As I’ve become more and more familiar with the birth world, I’m beginning to feel like there are just so many boxes to check as we prepare for birth and life with a new baby. When I think about what providers are advising, friends & family are recommending and influencers are endorsing… the pregnancy and postpartum “to do” and “to buy” lists are growing longer and longer.
As a VBAC mama and birth doula, I do understand that planning a VBAC often requires a little bit… more. We’ve written other articles about mental preparation, physical preparation and general suggestions to support you as you plan your VBAC. Today, however, we’re going to dive deeper into one particular suggestion that gets mentioned over and over again around pregnancy and postpartum – pelvic floor physical therapy.
It seems like in the last few years there’s been a bit of a buzz about pelvic health, so we want to present you with the facts and let you decide if pelvic floor physical therapy (PFPT) makes sense for you and your VBAC journey.
To help us get the most accurate understanding, we interviewed Dr. Betty DeLass, PT, DPT. She is an expert in pelvic floor physical therapy as well as the founder and owner of Reborn Pelvic Health & Wellness (she was also an incredible guest on our podcast, listen to her episode here).
Enjoy our interview with Dr. Betty!
About the Pelvic Floor
What makes up our pelvic floor?
The pelvic floor is made up of multiple muscles that sling from the tailbone to the pubic bone that support the organs above, provide sexual function, act as a sump pump, stabilize the pelvis, and the allow for sphincteric support for opening/closing for defecation and urination.
What makes the pelvic floor so important?
The pelvic floor is very important as it is part of the core canister: abdominals, low back, diaphragm and pelvic floor. It is a vital piece for pressure management and stability in the core.
What complications can arise if our pelvic floor is compromised in some way?
The pelvic floor works as a system. If it is compromised many adverse dysfunctions can arise: incontinence, prolapse, pelvic pain, tailbone pain, low back pain, hip or SI joint pain as well as implication in diastasis recti.
Why PFPT
Why did you choose to focus your work on pelvic health?
I was always interested in pelvic health, but ‘someone was always doing it’ at my place of employment. It wasn’t really until I had my first child where I became righteously angry and dove head first into learning as much as I could as fast as I could so that I could selfishly heal myself, then once I did I set out to change the world. I was extremely disappointed with the support I had during postpartum and knew that it was unacceptable. The best way to change something is to do it yourself, I was not going to wait around for the ‘system’ to change.
There are so many things to focus on in womanhood. Why is pelvic health one of them?
I personally feel like pelvic health is a vital part that needs attention. If you are able to move your body without pain, enjoy exercising, be intimate with your partner, jump on the trampoline with your kids and participate in life because your pelvic health is optimal you are able to not only enjoy your life, relationships, body function, but also then be able to serve your family, community and place of work that much more because you are not hindered by a pelvic health dysfunction that limits you or impedes your success in life.
PFPT in Pregnancy
Tell us how PFPT is useful in pregnancy.
PFPT is extremely helpful in pregnancy. We are able to work on any orthopedic pains (think low back, SI, SPD, hip, PF) that may have been sub-clinical (meaning not noticeable before pregnancy) that then gets a magnifying glass shown on it during pregnancy with hormonal changes and rapid body changes with growing a human.
Additionally, we work vigorously on the deep frontal fascial line (google it!) to improve the mobility throughout the chain allowing mom to move well, baby to get in good position and the pelvic floor to be mobile. We also help train each person how to coordinate and relax their pelvic floor, practice multiple pushing positions, and improve the flexibility/mobility of the PF to decrease risk of tearing.
Additionally, a lot of what we do during pregnancy helps with postpartum recovery, aiding in decreasing the learning curve and improving peoples awareness and empowering them about their own body and how to use it optimally. And not to mention prep for a VBAC 😉
When should someone start PFPT during pregnancy, and how long should they continue?
We would love to see everyone in the ‘preconception’ phase before they are pregnant, however we know that is not the reality of everyone, but we love when they do come in! Anytime after the first trimester once you are feeling less nauseous and sick is ideal. We will start out with an evaluation and then based on your current status make a plan of care individually.
Typically, if there is already dysfunction happening we will see you 2 x a week to get rid of symptoms, then drop down to a maintenance frequency of visits. If everything is going well and you have no pain or dysfunction we will minimally see you 1 x a month until you deliver for routine care. We then see you back again between 2-4 weeks postpartum. Six weeks is too long to wait. And rehab goes far further than 6 weeks. Postpartum can be a large range as well, it all depends on your prior status before during pregnancy, what happened during birth and what your specific goals are. Each person is so individual, there are no cookie cutter protocols.
Our community is made up of mostly mamas who are on a VBAC journey. Can pelvic health play a role in VBAC pregnancy or birth? How might PFPT support VBAC?
Absolutely! We have helped so many achieve a VBAC! We love being able to help in any way we can to prepare for a VBAC. We spend a lot of time working on the deep frontal fascial line (goes from your head to your toes) which can impact labor and delivery, pelvic floor mobility, and optimizing alignment/balance of muscles so that mom’s body is in an optimal place so that baby can get in an optimal place. We have even worked together with a client/patient having a successful EVC (Sam Clements) with a combo of pelvic PT and Chiropractic where she got her dream outcome!
PFPT Postpartum
How about after the baby arrives; is PFPT still important?
10000% PFPT is essential during both pregnancy and postpartum. If you were to have a knee or shoulder surgery, you would do some prehab and then rehab…right away and FOR MONTHS afterward to regain mobility, strength, coordination, and endurance to get back to walking, stairs, reaching overhead and throwing…why are we not putting just as much if not more energy and thought into doing PFPT before and after birth?!!? That is what we are trying to change! It is a vital time to help with early support and intervention to set our birthing people up for success during pregnancy, prep for birth and then recover postpartum.
