Redefining Postpartum: Pelvic Floor Therapy for Birth Prep and Recovery

Melanie Llanes is the founder of Best Self Wellness, a private pelvic floor physical therapy clinic. She started her practice to give women the tools, support, and confidence they deserve through pregnancy, postpartum, and beyond. With expertise in pelvic health, movement science, and strength-based rehab, Melanie helps women prepare for labor like athletes and recover like pros, empowering them to feel strong and capable at every stage of life.

What inspired you to focus your practice on birth prep and postpartum recovery, and how has that shaped the way you support women through every stage of motherhood?

I was inspired to focus on birth prep and postpartum recovery because I noticed a huge gap in how women are supported during pregnancy and after birth. Many women, including their providers, believe they need to have something “wrong”—an injury or dysfunction—in order to seek help, when in reality, education and prevention are just as important for supporting their health and recovery. On the other end, many pregnant and postpartum women are told by providers that their pain or discomfort is “normal” and are not given options for relief. Experiencing this both professionally and personally as a mom of two really shaped my approach: I want women to feel empowered, supported, and informed at every stage of motherhood, not just when something goes wrong.

What are common misconceptions patients have about postpartum healing, and how can healthcare providers better educate women on pelvic floor and core recovery?

A major misconception is that once a woman is “cleared” at her six-week postpartum checkup, she is fully recovered, which is rarely the case. Many women also believe that symptoms like urinary leakage, pain during intimacy, or even back pain are just normal parts of motherhood, when they are actually treatable issues. Healthcare providers can help by normalizing conversations around pelvic floor and core health, setting realistic expectations, and introducing physical therapy early to help women understand and support their recovery.

Can you share an example of a patient whose recovery improved significantly after addressing these misconceptions? What strategies or interventions made the biggest difference?

I saw a mom who was referred to me by her physician specifically for hip pain that started 6 months after birth. During her initial evaluation, I screened her for pelvic floor dysfunction. She had leakage with jumping and mild pain with penetrative intercourse. She said she had mentioned it to her OB/Gyn who told her it was normal. After one session of doing manual release work to her pelvic floor muscles, she had 50% improvement in hip pain. We had six sessions of PT in which I recommended increased water intake, educated her on her pelvic floor muscles and provided a movement program to re-educate her pelvic floor muscles. At discharge, her pain was alleviated, she was able to have pain free intercourse and jump without leakage. If she had not had hip pain, she would not have been referred to me and would probably have continued with leakage and pain with intercourse. We need to let women in general know that pregnancy and labor do change a mom’s body but we do not need to accept limitations—common does not need to be normal. We can help moms feel their best selves and learn to feel strong in their new bodies.

How do you tailor physical therapy programs to meet the unique needs of different patients, such as first-time mothers versus those with previous birth experiences or complications?

The first factor that helps determine a plan is whether their goal is to have a vaginal delivery or cesarean delivery. I am always educating moms that emergencies or other health factors may come into play during labor. However, if a mom already knows immediately that she would like an elective cesarean, our plan will be based on helping her have a comfortable pregnancy and educating her on how to recover after her surgery. If a mother’s goal is to have a vaginal delivery, there are three key components I focus on: pelvic and spinal mobility, pelvic floor relaxation, and breathing mechanics. When I assess a patient, I am looking specifically at which of those components or possibly all three that we need to look at.  I utilize manual therapy tools such as massage, joint mobilizations, dry needling to improvement joint mobility and to relax tight pelvic floor muscles. I always provide an exercise program that reinforces that manual work I do and aides in their strengthening for labor. Lastly, I am not only teaching them how to breathe, with their consent, I am palpating their pelvic floor muscles as they breathe and practice pushing in order to determine whether they understand how to push for labor. We follow up with education and labor positions to equip patients with the tools to meet their goals.

What are some of the key components of effective birth preparation, and how can physical therapy be integrated into patient care to help prepare for labor?

Effective birth preparation includes physical, mental, and emotional readiness. Key components are learning how to use the pelvic floor and core effectively, practicing proper breathing techniques, improving mobility and strength in the hips and core, and understanding labor positions that can help the baby descend. During my physical therapy sessions, I am providing exercises, education on body mechanics during labor, and strategies that are tailored to my client to prepare their body for the changes during pregnancy, promote efficient labor, and reduce birth injury. There is a key measurement that I measure in all my clients: perineal body length. Studies have shown that a perineal body of less that 3 cm puts a mother at risk obstetric anal sphintor injury during labor. Having this information helps guide their plan of care. We can focus on relaxing their pelvic floor, ensure they are in labor positions that reduce perineal injury, or even discuss the benefits of a cesarean.  Lastly, I bring in their support partners on labor pain and stress reducing techniques that they can utilize in replace of or in addition to medical interventions.

How can preparing the body for birth help reduce trauma and promote a smoother postpartum recovery?

When a woman prepares her body for birth, she is better able to handle the physical demands of labor, which can reduce the risk of large perineal tears, lower the chances of an unwanted cesarean section, and minimize unnecessary medical interventions. Proper preparation also helps optimize pushing mechanics, which can shorten the second stage of labor and support a smoother, more efficient birth. From my own experience and with patients, being physically prepared not only reduces trauma but also sets the foundation for a faster and more empowered postpartum recovery.