Physiotherapy for Pregnancy

Hi! Kathryn here! I wanted to take the time to scribe details about the way we take care of clients through their pregnancy, to both give an overview and help connect any of you who may be in this stage of life with valuable resources that have guided my clinical practice. As a mum of 2 girls (Sophie who at the time of writing is 13 and Vivienne who is currently 10), and as a musculoskeletal Physio who’s worked in the pregnancy space for over 20 years, I feel really passionate about using the knowledge we have as Physiotherapists to help inform, guide and empower women to navigate pregnancy in a way that’s best for their bodies from pre-conception, to the ante-natal period right through to many years post natal.

“We have an increasing amount of available research to help a woman physically navigate her pregnancy in a way that produces the best outcomes. Musculoskeletal Physioduring pregnancy allows our mothers to tap into this.”

But firstly, I wanted to talk about why I feel this musculoskeletal pregnancy work is so important. I realised, when pregnant with my girls, that the medical system is effectively designed for the safe and healthy delivery of the baby, meaning that the baby or unborn foetus’ needs drive the medical process. Of course a healthy baby should be the primary objective of pregnancy, however the mother’s body as the carrying vessel for the pregnancy is often discussed through the context of what the foetus needs to thrive, not the mother.

In addition, we now have an increasing amount of available research to help a woman physically navigate her pregnancy in a way that produces the best outcomes. Musculoskeletal Physio during pregnancy allows our mothers to tap into this.

Next, let’s talk about the different types of Physios that women can access during pregnancy. I am a musculoskeletal Physio, which is different to a women’s health Physio. Women’s health Physiotherapy is an area of Physio that requires specific training. This training educates Physios on using internal examination (via the vagina or anus) to assess the pelvic floor and surrounding tissue. It allows a more specific and accurate understanding of the pelvic floor when there’s pathology, injury, or dysfunction. I always make sure I have a number of highly experienced women’s health Physios on hand to provide specialised treatment for treatment of conditions such as prolapse, incontinence and trauma, and I work closely with these through our strict referral protocol when they are required.  

As musculoskeletal and sports Physiotherapists, our scope of practice for the pregnant client includes simple and quick resolving presentations of incontinence, pain and postural conditions related to pregnancy, delivery and post-natal loading, headaches, back conditions and pelvic joint pain throughout the pregnancy and post-natal period. We also have extensive skills in helping women to know how much exercise and loading is safe for them before, during and after pregnancy and we use our framework to advise on returning to sport after the baby is born. So if women are unsure about whether they should see a women’s health Physio, or a musculoskeletal physio who’s trained in pregnancy, we have a free 15 minute telehealth consultation so you can discuss and decide with us which type of Physio is most appropriate. 

Many women see us before conception so that we can help with the following:

• Planning an exercise routine that is safe for each body, particularly if there’s a past history of injury. Not only will getting into good exercise routines pre-conception will set women up for success in general, there’s also research to show that improving fitness before pregnancy has a positive effect on many long medical conditions such obesity, gestational diabetes and other long-term health conditions. .
• Having a pelvic floor assessment (but if we don’t catch women pre-conception this also works well in early pregnancy). We use the real-time ultrasound to do this, to get a visual picture of how the pelvic floor is behaving and whether each contraction is of good quality, endurance and strength.
• Helping to improve any pre-existing injuries, particularly in the spine and lower body to improve comfort levels as the future pregnancy progresses.
• Provide classes to support the strengthening and exercise process. 

During pregnancy we can help women to:

• Know what to expect with their bodies as pregnancy progresses
• Help to align each women’s current choice of exercise to the Sports Medicine Australia Exercise in Pregnancy Guidelines. 
• Assess and train the pelvic floor in line with best practice to help every pelvic floor to be effective during the pregnancy, delivery and beyond.
• Help women to decide on the best exercise program for them during their pregnancy. Research shows that keeping up a regular exercise routine contributes to many positive health outcomes. 
• If women would like to do exercise with our guidance, we work to decide which of our many studio exercise classes are best for their stage of pregnancy, current level of strength and fitness and past history. Many women do our 3:1 Clinical Exercise sessions (if no complications in pregnancy) or our 5:1 Rehab and Strength Classes (if there’s a pain condition or complication present). 
• Provide treatment for pain conditions, common ones which include pelvic joint (or pelvic girdle) pain, which may include the sacroiliac joint and/or pubic symphysis, back pain or rib pain.
• Providepregnancy massage with our remedial masseur in a way that’s safe and effective during pregnancy (including using a belly pillow so women can comfortably lie on their stomach for treatment. A very popular option!) 

When preparing for birth we can help to:

• Suggest physical preparations for birth for those who plan to deliver vaginally. Our 36 week appointment goes through pre-birth preparation from physical strength to birth skills to perineal massage
• Direct our women to good quality midwife advice to help maximise Caeserian recovery (we highly recommend this manual written by a midwife who’s had 6 Caeserian deliveries herself!) 
• Teach women how to push effectively
• Create a plan for the first 6-weeks after delivery to maximise soft tissue recovery 

In the post-natal period our role is to:

• Support women in the first few weeks with any issues that arise, from advising on the need for a women’s health Physio assessment to suggestions of relief of pain from delivery and feeding which we tend to see routinely in many regions including neck, shoulders, back, pelvis and even wrists and thumb. We provide a free 3-week post natal appointment so that women can discuss their concerns without having to leave home. 
• Perform a formal 6-week post natal assessment which includes an in-person real-time ultrasound assessment of the pelvic floor, triaging women who should see a women’s health Physiotherapist and creating a return to activity plan. 
• Guide women through the process of returning to the highest level of sport they wish to, over a clinically appropriate period of time 
• Provide post-natal classes through our studio which can be prescribed at appropriate times for each individual recovery. 

I hope this overview gives you an idea of the role that we take at Flex to help women navigate their pregnancies in a safe and supported way. Feel free to make an appointment if there’s any help you need. 

 

References:

Exercise in pregnancy: physiological basis of exercise prescription for the pregnant woman. Lumbers ER. J Sci Med Sport. 2002 Mar;5(1):20-31. doi: 10.1016/s1440-2440(02)80294-8. PMID: 12054383 Review.

Exercise during pregnancy. A narrative review asking: what do we know? Barakat R, Perales M, Garatachea N, Ruiz JR, Lucia A. Br J Sports Med. 2015 Nov;49(21):1377-81. doi: 10.1136/bjsports-2015-094756. Epub 2015 Jul 1. PMID: 26135742 Review.

The benefits of physical activity during pregnancy. Brown W. J Sci Med Sport. 2002 Mar;5(1):37-45. doi: 10.1016/s1440-2440(02)80296-1. PMID: 12054385 Review.

SMA statement the benefits and risks of exercise during pregnancy. Sport Medicine Australia. [No authors listed] J Sci Med Sport. 2002 Mar;5(1):11-9. doi: 10.1016/s1440-2440(02)80293-6. PMID: 12054382 Review.