Your BIRTH Partners

Who Needs A Pelvic Floor PT around Birth? #039

May 24, 2021 Season 3 Episode 11
Your BIRTH Partners
Who Needs A Pelvic Floor PT around Birth? #039
Show Notes Transcript

Spoiler alert: *most* pregnant and postpartum people could benefit from a Pelvic PT consult! 

Join us as we discuss with Dr. Rebecca Maidansky, PT, DPT of Lady Bird Physical Therapy where Pelvic PT fits into a continuum of care through pregnancy & postpartum.

Rebecca shares about:
~bias in seeking & referring to pelvic PT
~the short & long-term harm in normalization of pelvic floor dysfunction 
~importance of collaborative care to address concerns
~timing of pelvic PT consults
~what to look for to distinguish normal & abnormal pelvic floor recovery in postpartum
~role in healing after vaginal or cesarean birth
don't miss: the underrated issue that pelvic PT can address!

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Maggie, RNC-OB  0:06  
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth gear communities rooted in autonomy, respect and equity. I'm your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation, as we step out of our silos, break down barriers and hierarchies and step into the future of better birth care. 

This week on the podcast, we are digging into all things pelvic PT, and we are, this is just such an important conversation. And I think it is one that has been just really sorely underutilized. Physical Therapy in general doesn't get as much, you know, kind of as many of the attention, referrals that really needs to help clients do well. And this is not different during the you know, the pregnancy and postpartum period. You know, when you experience something like pregnancy, and all of the intense changes that happen in your body, there is some healing that needs to happen after that. And then healing shouldn't be happening bubble, people shouldn't feel like they have to guess about if the changes that are happening in their body after you know, part part of our normal. And luckily, pelvic PT exists to really help us to understand more about recovery. They are a great resource for us, as you know, birth professionals who want to make sure that those in our care are, are really getting everything that they need. And I think there has been a lot of assumptions and misunderstandings about when pelvic PT is, is necessary or is useful. And so I'm really excited for Dr. Rebecca Maidansky, a physical therapist specializing in pelvic floor to come on and really share more about the specialty and about how we can all be you know, referring and, and how and when pregnant and postpartum folks should be looking for a pelvic PT to be part of their care. So onto the show!

All right. Well, Rebecca, welcome. I am so excited to have you on to talk to us about all things pelvic PT today. So if you just want to introduce yourself to our audience a little bit and tell us kind of about like just a little bit background about you and education where you came from what you're doing.

Rebecca, PT, DPT  2:28  
Yeah, sure. I'm so happy to be here. Thank you for having me. My name is Rebecca. I am a pelvic floor physical therapist and the owner of a clinic called Ladybird Physical Therapy in Austin, Texas. We specialize on perinatal health. So we do a lot of managing pregnancy pains preparing for birth, recovering postpartum, and then of course, other stuff as well. But that's sort of our area of expertise.  I've been a pelvic floor PT for for nearly four years. Now, I have a background in sports and orthopedic physical therapists, I work with a lot of a lot of active pregnant people, too, who want to get back to activity. So that's sort of my approach is from kind of like this orthopedic sports realm, but we also we also really focus on just pregnancy and postpartum recovery.

Maggie, RNC-OB  3:11  
Mmm, that's great. That's awesome. So you are you an expert in mind then to really dive into kind of all of this idea about like, pelvic PT! One of the things we've been doing in this season is really talking about areas where we've helped maybe hold bias as professionals where we haven't maybe, maybe we don't understand something enough, or we've kind of have ignored it or just kind of made our own assumptions that maybe aren't based on what's about. So I don't know if you know, first you kind of just want to explain a little bit about pelvic PT, I think for a lot of us as folks existing in the world that it's worth it when we think of like pelvic PT, it's a kind of a narrow, a more narrow scope, perhaps in thinking like, "Oh, yes, it's for something if you've had like a really bad tear, or you're like, still peeing when you jump or sneeze years later," but can you give us kind of a little bit of an overview of some of the things that you typically see, especially during the like pregnancy, birth, postpartum continuum?

