If you would have told me two weeks ago that I would have closed the doors to my clinic, Southern Pelvic Health, a week later, and shifted my practice to a virtual one, I would not have believed you. Maybe I was naive (yes, I probably was), but this change came quick to me. It almost happened overnight. And, here we are. I am moving into my second week of working with my patients online. While for many, that seems incredibly scary, I actually think that shifting to an online platform for a while is going to do a lot of good.
Last week, I worked with a few other colleagues to host a webinar on bringing pelvic health online– basically, how do pelvic floor PTs treat most effectively without actually touching their patients? It was a quick production–one built out of necessity–and it sold out in 24 hours because rehab professionals everywhere are trying to figure out how we can still be there for our patients and help them get better during this time. (For my colleagues out there, if you missed it, it’s still available as an on-demand purchase!) I brought together 5 experts from various corners of the country and the world, and we spoke for nearly 2 hours about how we assess the pelvic floor, evaluate patients, and actually help patients get better in a virtual setting. It was full of creative ideas, and also challenged some of the current practice patterns. As you know, I work hard to always question my own practice–learn more–do better– and I’m excited to see what this next period of time does for me as I learn to better and more effectively treat my patients, to be creative with self-care treatments and home strategies, and to use movement to help patients move when my hands are unable to. I will share what I learn with you here, of course.
Pelvic PTs are not the only professionals taking their skills online! Last week, my daughter and I joined a “Frozen Sing-A-long” through a local princess parties company. I have been thrilled to see some incredible resources for people with pelvic floor dysfunction hop online, and I am excited to share some of those with you today!
So, what can you join virtually this week?
Yoga for Pelvic Health
My dear friend and colleague, Patty Schmidt with PLS Yoga, is incredible and specializes in therapeutic yoga for pelvic floor dysfunction. She is bringing several awesome classes online! AND, they are cheap– $15 per class (which honestly, is a HUGE value for the expertise she brings!) So, I do hope you’ll join in:
Gentle Yoga (Via Vista Yoga)– this really could be great for anyone with persistent pain, I think!: Tuesday, March 24th at 12p.m., Thursday, March 26th at 10 a.m.
Patty also is teaching private sessions virtually at $30 for a 30-minute session. This is a steal, believe me!
I also need to share with you all of the FREE yoga resources through another friend and colleague, Shelly Prosko. Shelly has this incredible library of Yoga options for pelvic health, all available right here.
I hope you are able to partake of these awesome resources. Remember, we are in this together my friends! I’ll leave you with a quote from a much-loved movie in my house, Frozen II, “When one can see no future, all one can do is the next right thing.” Let’s all try to do the next right thing amidst this craziness!
Wow- what a few weeks it has been! I don’t know about you, but it has felt completely surreal to me. My practice, Southern Pelvic Health, which has been steadily growing and serving people around Atlanta was suddenly put on hold, and many of my patients shifted to working with me in a virtual setting. Now, I know you may be thinking– how can you help people without actually touching them? I hope to expand on this in some future posts, because, honestly, I believe this is where we are going to be for a while (SO, WASH YOUR HANDS, and SOCIALLY DISTANCE, my friends!). But, this is heavy on the minds of pelvic PTs across the country. Thinking– how can we, as a profession, still help the people who need it? Make a difference in their lives? Help people control their bowels & bladder, have better and pain-free sex, live their lives without pelvic pain?
So, this post is for all of you PTs out there asking yourselves that! Earlier this week, I partnered together with some of the smartest, most innovative PTs I know– who are leaders in our field, and ALREADY practicing pelvic health in a virtual setting– and we are hosting a webinar to teach all of you how to do just that! So, join us tomorrow for this important event:
TAKING PELVIC HEALTH ONLINE!
LIVE Webinar Event: FRIDAY 3/20 AT 9PM EST
We are bringing an expert panel together to discuss how best to screen, examine, and treat patients with pelvic floor diagnoses—without actually being able to touch our patients! These experts have been ALREADY DOING THIS, with success, and we are so pleased to bring this to all of you!
