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At Home With Your Pelvis

postpartum self care survival tips

11/13/2019

 
My last post was about the importance of self care and creating space postpartum to process your birth and prioritize your physical and emotional recovery. Maybe you want to add in more self care, but you don’t have time to think of ways to help yourself. So, let’s do it together!
  1. Identify your support network: friends, family, neighbors who can help. Who’s the best organizer in this group? Ask them to make a sign up spreadsheet for people to bring meals, help with groceries, or be there to watch your baby while you shower. The goal is to get assistance without needing to be the managing person coordinating or directing all of this. You can then focus on the important things that only you can do. 
  2. Set up your space: It sucks when you get positioned to feed your baby and realize your water bottle is across the room! Be your own fairy godmother and put a glass of water, lip balm, and some easily grabable snacks (nothing that needs two hands) next to feeding areas to help out future you. My amazing sister-in-law (with 3 kids to manage) suggested this lifesaver tip. 
  3. Say yes: You were an independent person before baby and maybe not so good at asking for help...Now people are saying “if you need anything, let me know” and your gut reaction is still to say no. Say YES. What’s one thing you really need from the store that they can bring over? Can they show up with lunch? Or coffee? If you’re worried about paying them back, that’s what Venmo is for. Are you going out today and need an extra hand? Have them come over first to help you pack up and help out in the car. 
  4. Don’t sweat the small stuff: If it’s not critical to you and the baby, try to let it go. Is your home a mess? Oh well. Did you forget to call your friend on their birthday? They’ll understand. If you can’t give yourself a break during this time, when can you? If it’s absolutely impossible for you to not worry about these things, write them down. Keep a running list that I hope you never look at. Send it to your organizing friend!
  5. Sanity Hour: Do you have the blessing of going through this period with a partner or is there family staying with you right now? Amazing. Pick out a 30 minute to 1 hour time slot per day that is sacred time for you. You must be on your own at that time. No calls, no questions, no baby. Take deep breaths, stretch your back and arms, meditate. Watch some TV, write in a journal, read a novel. You need this.

               What are some of the things that helped you with self care? Comment below!

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your Identity Is more THan Mom

11/13/2019

 
I often get pushback when I say this, but I think you are just as important as your child. I know that little babe is helpless and needs constant care, but sometimes you still need to come first. As they say on airplanes, put on your own oxygen mask before helping those around you.This is often really difficult for women. Societal expectations raise us to put ourselves after others and we are taught to be caregivers. Any deviation from this can make many women feel guilty or selfish. This is amplified into your identity postpartum. Our society tells women that caring for yourself is selfish and being a good mom is about selflessness. This is dangerous rhetoric. You’re a woman with many interests, but now your thoughts and conversations mostly center around your baby’s growth and milestones. Your identity becomes Mom.
Although this is wonderful and your children add richness to your life, it’s important to keep your needs and recovery at the forefront. As an added bonus, you will do a better job caring for your children if you are healthy, rested, pain-free, and emotionally present.
Please take a moment to (without judgement) think through your recent days: did you treat yourself as a priority? Did you feel guilty taking a shower? Eating a sandwich? It’s natural biologically to tense and run over when your baby starts crying. I understand, but is someone watching out for you too? Have you caught your breath enough to think about how you’re feeling? Are you in a state of hyper-vigilance all the time? 
Sometimes I am working with a client on her scar and all of a sudden, she starts crying. The intensity or even trauma of birth can be overwhelming, but there’s rarely time to process it. You are immediately a mom, with a new life and new priorities. So, you may put any grief, fear, or anxiety you had about the birth in a lockbox. Seeing a pelvic floor PT is often the first time a woman starts processing these emotions, when the scar brings them bubbling up. 
It is also natural to feel some grief for the loss of the person you were. You feel different, you look different, you are different. Someone is constantly needing you and you no longer have time to yourself. Women often experience guilt about these thoughts, especially if you expected to feel only gratitude and all encompassing love. But having a baby is like throwing a bomb into your life. Even if it was an absolutely desired and sought after event, you are still picking up the pieces. Please be gentle and kind to yourself during the process. Prioritizing your physical and emotional recovery is an important, but often neglected, part of the postpartum experience.
Compassion and care for others requires self compassion and self care. As the great Ru Paul says, “If you can’t love yourself, how in the hell are you going to love somebody else?”
Amen.

Bladder Leaks are not normal.

