Progressive muscle relaxation isn’t just for adults—it can be a playful and powerful way to help kids manage stress, too. By turning relaxation into games—like blowing bubbles with slow breaths, dancing like stiff robots and floppy noodles, or squeezing toes in the mud—we can teach children how to notice the difference between tension and calm. The best part? When parents join in, kids don’t just learn the skill—they feel the calm spread through the whole family.
Today I am reflecting on the relationship between healthy eating and sleep. This morning, I was listening to the audiobook “The Sleep Prescription” by Aric A. Prather, Ph.D. I’ve been slowly working through his sleep “class” in HeadSpace and decided to listen to his audiobook as I work to improve sleep both for myself and for my clients. I’m just on day 2 at the moment, but this quote really struck me.
“Carb lovers, pay attention here: carbs are an interesting case. Studies have unearthed that while most carbohydrates will actually help you fall asleep faster, only certain types will help you stay asleep. Simple and sugary carbs (think pizza, white bread, bagels, pasta) can cause more wake ups throughout the night. In contrast, complex carbs (again, these are the more high-fiber foods like sweet potatoes, oatmeal, and whole grains) can stabilize your sleep patterns—possibly, Dr. St-Onge theorizes, because they also stabilize your blood sugar.[11]” Excerpt From The Sleep Prescription by Aric A. Prather, PhD https://books.apple.com/book/id1608147733 This material may be protected by copyright.
Lately I have discovered that my waking glucose levels are consistently in the pre-diabetic range. I have been using the Stelo non-prescription continuous glucose monitor and reading books like Good Energy by Dr. Casey Means and The Glucose Revolution by Jessie Inchaupé. And my sister-in-law gave me an extra Oura ring, which connects with the Stelo to give insights between glucose and other biomarkers! (Such an amazing gift… although I warn that there is an ongoing fee to use the Oura ring in addition to the up-front cost of the ring itself but also I think it’s totally worth it!).
The real reason I have my own business. Hint: It’s about you AND me.
Nesting parties ask us to re-think the way that we celebrate new parents and challenge us to focus on what the expecting parents need. It’s really less of a party and more of an opportunity to provide the family help.
Unlike baby showers, “Nesting parties shift the focus from stuff to support to help families prepare their homes and hearts for life with a new baby,” explains Lara Elfstrand, the pediatric sleep practitioner of Little Elf Family Services.
When you have a baby, there’s a lot that may surprise you. In this conversation Stephanie opens up about her transformation after seeking help and guidance for her new role as a parent. In this interview, Stephanie shares her challenges, frustrations, and the wins that she achieved through coaching and Gottman Bringing Baby Home classes at Little Elf Family Services.
As new parents, you hope that life with your baby will be exciting - a fun, new adventure and a chance to get to know a new member of your family. You want to create a warm, nurturing home for your children. You want time and space and support to bond with your baby. You want a peaceful postpartum. You want to instill positive values in your children. And if you have a partner, you want your relationship to be happy and connected. Ultimately, you want to raise a kind, positive human being that contributes to society when they are older.
Bringing a new member into the family is exciting and wonderful. It’s also challenging, stressful and can increase hostility between partners and even with extended family and friends. The dynamics of the new addition changes everyone’s lives and everyone is affected. Your identity changes. You shift from being a couple to being a family. You take on the identity of “mother” or “father” or “parent”, and you even deal with your parents as they take on the title of “grandparent” (whether for the first time or not). And if you have other children, they have to adjust to sharing their parents’ attention, affection, and time.
It is critical that new parents feel nurtured and supported, so that they can nurture and support their babies. Knowing that they are loved and safe is a crucial foundation for babies’ learning and development.
There are 3 types of support that new families need to thrive: physical support, relationship tools, and financial support.
In a perfect world, every birthing family would receive three kinds of physical support: a birth doula, a postpartum doula, and a pelvic floor physical therapist. Here’s why.
