Laura 0:00

We do this thing to women where we where we tell them that if they've had a really active pregnancy, like if they've been doing yoga, their whole pregnancy or they've been lifting heavy that whole pregnancy they're going to have this completely natural unmedicated vaginal delivery. Right. So we set people up for this expectation, and then they feel like a failure if they've not done that.

Tanya Tringali 0:24

Hey, everyone, I'm your midwife, Tanya Tringali. Welcome to the mother wit podcast, a show about the issues we healthcare consumers and providers face every day as we interact with the medical system. We'll talk about its blind spots, shortcomings, and share strategies we can use to feel seen and heard no matter which side of the table we sit on.

Hey everyone, welcome to today's show, I just wanted to take a moment before I get started. And let everybody know that I'm going to be taking a little bit of a hiatus, probably about the next three months before another episode comes out. I have some work that involves traveling and I have some really fun travels, my husband and I are finally taking our honeymoon to Europe. And then I have some personal stuff, healthcare stuff, family visits, things like that going on. So it's just kind of a long stretch, where I just decided, You know what, it's time to take a break. So, the good news is, this is episode 53. So there's a big back catalogue to listen to. So if you are a new listener, or you joined sometime in the middle of all that there's lots in the archives to listen to over the next few months. And then I'll come back and do some new episodes. Today's episode, which I actually just finished recording. And it's really exciting to me. I think you're really going to enjoy it. We are talking about pelvic floor PT, physical movement, activity, exercise, all the things and kind of the gaps in women's health care, ob care, the maternity world very broadly all of it. My guest today was Laura Williams, and gosh, are we doing very similar things but her through her PT lens and me through my midwife slash personal trainer or fitness lens. But that makes them look a lot alike. I think you're really going to enjoy it. There are moments I warn you where I get a little bit of passionate. And if you're on the healthcare perceptive side of the equation listening to this, you may feel like I'm singling people out a little bit and I apologize if I strike a bad tone. I just get a little passionate. I know deep down that the issues I'm raising are systemic and not about individual providers. So please know that as you listen. I just wanted to make sure that I said that as we get started. Anyway, let me properly introduce Laura before she joins us here. So Laura Williams is a doctor of physical therapy. She is a board certified Women's Health Clinical specialist. She lives in Salida, Colorado with her husband, two daughters and two dogs, Laura founded a practice called hearth healing. It's a pre and postnatal pelvic health consultation service that offers accessible information in a 100% virtual environment. And though it's not a substitute for in person health care, her consultations are a way to bridge the gaps that exist in maternal care. As I was saying a moment ago, she believes that everyone has a right to honest evidence based individualized support, we really stress the individualized component in this discussion. And that's where I get a little hyper sometimes. And at Hearth, Laura offers self management strategies, exercise modifications, early postpartum healing tips and guidance and appropriate resources products providers. Oh, so much more now that I've heard her talk. Her bio does little justice to how much work she's actually doing in her new practice. So I welcome today, Laura Williams. So Laura, thank you so much for joining me today.

Laura 4:24

Thank you so much for having me.

Tanya Tringali 4:27

So as we get started, of course, I would love you to introduce yourself to everyone. And while doing so you can tell us whatever personal details about your life you feel are appropriate. But one thing in having pelvic floor PTs on the show that I always want to, I don't know kind of see how you get where you're going for us midwives in the United States. This is not the case for midwives, like all around the world. Many of us are nurses and then become midwives. And then there's this element of virtual which of course we're going to talk about for the virtual world. And I think about PTs a lot. In that many pelvic floor PTs became PTs first then discovered the world of pelvic floor pt. And I don't think it's super, super common, although not impossible that somebody becomes a pelvic floor PT, knowing all the time that that's where they were going to land.

Laura 5:18

There's there are some nuggets of accuracy in there. And I'm one of those weird people who knew they wanted to do pelvic health from the jump.

Tanya Tringali 5:26

Awesome.

Laura 5:27

So you found a unicorn in me, I guess.

Tanya Tringali 5:29

I love it.

Laura 5:32

So I actually, physical therapy is my second career. So I was a professional, contemporary dancer, danced with companies through my 20s. And also taught yoga, did my yoga teacher training in like 2007, before I graduated, knowing that I needed a side hustle. And so movement has really been like the thread of my life. And I've everything I've done. A professional dance career typically has an expiration. And for me, it was multifaceted. It was both like the physical piece of that and not feeling like I could sustain that demand anymore. But also, I was always really pulled to kinesiology and anatomy, biomechanics. That really always made me tick. And I felt this real desire to go back to school and kind of dive in once I was a little bit older and felt ready to dedicate be more dedicated as a student. So in my later years of teaching yoga, before I went back to school, I actually had quite a few private clients, and several of them had pelvic floor dysfunction. A couple of them had had bladder slings, placed other types of surgeries for pelvic organ prolapse. And I felt like I had really hit the boundary of my abilities. As a healer, I was like, I do not know about these things, I do not know how to support you, I am not equipped. And that really launched my desire to go back to school. So I had this pelvic health world, and knowledge of its existence, even though then it was really in the infancy of the profession, in the back of my mind, the whole trajectory that I was in school. So I did my prereqs, I got into PT school. And I actually was one of the only people in my class that right away, requested to have pelvic health rotations. So I started getting some exposure really early on. And immediately out of school wanted to be in a year long internship with excellent pelvic health mentorships, so that I could be a generalist, but also really excel in that specialty right away. And that's how I ended up in Salida, Colorado, which is where I live now, because we actually have a really unique obstetrics program at this unsuspecting rural hospitals. So we treat people across all four trimesters of pregnancy and postpartum, right, you can come to us at any time during pregnancy, we've done a lot of advocacy work with all of our referring providers, that that should just sort of be the standard. And then we uniquely do labor and delivery training in the third trimester. So that includes the birth partner, and we talk about the biomechanics of birth and breathing techniques and pain modulation, really in the in an effort to sort of mitigate the risk of injury, under the assumption that everything is like safe and stable for mom and baby. And then our acute care PTs immediately see every birthing person before discharge, just to offer some fundamental information. So that's been sort of my trajectory to where I am now is all of this movement leading me to this profession. And really just getting deeper and deeper into the pelvic health world.

