Why the Left Side? A Postpartum Pattern To Watch For

Why does tension and restriction on the left side of the postpartum pelvis seem to show up so often? Explore a clinical postpartum pattern involving the pubic bone, bladder, ischiorectal fossa, and pudendal nerve.

After working with thousands of postpartum clients, I have started to notice some recurring postpartum patterns in the body. One of the strongest postpartum patterns I see is a tendency for more restriction, tension, and tissue change on the left side of the pelvis.

This is not true for every person, of course. Bodies are wonderfully variable, and postpartum recovery never follows one exact formula. But when I am assessing the pubic bones, bladder tissues, ischiorectal fossa, and now even considering what research says about pudendal nerve function after birth, I keep coming back to the same question:

Why the left?

A left-sided pubic bone pattern

If you have taken any of my courses, you have probably heard me talk about this already. When I assess the pubic bone and pubic rami postpartum, I very commonly find that the left side feels more restricted, hardened, or affected than the right. 

I would estimate that in 85–90% of my postpartum clients, the left pubic bone or pubic ramus has more palpable restriction than the right. Sometimes the right side is more involved – absolutely. But most often, it is the left.

In my hands, this may feel like increased density, hardness, less mobility, or what I describe clinically as an osseous lesion. It is one of those findings that becomes hard to ignore once you have seen it repeatedly over time.

And it has made me wonder whether fetal position during birth could play a role.

Could LOA positioning matter?

Left occiput anterior, or LOA, is commonly considered a favorable fetal position for birth. In LOA, the baby’s occiput – the back of the head – is oriented toward the mother’s left anterior pelvis.

As the baby descends through the pelvic inlet and then rotates through the mid-pelvis, the head, tissues, and bony structures are all adapting to significant pressure and force. My clinical theory is that this common rotational pathway may contribute to greater loading through the left pubic ramus and pubic bone.

Could the baby’s head create more compression or tension on the left side as it enters and rotates through the pelvis? Could that be part of why we so often find more palpable change there after birth?

I do not think we can say that with certainty. But it is a clinical question worth exploring, especially when the postpartum pattern appears so consistently.

The bladder often shifts left

Another postpartum pattern I find during internal assessment is that the bladder-related tissue feels shifted or compressed toward the left side.

More specifically, there often seems to be less space between the endopelvic fascia and the tissue I am palpating as the bladder region – more accurately, the pubocervical fascia – on the left side of the vaginal canal. The right side often has more available space.

Again, this is not every client. But it is common enough that I pay attention to it.

I do not yet know why this happens. It may relate to fetal head position, pelvic mechanics during labor, the way the baby enters the inlet, or another factor we have not yet fully identified. But when I see left-sided pubic bone restriction and left-sided bladder tissue compression in the same person, I cannot help but consider whether there is a broader postpartum left-sided pattern.

The pelvic floor muscles are different

Interestingly, I do not see the same consistent pattern in the pelvic floor muscles themselves.

The levator ani muscles and coccygeus muscles may be more restricted on the right, more restricted on the left, or restricted bilaterally. There is no clear left-sided rule that I have found in those muscle groups.

But there is one important exception: the ischiorectal fossa.

The ischiorectal fossa – sometimes abbreviated as the IRF – is the tissue space lateral to the sphincter complex and medial to the ischium. Clinically, I find that the left side is much more frequently restricted and resistant to superior mobilization than the right.

I would say this occurs in approximately 90–95% of the postpartum clients I assess. That is a striking postpartum pattern.

So while the pelvic floor muscles themselves do not consistently favor one side, the left ischiorectal fossa very often does. And using the left side adductors to help it release is key!

Research that caught my attention

While preparing for a Combined Sections Meeting presentation on postpartum bowel dysfunction with Susan Clinton, PT, and Laura Rowan, OT, I came across a prospective study by Sultan and colleagues published in 1994: Pudendal Nerve Damage During Labour: Prospective Study Before and After Childbirth.

The researchers assessed pudendal nerve terminal motor latency during pregnancy and again six to eight weeks after delivery. They found that vaginal birth was associated with prolonged pudendal nerve terminal motor latency, indicating an effect on pudendal nerve function after delivery.

But two findings especially stood out to me.

First, The study found greater pudendal nerve damage on the left side.

That immediately caught my attention because it aligned with what I have been seeing clinically: more left-sided pubic bone restriction, more left-sided bladder compression, and more left-sided ischiorectal fossa restriction.

Second, women who had an elective cesarean birth did not show the same change in pudendal nerve latency. However, women who labored and then had a cesarean birth did demonstrate increased latency on the left side.

