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postpartum physical therapy

Getting the right level of care in postpartum

Getting the Right Level of Care in Postpartum

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There’s this argument in physical therapy right now comparing the access to care in the United States and the access to care in other parts of the world. 

I hear a lot of misinformation getting thrown back and forth, but at the end of the day, what we really need to focus on is WHO gets to make the decisions.

Who decides you need care?

Here’s my theory…

1/3 of women will do just fine postpartum

1/3 of women would benefit from basic postpartum care

1/3 if women need high level expertise for complex issues or won’t respond to basic care

That’s why it’s been challenging for me to hop on the “everybody needs care” train. 

We have to acknowledge not every single person who gets injured needs rehab. Not every person who has a baby needs the highest level of PT care.

But what every person does need is better screening, to determine which bucket they belong in.

It gets confusing because you would assume therapy is therapy. But think about any other job. Think about where you work. There are people who do fine and just get by. But there are people you go to when you have a complex problem that has a complex solution, right? 

Physical therapy is the same!

Now, when we bring insurance into the mix (and this is where we all get a headache.)

Most people start with “Do they accept my insurance?’ when REALLY we need to start with “What bucket do I fall into?” 

Most of the time this idea of “physical therapy doesn’t work” stems from a complex problem getting put in the wrong bucket. 

Many large practices are productivity oriented. They focus on revenue generation (ahem, churn & burn) They are busy negotiating contracts with insurance companies. Because the focus is productivity, you usually get the basic stuff that doesn’t work for everyone in every bucket.

We need to be better at triaging up front. That’s why I am so adamant on putting out resources for everyone to access. I’m only one person (still  haven’t figured out cloning technology) and my time is a finite resource. And many people are limited by geography. But many people (moms and Pros alike) can learn outside of a one-on-one visit. 

All of the stuff I put out is to make sure all the buckets are addressed. But if you’re in that third bucket and you spend 6 months doing that basic stuff, you can get really frustrated.

As patients, we need to be aware there are different levels of care. 

In the case you might be in that third bucket and you’ve tried to DIY and you’ve tried the clinic down the street, please know it isn’t your fault. You were just put in the wrong bucket. 

The last thing we need to be doing is guiliting more moms. 

As medical professionals, we have to step up. If someone isn’t getting better and you don’t have the capabilities to help, you need to know someone who does. 

Being able to identify your strengths and where you may be lacking, and then having resources to help in those areas, that’s crucial.

 Tell me what you think about this.

If you’re a mom, and you’ve done all you’re supposed to do and still didn’t get better, where did the blame go? 

If you’re a pro, where is your wheelhouse? Which bucket do you help most?

whites normal down there surprised woman pelvis diagram

If everything down there is fine, then why do I feel like this?

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Ever feel like something was off, but you didn’t know if it was you or how it was supposed to feel?

Here’s my thoughts on how to handle this in Postpartum:

Maybe you second-guessed yourself because you just weren’t sure.

Or have you ever bought leggings and as you wear them, they start to slide down and give you saggy baggy bottom? (I KNOW I’m not alone in this.) I had been buying mediums in Athleta leggings FOR YEARS. Then  one time I was trying  them on in a store and an associate came up to me and said, “You know you should really buy them in a smaller size if you don’t want them to sag so much.” 

So, here am I thinking this saggy baggy thing is how they are supposed to fit! And I had no idea how WRONG I was! 

I’ve had so many moms come to me 2 or 3 weeks postpartum wondering if how they feel is normal or if they’ve somehow done irreparable damage. But what do they do before they come to me? They go to Dr. Google and dive down the rabbit hole. And now they have even MORE questions and doubts. 

Sometimes you just need someone to tell you what’s normal. 

And this needs to be more than your friend who just had a baby because their advice is only coming from the context of THEIR experience. 

This is why you need to have someone like a postpartum PT on speed dial. You can have a seemingly “normal” delivery but then a few weeks later, you can quite literally have something pop up. And 9 times out of 10, this happens right after you’ve been to your OB appointment and everything was fine. You think everything is going swimmingly until you start walking around (like me with my leggings) and you wonder if this is how you’re supposed to feel. 

My job is to put some perspective behind the situation. Just knowing you have someone who can give you context from the experience of treating hundreds moms is worth a hundred Google searches. 

Same thing with coaches and trainers. If you’re working with someone pre-baby, they already know your movement patterns and what is normal for you. 

We need to give moms quick and easy access to postpartum advice and support where they’re not waiting weeks to get on someone’s schedule. Establish relationships and set expectations BEFORE the baby comes. 

Don’t move forward out of fear, move forward out of confidence. 

I would love to hear about your experience. Did you have someone on speed dial? Did it take you a while to find that someone to walk you back from the edge of the cliff?