Pelvic Health Care In Pregnancy: Providers Weigh In

I kind of outed a physician yesterday for his obliviousness to providing a pregnant woman with back pain any more meaningful advice than, “It’s going to get worse until you have the baby.  Hang in there.”

In response to this common sentiment, physical therapist Jessica Keaney of Marathon Physical Therapy, recorded this statement video of what that means to her on both personal and professional levels.

Additionally, there are plenty of other providers involved in women’s health care encouraging and pursuing proactive engagement with women during their pregnancies.  A few spoke to Share MayFlowers and some of their excellent insights are excerpted below.

Let’s keep working together,


HotaLekha Hota, MD, a urogynecologist with Boston Urogynecology Associates in Cambridge, MA.

We see a variety of perinatal and postpartum problems that include symptoms of urinary urgency, frequency, nocturia, urge incontinence, stress incontinence, urinary retention, fecal incontinence, musculoskeletal pain, pain with sexual activity, vaginal pain and bladder pressure symptoms. We also see prolapse during pregnancy and afterwards.

I hope that in the next few years there will be easily understandable information for patients—a tool that they can refer to and understand what changes are happening to their bodies during and afterward. It should be readily accessible, however; something provided to them at an early pre-natal visit with more information about what occurs, again, during the delivery and afterward. I think education is very key. Most women feel that the symptoms they experience are part of childbirth and while that is partially true, they don’t realize that they do not have to live with it.

I would like to see the problems affecting female pelvic health are being identified earlier and women are helped to get into treatment quickly. Often, I hear that patients have been told that symptoms will get better on their own and to give it time or that it is normal, so otherwise beneficial care and counseling is delayed for months or years. Read the full interview here.

ChrisChris Just, CNM, is a midwife and Executive Director of Prenatal Education, Isis Parenting who had years of clinical experience prior to moving into education.

Is there anything you would like to add beyond what you are commonly seeing in your environment – what questions aren’t being asked enough?

There are a couple of issues that women seem especially afraid to discuss.  One is the issue of pelvic floor dysfunction.  The conversation among women on this topic does not match its prevalence.  It is reminiscent of the way women were self-conscious about menopause in decades past; instead of having open discussions they would whisper about “the changes” they were going through and were too embarrassed to seek out support.  The other issue that we all need to talk more about involves perinatal mood disorders.  The MA Legislative Commission on PPD is working hard to promote the use of screening and referral in both the prenatal and pediatric provider communities to improve outcomes.  I am proud to represent Isis in the commission’s Pubic Education sub-committee.

What conversations that you are having repeatedly with your clients around information you wish was communicated to them and other women by other health care practitioners and the media?  

In addition to more communication about prevention and treatment for pelvic floor dysfunction and screening and referral for perinatal mood disorders, I would add that, in general, patients appreciate when providers present choices and engage in shared decision-making.  I have been hearing complaints from women about the lack of introduction and communication on the part of some residents before they perform cervical exams. I also hear that women are unprepared for how tired, weak and sore they feel after birth and how difficult breastfeeding can sometimes be so I think there can be more education by providers and nurses on this topic in addition to clients hearing about it in our classes.   I believe that our culture needs to value the early parenting period more than we do currently.  Women are expected to get right back into the groove after having a baby because of media portrayals and also the pressure we put on ourselves.  The parent – child bond is priceless and we need to treat it as such. Read the full interview here.

JillJill Fieleke, CNM is a midwife at Mount Auburn Hospital, active in clinical practice and former facilitator of Mount Auburn’s weekly postpartum support group.

What you are seeing most in practice as it would relate to this theme of perinatal health:

During the 2nd and 3rd trimester, I commonly see women experiencing low back pain, hip pain, sciatica, pubic symphysis separation and general joint instability. Postpartum issues include recovery from cesarean section, recovery from laceration (perineal tears during vaginal delivery), pubic symphysis separation, and postpartum urinary incontinence.

What different interventions, non-surgical and surgical, do you recommend for those having these problems? 

It varies by question, but I talk about overall health/nutrition/exercise/rest.  I talk about exercises to strengthen the core and the pelvic floor.  I refer to physical therapy and to urogynecology and sometimes to mental health providers.

What changes would you like to see in Women’s Health in the next five years? Would you like to see more research to be performed in any particular areas?

What a fantastic question! And one for which I”ll likely keep thinking of additions to these comments!  I would wish for a more holistic approach to women’s health, and one that accounts for the many roles that women play in their families and in the community.  I think that group versions of care are an excellent modality for women – whether it is physical or mental health care.  I’d like to see more programing for adolescent girls. Read the full interview here.

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