Back to Baseline, One Pulse at a Time: Teaching PfilAtes™ to Postpartum Clients

PfilAtes™ Instructor Notes · Week 4

New moms often arrive with one instruction from their delivery team: "do your Kegels." Few get shown how. Your job isn't to treat her leakage. It's to give her a routine she can feel and keep doing.

What the research supports

A Cochrane review of 46 trials and more than 10,000 women (Woodley et al., Cochrane Database of Systematic Reviews, 2020) found that pelvic floor muscle training in pregnancy lowered the risk of leakage in late pregnancy and in the months after birth. For women who already leak after delivery, the review calls the evidence uncertain. So frame the work honestly: it's training, not a promise.

Breath matters, too. In a 2026 ultrasound study, women with stress leakage after childbirth showed much less deep abdominal (transversus abdominis) engagement at the end of a full, forceful exhale than women without leakage: 26% versus 59% (Li et al., Physiotherapy, 2026). It tested no exercise, but it's a good reason to train breath and deep abdominals together.

Before the first session

• Ask about clearance. "Has your doctor or midwife cleared you for exercise?" Don't start without a yes.
• Normalize it. "Leaking after having a baby is common, and the pelvic floor is trainable."
• Expect she can't feel it yet. Many women believe they're contracting correctly when they aren't, and coaching helps (Weinert et al., Healthcare, 2026).

The movement: Butterfly

Butterfly suits postpartum work: lying down, no load, no balance demand. Lie with knees bent, feet pressed together, knees apart, a soft ball between the knees. Peak engagement comes as the knees close.

Add the pulse, all three parts on the same beat:

1. Small range: Near the closed position, squeeze and soften the ball in tiny movements. Don't open all the way.
2. Percussive breath: On each squeeze, a short, sharp, open-mouthed "ha!" that pulls the deep abdominals in.
3. Voluntary lift: On that same "ha," draw the pelvic floor up, as if stopping the flow of urine. Then let knees, glutes and pelvic floor fully relax as she inhales.

The release counts as much as the lift. A pelvic floor that can't let go is a referral question, not a reason to push harder.

Cue to borrow: "Squeeze, 'ha,' lift. Now let everything melt."

Know when to refer

Pause and refer to a pelvic health physical therapist or her physician if she reports a heaviness or bulging feeling, pelvic or perineal pain, pain with intercourse that isn't settling, leaking that's getting worse, blood in the urine, or no contraction she can feel at all.

Your drill this week

Teach one postpartum client the Butterfly pulse. Have her rate it on the Movement Selection Worksheet (0 none, 1 mild, 2 moderate, 3 strong), note anything that hurt, and do five minutes morning and evening, timed to a feed if that's easier to remember.

References

• Woodley SJ, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2020;5:CD007471. doi:10.1002/14651858.CD007471.pub4. PMID 32378735.
• Li J, et al. Assessment of abdominal, diaphragm, and pelvic floor muscle function during respiratory tasks using transabdominal ultrasound in women with and without postpartum stress urinary incontinence. Physiotherapy 2026;132:101898. doi:10.1016/j.physio.2026.101898. PMID 41931880.
• Weinert, et al. Healthcare (Basel) 2026;14(5):651. doi:10.3390/healthcare14050651. PMID 41827606.