Protecting Your Pelvic Floor During Pregnancy

Pregnancy causes stress on your body and one of the areas impacted the most is your pelvic floor. What is the pelvic floor and what does it control within your body? How can pregnancy and birth impact your ability to control your pelvic floor? And what can you do during pregnancy to keep this important area of your body strong?

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Featured Expert




Preggie Pals
“Protecting Your Pelvic Floor”

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

Start of Audio

Destiny Bochinski:Your body experiences many changes during pregnancy.  One of the two groups of muscles that bear the most stress during this change is your pelvic floor.  But what exactly is your pelvic floor?  What does it do and how can you protect it while you are still pregnant?  I’m Destiny Bochinski, a Doctor of Physical Therapy at Scripps Memorial Hospital and this is Preggie Pals, Episode 19.

[Theme Music/Intro]

Sunny Gault: Welcome to Preggie Pals broadcasting from the Birth Education Center of San Diego. I am your host, Sunny Gault.  If you haven’t already, be sure to download our free Preggie Pals Apps available on Android and Apple Products.  You can also connect with the show through our Facebook Fan Page and through Twitter where you will find lots of great conversations and you can also network with other moms to be.  Do you have an interesting birth story you’d like to share?  We are looking for listeners who want to share their stories via Video Skype.  So if you’d like your birth story and you want it to be featured, go to http://www.preggiepals.com/submityourstory and send us some more information. Alright.  Let’s introduce some of the panelists here in the studio.

Jackie Kleber: Hi, I’m Jackie Kleber, I’m 25, I’m a Birth Doula and I’m due November 29th with this surrogate baby girl.  I have one child, he’s three and I’m going for an unmedicated hospital birth.

Misty Davies: I’m Misty Davies, I’m 33, I’m a Gemologist.  I am due October 10.  I’m having a little girl, my first child and I’m hoping for a medicated hospital birth.

Kate Gittins: My name is Kate Gittins, I’m 29.  I am a Sales Representative for Pearson Education.  I’m due August 30th.  I do not know the gender and this is my first baby and I’d like a hospital medicated birth.

Rabeka Harrison: Hi.  I’m Rabeka Harrison.  I am a Skin Care Professional with Mary Kay.  My little baby girl is due on the 11th of September and this is my third.  I have two little boys at home and I am going to have a water birth.

[Theme Music]

[Featured Segment: News Headlines]

Sunny Gault: Here’s a look at a story that’s making headlines around the internet.  If you guys want to check out these headlines, you can do so on our Preggie Pals Pinterest Board.  So this one is all about Social Networking:  Facebook in particular.  There is a couple in Illinois that had a hard time choosing between a couple of different baby names for their little girl.  So what did they do?  They basically started a Facebook poll so that anyone and everyone on Facebook could tell them what they thought.  So there were two names, in particular, they were going back and forth between and they claim that whatever Facebook chooses, that they are going to choose as well and fully support.  So what do you guys think about this?  Would you ever…., I mean baby names is kind of a huge deal.  We, in fact, did an episode on this for Preggie Pals.  Episode 5, I think it was.  You know, choosing your baby’s name is a big deal and I understand that you may not completely agree with your partner or spouse about this, but do you leave it up to Facebook?  What do you think?

Rabeka Harrison: For me, I wouldn’t, just because I like my privacy.  So, my page is extremely private, so I don’t even think I would ask my friends and family

[Laughter]

Sunny Gault: Would you ask them in person?

Rabeka Harrison: I might, but I think for me, I’d probably do like a dart board….

[Laughter]

Rabeka Harrison: I’d throw darts at a board and kind of play that game for, you know, the whole pregnancy and see which one comes up with the most percentage.

Sunny Gault: Right.

Rabeka Harrison: But, that’s just me.

Jackie Kleber: I wouldn’t because you always get those Negative Nancies and they have to like be huge downers about everything.

Sunny Gault: So you think they would criticize your name.

Jackie Kleber: Yeah.

Sunny Gault: Whatever it was.

Jackie Kleber: They’ll be like, “Oh, there’s too many of those!  How many other people are going to be that her name in the class?”

Sunny Gault: Yeah, yeah, yeah.  But what if you really just can’t figure it out?  What if…, what do you do if you and your partner just can’t agree?  Did anyone have this problem, those of you that have had kids already?

All: No.  It was a negotiation.

