Pelvic Floor Physical Therapy Should Be Standard Care for Expectant and Postpartum Mothers
As a pelvic floor physical therapist, I have witnessed an overwhelming need among women, particularly those who are pregnant or postpartum, to gain more access to pelvic floor therapy. Studies estimate that about one in three women may experience symptoms like leaking urine, trouble controlling gas, or pelvic discomfort. Professional organizations like ACOG highlight pregnancy and delivery as key factors affecting pelvic floor health. Many never receive care due to cost, distance, stigma, or lack of local providers. Far too many women are struggling to find specialized pelvic health services.
With that struggle in mind, I decided to apply for a maternal health grant. My team and I worked tirelessly to create an innovative proposal that combined pelvic floor expertise with telehealth technology to expand access for prenatal and postpartum women. The feedback from industry colleagues was positive, and the potential for this to create a positive ripple effect was strong.
When the application results arrived, the answer was a no. But it wasn’t the denial that bothered me. It was the reason behind it: our pelvic floor services were not considered primary care. But as any pelvic floor therapist will attest, the benefits of specialized pelvic health services are not “nice to have” add-ons. They are essential.
In North Carolina, as in most states, physical therapy is direct access. Patients can, and often do, come to us without a referral. In perinatal care, PTs are often the first, and sometimes the only, providers addressing urinary incontinence, prolapse, pelvic pain, diastasis recti, and musculoskeletal changes from pregnancy and postpartum. To suggest that PTs aren’t “direct care” is not only outdated, but ignores the real impact we have on maternal health outcomes.
What stings most is that the initiative we proposed could have meaningfully improved access for pregnant and postpartum women who struggle to find specialized pelvic health services. Our proposal for Telehealth PT would have expanded access to evidence-based treatment, early intervention, and education particularly in rural or underserved communities. It integrated virtual pelvic floor physical therapy, breath and pressure management training, heart rate variability monitoring, and behavioral health coaching to help bridge the maternal care gap in North Carolina.
Yet the grant was denied on the technicality that PT wasn’t considered a direct care provider. While grant criteria are important, rigid definitions can sometimes narrow the applicant pool in ways that overlook innovative, interdisciplinary approaches that prioritize women’s health in meaningful ways.
This dismissal reflects a larger, troubling trend. While PT is undeniably a professional doctoral degree, proposed federal rules could restrict certain loan forgiveness programs or funding eligibility, which only adds to the perception that our field is undervalued, even as patients increasingly recognize our expertise.
When policymakers and funders don’t recognize PTs as direct care providers, the consequences fall directly on patients: mothers go without help, chronic issues worsen, and preventable conditions become long-term problems. Physical therapists are not optional. We are frontline musculoskeletal and pelvic health providers who see patients daily, often before, during, and after their visits with physicians or midwives.
It’s time for funding agencies, legislators, and health systems to recognize what patients already know: pelvic floor physical therapy is primary care for prenatal and postpartum women. Excluding it from grant opportunities, especially on a technicality, undermines programs that could have a meaningful impact and only reinforces the gaps in maternal health that our healthcare system continues to overlook.
If you’re like me and want to see changes that prioritize essential women’s health in meaningful ways… let’s chat!
