Gaps in Maternity Care: Pelvic Physiotherapist Magdalena Hul on Better Prenatal, Birth, and Postpartum Health

There are significant gaps in maternity care during pregnancy, childbirth, and the postpartum period. People experience wildly different qualities of care in the transitions they go through during and after pregnancy. Studies report that medical experiences of prenatal care and childbirth are largely positive, with 11.5% and 20% of women stating negative or inadequate experiences with prenatal care and labor respectively. However, the ratio of inadequacy and dissatisfaction jumps to around 25% in care after birth, when the newborn is determined healthy and out of the womb.

The power relations between healthcare providers and pregnant people are complex and sometimes nebulous. While healthcare providers must walk the often blurry line between patient autonomy and patient (and patient’s fetus) safety, the patients themselves have an absolute right when it comes to their bodies. Especially in the case of complications like preeclampsia and choosing between vaginal birth and cesarean sections, healthcare professionals feel frustrated and at a loss of power when patients practice their autonomy over the mode of birth according to one study.

Almost a third of low-risk births are carried out through C-sections— which increase the chance of maternal morbidity— and there is currently a concerted effort to reduce the rate of the operation due to its inherent risks. Additionally, a large proportion of pregnant people are exposed to medications, only a fraction of which have been investigated with regard to benefits, risks, and dosage. This is compounded when further intersections are taken into account such as indigeneity and rurality.

The owner of My Pelvic Physio, an Ontario-based pelvic physiotherapy clinic, Magdalena Hul’s experiences with the medical system throughout her two pregnancies stand as a paradigmatic example of the above conclusion. As she specializes in preventative prenatal and postpartum care and is one of a few Physio Doulas in Ontario, Magdalena expected her experience to fully prepare her for her labors. Although intimately— and certifiably— knowledgeable on pregnancy and birth, when complications struck, she realized she was just as susceptible to implicit biases as any other patient.

“I ended up having my son premature at 34 weeks due to severe preeclampsia. My liver and kidneys were shutting down. I was in the NICU, everything was suddenly going down, and I was just not able to advocate for myself and my son anymore,” she recalls. “I knew what to do in the case of a full-term birth, but when there are so many complications, you just go along with the model they lay out before you because they’re the professionals after all.”

For people who don’t happen to be experts in the medical processes of pregnancy, the hesitancy to go with their gut and advocate for themselves against their doctor’s suggestions is even more intense. While most physicians recite the Hippocratic Oath— with “First do no harm” being the critical verse— this does not require healthcare providers to make the best decisions for the overall and long-term well-being of a patient. In fact, studies report that healthcare providers perform an increasing amount of C-sections without medical indication, and just out of convenience. Magdalena says, “You’re easier to manage if you have fewer questions and are less informed. With an overrun and understaffed healthcare system, providers are under pressure to do their jobs faster and more economically.”

That’s why part of My Pelvic Physio’s practice is a comprehensive education of the medical institution, particularly its procedures and norms around pregnancy, birth, and postpartum care. When patients are fully informed well before entering hospitals, they are more likely and able to preserve their autonomy. For instance, Magdalena makes sure to notify all her clients and patients to prepare for the likely case of an unplanned C-section. She also informs of the conditionally avoidable procedure of cervical checks. “There’s no research to support that dilation happens linearly. But, every time you get checked, you may notice that everything slows down because there’s currently a stranger inside of you. It causes pain and fear which sets off your sympathetic nervous system, and can increase your risk of infection each time someone is down there.”

So, unless the patient has just entered the hospital or is currently about to give birth, they can sensibly advocate for themselves and hold off on uncomfortable, and somewhat unnecessary, procedures.

Coming to the postpartum period, Magdalena experienced a sharp fall in her quality of care. Indeed, she was compelled to remove the stitches from her C-section wounds when doctors would not believe that her scar was not healing properly. Moreover, she’s heard many stories from clients who do not receive additional care after 6-8 weeks postpartum.

Even in more progressive healthcare policy, postpartum care is only provided until the 4-6 weeks post-birth mark. This is despite the Return to Running postnatal guideline, which finds at least a three-month period before postnatal people (who performed vaginal, uncomplicated births) should return to running. Physicians recommend physiotherapy for a period of 3-12 weeks (or more) for even an ankle sprain. So, postpartum patients remain unimpressed when they are told they are well and good after giving birth to an entirely new human after 6 weeks. “Your uterus increases up to 1000% of its original size. Everything needs time to shrink down and return to normal balance. That time is not anywhere near 6 weeks.”

She advocates for the medical institution to treat birth like any other injury. “We talk about scar tissue all the time when it comes to orthopedic surgeries, knee replacements, and so on. How is birth, whether through the vagina or through a cesarean, any different?” asks Magdalena.

Magdalena also emphasizes the importance of preventative pelvic physiotherapy in strengthening one’s pelvic floor against the biomechanical aftermath of pregnancy and birth, i.e., pelvic prolapse, incontinence, and vaginal dryness. “You don’t have to live with the pain and discomfort. Your pelvic floor stretches up to 3 times its original size after giving birth, and you can lose up to 25% of your pelvic strength just by carrying the extra weight of a baby,” she explains, “We deserve better than to live with it.”

My Pelvic Physio strives to raise awareness about pregnant and postpartum pelvic health across Canada and to uplift women and pregnant people in their security to advocate for the many options available to them. Magdalena Hul provides preventative prenatal and postpartum pelvic physiotherapy, along with physiotherapy for pelvic pain and dysfunction. Magdalena also ensures her patients are provided long-term postpartum care for patients to restore themselves completely, and to live and play with their children without fear, pain, or leakage.