Birth, Baby!

Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Doula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Doula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

Today, we have Doctor Emily with us.

Doctor Emily is a physical therapist, specializing in the treatment of pelvic floor disorders.

She graduated from the University of Oklahoma Health Sciences Center with a doctorate in physical therapy in 2013.

Since that time, she's enjoyed being a constant learner in her field.

She has an extensive history, including treatment of low back and neck pain, pelvic floor disorders, pediatric disorders, performance testing, and treatment of orthopedic conditions.

Doctor Emily has a passion for helping clients achieve lasting relief from the symptoms they're experiencing.

Thank you so much for being with us here today, Doctor Emily.

Thanks for having me.

We are so excited to have you on today.

I guess to start off with just going at it.

You're a pelvic floor therapist.

Can you tell us a little bit about what the difference is between a regular physical therapist and a pelvic floor physical therapist?

Sure.

Absolutely.

When somebody graduates from physical therapy school, they get a general degree.

We all graduate ready to work in any field.

But pelvic floor physical therapy is not really something that's addressed in PT school very much.

We get a little bit about some of the different diagnoses we might work with, but not really any treatment of it.

Schools are starting to do more of that, but it's just not very much that's actually in school.

A pelvic floor physical therapist does all of their education outside of school for pelvic floor disorders.

It's funny, we all joke around about during physical therapy school, we just forget you have an abdomen and a pelvis.

We'll do things across the back of the body.

We'll do the front and back of the arms, front and back of the legs, but nothing across the abdomen or the pelvis.

So we do special or extra education to learn how to treat the pelvic floor.

So certification programs outside of that, so extra certificates.

So there's a lot of certificate programs or lots of just putting together, grabbing pieces from several different certifications to create that full realm of what you're wanting to work with.

Gotcha.

If they barely even talk about it in school, what in the world brought you to want to do this?

So I started to just kind of naturally go that direction with different jobs that I had when I was graduating from PT school.

I started out at a clinic that was owned by a spine surgeon, and so we saw a lot of back pain, and I loved working with back pain, and that kind of naturally just led into some pregnancy work, just because there's a lot of back pain associated with pregnancy, and then ended up in another position where I got to start working a little bit more with women while they were pregnant and started developing a program for incontinence, it was a hospital-based clinic that I was in, and just really loved working with that population, and so that was when I really started taking a deep dive into special education so I could learn internal examination and just really niche down into that population and what things they're dealing with.

I've noticed that people don't even know it exists, so not only do they not really talk about it in physical therapy school, but people don't really know that it's a thing, and I mean, I've heard of people all the way from, I have a friend who had her five-year-old in public floor physical therapy for issues with not being able to go to the bathroom, and you know, you hear about it for older people as well, pregnant people, so that's really cool that you were able to find that through experience right after college.

So you didn't even quite know this is exactly what you wanted to do until you got a little more experience.

Yeah, yeah, it's, public floor physical therapy really has grown a lot, especially in the last 10 years, so I'm right at 10 years of being out of physical therapy school.

And so at that time, really nobody knew about it.

It was not a very common thing at all.

You could find them, but they were, you know, you might have one in your city, maybe, that did it.

And so it's really grown in popularity.

And for me, once I started doing some learning about it and some treatment with it, it was that missing puzzle piece that I was like, how have I been treating women with low back pain and not taking into account that having a baby maybe had something to do with the pain that they're having and that what position they delivered in might affect why they're having this particular pain?

Yeah, that's so crazy.

So when someone's looking for pelvic floor therapy, is it necessary for them to find someone that is specifically just pelvic floor therapy or could any physical therapist treat the pelvic floor?

Yeah, so part of it is going to come down to what's available in your area because it still is very much something that there's some areas that really don't have very good access at all to pelvic floor therapy.

Ideally, you're looking for somebody who is specifically specialized in pelvic floor treatment.

And ideally, really, I love when it's a place where the whole practice specializes in pelvic floor therapy as well.

Just you're going to get more, when they have that community at work where they can be asking those questions, I really feel like it creates better lifelong learning learning in that field.

