Transcription:
Physical Therapy Helps Mothers Before And After Baby Arrives

Prakash Chandran (Host): Norton County Hospital is a rural critical access hospital located in Northwest Kansas. It is proud to offer several services for expecting mothers, including physical therapy before and after baby arrives. Marissa Schamberger is a Physical Therapy Assistant at the hospital who oversees the OB Physical Therapy Program.

Marissa has completed special training in women's health and pregnancy rehabilitation and provides personalized care to improve patient outcomes during pregnancy and after the child's birth. From the plains of rural Northwest Kansas to you, this is Health in the Heartland presented by Norton County Hospital, where medical experts aim to empower health at any stage of life.

Marissa, thank you so much for being here today. I really appreciate your time. I'd love to get started by you telling us a little bit more about the benefits of physical therapy for your OB patients.

Marissa Schamberger, PTA (Guest): Yeah, the benefits are to help improve woman's health throughout the entire length of their living. So through puberty, through pregnancy and then through menopause. A lot of symptoms that show up during pregnancy does reoccur during menopause. So if we get it on track now the less likely they'll have ,symptoms the older they get.

Host: And when we talk about physical therapy, what exactly does that look like?

Marissa: We kind of look at the whole body. So physical therapy, we specialize in muscles in the body and the way the biomechanics work. So, if we can help improve that, the better outcomes they have and decreased pain and decreased symptoms.

Host: Okay. And so is that specifically massage of those muscles? And you know, I guess strengthening of those muscles over time?

Marissa: Yes and no. So we could have tight muscles and we can have weak muscles. Both tight and weak muscles can portray in pain. So it just, depending on their mechanics and what's going on with the body. We kind of look at the whole body as one and if we see some type of compensation, then whatever is going on with that compensation, that's when we figure out, okay, well, is this a weak muscle or is this a tight muscle. And it just, depending on that area, we'll kind of decide if whether if they need some manual treatment, which does include massage or trigger point releases or some type of strengthening to help improve the mechanics.

Host: Understood. So tell me a little bit about how the OB physical therapy program developed in the first place.

Marissa: So it honestly started my own journey I was pregnant with my son two years ago and I had terrible pain. I could not tolerate a lot of physical activity. I had really bad pubic symphysis pain and not a lot of people wanted to touch me because I was pregnant. It's a big contraindication in the physical therapy world. But I do know a lot of my pain was musculature. So I, there had to have been something that could be done that could make me a little bit more proactive and I kinda dig, did some digging and found woman's health. And it's been a heaven-sent.

Host: Yeah, that's incredible. I think that, yeah, so many healthcare providers are scared of, you know, injuring baby and of course mother that mothers don't get all of the care that they need and deserve right?

Marissa: Yes. I agree.

Host: So let's say a woman is listening to this and they're interested in getting started with OB physical therapy. How do they go about doing that?

Marissa: First talking to their doctor, also in the state of Kansas, we can do direct access. And what that means is we can treat patients whether you're an OB related or not, all you have to do is just show up to the physical therapy department, say you would like to be seen or depending on your diagnosis. And we can treat up to four weeks without a signature of a doctor. Anything after that, of course you would need to get a doctor's approval.

Host: So tell us a little bit about how the appointment goes, you know, like, so someone comes in for their prenatal physical therapy visit. What exactly happens during that visit?

Marissa: Yeah. So, specifically for the program that I started up, I do see patients at least four times throughout their perinatal and postpartum, specifically at the perinatal. I'd like to see them preferred during that second trimester once they are away from that first trimester. Just because that's when miscarriages are more profound.

So making sure that's out of the loop and they're kind of in a safer zone. At that first appointment, we'll kind of assess the body and figure out if there's any type of symptoms. The symptoms could include leakage and incontinence whether that's urine or fecal. It could also depend on orthopedic pain such as low back pain, coccyx pain, hip pain. Around 20 weeks, that's when we kind of discuss about the body mechanics, making sure everything is working good with each other, just because if one body part is working more so than the other, then that's when they tend to have more pain towards the end of their pregnancy, once the baby is beginning to grow and mom is getting a little bit bigger.

Also within that second visit a little closer to delivery is when we'll kind of discuss a little bit more about the labor positions and how to help and relax the pelvic floor to allow an easier delivery. During delivery, a lot of people think that you have to push so hard, but the reality of just the fact of being able to control the pelvic floor muscles and relax them and let your body, the contractions do its job.

And all you have to do is just relax the pelvic floor muscles to help baby drop down, to have the baby engage and drop down to the cervix that just to have easier access through the delivery.