Rebecca, PT, DPT  4:01  
Yeah, absolutely. I mean, I think that the bias towards pelvic floor physical therapist, both in patients and healthcare providers alike is that we, we work with people who've had these like really traumatic births or having these really big issues and what the research shows, what we've seen clinically is that pelvic floor physical therapy can be so much more than that, there is so much that can be done preventatively to support people in their goals of whatever their vision for birth is, whether it is a VBAC, a Cesarean birth, a home birth, whatever it is a medicated and unmedicated vaginal birth. And I think that what we're starting to see in our practice is that more and more people are becoming more educated about their birth and their recovery and they're wanting that so what we see a whole lot of from a diagnosis perspective is of course, urinary incontinence, pain with sex, constipation, bowel incontinence, we see a lot of pubic symphysis pain SI joint pain, tailbone pain. But we're also seeing a lot of people who are coming in, of course, urinary urgency, frequency that stuff as well. But we're also starting to see a lot of people coming in who are pregnant who are feeling well, and who want to know how they can support their pregnancy, how they can support their birth vision, how they can support their postpartum recovery. And there is so so much that can be done to help meet those goals. And so we do a lot of preventative evaluations to assess if somebody has a diastisis recti, what their control is of their pelvic floor, if they know how to engage their pelvic floor, if they know how to push what their global strength is, if they need any strengthening during pregnancy, if they need stretching and relaxation, and then training for birth. And then also kind of setting timeline expectations for postpartum recovery. Because what we do also see as people who are feeling really, really well at three weeks postpartum, which happens, who then go on a run, and all of a sudden have prolapse and leakage and all of these things that could have been very well prevented. So I think that you know, pelvic floor PT is becoming better known for treating issues. But I think where we were, I really hope the field is growing as to preventing them in the first place. Hmm,

Yes! And that prevention piece is so important. Obviously, we've seen so much in just mainstream medicine about you know, and obviously, in recent decades about how important, you know, preventative medicine is and as prevention is worth a pound of cure, and you know, all of that piece of it. So, given that, Why? Why do you think that pelvic PT then isn't really still seen as like, a standard of care? You know, why is that not that everyone just as they're going off to maybe find a midwife or an OB, whoever is kind of caring for them during pregnancy... Why aren't they also then at you know, whatever time in their second trimester may be going in and checking in with a pelvic PT?

I think a lot of it is our biases, our own biases, the biases of our healthcare providers, I think that a lot of people just don't know. I mean, I think that the general public is just coming into the awareness that we exist. And, you know, it's something that I think sounds very unconventional to people. And so if they're just hearing about it for the first time, and it sounds kind of weird, I think that as soon as they're met with hesitancy from their healthcare team, from their ob gyn, from their midwives, which unfortunately, it still happens, I think people are very quickly pushed away from it. And I think that our healthcare system does not do a good job of preventative care, nor do I think they do a good job of really caring for the quality of life of birthing people. And so I think that unfortunately, we are, we're just living in a medical model that treats illness. And that doesn't take, that doesn't take prevention seriously. And on top of that, we are societal only trained to avoid talking about pee, poop and sex. They're inappropriate. That's what we're told as kids, you don't say those things publicly. And on top of that, I think that a lot of our medical community isn't well trained on how to navigate bladder balance, sexual dysfunction. So it takes so long for a patient to even tell a physician or a midwife that they're experiencing these things. And then oftentimes, they're met with a provider who doesn't know what to offer them. And so by the time I mean, in the United States, it took six and a half, six years on average for people to find a pelvic floor physical therapist or treatment for pelvic floor dysfunction. And I think that a lot of those are a lot of the reasons why, unfortunately,

Maggie, RNC-OB  8:24  
Mmm. So six years....

Unknown Speaker  8:27  
That's the average for women. For men. I believe it's four. I know.

Maggie, RNC-OB  8:34  
I know, of course, no surprise that even present like that, that would feel like, you know, maybe women would have access to you know, an OB and it would be referring to that, that they still have even longer treatment times for an issue.