5/10/2019

 
I just caught a commercial for a new brand of tampons and pads. The gist of the commercial was natural products and female empowerment and I’m all for it! Until the part where they proudly said “We bleed, We leak…” and I was throwing my shoe, cursing: “$*&% Noooooo!! WE DON’T NEED TO LEAK!”
Yes, it is extremely common for women to have bladder leaks. 26% of women between the ages of 18-59 experience involuntary urinary leakage and this problem affects more than 25 million people in the US overall. But COMMON does not mean NORMAL. Normalizing bladder leakage adds to the problem. Our medical system often waves people away if they complain of urinary incontinence (bladder leaks), especially if the person voicing their concern happens to be older or postpartum.
I’m all for products that will help people be more comfortable and confident on their path to recovery, but the cynical side of me recognizes that these companies have a lot to gain from this normalization and lack of treatment. Especially since the incontinence industry was estimated at $65.9 billion in 2007, with projected costs up to $82.6 billion in 2020 and some women spend as much as $900 per year on leakage products and costs related to incontinence.
It doesn’t need to be this way. There’s a lot we can do to treat bladder leaks! Some thoughts to consider:
  1. Find what triggers your leaks: Is it a mechanical reason like coughing, laughing, sneezing, or the enemy of many women - the trampoline 😱? Or, is it more related to times you experience a strong urge to pee, such as seeing a bathroom, hearing water, or turning your key in the door when you get home? Maybe you leak in both types of situations? Knowing these triggers helps decide treatment.
  2. Log how frequently you actually go to the bathroom: For overwhelmed postpartum women, you may be forgetting to pee! If you’re drinking a lot of extra water for breastfeeding and forgetting to go to the bathroom regularly, this may be a big part of your problem. Make sure you’re going to the bathroom every 2-3 hours. Conversely, if you’ve been leaking for a while, you may have overcompensated by going to the bathroom too frequently. Your bladder may have learned not to hold. Getting a clearer picture of how frequently you pee and when you leak helps us make smart changes.
  3. You’re doing kegels but they aren’t working: Research estimates 15-25% of women do kegels incorrectly with only verbal instruction. Many women compensate with other muscle groups instead of the pelvic floor, or they overuse the posterior pelvic floor muscles (the ones closer to the anus). The muscles that help with bladder leaks are up front (around the urethra), so overusing the back pelvic floor won’t help! An internal pelvic floor exam will determine if you’re using the correct muscles at the correct time.
  4. Kegels aren’t always the answer: A tight and overactive pelvic floor can also lead to leakage. If your muscles are overworked, they may give out when you really need them and not be there to prevent leaks, especially at the end of the day.
If you experience bladder leaks, please seek treatment!

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Sources:
1. https://www.nafc.org/
2. Koyne KS, et al. (2014). Economic burden of urinary urge incontinence in the United States: A systematic review. Journal of Managed Care Pharmacy. 20(2). 130-140.
3. Subak, L, et al. (2006). The “Costs” of urinary incontinence for women. Obstetric Gynecology. 107(4). 908-916.
4. Bump, R., et al (1991). Assessment of kegel pelvic muscle exercise performance after brief verbal instruction. American Obstetrics and Gynecology. 165(2). 323-329.
5. Henderson, JW., et al. (2014). Can women correctly contract their pelvic floor muscles without formal instruction? Female Pelvic Medicine & Reconstructive Surgery. 19(1). 8-12.

