Physical Therapy Following Birth: An Interview with Physical Therapist and Pelvic Health Specialist, Dr. Celestine Compton

Nyssa Network member, Dr. Celestine Compton, is a doctor of physical therapy who specializes in women’s and pelvic health. She is passionate about changing the landscape of women’s health and wellbeing, and works in her profession and various online platforms to share knowledge in this field. Celestine is also a team member of Origin, an organization offering virtual and in-person therapy visits for pregnancy, postpartum, sexual health, and menopause. Originally from New Jersey, Celestine currently resides in California with her daughter and partner.

Nyssa’s Mia Clarke met with Celestine to discuss pelvic health for women after vaginal and cesarean birth.


This transcription has been edited for length and clarity. 

MC: Please can you explain the ways in which physical therapy can play a role in helping people heal after birth and if/how your practice differs depending on whether you’re treating someone who has had a vaginal or c-section delivery?

CC: After delivery, most people are not given adequate guidance about how to care for their postpartum body, what signs and symptoms to be on the lookout for, and how to best promote healing, whether following a vaginal or cesarean birth. Physical therapy aims to fill that gap in postpartum health care.

When working with a physical therapist, whether days, weeks, or months postpartum, they are concerned about what your current function is, what tasks or activities may be painful, difficult, or impossible for you to perform, and what specific goals you have following delivery. Your physical therapist will take all of this into consideration, along with your pregnancy and birth experience, in order to develop a plan of care that is specific to your needs. Treatment is individualized and will differ depending on your condition and your goals; how you deliver may play a role in your treatment, but not necessarily.

"Mostly, I just wish people knew that they do not have to experience the postpartum period alone. No one is expected to "figure it out" or "deal with recovery" on their own following an injury or a surgery. Why should birthing a baby be any different?"

MC: What do you wish more people knew about how physical therapy can help women heal after birth?

CC: Mostly, I just wish people knew that they do not have to experience the postpartum period alone. No one is expected to "figure it out" or "deal with recovery" on their own following an injury or a surgery. Why should birthing a baby be any different? There are physical therapists who understand the human body, what it goes through to make and birth a human, and how to heal and restore function safely and effectively postpartum. I hope we can change the expectation that after delivering a baby you are on your own, because physical therapy is a great resource for all new parents. 

MC: What do you advise people recovering from a c-section birth when it comes to recovering at home?

CC: Following a cesarean, some of the most difficult tasks may be everyday activities like getting in and out of bed, coughing, passing bowel movements, or lifting your baby in and out of the crib. When you are recovering at home, it can be helpful to do a virtual session with a physical therapist. Your physical therapist will assess your setup, your equipment, and your needs, and can provide guidance on the best ways to perform those same tasks with less pain, while also protecting your healing body. 

"If you don't have access to a physical therapist, try to listen to your body, use your arms and legs to help perform tasks you would typically rely on your core to perform, and problem-solve any issues early on to prevent forming bad habits or potentially slow healing."

MC: Could you share what your ideal postpartum treatment plan would look like for someone who has just had a c-section birth?

CC: Ideally, I would love to see someone for a virtual session within the first week following cesarean delivery. It can be helpful to speak with a therapist right away to know how to care for the c-section wound, how to promote good healing, and how to perform everyday tasks safely. Additional sessions would be geared towards addressing scar massage and desensitization, rebuilding core and pelvic floor strength, and preparing your body for return to work, sex, and exercise. Working with a therapist once every week or two over the first 8-12 weeks postpartum is a great way to be sure you are setting yourself up for a great full body recovery. 

MC: Please can you explain what diastasis recti is. If someone has both diastasis recti and undergone a c-section birth, what would you recommend as a treatment plan?

CC: Diastasis recti is a condition where your rectus abdominus muscles (the 6-pack muscles) are slowly pushed apart, stretching the connective tissue found between those muscle bellies to make space for a growing belly. This happens to almost all people in the third trimester and is not actually a problem in that situation. However, for some people, that tissue between the muscle bellies does not automatically go back to its pre-pregnancy state after delivery: the muscles may remain separated and the connective tissue between them may not be very supportive.

You may continue to have a diastasis postpartum whether you have had a cesarean delivery or a vaginal delivery and, regardless of your birth experience, your treatment plan will be focused on restoring tension to the tissue between the muscle bellies and rebuilding core strength through behavioural modifications and exercise. If you are 8 weeks postpartum and continue to have diastasis recti, meet with a physical therapist to determine a more personalized plan of care to guide you in further closing the gap.

