Let’s Talk Pelvic Health: Common, But Not Normal with Dr. Brooke Kalisiak | 268

These pelvic health issues are common, but they're not normal.

And so- Yeah … if you are brave enough to talk about them, you're gonna find more and more people dealing with them, and unfortunately, a lot of our medical community still normalizes it, and it's like, no, no, no, it's not a normal thing, it's a common thing, and there are things you can do to prevent it from happening or to recover from it

Hey, mama.

When was the last time anyone actually explained your pelvic floor to you?

Not just told you to do your Kegels or sent you on your way, but really explained what's happening down there and what you can do about it?

Because here's what I know as a labor and delivery nurse, the pelvic floor is one of the most overlooked, most misunderstood, but also one of the most important parts of your stinkin' body for your entire birth and postpartum experience, and most women don't find that out until something goes wrong.

Today I'm sitting down with Dr. Brooke Kalisiak, a pelvic physical therapist and the owner of Legacy Physical Therapy in St. Louis.

She has been helping women prepare for birth, recovery, postpartum, and overcome issues like pelvic pain and bladder leakage for over 20 years, and she is on a full-on mission to change the conversation about what's normal, what's common, and what is not normal.

This episode is packed with things your OB probably hasn't told you, but you deserve to know it.

So grab your tea, settle in, and let's get into it

Hello, Brooke.

Thank you so much for being here today.

Thank you for having me.

I'm excited.

So Brooke and I met in St. Louis.

We were both talking on a panel for Babies and Bumps, and you guys, her vibe is so like mine, and it was… Although, I got in a little bit of trouble.

We can talk about that later.

But- … I got a little slap on the hand.

But so she said vagina quite a few times, and y'all know that is, like, my thing.

I'll tell you a funny story about that, too, in a second, Brooke.

Yes.

But I love when, we don't, like, make it all jargony, and it's too much.

Like, let's just talk real, right?

Yeah.

It just makes it easier.

It's just another part of our body, and, you know, it's so important in the, the birth and postpartum world.

Like, you just, it's, you just gotta lay it out there and take away- Yeah … some of the mis- mystery of it.

Yeah, it i- it's so funny 'cause my youngest son, so I have seven kids, but my youngest son, he is so comfortable with the word vagina, but it's almost so much so.

Like, we were in, uh, Rome, and we went to the Colosseum, and just randomly, he tells the tour guide, who mind you was, like, late 20s tops.

He goes, "My mom is obsessed with vaginas" And I was like, "Let me clarify a little here."

Calm, but there's, there's some levels to that.

Okay.

Yeah.

I'm like, "Let's get clear right now."

Anyway, so we're gonna be talking about vaginas, people.

And we're gonna be talking about pushing and just picking Brooke's brain, and I'm gonna let you just tell everyone a little bit about you and why you started specializing in what you specialize.

And you can let them know what you specialize in.

Sounds good.

Well, my name's Dr. Brooke Kalisiak.

I am a pelvic physical therapist in St. Louis, Missouri, and owner of Legacy Physical Therapy, and we are a clinic that specializes in pelvic health issues.

So we work a lot with, pregnant and postpartum moms who are both dealing with pelvic floor issues and trying to avoid pelvic floor issues.

So we love the proactive person who's trying to make sure that they're optimizing their body for labor and delivery, and that recovery afterwards.

But yeah, I've been in the field for 20 years, and just really enjoy working with, these pelvic health conditions.

And so, like I said, the vast majority of our population that we work with are women dealing with some type of pelvic floor issue, but everyone has a pelvis, so we have both male and female patients at our practice, but I have a special place in my heart for that pregnant and postpartum population.

Yeah.

Well, Brooke, we don't talk about penises around here.

Like, that is not our jam.

Sorry.

It's only vaginas on The Birth Experience.

However- I love it.

I

love

it … I, I've been doing this… So it's funny because my daughter is about to turn 21, and she is literally my physical representation of my labor and delivery career.

Nice.

About to be.

Yes, so, so I'm excited.

So, like, what I would love to talk about, and I think even for me as a labor and delivery nurse, for a very long time until I started, like, educating myself outside of what the hospital provided, I really thought that you, like, had to tense up and use your pelvic floor to push the baby out.

