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Happy Hour with Dr. Allison and Dr. Natalie: Exploring Preconception, Fertility and Pregnancy

Natalie: I think we’re live. Okay. I am Natalie Marshall with Vitalize Physical Therapy and I am going to be… I’m trying to get Allison from Body Motion PT on here. And I’m the least tech savvy person in the world, so I’m sure all Facebook Lives are like this, right? So, let’s see. Okay, cool. People are watching, and this is gonna be super fun, so grab a glass of water, or a cocktail, or a glass of wine, or whatever your favorite beverage is, because we’re gonna do a happy hour talking about all things fun and pelvic PT. And I’m just waiting for Allison to join me. Let me see. And then, I think I click on her photo. Hi, Cassie. I miss you. Okay. So, this is just happy hour with Natalie right now. Oh, she says she’s on.  Let’s see. Does anyone know how to invite your friends? Let’s see my viewers. Oh, there you are, girl. I found you. This is like…adding Allison. Here we go. It’s about to get crazy.Allison: Am I here with you?

Natalie: Yay. You are. We made it.

Allison: Great, this worked. Awesome. I’m gonna get off this other live video.

Natalie: Yay. [inaudible 00:02:01]. Are we live? Oh, no. I missed… Oh, hang on, we popped off, technical difficulties, we’re gonna get this. Okay. I’m adding you again, girl. So, put in the comments what you guys want us to talk about, because we’re gonna talk about everything that you send us in the comment. Otherwise, we’re just gonna go off the cuff and see what we end up chatting about. Yeah, see, this is bad when two tech un-savvy people get together. I could just chat about stuff to start. 
Allison’s malfunctioning. “Invite me again.” Urinary leakage and frequency. You’re so bold. Thanks for asking about that. We are gonna chat about that for sure. There is a guest on the broadcast. Allison, let me try you again, girlfriend.

Allison: I might be back.

Natalie: Yay. Here you are. You made it. Okay

Allison: Okay, here we go.

Natalie: Yeah, here we go. We have a request already for urinary leakage and frequency. We love talking about that stuff, don’t we?

Allison: Yes.

Natalie: And “getting ready for labor and how to recover ASAP”, absolutely.

Allison: I love it.

Natalie: And I’m loving this. Okay. Okay. So, first of all, what are you drinking over there in Seattle? [inaudible 00:04:03]

Allison: Yeah, I’m working on a Rose, and I brought the bottle in case I needed that. I didn’t know how long we would go. So, what are you drinking over there?

Natalie: I know, [inaudible 00:04:10]. We might be here for a while. We might not, we don’t know. I’m doing a White Claw, a Black Cherry White Claw just for fun.

Allison: Nice.

Natatlie: Kind of a little spritzer. [inaudible 00:04:23].

Allison: I need to try that.

Natalie: Yeah, it’s delicious. Yeah. And I did…I’m very American right now with my [inaudible 00:04:30], so it’s cool.

Allison: Oh, I like it. That’s great.

Natalie: Okay, so basically, Allison, we get together all the time and chat, you and me chat, and what we chat about is always fun and pelvic-friendly. And so, we’re just like letting people in on our chance and rants today. So, it’s fun.

Allison: Yeah. Yeah. So we…

Natalie: Okay, cool. So… Oh, No.

Allison: I’m still here, though. That’s what matters and we’re gonna just…it’s all gonna work out.

Natalie: [inaudible 00:05:05]. Yeah, cool. So, okay. So, our talk today are like pre-conception like… Girlfriend, are you on a selfie stick? I taped my selfie stick down. You should see my contraption over here. It’s awesome. Okay, so.

Allison: My computer malfunctioned. So, here we are.

Natalie: Here we are. Yeah. So, what we’re gonna talk about today, though, is getting your body ready for pregnancy and then during pregnancy, getting your body ready for delivery, and so, all the fun stuff. And both of us are really holistic-minded, and we like to come at it from that kind of approach, I would say. And we just want to educate as much as possible. And, yeah. So, where should we start?

Allison: Let’s start with some pre-conception stuff. So, you kind of…let’s say you decide you wanna get pregnant. You think you can control it, so, you’re gonna start this month, and…

Natalie: So this month, it’s [inaudible 00:06:12] I’m getting pregnant, I’m off the pill, I just got off the pill, I’m getting pregnant this month. Where do you go, right?

Allison: Yeah, so. 

Natalie: Where can one go?

Allison: Yeah. In an ideal world, you know, you say, “Okay, I wanna get pregnant,” and hopefully, that happens for you right away. There’s a possibility that it doesn’t happen for you right away. Right?

Natalie: Right.

Allison: So, there’s a lot of things that can happen to the body and can cause things like infertility. And so, I think let’s go down the infertility route first, and then we can kind of pop over to the pre-conception stuff?

Natalie: Yeah. Jump in strong. And I think even if people do get pregnant naturally and quickly, is your body in the best place possible? Right? So that’s what we care about. So I can speak for myself, three plus years ago, when I went off the pill I was like, “Let’s get pregnant. Let’s go.” My body was not ready. And I know that for a fact, and through, kind of, my own holistic journey of figuring out what is good for your body and what would be good for your baby, that’s not where I was three years ago. So I’ve learned so much through that, which is awesome. So, it’s a team of doctors, and, it’s not for me. Just if you’re not getting pregnant, okay, what do we do? We go to an OB-GYN, or we go to a reproductive endocrinologist.