BIRTH DOULAS
A birth doula provides physical, informational, and emotional support during labor. They help birthing parents with comfort, suggestions, reassurance, and advocacy. Doulas may provide massage, relaxation techniques, and other types of emotional and physical support their clients need. And birth doulas can help partners to know what to expect during labor, as well as how they can best support the birthing parent.
According to Evidence Based Birth, “Overall, people who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans. In addition, their labors were shorter… and their babies were less likely to have low Apgar scores at birth. There is a smaller amount of evidence that doula support in labor can lower postpartum depression in mothers. There is no evidence for negative consequences to continuous labor support.”
During COVID, some birth doulas have worked completely virtually. Other birth doulas have supported families in person in their homes until it was time to go to the hospital and then switch to a virtual model if needed after that. Gemma Mrizo, at Doula Gemma says, “For me, …I think that the virtual model completely works. … I think every woman should still have a doula… The doula and the remote model almost feels like that's your expert to call when it's hitting the fan and you're panicking. And I think a lot of people like that, that they have somebody to back them up if they need it. And then if they don't, they're cool.”.
POSTPARTUM DOULAS
A postpartum doula’s role is to support you to get your needs met as a new parent, whether that is taking care of the baby so that you can get a nap or snuggle with your partner for a few minutes, getting you a warm bath to soak your feet as you feed your baby, pulling up a good breastfeeding meditation on YouTube, or making sure that your water bottle stays full. Postpartum doulas also provide a listening ear as you process your birth experience and learn to be a parent. A postpartum doula will encourage and support you in gaining confidence as a parent. DONA, one of the agencies that certifies doulas, says that a postpartum doula’s job is to be NEAR: nurturing, educating, assessing, and referring to additional resources.
PELVIC FLOOR PHYSICAL THERAPY
Pelvic floor physical therapy can decrease your chance of injury and help new birthing parents to heal after birth. “I recommend a visit with a pelvic physical therapist before or during pregnancy week 30. [Parents] need to start doing the exercises I prescribe daily 6-8 weeks before delivery for them to get maximum benefit.” Dr. Romy Havard of Peregrine Physical Therapy.
Julie Kwong of LadyBits PT puts it this way, “"Why wouldn't you (see a pelvic floor physical therapist)?" You've been through so much. This is the least you deserve--to heal after birth, be put back together. It's the very least you deserve.”
During pregnancy, most couples don’t know what to expect and don’t know what important conversations to have. As a result, they often feel resentful when their expectations don’t match with reality after the baby arrives. That’s why I love to teach the Gottman Bringing Baby Home program to expectant and new parents.
Bringing Baby Home educators give parents the tools that they need to express their needs clearly and respectfully, using research-based tools included in the Gottman Bringing Baby Home program.
Not only is the Gottman Bringing Baby Home program research-based, it’s also research-tested to increase relationship satisfaction. Babies of parents who have taken the class have been shown to cry less, smile more, and develop higher language and cognitive scores at one year of age than babies of parents who did not take the class. And that’s what new parents want!
You probably noticed that the support options above are expensive. There are a few insurance companies that will cover a birth doula but most insurance companies don’t. What if we can get the support that we need anyway?
Some hospitals have volunteer doula programs for doulas who are in the process of getting their certification, or want to donate their time. Ask the hospital where you are birthing if they have a doula program, and encourage them to develop one if they don’t.
Your friends and family can help support you. Let’s change the way that we do baby showers! Instead of receiving a zillion newborn onesies that will never be used, you can ask for a nesting party, where your close family and friends come over to help you to cook and clean and prepare your home for your baby.
You can also use a registry such as behervillage.com to ask for the specific support that you need to thrive. Be Her Village is a gift registry for services, not stuff. Expectant and new parents can register for either physical support, such as a birth doula, postpartum doula, or pelvic floor physical therapist, or relationship support such as a Gottman Bringing Baby Home class.
