#25 | Your Core & Pelvic Floor: Interview with Women's Health Physical Therapist Tara Gibson

May 20, 2020

In today's episode we're sitting down with physical therapist Tara Gibson, founder of Aligned Life Physical Therapy and Pelvic Wellness, where she works with prenatal and postpartum women in repairing and maintaining a healthy core and pelvic floor.

Just think Kegels, sex, abs, peeing when you sneeze, diastasis, and what can be done about scar tissue. Let's learn to how to strengthen, recover and tone where it matters most. Don't miss the incredibly valuable information in this episode on why a healthy core and pelvic floor are essential.

Aligned Life Physical Therapy
Voices for Pelvic Floor Disorders
Recovering From Birth

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View Episode Transcript

A lot of women are very self conscious about what has happened to their vagina since giving birth. I think that it is, unfortunately something that most doctors tell people that they're just gonna have to live with and then it'll will eventually quote unquote, go away.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast.
Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

In today's episode, we're sitting down with physical therapist Tara Gibson, founder of aligned life, physical therapy and pelvic wellness, where she works with prenatal and postpartum women in repairing and maintaining a healthy core and pelvic floor. Just think eagles, sex ABS peeing when you sneeze, diastasis recti. And what can be done about scar tissue? Let's learn how to strengthen, recover and tone where it matters most. Tara, thanks so much for being here today. Why is this area of the body that we're talking about the pelvic floor, so important, I feel that a lot of women just don't understand. And we'd love to kind of get the background on what this all means for women.

Well, I, interestingly, I think a lot of people don't even know what the pelvic floor is.

That is true. Yeah. And so you have to have a bit of an icebreaker on that because I know that there was I heard an interview once on television where an esteemed pelvic floor therapist was asked, was being interviewed by a male. And he said, You know, I'm so glad that we don't have pelvic floors and that's only something that women deal with. And it was it was actually a priceless moment because obviously we all have pelvic floors. But let's talk about women for today are sir Maren Parton are very, very important. It is the center of our being is the, you know, the essence, on on a, on a deeper level of I think how we how we identify with who we are as as women in our femininity, and our power that is the center of our sexuality, and is obviously part of our bodily function that, you know, allows us to have the lifestyle that we want to have.

It seems so few women know about pelvic floor physical therapists and the ones who do the clients of mine who do rave about it. I think my question is, how are those women benefiting? And why is this something all birthing women should be paying attention to?

Well, many women will suffer unfortunately, more stress than others. On the pelvic floor during pregnancy and during labor and delivery, and unfortunately a lot of our medical field is not aware that there is support physical therapy that can support that process and help women recover from what happens. It is a beautiful process but it can be very at times very damaging, and we need time to recover and repair from that and this is what pelvic floor physical therapy does.

Can I just jump in? Are you actually putting your hands on the women's vaginas?

Yes, I'm so glad you've asked that. I think a lot of people don't understand that there is a spectrum of work that's happening with pelvic floor physical therapy. And though this is not always the case, by any means, and I never will do treat somebody in this way unless they are fully comfortable and have signed a release to do so but a lot of my work is internal So I'm actually treating internationally. Sometimes even interactively, if that becomes an issue if I'm dealing with severe tailbone pain or a pull that is more posterior or toward the back, and I can't get to it magically. But oftentimes the work is bad. And so I am, I am working with someone that's very, very intimate and requires a lot of trust. And I have them gound and draped carefully and they're very comfortable on pillows. And my hands are gloved and I use, you know, a hypoallergenic lubricant. And I am talking them through every moment that I'm working. And I am, you know, explaining what I'm seeing because a lot of women are very self conscious about what has happened to their vagina since giving birth. And then I'm gently going in, it's very different than you might might experience at the gynecologist. It's, it's much more of a communication. And so I'm never pushing someone into a state of pain. I don't want them to be in a state where they're uncomfortable with me. We're going through Very gently. And if something is uncomfortable that if I may not make it all the way inside, we might just be treating on the surface and that might be where it needs to be treated. But sometimes I have to work deeper. And when you're dealing with clogged ducts and mastitis, you're also going to have your hands on the women's pasts as well. Very good point. It's very intimate. So with with their permission and with comfort, I'm treating around the breast tissue directly, gently and directly. And so we work together.

