Meet The Pelvic Floor Expert

SPEAKER_00 0:11

Hey guys, welcome back to Preview Alliance Podcast. It's Sarah and Whitney. And we have a special guest today. We have Emily here with us. Emily Gilmore. If you're in Birmingham, you should know about Thrive PT, okay? She is our go-to for pelvic flora therapy. And she is with us, and she's going to educate us on pregnancy period today, guys. So first off, I didn't know this, I'll admit this.

What The Pelvic Floor Does

SPEAKER_00 0:35

What the pelvic floor was. Can you give us a little bit of like what it is and why we need pelvic floor PT?

SPEAKER_02 0:41

Absolutely. So the pelvic floor is a sling of muscles that sits at the base of our pelvis. Um, it has three uh actually four kind of basic functions. We have bladder, bowel, sexual, and lymphatic drainage, and it's also huge in core stability. So it's a sling of muscles, they all attach to our pubis, our sit bones, and our tailbones and kind of serve all those functions. So they make the decision to keep things in and let things out and are also hugely influential with our core. So essentially we have a superficial um pelvic floor layer that would be responsible for keeping things in. So this is what would keep us continent that would keep us from peeing or pooping ourselves, but also needs to stretch at the appropriate time. So for having penetrative intercourse, these muscles would need to stretch at the appropriate time, as well as releasing our bowels and bladders when we choose to. Um the deep layer is really responsible for kind of pelvic stability and core stability, and it actually is the floor of the core. So these are hugely influential muscles that are significantly impacted with pregnancy and postpartum, but also really important to note that we can have issues with these without um being pregnant or being postpartum. They're just a part of the mechanical system. So because of these, these are normal muscles and they contract and relax um with normal functions. We can have the same issues with these muscles that we have with any other muscles. They can be tight, they can be spasm, they can be poorly coordinated, they can be weak, they can lack endurance. But because of what they surround and they surround um and they're, you know, in charge of bladder and bowel continence, um, as well as sexual functions, most of our issues with these muscles present as bowel bladder sexual issues. And so we think I have a blood, I have a bladder problem, I have a bowel problem, I have a sexual problem, but actually it's a lot of the muscles that are surrounding these that are not contracting or relaxing at the appropriate time. Okay, yeah.

Why 500 Kegels Is Bad

SPEAKER_02 2:26

Interesting.

SPEAKER_00 2:26

So then you grow a human. You grow a human and things go left. That's right.

SPEAKER_02 2:32

They get very stretched out. Yeah, yeah. Yeah, well, the interesting thing is during pregnancy, they actually get kind of tighter because hormonally, everything around our pelvis is spreading and our body's like begging for stabilization. Not to mention we have like a huge center of gravity change as we have this pregnant belly that's growing and growing every day. And so our body's like, hell, my pelvis is spreading apart. And so sometimes during pregnancy, our pelvifor can actually get tighter and cause some issues during that as well. So, you know, there's some bad advice floating around out there during pregnancy that we need to do like 500 kegels a day to prepare for birth. I've heard that. Yes. I don't know where that came from, but anybody who's listening, please do not do that.

SPEAKER_00 3:13

Yeah, okay. Tell us what to do.

SPEAKER_02 3:15

Right. So essentially, when we think about birth, the pelvic floor has like the stretch of its life, right? So it would stretch two to three times its normal length during birth. So we want our pelvic floor to be mobile. We want it to be able to kind of relax to its max capacity when we're talking about having birth. So a kegel contraction, which we kind of all hear about, is when we kind of draw our pelvic floor up and in. So we're kind of shortening that space, tightening that area, which is kind of exactly the opposite of what we want. Oh, okay, yeah.

SPEAKER_01 3:44

We have been told to do the absolute wrong thing.

SPEAKER_00 3:47

So now Emily is correcting this. Thank you. Everybody take notes.

SPEAKER_02 3:52

So, and again, like kegels are kind of like the blanket advice that we hear for like any public floor dysfunction. Yeah. Anything that you could possibly ever hear people, nothing against. I PMS sell people like do giggles, and then we don't even know what that means. But doctors just throw that out. Right. And I hate that. Yeah, yeah. Because like most people that are having issues with bladder leakage or gas control don't even do them right. So then we're just like doing bad giggles all the time.

SPEAKER_00 4:15

And we then it probably makes it worse. It makes it worse, right?

