I just want to clear the air on the difference between a vaginal exam at your 6 week post partum check up and a pelvic PT exam. Too often women come to me confused and distraught because they know things aren’t quite right down there, but their OB gave them the “all clear,” or worse, they received really bad advise or bad bedside manner regarding their symptoms. I could probably write a book on the things women have shared with me about what they’ve been told at their 6 week check up, but just to name a few…
One woman when she expressed that it felt like her insides were falling out did not even receive an internal exam and just a remiss comment, “I’m sorry, I hope that gets better for you.”
One woman at 30 years old was told that she’s in menopause (without any blood work, thyroid panel, or any other symptoms other than post partum vaginal dryness).
One woman with excruciating C-section scar pain with sitting or standing was told, “Well, you probably won’t feel normal for about a year.”
One woman, when expressing concern about her diastasis recti was given information for surgery.
Ok, I’ll stop because I could fill the page with stories of how women have been underserved and mislead at their 6 week post partum check up. Women are made to believe that they are receiving a full vaginal exam. What is actually happening is a tissue check. The birth provider is looking for signs of tissue healing, healing of stitches if there was a perineal tear, and/or signs of infection. When these areas check out normal and a woman receives the “all clear” it means that she will not cause tissue damage if she returns to exercise, intercourse, etc. There is absolutely no assessment of function, pain, leaking, etc. The all clear does not guarantee pain free sex, leak free exercise, or even that you should feel normal. Ideally, a birth provider would make this clear to the patient and be able to refer to pelvic PT if the patient has any pain with their exam or mentions symptoms that are clear signs of dysfunction.
The world would be a better place if OB’s collectively completed post partum care by leaving a sleepless, hormonal, post partum woman informed about her body with hope and options.
While I just dogged on the unfortunate situations women have come to me in, I must highlight the amazing OBs, midwives, and doulas who automatically refer post partum women to pelvic PT to ensure complete healing after birth, because it does happen. In fact, I just gave a training to 2 amazing, compassionate midwives who already refer to pelvic PT but wanted to be able to give more context and information to their clients at their 6 week post partum visit during the pelvic exam. I trained them in basic pelvic floor muscle palpation and assessment so that they could confirm with confidence that a woman would benefit from pelvic PT and also be able to explain to her with objective findings that,
She isn’t crazy.
It’s not all in her head.
She doesn’t have to just wait a year for things to feel normal.
Her tissues are healed, but she still needs rehab because she did the greatest act known to man- GIVE BIRTH- and just like any other athlete recovers and rehabs after injury or a huge athletic event, a post partum mother should too.
Briefly, a pelvic PT exam differs from a 6 week post partum check in that every layer of the pelvic floor muscles is checked for pain, dysfunction, restriction, and symmetry. Scar tissue is assessed for restriction or pain, pelvic floor muscles are assessed for power and endurance: fast twitch muscle fibers vs. slow twitch muscle fibers, support of the bladder through the anterior vaginal wall, support of the rectum through the posterior vaginal wall, urethra mobility, comprehensive diastasis check, etc. And, if your pelvic PT is a good one, you will also be assessed ORTHOPEDICALLY from your shoulders down to your feet because the pelvis is the center of the body and is affected by what’s above and below. Also, in regards to post partum, pregnancy and birth affects the WHOLE body not just the pelvis.
I have so much hope for the future of OB, pelvic PT, and the standard of care post birth. There is still much education to be done, but more and more women are standing up and refusing to live with pain, leaks, weakness, pelvic discomfort, and less than satisfying sex. Cheers to motherhood and complete healing after birth!
If you are in the Dallas area, I would love to help you. Find me at The Nest in Addison, or book online!