There's a lot of places now where they've added in pelvic floor physical therapy, but maybe they treat 25% to 50% pelvic floor, and then the rest is orthopedic.

So when you can get somewhere that just only does that, you just know that they're going to know what you're talking about.

Yeah, that makes a lot of sense.

So what are some reasons that someone should come get an evaluation, like some signs and symptoms that you can watch out for?

Sure.

So traditionally, you would be looking for physical therapy, pelvic floor physical therapy for any bowel, bladder, or sexual function symptoms.

So this could be leaking, maybe when you cough or sneeze, or leaking when you just realize you have to go to the bathroom and you can't get there quick enough.

It could be for prolapse.

So that would be when you feel like heaviness through your pelvis, almost feeling like things are going to fall out of your body, kind of, or it'll feel sometimes people feel like they're like sitting on a ball or sitting on a bulge or something like that.

Constipation is another one like that we very commonly work with pelvic pain, pain with sex.

So those are kind of the traditional things that are those who are familiar with pelvic floor physical therapy kind of think of, but some other things to consider would be really any symptoms that are associated with pregnancy or part postpartum as far as like just body symptoms.

So things like AB separation, or maybe you have a scar from tearing during delivery and it's just having a hard time healing.

But we also work with people outside of pregnancy and postpartum so they may have any of these symptoms and not actually have ever had a kid.

And then we also work with fertility as well.

Could someone that had a C-section still have pelvic floor damage?

Oh, yes.

Oh, yes.

I figured that was the case, but I figured that might be a question that people would come up with.

We're real transparent here and that's something that we always tell people when they're interviewing with us for doula services.

So I will share a little bit of my own experience and see what you think.

When I had my son, right after I had him, got up, went to the bathroom and kind of panicked and yelled for a nurse because I could see a bulge coming out of my vagina.

And I was like, what the heck is happening?

And the nurse like thought it was no big deal.

I was at a birth center and she was like, oh, that'll go back.

It's fine.

That's just like for right after, you know, no big deal.

And I was thinking, there's no way that is normal.

So we also talk a lot about what's common versus normal.

Common does not mean normal.

So if you have something like that happen where you can actually see a bulge coming after you've had your baby, yes, it might go up a little bit, but I'm assuming that would be a pretty big sign.

That's not just going to go away on its own, right?

You're going to need some help with that.

Yeah, that's definitely something that we want to get checked out.

The early postpartum period, in those first couple of weeks, we see a lot of movement of tissue that is going to change just as your body kind of re-regulates back to how its hormones were before pregnancy and delivery.

But it's something you definitely want to check out and know about because how you handle things with like how you're breathing and how you're picking up the baby and how you're nursing, those are all affecting pressure that's pushing down on that organ that's prolapsing.

And so the more we can, from the very beginning, work on that is going to really make long-term changes for you.

It was so surprising to me that it was like no big deal to her.

And probably because she sees it, because maybe it's more of a common thing, but I didn't get any instruction on making sure that I was sitting down more, lying down more, being careful not to move around too much in those first few weeks.

And I just got up and did all the things, not realizing that I was just causing more damage.

And that was only five years ago.

So it seems like now as we're in birth work, I do hear a lot more of the midwives at least talking about being in the bed, on the bed, around the bed for those first few weeks.

But that didn't even seem like something that they talked about.

So we definitely try to, even though we're not medical providers, give that recommendation to people for sure.

Yeah, that's great.

I love that.

Yeah, I think so I recently, I want to start recently, about a year ago now I did a spinning babies training.

And in our spinning babies training, the instructor was talking about pelvic floor therapy.

And the different places that they see it being helpful and kind of how spinning babies can work alongside with some of those things.

And she was specifically talking about C-sections and how so many people don't go to pelvic floor therapy because they don't think it's necessary because you didn't push a baby out.

And then she was talking about how just that heaviness in the swelling of the tissues and the organs and everything and how that really does affect the pelvic floor, or sometimes even more than a vaginal delivery would have.

And so it was just so interesting to me to hear that.