SPEAKER_02 4:18

So I want to kind of take that one second and we talk about an appropriate giggle. Let's do it. Teach us. Okay. Get ready, ready. All right, so we're doing this. I want us to think about the pelvic four like an elevator. Okay. So our superficial layer is like we're gonna shut the doors, right? So we get a squeeze and then our deep layer is a lift. So we get a squeeze and a lift, we come all the way up, and then it's most important that we come all the way down. So some of us like just kegle at the very top, and our elevator kind of gets stuck at the top, but it's just it's just as important to come all the way down and fully relax everything. So we squeeze, we lift, we come all the way back. And how many times? Everybody's probably kegling right now. How many times do we supposed to kegel or so? Like, just kind of like a normally dosed exercise, like, we would not do 500 squats a day. Yeah. Oh Lord, we're not working. We would not do 500 bicep curls a day, right? So, like, we do not need to do 500 kegels a day. And I I never recommend them like blanketly, yeah. Um, because if somebody is hanging out on the tight end of the spectrum and maybe they don't have good length or they clinch through their pelvic floor all the time, then kegels make them worse.

SPEAKER_03 5:23

Okay.

SPEAKER_02 5:24

So um we can have issues like leaking because things are also too tight. And so if they're just keggling, they're just getting worse. So appropriately dosed, because some not everybody needs strength, some people need length.

SPEAKER_03 5:35

Yeah.

SPEAKER_02 5:36

And I would venture to say with pregnancy, particularly with first pregnancies, we need length. Yeah. Especially in the third trimester. I'm like, you should not be kiggling at the red light. We should be talking about diaphragmatic breathing. We need to be doing pelvic floor stretching so that those muscles have the mobility to get out of the way.

SPEAKER_03 5:54

Yeah.

SPEAKER_02 5:55

Because really, like it's not our pelvic floor's responsibility to push a baby out. Our uterus will do that. Yes, whether we make a decision to do it or not. Yeah. We have to create space.

SPEAKER_00 6:04

Oh, I love that. And the more space we have, the less we care.

unknown 6:07

Yeah.

SPEAKER_00 6:07

And see, I think that's just something that we talk about mental health is a lot. We're just supposed to like know this naturally, right? And it's here's our pelvic floor. No one's telling you this in these OB appointments. No. Okay. Your friends are not honestly going to share this unless they've done, yeah, they've had an issue and they've sought someone like you, and then they can be a voice. But there's a lot of women out here, they just don't know.

SPEAKER_02 6:30

Yeah. Well, and because, like, you know, so many things are changing in pregnancy, posturally, you know, we can have some issues here that maybe weren't there before. And so people are like, oh, you know, sex wasn't painful before I'm pregnant, and now it is. Why is it? I guess I'll just stop doing it. Whatever. But a lot of times that, you know, that's a muscular issue. Like those muscles are tightening, they're kind of adapting, and they can respond really well to treatment.

SPEAKER_03 6:53

Yeah.

SPEAKER_02 6:53

And it's important to kind of seek treatment during pregnancy because um a lot of times we aren't like given a lot of options. And so, like, you know, a lot of the main issues we'll kind of see mechanically, we see some back pain. Yeah. And that's especially with um our moms who already have children because they don't, you know, they clock a little less couch time. We're lifting a toddler. We're also don't have great core strength with our pregnant, you know, putting babies in and out of the crib and all that. Yes. So you know, we'll see some back pain, but then some pelvic girdle stuff. So some SI pain kind of goes along with that back pain in the back, this area right here. But this one, um, pubic symphysis or pubic pain is also a big culprit. So we can have like two big causes of this

Round Ligament Vs Pubic Pain

SPEAKER_02 7:36

guy. The first one is the round ligament. So the round ligament will go from the pubis to the uterus. So this is what happens when people sit for a long time, they stand up and it's like, wow pow, lightning.

SPEAKER_00 7:46

Okay, so I did not have it with Will. Oh, and I had it with James, my second. I remember I fell to the ground. Oh, it's shocking. I was like, and my husband is like, What is wrong with you? And I was like, There is lightning in my vagina right now. Yeah. And I just need it to pass. And he was like, Do we need to go to the hospital? What is happening? And so I started texting my friends. I'm like, okay, why is my vagina hurting hurting and like it's lightning, and they're like, Oh yeah, I had that with mine, it'll go away. Oh yeah, it's this, or and I'm just like, I have to live like this.

SPEAKER_02 8:16

Right, yeah. Well, and a lightning lightning crutch. That's that's the street name for it. That's what people will call it. But you know, round ligament pain, there's some kind of easy things we can do for that. I mean, one of the easiest things that you can start doing right now to help with that is just slow your transitions. Yeah. So it's like quick sit-to-stands are gonna be like, well, pow.

