Pelvic Floor Physical Therapy Should Be Standard Care for Expectant and Postpartum Mothers
As a pelvic floor physical therapist and clinic owner, I was both surprised and frustrated to learn that, despite the many hours we devoted to our maternal health telehealth grant application, and the positive feedback we received from colleagues who were impressed by the initiative, it was denied because physical therapy was not considered a ‘direct care provider.’ Our innovative proposal combined pelvic floor expertise with telehealth technology to expand access for prenatal and postpartum women, yet it was dismissed in favor of more conventional, predictable applicants, essentially, just because we weren’t classified as primary care.
In North Carolina, as in most states, physical therapy is direct access. Patients can 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 To suggest that PTs aren’t ‘direct care’ is not only outdated, it ignores the real impact we have on maternal health outcomes.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. These are not “nice to have” add-ons. One in three women experience pelvic floor issues postpartum, and many never receive care due to cost, distance, stigma, or lack of local providers. Telehealth PT would have expanded access to evidence-based treatment, early intervention, and education, particularly in rural or underserved communities.
Our proposal 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 a technicality: PT wasn’t considered as 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.
