Pregnancy & Infant Loss Awareness

October 7, 2022 Jessica Dufault

October is National Pregnancy and Infant Loss Awareness Month! And as someone who supports clients around the physical changes during pregnancy and postpartum (no matter the outcome), I also know how important it is for clients to also be able to access mental and emotional support along this journey.

And, I have the pleasure of having Julie Kull, licensed clinical social worker, as a local resource for my clients seeking more support. We were able to discuss Infertility, Pregnancy and Infant Loss in depth. I’m sharing our convo here!

Jess: Julie, I am so happy that we’ve connected. We both support prenatal and postpartum families and having a professional like you to connect families with for mental and emotional support is essential in these life moments. You support families experiencing a variety of concerns such as infertility, infant loss, birth trauma and pregnancy after loss. Specifically, for someone who is pregnant after infertility and/or pregnant after loss, what are some things that can come up and how might support be helpful?

Julie: Great question! When someone is pregnant after a loss/infertility here are some of the things that I tend to see. Anxiety- fear that they will lose another pregnancy or that if they lose this pregnancy, they will not be able to get pregnant again. Isolation- being pregnant can lead to feelings of isolation. There is often survivor’s guilt that they were able to get pregnant or get pregnant again and I often hear that it can be difficult for people to connect with those that are pregnant that have not experienced a loss or infertility, but also feel so guilty and have difficulty connecting with those still trying to conceive. Disconnected from their bodies- sometimes the body no longer feels like a safe place- this can be common with infertility and loss. I also talk with people about trusting their bodies. It can be hard to trust that your body can keep this baby safe when you may be feeling like it did not keep another baby safe. Sometimes the carrying partner can struggle to connect to the pregnancy and it doesn’t feel real to them. This can lead to difficulty planning ahead for the baby and engaging in cultural norms to welcome baby (ex: baby showers). Lastly another thing that comes up is competing emotions. I think a cultural norm that we have here in the US is that people should be happy when they are pregnant when quite often there is a lot of mixed emotion. It can be really uncomfortable and confusing to try to feel these competing emotions at the same time.

Psychotherapy can be helpful for many things if you are pregnant after a loss or infertility. One of the biggest things is being able to work through many of these feelings that I listed above. Having a space where you can hear that your feelings not only are valid but often common after a loss or infertility can lead to less isolation and more connection with yourself and your pregnancy. Psychotherapy can help with feeling safe in your body again and connecting to this pregnancy while also processing the grief that you may feel around your loss or trying to conceive journey.

Jess: October is Pregnancy and Infant Loss Awareness Month. One thing that you and I have briefly discussed is that often after loss, families don’t perceive themselves as “postpartum” and thus they do not seek support in the same way as someone fortunate enough to take a baby home. What are some ways we can increase awareness around this and get people the care and support they need and deserve?

Julie: I think a little conversation around this can go a long way. Just using that terminology really normalizes for people that yes this was a pregnancy and yes after a pregnancy I am postpartum. I think normalizing that postpartum really means post pregnancy and not post having a baby or bringing a baby home. One thing that I do in my practice is to give the Edinburgh- a postpartum screener and review with clients what might be happening with their body in the postpartum phase. With clients that have an early loss/miscarriage I hear often that they are not getting the follow up visit that someone further along would get in the postpartum phase. I do think we have many wonderful providers in Madison and I think there has been progress in following up with clients after an early loss, I think overall we can do better by just normalizing this. Postpartum international has started offering loss groups. You and I belong to the Madison Postpartum Collective and services/support groups are offered for those that have had a loss. These may seem like small things but they matter.

Jess: For families experiencing loss, what general resources could you share? Resources that EVERYONE should/can have access to?

Julie: Locally we are really lucky to have some great resources:

Bereaved Parents of Madison- they have a great list of resources as well.

Kull Counseling- I offer a free support group for early loss/miscarriage on the first Thursday of the month

Mikayla's Grace

Madison Postpartum Collective

Nationally-

Miscarriage Association

Now I lay Me Down to Sleep- photographer

PLIDA

Star Legacy Foundation

The Miss Foundation

Postpartum Support International- support groups

Jess: Screening for Postpartum Anxiety and Postpartum Depression within postpartum families is more common today than ever before! For practitioners or postpartum people who may not be as familiar, what are some symptoms to look out for and based on that, who should be referred/seek more support from a professional?

Julie: For PPD symptoms to look out for can include: feeling sad or blue, thoughts of hurting yourself, lack of interest in things that you used to enjoy, irritability, hopelessness, changing in eating or sleeping patterns, not wanting to get out of bed, decrease in daily activities of living such as showering.

For PPA symptoms to look out for can include: excessive worry, irritability, on edge, loss of control, panic attacks, tightness in chest.

And a little less talked about but for PPOCD symptoms to look out for can include: repetitive unwanted thoughts that often are followed by an action that must be done over and over to try to reduce the anxiety around the thought.

I think overall anyone going through the postpartum phase could benefit from psychotherapy services. It is such a time of transition and growth, so much comes up with who you are and your own development.

In general, if any of the above symptoms are impacting how you function in your life it would be helpful to contact a professional.

Jess: I work with so many postpartum people who have experienced birth trauma and yet, they are hesitant to call it that. I’ve noticed people think of birth trauma as something that happens to our bodies rather than how our bodies perceive that experience. So trauma can look different among people and I’m hoping you can speak more on this. HAPPY TO REWORD

Julie: Yes, I have heard that as well. I think the word trauma has a bit of stigma attached to it unfortunately. I really think of trauma as the emotional response someone has to a distressing event. It often causes feelings of helplessness and overwhelm and has a lot to do with your ability to cope with what has happened. Two people can experience two similar things in labor and delivery and one can perceive it as trauma while the other might not. I also think there is some misunderstanding that if you have experienced trauma than you have posttraumatic stress disorder which is not true. Only a small percentage of the population will develop PTSD after being exposed to a trauma. Even if you do not have PTSD, if you have experienced trauma during childbirth it can be really beneficial to work with a psychotherapist and a physical therapist as well. Experiencing trauma in childbirth can impact your mental health and put you at an increased risk for developing postpartum depression or anxiety. It can also impact your ability to bond with your baby.

Working with a psychotherapist can help you work through distressing thoughts, and physiological sensations associated with trauma that get stored in your body.

Jess: Any closing thoughts or pearls you’d like to share?

Julie: My last little pearl is just to normalize mental health for parents. You do not have to experience a loss, a traumatic birth or infertility to seek mental health care. The road to parenthood has unique challenges and mental healthcare should be as normalized as physical healthcare.

I would just like to thank you for asking me to be part of this. I know you are a provider that really cares for her clients and pays attention to not only what is going on physically with your clients but also mentally. I think the move providers we have paying attention to the mental health needs of parents the more people will get the help that they deserve. It goes a long way in normalizing taking care of your mental health.

Birth Positioning Matters - And Why Upright Positioning Should be the Standard

April 26, 2022 Jessica Dufault

Being in an upright position during delivery has so many positive benefits. I believe every birthing person should have access to and the ability to chose these positions if desired.

