What is the role of a pelvic floor specialist for Moms after delivery and in the Fourth Trimester?

Join me with Kristine Godsil, pelvic floor specialist as we talk about the transition from pregnancy to motherhood. Why rest, renewing our body and recovery are so important

Episode Transcript:

Welcome back to first breaths to first steps. I’m Beverly Garrison newborn health coach and I’m here today with Kristine Godsil. She’s a Colorado physical therapist. We’re both located in the colorful state of Colorado. She practices orthopedic physical therapy, pediatric physical therapy, but her specialty is in pelvic floor physical therapy. When I was pregnant, I was always like, “really you can use a physical therapist during this time!” They have all these great resources now a days. It’s awesome to have Kristine with us today. Welcome. Thank you. It’s great. Kristine started with her current company Active- Core in March of 2021. And due to wanting more one-on-one time with her patients, she made that transition to environment. Her passion is not only getting patients pain-free, but really problem solving and figuring out what’s causing our pain or dysfunction. As well as giving us great tips and tricks of how to get these individuals back to health.

So today we thought we would talk about that timeframe immediately after moms have delivered. I like to label this discussion, rest, renew, and relationship. So Christine, let me have you start us off by really talking to us about what is a pelvic floor specialist , physical therapist, and how can we get some pelvic floor recovery immediately after delivery.. Absolutely. Yeah. So pelvic floor physical therapy, it really all entails any sorta urinary bowel or sexual health. So if you’re having any dysfunction or pain or just, aren’t sure what’s going on in any of those realms or systems, it’d be a good time to come in to see a PT. Cause at least we could figure out. If we’re the first stop, if it’s, if it’s truly muscle driven or if you’re having any sort of ligament restrictions or at least getting into the next set of hands, that would be helpful.

I think it’s you know, I think back in the day, my babies are 21, 19 and 17. You know, we, we didn’t always talk a lot about, you know, gosh, my body I’m really struggling with this, or you even have questions about your sexual health. We really. Didn’t talk about that. So I think it’s really nice to identify for our clients and our moms in particular, that you know what, there is someone that can give you good advice and walk you through some scenarios and help you kind of game plan and make, you know, just a solution that’s gonna work for you because I think there’s so many times where we think that kind of topics are taboo. And a lot of moms, I feel like don’t even talk about that with their OB GYN or their primary care providers. I think it’s great pelvic floor for sure. Absolutely. That’s where I always tell my clients too, that there’s no information, that’s too much information. And I kind of meet them wherever they’re at. Right? Like you’re saying, it’s a topic that’s taboo and in some cultures or in some families, it’s, it’s, there’s a spectrum to it. And so I always tell them to them just like, you’re not going to hurt my feelings if one that you. Really dive into the question, or you want to take a step back and maybe wait till the next session that you don’t feel comfortable enough. You know, I’m here for wherever you’re at on that journey. And we’ll kind of put those pieces together, right? Yeah. I mean, I spent a majority of my clinical career in pediatrics, so not a lot of women’s health, but I think we treat a lot of women in pediatrics because we’re there with mom. Talking to them.

And we have a baby in our first recheck tends to be at four to six weeks. And I think a lot of times we have a lot of questions beforehand. So it is kind of nice to find out who is the pelvic floor specialist in your area, or who does that type of work so that if you do indeed have an issue or a problem, you know where to go.

It’s easy. It’s like going to the pediatrician or going back to your GYN or, getting in to seek extra care with lactation. It’s just knowing that those people are out there and that we really do have that resource in the community . I think is super helpful.

Can you talk to me. What your thoughts are on just pelvic floor recovery immediately after delivery. What does that look like? Things should moms be doing? Yeah. Zero to six weeks, cause your next checkup after you deliver, baby is at that six week point, unless you have something else going on, people go on before that. But that six week mark is meaning that those tissues, whether it’s a vaginal delivery, whether you’ve had a C-section, those tissues should be healed. Your scar should be completely healed or come together and we should be able to see. Allowing for some sort of movement or some sort of stress onto those tissues.

That doesn’t mean that we can’t do anything before. But what that looks like is making sure we do get enough rest and recovery, like you’re saying. We mean into those, zero to two weeks, I generally have it of making sure that walks kind of stay just around the house. And are just as tolerated those kinds of things. You can lean into some like deep breathing if it feels comfortable, because what that does is kind of. And initiate that ebb and flow of your diaphragm and pelvic floor. And that stay for either vaginal delivery or C-section. And then usually when we’re getting to that, halfway point of that six weeks, so three to six week is when I start to initiate light tables or pelvic floor contractions, like deep abdominal contraction. Just initiating those things, not going a hundred percent, but making sure you can feel it right. And doing light repetitions, just throughout your day, hours or weeks. Those are the. And then I think the last set of it is that you can start to integrate a little bit of light exercises with those things. Once we feel that that’s comfortable and make sure that we feel that kegel or contraction, or that deep abdominal, you can start doing light bridges, light squatting other ones that I do are marching, those kinds of things in that four to six weeks realm.