SPEAKER_00 8:35

Right. And that's what happened. I have a toddler, so he's probably like trying to kill himself, and I'm like, up. Yeah, there you go.

SPEAKER_02 8:41

And even like rocking the pelvis back and forth a bit before we stand up, right? Like just getting a couple pelvic rocks so we get a couple easy stretches can really help with that. Round ligament pain is pretty benign, but it can feel terrible. Yeah. Right. The other more like sinister cause of this um pubic pain is pubic symphysis dysfunction. And that's this little disc here that connects kind of both sides of the pubis. So this area can really gap and spread and cause a lot of problems. And this would be more like I can't put on my pants and stand on one leg. Stairs hurt. I go for a walk, it's hurting more as the walk goes on. And this is one of the things in pregnancy that I'm like, ooh, we gotta be really kind of protective of this. Yeah. Because this is one of the problems that can get worse with birth and still be really debilitating postpartum. So I'm like, if we identify pubic symphysis dysfunction, we can start treating it during pregnancy, get them on the right um exercises and external supports, and a lot of times they really benefit from like a little support belt.

SPEAKER_03 9:40

Oh, okay.

SPEAKER_02 9:41

You know, and usually people with pubic symphysis dysfunction, like, I don't want them running.

SPEAKER_00 9:45

Okay.

SPEAKER_02 9:46

Because they get a lot of shearing in this kind of belt. Whitney's a runner. Yeah. I am. So, like, you know, if they have this, I'm like, we need to talk about some other, you know, activities and doing some appropriate strengthening.

SPEAKER_01 9:56

Now you mentioned like a supportive belt. What if someone used like KT? Would that help at all?

SPEAKER_02 10:01

I would say like KT tape can be a little bit tricky in pregnancy. Okay. Um, we use it sometimes, but because like the belly literally changes shape throughout the day, they can be a little bit more prone to skin irritation. And like the pubic synthesis can be kind of tough just because there's hair and stuff there. Gotcha. And yeah, ripping hair off kind of hurts. Yeah. Yeah, it does. So wax in the making there. Yeah, there you go. We'll try it, but I don't throw like all my eggs in that basket. Sometimes because if you if they sweat and the tape gets wet, you know, they can get a little bit more irritated. Just different people's skin tolerate different things differently. And so sometimes having like a kind of reusable belt that they can use to kind of give a little bit and adjust as needed throughout the day, yep, and throughout the pregnancy can be helpful. Um, the other kind of important thing to note about pubic symphysis dysfunction is a lot of times it kind of will be blown off as round ligament pain. Uh-they can be like difficult to differentiate. And so I would say if you're getting round ligament pain, you feel better as you get moving. Okay. You may have that initial pain. Exactly. So you're like still it kind of stretches out. It's that initial quick stretch gives you that pain, and then it kind of gets easier. It's gets moving and it feels better. Pubic symphysis typically gets worse. Okay. So it's like, I didn't have any pain when I started walking, and now I'm at the end of my walk, and it's I'm getting more and more pubic pain. And I think an interesting thing to note about this is that you know, most of us in the US deliver on our back. Yeah. But that actually gives us the most gapping of this area.

SPEAKER_00 11:28

Oh wow.

SPEAKER_02 11:28

So if we're actually, you know, already having an issue with this area kind of excessively separating or being unstable, delivering on our back is the worst position that we can.

SPEAKER_01 11:36

So for those mamas, would you recommend it?

SPEAKER_02 11:40

Either a sideline, either a sideline or an all-for delivery is more protective to the pubic symphysis and would reduce kind of maybe some postpartum um complications that we could we could have with that. So, and those respond round ligament pain, pubic syphysis pain, back pain, SI pain, all respond great to physical therapy. And you're kind of limited on your tools in pregnancy because like we can't take Advil and we can't get injections. Yeah. Things are kind of stripped away. And so, like, physical therapy is like a great way to manage your pain and as well as maintain your strength throughout your pregnancy. So if we can like maintain strength, maintain fitness, modify exercises, then not just you know, put lots of deposits in the bank for a better um postpartum recovery.

PT Options And Self-Advocacy

SPEAKER_02 12:27

Okay.

SPEAKER_00 12:27

I think it's important to say is like you can tell ask your provider and say, I need to deliver this way. I'm gonna try this way. Yeah, you know, I need this opportunity. You can advocate for yourself. A lot of your OBs, your midwives, your doula's, they may not be well versed on the pelvic floor, on PT, on what you need. So you can ask for referrals. You can go to your insurance and say, can you self-refer or do you need a referral?