Allison: Exactly.

Natalie: But what are they gonna do? They’re gonna say, “We’re gonna try Clomid or ephemera, or we’re gonna try IUI or IVF? I mean, those are the top things I would say, right?

Allison: Yeah.

Natalie: They’re gonna try something like that, or, they’re gonna maybe do some blood tests, or ultrasound, hCG diet. They’re gonna try a couple of different things. But basically, they’re gonna try to get you pregnant, but your body might not be at an optimal state. You might have a deficiency of a variety of things. You might have…oh my gosh, we could go on and on for days for that. For you and I, what we see though, is we see restrictions in pelvic floor muscles, right? Which are so closely contributing to the reproductive system. So the reproductive organs, the uterus and the Fallopian tubes and the ovaries, and why things are restricted in that area. We wanna get to the root of.

So, we want people to be able to achieve a healthy pregnancy and carry that through to be healthy, to have a healthy delivery too, and to not have back pains. So, I think so often too, people have underlying pain or bloat, or constipation, or even before pregnancy, they think, “Oh, this is just my normal…”or they don’t even know that it’s not normal. And I think that that’s super key for us to address.

Allison: Absolutely. Yeah. I think part of the thing of just like not realizing where your body’s actually at, maybe you don’t have…you know, maybe you have pain with intercourse, and you don’t realize like that’s actually not like a normal thing. It’s super common and a lot of people have that discomfort, but it actually makes it a lot…that can be part of the reason that you’re not actually conceiving, you know. And so, I think the last thing we talked about when we were talking about fertility is really 40% to 60% of infertility can stem from mechanical issues. And…

Natalie: Absolutely. And mechanical, you know, just to dumb it down, because sometimes, I hear words and I’m like, “What are they getting at?” So, mechanical just means what types of restrictions? Like, I brought my pelvic model.

Allison: Yes, please.

Natalie: So, I’m gonna show you just a little bit here. So, pelvic model, okay, pubic bone like that hard bone in the front, and then, here’s the clitoris. I said clitoris on Facebook Live.

Allison: Love it.

Natalie: And your urethra, your vagina, the anus, all the reddest muscles. I even see where people like have that Bartholin’s glands restricted, and their cervical fluid is not awesome, and that Bartholin’s gland secretes lubrication. So, that’s awesome. We need that, right? We need that, so our mucus can help… I just said “mucus”, [inaudible 00:10:35].

Allison: So, I’m just gonna pop in. Can I pop in there? When you’re talking…

Natalie: Hop in. Hop in.

Allison: When you’re talking about having that adequate lubrication? This is huge for like secondary infertility. So, if your hormone levels…say you’re trying to get pregnant, maybe it’s 18 months after you had your first baby, maybe it’s right away, maybe it’s 2 years or 3 years, if you are still breastfeeding, your hormone levels can be changed, and so, your estrogen is low. So, your lubrication is gonna be even lower. So, you know, that would be a good start as far as someone who’s just like hoping to get pregnant, maybe still breastfeeding, even if not, and may be your estrogen hasn’t come back fully, you know, that would be, the lubrication would be a huge factor, and also improving the comfort of intercourse.

Natalie: Like, let’s just say like… So, we’re kind of jumping forward, but your body like, is your body optimal? Do you have awesome cervical mucus? Do you have regular periods? What do your periods look like? Has anyone talked to you about that? What are your blood levels? What does everything look like for you? I mean, what is the big picture? Have you ever had someone look at the big picture? Not just like, “Oh, you’re not getting pregnant, let’s like get your eggs and the sperm and let’s connect them and like, let’s get you pregnant.” Like, what, for you, is like the driving force behind the root, like we’re about the root, right? We care about the root. So, is it simple stuff? Or is it more complex stuff? And that’s what we care about. Right? We’re like women’s health PTs, but we, a lot of times, direct people to other people as well, Holistic team approach.

And what Allison is talking about and the secondary infertility is huge, which I see so often, or people like, women, girls have the postpartum blues, the postpartum depression, and, of course, like your hormones are out of control. You have so many different highs and lows with that, and that’s a very normal thing to happen. Common, but not normal. Like, “Let’s get to the root of that too.” Like, what hormone levels, what should we address there? Libido. Why would your libido be high after having a baby and after having like this area, maybe an episiotomy or if it’s ripped and this area’s painful causing pain with intercourse, pain with tampons, pain with bowel movements. Like, “Don’t come near me.” You know, that area’s like this X zone, so your brain kind of connects that, and it’s all about the brain-body connection, which is what we definitely care about.

So, okay, back to pre-conception though because we can go… We’re gonna rant all night. Aren’t we?

Allison: I know. So, let’s maybe… Do we wanna go… What do you guys wanna know? Do you wanna know pre-conception? Or, let’s jump into the pregnancy body. So, I’m gonna jump a little bit into…I’ll just like briefly say pre-conception, and I’m not gonna do it justice. But if people have questions they can ask them in the feed. And I already see a few questions, and we can maybe come back to those after I do my little rants. And you can pop in at any time you want. We’re a little bit delayed. I think my internet is probably a little silly right now. But I would say…

Natalie: This quick question here. Sorry to interrupt. “Favorite form of birth control without affecting fertility.” I think that, that is a great question. And that’s not as much my realm. it’s a great… So, I… You know what? I would say that…

Allison: You mean the potential of fertility? That’s what I’m assuming.

