Nov 02, 2023 3 min
At Origin, we believe everyone should have access to the care they need to feel good in their bodies, at every stage of life — and especially during pregnancy and postpartum. So when Origin’s own Dr. Jessica Swartz, PT, DPT, was recently awarded a $10,000 research grant from the APTA’s Academy of Pelvic Health to study how we can successfully incorporate PT into postpartum hospital care, our entire team was celebrating from coast to coast.
We sat down with Dr. Swartz to learn more about her research and why it can help drive big, positive changes in maternal healthcare.
Thank you! With the funds from this grant, we’ll be investigating some of the reasons why we don't see physical therapy implemented in obstetrics more frequently. Our rationale is that acute care physical therapists are already in hospitals, treating patients in burn units, orthopedics, cardiac care, pulmonary care, neurological care, etc. Yet, for some reason, women and birthing people are overlooked, despite the fact that research shows they can benefit from physical therapy.
So we’re asking: what's stopping PTs from being a standard part of obstetrics? To answer this questions, we’ll be investigating some of the factors that support this added care or get it in the way. Our long term goal is to use this information to tailor interventions and succeed in getting PT included in postpartum hospital care.
Essentially, it’s having a PT perform a physical therapy screening prior to postpartum hospital discharge. In other parts of the physical therapy world, PTs are very much involved in the discharge planning process. They make sure people will have adequate support at home. They make sure patients are able to ambulate, navigate stairs, and manage their pain.
Obstetric patients need that too. So ideally, we'd be able to smoothly incorporate PT care into an already existing workflow and make sure that postpartum patients get home safely, and also get a referral for outpatient pelvic floor physical therapy, if they need it.
Well, it’s an understudied area, and that's why we're starting with basics, like asking which factors are contributing to this? So the short answer is, we don't a hundred percent know. In terms of a longer answer, we typically think of physical therapy as relating to the nervous system as well as the cardiovascular system and musculoskeletal system. And then we think of obstetrics as very much relating to the reproductive system. So in most PTs’ and other healthcare providers’ minds, these are very separate things.
But in pregnancy, all of your bodily systems have to change and adapt in order to grow a fetus, and the same goes for recovering from childbirth and caring for a newborn. So there's a big disconnect there. People are so focused on making sure that the health of the reproductive system itself is intact and that the health of the fetus is intact. And we forget that, hey, caring for a birthing person requires supporting their whole body and all of their systems.
PTs who work with pregnant and postpartum patients — which includes all of the PTs at Origin — know this, firsthand. But we need to get everyone else thinking that way, as well. I think that's the biggest barrier. One of the hypotheses of our grant is that physical therapists who don’t work in women’s health may feel unprepared for working with either pregnant or very recently postpartum women. In fact, they have all the knowledge they need, but because they're not using it every single day, it may feel like a big paradigm shift.
There are so many potential factors working against getting pregnant and postpartum people more care. From having to change PTs’ schedules to requiring a patient to see yet another provider when they’re recovering from childbirth, to getting hospitals and insurance companies to support this care from a financial standpoint… but what it comes down to is starting with the research.
I always remind my patients that, as women, we tend to put ourselves last. We tend to brush off issues like bladder leaks or pelvic pain. We tell ourselves that we're ‘just going to push through it.’ But I think we all, deep down, want to be the best versions of ourselves. And that means taking care of ourselves and making sure we put ourselves first. That's how we can really show up for all of the other people in our lives. That's how we can show up for work or our relationships or school or whatever endeavors that we have in your life. If we’re not taking care of number one and making sure that we’re the healthiest version that we can be, then we’re not bringing our best selves to the table. The bottom line is that it's not a selfish thing to be selfish sometimes.
Grant writing is a beast. And I did not know that when I started in research, so it was a bit of a rude awakening. You not only have to write what you want to do for the research, you have to follow very strict guidelines. The formatting alone is a major challenge — everything has to be very standardized and uniform.
A thorough literature review is the best starting point so you can build background on the topic that you're proposing. You have to make a strong case by talking about what makes your research unique and innovative. Then you need to write up an entire research plan — and this includes everything from how you're going to recruit your participants to how you’ll select, measure, and analyze your outcomes. You also need to include letters that show you have institutional support. You have to specify who will be on your research team, including extensive details on their education and research backgrounds. And you have to explain how you’re going to protect the safety of your patients and the security of your data. And finally, how you’ll do it all within a reasonable timeline and budget.
There are a lot of different, separate steps and a lot of different documents. The grant may have a seven-page limit, but supporting documents can amount to 50+ pages. So, yeah, I didn’t know that when I started!
During college, I was on the fence between wanting to be a sex therapist or a physical therapist, then I learned that women's health physical therapy exists. And I thought, this is it! This is a great way to combine both of my favorite interests and to help women physically and emotionally.
I graduated in 2016 from San Diego State University and immediately started working in a women's health clinic. The pace of being in the clinic day-to-day didn’t feel right for me at the time, so I decided to join my former DPT research mentor, Dr. Lori Tuttle, who was working on an R01 NIH funded project that investigated different modes of pelvic floor strengthening with biofeedback in the treatment of fecal incontinence. As a physical therapist, I was administering the research interventions as well as doing a lot of data analysis and learning how to write grants and papers that presented research findings on a national level. At the same time, I started teaching in the physical therapy program.
So I was doing a few different things and I was like, okay, this variety really works for me. I still get to be a clinician, but I also get to wear all of these other hats, and make an impact by contributing to a broader body of literature. I really enjoyed that aspect of it.
Yes, and I still can't believe that that's where life has taken me. I'm entering my fourth year right now, and am very excited to have received the APTA grant to fund this research.
Part of the reason why I came back to working in the clinic is so that I could remember my ‘why.’ Prior to coming on at Origin I had been out of the clinic for quite some time and I missed using my clinical skills. I miss talking with patients and I wanted to really connect with the patients we’re trying to help through our research.
Here at Origin, I can talk to postpartum patients every single day and I hear them say that they wish that they had learned about pelvic floor dysfunction sooner, and that they wish they had been given more resources while they were still in the hospital. That’s what keeps me going.