So you think you can Kegel?

Today, I will cover an uncommon topic which is pelvic floor health for the mother after birth.  In Europe, it is routine to discuss pelvic floor strength in postpartum visits and refer to a physiotherapist if there is a concern.  In America, mothers accept that they might pee when they laugh or cough after having children or in older age in general.  This is common but not normal and can be helped.  Incontinence is only one aspect of pelvic floor health.  It's also helpful to prepare for childbirth, for anyone that suffers with pain during sex, or with any other discomforts in that area. 

Let me know any myths you've heard or questions you have about pelvic floor health. 
Also, check out this podcast from the doula organization that trained me. 

http://toraisequestions.libsyn.com/episode-57-pelvic-floor-health-a-conversation-with-lynn-shulte-leech-physical-therapist-and-energetic-bodyworker


I interviewed Allison Poole, PT, MSPT about pelvic floor therapy.  She works in the building of Birth Roots on State Street in Portland and at Casco Bay PT in Falmouth. We talk about the misconceptions around kegels, what to expect during a visit, and what can be done to alleviate these symptoms.  

Q: What is one misconception about pelvic floor health you want to clear up?
A: That it’s for old ladies- I see women from the time before they get pregnant, during pregnancy through menopause. I also see women whom have never had children.
 

Q: What are these kegel exercises everyone talks about?
A: Treating the pelvic floor consists of much more than kegels. Kegels were developed by Arnold Kegel in 1948 as a way to strengthen the pelvic floor after childbirth. It’s an act of tightening and lifting the muscles of your pelvic floor, like you would to stop the flow of urine. However, it is just one tool, and even after verbal instruction, the majority of women can not perform a kegel correctly.


Q: There is some controversy on the actual benefits of kegels, tell me about your stance on them and when if ever you think they're appropriate?
A: Kegels are effective in training your pelvic floor. If someone has been found to have a weak pelvic floor, kegels can be helpful to train the muscles to contract quickly as well as for long holds. Just like if you had a weak leg muscle after surgery or injury, you would do small muscle tightening first, then as it got more coordinated and stronger you would transition to squats and lunges. The same thing applies to the pelvic floor muscles.
    Kegels are often prescribed without evaluation as most OB/GYNs and birth professionals are not trained in assessing pelvic floor muscle function. For instance, if a woman is complaining of leaking, the provider may assume it’s weakness, but in many cases it’s because the muscles are too tight and they can’t contract against a sneeze or cough, and there’s incontinence. So, if she does kegels at every stoplight, she would be making her condition worse, not better.


Q:Tell me some benefits women can expect from using pelvic floor PT before and after birth.
A: Seeing a PT who specializes in pelvic floor rehab and women’s health, including prenatal and postpartum PT can help in so many ways. Prenatally, women can learn safe exercises for the pelvic floor and core muscles as well as breathing techniques to help prevent or speed recovery after childbirth. PT can help treat pain that develops due to pregnancy, including low back and hip pain, pain at the pelvic bone and throughout the ribcage. PT’s are also trained in educating about proper posture and body mechanics to save your neck and back during pregnancy and during those first weeks postpartum.
      After childbirth, regardless of vaginal vs. cesarean birth, PT usually starts after the 6-week check-up. A thorough evaluation would address any issues, including pain, assessment of Diastasis Recti (the separation of the belly muscles during pregnancy), pelvic floor weakness/tone and abdominal/back strength and stability. Goals would be set to address specific issues that a woman is experiencing.
      Even if a woman is not having specific issues, ideally she should have an evaluation to insure she will not be making a potential issue worse. For example, had a split in her belly muscles, went back to the gym to do abdominal exercises like crunches and planks and actually made that split worse.


Q: Many women do not know what to expect during a visit can you discuss the first visit and exam?
A: An initial evaluation of the pelvic floor can be intimidating for many women. Each evaluation is specific to each person, and sometimes it could be 3 or 4 visits before I assess the pelvic floor directly.  I take a thorough medical and birth history and spend a lot of time talking about specific issues you may be experiencing.
     