Join me, Jessica Reale, PT, DPT, WCS, as I lead a discussion with Antony Lo of the Physio Detective and the Women’s Health Podcast, Sara Reardon- the Vagina Whisperer, Juan Michelle Martin- founder of the Zero to Telehealth Program, Julie Granger- virtual health and biz coach, and Susie Gronski- author and educator. We will discuss:
✅ How to get your ideal clients to see the value in virtual Pelvic PT care and convert in-person clients to virtual clients
✅ How to evaluate, screen, and provide pelvic health treatments without being able to physically touch or be present with clients.
✅ How to effectively help your virtual clients without manual therapy or internal examinations
✅ How to market your services in a growing and busy online market and build a practice that is sustainable in the long run.
Plus, Antony Lo has graciously allowed all participants to receive a BONUS link to a recorded virtual session of one of his clients with diastasis recti!
JOIN US FRIDAY 3/20 at 9p.m. EST! Registration is $49.
We are in an unusual time. Like many of you, I have been reading way too many articles and watched way too many news stories. COVID-19 is sweeping the world, and all of us have this immense responsibility to act, where we are, to do what we can to prevent the spread of this virus. Everyone is impacted, and everyone (hopefully) is trying to make the best decisions for themselves, their families, and society at large.
Healthcare is also seeing a shift—away from in-person care and toward virtual platforms. Right now, this is essential for so many reasons. The interesting thing is that at Southern Pelvic Health, virtual sessions have always been a part of what we do. And now, more than ever, we are working to be sure this service is available for anyone who needs it. Because, the reality is, pelvic floor problems don’t stop during a pandemic. In fact, for many, they can be exacerbated. Social distancing also offers the opportunity to stop and care for yourself, your health (along with your family & the community by flattening that curve!).
So, what is virtual pelvic floor physical therapy and what can it do for you?
The initial visit starts the same as an in-person session. We spend time discussing what is bothering you, in likely more detail than you thought we’d be discussing. We talk about your history, what happened when all of this started, what changed along the way, what is happening now. We discuss any pain or orthopedic problems you are having, your bladder health, bowel movements and sexual function. And most importantly, we discuss your goals—what you want to achieve how you hope to feel.
Next, we provide an exam. Now, here’s the difference in the virtual session. The components of the exam during which your PT would palpate your muscles or feel you move—we can’t do that. So, the exam takes on a different flare. We still watch you move from head to toe to identify how your body is working for or against itself. We may ask you to do different self-tests, feel different areas and see if you have soreness/sensitivity. We will give you additional information to see if you can activate certain muscles. And, from here, we can actually glean quite a bit of information. You see, the pelvic floor does not work in isolation. So, watching a person move alone can give us so much information about your function. I’ve written about this before, and here are a few that address this:
Next, just like in-person sessions, we start you on a plan to address the problem areas we have identified. This likely includes specific exercises for you to get started on, and some educational pieces to start improving your habits. We will also make a plan for the future—which could include virtual sessions only, recommendations for in-person consultations, or perhaps a hybrid! At our practice, we already have much of our content and exercises in a digital format. Any exercises we recommend will be given to you via video instruction in your patient portal. Behavioral education and other pieces like that will be provided for you both in our virtual session, but also via handouts e-mailed to you after.
Already an established patient?
This is even better. We have already done a comprehensive exam (or perhaps, another PT has already done this exam!), so we will have a complete picture of your situation. We will be able to discuss your progress, modify and progress your exercises, continue providing specific education, and help you continue to move forward to improve your function.
Live out of state?
This one is a little tricky. Technically, we are not able to see patients for physical therapy services if they do not live in Georgia. BUT, that does not mean we are not able to help you. We regularly offer virtual consultations and coaching services for people all around the country. This has been an amazing service to provide to play a critical role in helping to guide people to the services they need to get better. Our virtual consultations offer a similar format as our initial telehealth sessions. The difference here is that we would not be able to examine you and progress you in a program. We can offer some general guidance based on your symptoms, and very importantly, we can help you connect with more local practitioners to be on your healing team. We do the legwork for you—we find you resources, skilled practitioners (yes, we help you decide who your best options are!), and coach you along the way.
Are you ready to take the virtual leap? E-mail us today to arrange your first session at firstname.lastname@example.org!
Stay healthy my friends! And please, wash your hands!