You want to create a family that is safe, healthy, calm, and strong. Don’t be under-prepared for the amount of support that you will need. Start your journey to parenting with the knowledge, skills, and confidence to do just that.
Let’s chat about how things are going so far and how I can support you!
This week I spoke with Dr. Hannah Flammang about C-section scars. We talked about self care and things that we can do to help with recovery and healing after a c-section.
Dr. Hannah is a local chiropractor. She is opening her practice in Rocklin, but she does a lot more than just chiropractic. She really likes to work with women’s health patients, specifically in the prenatal and postpartum periods. C-sections are one of her favorites because she thinks it’s a very underserved population. You get sent home with pretty much no instructions other than: “don’t lift 20 pounds; watch your scar; make sure that it doesn’t have an infection; come back and see me in 6 weeks.” Then they clear you and say you’re good to go.
Dr. Hannah: A lot of times people want to work on them because they’re experiencing symptoms. They may have numbness in the area of the c-section scar. They may have hypersensitivity where you feel like you can’t put on underwear or wear jeans on that area because it’s just so sensitive to touch. Basically, you’ll have trouble connecting to those lower abdominals because things have been cut and moved around. Someone may come in to work on core work because they may have what we call shelfing: where the scar starts to develop a shelf and above the scar starts to fold over. That can definitely be helped by doing some scar mobilization and working on the area. So when patients come in to me for c-section scar work, it’s normally numbness; hypersensitivity and not being able to wear clothes, or things that are too tight or rub on that area, and having trouble with the abdominal region. That goes hand in hand with diastasis recti, which is the separation that can occur during pregnancy and postpartum. That can be heightened with a c-section because those muscles have actually been cut through and then stitched back together.
Dr. Hannah: Other than the baby and breastfeeding, this is a major abdominal surgery that unfortunately the medical system doesn’t really treat like a major surgery. I do a lot of sports rehab work as well, so I see people that have had ACL tears or they’re having rotator cuff repair on the shoulder, and they are given pre-hab (pre-rehab) to their surgery, and then they’re set up immediately with a physical therapist afterwards. I wish that c-sections were dealt with in the same manner, because it is a massive surgery.
So I’d say that the initial period should really just be around healing. I won’t work on anyone’s c-section scar, and I don’t recommend that anyone does any scar mobilization, if they are prior to six weeks postpartum. So if you’re in that zero to six weeks and you haven’t gone back for your six-week checkup, if your sutures haven’t healed or if you’re having any infection, then we definitely don’t recommend any scar mobilization at that point.
Once you’ve been cleared and there are no more stitches, then we can start to work on the tissues. First I have to start with, I am not your doctor and this is not medical advice. I highly recommend that you reach out to someone in your area, whether that’s me, or I can help you to find someone. But some of these things you can do at home.
So if you’re at least six weeks postpartum and you’ve got a nice scar, this is something to be proud of, not something to be embarrassed or hold a lot of fear around. I find that c-section scars become very emotional because sometimes it was an emergency c-section or things didn’t go the way that you wanted. You were planning for a natural birth, and it didn’t happen. And when you end up with a c-section, it’s something to be proud of. You birthed your baby.
We’re going to start with something I call scar desensitization. You’re going to use some things that you can find at home. I have an old makeup brush. It’s soft, not rough at all. And I have a little hand towel. C-sections cut through the superficial nerves that supply the sensation to the area, and it can give you all sorts of issues like numbness, tingling, and make that area hypersensitive to where you feel like you can’t put on leggings or jeans, and underwear rubs you. It can be irritating all day long. So with a healed scar and a clean makeup brush and a towel, we’re going to brush along the scar. We’re just trying to get that area used to a new stimulus. You can do it different ways. You can do it side to side. We can use the towel which is a bit rougher. We’re not pushing super hard. We’re not digging in with the towel. We’re just getting the area used to different sensations. If you have a pair of jeans that you can’t wear because of your scar, you can use that jean material just to get used to it. This is something you an do for like 5 minutes a day before you go to bed, just getting it used to different sensations.