SPEAKER_02 12:53

In in the state of Alabama, we can evaluate, but we have to have a referral for like a can a plan of care. But most OBs are like, cool, you want to do that? No problem.

SPEAKER_00 13:03

Yeah.

SPEAKER_02 13:03

In most other states, you can walk right through the door and just get treated.

SPEAKER_00 13:06

So kind of just check with your insurance ladies, check um with your state to see what's going on and having a, you know, OBs love them. This is not their wheelhouse. Right.

SPEAKER_02 13:16

I mean, because these are just mechanical issues. And a lot of times, you know, of course, like bodies are changing, right? So even if you're doing exercise and things before, but now you're like, uh, I don't know what to do with this belly, I'll just walk.

SPEAKER_03 13:28

Yeah.

SPEAKER_02 13:28

You know, but like resistance training is important during pregnancy. I mean, it helps keep us strong. Having that muscular stability is really crucial to make kind of feel good, and especially for, you know, caring for other kids or dogs or whatever. Yeah. You know, all the things that's a but a lot of people don't, you know, just don't know how to change their exercise to accommodate for pregnancy. And so they're just like, well, I'll just walk. And I'm like, no, we still need strengthening, you know? Yeah, exercise is very specific, and walking is not necessarily gonna give us all we need to kind of keep our bodies strong.

SPEAKER_00 13:59

Yeah. When during pregnancy do you see most people come to you? Do you think there's a lot like is that third trimester or second trimester? Or and then I guess another flip on that is when should they start reaching out to you?

SPEAKER_02 14:10

Right. So um, I mean, any kind of you're a little more limited in the interventions that you can do during the first trimester. Yeah. Plus, like people feel bad. Yeah, and most of the time activity levels are not that high during the first trimester. Can barely lift their head off the couch. Yeah. So like most of the problems start to present in the second trimester. Um that wave of energy comes in, then starts to win. You start moving, you get off the couch or leave the toilet. And that's when we have more of a significant change in regards to kind of posture, and we're starting to get a baby bump and moving around that as well. And so I would say anytime a mechanical problem presents, you can start, right? So if you start getting back pain at 14 weeks, we have people start therapy then. Some people may not start till 30, right? Because they didn't start having pain until um their third trimester, as far as kind of like preparation for birth, right? Because we think that birth is just like this intuitive thing that we know how to do, but it's really like a mechanical process that we can really benefit from some better mechanics and positioning options and things. Absolutely. So we offer some birth prep as well, right?

SPEAKER_00 15:17

That usually starts about 35 weeks. And what's some of the things that we can tell our listeners that's practical for them? Yeah, because um, they may not be able to find you know a great resource like you. Yeah. So I guess what is a couple of things they can do.

SPEAKER_02 15:30

So as long as you're cleared by your provider, um, and most people are, as long as they're still kind of cleared for intercourse because it's more gentle than

Perineal Massage And Labor Positions

SPEAKER_02 15:37

that. Um, I usually recommend starting perineal massage at like 35 weeks. And so that could involve um a finger in the vagina stretching those tissues in all directions. We have to think about, you know, that those that area is gonna have a 360 stretch. Yeah, yeah, it is with a baby's head. And um, our muscles were beautifully designed to be able to stretch that a lot more so than other areas in our body. But it's nice if the first stretch doesn't occur with a baby's head.

SPEAKER_00 16:00

Yeah, yeah. So if we can start stretching, I didn't experience that, but that frightens me, even just speaking of that.

SPEAKER_02 16:06

Yeah, so if we can start stretching that area, and it's not something you have to do like every day, even every other day is beneficial. And just there's lots of videos that we can link to this as well, but just kind of stretching, like one finger in the vagina, just kind of stretching that area, like we're going to widen that space side to side and down towards the rectum is where it's going to get a lot of stretching. Okay. I also recommend that people are kind of educated on different laboring positions because there's good benefit in changing positions. The more we're changing positions in labor, the more we're opening and creating space for our baby to want to be in a better position.

SPEAKER_01 16:44

So y'all would definitely recommend the peanut ball then.

SPEAKER_02 16:46

We recommend the peanut ball. I usually show people stuff in standing and sitting in quadruped or kind of all fours or kind of leaned over. Um, and then positions that they can also do if they choose to get an epidural. Yeah. Because like we think, you know, oh, once I get the epidural, I'm just gonna nap, and then they're gonna come in and they're gonna tell me there's tens and eight.