Let's get intimate...talking sex after baby

5/1/2019

 
As a pelvic floor PT, I find my clients feel really unprepared for returning to intercourse after birth. Many women go to their 6 week postpartum visit, are told they can have sex, and feel COMPLETELY overwhelmed by this prospect. “You think I can do what?? Already?!” Though you’re often given the go ahead at 6 weeks, you may receive little advice about how to return to sex and it may feel taboo to ask your doctor about it. So let’s get into it! There’s basically nothing I won’t talk about...
  1. It’s ok if you don’t feel ready. You and your body have been through A LOT. It is absolutely fine to wait longer. If your partner is mad about it, you can tell them I said so :). I’ll take the blame. Maybe you experienced a tear, have pain or prolapse, or you’re just EXHAUSTED. Wait until you’re ready. Please. Pushing through sex because you think you should can cause more pain.  
  2. Start with something less...invasive. Your body is different and the way you feel about it is different too. Start with lower pressure sexuality and intimacy. Have an orgasm! Get creative with your partner, get to know your body again, and have a good, intimate experience externally first. Sexuality is not just about vaginal intercourse.
  3. USE LUBRICANT. I cannot stress this enough. Postpartum, your estrogen level drops significantly. Especially if you’re breastfeeding, but even if you’re not. This drop in estrogen leads to more vaginal dryness, so lubricate! Lubricants are not created equal, so try a few options to find your favorite. Check reviews online or visit the very knowledgeable folks at Good Vibrations to get some advice. Many people love a good water based lubricant, like Slippery Stuff, which I use for exams. If a water based lube doesn’t last long enough for you and you have to keep reapplying, you may prefer a hybrid or silicone lubricant. Sliquid is a good quality brand with water based, hybrid, and silicone options.
  4. Scar tissue massage is your friend! I know touching your scar, or even looking at it, may feel scary but getting it moving better can make a world of difference to comfort with intercourse. This goes for perineal OR c-section scars! Try working on your scar in the shower! It’s a great time to do it because your hands are already clean and your body is warm with good blood flow to your skin. If it’s your perineal scar you’re working on, put one foot up on the side of the tub to reach better. Put your fingers on either side of your scar and wiggle it gently, sliding it side to side, up/down, in circles etc. The point is not to push into heavy pain, you want gentle stretching only. No more than 4/10 on a discomfort scale. If it hurts too much, you won’t be able to relax, which defeats the purpose. Don’t forget to breathe!
  5. Breastfeeding is not birth control!! There is a misconception (pun intended) out there that you can’t get pregnant if you’re breastfeeding. Some women don’t get their periods the entire time they’re breastfeeding, but others will. Because you ovulate before you get your period, and periods during this time can be irregular, you need to use a form of birth control! Unless your dream was always to have kids one year apart…
  6. Don’t be surprised if you lactate during sex. I know...that’s something you didn’t expect. Arousal can lead to lactation, so you may get some leakage of milk during intercourse. Some women choose to wear a bra and nursing pads during sex if this bothers them.
  7. See a pelvic floor PT! (That’s always my answer, right?) You might not have known we can help with this, but a pelvic floor exam can give you a better picture of what’s causing the problem with intercourse. Is it tight or sore muscles? Prolapse? Scar tissue? Let’s find out and give you recommendations tailored specifically for you!

AN Open letter to postpartum women

4/17/2019

 

Dear New Mom,
​

Like many women, you may have waited a full six weeks before seeing your OB after giving birth. You struggled and pushed and stayed up all hours, and maybe had major abdominal surgery (hi, c-section), and then a few days later you were waved out the door with an infant and no instruction manual. Six weeks of a whole new life: crying, rocking, pain, joy, struggle, love, and drama. Then, you get to your six week postpartum visit, sleep deprived and overwhelmed, and your OB says that you’re “healed” and “good to go” back to exercise, sex, and work. And you were probably thinking, “What?!?!”
I want you to know that no woman has ever told me they felt back to normal at six weeks postpartum. You are not alone. The six week visit can be traumatic because of the vast chasm between how you feel now and what you knew as normal before. You may look at your OB and wonder if they really recognize you, do they really see you?
To give your OB the benefit of the doubt, they likely mean you are progressing normally through this recovery process. Their time with you is so limited, they really only have the opportunity to check on healing of your uterus, any perineal tears or c-section scars, and talk to you about birth control. It is relatively rare the OB will check for prolapse or diatasis recti and they almost never assess your pelvic floor muscle awareness or strength. This brief visit and the recommendation to return to all activities can result in the unrealistic expectation that you should feel back to normal after 6 weeks.
This interaction may make you feel behind the curve or ashamed of your current body and how different it is. You may worry your OB is saying this is your “new normal”, and that this is all the recovery you can hope to achieve. This shame or worry may stop you from sharing how you really feel with others. You look around at other postpartum women, who seem to be happily coping and focused on their babies, and wonder, “Is this just me?” No, it’s not just you, and we need to talk about this together!
I want you to know that we’re here to help. Your body took nine months to prepare for this and will need time to recover. Fun fact: just the uterus shrinking back down to normal size takes about 11-12 weeks! There will be so many changes and you need knowledgeable, caring providers supporting you through this process.
In some other countries (bonjour, France!), this is standard care. Every postpartum woman gets referred to pelvic floor physical therapy after every birth. This makes sense! Your whole body changes during pregnancy and the delivery process can be very physically (and emotionally) traumatic. In the US, if someone tears their ACL, they often receive up to 6 months of rehab. Well, a lot more than your knee is affected during pregnancy and birth...
Postpartum women need support here in the United States AND we need to talk openly about our bodies and how we really feel.
Things are slowly changing in the US and the American College of Obstetrics and Gynecology has revised their recommendations for the postpartum period, to offer earlier postpartum visits and extend care through 12 weeks. Until more of these changes take effect though, you will need to continue to self advocate and seek out support. You do not have to get used to incontinence, painful sex, feeling weak in your core, or pelvic pain. Please reach out to pelvic floor PTs, The Lotus Method, postpartum doulas, lactation consultants, and support groups to help you on this journey.

Best wishes,
Jessica Abele, PT, DPT, NCS
Therapy Roo Physical Therapy

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