Misty Davies: It was a negotiation but, we had to negotiate…..

[Laughter]

Jackie Kleber: How many vetoes did you get?

[Laughter]

Misty Davies: Only a few.  Well, we had…, we had a list and then you know, we’d go back and if one of us said “No.”, then it was off the list but then it was a compromise later, so….

Sunny Gault: Wow!

Misty Davies: I did compromise.

Sunny Gault: That’s amazing that…, so your husband said “No”, and you took it right off the list then if you said “No”?

Misty Davies: And then put it back in….

[Laughter]

Misty Davies: It got put back in the bottom!  I think we’ve recycled a couple of names back to the bottom, but yeah, well, I mean, I do respect his “No’s” and he has to respect mine, so I mean, in the end, the ones that were really like adamant “No’s!”, they were off.  So…

Sunny Gault: Right.  If you knew if that your spouse couldn’t live with your, you know, baby or yourself or whatever, if that was the name, I think you’d probably take it off, right?

Misty Davies: Oh, yeah, definitely.

Kate Gittins: My husband and I are doing it that way too.  And then I found that with asking people’s opinions of names that I was thinking of, it just got really annoying.

Misty Davies: It is.

Sunny Gault: Yeah.

Kate Gittins: I mean, people hate the names or they love the names and then…..

Sunny Gault: Well, comments….

Misty Davies: I knew a so-and-so and mean to me in Elementary School and I was in first grade, that one day…..

Kate Gittins: Yeah, so they’ll come up with this nick-name for us…..

Sunny Gault: Yeah.

Kate Gittins: “You can name her that, but I’m going to call her this.”  I’m like “Oh yeah!  Whatever!”

Sunny Gault: See comments are different.  I don’t think I would post something online where people could just like rant and rave and comment but if it’s a poll, where you are just choosing one or the other and I have a feeling that’s what it was with this.  I think you can do just Facebook polls, where it’s you know, this name or this name and you can’t comment and you know….

Jackie Kleber: What did you guys do because you don’t know what you are having yet?

Kate Gittins: My husband and I actually we just picked two different names.  We just spent…,.we had been talking about names for a long time, we had a nice list of boy and girl names and we just narrowed it down.  So we were able to…, we really, we did really well, like collaborating about what’s best for a boy and a girl and we finally nailed them.  He still kind of likes the girl…, one of the girl names that we have, but…., yeah, I think, ultimately, like “I’m having this baby!  I’ve been carrying this baby for 10 months!  If I want this name I’ll get it!”.  So yeah.

Jackie Kleber: And then you have to think about your last name too.  How does it collaborate with your last name?

Kate Gittins: Yeah, exactly.

Misty Davies: And your initials!  My dad’s initials are G.A.S.

[Laughter]

Misty Davies: Really have to think of initials, rhyming and we’ve rhymed every name in the book…., I mean, so yeah.  Rhyming initials, nick-names…

Sunny Gault: Well, then when once you have one baby sometimes you want the name to not go hand in hand with your other kid’s name, but sounds good when you put it on a Christmas card or whatever, right?   And ….

Destiny Bochinski:… summons and they don’t know who you’re yelling at!

[Laughter]

Sunny Gault: Yeah, then suddenly just a whole of stuff comes out of your mouth, none of which are any names …..

[Laughter]

[Theme Music]

Sunny Gault: Today we’re learning all about the pelvic floor.  If this is your first pregnancy, it’s an area of the body you may not be so familiar with, but here to shed some light is Destiny Bochinski.  She’s a Doctor of Physical Therapy at Scripps Memorial Hospital right here in San Diego.  So, hello Destiny.

Destiny Bochinski: Hello.

Sunny Gault: Welcome to the show.

Destiny Bochinski: Thanks for having me on.

Sunny Gault: So…I hadn’t, you know I wasn’t even aware of what a pelvic floor was until, you know, you’re kind amidst this  and you’re pregnant and suddenly you know, you are really studying your body a little bit more, so for everyone out there, how would you describe the pelvic floor, what is it and what does it do?

Destiny Bochinski: Well the pelvic floor is essentially the area in between your pubic bone in the front and the tailbone in the back.  It consists of muscles, tendons, ligaments all the connective tissue therein and as well as some of the sphincters, your rectum, and your urethra.

Sunny Gault: Okay.

Destiny Bochinski: That’s pretty much it.

Sunny Gault: And then what does it do in the body?  Like what role does the pelvic floor within the body?

