Katie Bayer: Transforming Postpartum Recovery with Pelvic Floor Therapy

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Hello, today I have with me Katie Bayer, pt, dpt.

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Katie is the owner of Transition Physical Therapy in Vienna, virginia, and a pelvic floor pregnancy and postpartum specialist.

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She loves helping women prepare for birth and recover in postpartum, along with assisting them at any point along their pelvic floor journey.

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Katie is a mom to three girls twins, 13 years old, and a singleton, 10-year-old.

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Her own pregnancy and postpartum story, including her own VBAC, set her on a path to treating others going through the same experiences.

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Her goal is to arm people with information and help them to prepare for birth and postpartum and beyond.

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She, along with Megan McCutcheon, is also the co-founder of Beehive Wellness, a collaborative space with multiple holistic providers who support women and families, especially during their perinatal journey.

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Katie, welcome and thank you for joining me.

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Thank you, I'm so happy to be here.

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Yeah, it's been a long time coming, but we finally made it happen.

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Yes, I'm glad happy to be here.

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Yeah, it's been a long time coming, but we finally made it happen.

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Yes, I'm glad to be here now.

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I love it.

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Well, I want to hear about your twin pregnancy and then your VBAC, and then how that affected your body and how you made the choice to help women along their motherhood journey.

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Yeah, so when I first became pregnant.

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So we got pregnant pretty easily.

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We had been dating a long time, got married and I just kind of figured I don't know why this is going to take a while, it's just like start now.

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And at the time I wasn't a pelvic floor physical therapist, so I was just kind of a regular PT and knew surprisingly little even as a physical therapist, about pregnancy, about postpartum, about really nothing about the pelvic floor.

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So I'm going into this, you know, pretty blind early on.

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So we got pregnant and it was very much a surprise that it was twins.

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They actually missed twins on the first ultrasound.

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So at 12 weeks we luckily my husband was there for that one we had another ultrasound and it was like, oh, did the doctor tell you there are two?

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Because we had our ultrasounds shipped out to the local hospital actually where I worked.

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So that was a big moment and that was actually the day that I was announcing to my coworkers I was pregnant.

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So I came down and just like bawled and just was really honestly, like I say, you know, I'm going to someday tell my daughters.

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It was a very scary, emotionally charged day when we found that out and it was just shocking.

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I think we were just in shock for a good long while and then, you know, we settled in and the actual pregnancy of the two was actually easier, partially, I think, because I ended up going early.

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So I felt pretty good, I was 33 weeks and I felt like in the middle of the night I felt pretty good, I was 33 weeks and I felt like in the middle of the night maybe one of them had kicked my bladder and I peed but my water broke and pretty quickly progressed.

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And then, because they were small, the doctor was really good, I have to say I did like that practice.

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You know he really wanted me to understand why a C-section he felt was the best route, because they were little and baby B was transverse.

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And so they said we really just feel like this is best, you know, for babies.

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And I said, and I knew, you know, going in with twins, the chance of having a C-section was higher, no matter when they came.

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So I think I was just mentally prepared for that and so and it was just quick Now I know I go through labor very quickly.

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So actually they had put the spinal in and I was.

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You know they were getting ready and prepping me and baby A was coming out.

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So baby A had decided to start her little delivery.

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So they actually had we had 20 people in the room so like, basically, you have, each baby has a staff, has a whole team.

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So we had, through the you know, the sheet in front of you, the drape that they put up and they had to kind of put her back in to then deliver her via C-section.

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And then you know, baby B is very quickly, one minute later delivered and they went straight to NICU.

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So it's kind of a quick, you know, kiss and go moment.

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Looking back, I mean, obviously it's scary anytime your baby is going.

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It was early and going to the NICU and they did need support but they really were fine.

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Like when I talked to a friend who's a NICU nurse later, she's like, oh yeah, they were just like feeder growers, they just needed time.

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So they were there for about a month, three weeks and four weeks for each of them and then came home on heart monitors, which was stressful.

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That was probably.

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The NICU was stressful, but if anything, you know, I had just recovering from a major surgery and I could sleep.

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I woke up to pump and then I went back to bed.

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So it was kind of.

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You know, the silver lining to it all was that I actually had more time to recover.

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So we just kind of did the daily drives.

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You know, I would go a couple of times a day and my husband would go after work at night and then, you know, once they were home, we had some family support, which is great.

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Both of our families came down, both of our moms stayed for a bit, and that's that was very welcome.

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They're very good and just helpful where they need to be.

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But we lived in a place without family and so you know, they couldn't stay forever and that was challenging to have that.

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But you know, I would say the first year is a blur I'm not going to go too far out of like the you know, the birth journey, but my twins are like you know, what do you remember and what were our first words?

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And I'm like, honestly, I don't know, I didn't write it down.

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I was in a blur.

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We were just trying to keep them on schedule.

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I wrote down everything because I couldn't remember anything and it was just.

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It was just a lot of schedule maneuvering and just kind of trying to keep them, you know, somewhat together to keep sanity.

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So we, our original plan was to do, like you know, every couple of years, you know, have a kid.

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But for us it pushed the second pregnancy a little later.

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So my youngest was three and a half years after the twins and that was a very nerve wracking first ultrasound, I will tell you, because we didn't plan on having twins the first time and we were nervous about that second one because they missed it on the first.

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We were the new practice, we had moved to the Northern Virginia area for this one and so they looked a long time to make sure there was only one.

