Dr. Margaret Archer is a pelvic floor physical therapist with Mère Health and a mom of two boys. She specializes in pregnancy and postpartum recovery, with a fitness-forward, evidence-based approach to care. This is what she wants every mom to know about healing your body, finding the right support, and reclaiming your strength after birth.
As told to Motherly. Lightly edited for clarity and flow.
If you are pregnant or postpartum, this may be the first time you have ever heard about or thought about your pelvic floor. Welcome—you are not alone.
As women, we are undereducated about our bodies and that could not be more true when it comes to our pelvic floor. You may also be navigating the wide array of information on social media and the internet of what to do during pregnancy and what to expect postpartum. What’s safe, what’s not? Is this normal? Is it not?
You may be experiencing some pelvic floor symptoms like leaking or pain or you may be wanting to know how to prevent these from happening. Good news: you’ve come to the right place! As a fellow mom of two boys, and a pelvic floor physical therapist, we are going to talk about all things pelvic floor physical therapy.
My hope for you is that if you are reading this, you realize you are not alone, that you walk away knowing there are services out there to support you and you feel empowered to advocate for what you need!
What is pelvic floor therapy?
Before we discuss pelvic floor physical therapy specifics, let’s talk about how pelvic floor physical therapists are able to help women during pregnancy and postpartum.
Pelvic floor PTs can help women who are experiencing a wide array of symptoms during pregnancy or postpartum, including pelvic heaviness/prolapse, leaking (incontinence), pelvic pain, and/or core weakness.
A pelvic floor physical therapist can help determine the underlying cause of your symptoms and help to create an individualized treatment plan for your recovery postpartum. Additionally, a pelvic floor PT can be an integral part of your wellness and birth preparation team to help reduce symptoms during pregnancy and set you up for success in postpartum, no matter how you deliver.
Related: I tried postpartum pelvic floor physical therapy—here’s what happened
How does pregnancy change a woman’s pelvic floor?
Pregnancy, childbirth, and postpartum all have significant impacts on a woman’s body.
During pregnancy, there is an increased demand on the pelvic floor muscles, hip muscles, and core muscles to support a growing baby and body. Our bodies have both passive (ligaments and bones) and active supports (muscles) to support our body’s posture and movement throughout our day.
Because of the increase in demand, sometimes our pelvic floor muscles have to “do more work” and they can become fatigued, hold tension, and/or struggle with coordination and timing to do their jobs.
This is one of the reasons why pelvic floor symptoms like incontinence and pelvic pain can pop up during pregnancy—and it’s also why exercising during pregnancy is so important to keep your body strong as the demand on your body increases. Additionally, staying strong in pregnancy can help set up a woman for a quicker recovery postpartum.
While there are a lot of things that we cannot control during pregnancy or childbirth, we can “stack the deck” in our favor with exercise, education about our bodies, and establishing care with a pelvic floor physical therapist to help!
Pelvic floor therapy is so important for ALL women and ALL births.
Related: We need to talk about your postpartum pelvic health
How does a pelvic floor physical therapist help you?
A pelvic floor physical therapist can meet with you (and your support system, if you wish) prior to your birth to help you prepare for birth. This may look like educating and instructing you in exercises to help with labor and delivery, teaching you how to relax your pelvic floor, practicing pushing techniques, and providing you education on what to expect from a pelvic floor and core perspective.
Some women think—
or may have been told—
that if they are having a C-section, they do not need pelvic floor therapy. This could not be further from the truth! I encourage all women to participate in birth preparation sessions with a pelvic floor physical therapist and be educated on how to prepare for a C-section, if planned, or what to expect if they have an unplanned one.
While about 30% of deliveries are C-sections in the US, most women are undereducated about what to expect and how to recover from this major abdominal surgery. This is where a pelvic floor physical therapist can be a critical member of your support team.
Following childbirth, a pelvic floor physical therapist can help you begin the recovery process and can see you in the first few weeks after delivery. A woman may experience a variety of symptoms like pain, incontinence, or weakness. In the early days postpartum, a pelvic floor physical therapist can help assess your healing—
at your pelvic floor, abdomen or both—
depending on your delivery.