Destiny Bochinski: Well, it has a few functions.  Primarily it’s a supportive role.  It supports your bladder, your uterus, and your bowls.  So it allows and enables the proper function of all of those organs.  Clearly, it stretches to allow a baby to pass through, that’s a big function for it and that’s very normal for that to happen and it should, you know, it should do that on its own.  And it also acts a big stabilizing center of your body.  Everybody here has heard about the “Core”.  Everybody talks about Core Strengthening.  How many of you know your pelvic floor is part of your core?  It’s a really important part of your core.  Everyone’s doing crunches and sit-ups and ab-work.  That’s not the only muscles involved in your core.  Your pelvic floor kind of forms the bottom of your core.  If you look at your torso and your abdominals are part of it, your back muscles are part of it, your pelvic floor muscles are also a really important part in stabilizing your…, the center of your body.

Sunny Gault: For women out there, are there some women that are more prone to having these types of problems throughout pregnancy and even childbirth?

Destiny Bochinski: Well, I wouldn’t say there’s like a type of woman who is prone to issues, but there is definitely some risk factors that go along with pelvic floor issues.  Obesity is one of them.  Anything that causes increased pressure on the pelvic floors, so if you do a lot of height impact activities:  you are a runner or jumping, there’s even, you know, we’ve even had patients that are, you know high school girls who’ve had problems with incontinence because they are doing a lot of running and jumping in their sport.  Those are some of the things that can predispose you to pelvic floor issues.  Obviously, trauma during childbirth can lead to pelvic floor issues later on but doesn’t necessarily have to.  Smokers are predisposed to all sorts of things.  So….

Sunny Gault: Why smoking though?  Why is that impacting….

Destiny Bochinski: Smoking, Nicotine is a bladder irritant and smoking, the act of smoking kind of establishes and creates an imbalance in your lungs and your abdominal and thoracic cavity, so people who are constantly smoking and puffing, they kind of get out of touch with the abdomen and can develop some imbalance things and that affects your pelvic floor, because anything that changes the pressure in your abdominal cavity can change the pressure and force on your pelvic floor.

Sunny Gault: As far as the weakening of the pelvic floor is concerned, does it get weaker and weaker with each pregnancy or if we’re keeping up with this if we are doing the things that we need to be doing, can we avoid that?

Destiny Bochinski: It doesn’t have to get weaker with each pregnancy.  Obviously, well maybe not obviously, but with more than two, three, four, with successive pregnancies, you are more likely to have some kind of compromise and over-stretching of the pelvic floor muscles, you know trauma can occur and even during the pregnancy itself, even if you don’t have a vaginal delivery, just the pregnancy itself puts some pressure on the pelvic floor and contributes to some changes there, so you can do exercises in between that can help you maintain, but if you are going to have four, five, six, seven kids, you know, there’s definitely some increased risk there.

Sunny Gault: Okay, so for our moms in the studio who’ve already had babies, had you heard of the pelvic floor prior to giving birth and what’s your overall experience been since having birth?

Jackie Kleber: I had never heard of the pelvic floor!

[Laughter]

Sunny Gault: It kind of sounds weird doesn’t it?  Like, I mean….

Jackie Kleber: Even after!

Sunny Gault: Even after you didn’t hear about it?!  Really?

Jackie Kleber: Yeah.  No.  And then it was like ….

Sunny Gault: Is today the first time you’re hearing about this?

[Laughter]

Jackie Kleber: And then it was like, “Hey, why I’m I peeing every time I sneeze or cough or ….

[Laughter]

Jackie Kleber:….move or….

Sunny Gault: Yeah.

Misty Davies: I had heard about it because I’m an athlete so I actually had core strength stuff that we had to do that involved the pelvic floor and I hated those exercises and now I’m wishing…, I’m wishing that did them!

Sunny Gault: So, you were an athlete in high school or you continue to do that?

Misty Davies: And in college….

Sunny Gault: Oh, in college…..

Misty Davies: ….yeah, and after.

Sunny Gault: Okay.  So they told you about the pelvic floor then and doing exercises.

Misty Davies: I’m a distance runner, so…

Sunny Gault: Oh.  Yeah, running was one of the things you mentioned.

Destiny Bochinski:Yeah.

Sunny Gault: And you got to have a good core and well…., I just…..