After birth your rib cage is expanded and needs to come back down and in, your core, low back and pelvic floor muscles get ‘unplugged’ from the wall and the computer needs a reboot! We all know ‘mom butt’ is a real thing. We help get all the connections back ‘on-line’ and activating properly with good motor control and timing so that we are able to lift the car seat, set the baby in the crib, and give a bath without debilitating pain. We also help with any ‘damage’ that was done during delivery whether that is a c-section recovery or vaginal tearing that occurs. We are the rehab experts for all of this!
When should a postpartum mama be evaluated?
We love to see our mamas come in around 2-4 weeks postpartum. It needs to start before six weeks and extend far past six weeks. Six weeks is a flagship postpartum appointment, but it has nothing to do with rehab. Six weeks is when your uterus is healed from an infection risk standpoint and soft tissue healing timelines allow for progressive loading to occur. We however start before that because you still have to lift the car seat, baby and move during your daily life and then if you are wanting to get back to sexual intimacy and exercise we want to make sure you body is prepared and progressively overloaded appropriately given your individual needs. Some are ready to have penetrative intercourse at 6 weeks postpartum, while some are not ready until months later…same goes for running or powerlifting.
Are there things postpartum moms can do from home immediately after birth?
Connecting with your breath in a 360 degree fashion is the first step! Making sure you can breath all the way around your diaphragm. Then connect that with your PF and abdominal muscles. It is very important to connect and avoid ‘maxing’ it out.
What about women past their childbearing years, is PFPT still relevant for them?
10000%!! You carry your pelvis with you your entire life. You cannot trade it in like you can a car. Pelvic floor issues are not just limited to birthing people. They are prevalent in every body and everybody. Additionally, as we age we lose strength throughout the body and hormones change (hello menopause!). It is important to be able to have your pelvic floor functioning throughout the lifespan. As we age, the risk of falling goes up. Strength training throughout your life is a must!
What to Expect During a PFPT Exam
What could someone expect during their first PFPT session?
We will review your medical history ahead of time, ask clarifying questions and then dive into a full body movement analysis.
After that, we will look into the specifics of your spine, rib cage, breathing, abdominal cavity, hips, pelvis, SI joints and all the way down to your feet. We will then perform an external and internal pelvic floor examination (with consent). Similar, but different than an internal exam with your OB/GYN or Midwife (no stirrups or speculums). We will be looking through the lens of a physical therapist, at range of motion, strength, coordination, mobility, scar tissue, trigger points, and overall movement systems.
With the information we gather both inside the pelvis and out (dysfunction is usually a combination of both!) we will perform specific treatment interventions to get you symptom free and give you a plan of care (how often for how long we are going to see you anywhere from 10-16 sessions is very common) to optimize your body and pelvic floor and get back to living your life to the fullest! We always give you a home exercise program as well to compliment what we are doing in each session as you progress towards your goals. Once you reach your goals we graduate you into maintenance mode (1-2 x a year for regular tune-ups/prevention like the dentist).
What should they know about cost, insurance coverage and frequency of appointments?
We typically see people 2 x a week until symptoms are resolved (approximately 8 sessions) then we decrease to 1 x a week (approximately another 4 sessions) until all of your goals are met. This can be very independent on the person coming in to see us!
There are many models of care out there: cash, hybrid, insurance. Reborn Pelvic Health & Wellness is a hybrid clinic meaning we have many options. Our goal is to make it work financially for our patients. We are currently a preferred out of network provider with insurance, cash, HSA/FSA and carecredit! The only insurances we do not work with are Medicare/Medicaid plans.
The reason we have chosen a hybrid model is so that we can provide 1 on 1 care for hour long sessions. It allows us to use insurance and also deliver high quality care.
Finding a Pelvic Floor Physical Therapist
What’s the best way to find a pelvic floor physical therapist?
We recommend using the website www.pelvicrehab.com to find someone local to you. Also, ask your friends…they will tell you where to go!
Do you have any other tips for someone wondering if PFPT is for them or not?
Ask questions, get curious, explore your options that are available. I have yet to meet a PFPT that is not an amazing human!
“PFPT is life changing…don’t just take my word for it, just read the google reviews people write! It’s pretty incredible!” – Dr. Betty
We’re so grateful to Dr. Betty for chatting with us and helping explain pelvic health. Her knowledge, expertise and personality are such a value to this field and our community. We hope this conversation helps you decide if PFPT is something you’d like to pursue on your VBAC journey.
For more information about pelvic floor health, check out these episodes of The VBAC Link Podcast:
- Episode 294 – Hannah’s Induced VBAC due to Preeclampsia + More on the Pelvic Floor with Co-host Rebecca (Listen on Apple Podcasts or Spotify)
- Episode 198 – Dr. Betty DeLass with Reborn Pelvic Health & Wellness (Listen on Apple Podcasts or Spotify)
- Episode 161 – Brittany Sharpe McCollum + Pelvic Dynamics (Listen on Apple Podcasts or Spotify)
- Episode 119 – Pelvic Movement in Pregnancy and Birth with Gina Conley (Listen on Apple Podcasts or Spotify)
- Episode 114 – Pelvic Floor Health with Valerie Schwalbe, DPT (Listen on Apple Podcasts or Spotify)
As always, my strong friend, I will leave you with this affirmation and reminder…
We’re so grateful to be on this journey with you!
Don’t forget to join our Facebook community, follow-us on Instagram, check out our Parents VBAC and HBAC Education course and give our podcast a listen where lots of incredible women share their VBAC journeys.
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