Deborah Howell (Host): You know, we hear a lot about what happens before and during a cesarean section, but what about what happens afterward? I'm Deborah Howell, and today we'll talk about caring for your body after a cesarean delivery with Shandli Joyce, the High Point Rehab Adult Site Coordinator and Physical Therapist at Deaconess The Women's Hospital.

Hello, Shandli, welcome!

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Thank you for having me, Deborah. I'm excited to talk about the benefits of physical therapy for postpartum moms.

Host: Well let's do just that. First of all, why do we do physical therapy postpartum in the hospital?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: So in the hospital, the goal of physical therapy or PT, I might say later, is to provide early recognition and intervention for any issues that occurred during delivery. And we can determine that with a multi system screen. And then we educate moms on multiple topics to help make recovery easier and movement right after delivery a little bit easier.

Host: That makes perfect sense. And what kinds of things do you teach?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: So we teach scar desensitization to try to help calm those nerves down so it's not so icky whenever you put on a pair of pants again. And we then teach, the scar mobility and then what the core canister is and how to engage it, body mechanics, when and how to use an abdominal binder right after delivery.

Host: Okay, what's an abdominal binder?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: An abdominal binder is usually a white, stretchy device that goes around your stomach to help hold that post stomach up, and with a C section, we want to make sure it's underneath the scar, so that it is not rubbing on it and that it's providing an upward lift and not pushing anything down.

Host: And then what, benefit does that provide?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: So that helps the muscles engage a little bit better and helps blood flow to be better and then to help you move a little bit easier. Honestly, people may think it's more like a hug, when they use it. So some other things that we also teach is, posture with baby care, and then some bowel and bladder tips.

Host: Okay, and you also check for nerves and strength in the legs after surgery, correct?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Yep, that, and then checking to see if you have that stretching of the abdominal muscles called a diastasis recti.

Host: Okay and do you individualize your sessions for each patient?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Of course. It's important to tailor the visit to each mom. There's so many different factors to take into consideration. Is this their first baby? Do they have a toddler to care for as well? Is this their first cesarean delivery? Did they have their tubes tied? On and on. So, we can dive into what's more important to each mom, and go from there.

Host: Okay, and should postpartum moms follow up with a physical therapist like they do with their OB at, say, six weeks after delivery?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Yes, or even sooner. We can check their alignment and make sure that the pelvis is balanced after delivery, which will help with recovery faster. And if you're having any issues after delivery, we can address them and get you on the road to recovery even sooner.

But if you're having a typical recovery, you can wait until about six weeks. Because then we can check your scar mobility and do a pelvic floor exam if you want it or need it. And we can progress past those initial exercises, in most cases to get you strong again.

Host: Sounds great. And what is scar work?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: So, scar work it can include quite a few things, but, it's to calm those nerves down around that incision site. And then we also want to improve the mobility of the scar so it doesn't stick to what's around it. So, during a cesarean delivery, seven layers of tissues are cut and five are stitched back together.

And we want each layer to move independently and not be stuck to the others or be stuck to, say, your bladder or abdominal muscles or uterus. So, we want that tissue to be able to contract and relax without tugging on the others. So, that's the importance of scar work.

Host: Is this done through massage or?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Part of it is definitely a scar massage. There's lots of other ways, but definitely at the beginning, it's more that gentle massage.

Host: Let's talk a little bit now about pelvic balance and returning to exercises like running and court sports, because I'm sure all these moms want to get back at it. What do you recommend?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: So, I'm going to break that down, into two sections here. So, about pelvic balance, it's the state of your pelvis alignment. So, during pregnancy, and especially with a vaginal delivery, the pelvis moves to make room for baby, which comes from the pregnancy hormones causing those ligaments and tendons to be looser.

But this can cause instability, which can lead to many different issues. It could be aches and pains in your back, your tailbone, just your pelvis, diastasis recti, leaking urine. So, to help rebalance your pelvis, we use gentle movements and hands on techniques to line your pelvic bones back to their original state.

And so, your second question then, when should you think about returning to exercises like running and court sports? That's a tough one. There's a general time frame to begin would be around that 12 week postpartum mark, but it really depends on each mom's body. So, with seeing an OB PT, so an obstetric physical therapist, we can take a look at your core and pelvic floor and how they activate and coordinate, your breath patterns, your pain or leaking issues and your strength and balance of your lower half to see if your body is ready for that return. So there's so many tweaks and modifications that can be made to participate in your chosen activity and that will keep you safe where your body is at in your recovery. So our goal is to get you to doing what you love, but not returning too quickly to cause future issues.

