Ft. Joana Pacheco 

Physiotherapist Specialist in Pelvic Health

I was a mother. And now?

HPA Magazine 23 // 2025

The immediate postpartum period is a phase of intense adaptations and often a whirlwind in a woman's body. During the first weeks after birth, the body goes through hemodynamic, genitourinary, metabolic, and emotional changes. This moment requires specific care to ensure the woman's physical and emotional recovery.
In this scenario, pelvic physiotherapy plays an essential role in rehabilitation and prevention of complications, improving the quality of life postpartum

Postpartum Changes and Challenges
The pelvic floor (PP) is a set of muscles with urinary, faecal, reproductive, sexual, postural, and support functions. These muscles must be able to contract, relax, and move, resulting in a strong, flexible, and mobile PP. The postpartum experience can be accompanied by some emotional and PP changes and challenges, such as: perineal pain, urinary incontinence, sexual dysfunction (which can affect 83% of women), intestinal problems, haemorrhoids, scar pain and changes in sensitivity, postural changes, and abdominal diastasis (separation of the rectus abdominis).
Studies show that 85% of women in labour suffer some type of trauma, with a significant impact on their quality of life in the short and long term (Lopes et al., 2019). It is found that 57% of women are unable to voluntarily contract the PP (MPP) muscles, with the most common errors being contraction of the rectus abdominis or glutes, tilt of the pelvis, or respiratory apnoea (Neels et al, 2018).

Immediate Care: What to Do?
We can start some care activities immediately after birth, which are taught by the physiotherapist at the end of pregnancy:
• Hygiene and comfort: keep the perineal region clean and dry, protect, support, and hydrate scars;
• Posture and activities: adopt good ergonomics when caring for the baby so as not to compromise our body;
• Light exercise: gentle body and PP movements to improve circulation and reduce oedema.

 

When to Start Physiotherapy?
Assessment by a physiotherapist is generally indicated between 4 and 6 weeks after birth.
However, early self-care can be started with guidance. Studies show that regular follow-up by a physiotherapist is effective in recovering PP and preventing long-term dysfunction (Brook, 2020).
The Importance of Physiotherapy in Recovery
Postpartum rehabilitation should include:
• Perineal rehabilitation: assessment of the contraction and relaxation capacity of the pelvic floor muscles.
• Scar treatment: massage and specific care to improve tissue mobility.
• Abdominal strengthening: exercises to reduce diastasis and improve trunk support.
• Postural education: prevention of low back and musculoskeletal pain.
• Management of bladder and intestinal functions: reduce urinary or faecal incontinence and promote proper functioning.
• Return to physical activity or other situations specific to each woman.

Education and Awareness
Abdominal diastasis is a concern for many new mothers, with a prevalence of 70% in the immediate postpartum period, but may regress 8 weeks after birth. An accurate assessment by a physiotherapist is necessary to recover and preserve a competent and functional abdomen.
Techniques such as diaphragmatic breathing, MPP training, activation of deep abdominal muscles, postpartum ergonomics, and education are the basis of physiotherapy sessions.
The need for greater dissemination about pelvic care and health education for the proper care of women who have recently breastfed is highlighted.
In conclusion, pelvic physiotherapy in the immediate postpartum period is crucial to help women recover their functionality and well-being. Integrating this care into the hospital routine can reduce the impact of complications and improve patients' quality of life.
In the pelvic floor rehabilitation consultation, at the Hospital Particular do Algarve, Alvor and the Instituto HPA (Montenegro, Faro), it is possible to monitor this very important moment in a woman's life, offering individualized care, guided by specialized professionals to promote health, well-being, and better recovery.

Referências/References:
Afolabi, I. Postpartum Pelvic Floor Considerations Course. Plus, 2022.
Brook, G. Postpartum Physiotherapy: Evidence-Based Guidance. 2020.
Lopes G, Leister N, Riesco ML. Perineal Care and Outcomes in a Birth Center. Texto & Contexto - Enfermagem, 2019.
Neels H. et al. Common Errors in Pelvic Floor Muscle Contraction Postpartum. European Journal of Obstetrics & Gynecology, 2018.