Rebecca, PT, DPT  8:45  
I think a lot of that is I mean, a lot of that is also that we've normalized postpartum pelvic floor dysfunction. We've normalized peeing with coughing and sneezing. We've normalized never being able to jump without peeing. And so I think that that is a huge factor, holding people back amount of people I see who've been told like, "Well, yeah, you had a baby. What do you expect?" Or "Well, yeah, you're pregnant. What do you expect?" We've normalized pregnancy as a painful experience, we've normalized being a parent being associated with all of these dysfunctions. And so I actually think that it's a huge hindrance that people are going to see their OB-GYN being told that what they're experiencing is normal. And we're, you know, we're conditioned to trust our physician, so you don't look into it beyond that. Unless you I mean, honestly, half the time unless they stumble upon something on Instagram. And so it's there, you know, that that's a huge factor is that people just think they should be feeling these things.

Maggie, RNC-OB  9:41  
Ah, that's so frustrating. You know, it's, it's hard for something that is, you know, in many ways, it's like universal experience, something that, you know, millions of people have babies every year, you know, in the US around like 3 million, 4 million, that there's so many of us then that are going through this at the same time. And then instead of being able to, like, rally that together to, like, want better, to want to make the whole experience more comfortable, it ends up just kind of falling into like, yeah, it happened to me It happened to you like that there's not that same drive to then to then fix it. And I absolutely I think like, social media has its flaws, absolutely. But but there's so much good that can come from people than just having another place to look for information that hopefully they can bring to, you know, another whether it's a, you know, a trusted health care, you know, professional failure and say, like, "Hey, I'm experiencing this..." or, like, "this doesn't sound right, I saw this post on Instagram...." And it felt like maybe this is something that I should be looking into. Like, there is, there is power in, in that piece of it, but it needs to go so much, so much more because, like you said, so many people, they just you're accepting it. And that's and that I feel, you know, for, for all of us is, you know, birth professionals, like, it's our job to, to break that down to stop that stigma to make sure that we're really engaging with, you know, our clients and those in our care, to ask them and to not feel the need to, you know, snicker or giggle or be awkward about it, that this can just be as straightforward of a question as we have for everything else. All of the other bodily systems, we have that we ask our patients about, that they can also feel like, right, it's, it is totally reasonable and Okay, and necessary to have those conversations with, you know, with your midwife with your, with your physician, with your nurse, you know, I feel like I it's one of things that I have tried to really pay attention to as a nurse in the hospital, as I give people discharge instructions. I in the last couple years have really started honing in more on this idea that like, hey, couple things on this sheet. If these are still happening, you really need to let us know about it. Like it's really not. It's on here, because it might still be happening. But that doesn't mean it's, it's normal, or, okay. It's an actual issue. I feel like we need to be doing more in terms of people.

Rebecca, PT, DPT  12:06  
I think that I think that it is kind of our responsibility as healthcare providers who work with pregnant and postpartum people to be loud about this stuff, and to kind of like really work to talk about it in a way that feels really comfortable and safe to the people listening because I think there are a lot of providers who have assumed that their patients will feel uncomfortable talking about bladder bowel, sexual dysfunction. And when people come to see me, this is usually how it goes. They meekly tell me there's some sort of complaint, leakage, sex, whatever. And my response is, well, first of all, there's then they'll they'll say, like, I don't know, there's too much information. There's no such thing as TMI, your sexual health, your pelvic health is your health. And what I have seen every single time is the moment I say, there's no such thing as TMI. These are things I talk about every single day, this is part of your health, just like everything else, all of a sudden, it's like a floodgate opens with information because people want answers, they don't want to have pain with sex for the rest of their lives, they don't want to be too scared to go to the park and run around with their children, because they're scared, they're gonna pee their pants, they don't want to feel these things. But I think that a lot of people have been met with providers or friends or close people in their lives who they tell the truth to, and they get a very awkward and uncomfortable response. And so it quiets them down. And I mean, I see it most in our older population, with young pregnant people, postpartum people these days, I think that there is more more discussion amongst around this stuff. But when somebody comes in who's been having these symptoms for 20 or 30 years, it's really hard for them to talk about. So we need to be able to really confidently have these conversations, and we don't have to have all the answers. That's not what I mean. But we have to be able to talk about it.