Natalie: I think she’s asking about like, what birth control that we would recommend that doesn’t affect your fertility in the future, which is a great question. So, it’s not like, I wouldn’t say it’s a 100%, I want to say they might have a 96% effectiveness rate, but 2 groups… So, like, in the… Katelin Parkinson is a naturopathic doctor, and she works with people on their levels, and their charting, and helps people understand when they’re fertile, and when they’re not, which is great. And then, there’s also Creighton practitioners like Liza Scottfree [SP[, and she’s also does that too, the tracking. So, tracking your cervical mucus, and they are awesome resources for…that’s for birth control based on tracking your, I believe, temps and cervical mucus.

Allison: From like an actual, like hormonal perspective, or IUD versus like…

Natalie: IUD versus birth control pills.

Allison: …implants or anything like that. I would say that, I probably…I don’t feel adequate. I can’t really answer that question.

Natalie: Right. Right. That’s not my…I don’t think that’s my realm. I don’t know. I don’t…yeah.

Allison: So, sorry, we’re not helpful. Not quite helpful there.

Natalie: I know we’re not helpful, like maybe some like natural condoms and pull out method? I don’t know. I’m bad at that. Okay, cool. So secondary fertility after years of infertility and breastfeeding only if you have to… Oh yeah. So, yeah. Like, okay. So, let’s talk real quick about like, okay, secondary infertility. Do you wanna do that a little bit?

Allison: I don’t know. Should we go there? Or should we just jump into the pregnancy?

Natalie: I think we could answer that quick, you think? Perfect question.

Allison: I’m liking these comments.

Natalie: I said “pull out” on Facebook Live too. Okay. Okay, so, I think like secondary infertility is huge because if there are things that are restricted from having a childbirth with whether it’s a vaginal delivery or a C-Section, you have scar tissue. So, come see a pelvic PT. Like, let’s figure out what is going on with your system. Like, how many times do we mobilize C-Sections scars? And then, this is the thing, I used to warn people. I’m like, “Do you wanna get pregnant?” Like, are you guys good? Or like, are you hoping for another child soon,” or whatever. And, if they’re like, “Oh no. Like, we’re good.” Okay. Have another form of birth control, because, once we mobilize around this uterus, like the C-Section scar, a lot of times, like… Am I right?

Allison: Yeah.

Natalie: I mean, it is…

Allison: I couldn’t agree more, and I think…

Natalie: [inaudible 00:17:10] that’s huge. 

Allison: Yeah. And so, with the C-Section scar, you get like some serious adhesions that are also tied to the pelvic floor. So they’re all connected. And once you start releasing that, and the organs can move more freely, then you really improve your chances. So, I think that’s the best thing when talking about secondary infertility. I also wanna preface that even if someone says they’ve had… Well, I’ve been in a pelvic floor rehab, and, you know, I did that right after my baby was born. Things can change. Your body can change. Your hormones can change. Everything changes. So, it doesn’t hurt to get another evaluation. And I rarely seen a pelvic floor without restrictions, or a C-Section scar that isn’t bound down still just a little bit, or a uterus that’s not moving, or fallopian tubes that aren’t moving.

So, I would say that’s all part of the picture…

Natalie: Absolutely.

Allison: …as far as the secondary infertility, really important things.

Natalie: Huge.

Allison: And then… Oh, yeah. Go ahead.

Natalie: Oh No, thank you. Joel. Katelin does this justice model. That’s what I was trying to think of. Katelin Parkinson does that justice model. That’s a great…that one in the Creighton model for birth control. Just commenting on comments.

Allison: Okay. So, Rachel asks about low back pain, and what can we do to prevent or help decrease low back pain during pregnancy? So, this all has to like…this ties into pre-conception. This ties into prenatal. So…

Natalie: Absolutely.

Allison: …really, if you know like you wanna get pregnant, I would say the number one thing is you wanna be connected to your core muscles. So, this is gonna be your transverse abdominis, your diaphragm, your pelvic floor muscles. You’re gonna want your glutes. You want this to all be timing and timed correctly. And so those muscles can be… It’s important that they’re coordinated. And so, you really want someone watching you to make sure they’re coordinated. So, maybe you have a great pilates instructor, someone who can really help make sure you’re contracting and relaxing and coordinating.

But I would say that a pelvic floor physical therapist is gonna be your best bet in order to really tell you if your muscles are working the way they should. And really, like a lot of people, they might be suffering back pain during pregnancy, and that is kind of like the symptom. So, that is the symptom, but how we can correct that is through still strengthening these muscles even throughout the pregnancy. And these muscles have to be addressed throughout pregnancy in order to prevent things like an ab separation, which is known as a diastasis recti. And this is so preventable, and you really don’t have to live with the separation. And so, that is like the first step. Like you find out you’re pregnant, or you wanna get pregnant, learn how to activate your transverse abdominis so you don’t separate. And if you already feel like you kind of separate or you have really defined abs, that doesn’t necessarily mean you’re not gonna separate. That actually predisposes you to possibly separate more.

