Authors
- Dufour, Sinead PT, PhD
- Guest Editor
Article Content
After childbirth, most parents report feeling overwhelmed and unprepared for not only the task of parenting but also the array of symptoms experienced by the birthing parent.1 The fourth trimester denotes the first 12 weeks postpartum. Despite this time representing a critical window for healing and recovery, substantial gaps in primary care exist.2 Care encounters focus on aspects of the baby's health, and, in many instances, a single care session at 6 weeks postpartum is the only interaction a birthing person has with a health care provider. As such prevalent issues that span pelvic pain, pelvic floor dysfunction, difficulties with returning to high-impact exercise, and general physical and emotional recovery are not adequately addressed, setting up a potentially long-lasting negative health trajectory. Physical therapist, particularly those with additional expertize and interest in perinatal care, represent a key provider group well positioned to bridge this gap.
This inaugural special issue spans a diversity of important topics and research designs from authors who represent different provider groups and collectively informs clinical practice and future research. Ultimately, this entire issue highlights the need for physical therapists to step in and step up to enhance care in the fourth trimester. We thank our manuscript and book reviewers for their dedication and service as well as all of the submitting authors.
-Sinead Dufour, PT, PhD
Guest Editor
REFERENCES
1. Tully KP, Stuebe AM, Verbiest SB. The fourth trimester: a critical transition period with unmet maternal health needs. Am J Obstet Gynecol. 2017;217(1):37-41. doi:10.1016/j.ajog.2017.03.032. [Context Link]
2. Savage JS. A fourth trimester action plan for wellness. J Perinat Educ. 2020;29(2):103-112. doi:10.1891/J-PE-D-18-00034. [Context Link]
Highlights in This Issue:
In the first ever clinical practice guidelines focusing on postpartum pelvic girdle pain, Simonds and colleagues map out graded recommendations across 6 practice domains to support clinical decision-making. Notably, the synthesized evidence aligns well with the evolving pain science literature base, which has long been lacking where perinatal pelvic pain is concerned. These guidelines grade risk factors, prognostic factors, systems screening, evaluation, and interventions, all highlighting the fact that a pathoantomical care lens does not facilitate evidence-based care.
The chosen clinical commentary by Donnelly and colleagues mounts a strong argument for the consideration of multiple factors outside of the biomechanical and structural domains pertaining to running in the postpartum periods. This article complements the cohort study by Christopher and colleagues investigating differences in running kinetics, strength, and flexibility in postpartum runners (PPRs) and age-matched nulliparous controls. The between-group differences highlight possible deficits present among PPRs.
Havens and colleagues analyzed survey responses from almost 4000 "babywearing enthusiasts." The results shed light on various health domains relevant to the fourth trimester from a biopsychosocial perspective, pointing to where physical therapists can level up care. In a retrospective review of 70 data sets of individuals who sustained third- or fourth-degree birth-related perineum tears, Kim and colleagues explore the important potential of pelvic health physical therapy.
The issue also includes a welcomed addition to the diastasis rectus abdominis (DRA) literature. Berg-Poppe and colleagues systematically reviewed the current body of conservative care interventions for DRA and included 14 studies (9 of which were randomized controlled trails) in their analysis. Results favored abdominal and associated deep system motor control exercises in addition to using electrical muscle stimulation as an adjunct therapy.
Editor's Note:
It is my great pleasure to thank Dr Sinead Dufour for the fantastic job that she has done as guest editor for this important special topic issue. The JWHPT editorial team is grateful for her dedication and insight. It has been an honor to work with Sinead.
We have received many wonderful submissions for this fourth-trimester special issue. However, due only to space constraints, these accepted manuscripts will be published in subsequent issues.
-Cynthia M. Chiarello, PT, PhD
Editor-in-Chief