I am I never knew that exists. I really didn't think that. Yeah, I didn't. I had no idea.

I think there are; it's a very highly in quickly growing field. The internal work is just part of our process and truly is just part of the process. But we look at the internally which is a very private area is also just another part of the musculoskeletal system, a very intimate part, but a part that can very much be affecting someone's experience in their life and in their function and in their intimate relationships.

So when you talk about recovery, what is it? Can you help our listeners out there understand what what are the long term consequences? Or what are the complications of the pelvic floor that women deal with.

So the pelvic floor being a, you know, I had not actually identified as being the area between the pubic bone and the coccyx and between the two sits bones and we have all the muscles and fascia, that's a nerves that surround those, those very important structures. And so often, first of all, in just the weight of carrying a baby to term, the weight and how that can affect the vasculature and just the organs underneath the the uterus and then the the actual pelvic floor muscles and fascia underneath that and the bladder maybe and the bladder can all be pushed down in a way where their own ligaments, their ligaments of support, actually becomes overly stretched, and can be forced into positions where they need to recover from that. And this is what is called prolapse of an organ. If it's dropping out of its original position, there are different degrees of that some are more severe and affect function and some don't. On top of that, through the process of actual labor and vaginal delivery in particular, there can be damage actual tearing, not only to the connective tissue and skin, but even the muscular layer that is inside the vagina, the pelvic floor muscles that are what we use when we do a key goal
that's actually very common right there. I mean, it's there. It's very common for those muscles to be torn.

Yes. And to some degree, you would say that that is normal. I mean, I definitely know there's a handful of women that will go through a full labor and delivery and not tear.

Do you know why? I mean, I always felt it was related to the position that I was in when I was giving birth but sure, is it nutritional? Are there other factors. There can be absolutely multiple reasons for that some of that is going to be a genetic component in terms of just the integrity of your connective tissue. And whether or not you're more prone to stretch and possibly tear, the degree of stress that's happening over the duration of a labor, the amount of force that is being applied, or sort of any sort of stress on the pelvic floor, especially a long laboring process can be very, very stressful. And you add to that how a woman has carried up to that point can affect the pressure of where the baby is sitting in the pelvic floor and can be can lead to being more risk for tearing during labor as well.

So is it true then that women who are very fit such as runners, cyclists, weight lifters, who have very strong pelvic floors and very tight muscles are potentially at greater risk of tearing because those muscles don't relax to a degree That is true. There is death as a polities teacher and being originally being trained in a very classical method where there was a lot of engaging and lifting and tightening of the pelvic floor. I was a ballet dancer as well similar concept. It's like pull it up and keep it up. That strength can actually work against someone when they go to deliver a baby if that the muscles and fascia have been being held in such a tight position for so long, that they're not able to fully relax. And that can absolutely lead to tearing. Yes, so it's not just about weakness, it can be about tightness.

We're going to talk about the abdomen and the diastasis recti as well, but I think that's a similar concept.

Very much so. Okay, we'll go into that right now. Because I was just thinking the same thing. Can you explain Tara, why and how the core the abdomen plays such a pivotal role in the health of the pelvic floor. What's the relationship between what we think of as the core and apologies sense, and the pelvic floor? Yes.

Well, neurologically, there is a connection. neuromuscular Li that when the deepest layer of the abdominal core is firing will facilitate or what we call turn on the pelvic floor as well. So they work in unison with each other, and they should. They also work in unison with each other with the breath, particularly with an exhale and relaxed exhale. There should be a slight lift of the pelvic floor and a slight contracting of the abdominals and narrowing of the waistline.

Can you just give us an example. So our listeners might understand that concept of how the the deeper abdominal muscles work with the pelvic floor, like what kind of activity might somebody be doing where that would be? strongly engaged?

