Deborah Howell (Host): Pregnancy and childbirth. While a celebrated life experience can place significant stress on the joints and soft tissue structures of the pelvic region, and that can cause pain and inconvenience. And welcome to you. I'm your host, Deborah Howell. Our guest today is Caitlin Daly, a physical therapist at Jefferson Healthcare, and we'll be talking about pelvic floor physical therapy and how it can be helpful for your pre and postnatal health. Thanks so much for being here, Caitlin.

Caitlin Daly: Thanks for having me.

Deborah Howell (Host): My first question to you is, how does pregnancy affect the pelvic region in the body, specifically the joints and the soft tissue structures?

Caitlin Daly: Yes. So pregnancy is going to change the body significantly over several months as the baby grows. We're having a significant amount of stretching of the abdominal wall. our posture is changing as our center of gravity is changing. It can place a lot of stress, and again, sometimes result in pain in the lower back. The sacro iliac joints where the spine meets the pelvis, the pubic bone and the pubic synthesis or the joint in the front of the pelvis, the hips and even the lower body.

Deborah Howell (Host): Okay. And what are some of the resulting conditions of the stress that pregnancy can cause?

Caitlin Daly: Yes, a lot of patients can, again, generally experience, like I said, pain in any of those areas, as well as sciatica or nerve pain radiating down the legs. patients can also experience, unfortunately, issues with urinary leakage or incontinence related to stress on the pelvic floor at the bottom of the pelvis. Pelvic organ prolapse is another common condition during or after pregnancy, related to the laxity and again, the downward stress that is occurring on the pelvic organs like the bladder, the uterus. and all of those can cause soft tissue strain, or injury. So sprains and strains to the muscles and the ligaments can occur, again, during and after pregnancy.

Deborah Howell (Host): Okay, now that's the bad news. Now the good news is we have pelvic floor physical therapy. Who's a good candidate?

Caitlin Daly: I would argue, certainly any pregnant patient that is experiencing any of these symptoms, while continuing to have some of these stresses is inevitable throughout pregnancy, physical therapy can help to manage them. I also love to see my postpartum patients around six weeks post, or for some patients even sooner if it's indicated. I am working with, my primary care physicians and OB GYNs. Try to make it more of a standard of practice to recommend all postpartum patients for physical therapy to help rehabilitate in the same way we would after any other injury or surgery or soft tissue stress.

Deborah Howell (Host): Okay, now it's my first visit to you for physical therapy, where does it take place and what does it entail?

Caitlin Daly: So our clinic at Jefferson Healthcare is located, in the bottom floor, on the waterside entrance. I have my own private office with a closed door. And my first visit, again, we're mostly just. Going over the history, and I do a lot of talking about anatomy on that first visit as well. I find that especially for first time pregnant patients, they're still learning what to expect, and even for patients when it is their second or third or fourth pregnancy, every pregnancy is different. And so we like to talk about where they are at that moment in time.

In that first visit, I will often do an external screen of the body where we're looking at. Range of motion of the back of the hips. We're testing strength. We're talking about things like how are you sleeping? What position are you sleeping in, how are you doing with your work and your day-to-day activities and how can we help with some of those things? If indicated, we do also do a pelvic floor assessment that can be done externally from the outside or internally intravaginally with kind of agreement from either primary care or obstetrics and gynecology about appropriateness for that.

We always want safety for both mother and baby to be of our utmost importance, but that can also occur, especially if patients are complaining of, urinary problems or pelvic pain. So we also work to improve pelvic floor flexibility and relaxation to prepare for vaginal delivery.

Deborah Howell (Host): Okay. Got it. Now let's talk about muscle strength and control training. Why is that so important?

Caitlin Daly: Yes. Again, as our bodies change, we're going to need more, core strength, which includes the back, the abdominal walls, the pelvic floor. We wanna make sure that that body is staying supported throughout pregnancy, and we're decreasing stress and strain on the other soft tissues and on the joint. Again, learning how to control your pelvic floor in particular can not only help mitigate urinary and bowel dysfunction during pregnancy, but can also help to speed the recovery after pregnancy as well.

In addition, like we just mentioned, learning how to relax the pelvic floor and improving that flexibility can really help patients prepare for vaginal delivery. Less likelihood of needing an episiotomy where they cut the tissue or having a traumatic tear. Both of those issues can result in more problems with the pelvic floor after delivery as well. And so addressing that prior to delivery and helping patients in their delivery positions can really improve outcomes for both mother and baby.

Deborah Howell (Host): I think you pretty much almost answered my next question, but just in case there's something I missed. what do you discuss with your prenatal clients?

Caitlin Daly: Right. So we do definitely discuss the delivery process. Kind of what are their goals? Are they going to be having that in the hospital? Are they gonna be doing that at home again, definitely practicing their positions, learning how to bear down without holding their breath. So really kind of helping to coach them through that process. And again, definitely like I said, manually stretching the pelvic floor, whether they're doing that on their own or with assistance from their partner can really help, decrease injury during labor. And then we also talk about what aftercare looks like as well. And how we can address those new changes and stresses on the body.

Deborah Howell (Host): Now I understand you have a program that includes body mechanics for activities of daily living and childcare. Can you tell us a little bit more about that?

Caitlin Daly: Yes. As opposed to other surgeries, for example, we'll say, where it's kind of again, a planned, traumatic tissue event. we're often told, oh, bed rest, rest, take it easy, lay low, don't go back to activities right away. You have a newborn that needs care immediately. And while of course you ideally have, a partner or another community of assistance helping to care for that child, mothers have to lift and carry and breastfeed or feed their children right away. And so we wanna address things like posture and lifting mechanics and making sure they're being careful about not creating, again, more stress on some of those structures that may or may not have already been problematic during pregnancy.

Deborah Howell (Host): Sure. Now I'm imagining that you develop a patient specific evaluation and treatment plan for each patient. Is that correct?

Caitlin Daly: That is absolutely correct. we always want to provide individual based care. every person is different. Like I said earlier, every pregnancy is different, and so we want to treat them based on their individual needs and goals as well.

Deborah Howell (Host): Sure. And the point being for so many women, you don't have to live with these inconveniences. It's okay to talk about them and you know, there is help.

Caitlin Daly: Absolutely. I think for a long time, patients have relied on information from family and friends, but there are also a whole host of professionals that are able to give a little more specific guidance about these individual facets of pregnancy and childbirth, including lactation consultants, and pelvic floor physical therapists.

Deborah Howell (Host): Is there anything else you wanna add to our conversation?

Caitlin Daly: I think we about covered all of it. Again, I just, encourage my patients to come seek, intervention even if they're not having problems. Again, often conversations I have with patients bring up issues they didn't think that, physical therapy could address. and again, we can help kind of prepare for some of those after birth challenges that they maybe don't anticipate.

Deborah Howell (Host): Sure. It's always good to have a pelvic ally in your corner. Right?

Caitlin Daly: Absolutely.

Deborah Howell (Host): Well, this has been such helpful information, Caitlin. Thanks so much for sharing your expertise.

Caitlin Daly: Thanks.

Deborah Howell (Host): And if you'd like to find out more, call Jefferson Healthcare Rehabilitation Services at 360-385-2200 to discuss your options today and to listen to a podcast on this and other topics of interest, go to jeffersonhealthcare.org. If you found this podcast helpful, please share it on your social channels. Thank you so much for listening. I'm Deborah Howell. Have yourself a terrific day.