And I think that's one of the biggest misconceptions, so I'd love to dive in right there.

Yeah, very much so.

The pelvic floor muscles are that bowl of muscles on the bottom.

So think about it.

If we tense them up, they contract and lift up into us and close off around the holes.

They're, they're what we used when we're learning to potty train.

So they, they close off the holes.

So we don't want to be contracting them when- Mm-hmm … we're trying to push a baby out.

Those pelvic floor muscles need to elongate and relax and stretch out, and it's the uterus in our body that does the work to, to push the, the baby out.

It is not our pelvic floor muscles.

But I think, like we, we kinda said earlier, like, there's a mystery around this area.

A lot of people don't have any awareness of what's going on in that area, and so then they're, they're in labor and they're told to push, and they don't know what to do.

They're just like, "Okay, well, I am not sure what to do here, so I'm gonna, I'm gonna squeeze, and then I'm gonna push" and we just end up- Yeah

with this like, I call it pushing against a closed door.

It's like it doesn't feel like anything's going anywhere 'cause you're fighting yourself with it, so.

Yeah.

I say the same thing all the time, and I've done, like, a video before of, like, having someone coming through the door, and, like, someone else actively pushing the door- Yep

on them.

Very much so.

And it does not make for a very good entry- No … at all.

No.

A lot bigger- So- … chance

for

entry there, so.

Yeah, and I, you know, it's so funny 'cause as you were talking, my very first child, was a long time ago, he's 36 now, and- I remember my nurse saying to me, "Push down and out, down and out."

And I'm like, "What the hell does down and out mean?" Yeah.

But I feel like now that there's so much education about the pelvic floor-

Mm-hmm

In your mind, it makes it logically make sense-

Mm-hmm

… Trish: what you're doing.

So I would love for you to, like, walk through if you had a patient that's sitting here who comes to you, and she's like, "Brooke, I'm scared to death of pushing.

I'm scared of tearing," 'cause we all know that's, like, the number one fear- Oh, yeah … that they all have.

Mm-hmm.

Like, let's walk through the listeners like they're sitting there with you.

Mm-hmm.

And, like, give us some, like, practical steps and tips and- Yeah … Brooke wisdom.

Yeah, so I mean, that's the beauty of what we do here in pelvic physical therapy is getting people, giving people the opportunity to practice that ahead of time.

So if you're here in person, we practice that in many different positions to figure out what is your best position that you can create that push.

So you know, some people are surprised to realize, like, "Man, I can push really well when I'm on my side," or- Mm-hmm … "When I'm on all fours," and that.

So, we get to practice that with that feedback from the therapist on what exactly is happening in that situation.

But if you're new to trying to experience what pushing feels like, an example I love to give people is, belly big, belly hard, which at the end of your pregnancy it really feels that way.

But thinking like you swallowed a beach ball, and you're trying to take that beach ball and push it down towards the pelvic floor area.

And for some reason, for a lot of people, that visual of like, "Okay, I've got that, and I've gotta push that downward," really helps them to kinda open up, and get that correct kinda pushing position.

And for others, it's really playing around with it in different positions.

So I highly recommend not just practicing that in sitting or in laying down with your knees up or that, but trying, laying on your side, in a squat position, on your hands and knees, over a ball, ' cause you might find, like, oh wow, like, I really feel this push in this position, but I don't feel it as much in this one.

And so it can kinda give you a list of like, cool, these are my, my good positions that I can feel it in.

So.

I, I love that, and I love the analogy of the beach ball because if you're thinking about l- lowering it, you, you automatically, your brain kinda realizes that you have to open the door and, like- Yeah

relax to push it down.

So that makes- Right … a lot of sense.

Mm-hmm.

And I love that you mention practicing those positions.

We teach our students that as well.

We have a course that's only positions.

It… That's all it is, is just- Right.

Yeah … all positions, whether it's pregnancy posture- late pregnancy for pain, or pushing with an epidural or without.

And we tell them the same thing.

We're like, "Create, like, the vibe." You don't want- Yeah … your toddler running around screaming and stuff.

