The transformation from being a pregnant woman to a mother of a newborn can be one of the most joyous periods in a women’s life. But various health issues resulting from pregnancy, labor, and delivery can create challenges for the new mother while caring for her infant. Physical limitations and pain may be great enough for a mother to feel overwhelmed with her daily routine. In addition, mothers generally place the maintenance of their own health far down on the list of priorities.
After delivery of a baby, over 60% of women will have separation of their abdominal muscles (which results in abdominal instability) and will experience lower back pain. Over 50% will experience urinary incontinence. 40% will have an episiotomy which may cause painful scarring and weakening of the pelvic floor muscles. 25% give birth by Cesarean section which can result in increased pain and dysfunction. 10% of women experience fecal incontinence. However, opportunities now exist for women to receive care and be proactive with their own wellness following the delivery of their baby.
Physical therapy can have a significant impact on the health and wellness of the new mother. In Australia, and now in a few cities in the United States, physical therapists assess a woman within 24 hours of the delivery of her baby. A treatment program is then developed that includes basic exercise. Additional exercises are started in physical therapy on an out-patient basis. Research has shown the benefits of exercise within 6 weeks after delivery include:
- Increased weight loss. Average weight loss is 8.6 lbs. Muscle tone is improved.
- Improvement or elimination of urinary incontinence.
- Increased abdominal strength, making the trunk more stable.
- Reduction or elimination of lower back pain.
- Improvement of energy level.
- Significant decrease in anxiety, depression, and mood disturbance.
Damage to the pelvic floor muscles during delivery can cause immediate and life-long problems for a woman. She may experience urine leakage as a result of weakened and strained muscles. An episiotomy may have been performed or tearing may have occurred which can result in a painful scar and lead to painful intercourse. Fecal incontinence often occurs if the tear is severe or the cut is deep. If the pelvic floor muscles never fully recover from the stretch and strain of labor and delivery, a woman will be more likely to experience urinary incontinence and a “falling down” of her uterus, bladder, or rectum later in life. Pelvic floor muscles need to be exercised to regain full function after delivery just as leg muscles need to be rehabilitated after a knee injury. Strengthening the pelvic floor muscles include performing Kegel exercises, which most women have at least heard of. However, more than 50% of women perform Kegel exercises incorrectly, even if they have been instructed by their physician. The most common mistake is pushing the pelvic floor down rather than pulling up and in. Another problem is identifying the proper muscles to use. A women’s health physical therapist can be extremely helpful in assisting the new mother in regaining full strength of these muscles. The success rate is very high with the reduction or elimination of urinary incontinence. A physical therapist specializing in women’s health can also treat problems which cause painful intercourse and pelvic pain in general.
Many women experience low back pain both during pregnancy and after delivery. The risk for low back pain is increased as the mother begins to care for her newborn. Stress is placed upon the back with repetitive bending to lift the infant, frequent diaper changes, and transporting the baby and equipment in and out of the car. Breast feeding can also cause back and neck pain. If the back pain is not addressed, women may continue to suffer from chronic episodes later in life. Physical therapy can treat the low back and neck pain. Treatment would also include education for the mother about correct bending and lifting techniques with the baby to minimize strain on the low back. There are also positioning techniques to use while breastfeeding to avoid pain. Learning to prevent back pain will be a life-long benefit for the new mother.
Weight management is also a concern after delivery. A women’s health physical therapist is able to assist the new mother with an exercise program, often incorporating the infant into the workout. Work with core muscles, including the abdominal muscles, is very important. Many women report a sense of well-being with exercise during this period.
A women’s body undergoes significant changes during the course of pregnancy, labor, and delivery. Muscles are stretched and weakened. The pelvis is strained. A women’s health physical therapist can help the new mother return to her pre-delivery physical state, and prevent future problems that may not present themselves immediately after delivery of the baby.
Pam Palmer PT is a women’s health physical therapist and owner of Palmer Physical Therapy for Women, Inc. in Wichita, KS.
Palmer Physical Therapy for Women, Inc.