Pregnancy and postpartum bring big changes—your pelvic floor deserves care and attention through it all. In this conversation with Dr. Romy Havard of Peregrine Physical Therapy, we talk about simple, preventive ways to support your body before and after birth. Her gentle wisdom reminds us that caring for ourselves early helps us heal, move, and enjoy life with confidence.
During the pandemic, I interviewed parents and professionals about what it’s like to have a baby during the pandemic. One of the interviews I did was with Dr. Romy Havard (she/her) of Peregrine Physical Therapy. If you’d like her thoughts about the pandemic, you can check out the original blog post. But I wanted to create a separate post to call out what she had to say about what pregnant people need to know about supporting their pelvic floor, because this is the part that is still relevant today.
Here is what we talked about (all emphasis mine):
Me: What do you wish that new parents knew?
Dr. Havard:
New moms should seek care early and really consider preventative strategies. The more you can do to avoid more acute and serious issues, the better you will do and the more options you will have. Pelvic physical therapy is inseparable from the postpartum experience and should be part of postpartum care. Especially for moms who may not even get physicians to look at their pelvic tears. At 3 months, maybe you want to go back to having sex. At 6 months, you want to go back to running.
… The women who are crying in my office are months from birth and they have been waiting for things to fix themselves. If they had started earlier, it would be a small thing. It wouldn’t interfere in their marriage. It wouldn’t make them start to wonder if they could have another kid. There are lots of difficult thoughts.
OBGYN postpartum just wants to make sure your cervix is closed, you’ve passed the placenta, that you don’t have infections, that you have contraception. They are not addressing the pelvic floor. If you are leaking at 6 weeks, that’s not normal. OBGYNs take care of general health, deliveries, general wellness, infection, venereal disease, contraception. Dealing with preventable testing like pap smears. They are not really treating leaking, prolapse, and pelvic pain issues. Some of them are so helpful, quick to get back to patients.
On one hand, just doing postpartum care is a little after the fact. Currently in the US and Britain 85% of women will have a perineal tear, 75% will require sutures. I have one visit during pregnancy to decrease their chance of injury in delivery. It’s not the same as childbirth education. It’s just things that moms can do to decrease their injury. OBGYNs don’t necessarily work from the position of the mother ergonomics. It’s more about the baby. Working on the preventative side is great. I do recommend a visit with pelvic physical therapist before or during pregnancy week 30. You need to start doing the exercises I prescribe daily easily 6-8 weeks before delivery for them to get maximal benefit. I just had a mom who went through it and had no tearing. This is where we need to move - to not just care for tears postpartum. In Australia a lot of people have a pelvic PT during labor so mom doesn’t get hurt. Pelvic physical therapists in the United States don’t have hospital privileges to attend labor and delivery. The least I can do is to do education with moms about taking care of you to avoid tearing, prolapse, urine prolapse, etc. and sometimes c-section.
Me: If you were to look ahead to the future and everything amazing that you can imagine comes true, what would that look like?
Dr. Havard:
In Britain about 2 years ago they voted to add pelvic physical therapy to the standard of practice to be included in national health care. Now even low and middle income women can have this as part of postpartum recovery. Our mortality rate is equal to Mexico. A lot of the moms I see are also more into progressive prevention. I recommend if I was doing bare minimum for someone who is doing great otherwise is:
- one visit during second trimester in case you need a C-section or to minimize injury
- one visit at 6-8 weeks.
- Another visit ideally around 3-4 months. There’s a big hormonal shift then and a lot of women their repairs get worse at 3-4 months. 1 of 9 births will have a Hashimoto event.
- A visit around 6 months for women if they’re doing great. If they are fine with walking or jogging, a 6 month visit may be enough.
- For cross fit or heavy runners, another visit at 12 months as well.
I just want to send a big shout out to Dr. Havard and thank her for sharing her wisdom and experience. She serves in the East Bay in California. You can find her at https://peregrinept.org.
About Dr. Havard: Dr. Havard provides the East Bay Area, CA with orthopedic, prenatal, postpartum, pelvic floor, and wellness services. She went to UC Berkeley for undergraduate and later attended the UCSF/SFSU Joint Graduate Program in Physical Therapy with MS and DPT degrees. She is also Board Certified in the Orthopedic Section (OCS). While she uses a broad variety of skills, she is most influenced by the Institute of Physical Art and utilizes functional manual therapy for optimal efficiency. She is also enthusiastic to incorporate concepts from Herman Wallace in pelvic health and contribute to advocacy for postpartum, incontinence, and transgender care.
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