Maggie, RNC-OB  13:56  
Yeah, absolutely. another thing I think, you know, it comes with practice, right? It comes from if you grew up in, you know, in a family or, you know, you weren't educated to really have frank discussions about this, and you're still feeling, you know, residual kind of anxiety or that this is a private, you know, matter. That's something that like, Great you can practice, practice with your colleagues, talk through it, talk to your family, sit with a friend, talk to yourself, record yourself asking people questions about this until you feel like it's something you can do just very smoothly, as much as you assess every other part of you know, their body, so that it comes out naturally so that they know you're comfortable with it, they can be comfortable with it, too. I think there's, there's that piece of it where, you know, those, you know, birthing people, pregnant people, postpartum people don't feel comfortable saying stuff, perhaps or they just accepted as normal. And then I think there's also maybe this piece of providers who are maybe slow to give a referral. And so I don't know if you know, I don't know... I've certainly heard I've seen it in you know, in practice and I've heard from friends who've said something to their, you know, to their physician or their midwife after after having birth, that like no I'm having this issue. I don't know is this you know, Is this normal? Is this okay? And that they, in one instance, a friend had particularly asked like, Hey, I think I need, you know, pelvic PT referral, I think that would be helpful, and that their provider was like, "Oh, no, we wouldn't do that unless this is still going on, like, several months from now." So I'm wondering too about like that. How you know, where that piece of it is coming from what you see in your practice?

Rebecca, PT, DPT  15:27  
You know, I think that, I think that unfortunately, you're what you're describing is really common. I think that it you know, I, there are a couple ways to navigate this. So on one hand, I always tell people, you can ask for a referral. It is like, even if your physician says, and you don't really need it, you can say I want it, and they should give it to you, unless there is some medical reason where they believe that you are not safe to participate in physical therapy, which is very rare. We do definitely still see some hesitancy in Austin, Texas, I have some really amazing relationships with local OBs and midwives who openly refer and it's incredible. And the ability to be able to text back and forth with OBs about their patients care is so incredibly valuable. But we do hear these stories of people who say, you know, I asked, they said, I don't really need it. And this is the problem when that happens. The problem is that then it pits me against their OB. And I have tried very, very hard not to do that. I don't like to be in the middle of relationships between healthcare providers and their patients, because by weakening any individual relationship, you weaken that patient's overall care. So by an OB saying, "No, you don't need it," even if that patient wants it, it puts in their head, that they might be wrong, but they might not actually need to come see us, they come to see us and they think and maybe you don't really need this. I think that that hesitancy, and referring really comes from a lack of understanding of what a isn't, isn't normal, and what can and can't be done about it. It is what I tell people, they should expect postpartum as you may have pain, leakage, discomfort for the first two to three weeks, it should get better consistently. But for a few weeks, I mean, you just gave birth right? Like you're recovering, it makes sense that you might be a little bit uncomfortable. If it continues past three weeks, and it's not getting markedly better consistently. That is when you need to start care, not at six months, 12 months down the road: at two to three weeks out. Because if we think about somebody, post op knee replacement, where they literally have construction surgery on their knee, right, they chisel the bone down with a hammer and saw, they put it back together with metal parts in place. They start PT the same day. Right the same day, realistically, our pregnant and postpartum, postpartum people should be seeing a physical therapist in the hospital before they're discharged, they should be starting physical therapy immediately. But I think that we are worlds away from that being a standard of care. And that really scares a lot of physicians. Two to three weeks is where I think that if you're still uncomfortable, we need to be having that conversation. And I also tell people, if you talk to your physician about it, and they're really hesitant, and they say, you don't need to, I don't want to send you not yet, you can call a physical therapist still see them for an evaluation in most states, and most states, you don't need a referral for initial appointment. And once you form that relationship, they can call the physician office all the time and say, "Hey, I saw your patient, I really think they'd benefit from care for this, this and this reason," and the vast majority of the time, they're like, "Yeah, whatever. That's fine." Right?

Maggie, RNC-OB  18:43  
Yeah. Oh, that's so interesting. Yeah, I think they're I, you hit on so many important parts there. I feel like that piece of the trust that we build, you know, between our patients, and how that erodes when we start having those kind of those blocks in care and pitting each other against ourselves like that helps no one. And I think it's this bigger conversation too. You know, if ideally, by two to three weeks, people who are having an issue are getting into care, and most people aren't seeing their health care provider till six weeks, then obviously, we're missing it. And we've talked, you know, at length on the podcast before about just the ways that we fail folks during the postpartum period. And this is a chief one of them, like we're not checking in often enough then to actually pick up if there's an issue and we're counting on people who are also taking care of a newborn, and sleep deprived and getting to navigate a whole new body to be able to tease out I don't know, is this normal? Do I need to find someone all of a sudden by myself like, right, it's putting way too much pressure on them when they already are. In the midst of so many changes, and under just just physiological stress, recovering from birth.