Right? Well, if someone is is actually doing a key goal If they are trying to stop the feeling of urinating, if we're just talking about the specific activation of that muscle, so it goes vice versa when I lift my pelvic floor, which is what that key goal is, without going into the details of what a key goal can be, because that we could go deeper into that those deep abdominal muscles will also fire with that they fire together. So there'll be kind of a lifting sensation that goes through the abdomen. Can you isolate them individually? Actually, yes, studies have shown that you can, but that in a regular functional state, they should work together as a unit if one is damaged, or if one has been turned off. This could be for postural reasons, and I'd really like to talk about that stress, dysfunctions and how we're breathing, then they may not be working in coordination with each other anymore, carrying a very heavy baby over time, and then going through a very stressful labor and delivery process can also contract To that, and ideally we want them always working in conjunction with each other.

That's right, they should both stretch and they should both contract there should be a sense of within a gentle inhalation, the pelvic floor should gently drop like a trampoline and the abdomen as well as the ribcage should very gently expand outward, kind of in a circumferential circular way, very gently, it's not extreme. And then on an exhale, everything should recoil up our body is a pressure system. Some people confuse that with a belly breath. It's not about pushing your belly out. It's about allowing the pressure to go through your whole system, all the way down through the pelvic floor.

That makes so much sense. Your yoga breathing and it's it's not breathing up into the neck. It's not. It's not fully the upper chest does move, but it shouldn't move much only when we're running away from a tiger. That's when these other breath muscles should come in. But many people stay in a state where they're constantly breathing from muscles that are not allowing that pressure system. to function properly. And it sounds ironic, because we're, we think, Oh, we got to keep our stomach pulled in all the time, don't we? No, we don't. We need to adjust our posture and trust that it will stay in and with proper exercise and proper movement patterns, and it should function optimally.

And that is something that postpartum women struggle with so much that that abdomen after your diathesis wreck die, to some extent that is completely normal. diathesis is a normal part of the postpartum process. It's supposed to happen, right? But I think people are really afraid of it. Now. It's become sort of this, oh, I have diastasis I can't do this. I can't do that. Can you help us understand what's normal, what's not when it's problematic? And when not not repairing? It means for the woman's body?

That's a good question. I think there there's a lot of stigma associated with diastasis recti. And for people who do Don't know what that is it is a splitting apart, a spreading of the linea Alba which is the connective tissue between your six pack ab muscles, the surface layer abdominal muscles on the front, they have this strip of connective tissue in the middle. And that will naturally spread apart during pregnancy. It has to every woman will experience that by the end of their pregnancy. And the relaxing hormone allows all of those connective tissues which is a fascia and ligaments and tendons to stretch so that the baby can exit the pelvis. And so the abdomen can expand. But then as the hormones rebalance themselves over time postpartum, that should begin to close and come back to its more normal position, which, you know, shouldn't be more than about a fingers breath apart. It's not something to be concerned about, necessarily. It's something that I advise people get evaluated. by a physical therapist if they can not all of the gynecologist will understand the process of doing that some may some chiropractors understand that process as well, and some some nurses and midwives. Yeah,
I think the issue is that they are looking at an error evaluating it, but they don't really know when it's a problem and when it's not a problem or if it's properly healing or not that that follow up piece of it right, within the first three months, that should start to resolve its normal position. And if it is not, I absolutely AM. What does that mean I say about a fingers breath, there's specific testing method that you can do to determine whether or not you have a diastasis recti. That could also involve a hernia, which is where some part of the organs usually the small intestine can actually be protruding through that opening, and kind of like a 10th like structure popping out through the abdomen. It's not just pregnant women. It can happen to anyone who has a distended abdomen but When there's the hernia is considered the medical risk. So diastasis recti is not considered a medical condition generally, but it's identified as being more than two fingers width between the, the rectus abdominus. If you're lying on your back and you put your finger right on your navel, it's not the it's not just at the navel, it goes from the pubic bone up to the sternum, but that's usually the one of the widest points. And if you just gently place your fingers there side by side and curl your head off the mat, you will feel whether or not you may or may not feel that's something that often needs to be evaluated by a professional. whether or not there is a space that exceeds two finger width. And it's not just the space of the two finger widths where you might feel the sides of the abdomen squeezing against them, but it's how deep the hollow is. So the depth as well as the width becomes something that becomes if you're fitting two, three or four fingers in and you can go in about an inch and you feel this kind of excess space. Or if when you start And not only is your belly kind of protruding forward more than it should after two to three months, but you see, almost like something soft or something else kind of coming out the middle of it that doesn't feel right to you. Those are more extreme conditions, it can become an issue later, there are women that will have a diastasis recti never have a diagnosed and be completely fine, they won't have any pain, they will be symptom free, they may not have quite the physical appearance that they want, because it will often affect one's ability to fully engage their abdomen and for them to have a resting tone where their abdomen is sitting more flat. But it may not be serious. What can happen though, and this is why I really advise that all women at least get it evaluated not to obsess over it but to have that to evaluate it not just for aesthetic purposes is that when there's a split and there is what often happens with women and this is often associated with this C sections they will lose the ability to feel their abdominal core. So When I have them or when they're returned returning to exercise and they try to engage their abdomen number one, they may not feel it. Number two, it may manifest as a pelvic floor dysfunction like they may start leaking urine and it may not be just related, it may not be directly related to the pelvic floor so much as the core not being able to fire in a way that supports the pelvic floor.