Destiny Bochinski: Even if you do those long distances, you know, not everyone has heard the marathon stories.

Misty Davies: And when you are running that long anyway, you pee when you run and you just, you just don’t stop.  Especially in a race, you don’t have time to stop and pee!

Sunny Gault: I’ve often wondered how that worked.

Misty Davies: Oh you just pee and it goes down your leg!

Sunny Gault: That is hysterical!  Oh my gosh!

[Laughter]

Destiny Bochinski:Some people do more!

Misty Davies: Yeah!  Yeah!  I have stopped for those moments.

[Laughter]

Destiny Bochinski:That would be my choice as well.

Misty Davies: Apparently I didn’t, one win, but no, for moments I opt…, I do opt to stop.

Sunny Gault: Okay, back to pregnancy….

[Laughter]

Sunny Gault: How is the pelvic floor impacted by childbirth?  What happens?

Destiny Bochinski: Child birth:  So, there is a lot of stretching.  Everyone talks about dilation and dilation really refers to the cervix, but once the baby gets past the cervix, your pelvic floor has to stretch as well.  So we talk…, everyone talks about Kegels and about strengthening and everything, but there is not enough emphasis placed on the relaxation of the pelvic floor.  So when you are giving birth, the pelvic floor has to relax and open up.  Those muscles that would act as stabilizing and supportive muscles, they also have to act and just allow things to pass.  They have to stretch and they have to pliable.  So, and it’s just not the muscles, the connective tissue and then there is nerves down there too and so nerves can get moved out of the way and compressed while the baby passes through, so, there is a lot of opening and stretching that goes on in the pelvic floor during delivery.

Sunny Gault: I see.  And we don’t see this too much anymore, but episiotomies, you know, we obviously see tearing, but I think there is more of a trend now going towards tearing as opposed to, you know, going ahead and doing an episiotomy beforehand.  How does that impact the pelvic floor?  What is your experience been as far as seeing cases and stuff?

Destiny Bochinski: Yeah it’s a good trend.  It’s a good trend because the research really doesn’t show that episiotomies have been protective at all.  It’s kind of an interesting thought that initial thought was we’ll do an episiotomy to protect further tearing of the pelvic floor, so you’re cutting something so you can protect it.  So they cut through and sometimes, tearing can go beyond that, so it’s not necessarily just where they cut.  You know, there’s scaring and sometimes, women have more pain after an episiotomy than they would after tearing and you know, long-term, you know, the area has to heal, you’re forming scar tissue around the area that has to get more flexible and you have to strengthen around it, so you know, there is definitely…, it’s a trauma that doesn’t necessarily have to occur.

Sunny Gault: Okay.  Now we’ve been talking about, obviously, all this is having to do with a vaginal birth, but what about for other births out there, does that still have an impact on the pelvic floor?  If you are going to have a cesarean, let’s say?

Destiny Bochinski: Well, there’s…., I mean, there’s definitely an impact on the pelvic floor, just while you are pregnant, just the entire nine months.  I mean you have all these hormones going on in your body, that loosen up your joints and create this flexibility in your muscles and then create stress through the pelvis because as your pelvis widens it causes the muscles to stretch and become a little uncomfortable sometimes and then you have the downward pressure as the baby gets larger and heavier, you have that downward pressure on your pelvic floor, so you are going to have some stretching, effect.  Some of the women that I talk to later on and you know, in their third trimester and they are saying:  “Kegels?!  How….?  Where….? You know, I can’t even feel those muscles anymore!  [Laughs]  How I’m I going to contract that?!”

Sunny Gault: Yeah.

Destiny Bochinski:So, you know, it’s…., you’re not…, you’re not limiting the stress on your pelvic floor by having a cesarean.  You aren’t eliminating the chance of having a trauma to your pelvic floor from…. when you have a cesarean, but you’re not going to eliminate the…, you know, the nine-month stress beforehand.

Sunny Gault: What do you typically recommend to pregnant women to protect their pelvic floor before you know, going into labor and delivery?

