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  • Danyell Russell, PT, DPT

Dear Mama, Advocate For Yourself!

As most of you know, I recently gave birth to a beautiful baby boy. Throughout my pregnancy and into this postpartum period I have come to several realizations about how our healthcare system treats women. And quite frankly, I’m pretty pissed off about it.

First of all, can we talk about postpartum care for women?

I just had my 6 week postpartum appointment with my OBGYN last week. My provider was in the room for a grand total of 2 minutes, if that. She was in the room long enough to do a very quick internal exam, to ensure that my uterus had shrunk down to it’s normal size, to check to make sure that my tearing had healed, and to ask me about what birth control option I would prefer.

Things she did not ask me about or bring up: if I were having any pain/heaviness/leaking, how I was doing from an emotional or mental perspective, if it were safe for me to return to sex at this time, if it were safe for me to return to exercise at this time, or if I had any pelvic organ prolapse or diastasis recti. I literally had to stop her as she was about to walk out of the room to discuss getting a referral for pelvic floor physical therapy. And then when I did ask her about pelvic floor physical therapy, she was taken aback and had no concept of WHY I would want physical therapy. I had to educate my OBGYN, who is supposed to be the expert in women's health, about the benefits of pelvic floor PT and why it should be standard of care for every postpartum woman.

Why is this a problem? I am a doctorate level trained physical therapist and a pregnancy and postpartum specialist. I am well educated in human anatomy, healing times, and rehabilitation from injury. I am well versed in the changes that happen during pregnancy and the trauma that occurs during childbirth. I am also aware that these changes and trauma can result in long term issues for postpartum women. And despite all of these things, my provider STILL tried to tell me I did not need physical therapy.

Now imagine with me if I were a woman without any medical background. My provider just came into the room and spent less than 5 minutes with me. Didn’t ask if I were having any pelvic floor symptoms. Didn’t screen me for postpartum depression or postpartum anxiety. Didn’t give me any guidance on how to return to exercise or sex, or even if it were safe to do so. Can you imagine that I would feel pretty lost? Can you imagine that I would assume that the urine I have been leaking is normal? Can you imagine that I would assume the pain and discomfort I feel when I lift my toddler is normal? Can you imagine that I would be fearful to have sex with my husband because it hurts to even sit down? Can you imagine that I would put off getting back to the gym, because I can’t even imagine trying to do a weighted squat when it hurts just to get up off the ground?

Unfortunately this scenario happens quite often. Women go in for their ONE postpartum check 6 weeks after having their baby and leave the office feeling lost and disappointed. They saw their OBGYN 15 times while pregnant to check on their little one and make sure they’re healthy and growing, but they only get 1 visit that is dedicated to them. And then their visit is here and gone before they know it, and they have no answers for the symptoms they’re having. And they assume that because their provider didn’t ask them about the symptoms, that it is normal. They assume that if it were important to address, then their provider would address it with them. And sometimes, they don’t even know what questions to ask.

Clearly there is a problem with how care for women is managed in their postpartum period, and I would love nothing more than to come alongside with these providers to improve the quality of care given to these women. But in the meantime, women have to advocate for themselves. Women have to ask the questions about their symptoms. Women have to ask about returning to activity and sex. Women have to ask to be referred to pelvic floor physical therapy. But how do women know what to ask about?

Here’s some things to bring up to your provider if they don’t bring it up first:

  • Feelings of anxiety, depression, or “not feeling like yourself”

  • Continued bleeding at your 6 week appointment

  • Feeling of heaviness, pain, or feeling like things are going to fall out of your pelvic floor

  • Any pain you may be feeling

  • Leaking of urine, fecal matter, or gas with activity, sneezing, laughing, coughing etc

  • Return to sexual activities

  • Return to exercise

  • Seeing a pelvic floor physical therapist

As mentioned earlier, I believe that every woman should see a pelvic floor physical therapist during their pregnancy and in their postpartum period. Throughout pregnancy there are numerous musculoskeletal changes that happen which often result in altered mechanics even in the postpartum period. In addition, childbirth whether it is done vaginally or via c-section results in the injury of tissues. We know that injuries rarely just heal on their own without any long lasting effects. Would we expect an athlete with an ACL injury to just rest and recover, and then be able to achieve the high level of function they had before the injury? No, they go to physical therapy and get help from a professional to assist them in getting back to their full potential. In the same way, pregnant and postpartum women should be going to a physical therapist to help them recover from the trauma of pregnancy and childbirth and to achieve their full functional potential.

Bottom line, we as women have to advocate for ourselves both in our pregnancy and postpartum period. Don’t be afraid to speak up and ask your OBGYN these questions. Don’t be afraid to tell your provider what you feel like you need. And don’t be afraid to ask for physical therapy!

I would honored to be a part of your pregnancy and postpartum journey. Please contact me if you have any questions or if you would like to see how physical therapy can help you!

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