Pregnancy & Postpartum Care: When Should You See a Pelvic Health Practitioner?
Pregnancy and having a baby bring a lot of changes to your body, and you don't have to wait until something feels “wrong” to seek support.
Pelvic health care during pregnancy and postpartum can help with everything from pelvic and back pain, bladder symptoms and pelvic floor concerns to birth preparation and recovery after vaginal or caesarean birth.
Some people come in because they're experiencing symptoms. Others simply want to understand their changing body, prepare for birth or have their recovery assessed after having their baby.
So, when should you book? And what can we actually help with?
Here are some of the questions we are commonly asked.
When should I see a pelvic health practitioner during pregnancy?
There isn't one particular point in pregnancy when you need to start pelvic health care.
You might book because you're experiencing a particular symptom, such as:
Pelvic girdle or pubic symphysis pain
Lower back pain
Hip or glute pain
Rib or upper back pain
Bladder leakage
Urinary urgency or frequency
Pelvic heaviness or pressure
Constipation
Pelvic floor pain or tension
Pain during intercourse
You can also attend when you're feeling well and simply want guidance around your pelvic floor, exercise, movement or preparation for birth.
Is pelvic pain during pregnancy normal?
Pelvic, back and hip pain are common during pregnancy, but common doesn't mean you simply have to put up with it.
As pregnancy progresses, your body adapts to changes in load, posture, movement and the increasing demands placed on your pelvis and surrounding muscles.
There can be many contributors to pregnancy-related pain, which is why treatment should be individualised rather than assuming every pregnant person has the same problem.
Your appointment may involve assessing your back, pelvis, hips, muscles, movement and pelvic floor depending on your symptoms.
Can you help with pelvic girdle pain during pregnancy?
Pelvic girdle pain can cause pain around the front or back of the pelvis and may make activities such as walking, rolling in bed, getting dressed, climbing stairs or getting in and out of the car uncomfortable.
Assessment can help identify movements and areas that may be contributing to your symptoms.
Management may include hands-on treatment, movement modifications, exercises, strengthening and strategies to make day-to-day activities more comfortable.
Can pelvic health care help with bladder leakage during pregnancy?
Yes.
Pregnancy increases the load placed on the pelvic floor, and some people begin experiencing urinary leakage during pregnancy, particularly with coughing, sneezing, laughing or exercise.
However, leakage doesn't automatically mean you simply need to do more Kegels.
Pelvic floor function involves strength, relaxation, coordination and pressure management.
A pelvic health assessment can help determine what your pelvic floor needs and give you strategies appropriate for your pregnancy.
What about pelvic heaviness or pressure during pregnancy?
Some people notice increased heaviness, pressure or dragging through the pelvis or vagina during pregnancy.
There can be different reasons for these sensations, including the increasing load through the pelvis and changes in pelvic floor function.
If you're experiencing new or persistent heaviness, it's worth discussing rather than simply assuming it's a normal part of pregnancy.
Your pelvic health practitioner can assess your symptoms and determine whether further investigation or management is appropriate.
What is a birth preparation appointment?
A birth preparation appointment focuses specifically on preparing your body and pelvic floor for labour and birth.
During a vaginal birth, your pelvic floor needs to do something quite different from the strengthening we often hear about, it needs to be able to relax and lengthen to allow your baby to descend through the birth canal.
Birth preparation may include:
Understanding your pelvic floor
Learning how to relax and lengthen your pelvic floor
Breathing strategies
Labour and birth positions
Pelvic and hip movement
Pushing strategies
Perineal preparation
Internal pelvic floor assessment or release work when appropriate
The aim is to help you feel more familiar with your body and give you practical strategies you can use during labour and birth.
Is internal pelvic release work used for birth preparation?
It can be.
Internal pelvic release work involves working vaginally with the pelvic floor muscles and may be incorporated into birth preparation when appropriate.
Your practitioner may assess how well your pelvic floor can relax and lengthen and identify areas that may be holding increased tension.
Hands-on treatment may involve gently holding or moving over an area of muscle while incorporating breathing, hip or leg movement to help the muscle relax.
Internal treatment is always optional and only performed with your consent.
We have a separate guide explaining Internal Pelvic Release Work in more detail.
Is birth preparation the same as perineal massage?
Not exactly.
Perineal massage generally focuses on preparing the tissues around the vaginal opening and perineum for the stretching that occurs during birth.
Pelvic floor birth preparation can be broader and may include pelvic floor relaxation and lengthening, breathing, positioning, movement, pushing strategies and internal pelvic floor work.
Your practitioner can also discuss how and when to perform perineal massage yourself if appropriate.
Should I have a pelvic health appointment after giving birth?
