How Pelvic Health Physical Therapy Aligns With NPQIC's Maternal Health Initiatives

This post was written as a collaboration between Colleen Grant, PT, DPT and Kara Foster, MPH.

Ask most people what physical therapy has to do with childbirth, and you'll probably get a blank stare — maybe a vague nod toward "kegels." Yet pelvic health physical therapy touches nearly every domain of maternal health: musculoskeletal function, bladder and bowel control, the physical work of caring for a newborn, mental health, and even cardiovascular health. It is some of the most whole-person care available during pregnancy and postpartum, and in Nebraska, it fits naturally into a strong statewide framework already working to make birth safer.

What Is a Perinatal Quality Improvement Collaborative?

A perinatal quality improvement collaborative, often shortened to PQC, is a coordinated group of clinicians, hospitals, public health leaders, and patients who work together to standardize evidence-based practices around pregnancy and childbirth. The idea behind them is simple and hopeful: most severe maternal complications, and many maternal deaths, are preventable. But prevention depends on every hospital in a state, not just the best-resourced ones, using the same evidence-based approach when it matters most.

PQCs give states a structure for making that happen. They gather data on outcomes, identify where care varies or falls short from hospital to hospital, and help every birthing facility adopt shared "bundles" of best practice around the biggest drivers of maternal harm — things like hemorrhage, severe hypertension, and postpartum complications that go unrecognized until it's too late. Nearly every state now has some version of this model, loosely connected through the National Network of Perinatal Quality Collaboratives. But how each state's collaborative is structured, who has a seat at the table, and how deeply it reaches into community — that varies a great deal.

What Makes Nebraska's Collaborative Unique

The Nebraska Perinatal Quality Improvement Collaborative, known as NPQIC, is Nebraska's version of this model, and it has a few features that set it apart.

1. The first is its reach. Since its founding in 2015, NPQIC has not stayed limited to a handful of academic medical centers. It has worked steadily to get evidence-based practices adopted across nearly all of Nebraska's birthing hospitals. Its Postpartum Alert initiative, for example, is currently active in 42 of the state's 43 birthing hospitals, and its Respectful Care initiative in 30. In a state with a lot of rural geography and a wide range of hospital sizes, that level of statewide adoption doesn't happen by accident — it reflects years of relationship-building with hospitals of every size, not just the largest systems.
2. The second is that its structure is genuinely inter-professional. NPQIC is not one specialty handing down instructions to everyone else. Its initiatives are shaped by obstetricians, midwives, nurses, and public health leaders working together — and, as this piece argues, there is real room for physical therapists, doulas, and other members of the care team who touch a birthing person's experience along the way. Maternal health outcomes are shaped by many hands, and NPQIC's collaborative model reflects that reality rather than working around it.
3. The third, and perhaps most distinctive, is that NPQIC has built in a structure for accountability to the people it actually serves. In 2025, it launched the Nebraska Alliance for Maternal and Infant Health, known as NAMIH, specifically to embed patient and community voices into its quality improvement work. NAMIH actively recruits people with lived experience — pregnant and postpartum patients, NICU parents, doulas, and community health workers — to advise on where gaps in care remain and what still needs to change. Representation across cultural and linguistic backgrounds is a deliberate priority, not an afterthought.

Put simply, NPQIC is not only asking what the research says hospitals should do. It is also asking who is being left out, and how it would know. That combination — broad statewide reach, real inter-professional collaboration, and direct accountability to patients and communities — is what makes it a strong, still-growing framework for closing gaps in maternal care. Pelvic health physical therapy is one of the gaps worth closing.

What Pelvic PT Can Do During the Perinatal Period

Prenatal pelvic floor therapy establishes a baseline understanding of a person's pelvic health before the demands of pregnancy compound any existing issues. It can reduce pelvic pain and pressure, address urinary leakage, help prepare the body for labor and delivery, and teach effective pushing mechanics — which can reduce the risk of tearing and pelvic organ prolapse.

