Postpartum Pelvic Floor Considerations
Top Contributors - Jess Bell, Kim Jackson and Carin Hunter
Introduction[edit | edit source]
The postpartum period has been divided into three phases:[1]
- The initial / acute period which covers the first 6 to 12 hours after birth
- The subacute period which lasts between two and six weeks
- The delayed postpartum period, which can last for six months
The effects of birth are usually felt most during the first 12 weeks postpartum[2] - the time also known as the fourth trimester.[3] However, in reality, childbirth can impact a mother’s pelvic health for much longer than just the fourth trimester. Thus, pelvic health should be a key focus during the postpartum period as the pelvic health foundations established during this period can have a long-term impact women.[2]
The Fourth Trimester[edit | edit source]
During the fourth trimester, tissues are still healing and the body is "finding its new self".[2]
Specifically during the first two to six weeks, the body experiences significant changes in terms of:[1]
- Haemodynamics
- Genito-urinary recovery
- Metabolism
- Emotional state
Changes in the later postpartum period tender to be very gradual and pathology is not common.[1] Because of these changes, it is important not to overstrain or exert the tissues. Instead, the focus should be on:[2]
- Rest
- Recovery
- Replenishment
- Restorative practices
Expectations for Recovery[edit | edit source]
It may be necessary to discuss recovery expectations with women. Savage[4] suggests having a wellness action plan can help expectant mothers and their families to be proactive and prepare for their physical and emotional needs after the birth of their baby. However, it is important to note that many women in the fourth trimester will have to plan:[2]
- Their return to work
- Childcare
- Getting strong enough to manage everything on their own etc
Discharge from Obstetric Care[edit | edit source]
Many women will be discharged from the care of their midwife or obstetrician after their six-week follow-up unless there is a specific medical concern.[2][5] These time-frames / standards may vary in different countries.
At the point of discharge, not all women will be given a comprehensive examination of their pelvic floor. However, when it is safe and appropriate, a women's pelvic health physiotherapist can provide this evaluation as needed. This is often around the five to six-week mark once bleeding has stopped.[2] It is also possible to teach clients how to perform a self-examination of their vulva and perineal region with a mirror.
The rest of this page will discuss six specific areas that pelvic health physiotherapists can review with their clients prior to the six-week assessment to enhance their pelvic health.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. J Prenat Med. 2010;4(2):22-5.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Afolabi I. Postpartum Pelvic Floor Considerations Course. Physioplus, 2022.
- ↑ Paladine HL, Blenning CE, Strangas Y. Postpartum care: an approach to the fourth trimester. Am Fam Physician. 2019;100(8):485-91.
- ↑ Savage JS. A fourth trimester action plan for wellness. J Perinat Educ. 2020;29(2):103-12.
- ↑ Spelke B, Werner E. The fourth trimester of pregnancy: committing to maternal health and well-being postpartum. R I Med J (2013). 2018;101(8):30-3.
