Chapter 24: Women's Health: Obstetrics and Pelvic Floor

Introduction

Throughout a woman's life cycle, specific gender differences need to be recognized for their relevance to rehabilitation. Recent research has shown repeatedly that women have specific and distinct physiological processes that extend beyond the obvious considerations of anatomy and hormones, including differences in symptoms of heart attacks and in metabolism of medications.⁵⁸ Clearly, the pregnant or postpartum patient presents a unique gender-based clinical challenge for the physical therapist. Although pregnancy is a time of tremendous musculoskeletal, physiological, and emotional change, it is nonetheless a state of wellness. Pregnant women are typically well motivated, willing to learn, and highly responsive to treatment suggestions. For many women, the therapist is able to assess and monitor the physical changes with the primary focus on maintaining wellness. The ability to educate women about the role of exercise and health promotion during this key life transition provides a significant professional opportunity and responsibility.

In cases of musculoskeletal impairment related to pregnancy, the therapist is able to examine and treat the patient by incorporating knowledge of injury and tissue healing with knowledge of the changes during pregnancy. By considering a broader perspective, it is recognized that all female patients can benefit from education regarding the role of the pelvic floor muscles in musculoskeletal health, specifically in trunk stabilization. Specialized treatment of pelvic floor dysfunction is critical to quality of life for women experiencing incontinence, pelvic organ prolapse, and a variety of pelvic pain syndromes. Although all physical therapists can fairly easily incorporate activation of the pelvic floor muscles as a key component of trunk stabilization exercises, true expertise can come only with further training and mentoring. Advanced study of pelvic floor anatomy, evaluation, and treatment is highly recommended for therapists who wish to specialize in this area.

This chapter provides readers with basic information about the systemic changes of pregnancy as a foundation for the development of safe and effective exercise programs. In addition, a review of pelvic floor anatomy, function, and dysfunction serves as an introduction to the treatment of pelvic floor disorders. The chapter emphasizes modification of general exercises to meet the needs of the obstetric patient and provides information to assist in the development of an exercise program for an uncomplicated pregnancy. Cesarean delivery, high-risk pregnancy, and the special needs of patients with these conditions are also discussed.

Overview of Pregnancy, Labor, and Related Conditions

Characteristics of Pregnancy and Labor

Pregnancy

Pregnancy, which spans 40 weeks from conception to delivery, is divided into three trimesters, with characteristic changes during each.^36,53,74,82

First Trimester Changes

During the first trimester (weeks 0 through 12), the following occur:

• Implantation of the fertilized ovum in the uterus occurs 7 to 10 days after fertilization.

• The mother ...