Host: Right, patience is such a virtue, right?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: It is, it is. It's tough to think about what you used to do before and not be able to do it right after you deliver.

Host: Exactly. What about returning to intercourse?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: So, it can be terrifying and exciting at the same time.

But there are things that you can do to help that experience be enjoyable again. So, the key is going at your own pace and communicating with your partner. Even if your OB gives you the all clear at six weeks, doesn't mean that you are mentally or emotionally or that your body are truly ready.

So, with seeing an OB PT after delivery, we can address many parts of that, and help prepare your mind and body for a more enjoyable experience.

Host: I'm sure it's just wonderful to have somebody outside your family that you can just talk to about this.

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Yes, exactly, so sometimes that debriefing on the birth is really important for healing, and you don't think about that, or you don't want to say, burden your family with that, so, that's what we're here for. We're to help move through that aspect and it's not just hands on exercises and doing all of that. We have to address both parts.

Host: You're like the bartender.

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Yes, it's true. Yes.

Host: All right, Shandli, can you tell us about rib flaring and diastasis recti?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Yeah. So, rib flaring and diastasis recti are both things that can and often do occur when you're pregnant. They're both ways the body can make room for baby. So, your ribs can flare out or expand, and like I said, that occurs whenever that ribcage expands and you might notice this if baby was kind of shoved up in there for a good amount of your pregnancy. Or even after birth, you might notice that you still have it going on when you put on your old bra and the band is too tight.

It's usually due to that ribcage staying expanded. So, sometimes it's only one sided too, but there are exercises we can do to help with that. And then, diastasis recti, there's many definitions, but it is basically the stretching out of the tissue between your six pack abdominal muscles right down the middle of your belly.

That tissue is called the linea alba. But, this is normal to an extent when you're pregnant, and to happen in that third trimester. Our bodies just have to make room for babies, so it's pretty amazing that our bodies can recover on their own from this, if we do the right things, and more importantly, learn what not to do. And there's a test to check for this, which tests both the width of the stretching and the depth of the tissue, which is important. But usually we give you 8 to 12 weeks to let the body try to fully heal. But if it's still there after that time, then PT is recommended. So to know if you have this, you may see a dome or coning or a bulge in the middle of your belly when you lift baby, cough, sneeze, or when you're getting out of bed. But we can help kind of guide you back to take control over that again.

Host: You have to wear so many hats in your profession, but I bet you love them all.

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Love them. Yes, it ties you in and makes you connected with the patient and you're really helping them return back to living, I want to say normally, but maybe their new normal too. So that's exciting to kind of guide them through that and get them to recognize their bodies can do amazing things and they can get back to doing what they love.

Host: It's sort of amazing that moms from hundreds of years ago didn't have any of this support. Can you even imagine going through this without in the modern time?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Well, and I think modern times, we kind of get told to get back to doing things quickly, especially in the Western culture. So, I think there's a point in needing to slow down and asking for help, and allowing it, is another aspect. And we need to kind of go back to those old times when that was allowed to happen, so that we can really not create issues in the future for ourselves and be able to enjoy life with our kiddos.

Host: Well said. Is there anything else you'd like to add to our conversation?

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Honestly, I could go on about everything we've talked about more as to why seeing an OB PT is important after birth. But truly I just want moms to remember that the time after birth should be observed as a sacred bonding time between them and the baby. It's a time for deep care and rest for the new mom.

And given you spent the last nine months growing a human being, and now you're recovering physically from that and labor. So be patient, give yourself grace, and ask your OB for a physical therapy referral to help yourself recover.

Host: Shandli, I hope every new mom and her husband or partner, has access to the kind of services you provide, because it's so, so important.

Shandli Joyce, PT, DPT, CLT, ATC, LMT: I believe that too. I think, it needs to be recognized more.

Host: Well, Shandli, thanks so much for all the great information. Such a pleasure having you on the podcast. And I should include, those having a baby without a partner as well. They especially need your services.

Shandli Joyce, PT, DPT, CLT, ATC, LMT: Especially. Definitely. Thank you so much for having me.

Host: Our pleasure and that wraps up this episode of the podcast series from Deaconess the Women's Hospital, a place for all your life. For more information about High Point Therapy, please visit deaconess.com/thewomen'shospital/services/highpointtherapy. And please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts.

And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening. Have yourself a great day.