Here are TEN benefits to upright positioning

You’ll get a gravity assist. Working with gravity is much easier than working against it!
Less compression of the aorta which carries the oxygenated blood to mom and baby
Uterus is more efficient and have stronger contractions
Baby will be better positioned to pass through the pelvis
The pelvic outlet is wider. This is the bottom of the pelvis where baby exits. More space here is always good!
Satisfaction rates with birth are higher and pain levels are lower
Shorter length of pushing (by 8 minutes!)
Lower rate of vacuum/forceps assist
Reduced risk of G3-G4 perineal tearing
Fewer cases of cesarean birth due to Failure to Progress

So, two basic take-aways for you would be:

FREE THE TAIL. When the baby is lower in the pelvis, the sacrum and tailbone need to open. If you are in positions that restrict this natural movement, then the outlet space is compromised. You can free your tail by being in more upright positions such as kneeling, hands and knees, birth seat/stool, supported squat and more! These positions are possible with birth team support even with low dose or regular dose epidurals.

USE GRAVITY. This just gives the uterus and baby a natural assist. The path has the least resistance!

Talk with your birth team today to figure out if these positions will be right for you.

As always, thanks to Evidence-Based Birth for keeping me up to date with all this incredible info!!

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

That Early Postpartum Poo...

April 8, 2022 Jessica Dufault

Because let’s face it, it’s a bit scary. You’ve just given birth to a baby (perhaps more than one even!), a placenta and now…you need to poop. That’s like 3 births in just a few days.

If you’ve had a vaginal birth, the pelvic muscles have just undergone a stretch that was 250% MORE than it’s normal length. And not to mention if there was a tear or episiotomy that may have required stitching. It is undoubtedly going to feel vulnerable.

If you’ve had a cesarean, this is major abdominal surgery! Cutting through numerous layers of skin, fat, fascia, and of course, the uterus. Add on top of this swelling and pain and a poop is the LAST thing you want to do.

So after all births, the thought of pushing ANOTHER thing out of your body can feel a bit overwhelming. And hopefully these tips can help!

Get a stool to help pass your stool! A squatty potty or something where your feet can be elevated 6-9”. This allows your pelvic muscles to be on slack!
Water, water, water. It’s easy to get dehydrated those first few days especially, so be proactive here. Not enough water = harder stool.
Stool softeners and/or poop friendly foods! Remember, stool softeners add moisture, which makes things easier to move. Also consider enough fiber (25g is daily recommendation!) but be sure not to add too much too quickly. Add good fats too like avocados, coconut/olive oil which all help keep things moving through the tracks!
Consider a bidet or at the very least a peri-bottle rinse (vs. wiping)
You may want to support your perineum. That’s the tissue right between the anus and vagina and a little upward pressure here can feel supportive.
You may want to support your cesarean incision with a little pressure inward from a pillow
Breathe well!

Did you find these tips helpful? Let us know what things you tried and found useful the first few postpartum poops!

Kegels Don't Belong in Your Birth Preparation (but these 4 things do!)

March 28, 2022 Jessica Dufault

It may surprise you to hear that your pelvic floor muscles play ZERO roll in pushing baby out during Labor & Delivery. Contractions are your uterus slowly gaining power for pushing baby down and out. Your body’s job is to release, create space and yield to the process.

So, ditch the Kegels. And do these 4 things instead!!

LEARN HOW TO BREATH WELL DURING ACTIVE LABOR
Whole core breathing is a great way to create space and softness to allow the uterus the SPACE to do it’s hard work.
LEARN A PELVIC DROP OR REVERSE KEGEL FOR DELIVERY
You can start practicing this around 34 weeks pregnant. Get guidance from your pelvic PT to ensure you are doing this correctly. But I like to think of using an exhalation to “gently lay an egg” (or in this case, baby’s head!)
PRACTICE LABOR AND DELIVERY POSITIONS
Learn when and how to position your pelvis, hips and spine to open the path for babe.
PERINEAL PREPARATION
It’s really not about “stretching” the perineum. This is a great place to practice breathing well and your reverse Kegel in order to yield to babe passing through. It’s about telling your pelvic floor to literally “get out the way”

Did you find these tips helpful? Which will you try? Comment below, I’d love to hear from you!

How To Protect Your Perineum During Birth

March 25, 2022 Jessica Dufault

One of the most common fears I hear from clients is “I am afraid of tearing during birth”. If this is your concern too, you are definitely not alone! Here is an idea to sum up how to help you meet these goals:

Create a calm internal and external environment where you are creating SPACE for baby to move down rather than using FORCE.

Here are a few simple tips that can help you create space, not use force and thus reduce your risk for tearing. These are tips pulled from Evidence Based Birth and can be helpful to discuss them with your Midwife, Doula or OB and practice BEFORE go time.

Wait to push until you have a strong urge. And you should direct how and when you push, not someone in the room yelling “PUSH”
Attempt to move baby down between contractions. The uterus is doing the hard work of moving baby down and we don’t need to add a lot of extra force on top of that. So, a gentler recommendation might be to move baby’s head down between contractions.
Be patient during crowning. It may be advised to stay here 5-10 contractions. If the perineum turns “white” or ”blanches” the tissue is too taut and it might be best to slow down!
Positioning. How you use gravity, positioning your spine, pelvis and hips can make BIG a difference
Avoid instrumentation if possible. This means episiotomy, vacuum and forceps as these things will increase your risk for tearing.
Warm compress. Using this between pushes can reduce the risk of moderate tearing.
Consider starting perineal massage at around 34-36 weeks pregnant and when cleared by provider
Breathe well! Remember SPACE not FORCE

Did you find these tips helpful? Which will you try? Comment below, I’d love to hear from you!

Postpartum belly binding vs compression support

October 25, 2021 Jessica Dufault

Does postpartum belly binding work? What does it do? What kind of product should I buy? Is it harmful? How long should I do it? Is it safe after a c-section?

I get these questions all the time. I hope to give you some info that feels helpful as you navigate your postpartum body and all the do’s and don’ts you’ve likely been reading up on!

Some people will feel mentally, emotionally and physically better to know they will have some belly and pelvis support early postpartum. And in the following cases, I’d say go for it!

episiotomy, perineal or cesarean scar tissue that needs support
pelvic organ prolapse or feeling of heaviness/pressure into the pelvis
pelvic pain, like at your SIJ or pubic bone (SPD)
large diastsis recti (not technically diagnosed until 12 weeks postpartum)
umbilical hernia
Reduced confidence in your ability to move around and care for baby

But how does it work? Right now, those floor and core muscles are at a disadvantage given the whole growing a human for 9 months and the labor & delivery thing you’ve just experienced. Wrapping and compression works by basically replacing the job your muscles would normally be doing by providing support for your spine, your organs (belly and pelvic), and supports those ligaments and tendons (the things that connect bones to other bones and muscles to bones). Here are some further considerations:

It is OK (with provider clearance, especially if you’ve had a cesarean birth) to bind for a few days up to a few weeks postpartum. Anything longer than that is not necessary AND might cause your floor and core to kinda forget it needs to do some work!
I would caution against ‘waist’ only binders. This puts undue downward pressure on your pelvic organs and pelvic floor muscles which have already been through a lot during pregnancy, labor and delivery
I like wraps that start at the hips/pelvis and wrap all the way to the top of the core, which is the diaphragm and lives at the base of the ribs.
You might also consider compression or recovery shorts, which come in a longer version or even pants! (Affiliate Link above. Use code JESSICADUFAULTPT for a 20% discount!)

Can I Continue Impact Exercise During Pregnancy?

December 7, 2020 Jessica Dufault

Let’s make answering this for yourself as easy as possible!