Host: Yeah. You know, one of the things that I have heard is that, you know, even though it's portrayed like, such an intense event on television; a woman's body is meant to just contract naturally. And if you are trained to just let it happen, it can be quite a painless and fast experience. What about the postpartum visits? Talk about that.

Marissa: So, yeah, the post partum, I like to see them as soon as they deliver baby. So within that first 24 to 72 hours after delivery. During that time, we'll kind of discuss pain management. And actually I want them to, so everything that they learned with that first and second appointment which is consists of diaphragmatic breathing, Kegel activation, all of that is going to benefit mom from after delivery on the way up to six weeks appointment, which is when I will see them again.

But until then they kind of focus more on getting those muscles start activating again, just because they go through so much trauma during labor, whether it's through a vaginal delivery or a C-section, it's just a lot of trauma to the body. So getting them able to reactivate those muscles and help with the swelling process and pain management ill help them with that postpartum stage. At that six week appointment, we'll kind of reassess just to see how everything's developing. If they had a vaginal delivery, we'd like to make sure that the Kegel activation is going very well, meaning the pelvic floor activation. Just to make sure everything's working together on top of that core engagement.

They a mom just grew a baby for nine months, so that core does a lot of very flacid, postpartum, and just their body doesn't know what to do. And so we try to make sure that everything's starting to work properly again. So that's the way they don't have low back pain or incontinence later down, especially during that menopause stage.

Host: Yeah, what's interesting is you're speaking to a lot of familiar symptoms or things that my wife went through, you know, after, you know, postpartum, she delivered vaginally and had you know, just a lot of pain, like some pelvic floor dysfunction, some low back pain. So I'm curious, like someone like her where things, I guess before the pregnancy were actually fine, but afterwards she really could have used the physical therapy. Are people like that, able to come and get help and treatment from physical therapy in that state?

Marissa: Yes. So actually I believe in the motto that just because it's been 10, 15, 20 years or even two days postpartum, you're still in that postpartum stage. And there's ways that you can improve the body mechanics. There's, your body is just very smart and it can learn and readapt it very well. Yeah, there's definitely help out there for even somebody like your wife, who could help improve some of those mechanics. It's definitely never too late.

Host: So one thing that I always like to try and close with, it's just a question about your own personal experience, especially having started this program. Out of all of the patients that you have seen, you know, perinatal and postpartum, what is one thing that you just know to be true that you wish more mothers knew before they came to see you?

Marissa: Oh, that's a good one. I can't really speak for the OB side, but I do know that a lot of those patients that I do see within that post-menopause stages, they always wish they would have known this right after they had their baby or even before they got pregnant. So, they could work on all this stuff and can have control over their body again, I feel like a lot of OB moms postpartum, you know, they deal with that incontinence. They deal with that low back pain. They deal with that hip pain and that's something that you don't have to live with. You can have control over that bladder control. You can have control over the pain that you're having within that back, or that hip pain.

And I feel like a lot of times know as moms, we want to continue to stay active and be able to run with our kids, but we can't because our joints don't want to hold up or we have that incontinence and that leakage and you know, I want to encourage moms to be able to go back to the things that they enjoy, whether it's that jumping on the trampoline with their kids without peeing their pants, or is that being able to crawl on the floors with their kids. Like, I just want them to be able to stay as active as we can because we know that helps within the later years,

Host: Absolutely. And I'm so glad you brought that up because again, with my wife, her and her friend gave birth around the same time and the pain and recovery that they went through, which in some cases took more than a year. They just assumed that it was a normal part of the healing process that they just had to deal with it, that there wasn't any help for it. And it was really hard for them. So it's wonderful to know that there is a focused resource that acknowledges that there needs to be proactive, physical therapy before birth, and afterwards that can help them.

Marissa: Yeah. And I mean, even before I came into this field of women's health side of things I've treated patients who have dealt with the same thing and just felt in control and, you know, we would treat them pretty much the same way, but this woman's health, it's a big thing. Part of the body that I feel like I wish I would have known at least two, three years within my PT career.

Just because I think back about those patientss, I'm like, oh my gosh,and the signs, all the signs were there and I could have helped that patient to be the best that they could be. But I stopped at the average because they stopped showing, yeah, they felt better, but they weren't completely a hundred percent healed. And that was definitely the missing piece was looking a little deeper into that pelvic floor.

Host: Yeah, I love it. Well, Marissa, thank you so much for your time today. I really appreciate it.

Marissa: Yeah. Thank you so much.

Host: That was Marissa Schamberger, a Physical Therapist Assistant at Norton County Hospital. You can visit Norton County Hospital online@ntcohosp.com to learn more about physical therapy and other services offered. Thanks again for listening to this episode of Health in the Heartland.

I'm your host Prakash Chandran. Take care of yourself and others and be well.