A few weeks ago, my husband returned from spending a few days at Barnsley Gardens Resort, where he helped with a fundraising event for the Atlanta Area Boy Scouts of America. Upon his happy return (for all parties involved– single moms: you are rockstars!), he gifted me with a bottle of my favorite relaxing lotion, scented with lavender and peppermint. It is heavenly, and we both adore it! It has become a tradition that he brings me a bottle every time he helps with the event in November. Why do we both love it so much? Well, 3 years ago, we spent 2 wonderful nights at Barnsley Gardens for a mini babymoon. It was our last getaway as a family of two. I was super pregnant, but we ate delicious food, relaxed in the pool, went on evening walks, and slept in. We had an incredible couples massage also, and this lotion was the smell of the spa. We bought a bottle then, and even now, 3 years later, using the lotion evokes feeling of peacefulness, joy, love, and overall relaxation.
So, what happened there? How do brain-smell associations work? (And I know some of you are sitting there thinking…what does this have to do with the pelvis?)
We’ve all been there, right? When I hear the song “Kiss me” by Sixpence None the Richer, I’m transported back to the middle of the summer working as a lifeguard. I smell sunscreen and chlorine and feel the warmth of the sunshine. When I smell a certain blend of middle eastern herbal tea, I’m transported back to Cairo, Egypt where I studied abroad in college, walking through the busy streets at the downtown market. Our brains are incredible like that. Certain memories impact us, and cause our brains to form neurotags– specific patterns of neural activation based on that single input. This is why all of the pieces of the memory come flooding back to you when you have the evoked stimulus (in my case recently, amazing lavender mint lotion).
Now let’s jump into pelvic health, and particularly, chronic pain. What if the brain forms neurotags about pain? For example, what if a person began having pain with sitting, and let’s say, for this example, they experienced a few situations where they needed to sit for a long period of time, and the pain was just awful. As we have discussed many many times, we know that all pain is produced by the brain, that the brain can play tricks on us, and that the brain does change over time due to pain and many other factors. The brain could then, build a neurotag about sitting. Basically, when the person in the above example goes to sit, the brain will activate the neural pathways to remember pain, negativity, perhaps anxiety/stress about the situation, etc. and instead of amplifying the feelings of peace and love (like my lotion!), the brain will amplify the feelings of distress and pain. What about a painful medical examination? A negative sexual experience?
Fascinating, right? So, what can we do about it?
First, recognize a negative neurotag for what it is– your brain recognizing familiarity. And what it is not– a true interpretation of the current situation.
Next, change up the pattern to trick your brain. If you have pain when bending forward to pick something up, can you try the bending motion while lying down (ie pulling your knees up to your chest)? If you had a negative medical exam and start feeling anxious about your appointment, could you see a different provider at a different office? Perhaps request a different position for the exam? If you have pain with sex, could you alter the experience? Maybe this means a different position, different location, different warm-up?
After that, aim to build new, positive neurotags for your brain. How do we build positive neurotags? It can start by building a positive association for your brain. So, this could mean diffusing a calming oil blend while listening to a guided relaxation track. Once this association builds for the brain, you could then try using the same scent within a typically negative situation (assuming you have also removed the negative stimulus!). For people with pelvic floor pain, we often use gentle manual treatment (either with a finger or vaginal trainers) to provide a safe input to the tissues in a way that the brain will not guard and protect by pain. Now, envision pairing that calming scent with gentle pelvic floor muscle desensitization? The options are endless for creativity in building positive neurotags! Movement can also be great to build positive neurotags! If you find that pain limits what you can do, working with a physical therapist to develop movements you can do, that keep you at minimal to no discomfort can help your brain build neurotags for safety with movement again!
If this is fascinating to you (as you know it is to me!), here are a few other resources to check out:
These amazing Vlogs by Jilly Bond, one of my favorite physios across the pond (You may recognize a certain someone in the second video!):
Agency is defined as, “the capacity of individuals to act independently and to make their own free choices.” What does this mean for healthcare? How does the healthcare consumer maintain and create agency while also navigating the complexities of medicine?
A few weeks ago, I traveled to Washington DC to teach a group of 40+ physical therapists and occupational therapists about working with people who are dealing with various types of pelvic pain. Over this 3-day course, we covered topics related to diagnosis, medical management, manual therapies, movement interventions, and much more. On the third day of the course, I gave a lecture on “trauma-informed care.” What is trauma-informed care? Trauma-informed care means the “adoption of principles and practices that promote a culture of safety, empowerment and healing.” While we do focus on how widespread trauma is, the varying ways people experience trauma, and strategies to develop sensitivity, respect and consideration for the needs of our patients, we also strongly emphasize the importance of treating all patients in this way. One of the key pieces in doing this is helping a person develop a strong sense of agency– the ability to make their own educated decisions and partner alongside their healthcare professionals, instead of being the recipient of directed care.
