So why should I bother booking a postnatal check with a Women’s Health Physiotherapist…. surely my GP review is enough…?
It is totally understandable that in those early months after baby arrives, when sleep deprivation is hitting its peak and simply just making it through the day is an achievement, the last thing you would want to do is have your bits examined again. Especially when you have been checked by the public health nurse (PHN) and the GP already.
But in reality, GP’s and PHN’s are limited to time and extremely busy, therefore the vast majority of focus is on your baby and you will usually get screened for postnatal depression, there will be a family planning discussion, may be a visual check of the perineum or C-section if you request it and then some questions about incontinence. Of course, there are exceptions to the rule but in general it is rare that pelvic floor muscle function is assessed, tummy muscle gap/diastasis is checked or a graded return to exercise plan is put in place.
But, that is to be expected – pelvic musculoskeletal assessments, especially internals and exercise prescription postpartum are the domain of specialist women’s pelvic health physiotherapists and the evidence states that all women who have had a baby should have a postnatal check-up/Mummy Check/Mummy MOT regardless of how or when the baby was born. Women are advised to attend from 6 weeks postnatal and onwards as it is never too late to be checked. This helps prevent long term issues down the track. In fact, postnatal rehabilitation is standard care in France for new mothers.
So, why should you prioritise this extra check-up especially if you feel like there is nothing wrong?
Here are five things that a specialist physiotherapist can ascertain at a postnatal check:
1. Pelvic Floor Muscle Assessment
These muscles form a sling at the bottom of the pelvis. They are responsible for keeping the bladder and bowel from leaking, holding up the pelvic organs, supporting the lower back and pelvis, and maintaining optimal sexual function. Pretty important muscles and not ones you want to neglect!
During a vaginal birth, the pelvic floor muscles stretch up to four times their normal length to allow the baby to be born. They may have torn or been cut, and even if they are were intact, they have undergone the equivalent of a significant sporting injury and need adequate rest and rehabilitation.
But if you think a caesarean birth means you are in the clear – I’m sorry to say you’re not! Research has shown that long term, it is the pregnancy itself that is the biggest risk factor for pelvic floor muscle dysfunction, due to the weight of baby, uterus, placenta etc sitting on these muscles and the hormonal changes that occur in conjunction with it.
In order to check these muscles, your physiotherapist will assess your pelvic floor muscles either vaginally or by using a real-time ultrasound (if she/he has access to one). The ultrasound is placed on the lower tummy and shows the physiotherapist how well the pelvic floor can lift and relax. Plus, you can see this on the screen too, which is great for feedback and learning.
A vaginal examination, however, is the gold standard assessment method and a lot more information can be gained such as pelvic floor muscle strength, tone and the presence of pain or a prolapse. This more thorough examination is even more essential if you wish to return to impact exercise or weight training, or have any symptoms of pelvic floor dysfunction, such as:
Bladder or bowel incontinence
A feeling of vaginal heaviness
Any pain in the vaginal area
2. Abdominal Muscle Assessment
Your tummy muscles will be checked to see if they have returned to normal after delivery or if a gap/diastasis remains. It is normal for women to have some degree of stretching in the midline tissue and movement of the “six pack muscles” during pregnancy and if this was assessed immediately after delivery, we would expect the muscles to still be sitting apart from each other and be quite weak in the midline.
Most women will receive a postpartum physiotherapy advice booklet in their discharge pack from hospital that provides basic information/exercises to start implementing in the first few weeks. This should be enough for you in the early days to encourage optimal healing with relative rest and avoiding activities that cause repetitive increases in abdominal pressure, such as:
Chronic coughing and sneezing
Straining to open your bowels
But research has shown that natural healing only occurs in the first 8 weeks postpartum and if the tissue in the midline isn’t back to being thick and strong by that stage, you will need to do specific exercises to rectify it. Your physiotherapist can put an individualised program in place for you, at your check if it is applicable to you.
3. Musculoskeletal Assessment
Your physiotherapist will ask you about any current or past pain or injury to any joints or muscles.
The most common complaints in these early weeks are:
Pelvic girdle pain (pain in the pubic bone or buttock region)
Coccyx (tailbone) pain
Early diagnosis and management of these issues is essential to stop them becoming chronic problems. Posture will also be addressed and education and retraining will be provided.
4. Bladder and Bowel Function Screening
Many women experience bladder or bowel dysfunction during and in the early weeks after pregnancy. Your physiotherapist will ask you questions about:
How much you’re drinking
How often you’re opening your bladder and bowels
Whether you feel an urgent need to get to the toilet
Whether you have a history of pain with intercourse
Whether you experience any urinary or faecal leakage
And a whole lot more questions!
While these may be embarrassing issues to discuss, it is so important that someone asks these questions and delves into whether there are any early signs of dysfunction. Prevention is better than cure, and your physiotherapist can pick up anything at this point that isn’t quite right and help put a plan in place to optimise things before it becomes a bigger issue.
5. Return To Exercise Plan and Goal Setting
Everyone has different goals regarding return to exercise and activity after having a baby. But, whatever your goals are, it is important to discuss them with your women’s pelvic health physiotherapist and together you can work out how achievable they are, and what steps are required to safely achieve those goals.
Of course, as physiotherapists we want everyone to achieve their activity goals but sometimes we need to bring you back to basics and rebuild from the foundations up depending on how your pregnancy and birth went. This allows you to phase up your activities at a safe pace and avoid further issues setting in down the track or causing trouble in a subsequent pregnancy. This assessment will test where you’re at with your core strength and your ability to transfer load effectively when you do abdominal muscle exercises, high impact exercises, weights, running etc – whatever it is that you individually want to achieve.
In this way, a postnatal check is a very individualised assessment and it encompasses the whole body. Women should never assume that one woman’s muscle activation, hormonal changes, and birth trauma are the same as the next and although there are many common issues that affect women in the short and long term after childbirth – incontinence, vaginal prolapse, back pain etc – there are things that can be put in place to help to prevent and treat these issues. You don’t need wait for problems to occur or to worsen, you can be proactive by seeing a specialist Women’s Pelvic Health Physiotherapist in the early months after delivery.
Making an appointment is easy, simply search for a private physiotherapy practice that has someone who specializes in this area (you don’t need a referral) or ask your GP to refer you to see a specialist physiotherapist in the public system.
Suzanne Carney is a clinical specialist in women’s and men’s pelvic health physiotherapy. She holds a masters level qualification in this area from Curtin University in Perth, Australia where she lived for seven years. She has been a physiotherapist for more than 10 years and has recently set up Anatomy Physiotherapy in Claremorris, Co. Mayo which is a specialised practice for women's, men's and pelvic health. Suzanne also works part-time in Mayo University Hospital as senior pelvic health physiotherapist. To get in touch with her email firstname.lastname@example.org or call 083 034 3277.