Why Aren't OTs the Standard in Postpartum Care?

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Transcript

If you've ever looked at postpartum care and thought, how is this not an occupational therapy lane? You're definitely not alone because let's be real, feeding, sleeping, toileting, bathing, mobility, wound care, body mechanics, pain, mental health, identity shifts, routines and roles, postpartum is basically one giant ADL and IADL reboot. 

Today, I wanna walk you through a real world example of what it can look like when an OT brings maternal health into the hospital setting in a way that's systematic, not only when someone happens to think of OT, but actually built into care. This is a solo episode, but I'm sharing a story and a model that came straight out of acute care.

How one OT went from noticing a gap to building a postpartum OT program with automatic consults. As you listen today, I want you to keep asking yourself one question, what would have to be true in my hospital or in my setting for this to be the go-to?

( Intro )

Most specialty paths don't start with a perfectly mapped out plan. They start with a client you can't forget. In this case, it began early in an OT's acute care career.

During the COVID era, when pregnant clients were coming in critically ill, some needed emergency C-sections for earlier than anyone ever wants, just so they could be placed in an ECMO, a life support intervention that oxygenates the blood when the lungs can't keep up. But here's the part that stops you even more in your tracks. OT was doing OT things.

Tolerance, ADLs, function, mobility, while a brand new mother was literally fighting for her life. And the question became obvious. We automatically support so many post-op clients.

So why aren't postpartum clients getting treated like this? We know C-sections are a major abdominal surgery. Vaginal delivery can come with significant tissue trauma, pain, mobility limitation, and functional disruption. Yet in so many hospitals, OT isn't a default part of postpartum recovery.

So that's the origin point, seeing a gap, realizing it's systemic, and deciding it's worth solving. So what does it actually take to turn an observation into a program? Well, it starts with doing what OT's do best, assess the system, collect data, identify barriers, and build a functional plan. So start with a deep research dive, not just what OT can do, but what other countries do, what outcomes exist for rehab with abdominal surgeries, and how those principles translate to postpartum recovery.

Then listen to clients, interview postpartum parents asking questions like, what do you wish someone taught you before you left the hospital? What surprised you? And what was harder than you expected once you got home? Then came the relationship piece, finding a champion in OB leadership. One of my recent level one functional pelvic health practitioner graduates had a meeting with their OB department leader. 

This OT came prepared. She wasn't just enthusiastic, but she had really clear rationale, where the gaps were, what the evidence suggests, and what postpartum clients are reporting they need. And this was the big operational step. She asked for what changed everything.

Automatic OT orders for postpartum clients, including vaginal deliveries and C-sections. Sometimes hospitals start with those higher need cases first. You know, I'm talking C-sections, higher degree tears, because that can feel, well, easier to justify.

But this model pushed beyond that with a prevention mindset, which I just love. Even when delivery is quote, unquote, uncomplicated, postpartum rarely is. We see things like pain with sitting, back pain, rib or shoulder discomfort from feeding positions, perineal pain, difficulty getting in and out of bed, toileting challenges, fear, anxiety, and just simply not knowing what's normal.

So the program evolved into OT sees postpartum clients within 24 to 48 hours, if medically stable, with the goal of education, function, and a safer transition home. You might be wondering at this part, what were the actual interventions that my level one graduate did? Honestly, beautifully basic OT. I'm talking ADL performance and modifications.

I'm talking bed mobility and body mechanics after abdominal surgery, toileting strategies, hygiene adaptations, feeding position support and comfort problem solving, functional mobility while managing pain and fatigue, education for what to watch out for medically, equipment that changes somebody's day immediately, cushions, long handle tools, shower supports. These things aren't flashy, but my goodness, are they effective? All right, let's talk about what tends to be hard because if you're listening and thinking, okay, I get this, right? I like this, but my hospital would never. You're probably thinking about a few predictable barriers.

