Creating “Safety in Me” in the Pregnant BIPOC Community
by Dr. Keeli Gailes, PT, DPT, ATC
Pelvic health physical therapy can help create a sense of “safety in me” for pregnant people of color. We have recently discussed the importance of integrative pelvic floor physical therapy during a healthy pregnancy as well as when pain and dysfunction are present. Beyond this, however, physical therapists are uniquely situated to both know the warning signs/symptoms of potential complications such as preeclampsia, as well as to have the time to listen and investigate a parent’s concerns. Having an informed advocate on your team can be an extra level of security and can create a feeling of safety in a medical system that has demonstrated that it is still far from equitable.
DIMs and SIMs
Pain science has taught us how important having a sense of safety is in how your body responds to stress and other stimuli. We use the acronyms DIMs and SIMs to describe things that create as sense of “Danger In Me” or Safety In Me”. Unfortunately, pregnant people of color have many different things that are creating a sense of “Danger In Me”. Pelvic health physical therapy carries powerful potential to help create a sense of “safety in me” for pregnant people of color.
Reason for Fear
The effects of poor maternal healthcare in the U.S. are all too evident. Childbirth in America is more dangerous now than it was in 1990, and this threat is 2-3 times as great if you are an African-American or American Indian and Alaskan Native (AIAN) woman living in the U.S. One explanation for this difference is that: “Black women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, thus making pregnancy riskier at an earlier age”2
Other rationales for this disparity include; decreased access to care based on geographical location, medical provider bias (such as the belief that black people experience pain differently), as well as differences in the education level of individuals treating black and brown women (students vs. fully trained providers) as described in the documentary Aftershock.
While these issues have been recognized, and attempts have been made to address them for at least a decade, there continues to be push-back. This pushback is demonstrated by the fact that of the 4 bills that were brought to congress between 2010 and 2020 to address maternal health, only 2 of them made it through congress and were able to have a positive impact on maternal health. The result is a continued disparity of maternal health outcomes.
Reducing Complications During Delivery
It is understood that C-sections can be necessary and life-saving when necessary. Unfortunately, however, as our C-section rates have gone up in the U.S., our maternal mortality rates have also gone up. This begs the question of whether many of the C-sections are, in fact, “necessary”.
One way to support the belief that pelvic floor physical therapy helps decrease the likelihood of complications during delivery is to look at the decreased rates of C-sections that are seen when the physical presentation of the mother is taken into account such as with the Spinning Babies method. There are unfortunately not a lot of studies on this topic currently. Anecdotally, however; patients, midwives, doulas, and PT’s alike understand the significance and see the results.
Is it a Coincidence?
When there are complications during a delivery, the end result is often (though not always) a C-section. As a way to gauge the impact that pelvic PT may have on birth outcomes, I’d like to use France as an example. While we cannot determine causation, it is interesting that:
In France;
- All care is covered at 100% for any woman who is at least 6 months pregnant and they are universally covered up to that point with a 30% co-pay and a 1 euro “participation” fee for each visit or test with no deductible.
- They also get a standard referral for 10 “birth preparation” sessions with a pelvic physiotherapist before their first delivery.
- The C-section rate is 21%
In the U.S.;
- Approximately 8.3% of the population is uninsured and even those who are covered to some extent, may not be able to access physical therapy due to cost or lack of referral.
- There is also limited access to “birth preparation” training in the U.S. as it is typically an out-of pocket expense, and must be sought out by the individual.
- The C-section rate is 31%
Hopefully, we will start to see more studies on this topic as time passes and the spotlight continues to be on maternal health. For now, all we can do is use “common sense”.
Inequity of Financial Burden
About 75% of women in the U.S. report that they would deplete their savings to allow for 8 weeks of unpaid maternity leave and the U.S is one of the only developed nations that does not guarantee paid maternity leave. On top of that, studies have shown that there is significant racial disparity in the access to paid maternity leave, with black and hispanic women averaging 2-4 weeks less of full-pay equivalent during leave than white women.
With these statistics, it is easy to understand how important it is for people who are pregnant to continue working through as much of their pregnancy as possible. If you have to be on bed-rest for the last 2 months of your pregnancy because of pain, you will already have depleted your savings before the baby is born. You may then not be able to take the time off that your body needs to recover, and your baby needs to bond, in the postpartum period.
Advocating for Change
There needs to be a national policy guaranteeing paid maternity leave and a plan for how to make it viable. I believe that the lack of this guarantee is a contributing factor to both the high maternal mortality rates, as well as declining birth-rates seen in the U.S. People, especially those of color, are often afraid to be pregnant because of the risks involved. They may also be worried about how to care for their family if they had to take maternity leave. Finally, carrying this increased stress, and lack of adequate healing time before returning to work, are more likely to put them at risk in the postpartum period. This reality is even more exaggerated in a post-wade era.
Other policy changes to support birthing people are needed and physical therapy is far from the only solution for these concerns. This being said, if pelvic health physical therapy referral becomes standard-of-care for all pregnant and post-partum women, we can more easily address many of the concerns. We will continue to advocate for a system that supports the parents, babies, and our society as a whole. For now, pelvic health physical therapy can help you decrease stress, anxiety, pain, and income loss now! You may just have to seek it out (direct access) or know to ask for a referral!
Physical Therapists are Frontline Care Providers
Physical therapists are able to help discern potential causes for symptoms that might be brushed-off by another provider as “normal”, such as swelling and headaches. This can help reassure you when the cause is simple and easily addressed, or help you know when your concerns are valid. Then, they can provide you support in advocating for further investigation if needed. Furthermore, integrative pelvic health physical therapy can help pregnant people of color in these and other ways;
- Help you decrease pain and pelvic floor dysfunction,
- Help you maintain function as long as possible to minimize income loss,
- Help prepare your body to be in an optimal state for an uncomplicated delivery,
- Help you set reasonable expectations around delivery and explore options based on your preferences,
- Teach you pain-control techniques for labor to allow for fewer medical interventions (as more interventions are connected to higher likelihood of c-section),
- Empower you to advocate for your birth preferences AND have an advocate on your team for delivery day,
- Connect you with resources such as a doulas and lactation consultants to advocate for and support you through delivery and breastfeeding,
- Give you general guidance on nutrition and refer to a dietician or nutritionist if needed,
- Help you learn about how you can sleep better, move safely, and decrease stress.
