When it comes to postpartum recovery, we strongly believe that ALL mothers deserve access to high quality education and assessment from a trained pelvic floor physical therapist. However, we are often asked who has the highest risk, and which patients should be seen by physical therapists as soon as possible.
Who can help identify mothers at higher risk of pelvic floor dysfunction?
In the hospital setting, nursing staff, obstetricians and midwives present at birth can identify patients at higher risk of dysfunction and trigger a referral for pelvic floor physical therapy evaluation. Clinical staff who manage patients during pregnancy and postpartum also have an opportunity to observe risk and refer patients for physical therapy.
We did a review of the literature to help determine who can benefit the most from immediate assessment. Remember- all mothers can benefit from education from physical therapy to decrease long term risk of incontinence, pelvic pain, pain with sex, and other pelvic floor complaints.
Here’s what we found (in no particular order):
Shoulder dystocia
3rd or 4th degree tears
Use of Forceps or Vacuum
Vaginal Breech Birth
Greater than 3 hours time from complete to delivered ("Pushing")
Back pain impacting mobility
Multiple birth
Hysterectomy after delivery
Pre-existing pelvic floor dysfunction
Age >35
If you have any questions about pelvic floor physical therapy, or how to schedule a visit with a physical therapist postpartum, send an email to hannah@exhalepelvichealth.com
For Providers:
Click below to download a copy of the screening tool to use in your clinic. Feel free to add your own branding, but please leave the footer in place.
References/Further Reading
Coyne K, Sexton C, Irwin D, Kopp Z, Kelleher C, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. Br J Urol Int. 2008; 101:1388–1395.
Mannion C, Vinturache A, McDonald S, The Influence of Back Pain and Urinary Incontinence on Daily Tasks of Mothers at 12 Months The Influence of Back Pain and Urinary Incontinence on Daily Tasks of Mothers at 12 Months Postpartum . Tough University of Calgary, Calgary, Alberta, Canada.
Handa V, Nygaard I, Kenton K, et al. Pelvic organ support among primiparous women in the first year after childbirth. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(12):1407-1411. doi:10.1007/s00192-009-0937-3.
O’Boyle AL, O’Boyle JD, Calhoun B, Davis GD. Pelvic organ support in pregnancy and postpartum. International Urogynecology Journal. 2004;16(1):69-72. doi:10.1007/s00192-004-1210-4.
Wai CY, Mcintire DD, Atnip SD, Schaffer JI, Bloom SL, Leveno KJ. Urodynamic indices and pelvic organ prolapse quantification 3 months after vaginal delivery in primiparous women. International Urogynecology Journal. 2011;22(10):1293-1298. doi:10.1007/s00192-011-1438-8.
Stapleton DB, Maclennan AH, Kristiansson P. The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey. The Australian and New Zealand Journal of Obstetrics and Gynaecology. 2002;42(5):482-485. doi:10.1111/j.0004-8666.2002.00482.x.
Albert H, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstetricia et Gynecologica Scandinavica. 2001;80(6):505-510. doi:10.1034/j.1600-0412.2001.080006505.x.
Norén L, Östgaard S, Johansson G, Östgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. European Spine Journal. 2001;11(3):267-271. doi:10.1007/s00586-001-0357-7.
Stephenson RG, OConnor LJ. Obstetric and gynecologic care in physical therapy. Thorofare: SLACK; 2000.