Another thing that I love to get patients to work on is scar pulling. We’re not yanking. All of this is super gentle. We’re just going to pull in different directions. We’re just trying to get that scar to have mobility. Scar tissue gets a bad rap. Everyone likes to blame all their issues on scar tissue. But scar tissue is super useful because it heals things, and brings you back together. As we pull, we are working on getting all those layers mobilized that were cut through. In a c-section they cut through about seven layers: 1. Skin 2. Fat 3. Rectus sheath (fascia) 4. Separation of the rectus abdominis muscles 5. Parietal peritoneum 6. Loose peritoneum 7. Uterus. You may feel that one side feels tighter than the other, and that’s okay. That’s really normal.
Another thing we can do is called skin rolling. That looks like grabbing your skin. And we just want to remind you that everyone has belly fat. That’s normal. We’re going to grab the skin around the c-section scar. If it’s too tender to do over the top of it, we can go either above it or below it. We grab some of the skin and gently pull it and roll it. You can roll slowly over the scar. Most people will find that the edges of the scar have what feels like little knots in them. That is scar tissue from the healing, which is important. But you can use skin rolling to move those around and mobilize them. It may be a little uncomfortable, but it shouldn’t be super painful. If we’re pushing 6 out of 10 pain level then we’re either doing it wrong or there’s something else going on. You can even grab it and go sideways.
The next step would be to go even a little bit deeper, so I normally recommend that people do this while on their back. It’s great to do at night before you go to bed. We’re going to massage with gentle circles, trying to get things to move a little bit better. You’ll notice again that once side is typically more tender than the other. You may have more of those feelings of scar tissue on one side more than the other side. I’d suggest just 5-10 minutes every day.
Belly breathing is something you can do starting in the first few weeks postpartum. It has nothing to do with the incision itself, and we’re not doing any scar work, so you can do this in the first weeks postpartum whether you have a vaginal delivery or a c-section delivery.
There’s no right or wrong way to breathe, but one I like to work on with postpartum moms is working on getting our breath lower into the abdomen. This is easiest to lie on your back on a hard surface like the ground. When we take a deep breath in, I want everyone to see where their breath goes. You can have a hand on the chest and a hand on the belly if that’s helpful. We are going to take a deep breath in, and then let it all the way out. A lot of us are chest breathers, which is not a bad thing, but ideally we’re going to work on getting our breath lower in the abdomen so that we would consider ourselves more belly breathers than chest breathers. If you’re going to start to work on core strengthening, having your breath down low into your abdomen and using that to your advantage is huge.
To practice belly breathing, it’s easiest to be on your back. Put both hands on either side of your abdomen with your fingers on the side so that you can feel both sides of your abdomen. We’re going to take a big breath in, and we’re going to expand all the way around rather than just pushing the belly out. We’re trying to breathe into the outsides and into the back as well, trying to get that breath a little bit lower, helping to expand the area and bring awareness to it after a c-section or abdominal surgery.
A really good core exercise to work on postpartum is just bringing the legs up into a 90 degree position. We’re going to make sure that the back is flat on the floor, and we want our hips to be as bent as they need to be to help flatten the back so that we aren’t arching. We’re keeping our ribs down and ducked. And as we work on breathing into the abdomen, it’s a bit more challenging but it’s helpful to have the legs out because now you have something to push against. We’re going to breathe nice and low into the abdomen. Then we will slowly bring our feet down one at a time into a heel tap.
Lara’s note: this is good to teach our kids too! Common and Colbie Collait and Elmo have a cute song about belly breathing that you can check out on YouTube.
Hannah’s response: If you have a baby under the age of 2, watch them breathe. They are expert breathers. As life goes on and we get to school, we sit more often, we have more stress, and our breathing patterns start to change. If you watch babies, they are amazing belly breathers.
