Postpartum Culture Around the World : How Does The United States Compare?

WestEnd mom and baby

Postpartum Strong® is a unique musculoskeletal program developed for women to regain muscle strength of their abdominal and pelvic floor muscles. Clinical research now supports rehabilitation after a normal or challenging birth or pregnancy to prevent incontinence, prolapse and sexual dysfunction. Routine care around the world is quite different than postpartum care in the United States. After preparing for nine months to assist the developing fetus, and taking care of yourself, the six week check up consists of a check to see that the mother is recovering, baby is growing and birth control is offered. Very seldom is the muscular status of the woman checked or questions asked about leakage with laughing/coughing/sneezing, backache when lifting or holding your baby, pressure or a bulge in the pelvic. Therefore, if women were screened for abdominal separation, pelvic floor muscle relaxation or increased tension, as well as postural problems . . . many of these issues could be averted.


Other countries offer a different postpartum culture for women, such as:

german flagGermany – Midwives visit for 10 days and women get body coaches for 6 weeks to check on the baby and exercise with the mother.

france flagFrance – Midwives visit for 5 days and women receive 10-20 sessions of la rééducation périnéale.

la rééducation périnéale
la rééducation périnéale

Other countries, like New Zealand and Canada, check for separation of abdominal muscles. In America, because women are uninformed about muscle rehabilitation and post delivery care, they have a difficult time distinguishing fact from fiction when researching topics on the internet. Mostly, they expect their body to snap back and not be the one who has the problems with pregnancy, birth, nursing and regaining body function to preform everyday tasks.

Not one physician has told me they have been educated on postpartum musculoskeletal rehabilitation emphasized during medical school or residency. Therefore, unless they have gained knowledge over the years, this is a topic that is not addressed unless the patient brings up a concern.


The more women are educated, the less we will hear comments such as this: “I was cleared for exercise at six weeks, so I ran five miles. At the end, my bladder fell out.” “My belly pooch never went away after doing hundreds of sit ups. I found out it was because my stomach muscles were pulling apart.”  

And hear more of this: “I tried to have intercourse and the pain was like a hot knife. Having another glass of wine didn’t help. Learning how to relax my pelvic floor muscles made all the difference in the world.”


angie with patientMany medical professionals are unaware of women’s health physical therapy for post-birth screenings or intervention. Demands of taking care of a newborn and yourself are often not balanced. As a result, many women become fatigued taking care of others, to be the best mother, wife. What women sometimes do not realize, is that you must take care of yourself as well!

An analogy would be: for an orthopedic knee surgery, the patient receives a couple of visits of physical therapy prior to the surgery and typically a month or two post surgery to have the best outcome. Without screening postpartum women do not know they have a condition that could be treated.

Insurance will cover for muscle disuse and muscle incoordination, which all women have post delivery. Muscles Vaginal delivery is a trying event, affecting muscles, nerves and connective tissue.


Recent clinical evidence aids our understanding of morphological changes in the pelvic floor and abdominals during pregnancy and after childbirth.  Tissue trauma takes time to recover. Pregnancy hormones continue to circulate for three months post-delivery or cessation of nursing. Without intervention, little change of the pelvic outlet opening changes after four months. Therefore, the importance of muscle rehabilitation is critical.

   1 in 3 will have bladder leakage

36% discover separation of stomach muscles 

30%-50% experience a heavy feeling that could be a descent of pelvic organs

Published by Dr. Cora T Huitt

Cora T. Huitt, PT, DPT, BCB-PMD ~Thirty seven years of clinical practice, specializing in women's health for fifteen years. ~BS Degree in Allied Health Professions, Ohio State University, '72. ~Master of Arts in College Teaching (MACT) focus in Physical Therapy & Therapeutic Exercise, University of North Carolina, '76. ~ Doctorate of Physical Therapy, Alabama State University, 2010 ~Attended multiple courses offered in Women's Health Physical Therapy, including Pelvic 1, 2, 3 Course in Women's Health Section APTA. ~Member of VPTA and APTA, Women's Health Section. ~BCIA-PMDB Biofeedback- Pelvic Muscle Dysfunction Biofeedback. ~Certified Pilates instructor, ProHealth. ~Affiliate member of the American College of Obstetrics and Gynecology. ~Member of International Continence Society. ~Member of National Vulvodynia Association. ~Adjunct Clinical Faculty for student affiliation at multiple universities. ~Director of APTA Women's Health Residency since 2007, credentialed in 2008. (only other residency at Duke Unviersity)

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