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And so that was definitely just a relief, you know, just to be able to have kind of a single pregnancy and kind of hope for a more standard or whatever that means, kind of normal delivery and birth.

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But I was diagnosed with gestational diabetes with her, so that was just.

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I mean, it was challenging in some ways because you know you have to monitor everything and you have to eat very healthfully.

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But then because you eat really healthfully, like you don't gain as much weight and you just feel a little bit better, and I exercised, and you know, by the end of the twins pregnancy we were living in New Jersey and I was like pizza every day, you know, ice cream.

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It was great.

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But with this one it probably was good in some ways that it forced me to be a little bit healthier.

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With that pregnancy, because of the gestational diabetes, the with that pregnancy, because of the gestational diabetes, the practice that I was in I didn't love.

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Now, looking back, I think I would have gone with somebody else had I known more about them.

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But they were a large practice and they just kept kind of scaring me a little bit into like, oh, this baby's going to be a linebacker.

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You know she's going to be huge.

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Actually we didn't know what we were having.

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So the baby's going to be huge, baby's going to be a linebacker.

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And you know she came two weeks early, which I'm glad for.

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It was like after 33 pregnancy.

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Like 38 weeks felt like forever, but she was, you know, seven, four.

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She wasn't a huge baby and she maybe would have been, you know, closer to eight had she gone to extra two weeks, but who knows?

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But anyway, so that pregnancy was actually much harder on me and the gestational diabetes I'm sure was contributing.

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But I also had really bad varicosities in my leg.

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I worked full-on compression hose the entire pregnancy, which at the end of any pregnancy is so hard to get on, but I literally could not have like worked or walked around without them.

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So it was totally worth it.

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But not easy, and so physically this one really took its toll on me, much more so that it felt like the twins did, and you know I'm three and a half years older as well, so I'm sure that contributed.

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So she came the same in the much the same way in the middle of the night, more like 430.

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Water broke.

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I always had the pop in the gush.

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So with each pregnancy I kind of had the very obvious start and then, you know, call the doctor, they say take a shower, count your contractions.

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So I shower and I can't count my contract.

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I'm like am I bad at this?

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I don't know what to do.

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It's not, I'm not.

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The math isn't working out.

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I think I was basically just in like full on labor, no contract.

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They were just like one long contraction really quickly, because when I got to the hospital an hour later I was eight centimeters.

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They're like why weren't you here earlier?

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And I was like I had no reason to be here earlier.

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Like I didn't feel like I was in labor, so and then I had her.

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You know, basically from beginning to end it was like four hours, so it was 430 to like 830 in the morning.

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So I think the only reason because the hospital I delivered at is known for C-section and not good about VBACs, but she just came so fast and furious there was really no other option and she, you know, was able to be delivered pretty easily.

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So it was hard, I mean, it's challenging.

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I did get an epidural, even though it was fast.

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That was my plan and it worked, but I'm not sure how intense it was.

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So I felt much of it, but it was what I wanted.

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It was that, you know, I wanted the VBAC.

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Had I had the C-section, that would have been fine too, but I really was hopeful for the VBAC and so I was glad to get that.

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And she came right home and it was nice having just one baby to hold and I have to kind of schedule, you know, around a second baby and breastfeeding was easier.

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I never the twins never really got breastfeeding, and so it was nice just to have one, you know, to be able to do that which I wanted to do.

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So, yeah, so those are my birth journeys, birth stories, and you know, I think I'm not sure we'll talk about all the things I've learned, but I just know like through my experience, I realized how little I knew about everything, and I'm a profession that you know, as a physical therapist.

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I feel like I should have known more and so, god, there's so much now that I would go back and do differently now that I have this breadth of knowledge that I have now and that really all that whole entire journey really both of them is what inspired me to kind of go on and learn the kind of pelvic floor pregnancy portion of physical therapy.

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Yeah, that's so important.

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I feel the same way.

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I feel like I mean, even now there's not a lot of knowledge within the medical field, it's just starting.

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People are starting to send people to pelvic floor physical therapy, but then I still hear people talking about oh, do your Kegels, and I'm like I think we've moved past that.

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No, we have.

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That's what we learned in nursing school, right, and even that there's so much nuance of whether you even should do Kegels, I mean.

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But I was in stirrups after the second pregnancy and mentioned something about you know leakage or something which I didn't have a big issue with.

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It's like ah, you can do Kegels, but it doesn't work.

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I was like great Thanks, that's the only speech I got about anything postpartum and it was like great.

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Yeah and not helpful.

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So my I guess my question as far as, like the pelvic floor physical therapy is what do they teach in PT school?

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Because I find that not many physical therapists that aren't specialized in pelvic floor really know to even pay attention to it.

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I will say, when I graduated in 2007, nothing, you know, I'm trying to think back Was the anatomy even like referenced?

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It probably was, but like never in, let's say, cadaver lab, which we look at everything, we definitely didn't dissect that.

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It really wasn't spoken about at all.

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I think it's better now, but I also think the people who are choosing to go into it earlier are actually entering these courses, these extra courses, while they're in school, versus getting the knowledge in school.

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I'm sure there are some schools that are better.

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I just, and to be fair, I think that the physical therapy degree you're supposed to graduate as an entry level and pelvic floor therapy is this extra training, but I think more attention needs to be paid to it, not as a like pelvic floor internal, this whole other separate, very specialized thing, but the pelvic floor is a part of our core, it's central to our body, it's a sump pump for vessels, it's all of these things that everybody needs to pay attention to.