That's amazing because you talked about just a little bit ago how these two parts of the body must work together all the time and if a woman is having incontinence issues, she's going to go to her gynecologist or her ob, and she's going to get

a diagnosis and maybe medication or maybe surgery or something like that. But really it could be as simple as not having repaired the dialysis. It really because if you think of the abdomen and its base being the the torso, which includes the abdomen and the low back and the sides and the rib cage and then its base being the pelvic floor, It's like a cylinder. And it needs to have a proper pressure system not only internally as we breathe and stretch and contract, but externally it needs to be held. And so if that is not being held from the front and from the bottom, then you're going to lose, you can lose some function and the other way that that can manifest is a more low back pain, which is so common, you've even increased cramping with menstrual cycles because of how certain pressures that are happening in the on the ovaries as a result, all of this, you know, we're not treating the organs as as organ structures as a pelvic floor, women's health physical therapist, but we're treating what is should be keeping the organs in their optimal state. So when I say cramping around our menstrual cycle that's and its relationship to a diastasis recti. That's what I mean. There can be many reasons for that. So that was of course aside, but usually that's not one that is considered Whenever it goes with that kind of complaint to a healthcare provider.

That's right. That's right.

I had I have three children. And I would say that it took me a full year if not two, to kind of get that dialysis back to a normal, healthy place.

Yes. And were you guided on what to do?

Not at all, I mean, on my own guidance, okay. I wouldn't say was seriously working on it either. But I definitely noticed that it took a very long time, if you look at the parts of our body is blocks our head, our shoulder girdle, our chest cavity, our pelvis, our hips and our legs and feet. Think of them like blocks. And if they're tipped in certain angles, or if one is in front of the other, then it no longer has a balanced structure and the tissues, the tension forces are going to pull on each other. And so especially a pregnancy posture puts one in a position where the most pressure tends to be going out into the abdomen. If they don't know how to correct that or have a sense of what it means to certain muscles should be kept strong. Number one But the way one moves and the way one stands is very much key. And I can go into more detail when that's appropriate.

But it's also important for fetal positioning throughout pregnancy, right? Oh, yes, yes, absolutely. And for just for the baby to feel comfortable. So as we get larger in pregnancy, to recognize that we need to keep our muscles active, so that we're not just hanging out on our already lacks joints. And what I mean by that is one tends to stand when they're pregnant, often locking their knees, turning their legs out, holding their low abdomen with their hands, perhaps and then letting their baby kind of push forward and their chest kind of collapses. And yet, they, you know, because they get tired. So the correction of the posture, I have women stand against a wall. And I say walk your feet out from the wall, just enough so that you know, maybe a foot to two feet foot and a half and your feet are about hip width apart. And you just soften your knees a little bit so that you can feel because what often will happen in pregnancy is that the lumbar spine, the low back will go into what we call an excessive lordosis, where it will overly extend. So against the wall, you soften the knees and then imagine as you breathe out that you could actually use your app, abdominal core, and maybe the support of your hands to pull your baby into your spine and bring your spine toward the wall so that your tailbone is lengthening down the wall. And so you're lengthening the back body and lifting the front body. If you imagine your pelvis like a bowl of water, you want to imagine not that you can fully achieve that because the baby's more in front of you than behind you. But you want to imagine that you could bring your little baby into the bowl.