Rebecca, PT, DPT  19:59  
And that's enough. One of the main we can talk about prevention and prenatal care and how important that is. But establishing care with a physical therapist prenatally, which I think a lot of people are still unfamiliar with the benefit of one of the main things that I tell people is that you can email me whenever you're my patient, right? Like, you can contact me and say, "Hey, I'm feeling this... Is this normal?" And I will email you back and tell you whether, "hey, I think you need to absolutely call your ob about this." or "Hey, I think that this is a really normal thing that we see in healing," you know, like it, the benefit of having just that contact, then the amount of safety that that evokes in our in our patients is so incredibly valuable. And I think that in blocking people starting care prenatally, we are blocking their ability to have support in that postpartum period.

Maggie, RNC-OB  20:53  
Mmm, yeah. So I think that one of the questions I had for you was kind of the too early to late, like, Is there a time that would be too early to seek, you know, pelvic PT, you wouldn't be able to really can accurately assess the situation? Or is there a time that is just like, it's, it's too late in there? There really isn't anything that came down at that point?

Rebecca, PT, DPT  21:12  
Yeah, that's a really good question. I think in terms of too early, it depends on the goals. And so if somebody calls me and they're like, "Hey, I want to, you know, I need to exercise modification," but they are, you know, six weeks pregnant. If you're feeling good, you probably don't need to modify that point. You're like, I think that there, there are certain things that we can start that we should start at certain times. However, I see people who are, you know, 8 10 12 weeks pregnant, who are like, "Hey, is this too early?" And it's like, it's, you know, it depends on your goals, if you want to come in, and you want somebody to make sure that you know, if you want to ask questions, it's never too early. If you want to have a general strength assessment with baselining. It's never too early, your physical therapist will not do an internal evaluation during your first trimester. So that's, you know, relevant to know. But that just means that maybe it's beneficial to start preconception. I, when I discharge a patient postpartum, I tell them that they would benefit from, especially if they had leakage prolapse, I suppose they would likely benefit from coming in prior to getting pregnant the next time if they're planning on having more children, so that we can get an idea of prior to this pregnancy, where's your baseline, because it might be different, where it was when you ended your rehab from your last pregnancy? So in that sense, it's never too early. It's, it's never usually during pregnancy, if somebody's feeling really well, they're active, they're fine. I usually say like, Okay, come in around, you know, because we want to be mindful of resources. And so we we usually, we'll say, come in around like the 20 week mark, for a prenatal evaluation, your body will start to change, we have a better idea of, are you having difficulty managing and abdominal pressure? What's your exercise? Like? What do you like to do, and now we might need to actually modify it. But in terms of is it in terms of too early for postpartum recovery, which is a whole separate topic? Sure. I tell people, you know, the first week, if we had it built into our health care system, that you start PT immediately, nothing would be too early, you should start rehab immediately after any operation or procedure or birth. Generally, I recommend because we have to be mindful of the system we exist within, I recommend two to three weeks, which is extremely early in the minds of a lot of people as the beginning your postpartum rehab, and then it is never too late. It's never too late. Whether you are five months, five years, 50 years postpartum, we see people improving with symptoms, just with rehab.

Maggie, RNC-OB  23:41  
Yes, that's really it. I think there's that piece of that integration to the healthcare system. Like it would just, I would love to see pelvic PT at the bedside, that that's part of people's, you know, evaluation to kind of discharge and, you know, go home and get situated because I also think, you know, once we've talked about before, to like, just how hard it is, sometimes when you you have a newborn and you're navigating all of that, like getting out of the house to go to appointment just feels hard. It's just like another thing on your list. And so then you put it off because you know, whatever. And then you just you end up you know, missing out on that piece, I think for for people who are listening to this because they're absolutely people in the audience who are still now many years postpartum. I think could you say that, again, like that there is you can still help someone if you are five years, 18 years, 50 years postpartum.