Postpartum, the benefits are just as significant. Pelvic PT helps restore muscle strength and coordination, addresses urinary or bowel incontinence, supports recovery from perineal tears or episiotomies, improves scar mobility after cesarean delivery, helps manage or prevent pelvic organ prolapse, addresses diastasis recti (abdominal muscle separation), and reduces chronic pelvic pain and sexual dysfunction.

This is whole-body care for one of the most physically demanding experiences a person can go through. It touches:

• Musculoskeletal dysfunction. Pregnancy changes posture, gait, joint laxity, and load distribution through the spine, hips, and pelvis almost overnight. Low back pain, pelvic girdle pain, diastasis recti, and round ligament pain are common — and treatable. Postpartum, the body needs guided rehabilitation to recover strength and function, not just time.

• Bladder and bowel management. Urinary leakage, urgency, constipation, and fecal incontinence are widespread after childbirth, and they are not something birthing persons should be told to simply live with. Pelvic floor muscles can be assessed, retrained, and rehabilitated, often resolving symptoms that patients assume are permanent.

• Maternal ergonomics with self- and infant care. Feeding, lifting a car seat, bending over a crib, carrying a toddler while holding a newborn — postpartum bodies are asked to do enormous physical labor almost immediately, often while still healing. Pelvic health PTs teach body mechanics that protect healing tissue and prevent new injury during this demanding season.

• Mental health. Pain, leaking, and physical limitation take a toll that goes beyond the body. When someone can't pick up their own baby without pain, or doesn't feel like themselves physically, it affects mood, confidence, and bonding. Supporting physical recovery is supporting mental health.

• Cardiac maternal health. This one surprises people. Pelvic health PTs working with postpartum patients are positioned to monitor blood pressure responses to activity, recognize signs of overexertion, and have direct conversations about cardiovascular health during a return to movement — at exactly the window when cardiac complications are most likely to go undetected.

Pelvic health PT supports the whole person through one of the most physically demanding experiences of their life. It is not a luxury. It is foundational perinatal care.

Where Pelvic Health PT Meets NPQIC's Initiatives

NPQIC has built a portfolio of statewide initiatives addressing the specific, evidence-based drivers of maternal morbidity and mortality in Nebraska. Pelvic health PT connects to nearly all of them.

Respectful Care Initiative

NPQIC's Respectful Care Initiative, now active in 30 of Nebraska's 43 birthing hospitals, centers dignity, patient voice, and culturally responsive care at every touchpoint of the birth experience. Pelvic health PTs are, by the nature of this work, providers of deeply personal, vulnerable care. Building trust, listening without judgment, and treating patients as full partners in their own recovery is not optional in this field — it is the job. PTs serving this population practice respectful care every time they sit with a patient's pain, their fear, or their unspoken assumption that "this is just what happens now."

Postpartum Alert Initiative

NPQIC's Postpartum Alert Initiative, active in 42 of the state's 43 birthing hospitals, uses a visual alert system to help providers and patients recognize the warning signs of life-threatening postpartum complications during the critical window after birth. Pelvic health PTs reinforce this initiative directly. Many patients return to PT in the weeks after delivery, or after a pregnancy loss, and these visits become another touchpoint where warning signs can be caught. A PT who notices unusual swelling, breathing changes, or concerning blood pressure during a session isn't just treating a pelvic floor — they may be catching a complication before it becomes an emergency.

Prevention of First Cesarean Delivery

NPQIC has worked to support the safe prevention of primary cesarean delivery, aligning with national guidance from ACOG and SMFM. Pelvic health PTs contribute to this goal directly through prenatal birth preparation education — teaching pushing mechanics, pelvic floor relaxation, positioning, and body awareness that can support a vaginal delivery. This isn't about pressuring anyone toward a particular birth outcome; it's about ensuring that when a vaginal delivery is the safest and most desired path, the body is prepared to do that work effectively.

Obstetric Hemorrhage

Postpartum hemorrhage is one of the leading preventable causes of maternal death, and recovery from a hemorrhage event often requires extended, careful physical rehabilitation. Pelvic health PTs frequently work with patients recovering from significant blood loss, hemorrhage-related procedures, or the extended healing timelines these complications create, supporting a slower, safer return to function and movement.

