Why You Need to Know About Pelvic Floor Physiotherapy

Why You Need to Know About Pelvic Floor Physiotherapy

Naomi Mendes-Pouget

2020

My Musings... | Perinatal Resources | Postpartum Health and Well-being

Because of pelvic floor physiotherapy I no longer pee when I sneeze.

 

You know I’m always going to keep it real with you, dearest reader! Being a life-giver has real affects on this body–we’re not robots nor elastic bands that just ‘snap back’ into place after 9+ months of growing and shifting. Remember that.

In a bit I will welcome guest writer Rabia Mirza, Registered Physiotherapist including Pelvic Floor and Certified Personal Trainer, to tell us exactly why we NEED to be caring more about our pelvic floor health. She is an expert! But first, allow me to tell you my story.

Now let me backtrack a bit here…

…I actually started going to pelvic floor physiotherapy DURING pregnancy.

 

That’s right! Even before the peeing-in-my-pants thing. I was having a pretty ‘normal’ pregnancy. Radical eh, seeking healthcare proactively?! I know. We’re not really taught that we can–and I’d argue should–do that! At least I wasn’t.

If you’re thinking you don’t need to see a pelvic floor physiotherapist because you don’t have symptoms… I will argue that if you have a growing baby inside your uterus–putting weight and strain on your pelvic floor because *gravity*– you should see a pelvic floor physiotherapist. And of course, it goes without saying that if you DO have symptoms…definitely make an appointment, love! Read on to hear more about this from a professional shortly.

Back in university when I was studying midwifery, I was lucky enough to have a guest lecture about the importance of pelvic floor health (and thus physiotherapy), so I was already familiar with this concept.

Seeing a pelvic floor physiotherapist during pregnancy can help on so many levels, namely the 4 P’s: Preventative, Physical exercise, Pain, and Preparation for labour.

Wow! (Source: https://westendmamas.ca/benefits-pelvic-floor-physiotherapy-pregnancy/)

Shortly Rabia will go through some of the juicy details and benefits of pelvic floor physiotherapy, and you can also visit the link above to learn more. But seeing the physiotherapist in pregnancy got me feeling in control of my present and future health, and even potential outcomes (to *some* extent!). 

Me in my ninth month of pregnancy.

 It was so empowering to proactively care for my health and well-being, with a provider who *THRIVES* off of seeing birthers be proactive.

 

My physiotherapist taught me how to effectively BREATHE (again: wow! I didn’t realize how much of an effect the way I breathe has on my pelvic floor health!). She also taught me how to make that breath-pelvic floor connection stronger in my body and mind. Prenatal yoga was also wonderful for this.

And you know those ‘Kegels’ that everyone talks about? Well I could trust my pelvic floor physiotherapist to teach me how to do those, EFFECTIVELY. This helped me later on in pregnancy when I did experience some of those embarrassing (but common!) symptoms like losing control of my bladder.

In my labour and birth, pelvic floor physiotherapy had prepared me and my body for what was to come.

 

That awesome breath-pelvic floor awareness I had built prenatally through my pelvic floor physiotherapy sessions truly helped me in labour. It taught me how to be aware of the tension I was holding in my pelvic floor, and how to release it. That ultimately played a role in helping me shorten my labour and meet my baby sooner! What a true gift.

 

Pelvic floor physiotherapy in the postpartum period: my experience

After the birth, there was some injury sustained to my urethra area (and I say that in the most loving way… I didn’t expect immaculate birth!). My pelvic floor and core muscles also felt very wobbly and weak. Makes sense–everything was shifted around and there was no longer a giant uterus balloon taking up a bunch of space and putting pressure on everything! Aaaaand I pushed a baby out of me.

Going back to pelvic floor physiotherapy regularly, after the first six weeks I took to heal on my own, was something I looked forward to. Again, I was taking my health seriously. Especially since our society teaches people with female reproductive organs to stay in the dark and in shame about it. 

Now, since I had been taught how to do Kegel exercises effectively PREnatally…

 

…They were now easier to do POSTnatally, despite things feeling rather wonky and weak down there. It would have been like trying to learn how to play tennis with a limp arm, I think! This way I had some muscle memory to help me.

My pelvic floor physiotherapist, who happens to be Rabia, also kept me very in the loop with exactly what exercises I could and should be engaging in, and how to engage the core properly during every day movements (like picking up my baby) to avoid accidental further damage (I had some abdominal separation). 