But what I feel like surprises a lot of women, and I get, again, I get flack online for this as well, is that sometimes on their back- Like for me, with all of my kids, I, I was unmedicated.

Mm-hmm.

I did all the positions, and with all of them, at the very end, for the last few pushes, I found my power on my back.

Not straight on my back.

Yeah.

But I think that them getting comfortable with the positions, and also letting go of any absolute.

Mm. Yeah.

Because you can't go into birth with any absolute.

Correct.

Yeah.

Like I tell my students all the time, "You can refuse everything, but should you?" Mm-hmm.

And I, whenever I talk about pushing on the back, I get so much flak from all the people.

Like, "It's not good." No, but if it works for you-

Yeah

… Trish: then you can use it.

So when- Yeah … so let's go back.

So you said that your superpower is making pelvic health feel relatable- Yeah

and comfortable to talk about.

So what do you think the thing is that most women, when they come to you, are most embarrassed about?

Mm-hmm.

Or, like, what do you want them to know about that?

I'd say, I mean, the vast majority of our patients come to us with some type of bladder issue.

That's probably the most common.

So some type of leakage, and it happens during pregnancy as well, but is- Mm-hmm … really common in that postpartum period 'cause those pelvic floor muscles, especially if you delivered vaginally, went through a massive stretch.

Mm-hmm.

And the nerves that supply them went through a stretch, and the bladder got pushed on as the baby went by.

So everything's a little bit off and needs time to recover, and sometimes it needs some help recovering.

And I think as a society, uh, you know, I've been doing this for two decades now, and I've seen a change over time, and we're talking about it more, and there's more, familiarity with pelvic physical therapy as an option for people, and people are being more proactive health-wise, as it relates to their pelvic health.

But I still see so many women get told by their doctor, like, "Oh yeah, you just had a baby. Leakage is gonna be normal. Like, when it gets bad enough or after you're done having kids, come back and we'll do surgery." And it's like, okay, like I just got brave enough to tell you that I'm dealing with bladder leakage, and you just kinda- Mm-hmm

write me off with it.

And so, so many people come into my office, and they might be either or-- very early postpartum, or they might be years postpartum, and they're like, "I know I probably waited too long. Is there anything that I can, can do about this right now? Like, I didn't, you know, I just, I just thought I had to live with this."

But then my friend said, "No, you need to try pelvic physical therapy." And they, they, they try it out and that.

And so, you know, letting people know that, you know, these issues… my tagline is that these pelvic health issues are common, but they're not normal.

And so- Yeah … if you are brave enough to talk about them, you're gonna find more and more people dealing with them.

And unfortunately, a lot of our medical community still normalizes it.

And it's like, no, no, no, it's not a normal thing.

It's a common thing.

And there are things you can do to prevent it from happening or to recover from it without having to just rely on diapers for yourself.

Those are for your babies, not for you.

So…

Yeah.

And it, it's just maddening because we know a lot of these issues, if men were having them, they would not be waiting and trying to figure it out.

Like- Mm-hmm … they would be actively figuring it out- Right … right now.

Yeah.

So with that- And these women, you mentioned something about, them waiting and then them coming because they've heard from someone else.

Is there, like, in your mind, like, a too soon or too late in this?

Like, too soon to see you or too late to see you?

No, no, it's never too soon, it's never too late.

As far as early postpartum recovery, when we work with someone during their pregnancy, we check in with them a couple weeks after they deliver and do a virtual check-in appointment to make sure things are going all right.

If, if everyone's had a fairly normal birth experience and they're feeling really good from it, we really do try and value the rest and recover aspect afterward.

Yeah.

I mean, there's definitely some gentle things that people can be doing at home, to kind of support the recovery there.

But I don't need them getting out and about with their baby to-- for a special appointment to see me.

So we usually wait until about the six-week point to see someone in person and evaluate what are your pelvic floor muscles doing?

What are your abdominal muscles doing?

Do you have an abdominal separation?

So all of these different things that can happen with pregnancy and that postpartum recovery.

We're kind of making sure everything's moving back in the right direction and, working the way that it should be and coordinating together well.

But that being said, I've seen someone as early as a week after delivery because they're having pain issues, so they-

Mm-hmm

… Brooke: can't sit comfortably 'cause something's off down there.

