Transcription:
Pelvic Floor Therapist Role in the Care of the Postpartum Woman

Melanie Cole (Host): Physical therapy is not just for recovery anymore. Pregnancy and postpartum physical therapy can be so useful for remedying common discomforts like back pain, or for enhancing your body's ability to have a smoother pregnancy and birth. Welcome to Say Yes to Good Health with Memorial Hospital.

I'm Melanie Cole, and I'm so glad to have you join us today, as we talk about the women's health physical therapist role during pregnancy and after. Joining me is Katie Ruebush. She's a Physical Therapist with a specialty in Women's Health and Pelvic Floor Physical Therapy at Memorial Hospital. Katie, I'm so glad to have you on.

So, I remember when I was pregnant and some of the pains and aches and things that I had, and I wasn't quite sure what to do about them, but there's also other issues people don't think about like postural issues. And tell us a little bit before we get into this pregnancy about what women's health physiotherapy really is and how and why you can help pregnant women.

Katie Ruebush, PT, DPT (Guest): Well, thank you for having me. I'm really excited to be here and talking about a subject that I'm so passionate about. Physical therapy can provide lots of different avenues for the pregnant woman. We need to think about how as the baby grows, you know, our postures are changing. Our movement patterns are changing. Our muscles are reacting to those different loads in different ways and what the physical therapist can provide, and particularly a therapist who specializes in treating pregnant women, is methods to create an optimal environment for all of your muscles, all of your joints, so that you can have a very healthy, a very active and very comfortable pregnancy.

Host: Well, tell us a little bit about some of the situations that you help people with. I mentioned postural. And so did you, and then back pain, I mean, there's obviously weight gain, which we can't really do anything about, but we're also stressed out. Maybe our balance is a little thrown off. Tell us a little bit about what you do and how you do it with pregnant women, because it can be a little bit confusing.

Katie: Well, we start by taking a team approach. Here at Memorial Medical Clinic, we have several healthcare professionals who are going to help you through this journey. So, not just the physical aspect of pregnancy, but also the different stressors that come along with that, whether it's the first pregnancy or maybe you have other children you're caring for during pregnancy. You know, all of these things can add to your stress. So, we also utilize a mental health counselor who can help you work through some of those things. And besides that, we have a dietician who can help you meet your nutritional needs for you and the baby, and, you know, manage, manage the weight gain. We know that eating a healthy, balanced diet and exercising regularly has so many benefits for mom and baby.

But specifically with physical therapy, we can address the aches and pains. We can address any urinary leakage. Constipation is actually a very common symptom in pregnancy and postpartum due to different changing hormone levels. So, these are all things that we can address.

Host: So, tell us when you would address these things. When would you tell somebody is a good time to start looking into or talking to their gynecologist or their primary care provider about starting physical therapy for pregnancy?

Katie: I think within that first trimester, talking to your doctor about coming in for some physical therapy, because we know that the healthy, healthier you are throughout that pregnancy, the better the outcomes and the better shape that you are in going into labor and delivery, the better the outcomes.

Labor is the most intense workout of your life. I myself have run a marathon and I've also had two children. And I will tell you that labor and delivery is way harder than running a marathon. And you have to have endurance. You have to have some strength depending on the different positions you're going to be in.

You have to have some hip flexibility depending on the position you're in. So, things you might not typically think of, we have to prepare for this event. This is a big event in our lives, and there's a lot of kind of training that you can do to prepare for that, so that you have the easiest labor and delivery that you can, but also the fastest recovery postpartum.

Host: Well, that's true. And as an exercise physiologist, I know we were taught so many years ago that the better shape you're in, the more you're able to withstand that marathon, as you say of labor and delivery. Now, tell us just a little bit about if somebody is in shape, if they have been an exerciser before they get pregnant, does that make a difference for what you do with them? As opposed to someone who never really was an exerciser and then comes to you for help? Is there a difference in what you do with people?

Katie: I think it's all about treating everyone individually and whatever the patient's goals are, that's where we're going to focus. So, if you were a high-intensity exerciser prior to pregnancy, we're going to work with you to figure out how you can safely do the activities you enjoy while you're pregnant.

And some of what we do is recommend different products that are going to help you maintain those activities, help you maintain the ability to go to work and be pain-free, during those nine months. So, no matter what your activity level is prior, we're going to help you maintain those activities. And maybe we'll add some things to the activity to enhance the pregnancy and again, lead to better outcomes postpartum.

Host: Tell us a little bit about what you've seen, Katie. So, you know, without mentioning any patient's names or anything, how have your outcomes been? Because people ask their friends, oh, you did physical therapy while you were pregnant. How did that work out? How have you seen it's working out for women?

Katie: Well, I think the first thing is that people need to realize that you don't have to live with the pain you're experiencing during pregnancy. I think too many times women are told, well, that's just part of being pregnant. Well, it doesn't have to be. So I can't tell you the number of people that I, I have met postpartum who have said oh, I had pubic symphysis pain or pelvic pain or incontinence or back pain through pregnancy, man, I wish I would have learned about you when I was pregnant. So, I think it starts there, just knowing that help is out there. It's not something you have to live with. There are ways to address these issues and you just got to come see me and we'll figure it out together.

