Obstetric and Postpartum Physical Therapy
Obstetric and Postpartum Physical Therapy
Know the antenatal and postpartum timeline and what is expected versus concerning. Antenatally, focus on activity modification, pelvic girdle pain management, breathing and pressure management, and preparation for labor within scope. Postpartum, understand perineal trauma classification (first through fourth degree), cesarean recovery, diastasis recti abdominis, pelvic floor recovery, and return-to-exercise and return-to-running progression.
Be clear on precautions: signs of infection, wound dehiscence, thromboembolic symptoms, heavy bleeding, and severe or new pain warrant referral. Understand that postpartum tissue healing continues well beyond the traditional six-week check, and that clearance for intercourse or high-impact activity is a clinical decision, not a calendar rule.
Traps: treating the six-week mark as a universal return-to-activity gate; assuming cesarean delivery protects the pelvic floor (pregnancy itself is a major load); missing fourth-degree injury implications for continence and sexual function; and prescribing aggressive abdominal loading before assessing doming, breath coordination, and pelvic floor response.
Rule of thumb: progress by symptom response and load tolerance, not by weeks since delivery.
Worked example: A patient eight weeks postpartum after a second-degree tear wants to run. Assess leakage, doming, pelvic floor coordination, and single-leg load tolerance; if any fail, build capacity first and re-test rather than clearing on time elapsed.