Did you know that the single most common major abdominal surgery in the United States isn’t typically followed by inpatient physical and occupational therapy (PT and OT)—even though the patient goes home to care not just for herself but to be the primary caregiver for a brand new baby as well?
It’s true.
Despite the fact that daily or twice-daily PT and OT are standard of care on the first post-op day for virtually every other inpatient surgery, from joint replacement to cardiac surgery to stroke surgery, women who undergo C-sections are not ordinarily evaluated before they go home. This is to say nothing of women who give birth vaginally, even those who suffer first-, second-, third-, or even fourth-degree perineal tears.
Something needs to change.
Maternal health in America is not trending in the right direction
Natural Womanhood readers are no doubt aware of the abysmal statistics when it comes to maternal mortality (death during pregnancy up through the first year postpartum) and morbidity (pregnancy- or postpartum-related medical conditions occurring during that same timeframe) within the United States. But what are the numbers in the U.S. so dismal compared to the rest of the developed world—and why are they getting worse?
Why are maternal mortality and morbidity on the rise?
The reasons for these discouraging stats vary, and may include improved reporting (which is a good and necessary thing) as well as an increasing proportion of (relatively) older women conceiving, including women who, mirroring the general public, struggled pre-pregnancy with their weight, blood pressure, diabetes, and/or heart disease [1]. Another major interlinked contributing factor is the high rate of C-sections, accounting for 1 of every 3 births [2].
Added to all this, an increasing number of American women live in maternity care deserts, meaning areas where there are no birthing facilities or obstetric clinicians. Perhaps unsurprisingly, living in a maternity care desert is associated with increased maternal mortality [3]. As of 2022, 1,104 counties were classified as maternity care deserts, and it’s a number that continues to grow.
The majority of maternal deaths occur after birth and before the 6-week checkup
Fully 57% of all maternal deaths occur during the first 6 weeks postpartum (note: this is before the traditional six week postpartum checkup), and the top two causes are infection and hemorrhage [4]. This means that, on a systemic level, large numbers of women are falling through the cracks.
This is why for the past eight years, the American College of Obstetricians and Gynecologists (ACOG) has actually recommended a much earlier touchpoint for women and their obstetric clinicians, even though the vast majority of OB practices do not follow this guideline.
Common sense suggests that newly postpartum women would benefit from additional oversight and guidance, especially before discharge from the hospital. Enter acute care PT and OT.
What does PT/OT for brand-new moms look like?
Starting with one hospital in 2023, and expanding to a second in early 2025, women who give birth at either of two Duke University Health System hospitals have access to PT and OT care. What’s being assessed? Therapists ask about, demonstrate, and educate on similar skills and questions as other post-op patients would receive, plus some specific to C-sections.
This includes things like asking about the number of steps in the home, ability to get in and out of bed, chair, and bath or shower with the least pain, assistance with movement and activity for gas pain, and teaching diaphragmatic breathing [4]. Additionally, therapists cover ways a new mom can carry and care for her newborn (including protecting her incision during baby care), lifting guidelines, scar massage, etc. Therapists can make recommendations on activity modifications, strengthening exercises, and more.
Since a mother’s needs don’t end when she leaves the hospital, Duke University Health System and others also offer telehealth options for ongoing support, including using a screening tool for post-birth complications, and/or regular and early in-person visits (as we at Natural Womanhood have advocated for repeatedly).
Are you thinking this sounds expensive? Think again. Since implementing their collaborative approach to inpatient PT/OT for newly postpartum moms, Duke University saved an estimated $500,000 over 18 months due to prevention of readmissions—proving that good, timely care is better for everyone (moms, babies, and hospital systems).
Are you thinking this sounds expensive? Think again. Since implementing their collaborative approach to inpatient PT/OT for newly postpartum moms, Duke University saved an estimated $500,000 over 18 months due to prevention of readmissions—proving that good, timely care is better for everyone (moms, babies, and hospital systems).