"Learning about your core, your pelvic floor, your diaphragm, and your whole body's function before delivering a baby can be very helpful in making achievable goals and having greater body awareness postpartum."

MC: Would you recommend starting physical therapy prior to birth? If someone is having a planned c-section, is there any type of pre-birth protocol that you’d recommend? 

CC: I encourage all people to meet with a physical therapist before birth. If for no other reason, learning about your core, your pelvic floor, your diaphragm, and your whole body's function before delivering a baby can be very helpful in making achievable goals and having greater body awareness postpartum. Working with a physical therapist beforehand can also set a great foundation to continue receiving care in the postpartum period, if needed. In the case of a planned cesarean, working with a physical therapist in advance can be especially helpful to learn what to expect and how to care for your body immediately after surgery; trying to learn these strategies in the hospital immediately following delivery, while you are devoting all of your time, energy, and thinking to caring for a new baby, is not always as effective.

"Having experienced a cesarean delivery does not automatically mean that you will have impairments that would affect future deliveries."

MC: Does your therapy approach change if someone is preparing for a c-section birth after c-section (CBAC) or a vaginal birth after c-section (VBAC)?

CC: Having experienced a cesarean delivery does not automatically mean that you will have impairments that would affect future deliveries. If you and your medical provider decide that a VBAC or CBAC is the safest or most appropriate option, then your therapist will support your decision and work with you towards your goals. Your physical therapist is going to assess your body and give tailored guidance and exercises that would best prepare you for your specific birthing plans.

"There is still a shockingly popular belief that "women have been having children forever and never received help in the past, so why should they need help now?" Of course, you would never hear this same statement in conversations about enlarged prostates or erectile dysfunction. But when it comes to pregnancy, I hear those exact words all the time and from all types of people."

MC: Awareness of the importance of physical therapy seems to be growing– but there’s still a long way to go when it comes to understanding its role in postpartum recovery. Why do you think this is?

CC: First of all, postpartum recovery is not taken seriously in America. There is still a shockingly popular belief that "women have been having children forever and never received help in the past, so why should they need help now?" Of course, you would never hear this same statement in conversations about enlarged prostates or erectile dysfunction. But when it comes to pregnancy, I hear those exact words all the time and from all types of people.

Secondly, good or bad, when someone mentions physical therapy, most people have a general idea of what that is and I can almost guarantee that their first thought is never related to pregnancy or postpartum recovery. It can be difficult to change people's minds about something as simple as seeking help postpartum, or as simple as what it means to work with a physical therapist, and our profession just needs to do better to change both of these public opinions and normalize physical therapy's role in postpartum recovery, but also in every phase of life when dysfunction may occur.

"Women are learning that so many things we have just been expected to deal with in our lives, in our jobs, and in our healthcare, are not at all fair or right, and they are pushing for change."

MC: How would you like the landscape of maternal health to look in 5 years from now? What conversations do you want to be happening and how do you see your role in that movement?

CC: When we are unable to participate in our sport or exercise because of an athletic injury or a knee or shoulder surgery, we reach out to a physical therapist in order to help us recover and restore our function. If we are unable to participate in our sport or exercise or have sex or do our jobs or perform basic everyday tasks during pregnancy, postpartum, our menstrual cycle, or menopause, we just deal with it.

I hope that, in the next 5 years, we can at least start to normalize seeking help when women experience pain, incontinence, pelvic pressure or dysfunction at any stage of life. This change is already starting to happen: Women are learning that so many things we have just been expected to deal with in our lives, in our jobs, and in our healthcare, are not at all fair or right, and they are pushing for change. Of course, we still have much further to go, but the conversations have been started; we all just need to do our part to keep pushing forward. As a women's health physical therapist, sharing my knowledge and expertise with anyone and everyone who will listen, like in this interview, is one way I try to help push forward.

MC: You’re part of the team at Origin. What made you decide to become part of the team and how do you see platforms like Origin evolving to impact the broader landscape of women’s health?

CC: For a long time, physical therapy centered on women's health has been difficult to find and even harder to afford. Origin's mission is to bring access to physical therapy to all women at every stage of life. They are working to change the current status quo, and I am here to be a part of that change. But physical therapy is just one piece of the puzzle; many more platforms, practices, and providers have also joined the cause to further improve women's health care in America. I look forward to seeing these different fields, experts, and communities work together, Origin included, to effect real change in the lives of women all over the country and, eventually, all over the world.

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