Rebecca, PT, DPT  24:36  
It is it's never too late. I think that it's so unfortunate how often people call me and they say, hey, my mom has prolapse. She's 70 I know there's nothing that can be done, but I want to get ahead of it now. Usually, I say you both should come see me because it's never too late. I've had people who are 80 years old, who've had leakage for 60 years who have improvement in symptoms at six to eight weeks, you know?

Maggie, RNC-OB  25:05  
That's amazing, and also so heartbreaking. 

Rebecca, PT, DPT  25:08  
Like, it's heartbreaking. And it's heartbreaking because when you look at when you look at the health impact of really simple postpartum symptoms like leakage, we see increased incidence of cardiovascular disease later in life. Because people are less active, they're less likely to participate in sport, they have lower body image, they're less socially active, there has really far downstream effects. And I think that when I talk prevention, I'm not just thinking how do we prevent you from having leakage during pregnancy and two months postpartum? I'm also thinking, how do we make sure we educate you that these things are likely to pop up again, during menopause? How do we make sure to educate you that later in life, it's never too late, your body never loses the ability to get stronger. We treat elderly folks like they're already dead. And there is I mean, that's a strong statement. Yes, true. We are terrified of taxing them. And there is no reason to treat them that way. They can get stronger. They still have goals. They, you know, like, it's very frustrating.

Maggie, RNC-OB  26:19  
Yes, it's so frustrating. Yeah. So and so I think maybe one other question I had for you is like so what do you see is like, kind of maybe like the most common reason you see people being treated? And then on the other hand, like, what's the most underrated one that you wish everyone was getting checked out for?

Rebecca, PT, DPT  26:37  
Oh, that's a great question. I don't know that there is one thing that we see the most frequently but the most frequent cluster of symptoms. I'm going to give you a little list urinary incontinence, like coughing, sneezing, stress incontinence, specifically, leakage with jumping is super common. But we also see a lot of urinary urgency and frequencies and people who feel like they have a small bladder, which like you don't unless you've had bladder cancer or an operation on your bladder, you do not have a small bladder, you probably a pelvic floor tension. We see a lot of pain with sex, a lot of painful periods. Because oftentimes, tension in the abdominal wall on the pelvic floor can contribute to those pains. I think that one of the most underrated things that we see that I've been noticing more and more, it's so common, and nobody thinks to treat it as tailbone pain. We seating so much tailbone pain, and we see I mean, usually what happens is we're treating somebody and they're like, "Oh, yeah, I've had tailbone pain for 20 years." And it's just like, crap, like, you know, that alone is a treatable symptom. losing a lot of tailbone pain, I would say, pubic symphysis and SI joint pain are also kind of underrated. Physical therapy can be really, really helpful for that during pregnancy and postpartum. And I think people think of it more as a chiropractic issue, but in reality, that's the place where we see where chiropractors and physical therapists would really do better if they were collaborating on that together.

Maggie, RNC-OB  28:02  
Yeah. Hmm. That's interesting. And then what so for, you know, our audience who are not clinical birth workers, what are some things that you feel like they can be on the lookout for? if, you know, as they're helping, whether it's during, you know, pregnancy or in the postpartum period? Like, are there certain signs symptoms, complaints that if they heard it from a client, that that would be or for for the pregnant listeners in our audience who are thinking like, oh, shoot, what should I be on the lookout for? Do you have kind of like, big, you know, red flag symptoms that you would recommend that anyone could kind of assess without being a care provider?

