PT and Doula Care: Perinatal Period

Going into my first childbirth, I naively thought that because I was a physical therapist and had some pelvic health knowledge that I would innately know how to navigate through labor and postpartum recovery. My labor was relatively uncomplicated but ended with getting an epidural and being coached to push with a closed glottis (“purple push”) for 4 hours before bringing my daughter into the world. In the postpartum period, I struggled with returning to running and was experiencing leaking 9+ months after childbirth before I started to delve further into the world of pelvic health in order to try to “fix” myself. By 1 year postpartum, I was finally starting to feel like myself physically only to experience a temporary worsening of symptoms again after becoming pregnant at 18 months postpartum.

During my second pregnancy, I knew that I wanted to be more informed and confident for my second labor and delivery and set myself up for a better postpartum recovery. I realized that one of my biggest mistakes with my first childbirth experience was having this preconception that I didn’t need help rather than seeking out resources to support me in this important life event. I found an online childbirth preparation course by another pelvic floor physical therapist and sought out in-person pelvic floor physical therapy for before and after childbirth. When my son was born, I was able to instruct my husband how to provide hands-on pain relief techniques, tell my birth team how I wanted to position myself, and use mantras to get myself through the worst of the contractions to have an unmedicated vaginal birth. The empowerment that I felt from being confident in myself and achieving my desired birth experience was unlike any other accomplishment I have had to date.

With each of my birth experiences, my passion and interest in the birthing process grew. I found myself wanting to be able to share information with others so that they too could feel empowered instead of scared about childbirth. That’s when I found a doula training course presented by two pelvic health physical therapists. The course really opened my eyes that by pairing the world of physical therapy and doula care, we can serve clients in a way that is very rare in healthcare.

As physical therapists we have a better understanding of the human anatomy and physiology than most individuals and can allow doula clients direct access to PT services in order to:

1. Provide treatment and guidance to reduce unnecessary pain through pregnancy

2. Instruct them how to physically prepare for childbirth with pelvic floor coordination, perineal massage, positioning and breathing techniques

3. Be a resource in the early postpartum period to restore mobility and breathing mechanics and reconnect to the core and pelvic floor

4. Provide education to help them navigate through recovery of their cesarean section scar, vaginal tearing, or prolapse symptoms

5. Provide a graded approach to return to activity (without leaking!!)

6. Refer them to other professionals as indicated (mental health, lactation consultant, OB/GYN, etc.)

Serving in the role of a physical therapist and doula is uniquely allows us to:

· Be with these individuals before, during, and after the birth of their child(ren)

· Develop strong and meaningful relationships with clients

· Be a trusted individual to help them process their birth experience

· Be able to refer clients for additional help sooner as we are likely seeing them or communicating with them more often than other providers

Something to consider with this combined role is that it does require flexible scheduling and good communication to meet the needs of the pregnant client as well as having a support system of some kind in place in order to fulfill the needs of both PT and doula clients. However, I find this unique combination of roles so fulfilling and that it feeds my passion for aiding people through their perinatal journey so that they can feel strong and confident rather than scared and incapable.

I am honored to be chosen as a scholarship recipient through the Academy of Pelvic Health and am excited to further my education to better serve my clients through their pregnancies, labor and deliveries and postpartum journeys as I continue to explore the opportunities that serving as a physical therapist and doula can offer.

A fun fact that I discovered after my doula training is that one of the co-founders of a well known doula training program (Doulas of North America (DONA)), Penny Simkin, was a physical therapist as well!

Author: Ashley Williams, PT, DPT

Author Bio: Ashley Williams, PT, DPT is a graduate from the College of Saint Scholastica (2018) and works at Journey Physical Therapy and Childbirth Services LLC. She resides in Minnesota with her husband and two children and has a passion for injury prevention in athletes, allowing individuals to have an empowering pregnancy, birth and postpartum recovery, and helping individuals maintain mobility through all ages.