And since then, I've been such a huge advocate of my clients who have cesareans at least going and talking to a pelvic floor therapist and being evaluated.

So can you tell us just a little bit, just because we've had so many clients asking about that recently, can you tell us a little bit like what you see in C-section patients and what that kind of looks like?

Absolutely.

So one of the things that I think is really easy to forget about with a C-section is not all C-sections were planned C-sections.

And so for so many moms, they went through the trial of labor first and then it transitioned to.

So maybe they pushed for a long time or they were going through labor before going to the C-section.

And so we have a lot of those changes, even though the baby did not actually pass fully through the vaginal canal, we still have some of the same changes that we would see with a vaginal delivery.

But then in addition to that, that scar, like where they do your incision, they go through so many layers there to get all the way down to where that baby is at.

And it's a pretty significant scar.

They very often develop some scar tissue around it, which is going to tug on your bladder, tug on your uterus.

So it's really common to see pain with sex after having a C-section, because all that scar tissue, as you're getting that movement during intimacy, it's pulling on that scar and it can be really, really uncomfortable.

But then we also see lots of back pain and a really hard time, like engaging abdominal muscles again, especially as we're trying to close down any ab separation as well.

Those are all things that we're working on really commonly, but we're still seeing even, I mean, we can see the leaking, we can see constipation, all of the things that we would see in a vaginal delivery, we just, the baby didn't pass directly through the vaginal canal.

Yeah, we have a few people recently that have been talking to us about wanting a VBAC.

And one of our big recommendations is chiropractic care and pelvic floor therapy.

Because if you're going to after, one of them has had two cesareans.

And like, if you want a vaginal birth after these two cesareans, you have some bodywork to do, you know, because all of those things can make a difference.

You maybe would be able to have a totally awesome VBAC.

But if your body is so tense and having, you know, all of these things out of sorts, it's going to make a big difference in the success rate.

Absolutely.

Love all of that.

I think it's just, it's so important to talk about just the different ways that people give birth and how it doesn't necessarily mean, just because you have a C-section, it doesn't mean that things didn't happen to your body and that you're just going to heal and be, you know, totally back to normal again.

I just think it's so important to talk about that.

So should someone, kind of moving on, I guess, should someone come in in pregnancy or is it better for them to come in just postpartum and kind of how does that help during each of those times?

Yeah, so I would definitely say both.

During pregnancy, we're going to help with several things.

We start working through some birth prep, just kind of getting, working through, how is your pelvic floor working?

How do we connect into your pelvic floor for delivery so that your pelvic floor can relax?

I think a lot of people go into delivery thinking that they need to have a strong pelvic floor because they're thinking about pushing out a baby and they think their pelvic floor needs to be strong, but actually your pelvic floor needs to relax.

Your pelvic floor needs to be able to lengthen and relax so that the baby can pass through.

So we do a lot of work with just bodywork prepping for delivery.

Also, we work on addressing any pain that comes up, and those things are kind of hard to tell what's going to come up, depending on when we start your evaluation.

And so we like to go ahead and get started, come in, establish a relationship with a pelvic floor therapist so that then as something pops up, you can kind of get back in pretty quickly and like get started working on it, rather than trying to at that point figure out, okay, who do I want to see?

Do they have availability to get me in?

Things like that.

So we also work through birth positions, and then we manually check the muscles of the pelvic floor.

And so the thing that I like to say on this is a lot of people will say like, oh, well, I don't have any pelvic floor symptoms.

I'm not having any leaking during my pregnancy.

I don't have any pain, so I don't really need to get checked, right?

And the thing is, unless we actually check, we're just guessing.

And you deserve more than a guess.

You deserve to actually know what your pelvic floor is doing.

And so definitely getting checked during pregnancy and just doing all of that prep to get ready for delivery.

Then postpartum, this is when we're just kind of putting all the pieces back together.

We'll work through what actually transpired during delivery, what positions were you in, what actually happened during that time, how long did you push for, did you tear, anything like that.

And also have you had previous deliveries that have they had tear afterwards as well?