The idea of agency can seem fairly basic. Shouldn’t every patient feel like they can make their own decisions? Shouldn’t they feel like their healthcare providers are all members of the same team? But, that is often not the case. When a person loses this agency, they can end up in situations where things start happening to them, instead of with them, and this can create difficult and sometimes traumatic experiences. This could be a mother who feels pressured to have a birth intervention she was really not comfortable with having. This could be a person being scolded for not being “compliant” with their recommended home exercise program (as opposed to their clinician understanding what happened and partnering with them to fit exercise in their lives). Or, it could be feeling pressured to continue a painful examination that they otherwise would choose to stop.
There are many reasons why losing one’s agency is detrimental. Remember, the pelvic floor muscles respond to threat. So when a person is in a situation where they feel threat (whether that is due to stress, a difficult situation, or other circumstance), the pelvic floor will activate. When someone is dealing with something like pelvic pain, sexual pain, and other diagnoses, this can lead to a problem becoming worse. So, how can you maintain your agency as a patient?
Ask Questions. All the Questions. “The only stupid questions are the ones that are not asked.” If you aren’t understanding what is being recommended to you, ask more questions for clarification. Your healthcare provider should always be happy to answer any questions you may have to help you make the best decisions for your care. This also applies to times when you are in the middle of a treatment/procedure/etc. Ask away. Try saying:
“Would you mind explaining my options again?”
“Can you clarify what the benefits and risks would be to…”
“Are there any risks in not moving forward with that treatment?”
“What are the reasons you think I need to…”
“I’m sure you have a busy day, but it would really help me if you could answer a few questions.”
Don’t be afraid to slow things down. If your treatment session or medical appointment is going a direction you are uncomfortable with, or if something is happening that you don’t feel like you understand, feel free to take a break. Try saying:
“I need some time to think about that.”
“I would like to take a few minutes to consider my options.”
“I would prefer not to move forward with that today.”
“Can you explain _______ to me again?”
“I’m not sure I understand all of my options.”
“I’d like to go home and think about all of this. I’ll let you know what I think at our next visit.”
Bring a friend. If you know that you tend to get overwhelmed at your appointments and have difficulty expressing your needs or how you feel, consider bringing a friend/partner/spouse who will have your back! Tell them in advance what you want their role to be and how they can help you! This could be stepping in to ask for some time to consider options, asking a provider to slow down and repeat their explanation, or simply being a person to be present with you during a difficult appointment.
I hope these tips have been helpful in helping you develop strategies to create agency as a patient. If you are a healthcare provider, I urge you to reflect on your own practices. Do your words and actions support your patients in maintaining autonomy? support agency? Do you unintentionally pressure patients into participating in treatments or exams that they may not feel comfortable with? Do you shame patients when they don’t follow your recommendations? None of us are perfect. I truly believe that most health care providers have the best of intentions. But, we can all do better. Reflect on our own words, habits, body language, and be better partners for our patients!
What other strategies have you found to help you improve your agency as a patient?
I am 2 weeks in to my new practice, and absolutely loving it! I was fortunate this past week to be a guest on the podcast series, Real Talk with the Pelvic Docs. Jenny LaCross has been a friend for a few years (we connected when she was in her residency program), and she’s doing amazing things for the pelvic health community! It was such a pleasure to talk with her about my experiences with pregnancy, childbirth and my own postpartum recovery. You’ll also hear more about my journey to private practice and my hopes and dreams for the future! I hope you enjoy this podcast as much as I enjoyed recording it!
Hi everyone! I’ve been staying up till midnight nearly every night, and no, it’s not because of my baby (she’s an amazing sleeper!). It’s because TODAY is move-in day at Southern Pelvic Health! My garage is packed with furniture, and I can’t wait to get this space ready!
We are also getting social!! I love blogging here, and I’m excited to bring smaller bits of content, tips, and pelvic floor love to the social media scene! Check out our Instagram and follow @southernpelvichealth! You can also find us on Facebook!