Not having symptoms? You're good to go
Having symptoms? This post is for you!

Symptoms indicate that your tolerance to load/impact is reduced. Meaning the core doesn’t have the endurance or core control in its current (pregnant) state.

What are some symptoms to look out for when doing impact exercise while pregnant?

Any pain that doesn’t resolve quickly after activity like hip, knee, low back, sacral or muscle pain
Urinary leakage: do you lose even a drop when you don’t plan on it? This is urinary incontinence
Urinary or bowel urgency: that feeling of I gotta go right now
A feeling of heaviness/pressure or that ‘something is falling out’ of your pelvis. This indicates your pelvic organs aren’t happy

These are just SIGNS that something is off in the pressure system of your core. This does not necessarily mean STOP your exercise, it means pay attention and modify it in some capacity.

Options might be:

Reduce your weights and try a resistance band instead or just body weight
Reduce # of sets/reps
Reduce running time/distance/speed
Change running surface (cement to mulch path?)
Try cross training and lower/no impact days in between impact days
Adjust your pelvic to rib alignment
Breathe better

Period Headaches

October 27, 2020 Jessica Dufault

Period headaches. If bloating, cramping, irritability, heavy bleeding aren’t enough, some of us experience headaches or even migraines right before, during or after bleeding. We can blame hormones for this (once again!), as there is a plummet in estrogen just prior to bleeding.

Other possibilities that can lead to headaches?

Anemia due to excessive blood loss

Dehydration

Stress

Suboptimal nutrition

Birth control pills or hormone replacement therapy

AND according to Aviva Romm (Blog: https://avivaromm.com/hormonal-headaches/), quite possibly an estrogen-histamine connection

Drops in serotonin levels

Even a decreased pain threshold prior to bleeding

And here’s the thing. NONE of these symptoms, including headaches, should be considered normal! The menstrual cycle is considered the 5th Vital sign (American College of Obstetrics 2015) because it is a biomarker of a bleeding person’s overall health. If something is ‘off’ with you period, you can be certain something else is going on such as stress, hormonal imbalance, inflammation or other pelvic conditions to name only a few.

I am disheartened/angry/incredulous to see advice on blogs and articles (from MDs nonetheless!) like “skip your sugar pills/period to skip the estrogen plummet to skip the headache” and “track your period in an app so that you can start taking Ibuprofen a few days ahead of time” This advice is essentially ignoring the underlying concerns with the 5th vital sign and is not good advice.

Advice I can get on board with?

Anything that increases the awareness of your cycle, the understanding of your hormones and learning to SUPPORT and NOURISH your 5th vital sign
Taking a workshop with a FAM instructor-they know SO much and can educate people young and old on body literacy and healthy menstruation patterns
Listening to, reading or working with Health Coaches, Reproductive Health Practitioners, naturopathic physicians (or holistic MDs) who are experts in ALL things period

Book: the 5th Vital Sign by Lisa Hendrickson-Jack and her podcast Fertility Friday
Book: Fix Your Period by Nicole Jardim
Blog: Hormonal Headaches and Aviva Romm’s podcast Natural MD Radio (multitude of topics on women’s health issues)
Assess triggers which could be a multitude of environmental factors, stressors, food/drink such as caffeine, alcohol or sugar.
Watch xenoestrogens

4. And generally speaking

reduce stress
drink plenty of water
get good sleep
Anti-inflammatory diet

Do you take your 5th vital sign seriously? What have you learned about your body that helps better manage period symptoms?

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram for a ton of free support on common women’s health concerns.

Yoni Eggs

October 14, 2020 Jessica Dufault

As a Pelvic Physical Therapists, I get asked a lot about Jade eggs otherwise known as Yoni Eggs. I think when used correctly, there can be numerous benefits from using Yoni eggs:

Strengthen Pelvic Floor Muscles (PFM)-yes! When used correctly in conjunction with all parts of the core system (respiratory diaphragm, abdominals) this can help give your PFM biofeedback and improve the connection between your brain and body. It can help you find your muscles and work to correctly contract/release and thus improve PFM strength and endurance.

CONSIDERATIONS WHEN USING FOR STRENGTHENING:

Over-enthusiastic Kegeling or incorrect Kegeling can be a cause of pelvic pain. Some women need to only release PFM tension and do not need to do Kegels!

There is NO need to keep them in all night (risk for bacterial infections...jade is semi-porous).

There is NO need to stand/walk with one in. PFM never work in isolation (it needs to coordinate with your abs and breath too) and the PFM should never just squeeze and hold, hold, hold, hold, hold. It needs to be able to contract and relax, just like a jellyfish in order to absorb day to day forces. .

Improvement of orgasm-yes! It is the PFM that contract/relax/contract during orgasm and It is reasonable to say that with better PFM strength and control, our sexual health can improve

Decrease incontinence-yes! Better coordinated core, more likely to active well during a laugh, cough, jump or sneeze

Improve lubrication-yes, possibly! Better movement, contraction/release of PFM can improve circulation/blood flow. And blood flow brings lubrication.

In my world, there is currently no research to support that the properties of the stone can

Balance hormones

Change/improve your Cycle, like alleviate cramps and lighter flow

Remember, no research does NOT mean you can’t or won’t experience some of these last few things!!

Do you use Yoni eggs? What are your challenges? What feels improved?

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

Alternatives to Birth Control Pills

August 19, 2020 Jessica Dufault

As a pelvic PT, I am seeing the ways in which hormones can profoundly affect bodies. For some, hormones allow us to feel more like ourselves. And for others, hormones can make us feel less like ourselves and thus it is important to understand possible alternatives to birth control pills. Keep in mind please that I am still researching and understanding all the options around birth control and there is SO MUCH to learn. I want to thank my colleague and friend Ashley Hartman Annis for help with this blog as she is a Fertility Awareness Method (FAM) instructor and just all around cool human!

Intrauterine Device (IUDs)

These devices are inserted into the uterus and you can choose a hormonal or non-hormonal option.

Hormonal (such as the Mirena) - People tend to incorrectly believe these hormones act locally on the reproductive organs however these hormones have been found to have more systemic effects, just as with The Pill! So all the things that can sometimes occur due to hormones from The Pill can also occur with a hormonal IUD. This IUD is 99% effective, a bit invasive to get in/out however for some people it can also be easy, and can last up to 5 years

SIDE EFFECTS and RISKS: Ovarian cysts, depression, boob soreness, Pelvic Inflammatory Disease, absence of period, perforation, expulsion, pelvic pain, infection, heavy/irregular periods

Non-hormonal (Paraguard) - Made from copper which is toxic to sperm! This IUD can be removed at any time and fertility resumes quickly. It is 99% effective, can be a bit invasive to get in/out for some people and can last up to 10 years

SIDE EFFECTS: cramps, spotting between periods, heavier bleeding but these may all decrease over time

Natural Family Planning (NFP) - This method helps you realize when you are ovulating so you can decide to have intercourse or not have intercourse on certain days based on your pregnancy goals. This method includes monitoring your cervical mucus and measuring your basal body temperature. With average use, according to the Center For Disease Control, it is 76% effective. Often, because of the foundations NFP is rooted in, it may be an acceptable form of birth conrol for religious affiliations, is generally targeted for heteronormative and married couples and may not condone use of condoms (or other barrier methods) during fertile days.

