctor and midwife I worked with for my three pregnancies.  I recognize that their biggest job was to get mom and baby to the finish line alive and healthy.  They just didn’t have all of the training in the nuances of the pelvic floor like the pelvic health PTs have in our post professional courses.

So here is a summary of 8 things that SHOULD be covered but are not by our doctors and midwives.  

1)  Assess your pelvic floor muscles… and I DON’T mean when they pass a speculum straight past them.  The tone of the muscles at rest, their coordination, their strength, and their ability to relax are all important.  Is the strength symmetrical or is one side lagging with endurance or over tight?

2)  DON’T just tell women to do their Kegels. This makes pelvic PTs roll our eyes or think curse words.  Exercise is medicine.  Shouldn’t the person be properly diagnosed before we go prescribing something?  And telling someone to just do Kegels… how many, for how long should they contract, what should it feel like?

Did you know that many women have no clue how to do a Kegel?  And many other women have muscles that are in spasm or have pain or trigger points?  If a woman in spasm did more Kegels, this could actually make urine leakage worse!  If she has pain (which medical professionals do not often ask about), Kegels will also worsen the issue.

A pelvic PT is fully trained to assess these things and properly prescribe Kegels at the right time and in the right way for EACH patient.

3) Evaluate the pelvic floor for scar tissue.  Help the patient understand how to help with their own scar tissue healing and prevent adhesions.

4) Check for diastasis recti or abdominal separation.  Most women will have this during pregnancy.  40% of women will continue to have this after they deliver.  Guidance early on is helping in healing this to the best possible extent.  Identifying excessively large separations is helpful in guiding these women towards specialist and in some cases surgeons.  So many women come to me wondering if this could be their issue with persistent back pain or why their belly still looks pregnant years later. Why weren’t they assessed as a matter of routine procedure?

5) Palpate and check the pelvic bones for injury or pain.  Specifically the pubic bone and coccyx which can be fractured in the delivery process or injured.   

6) Ask the woman about issues with bowel and bladder as well as pain with sex.  This is really basic, yet if we don’t ASK our patients, then they might not know to tell you or not know how to bring up the issue on their own.  All of these issues can be addressed if only medical professionals ASK.

7) Return to sex.  Can we just stop telling patients to have at it because 6 weeks have gone by on the calendar?  EVERY BIRTH is unique.  Every body goes through different traumas and heals differently.  Let’s protect our new mamas a little better than this.  Let’s give them more tools to help them return to their normal activities safely, including sex.

8) Return to sport.  Again with the magical 6 weeks thing.  Respect the fact that women are feeling quite awkward at this stage after delivery with their bodies still feeling pretty foreign and frumpy.  They are eager to get back into shape and feel good again.  But our postpartum bodies need to gradually get back to activity.  We are not digital and our bodies are still at risk in these early months for injury to our pelvic floor.  I would rather be conservative than be a part of the reason a young woman has a pelvic prolapse.  We should arm her with the knowledge of WHY she needs to be careful and what symptoms to look for.  Full return to fitness and exercise activities WILL COME.  We just need to be smart about it!

So if  YOU or a friend is expecting a baby, keep these things in mind when it comes to postpartum care.  ALL of these things would be assessed by your pelvic specialist PT.  With a PROPER postpartum assessment, there are no questions left unanswered and the ambiguity for return to regular activity is removed.  Not to mention, proper healing is optimized and we are at MUCH LESS RISK for further pelvic floor injury due to lack of guidance.

If you have had a baby recently or within the last couple of years, CONTACT ME for a free 15 minute consult to tell your story and see if we can help YOU.

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