Getting a referral for physical therapy after pregnancy
November 13, 2012 10:55 AM   Subscribe

I am interested in getting a referral to a physical therapist after pregnancy--I have some questions about how to go about it.

My adorable baby is almost a month old. I am a small lady whose belly got really huge during my pregnancy, and I have zero strength in my core nowdays. I still have trouble getting out of bed, or even lifting my little guy (who actually is an enormous guy). I suspect I have have rectus diastasis, based on the look of my belly (I actually think I had it pre-pregnancy, looking at pictures of it online). I also had a c-section (after 20 hour of labor).

Even pre-pregnancy, I never had a very strong core, despite the fact that I was in otherwise great shape, and want to make sure I'm working these muscles efficiently and correctly.

Other than the weak core, I don't have any other physical issues--no back pain, no incontinence, no pelvic pain, etc.

I'm interested in getting a referral to a physical therapist to help build up strength again; I'm wary about doing stuff I found on the internet at home, as I'm not sure if I'm doing them correctly or making things worse.

Is it reasonable for me to request a PT referral, given my issues? Who should I talk to, my OB/GYN or primary doctor? Is there a certain vocabulary I should use? Is this something a trainer at my gym can do, or should I go the medical route?
posted by Ideal Impulse to Health & Fitness (10 answers total)
You could ask your OB/GYN for a referral at your 6 week post-partum visit, although if it were me (and it was just a few short months ago), I'd wait for clearance to exercise, start a solid exercise routine, and see how things improve before visiting a specialist. I was still feeling pretty lousy core-wise at the one month mark, but things have improved, particularly since I started doing some pilates exercises at home.
posted by ThePinkSuperhero at 10:58 AM on November 13, 2012

I would talk to your OB about it. I had triplets, and since it's very common to have diastasis recti with multiples pregnancies, I wanted to know if I had it, and he confirmed I did not. I have heard that regular core-strengthening exercises can make it worse, which is why I think it would be best to get a referral to a PT.
posted by pyjammy at 10:58 AM on November 13, 2012 [1 favorite]

It is incredibly reasonable.

I had PT for post-pregnancy and during pregnancy related reasons with both of my children. With my first child when I had PT after my pregnancy, my OB wrote me a prescription. When I needed PT during my second pregnancy, my regular practitioner wrote me a prescription because I was seeing a midwife who didn't have prescriptive abilities in my state (homebirth midwife) and she and my regular NP both monitored and followed me through my pregnancy.

So, I don't think it matters WHO writes the prescription.

I'd also mention that 6 weeks is normal physical recovery time for a routine vaginal birth. For c-sections, it's much longer. I didn't feel close to normal for three months after my first was born, and then in my particular case, I had ongoing pain and issues for seven more months. So, don't expect that you should be 100% just yet anyway.
posted by zizzle at 11:03 AM on November 13, 2012 [1 favorite]

Me too: I had an unplanned c-section 11 weeks ago and my core is still weak and achy. I also suspect I have diastasis recti (same thing, different name). I think you'll have no problem getting a referral from your OB/GYN.
posted by Specklet at 11:11 AM on November 13, 2012

I got a referral for PT after pregnancy for my back (pregnancy weight and baby carrying twisted a vertebrea in my spine). It's incredibly common and your OB or regular physician should be happy to comply. Depending on your insurance you might be limited by number of sessions. I had 10, and it was more than enough to help me out and start me on the road toward self-care. Go the medical route first, then continue on your own through a gym or yoga studio.
posted by katypickle at 12:14 PM on November 13, 2012

This is completely reasonable. You didn't just have a baby, you also had abdominal surgery. Other people who have abdominal surgery are referred to a physical therapist as a matter of routine for their recovery. There's no reason you shouldn't be.
posted by linettasky at 12:51 PM on November 13, 2012

It's a great idea and I wish I'd done it.
posted by The corpse in the library at 1:01 PM on November 13, 2012 [2 favorites]

Best answer: Absolutely reasonable. I don't think it matters too much who you get the referral from, but be prepared to push for it. Some care providers seem resistant to the idea that there are things that can help pregnant women with their discomfort or strength. I suspect if you need a magic word, emphasize that it's difficult for you to pick up your baby. You may need to research physical therapists in your area - you should go to one who is experienced in working with pregnant or postpartum women.

I saw a physical therapist for diastasis recti (and another problem) during my pregnancy. She was very helpful in identifying the problems, coaching me through exercises, and giving me alternative movements. You are right to be wary about following the internet's instructions -- I am a dancer and used to isolating muscle groups, but I was surprised at the subtlety of the exercises my PT assigned me. My PT also confirmed that regular core-strengthening exercises (crunches and so forth) can make diastasis recti worse. Don't go to a gym trainer until a PT clears you for it. (By the way, I have not-awesome insurance, and my co-insurance payments on the PT sessions were cheaper than going to a movie.)

Websites about diastasis recti are pretty freaky - they make it sound like if you don't do a million reps of some exercise per day, your intestines and uterus are going to fall forward and you'll have a Santa belly for the rest of your life. Not the case at all!
posted by stowaway at 2:34 PM on November 13, 2012

Response by poster: Thank you for your comments--I wasn't sure if this was a A Thing that women did.
posted by Ideal Impulse at 3:22 PM on November 13, 2012

Are you asking for a referral because you don't know how to pick one, or because your insurance needs it?

Some insurance carriers don't require a referral for PT (Premera, for example allowed me to self-refer).

If you need help picking a good one, for someone in the Seattle area, I'd highly recommend Olympic Physical Therapy. Great providers, great customer service. They also have an attached training group called Athletic Engineering, if you're interested in a trainer or specific help from an exercise perspective.
posted by Gorgik at 5:50 AM on November 14, 2012

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