Why there are different variations of zero to two, three to six. I can, I’m sure you can relate in pediatrics is that there’s no hard line. Because it’s based on, where you’re meeting a child for a milestone, same for mamas. Right? If you don’t feel like you’re comfortable or you’re getting pain of trying to do a Kegel at three weeks, Give yourself a couple more days, right? Maybe your scar is healing in a certain spot that where you’re contracting. So don’t use those as hard and fast rules. Make sure you’re listening to your body so that you can start that healing process and make sure you’re getting that rest that you need.

Sure. I think sometimes, well, Live in Colorado. We’re in the land of quite fit people. And sometimes I feel like there’s this unrealistic expectation of I’ve had this baby, so I should be going back to normal. But it’s a major health event, even if you didn’t have a C-section or a surgery, right. That poor pelvic floor sometimes, you know, takes a little bit of abuse.

And so. You know, ripping or needing an episiotomy or things like that can really kind of change our recovery plan and how things progress. I think that you bring up a really good point on, take a little time that’s allowed it’s okay. And that, not having just a unrealistic expectation of that timeframe.

As far as C-sections, what sort of restrictions activity-wise do you guys have moms follow within that first couple of weeks, time period after delivery? Yeah. So like any abdominal surgery. Cause if you think, if you walk it back, right. A C-section is a major abdominal surgery, right? Thinking of those restrictions, you’re not going to want to do any excessive bending, twisting, anything like that. Most of the time they limit the weight of your baby. I always like to tell the story, my sister, she had a C-section her son was premature. He went home at four pounds. And so when they gave her that spiel, she was like my baby or anybody else’s , what’s that what’s that rail or ones that justification. I always like to level it , if you think about a weight restrictions, usually about eight to 10. Generally babies. Aren’t more than that either. And think that a gallon of milk is about eight pounds, so nothing heavier than that that realm. Putting into something a little bit more tangible that way, too.

And again, it’s leaning into that recovery period, making sure that you’re not getting any sort of pulling or anything like that. Different things to look out for of, scar healing making sure that there’s no infection. Making sure bandages or stitches are healing. Well, those kinds of things are staying on properly, right. Or that are opening up. Right. Absolutely. And then we’re looking into, to is sensitivity. Is there any pain, is there any numbness, those kinds of things, because generally at that six week appointment we’re going to be looking into that of making sure if the tissues feel the same and then are those tissues moving the way that they should.

And then how can we initiate all of that with massage? Right. I think you do bring up a good point because that is kind of the general statement that we hear is that, you know, don’t lift anything more than your baby and babies come in different sizes, packages, whatnot, so pounds, and that, that visual of, lifting a full gallon of milk. That’s a really good piece of information to tuck away for us to go, okay, my baby. Six pounds, seven pounds. That’s about it.

A lot of times too moms are given driving restrictions. First couple appointments to get your baby in at least right after discharge. Maybe a couple of weeks after that, that you weren’t driving for those. If you’ve had a C-section. And making sure you have a helping hand like what you’re touching on. Somebody dragged knew somebody who walk babe up the stairs, saying you need to go to the apartment or walk into the house. Those kinds of things too. Yeah. Right. Exactly.

What minor activity can be performed safely, right after delivery. And when do you suggest stepping up activity? Yeah. So usually it’s after that zero to two weeks. Right. And making sure that walking’s comfortable. And when I have people start kind of a walking program, say during that second week. Of trying to go outside, go around the block or something for five minutes. And if that feels okay right the next week, then let’s bump it up by five minutes. I usually have that a nice additive. Maybe, or around 20 to 30. Depending on how your body’s responding and making sure that that’s comfortable.

And then we talked about, adding some light squatting or like sit to stands or bridging kind of in that like four to six week period. But again, that’s mainly to win that. Solar isometric pelvic floor contraction feels okay. Or that deep abdominal one feels. Okay. And just gauging it based on that, of how your body feels, because I’ve had some patients too, that they initiate those kegels or that deep abdominal contraction at like week five They’re just there they couldn’t feel it before, couldn’t it or didn’t feel okay enough. Right. It felt off. They just waited and they mainly focused on walking or whatnot. Gaging it to you cause that’s okay. And it should be, it should be tailored to you.

Well, and I think you bring up a great point because there’s a lot of differences amongst us as moms. And not only is every mom different, but every pregnancy within the same mom is different. And so what you may have been able to do your first or second pregnancy, you may not be able to do your third pregnant. At the same time point. I think you bring up a very good point in that, for sure.