So you want to make sure that your abs are balanced. Natalie and I both are like humongous believers in manual therapy, so much fascia and so many different muscles and joints can be released to help decrease the strain on the diastasis, so you don’t end up having to like rehab this huge separation postpartum. And I say the separation because that’s really what people care about aesthetically. People contact Natalie and I every day, because they’re so interested to help fix their separation or get their flat stomach back. And really, that’s just an aesthetic thing. But down the line, it becomes less of an aesthetic thing. If your core is never restored, you have so many…I’ll come back to that question in just a second. If your core is not restored and if you have that diastasis, you’re actually going to be putting so much more strain on your joints throughout your years after pregnancy.

So, you’re gonna be predisposed to getting joint replacements later down the line in your 50s, 60s, and then that’s when the wheelchairs happen later on. And I’m just being totally honest, but that’s what we need to know and that’s what people need to know.

Natalie: Yeah. And how many times do we say this? Like, optimize your body now, because what kind of 80-year-olds do you wanna be? I ask people this all the time. I’m like, “What kind of 80-year-old do you wanna be? Do you wanna be the 80-year-old that’s in the nursing home, that someone’s cleaning your yeast rolls, the yeast out of your rolls and wiping your butt, and you’re peeing in your pants and you smell, like you smell like urine. Do you wanna be that 80-year-old? Or do you wanna be the one that’s so cute with their grandkids, and they’re holding hands with their spouse, and they’re just like, going to the store, and they’re driving themselves everywhere, and they can still clean their house, and they can still run a marathon? Like what kind of…you know, like, optimize now.”

Allison: No. It’s a really honest… That’s a super honest question. I mean, and just that’s the reality. That’s not very PC, Natalie, but that is…

Natalie: I know.

Allison: That is the reality.

Natalie: Very reality.

Allison: Good.

Natalie: So back to diastasis, and I think this awesome point that you’re about to talk about is all the different things, not just aesthetics of the belly, which is super important, but all the other things that can go into it and how the strength and the extensibility of the abdomen is so important too. So, during a pregnancy, you don’t just want this strength, you want this extensibility of your muscles to move and contract and relax how they’re supposed to. So you want to make sure that those muscles, like Allison said, are balanced. So everything below the rib cage…I mean, really, in conjunction with this rib cage, everything below and above is all interconnected. And how are you moving? What are your muscles doing? That’s huge, because what happens is, what we find commonly, is people come to us and are like “I do kegels for days. That’s not working.” It’s like, “No kidding,” because things are restricted. Like you have these trigger points and these muscle knots that are restricted.

So we need to release those so that your muscles can actually fire how they’re supposed to contract and relax, because if they’re stuck like this, and they have… Like, pretend that these muscle fibers run like parallel, like my fingers would. If you have that muscle knot, it looks like this. And so, your muscles try to contract. They can contract a little bit, but not a lot. So and if they can’t contract a lot, they can’t stabilize how they’re supposed to. And as we know during pregnancy, you have a lot of ligamentous laxity. So, the extra hormones in our body increase the laxity, which ligamentous laxity is the ligaments which attach bone to bone, become lax and stretched out, so they aren’t stabilizing how they should. So the muscles have to do their job. So if the muscles are contracted like this, we need to relax them to a point to normalize them so that we can contract and relax, so to strengthen and stabilize.

Allison: Yeah. And I wanna take it a point further, and I’m going off topic. There’s some questions about people are mind blown that you don’t have to have an ab separation. I actually did not in both my pregnancies. My abs are still together.

Natalie: Go, girl.

Allison: But just because you don’t separate during pregnancy or you don’t have a pelvic organ prolapse during pregnancy and delivery, which I actually never see, the organs are usually always descended to some extent, unless you have a retroverted uterus, which means that it’s just positioned a little differently, but usually, there’s always some degree of descent of the organ so that…everything’s a little lower after childbirth, which is normal, and it happens and there’s so many things we can do to help, which is why we’re on here sharing.

But what I see is not only… So, if someone doesn’t get a diastisis during their pregnancy, that’s fantastic and that’s awesome. But what people fail to notice sometimes is because of this hormonal change that lasts…I’m just gonna be honest, it lasts for years, and that’s just the reality. And so, a lot of people…

Natalie: I mean, 50 years. You could be 80 and still have this problem. I saw today…

Allison: Yeah. And then you got the menopause changes. I mean, we are a constant ball of changes.

Natalie: [inaudible 00:26:06] about 50, but, yeah.

Allison: What?

Natalie: I can’t remember the age of this girl. I think she’s around 50 and maybe a little younger, but she had her babies, you know, whatever, 15, 20 years ago has a diastisis and is coming in, and never after having babies felt the same. Gosh. Oh Allison, let’s talk about that for just one minute.

Allison: Well, can I finish on my diastasis comments?

Natalie: Oh. Yeah. Yeah. Yeah. Getting ahead of myself.

Allison: I was just gonna say if someone’s lucky enough not to have the diastasis during pregnancy, maybe they were taught to use the right muscles, but oftentimes, they’re not. They’re just get lucky with that. Then, I see sometimes they actually give themselves a diastasis when they start returning to exercise.

Natalie: That’s right.