I am super excited! I am hosting Dr. Andrew Goldstein at my NEW CLINIC for a one-day intensive course on Vulvar Dermatology on Saturday, November 2nd!!! This course is open to PTs, MDs, PAs, and NPs, and should be absolutely epic!!
Dr. Goldstein is known internationally as a leader in the treatment of vulvar pain disorders, and is very well-published on the topic. It should be an incredible day of learning, and I can’t wait to show you all my new space!!
I hope you will join me for this important class! Pelvic PTs and other HCPs- let’s always keep learning!
Did you know that last week was international breastfeeding week? I know this event and really, even discussions about breastfeeding can lead to lots of thoughts amongst mamas. Pride, having accomplished something challenging. Sadness, if your breastfeeding journey did not necessarily go as planned. Fear, as to whether your baby is actually getting enough milk and growing the way she should. Joy. Guilt. Happiness. Anger. The list goes on.
I think it’s important that while we recognize that breastfeeding has incredible benefits, we also recognize what is most important– a fed and growing baby and a healthy happy momma. There is so much that goes into the decision a parent makes about how to feed their baby, and it’s important that we help all feel supported and loved– not judged and put down. (Again, let’s build each other up, parents!!)
Musculoskeletal pain postpartum is fairly common. A 2019 study of 400 breastfeeding women found that around 37% experienced neck pain and 22% experienced low back pain. Another 2015 study looked at the experiences of 229 individuals after giving birth. Around 50% experienced back pain and 25% had an onset of back pain at 2 or more weeks postpartum. (This later onset makes a lot of sense to me based on the big changes in movement and positioning that often happen after having babies.)
So, if you are having back pain after childbirth, you’re in good company. I’ll add here that while this is indeed common, it if not normal. This is good news, because it means that we actually have strategies to help this improve.
What can a nursing mama do to help these aches and pains?
1. Be sure you are using good mechanics when you feed your little one. My daughter takes 20-30 min to feed and ate every 2-3 hours after birth (and now, at 9 weeks old, still eats every 2 hours or so during the day–but sleeps more at night!! Yay!). That means that she feeds anywhere from 160-360 minutes each day. That is a long time to be in the same position. So, to minimize aches and pains, aim to sit with support at your back. If possible, find a comfortable place to feed your baby where your body can relax and you aren’t having to work to stay in a good position for feeding. Also, be sure you bring your baby to your breast not your breast to your baby. If you are having to bring your breast to your baby, you’ll inevitably slump down and holding that position for 20-30 minutes makes my back hurt just thinking about it.
These recommendations also hold true for my pumping and bottle feeding mamas. Pumping also leaves you in one position (unless you have one of the new styles of pumps like the Elvie– more to come later on that!!) for a long period of time, so being sure you have a comfortable place to pump and feed your baby is key!
2. Use pillows and cushions to provide support. Remember, 360 minutes in one position each day can be touch. Try using pillows like the boppy, brest friend, or others that support the baby being lifted to the breast. I actually find for my daughter that I like the boppy more when I sit in my glider or recliner, but I prefer the brest friend when I’m sitting in bed (used with a pillow under it for positioning). Right after birth, depending on where I was sitting, I sometimes just preferred using a few pillows, or using a football hold position to nurse. So, try a few options and see what helps you get into the most optimal position.
If you are bottle feeding, using pillows and supports like this can still be helpful to keep you in an ergonomic position and support your baby during your feed.
3. Change it up. When it comes to posture, the current thought is along the lines that there is not one perfect posture per se, but rather variability in posture and movement seems to be important. So, changing up your position to feed can sometimes help. This can mean feeding in a wrap or a carrier (I have yet to master that!), or nursing while lying down (my most favorite!). Sometimes mixing it up like this can make a big difference.
4. Take movement breaks between feeds. This goes along with Tip #3. Movement breaks like this feel amazing to me after nursing my little Mary. The following movement sequence is meant to take you out of the position you’re in to feed, and help restore some variability. Doing a short movement series between feeds like this can really help improve these aches and pains.
Cat-cow: I love this exercise because it allows your spine to move well into flexion and extension. This can feel great when you have been feeding for so long or holding your baby in a slightly flexed position. Pairing this with breathing can be fantastic as well (and helps to get your deep core–including your pelvic floor–involved). To do this, inhale while your back extends and your head comes up. Exhale while you arch your back, tucking your pelvis and allowing your head to drop down.
