What is A “WOF”?
Pelvic Health Physios use the “WOF” as a screening type of assessment. The purpose of this is different in pregnancy and post natal WOF assessments, but the aim is always the same: to prevent or manage pelvic floor injuries and incontinence, and to optimise function and achieve your goals.
Assessments always vary depending on the woman’s concerns, with treatment plans aiming to address the individual taking into account her history, goals, and physical requirements. Stage of pregnancy will also guide these appointments.
Pregnancy WOF
Assessment/screening for the pregnant woman typically includes:
– assessment of posture and core
– screening for DRAM (parting of the abdominal muscles)
– exercise options
– address any concerns around continence or constipation
In the 3rd trimester it is important to have a discussion around delivery plans and body preparation for delivery (vaginal or c-section), including topics such as perineal release, expectations after c-section or vaginal delivery, pelvic floor rehabilitation and more.
Post Natal WOF
Assessment/screening for the post natal woman covers all of the above topics, but time and attention is typically more of pelvic floor recovery focused in order to address any concerns around continence, prolapse, healing of tears, and any other perineal/pelvic floor concerns.
An internal vaginal examination is routinely offered (and recommended) for assessment of concerns such as pelvic organ prolapse and pelvic floor muscle strength or dysfunction, pain, assessment of perineal tears, as well as assessment of readiness to exercise from a pelvic floor risk perspective. You are always able to decline and internal examination should you prefer.
If you have sustained a maternal birth injury, ACC can help to subsidise pelvic health physio fees. If you haven’t already applied, this can be done through Silverdale Physio.
Click here to read more about maternal birth injuries…
Why do we recommend women do a WOF after each baby?
Every pregnancy is different. Every delivery is different. What is the same, though, is that your body goes through dramatic changes over a short amount of time through the birthing year, and the mechanical (and let’s not leave out psychological and physiological) demands on the body during this time are significant, whether your experiences is positive, or more of a challenging one.
Pelvic Health Physio’s love the post natal WOF as it gives us not only the ability to screen any changes that may have happened during your pregnancy or delivery, but it also allows us to promote what we do so that should a concern arise later in life (or should there be a pre-existing concern), women are learning that there are many management options.
Specific to each pregnancy and delivery, we are looking for risk factors of pelvic floor dysfunction and prolapse, so we can either prevent, or manage, these types of events. This is for both c-section and vaginal deliveries, as pregnancy in itself will put a lot of pressure on things “down there”.
It is also important to us to enable women to return to activities she enjoys. Whether that be going for a walk, or returning to CrossFit, we understand there is a large spectrum of what is considered “normal” for a woman to demand of her body. This does mean that advice and treatment really does need to be tailored to every individual woman; there is no one-size-fits-all in this field, and this includes management plans after each and every baby.
Why WOF before delivery?
Pregnancy WOF aims will vary depending on stage of pregnancy. I typically encourage women to come in a minimum of 3 times during the birthing year; during her first or second trimester, around 35 weeks, and then for a post natal WOF.
Why 3? Well…
1st/2nd Trimester
I want to ensure you are able to exercise through the pregnancy, safely, and enjoyably. Many health outcomes are related to exercise in the year prior to and the duration of your pregnancy. Remaining active has associations with better health of mother and baby, including mental health and wellbeing. We also want women to be fit enough to manage her labour, should she be opting for a vaginal delivery, and strong enough to be managing carrying and feeding a baby once they arrive. We discuss things like pregnancy related pelvic girdle pain, how to continue exercising through the pregnancy, what to expect to change in your biomechanics. This is particularly important in high risk pregnancy, where exercise options may be more limited.
We also discuss pelvic floor training and pelvic floor recovery related to pregnancy and delivery.
3rd Trimester
I recommend the 3rd trimester appointment be around 35 weeks; once the birth plan is known. The 3rd trimester appointment is aimed at preparing your for both; it is important to discuss both c-section and vaginal delivery, as things don’t always go to plan and I like women being prepared! But we do focus on your birth plan, and in particular this time is valuable for women to prepare for vaginal deliveries. With the approval of your LMC/OB, we can perform an internal examination to assess your ability to coordinate the pelvic floor during delivery, as well as to teach you perineal release and evidence for minimising perineal birth injuries.
You can also choose to do regular perineal release with a pelvic health physiotherapist in preparation for your delivery.
Post Natal WOF
An appointment after the delivery, as discussed above.
The Birthing Year Package
In light of all of this, I am putting together a package called “the birthing year”, which will be a package deal for 3 appointments spaced out through the 1st/2nd trimester, 3rd trimester, and post natal assessment. Watch this space!
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