So, I think the other thing is just personally knowing that I was lucky enough to experience a very active pregnancy. Postpartum, personally was a very fast recovery, and so time and time again, the research is showing us that the healthier you are during pregnancy, the quicker you're going to recover and the better you're going to feel once the baby is here. And now you have this other job of taking care of another human being.

Host: Well, you're right about that. And I remember I was working right up until, as a personal trainer at the time, right up until next day delivery. But then I was back pretty quickly because I had kept so active. Now as a physical therapist, I'd like it if you, since you work this multidisciplinary approach and you work with so many healthcare providers, do you have some red flags that you would like women to know about if they're out exercising on their own and they're coming to see you or they're, you know, doing what they're supposed to do, but some things that you tell them at sessions, listen, if this happens to you or if you get dizzy or if you'd this, some things that you identify when you're with them, or if they're on their own that you want them to be aware of and that would warrant a call to their provider.

Katie: Any time you have any doubts about what you're feeling, you should call your doctor. You know your body better than anyone else, but particularly with exercise, if you have any cramping, any contractions, any bleeding or leaking, these are all things that you would need to call your doctor and discuss. But whenever in doubt, it's only a phone call and it doesn't take long. And if you have any concerns, you really just need to call. And sometimes it's, you know, a five or 10 minute visit to check things out with your physician. But whenever in doubt, you really need to call.

Host: I agree with you. And how do people get an appointment with you, Katie? What's the process for getting an appointment and wrap it up for us with your best advice about pregnancy physical therapy and the benefits that it can help pregnant women with labor and delivery.

Katie: Well, to get up an appointment with me, you just need to call our office and we can get you set up with that. And the biggest advice I can give you is go back to the basics. Eat a healthy diet, exercise. And as simple as that is, what we can do here is help you achieve that because as simple as it sounds, it's very difficult to do with all of the different things going on during pregnancy.

So, I would just encourage people to do light activity, do some walking every day. And when these issues present themselves, know you do not have to live with them and come and talk to us because we can help you. And we would love to help you.

Host: Tell us a little bit about postpartum physiotherapy and what is it you do with people that come in and want this type of therapy?

Katie: Postpartum physical therapy encapsulates several things. It helps to think about first, the trauma that is happening to the pelvic floor. The pelvic floor is this group of muscles that sits in the pelvis and after childbirth, there is trauma to those muscles. There's trauma to tendons and ligaments and nerves in that area. And what we are doing is restoring those structures and we're also restoring the abdominal wall. All of those abdominal muscles have also been stretched and then after having a baby, we need to restore that and we need to relearn postures, relearn movement patterns. Here for nine months you've been moving in a different way than you're used to.

So, it's relearning all kinds of things. We're also addressing scar tissue, whether or not you've had a vaginal delivery or a C-section there commonly is scarring and we are working on that scar so that it's not painful and that it doesn't create a problem in the future. Other things we can address are, you know, if you choose to nurse, we can discuss positions for nursing.

Because you are in that position quite a bit, and it can cause a lot of neck and back and shoulder pain. We can discuss how you can safely return to your prior activities, your fitness routine, your work. We can address pain during intercourse. You know, the first time that you have intimacy after having a child can be painful. And so we can address those sort of things. The list goes on. Another very common symptom postpartum is constipation. And again, it's due to all of those hormones and some other reasons, but that's another symptom that we can treat in pelvic PT.

Host: I remember those days. And I remember the constipation too. And I also remember that I took a walk with my new baby right after giving birth and, had some complications from doing that. And the doctor said, I said, you could take a walk down the end of your driveway, not go on like a mile walk. Cause it was like two days later.

So, we do have to learn our boundaries. And we have to learn what we can do safely and what we can't. So, Katie, when is it that a person would see you? Would this be somebody ideally that you will have seen through their pregnancy and then they go into labor and then, you get them afterwards. When is the ideal time that somebody can start to see you after having a baby? And of course it depends on, you know, what happened with labor an delivery.

Katie: Ideally, I would love to see patients post-partum within the first two weeks, if the doctor is in agreement with that. For sure, I want to see patients at their, after their six week followup with their physician. And the reason is, is that there are really no other procedures and really no other surgeries that people are having, where we don't start some sort of low level safe exercise or activity immediately.

We know that there are better outcomes the sooner that you mobilize. Better outcomes, the sooner that you are restoring and taking care of these tissues and structures. But you definitely need to see me if you're experiencing any of the following pelvic pain, pain during intercourse, constipation, back pain, any urinary or fecal incontinence or leakage, any urinary frequency or urgency, things like that. You definitely need to be getting in to see a physical therapist.

Host: Such important information. Tell us a little bit, you mentioned before about, you know, picking up baby and you're doing all of these different things, whether it's nursing and picking up, maybe you have other kids in the house as well. So, tell us how those things impact the imbalances that we had. Some people get hip pain after or back pain after, you know, maybe they put on a bunch of weight and can you help them with that weight loss. When they've had their baby and they have to carry the baby around, they have other kids, whatever, how are you helping them with some of those biomechanical things that they are maybe going through?

