Postpartum

How to Find a Great Pelvic Floor Therapist After Having a Baby

What is the Pelvic Floor?

The pelvic floor is a group of muscles and tissues that support your organs, support urine and stool movement, and impact sexual function. Throughout pregnancy and birth, the pelvic floor goes through a number of changes. The muscles can tighten and loosen, the tissue lengthens and the function of the pelvic floor can be compromised through the pressure it undergoes. After birth, changes in your pelvic floor may lead to complications with sex, urination, pain and discomfort. Whether you have a vaginal or cesarean birth, a pelvic floor therapist can be helpful in healing. Both tissue damage around the vagina and cesarean incisions can create complications for women.

Related: Postpartum Resource Planner

Disclaimer: (I am not a medical provider. I am a mom, a researcher, a coach. My goal is to help you have the information so you can seek your medical provider if needed. Information from this site should not replace your regular medical care.) Also, this post may contain affiliate links which means, at no additional cost to you, we may make commission on any purchases made through links. 

during pregnancy, the baby can cause changes to a woman’s pelvic floor

Why pelvic floor therapy?

If your shoulder or knee went through as much physical trauma as your pelvic floor does, you would likely receive a referral for physical therapy. It is totally normal to need to “retrain” your pelvic floor after the weight of bearing and birthing a child.

This is even standard care in some parts of the world. According to this article in HuffPost, For decades, the French government has subsidized “perineal re-education,” i.e., physiotherapy that helps strengthen a new mother’s pelvic floor.“This is a kind of physical therapy designed to retrain the muscles of the pelvic floor, including the vagina, and is one of the cornerstones of French postnatal care,” she (French mother and writer, Claire Lundberg) wrote.

For mothers in the US and many other countries, pelvic floor therapy is not standard care and we are often left to hear about it from a friend, a blog, etc. and find our own way. However, it is important to be able to gain confidence and comfort in the pelvic floor after birth. Some women go years without giving the pelvic floor attention and healing and then deal with things like pelvic floor prolapse even 10 years after birth or incontinence for years. While things like peeing while jumping or painful sex may be common, these are not normal and you don’t have to live with it forever. Pelvic floor therapy is designed to help you through these issues.

RELATED: The Pelvic Floor, Kegels, and What Happens in Pelvic Floor Therapy

pelvic floor physical therapy

How to Find a Pelvic Floor Therapist

When looking for a pelvic floor therapist there are a few things you want to consider.

  • Do you need your therapist to take insurance or will you use private pay?

  • What days and hours are you able to attend an appointment?

  • What do you need to feel comfortable at this type of appointment (gender, personality of therapist)

Where to Look for Pelvic Floor Therapist

Maybe you already know a pelvic floor therapist or have a friend who can give you a recommendation, but if you’re starting from square one, let me help you out a bit!

Databases

I found that there are a few “databases” online where you can put in your location and look for a provider. Unfortunately, I found the results to be very limited both in number of results and ability to filter and find specialties. Pelvicguru.com and pelvicrehab.com turned up better results, but still felt quite limited.

Google Search

You can try a Google search in your area. Example: Women’s Pelvic Floor Therapist Columbus, Ohio. This will likely bring up both individual therapists and offices that provide this service. Once you find options, take a look at the website and look at their services, specialties and/or staff to see if there is mention of pelvic floor and/or women’s health.

Social Media

Sometimes the best information you can get is from finding recommendations from others. If you’re area has a local moms Facebook group, this can be a great place to ask for recommendations. You can also follow the #pelvicmafia on Twitter or Instagram for posts from and regarding pelvic floor specialists.

Your OB/Midwife/PCP Referrals

If you’re experiencing symptoms that lead you to seek out pelvic floor therapy, you can talk about these symptoms to your medical provider. This may be your OB/Midwife and/or your primary care provider. Many providers are not trained in pelvic floor and therefore may not have answers, but you can directly ask them to write you a referral for pelvic floor therapy.

*Note I have had some clients share that they were told there pain/discomfort/worry was “normal” and were not written a referral. Know that there is no degree to which you need to experience these things to warrant pelvic floor therapy. Remember, this is standard care in some areas of the world. If your provider doesn’t believe you need it, but you do, go with your gut and seek out a therapist.

RELATED: Sex After Baby: Am I Ready?

Normalizing Pelvic Floor Therapy

While many parts of the world still do not see pelvic floor therapy as standard postpartum care, many women are speaking up about the importance of this healing. It can be awkward to talk about painful sex, peeing yourself, feeling heavy “down there” and other things that come with pelvic floor complications, but the more we speak up for ourselves and speak with one another, the less awkward it becomes and the more women know they don’t have to suffer with those issues forever.

Many providers and women see birth as the goal in a pregnant woman’s health, but truly the goal should be a supported and healed mother to take care of her new baby.

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best clothes for a new mom
Postpartum

Sex After Birth: When & How to Approach Postpartum Sex

How do you know when you’re ready to have sex after birth?

husband wants to have sex but i just had a baby and i’m not sure if i’m ready

Do you need to be ready to have sex again 6 weeks after giving birth? If you get an “all clear” from your doctor or midwife at your checkup, does that mean you should feel ready for sex again?

A lot of women find themselves confused and feeling isolated when it comes to the conversation of sex after baby. Who can you talk to about sex when you’re a new mom? Can you bring it up at playgroup or with your friends? Women feel like they should be ready, even if they aren’t. This leaves new moms wondering if they’ve done something wrong, if their body is “broken” or if they are disappointing their partner.

