Liz Miracle, PT, on applying ACOG's postpartum guidance to virtual pelvic care

Existing ACOG guidance on postpartum care already supports non-office assessment, and that same rationale could extend to pelvic floor physical therapy, according to Liz Miracle, PT, MPT, WCS, pelvic floor physical therapist board-certified in pelvic and women's health, and Head of Clinical Quality, Origin.

“I'm going to kick this back to ACOG's own Committee Opinion No. 736: Optimizing Postpartum Care, which states that initial contact within the first 3 weeks is recommended, and that this assessment doesn't have to be an office visit,” she said.

ACOG Committee Opinion No. 736, issued in 2018, recommended that all women have contact with a maternal care provider within the first 3 weeks postpartum, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. On the timing and setting of that contact, the opinion states:

“Assessment need not occur as an office visit, and the usefulness of an in-person assessment should be weighed against the burden of traveling to and attending an office visit with a neonate. Additional mechanisms for assessing women's health needs after birth include home visits, phone support, text messages, remote blood pressure monitoring, and app-based support. Phone support during the postpartum period appears to reduce depression scores, improve breastfeeding outcomes, and increase patient satisfaction, although the evidence is mixed.”¹

She noted that the guidance itself frames in-person assessment as a trade-off against the burden of travel.

“They've already decided this for their own care setting, and are stating that the usefulness of an in-person assessment should be weighed against the burden of traveling to and attending an office with a neonate,” said Miracle. “I would argue that this rationale is no different for attending pelvic floor physical therapy appointments.”

She argued that clinicians should reconsider assumptions about the necessity of in-person care.

“Providers should open their minds to the idea that virtual care can be comparable to in-person [care]. It's really something that is going to break down those barriers and help them think differently about how their patients can get access and treated with outcomes to boot, basically,” Miracle said.

The comments build on Origin's retrospective analysis of 4,662 female patients, which found comparable rates of clinically meaningful improvement on the Pelvic Floor Distress Inventory-20 across virtual, hybrid, and in-person care, with no pairwise between-group comparison reaching Bonferroni-corrected significance.² Virtual patients who achieved that improvement did so with fewer than half the attended visits of in-person patients (mean 6.7 vs 13.8) and in roughly half the care episode duration (116 vs 210 days; both P < 0.0001).

In a previous discussion, Miracle detailed these findings further, speaking to the feasibility and flexibility for virtual pelvic care. Click here to watch.

References:

1. ACOG Committee Opinion No. 736: Optimizing Postpartum Care (2018). Obstetrics & Gynecology, 131(5), e140-e150. https://doi.org/10.1097/AOG.0000000000002633
2. Link A, Worman R, Kavassalis N, Miracle L. Expanding access, maintaining outcomes: virtual, in-person, and hybrid pelvic health care in a retrospective cohort of 4,662 patients treated at Origin. Origin. 2026. Accessed August 12, 2026. https://www.theoriginway.com/2026-outcomes-white-paper