SIDE EFFECTS: NONE

Fertility Awareness Method (FAM): This method is based on similar science to NFP however tends to be more inclusive of all bodies, orientation, gender and relationships. It teaches you body-awareness through monitoring your cervical mucus, measuring your basal body temperature and even assessing your cervix in order to understand the cycles of the body, which is valuable for anyone to learn! The above techniques can then be used to understand when you are ovulating in order to either avoid sex or choose protected or unprotected sex in this more fertile time, depending on pregnancy goals.

Effectiveness varies on the specifics of the method one is using, but a study in 2007 showed sympto-thermal method to be 99.4% effective at preventing pregnancy if users chart every day, follow the guidelines for when unprotected intercourse can and cannot lead to pregnancy and work with an instructor. Typical use varies from person to person depending on how dedicated someone is to learning their cycle, if they follow the guidelines and if their cycle is clear enough to interpret.

**With all non-hormonal methods, make sure you and your partner(s) are having regular conversations about STIs, getting tested, and having safe(r) sex. Methods like fertility awareness do NOT protect against STIs, so keep that in mind and use a condom!

SIDE EFFECTS: NONE

Other options: Condoms both internal and external condoms, spermicide, sponge, diaphragm, and more permanent options such as vasectomy and tubal ligation (surgical).

Have you tried hormonal and/or non-hormonal birth control methods? What are your experiences? For those that have more experience here, what would you add or modify?

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

Women's Fitness: How To Avoid Falling Through the Gaps

July 17, 2020 Jessica Dufault

This blog was a fun collaboration between Paige Dunmore PTA, Postpartum Corrective Exercise Specialist (Pelvic Underground) & Jessica Dufault, PT, DPT (Mindful Motion Physical Therapy).

Paige and I, who are both trained in Physical Therapy and specialize in Women’s Health, are astutely aware of the gaps that are present in the general fitness industry, especially when it comes to women’s needs. Navigating the sea of opportunities that one could take within their fitness journey is no easy task and can feel overwhelming when seeking support with fitness specific to her needs. There are several things we would like to highlight in this blog and certainly hope this opens up further discussion and dialogue.

The concern with group classes. Even with movement instructors who do have specific training in women’s health, it is an extremely hard task to address specific needs within a group format. We believe each woman benefits from very specific feedback, cueing and guidance in order to best address her unique needs. Global cues like “flatten your back into the mat” during core exercise or other overly restrictive guidance like “if you have prolapse or diastasis recti, please don’t do planks” may not be accurate for every woman in the class.

Solutions? Private sessions with a pelvic PT or a specialty-trained personal trainer are important PRIOR to a shift into a group format. This empowers women to know their unique needs and how to modify and make informed exercise decisions.

Women often do not understand the fluctuations in the body (and symptoms), especially when it comes to fitness during transitional periods such as pregnancy, postpartum, peri-menopause or menopause. The body drastically changes within these unique periods of time and understanding how to adapt to this is important.

Solutions? Women must educate themselves, seek reputable resources and providers to help guide them in their fitness goals. It is important to work WITH your cycle instead of against it which can mean the difference between health and strong life transitions vs. falling apart and getting injured at every turn. Often women experience prolapse and hernias around menopause as a result of never learning the signs and symptoms that were present years prior. Women can get away with a lot of compensation and ‘ignoring’ of mild symptoms for only so long! Pregnancy and menopause are two of the great equalizers when it comes to fitness. One of them will get women to eventually listen and start asking better questions about their fitness.

There is some ambiguity on what “CORE” actually means in the fitness world. When we are attempting to address women’s health concerns and symptoms, it is important to really understand what core means. This blog goes into more detail here, but it’s really about the communication and responsiveness of an entire ‘system’ of muscles which include the pelvic muscles, the respiratory diaphragm as well as the deep abdominals (transverse abdominus). The big three that make up the core help to support the spine, pelvis, and pelvic and abdominal organs. Alignment, good breathing patterns, and form are essential to tap into this core system and is foundational in how we address symptoms and keep women injury free!

Solutions? Understand this system! Work with PTs, PTAs, movement instructors and online programs with people who work with the core in this way.

Lack of guidance on postpartum healing timeline and guidelines from care providers. Culturally, there is a push for early return to activity and ‘bouncing back’ ASAP. At 6 week check-ups women are told everything is good to go and ‘life can resume as usual’. And some women return too quickly to higher impact activity that can cause unwanted pelvic symptoms. It is important that women and the fitness industry understand that cueing and graded-exercise progressions are essential for women returning to exercise. Just as we would advise someone on how to gradually train for a marathon, there is a specific way we advise postpartum women to gradually return to higher level exercise. It’s important to honor the body’s need to heal both inside and out before asking it to do everything it did before birthing a baby. The same goes for abdominal surgery (whether it is C-section, hysterectomy, or any other surgery where the abdominal wall is opened up).

Solutions? Women need 12 weeks of healing before returning to ‘bootcamp’, HIIT, higher level cross-fit or running activity BUT the preparation for those activities can start sooner. So that by the time 12 weeks hits, her body is prepared for the return to the exercise of her choice.

Not all PTs, trainers or general health providers are created equal. We all come from different backgrounds, experiences and a different lens on the human body.

Solutions? Seek providers and instructors who have very specific training in Women’s Health (resources listed at end of blog!). If you aren’t sure about someone’s credentials, ask!

There is ever-evolving evidenced based ways to approach women’s healthcare and fitness! How we have supported women with diastasis recti, prolapse and strength training programs to improve or stave off symptoms has changed SO much, even in the last 10 years. The field of women’s health has seen significant growth recently as more and more providers finally begin to pay attention to the unique needs of women. There are so many more options available that didn’t used to exist. It’s exciting!

Solutions? Do a little digging and find the professionals/classes/education that feel best to you. Be informed and take control of your health. Check out some of the resources listed below and let us know how we can help or if you have any questions! Last, but not least, don’t take no for an answer, whatever that no might be. If you aren’t happy with the solutions you are provided, seek out another opinion. Every woman is unique and needs to be considered individually. Work with someone who has such specialty training in this that they are able to keep up on the updates (I keep saying the same thing??)

Specialty Trained PTs, PTAs and Fitness Pros

Julie Weibe-Women’s Fitness Professional

Academy of Pelvic Health Physical Therapy

Trainers with PCES certifications

Other resources:

The Pelvic Guru

Prenatal and Postpartum Care in Madison WI

Postpartum Hair loss: What is normal and what is not?

June 22, 2020 Jessica Dufault

Postpartum hair loss is quite common. For most, it is a temporary occurrence which, on average, starts at about 3 months postpartum and is related to hormonal fluctuation. During pregnancy because of hormonal influence there is an increase in the percentage of hair follicles in ‘growth phase’ which means thick, luscious hair. In the postpartum period, there is an increase in the percentage of hair follicles in ‘resting phase’ which is followed by shedding and thus (for some of us!) can lead to a LOT of hair loss. Usually hair growth will resume a more balanced growth/resting phase by 1 year postpartum.

If you are losing excessive amounts of hair and this starts or continues beyond 12 months postpartum, it might be advisable to talk to your healthcare provider about it. And generally speaking, there can be two things to assess when it comes to excessive hair loss - iron deficiency and thyroid concerns.