Severe Hypertension in Pregnancy

NPQIC's work on severe hypertension addresses one of the most dangerous, and often underrecognized, threats to maternal health, including in the postpartum period. Pelvic health PTs play a quiet but meaningful role here: monitoring blood pressure responses as patients return to activity and exercise, and having direct, ongoing conversations about cardiovascular health during a phase of recovery when many patients aren't seeing a physician regularly.

Perinatal Depression Screening

NPQIC's initiative to establish universal perinatal depression screening recognizes that maternal mental health conditions are the most common complication of pregnancy and childbirth. Pelvic health PTs see firsthand how physical recovery and mental health are inseparable. Pain, incontinence, and physical limitation can deepen anxiety, isolation, and depression, and regaining physical function and confidence can be part of someone's path back to feeling like themselves. PTs are well positioned to recognize when a patient may be struggling and to support the broader screening and referral network NPQIC has worked to build.

The Access Gap

Pelvic health physical therapy is one of the most underutilized and inequitably distributed tools in perinatal healthcare. It addresses the pelvic floor — a group of muscles at the base of the pelvis that support the bladder, bowel, uterus, and reproductive organs, while also playing a role in posture, stability, and breathing. During pregnancy and childbirth, these muscles endure real stress: supporting the growing weight of a baby, stretching during vaginal delivery, and adjusting through the physiological changes of the postpartum period. Even those who deliver by cesarean aren't exempt — carrying a baby to term, and often laboring before surgery, still affects pelvic floor function.

Access to this care during the perinatal period is far from universal, and the disparities in who can access it mirror the same systemic inequities driving the maternal health crisis as a whole.

Cost and insurance coverage are major barriers. Pelvic floor PT isn't consistently covered by all insurers, and Medicaid reimbursement rates — which disproportionately affect Black and Latinx birthing people, who are more likely to rely on Medicaid — often make it harder to find providers who accept that coverage. Geographic barriers compound this: rural communities in Nebraska and across the country may have few or no pelvic health PT providers within a reasonable distance. For families already navigating transportation challenges, childcare needs, and the demands of a new baby, an hour-long drive each way isn't a realistic option.

There are also awareness gaps. Many birthing persons are simply never told that pelvic health PT exists, let alone that they might benefit from it. A brief mention at a six-week postpartum visit, if there is one, isn't enough. For communities where medical providers have historically dismissed symptoms or failed to offer adequate information, patients may not even know to ask. Research confirms that patients from more resource-deprived communities are less likely to access specialized postpartum pelvic care, even when that care is available.

What Each of Us Can Do

If you are a healthcare provider, consider adding a pelvic health PT referral to your standard perinatal care pathway, both prenatal and postpartum. You don't need to wait for your patient to report symptoms — ask about their pelvic floor, and normalize the conversation.

If you are a hospital administrator or quality improvement leader, examine whether pelvic health PT is mentioned in your discharge education. Is it offered equitably across your patient population? Are you tracking who gets referred and who doesn't?

If you are a policymaker, look at the coverage gaps that prevent birthing persons from accessing pelvic PT through Medicaid and state insurance programs. These gaps have real consequences for real people.

And if you are a birthing person, know this: leaking urine when you laugh or sneeze is not just "a mom thing" you have to live with. Pelvic pain during pregnancy is not something you simply endure. Postpartum pain with intercourse is not inevitable. You deserve care — comprehensive, respectful, whole-body care — and you are allowed to ask for it.

Nebraska has built coordinated, evidence-based, community-informed infrastructure to address its maternal health crisis, and pelvic health physical therapy supports that same goal through the lens of physical recovery and whole-body health. Ongoing areas of focus include routine referrals to pelvic health PT as a standard part of prenatal and postpartum care, patient education so every birthing person knows this resource exists, insurance and Medicaid coverage that supports access for the patients who often need it most, and continued integration with NPQIC's existing initiatives.

To learn more about NPQIC's initiatives and to get involved, visit npqic.org. Also, reach out to our Pelvic Health Center navigator if you or a loved one has questions or would like to know more information.