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So I do wish and hope now that it's being paid attention to more.

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It wasn't when I was in school.

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Yeah, all I remember is my professor in nursing school saying that she does Kegels at Red Lights.

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And that's all you need to know.

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That was all I got.

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Yeah, that's probably more than most.

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I feel like I was lucky because we had a Pilates studio down the street from me in New York that I went to and I did like private classes because I knew I had back problems and so I knew that I needed to help strengthen my back, but they focused on the pelvic floor.

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That's good, yeah.

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So I feel like I got a lot of pre-pregnancy help, but the problem was I felt like when I was pushing it's the opposite, so it would have been helpful to know how to release my pelvic floor so that I could push my baby out and we moved away.

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So then after that, I just kind of didn't do anything, and I wish that I had, because after my second was born, I really needed pelvic floor physical therapy and I went ahead and got it, but I just feel like I could have done more at home, and the physical therapist that I went to she was lovely, but she hadn't had kids, so she was very receptive to my feedback of like this is overwhelming I'm not doing the exercises.

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I love the suggestions you're making.

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However, it's not being worked into my life, and so then she was great about asking me okay, well, when you're doing, what are you feeling, like the heaviness, and I'd be like running up the stairs, and she'd be like, oh, blow out when you're running up the stairs.

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And that was a game changer.

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And then the same thing for, like, when you're sitting down or standing up, you know, having the right pelvic tilt and the blowing out and the making sure that you're not bearing down.

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And it was the practical things that were so helpful for me because, honestly, at that stage in your life it's so hard to do the exercises you're supposed to do.

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Yes, so I'm sure you have a lot of insight into that.

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Yes.

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So it's funny because, as a new grad before I got into this, but even just like a fresh graduate, you're like everyone must do their home exercises.

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Come on, let's be diligent, let's check these off three times a day.

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Two sets of 20.

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And over time, as you learn more and definitely doing what I do and treating who I treat, I just ask them first, what is your bandwidth right now?

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Like what do you actually have space for?

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If you're fresh postpartum, I know it's not much because you're not sleeping.

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If you have a toddler, there's zero time.

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It's your first, it's still there's just there's so many layers to it, and so you have to meet them where they're at, because otherwise you're not going to get them better by telling them to do stuff they're just not going to do.

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So I like to offer, if you feel like you have time and someone says, yeah, I might be able to eke out some time, here are some things you can do Other than that.

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Let's just either just work on the functional things like you're talking about, or when you're standing at the microwave, can you do this like one little thing.

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Or when you're doing this, can you do this one little thing and try to like infiltrate it into your day, which, honestly, for most people that's the best way to do it.

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But especially in this time period where you just you're not going to get 30 minutes even if you have it, most won't give themselves 30 minutes to just be like.

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I'm going to go on this run, I'm going to ignore all the crying, I'm going to lie here and do my pelvic floor PT.

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And you know, if somebody says they can do that, great, like that's, we can mold to that too, but the majority don't.

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Or they say they will and they can't, which is no judgment.

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No judgment Like I never.

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I think people, people come in and they're like I feel so guilty, I didn't do my home exercises, and I'm like, okay, that's fine.

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Well, how do you feel?

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You know, like if we really are still feeling bad, let's really try to sneak them in somewhere and see if it helps.

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But let's just take each day, each moment like.

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This is a stage of life where this is what it looks like.

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You don't have a lot of time, so what can we realistically do or fit in?

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Yeah, and not that it's ideal, but you can fit them in more later.

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You know, like it's kind of a lifestyle change rather than let's get the pelvic floor taken care of immediately after birth.

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Yes, and that's also what I tell people.

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This is a journey from here until you die.

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Really, like you know, we're going to have this pelvic floor.

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Right now is a really good time, a really important time, to really address some issues.

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You're in this perinatal period where you're making and delivering humans, your hormones are all over the place, and then we have this gap where you'll have hopefully a little more time to pay attention.

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But it's not like, oh, we stuck that pin in, we did pelvic floor physical therapy, we're better, and then the rest of your life.

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You don't have to think about this stuff.

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Like the stuff I'm teaching people.

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I'm like this, really, this is like forever stuff for the most part, especially all of the functional things and then exercise.

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I really just tell people let's try to integrate what we've taught you here into whatever you like to do, because if I tell you yoga is great for you and you hate yoga, you're not going to do it.

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So what do you like to do?

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And let's try to marry everything together.

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But then I'm trying to keep this person in front of me out of a nursing home for incontinence or not having UTIs, and that's what kills you in the end, because that is ultimately that's what sends us into nursing homes and increases our death rate.

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So my goal is now, but forever learning lifelong things that also are just more easily infiltrated into your life versus a task you have to do and check off every day.

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Yeah, that's so important.

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Before we move on, I know I want to talk to you about how you prep people for birth because, I mean, I just happened into Pilates so I had no idea that what I was doing was a good thing to prepare for birth.

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But I've heard that a big part of what can exacerbate the issue in the postpartum period is how you sit while you're breastfeeding.

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Like you spend so much time breastfeeding.

00:17:07.728 --> 00:17:09.491
How do you address that with moms?

00:17:09.491 --> 00:17:16.242
I know you're trying to go through the specific points of the day and try to focus on how to be better in those points.

00:17:16.242 --> 00:17:17.326
What about breastfeeding?

00:17:17.326 --> 00:17:17.867
What are some?