Tanya Tringali 8:58

I rarely wish that my listeners could see me, but you can see me and I can't wipe the smile off my face because of everything you're saying. But you're saying something so special and unique. And you acknowledge that and you know how special and unique that is. And I know you're on a mission with your virtual practice that you're going to tell us all about. But I just want to say right now that if you need a new mission, I think your new mission should be to branch out to hospital systems and recreate this program.

Laura 9:28

Well, the, you know, the program wasn't really my baby. My mentor and Krogan felt really founded the obstetrics component of our pelvic health PT program. And we've, like I came in and have really helped influence the growth of the program and the progress of the program and have been a catalyst and continuing those really thriving relationships with our referring providers and that like level of mutual understanding of scope of practice of the demands on every professional, all those things are really important to me. And I really appreciate how healthy those relationships have to be in order for a program like this to exist and persist. So I can't take credit for the program existing. But we have, you know, spoken on national platforms and regional platforms about this program. And then there have been other PTs more specifically in the acute care world. I don't know if you know about the pelvic health network, Rebecca Seagraves, she's really run with this and is on a mission with her company to implement this as more of a national standard. And they just, I'm going on a huge tangent, tangent now. But there's some cool new literature out that they've been working on about the impact of early intervention, particularly after cesarean and how physical therapy should be the standard of care and acute care, after all births, but cesarean is sort of how we're wedging ourselves in, right, because it's sharing post op. So it's language that people can understand.

Tanya Tringali 11:02

So one question I have for you just, I mean, I love that this is happening out of your intro like this isn't even where we intended to go in this conversation. But I can't I can't help myself. Can you talk a little bit about the nature of the collaborative relationship that you have with OBGYN? And are there midwives involved in this? And what's that like? Because one of the things and I know, you know, this, I'm totally preaching to the choir, I work with people all over the country, and indeed, all over the world sometimes. And pretty much across the board, people have to advocate hard for themselves just to get a referral to a pelvic floor pt. And that's something that I've just literally biding my time and waiting for it to change at this point. And I can imagine a program like this really does turn that on its head, but what does that relationship actually look and feel like?

Laura 11:51

Yeah, I think what's been really unique is that we've approached it from a real like client up perspective. So it has to start with the people who are experiencing the thing, realizing that they are receiving this element of care that is really changing their outcome, and bringing that back to their provider. So that I think has been one of the most fundamental ways that we've achieved, what we have is that over time, you know, our patients are going back to their providers and being like, this is changing my postpartum experience. Everyone should have this, right. And so they're hearing that over and over, or we're just really trying to equip people on our end with self advocacy strategies. These are the things that you have control of during your birth experience. These are the questions to ask, completely respecting and honoring the training, the clinical reasoning, the algorithmic approach that nurses and doctors are taking, or respecting the birth environment that every birthing person chooses, right? If they're at home with a midwife with a doula with a doula in the hospital, whatever it is, still letting people know what their choices are. And then then being the ones to advocate for those choices. So that's been one, one really critical piece, is that ground up approach.

Tanya Tringali 13:17

Are there midwives in the system?

Laura 13:19

Yes, not at all. They don't deliver at our hospital. So if you we actually don't even have OBs delivering at our hospital, we're a small 25 bed rural, like level four Trauma Center. So it's family practitioners that are delivering, which is really amazing. Actually, it's about as close to having a home birth and a hospital. As you can imagine. It's also allowed us to implement a lot of these programs because we deliver about 100 babies a year, right? Not one to 300 a month. This is not a huge tertiary hospital where there's a lot more red tape. And it's also a small town. So we know, we know all the physicians right there at the coffee shop there at the bar, our kids are in preschool together, it's much more of a sort of unique close relationship and availability in that way. But I think beyond respect beyond opening open communication beyond showing up with coffee and doughnuts and flyers and information and PowerPoint presentations. It's about procedural changes, and policy changes that don't put more demand on the healthcare workers. So the way that this ended up being successful program is that there's a box that's automatically checked in the system after someone delivers a baby, and that box sends an immediate order to the physical therapy department, that maze and so the physician has to uncheck that box if they think that that is not appropriate for whatever reason or the patient is welcome to decline that support right but asking by asking our OBs our family Doc's, our midwives to add another thing, our PTs, right to add another thing to their very, very saturated day is the reason that these things fail, because we're so tapped out. So it had to be an automatic system, it had to be something that did not burden.

Tanya Tringali 15:24

Amazing. Amazing. Okay, I have a million more questions, but I'm going to force myself to get us back on track, because what we were going to talk about is equally interesting. Okay, so from here in this background, I get now your path from PT to pelvic floor PT, which are very tightly intertwined. How did you end up founding this virtual practice that you have?

