FUNCTIONAL POSTPARTUM DIAGNOSIS

At Medfemina, we focus on the highest quality of patient care, which is why we undoubtedly consider the importance of postpartum functional body assessment by a certified gynaecological physiotherapist as an important aspect. This is the second necessary appointment next to the postpartum gynaecological consultation.

Functional postnatal diagnostics helps to assess a woman’s body after childbirth in terms of changes that have occurred in posture, analyse posture patterns, ranges of motion, muscle tone disorders, pelvic floor muscle abnormalities, muscle weakness, and muscle and fascial imbalances.

A woman’s body undergoes tremendous changes during pregnancy; on the one hand, the deepened curvature of the spine, changing breathing patterns, changes in muscle tone in the body, posture, habits, professional work, and the course of pregnancy and childbirth can all significantly alter the function of muscles, ligaments, and fascia, as well as the work and statics within the pelvic floor muscles. During a functional postpartum diagnosis, our physiotherapist will meticulously assess the patients’ body work function.

What does such diagnostics include ?

1. Interview with the patient
2.  Analysis of body posture and daily behaviours
3.  Respiratory track assessment
4.  Examination of the abdominal wall (palpation, functional tests)
5.  Examination of abdominal integuments using ultrasound equipment
6.  Examination of pelvic floor muscles (per vaginum or per rectum and using ultrasound)
7.  Evaluation of the scar after caesarean section and perineal incision
8.  Summarize and offer the patient a plan for physical therapy.
9.  Introduction to initial therapy.

Interview with the patient

This is the first and necessary thing to start our cooperation with. It is extremely important for the patient to provide us with as much detailed information as possible, e.g. the course of pregnancy, the course of labour and puerperium, the type of delivery, the number of deliveries, pain complaints, physical activity before and during pregnancy, the type of occupation (sedentary or moving), we will also ask about micturition, defecation and urinary incontinence. The more information we get from the patient, the better and more accurately we can help. The interview is intimate, in a relaxed atmosphere with complete confidentiality and respect for the patient. We respect the situation when a patient does not want to talk about something.

Analysis of body posture and daily behaviours

Analysis of your current standing posture will give us the answer what your movement patterns are, about your habits, how your abdominal pump behaves, what the curvature of the spine is and how the feet and the rest of the body are positioned. We will try to find the perfect possible posture for your body, and see what its response is. We will check the ranges of motion in the joints, which will show what needs to be worked on to restore the body’s functionality and efficiency after childbirth. Please remember that our daily posture, and the way we walk, sit, lift weights etc. is very important in the process of therapeutic success, healing and tissue contraction, so this is never forgotten during your visit.

Assessment of breathing pattern (breathing track)

Assessing how you are breathing (breathing track) whether it is going properly or if something is disturbed is another necessary piece of the whole puzzle because the body is one entirety, so we always check how you are breathing. The way you breathe affects the appearance of your abdomen, your pelvic floor muscle tone, posture and central stability.

Examination of abdominal integuments (palpation and ultrasound)

During this examination, we palpate the state of tension of patient’s abdominal tissues, perform functional tests to determine the function of abdominal muscles, the tension of the white line (linea alba) and crescent line, and assess how the abdominal muscles interact with the pelvic floor and diaphragm. Then, using ultrasound equipment, we also examine the functional workings of patient’s abdominal muscles. Ultrasound also allows us to accurately assess the distance of the rectus abdominis muscles from each other and the behaviour of the muscles in relation to each other at rest and during tension.

Examination of pelvic floor muscles (per vaginum or per rectum and using ultrasound)

This is the most extensive examination and the most significant one that we perform in our department. The first examination is conducted per vaginum and if necessary with the help of ultrasound equipment. This study will give us information about whether: your pelvic floor muscles have too much tension, or perhaps there is a weakening of the muscles, if there are asymmetries, if there is a lowering of the reproductive organs, if there is soreness, if you can tighten the pelvic floor muscles correctly and what is the correlation of pelvic floor muscle tension with abdominal pumping, breathing and other muscles in your body, and if the front and back walls of the vagina are working properly. We use palpation examination and Biofeedback. If you activate your pelvic floor muscles incorrectly or are unable to do so, we will teach you the correct tension – this will be a very important stage for you, requiring focus, attention and concentration on the task. This will ensure that you will be able to work your pelvic floor muscles correctly on your first visit, and we will tailor your pelvic floor training to the needs that your muscles currently have.

Evaluation of the scar after caesarean section and perineal incision

The evaluation consists of visual and palpation assessment to determine the degree of tissue mobility, pain, and the behaviour of the fascia and scar when standing (your typical posture). We teach the patient to care for the scar and mobilize it independently. The area of mobilization we will undertake will depend on the degree of change, the time after surgery and the patient’s personal capabilities.

Appointment summary and treatment plan

Once the examination is complete, we move on to summarize the meeting. We will present you what is good, what should be improved and what, in our opinion, you should start with. We will provide you with accurate and clear guidance on the ergonomics of your daily life. You will also receive the initial exercises and their instructions for you to do on your own at home and apply Kinesiotaping (if needed). If you decide to continue working with us and you will be willing to get back in shape after childbirth with our help, we will present you with an action plan, so that you know clearly what we will do, how to work, with what frequency. You will always receive an exercise homework assignment after each completed therapy meeting, which we will first learn together. We want to be sure you are doing the exercise correctly.

How to prepare for the first appointment?

• one hour before the meeting, please drink about 500 ml of water. With a filled bladder, we will be able to check the workings of your pelvic floor muscles on the ultrasound screen.
• Prior examinations, consultations, and hospital information sheet will also facilitate the meeting.
• The appointment takes 60 minutes.