Barrier number one, they don't need OT. This is where you reframe from fixing a crisis to preventing a cascade. The simple truth is this, postpartum clients are going home fast, often within a day or two, and then they're expected to perform brand new life role with a healing body.

Even when they look quote unquote fine, OT catches issues early and reduces downstream problems. Okay, you ready for barrier number two? Department logistics. A new program isn't just clinical.

It involves staffing, right? You're moving hours and coverage away from other service lines. You need managerial trust, a plan and a way to cover the unit when you're off. A practical solution here that works really, really well is train OT backups so the program doesn't disappear when one person is on vacation or sick.

Barrier number three, interdisciplinary concerns. Okay, my best advice here is to approach OB and nursing with things like this. I am not here to take over.

I'm here to support the client and support you. What do you need from OT? I really think that language matters. It helps reframe it to that collaborative approach which is exactly what you intended from the beginning.

And one more thing I want to highlight, in this model, OT was the default consult. PT was added on as needed for things like gait, balance or unresolved musculoskeletal symptoms if they were present. That's such a respectful, efficient approach that works so well in acute care.

So here's the part that gives me chills because the impact shows up in both stories and systems. A powerful client example from this model was a mom who after previous delivery experienced really severe joint instability. She actually dislocated both of her hips postpartum and she came into her next birth terrified it would happen again.

And my level one graduate didn't just hand her a generic packet, she addressed fear, function and prevention. She looked at a conservative mobility approach, precautions and adaptations to reduce risky movement, equipment to minimize bending and strain and a plan for caring for her new baby and her other kids. The outcome wasn't just she could do it, she felt safe enough to go home and live her life.

And on a system side, early program data compared year over year showed a reduction in readmission rates after implementation. This went from about 4.3% to 3%. That's huge.

There were also signs of fewer wound complications and more appropriate referrals, home health and outpatient pelvic health because OT was identifying needs before discharge. So that's what happens when OT shows up early. We don't just treat problems, we redirect trajectories.

So if you zoom out, our future is big. The dream is not only hospital-based postpartum OT, it's a continuum pregnancy education that's actually functional. Pelvic health basics accessible to every client, prevention strategies around tears, positioning and recovery, stronger postpartum follow-up windows because many maternal health symptoms show up later, often around the time that they're heading back to work and ideally more home-based support.

Some countries have postpartum home visits built into the system for weeks. In the U.S., we're still fighting for basic leave. So we build what we can, program by program, unit by unit, provider by provider.

If you're listening as an OT student, a new grad or a seasoned clinician thinking, I wanna do that, Lindsey, here is a grounded starting roadmap. Number one, talk to the unit. Ask nurses and providers what postpartum clients struggle with most before discharge.

Number two, start collecting stories and patterns, even simple tracking, common pain areas, common financial barriers, all build your case. Number three, bring research, but translate it. Tie postpartum needs to what hospitals care about, readmissions, complications, safety and client experience.

Number four, pilot with a defined population first. If you can't get everyone immediately, start with C-sections or higher risk groups and expand. Number five, create a repeatable toolkit.

A packet, an educational checklist is awesome, equipment recommendations, referral pathways, making it super easy to replicate. And last, number six, get basic pelvic health education, right? You don't have to do internal pelvic floor exams to be effective in postpartum acute care, but you do need to understand pelvic floor basics so you can answer questions like, is leaking normal? What do I do about heaviness? And how do I move without flaring pain? If you wanna get started today, OT Pioneers is available anytime on my website, www.functionalpelvis.com. and this is a great way to get started and start changing lives. The big takeaway is this, postpartum OT in acute care doesn't require you to reinvent OT.

It requires you to apply OT where it's been missing and to advocate for systems that don't depend on whether a client gets lucky enough to have the right clinician notice the problem. If this episode sparked something for you, share it with an OT friend and one OB nurse. That's how cultural shifts start, one conversation at a time.

(Outro)