That is important because it suggests that the impact may not be solely about the baby being born vaginally. Some of the strain or nerve impact may happen higher in the pelvis during labor itself.

What could be causing it?

We do not have a complete answer yet. But I think there are some interesting possibilities to consider:

• The common LOA fetal position may place greater force through the left side of the maternal pelvis.
• Fetal head descent and rotation may create asymmetrical tension through the pubic rami, fascial tissues, and pelvic outlet.
• Compression, stretch, or traction on the pudendal nerve may be greater on the left in some births.
• The mechanical demands of labor itself – not only vaginal delivery – may contribute to postpartum tissue and nerve changes.
• There may be additional factors involving maternal pelvic shape, mobility, soft-tissue adaptations, fetal position, duration of labor, or birth interventions.

At this point, these are clinical observations and theories – not definitive explanations. But I love when clinical patterns and research begin to overlap. It does not prove the “why,” but it does give us a reason to look closer.

What this means clinically

For practitioners working with postpartum clients, I think this is simply an invitation to assess with curiosity.

Do not assume the left side is always the issue. Every body deserves an individualized evaluation. But consider checking:

• The mobility and tissue quality of both pubic rami.
• Space and mobility around the bladder and pubocervical fascia.
• The ischiorectal fossae, particularly the left side.
• Pelvic floor muscle tone and coordination bilaterally.
• Sacral and sacroiliac joint position and mobility.
• Bowel, bladder, pelvic pain, and nerve-related symptoms in the context of the person’s birth history.

It is also important to remember that a pattern does not equal a diagnosis. Palpable asymmetry alone does not tell us whether someone needs treatment. We always need to connect our findings with symptoms, function, history, goals, and the whole person in front of us.

I would love to hear what you are finding

Are you noticing more left-sided restrictions in your postpartum clients too? Do you find more changes around the left pubic ramus, bladder tissues, or ischiorectal fossa?

And if you have a theory about why the left side may be more involved during birth, I would truly love to hear it.

I know we all bring our own clinical lenses and biases to the work. I am left-handed, after all, so perhaps that influences what I notice! But I do my best to assess each body as objectively as possible, and this left-sided postpartum pattern continues to show up.

The sacrum, interestingly, can often shift toward the right, with right-sided SIJ involvement being another pattern I see. So this is not a simple “everything is left” story. But in the pubic bone, bladder region, ischiorectal fossa, and possibly the pudendal nerve, the left side certainly deserves our attention.

Frequently Asked Questions

Is left-sided pelvic restriction common after childbirth?

A left-sided postpartum pattern may be seen clinically in some postpartum clients, particularly around the pubic ramus, bladder region, and ischiorectal fossa. However, there is not currently enough research to establish that left-sided restriction is a universal or expected finding after childbirth. Individual assessment remains essential.

Why might the left side of the postpartum pelvis be more affected?

There are several possible explanations, including fetal position, fetal head descent and rotation, asymmetrical loading through the maternal pelvis, pelvic anatomy, and the mechanical demands of labor. The common left occiput anterior (LOA) fetal position is one possible factor, but more research is needed before a causal relationship can be established.

Can childbirth affect the pudendal nerve?

Yes. Research has demonstrated changes in pudendal nerve function following childbirth, particularly after vaginal birth and labor. One prospective study found prolonged pudendal nerve terminal motor latency after delivery, with greater changes on the left side. These findings suggest that labor and birth can affect pudendal nerve function, although they do not explain why the left side may be more affected.

What should pelvic health therapists assess when they notice left-sided postpartum restrictions?

Rather than assuming the left side is the problem, therapists can assess both sides and consider the entire clinical picture. Areas to evaluate may include the pubic rami, bladder and pubocervical fascia region, ischiorectal fossae, pelvic floor muscles, sacrum and sacroiliac joints, as well as bowel, bladder, pain, and nerve-related symptoms. Findings should always be interpreted alongside the client’s birth history, symptoms, function, and goals.

You can learn more about working with the postpartum patterns and restriction in the Holistic Treatment of the Postpartum Body course which is offered as an online course and a live training.

Does a left-sided pelvic finding mean something is wrong?

Not necessarily. Palpable asymmetry or tissue restriction does not automatically indicate pathology or the need for treatment. A clinical finding becomes more meaningful when it is considered alongside symptoms, functional limitations, relevant history, and the individual’s goals. The left-sided postpartum pattern described here is a clinical observation and hypothesis—not a diagnosis or established postpartum rule.

About the Author

Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com