Their back or their hips or their tailbone or their pelvic floor or their lower abdominal area is just bugging them, and they can't take care of their baby the way that they want to.

And in that situation, it's like, "Come on in. Let's help you out as, as much as possible so that you can get back to taking care of your baby right away."

And on the flip side, our body's amazing.

It is never too late to make a change.

I think our oldest patient here was 93 years old, so talk about-

Wow

… Brooke: couldn't hurt him.

You know, like- Yeah … when?

But, like, it's never too late to make a change, and that's the beauty of the human body is that we can teach it new things and, and our body can react different ways.

So, a lot of women, we've found it's pretty common that once their kiddos hit school age, they hit kindergarten or even preschool, they're suddenly like, "Hey, I actually have a little bit more time. Like, I can do something- Yeah … about this now. I'm gonna come in now." So w- we tend to see a lot of women who wait until their kids hit that school age and then come and see us too.

Which is literally just how it is because time flies and you're so busy and you're taking care of these kids, and like you don't think about yourself at all.

Mm-hmm.

Or if you do, it's like right when you go to bed and you're like, "Oh, I need to do that", and then the next day takes over.

Yeah.

Pretty

much.

So one thing you said is you said at one week they're like having pain and they're not able to sit, but don't you think like a lot of women would be confused on that one?

Like, how would she know this is something I need to have checked out?

Because I know I had stitches- Oh, yeah … with some hemorrhoids.

Yeah.

Oh, yeah.

You know.

No, I'd say in that situation, that's probably someone that we've worked with during their pregnancy, and they've maybe h- already had some issues.

So pretty common, pain issues- Mm

that happen during pregnancy are sciatica or SI joint dysfunction or low back pain.

And so in that situation, a lot of times we'll get that phone call from someone that like, "Uh-uh, that same pain that I had that we were working on, it's back, and it's really bad right now." So I'm glad you asked the clarifying question, 'cause yeah, you are going to have some pain and- Yeah

discomfort from delivery.

It, it is not all peaches and roses, so let, let's be real here.

No.

But, it definitely… it's more of a situation where like a, an existing pain condition is coming back with a vengeance, and it's preventing them- Okay … from doing things that they wanna be able to do.

Okay.

So that makes sense.

So now I would love to talk about what are some things that you recommend that pregnant women- actually should be doing or not doing, you know, to protect her pelvic floor, to protect, you know- Yeah … her body.

Yeah.

So something that's wonderful to get started during pregnancy, 'cause it is something that you can carry over in the very early postpartum phase to help reconnect it, the muscles, is what I call core connection breathing.

So our diaphragm, our belly, and our pelvic floor muscles all work together to regulate pressure in our abdominal area.

And so if we can start getting used to coordinating together those systems while we're pregnant, we can then right after we have the baby, start that back up again.

And then, so when you're pregnant, I say sometimes it's a little bit easier, 'cause you have the baby in there.

It does stretch-

Yeah

… Brooke: out a little bit, but I tell them to hug the baby with, hug their baby with their belly.

So inhale and relax, exhale, and try and hug their baby with their belly, pull in around it, and hold for a few seconds, and then let it go, okay?

And getting used to what that feels like and that ability to kind of pull the abdominal muscles in gently around the baby, and thinking about it all the way down into the pelvic floor, 'cause when we hug our baby with the belly, we should also feel the pelvic floor kinda lift up and in a little bit as well.

So practicing that, movement, honestly, like five to 10 reps once or twice a day.

It's not something… Uh, you don't need to walk around all day holding everything tight, definitely not.

Yeah.

But you know, just practicing that and getting it used to it, because that's something in, like, a day or two postpartum you can start doing that again to try and reactivate those, the abdominal core, diaphragm and pelvic floor muscles kind of coordinating together.

So that's, like, the earliest, exercise that you can get back to and kinda get that connection going again.

Well, and that's also a great breathing technique for mindset and- Mm-hmm … fear and- Yeah … anxiety.

Mm-hmm.

It really is.

It's so crazy how powerful just breathing-

Yeah

… Trish: is.

That's one of the things that we teach.

I did Lamaze for my first birth.