Iron-deficiency related hair loss

Low iron can occur in women of child bearing age, especially if they have heavy menstrual bleeding which is one of many possible contributing factors. Measuring the Ferritin levels in your blood is one test that is sensitive enough to assess how much stored iron you have in your body. Normal levels are considered 10-15 ng/mL however some specialists believe this is too low when considering treating hair loss and will have patients shoot for levels around 50-70 ng/mL. So if you test low in iron (with or without anemia) it may still be worth considering increasing your iron-rich foods or iron supplementation with the guidance of your doc. NOTE: If you are just ‘guessing’ this is the reason for your hair loss and start supplementing and your iron is NOT actually low, this can be harmful!). Although the research is conflicting, many specialists concur that when the iron deficiency is treated, it stimulates the follicles to be in growth phase rather than resting/shedding and can help counter excess hair loss.

Thyroid-related hair loss

Remember the hair follicles in the ‘resting phase’ discussion above? Well, thyroid hormones are directly involved with hair follicle function. So, if you have more ‘resting phase’ follicles, this will be followed by excessive shedding/hair loss. Getting a thyroid test might be helpful if you are having unusual postpartum hair loss AND other symptoms.

At 1-6 months postpartum, you could be experiencing the first phase of thyroid dysfunction- hyperthyroidism (high level of thyroid hormone circulating in the blood) although often we (and healthcare providers) don’t recognize the initial symptoms of hyperthyroid

Anxiety
Irritability
Rapid heartbeat or palpitations
Unexplained weight loss
Increased sensitivity to heat
Fatigue
Tremor
Insomnia

4-8 months postpartum is when symptoms become more apparent due to being in the 2nd phase of thyroid dysfunction- Hypothyroidism (low level of thyroid level circulating in the blood):

Lack of energy
Increased sensitivity to cold
Constipation
Dry skin
Weight gain
Depression

Here is something very important to note.The standard TSH test given at the doctor’s office might not tell the whole story! Your thyroid health is beyond just TSH. TSH indicates how well your pituitary gland functions rather than directly assessing thyroid function. If you aren’t getting answers and have some of the above symptoms, I would absolutely recommend seeing a functional medicine practitioner who will look at ALL the key components of thyroid function and to work toward more optimal ranges. They may run a complete thyroid panel which would include TSH, Free T3, Free T4, Reverse T3, and thyroid antibodies. This total thyroid panel will test for normal thyroid function as well as how well thyroid hormone is working in your body. It assesses the conversion of T4 to T3 (the active form of the hormone) and this is important because T3 drives metabolism function within our cells!

So, sometimes hair loss is common. And considering how much hair loss is occurring and the timeline of when it is happening might be helpful for determining if you should talk further with your medical provider.

Do you have experience to share on abnormal postpartum hair loss? Who did you seek guidance or support from? What tests or treatments were helpful for you?

Sciatica and Pregnancy

June 5, 2020 Jessica Dufault

Sciatica or sciatic-type pain is fairly common during pregnancy. Many women are told this is a normal occurrence during pregnancy (I would use the word common), however we believe women can have happy and healthy bodies throughout pregnancy and I want you to know there is something you can do about it!

The sciatic nerve is made up of several nerves that come off the spinal cord and exit through the low back/sacral bones. They combine into one big, thick nerve that runs through the back of the buttock and branches out again down your leg all the way to your foot. We may experience true sciatica, where the nerve is irritated and causes pain (numbness/tingling/weakness) all the way down the leg. It usually affects only one side and things like sitting (hard chairs, or sitting for extended periods of time), bending forward, hiking or walking uphill or going up stairs can make this feel worse.

It is important to note that sciatica is often confused with Sacroiliac (SI) Joint pain which may give you sciatic-type symptoms. The SI joint is where the end of your spine (sacrum) connects and makes a joint with the back of your pelvic bones. This is held together by ligaments and is undergoing significant changes during pregnancy! If this joint is irritated, it often starts as lower back pain and progresses to radiating pain to the hip and even upper leg (but not usually past the knee). Some will have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements (moving from sit to stand), standing on one leg (putting on pants!) or climbing stairs.

Understanding WHAT you are experiencing is important. There is a difference in how I support women who have sciatica vs. SI joint dysfunction. Understanding WHY you are experiencing sciatic symptoms is also important. If you know the WHY, then you can make more informed choices in how to address it based on the unique needs of your body. Here are some considerations for the why this may occur

Diastaisis recti
Weakness in the core, pelvic floor or hips
Decreased mobility of the hips
Tension in muscles of the hip or pelvic floor
Poor sitting/standing postures
How/where baby is sitting
Hormonal influence
Weight gain/fluid retention

Remember that pain does not equal tissue damage! The pain with either condition can be intense and it is super easy to get worried about it and to reduce or stop activity. KEEP MOVING! It is important to continue moving as you try to work through it, and a little guidance can be really helpful! Here are some general considerations for self-treatment.

Gentle stretches. I want to be VERY clear. If we could all ‘stretch’ our way out of pain, we would have done so already. Stretching and particularly over-stretching can do more harm than help in this case. Gentle stretches where you are tight will give you some temporary relief, however it will be more important to work on strength and posture. Check with your PT first, but self-nerve glides can reduce nerve sensitivity. And range of motion/relaxation work can be more effective than a ‘stretch’
Strength training for your hips, low back and abdominal muscles. This may include working on the specific muscles like the deep core (pelvic floor, TA, diaphragm, multifidus) as well as glut med and max.
Massage or self-trigger point release can also give you some temporary relief, but given how sensitive these tissues can be, please don’t crank on them!
Diaphragmatic breath. Working the diaphragm in coordination with the abdominals and pelvic muscles is a real treat because it nourishes and massages the whole core. It brings you into parasympathetic activity, which is where we rest, heal and ‘downtrain’ our overactive muscles and nerves
Some women really enjoy the relief they get with support belts like this one
Walking. Walk, walk, walk. Even if it is just short distances, several times/day. Motion is lotion. If hills or uneven surfaces are aggravating, stay on level, softer ground if able.

Be mindful of your standing posture

Sleep positioning can be helpful. Getting off those hips or improving your overall alignment can reduce pressure on the back, hips and pelvis
Be mindful of how you bend and lift
Change your sitting posture. No hard chairs! Try sitting on a yoga blanket or towel, just under your sit bones. This will bring your hips just higher than your knees, which will allow you to sit in a more neutral posture for your spine and pelvis. No crossing just one leg over the other! Try to get up/move every 30 min
Be mindful of how you transition. Log roll when moving into/out of bed and move sit to stand with good control. This is a great exercise to strengthen too!

Sciatica and SIJ pain can be a real pain in the ass. BUT, there are lots of resources and support available to you. You do not have to suffer alone and in fact, we believe you can be pregnant and NOT experience unwanted symptoms

NEXT BLOG: Postpartum Hair Loss

Menstrual Cups: Use and Safety From a Pelvic PT’s Perspective

May 29, 2020 Jessica Dufault

There is a LOT of vagina, blood, and general menstrual talk in this blog (obviously). You’ve been warned.

Women are swimming in a sea of options when it comes to availability of things we can stuff into our vaginas during menstruation. In the last several years, products like cups and discs have become more popular due to less environmental impact when compared to one time use pads and tampons. And the fact that cups and discs can be worn 12 hours is certainly appealing. And mess free sex? Possibly another reason to switch. And with switching to new products comes questions and concerns. I am hoping this blog will give you more information and lead you to making the best decision for your needs.