Laura 15:53

So my private practices called Hearth healing, and I decided to work as a consultant because I recognized all these barriers that people were facing to not only in person care, but really just kind of fundamental information about the intrinsic healing of the birthing person that people are not getting, because of those barriers to in person care. So there's a lot of really rich, good meaningful stuff that I think everybody deserves to know about their changing body during pregnancy and postpartum. That should not require a referral, a 12. week wait. Navigating a complex healthcare system, knowing whether you're, you know, in network, then having transportation and having appropriate maternity leave, having daycare, all these things that stand in the way of people just knowing how to take care of their bodies after they take have a baby, right? So this was also personal to me, because I had when my wife delivered my first child, three and a half years ago, and my most recent child 10 weeks ago, but my first one, I went in, like knowing all the things, right? I was like, I got this, I had the, you know, we do this thing to women where we where we tell them that if they've had a really active pregnancy, like if they've been doing yoga, their whole pregnancy, or they've been lifting heavy that whole pregnancy, they're going to have this completely natural unmedicated vaginal delivery, right. So we set people up for this expectation, and then they feel like a failure if they've not done that. Or if the birth outcome looked different than that. So that was my experience was that I went and not only with all of this information as a health care provider, and I've been teaching about physiological birth for a long time, and I knew all the things to do, and I love my doctor. And I had an amazing doula. And I had a super weird labor pattern, and a really, really long delivery with an epidural. I attempted pushing for 10 hours, and ended up with an emergency cesarean. And I waslike, beside myself. And I just did not know how to navigate that grief as a professional anymore. Like I didn't know how I was gonna go back to the work I had been doing. Because if I couldn't live it, if I couldn't embody it, how could I talk about it. And I also felt like my body failed me. So I felt this just complete, like I was at the edge of this cliff. And I did not know how to back away from it. So I had my own experience of feeling. Like even though I said out loud, I'm struggling, the resources were not made more available to me. And I think it really opened my eyes to the fact that a lot of people are having this experience where they are experiencing. They're experiencing the out the fallout of birth trauma, or they're experiencing postpartum depression, and they're having all these new physical symptoms that they don't understand. And people aren't asking them about it. So they don't feel like they have permission to talk about it. And if they do kind of summon the bravery to bring this stuff up to their provider, usually once at a six week postpartum follow up appointment, which is short and brief. They're met with lack of resources, right? Nobody's saying, Okay, here's what you're going to do next. And the things that really helped, like meeting with physical therapists get having a mental health provider on board, having a midwifery in Home Support Program, those things should just be the standard of care and they're not. And they're not available to most people. So I navigated that, that made me really crack the conversation open with lots of my peers, my friends, my patients, my colleagues. And I just felt like there. It just made me so aware of this gaping hole in maternal care, particularly from zero to six weeks postpartum, and I wanted to fill that gap so heart healing was my A way of attempting to do that.

So I'm working as a consultant, I'm not working under my DPT license having a national reach was of the utmost importance to me. And this was the way to do that. I made the first phone call I made was to a lawyer to say like, how do I do this? How do I set up my LLC? What are the parameters under which I can work? What can I talk about? What can I not talk about? And we agreed that, and I'm saying this right now, I'm including this in our talk, because I want other people to understand this that this advice to me was that if it's something you can disseminate in a book, you can call it consulting. So I feel like in good faith, I can help educate people, how about how to breathe when they move, about how to get in touch with their scar, about how to safely pick up their baby 1 million times a day, how to safely take care of their home, how to safely start moving their body, without having to do an in person in person evaluation. So I'm not diagnosing I'm not doing hands on. But I'm helping people be less afraid of what is happening to their bodies and more empowered to start to take those steps to feel at home in their skin again, until they can get an in person evaluation, which there's really no substitute for. So I started with just postpartum and now I'm doing consulting across five trimesters.

Tanya Tringali 21:28

Are you pregnant? Or a new parent looking to ensure a better postpartum experience? Or are you a birth worker looking to improve your postpartum care skills? Check out thriving after birth, an online self paced course by me midwife and educator, Tanya Tringali. It's 10 and a half hours of video content featuring experts in lactation, mental health, pelvic floor health, pediatric sleep issues, you also get worksheets and a workbook as well as options to have a one on one session with me sign up and Motherwitmaternity.com/thriving. And let's improve postpartum care together.

Yeah, there are so many parallels between the work you're doing and the work I'm doing and how we got to this place. I mean, it's it's kind of eerie, I mean, short of your personal birth experience being the catalyst for this and my story being different in that regard. And we come from different professional backgrounds, but the work we are doing is so similar. The gaps we're focusing on are so similar. This is fascinating to me. It's so nice to know, that you're out there offering this I'm I'm thrilled. In light of everything you just said. How do you help someone decide when it's time to see someone in person? How do you navigate that?

Laura 22:56

Yeah. Certainly, like the hard and fast answer to that is that if anyone presents to me with something that feels like a yellow or a red flag, I'm not the right place for them to be. Right. So if someone has is very early, acute, postpartum, and they're describing, you know, calf pain to me, I'm not dealing with that person, I'm sending them to the PT. That's an extreme right, if somebody's having issues with their heart rate, or their blood pressure, those are not things that are appropriate for my space. Any concerns about cardiovascular health, any neurological issues, those things need to be screened by a professional in person, period? The softer version of that answer is that I always want someone to have a pelvic floor evaluation by a qualified pelvic floor physical therapist, which is different than having a gynecologic exam. Because we are our training is to assess, you know, with a gloved one finger, each individual muscle in each individual of the three layers of the muscles of the pelvic floor. And we're not just we don't just care about the strength of the pelvic floor, we care about the range of the muscles in the pelvic floor, we care about the coordination of the muscles in the pelvic floor. What's their endurance, like? What's their fast twitch capability, like just like any other muscle in the body? And so I always want someone to have that in tandem with what we do. And so if someone is describing painful intercourse to me, or they're describing heaviness in the pelvic floor, or they're having leakage when they cough, sneeze, laugh, jump. I want that person to also be evaluated by someone that give them direct feedback about the things I just described, right? The coordination, the length, the activation of those muscles. Because it is not a one size fits all approach. But for the most part, I can make generalized assumptions based on what someone's telling me, and give advice that I think is a really safe jumping off point. So if you're having painful, you know, intercourse, there's hormonal reasons for that. There are tissue change reasons for that. And there are muscular reasons for that. And there are probably emotional reasons for that. And there are lots of self management tools that they could start to implement breath that supports lengthening of the pelvic floor tools that allow them to do some self trigger point release safely and gently until they can get that evaluation, right. So sometimes I'll have someone start with some some strategies, and if they're just not seeing any change, or they're just not getting better, or hopefully not. But if they're getting worse, than they definitely would need to have an in person evaluation first. But my ideal is that someone is doing this in partnership with that word. Because it's more accessible. And you can do this from the comfort of your home.

Tanya Tringali 26:14

So how do you navigate that if you do have someone which you want them to be seeing an in person, therapist, so they've got that person, they've got the homework and all the things given to them by that person? How do you integrate into that and become part of that team? And have you been welcomed in that team by the other PT?