It was a hospital Lamaze class.

I ended up on oxygen.

I was hyperventilating.

And people are always like, "What are some breathing techniques?" And literally we, we show 'em almost basically the same as what you said, just a little bit different.

Yeah.

And it's one breathing technique, and then we, obviously we teach them the candle, like panting during- Yeah, yeah

uh, the ring of fire.

But I think people overcomplicate breathing, and they Underestimate the power-

Yeah

… Trish: of breathing techniques.

Yeah.

You know?

And I think it can be really hard for a lot of women, especially if you grew up as an ab gripper.

You were like, your, your mom always told you, "Stand up straight and pull it in."

Yeah.

And so you're used to pulling everything in and not letting that belly move.

Yeah.

It, you know, in order… If that's the case, in order to get a deep breath, you, the only way you can do it is to go up into your upper chest and shoulders.

And so if that's a habit that you've had in place for, heck, it could be decades, Yeah

and that, depending on when your pregnancy comes, and then you're pregnant, and baby's sitting up there pushing up on your lungs and, you know, giving you no room that way.

Yeah.

So again, the only time you can get a deep breath is to breathe up into your shoulders.

It can, what seems like a simple breathing pattern as we talk about it right now, can feel completely foreign.

And they're like- Yeah … "Oh, yeah, no, that's why I always make people practice their, their breathing and their exercises when they come back to see me, 'cause, like, I, I wanna say, like, eight to nine times out of 10, someone will come back, "I've been doing my deep breathing." I'll be like, "Okay, cool.

Show me." And they're like…

Yeah.

And I was like,

" Brooke: No, no, no, no, no, no, no.

That wa- that, that wasn't quite what we were doing." So-

Yeah

… Brooke: it's something that for a lot of people, they have to really change that pattern and practice it, and it can feel very mentally challenging to kinda do.

Yeah.

Well, and it, it… I definitely, I did breathwork at a, an event recently.

They had a breathwork person.

Mm-hmm.

And it definitely can be, like, almost intimidating when you first start to try to figure it out, and you're like, "What the heck am I doing wrong?" Mm-hmm.

But it's also, once you get it, you get it.

Yeah.

Very

much so.

So for you guys listening, like, I… And I love this 'cause you demonstrated this at Babies and Bumps- Yeah

for the ladies.

I do remember that.

And I feel like when you're pregnant, you feel like you're out of control.

And that's a way for you to, a simple, like we're not asking you to go like walk for 45 minutes and- Mm-hmm … lift some weights and do some squats, although you guys know I want you doing some like-

deep sitting squats.

But it's a really simple way for them to, like have some control- Mm-hmm … in this, 'cause everything feels so out of control.

Okay.

So, we've been talking about pregnant women.

Can you walk me through a postpartum, like a patient who comes to you postpartum- Yeah … because I feel like it's a big mystery.

I know some of my students, 'cause we hang out with our students a lot on, on Zoom.

We, we have pregnancy hangouts, and a lot of them are intimidated to- Yeah … come see you.

Mm-hmm.

And what the heck is she gonna do?

Like-

Hmm

… Trish: what's she gonna put inside me?

Yeah.

No, that's- What are these things?

Completely typical.

So I feel like, I feel like someone who has not c- like we tell all of our students to see a pelvic floor specialist for a baseline.

Yeah.

And, I wish I had done that.

Mm-hmm.

But I feel like what I see with my postpartum students that come to me later in pregnancy, they don't see a pelvic floor specialist.

They have this like fear of the unknown to come see you- Yeah.

Yeah … because they've had a lot of trauma down yonder.

Mm-hmm.

So I'd love you to kinda like walk us through what does a postpartum- Yeah … visit looks like, looks like for you.

Yeah.

No, I'm happy to do that, 'cause you are right.

The mystery of like wait a minute, like especially for some people who have like the example I give is I had a patient who, had to do physical therapy for like an ankle sprain recently, and she

So that's her visual of what physical therapy, and she's like, "Brooke, you just, like I waited a while to see you 'cause I just couldn't, like I couldn't picture it.

I mean, I was going to physical therapy for my ankle, and there were like 20 other people in the gym, and everyone-" Yeah … "doing exercises, and I'm supposed to talk about my pelvic area?"

