Why Aren’t OTs the Standard in Postpartum Care?
OTs in Pelvic Health Podcast · 14 min listen
If you've ever looked at postpartum care and thought, how is this not an occupational therapy lane?, you're not alone.
Because let's be real. Postpartum is basically one giant ADL and IADL reboot.
"We automatically support so many post-op clients. So why aren't postpartum clients getting treated like this?"
In most hospitals, OT still isn't a default part of postpartum recovery. One of my recent Level 1 graduates decided to change that in hers — and built a program where every postpartum client gets an automatic OT consult.
This is the story of how she did it, what she actually does in those sessions, and the roadmap for anyone who wants to build the same thing in their setting.
What postpartum actually involves:
Tell me that isn't occupational therapy.
In this episode:
- The ICU moment that exposed how arbitrary postpartum OT referrals really are
- How one OT built the case for automatic consults, and what she asked her OB leadership for
- The interventions she actually delivers, none of which are complicated
- Three predictable objections and how to answer each one
- What happened to readmission rates after the program launched
- A six-step roadmap for building this in your own setting
It started with a client she couldn't forget
Most specialty paths don't start with a perfectly mapped-out plan. They start with a patient you can't stop thinking about.
This one began early in an OT's acute care career, during COVID, when pregnant clients were arriving critically ill. Some needed emergency C-sections far earlier than anyone ever wants, so they could be placed on ECMO — the life support intervention that oxygenates the blood when the lungs can't keep up.
And here's the part that stops you in your tracks. OT was there, doing OT things. Tolerance. ADLs. Function. Mobility. While a brand new mother was literally fighting for her life.
Which made the question obvious.
We automatically support so many post-op clients. C-sections are major abdominal surgery. Vaginal delivery can come with significant tissue trauma, pain, mobility limitation and functional disruption.
So why aren't postpartum clients getting treated like this?
That's the origin point: seeing a gap, realizing it's systemic, and deciding it's worth solving.
How you turn an observation into a program
It starts with doing what OTs do best. Assess the system, collect data, identify barriers, build a functional plan.
She started with a deep research dive. Not just what OT can do, but what other countries do, what outcomes exist for rehab after abdominal surgery, and how those principles translate to postpartum recovery.
Then she listened to clients. She interviewed postpartum parents and asked them three questions: What do you wish someone had taught you before you left the hospital? What surprised you? What was harder than you expected once you got home?
Then came the relationship piece. She found a champion in OB leadership and secured a meeting with the department leader.
And she came prepared. Not just enthusiastic — she had clear rationale. Where the gaps were. What the evidence suggests. What postpartum clients themselves were reporting they needed.
Then she asked for the thing that changed everything.
Automatic OT orders for postpartum clients, including both vaginal deliveries and C-sections.
Some hospitals start with the higher-need cases first — C-sections, higher-degree tears — because those can feel easier to justify. This model pushed past that with a prevention mindset, and I love it for that.
Because even when a delivery is "uncomplicated," postpartum rarely is. 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 simply not knowing what's normal.
The program became: OT sees postpartum clients within 24 to 48 hours if medically stable, with the goal of education, function, and a safer transition home.
Learn with me for free
Start where every pelvic health OT starts, with a free AOTA-approved CEU class. Take either one, or both.
New to pelvic health?
The OT Practitioner's Role in Pelvic Health
Where pelvic health sits in OT scope of practice, plus simple interventions you can use with clients tomorrow.
Free · 1 hour · 0.1 AOTA CEU
Sign up for freeWondering where it fits in your setting?
The OT's Guide to Pelvic Health Practice Settings
Nine settings where OTs are already doing this work, from hospitals and SNFs to living rooms and L&D units. No private practice required.
Free · 1 hour · 0.1 AOTA CEU
Sign up for freeWhat she actually does in those sessions
You might be wondering what the interventions look like. Honestly? Beautifully basic OT.
The interventions:
- ADL performance and modifications
- 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 on what to watch for medically
- Equipment that changes someone's day immediately: cushions, long-handled tools, shower supports
None of it is flashy. All of it is effective.
"My hospital would never"
If you're reading this thinking I like this, but it would never fly where I work — you're probably picturing one of three predictable barriers. Here's how to meet each one.
Barrier one
"They don't need OT."
This is where you reframe from fixing a crisis to preventing a cascade.
The simple truth is that postpartum clients go home fast, often within a day or two, and are then expected to perform a brand new life role with a healing body. Even when they look fine, OT catches issues early and reduces downstream problems.
Barrier two
Department logistics.
A new program isn't only clinical. It involves staffing. You're moving hours and coverage away from other service lines, so you need managerial trust, a plan, and a way to cover the unit when you're off.
The solution that works well here: train OT backups, so the program doesn't disappear when one person is on vacation or out sick.
Barrier three
Interdisciplinary concerns.
Approach OB and nursing like this: I'm not here to take over. I'm here to support the client and support you. What do you need from OT?
That language matters. It reframes the whole thing as collaborative, which is what you intended from the start.
One more thing worth highlighting. In this model, OT is the default consult, and PT is added as needed for gait, balance, or unresolved musculoskeletal symptoms. That's a respectful, efficient approach that works well in acute care.
The part that gives me chills
The impact shows up in both stories and systems.
From the unit
One mother had experienced severe joint instability after a previous delivery — she dislocated both hips postpartum. She came into her next birth terrified it would happen again.
My Level 1 graduate didn't hand her a generic packet. She addressed fear, function and prevention together: a conservative mobility approach, precautions and adaptations to reduce risky movement, equipment to minimize bending and strain, and a plan for caring for her newborn and her other children.
The outcome wasn't just that she could do it.
It was that she felt safe enough to go home and live her life.
And on the system side, early program data compared year over year showed real change.
4.3% → 3%
Readmission rate
Year-over-year, after the program launched
Fewer
Wound complications
Identified and addressed before discharge
More appropriate
Referrals
To home health and outpatient pelvic health, because OT was spotting needs early
That's what happens when OT shows up early. We don't just treat problems. We redirect trajectories.
What the future could look like
Zoom out and the vision is bigger than one hospital.
The dream isn't 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 right around the time someone is heading back to work
- More home-based support
Some countries have postpartum home visits built into the system for weeks. In the US, we're still fighting for basic leave.
So we build what we can. Program by program, unit by unit, provider by provider.
Your roadmap
If you're an OT student, a new grad, or a seasoned clinician thinking I want to do that — here's a grounded place to start.
Talk to the unit.
Ask nurses and providers what postpartum clients struggle with most before discharge.
Start collecting stories and patterns.
Even simple tracking — common pain areas, common barriers — builds your case.
Bring research, but translate it.
Tie postpartum needs to what hospitals care about: readmissions, complications, safety, and client experience.
Pilot with a defined population first.
If you can't get everyone immediately, start with C-sections or higher-risk groups and expand.
Create a repeatable toolkit.
A packet, an educational checklist, equipment recommendations, referral pathways. Make it easy to replicate.
Get basic pelvic health education.
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 the questions you'll be asked: Is leaking normal? What do I do about heaviness? How do I move without flaring pain?
The big takeaway
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 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.