Laura 26:35

Yep, I find I feel like I'm a, what I find most of the time is that I'm on the front end of care. So I'm like a referral generator. I'm like a PT cheerleader. Got it. So most of the time, what happens is if someone comes to me, and then they either learn from me that they need to be going to a pelvic health PT, or they're seeing me until they can get into a pelvic health pt. And so then in a way I pass the baton. Which is also a really beautiful way that I think you transition to working with more of like a personal trainer, or getting into the fitness space to write and we can talk about that more. But that's the role that I typically play. And I also see a lot of people who are, who want to come to me because they're not sort of pathway to into the traditional medical model. So it's really expensive for them to go to in person physical therapy, or they are having a home birth, and they don't want to be filtered into the hospital system. And this is a way for them to access some of the information that they would be getting from a PT at the hospital, or at a private practice, but without having to go in person. So they still feel like they're getting more, it's more synergistic with that homebirth experience that they're sort of seeking. But with all of the PTs that I work with, like this business is not in competition with what we do, it's really synergistic. It's really supportive of what we do. And in a way, it supports a really really overstressed system. Because the waitlist to get in to see one of us is at least eight weeks. And then by the time you get into see us, if you don't already have more than four visits booked, we won't see you again for another eight weeks. So it's hard to have that continuity of care. And if someone is waiting 12 weeks to learn how to breathe when they move, and that's something that I can support them in doing earlier that by the time they get to PT, they're sort of set up with that foundation and it makes the PTs job easier.

Tanya Tringali 28:39

So when are you typically starting your work with people and I'm the lens I'm coming at this from is as pelvic floor PT has become something people are more aware of its existence, more accepting of it. What I see is this belief that this is about postpartum and I see this from both providers and clients. And the shift that I'm hoping to see. And this is what I do with my clients is encouragement towards the idea of being evaluated at least once during pregnancy, even if you're feeling good, and let's face it, most people end up having some common discomfort of pregnancy, that's musculoskeletal in origin, let's face it, I don't care how fit you think you are. I don't care how good you think your posture is, like, whatever, you end up with something. And so I wait for that opportunity. Kind of the first little thing someone says whether it's about discomfort with sex or something with movement or whatever, I use that as my opportunity to say, Have you thought about seeing a pelvic floor PT? Oh, yeah, yeah, I'm gonna do it postpartum? No, but what about seeing one now and part of my logic I'm not a pelvic floor PT. But part of my logic here has long been that I think it would be highly beneficial to the provider and ultimately to the client to get a handle on someone's baseline. What was their pelvic floor like before the birth, whether it was an easy birth or a traumatic birth, or a C section or a vaginal? Because everything's going to change whether it's a change because of scar tissue, the way we hold our body tension, yada, yada, I'm preaching to the choir. I know, but our clients need to hear this. You know, I want that change to be evaluated, because I think the therapy is more valuable. And can we can heal faster from that perspective? Are you with me?

Laura 30:41

100%? I'm just nodding.

Tanya Tringali 30:47

Like, that's where I want providers to go. And so that's part of the reason I do the work that I do, I'm not gonna go back to school and become a pelvic floor PT. But if I could do my life over again, I'd really be interested in doing that. So what I do is, I've a midwife, who's a personal trainer with a lot of experience around pregnancy postpartum and all this stuff. And I've worked very closely with pelvic floor PTs through my entire career. So I feel like I know a lot. It doesn't make me a PT. But I try to like connect these three spheres that I think need to be deeply interconnected all the time. And we all need to know where our skill set ends and somebody else's because

Laura 31:27

Yes. How do I even begin to respond to all the things? You said there were so many juicy layers in there? Yes. So like, I feel like the trajectory of my business is Case in point, what you just said, like, You are the spokesperson for the trajectory it took because I identified this gap, I really wanted to fill it, which was in that postpartum space. But then the more I did it, the more I realized, my feeling was like, Oh, I wish you had known. Oh, I wish someone had given you this information before. Oh, I wish, right. Because the key to no matter how your birth goes, we have so little control over how we end up playing out what ends up playing out and labor and delivery and how our babies enter this world, whether they are pushed or lifted, you can know and do all the things. So there's always going to be work to do to unpack that. But at the end of the day, it is so much easier to do that work of unpacking, if you went into your labor and delivery with understanding and agency and support. And then you had a team built for you on the other side. So I feel like pregnancy in and of itself, the state of becoming pregnant is enough of a biomechanical change that it warrants physical therapy, you do not even have to be having any pain or dysfunction. To go see a pelvic PT during pregnancy. That was my soapbox.

Tanya Tringali 32:59

Yeah. And what I tell people is, I and I say this even to postpartum people who think they're fine and don't feel like they need it. And I'm like, It's okay. You don't have to go. I'm not trying to make you go. But I just want to put this out there as an idea. Go once, you will inevitably leave with some new skills. Even if this isn't about resolving pain, I promise you will leave with new skills. And at least this very centered awareness that you are in a good place, you won't wander about things that you feel in the same way as if you never got the information. But then I take that and translate it over to pregnancy over and over and over again. Like let's just move this whole thing forward.

Laura 33:41

We're, you know, we're a, we're a bucket of culture, we're a culture that just says like, I'll just do my bucket meditation and get on with it. And there's no room for me to complain, my complaints are not welcome. And sometimes going to see a provider, especially if it feels like more of a tertiary support person. That's should be pelvic PT should be part of your primary care team. I think that's how we need to reframe it is that this is primary care. This is preventative care. But you never know the things that once you're in a space with someone who actually has the time to ask you about the things that you didn't think were that you thought were too stigmatized to talk about, right? Or they'll bring things up that you are struggling with, that you didn't recognize or that you've just been pushing aside because you didn't have permission to talk about them. So it honors space for that, right for all those little concerns and all those little discomforts to come up and for you to be able to discuss those and air those. And it teaches you how to move safely to support a healthy pregnancy. And then ideally, work with someone that you develop a relationship with so that you're already in there. You're already in this therapeutic alliance with someone after your baby is born. And then that closes that gap, right? I tell my clients now to comment one week postpartum, unless they feel like they can't leave their house, or I'll come to their house, I don't care. I want people to have support right away. And it's much easier to access them if they've been seeing me during pregnancy.