Unfortunately in the world of women’s health, there isn’t a ton of research to support our informed decision making processes (surprise, surprise). This is mostly because women’s bodies are complex, require longer studies which costs more $$ and who really gives a shit (it wasn’t until 1993 that federal law mandated women be included in NIH-research). Why research women when they can just extrapolate research from men and assume it also holds true for women? So trust me when I say there is scant research on the topic of menstrual products and safety.

To start, we can use a comparative study by Howard in 2011 which looked at menstrual cup wearers vs. tampon wearers. The main results of this small study were that there were no differences in pelvic health concerns when comparing the two groups (read: no group had more issues with prolapse). One thing to note is that prolapse in general is fairly common in women, especially postpartum women (BTW, once postpartum always postpartum, so no timeline here). As more women are wearing cups and as we have more info/awareness/diagnosis/support around prolapse, there tends to be an unwarranted correlation here. Also, we know that Toxic Shock Syndrome risk is very low using cups. We used to think it was zero risk, but have at least one case reported.

But, I still have some thoughts about how to ensure these products are actually safe.

And first and possibly most important is that size really does matter. So, if you feel like you have a longer vaginal vault then a longer cup is probably needed. Short space between the opening of your vagina and your cervix (tip of the uterus)? Like, can you poke your cervix with your finger? Then a shorter cup length will be needed. Do you prefer one more firm or squishy? This will depend on your anatomy and the walls of the vagina. Do you have shorter fingers? Then one with a longer stem might be important. Note that discs, which are different from cups, do not have stems. So you have to be really comfortable going fishing high up in your vag behind your pubic bone for the edge of the disc, hook it with your finger to pull it out.

Most women can get cups in eventually but will take some trial and error. With the cup, you can use the c-curve or the punch down fold (google!), depending on your needs.. With the disc, you just fold in half slide it up and back until it hits the back wall of your vag and finish by pushing the front of the disc all the way up and under the pubic bone. I like to have women create an open feeling in their vagina with their breath (inhale, open the doors to the vagina!). Once the cup or disc is in place, the cervix should be right in the middle. It may take some practice to get it comfortably in place and without leakage! This is where we can get some help from a panty liner or period underwear (<—affiliate link). Use code THAT_PELVIC_LADY10OFF for 10% off order!).

Now the getting it out bit. This is where women can come up against some trouble. Unlike a tampon that we just pull out by a string, we cannot just pull the cup out by its stem. There is some debate about whether the cup actually suctions vs. seals, but in the end, I am not too worried about that. If it is suction/sealed and we pull it straight down, it will likely pull pelvic contents gently with it. We must break the seal first before pulling (a pinch and twist is nice. Some cups come with valves!).

Often-times, the cup feels really far up there and so we must use the stem to pull it down before we can even break the seal. If this is happening, please see section on how fit/size matters. Also, we are being advised to ‘bear down a bit’ like we are pooping to help get this thing out. I think a light bearing down in this manner is not inherently dangerous and probably no more risk than our daily pooping or farting. However, if you have to really push/strain and do this EVERY TIME to get it out and are vulnerable to prolapse (postpartum, chronic constipation, have a small asymptomatic prolapse etc)...then no good. As mentioned above, instead of bearing down, I like to help women create more space and openness in the vaginal area by releasing the pelvic muscles vs. pushing the pelvic muscles down. Also note that just before and during our bleeding, hormonal influence makes these pelvic structures a bit more vulnerable. The uterus/cervix will already drop a bit and pelvic muscles aren’t quite as resilient in this phase!

WE MUST ALSO BE CAREFUL TO NOT SUCTION OR PULL THE STRING OF AN IUD! THIS CAN HAPPEN ALTHOUGH SEEMS RARE

Avoiding these dilemmas with the cup is one reason why I personally switched to a disc. I have a slight bladder prolapse and I could feel it bulge every time I was bearing down to get that damn thing out (even with attempting my “opening the doors to the vagina” party trick). I just could not figure out how to avoid this with the cup and didn’t want to continue investing money beyond the 3 cups that already didn’t work for me.

So I researched. and decided to trial a one time use Flex disc (<—-affiliate link. I still felt better about 1 disc vs. 4-6 tampons/applicators however the disc rim is a ‘biocompatible polymer’ whatever that means). The pros for me were the ease with getting it in and out, less leakage and I couldn’t feel the stem (because it doesn’t have one). The cons are that it is actually quite messy (wow, that much blood exits my body in 10-12 hours? How I am still upright?). Much more messy for me than the menstrual cup because the disc has to tip a bit on its way out. So, for me, absolutely not an option to do this in a public bathroom. I solved this problem by taking it out in the shower (since it is only every 12 hours!). As already mentioned, you have to be comfortable with getting your fingers up high, finding the rim, hooking it and pulling it out. I am a pelvic PT. I know this anatomy fairly well but I know anyone can do it with some practice. So, I finally switched to this reusable disc. The cons with this particular disc is that it is more flimsy (the Flex was firm and knew where it was going) plus I occasionally need lube with this disc to get the material to slide.

Please make sure you rinse and wash your cup or disc each time. Our vulvas have a wonderful microbiome that keeps us clean and pH balanced, so please use nothing other than water and possibly mild soap when cleaning your vulva and cups. We don’t need to disrupt what already works so well!

Also, we know nothing. Due to lack of research, we just truly don’t know. So we just have to continue to suss out what feels OK for our bodies and what does not. Every female body is unique. If you have concerns about your pelvic health or menstrual cup/disc wearing, please consult with your OBGyn or Pelvic PT who can certainly give you more unique guidance.

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

NEXT BLOG: Sciatica and Pregnancy

Beyond The Gap: Updates for Diastasis Recti Management

April 20, 2020 Jessica Dufault

100% of women have have some degree of diastsis recti (DR) in the 3rd trimester. This isn’t stated here to increase fear but instead to let you know this is physiologically normal! Understanding DR and where you are in your journey will be helpful in managing it and related symptoms.

Here is just a bit of functional anatomy.

The fascia (linea alba) holds the two halves of your superficial abdominals together. This fascia is actually very pliable, just like taffy. That taffy gets a bit stretchy in the middle when you slowly pull outward on both ends, like with belly expansion during pregnancy. Usually, this is not a giant tear or hole in the fascia or muscle, as many women believe!

The goal is to regain the tension in the taffy between the muscles and not necessarily to bring the muscles together. We don't need to close the gap in order to look better, feel better and improve function!

The old way of DR assessment consisted of measuring the width of the gap. We still do that, but also important is testing if you can generate TENSION in the fascia when you engage during the test. And what happens to the fascial tension when you contract your pelvic floor and deep abdominal layer. This gives us way more valuable information about prognosis and ability to address symptoms related to DR.

Let’s talk about management strategies along your pregnancy and postpartum journey with tips for better management during each phase!

Pregnancy

While you can't prevent DR, you can use strategies to avoid stressing it further while pregnant. I don't want you to be fearful of DR!! But a few tips here may be helpful in postpartum healing, so it's worth exploring

🌺 Avoid repetitive increases in intrabdominal pressures. This means breath holding while lifting something, straining to poo, etc

🌺 Alignment matters! How you stack your pelvis and torso keeps the pressure optimal and reduces the pull on DR

🌺 You want to optimally connect and coordinate the work between your pelvic floor, abdominal, diaphragm and low back muscles. See a specialist to guide you in this

🌺 Avoid engagement of your abs in a "sit up" fashion. Both as an exercise or as a strategy to move from your back to sitting up (always log roll onto your side and then sit up!)