In the clinic I also use a lot of cupping. I use the little silicone cups. It is similar to scar rolling, where we are pulling up on the tissue. The cup is just a way to do that without having to use your hands, and it can get into smaller areas where it’s really hard to pull on the skin. You can use the cups to get the fascia moving better underneath the scar.
The website may not be up and running yet, but it will eventually be craftedhealthco.com. You can find Dr. Hannah on Instagram at @craftedhealthco. You can email me at Hannah@craftedhealthco.com. If you have a c-section scar or postpartum rehab that you would like help with, please reach out to Dr. Hannah.
Recently I had the exciting opportunity to interview Juan Irby II. Juan is a postpartum doula for dads. Here’s an excerpt from our conversation together.
I am Juan Irby. I am a postpartum doula for dads and also for families. I'm located in the North Carolina area--the Charlotte/Concord area. I started my journey with my first son, my first child. I went through postpartum depression and anxiety. You know I was having those feelings, okay, I'm not getting enough sleep. Is he okay? My life is changing; my life is not normal anymore.
And as a man, we're taught, “Don't cry. You're okay. Man up.” Things like that. But it's okay for men to cry. It's okay for men to seek help. Seeking help does not mean being defeated at all. And so, when I looked at go seek help there was no help in my area.
So, years go by, a friend of ours came over for Memorial Day, and we started talking about being a postpartum doula. So, I looked into it. I signed up that the next month. And in June, I became a certified postpartum doula and my business is called From Dad to Dudla. So you can find me on Instagram at dadtodudla and my website is www.dad2dudla.com, and I provide services for families, for dads. If you just want to talk and have one-on-one connection, you can share your story; I can share my story. And we can just chat, and go from there. But, my background is in business.
So I haven't done any in person yet. I've just done more virtual. I've had a few clients in Seattle, and one in Arizona, and we talk on a weekly basis just to get to know each other and also for me to see where their head space is. I want to make sure that, as a dad that they are not being forgotten in the fourth trimester, and because most dads are forgotten either in the birth or after birth, and I want to make sure that they are not forgotten because they play a great role in their child's life.
Some of the challenges that I've seen, were dads being afraid of not having that one on one bonding time with their child or children. And what I would totally recommend is skin to skin contact. Skin to skin contact is very important within these first few hours of the child's life. And because having skin to skin contact is having your child listen to your heartbeat so it's going to regulate you and also going to regulate your child. It's going to catch on to your hormones, and it's going to calm you down, and also going to calm your child down as well. And just having that skin to skin contact is also going to regulate your child's temperature as well. So just making sure that that contact is there, that's going to start the bond of you and your child and you can do it from an hour, two hours, three hours, as long as you want to.
What I like to focus on is the mental health of mom, dad, brother, sister, and everybody that want to be involved in that family. I know most people don't talk about it but I like to prepare a postpartum plan. And by having a postpartum plan, that lets you know, okay, who is going to be allowed to come into my house? Who's going to be allowed to touch my child or children? Who can, you know, do this and do that? And by having that plan and posting it on the refrigerator, or whatever, that gives them, Okay, this is what we need to do. If a baby is crying, okay, why is the baby crying? Is it hungry? Does it need to be changed? And just making sure that all of those options are there on that plan, so that mom can know, dad can know, because we have a lot of first time parents, and they really don't know how to do those things or how to change the diaper how to babywear, and I'm a huge fan of babywearing also.
I love the Moby Wrap classic. It's a large sheet of fabric. And I would use that for my skin that skin. So I will take off my shirt, wrap my son up in the Moby wrap, And he will be up against my chest, and also allowed me to get housework done, because he would fall asleep in the Moby Wrap. So while he's still asleep I was able to get things done, and have a sense of normalcy, while he was sleeping. And there tons of wraps out there. You have the Moby Wrap. You have the Katan. There's so many out there and I do recommend babywearing as skin to skin contact. Or just open up your shirt, put him in a blanket and just hold him close.
