A pregnant woman lifts green dumbbell weights inside her home.
Exercise can play a leading role in fighting the rigors of pregnancy. A specially designed regimen can help bolster pelvic health. (For Spectrum Health Beat)

Once your baby is born, it seems like everything in the house naturally re-centers on the baby’s schedule—food, sleep, work, family time.

All of life hinges on the needs of the newest, littlest person in your home.

But what about mom’s needs? Who’s looking out for her health in the critical postpartum period?

And for that matter: Who guides her through the health challenges during pregnancy?

A physical therapist can play an integral role in mom’s health and recovery.

“Pregnancy and the postpartum period are times of huge body changes for a woman and her family,” said Maureen O’Keefe, PT, a pelvic health physical therapist with Spectrum Health.

Physical therapy

Physical therapists who specialize in pelvic health can play an integral role in helping moms during pregnancy and beyond.

O’Keefe creates custom treatments for patients, watching for musculoskeletal issues such as lower back pain, hip pain, pelvic girdle pain and such.

During pregnancy and in the postpartum period, women can be more predisposed to these types of problems, O’Keefe said.

Muscle weakness, joint instability or other issues that exist prior to pregnancy may worsen during pregnancy and afterward, she said.

A pelvic health physical therapist can teach moms how to coordinate their muscles and move more efficiently and safely.

It might seem like a no-brainer to treat pain during pregnancy and the postpartum period, but this hasn’t always been the case.

Many of the things we recognize now as treatable conditions—soreness, stiffness, aches, pains—and so forth—were at one time considered “normal” parts of the pregnancy process, said O’Keefe, who has a doctorate in physical therapy and has worked in the field since the 1990s.

The reality: All of it can be treated.

“We can treat any pain they experience during pregnancy, including things in the arms, such as carpal tunnel syndrome or neck pain,” O’Keefe said.

“Additionally, (we) can teach pregnant women safe exercises and activities to prepare her body for labor and delivery.”

Readying for baby

Expectant moms can use physical therapy to optimize their pelvic floor function, which can prevent or minimize urinary incontinence and pelvic organ prolapse, O’Keefe said.

Patients can even benefit from simple adjustments in their routine—learning to lift things more efficiently, for instance, or learning to stand properly.

Learning to get in and out of bed the right way can prevent strains to the pelvis, abdomen or lower back.

“As the woman’s womb grows and the abdomen expands there are many changes to the abdominal wall,” O’Keefe said. “A pelvic health physical therapist can teach a woman how to best maintain her core integrity, allowing for good core control.”

This can also address the issue of separated abdominal muscles, as well as shortness of breath, which can develop during pregnancy.

O’Keefe often zeroes in on effective breathing techniques, pushing mechanics and birthing positions.

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In pursuit of pelvic health

Spectrum Health physical therapist Maureen O’Keefe recommends you start on these three areas to target pelvic pain during pregnancy and in the postpartum period:

Lower abs  

Engage your lower abdominal muscles for core health. Sit in a chair and gently draw in your lower abs toward your spine. Hold for 5 to 10 seconds. In doing so, you should be able to breathe naturally. Relax and repeat.

‘Log roll’ 

Getting out of bed properly can help you avoid strains and injury. You should log roll out of bed, rather than using a jack-knife position that forces you to sit up. The log roll helps you avoid straining the abdominal wall and reduces the possibility of separated ab muscles. Also, by keeping your back, pelvis and trunk together, you avoid movements that could hurt your back.


Squats help strengthen your pelvis and legs. If you need help balancing, hold on to a countertop or the back of a couch. As you squat down, you want your hips to move backward a bit. As you return to a standing position, engage your glutes by squeezing them tight.

“Some women develop fluid retention during pregnancy,” she said. “A physical therapist certified in lymphedema treatment can help women experiencing this swelling.”

The bottom line? Don’t resign yourself to living with a given condition.

Involuntary loss of urine? It doesn’t have to be your new reality.

“We now know there is a complex coordination of the core muscles, including the pelvic floor, that happens to maintain continence,” O’Keefe said. “Through skilled physical therapy, women can learn how to effectively coordinate these muscles to avoid leaking urine.”

Back pain? You can fight against that, too.

“There are so many things that can be done to help address low back pain during pregnancy,” O’Keefe said.

For starters: Commit yourself to physical activity, even when you’re pregnant.

“We encourage women to keep their fitness up,” she said.

A pelvic health physical therapist is uniquely positioned to help you modify exercises to suit your needs.

The recovery

The 13 weeks after birth are often referred to as the fourth trimester.

One of the problems women face during this period is separated abdominal muscles.

Exercise can help rehabilitate these damaged tissues—but not just any exercise.

“It’s important that a woman be guided by an appropriately trained pelvic health physical therapist to learn what exercises and activities to avoid and which ones are recommended to optimize recovery of the abdominal wall and pelvic floor,” O’Keefe said.

“We check every woman for (separated abdominal muscles) and we help her ongoing back pain, neck pain or hip pain,” she said. “We teach her how to effectively rehabilitate her pelvic floor muscles and coordinate the core muscles again.”

An important tip: Avoid constipation and straining.

You don’t want your pelvic floor and pelvic organs to experience excess straining during bowel movements.

Breathing techniques and effective use of body mechanics can help manage abdominal pressure.

A pelvic health physical therapist knows full well the importance of monitoring the healing of a C-section scar, for example, and treating lingering labor pains during exercise.

“During the postpartum period, it’s important to allow yourself time to recover,” O’Keefe said.

It’s also important to develop a healthy sleep schedule, as hard as it may seem when caring for a new baby.

Ultimately, the postpartum woman is in a recovery period herself.

“We also instruct women in effective and safe return to exercise and fitness routines,” O’Keefe said. “We have postpartum running guidelines and a progression of exercises that women should be able to do effectively prior to running again.”

O’Keefe said a skilled pelvic health physical therapist will help you feel safe, supported and confident as you reclaim all aspects of a healthy body.

“We even help with any challenges related to recovering intimacy and pain-free intercourse,” she said.

“Don’t accept that leaking urine or low back pain or a ‘mommy pooch’ are simply normal and to be expected,” she said. “There are effective treatments for all of these things.”

One of the most important pieces of advice you’ll hear from O’Keefe? Be gentle on yourself.

Know that you’re not alone and there is help.

“If a woman is feeling down or depressed following pregnancy, she should bring this to the attention of her physician or physical therapist,” O’Keefe said.