After the intake, I check posture, strength of the abdominals, assess for Diastasis Recti and muscle tone/tenderness in the “bike shorts region.”. In the case of a cesarean birth, I also check the scar for sensitivity and mobility. For the pelvic floor assessment, the woman is draped and lying on her back with knees bent, no stirrups. With one finger, I assess tenderness and muscle tone of the vulva, observe you doing a kegel and then assess internally the same things; muscle tone and tenderness as well as the ability to contract and relax the pelvic floor muscles. Finally, I assess for pelvic organ prolapse (descent of the internal organs into the vaginal cavity).
     The entire evaluation takes about an hour. I explain the findings and what PT would help with. We make goals together, and I always give something to get started on at home that day. The duration and frequency of appointments is completely individual, and I strive to work around what is realistic for each person. I do not believe in “protocol PT” (ex. 2x/wk x 6wks), but instead what is going to make each person successful in reaching their goals.


Q: Do men ever need pelvic floor therapy?
A: YES! Men are seen for pelvic floor PT for incontinence, pain, issues after prostate cancer among other things. I am not yet trained in seeing men for pelvic floor dysfunction.


Q: Many women think it's normal to urinate a little while laughing/sneezing/etc after birth or when they are older, what are your thoughts on that?
A: IT IS NEVER NORMAL. It is common, 1 out of 3 women will have pelvic floor dysfunction in their lifetime, but it is never normal to leak, EVER. Unfortunately, it is a taboo subject, especially among older women, and therefore no one talks about it, even to their doctor. It takes many women several visits to their doctor before bringing it up. The bottom line is you don’t have to live with these symptoms, and there are very qualified people that are passionate about what they do to help you lead a more active, healthier (drier) life!


Q: Can you include your favorite visual representation of the pelvic floor?
A:

pelvicfloor.png
 


Q:Any funny stories about pelvic floor therapy to lighten the conversation :)
A: To train to become a pelvic floor PT, we have to practice on each other. So on my first day at the Herman & Wallace Institute, I introduced myself to my partner whom I had never met, then within an hour we were on a table performing pelvic floor assessments on each other...it’s quite a way to get to know your colleagues at a whole other level!


Q: Anything else you'd like to add?
A: I see women at Birth Roots on State Street in Portland and at Casco Bay PT in Falmouth. I also am active on social media as MamaPT207 and offer monthly workshops.  I welcome emails and phone calls with ANY questions you may have. Thank you!

Allison Poole, PT, MSPT
Pelvic Floor and Women's Health PT
Casco Bay Physical Therapy
367 US Route One, Falmouth, ME 04105
101 State St Suite C, Portland, ME 04102 (Within Birth Roots)
p: (207) 781-5540  f: (207) 781-5542
Facebook & Instagram: mamaPT207
www.cascobaypt.com

Community Doula Birth Program

communitydoulabirthprogram

    I wanted to share with all of you something I have been a part of building the past few years and launched last year,  the Community Doula Birth Program!

It’s a non-profit I co-founded with four other doulas that matches low-income women with doulas working towards their certification. 

    I am passionate about this program because I believe it will create change in our community.  Change that is necessary to shift the way women birth in this country.  

    The way women are treated during their pregnancy, birth and postpartum transition shapes their parenting.  Can you imagine feeling out of control and unable to make decisions during your birth which then leads you to doubting the way you make decisions during parenting?  There is such a thing as motherly instinct and this is overlooked too often.  Let alone getting into the topic of what informed consent actually is!  This is not just the way the medical field can treat mothers, this is also the way family and friends can treat them.  Having the right support during this time can make all the difference.