SPEAKER_01 17:06

No, that did not happen for me. Yeah. Now I am team epidural. Let me just say, I loved my epidurals, but I did not sleep with my epidural.

SPEAKER_02 17:13

Yeah. So, I mean, but there's still good benefit to changing position and like moving from side to side and moving the peanut around. And there's tons of um resources out there as far as like different positions, and yeah, and we're wanting to kind of change those every three to five contractions. Yeah, which probably seems like a little more frequent than we would expect.

SPEAKER_01 17:31

I remember my nurse was like flipping, right? And it was great because again, I didn't have bad deliveries at all. Right, yeah. And so, and then she did the tug of war thing too. Yeah, that was super helpful with my first to get her underneath my pelvic bone.

SPEAKER_02 17:44

Right, yeah.

SPEAKER_00 17:45

But if you don't have that type of nurse, she was gold. Like, I was singing her praises all the time.

SPEAKER_02 17:49

And I think the assumption is a lot of times, like, oh, uh, they're gonna tell me what to do, right? And I'm like, you can't assume that they're not all created equal, they're not, and and you know, that's where like having a doula can be really helpful. Absolutely. Because they can support and direct your your birth and your positioning. I also think it's just helpful if people have things to focus on that are not like the start and the end of birth. Yeah, yeah. It's like I have things to do and stuff to work on and positions, and again, yes, we have tests that we can do to help create space. Yeah. And if we have space, then babies want to do what they want to do. And so offering that variety and and shifting through our pelvis is helpful. Absolutely. Um, the other thing we focus on is appropriate breathing.

Breathing And Smarter Pushing

SPEAKER_02 18:32

Okay. Right? So, like in the hospital, we're taught like one kind of push. One, two, three, hold your breath and push it. Everybody's purple in the face. Yeah. But I like for people to kind of feel equipped with different tools and like, can we try um more of a gentler push where we learn to kind of distend through our pelvic floor? So again, like most everybody is kind of familiar, at least with the word of Kegling. Some people are like, I think I'm doing it, I think I'm not doing it. But going the other way and like actively bearing down through our pelvic floor is a weird motor skill. Okay. Yeah. Right? Yeah. Where we're like opening the holes. Yeah. Right? Like most of us don't. Yeah, I know. I'm trying to do it right now. Yeah. So, like, I usually, and I want to, I'm gonna try to teach people how to do that while they are not holding their breath. So I like a I like to kind of cue like a what I like to call like a big belly, hard belly breathing.

SPEAKER_03 19:23

Okay.

SPEAKER_02 19:23

So if they like have their hands on their belly and they take a big breath, they fill their belly up. Now can they like exhale and push their belly out more? That's offset. It's opposite, right? I was about to say, I'm having to really put some mental effort into that. And so, but I like that cue because, like, if you have an epidural, you can't feel anything down there. Yeah, right? Yeah. But you can have your hands on your belly and know that if I'm exhaling and my baby's headed back up towards my spine, I'm probably contracting my pelvic floor and it's moving in the opposite way.

SPEAKER_01 19:55

Okay, so I worked in L and D for several years, and I cannot tell you the amount of patients that said, I would push, and then next thing I know, baby just comes right back up. Oh my goodness, that explains so much.

SPEAKER_02 20:06

So, and I can tell them like you can have your hands below your belly button, and you can feel your belly fill up with that good, deep, diaphragmic breath, and then like keep it there and like get, you know, kind of like push out against your hands as you're exhaling, gives you that pelvic floor distension. So then instead of our babies trying to descend and we're contracting all these muscles, our baby's descending and we're opening, we're pushing them out.

SPEAKER_01 20:29

And it's really like yeah, light bulb moment over here.

SPEAKER_00 20:32

Y'all and this is why we need to learn this now, because when you're in pain, people are yelling at you over you, not yelling, but like push, push. You're just like, I'm at my within.

SPEAKER_02 20:44

You need to know it. Well, and if you can't feel it, we need strategies of like some other type of and also watching, you know, not eyebrows down to watch either. Yeah, right. And and also like, what are we looking at? Yeah, the whole area looks unreliable. Yes. But like having a tactile cue of somewhere somebody can touch that you can feel, that you can push out against, it's helpful. And and practicing those strategies when we aren't in labor.

SPEAKER_00 21:08

And calm ish. Yeah.