🌺 Make sure you are breathing well! Using lateral expansion of your ribs is so important. There are SO many benefits, but the big ones are torso mobility, full access to your diaphragm, positive impact on DR, your pelvic organs and of course the pelvic muscles!!

Labor and Delivery

Yes, there are even some considerations for how to better manage DR when on your labor and delivery journey!

🌺 advocate for the ability to be mobile during labor

🌺 avoid pushing that increases intra-abdominal pressure for sustained periods with a closed glottis. This means no purple pushing or closing your throat

🌺 choose positions where your sacrum can be free. Even if laboring on your back, this is still possible to modify so that your sacrum isn't restricted by the bed

🌺 advocate for practices that reduce the likelihood of operative birth procedures

Postpartum

These recommendations can be broken up into early and late postpartum strategies for management of DR. Remember to please give yourself the time and space for healing!! You can't technically be diagnosed with DR before 13 weeks postpartum anyway.

Tips in early postpartum (up to 13 weeks): .

🌺 practice postures that reduce excessive intra-abdominal pressure

🌺 reduce activity where you have repeated high intra-abdominal pressures (breath holding, constipation)

🌺 avoid engaging abs in a "sit up" fashion

🌺 establish good diaphragmatic breath

🌺 start with exercises that focus on coordination of abs, diaphragm and pelvic muscles and the progress once inner control is achieved

🌺 avoid high impact exercise

🌺 avoid exercises which cause incontinenc

Tips in late postpartum (after 13 weeks):

🌺 neutral spine posture and alignment

🌺 ensure good diaphragmatic breath

🌺 optimize body mechanics for day to day tasks

🌺 reduce habitual activity that increases intra-abdominal pressures (constipation, breath holding when lifting, pushing etc)

🌺 correct any exercise that causes doming of abdominal wall

🌺 approach concentric contraction of superficial muscles with caution (sit ups etc)

🌺 address any thoracic or pelvic contributions to DR

🌺 approach exercises that cause incontinence with caution

Reference: Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Abdomins: A Delphi Consensus Study. Journal of Womens Health Physical Therapy 2019

NEXT BLOG: Menstrual Cups: Use and Safety

What is the difference between Diastasis Recit and an Umbilical Hernia

April 13, 2020 Jessica Dufault

First, a bit of anatomy to fully understand both conditions.

Diastasis Recti (DR).

The white fascial line is called the linea alba and it is what holds the two halves of your superficial abdominals (rectus abdominus) together and is actually very pliable. All of your abdominal muscles have attachments into the linea alba. When you are pregnant, you can think of this linea alba like taffy that gets a bit stretched and loose in the middle when you pull outward on both ends. This stretch is physiologically normal and is a way we can create more space for growing a human! Sometimes women mistake the overstretched taffy to be a giant ‘hole’ in our muscles, and that is not actually the case in most instances. Again, just a bit ‘stretchy’ like the piece of taffy that lost its tension.

WANT TO LEARN WAY MORE ABOUT DR? CLICK HERE FOR YOUR FREE VIDEO GUIDE

Umbilical Hernia (UH)

An umbilical hernia is a loss of anatomical integrity at the linea alba, meaning there is actually a hole in the taffy. This is where fatty tissue or part of your intestine can poke through the tissue, at the level of the belly button. This can cause the belly button to ‘bulge’ outward. So, a DR can sometimes lead to an UH but they are not the same thing!

What to do if you have DR or UH?

Having a DR or UH is NOT just a cosmetic concern. There are good reasons to pay attention and to seek appropriate resources for managing these conditions. We know that an imbalance in the core can lead to long term pelvic problems however there is good news! Your belly can look better, feel stronger and you can have less to no unwanted symptoms without ‘closing the gap’ or needing surgery for either condition although in extreme cases, this might be required.

Usually, DR that isn’t healing or an umbilical hernia can be related to an imbalance in your abdominal muscles , meaning something is tight or weak (usually both!) and can’t effectively do its job. A second but related cause is also a pressure issue, meaning the balloon of your core can’t accommodate extra forces being put upon it. Many factors come into play here, but how you stand, breathe and use your body day-to-day or during exercise could be causing excess pressure in the balloon. KNOWING THE WHY OF YOUR CONDITION IS VERY IMPORTANT FOR ADDRESSING IT. There is unfortunately no ‘one size fits all’ strategy for healing these conditions. Please see a pelvic PT for a full and individualized assessment of your condition(s) and how to best address it through lifestyle and behavioral modifications, hands on therapy, and specific exercises!

NEXT BLOG: BEYOND THE GAP: UPDATES FOR DR MANAGEMENT

Postpartum Sex

September 16, 2019 Jessica Dufault

First, some clarification. Although this blog mostly talks about early postpartum changes that can affect sexual health, once postpartum ALWAYS postpartum. So a lot of these things can crop up again (for similar hormonal reasons!) in the perimenopausal area of our lives too.

For some, all may go well on initial attempts to returning to sex after the birth of a baby. For others (many, many others!), there may be unwanted physical symptoms with sex. The focus of this blog is to discuss a few of the possible symptoms. What is normal and what isn’t?

Pain with intercourse. There could be many reasons why there is unexpected pain or discomfort during penetration. All the below symptoms are common, but should not be considered your new normal.

One possible cause of pain is restriction from a perineal tear. Whether stitched or not, there is a build up of scar tissue which makes the tissue less resilient to stretch and pressure. A little self-scar release starting at 6 weeks can be really helpful to improve resiliency and thus improve the tissues tolerance to friction!
C-section scarring may also contribute to pain. This scar is deep and can affect a lot of structures in the pelvis and abdomen along the way. Scar massage here at 8-10 weeks will also be helpful for keeping the tissue mobile.
Pain/pressure into the pelvis due to pelvic organ prolapse. This is where the uterus/cervix, rectum or bladder shift their position and can impede vaginal space. Think about a person leaning on the outside of a tent where the person is a pelvic organ and the tent is the vaginal space. When something tries to enter the tent (read: vaginal penetration) there is less room because the tent space is compromised. Certain positions during sex may now be painful.
Believe it or not, many women experience pelvic muscles that are actually too tight in the postpartum period (hence why we don’t believe Kegels are silver-bullet exercise to all concerns in the pelvis). When tight, there is less space for penetration, which leads to pain.

Inability to attain orgasm. Common, not normal. You have deep pelvic muscles that support your core and pelvic organs but you ALSO have superficial pelvic muscles. The superficial muscles optimize sexual health. Both layers get stretched during labor and delivery and may need some neuromuscular re-education on doing their job again!

Vaginal tissue dryness. Common, not normal. Vaginal tissues rely a LOT on estrogen, which plummets in the postpartum (and perimenopausal) period. Estrogen brings blood flow and blood flow brings lubrication. Friction from penetration on the ‘drier’ vaginal tissue can be uncomfortable. Locally, people working at A Woman’s Touch are your Lovely Lubrication Experts. Otherwise, make sure you research good, quality lubes. High quality lubes can make all the difference to reduce penetration friction AND we don’t want the tissues absorbing any unnecessary chemicals!

Loss of urine during penetration. Yep, it happens. Common, not normal. The active pelvic muscles are responsible for supporting the bladder and keeping us continent. These muscles have to release fully during penetration and in the postpartum period (due to many factors!) this release may cause the bladder to leak urine.