Rebecca, PT, DPT  28:38  
You mean, assess, like, if they realize they're having them as, like a sign that they should do something about it? Yeah, you know, I, it that list is extensive, and I will, I will go down that road in a second. But I think the really the one thing that I hear where I'm like this is probably actually just a normal change that happens with pregnancy get better postpartum. Because I think that this is one where people are like, Oh, I heard you say that, should I do do I need to care for it is frequent urinary frequency during pregnancy, all right, like you have a baby sitting on your bladder, it is very, very common to wake up a lot at night to pee and to have to pee a lot during the day, because a baby might be literally kicking you or head butting you in the bladder. So that is I think, like, honestly, one of the only times that I will say like, no, it really might just get better after you give birth is really my normal change of pregnancy. If you're still feeling that postpartum 100% is a sign that you should seek care if you're feeling that prior to pregnancy absolutely is fine, you should seek care. But during pregnancy specifically, that to me falls within the range of normal in terms of what they should be looking for in terms of how people should be, I think kind of like assessing themselves. And it's a tough question to answer because really, I think every single pregnant person would benefit from an evaluation. But if we're talking treating a problem, I would say leakage if you're having urinary incontinence with sneezing or exercise, if you are feeling heaviness in your pelvis Like there's a weight in your vagina, that is definitely a sign that you should consider physical therapy, if you are having pain that is limiting your ability to be active. So a lot of times I'll see people that are like, oh, it'll get better postpartum, I have this SI joint pain, this back pain. And it may or it may not, but one of the best predictors of a healthy birth is being able to be active through pregnancy. And so making sure that you are treating any pain during pregnancy, rather than just waiting for afterwards. And I mean, also, just as an aside, it does not always just go away afterwards, we're told people are told that that it's not true. So pain leakage, heaviness, or anybody who feels like they are less active because they're not sure how to be active safely. That's another really big reason to see a PT. Yeah.

Maggie, RNC-OB  30:51  
Oh, and then another question. Within the last month or two, I had seen something you had shared about after a Cesarean birth and see scar massage. And that feels like something the way you would demonstrate it was definitely very, like, independent, the birthing person, postpartum person can do it after their birth. I would love to see that like, in the mainstream for how we help people and because I know so many people who have had cesareans, who still years and years later have have pain or have loss of sensation, you know, and just have discomfort from where vision and their scar was, is that something that like anyone could do? Do they need to see a pelvic PT first to kind of like evaluate for that? Or where does that kind of fall in the mix of that?

Rebecca, PT, DPT  31:36  
That's a really good question. You know, I think that if somebody is if somebody scars healed, right, you're at least six weeks postpartum, your scars healed, you've been cleared by your ob or midwife or your ob probably if it's a cesarean, to you know, to return to normal activity, you are likely safe to begin working on your own scar, people, especially following an emergency c section tend to be very hesitant to touch their scar tend to be very averse, touching the scar. And so I think that if that is the category you fall into seeing a physical therapist can be really beneficial to help you create essentially a desensitization program. Because what I always tell people is there is very little benefit to blowing past your body's comfort level. And just like blasting through it and ignoring your aversion, the benefit really comes from slowly graded exposure. And so if you feel fine, your scars healed, you're not going to hurt it by getting some lotion and rubbing it around. But there's really no way to do it wrong, the goal is to just get that tissue to be more flexible. But I think a lot of people tended to be pretty gentle on themselves or just scared to touch it all together. And I think physical therapy can be really beneficial for that specifically, or to just teach you various techniques, because it's not just about pushing down and moving it around, there's a lot of benefit to using suction to lift the scar up. And that's something that you can do on your own at home. But a lot of people benefit from training on and doing.

Maggie, RNC-OB  32:58  
Oh, yeah, that's great. Because I do I think sometimes people think, you know, pelvic PT, right? This would only be something for after a vaginal birth. And obviously, there's so much more that goes into it beyond that.

Rebecca, PT, DPT  33:09  
yeah, I do think unfortunately, you know, 30% of people in the United States have a cesarean birth 30%. That's huge. You said three to 4 million people give birth to yours. That's a million people roughly who are having a C section every year. And so I it's, you know, it's funny when I talk about pelvic floor physical therapy for postpartum recovery on social media or in blog posts, or when I you know, when I'm talking to people, they people will usually say like, well, but what about for a C section? And my answer, the vast majority of the time is that there is no difference. Like you still need postpartum rehab, following up this area after birth, if anything, maybe you need more, depending on how you know how birth one because then you have you have 10 months of this increased progressive strain on your body and then surgery. I think that you know, largely when I talk about postpartum recovery, I am encompassing vaginal & cesarean birth together, I understand why people wonder if that's the case. But the C section scar work is obviously something that's, you know, kind of specific to this area and birth however there you know, considering the prevalence of tearing with a vaginal birth and the peronism scar massage is also very important following a vaginal birth.