00:17:17.948 --> 00:17:19.432
Yeah, so any kind of feeding.

00:17:19.432 --> 00:17:23.067
So you're spending many hours in this position, especially initially.

00:17:23.067 --> 00:17:26.656
There's just a lot of time spent sitting, generally Early on.

00:17:26.656 --> 00:17:28.628
I like to recommend a variety.

00:17:28.628 --> 00:17:33.369
So if you have a couple stations in your house, that's ideal because it just gives you a variety.

00:17:33.369 --> 00:17:34.534
Our body just likes variety.

00:17:34.554 --> 00:17:36.086
It doesn't like being in one place for too long.

00:17:36.086 --> 00:17:41.549
If you have one station, that's fine, but you need to have support, and I don't just mean a boppy.

00:17:41.549 --> 00:17:50.192
So people come in, they have their like pretty glider and they have their one boppy and then they try to breastfeed and then they're in pain because it just doesn't offer enough support.

00:17:50.192 --> 00:17:55.073
You want something that is super supportive, probably shoving a couple of pillows behind your back.

00:17:55.073 --> 00:18:00.582
I think I ended up.

00:18:00.582 --> 00:18:00.960
I hated the Boppy.

00:18:00.960 --> 00:18:02.741
I eventually used it with like two or three pillows, but you just need like.

00:18:02.741 --> 00:18:03.499
You want like all the pillows, just like.

00:18:03.499 --> 00:18:06.358
Put them all in your little space and it's not going to look pretty, I think.

00:18:06.358 --> 00:18:10.733
Like you know, on Pinterest or Instagram you see these like beautiful little nursing areas.

00:18:10.733 --> 00:18:17.150
Just shove it filled with pillows and support yourself so that you're not bending down because you're not going to be.

00:18:17.190 --> 00:18:21.455
Our bodies aren't meant to be in one passive position for long periods of time.

00:18:21.777 --> 00:18:29.655
So I say, assume you're going to get tired and start to collapse, but if you're supported then at least you're, you know, in a good position.

00:18:30.237 --> 00:18:42.439
Move as you can so, like you know, little movements like rocking your hips, call it seated cat cows, you kind of once baby gets a little bit more accustomed and you're not putting all your attention to like just trying to keep everything going with the breastfeeding it's easier.

00:18:43.006 --> 00:18:54.676
But creating a little bit of movement, trying to have a variety of how you're sitting, which way you're propping, which breast you're starting with Sidelining, is great if the baby can do it, because it just gives you again just a variety of positions.

00:18:54.676 --> 00:19:09.692
Plus you can be a little bit more neutral and then not that like hunch forward position and I would say you definitely want to see a lactation consultant if there's any issues, because if there's issues you're just going to constantly be battling and you can't think about your posture if you're battling and trying to get your baby to feed.

00:19:09.692 --> 00:19:27.757
So I would say, just like all the ugly pillows everywhere, support, you know, don't worry about looking pretty, and then, as much as you can, have a variety of positions, including in sideline, and then get some help if you need it just so that the actual task can be as quick as it can be and as efficient as it can be.

00:19:27.777 --> 00:19:30.527
I'm just having like these flashbacks of breastfeeding all night long with my son.

00:19:30.527 --> 00:19:31.869
That was just attached to me.

00:19:31.869 --> 00:19:35.807
I had the my Breast Friend and I would put it on like an inner tube.

00:19:35.807 --> 00:20:06.436
I'd have it all the way up to here because I don't have large breasts, so we had to be right all the way up and then just stacked with pillows in the smack middle of the bed because he didn't want to ever stop and I was like basically up all night trying not to fall asleep, and so I had all that stuff next to me to try to avoid dropping him, like I had every everywhere, and I would just clasp my arms and just anytime that I'd start to feel myself relax and let go, I'd startle myself awake.

00:20:06.877 --> 00:20:11.444
It was awful, I mean, of course, my pelvic floor was destroyed by the end of that 16 month period.

00:20:11.444 --> 00:20:13.511
Yeah, it's hard on it.

00:20:13.511 --> 00:20:17.105
Yeah, it's really bad, and I had no idea at the time that that was contributing.

00:20:17.105 --> 00:20:21.173
I just really tried to just get to the point where I could stay upright and not drop him.

00:20:21.173 --> 00:20:31.186
Yep, because it was like if I could put him down for an hour he'd be up in an hour and it just got to the point where it wasn't sustainable and I couldn't I mean half the time.

00:20:31.186 --> 00:20:34.848
We just end up there, because as soon as I'd wake up I put him down.

00:20:34.909 --> 00:20:42.332
But it's hard and I say like there's ideal, obviously, and then there's real life and there's sometimes where if you, if your baby's always like that, you have a choice.

00:20:42.332 --> 00:20:46.074
I mean, it's in the middle right, like I feel like you can try to get help for certain things.

00:20:46.074 --> 00:20:57.079
So maybe something would have helped that journey if you had I don't know hired a lactation sleep consultant, something maybe not, because sometimes just that it just is what it is and so it's like you know, is there something you can do?

00:20:57.079 --> 00:20:59.260
Let's like look into that, let's see if that would help.

00:20:59.701 --> 00:21:11.311
If there's not, okay, what can we do to work within this framework that you have and that isn't going away anytime soon and it's not always pretty, but we kind of make it as good as we can and then maybe clean up a little bit after.

00:21:11.311 --> 00:21:12.194
But there's a lot.