I think also the last thing that I wanted to touch base on was immediately after just talking about best positions for moms, when they’re sitting, when they’re holding their babies and, or feeding, can you address some of those things. Yeah, absolutely. Best positions generally, and I think for breastfeeding or any sort of feeding, right. Whether it’s bottle or breast is, is making sure that you’re comfortable. And that’s hard sometimes, especially if it’s a middle of the night feed. You’re I’m not going to go grab three pillows for this.

But make sure you know, and have what set up best for you. Use that boppy pillow. I think. Well, I think that’s, that’s just for babe. It’s really for mom too of making sure that your arm supported, it’s not completely holding baby upright. So if you are sitting upright, if being in a more reclined position is comfortable that you don’t feel like you’re putting a lot of weight on that mid or upper back we’re not getting a lot of tension in the shoulders, right? They’re not coming in up to ears while we’re feeding just making sure that they have support. I’ve had people play around with side-lying as well. For breastfeeding, that’s a great option. Let’s you get some rest puts baby in a great position to, and that way your muscles aren’t overworking, especially during those night feeds. Figuring out for you. Is it more comfortable being reclined? Is it at a side sit and what to kind of do afterwards, making sure you find the stretches that work for you. If you feel like you’ve sat in a wonky position for the last 20, 30 minutes. Get out of it, get a nice side body stretch, stretch out your neck while your shoulders. So you’re, you’re not holding onto that tension. Right. I think you and I have talked before, just about the importance of pillows. I love pillows, smaller pillows, any pillow you can get. I think it helps to get us in a good position, especially with feeding. A really good thing to remember is bring baby up to you and not you down to baby.

It gives you better body mechanics, and you will feel better later doing. But I love the Boppy and I love little pillows that you can also use in addition to the boppy, just to get that perfect position. It doesn’t seem too bulky if you can get, I don’t know if you remember back in the day when you used to fly and be able to get a pillow and a blanket, but smaller pillows, a little pillow.

In addition to that, Bobby sometimes can really put that little baby in a much better position for you that you’re not having to. Contort your body to fit that need you got it. And just like, you’re talking about different sizes of pillows cause sometimes those aren’t readily available or you can’t find like a perfect size. I’ll have of you people play around with different like rolls. Washcloths to hand, to bath, to beach towels. Depending on what that need looks like and how you need to form it to , whether it’s your side, but. Just underneath the arm or whatnot. Cause that can be an easy fix and something you already have laying around.

Right. For sure. I do like to advise, mom’s get your feet up after a delivery. If you’re sitting, especially daytime feeding and maybe you’re in a part of your house where there’s a couch, get your feet up, just helps to decrease all that fluid, pulling down to our. Our lower extremities to both our legs and our ankles. I think that can just help reabsorb and decrease some of that swelling that we see in that situation.

What about positions for sleeping right after delivery? Do you have any suggestions for that? Yeah, it’s kind of similar to any of those during pregnancy, especially like, we already talked about how, even if there’s a mama, that’s more active or, we have that bounce back mentality. And granted sometimes that happens for women and kudos to you, but sometimes it doesn’t. And that’s okay. And I feel like you’re still having some of that fluid or you still have some of that extra weight , making sure you’re meeting your body where it works at. I think that is like, you’re saying pillows, man. They, they do it all and we can show them some to combat any of those. Now that you can be more back sleeper, laying supine, you can do that. Like you’re saying feet up whether it’s on a wedge, whether it’s just underneath your knees, whatever’s most comfortable and makes you relax down to cause getting that relaxation, not just to the body, but the pelvic floor is also huge. Making sure you’re comfortable in those positions. I always kind of joke with you, Kristine, that I’m your old friend, but I think even just reminding moms, you know, even when you’re getting up, just from a laying down position, sometimes rolling to your side, helping to push up and not necessarily straining those abdominals or expecting that they’re going to work as well as they did before.

Absolutely. Kind of an easier thing to think about, be nice to yourself, meet your body where it’s not exactly what you said, meet your body, where it’s at. Yeah. If you’re saying a true log roll, I feel they teach that for any back surgery or any sort of total hip, total knee? How to get out of bed properly. I don’t know if that always happens before you exit especially after a C-section, but you were saying roll onto your side, have your feet hang off and then push yourself up. No reason to do a major crunch or sit up to get out of bed. It puts way too much pressure and I know it won’t feel good. Give yourself a break. Exactly.

Well, Kristine I really appreciate you being with me here today. I think we covered some great things as far as immediately after delivering. Rest renewing your body and talking about that relationship of healing. I appreciate your time. If any of you listening found the information that Kristine and I talked about helpful, you can contact me in the link below and until next time be well.