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  • OB-GYN Group Embraces 'Fourth Trimester' Concept, Acknowledges Role of Physical Therapy in Postpartum Care

    A task force for the American College of Obstetricians and Gynecologists (ACOG) says it's time to frame postpartum care as an "ongoing process" requiring a personalized, cross-disciplinary approach—including the use of physical therapy when appropriate. APTA and its Section on Women's Health have registered strong support of the recommendations.

    In a committee opinion issued in May, ACOG's Presidential Task Force on Redefining the Postpartum Visit embraced the concept of the "fourth trimester," the idea that mother and child need ongoing care through at least the first 12 weeks after delivery. According to the task force, the fourth-trimester concept stands in contrast to the practice of an "arbitrary" single encounter with a primary care provider, often at 6 weeks after giving birth.

    Instead, the task force recommends contact with a maternal care provider within the first 3 weeks postpartum, during which the provider and patient would discuss a wide range of postpartum issues—from feelings of depression to the need for physical therapy to address incontinence and resumption of physical activity. Later, but within 12 weeks postpartum, a "comprehensive postpartum visit" should take place, according to the recommendations. That visit would also serve as a transition into ongoing well-woman care.

    The formal acknowledgement of physical therapy's role in postpartum care represents a significant conceptual shift, according to Carrie Pagliano, PT, DPT, president of the APTA Section on Women's Health.

    "Physical therapy has played a role in the postpartum health of women for many years; however, patient access to care was often limited to mothers who have a referring provider having prior experience with physical therapy, or it was simply left to the patient to find her own answers for her postpartum issues," Pagliano said. "Formal recognition of physical therapy in the fourth trimester not only recognizes our expertise in this area of care but provides a clearly stated standard of care for physicians providing postpartum care options for their patients."

    In a joint letter to ACOG on behalf the section and APTA, Pagliano and APTA President Sharon Dunn, PT, PhD, applauded the inclusion of physical therapists as a part of the health team envisioned in the recommendations.

    "Physical therapists' knowledge base and expertise related to the assessment and treatment of urinary and fecal incontinence, and for perinatal musculoskeletal issues including sexual dysfunction, pelvic girdle, and low back pain, as well as diastasis recti and painful scar tissue, will complement the contributions of other health care providers working in this important area of practice," the letter states. "Including physical therapy as a standard of postpartum care will increase the resources available for women to return to or improve their quality of life."

    For its part, the task force hopes the recommendations will influence payment and other policies around postpartum care, and will help to underscore the importance of fourth-trimester care among new mothers, among whom an estimated 40% never attend a single postpartum visit

    "The recognition of the fourth trimester is extremely important," Pagliano said. "Historically, women have talked about postpartum issues among themselves but may have been told 'that's just what happens when you have a baby.' These recommendations move the conversation into the light, providing a clear pathway, opening opportunities to discuss prevention, education, and treatment options for mothers following birth."


    • Wonderful news! Thank you APTA and SoWH!!

      Posted by Jeanice Mitchell on 7/11/2018 11:05 PM

    • Yes! I've been working on a project supporting this concept for about 4 years. Read about it on the Pelvic Health and Rehab Center Blog. https://www.pelvicpainrehab.com/pregnancy-and-postpartum-pelvic-health/5516/antenatal-and-postpartum-pelvic-floor-physical-therapy-as-standard-of-care/

      Posted by Ann Croghan on 7/11/2018 11:56 PM

    • Every woman should see a pelvic health Doctor of Physical Therapy at 3 weeks postpartum for a comprehensive musculoskeletal and pelvic floor examination, screening for postpartum depression, and intervention to guide the optimal musculoskeletal recovery from pregnancy and childbirth. The pelvic health Doctor of Physical Therapy is the most qualified provider of choice to determine the need for postpartum musculoskeletal health care, not the Obstetrician/Gynecologists who have no formal training or expertise in musculoskeletal health care.

      Posted by Cindy Neville, PT, DPT, WCS on 7/12/2018 11:03 AM

    • I am very happy to hear about inclusion of PT and discussion regarding the fourth trimester. I have been clinical practice for 38 years and unfortunately this is not a new concept and has been advocated and in our continuing education since I graduated in 1980. Hopefully changes will move at a more rapid pace and follow our APTA vision of transformation!

      Posted by Deborah Riczo on 7/12/2018 11:19 PM

    • Great news and appreciate the continued support of the APTA. The Results Physiotherapy Mommy Bounce Back program was a huge success from the day we launched it two years ago. We need to continue to make this information available to moms. I wish we had the advertising budget the "live with your incontinence" companies seem to have!

      Posted by Mark Tinsey on 7/13/2018 10:01 AM

    • As a mom of a 4 month old, I can completely relate to the needs during the post-partum period and the challenges that come with the lack of recognition of these serious needs. I am ecstatic about this update and the role PT will play!

      Posted by Kandis Jones, PT, DPT, PCS on 7/13/2018 4:35 PM

    • I've also been in clinical practice for 38 years - the last 22 in pelvic health. Patients of all ages constantly ask me "why didn't anyone help me with this after my baby was born?" I'm so glad to hear that the 4th trimester is finally being recognized by ACOG and look forward to working more with our providers to establish more specific standards for post-partum care.

      Posted by Mary Prechel on 7/13/2018 11:36 PM

    • This is huge! I am excited to Canada to follow this format! It opens the conversation like mentioned to prevention not only rehabilitation! Women need to receive information about their pelvic health earlier in life, prior to babies, to help support a decrease in trying to fix problems that potentially may have been avoided with care prior to pregnancy! Still more research needed but again a great step!! I applaud the ACOG!!

      Posted by Myranda on 8/2/2018 4:35 PM

    • What great news! Thank you Carrie Pagliano and the SoWH for al of your hard work on getting this done!

      Posted by Cookie Freidhoff, PT on 8/5/2018 1:19 AM

    • Yes, positively we need to support Mothers antepartumly and postpartumly. We also need to support females in general and female athletes with inclusion of pelvic floor work. I begin this education post an Elizabeth Nobel course. I practiced this for 15+ years and included the education for Moms during prenatal visits and through a Moms in Motion Class. Inclusion of TA and pelvic floor work for all females with back pain is also important. Accurate checks and PT intervention for DRAs also of importance, with inclusion of pelvic floor work, proper bracing, taping with a progressive approach to care. Use of biofeedback in care can also highly benefit the education to the patient. Lets continue to keep females in motion.

      Posted by Lisa Martin on 9/3/2018 10:55 PM

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