Expecting in 2024? Here’s Why You Should Consider Physical Therapy For a Smoother Pregnancy

Are you expecting a new arrival this year? As exciting as it is to design the nursery, create your registry, and plan your maternity photos, prioritizing your physical and mental health during pregnancy is crucial – especially for first-time moms. That’s why we sat down with Dr. Amy Robinson of Restore Your Core Physical Therapy to learn more about how adding physical therapy to your routine can make for a smoother pregnancy.

Q: How can physical therapy help me have a healthy and comfortable pregnancy?

A: Physical therapists who specialize in pregnancy-related care can help moms stay active and relatively pain-free throughout their pregnancy in most cases. Pregnancy affects many parts of the body and can contribute to pain and dysfunction.  

Common changes that contribute to pain during pregnancy:

  • Hormonal changes – Relaxin and progesterone levels are elevated during pregnancy which loosens the ligaments and joints. This can lead to instability causing joint and muscle pain.
  • Uterine Expansion – as the baby grows, the uterus expands to accommodate it. This often leads to low back pain, sciatica, SI joint pain, and discomfort or pain in the abdomen, groin, and thigh. 
  • Increased abdominal and pelvic pressure – as the baby grows, the head often pushes on the pelvis. This can lead to pubic bone, SI joint and back pain, sciatica, and pelvic floor issues which may include constipation, urinary leaking, pelvic pain, pain during sexual relations, and rib pain. Additionally, this can also impact your ability to breathe comfortably. Moms often notice they have a diastasis (abdominal bulging or invagination) as the belly expands.
  • Changes in posture – as the baby grows and the belly expands it changes your center of gravity. This often causes back pain, and abdominal discomfort, and affects how the pelvic floor functions which can result in increased urinary leaking and pelvic organ prolapse.

After a thorough evaluation, physical therapists who are educated in pelvic health can create an individualized treatment program to address the common symptoms listed above. Pregnancy is healthy and should be enjoyed without the above afflictions.

Q: What specific exercises or stretches do you recommend that help me prepare my body for childbirth and promote a smoother pregnancy and delivery?

A: Every mom has a different birth plan; moreover, we collaborate with each mom to help her achieve her individual goals for labor and delivery. Exercises that improve flexibility and strength help moms during pregnancy, labor, and delivery. 

A major area of focus for moms opting for a vaginal delivery is on normalizing pelvic muscle tension. This normalization helps the pelvic bones to expand and change, thereby allowing the baby to move into the birth canal and progress into the pelvic outlet for delivery.

We also teach moms and their partners perineal massage to improve the extensibility of the perineal tissues. Research shows this can decrease perineal tears and episiotomies during vaginal deliveries. 

Every mom has her unique medical history; therefore, specific exercises are prescribed for every single client. For example, a few exercises that help to decrease pelvic muscle tension include child’s pose, happy baby, and a supported deep squat. We teach our moms to couple these exercises with deep breathing focusing on rib cage expansion and pelvic muscle relaxation.

Q: What are some specific recommendations for recovering from childbirth and regaining strength after delivery?

A: Every new mom should seek the services of a qualified pelvic floor physical therapist for a pelvic floor examination each time she delivers. These services should be sought regardless of the delivery type, C-section, or vaginal delivery. So many moms say “I feel good” but upon examination in the clinic, the assessment reveals that they are pushing instead of contracting their pelvic muscles. Pushing can lead to urinary leaking and pelvic organ prolapse over time. Other moms are doing Kegels, but the pelvic muscle assessment reveals they have an overactive pelvic floor which means they are holding too much tension. Doing Kegels when the pelvic muscles are overactive can lead to constipation, urinary leaking, pain during sexual activities, and pelvic pain. 

Assessing scarring tissue is also of utmost importance as perineal scars or episiotomies can lead to pelvic pain when sitting, during sexual activities, and/or with bowel movements. C-section scars should also be assessed and mobilized as scars in the abdomen can lead to abdominal pain, constipation, pain during sexual activity, urinary leaking, urinary urgency, decreased ability to orgasm, and back and hip pain. C-section scars can also contribute to secondary infertility. 

New moms often need help with correcting posture, improving rib mobility, engaging the abdominal and pelvic muscles, and regaining strength throughout the trunk and hips. We encourage all moms and assist them in reaching their personal goals.  Examples may include, but not be limited to walking 3x per week, returning to running, jumping on a trampoline with their older children, or returning to higher-level exercises.  

Q: Can you recommend any specific pelvic floor exercises for better pelvic health during and after pregnancy?

A: A pelvic muscle assessment is the key to knowing what exercises need to be completed during pregnancy and in the postpartum phase. The gold standard for a pelvic exam is an internal pelvic muscles examination performed by a specialty-trained pelvic PT. Some moms have weak pelvic floor muscles and would benefit from Kegels, but others have overactive pelvic floors and need to start with relaxation exercises.  We always say ‘If Kegels worked, every woman would do them and no woman would forget to do them.’  Kegels are just isolated pelvic muscle contractions and it is well known that our muscles are not meant to work in isolation.  

We teach women how to engage the pelvic muscles with the other inner core muscles that work as a synergistic unit to stabilize the spine and pelvis. We then work toward making sure the inner core and outer core work together to allow for higher-level activities. Coordination is key and working the muscles in functional positions is critical. 

Kegels alone are not the answer.  

Here is a great example: Think of the foundation of your house.  If it was built well, the foundation is strong and supports the rest of your house; however, if the roof is collapsing it does not matter if you have a strong foundation. The house will still collapse. The same is true for the pelvic muscles. You can have strong pelvic floor muscles but still have issues with urinary leaking, pelvic organ prolapse, and pelvic pain. The pelvic floor muscles must be trained as a part of whole-body movement and continually reassessed during the training process to ensure each mom is progressing toward her goals.

Q: Can I integrate ongoing PT and exercise into my routine to maintain a healthy and active lifestyle during and after pregnancy?

A: Yes, we work with every mom to determine what activities she is having trouble doing, what she wants to add, and what she wants to return to doing during pregnancy and postpartum. We then collaborate with every mom to create an individualized program to allow her to incorporate the exercises into her everyday life. We teach each mom the principles of how to progress into new exercises and we often have moms who ask to continue physical therapy as part of an ongoing program that allows for periodic check-ups.