Wall Angels: This is another of my favorites. This exercise stabilizes your low back while encouraging movement at your shoulders and mid-back. It feels AMAZING if you have been sitting for a while at a computer…or in this case…sitting for a while and feeding a little one!
Reach and Roll: This exercise is a good one to get some movement in your shoulders and thoracic spine. Keep your pelvis “stacked” and your knees and hips bent to 90 degrees to encourage movement through your upper back.
Child’s Pose: This is a nice position to open your hips, lengthen your spine and extend your shoulders. As a bonus, a wide-kneed child’s pose also encourages lengthening of the pelvic floor muscles, so this is a favorite exercise of mine for individuals with pelvic floor overactivity or pelvic pain. **If you are fairly early postpartum, you may not want to lengthen your pelvic floor this way. So, in your case, consider keeping your knees together rather than wide.
5. If pain persists, seek help! This could mean seeing a lactation consultant if you are needing help positioning your baby. It could also mean seeking an evaluation with a physical therapist who has experience working with people postpartum (usually, this primarily includes pelvic health PTs). While back pain can be very aggravating, it is often very treatable. We usually see good results for people experiencing this, very quickly.
I hope this helps some of my fellow nursing mamas! If you have any questions or comments, feel free to reach out!
6 weeks ago, we welcomed our second daughter into the world. Mary Lynn was 6 lbs 10 oz of squishy, adorable, babyness. And she came into the world via a Caesarean birth. And it was amazing. And hard. But good.
C-sections come with challenges, just like vaginal births do, and for me, these challenges included a significant blood loss that led to me fainting on the second day, a super low blood pressure due to a response to the epidural that contributed to the fainting but also meant going off of my epidural pain meds really early, and nerve pain that lasted for about a month after Mary was born. (We’ll y’all more about that another time.)
Since I am living the early postpartum life, I thought it would be fun to do a series of posts on my own rehabilitation journey (since, in many ways, each of my births has been a mini-case study for myself!).
So, let’s talk Cesarean rehab in the first 6 weeks!
Moving well after major abdominal surgery
I love when people imply that birthing via Cesarean section is somehow “the easy way out” compared to birthing via the vagina. Hello people, this is major abdominal surgery! All mommas get birthing badges– let’s support each other in our journeys, right?!
Initially after a Cesarean, movement alone can be challenging. Standing up from a chair. Rolling over in bed. Lying down in bed. But the good news is that with some easy tips, this movement can become much easier. First, as you are moving, bending, standing, etc. remember to “blow before you go.” This easy to remember phrase comes from my friend and colleague, Julie Wiebe. This means, begin to exhale before you initiate a movement. Breathing like this with movement helps to control pressures within the abdomen and pelvis, so it can significantly help you in your movement after having your baby- both in terms of ease but also in protecting your pelvis and abdomen.
When standing up from a chair, remember, nose over toes. Scoot to the edge of the chair first. As you go to stand, lean forward first. This puts your body weight over your legs and helps take the burden away from your core.
When you lie down or get up from lying down, channel your inner log. So, when you lie down, first sit on the edge of the bed. Slowly lift your legs onto the bed, then lower the rest of the body down, using your arms for support. If you need to roll over, bend your knees, then roll your body as a unit- like a log. Reverse these steps for getting up out of bed.
Abdominal Binders and Compression Underwear? It depends. It may be worth considering using an abdominal binder for the first few weeks after your birth, progressing to wearing compression underwear or shorts(ie Spanx, SRS recovery shorts, Core shorts). These types of garments provide support to the abdomen and can be incredibly helpful for moving and walking around after your surgery. The flip side with compressing the abdomen is that it can impact how well you can move your ribcage and can influence pressure mechanics within the pelvis. So, if you are already struggling with pelvic organ prolapse or urinary leakage, or if you pushed for a period of time before having a Caesarean birth, it may be worth talking with a pelvic floor PT prior to utilizing this during your recovery. Generally, the compression underwear/shorts provide more support to the pelvic floor and abdomen, so they may be a little better with pressure modulation than the binder. For me personally, the binder and compression undies were amazing! They took away my nerve pain, and helped me move much better. I chose to wear these sporadically during the day (a bit on, a bit off), and practiced breathing well with my diaphragm during the times the binder was off.