I was like-

Yeah

… " Brooke: Yeah, this is a little bit different here." And so- Yeah … pelvic physical therapy is one-on-one, with your therapist, usually behind a closed, you know, in a closed treatment room, with no one else around, except anyone, like any support people you would wanna have there.

Mm-hmm.

it is extremely consent-based, where the therapist should be asking your, giving you information about what's gonna happen and asking your permission very much so along the way.

Yes,

please.

Yes.

Always, always asking permission.

Sometimes my patients are- Yeah … like, "Really, Brooke?

I gave you global consent, consent." I was like, "That's great.

I'm gonna keep asking permission every time I touch-" Yeah … "a private area." But, First, we do a lot of talking just to see what's going on with you, what symptoms you might be experiencing, what you've done that's helped, what's maybe causing problems, and getting a sense of what you hope to get out of your time here, and that, 'cause that may be different than what I think might be important, so we wanna make sure that we analyze that and, make sure that we're addressing your goals.

And then typically, the evaluation'll start with a posture assessment and looking at how you're breathing, checking to see if you have a diastasis, which is the separation of the abdominal muscles, and that's typically done in a laying down position, to see how big that separation might be or if it's present at all.

Then we're checking your abdominal muscle strength.

if you've had a C-section, we're gonna check your C-section scar to see

how it's healing.

How-- So how are you checking the abdominal strength?

Do you-

We check abdominal strength with two or three different tests.

So one is a, like a basic sit-up test, Okay

to, that's gonna look at the rectus abdominis muscles, which are the six-pack muscles in the middle, to see how they do curling you up.

The others is looking at the transverse abdominal muscles, which are the muscles that wrap in from the side and make a corset around us and kinda-

Mm-hmm

… Brooke: they're our pull-it-in muscles, and they get the most stretched out during pregnancy.

So that's, having you try and give yourself that hug.

Like, that's why I tell people- Yeah … to practice it during pregnancy.

Like, can you hug in around the baby?

There's just no baby there now.

And then we challenge that by moving your arms or legs different ways to see if you can keep holding that position, or do you start to feel those tummy muscles push out or your back arch off the table or that?

So that's how we assess- Okay … how those muscles are working.

Which

is another reason why you probably wait till they're at least six weeks postpartum.

Yeah.

Yeah.

Very

much so.

'Cause you are not feeling all that when you're two weeks

postpartum.

No, no, definitely not.

Yeah.

I mean, so- But again, getting a baseline where people are at with it.

Yeah.

Also gonna look at hip mobility by moving the legs around a few different ways to look at how, how mobile they are, and testing the strength of the buttocks muscles.

That's often done on the side where we kinda lift the leg up and back and see if you can kinda hold that.

And then to the patient's comfort level, we assess what's going on with the pelvic floor muscles.

So typically, that involves, putting a sheet down on the table and one for the patient to cover up with, and then we step out for a moment and have them undress from the waist down and laying down on their back covered up with the sheet.

There's no hidden stirrups here, nothing like that.

Yeah.

And no speculum is used.

It is the gold standard for a pelvic floor assessment is a single finger insertion into the vaginal canal.

And so with the patient's permission, we put some lubricant on one finger and insert the finger into the vaginal canal, first checking very superficially, so especially if they had any tearing or, A episiotomy in that area, we want to test the scar tissue mobility, and then, sliding our finger in further to check the deeper layer of muscles, asking them to try and, like, think about squeezing around our finger or to try and, contract like tr- they're trying to hold back pee or gas to see if they can develop that p- muscle squeeze.

But also checking for tense spots in the muscle, just like, you know, you might push up here on your shoulder and be like, "Oh, there's kind of a knot up there that, that doesn't feel so hot." Yeah.

That tells me that, yeah, there might be a tense spot or, or a knot or trigger point in the pelvic floor muscles that might need to be dealt with so that it can function accordingly.

That part-

And how do you deal with that?

just like you would up in the, the shoulder and the neck area.

That's what I was thinking.

Yeah.

It just happens to be- We're getting

down and dirty here today, guys … a flat area of our body.