I do actually, I like to tell people about Postpartum Support International, and being a PSI coordinator for dads. I like to recommend dads to come to the support groups that we have at Postpartum Support International. And they can share their story. They don't have to talk. But if they choose to talk, it's a group of men in there who share their stories. We come together. We have a whatsapp outside of the meeting that we have every month. And so, we check on each other. We say hey, has anybody gone through this yet? Or has anyone tried this? Or has anyone tried that? And that's how we as dads can communicate amongst ourselves. And so that way we can support each other, even though we may not be there in person. We can be there to support them and give them advice via that app.
So you would go to www.postpartum.net and or just type in Postpartum Support International, and there are a ton of resources on there from therapists to doctors to doulas to postpartum doulas, and there are coordinators that help you find someone located in your area with PSI.
I was in a doula group on Facebook, and someone reached out to me and said, I think you would be a good fit for this right here. So I did some research on being a PSI coordinator, and I emailed the manager. I was like hey, I would love to do this. My name is Juan Irby. I'm a postpartum doula for dads. I specialize in dads. I want to make sure that they're okay. If I need to lead a support group I can, and go from there. And so she emailed me back and was like, I love this. This is fantastic. I really need you on board ASAP. So, I went through the training, and I am now a PSI coordinator, specialized for dads, and we have a dad Zoom call. It's once a month right now, but we're gonna open it up to maybe once or twice or maybe three times a month. So dads can come in, express themselves and just get things off their chest, and we also have a support group for moms as well. And we also have a support group for women of color, BIPOC, and everything else. Anything you could think of, PSI has it.
I do actually. I am a huge advocate for parenting as a team. I would suggest that before you bring the baby home or right when you know that you're pregnant, come up with a plan on who's going to be doing what at home.
Are you guys going to breastfeed or bottle feed? If you do bottle feed, who's going to clean the bottles? Who's going to prepare the bottles? Who's going to make sure that the bottles are sterilized? That plan needs to be put in place because it's okay if one person does it and it's okay if both people do it.
But if we have that plan already, then we can say, "Okay, I'm gonna go down here to warm up the bottle if you can go get the baby." Or, "if you can go and get the baby, I'll go take care of the bottle," and we can tackle this together. And if and when baby does poop or pee then dad can change the diaper while mom gets the bottle, or mom can change the diaper while dad cleans the bottle. Just having those small conversations about that can really benefit the whole entire team. Who's going to take the first shift? Who's going to take the night shift? Who's going to take the day shift? Who's going to take the nap time?
When the baby sleeps, everyone should sleep, and I truly truly recommend that if the baby's sleeping, you need to get some rest as well.
I will also suggest hiring a postpartum doula. Because, while the baby is sleeping, the doula could be doing some laundry. The doula could be preparing a meal or doing those small things that you normally do on a daily basis. Until you guys get back into a routine with this new person, we're going to hire someone to help us out to just do the things that we normally do, because mom just gave birth or just had a c-section, and can't do a lot of going up and down the stairs or walking or things like that.
Dad is here. Dad can go up and down the stairs. Dad can do the laundry. Dad can do this, but dad also needs to rest. Dad also has his own birthing experience. And dad also has his own birthing story. Mom has her birthing story and dad has his birthing story. So I think it's very important for those things to be talked, those things to be expressed to one another, because communication is a big factor when it comes to parenting. And you have to communicate with each other in order for these things to get done.