Allison: And that is scary. And that is like, you’ve gotta let things heal. You have to… I think jumping back into water skiing and cross fitting can be great at a certain point, but you just want to respect like where your body is. And I have to be so honest with you, my last two pregnancies, I just, I never did that. I honestly forced myself, had the mentality that I was gonna get my body back, and lose all the weight, and just feel like a rock star because I felt so frazzled, which I still am sitting here feeling frazzled. 
But you know what? You kinda just get used to it, but I also have the support and help that has guided my body in a healthy way. But I get it. Like, I’ve jumped back into the bootcamps, the high intensity interval trainings and plyometrics way too early. I’ve made my prolapse way worse than it ever needed to be.

And so then I’ve had to get help for that. And really, what it comes down to is it’s comes down to not respecting where your tissues just aren’t where they were. So like you’re still a strong woman, you can still do all these things, and like I love to lift heavy weights, but I just have to realize where my pelvic floor is at right now, after just having two babies in the last three years. So, I mean, it’s getting the help you need, and it’s getting the support, and just knowing that your body, in all reality, is not the same. And there’s so many things we can do to help that. So…

Natalie: Absolutely.

Allison: Okay. Off my little thing. You go. I interrupted you where you… Should we answer some questions?

Natalie: Yeah. I was looking back. Okay. So, “Low back pain. Okay, “What can you do…” Did we answer that one okay? “What can you do to prevent or help decrease pain during pregnancy?” I mean, the truth of that one I think for us, and, of course, everyone’s probably like, “Oh, yeah,” Of course you say that. PT. See a good pelvic PT because there’s nothing like it.

Allison: And not a good one. I’m saying, someone that listens to you…

Natalie: Consistent.

Allison: …spends time and puts their hands on you. Doing a quick 10-minute little session, or 15-minute session and being passed off to aids and seeing different providers, honestly is not the holistic care that I think is what gets you better. You know, I mean, that’s why we’re at where we are today. And so, yeah. I think it’s important to help. You know, and if you’re not in our areas, and even if you aren’t, we know people everywhere and we can find you a good pelvic floor PT who will spend time hands on and really help guide you. So, I’m going to…I’m in the sun here. Sorry.

Natalie: Oh, you are. I know.

Allison: Let’s see.

Natalie: I wish I could hand you my shades. “What are the best things you can do to prepare for childbirth? I’m terrified.” I think that’s huge. And I think that a lot of people are terrified. I think that that’s one of the most common things that I hear is that people are terrified because they don’t know what to expect. We probably, I would say, have a lack of education in that department. Like, people just expect that women…yeah, as women we’re strong and we kind of know what to do. But do we? I mean, I think there’s a lot to do to prepare. I love to see people throughout a pregnancy, just every… If a person’s normal, healthy, regular, I’d love to see someone every four to six weeks to stay on stuff, progress their exercises, make sure their body’s optimal, make sure that everything’s aligned, make sure the muscles look good, and just keep people out on track for that.

And then, starting perennial prep, the area that stretches to deliver a baby vaginally. So between vagina and anus, I think that that’s like super important to understand this perennial prep and get someone who knows what they’re doing to either teach you how to do it or do it for you, starting around 32 to 34 weeks depending on your situation. If you’re high risk, is a little different. But I think that’s key.

Allison: I think that’s definitely key.

Natalie: And to learn those muscles, because those are the muscles that actually push the baby out. I tell people another gross thing. I’m saying a lot of gross things on Live tonight. Like, you basically poop a child out, right? And so, and those same pooping muscles are pelvic floor muscles. So, you’re bearing down and you’re breathing, and if you’re vaginally delivering, that baby’s coming through, and that turd wants to keep sucking back up a lot of times. So, if you practice that in good positions that you’re doing, and you can breathe through that, and you know how to bear down your pelvic floor, and you know, what it feels like when it clenches and it’s scared, and you can [inaudible 00:32:02] it’s huge.

Allison: I mean, so that is why…and I would say even before pregnancy, that’s why you wanna come see us, like learn how to poop, and then your whole entire 9 to 10 months, you get to practice for a pushing. And, I mean, that’s pretty incredible. And I think…

Natalie: Incredible.

allsion: …teaching someone to poop and doing it right, right there, you’re gonna prevent anal fissures, you’re gonna prevent hemorrhoids, you’re gonna prevent a lot of the low back pain. And so, I think that’s all how you can prepare. So, it’s such a good analogy. We got a question from…let’s see here, from Sarah. And it said, “Do you recommend a PT before the baby? I was thinking for sure after. But not sure I need it right now.” And I would say, “Absolutely.” I was treating a patient yesterday who I’ve been seeing since she was 20 weeks pregnant.

And I asked her yesterday, I said, you know, what is the one thing… Her delivery didn’t quite go as planned. So, it was one of those let 25% that you just can’t really avoid a C-Section, her baby ended up being a surprise breach. But, I started seeing her at 20 weeks prenatally, and she said, “You know, if I would’ve seen you since before I even got pregnant, I think I would have not had to suffer the way I did.” And she had a lot of dysfunction going on. And she was in a lot of pain, and she was nauseous until she started seeing me. And pretty much, when she started PT, her nausea went away. And that was like 20 weeks that she couldn’t even work. I mean, it was that bad.

