You see the whole person—so do we.

Together, we can support your clients’ physical and emotional well-being, leading to more confident births and smoother postpartum transitions. At Kins, we believe pelvic floor physical therapy should be as accessible and inclusive as possible, no matter where your patient lives or what their insurance looks like.

After many conversations with Midwives, we often get asked: “When is the right time to refer?”
Here’s the short answer: There’s no wrong time.

Below, we break down the best times to refer a client for pelvic health PT, from early pregnancy to postpartum recovery, with clear guidance on who benefits, when, and why.

Pregnancy / Prenatal Care

Referral timeline: Any stage of pregnancy (Evidence says earlier can even be better)

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Who benefits:

Those experiencing...

• Increased urinary urgency or nocturia
• Constipation or diarrhea
• Pelvic heaviness or pressure
• Vaginal/bladder pain
• Urinary, gas, or fecal leakage
• Pain with sex
• Abdominal discomfort or diastasis recti
• Lower back and/or hip pain
• General orthopedic concerns
  

Common PT Strategies:

Too often, pregnancy symptoms get brushed off as “just part of the journey”—but they don’t have to be. At Kins, we meet people where they are, and help them feel better and empowered. Our treatment plans are personalized, focusing on optimizing function in each trimester - this can include strengthening hip and core muscles, training pelvic floor coordination, and posture/activity modifications for joint protection. . We guide on how to move safely and confidently, offering trimester-specific exercise education to keep people active without adding strain.

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Why it matters:

Addressing symptoms and concerns  during pregnancy—not just after—can significantly reduce postpartum issues like incontinence and pelvic pain.¹^-³ Plus, prenatal exercise reduces the risk of gestational diabetes ⁴^-⁷ Staying physically active during pregnancy has been shown to decrease active labor times as well.¹⁸

Labor & Delivery Preparation

Support the body for the most important marathon of their life.

Referral timeline: 2nd or 3rd trimester

Who benefits: All pregnant people

Common PT Treatments:

This is where physical therapy meets birth prep. We teach breathwork to coordinate pelvic floor relaxation and pushing, offer perineal stretching guidance (solo or with partner), and help identify optimal pushing positions based on each patient’s anatomy. Education is a huge part of labor & delivery preparation, and physical therapy provides individualized information to support a person in meeting their birth plan.

We also provide non-medical pain management education—think:

• Labor-friendly movement
• Abdominal lifts
• Sacral counter-pressure
• Breathwork
• Manual therapy

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Why it matters:

Diaphragmatic breathing can lower pain perception and anxiety, and even shorten labor.⁸^-¹¹ Perineal massage starting at 34–36 weeks can reduce 3rd/4th degree tears, episiotomies, and need for vacuum or forceps assisted delivery.^12-14

Postpartum Recovery

A new parents’ body is going through healing and recovery with entirely new emotional and physical demands. Life is different with a kid and PT can support birthing people across the entire postpartum journey.

Referral timeline: Postpartum check-up or any time after birth

Who benefits:

• People experiencing any of the symptoms listed above
• People looking to safely return to activity
• People who want to prepare their body for new parenthood (think excess lifting, squatting, bending over to feed baby).
• Pain from perineal tears or C-sections
• Pelvic organ prolapse
• Diastasis recti
• People seeking guidance with return to running or exercise

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Common PT Treatments:

We support people  across a spectrum—from those managing prolapse or incontinence to those who “feel fine” but want help returning to exercise or intimacy. This may include a combination of modalities including strength training, mobility, education and more.

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Why it matters:

These symptoms aren’t just physical. Pelvic floor issues are linked to postpartum depression and anxiety.¹⁵^-¹⁷ Early support through PT can reduce these risks while helping people feel confident, strong, and whole again.

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Let’s Make Referring Easy

Midwives are uniquely positioned to guide clients toward pelvic health PT—often before anyone else does. That’s why we’re here to be your partner in care.

- Refer in minutes
- Covered by insurance
- Virtual-first, inclusive, and trauma-informed

Your clients deserve options—not limitations.
Let’s give them the care they need, when they need it most.

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For referral information click here

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References

1. Romeikienė, K. E., & Bartkevičienė, D. (2021). Pelvic-floor dysfunction prevention in prepartum and postpartum periods. Medicina, 57(4), 387.
2. Ren, S., Gao, Y., Yang, Z., et al. (2020). The effect of pelvic floor muscle training on pelvic floor dysfunction in pregnant and postpartum women. Physical Activity and Health, 4(1).
3. Kahyaoglu Sut, H., & Balkanli Kaplan, P. (2016). Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourology and urodynamics, 35(3), 417-422.
4. Hopkins, S. A., & Artal, R. (2013). The role of exercise in reducing the risks of gestational diabetes mellitus. Women’s Health, 9(6), 569-581.
5. Cordero, Y., Mottola, M. F., Vargas, J., Blanco, M., & Barakat, R. (2015). Exercise is associated with a reduction in gestational diabetes mellitus. Medicine and science in sports and exercise, 47(7), 1328.
6. Mottola, M. F., & Artal, R. (2016). Role of exercise in reducing gestational diabetes mellitus. Clinical obstetrics and gynecology, 59(3), 620-628.
7. Wang, C., Wei, Y., Zhang, X., et al. (2017). A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. American journal of obstetrics and gynecology, 216(4), 340-351.
8. Marzouk, T., & Emarah, H. A. (2019). Effectiveness of breathing exercise on reducing pain perception and state anxiety among primi parturients. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 8(2), 15-22.
9. Amru, D. E., Umiyah, A., Yastirin, P. A., et al. (2021). Effect of deep breathing techniques on intensity of labor pain in the active phase. Int J Soc Sci World, 3, 359-64.
10. Issac, A., Nayak, S. G., Priyadarshini, T., et al. (2023). Effectiveness of breathing exercise on the duration of labour: A systematic review and meta-analysis. Journal of global health, 13, 04023.
11. Cicek, S., & Basar, F. (2017). The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women. Complementary therapies in clinical practice, 29, 213-219.
12. Aquino, C. I., Guida, M., Saccone, G., et al. (2020). Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. The Journal of Maternal-Fetal & Neonatal Medicine, 33(6), 1051-1063.
13. Dieb, A. S., Shoab, A. Y., Nabil, H., et al. (2020). Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial. International urogynecology journal, 31, 613-619.
14. Abdelhakim, A. M., Eldesouky, E., Elmagd, I. A., et al. (2020). Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. International urogynecology journal, 31, 1735-1745.
15. Swenson, C. W., DePorre, J. A., Haefner, J. K., et al. (2018). Postpartum depression screening and pelvic floor symptoms among women referred to a specialty postpartum perineal clinic. American journal of obstetrics and gynecology, 218(3), 335-e1.
16. VanWiel, L., Unke, M., Samuelson, R. J., & Whitaker, K. M. (2024). Associations of pelvic floor dysfunction and postnatal mental health: a systematic review. Journal of reproductive and infant psychology, 1-22.
17. Peinado Molina, R. A., Martínez Vázquez, S., Martínez Galiano, J. M., et al. (2024). Prevalence of depression and anxiety in women with pelvic floor dysfunctions: A systematic review and meta-analysis. International Journal of Gynecology & Obstetrics, 167(2), 507-528.
18. Watkins, V. Y., O’Donnell, C. M., Perez, M., Zhao, P., England, S., Carter, E. B., ... & Raghuraman, N. (2021). The impact of physical activity during pregnancy on labor and delivery. American journal of obstetrics and gynecology, 225(4), 437-e1.