And just kind of putting everything back together, working through all of the symptoms that mom is having and then getting her back to whatever it may be that she's wanting to get back to.

I feel like I'm just sitting over here in my brain going, preach because I have so many family and this is why we do this, right?

This is why we wanted to do this podcast is because we can tell people all day, you need to see a pelvic floor physical therapist or you need to see a chiropractor or a lactation consultant could help you.

But hearing it directly from you on the why, because we know the basics, but you put it so much more eloquently and I am just so glad people are going to get this information.

The thing about being able to relax your pelvic floor, I am constantly trying to find new ways of saying, relax your bottom, because in labor so many people are tensing up.

So I have found that the people that do pelvic floor PT during their pregnancy, and I know you guys do talk about pushing and ways to push, like this push prep thing people are doing.

Before I knew anything about it, I thought it was kind of funny or silly.

It is gold.

These people are pro pushers because they are knowing what muscles to relax, what muscles to use, and having you guys do that manual, I mean, physically having them touched so that they can feel what those areas are feeling like is really priceless.

Yeah, absolutely.

Yeah, I totally agree.

I always tell moms who are nervous about pushing and they're like, oh, I've been doing all my Kegels and I have a really strong pelvic floor.

I'm like, no, please stop.

That is not, that's not the goal there.

If you want to work on practicing for pushing, go see a pelvic floor therapist.

They will give you the exercises.

They will give you exactly what you should be doing to help with that process.

How long should someone wait before they come in postpartum?

So this really depends on what symptoms we're looking at traditionally.

So most commonly, somebody would come in for their first check at about four to six weeks postpartum.

We definitely want to make sure that the cervix is closed and that the bleeding has stopped, just so that we make sure we're not influencing any sort of infection risk.

That is specifically for doing an internal examination, which is typically going to happen at that first evaluation.

But there's plenty of other things that might warrant a visit that has nothing to do with internal work.

And so those things can start sooner.

For instance, a lot of moms experience a lot of upper back pain, especially with nursing.

And so if you're having a lot of pain with that, that's something that we can address.

We don't need to wait a whole month or six weeks after delivery to address that.

We can start working on that sooner.

And they would go to a pelvic floor PT even for the back issues?

Yeah, absolutely.

So we specialize in the pelvic floor, but the pelvic floor doesn't exist in a vacuum.

So we still treat head to toe.

We just have specific knowledge for things that are going to affect the pelvic floor.

But if I just treat somebody's pelvic floor, their things are going to come back really often.

We're regularly looking at the upper back, the neck, the ankles.

There's so much that goes into treating a whole person rather than just the leaking they're having or the pain they're having.

Yeah, that's awesome.

So when people are coming in at six weeks postpartum or whatever, do people bring their newborns or older children to their appointments?

It depends on the clinic, but at my clinic, yes, that's very, very common to have little ones in here.

We're all very ready to have little ones in here and know that sometimes there's some noises associated with little ones, and that's just fine.

There's also clinics that will do mobile visits so they'll actually come to mom.

So it's something that we do as well.

So that, you know, in that, especially those first few weeks, the goal is rest, stay in bed, and bond with baby.

And so sometimes it's helpful when we can come to you instead.

Yeah, that's so helpful.

It can be just so overwhelming for moms having all these different appointments and having to, you know, bring baby to the pediatrician and then to the OB and then to the, you know, chiropractor and physical therapist and all these different things.

It's just can be so overwhelming, especially when we're telling them, you know, you're supposed to spend a week in bed and another on the bed and another near the bed.

And then we're like, oh, but also we have 35 appointments for you to go to.

I feel like that's such, it shouldn't be a luxury, but it sounds like such a luxury to have a lactation consultant come to you and there are mobile chiropractors and you can get a massage in your own house and having the physical therapist come to you.

It shouldn't be a luxury, but my gosh, that would be amazing.

How often do people typically need to come in?

So this really depends person to person.

It depends very much on what stage of care we're at.

So things are going to look different during pregnancy than they are during postpartum.

