When The Physical Therapist Becomes The Patient: Lesson One

My oldest daughter turned eight years old this week. As I take the momma stroll down memory lane, I realize that so much of my story as a women’s health physical therapist began with her birth. I will be sharing some of the eye opening moments I had as I became a postpartum patient over the next few weeks. I am certain that I’m not the only mom who stumbled through their postpartum journey feeling lost, hopeless, confused, and defeated. My desire is to see every mom educated and empowered as they begin their journey into motherhood. I hope to use my voice and any platform I have to make sure moms have a clear picture of the orthopedic considerations that surround pregnancy and postpartum recovery. I want to join other providers and truly change postpartum healthcare for women. Because EVERY mom should have postpartum physical therapy after having babies. That hard reality was my first lesson.

I had only a single afternoon teaching session, a” lab” in PT talk, that covered physical therapy interventions for pregnant and postpartum patients. During that instruction time they taught me and my classmates one…maybe two exercises to treat women with diastasis recti. We briefly discussed pelvic organ prolapse and surgical interventions for incontinence. I was thankful to know that pelvic floor PT was an up and coming area of women’s health physical therapy when I graduated in 2004. I thought it would be very needed… you know, if you delivered triplets. It would certainly be essential… if you, deep breath, had a traumatic labor and delivered an eleven pound baby with a vacuum assist or forceps after hours of pushing. I learned that some moms might experience incontinence and pelvic pain after having babies … but I was pretty sure that would be a rare occurrence and most likely only if you had a grade IV tear.

I share my postpartum story with moms now, because my journey through diastasis recti, pelvic organ prolapse, and umbilical hernia changed my life and it changed the direction of my career. I stumbled through my first postpartum recovery without a plan. I did not spend time reconnecting and rebuilding my core and pelvic floor. I didn’t know that I needed to. I had multiple episodes of back pain and hip pain over the next several months. My knees hurt when I ran. I didn’t learn how to safely return to high intensity and high impact training. I didn’t understand that breastfeeding hormones could have an impact on my connective tissue healing so I went hard with all the burpees and mountain climbers and tuck jumps. I didn’t understand why it felt like my tampon couldn’t stay in place, but I reasoned that it must just be something that changed after having babies.

Then, at twelve months postpartum, I got pregnant with my second daughter. I was still breastfeeding at the time and though I was back to long distance running and high intensity training, I knew that I still felt “clunky”. My core didn’t feel solid yet and I still had some low back and pelvic girdle pain. I talk about hormones so much now because I truly underestimated my connective tissue healing and how my hormones delayed that process.

My second pregnancy was eye opening for me. At eight weeks pregnant, I looked four months pregnant. I already had a pretty severe diastasis and hernia in my first trimester. I sat in confusion at my first appointment asking ALL the questions. I reached out to my friends who were women’s health specialists. I researched every brace and binder for pregnancy. I cried…a lot. I endured all the comments asking if I was having twins. I watched my belly grow bigger and bigger felt hopeless. I read every article and book I could find from every expert on diastasis recti.

So, my first lesson in postpartum recovery was understanding that every mom should go through pelvic floor physical therapy and postpartum rehabilitation, regardless of how she delivers her baby. I had the incorrect expectation that if I was strong and fit prior to pregnancy, I would bounce right back after delivery. I had the incorrect assumption that if I had the unmedicated, vaginal delivery I planned for, I would avoid postpartum injuries. And, since I was successful with my birth plan and delivered my daughter without perineal tearing or stitching, I thought I was exempt from needing physical therapy.

I am thankful for the trail blazers in women’s health physical therapy that have gone before me, because voices like Diane Lee and Julie Wiebe truly gave me hope and confidence that I could rehabilitate my body and return to being athletic. My second postpartum recovery was long, but I did it the right way. It took me a full two years to feel solid in my core and functional with my strength, but I returned to long distance running and weight lifting.

I was fearful to get pregnant a third time and uncertain how my body would respond to a third postpartum recovery, but as I write this blog, my three little girls are running around me in circles. My third pregnancy was difficult, and my recovery was long, but I did it the correct way and I am actually stronger now than I was before having children.

If I could go back in time to my first pregnancy, I would scale back my prenatal workouts and decrease my load and intensity. I would have spent more of an effort staying connected to my core and pelvic floor. I would have started immediate postpartum physical therapy and I would have checked in with a pelvic floor specialist after my six week release. I would have taken the time to rebuild my pelvic floor and core muscles before I jumped back to running. I would have modified my workouts while breastfeeding and watched for symptoms of pelvic organ prolapse or abdominal wall injury. Unfortunately, I can’t go back in time, but I can use my voice and my platform to educate all the women that come into my influence so that they never have to say “ I wish I would have known that”.