P.S – If you’re wondering why I’m sharing this vulnerable and intimate photo of myself in the very first hour after my homebirth… It’s to bravely show you what is within the realm of normal. We never get to see and so we never get to know! It’s important to me that I can share and educate about birth and postpartum. Birth is a normal process.

Here’s yet another benefit: improvement of sex after baby.

 

Yes, I said it! I noticed in the postpartum that my vaginal muscles were holding a LOT of tension, therefore causing pain upon insertion. #SorryNotSorry #AllForTheCause #KnowledgeIsPower. So that was another thing that the pelvic floor physiotherapist really helped release and work through.

Rabia really helped my core heal properly. She was so in-tune with the connective tissue and how it was very sticky and jumbled up (my interpretation). She did physical therapy to help it un-stick, and that felt so good afterwards. Additionally, she offered me acupuncture to also help with core healing.

So, my dear and lovely reader, that’s my story. What you’ve just read highlights why I am such a die-hard advocate of pelvic floor physiotherapy from pregnancy through the postpartum. 

Fun fact: Did you know that in France, pelvic floor physiotherapy is one of the cornerstones of postnatal care?

 

The government subsidizes it for new parents. We are waaaaay behind!! As a result, way too many people think that peeing when they sneeze is just the new normal and sacrifice you make as a parent. I say HOGWASH! And now that you’re reading this blogpost, hopefully you’ll call BS too!

So without further ado, it is my HONOUR to introduce Rabia Mirza, one of the two amazing pelvic floor physiotherapists that have cared for me in the past year. She currently works out of Upper James Physiotherapy in Hamilton, and also has a clinic space in Mississauga! Rabia is passionate about body and pelvic floor optimal health, and does great work in increasing public awareness of pelvic floor health. She is here today to talk about postpartum pelvic floor physiotherapy. Take it away, Rabia! And thank you so much for sharing your wisdom and knowledge here.

What is postpartum pelvic floor physiotherapy? 

 

Postpartum pelvic floor physiotherapy is a branch of physiotherapy specifically for the needs and concerns of postpartum women. And when I say postpartum women I mean moms in general, there is no time exception for what we consider postpartum!

Our role in your postpartum journey is to make sure that all your needs concerning your pelvic floor are being addressed and cared for. The pelvic floor has a role in bladder, bowel, sexual and functioning and also has implications for low back and pelvic pain.

A pelvic floor examination involves a detailed subjective history and an internal examination of the pelvic floor muscles. After the examination we develop a plan including manual internal therapy, kegel exercises, core exercises and self-management techniques for home.

What happens to the pelvic floor with pregnancy and childbirth?

 

The greatest changes occur at the pelvic floor during pregnancy and especially during labour. With pregnancy, the pelvic floor muscles are forced to take on more of a load with the growing baby in the uterus and the relaxation of the pelvic bones as your body prepares for childbirth. Sometimes this increased load weakens the pelvic floor muscles and you develop symptoms including pelvic pressure, groin and low back pain, and sometimes urine leakage with sneezing and coughing.  During labour, the pelvic floor muscles act as a gateway and often get injured and torn in the process. The tearing of these muscles should be thought of as a tear in any other muscle in the body, physiotherapy is required for optimal healing!

Although C-section deliveries often don’t cause tearing at the pelvic floor muscles, the accompanying scar at the lower abdomen requires optimal healing and movement. This scar has implications for pelvic and abdominal pain and often requires mobilization.

Do I need postpartum pelvic floor physiotherapy?

 

The short answer is YES. Even if you aren’t having any symptoms it is still imperative to make sure the pelvic floor muscles are healing optimally. It is also important to check on the pelvic floor and core muscles before returning to exercise to ensure a healthy and safe return to activity.

If you are experiencing any of the symptoms below, pelvic floor physiotherapy is for you!

  • Urinary leakage (incontinence) with sneezing, coughing, laughing, jumping
  • Vaginal discomfort or pressure
  • Pelvic, groin, or low back pain
  • Overactive bladder
  • Pain with intercourse
  • Pain or pressure with exercise
  • Diastasis recti (ab separation)
  • C-section scar

 

Where can I go to see a pelvic floor physiotherapist?

 

To book an appointment with me you can visit Upper James Physio. We offer 1 hour initial assessments and 45 minute follow-up appointments. If you’re not in the Hamilton area I would recommend searching for a Pelvic Floor Physiotherapist online. Because pelvic floor is a speciality, not all physio clinics offer this service. Take charge of your postpartum healing and book in an appointment. 