00:21:12.194 --> 00:21:18.134
There's a lot of small things you can do how you hold, you're not breastfeeding, what can you do, like, when you get up, what are some things you can do.

00:21:18.134 --> 00:21:21.298
So there's little things you can add in to make it a little bit easier.

00:21:22.099 --> 00:21:32.413
Yeah, Just like you said you as a physical therapist, me as a nurse it was amazing, Even in my second pregnancy and birth, how little I knew and I mean like financial constraints as well.

00:21:32.413 --> 00:21:42.467
It's like you know, can I have somebody come take the baby and help them sleep, or do I just suck it up and deal with it?

00:21:42.467 --> 00:21:47.200
And I feel like I was just of the belief that I had to suck it up and deal with it, and I think a lot of moms think that.

00:21:47.200 --> 00:22:05.272
But at this point, even five years later, I feel like there's so many more resources that are affordable and insurance covers more now, like lactation and pelvic floor physical therapy, whereas it was hard to find five years ago for me to have something that my insurance would cover.

00:22:05.272 --> 00:22:22.107
So it's just interesting now that there's so much more out there and I think it's really important that we're encouraging moms to utilize their resources and they don't have to tough it out and there's not really a whole lot of benefit from toughing it out if there are now resources that are affordable.

00:22:22.208 --> 00:22:24.875
Yeah, and I think there's definitely like cost is always a factor.

00:22:24.875 --> 00:22:28.279
So you know, whether it's me or somebody else, I totally appreciate that.

00:22:28.279 --> 00:22:39.617
I think just culturally in our country, and I was very much like I'm, and I still this is a personality trait that I have to constantly kind of check in, that I am independent to a fault, I don't want help, I'm on my own, I'm good, no, I'm good.

00:22:39.617 --> 00:22:52.576
And so I think it's taking help from friends when they offer, you know, like no, no, no, we got it, we're good, we're good and you know, taking family, you know, if you want them there, taking whoever offers anything, even if you don't have a lot of good friends or family in the area.

00:22:52.576 --> 00:22:54.209
Your neighbor stops by, take it.

00:22:54.209 --> 00:23:07.923
You know, like, you know other cultures, in the first 40 days some women are literally not allowed to get out of bed and it's like we'll just flock, like women neighbors, family flock to them and they don't do anything.

00:23:07.923 --> 00:23:14.866
And you know they're shocked when they come here and it's like, oh, that doesn't exist and I don't know, we can't rewrite American history.

00:23:14.866 --> 00:23:15.887
That's not going to be the way.

00:23:15.887 --> 00:23:18.128
Probably we're not going to shift that severely.

00:23:18.808 --> 00:23:29.354
I think we need to understand that this is a time where if you're not giving yourself some time to sleep, to sit, not allowing some help in, it's like longer to physically heal.

00:23:29.433 --> 00:23:32.796
I talk to people about like you need to sleep and they're like, oh well, I need to do other things.

00:23:32.796 --> 00:23:35.017
I'm like you won't physically heal as fast.

00:23:35.017 --> 00:23:38.337
Your whole thing, your pelvic floor, everything won't feel as good.

00:23:38.337 --> 00:23:52.768
We're not going to be doing any intense work until, like, physical work, until you're sleeping, like I don't want you doing any kind of working out, until you're getting a good four to five, six hour chunk because you can't, your body is going to, it's going to give up on all the healing and try to go to all this other stuff you're trying to do.

00:23:52.768 --> 00:23:55.207
And as far as you know the cost thing, you know.

00:23:55.207 --> 00:24:39.040
I also think it's a framework of like what we think about as being important no-transcript address it now, and that's definitely true for public floor but even just thinking about like getting a little bit of extra help, like you'll be yourself back to work, back to more efficient mode quicker.

00:24:39.040 --> 00:24:42.164
So sometimes it's just a matter of viewing things a little bit differently, I think.

00:24:42.486 --> 00:24:43.346
Yeah, I agree.

00:24:43.346 --> 00:24:50.236
I think also some of it's just the overwhelm, Like you go to find resources to help you and then you're just like I don't know which one's going to help me.

00:24:50.236 --> 00:24:50.375
Yeah.

00:24:51.403 --> 00:24:52.299
Don't even know what to go with.

00:24:52.299 --> 00:24:53.826
No, because Google is overwhelming.

00:24:53.826 --> 00:24:58.765
I mean, there's just too many options and who the heck knows what's good and that's.

00:24:58.765 --> 00:25:08.696
You know, I'm probably getting ahead of myself, but that's what we kind of wanted here at Beehive was not only providers but like we have like a network of cards to be like OK, this person isn't here, but here's an option.

00:25:08.696 --> 00:25:23.653
Here's a person we know and met and we seems really good because Googling at 3 am for a lactation consultant like you said, it's overwhelming and you're exhausted and how can you think straight to like make a pretty important decision?

00:25:23.693 --> 00:25:25.576
Yeah, and that's why I think both of us are involved.

00:25:25.576 --> 00:25:32.444
I had the babysitter people on here, amy and Lindsay, and I really hope that they go nationwide, just because moms need it.

00:25:32.444 --> 00:25:36.520
We need a service registry and we need curated recommendations and so that we're not up on that, because all of us have done it.

00:25:36.520 --> 00:25:45.932
All of us have been up all night Googling who's going to help us, and I think that's why we all do what we do right now, because we don't want anybody else to go through that 100%.

00:25:45.991 --> 00:25:46.132
Yep.