A postpartum pelvic health appointment can be valuable whether you've had a vaginal or caesarean birth.
Pregnancy itself places significant demands on your pelvic floor, abdomen and surrounding body, regardless of how your baby is eventually born.
After birth, we can assess how your body is recovering and help guide your return to movement, exercise and everyday activities.
You don't need to wait until you're experiencing a significant problem to have a postpartum assessment.
What can a postpartum pelvic health appointment help with?
There are many reasons someone may seek postpartum care, including:
Urinary leakage
Pelvic heaviness or pressure
Pelvic organ prolapse symptoms
Pelvic floor weakness
Pelvic floor tension
Pain during intercourse
Vaginal or perineal discomfort
Recovery following tearing or episiotomy
Caesarean scar concerns
Abdominal weakness or changes
Back, hip or pelvic pain
Returning to exercise
Returning to running or higher-impact activity
Constipation or bowel concerns
Simply wanting to know how their pelvic floor is recovering
Postpartum recovery looks different for everyone, so your treatment and rehabilitation should too.
Isn't the pelvic floor just weak after having a baby?
Not necessarily.
This is one of the biggest misconceptions about postpartum pelvic floor recovery.
Some women do experience weakness. Others may actually hold increased tension or guarding through their pelvic floor after pregnancy and childbirth. And some can have areas of both weakness and increased tension.
When you consider what your body has been through, this makes sense.
For approximately nine months, the pelvic floor has been adapting to the increasing weight and pressure of a growing baby. Childbirth then places further demands on the pelvic floor and surrounding tissues.
Following birth, some muscles may remain tender, guarded or have difficulty fully relaxing.
This is why postpartum pelvic floor rehabilitation isn't automatically about doing more Kegels. Sometimes relaxation and reducing tension need to occur before or alongside strengthening.
Can internal pelvic release work be used postpartum?
Yes, when appropriate.
If your assessment identifies areas of increased pelvic floor tension or tenderness following pregnancy and birth, internal pelvic release work may form part of your treatment.
This may involve gently holding or moving over particular pelvic floor muscles, sometimes combined with breathing or movement of the hip or leg to help reduce the load through an area and encourage relaxation.
Internal treatment isn't something every postpartum patient needs, and it is always optional.
What about recovery from a vaginal tear or episiotomy?
Tearing and episiotomy can affect people differently.
Once tissues have appropriately healed, some people may experience ongoing tenderness, pulling, sensitivity or changes in the way the surrounding pelvic floor muscles are functioning.
Pelvic health care may involve assessing the scar and surrounding tissues, pelvic floor function and any symptoms you're experiencing.
Treatment is based on your individual stage of healing and presentation.
Can pelvic health care help after a caesarean birth?
Absolutely.
Having a caesarean doesn't mean your pelvic floor has been unaffected by pregnancy.
Postpartum treatment may also look at your abdominal wall, caesarean scar, breathing, movement, strength, back and pelvis.
Once appropriately healed, scar treatment and rehabilitation may form part of your recovery depending on your symptoms and goals.
When can I return to exercise after having a baby?
There isn't one date that suits everybody.
Returning to exercise depends on factors such as your pregnancy, birth, healing, symptoms, previous activity and the type of exercise you're hoping to return to.
Rather than focusing only on how many weeks postpartum you are, we can look at how your body manages movement and increasing load.
For someone wanting to return to running, gym training or higher-impact exercise, this may include assessing pelvic floor symptoms, strength and movement before gradually progressing load.
Is pain during sex normal after having a baby?
Pain with intercourse can occur postpartum, but persistent pain shouldn't simply be something you feel you have to tolerate.
There can be several contributors, including hormonal changes, tissue healing, scar sensitivity and pelvic floor muscle tension.
A pelvic health assessment can help identify factors that may be contributing and determine what treatment may be appropriate.
When should I book a postpartum appointment?
You can book when you feel ready and depending on what you need help with.
If you've recently given birth, your treatment will always take into consideration your stage of healing.
You can also seek help much later.
There is no expiry date on postpartum care. If your baby is six months, two years or even several years old and you're still experiencing symptoms that began during pregnancy or after birth, it's still reasonable to have them assessed.
Pregnancy & Postpartum Care in Healesville and the Yarra Valley
At Yarra Valley Women's Health in Healesville, pregnancy and postpartum care is individualised to you, your pregnancy, your birth and your recovery.
You might come in for pregnancy-related pain, pelvic floor concerns, birth preparation or support returning to exercise after having your baby.
Or you may simply want someone to assess how your body and pelvic floor are functioning through this stage of life.
You don't need to know exactly which treatment you need before booking. Your practitioner can assess what's happening and help determine the most appropriate next steps for you.