Maggie, RNC-OB  34:19  
So much we just need to incorporate into into our care and what we're offering to people so that they have more.

Rebecca, PT, DPT  34:27  
Yeah, yeah, no, I mean, I completely agree this conversation is making me think that I like really want to put together a handout and get it into the hands of the labor and delivery unit and hospitals, just like give it to you know, if nothing else, like here's your postpartum recovery timeline, your cesarean scar massage handout like just give this to people when they leave. If nothing else, that's better than nothing.

Maggie, RNC-OB  34:50  
Oh, I asked one other person as well. That would be so that is such a need. We need something like that. I've worked in several hospitals now. And none of them have had anything even close to that, you know, we literally have like the check block of like, Oh, these would be things would be like an emergency. And outside of that there's really very, very little information about like, normal variations of normal end, and how to kind of be aware of that. I feel like that would be such.

Rebecca, PT, DPT  35:19  
I'm gonna do it. That's my assignment.

Maggie, RNC-OB  35:21  
Okay. Thanks. Thanks for coming on the podcast. And now you have homework. So. But yeah, I think that it's just it's such a neat, I think it'd be so helpful. Another reference, another resource to give to people. So it isn't just this, you heard from a friend, oh, your mom said, she's been dealing with, you know, incontinence for the last 30 years. And she had you. So I guess this is normal, you know, you're not dealing with any of that. And also, again, because not all providers have the same access to continuing education or the same desire to, you know, look into it, that helps to kind of get to be somewhat of an equalizing force for a lot of the issues that come up with why people don't have good access to, to pelvic PT. So I will be eagerly awaiting that, that resource.

Rebecca, PT, DPT  36:04  
I will send it to you know, it's frustrating. I think that, and that's why these conversations, I think are so valuable talking to people, interdisciplinary conversations, because I, you know, we all live in our own little worlds. And that, for instance, would be so easy for me to create, because it's something that I say over and over and over again, every single day of my life. It'll take me 30 minutes. I'm going to do it tonight. But I think that when we, when we don't have these conversations, these interdisciplinary conversations between providers, we miss these huge gaps, like these really obvious holes, that could very easily be filled if we had better communication between professions. Yes,

Maggie, RNC-OB  36:45  
yeah. I mean, that obviously, that's why I'm, I'm so grateful for you, and all the guests who come on the podcast really talk about like, their area of expertise and share with all of us as a greater birth community, because it is so easy to get in your silo, you learn one way to do things in school, or you get to you know, whether you're practicing in hospital or out of it, you know, you kind of get into your little niche, you do kind of the same things every time because that's just what you've always done. And it's so easy to, to just miss whole things like this. And not even you don't even know sometimes it's blank spots. You don't even realize that you're missing this whole piece that that people need. So yeah, absolutely. No. Well, thank you, Rebecca, is there anything else you'd like to share with our audience? 

Rebecca, PT, DPT  37:24  
Oh, no. I mean, I think that we covered a lot of things. I'm sorry for going on a tangent towards the end. But I don't know, this was amazing. I'm so grateful that I have got to have this conversation with you. And that we got to dive into into some of these topics.

Maggie, RNC-OB  37:38  
Thank you so much, Rebecca, really appreciate coming on with us. 

Rebecca, PT, DPT  37:41  
Yeah, of course, thanks for having me, Maggie.

Maggie, RNC-OB  37:45  
Oh, I just love that conversation with Rebecca and really appreciate all of her time coming on here to share more about her work and to educate all of us. So we can be more aware as we go to care for people and as as we examine our bodies ourselves, and figure out where we could use more support and recovering from birth and really embracing our bodies as a transition in the postpartum period, as long as that may last. So thank you so much for tuning in. We love to learn and grow alongside with you. You can find us at Your BIRTH Partners across social media. And we'd love for you to join our Facebook group, Your BIRTH Partners Community, where we have a chance to dig into some of the topics each week and a space for more conversation. You'll also find more information in our show notes. We'll leave more to Rebecca's work and some of the other resources we found really helpful as you go to learn more about pelvic PT and kind of what is what is normal variations are normal and things that need to be treated in the postpartum period in particular. So we hope you find this helpful as you're going out and changing your practice in the real world as we all work together for more collaborative, inclusive and equitable care. Till next time!