00:25:46.599 --> 00:25:49.010
So we've talked about postpartum.

00:25:49.010 --> 00:25:51.059
How do you prepare for birth?

00:25:51.279 --> 00:25:51.701
Yeah.

00:25:51.701 --> 00:25:57.743
So it's funny because when I first got into doing pelvic floor, I really really thought more about that postpartum period.

00:25:57.743 --> 00:25:59.767
That's kind of what gets all the attention.

00:25:59.767 --> 00:26:09.916
But the more I did it and the more I worked with people, there's so much you can do to mentally, physically and just like on a knowledge level, prepare.

00:26:09.916 --> 00:26:13.547
So when you think about going into labor, think about being pregnant.

00:26:13.547 --> 00:26:14.990
I mean thinking back to when I was pregnant.

00:26:15.339 --> 00:26:17.626
I think most people don't even know what your pelvic floor is Like.

00:26:17.626 --> 00:26:19.522
You hear the word, but what the heck?

00:26:19.522 --> 00:26:20.204
What is that?

00:26:20.204 --> 00:26:21.970
Like a floor in your pelvis, like what is this?

00:26:21.970 --> 00:26:31.509
And oftentimes people are told to like kegel their babies out, and it's just obviously the opposite.

00:26:31.509 --> 00:26:33.275
Yeah, our pelvic floor does not push a baby out, and so there's things we can work on.

00:26:33.295 --> 00:26:39.654
So basically, my approach to pregnancy, for birth prep, is you want to open and release things.

00:26:39.654 --> 00:26:41.000
So, yes, we want to be strong.

00:26:41.000 --> 00:26:45.554
That is a part of the kind of pregnancy prep If somebody definitely has some weaknesses.

00:26:45.554 --> 00:26:54.384
But my primary thought process when someone's coming to me for birth prep is what is tight, what needs to be opened, because baby needs to get down into pelvis, baby needs to get through and out.

00:26:54.384 --> 00:27:03.028
So that's, you know, abdominals, that's looking at the diaphragm, because if baby's kind of getting shoved, you know, in certain places it's just less likely for them to be in a good position.

00:27:03.028 --> 00:27:09.625
So I want there to be an optimal kind of release and opening throughout the entire kind of canister we call it, like diaphragm, all the way to pelvic floor.

00:27:09.625 --> 00:27:15.407
If you've had a C-section when you're prepping for a VBAC, you definitely need scar work.

00:27:15.407 --> 00:27:20.364
If you haven't done it, and as your belly grows, we need to work on that scar tissue because it's like a block.

00:27:20.364 --> 00:27:25.090
You know you have this tissue that can just stay tight and kind of prevent baby from being able to drop down.

00:27:25.632 --> 00:27:26.973
And then the pelvic floor.

00:27:26.973 --> 00:27:36.107
It's a combination of making sure that there's the ability for it to lengthen and to open, but it's also for the person to connect to it, cause like, how often do we touch our pelvic floor?

00:27:36.107 --> 00:27:38.963
How often do we even know what that feels like to?

00:27:38.963 --> 00:27:40.968
I mean, you kind of can feel what a Kegel feels like.

00:27:40.968 --> 00:27:49.973
Most people don't know how to lengthen or open their pelvic floor, and then we do look at pushing a little bit, but as long as the person knows how to activate their core properly with breasts, which we work on.

00:27:49.973 --> 00:27:57.702
I don't go into that too much because it just becomes so overwhelmingly automatic as you do it and you really have no choice but to push once you feel like you have to push.

00:27:57.702 --> 00:27:59.506
So we go over a little bit of the core mechanics.

00:27:59.506 --> 00:28:03.673
But really that pelvic floor opening lengthening, that sometimes includes internal work.

00:28:03.673 --> 00:28:06.337
But if someone doesn't want it or can't have it for some reason doesn't have to.

00:28:06.337 --> 00:28:07.762
There's other ways to kind of get around it.

00:28:07.762 --> 00:28:10.570
But to me that's the best way because it's feeling.

00:28:10.570 --> 00:28:13.509
What does it feel like when this area is open and feel stretched?

00:28:13.509 --> 00:28:17.382
Okay, can I access my breath to allow it to release even more?

00:28:17.382 --> 00:28:18.584
What does that feel like?

00:28:18.844 --> 00:28:26.736
And then, talking through the different positions of your hip and your spine to open both the top of the pelvis and the bottom of the pelvis.

00:28:26.736 --> 00:28:37.073
So earlier in labor you do certain things to open the top of the pelvis, later in labor there's just hip and sacrum or spine positions to basically allow that bottom part of your pelvis to open up better.

00:28:37.073 --> 00:28:39.539
And then how do we apply that to different positions?

00:28:39.539 --> 00:28:44.429
So even if you have an epidural, you can still be in different positions, especially if you have a doula.

00:28:44.429 --> 00:28:46.172
I mean the more people in the room the better.

00:28:46.172 --> 00:28:52.011
But you know, nurse and partner can help you get into all fours, can help you definitely into sidelining.

00:28:52.640 --> 00:28:55.887
Birthing on your back is not evil, but it just shouldn't be forced upon you.

00:28:55.887 --> 00:28:58.442
So if you end up there, that's fine.

00:28:58.442 --> 00:29:02.749
I've had people come in feeling really guilty that they birthed on their back and I was like, well, why, you know?

00:29:02.749 --> 00:29:05.413
And they were like, well, I was just so tired, I just felt like the best place.

