Postpartum Physical Therapy: How the U.S. Falls Short

The United States is currently the only developed country to not mandate paid parental leave. Only 14% of parents in this country have the ability to take paid leave, while 23% of childbearing folks return to work within 10 days of delivery. Multiple health conditions are commonplace after giving birth, and in this country are deemed “normal” and often left untreated, such as pelvic floor dysfunction and diastasis abdominis recti. In contrast, countries such as the United Kingdom, Germany, and France offer postpartum physical therapy up to 16 weeks postpartum as a standard of care. Even the World Health Organization recommends postpartum physical therapy in order to help address these common health issues. 

Pelvic floor dysfunction can include incontinence, sexual dysfunction, pelvic organ prolapse, pelvic pain, and constipation. The muscles of the pelvic floor are put through immense strain during pregnancy and childbirth, and ligaments weaken from hormonal changes during this time. These symptoms aren’t only short term, but often become chronic issues. 76% of folks who experience urinary incontinence postpartum continue to have symptoms 12 years later. 

Diastasis abdominis recti is a separation of the abdominal muscles at the midline connective tissue and is reported in over two-thirds of pregnancies. Approximately half of these cases improve with time, while the others remain chronic conditions leading to decreased core stability, postural control, and low back pain. 

As physical therapy is a low-risk, minimally-invasive, and cost-effective treatment for these conditions, why are we not promoting this as a standard of care in the United States? Studies show folks who receive postpartum physical therapy are 5-8 times more likely to eliminate symptoms of urinary incontinence compared to those who received only general education on the matter. So if you are dealing with postpartum symptoms, I would encourage you to give physical therapy a chance at regaining the life you deserve. 

References

1. Critchley CJC. Physical Therapy Is an Important Component of Postpartum Care in the Fourth Trimester. Physical Therapy. 2022;102(5). doi:https://doi.org/10.1093/ptj/pzac021

2. Rovner ES. Postpartum Pelvic Floor Muscle Training and Urinary Incontinence: A Randomized Controlled Trial. Yearbook of Urology. 2014;2014:33-34. doi:https://doi.org/10.1016/j.yuro.2014.04.015

3. Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bø K. Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial. Physical Therapy. 2018;98(4):260-268. doi:https://doi.org/10.1093/ptj/pzy008

4. Von Bargen E, Haviland MJ, Chang OH, McKinney J, Hacker MR, Elkadry E. Evaluation of Postpartum Pelvic Floor Physical Therapy on Obstetrical Anal Sphincter Injury: A Randomized Controlled Trial. Female Pelvic Medicine & Reconstructive Surgery. 2021;27(5):315-321. doi:https://doi.org/10.1097/SPV.0000000000000849