Okay, and we know in bowl, so the bowl is you know, we want to balance our pelvis. So So this, this idea that and with the round ligaments stretching, which is going from the pubic bone up into the uterus, it's going to because that there's a tightness and some women will experience an actual pain during pregnancy that's associated with the round ligament stretching it round ligament pain, that's what Yes, yes, yes. And the hip flexors for those who know what these are this the so ilio so as muscles and iliac, as muscles will get short, where the that there will be a falling forward. I'll just say that much where the bottom is behind you a little in the bellies falling forward and the back is a little bit arched and our abs are not quite doing what they should do. But it's not about how many ab exercises can you do. It's about how much correct abdominal activity can you apply in order to maintain a healthy posture because when you're in that healthy posture, the core Muscles should be turning on automatically, even through pregnancy and you have to practice it more through pregnancy. But you want to do that from the very beginning. Especially before we also say, just try to get out of that habit of crossing legs all the time, because some of us Oh, but I'm doing it right now sitting here. Sure, looking at you.

So when you cross your legs, it is turning off the hip flexors, but also turning off any core stability so people become cross leg. Now, I'm crossing the legs for many people will be very uncomfortable at first, and they'll often complain of Oh, discomfort in my low back or hips or it just doesn't feel great. How do I sit? How do I find the most comfortable position that's really optimal for me? Yes, you are turning off your core when you sit with your legs crossed no more. You can do it but you can be conscious of it.

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I just want to play back to the round ligament for a second because I know that this is such an issue for women in pregnancy, particularly in the third trimester. And often the response they get if they complain about Rog round ligament Pain is simply it's just round ligament pain, it'll pass, there's some part of the facile system that is overly restricted. That is blending in with that round ligament. So if we can take the tension off another area of the body that might be pulling on it, sometimes that can help relieve that discomfort. So for instance, massaging out the front of the thighs, the tops of the thighs, like taking one of those stick rollers, or you can find these on Amazon and just massaging out your quadriceps up to the you can just sit there and do it.

I got a job for the partners, right? Yeah, I got a job for the partners also massaging out the sides of the glue deals, and then practicing rounding through the spine forward to give yourself a little stretch of the low back which is putting that round ligament on a little bit of slack. Oftentimes, people who are more prone to that splitting of the of the wall to a degree that it doesn't recover as well as you would like has to do with a towel. tightness on the outside of the abdomen and into the low back, reaching your arm over to one side and breathing into your side to actually open what we call the quadratus lumborum, and the latissimus line and the rib cage on that side so that you're opening the side body up, then it's allowing there to be less pull on the center of the body.

That's a great recommendation. Thank you so much.

Step number one of increasing the likelihood of a well positioned or optimally positioned baby is having a good posture throughout your pregnancy starting at the beginning, not just when you're big, but it's so good to hear that this is not only it's not in a silo, it's not just for the sake of your baby. It's not just for the sake of your core. It's not just for the sake of your recovery. These are all intertwined. And there's a reason the body has to function in this way. It is optimal overall. And it's just a habit we have to get into.

We can train ourselves to have good posture, absolutely. We can change and I think just even if you take away 10% of what I'm saying it's going to help you Little changes we make in ourselves can shift an entire paradigm of how we're moving, it can be a very small thing, so don't be overwhelmed by too much.

Tara, I'd love you to talk now a bit about how everything you've discussed so far is the same or different for women who experience a surgical birth or a C section. And what unique issues those women might face postpartum. Mm hmm.