Destiny Bochinski:So, the position and the way you deliver is really important and I know, you know, that’s not a lot…., it’s not talked about a lot, but there is different positions that you can get into that are going to decrease your chances of having tearing or trauma to the pelvic floor and different ways that you can allow your muscles to relax better.  So if you are in a supportive, relaxing, nurturing environment where you are able to let things go and breath and allow your pelvic floor to open, then you are much less likely to have a tear because you can let those muscles stretch.  It’s like if you were stretching your hamstring and you were trying to push against the person and really resisting it, you know, your hamstring is not going to stretch as well.  Same thing with your pelvic floor.  So that’s one thing that:  giving…., giving birth on your back, with your legs up is a lot more pressure on your pelvic floor and it closes, narrows the area for your baby to pass through so you have to push harder to get the baby through.  So any time you have to push harder puts more stress on your pelvic floor.  So that’s, you know, typically not a really recommended position to deliver.  I also just…., it’s important for you to stay active when you are pregnant, to stay healthy, you know, eat well, exercise, do your Kegels but also make sure you are able to do the opposite of that.  Make sure that you are able to relax the pelvic floor.  Do some relaxation and visualization before and make sure that you’re, you know, you’re able to keep balance in your life.  If you are stressed out going into your birth, it’s hard for your muscles to relax.

Sunny Gault: Okay.  I found it so frustrating:  You know, I went to a…, just a general childbirth education class prior to giving birth to my first and they would just say:  “Kind of…, you know just do your Kegels!”  And they would give us a little sticker that just said you know:   Reminder – Everyday do your Kegels, and I always wanted to know:  Well, what specifically do I do?  And I think that’s an area that isn’t really discussed.  I mean, I think we know now what “A Kegel” is and you know, how to control that muscle, we talk about that a lot, but specifically, what…, what…., how…., I mean is it a “release and hold” or “hold – release” type thing?  Or what do you do to really strengthen that muscle again prior to giving birth?  What’s your recommendation?

Destiny Bochinski:Well, the pelvic floor has to function…, you know, the kegel muscles have to function in a couple of different ways.  You know, when you sneeze or laugh, it has to be a quick contraction because you don’t time to go:  “Okay.  One, two, three – Ha, ha, ha, ha, ha!”

[Laughter]

Destiny Bochinski:So, you have to…, it has to be able to contract quickly, but it also has to have a long endurance laugh.  You know, if you are a runner laugh – an endurance contraction.  You have to have a certain amount of resting muscle tone there and you have to be able to hold the contraction for a longer – I’m talking about muscular contraction, not a, you know, a baby contraction!

[Laughter]

Destiny Bochinski:Which I know everybody is having right now!   So, that muscle muscular contraction, you have to be able to maintain for longer, so what I usually, and again, this is kind of on an individual basis.  It’ depends on what…, you know, if somebody is having some issues with her pelvic floor, then we definitely have to evaluate that and look and see what we see.  But if you’re not having any issues and you just want to increase the health and the strength of your pelvic floor, we usually recommend you know, doing some endurance contractions where you squeeze and hold it for ten seconds, and then you relax fully, make sure the pelvic floor completely relaxes for ten seconds, and then you repeat that ten times.  And then, after that, I usually have people just do some quick contra…., quick squeezes.  So they squeeze/release, squeeze/release, squeeze/release ten times or so.

Sunny Gault: Is that something you would just do in one day or how often do you recommend to do those exercises?

Destiny Bochinski:If you are not having any issues and you don’t need to correct something that’s going on, then once a day would be sufficient to maintain what you have.  If you want to increase the strength of your pelvic floor, you might want to do it a couple of times a day.

Sunny Gault: Okay, alright, very good.  Well, when we come back, we are going to discuss some of the potential pelvic floor problems that are caused by pregnancy as well as labor and delivery and when you may want to check out and see a physical therapist for some of these issues.  We’ll be right back.

[Theme Music]

Sunny Gault: Okay, welcome back.  We are talking about how we can protect our pelvic floor and Destiny Bochinski, she’s a Doctor of Physical Therapy at Scripps Memorial.  She’s our special guest today.  So Destiny, let’s talk specifically about some of these potential problems that can be caused by pregnancy as well as labor and delivery and when we might be able to come see somebody like you and get some help?

[Laughter]

Sunny Gault: Because we all need help!

Destiny Bochinski:Any time!

Sunny Gault: Let’s start with the problems first.  What are some of the common problems that women have?

Destiny Bochinski: Problems.  Incontinence.  You know something like 30 percent who are pregnant experience incontinence at some point.  That’s an issue.  Pain.  Pain is a big thing that we see women for.  Low back pain, pelvic pain, sciatica, pain in the pelvic floor and then post labor and delivery, you know, people who are healing from cesarean sections, people who are healing from episiotomies who continue to experience kind of incontinence or pain, having a difficult time getting back to having sex comfortably, and as well as anything that’s residual that they experience during.  So if there was any specific trauma that can definitely complicate your healing time afterward.  But we see people for all sorts of things like that.

