International Childbirth Raises the Bar for the Standard Care in Obstetrical Patients in the United States

If you’ve ever had a baby, witnessed one being delivered or heard of someone’s detailed labor and delivery story, one thing’s for sure, there was pain involved.  We’re not talking about a little discomfort here, folks. It’s a deep, intense, undeniable pain and, quite honestly, we’ve come to expect pain during a situation like this. It would be absolutely crazy to think otherwise. I mean, it’s equivalent to having a small melon exiting out of an opening the size of a child’s sock. Yes, the sock will stretch, the melon will emerge, but not without some repercussions…sometimes big repercussions.  Often, these consequences can be serious and have lasting musculoskeletal effects.  So what’s a girl to do?

Many would say, childbirth trauma is inevitable so “push” through the pain and try to get over it quickly, pun intended. Unfortunately, this is frequently the default response to childbirth in the United States. There is little to no preparation of the pelvic floor muscles, the low back, the abdomen, nor education for proper breathing, delivery positioning, energy conservation or anything, for that matter, that adequately prepares a woman’s body (her musculoskeletal system) for the delivery of a small human being.  However, for many years now, international countries, such as England, Germany, Australia, Brazil and South Africa (to name a few), have taken proactive measures to assist women with labor and delivery. Doing this lowers the risks of long-term musculoskeletal injuries or urogenital dysfunctions.  One way these international countries have elevated the standard of obstetrical care is to include physical therapists throughout pregnancy, during labor/delivery and for post-partum recovery. You might be saying to yourself, “Physical Therapists? Don’t they just give massages?” Brace yourselves….wait for it….no, they don’t.

Physical therapists are not massage therapists. They are, however, musculoskeletal experts that have unique knowledge of the evaluation, assessment, treatment, disease/injury prevention and general wellness of the human body.  In other countries, the physical therapists that assist with prenatal and post-partum women are called obstetrical physiotherapist and have advanced skill and training in women’s health. In the United States, we call them women’s health physical therapists. I know, ingenious. They, too, have advanced knowledge and extensive training in women’s health; however in the U.S., their services have only been considered for the prenatal patient with abnormal or life-altering pain or for the complicated post-partum patient with pain and/or pelvic floor dysfunction (i.e. urinary incontinence, organ prolapse or pain with intercourse).  But imagine with me for a moment, a progressive, forward-thinking obstetrical United States. What exactly does that look like?

If the U.S. adapted a higher standard of obstetrical care, every pregnant women would be evaluated by a women’s health physical therapist.  During the prenatal phase, she would get education and training on pelvic floor stabilization, core strengthening, body mechanics, birthing positions, perineal massage, breathing, relaxation and proper Valsalva for effective pushing, etc.  Then, in a perfect “U.S. obstetrical world”, these women’s health physical therapists would be included in the delivery room to help with pain management, assist with birthing positions that open the pelvis and decrease risk of vaginal/perineum tearing, perform perineal massage to allow adequate room for the decent of baby, provide biomechanical support and coach the patient on the when’s and how’s of proper pushing…just like what’s being done by obstetrical physiotherapists right now in other countries! Finally, all post-partum women would follow up with their women’s health physical therapist to assess healing of vaginal and/or abdominal tissues, educate on scar management and facilitated tissue recovery, learn mechanics for lifting baby as well as breastfeeding and restore pelvic strength. Of equal importance, women’s health physical therapists would also help new moms get their bodies back in shape, set realistic goals and expectations of motherhood and restore her vibrant, sexual health. Yes, I said “vibrant!”  Who wouldn’t want that?!

Good news! If you belong to a cutting-edge OB-GYN practice, you may have already heard about women’s health physical therapists. If you haven’t, I invite you to do a little research and see for yourself how effective this type of physical therapy is for pregnancy, labor, delivery and post-partum. Don’t be shy, ask your doctor to include physical therapy as part of your prenatal and post-partum experience. 

Dr. Sara Bolden is a Women’s Health Physical Therapist, Board-certified Women’s Health Clinical Specialist, certified in Functional Medicine, owner of Women First Rehabilitation in Woodstock, GA and author of What a Girl Wants: The Good Girl’s Guide to Great Sex

Company bio:

Women First Rehabilitation is an elite healthcare practice devoted exclusively to treating individuals with pelvic pain, urogynecologic disorders and pelvic floor dysfunction in all phases of life. All of our practitioners are licensed women’s health physical therapists with advanced knowledge and training in women’s health. For more information, visit