Final thoughts…

 

Thank you so much, Rabia, for lending your expertise!

 

Dear reader, we want to know: Did you know about pelvic floor physiotherapy? Have you had pelvic floor physiotherapy? How was your experience? Drop a comment below, let’s start a conversation about this important facet of health!

 

MUCH LOVE,
XO Naomi & Rabia

 

You May Also Like…

Newsletter

Sign-up to hear more from me

"We couldn't have gotten through..."

“We have three kids who were all under 2.5 years old during our time with the Doula. Naomi worked through the night a couple nights per week to give my husband and I some rest, as we had toddler twins and the newborn to look after through the day. We couldn’t have gotten through the days without the rest we got at night thanks to Naomi!” -B.F.

"We felt very comfortable..."

“Naomi saved us! We had twins and really needed sleep. She gave us a break! She was/is kind, caring, compassionate, and understanding. We felt very comfortable leaving our boys with her which is rare, given we are new parents. She exceeded our expectations tenfold! My husband, myself, and our two boys love her!” – A.F.

"Having her serene presence and focus on me, the mom,..."

“…reminding me to hydrate; listening; trying to find some solutions; was very soothing, and the other kids also felt more cared for, I believe. For a third time mom, it’s so much more about the other children… It’s so difficult to find time for myself, whilst having to take care of a newborn and worrying if the older ones will be a little left behind… no mom of more than one would enjoy the pampering and the attention and care if she felt not all the children were being looked after. So when Naomi minded them, it was bliss. In this context, not usually having the time for myself, the nutrition part was especially important. I was constantly reminded that for the family to be well, I had to prioritize my own wellbeing.” – M.B.

my mission

Helping new families have a supported and  transformative post-birth period.

Imagine: You’re in a pitch black room, and you know there is a door somewhere in that room. That door symbolizes sanity and wellness post-birth. Eventually, by feeling around, you will find the door– despite obstacles along the way. I believe in you. But imagine how much easier it would be to find the door if there was a little candle by the door, guiding you and making you feel a little less lost and disoriented, and more confident. That’s what a having a Postpartum Doula is like.

Book an appointment with The Postpartum Nest using SetMore

Get In Touch

   Want to Touch Base?

Do I Need a Postpartum Doula and a Midwife?

Do I Need a Postpartum Doula and a Midwife?

Do I Need a Postpartum Doula and a Midwife?

2020

doula | midwife | postpartum | postpartum doula

(TL;DR : Yes, yes you do need a Postpartum Doula and a Midwife. They are different.)

I get it: the birth & new parenthood world can feel like a completely different universe. It can be new and confusing. SO MANY NEW WORDS!! There is lots to learn. I hear you. So if I can help clear something up for you then that makes me very happy.

If you’re here, I’ll assume for now that the terms ‘Doula’ (in this case, Postpartum Doula) and ‘Midwife’ are causing some confusion. THAT’S PERFECTLY OKAY! In fact, I’ll discuss below why it may be COMMON to mix the two up.

Luckily, I have experience as both a Student Midwife and as a Postpartum Doula! Both professionals are wonderful, complementary, and are well worth your time learning about and considering.

I’ve also invited a great friend of mine, Vishali, who is a new Registered Midwife (RM) as a guest on this post, to also share her expertise on the subject. Welcome, Vishali!

Disclaimer: this is not a definitive or exhaustive comparison of the two professions. Just some main points we’ve come up with.

midwives-and-doulas-are-different

Why do a Postpartum Doula and a Midwife Sometimes get Mixed Up?

 

Great question. There are a few similarities, along with history, that Doulas and Midwives share.

  • Doulas and Midwives tend to be natural-focused. Meaning, they view birth and the postpartum as natural, normal processes that ought to be complemented with holistic, nature-based and gentle approaches whenever possible.  *This is trend, not a rule*
  • Doulas and Midwives are experts in NORMAL.
  • Doulas and Midwives have been around for centuries! H(er)storically, A woman well-versed in perinatal health and wellness would typically support the women of their community in the perinatal year and in female sexual health matters. Generally, the female elders and relatives would typically tend to the mother in similar capacities in which a Postpartum Doula does today (with exceptions). Often the Midwife would embody the work/care of a Postpartum Doula as well. 

See? You’re not alone or crazy for getting the two mixed up. In fact, it shows that the herstory of caring for perinatal persons isn’t forgotten! Yay. Now, let’s come back to the present and explore what makes them different professions nowadays (in the Ontario, Canada context!)