Similar to my previous blog Returning to Exercise in the 4th Trimester...If I have symptoms, what should I do? There are many options!

Ignore the symptoms and hope they go away (not recommended)
Pretend Kegels can fix everything (also not recommended)
Give yourself ample time to heal and SLOWLY return to sexual activity (good advice)
See your Pelvic PT who will support your body specific to its unique needs (best advice)

Once you are cleared for sex (at 6 weeks-ish), it may not be easy to immediately return to full on, pre-baby sex! Last few tips/reminders:

This is the time to start working on the tissues, gradually get them used to pressure, stretch, friction etc. Get ahead of the Lubrication Game by being proactive-there are many options to make penetration more comfortable! IF SEX HURTS, STOP and see a PT who can help you figure out the WHY. And…as always, I will end with raining all over the darn Kegel parade. They may not be the best answer for you.

NEXT BLOG: Diastasis Recti vs. Umbilical Hernia

Why I Don't (usually) Recommend Squatting During Delivery

August 15, 2019 Jessica Dufault

“Is squatting an optimal position during delivery?”

My answer, in short, is no.

But people have been squatting for birth since the beginning of time. What has changed? What am I noticing with squatting in clients that would lead me to recommend other positions during delivery? What do I know about body mechanics and birthing that has led me here?

To sum it all up in one succinct sentence....We do not squat correctly!

Essentially we butt tuck. This is where the butt bones and tailbone tuck under, the lumbar spine curves and the pelvic muscles shorten. This is due to many variables, one big one being that functionally we never use a squat. We don’t socialize, eat, cook, clean or eliminate in a squat. What we don’t use, we lose (or in reality, never had)

Also, we tend to turn our feet outward, externally rotate our hips and come up onto the balls of our feet. This is likely due to poor ankle and hip mobility and if we accommodate like this, it becomes a much more comfortable deep squat.

Why does squat form matter for birth outcomes?

What do these compensations have in common? THEY ALL NARROW THE PELVIC OUTLET, which is important because this is where baby exits! This position might be advisable in the early stages of labor when we want to increase the pelvic inlet space but not advisable when we want to open the pelvic outlet space for delivery.

In short, the incidence for perineal tearing in this position during delivery is higher.

I would love to hear your experiences with squatting for delivery, please let me know. The more we discuss, debate and learn from each other, the better for the people we support!!

Note: Not every person has poor squat form and with guidance, squat form can improve. See my attempt to compensate and improve squat form below however, even with compensation, my butt tuck and pelvic outlet orientation is not drastically improved. I truly don’t believe there is a ‘perfect’ way to squat. However, we can’t NOT squat regularly and then expect it to magically work well during L&D based on the above biomechanical considerations.

NEXT BLOG: Postpartum Sex

Congrats! You've Been Cleared to Return to Exercise in the 4th Trimester

August 9, 2019 Jessica Dufault

It’s been 6 weeks. Your check-up goes ‘well’ and you’ve been cleared to return to exercise. So you lace up your running shoes, head out the door (possibly pushing a stroller?) and go for your first run.

For some, all may go well. For others (many, many others!), there may be symptoms. The focus of this blog is to discuss a few possible symptoms. What is normal and what isn’t?

Peeing in your pants

Urinary Urgency

Pooping in your pants

Heaviness or pressure low in the pelvis

Difficulty keeping a tampon in

Pain

So...if I have symptoms, what should I do? There are many options!

Ignore them and hope they go away (not recommended)
Pretend Kegels can fix everything (also not recommended)
Give yourself ample time to heal and SLOWLY return to exercise (good advice)
See your Pelvic PT who will support your body specific to its unique needs (best advice)

As a pelvic PT, the advice is simple. New recommendations indicate that no person who has given birth should return to running prior to 3 months postpartum! Once you are cleared for exercise (at 6 weeks-ish), it may not be time to lace up those running shoes just yet. There is a graded and therapeutic approach to returning to impact activity.

As you can see, it is not as simple as just doing your kegels (you’ve heard this by now I am hoping??). The postpartum body is complex with lots of cogs interacting within the machine. A pelvic PT is the expert in helping you discover exactly which cogs need some love and support in order to optimize function and quality of life.

NEXT BLOG: Why I don’t (usually) Recommend Squatting During Birth

Women Benefit from Seeing a Physical Therapist Early in Postpartum Period

September 19, 2018 Jessica Dufault

We believe all women should have a postpartum pelvic exam and a supportive treatment plan with guidance from a specialized physical therapist. This is usually initiated 6 weeks after vaginal birth or 8 weeks after cesarean birth and should absolutely be a standard of healthcare in the US (another much longer blog post, perhaps?).

New moms have numerous physical postpartum concerns. Whether it is a urinary or bowel concern, a sense of pelvic heaviness/pressure, perineal discomfort, diastasis recti, pain with sex or even back pain, these can all be symptomatically overwhelming. And often these are the symptoms that can fall through the medical ‘cracks’ with standard postpartum care.

Ginger Garner sums this up with a beautiful blog where she quotes Robyn Lim, a maternal health advocate.

“All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six-week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. This neglect of postpartum women is not just poor healthcare, it is abusive, particularly to women suffering from painful physical and/or psychological disorders following childbirth.”

So, hopefully we can agree that a skilled pelvic examination 6-8 weeks postpartum should be a standard for women’s health and wellness. However, I have also seen the value supporting women even earlier in the postpartum period.

We believe new moms greatly benefit from early access to a pelvic physical therapist for general postpartum education.

We believe, with early postpartum support and education, (and with continued guidance beyond 6 weeks), women can become more mindful of postures and behaviors that exacerbate symptoms. Small bits of immediately applicable information help women feel supported and confident that they can have a positive impact on their postpartum body.

We believe it is important to provide a safe, open and supportive environment where new moms get extended one-to-one time with a specialized health care provider (that’s us!). Because of this, we are able to screen and make early referrals as necessary for any other medical concerns.

We believe (and know!) that women want reliable and individualized postpartum medical information sooner rather than later and seeing a pelvic physical therapist is certainly a safe and cost-effective resource. A recent client of mine was referred in her early postpartum period, about 1 week after giving birth. She had numerous concerns about the physical sensations she was experiencing in her newly postpartum bod. Here is what we discussed!

Standing postural education to reduce pressure in her abdominals and pelvis
More appropriate ways to hold and wear baby to promote postpartum healing
How to breathe correctly, which is essential for increasing blood flow, circulation and gentle mobilization to perineal scar tissue
Education on how to reflexively activate the deep core in order to support her core/pelvic organs when picking up her baby, transitioning sit to stand, and protecting diastasis recti if present
Recommended baby-feeding postures to reduce strain on her neck, shoulders, abdominals and pelvis
Water intake and output goals to decrease urinary urgency, frequency and incontinence concerns
Positioning on the toilet and behavioral techniques to ease pain with bowel movement.
How to slowly and easily move back into exercise

The above education is a partial glimpse into the information pelvic physical therapists can provide for women, which is information all should have access to! Daily I hear “I wish I would have had access to this information sooner” or “Why didn’t I know about this?” or even worse “Why did I just suffer through this for so long?” My opinion continues to be that early postpartum education, specific to each woman’s unique concerns, can help a woman feel more empowered and supported when navigating her newly postpartum body.

Next Blog: Congrats! You’ve Been Cleared to Return to Exercise in the 4th Trimester

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