And so, I just think there’s so much that PT can do, that even if you feel like you’re totally normal, check your pelvic floor before you even get pregnant. Or, you know, once you find out you’re pregnant right away, you can do the monthly checkins. Once I start with someone, if they’re just seeing me for the…I have a prenatal nurture package and Natalie provides a very similar thing. And when you get pregnant, you can do just this, like maintenance wellness every three to four weeks of just checkins, balancing all your muscles, making sure everything’s firing, making sure that you have a good holistic program to keep you really healthy, and just prepare you optimally for labor and delivery. So, yes, pregnancy before…or PT before pregnancy and during, even if you’re pain-free. People in other countries just get this. But we have to fight for it. And it’s because we just haven’t educated enough. And so, that’s why Natalie and I like, we talk like this every week on the phone. So we’re just gonna keep talking like this, and we’ll just keep sharing it with you guys, and we like to talk about our different patient experiences and, you know, trade treatment ideas too, so it just helps everyone. So, yeah.

Natalie: They were fine.

Allison: Go ahead, Natalie. Take over.

Natalie: Okay. Yeah. One question we got from Ashley. “How do you restore hormones and increase estrogen?” For us, we would definitely recommend…I mean, we help with the physical stuff. And, of course, improving the tissues, for instance, like we mobilize the small intestine that improves serotonin levels, which are your happy hormones? Right? So that’s one thing that we do. But we don’t…we aren’t hormone specialists. Functional medicine doctors and nurse practitioners are. They’re awesome. Same with naturopathic doctors. So, that’s who I like to refer that question to. How do you restore hormones and increase estrogen? I don’t know if you have any…

Allison: I will agree with you there. Yeah.

Natalie: [inaudible 00:35:55]. And then, okay. That we answered. And then Erin says, “Hey, lovely ladies. Sorry I’m jumping on a little late, but…

Allison: You might have a newborn at home, Erin. We’ll post this for everybody who can’t watch it live. We’ll post this later.

Natalie: Yeah, [inaudible 00:36:17]. Yeah. She says, “I’m five weeks postpartum. How do you know if you have a diastisis? I can’t wait to get back to exercising.” Erin, is there someone around you that can check? And also, I recommend this to everyone. So I…

Allison: Is Erin close to Indianapolis?

Natalie: An hour and a half-ish.

Allison: Yeah. That’s a long ride.

Natalie: But, you know what? The thing is, I think that if you could see someone in a girlfriend, if I’m up there, I would totally see you. This is our mutual friend’s sister who just had a baby. And I recommend actually everyone before you start exercising, you should really see a pelvic PT one time. One time. I talk to people on the phone for free. Okay? First chat we chat for… It’s complimentary. I would just wanna help. We truly just wanna help people. And if people…if curious, I just say, comment just for once, one time. Let’s just check it out. Let’s just see what your body’s doing. How many people, Allsion, tell us, “Oh, my gosh. I had no idea there was someone like you until I saw you.” Right?

Allison: Yeah. Or, “I wish I found you earlier.” Right? I mean, that’s what we hear all day long. So, that, I mean, that’s why we’re here educating too. So, yeah. But Erin, you take that trip and you go see Natalie.

Natalie: You take that trip, girlfriend. Come down here, visit your sister and I’ll see you, for sure. There’s some cool people too in Chicago, which, I don’t know. Are you close to Chicago-ish? So, maybe, yeah. [inaudible 00:38:10].

Allison: So Natalie and I are gonna be live again as we… Do you have that date in front of you, Natalie?

Natalie: I’m in my paper calendar.

Allison: Let’s see if I can find it.

Natalie: It’s two Tuesdays from now. Let’s see. The 31st.

Allison: The 31st. So, Tuesday the 31st, we’re gonna be on same time. We’re helping to rack up just some of your questions, and we’ll answer them as you guys post them. And we look forward to just helping you. Erin, also, there are some videos that we can send you about checking your own diastasis. So, I can send you… I have a little postpartum checklist similar to what I sent you when you got pregnant, and I can send that to you too.

Natalie: We can show that quick, huh?

Allison: You wanna show that?

Natalie: Well, yeah.

Allison: You wanna do it?

Natalie: I’m not gonna lie. You guys should see this rig up. My selfie stick is taped down, so I can’t move that. But basically, you lay down on your back, and am I out of the picture?

Allison: No.

Natalie: So, you lay down… Am I?

Allison: You’re a little. So, let’s maybe…

Natalie: You lay down on your…

Allison: Yeah. Should we do it maybe standing? I mean, the best way to do it is laying down. That’s obviously ideal. But let’s… 

Natalie: So you lay down on your back, yeah, with your knees bent, and you feel right above your belly button, and then you lift your head and your shoulders up, and then you fill in that gap. And, if there’s a gap, if there’s a hole that you can fill in. So if…

Allison: If you feel a separation between the two sides of your abdominal wall.

Natalie: Yeah. Because the linea alba is that muscle that connects your six pack ab [inaudible 00:40:03]. You see the white part down people, six pack abs, and you see the red of the muscles in a picture.

Allison: In an anatomy photo.

Natalie: In an anatomy photo. Yes.

Allison: Down at the beach.

Natalie: And… Yes, down at the beach, and you see the line down the six pack abs. That line would be separated, and you would have like, kind of, like your belly, because it can’t come together, it pooches here. And not always do people have a diastasis recti, but they still have the pooch too.