Additionally, they can help you reduce symptoms if you are having any, and start you with gentle mobility exercises to heal your body and lay the foundations for returning to exercise and intimacy. This may include teaching you how to mobilize your scar tissue, reconnect with your pelvic floor and core, and feel empower you on your postpartum journey.
Related: You can (and should) start pelvic floor exercises right after birth. Here’s why
When should you start pelvic floor PT?
This is why I recommend establishing care with a pelvic floor PT prior to delivery so that you have someone who can support you starting as early as two weeks postpartum and care for you as long as needed.
How long is a pelvic floor PT session?
A pelvic floor physical therapy appointment is typically 30 minutes to 1 hour. A pelvic floor PT can help screen and connect you with resources and providers that you may need for common postpartum conditions like depression, anxiety, feeding difficulties or communicating with your OB provider if there are medical concerns.
Why does pelvic floor therapy matter postpartum?
Pelvic floor physical therapy is often overlooked in the U.S. and women are usually referred only after they advocate for themselves, or worse, they’re never referred at all due to lack of awareness, dismissal of symptoms, or barriers like access, cost, or time.
While birth can be beautiful, it is also a physical trauma that requires healing—
and ideally, the guidance of a professional to help maximize healing and recovery. For example, after a knee replacement, patients start physical therapy immediately in the hospital and continue for weeks or months.
Birth should be no different. A pelvic floor PT is uniquely trained to guide you through the recovery process. That’s why I advocate for early postpartum pelvic floor physical therapy for all women.
Think about the knee replacement example again: it would be irresponsible to send someone home for six weeks with no PT and then say, “You’re good to go! Just listen to your body.”
But that’s essentially what many postpartum women are told—and it doesn’t make sense.
It’s no wonder so many women feel lost on how to return to exercise, struggle with incontinence or have pain with intimacy.
We are missing the mark on providing care to heal from birth. Women should have access to pelvic floor therapy services to educate them on what to expect, address any symptoms they are experiencing early on, and begin healing immediately.
Related: 5 expert tips for healing your pelvic floor from birth (without leaving home)
When should you start pelvic floor therapy after giving birth?
I recommend that all women have an appointment with a pelvic floor physical therapist between 2-4 weeks postpartum. This often requires women to advocate for themselves and request a referral, as it’s not yet standard practice.
An early visit with a pelvic floor PT can help identify any medical red flags, start you on early mobility exercises, reduce pain, provide education on healing timelines, refer to other providers if needed, and empower you in your recovery.
After the initial k appointment, I recommend another visit between 6-8 weeks. This allows your pelvic floor physical therapist to continue assessing your healing and progress. For some women, this may include c-section scar mobilization. For others, it may include a pelvic floor exam (external and/or internal) to assess tissue healing and pain. This visit may also cover return-to-intimacy guidance.
Many women are fearful of returning to intimacy following childbirth, and while common (but not normal), some women experience pain with intimacy after birth.
A pelvic floor PT can help guide you with strategies, exercises, and tools to help you return to pleasurable intimacy (when you are ready!). Every woman’s postpartum recovery is different, so finding the right provider is key. Establishing care during pregnancy is ideal—but it’s never too late to get started.
Can pelvic floor therapy help with pelvic floor disorders?
Yes! Pelvic floor physical therapy can help with common postpartum issues such as incontinence (leaking pee, poop, or gas), constipation, pelvic pain, hip/back pain, pain with intimacy, core weakness, C-section recovery, and more.
What can I expect during a pelvic floor physical therapy session?
Before booking your first appointment with a pelvic floor physical therapist, you want to consider if the therapist is a good match for you.
Pelvic floor physical therapy can feel intimate, especially if you’re dealing with trauma or pain.
You want to find a provider who you feel connected to, trust, and someone who listens and understands your specific goals.
You will also want to consider how you would like to receive your services. There are providers who can see you in a clinic setting, virtually, or in your home. Choose what works best for your lifestyle.
Ask questions like: Do you accept insurance or offer documentation for reimbursement? How often will I need to be seen? Will I see the same provider every time?