Oftentimes we'll get somebody that's just trying to establish care with us, maybe in their first trimester.

They know they're going to need pelvic floor therapy, but they're not really having any symptoms at that time.

And so we're not going to be working super regularly early on.

It's going to increase in frequency with trimesters.

So we get a little bit more frequent during second trimester and then a little bit more frequent during the third trimester also depending on just whatever symptoms they're having.

And then the same thing for postpartum.

It really kind of depends on what actually happened during labor and delivery, what symptoms are having afterwards.

Most of our clients come in about once a week when we're in that postpartum recovery phase.

But we also spread visits out as we get towards the end.

So it really kind of just depends on the person and what symptoms they're having and what they're wanting to get back to.

What's the biggest piece of advice that you would give to someone?

It can be for pregnancy or it could just be to all women in general about pelvic floor.

And also, I mean, I guess men sometimes need pelvic floor therapy as well.

So I guess we didn't even touch on that, but what would be your advice?

So I'd say if you are not getting the answers you're looking for, keep looking.

The number of women that end up sitting across from me at my desk and telling me like, I went to get my questions answered about why I'm leaking.

And they told me, well, you've had four babies, so just deal with it.

Like it's just normal.

And when you can't deal with it anymore, let me know and we'll do a hysterectomy, which just blows my brain because those are to very deal with it and like take out an organ or like opposite sides of the spectrum.

There's so much that can happen in that time, but that's true for so many things.

Like if you go to whatever provider and they do scans and they see that like structurally things are fine.

So you must be fine then, right?

And that's not true.

You just need different people with different pieces of the puzzle who look at different parts of what's going on.

So I, you know, am not going to do x-rays or ultrasounds on organs or bones to see if they're whole and complete.

That's a different piece of the picture that I refer to somebody else.

But then when we're looking at, hey, everything is whole and where it's supposed to be, but it still hurts, okay, come to me.

Let's figure out what's going on there so that you're not having these symptoms all the time.

Yeah, that's really helpful.

I think that so many people feel really unheard and they feel like everyone just thinks they're crazy because they're having some sort of ailment, pain, feeling, and nobody takes it seriously because, well, you just had a baby.

It's, you know, same thing with mental health, you know, oh, it's just the baby blues.

You'll be fine or yeah, it's hard.

So I'm so glad that there are people like you that we can refer out to because feeling heard also can help so many of those other things like mental health.

Can you tell people how to find you if they wanted to?

They're like, oh my gosh, I loved Doctor Emily from the Birth, Baby!

podcast.

How would they go about finding you?

So my practice is in Georgetown, Texas.

It's Pillar Physiotherapy.

So we specialize just in pelvic floor symptoms, and we specifically just treat women.

I liked what you said earlier about male pelvic floor.

That is absolutely an area that requires specialists and people who work specifically on that.

My practice just specifically doesn't do that, but there's others in the area that do, and I can always get people connected with those if that's what they're needing.

But so I've got my practice in Georgetown, Texas.

We do also offer mobile visits as well.

And then we're on Instagram, Facebook, and TikTok at Pillar Physio.

We will definitely add those notes in the show notes of people, how people can find you.

That's really interesting that you only work with women, and that's pretty cool, because I will say, when I went to a pelvic floor PT, when I had a tiny baby and I'm going in with a stroller and my burp rags and being thrown up on during my exams and everything, there were men in the waiting room.

And that was a little bit, it's fine.

But it did feel a little weird to me that there were these older gentlemen that are dealing with prostate things and all of these things that they're in there for.

And I'm sitting here in my postpartum body with my boobs leaking onto my shirt.

So I really like that, that you have a women's only practice.

That's pretty cool.

Yeah, we've loved it.

It's been great.

Well, thank you so much for being here with us today.

I think that our listeners are going to get so much great information and we hope to talk to you soon.

Thanks for having me.

Thanks for joining us on this episode of Birth, Baby!

Be sure to tune in next week as Ciarra and I talk about pain management options during labor.

Thanks again to Longing for Orpheus for our music.

You can check him out on Spotify.

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