Sunny Gault: And by trauma you are talking about birth trauma…,

Destiny Bochinski:Um hum.

Sunny Gault: Like something that happened during the process.

Destiny Bochinski:Um hum.  Tearing, tearing, episiotomy, nerve compression, people…., you know, if the baby is sitting on the perineum for a really long time, crowning for a long time, you can get nerve compression issues, nerve stretch issues….

Sunny Gault: What’s a long time?  When you say crowning for a long time, do you have any idea what they….

Destiny Bochinski:Well, my personal experience;  I was at a birth where a baby was crowning for like 25 minutes.  I don’t know how that compares in the scope of things.  She didn’t have any issues afterward….

Sunny Gault: So, after we have our babies, and we may notice some general incontinence after we have our babies, but how long, you know, until we realize:  Okay, this is really a more serious problem?

Destiny Bochinski:It’s never a normal thing to have incontinence.  It’s never…

Sunny Gault: Period.

Destiny Bochinski:Period.

Sunny Gault: Any kind of incontinence?

Destiny Bochinski:Period.

Sunny Gault: And when we say incontinence are we talking about anything…

Destiny Bochinski:Inability to control your urine.

Sunny Gault: At any time, whether you are sneezing, coughing, whatever?

Destiny Bochinski:At any time. It’s never a normal thing for you to be unable to control your urine or your bowels.

Sunny Gault: Okay.

Jackie Kleber:Except when the baby kicks your bladder?

[Laughter]

Destiny Bochinski: Okay, there are, there are those…, it’s normal to go pee more frequently.  It’s normal to need to go really often, but you should always be able to make it there in time.  Unless, you know, unless you drink a liter of Gatorade and are like five miles away from the bathroom.  You know, extreme circumstances.  But you shouldn’t be experiencing normal inability to control your urine. That’s not a normal thing.  So, you know it’s…, I think a lot of women assume it is….

Sunny Gault: Yeah, because you hear that all the time.  Oh, we are having incontinence issues!  Oh, well you just had a baby!  Whatever!

Destiny Bochinski:Right, yeah.  And for a lot, for some people it does resolve and they…, and they do their Kegels and they…., and they heal from, you know, from after the childbirth and they get better and it resolves but they might come down with problems later on during life, you know 15 years later, that might have been…., you know, headed off if they had some treatment at the time.

Sunny Gault: Really.  Okay, it can be….

Destiny Bochinski:It can re-occur.  It can re-occur.

Sunny Gault: Yeah, yeah.  Okay.

Kate Gittins: Other than doing Kegels, what treatment could you do?

Destiny Bochinski: So, we do in Physical Therapy, we do a lot of co-ordination type of treatment.  We make sure in addition to education, we make sure that you know where your pelvic floor is, how to control it, what kind of things put pressure on your pelvic floor, what kind of things to do to avoid putting stress on your pelvic floor, positions to get in to help you heal as well, if you’re healing from labor and delivery and then exercises to strengthen everywhere around it, so we want to make sure that you can contract your pelvic floor muscles separately from your abdominals, separately from your buttocks muscles, separately from your thighs and…, and control everything well.  And we do that with different…, different kinds of treatments, but Kegels are part of the picture, but they are not everything.

Kate Gittins: Okay.

Sunny Gault: So what can we expect if we decide to come see a physical therapist?  What is the process of you know, trying to, you know diagnose what happens, and then how you treat it?

Destiny Bochinski: So you’ll get a quote, un-quote “diagnosis” from your doctor and when they send you to Physical Therapy because in California we don’t have direct access, you have to get a referral from a Physician first.  Or you Midwife.  Midwives can refer too.  And then, you will come in with your diagnosis.  We’ll talk to you about what’s going on with you, what your past labor and delivery is, what kind of issues you had while you were pregnant afterwards, what kind of labor you had, what kind of delivery you had, any trauma that occurred and then in order for us to really do our Physical Therapy assessment, we have to assess the pelvic floor, both externally and internally.  So we a vaginal exam where we test the strength of the muscles, the endurance of the muscles, look at the connective tissues, see if there is any movement.  You guys have heard of prolapse, where the…., either bladder falls down or the rectum falls down or the uterus falls down into the vagina.  We check for those types of things and we do some bio-feedback, which looks at the control of the muscles and how you are using other muscles attached or surrounding the pelvis, the abdominals, in the back and everything.