Moms who give birth vaginally may benefit from inpatient PT/OT too
C-section moms aren’t the only ones who can benefit from in-hospital PT/OT. According to the Duke University press release about their program, PT/OT referrals are also appropriate for “perineal tears, pelvic girdle pain in pregnancy, coccygodynia (a painful syndrome affecting the tailbone/coccygeal region) and pelvic organ prolapse, among others.”
Help for moms who experience vaginal tearing
Perineal tears range from first-degree (least severe) tears involving the outer layer of the vagina, which don’t require stitches but may be quite painful, to fourth-degree tears involving all the tissue from the vagina back to the rectum, leading to inability to control bowel movements and requiring surgical correction.
While the impact of PT/OT for a more severe tear is self-evident, even a tear that’s “only” first-degree could benefit from PT/OT, particularly for a first-time mom. This isn’t coddling, it’s caring. While a less-severe tear might not incapacitate a woman, PT/OT can help her identify less-painful ways to move, pick up, and care for her baby, leading to improved functionality, mobility, confidence, and mental health.
While the impact of PT/OT for a more severe tear is self-evident, even a tear that’s “only” first-degree could benefit from PT/OT, particularly for a first-time mom. This isn’t coddling, it’s caring. While a less-severe tear might not incapacitate a woman, PT/OT can help her identify less-painful ways to move, pick up, and care for her baby, leading to improved functionality, mobility, confidence, and mental health.
Additionally, 2024 research found that levator ani muscle injury, which can occur during vaginal birth due to overstretching of the levator muscle and birth canal tissues, occurred in 55% of women who years later experienced pelvic organ prolapse [5]. What if we could get to these women much, much sooner?
Kickstarting recovery for moms who were on bedrest before giving birth
Finally, any mom who was on bedrest before birth due to a high-risk pregnancy condition naturally experiences deconditioning from lack of activity. No matter how she ultimately gave birth, her strength, range of motion, and functional mobility should be assessed. Helping a woman get back on her literal feet should be standard of care, and the glaring absence of in-hospital protocols around this is a blight on the field of women’s healthcare.
How inpatient postpartum PT/OTs can help with maternal mental health
As Dr. Rebeca Segraves, OT, founder of the Pelvic Health Network advocating for inpatient PT and OT for new moms, observed in a candid interview on the OT Potential Podcast (starting around 28:00), in-hospital PTs and OTs can play an indispensable role in a new mother’s care, but not just through physical support.
Maternal mental health issues, collectively referred to as postpartum mood and anxiety disorders or PMADs, are the single greatest contributor to maternal death in the first year postpartum [6]. But a PT or OT, who spends more sustained one-on-one time (between 30 minutes and an hour for one session) with a patient than perhaps any other professional in the inpatient healthcare setting, has a privileged front row seat to a woman’s labor and birth story.
If a woman needs to unpack her experience, a PT/OT communicates by their very presence that they are there for her, not just for her baby. She is not alone but supported, not forgotten but surrounded. And if there are red flags for significant mental health issues early on, a PT or OT can be part of the solution, sounding the alarm to get help.
How can you check whether your hospital offers PT/OT for postpartum moms?
This directory, which was created by Dr Segraves’ Pelvic Health Network organization and is updated as more institutions come on board, lists the 118 hospitals nationwide that currently offer inpatient physical therapy and/or occupational therapy. Each listing further specifies whether inpatient postpartum OT/PT is for C-section moms only.
Want to find out more about how you can incorporate this innovative approach to postpartum care in your practice or hospital system? Healthcare professionals can learn more about facilitating inpatient PT/OT here.
The bottom line
Whether it’s an early labor lounge to help reduce the likelihood of an unnecessary C-section or encouraging every single new mother (whether it’s her first or twelfth baby) to see a pelvic floor physical therapist, we at Natural Womanhood strive to promote best practices throughout pregnancy, labor, birth, and the postpartum period.
PT and OT care for new moms, starting before they’ve even left the hospital, is in keeping with that commitment to the health and wellbeing of both mothers and babies. When a mother is supported, both mentally and physically, she can better care for both herself and her new child. Both are worth fighting for.