00:29:05.413 --> 00:29:06.515
Well, that's fine.

00:29:06.515 --> 00:29:11.950
But here are some, you know, tips to get it to the point where you can open up your sacrum a little bit better so it's not getting squished on the bed.

00:29:12.291 --> 00:29:21.711
So kind of just basically talking through all the options, having them practice it somewhat when they're pregnant and then really trying to hone in the fact that it's not a plan.

00:29:21.711 --> 00:29:23.333
It is kind of like your preference.

00:29:23.333 --> 00:29:27.378
I always say you're going to maybe like certain positions and certain things.

00:29:27.378 --> 00:29:30.376
You're going to get into the delivery room and you're going to hate all those things.

00:29:30.376 --> 00:29:34.827
You're going to want something different and that's fine.

00:29:34.827 --> 00:29:40.084
And as far as like even the positions and the hip and the back, I'm like here's the black and white of it.

00:29:40.084 --> 00:29:42.186
When this happens, this happens in your pelvis.

00:29:42.186 --> 00:29:53.766
But you know what, if you're late in labor and you want your knees in the other position and it feels good to you honor what's happening in your body, we give you the script.

00:29:53.766 --> 00:29:56.038
But you know, go off script based on how you feel, and then if you have an epidural, you really can't feel anything.

00:29:56.038 --> 00:29:58.807
Then you can kind of stick to the script and at least you have some guidance that way.

00:29:59.147 --> 00:30:00.412
Yeah, that's also important.

00:30:27.359 --> 00:30:39.346
no-transcript well, it depends because everybody you know, depending on when you're coming in for pregnancy, you can have some pain or swelling or issues.

00:30:39.346 --> 00:30:44.669
So you know that's always considered and sometimes we don't even do truly internal.

00:30:44.669 --> 00:30:50.028
We're kind of a little bit more on the outside, really, just kind of at the opening of the vagina, versus really going inside.

00:30:50.028 --> 00:30:52.761
But yeah, you definitely can, as long as there's no cervical issues.

00:30:52.761 --> 00:30:55.049
Basically I tell patients if you're allowed to have penetrative sex.

00:30:55.049 --> 00:30:57.281
We're doing a lot less than that.

00:30:57.281 --> 00:30:59.203
So as long as that's safe, we're good.

00:30:59.203 --> 00:31:03.209
We generally would get a prescription from a provider anyway because they're being seen by them.

00:31:03.209 --> 00:31:07.454
But I have zero concerns and I feel like there's so much benefit.

00:31:07.775 --> 00:31:12.196
There's always like a discussion of when to start and some people don't do until third trimester.

00:31:12.237 --> 00:31:21.703
I usually start within the second and I avoid the first trimester, not because I actually think it does anything, but because there's a higher risk of miscarriage anyway.

00:31:21.845 --> 00:31:26.372
And if we do internal work and you miscarry, I truly don't believe there's the cause of it.

00:31:26.392 --> 00:31:41.489
But if you link those two things then I feel like pelvic floor PT will always be a little bit of a challenge for you and I don't want anyone to ever feel like A they did something to themselves or like made a choice, you know, to do something to themselves, or I don't want them to ever link the two things because I think it's so important.

00:31:41.489 --> 00:31:43.492
So that's honestly the only reason I really avoid it.

00:31:43.492 --> 00:31:47.221
But once they, I mean we have plenty of time so there's no rush really either.

00:31:47.221 --> 00:32:14.201
But if somebody has pain, whether they have something like called vaginismus, which is just tightness and pain without having a baby, so without a postpartum issue or if they have previous scarring, perineal tear and scarring we definitely want to be doing internal, especially if they haven't done anything before, to try to release and open some of the scar tissue or address some of the pain and whatever the cause of it is, so that they feel more comfortable going towards a vaginal delivery, if that's what they want.

00:32:15.022 --> 00:32:17.628
Okay, last thing that's coming up for me perineal massage.

00:32:18.991 --> 00:32:19.393
Yes or no?

00:32:19.393 --> 00:32:28.705
Okay, so I would say evidence and my anecdotal whatever advice would be yes during pregnancy, a thousand percent Do.

00:32:28.705 --> 00:32:33.085
I think it helps in the end stage where they're like you're, you're crowning and you're rubbing.

00:32:33.085 --> 00:32:40.612
I think evidence is mixed, but mostly no, I'm generally not there and they can decide if they want that, but they can consent to it or not.

00:32:40.612 --> 00:32:44.601
I do think there is value and I think it's a combination of things.

00:32:44.641 --> 00:32:48.691
So is it because we're stretching the tissue and we're opening everything?

00:32:48.691 --> 00:32:51.224
Maybe that's a part of it, especially if there's scar tissue.

00:32:51.224 --> 00:32:52.208
I think that is a part of it.

00:32:52.208 --> 00:32:58.957
I also think it's the connection of your brain to the area as you're doing it to understand.

00:32:58.957 --> 00:33:07.971
Okay, this is an area where I'm going to send my brain to open, release and I think honestly, it's probably a lot more that, especially with somebody who is their first child To me.

00:33:07.971 --> 00:33:24.788
A lot of the pelvic floor work I do yes, it's oftentimes to release things half the time is to connect to it, it's to find it with your brain, is to be able to access it with your breasts and it's be able to get that mind, body connection to this area that, for many reasons, I think is often ignored within ourselves.

00:33:25.609 --> 00:33:29.674
So it's not necessarily massage as we term it.