Have you heard of the Gottman Institute and their Bringing Baby Home program? I think it would be like so right up your alley. So the Gottman Institute studied marriage for many years, and they found they can predict, divorce, with like 90-some% accuracy. And so then they studied what happens to marriages when a baby is born. And they found that two thirds of the couples they studied experienced significant amounts of hostility. They created the Bringing Baby Home program to help with that communication that you were talking about, and the teamwork and asking questions, similar to what you're saying about creating a plan around what you're going to do for feeding. There are all kinds of activities in there about what kind of plans you need to make together as a team, and managing conflict and building friendship and intimacy skills. It's one of my many favorite things I like to teach. It’s been a good tool in my toolbox. It has a whole section about why dads are important. In general, dads tend to be super playful, and that is one of their superpowers. The play and the soothing are both things that dads can be really great at. And that's really powerful for the relationship as a couple, and for equality and both parents feeling confident and capable. You’re so right up my alley that I feel like I could just keep talking. But I also was totally hear what you have to say, so anything else that you want to add or anything else that comes to mind, I just love everything that you've. I love your work and and all the stuff I want to thank you so much for being here even, I don't know how much you want to say about where you are right now but congratulations.
Find Juan Irby on Instagram at dadtodudla and www.dad2dudla.com
Find Bringing Baby Home at little-elf.org/bbh or The Gottman Institute
Watch Juan’s interview here: https://www.facebook.com/placerbirthconnection/videos/557183272376797
I have been interviewing parents and professionals about what it’s like to have a baby during the pandemic. Recently I interviewed Dr. Romy Havard (she/her) of Peregrine Physical Therapy. Dr. Havard provides the East Bay Area, CA with orthopedic, prenatal, postpartum, pelvic floor, and wellness services. She went to UC Berkeley for undergraduate and later attended the UCSF/SFSU Joint Graduate Program in Physical Therapy with MS and DPT degrees. She is also Board Certified in the Orthopedic Section (OCS).
While she uses a broad variety of skills, she is most influenced by the Institute of Physical Art and utilizes functional manual therapy for optimal efficiency. She is also enthusiastic to incorporate concepts from Herman Wallace in pelvic health and contribute to advocacy for postpartum, incontinence, and transgender care.
Here is what we talked about (all emphasis mine):
Me: What are some of the challenges that you have experienced serving families during the pandemic?
Dr. Havard:
For the past 6 months, a lot of the major hospitals have ceased doing in person care for the majority of prenatal appointments. Unless you have dire deliveries, even the one postpartum follow-up is done online with OBGYN. So women who are delivering have little to no before or after care according to ACOG (American College of Obstetricians and Gynecologists) standards. Normally you have all of your check-ups. Everything except the ultrasound and the diabetes test is done online unless you have preeclampsia. New moms are particularly isolated. Some are traumatized. Resources are few. Normally you would meet other moms in a mom group. They don’t have that extra help. They are wondering if their pain and lack of function are normal. I’ve been extraordinarily busy because I’m doing in-person visits. People are driving 45 minutes to see me because they could not be seen closer to home. I often have women who cry through their appointments. I have some days where half of my women are crying through their appointments.
Two years ago ACOG had an article that they released about how postpartum care in the US is substandard. That one appointment postpartum is not enough. But they didn’t really define what better care would be. Pelvic physical therapy should be done with all our moms. And even that isn’t being done.
Me: What are some of the frustrations that you have experienced serving families during the pandemic?
Dr. Havard:
I’m outside the electronic medical system. Smaller offices are easy. I fax them and they get back to me. If I think that this patient needs something specific, those offices are easy to deal with. But most of my patients come from giant Kaiser or giant Sutter. I write them. I fax them. It’s very hard to get them to get the patient what they need. I’m asking for things that are out of my scope of practice. Their lack of participation is alarming. These are things that I can’t do for them. Way more so during the pandemic. A lot of physicians doing Telehealth are doing it from home. If they are never going into the office. If no one is scanning notes and they can’t get to it… I’m not sure what is happening there. It’s even harder to contact doctors. I’m still in the medical system. I still need medical and surgical consultations from doctors. These people are already being seen by these people. I don’t know what’s going on over there. I don’t know if they have had a COVID breakout or what they are going through, but there’s only so many ways that I can send letters through.
Me: What are your fears for new parents at this time?