Sunny Gault: And can most things be treated with physical therapy or what are odds of the only needing Physical Therapy for your issue?

Destiny Bochinski:Well most things related to what?

Sunny Gault: Well….

Destiny Bochinski:Anything related to the pelvic floor?  So…, I mean…

Sunny Gault: Well, yeah, so labor…, I’m just thinking…, I’m thinking more of incontinence because I think that’s a common thing most women face.  You know, okay, so…., I get…., and I know it does depend on the severity of your incontinence, but…., you know, your personal experience with people coming in with incontinence issues, how often do they just need Physical Therapy and that’s it?

Destiny Bochinski:Often.

Sunny Gault: Okay.

Destiny Bochinski:Often.  Yeah.  It’s really helpful.  Yeah.  And…., and even women with other, there’s other bladder issues that can go along with it, you know having to pee every 20 minutes or you know, getting up four or five times in the middle of the night.  Not your baby waking you up but your bladder waking you up….

[Laughter]

Destiny Bochinski: And having a strong urge to go and you only go when you have like a couple of drops.  That’s…., all that stuff is not normal either, so those things can all treated with Physical Therapy as well.

Rabeka Harrison:Well, how long typically, does it take to heal, especially after birth?  Like after my first, I had an Episiotomy, so they actually cut in the pelvic floor, at that point, like when they do the episiotomy and how…, like I never felt like I really healed from that because I peed when I coughed, I peed when I laughed, I peed sometimes just standing up, I mean, it was just really embarrassing actually.

Destiny Bochinski: Absolutely.  Yeah, so when they do the Episiotomy, they cut the skin and it depends on, it depends on how deep they go.  They can cut some of the superficial muscles and it’s not always in one direction, they can go straight down, they can go to the side, so there’s different things can be involved and it can definitely, the pain, just the pain of the episiotomy can inhibit your muscle function in that area for a while.  So you can definitely have some complications and urinary issues from that.  How long does it take to heal?  You know, your body is really laying down scar tissue and healing for the first couple of months, but everyone’s different.  It depends on how… when you start getting back to your daily activities.  Do you, you know, take some time off of your feet?  And are you using some ice on the perineum and being really good with the rest of your body too?  There’s things that we can do that help and things that we can do that harm and I think, there’s a big emphasis on you know, getting back to everything right away.  You know, I went for a walk on day two!  And I did this!  And you know, I’m fixing the dinners now.  And that’s not necessarily a good thing.  I think we need to recognize that birth is a big thing for the body to do and it doesn’t mean that you need to bounce back from it right away and we shouldn’t be expected to bounce back from it right away and get back to all of our daily things because your body needs time to heal.

Kate Gittins: What’s a normal downtime for like, I mean, recommended downtime, once you’ve had the baby?  Six weeks?  I mean is it….

Destiny Bochinski:Down time being?

Kate Gittins: …as far as like….,

Misty Davies: No heavy lifting, stuff like that….

Kate Gittins: ….. no heavy lifting, no vacuuming, no walking, no …., no…., you know, I mean….

Destiny Bochinski:It depends on what you had…, what…., what your labor entailed.  Like how long were you pushing?  Did you have any tearing?  Or Episiotomy?  How long was the overall labor?  How big was your baby?  Because that has an effect too.  But, you know, I definitely say, I mean, my midwife recommended two weeks of “Pajama Rest”, that’s what she said.

Sunny Gault: Oooh, I like your midwife!

Destiny Bochinski:I know!

[Laughter]

Destiny Bochinski:And I wish that I would have done it!

[Laughter]

Destiny Bochinski:But she said you know, “Don’t get up for anything other than going to the bathroom, nurse, nurse in bed, so you can sit up to nurse, but you know, don’t do anything for two weeks”.  It’s…., your body is really healing for a couple of months afterward and sometimes longer depending on what was…, what went on.  So downtime, you know, it varies…..

Kate Gittins: I think there should be a rule.  We should all….

[Laughter]

Rabeka Harrison:Pajama time for sure, for two weeks.  I just go ahead and live by that!