Tanya Tringali 35:17

Absolutely, I think one of our jobs when we have chosen this path of the kind of supportive, largely virtual role that people don't anticipate, but people who have worked with us in this style of care will inevitably talk about for years to come. Is that part of the gift of just being willing to take the journey with us is that we ask them questions that they didn't know to ask themselves. And it's amazing, I'll start a session with someone, let's say, from a place of like, Hey, these are the basic ideas of what's on my agenda for today, based on where you're at and your healing, how many weeks postpartum you are, whatever it is. But before we tackle that, what's the what's at the top of your list, right? So I kind of make sure we get there. And once in a while somebody's like, I don't even know what I need to talk about. And like I will, let's just start with my list then. And before you know it, the questions are flying left and right, because you just have to open that can of worms and give people the space and time. And I think that's the piece that I want people to know is you are worth that space and time. You don't have to know that you need the help. You just should trust that everyone deserves this layer of support. And gifts will come I promise. I haven't taken care of anyone who wouldn't agree with that.

Laura 36:45

Yes. And if you've overshot it, like if you have a, you know, vaginal delivery with minimal tearing, and you feel amazing, and you're crushing life, and it's your second kid, and you're like, Oh, I just scheduled way too many of these appointments, which is almost never the case. That's okay. But isn't it so much better to have that care team ready to go and know that you've equipped yourself with that space for you, for your body for your health, so that you can better show up for all the other demands on you. And there are so few opportunities like that for us as just people in general, let alone women, let alone mothers to to carve out that time to actually think about that intrinsic wellness piece.

Tanya Tringali 37:37

All right. So to bring this part of the discussion to a place that's really tangible for clients, for consumers. I would love it if you're able to give a few 123, let's say examples of things that you can work with, work with someone on in each trimester of pregnancy, to bring this whole puzzle together about why we're harping on. The sooner you integrate into this type of Care Alliance, the better off you're going to be.

Laura 38:13

Yeah. Okay, so I'm going to speak specifically about virtual care about consulting. This certainly trickles over to if you can get to an in person Pelvic Health, Physical Therapist right away at the beginning of your pregnancy, do it. But in the consulting space, first trimester, I want to establish that relationship, I want someone to feel like I'm a person that they can open up to, I think finding the right provider is as important if not more important than finding a provider. So just learning about each other and learning about what somebody's you know, story is coming into their pregnancy, what their goals are for their pregnancy, really establishing how to help them meet those goals. And then really supporting the shift that happens often in first trimester, which is mostly an energetic shift. So helping people negotiate how do I keep moving? How do I you know, exercise is usually a huge priority for people during pregnancy. So helping them honor that there are massive energetic shifts, their nutritional needs are different. I'm not a nutritionist, but sort of opening the door for finding helping them understand that that's a really important component of their ability to continue to move and helping them adapt and then starting really, really good biomechanics of breath right away. So instilling driving home the point that I want them to be exhaling when they exert, exhaling when they lift, thinking about the movement of their pelvic floor in relation to their diaphragm with all of their movements so that it becomes habit before they undergo this really, really massive physical change. So sort of laying a foundation in that first trimester. second trimester is typically about maintenance. So continuing movement, and this is where a lot more of sort of the musculoskeletal pain tends to rear its ugly head is in that second trimester when you are going through more of a physical transformation. So helping people keep their bodies in balance, building off of the skills they learned in first trimester, and then also thinking about some of the more forgotten parts of self care, like stretching and thoracic mobility. As those postural changes really start to develop in second trimester, really making sure that we're balancing that postural transition with good support and stability. And then in third trimester, late third trimester, people are ready to start to actually think about labor and delivery and a birth plan. So a big piece of my job as a consultant is helping people be well resourced, and find the right providers and the right, just the right team around them. So third trimester is where I help people plan for labor and delivery, both by encouraging them to start to decide who's going to be on your team. No, even like, where are you having your baby, if they haven't already made that decision? Well, before then, a lot of people asked me for the language to bring to their OB. So I hear all the time, my visits with my OB are so fast, and I get really flustered. And then I leave and I have like 12 things I wanted to ask them about. I really, I want people to go into birth with a loose plan. I don't want them to go in with a an inflexible plan. But I want people to go in informed, like I want people to go in understanding the different ways they may be induced, the different interventions that may be offered to them. what those things mean, what are the risks and benefits, how to have those conversations with their birth partner, how to empower their birth partner to be their advocate in the in the circumstance that they couldn't advocate for themselves. Because giving informed consent is different than giving consent, if you're asked for consent at all. So that's my biggest thing during third trimester is really wanting people to go in with strategy and information and still feel like super optimistic about the ideal birth outcome that they want to have. And I want them to hold on to that with every fiber of their being. But knowing the alternatives that may present makes them much more processable if they transpire. So it's a lot of information. And, and I do labor and delivery training virtually. So I talk about positioning for labor versus positioning for delivery. Again, like with the birth partner, I mentioned this in the beginning, but we do a lot of training on specific hands on assists things that if they have a doula, the doula would also do that. Then the birth partner isn't hearing and seeing for the first time during the act of actual labor and delivery, which can be really overwhelming. Yeah. So I want the birth partner to be just as invested as as the birthing person. And I want to equip them with like real strategies to feel like they're involved. And then third trimester is also where we're planning for postpartum. So who, how are you going to ask for help? What is going to be helpful? Who are you gonna call on for help? Not just like beyond a meal train. You know, is there a postpartum doula in your area that you can hire can be an objective person to come over and help you fold your laundry and hold your baby. And sometimes people don't know what that what they're going to need until they're in it, but I really want people to be over prepared for that. Absolutely.

Tanya Tringali 44:00

Did you know that less than 15% of people meet guidelines for recommended amounts of physical activity during pregnancy. As health care providers, it is our duty to promote health and wellness throughout the lifespan and the perinatal period is all too often overlooked. Our clients look to us for guidance on this, and we do the best we can with the knowledge we have. But that's often based on a combination of life experiences, common sense and myths. My new course exercise in the perinatal period for healthcare providers is designed for providers who are motivated to improve their ability to support their clients in getting or staying active throughout the perinatal period, including their postpartum return to fitness. Click the link in the show notes to learn more.