 

What Does a Midwife do that a Postpartum Doula does Not?

  With GREAT pleasure I’ve invited Vishali Arumugam RM, a Registered Midwife from Durham-Markham Midwives, as a guest to shed some expertise here, and she has graciously agreed! Vishali studied Kinesiology and Health Sciences at York University, obtaining a Bachelor of Science in 2010. She then went on to study the rigourous Midwifery program at Ryerson University, where she obtained her Bachelor of Health Sciences in Midwifery after four years of full-time studies. Her journey to become a midwife was inspired by her ancestor in India who was a midwife. Vishali graduated from the Midwifery program in 2019 and is now a midwife with Durham-Markham Midwives. Welcome, Vishali!

Vishali:

Thank you for asking me to talk about midwifery in your blog post! Midwives are primary health care providers specialized in low-risk pregnancy and birth. We have four years of university education during which 2.5 years is focused on rigorous clinical training, almost like a medical residency. We are publicly funded through OHIP and are regulated by the College of Midwives of Ontario. Midwives provide care to pregnant people in antepartum, intrapartum and 6 weeks postpartum.

Antepartum:

 
  • We see people in clinic for the regular pregnancy check-ups.
  • Order blood work and ultrasound necessary to monitoring both the mother’s and the fetal wellbeing.
  • Have informed choice discussions with the parents so they are able to make the right decision about the care in pregnancy and their birth plan.
  • Prescribe medications for urinary or vaginal infections and nausea/vomiting.
  • Consult with obstetricians if any complications arise in pregnancy.

Intrapartum:

 
  • Assess the women either at home or at hospital in early labour
  • Deliver baby either at the hospital we have privileges in or at the comfort of their own home (We always carry all the necessary birth equipment and emergency medication in our car )
  • We are certified in Neonatal resuscitation (NRP) in case a baby is born with difficulties breathing.
  • We consult with obstetrician if the woman requires assistance with delivery through vacuum, forceps or c-section. 

Postpartum:

 
  • We see mom and baby 2-3 times at home within the first week of delivery to ensure the dyad are stable, healing well, support with breastfeeding and monitor newborn for issues like dehydration, jaundice and extreme weight loss.
  • We then see mom and baby at the clinic at 2, 4 and 6 weeks from delivery to ensure mom is recovering and coping well emotionally, baby is gaining well and answer any concerns parents might have.
  • Monitor moms for postpartum depression and connect them to the right resources.
  • Prescribe medication for nipple pain, breast infection, milk supply and oral thrush
  • We consult appropriately with either lactation consultants or paediatricians if there are any concerns with baby’s weight gain or health.

Closing Comparisons:

 

Unfortunately, midwifery care ends after 6 weeks postpartum and our clients are discharged back to their family physicians and paediatricians. However, you can choose how long you would like support from your postpartum doula.

Although midwives come to your house few times within the first week of delivery, we are unable to spend more then an hour since we are providing care for about 120 clients per year who all need our time to either attend their labour or antepartum concerns. So we prioritize this hour to ensure you and baby are clinically stable. Postpartum doulas are experts in providing support for new moms who are transitioning into motherhood and learning to keep up with the demands of feeding their newborns every 2-3hrs while lacking sleep. They can especially be helpful on days where baby will be cluster feeding (constantly latched on to mom) when they are going through growth spurt (this can happen every 3-4days in the first 2 weeks).

    Thank you so much for sharing your valuable insights, Vishali! My dearest reader, if you have any questions for Vishali please pop them in the comments at the end of the post!
midwives-do-home-visits

What a Postpartum Doula Has that a Midwife Does Not

 

Postpartum Doulas are set up to have more time with you

 

The biggest difference, in my opinion, is TIME. Postpartum Doulas work with their clients to determine exactly what the client wants and needs, and what kind of support will work for the family. The client dictates the time committment. The Postpartum Doula’s scope and number of clients are smaller than a midwife’s, thus we are able to commit more time to each client.

 

And that’s an intentional difference! Remember, Midwives are health care providers. They make sure you and babe are healthy. Doulas want to make sure you feel supported. That typically takes more time!

 

For example, Postpartum Doulas can do light chores around the house. You will probably have a list ready of ways we can support you, and it’ll take some time to get that done for you, and we are MORE THAN HAPPY to. Please do not expect this from your midwife at their postpartum visits!!!!