Allison: Right, right. And that’s just retraining a lot of these muscles. So, you know, and it’s easy to say like, “Go do some ab exercises,” but that’s just not doing it justice. Like, really, someone needs to have their hands on these muscles, feel them coordinating. This is what’s gonna prevent the back pain later on. This is what’s gonna cure a lot of times, the right SI pain that is just like so common postpartum. And so, I think just getting one check. In most countries, some countries… In France, they get 10 visits to restore the abdominals, and then 10 visits to restore the pelvic floor. So, that’s like pretty incredible. And Natalie and I can do that for you. No one can…

Natalie: You could be like a French woman.

Allison: You could be a French woman. They’re really small waisted, so I’m down with that. Like…

Natalie: Yeah, for sure. Let’s talk about constipation.

Allison: You wanna go to constipation?

Natalie: Yeah.

Allison: Okay. Postpartum constipation or prenatal constipation.

Natalie: I think even prenatal.

Allison: Okay. Do you have someone in mind that you’re thinking of recently? I’m moving around because I’m like getting glares of sun and it’s hot in Seattle. We’re in the 90s today, and we’re not usually.

Natalie: Oh, sweating over there?

Allison: I am sweating. Yeah.

Natalie: Yeah. You need an ice cube.

Allison: My wine’s getting warm.

Natalie: Oh, yeah. Not good.

Allison: Okay. So start, yeah. Tell us what you’re thinking when you’re talking about prenatal constipation.

Natalie: Yeah. So ideal pooping positions is getting some yoga blocks under your feet. Like the worst thing that you could do is have constipation and all these hemorrhoids before you deliver, right? I mean…

Allison: Before pushing.

Natalie: Right.

Allison: They’re just gonna get bigger and feel more…

Natalie: Yeah. And I think the huge thing that we just chalk up to, “Oh, constipation? Just take some Miralax.” Well, a lot of times, like, I just tell everyone like, “Rub your belly. Just like rub it.” Like who rub…does anyone rub their their belly anymore? Just like, you know, I think rubbing the belly is huge, and I think to the pelvic floor again, can try to be lifting so much, because by the end of the term, your body’s holding up an extra, like almost 12 pounds, typically on average, an extra 12 pounds of weight. So, what does the pelvic floor gonna do if it’s not properly trained? It’s gonna start to try to support like by contracting and by protecting. Protective mechanism is to contract. So what does that do? The pooping muscle here, it restricts too. So people have a really hard time with this. And I think that’s key. Of course, tons of water, get your water, and get your good pooping position, rub your belly. But a lot of times, I see people’s pelvic floors are just restricted leading to that constipation too.

Allison: Yeah. And I would say that a lot of people deal with this prenatally. So, it’s something to get checked out. If you’ve been seeking a diet, you’re like, “Maybe I have IBS, maybe I’m just gassy.” Like this is something that you should definitely, you know, come see us. We can definitely check you out and at least put you in the right direction if we can’t help you. And then let’s take this a step farther. So, you’re constipated through pregnancy, and then, is this just gonna resolve naturally after pregnancy? Or, I mean, no, I’m gonna answer the question. No, it’s not, you know? What happens is as the uterus expands, it really restricts the large intestine. So like everything is pushed to the side, and that colon, the large intestine a.k.a colon, that just gets kind of stuck around and it stops really moving. And then it’s really hard to have smooth and regular bowel movements, therefore, you end up with “constipation.”

And so, a lot of times I see people that got prescribed Miralax or some stool softener, which is the common practice postpartum, and they just can’t let that stool softener go. Like, they’re still using it at eight weeks, at three months, at six months. And so, really, I’m not saying just cut the Miralax cold Turkey, or cut the Ducolax cold Turkey, I’m saying like you just wanna get checked out, and there’s a lot of things that we can help so your body becomes less reliant on that stool softener. When you’re taking those kinds of stool softeners your body really depends on that. And there’s usually, especially postpartum, some functional restrictions that are causing that constipation.

And then therefore, you’re straining, and you can actually prolapse yourself postpartum with straining to have a bowel movement just because the tissues haven’t returned. So maybe that’s a lot of times when I start to see the pelvic pressure postpartum is after someone’s had like a bowel movement that was really hard to pass. So yeah. I got a helicopter flying overhead.

Natalie: That’s fun.

Allison: Yeah.

Natalie: We got a question from Facebook Messenger or private message about ligament pain during pregnancy. I think that’s a great question. I think a lot of people have that. So, again, it’s kind of the same thing. And I will say, it depends on what stage of pregnancy that you’re in, but a lot of times with pelvic PT, what I’ve seen at least is we could resolve that at 100%. I don’t know if you see the same thing Allison, but I hate even to say an in 100%. But let’s say 99.9%. So when the tissue is doing what it’s supposed to be doing and things are strong how they’re supposed to be…this is another example of how…so, the round ligaments, they’re stretching and everything’s pulling and things are shifting. 
But how can we stabilize as best we can and get everything held in the right position? Right? During this pregnancy. So, everything’s gonna, expand. Everything’s meant to grow. Your perenium’s meant to stretch. But how can we get it to the optimal so that you don’t have these issues that come later? We want them tissues to do their job. The body’s meant to do this. You’re meant to have a baby. Like your body… Like, we women, like, that’s what we do, right? That’s not all we do, but that’s one of the things we can do. We’re like superheroes, but how can we do it to the best of our ability? That’s what we’re passionate about. We wanna help people just like… We don’t want people to complain about peeing their pants with their friends or pooping their pants.