Related: Postpartum exercise guidelines are changing–here’s why some OBGYNs recommend waiting 12 weeks after birth to workout
What can you expect in your first pelvic floor PT session?
For your first pelvic floor physical therapy session, you will start first by talking with your provider.
Your provider will likely go through your medical history, a thorough questioning of your symptoms, and, most importantly, a discussion of your personal goals. Depending on what your visit is for, the first session may then have a hands-on component.
This may include:
- looking at your posture and how you move
- your strength and range of motion
- assessment of your tissues.
- a pelvic floor assessment, which could include external and/or internal assessment if the provider thinks it is appropriate and you agree.
This also may happen at a future visit, if warranted and agreed upon. Your provider should explain why they recommend any assessment, offer draping to protect your modesty, and stop if you’re uncomfortable. You are in control in the driver’s seat.
Your PT may assess other connected areas, like hips, back, or even feet. After your evaluation, you should discuss what comes next, home exercises, and how often you’ll meet.
Reframing pelvic floor therapy as an act of self-care and reclaiming your body
During pregnancy, there is a large amount of attention placed on mom and when the baby has arrived, mom and her needs can quickly become secondary to caring for a newborn. In our culture, moms are expected to “bounce back” and there are plenty of areas where women are being promoted packages that promise “six-pack abs at 6 weeks”, etc. This can leave women feeling frustrated with their bodies or trying to rush through their recovery.
Maternity leave, if provided, is often short, and women are returning to the demands of work, life and motherhood without prioritizing healing their bodies. I often have this conversation with women, and I have been there too!
Prioritizing your health is not selfish.
A healthier you, is not only a healthier you for you but also a healthier you as a mom, as a friend, as a partner and maybe one day as a grandma! You deserve to feel strong in your body, be able to jump on the trampoline without leaking, and have a fulfilling and pain-free intimate life. That doesn’t change just because you are a mom. Prioritizing your pelvic health matters now and it matters to set you up for your future.
Common pelvic floor physical therapy exercises
Following childbirth, a woman can begin her postpartum recovery starting day 1!
This may look like walking a little while in the hospital, working on some deep breathing exercises and performing gentle stretching exercises for the first 1-2 weeks.
Starting between 2-6 weeks a woman may begin some pelvic floor and core re-connection exercises like bridges and pelvic floor muscle contractions, some light bodyweight exercises and increase their walking.
As a woman progresses in her recovery, she may then begin more strength training with weights, starting to return to impact exercises and progressing her core exercises. When returning to exercise, it is important that a woman be educated on symptoms to look out for which may be indications that exercises may need to be modified or not initiated until medically assessed. This may include things such as high blood pressure, active signs of infection or significant increases in bleeding.
A pelvic floor physical therapist can help establish what exercises and routines are best for you and guide you through your recovery process. One aspect of a pelvic floor PT’s role in your care is educating you on how to navigate pelvic floor symptoms if you experience them.
For example, after childbirth may be the first time that a woman experiences urine leaking while trying to jump. This can be scary and could lead to a woman avoiding jumping activities in the future. We don’t want that for you and you don’t want that for you!
A pelvic floor physical therapist can help you understand how to modify and strengthen your body so that you can experience symptom-relief and healing. We want women to get back to the things that they love and a pelvic floor PT can help with providing an individualized, tailored approach for you.
Expert tips on pelvic floor therapy
- Just because it’s common, doesn’t mean it’s normal. Pelvic floor symptoms like incontinence and pain with intimacy are common postpartum but they are not things you have to “deal with because you had a baby.”. There is hope for healing and pelvic floor PTs can help you.
- During your postpartum recovery, it is important to recognize that progress is not linear. Postpartum is a hard season of life and I find that women can feel frustrated and disheartened by setbacks. Maybe you are in a place where exercising at a gym feels impossible because you have a newborn and toddler at home or you finally are starting to feel like yourself again and then you’re hit with a two week battle of daycare viruses and you’ve lost the strength you had gained. Keep your head up, mama. Recovery is a marathon, not a sprint.
