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Early Postpartum Rehab - When to Start

In this blog, instructor Heather Rader, PT, DPT, PRPC, BCB-PMD, discusses the concerns and fears therapists have when treating mothers recovering from childbirth and how her upcoming course can prepare therapists to confidently treat patients within hours to weeks after childbirth.

 

When is it OK for a new mom to start therapy?

When a new pelvic therapist asks me this question at courses, my answer begins by shifting the focus towards the birth itself. Childbirth is a mechanism of injury, not a “special population.” The real question then is when is it OK to start therapy after perineal or abdominal tissue trauma? When your clinical reasoning begins from this point of view, it removes biases you may have about childbirth and instills confidence in your skills as a trained clinician. Every therapist learns acute care skills - how to treat wounds, how to mobilize post-op patients, and how to screen for medical complications. Simply put, dear clinician, you know more than you think you do.

On average, 3.75 million women give birth in the US per year (1.) 100% will have some level of injury because of it. Those injuries will be perineal, abdominal, or both. There will be muscle strains and ligamentous sprains. There will be soft tissue bruising and swelling.

There are risks of immobility and re-injury without proper patient education. There might be stitches or staples in the abdominal or vulvar skin. There will be pain issues, mobility issues, safety issues, and definitely body mechanics and ergonomic issues. Given these obvious musculoskeletal and mobility impairments, I ask you to ponder this - what profession is better prepared to assess the acute and sub-acute needs of a new mother than rehab professionals?

Let’s imagine the same question posed to an acute care therapist about newly injured trauma patients.

Every lecture on the history of rehabilitation highlights the early days when bed rest was thought to be therapeutic.

Through research and clinical observations, we know immobility was, in some cases, deadly. Nowadays, it is considered standard of care to begin mobilization as early as medically possible, even in the ICU. And so should it be with new mothers. When should a person who was in an accident start rehab? What information would our therapist need to determine when to start and what early intervention is medically appropriate?

  • Is the patient medically stable?
  • Are the injured tissues structurally stable?
  • Have any problems developed as a result of being immobilized in the hospital?
  • Are there other co-morbidities to complicate the recovery?
  • How is the patient’s mental status after the trauma?
  • What social support is in place to assist with short-term and long-term needs?
  • Can the patient function independently? Need home health? Benefit from outpatient therapy?

The clinical decision-making and critical thinking necessary to manage the care of an acute care patient is not much different than that of a pelvic therapist managing the recovery of a new or “acute” mother. More and more hospitals and birthing centers are incorporating acute care therapy within hours of birth. There are anatomical and physiological differences because of the effects of pregnancy itself that the clinician must learn, however. While the patient is recovering from childbirth, the body is returning to its pre-pregnancy state. Having a better understanding of the late pregnancy, birth, and the peripartum state has on healing can assist the motivated clinician in adding maternal-based therapy to their skill set.

The course Peripartum Advanced Topics covers medical screening, early exercise, patient education, hospital-based programming, and treatment strategies, as well as early outpatient care and fitness transition planning, such as returning to running.

If you are contemplating expanding your outpatient practice to see patients early in the “4th Trimester” or even earlier in the acute setting after the 4th stage of labor (recovery), consider signing up for the course.


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Upcoming Continuing Education Courses

Mobilization of Visceral Fascia: The Gastrointestinal System - Self-Hosted

Jun 25, 2021 - Jun 27, 2021
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Medford, OR Satellite Lab Course

Jun 25, 2021 - Jun 27, 2021
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia: The Gastrointestinal System - Chicago IL Satellite Location

Jun 25, 2021 - Jun 27, 2021
Location: Athletico Physical Therapy

Mobilization of Visceral Fascia: The Gastrointestinal System - Athens, GA Satellite Location

Jun 25, 2021 - Jun 27, 2021
Location: Thrive Integrated Medicine

Pelvic Floor Capstone - Satellite Lab Course

Jun 26, 2021 - Jun 27, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Self-Hosted

Jun 26, 2021 - Jun 27, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - Garden City, NY Satellite Location (CANCELLED)

Jun 26, 2021 - Jun 27, 2021
Location: Metro Physical & Aquatic Therapy

Pelvic Floor Capstone - Mequon, WI Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Health In Balance Physical Therapy

Pelvic Floor Capstone - Self-Hosted (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - Torrance, CA Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Women's Advantage Inc

Pelvic Floor Level 2A - Charlotte, NC Satellite Location (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Ivy Rehab Physical Therapy

Pregnancy Rehabilitation - Remote (SOLD OUT) Course

Jun 26, 2021 - Jun 27, 2021
Location: Replacement Remote Course

Pelvic Floor Capstone - Bozeman, MT Satellite Location (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Great Northern Physical Therapy

Pelvic Floor Level 2A - Virginia Beach, VA Satellite Location (SOLD OUT)

Jun 26, 2021 - Jun 27, 2021
Location: Southeastern Physical Therapy

Pelvic Floor Capstone - Decatur,GA Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Emory Healthcare

Pelvic Floor Capstone - Chamblee, GA Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Revelle Physical Therapy Atlanta

Pelvic Floor Level 2A - Belle Chasse, LA Satellite Location (CANCELLED)

Jun 26, 2021 - Jun 27, 2021
Location: Rehab Access Belle Chasse

Pelvic Floor Level 2A - Hebron, NE Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Thayer County Health Services

Pelvic Floor Level 2A - Chicago, IL Satellite Location

Jun 26, 2021 - Jun 27, 2021
Location: Advocate Condell Medical Center

Sacroiliac Joint Current Concepts - Remote Course (SOLD OUT)

Jun 26, 2021
Location: Short Form Remote Course

Coccydynia and Painful Sitting - Remote Course

Jun 27, 2021
Location: Short Form Remote Course

Working with Physiatry for Pelvic Pain - Remote Course

Jun 27, 2021
Location: Short Form Remote Course

Mobilization of the Myofascial Layer - Self-Hosted

Jul 9, 2021 - Jul 11, 2021
Location: Self-Hosted Course