I had a girl who like, she was pooping in her pants after her delivery for… And she hadn’t seen a pelvic PT pre-delivery. She saw that after, which is great, but I wish we could have worked together before so that she didn’t have these months and months and months of pooping in her pants from having an episiotomy scar. That stinks, like really?

Allison: Yeah.

Natalie: Hate that [inaudible 00:47:47].

Allison: And the beautiful thing is like a lot of times these can be quick fixes, you know?

Natalie: Right. Mm-hmm.

Allison: When you can release some of that scar tissue that’s causing that, I mean, that can be a huge difference maker.

Natalie: Yeah. I think a lot of people too… Are you itching to go or can we talk about pee?

Allison: I’m a little worried the kids are gonna walk in any minute. But, they haven’t yet.

Natalie: Yeah, you let me know, girl.

Allison: Yeah. I’ll just keep drinking my wine. So, I’m like ready for them. No, I’m just kidding. But not really.

Natalie: [inaudible 00:48:22] because I just forgot. That’s one topic we didn’t cover, pee.

Allison: Okay. Yes. Yeah. We need to go into that, especially…

Natalie: Leaking.

Allison: …urgency during pregnancy.

Natalie: Leaking, urgency, frequency, all the stuff. That’s a thing that a lot of people laugh about, that they are sneezing and peeing their pants. They call it peezing, that’s the thing. And it’s…

Allison: I haven’t heard that.

Natalie: Peezing. Yeah, I know.

Allison: #Peezing.

Natalie: #Idon’twantyoutopeez. But like when people are just like, “Oh, it’s fine, I’ll just get a bigger pad.” I’m like, “Really?” Like how would we just fix that problem? And how about if you just don’t pee anymore? Or the urinary urgency…like, the bladder can become restricted because everything, as the baby expands in there, everything including bladder can become restricted too. So, a lot of times the bladder, which is made above transitional squamous epithelial cells, it’s meant to stretch and grow and expand. And if it’s stuck with more fascias, a lot of times it can. And that urgency too can come from the nerves being restricted, making your bladder feel like it has to go all the time. So there are, again, tones…

Allison: So, Natalie, how do you fix that?

Natalie: How do I fix which part?

Allison: Like, I’m coming to you prenatally and I’m incontinent, or I’m having some serious urgency. I’m getting up eight times a night, and I can’t sleep. So, what are you gonna do for me?

Natalie: What stage of your pregnancy are you in?

Allison: I’m gonna be 23 weeks.

Natalie: Okay. Because I will say when people get to their like, they’re nearing their delivery date, their body will have them get up to go more frequently during the night, and that prepares your body to get up with your baby too. So, sometimes I just chalked that up to that. When it’s like, “Oh, I was fine throughout, but then I started to have to go to the bathroom more often in the middle of night.” That, I a lot of times say, that…for that it’s your body, right? Would you agree?

Allison: Yeah.

Natalie: It’s your body kind of preparing you to get up during the night? But for urinary frequency and urgency, going to the bathroom with an urgency like, “I gotta get to the bathroom right now, move aside or I’m going to push you.” That we would, again, assess head to toe, what’s restricted, what’s not, what’s not strong, what’s weak, what’s restrict…I already said that. Is everything moving how it’s supposed to? That’s huge.

And then if people think that they have to go to the bathroom, do you really? You know. I think the first urge, or the first urge you get to go… Allison just popped off. So, if your bladder is 30% of the way full, that’s when you first get the urge. So, you can do an urge suppression technique to reduce the urge to go to the bathroom, and that’s just kegeling 5 to 10 quick times and help relax your bladder. So when you contract, your pelvic floor contracts, and that helps the detrusor muscle of the bladder to relax because the two work hand in hand. So as the pelvic floor contracts, the detrusor muscle of the bladder relaxes. And so the bladder can then relax.

I think we lost Allison on the other end in Seattle. Her kids might have come out to get her. So, let me see if I can add her back in. And if not, I think we can…we’re gonna have another Facebook Live though in 2 weeks, same time on Tuesday, 6:30. I think it’s the 31st, 2 weeks from today. We’re gonna talk about another fun topic. So, Allison says, “I’m malfunctioning again.” Let me try to get her back on so she can… Did she just say that? But, yeah, we are going… Let’s see. I don’t know how to do that again. The Add option is not there for Allison. This is how tech crazy we get.

Anyway, like I said, next Tuesday, hopefully we’ll be better at the tech stuff. Thanks for joining us Allison with Body Motion Physical Therapy. She’s in Seattle, Washington. Check her out. She says she’s now malfunctioning, and you can close down the show. Okay, cool. And I’m Natalie with Vitalize Physical Therapy Indianapolis. If you guys want to find a great pelvic PT and you aren’t in our area, feel free to private message us or reach out to us. We’d love to help you guys. I mean, if you’re in our area, of course, we’d love to help you. Just let us know what questions you have, and hope you guys have a great night. Thanks for joining us for happy hour.


Allison Feldt

Body Motion Physical Therapy

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