For someone who has undergone a C section, or certainly multiple c sections and depending on how their bodies scars, they may have a very difficult recovery. There can be a lot of pain in those initial six weeks of recovery six weeks to two months, or it can manifest as another problem a little bit later down the line. Like a urinary incontinence, a pain with suddenly there's a pain with intercourse that they didn't have before. And this is someone who hasn't delivered vaginally, I mean that will definitely can go hand in hand with someone who's had a bad gentle delivery. or certainly low back pain, hip pain. I've even had women come in and see me they've had a neck pain that once we treated this area and scar, the neck pain subsided, headaches. Another one, I mean, this is what I mean by the fascia, which is the connective tissue and scar tissue being, you know, part of that system that it will tug. It tugs on the system. So, when we think about a C section scar, what you see on the surface is like the tip of an iceberg. And for some women and just by assessing it, I can tell I've had women come in I felt their scar and I said, You know what, your scars fine, it's doing its job. I don't think it's the source of your problem. And there are other women that come in and I can feel it's not just what it looks like on the outside I can feel how many layers deep Yes, it's like it's wrapped itself around their poor organs and and the vasculature and their nerves and that sounds horrible, but it really can do that it can kind of adhere itself and grow like IV in that sense, it can become very thick. And that's when it needs to be manually moved in order for someone to reconnect to a healthy posture. For one thing, a lot of times with a C section scar, or from a C section, women will be pulled more noticeably into that kind of dysfunctional pregnancy posture where the baby is falling out of the bowl. And they're they're tipping forward and and they are will lose control they will lose the stability in their deep abdomen and in their deep low back and that they because it is so low. It's not only the uterus, but the bladder that can be pulled on. And that can affect pulls down into the pelvic floor and affect the function of of, you know, urinary control.

I never knew before today a woman who experienced a C section could have incontinence issues postpartum.

Yes, and it's it is and it seems surprising and is it less than Common Yes, but it is not uncommon, in my estimation, I think other pelvic floor therapist would agree, and specifically pelvic pain. And what I have found is that those are the women that require more manual treatment from a physical therapist initially, to unwind that scar tissue. And I recommend that people do that within the first six months because by a year that scar tissue is set, can you break a little bit of its borders off of the surrounding structures? Yes. But it's no longer laying down fibers. So you want to do this early on. So how is a woman to know I mean, if she doesn't have vaginal pain, or maybe she hasn't had probably not had a pap smear, she's never returned to having intercourse, or she's not having incontinence. How does she know that she might have some of this scarring problem and needing it be in need of treatment?

Well, first of all, for the first three three to four weeks. You don't want to mess with that scar too much. I mean, as a therapist, I can do some gentle work on it. But I often say let's let it let's just let it heal for a month. Some therapists may feel a little differently about that. But I like to start working after a month to six weeks on a C section scar, what someone can do so they want to leave it alone, basically. But assuming it's not infected, and everything seems to be healing Well, if a woman is comfortable, she can go down there at about six weeks and touch that scar and and gently try to move it from side to side or up and down and feel does it have the same playability and ability to move even though it's a little bit thicker than say the tissue just above it or on the sides? That might be an indicator that you want somebody to take a look at it. Also, they may have a problem feeling their abdominal core because again, because of that stitching, it is pulling, they're cutting through the abdominal muscles. There's no way around that So it loses some of its ability to function as a core stabilizing system. And oftentimes, we have to loosen that in order for the muscles to have their proper length tension relationship again, should women who have Syrian sections are they? Or should they be more inclined to get physical therapy afterwards for pelvic floor and abdominal function, and the thing is, many of them will be fine. So it's relatively fine. They may have a dysfunction that shows up 10 years later because of just a posture that they've been pulled in, but they weren't having dysfunctions. Before that however, I advise, at some point that C section scar in my experience for a good 50% of the women is going to cause a problem if they it's worth at least having someone evaluated I mean, just get an evaluation like they're at higher risk, and they usually need to wait about six weeks to be clear by their doctor before you will come see a physical therapist for that.

So Tara, can we just talk about key goals for a minute Because it's such a everybody knows about key goals. But I think there's a lot of misinformation out there about how to do a key goal. Should I do a key goal? Well, I've heard even some women say that they're they were told they weren't supposed to Eagle.