SPEAKER_02 21:09

So you're like, all right, I know how to distend. And I would say nine out of ten if I'm like watching a public four and trying to get a mom to learn how to move in that direction, nine out of ten respond with shoot the tampon out. So if I'm like, Okay, move, like you're gonna shoot a tampon out. They're like, got it. Oh, I got that. Okay, yeah.

SPEAKER_01 21:28

That makes so much sense. It makes sense.

SPEAKER_02 21:30

And so it's that same motion of like if you're gonna like shoot a tampon out, that we're kind of looking for for that's where our pelvic floor is kind of most coordinated.

SPEAKER_01 21:38

So if you have a question, like I'm just piggybacking off of this right now. And so with those mamas who felt like they pushed and then baby just came right back up, and that happens for an extended period. Have you seen either more third and fourth degree epesiotomies with situations like that? And I've had several mums say that, you know, eventually they're serving Bolan. So then they would end up with a C-section. Do you feel like there's like a connection between that tightening and baby coming back up and those kind of outcomes?

SPEAKER_02 22:10

Well, you know, um maternal research is really poorly funded. This is this is a second secondary soapbox, right? So like we're not getting good research. You're listening out there to us funding. They are not funding it, which is ridiculous because we have an ample, never-ending patient population that we could fund and draw. We aren't, um, which is really frustrating. Yes. I would say anecdotally, from my experiences of seeing women when they're pregnant and with postpartum, when they have good mobility and a good pushing strategy where everybody is like rowing in the same direction, they tend to tear significantly less, they tend to push for far less time. And we know that those two factors of like pushing for a really long time could cause more of the prolapse issues, postpartum. Also, like if we're pushing for a really long time, baby starts to get distressed, that increases our likelihood of an instrument-assisted delivery. So vacuum or forceps, which are directly related to more extensive tearing. How could it not be? Yeah, and and sometimes I wonder like, is it just that there wasn't the mobility like in the tissues? Like, did they have a tight pelvic floor maybe even before they got pregnant? And then like they, you know, were just everything was moving in the right a way that was kind of combating what wanted to naturally happen. So I would say, in my opinion, and again, I don't have like the research, I don't want to back this up because it's poorly funded. Yeah, yeah. Throwing this hands in. But I feel like if we had better mobility, if we utilized different positions that actually helped open the pelvis mechanically, um, like would outcomes be better. Yeah. Because I feel like from a lot of our moms that we treat that we do this, but like, man, birth outcomes are better. Like first time moms having only grade one or small grade two, you know, and pushing for less than 45 minutes.

SPEAKER_01 24:01

I was gonna say, what to you is an extended amount of time to be put?

SPEAKER_02 24:06

I would say greater than two hours.

SPEAKER_01 24:07

Okay. That's about right. Which I mean in the hospital.

SPEAKER_02 24:10

And that's exhausting. Yeah, it is. And I and I tell people too, I'm like, this breathing while you push or kind of this is kind of like breathing the baby down. Yeah. Right? It's energy saving. If we start our pushing process with a 10 out of 10 full pressure push, that's hard to maintain for two hours. So if we can start with like a gentler version where we're like breathing and we're circulating good oxygen, we're kind of like breathing the baby down and creating space, then at the very end, when like we need to get that baby under the pubis, we have gas in the tank to do it. To do it. We haven't already been using 10 out of 10 pushes for 90 minutes.

SPEAKER_01 24:46

Yeah, exactly. So it's like don't start the marathon out at your quickest pace. Like you want to finish the right thing.

SPEAKER_00 24:51

Work smarter, not harder, ladies. Absolutely. We gotta learn that early.

SPEAKER_01 24:54

Right.

SPEAKER_02 24:54

And again, like I feel like a lot of people are open to stuff if you ask. Yeah. Yeah. Right.

SPEAKER_01 25:00

So it's like they know it's an option.

SPEAKER_02 25:02

Right. And so, like, you know, I'll be like, you know, ask if you can start in sideline, which you can do that with an epidural. Yeah. Or like if you, you know, ask if you can start in all fours. Because like sometimes if um, you know, they still have good movement in their legs, that you know, they'll be like, okay. Yeah. But like if you're on your back and the baby's like, you know, headed towards the pubits, they're gonna be like, that's not a great time to take that position. Yeah.

SPEAKER_01 25:23

With my first, I remember we were doing tug of war, and that's when I started the pushing phase. And that was so nice to have that leverage to pull up and not be just like flat on my back during that pushing stage. And then it's like, once she got out from under that pelvic bone, like I mean, it was like sister is coming.