Dr. Havard:
I just don’t want something to be missed. In pelvic therapy, it’s not life or death, but there are issues around it that I worry that women not pursuing more medical care for things are going to make things worse later. I’m getting more severe diagnoses than I used to as well. I’m having more fecal incontinence patients than I used to and that’s alarming. They should be having consultations with colorectal surgeons, but these are considered non-essential services. I am worrying about their fecal incontinence long-term. I’m trying to be supportive and educate but not be triggering. I want moms to have all the tools, but I don’t want to say “and you need to do this now.” It’s easier when you are treating within a group of integrated professionals. I am not meant to be doing PT on my own with patients. They should be having medical support, nutritional support, GI support.
Me: What do you wish that new parents knew?
Dr. Havard:
New moms should seek care early and really consider preventative strategies. The more you can do to avoid more acute and serious issues, the better you will do and the more options you will have. Pelvic physical therapy is inseparable from the postpartum experience and should be part of postpartum care. Especially for moms who may not even get physicians to look at their pelvic tears. At 3 months, maybe you want to go back to having sex. At 6 months, you want to go back to running.
… The women who are crying in my office are months from birth and they have been waiting for things to fix themselves. If they had started earlier, it would be a small thing. It wouldn’t interfere in their marriage. It wouldn’t make them start to wonder if they could have another kid. There are lots of difficult thoughts.
OBGYN postpartum just wants to make sure your cervix is closed, you’ve passed the placenta, that you don’t have infections, that you have contraception. They are not addressing the pelvic floor. If you are leaking at 6 weeks, that’s not normal. OBGYNs take care of general health, deliveries, general wellness, infection, venereal disease, contraception. Dealing with preventable testing like pap smears. They are not really treating leaking, prolapse, and pelvic pain issues. Some of them are so helpful, quick to get back to patients.
On one hand, just doing postpartum care is a little after the fact. Currently in the US and Britain 85% of women will have a perineal tear, 75% will require sutures. I have one visit during pregnancy to decrease their chance of injury in delivery. It’s not the same as childbirth education. It’s just things that moms can do to decrease their injury. OBGYNs don’t necessarily work from the position of the mother ergonomics. It’s more about the baby. Working on the preventative side is great. I do recommend a visit with pelvic physical therapist before or during pregnancy week 30. You need to start doing the exercises I prescribe daily easily 6-8 weeks before delivery for them to get maximal benefit. I just had a mom who went through it and had no tearing. This is where we need to move - to not just care for tears postpartum. In Australia a lot of people have a pelvic PT during labor so mom doesn’t get hurt. Pelvic physical therapists in the United States don’t have hospital privileges to attend labor and delivery. The least I can do is to do education with moms about taking care of you to avoid tearing, prolapse, urine prolapse, etc. and sometimes c-section.
Me: If you were to look ahead to the future and everything amazing that you can imagine comes true, what would that look like?
Dr. Havard:
In Britain about 2 years ago they voted to add pelvic physical therapy to the standard of practice to be included in national health care. Now even low and middle income women can have this as part of postpartum recovery. Our mortality rate is equal to Mexico. A lot of the moms I see are also more into progressive prevention. I recommend if I was doing bare minimum for someone who is doing great otherwise is:
- one visit during second trimester in case you need a C-section or to minimize injury
- one visit at 6-8 weeks.
- Another visit ideally around 3-4 months. There’s a big hormonal shift then and a lot of women their repairs get worse at 3-4 months. 1 of 9 births will have a Hashimoto event.
- A visit around 6 months for women if they’re doing great. If they are fine with walking or jogging, a 6 month visit may be enough.
- For cross fit or heavy runners, another visit at 12 months as well.
I just want to send a big shout out to Dr. Havard and thank her for sharing her wisdom and experience. She serves in the East Bay in California. You can find her at https://peregrinept.org.
Resources:
©Lara Elfstrand, MA ECSE, IF-ATMHP - Little Elf Family Services, P.O. Box 5098, Auburn, CA 95604