So right, and let's get skinny on key goals. The answer is that truly, we all women should be able to perform a proper key goal and be able to fully relax their pelvic floor as well. key goals are, are very important to be able to do because they are essentially the activation of the pelvic floor. What tends to happen with women because of postural changes, and stress and breathing dysfunctions is that the pelvic floor muscles aren't functioning properly, so they'll tend to stay either in a position where they're completely turned off. And they just are no longer doing their job and then you add the pressure of a baby in a stressful birth and then it doesn't recover afterwards because they've never gotten themselves back. Quite back together again. And that will lead to an incontinence. And then there is the dysfunction that I find more commonly, frankly, which is a pelvic floor that is locked in a tight position. And now so anyone who's listening right now, if you just take a minute in the position you're sitting in and notice, if you try to do if you notice your pelvic floor, the muscles are in the vagina and around the urethra. Are they active? Or are they relaxed, also around the anus? Because what I find and you may not notice it in this moment, but I'd encourage everyone to pay attention to this throughout their day, when you're stressed, or based on how you're sitting. Do you ever notice dependent a can depend on a personality type to and the job you're doing? Are you holding I don't want you to hold your pelvic floor. You want to feel a sense of releasing it down so that you can activate it when you need it. You want to find when you're sitting you can lean back, but whenever possible, bring yourself up so that you're on top of your business. Bones almost slightly in front of them so that it's the triangle space between your pubic bones and your pubic bone and your sit bones. Relax your tailbone, so you're not tightening your back muscles. And right there, Your feet should be planted on the ground and your leg should not be squeezing together. So give yourself a base. And in that base, if you start to think of this as a proper legal, closing the front of the vagina almost right by the urethra or the or the clitoral area, almost like you're doing a kiss, like a pucker like a little squeeze at the front and then start to lift internally. You should be able to feel that a little better when you're right on top of the pelvic floor and then can you hold that for 10 seconds without it being a huge effort? Do you notice whether your low abdominals are coming on with it or not? And if that is an effort, then that means something might need to be reorganized and then after 10 seconds, can you completely slowly with control, let it go all the way down. That's as appropriate receptive training proprioceptive your ability to feel what's happening in your body.

I think the biggest misunderstanding on key goals is the release. Part of it, is that what you're finding very much so a lot of women can feel themselves activate but they can't even feel themselves let go. I'm not sure if I'm doing it, I don't know. That's where the the breathing is a big part of this. If you're lying on your back, or sitting whichever becomes more efficient for you to feel it right on the pelvic floor and your legs are bent on your back and you just let your abdomen expand in a gentle breath. That's when the pelvic floor should completely relax on that inhalation when you're doing it as an exercise. And then as you exhale on that relaxed exhale, you should be able to feel and and consciously do it. A closing of the base and a drawing in and up not to a point where you're shivering, but to where you can feel Can I go through steps like point 12345 that's usually deep enough and can I put that back down. And just being able to feel that difference is something that you can practice I have people just count to five as they lift or 10. And then reverse that down to the rhythm of their breath. And to do that 10 times is a great way to practice your key goal. Now, if you're having incontinence issues, a solution can be quick eagles, where you're not thinking about any of the details I just said, but when you feel you have to go and you're not sure if you can hold it, key in the door waters running, you relax, first of all, and you just do a series of 10 quick squeeze, pulses pulse, pulse, pulse that might also be appropriate or correct me if I'm wrong, but for women who are newly postpartum because it would be very hard for them at that point to hold it. Absolutely. And the way to build the strength yes and quick eagles are safe to do in that sense, as long as there is not any, you know, significant tearing that just needs a little bit more time to heal. You don't want to be in pain when you do it.

Should Kegals be done the same way prenatally and postpartum or is there just difference between the two. When you're recovering versus preparing for badly birthing a baby, the different there is a difference. And the difference is this as you get prepared to vaginally deliver and you start doing any sort of hypnobirthing, for instance, or any sort of preparation for the release for the opening, one wants to focus on being able to breathe in and out and just expand the pelvic floor, visualize everything just opening, there should be hip opening exercises to just stretch the pelvis gently so that you can really feel that there's a sense of space there. You want to make sure that there's space and you want to learn by the time you're getting close to delivering that you know fully how to relax that pelvic floor because I find that those those people who've done too much polities, for instance, because I'm a body's teacher, I can say that are the ones that tend to tear more, or also, possibly the women who are doing excessive key goals and focusing on track just the contraction.

That's right, the contraction Till the time I don't think women are actually getting that education or advice that they really need to be focusing on the release part of it absolutely. Now postpartum, it's important to get on a program that involves some gentle core and pelvic floor activation, where there is a little bit more emphasis in finding endurance. So quick Eagles to start. And then as you start to sense what you're doing, you practice holding for five to 10 seconds as you're breathing out. And then as you breathe in, you let it release.