SPEAKER_02 25:42

Yeah. Well, and that's and that's you know, we expect that to be intuitive, but also like when we're on our back, you know, we're laying on our tailbone, we're laying on our sacrum, and those are spaces that should have, you know, at least 18 degrees to move out of the way. Yeah, but then we're just laying on them. So then we're not taking advantage of any kind of backwards motion that we could have. And so even popping popping like a little towel roll under your your sacrum or a um a noodle, like a swim noodle, a little piece of one, okay, then it kind of allows that pelvis to kind of become like this, so that we're not just laying on all these tissues, they have room to stretch this way.

SPEAKER_01 26:19

So would you say, like, if someone in a hospital bed and they start out on their back and all the things, and then they start like actively pushing, and they're almost in like semi-upright, like somewhat seated position. So like they have an angle to them. Is that more ideal of a pushing as opposed to just like laying? With does that provide so, yeah. Because I feel like that's what they did with my second daughter, yeah.

SPEAKER_02 26:43

And like, of course, that's a little bit more gravity assisted as well. So, like, gravity's gonna be.

SPEAKER_01 26:46

But I was still in the hospital bed, technically on my back in a sense. But I remember like I wasn't like laying down. Does that make sense? For sure.

SPEAKER_00 26:54

I think there's a lot here that cut it boils down to you gotta

Training For Birth With Resources

SPEAKER_00 26:58

educate yourself. We're here to do that for you guys. Yeah, empower yourself, know to speak up, yep, and do what's best for your body and baby. Now, baby distress, you know, you you there's a lot of things. As I said, we can't handle the normality, you know, but if things are in your control and you can advocate, and I would also say that there's just things you can do to prepare.

SPEAKER_02 27:17

Yeah, you know, like that we aren't just like hitting a run with never having stretched. We would we would train for a marathon, we would train for a race, do the same thing. And doing um spinning babies has excellent. They are fantastic. You know, they have free exercises that you can access on their website to, ladies, with the help with baby positioning uh and to help with hip mobility and back mobility so that you you have the range in your body and you can work on all that stuff with your pregnant, and you can work on your pelvic floor mobility and you can work on these breathing strategies so that way we aren't like trial and erroring when we're in extreme pain during labor.

SPEAKER_00 27:54

Yeah.

SPEAKER_02 27:55

When it's game time.

SPEAKER_00 27:56

Yeah, it's game time. I mean, because you know, an athlete's not gonna go to his race or his game. Yeah, I've never done anything before.

SPEAKER_02 28:04

And I think like some of the birth education classes out there, I mean, they talk a lot about what birth is and the process of it, but not like how to do it.

SPEAKER_00 28:12

I feel like no one taught me any of this.

SPEAKER_02 28:15

And nobody talks about like they have stuff in your room, like a ball or maybe a peanut, but not like how to use them or which positions you could use them. They're just like, you want to bounce on that? Yeah, I guess.

SPEAKER_00 28:25

You're like, sure, I guess.

SPEAKER_02 28:26

Yeah. So I I think we have like a long way to go as far as like educating birthing people on like like physical preparation that you can do for your body that can, you know, that can help. Help with better outcomes and make pregnancy more comfortable because it doesn't just have to be this thing that we suffered through. Yeah, your baby's gonna come out and it's gonna be better. And there is some expectation that some manic mechanical problems, you know, may get better, I mean may get worse as the pregnancy presses, and that may be the case, but that's not always the case. And sometimes they have to resolve and they can exercise better and they can feel better, and there's there's options out there, and a lot of times they're not always offered, but you can advocate and you can ask for them.

C-Section Prep And Recovery Tools

SPEAKER_00 29:04

Finally, what for our C-section mommies? Because I had no choice. I was C-section for both. I knew that. Was there anything I should have done in pregnancy to prepare to help? Well, again, like spinning babies has exercises on their website for breach babies. Mine weren't breached, they just I had no choice. I had placenta issues previous, so and then a creed of so I couldn't get it out. So but I always felt like it was a major abdominal surgery that no one they're like, well, you're just gonna recover it from it. So I didn't know what to prepare for.

SPEAKER_02 29:34

Well, and I would say, like, if you know you're gonna have a C-section beforehand, again, like working on hip mobility, working on back mobility, making sure like all those tissues are nice the abdominal walls kind of out.

unknown 29:48

Yeah.

SPEAKER_02 29:49

And like having the appropriate tools at your disposal immediately postpartum.

SPEAKER_00 29:54

And what should that's good that that's a good note. What should we have? Like tools, right?

