The Never-Ending Birth - Postpartum Patterns of the Bony Pelvis, Clinical Implications, and Solutions

Overview

The Never‑Ending Birth – Postpartum Patterns of the Bony Pelvis, Clinical Implications, and Solutions is an evidence-informed online course from the Canadian Physiotherapy Association (CPA) Congress 2021. This 45‑minute session explores how pregnancy and childbirth alter the structure and function of the bony pelvis, identifies common postpartum patterns, and provides practical strategies for physiotherapy intervention.

The course emphasizes the interplay between bony pelvic changes, soft tissue adaptations, and psychosocial factors, highlighting how birth mechanics and trauma can affect long-term pelvic function. Clinicians will gain actionable insights to assess and treat postpartum pelvic issues, supporting better outcomes for their patients.

Learning Objectives

By the end of this course, participants will be able to:

1. Describe physiological pelvic changes during pregnancy and postpartum, including pelvic widening and positional shifts.

2. Identify common postpartum pelvic patterns, such as leftward rotation and right sacroiliac elevation, and their functional implications.

3. Assess bony landmarks and pelvic mobility, including techniques to measure angles and intertuberosity distance.

4. Understand the impact of trauma and emotional factors on pelvic biomechanics and postpartum recovery.

5. Apply targeted interventions, including sacral traction, shear maneuvers, and intravaginal protocols, to restore pelvic stability and function.

6. Recognize risk factors for pelvic floor weakness, pelvic organ prolapse, and pain during intercourse.

Audience

This course is designed for:

• Pelvic health physiotherapists and clinicians specializing in obstetrics, postpartum care, or women’s health

• Healthcare professionals managing prenatal and postpartum populations

• Students or early-career practitioners seeking evidence-informed strategies for pelvic assessment and intervention

• Clinicians interested in integrating manual therapy with trauma-informed care

Why This Course Matters

Postpartum pelvic dysfunction is common, multifactorial, and often overlooked. This course addresses both structural and psychosocial contributors:

• Prevalence & Prediction: Higher pain during pregnancy predicts increased postpartum pain, underscoring the need for early assessment.

• Pelvic Patterns: Leftward rotation of the pelvis with right sacroiliac elevation is a common clinical presentation influenced by fetal position, birth mechanics, and birthing positions.

• Functional Consequences: Widened pelvis can overstretch pelvic floor muscles and ligaments, causing weakness, pelvic organ prolapse, and pain during intercourse.

• Trauma & Recovery: Emotional trauma can “freeze” the pelvis in an open position via sympathetic nervous system activation, emphasizing the link between emotional health and biomechanical recovery.

• Intervention Strategies: Techniques such as sacral traction, shear maneuvers, and intravaginal protocols restore alignment, function, and stability.

This course provides clinicians with practical tools to assess, treat, and monitor postpartum pelvic issues, improving patient quality of life and clinical outcomes.

About the Presenters

• Julia Di Paolo, Reg.PT – Pelvic health physiotherapist and educator with over 20 years in musculoskeletal and women’s health practice.

• Lynn Schulte, PT – Founder of the Institute for Birth Healing Inc., specializing in pregnancy and postpartum care.

• Dr. Lori O’Neill, PT, DPT – Clinician and educator integrating biopsychosocial models into pelvic health practice.