- Create small, attainable goals that matter to you. This could include things like setting a goal to work on your C-section scar for two minutes while you’re in the shower every day or doing 10 bridges while your newborn does tummy time. A pelvic floor PT can help you build an individualized plan to meet that goal.
- It is never too late to start. Maybe you’re reading this and you’re 6 years or 16 years postpartum, and wondering if it’s too late for you to start because you are continuing to deal with pelvic floor symptoms. Be encouraged, it’s never too late!
The bottom line
Your body deserves care and attention in postpartum—without shame or guilt. Pelvic floor therapy can help you heal, feel strong, and return to the things you love. You don’t have to navigate this alone, and it’s never too late to start.
FAQs
- Is pelvic floor therapy only for women who had a vaginal birth?
- Some women think or may have been told that if they are having a C-section they do not need pelvic floor therapy and this couldn’t be further from the truth!
I encourage all women to participate in birth preparation sessions with a pelvic floor physical therapist and be educated on how to prepare for a C-section, if planned, or what to expect if they have an unplanned one. While about 30% of deliveries are C-sections in the U.S., most women are undereducated about what to expect and how to recover from this major abdominal surgery.
This is where a pelvic floor physical therapist can be a critical member of your support team! To summarize, whether you are having a planned C-section or planning for a vaginal delivery, pelvic floor physical therapy is important to prepare you for childbirth and what to expect in the early days postpartum.
- How do I know if I need pelvic floor therapy?
- Pelvic floor PTs can help women who are experiencing a wide array of symptoms during pregnancy or postpartum like pelvic heaviness/prolapse, leaking (incontinence), pelvic pain and/or core weakness.
A pelvic floor physical therapist can help determine the underlying cause of your symptoms and help to create an individualized treatment plan for your recovery postpartum. Additionally a pelvic floor PT can be an integral part of your wellness and birth preparation team to help reduce symptoms during pregnancy and set you up for success in postpartum no matter how you deliver.
- Is pelvic floor therapy covered by insurance?
- Depending on your insurance plan and the provider you want to see, it can be covered!
If your provider does not take your insurance or your insurance does not cover pelvic floor physical therapy for your specific goal or condition, you can ask the provider if they can provide a superbill which you can submit for insurance reimbursement coverage or you can use your HSA/FSA. Additionally, some providers who are out of network may offer packages or plans that may allow for cost saving.
- Do I need a doctor’s referral to start pelvic floor physical therapy?
- Some states have what is called “direct access” physical therapy meaning that you can see a physical therapist without a referral from your provider; however, each state has different rules. When you are booking an initial evaluation, the provider will be able to tell you if you need a referral to begin care.
- Can I do pelvic floor therapy at home?
- Absolutely! There are providers who can see you in a clinic setting, virtually or in your home. You want to consider what matches your lifestyle and time commitments to help prioritize your treatment.
- Is pelvic floor therapy painful?
- Depending on the cause of symptoms, sessions can have occasional pain, but it is expected that pain should decrease during and between sessions.
For example, if a woman has pain with intercourse and she has a painful and overly sensitive scar from vaginal birth trauma, during the evaluation the physical therapist may touch that area to see if it replicates her similar symptom of pain with intimacy.
If it replicates her symptoms, the PT then may do scar tissue mobilization to the scar to help improve its ability to move and be less sensitive and teach the woman how to help improve her scar at home! This would result in the scar being less painful to touch over time and help her get to her goal of pain-free intimacy!
- How long does pelvic floor therapy take to work?
- It truly depends on the individual client, their goals and their symptoms. Some women can experience relief in their symptoms within 1-2 visits and some women may need more. This is a great question to ask when you are trying to identify a provider who is right for you!
About the author
Dr. Margaret Archer, PT, DPT is a pelvic floor physical therapist who works for Mère Health. She is a mom of two and is passionate about empowering women through all phases of life, with a specific focus on pregnancy and postpartum care. She believes in a fitness-forward approach to evidence-informed, collaborative pelvic floor physical therapy.
Mère Health offers full-service virtual care—from specialized therapy to functional medicine—for preconception, pregnancy, postpartum, and beyond. Available in Georgia and South Carolina.