SPEAKER_02 29:58

Like is it for a postpartum recovery?

SPEAKER_00 30:00

Uh-huh with her C-section. What would you to pack? I mean, is it anything you can pack in a bag that these moms who maybe they're fixing to pack their bags that you're like, this is gonna help you?

SPEAKER_02 30:08

Well, I would I usually recommend like if they end up having a C-section, I tell them to like ask for an abdominal binder in the hospital.

SPEAKER_00 30:14

Okay, so I put that, I had a great nurse and she's like, You need this. I didn't know I needed it until she told me.

SPEAKER_02 30:20

Yeah. Because again, controlling that swelling makes it a lot more comfortable. Well, as that compression feels good and makes your trunk feel more.

SPEAKER_00 30:27

Well, because I remember I stood up and it went boop. Yep. And I was like, oh boy, my organs are like at my feet. That's how it felt.

SPEAKER_01 30:32

Yeah, right. I remember with both my children. First time I stood up post-delivery, I was like, Oh, my insides are just gonna fall out of my vagina. Yeah. I was like, they are just all gonna and they even did not have bad traumatic deliveries, but I was like, oh, oh, I don't need my intestines to leave me. Like, you gotta stay in, you gotta stay in.

SPEAKER_00 30:48

Would you think the hospital should give this to the ladies or should they put it in their bag or like go on Amazon and find me? The hospital should have them. Okay. They should have to dig them up. Okay.

SPEAKER_02 30:58

But I usually recommend, like, because you know, belly changes a lot during the first two weeks postpartum. And so I usually recommend that um that they get the hospital one. There's a little more velcro, a little bit more adaptability for when you're kind of repping changing size. And then when you get home, I like the C panty.

SPEAKER_00 31:13

Okay.

SPEAKER_02 31:13

So it's like a compressive pair of panties that you can wear and it offers compression to the perineum, the abdominal wall, and it has a little strip for um uh like a silicone scar strip for shipping time ladies. If you think you're gonna have a C section, go ahead and look that up. And I would say um, like a good ice pack, and this holds true for both vaginal and cesarean birth, but like the gel ice packs, not like just corner piece, yeah, the gel ice packs that are actually gonna be colder, um, a postpartum recovery legging or short are hugely helpful.

SPEAKER_00 31:45

Okay.

SPEAKER_02 31:45

Um, as well.

SPEAKER_00 31:46

So having that before you need it is always a good thing.

SPEAKER_02 31:49

Yes, be prepared. Yeah, but you know, if you don't know you're gonna have a cesarean birth, then you go in and have one. We have Amazon. Yeah, Amazon.

SPEAKER_00 31:55

We get especially in Bourbon. It's right down the road. That's right.

SPEAKER_01 31:59

Order while you're in the hospital and we'll be on your doorstep when you get it.

SPEAKER_00 32:01

I totally did that, Duran. Um I was like, oh, actually, I need this and these because you're upfeeding anyways, right? So what do we do? We shop.

SPEAKER_01 32:07

But um doing purchases.

SPEAKER_00 32:10

That's right. Oh, I

Wrap Up And Final Message

SPEAKER_00 32:11

know. Well, Emily, we're gonna bring you back and you're gonna tell us all about postpartum because I think what we can take away from this, ladies, is we're gonna link a lot of resources. Your Instagram, your business is Instagram, we'll do the spin and scissors. So if you cannot find a local pelvic floor therapist that you can educate yourself, um, Instagram, the internet, YouTube's great, knowing to advocate yourself, how you can do different positions and start early. If you're noticing the pains, you don't have to live with it. Ask to see someone.

SPEAKER_01 32:45

Yeah.

SPEAKER_00 32:46

So you can never go wrong with asking and referral and figuring out how to advocate for yourself. But we appreciate you so much.

SPEAKER_02 32:54

Yay, thank you for having me. It's a pleasure.

SPEAKER_00 32:56

All right, till next time.

SPEAKER_02 32:57

See y'all.

SPEAKER_00 33:00

Maternal mental health is as important as physical health. The Preview Alliance podcast was created for and by moms dealing with postpartum depression and all its variables like anxiety, anger, and even apathy. Hosted by CEO, founder Sarah Parkhurst, and licensed clinical social worker Whitney Gay, each episode focuses on specific issues relevant to pregnancy and postpartum. Join us and hear how other moms have overcome mental health challenges as well as access tips and suggestions on dealing with your own challenges as moms. You can also browse our podcast library and listen to previous episodes at any time. Please know you're not alone on this journey. We're here to help.