Laura 44:47

And then the fourth trimester is what we consider like zero to 12 weeks postpartum. And there's critical healing that happens during that phase no matter how you deliver a baby. So I want to helps support people laying down really malleable scar tissue and want to help people renegotiate coordination of their muscles bringing sensation back to scarred areas, just really early, gentle, foundational work of rebuilding to get to the point of return to exercise as it looked before, even though it may feel totally different. And then I call fifth trimester, anything beyond that, but it's still really to the end of that first year. And it's more about that return to work, return to sport, layering in more demand on top of the foundation that you lay in your fourth trimester.

Tanya Tringali 45:41

And I always, I always put sex in that mix, too.

Laura 45:44

Yeah. Oh, yeah.

Tanya Tringali 45:46

Because the truth is, it depends on what someone tackles first, where we're going to get our first big bout of information from, you know, and so I never know what someone's going to do, and what they're going to tackle first. So we're kind of like grouping it all together, and thinking about these things. And also, I think, to D stigmatize the topic, some people are still really not used to health care providers, talking to them in a laid back sort of way about sex and an appropriate but laid back way. And so I want to get ahead of that. Because otherwise, you're getting the debrief after a situation that was like, whoa, what just happened there? So yeah, totally.

Laura 46:28

Yeah. And it's an activity of daily living. bowel and bladder function and sex are part of life that we take for granted until they are not going well. Yeah, right. And then it's really devastating. And we don't have a safe space to talk about it. So I love that that what you're saying is like, it's our responsibility to bring up the subject to make out the space for that to safely discussed. And I wholeheartedly agree with that. And it's in my intake form. Right. So it's right there. It's one of the things that people can check the box, and then it's on my radar. And it's usually the place that there's an indication that there's something else going on. Right, painful intercourse is usually about a musculoskeletal problem. Right? Well, and that's hormonal swing.

Tanya Tringali 47:18

And I think that's the thing I talked about this on many podcasts. So people who have been listening for a while have heard me say this a million times. It took us an ungodly amount of time, to get key goals, to be taught by average providers, right, the everyday provider who's not involved in research and all of these things. And by the time we got it there, we had emerging research that deals were not the end all be all, that we've got a whole world of people teaching key goals as if a weak pelvic floor is the only problem with pelvic floor could have. And now we're all like, put on the brakes, guys, we've got all these tight pelvic floors. So the pendulum just frickin keep swinging, and it's going to keep swinging.

Laura 48:01

Well, and the reason that it's swinging is because it's swinging in the media. Yeah, and it's not coming from an..., like, there's a time and place for kegels. And there's a time and place for lengthening of the pelvic floor. And all kegels are not created equal to ask kegels, their slow kegels, and it depends what the person needs. And so it has to come from an individualized evaluation, right? And that the problem is that this information is so accessible and digestible to the public and to the masses. And so people are putting it out in a generalized way. Because, like, don't hate on the Kegel in the right context,

Tanya Tringali 48:43

Right. But I think you're also being very generous, because what we have, unfortunately, media aside, is an army of health care providers who think they've done their postpartum education by telling people to do key goals. Furthermore, I'll take it one step farther. You said at the beginning of this podcast, something that we've talked about many times on the show that a gynecological exam is not the same as a pelvic floor exam, there are two wildly different things. But what we have and I've seen it a million times, the provider who is, quote, unquote, taking the extra step is at least asking someone to do a kegel during that so called six week postpartum exams, but but they don't know what they're feeling for. Right? It means nothing. And I've seen all these providers go, great, great Kegel move on exams over and it's like, there's nothing there. So they might be squeezed your fingers a little bit, but there's no tweaking, there's no figuring out what's going on with the connection between the transverse abdominus and the pelvic floor. There's no communication about that is the way in which I see like a very rudimentary dialysis assessment, and then you layer on top of that whether someone needs and values that as an assessment are not. So it's a very layered problem, which is why I create I created a course that is being it's put out through empowering midwifery education. It'll be in the show notes. It's always in the show notes. But it's a course on fitness in the perinatal period for health care providers, right. And so we start by taking people through the facts, what are the guidelines? What are the recommendations? How do we share that information with people in a way that is not going to be fear mongering, not going to feel overwhelming all that stuff? But then it slowly morphs through? How do we help people stay active during pregnancy, regain their strength postpartum. But also, it just underlying all of it is how do we talk to people about this in a way that makes the healthcare provider not necessarily feel like they have to suddenly be a fitness professional, I'm not suggesting that. But we have to have the language. Just like we've got clients out there spending their own extra money on people like us to learn the language to be good advocates, healthcare providers have to return the favor and say, Oh, I know how to have this conversation in a safe way. And I know how to help you find the resources that you're looking for, to get you there. But we haven't quite gotten there yet. Because when a visit is 15 minutes, start to finish soup to nuts, including reading your notes before you go in and writing your notes when you leave. I don't mean to blame the provider. They don't have the time. We are lucky that they asked the person to do a kegel. Yeah, so it's a systemic issue, not a provider issue.

Laura 51:36

Yes, and they've asked you to do the Kegel in a supine position, but most likely your functional deficit is in standing is in jumping is in running, right? So we can only glean a very, very small sliver of the problem from a supine evaluation supine, is lying on your back. And looking at a global Kegel, right, where you're asking me to contract all of the muscles of the pelvic floor at one time doesn't give me any information about the sensitivity of those muscles, the pain of those muscles, the recruitment of different muscle groups individually from each other. Right, while you're in motion, nonetheless, well, and why are in motion? And so that's why you need a specialized evaluation. So right, like, we would love for our providers to be screening for these things. And what you're, what you're talking about is equipping people with an enough of an understanding that they can be excellent screeners, right. They even know what they're looking for. And like, have an understanding of the fundamentals and then get people to the right place.

Tanya Tringali 52:51

Absolutely. Because that's the thing. I don't actually want providers to feel that they need to go down this rabbit hole. If it was, you are healed. obstetric, ly, meaning your C section, Scar, your perineum, whatever else is involved, your tissues look healthy. All of this looks good. We've sorted out what you want for contraception, your inter conception care is squared away, I present the to the pelvic floor PT now, like I would be at peace with that. We don't even have to get involved with the diathesis and the kegel If we had solid teams like what you started your story telling us about, which is why I couldn't wipe the smile off my face.