So prenatally, you talked about posture, would you put that at the top of the list, probably, I will put that at the top of the list. And then I would add to that.

The top of the list is being able to posture really balance yourself in the way I described against the wall and then taking that away from the wall. And also correcting your sitting posture so that you're you're forcing your core to work just by staying upright without putting too much tension in your body at the same time and that goes all the way through the crown of the head. I haven't talked as much about the shoulders, but you do want to have a sense that you're Shoulders are resting right over your pelvis, and your head is resting right over your shoulders. So that can take some practice. Then the other thing I'd like to add to that, take some slow deep breaths in, and as you exhale, I want you to think of just opening and relaxing that pelvic floor. You can even pull your knees towards your chest and open them to the side like a happy baby pose and just breathe into the pelvic floor and imagine what it is to let everything go. And I will repeat that for five to 10 minutes every night. If you're comfortable, you can be on your side or even in a child's pose, anything that is comfortable, if you're not comfortable being on your back toward the end of pregnancy, of course, and just really feel what it is to let go of those muscles. That's very key so that you can not be contracting while you push. If you have to push during your labor. I hope you don't. You don't want to contract your pelvic floor muscles, while going through the labor process.

When you Say you hope she doesn't have to push. What exactly do you mean by that?

Well, I think that oftentimes we're told by our doctors, that there's this pushing phase that happens during the labor process where someone is needing to facilitate some needing to almost force the baby to come out, maybe before that baby is ready. And so the process of going through labor and when we've had epidurals, which many women have, unfortunately, you can't feel what's happening. And so as a result, it's hard to trust that your body will naturally do the contractions necessary to let that baby come into the world. And so what happens is people tend to bear down and really push and in the process of contracting their abdominals to do that, they often will contract their pelvic floor at the same time, and it becomes a combination that can lead to excessive tearing, and excessive force that can just cause tearing because it didn't have the time to just gently stretch Now, as the baby comes through, it's an unfolding in the birth path. And when you are pushing a baby, when the body isn't experiencing that natural explosive reflex, that gentle unfolding, you're pushing the baby into taut skin tissue right into taught.

Exactly right. And I think often that that is what's encouraged. And so I would encourage mothers to understand what it means to release relax that area, way before they're in that, that state of labor so that they can understand what it means to not do a cable, and then you can revisit those postpartum after a couple weeks of letting your pelvic floor heal. I always imagined that for the women who get an epidural, the sacrifice they're making the trade off for that reprieve that they're getting, is that they lose communication with the baby Sometimes your body and your baby are telling you to kind of lean to the left and thereby creating extra space somewhere inside on the right or you're feeling everything. But you're also in communication. And we take that breath in and we breathe as we bear down. And then as soon as the baby starts to go into that, with drama, that relax that relinquish easing back, like a wave, like a wave, a wave comes forward, and then it eases back, we have to kind of exhale, we relax, and we wait again until we get that signal that the natural explosive reflex is coming on again, and then we bear down and the baby moves a little bit more forward again, as that tissue is unfolding.

It's such a beautiful image. And I think that that is something that that women can maybe access a little more easily if they understand that they don't want their pelvic floor to work against them, when they're going through that process. So before they reach that state, I think I think it's very important for them to learn what it feels like to have a strong strong control over that pelvic floor. But to be able to say, now it's time to let go. Now it's really time to let go and to be able to feel that and practice that before what we hope will be a beautiful labor experience. When you're holding your child minimize the the standing on one hip. Pull that baby in the middle, and that forces your whole upper back to work as much as you can. Use a rap use something that is supporting your baby in a way where you can have your hands free. But watch that you're not shifting side to side all the time that will throw off your pelvis. Use these few tools to imagine yourself like you're a tree that's rooted to the ground, this beautiful proud mother growing up through the crown of her head. You're going to be strong for your baby, you're going to be strong for yourself and let this go forward with you because I promise you if you just take a few of these tools, you will get stronger and three, six, twelve months down the line, you'll feel different.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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