OBG/Gynae Physiotherapy Explained: Dr. Juhi Saxena on Pregnancy, Postnatal Care & Pelvic Floor Health (Part-3)

Dr. Juhi Saxena (PT): Exercises during pregnancy are actually customized—I can’t generalize them. For instance, if there are two mothers in the second trimester, I might not give them the same exercises. Maybe their posture is different, their pelvic opening needs something different, or they have issues other than pelvic floor, where the body might need to work on something else. So it’s a tailored program based on the individual.

When we conduct group sessions, we tend to generalize exercises trimester-wise because it’s easier to address a group of mothers that way. But honestly, if you’re seeking help from a gynecological physiotherapist, one-on-one individual sessions will be more effective for achieving your goals.

So yes, exercises do vary from trimester to trimester and mostly depend on individual needs and their specific situation.

Dr. Juhi Saxena (PT): Alright, this can be explained with a beautiful example. Think about our parents, like our mothers—that’s one generation—and then their parents, our grandparents, the older generation. In India, we have a long-standing tradition called the Japa system.

Japa is the 40-day postpartum care system practiced across all regions of India—north, south, east, and west. You must have heard from your dadis and nanis saying, ‘In our time, we did Japa properly and never faced any issues. But look at today’s generation—they don’t follow anything.’ Right?

Now, if we look at our mothers’ generation, many moved into nuclear families or relocated with their husbands. They often didn’t have access to extended family support or proper guidance during their Japa phase. So, they are coming up with a lot of health issues and facing many problems at a very early age.

These are correct examples—if care is taken at the right time, you won’t have prolonged issues. But if care is not taken at the right time, definitely, it will show up in the long term.

Dr. Juhi Saxena (PT): See, Japa is usually taken care of by family members, a nanny, or a Japa maid, and that’s absolutely okay. But convincing them to consult us depends on the rapport we build early on.

For example, if a woman has just delivered and I walk into the room as a stranger asking her to connect with me, it will be very difficult. She’s going through a lot emotionally and physically and dealing with huge changes. At that moment, simply saying, ‘Come meet me, I’ll help you,’ won’t work. She won’t connect right away.

Building that connection needs to start during pregnancy, or even pre-pregnancy, whenever the mother first comes in contact with us.

The most important thing is how we communicate. If you flatly tell someone, ‘Don’t do this,’ they’re less likely to connect. But if you say, ‘Why don’t you try it this way? It might help you,’ it lands much better. You can still acknowledge their way of doing things and say, ‘You can continue if that’s what you prefer—but here’s a suggestion that might work better for you.’

Dr. Juhi Saxena (PT): Postnatal sessions are good to start as soon as the mother has delivered—that’s the right time to reach out and begin building rapport.

To build rapport, you need to listen to the mother. She’s getting advice from doctors, relatives, in-laws, friends, and thanks to the Internet, she’s flooded with information and may not know what to do because she wasn’t prepared for it before. Reaching out and listening to her is the first step to gaining her confidence. 

Instead of telling her authoritatively, ‘Don’t do this, don’t do that,’ or ‘You’re not supposed to do this,’ make small changes she can easily adopt. The approach shouldn’t be authoritative; it needs to be soft and friendly. That’s how you can gain trust and help her.

Usually, mothers first reach us during their initial 3-day hospital stay, often referred by their gynecologist, especially if they have issues like difficulty standing, sitting, or basic mobility. Most commonly, they come after 6 weeks.

Many gynecologists are apprehensive about early physiotherapy—saying ‘not to do this’ or ‘not to do that’ till 6 weeks—but there are exercises and activities a mother can safely do from day one and can continue working with them through those 6 weeks, no doubt.

Sometimes, family dynamics cause delays, so practically, 6 weeks is considered the perfect time to re-discuss and start sessions—when there’s nothing that could harm her. But yes, if a mother reaches out on day one or two, we can help a lot better, starting early, too.

Dr. Juhi Saxena (PT): I have a lot to say about that. First, during pregnancy, there’s a very common belief that if you do mopping or, in fancy terms, the duck walk, you’re more likely to have a normal delivery. That’s a myth. Does every mother actually need to do a duck walk? We don’t know how wide her pelvis is or what condition her muscles are in. Yet, we tell her to mop the floor or do the duck walk blindly.

Also, no one talks about the tough side of delivery. Everyone only shares the glossy, happy part. You’re told, “Just push; once the baby is out, everything is done.” But that’s not the whole story. There are days filled with pain and emotional changes that no one discusses. The moment you deliver, you’re exhausted, sometimes too weak even to hold your baby. But people only say, “It’s done, you’re fine now.”

There are also myths like mother-in-laws telling you to drink milk with lots of ghee for a normal delivery. But if the mother’s pelvis is narrow and the baby’s head can’t engage, no amount of duck walking or drinking ghee will make a difference.

Then there’s this stigma around Caesarean sections. People say things like, “You chose a C-section because you didn’t want to endure pain,” or “Your gynecologist must be one of those who prefer C-sections.” It’s not always the mother’s choice or the doctor’s preference. Sometimes, the anatomy of the mother or the baby requires it. The baby’s condition matters too—sometimes it can’t handle a natural birth. Yet, mothers get blamed and demotivated, as if they’ve done something wrong. That’s another big myth.

Post-delivery, there are myths like “Don’t walk, don’t climb stairs, keep the AC off, sit still without a fan.” That may have been true decades ago when temperatures were cooler. But expecting a mother to sit without a fan in 46°C heat? That’s cruel.

These myths and realities are exactly what we address in pregnancy sessions—preparing mothers with the right information and care.