Handling your incision
Initially, your main focus here is keeping your incision clean, and monitoring it to make sure it is healing well with no signs of infection. Around 6 weeks, if you are cleared by your physician, you can begin to gently mobilize the tissue around the scar and aim to desensitize the scar. I usually start above and below the scar, before working on the scar itself. You can perform gentle massage to the tissue above and below the scar and gently stretch the skin in all directions above and below the scar. You can also gently desensitize the scar by touching it with your fingers or a wet cloth, and gently rubbing across the scar in all directions. We can mobilize this scar tissue further, but we are going to talk about this in a future post as this post is focusing on the early period of healing.
At this time, you can also begin applying silicone gel or silicone strips to help soften your scar and prevent hypertrophic or keloid scars. Silicone is considered a gold-standard treatment for the prevention or treatment of hypertrophic scars. While most of the research regarding silicone is of poor quality with significant bias, evidence does tend to suggest a positive benefit. My first Caesarean did lead to a hypertrophic scar, so I began applying silicone gel to my scar once cleared by my OB to do so, around 4 weeks after Mary’s birth. I’ll report back on the difference between this new scar and the old one (See, mini case study!).
**I also have to note here that my colleague, Kathe Wallace, has a fantastic book that details some recommendations for scar tissue management after Caesarean. Kathe also offers a free abdominal scar massage guide at her website, which is a fantastic resource!
Exercise in the Early Postpartum Period
If I could give you one piece of advice on this early postpartum period, it would be to relax. Give yourself a break. Allow yourself to recover and heal. I find that so many people want to jump into too much, way too soon, and unfortunately, this can be more harmful than it is helpful. Remember, you just did something incredible. You just had major surgery. You deserve to rest.
When we think about exercise during this initial period of healing, we are going to start very gently. Here are a few things you can get started on:
Walking: I’m not talking about going and walking several miles. During the first few weeks, it’s best to really rest, and give your body time to heal. Getting up, walking around the house as you feel comfortable can be very beneficial. As you continue to heal, during the next few weeks, you can increase your walking. So, this may include some outings and short periods of walking between 2-4 weeks. Between 4-6 weeks, you can generally consider a leisurely walk in your neighborhood or a longer outing. The key here is to listen to your body. Rest when you need to, but gradually move to increase your endurance. After you see your OB for a postpartum visit around 4-6 weeks, and you are cleaned to do so, you can continue to gradually increase your walking as you are feeling comfortable. Are you antsy to jump back into running? Zumba? Bootcamp? Pilates? Don’t. We’ll get there. But let’s rest right now.
Breathing: You all know I am fairly obsessed with the diaphragm. 4 years after this post was written, I still think it’s one of the coolest muscles in the body. The diaphragm works in coordination with the pelvic floor muscles, deep abdominal muscles and deep low back muscles to provide support to the abdominal organs, modulate pressure in the thorax and pelvis, and provide dynamic stability to our spine and pelvis. Slow breathing, aiming to expand your ribcage and relax your abdomen as you inhale, then slowly exhaling your air can be incredibly beneficial to re-establishing these normal functional relationships.
Gentle Pelvic Floor Muscle Activation & Relaxation: First, my biggest recommendation would be to SEE A PELVIC PT before and during your pregnancy so you really know your current function and can have an individualized plan to get the most out of your muscles and your body. I encourage people to discuss their delivery with their OB, and ask about beginning gentle pelvic floor and abdominal exercises. The timeline for starting this will depend on the specifics of your delivery, and we want to be smart when activating muscles that have been cut. When your provider is on-board with you starting, I like to pair gentle pelvic floor and abdominal wall activation with breathing. This looks like this:
Inhale, expanding your ribcage, relaxing your abdomen and your pelvic floor muscles.
Exhale and gently draw in your pelvic floor muscles, allowing your lower abdominal muscles to also gently draw in. Aim for a “moderate” effort to allow activation of the muscles but not overactivate them.
Then, relax your muscles again as you inhale, repeating this cycle.
Aim to do this for a minute or two, twice each day.
Stay tuned as we continue this journey over the next few weeks and months! What have been your challenges after childbirth? For my fellow health care professionals, what else do you like people to know immediately after a caesarean birth?