Laura 53:34

Yeah, and I have so many people, I hear stories all the time still about people saying that they went to that six week follow up appointment. And were diagnosed with something like a prolapse or a prolapse. The word prolapse was like thrown out there. Mm hmm. And then no referral was made, no follow up care was given. I think that in a consulting space, I'm giving some pretty fundamental information that any provider could be giving to help people stay safe and at least not progress the state of their tissue to said and also it's such a scary thing to tell someone when it may, at six weeks postpartum not be any sort of indication of what their long term wellness is going to look like. So to if you're going to assess it, and you're going to put it out there and you're going to use a diagnostic term, you have to be able to follow that up with a good team of support people that have the time to do the thing you don't have time or expertise to do.

Tanya Tringali 54:35

To boot. I am I find this problematic for another reason. Because we know that what we see as evidence of a prolapse poorly correlates with one's lived experience. Yes, meaning 100% Someone can have a very minor prolapse and feel it profoundly well Someone else can have a seemingly big prolapse and feel it not at all. Those two things can happen and get just that word is enough to make someone start gripping the hell out of their pelvic floor out of fear that their uterus is about to fall out and change everything about their biomechanics from that on. Yep. And I've seen people who are depressed because of this diagnosis that came six months, a year, two years before

Laura 55:27

Yeah, because you your life gets smaller, when you start being afraid of movement. And 90% of the time, when I evaluate a pelvic organ prolapse, and do see that there is a diagnosis of anterior posterior vaginal wall to set, that person does not have a weak pelvic floor, right? That person, often ligaments, very shortened pelvic floor, because they have been guarding so hard for so long, to try to keep their organs in and, or even psychologically, they think that things are falling out, like what you've said, that isn't actually what's happening, right. And that's been their biological physiological response. And so that's created tension. And when you have too much tension in your body, your body, your muscles can't respond. So they can't contract quickly against the flow of urine to protect you from a leakage.

Tanya Tringali 56:17

And this is akin to when a provider who doesn't elaborate further tell someone at a six week visit that they have an X, get X number of finger breath, dialysis, and then the exam is over. Well, that person very well might roll to their side and push themselves up with their hands for the rest of their life and never engage their core, because they got the memo that they shouldn't engage their core, if it looks a certain way or feels a certain way or healing is required. But but by whatever the logic is what they've come up with, we've all seen these things, the disruptions and people's long term lives because of a flippant diagnosis of something that we think is minor. And we didn't know the impact it had. So I think we've gotten to a point where we talk about language a lot as healthcare providers, but we don't think carefully about certain diagnostic terms that we share with people we leave, we leave them feeling like we did our job, because we shared some information with them. But we scared them in the process and didn't even know it.

Laura 57:20

Yep, I think we have to remember that everything is a grayscale, and everything is individualized. And these words often are only supportive, and the way that we communicate with each other as healthcare professionals, because we have to have standardization. But they're not really that supportive when we talk to our patients most of the time. Yeah. And anything that is like a hard and fast rule is probably not the right way to approach a problem. Right? Like, oh, you have a dialysis which to be clear, like it's not even a diagnosable dialysis unless it's beyond two centimeters wide. Right? And that's a misconception, right? doing crunches is not the enemy doing situps is not a thing you can never do. Again, it's about how you do them. And I think we apply that to, we have to apply that to everything in healthcare. It's about quality. It's about the way we do things. It's about mindfulness, right? People ask me like, well, when can I start running again after I have a baby? And the answer to that question is unique to the individual. Because it's about how that feels to them along the way. Now, I do think everybody should be doing certain things to build up to running again. Because there are certain hormonal, biological physiological changes that have happened that need time, right, that, that you have to relay a foundation, no matter how you deliver your baby, your pelvic floor, your abdominal wall, have been so lengthen those muscles are inhibited, we have to record meet them and lay a foundation to get back to the high impact demand of running. But how long that takes is really unique to the individual. So it's not to say you can never run again. And it's not to say that you can run it for weeks, there's a gray scale, and we've lost sight of that.

Tanya Tringali 59:12

Totally. But on this point, I don't think I've ever mentioned this specifically, I'll put it in the show notes this time. I definitely go into this in my course that I mentioned. But you know, there was a consensus panel of largely pts and pelvic floor PTs, who put together a set of essentially returned to running guidelines. I think guidelines is too strong of a word, but they're very good. And one of the things that's in this document that regular people who don't need to feel like they typically know how to read research or anything like that can do is there's a few pages in this document that lay out what are believed to be the prerequisites to running and there are things like single leg stability and whatnot. And I think these are fantastic exercises for people to do Just give you some structure as you make your way back to anything, it doesn't even have to be specific to running. Because if honestly, if strength is your goal, all of these exercises are about strength, strength, stability, mobility, etc, etc. Anyway, I'll link this in the show notes so that people can find these pages because it will give you ideas for exercise for months, and help you find your way back to running, which and just to finish the thought, based on these, the at this consensus group, the general thinking is that it takes people about six months to get back to the type of running that they once did. That doesn't mean you don't run ever until six months, but it's a slow progression that involves lunges to uphill climbs to intervals, etc, etc, until you're running what you were. So I think that's another thing people get turned off, they go, Oh, no, you're gonna tell me some long time before I can run, I don't even want to hear that because I need it for my sanity. And then they just go back. But no, there's a path you can take that feels good to.

Laura 1:01:04

Yep, and if you do start flick to the flip side of that, you know, if you do start running at six months, or you've progressed up to a certain amount of mileage by six months or a pace at six months, and then things start to decline, the trajectory is not a straight line, right? Progress is not linear. And so just remembering to that if you hit one of those milestones, and then all of a sudden, something doesn't feel right to trust that intuition. And it may mean that you need to spend a little bit more time in one of those earlier building phases. Or maybe that's a time that you need to get another evaluation, right, you can only get pelvic PT for the first 12 weeks postpartum. And then it's over. And love seeing people who have really returned to sport and now some of that nuanced stuff is showing up. You know, I don't have SI joint pain in my right hip anymore until after eight miles of running. So there's something to really chew on. So let these guidelines beat guidelines, this is not a protocol, this is not a one size fits all approach. These are generalized guidelines, these are, can be used to really empower you and be really helpful for people. And I know the guidelines that you're talking about, and I'm, I'm stoked that you brought that up. And that's the kind of thing that I try to get people to is people like you like the next step from me is working with a trainer is working with an exercise program. There's tons of online programs that are really rich and good and well crafted and built by experts. People can access and they can be self taught and they can be self paced. And you just need someone to help you understand. This is a reason that something maybe too much like this would be a sign from your body that you've done a little too much too soon. And here's a scale back.