 

Postpartum Doulas are hired to make space for you and your family to do the things that will make you feel good. Space and time are one in the same.

 

Postpartum Doulas have more freedom in what they offer and how

 

In Ontario, Postpartum Doulas are not regulated, and are privately funded. (Sometimes Postpartum Doulas are available through charitable and community organizations.) Thus, our scope extends beyond the 6 weeks postpartum of midwives. And each Postpartum Doula’s time scope may be different. At The Postpartum Nest, our time scope is 6 months postpartum. But if you need support and you are more than 6 months postpartum, feel free to contact us and we can still connect you.

 

Also, since Postpartum Doulas aren’t regulated by the government of Ontario (yet), there is more liberty in the services each Postpartum Doula can offer their clients. Each Postpartum Doula has complete autonomy over their business and services! Thus, it makes it easier for you, the client, to find a Postpartum Doula that meets you and your family’s needs. Yay!

 

Postpartum Doulas are an addition to your support circle

 

Postpartum Doulas are not an either/or professional; they are an AND. Meaning, they are an addition to your support team/circle for the postpartum, and it does not exclude you from being able to access any other service. (Remember when I/Vishali explained that you can either have a Midwife OR an MD as your/baby’s health care during the first 6 weeks (unless it’s a consultation).)

The Postpartum Nest Advocates for Babywearing!

In Sum, You Should Have a Postpartum Doula AND a Midwife

 

In sum, the KEY takeaway I want you to have here is: Midwives are great. Postpartum Doulas are great. They are different professionals. The best case scenario is having BOTH! You can do that! And, I’ll argue till the end of my days, you should (and I DON’T usually use that ‘s’ word).

 

Midwives and Postpartum Doulas are complementary to each other.  Both will hopefully and probably be fierce advocates for you. Happily, Midwives are covered by the Ministry of Health (Ontario). However, Doulas are not, but maybe one day? Who knows. It would definitely improve maternal mental health outcomes in Ontario, even Canada, but that’s a discussion for another day!

 

Next Steps:

 

Look into midwives in your area and see if they might be a good fit as your perinatal primary health care provider. They are experts in normal pregnancy, birth, and postpartum health for you and your growing babe(s). If you need help finding a midwife, I might be able to help! Let me know.

 

And do yourself and your family a massive favour and invest in a Postpartum Doula! Ready? Book an appointment for a free discovery call with us today to continue the conversation. And share this blog post with someone else who you think should know about Midwives and Postpartum Doulas!

 

Thanks so much for reading!

 

Xo Naomi

You May Also Like…

Newsletter

Sign-up to hear more from me

"We couldn't have gotten through..."

“We have three kids who were all under 2.5 years old during our time with the Doula. Naomi worked through the night a couple nights per week to give my husband and I some rest, as we had toddler twins and the newborn to look after through the day. We couldn’t have gotten through the days without the rest we got at night thanks to Naomi!” -B.F.

"We felt very comfortable..."

“Naomi saved us! We had twins and really needed sleep. She gave us a break! She was/is kind, caring, compassionate, and understanding. We felt very comfortable leaving our boys with her which is rare, given we are new parents. She exceeded our expectations tenfold! My husband, myself, and our two boys love her!” – A.F.

"Having her serene presence and focus on me, the mom,..."

“…reminding me to hydrate; listening; trying to find some solutions; was very soothing, and the other kids also felt more cared for, I believe. For a third time mom, it’s so much more about the other children… It’s so difficult to find time for myself, whilst having to take care of a newborn and worrying if the older ones will be a little left behind… no mom of more than one would enjoy the pampering and the attention and care if she felt not all the children were being looked after. So when Naomi minded them, it was bliss. In this context, not usually having the time for myself, the nutrition part was especially important. I was constantly reminded that for the family to be well, I had to prioritize my own wellbeing.” – M.B.

my mission

Helping new families have a supported and  transformative post-birth period.

Imagine: You’re in a pitch black room, and you know there is a door somewhere in that room. That door symbolizes sanity and wellness post-birth. Eventually, by feeling around, you will find the door– despite obstacles along the way. I believe in you. But imagine how much easier it would be to find the door if there was a little candle by the door, guiding you and making you feel a little less lost and disoriented, and more confident. That’s what a having a Postpartum Doula is like.

Book an appointment with The Postpartum Nest using SetMore

Get In Touch

   Want to Touch Base?

Pin It on Pinterest

Book an appointment with The Postpartum Nest using SetMore