    Low-income women in this community have a particularly hard time getting support.  They cannot afford the full cost of a doula.  Before we get into this, let’s touch base about some of the ways a doula is supportive and how these ways factor into long term outcomes:

  • continuous labor support has been shown to improve birth outcomes which in turn improves postpartum adjustment

  • doulas decrease the chance of c-sections therefore avoiding longer postpartum recovery time

  • doulas help partners work as a team which builds parenting structures

    Women carry their birth story with them forever.  The way women experience their birth stays with them just as any event in our life can, except other events aren’t typically about bringing another human life into the world that you are responsible for.  We often hear people say “if you have a healthy baby nothing else matters”.  OF COURSE a healthy baby is sooo important but what is also important is having a mentally healthy parenting unit.  We cannot minimize a traumatic experience by saying “well at least you have a healthy baby!”

    If the mother and partner feel confidence, joy, excitement and empowerment from their birthing experience they’re going to bring that into parenting.  The opposite is true, if they felt out of control, like they failed or like their body wasn’t good enough to birth the way they wanted that can trickle down into their parenting.  It is so important that mothers and partners are supported in a way that gives them confidence to do this on their own.  We also have many mothers in our program that do not have a partner to give them support which makes the support of the doula that much more valuable.

communitydoulabirthprogramfoundation

    Our mentoring program offers extra support to doulas.  Each doula is matched with a mentor doula that has been to 50+ births.  This mentor is mainly phone and email support for the doula.  Only in certain circumstances would the mentor attend the birth with the doula.  This is the only structured mentoring program for doulas in Maine.  The majority of doulas attend births alone and this can be very intimidating when you are just starting out.  Our doulas also have a handbook that gives them tips, tools and forms for their prenatal and postpartum visits.  We are also collecting data after the births to compile outcomes.

    CDBP is run on a sliding fee scale which means we collect the income and family size of our clients and put them on a fee scale that coincides with the poverty guidelines.  This is because we feel clients value the service more if they contribute something to it no matter how small it may be.  

This is the website for Community Doula Birth Program:
communitydoulas.org

Check out this article for more information on the evidence for doulas:
http://evidencebasedbirth.com/the-evidence-for-doulas/

 

 

 

The Second Time Around


I started practicing as a doula after the second time I went to a doula training.  Both times, I was trained with toLabor (the organization formerly known as ALACE).  It was 2008, I was 21 years old and just going into my senior year at the University of Maine at Farmington.  I left my training feeling exhilarated and ON TOP OF THE WORLD!!!  

Literally, I went to the Delorme Museum after and screamed my excitement to the world.

Then….life happened.
 

It would be 4 years before I took the training again.  I felt so moved and changed by the end of this training too. We were a group of women that came out on the other side with empathy, knowledge and awareness ready to change the future.   
 

One thing I found helpful about toLabor was that you perform pelvic exams on each other during the last day of training.  Now, believe me, everyone was nervous about this.  It’s weird, it’s awkward, it’s uncomfortable and it’s something pregnant women go through many many times, sometimes done by someone they also just met.
 

This learning experience taught us trust, communication and plain old anatomy.  We felt the cervix, the pubic bone, we found 0 station and we did kegels.  Pelvic exams are completely out of the scope of practice for doulas by the way, this is NOT something I ever do for clients in this role.
 

The reason we performed them on each other was to learn about what our clients go through and to learn the path the baby takes while going through the birth canal.  We were also taught how to show respect and practiced communication during vulnerable intimate moments like these.  I was honored to share those learning moments with fellow doulas.  


After that training, I ended up going to two births in two weeks.  I was hooked and I knew this is what I was meant to do.  
 

I’m looking forward to sharing my journey of being a doula with you.  You’ll get to know my personality through these posts and if you’re lucky (which I have a feeling most of you are) you’ll get to see my humor show through also.
 

I’m grateful to have taken the training twice.  Sometimes life gets in the way but it’s not always a bad thing, a detour can show you the landscape you never imagined seeing while you travel to your next destination.

By: Amanda Powell
September 6th 2015