[Laughter]

Destiny Bochinski:Like for Cesarean they are saying you know, they don’t want you to lift or do anything heavy for you know, six to eight weeks afterwards, but if you think if you’ve had Cesarian or an Episiotomy, you’ve also had some trauma there to your pelvic floor.  It might not be as visible as a cesarean scaring, it’s not major surgery but you are still healing in that area and it takes your body that same amount of time to heal.  So.

Sunny Gault: Okay, what advice do you have for mothers out here?  Maybe you are still pregnant and may want to prevent some of these issues, what would be your elevator pitch to them about what they should do to protect their pelvic floor?

Destiny Bochinski:Geez, there’s so much!

[Laughter]

Sunny Gault: There’s no elevator…, there’s no 30 second pitch for that!

Destiny Bochinski: I feel, well, okay, I just feel like education is the key to everything.  That’s why I got into this area, Physical Therapy, because I think there’s…., like you said, who knew what the pelvic floor was before I got pregnant?  I think there’s a lot of…., we need to demystify the area.  We need to find out what it is, you know, what’s going on?  What happens while we are pregnant and then during labor and delivery?  And if we have more information I think then we’ll be more empowered to seek out answers for ourselves.  And to really say, you know, “Okay, this is happening with my pelvic floor.  I have this information and now I want to do something about it, because this is not normal or this is not okay.  It’s not something I’m willing to live with”.  So I think that education is key for everything.

Sunny Gault: Okay.  So if we notice some problems after having birth, we know now that it’s not normal [Laughs] and that we should probably see somebody about this.  Maybe our, just our General OB at first and then they could refer us to somebody like you.  Okay.  Thanks Destiny.  Thanks for all the information.

Destiny Bochinski:Thank you.  Yeah.

Sunny Gault: It was really great.  If you guys have a question for our expert about today’s topic, feel free to send us an email through our website or call our Preggie Pals hotline, it’s 619-866-4775 and leave a message and we’ll include that message in an up-coming episode.

[Theme Music] 

[Featured Segments: Prenatal Fitness Tips -Can I work my abs during pregnancy?]

Sunny Gault: Before we wrap up today’s show, here are some great pre-natal fitness tips.

Lisa Druksman:Hi, Preggie Pals, I’m Lisa Druksman, Chief Founding Mom at Stroller Strides, where you are going to have a great time with your baby, get back in shape and meet other new moms.  And I’m here to answer any of your questions about fitness and pregnancy.  Today’s question is:  Can I work my abs during pregnancy?  And the answer is:  Yes, yes, yes!  You definitely want to work your abs during pregnancy, for so many reasons.  You want to be able to support the weight of that baby.  It’s going to help your back.  It’s going to help you feel better throughout this pregnancy and the fact is, it’s going to help you get back into shape after you have the baby which is I know, so important to you.  Now I know the challenge in why so many moms don’t work out abs during pregnancy, is because they are told not to lie on their back after their first trimester.  And this is true.  This is due to something called Supine Hypertensive Syndrome, which not even all moms will have, but basically, it’s the weight of the baby in the uterus blocking the Vena Cava, so you are not getting enough blood flow possibly to the baby.  But there’s so many exercises beyond just basic crunches and sit-ups that you can do for your abs.  You can do Plank Exercises.  You can adjust yourself a little bit at an incline.  Really, just think about hugging your baby all the time, using your core muscles.  Your abs are not quite as functional when they are all stretched out over baby, but they can still work and you do want to still address them and hopefully if you are doing total body workouts, you are doing functional movements that are going to use your core throughout your pregnancy and it will help you so very much.  Visit http://www.strollerstrides.com for more great information on how to stay fit throughout pregnancy and parenthood and be sure to listen to Preggie Pals for more great pre-natal fitness tips.

[Theme Music]

Sunny Gault: That wraps up our show for today.  Don’t forget the conversation continues on our Facebook fan page and on Twitter.  If you are Tweeting, be sure to use the hash tag #NewMommyMedia#.  Coming up next week, we are discussing The Different Stages of Labor and Delivery.  Thanks for listening to Preggie Pals, Your pregnancy, your way.

[Disclaimer]

This has been a New Mommy Media Production. The information and materials contained in this episode are presented for educational purposes only.  Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts.  Though such information materials are believed to be accurate, it is not intended to replace or substitute for professional medical advice or care and should not be used for diagnosing or treating health care problems or disease or prescribing any medication.  If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider.

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