Tanya Tringali 1:02:49

Yeah, yeah, absolutely. And, and just to be clear, the work that I do with people, when it comes to the personal training, fitness side of things is all virtual also. And for some people, I help them develop their programming, I have existing programming, yeah, I go a bunch of different ways. Some people who are CrossFitters, I'll get them to talk to their coach and get like the whole next month of programming, and I'll modify it for them as they're progressing. So that I'm if the coach isn't, you know, very familiar with people in postpartum, I'll take that work on for them and kind of do that modification. And then the other thing I do is I have people sending me videos, this is me doing my heel slides, and this is what feels weird. Okay, let's change this breath strategy. Let's do this. Let's do that. And sometimes when somebody hits a wall, they take their computer or their phone into the gym, and we work out together, and it works just fine. Like I help people get back to jump rope, double unders, various weightlifting moves, where they're feeling pelvic pressure, or starting to pee at the bottom of a lift, or whatever the case may be. Those are the ways in which I can help people get over little hurdles. It's not the same as having somebody looking at you, touching you in the same space. But there's an enormous need for people who are largely self sufficient, but just hit little speed bumps. And that's how I see my job, whether I'm in the midwife realm, or the fitness realm is like, let me just help you over the speed bumps that you don't know are coming, or that just happened and you couldn't have predicted it.

Laura 1:04:20

Yeah, yep. And I think a lot of times, Pts get people to a certain level of function and then run out of visits or we don't have the time necessarily to be more like athletic trainers or personal trainers. And so then there's a need for you. Right, like whether it's virtual or in person to be to be leveling up, but have a support person when it's like the injury is resolved. But now we're really getting back into sport.

Tanya Tringali 1:04:56

Yeah, I'm really fascinated by the PTs. that are starting to. And there's more and more of them. Especially I come from a CrossFit world and mindset. So I see a lot of it coming from the weightlifters and the CrossFitters. But the PTs that are out there that basically have small gyms and their office so that they can work with someone under the barbell, or in given situations. I think that is an evolution that is just so huge to bridge that gap. It's so critical that we don't just end that work together on the table, so to speak, that we say, Okay, you're good on the table, the tables, the laboratory. Now, let's get up. Let's see what happens when you try that strategy doing what you love to do.

Laura 1:05:40

Yeah, you've got to watch someone actually do the functional thing. That is the goal.

Tanya Tringali 1:05:47

Do you work with a lot of dancers?

Laura 1:05:49

I'm not really, I mean, I live in a place where there aren't a lot of dancers. So in person, I don't see them. I have lots of friends that are dancers. So I certainly do consulting our dancers, but it's not like a niche.

Tanya Tringali 1:06:06

Anything else you really want to share that we did that we meant to touch on, but maybe didn't?

Laura 1:06:10

Oh, my gosh, I think we talked about so many things we've talked about so much.

Tanya Tringali 1:06:14

And I'm being mindful of your time and of the fact that you have a 10 week old baby that is very likely to wake up and want to nurse any moment. And so I want to make sure that we end before you are in desperate need of going back to her but I got your mommy hat. So I haven't heard a peep either. But that's why I'm like it's due to come.

Laura 1:06:31

This hit the spot for me to get to have a whole conversation without being interrupted. But no, I'll just say that, like this conversation is so exciting to me, because we're trying to look at, you know, getting people access to care and support in what has to this point been a non traditional way of doing so. And I'm so excited about the direction that this is heading in. And excited to be a part of it and excited to be connected with you. And I just want people to really like continue to advocate for themselves, and seek out experts that are trying to be available to them in a different way.

Tanya Tringali 1:07:11

Absolutely, I am so thrilled to have met you I look forward to continuing to know you maybe some future collaborations, we are definitely on the same page here. I really love what you're doing. And it's been lovely, lovely having you I think that this conversation will have been very informative for both our healthcare providers and consumers. And on a final note, I just want to say sometimes when we get into these conversations, I get a little excited and worked up and I sound like I'm blaming the provider. And I just want to say if I sounded that way, at any point, that is not my intention, I have been in those shoes, I was in those shoes until I couldn't wear them anymore. And so that tone and that passion comes from a place of so desperately wanting to change it. But deep down, I know that it's the system that created the problems that we have. And I would just want to be a resource to both groups, and help make some of these things better for everyone. And you're doing that. Thank you so much.

Laura 1:08:12

Yeah, thank you so much. Thanks for having me.

Tanya Tringali 1:08:14

Yeah. Do you want to tell everybody how they can find you?

Laura 1:08:17

Yeah. So my website is yourhearthhealing.com. And I'm on Instagram @yourhearthhealing. And you can always just contact me right through the website. And I'd love to hear from you. Awesome.

Tanya Tringali 1:08:33

I'll make sure that's in the show notes. And if there's anything else that you want to share, I'll be happy to put them in as well. Okay.

Thank you for listening to the mother whip podcast. If any of the issues we discussed today resonate with you or your experience, I'd love to hear from you. Leave me a voicemail at 917-310-0573. Or better yet, email me a voice memo @Tanya@ MotherWitMaternity.com. I really want to hear what worked for you what didn't work, what support you'd wish you had, how you got through the tough times how you advocated for yourself, or especially any tips you want to share with our listeners. I want to hear all of it. And if you'd really like to work together, you can get a discount on your first consultation with me at Mother wit maternity.com using the code firstconsult10%off. That's one 0% symbol, all one word. Okay, that's all. That's wonderful being in community with you all. Thanks again for listening and see you next time.

Carolina 1:09:49

And remember, listeners, nothing we discussed on this show should ever be considered medical advice. Please speak to your local provider about anything that comes up in this show that resonates with you and your needs and your health care

Transcribed by https://otter.ai