The pressure to be ready for sex after birth can come from many places.

  1. Many providers mark the 6-week check up with an “all clear” to return to sex and exercise.

    While some providers take time to discuss all the changes a woman has experienced after having a baby, many women have felt rushed in these appointments and deduced to being sexual and fit again. This conversation of “your vagina is healed, you can have sex and exercise” creates a layer of pressure for a mom to be ready for intercourse.

  2. Pressure can come from a society that prioritizes sex in many ways

    There is an underlying assumption that a new mom “owes” sex to her partner because the partner has waited until mom is physically able again.

  3. Some women feel pressure from partners who don’t understand all the changes of new motherhood.

    A partner may feel like an “all clear” from a doctor is the green light everyone needs. When women are taught so little about their natural changes in postpartum, partners have even less understanding. This can be confusing and cause resentment in couples.

RELATED: Is this Weird for Everybody? Postpartum Sex

mom is not sure what to expect having sex after giving birth.

So What Does It Mean to be “Ready” for Sex Again?

A woman needs more than healed stitches to be ready for sex. It is a mental, emotional AND physical experience and transition. Some women are ready to get “back in the sack” right away, but for many women this is complicated and takes more time than the prescribed “all clear.”

Physically Ready

Being physically ready for sex includes healed birth sites- whether that is vaginal or cesarean (or both). This is usually what your medical provider is checking for you and giving an “all clear” for at a follow up appointment. Your pelvic floor undergoes a lot of changes and sometimes damage through birth and delivery. Many countries have pelvic floor physical therapy as standard care. In America, this is often something the new mom must seek-out. Pelvic floor physical therapy can be extremely beneficial if you’re struggling with incontinence, a “bearing down” weight on your pelvis and/or if sex is painful at any point. Many women (including myself) find sex to be significantly better after pelvic floor rehab. Breastfeeding can create a different feeling in your breast. If your breasts have been players in sexual experiences previously, you may need to address the change in sensation, feeling or even breast pain as you adapt to breastfeeding. Breastfeeding can also cause more vaginal dryness meaning- lots of lube is needed!

RELATED: Do I need to Exercise My Pelvic Floor?

Mentally Ready

Motherhood, especially early motherhood, takes a lot from you mentally. Your day is filled with figuring out how to take care of baby, set new schedules, making appointments, figuring out naps and feedings, etc. On top of this, your hormones are continuing to shift and many women are met with some mental health struggles in postpartum.

It is just as important for a new mom to be mentally ready for sex as it is for her to be physically ready.

When you are thinking about engaging sex again, consider what mental roadblocks you are facing. Is it hard to find time to think about anything sexual and therefore, get in the mood? Are you facing anxiety, depression or another struggle impacting your libido and mood? Is your changed body creating self-talk that is impacting your confidence?

Once you are able to identify these mental roadblocks, they are important conversations to have with yourself, a trusted friend and your partner. Working through these things not only has a positive impact on your sex life, but your life and motherhood overall.

feel like i’m not ready for sex after birth but my husband really wants it

Emotionally Ready

If we feel depleted, it can be hard for us to connect. If we feel resentment or like our needs aren’t being met, we can shut down. Being emotionally prepared for sex can mean having our cup filled and feeling safe and accepted. This could be seeking self-acceptance, acceptance from our partner, etc.

If you are feeling depleted and/or disconnected, prioritize intimacy that is not necessarily sexual, but creates space for you to be seen and feel connected. This could be intentional conversations with your partner, foreplay, body acceptance practices and self-talk, etc.

RELATED: Postpartum Emotions

Words from the Postpartum Together Community

When I asked my online community what they would like to say to a mom who is thinking about sex again after baby, here is what they had to say. May these words help you remember you’re never alone, motherhood and relationships are messy, and there’s no one “right” way or timeline for you.

  • Listen to your body and take the time you need (before and during)

  • Talk to your spouse about your insecurities and what they can do to help

  • Use lots of lube

  • Stop if you’re in pain or uncomfortable

  • Start by taking a shower and appreciating this new you

  • It’s okay to not be ready. Your body is a priority.

  • Don’t feel bad if you need to stop

  • Don’t force anything

  • Sometimes your mind is your biggest enemy. If you feel ready, try. If it’s not comfortable, stop.

  • Lots of foreplay

  • It can be scary and overwhelming

  • Talk about it. A Lot. Take it slow. Try and relax.

  • You create your own timeline

  • Your husband doesn’t care that things are in different places- he loves all of you, not parts of you.

  • Go for it if you’re ready. It can help you return to parts of yourself that you have forgotten in motherhood.

  • Speak up about what feels good and what needs to be different

  • Decide to make it more about you and have fun

  • It’s okay if you don’t want to have intercourse but do find other ways to connect with your partner

  • You are still sexy

  • Just because there is societal pressure doesn’t mean you’re ready

  • Everyone’s experience is different and that is okay

Related: Setting Boundaries After Baby

Everyone’s experience is different. 

That is okay. Your experience is valid. 

There are ways to move into intimacy and sex, but there are not timelines or guidelines you need to abide by.

Having sex after birth is different for everyone, but there are a number of things you can evaluate to help you know if you are ready, what your needs are, and how to communicate that with your partner.

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