00:33:29.674 --> 00:33:31.722
It's more like mind-body connection.

00:33:31.782 --> 00:33:38.556
Yeah, it's a little bit of both, but I would say everybody benefits from the mind-body and then some people would benefit from the actual stretch.

00:33:38.556 --> 00:33:39.259
I think it just depends.

00:33:39.259 --> 00:33:42.306
But if you have scars too, I think, why not open it?

00:33:42.306 --> 00:33:45.853
Let's let these tissues open and release as much as we can beforehand.

00:33:45.853 --> 00:33:49.361
But I think everybody benefits from that connection piece.

00:33:49.560 --> 00:33:59.182
That's so interesting, yeah, and the scar tissue I find interesting too, because the more I learn about baby's choice of positioning because it's not like a conscious choice, it's a reflex, right?

00:33:59.182 --> 00:34:04.740
So your baby's going to put themselves in the position that their little reflexes tell them to go.

00:34:04.740 --> 00:34:10.342
So if it's like if there's something tight over here, they're going to move in a different direction.

00:34:10.342 --> 00:34:15.425
So like if it's the rooting reflex, they're going to go like that and so they get into this wonky position.

00:34:15.425 --> 00:34:27.706
And I find it interesting because I had an appendix surgery that was very big when I was in my twenties and I had no idea that it could affect my pregnancy and both of the kids were occiput transverse.

00:34:27.706 --> 00:34:30.302
And I'm wondering yes, 100%.

00:34:30.342 --> 00:34:31.045
I would bet money.

00:34:31.045 --> 00:34:43.347
I can't tell you that surgery, especially even when it goes well, how many hip you know, back pregnancy issues come along with that and we're like, oh, it's just an appendix, no big deal it is.

00:34:43.347 --> 00:34:48.762
It's a big surgery and it affects things and if you've had any scar, it sounds like you probably had a lot of scar tissue.

00:34:48.762 --> 00:34:51.833
I would, yes, I mean yes, a hundred percent.

00:34:52.173 --> 00:34:57.371
Yeah, I have opposite side hip problems, opposite side back problems, like everything.

00:34:57.371 --> 00:34:58.313
Everything went wrong.

00:34:58.313 --> 00:35:03.911
I feel like after the surgery I couldn't even feel my core muscles anymore, it's insane.

00:35:03.911 --> 00:35:07.090
And the same thing kept happening after each pregnancy.

00:35:07.090 --> 00:35:08.766
I couldn't reconnect with my core.

00:35:08.766 --> 00:35:09.864
It took me like a year or two.

00:35:09.864 --> 00:35:12.568
I finally got to the point where I'm like, okay, there they are.

00:35:12.829 --> 00:35:16.431
Yeah, and I think you know people think about like what you do in pregnancy and postpartum with PT.

00:35:16.431 --> 00:35:27.891
Yes, we're treating your pregnancy and we're treating your postpartum body, but we're treating your body before that.

00:35:27.891 --> 00:35:28.271
That now is here.

00:35:28.271 --> 00:35:33.045
So, like anything that carried with you, like your scarring, any old back injury, any old, whatever it is, it's still there and it's just layered now.

00:35:33.045 --> 00:35:34.289
So we have to treat all of it.

00:35:34.289 --> 00:35:42.985
So, like you came to, you know, pregnancy PT, there would be a ton of scar work done, you know, there just to help prepare that area to again open and release.

00:35:43.827 --> 00:35:46.655
Yeah, that's a nice little shout out to all moms.

00:35:46.655 --> 00:35:50.768
Hey guys, if you've ever had abdominal surgery, please go get pelvic floor physical therapy before you get pregnant.

00:35:50.807 --> 00:35:56.009
Yeah, or when you get pregnant I mean before, before or whatever yeah, or during all of it.

00:35:56.309 --> 00:36:01.824
Just make besties with your pelvic floor, Definitely Well.

00:36:01.824 --> 00:36:04.228
Is there anything else that we didn't cover that you wanted to talk about?

00:36:04.969 --> 00:36:07.855
No, it's a little bit more about kind of the beehive you know that we have here.

00:36:07.855 --> 00:36:15.326
So Megan McCutcheon is a perinatal mental health therapist and we met when I was opening my business in 2021.

00:36:15.326 --> 00:36:44.954
And we just immediately connected as just like like minded people and friends and we have just had a vision for this place where we wanted many providers like we were talking about like not Googling, you know, at 3 am let's have a place that has providers present and has a network of people to refer to, and so we opened that this past September and then before that we kind of existed as an online entity and we created a birth prep course, kind of from a PT mental health flange so it's not replacing traditional birth prep course kind of from a PT mental health flange so it's not replacing traditional birth prep.

00:36:44.954 --> 00:36:51.547
It's just like a nice additional piece that kind of gives you the layers and we give you different tools and I talk about that.

00:36:51.588 --> 00:36:59.063
You know what I was talking about as far as your hip and your back and kind of ways to open and release and then a little bit of a kind of a early postpartum advice as well.

00:36:59.063 --> 00:37:05.956
So we have that online for anybody who kind of wants a different slant or approach to their birth prep and it's an easy kind of modular, take your time kind, of course.

00:37:05.956 --> 00:37:10.492
Basically, my mission and Megan's mission is really just to help people during this time.

00:37:10.492 --> 00:37:19.382

Katie Bayer: Transforming Postpartum Recovery with Pelvic Floor Therapy

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