Katie: Well, life is so different after you have a child. Everything you're doing is with one hand or with a baby on your hip, or you're pushing a stroller or you're carrying this huge heavy car seat around. So, muscles do become imbalanced and we do develop different patterns that might not be optimal. And so it's my job to be kind of a detective and figure out what are you doing throughout the day that's causing your dysfunction, whether that's pain or urinary symptoms, whatever. We can really tease out what are the drivers of your symptoms and how do we fix those.

Host: Yeah, because we really get used to waddling in a way, walking in a different way than we used to when we were, you know, before we were pregnant. And so then afterwards, you kind of forget how you used to walk when you weren't having this weight pushing in front of you, which was shifting your center of balance, right? So you even work on gait too, right?

Katie: Correct any lifting, any activity that you're doing, maybe you're even sitting differently because now you've been nursing this child, maybe you're pumping through the day. We may be doing a lot of different postures that we are not used to, and that are not optimal. Our joints and our bodies are built to take stressors and forces in a certain alignment and a certain posture. And if we aren't doing that, dysfunction occurs.

Host: We talked a bit about weight loss before, but didn't really get into it. And it's one of the bigger concerns that women have after pregnancy. How can you help them with weight loss?

Katie: I think the weight loss is a really important piece. You need to do it in a safe way, and it's not something that is a priority because of appearance, but it's a priority because of your health. And we know that especially if you're planning to have another pregnancy down the road, we know that if you go into that next pregnancy, at a optimal BMI, you're going to have a better pregnancy. You're going to have a healthier pregnancy and delivery, and it's always better for mom and baby.

So, we also need to take into consideration that you just spent nine months growing a human being. You do not want to lose that weight quickly. We need to do that in a safe environment, under supervision of a physician, a physical therapist, a nutritionist; all of these people that are going to help you do it in a safe and effective way, so that you can live your healthiest, most active lifestyle. And when you do that, you're going to be a better mother, a better caregiver for your kids. And I do, definitely have a passion for helping women do that in a safe and healthy way.

Host: Well, I can certainly hear that. Now tell us what a session is like, because some women may be embarrassed. I mean, literally they've just had a baby and a lot of people, you know, the, the humility kind of goes a way when you are giving birth, but when they're coming in to see a physical therapist, how does that work with you as far as compassion and privacy?

Katie: Well, it's in a very private setting. If you would like to have someone with you for your comfort level, that would be fine. Otherwise you're going to be just meeting with me and there is absolutely no judgment. I've been there twice. I understand that, you know, there's some, there's some comfort level concerns sometimes because you know, you, you do have some differences in how you look after having a child, but you're in good hands and it comes from a place of caring about helping you get back to everything that you love doing. And when you come in, I want to know what your goals are and I'm going to do everything I can to help you reach those goals.

Host: I'm sure you do so, and I bet you're just so cool to work with. In the last few minutes, Katie, talk about your team at Memorial Medical Clinic and let the listeners know what they can expect from appointments from you all and how you work in this multidisciplinary way.

Katie: Within our team here at Memorial, we have two OB-GYN physicians, Dr. Bell and Dr. Jones, who are both incredible physicians. We have a wonderful nursing staff. We have me, the physical therapist. We have a dietician Ashlyn Houseright, who's also a lactation consultant and has a passion for helping women during pregnancy and postpartum with their nutritional needs. And we also have mental health counseling where you know, things that come up that provide, help during pregnancy, postpartum, postpartum depression, and really just dealing with this new version of life that we haven't experienced yet. These are all people that can help optimize the patient experience.

Host: You mentioned a nutritionist, right? So, that's helping people with that weight loss. So, when they see you, can they get appointments with all different ones of you? Do they set them up separately? Do you all help each other set up the appointments? Just tell us a little bit about how that process works.

Katie: When you come in, we are going to help direct you to all of the people that are going to help reach your goals. And so when you come in, depending on what the patient needs, we're going to try to get you to see as many people that day as you can.

Host: You know, that's just great information for listeners to hear that you guys really help them get all of this done and that they don't have to worry about it. They can just get that, you know, talk to their primary care provider or their gynecologist and, and get in to see you for pregnancy and postpartum help, and that you will help direct them, whether it's the nutritionist or mental health counseling for stress, Lord knows, we all that right now, you know, whether it's lactation, whatever it is. And physical therapy being such an important part of post-pregnancy really therapy for all of us, because we can't take care of our new little babies and the rest of our loved ones, unless we take care of ourselves.

So that's, what's so important. And to make an appointment with Katie, you can call 217-357-6560. Or for more tips like this, you can visit our website at mhtlc.org to get connected with one of our providers. That concludes our episode today of Say Yes to Good Health with Memorial Hospital. I'd like to thank our audience and invite you to download subscribe, rate, and review on Apple podcast, Spotify, Google podcasts, everywhere that podcasts are played. I'm Melanie Cole and share this with your friends and family on your social channels. Thank you so much.