But so yeah, we have various manual therapy or soft tissue techniques which can involve putting deep pressure over the muscle or doing, like, a gentle stroking motion.

It can be similar to, like, perineal massage if we're dealing with- Okay … the scar tissue or that in the area.

We're just working on the restrictions, and it might be something that we work on with them here in the clinic.

It might be something that we're teaching them to do to themselves at home.

You know, I love to give postpartum moms tasks they can do when they shower, 'cause that seems to be their only- Yeah

alone time.

So- Yeah … you know, being able to try and, you know, fit it in that way.

But ultimately, like, we come up with a plan based on that information of what are our problem areas and what do we potentially need to work on to accomplish their goals.

And they go home, at our place, they go home that day with things that they can work on right away to start getting, feeling better, as well as things that, we're gonna be working on in the future and how often that we might need, needing to get together to accomplish their goals.

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Mm-hmm.

That, like, when I first started online, there wasn't a lot of people.

There was a few, but- Mm … I feel like now, these women who are having babies now are so much- Mm-hmm … like, more educated.

But even for me, like, I didn't know exactly all of what you do 'cause I've never done it.

Yeah.

So I love, like, just demystifying that because the fear of the unknown is so real.

And- Yeah

she's got a newborn, she's tired, she has no sleep, her boobs are hurting- Thank you … her bottom's hurting, she's got all these things going on.

Yeah.

But I just wanna encourage you guys, if you're listening, I'm gonna have you pipe in on this as well, is that taking care of this now when you're younger, you're just gonna have an easier life, like, as a woman.

Yeah.

I think we put off our own self-care, and especially, like, my age, we just, that just wasn't the thing.

Mm-hmm.

Like, you took care of your kids, like, their needs, your partner's needs.

Mm-hmm.

And, like, we just were always on the back burner.

So I really applaud the women who are doing this and taking control of their journey.

Mm-hmm.

And I would love to hear what you have to say about, like, if, let's say they're having… Like, s- what's, you said the urinary, right?

Mm-hmm.

Yeah.

They, let's say they're having, they're leaking, and- Yeah … they're listening to their nanny and their Aunt Sally and everyone saying, "Oh, that's just what happens after you have a baby."

Yeah.

Yeah.

Like, what are some repercussions down the road if they don't-

Yeah.

No, that's a great- … deal with this now?

… to think about it.

And so I'll take a step back from it where you had said originally that you, you know, think even if people are doing well, you recommend them getting in and getting a baseline, and that is so true because the human body has a lot of redundant systems to it.

Like, we're, we're designed to survive.

So-

Yeah

… Brooke: we can come out of, you know, delivery into that postpartum period and actually be doing pretty well, not, not having any issues, and thinking like, "Cool, I'm one of the lucky ones. This is awesome." Yeah.

"I'm bouncing back. Oh, great." But you may have some underlying pelvic floor dysfunction or weakness or coordination issues with the core muscles or separation of those abdominal muscles, just not enough that it's causing any symptoms at that time.

Yeah.

But what happens is down the road when Mother Nature comes a-calling again, especially that menopausal period where we take estrogen out of the picture, that is when I see a ton of women who didn't necessarily have issues for early, early postpartum starting to have issues, and a lot of it can be traced back to, oh, you have an episiotomy scar that's not moving very well, or your C-section scar is not moving well.

You never really rehabbed your abs, and you have some funky movement patterns with your abs- Mm-hmm … that are putting pressure down.

So again, our body figures out how to get it done, but it might not be the best way.

Yeah.

And that's where we can get into problems and that, and so I love the idea that everyone should come in at least for a baseline appointment, to be evaluated.

Now, don't get me wrong.

In that situation, we have green-lighted women who are doing great postpartum and being like, "Hey, you are doing really well. We don't necessarily have to worry. Here are some things to look out for in the future should you start to notice stuff." Right.

"But you're in a good place."

And then there are others that we catch some sym- some stuff pretty early.

They're not necessarily super symptomatic, but if they didn't change some patterns or they didn't do some more- Yeah … rehab work, they're going to start to be symptomatic.

And then there's- Mm-hmm … a third group where it's like, "Oh, you are symptomatic right now.

You are dealing with a lot of bladder leakage.

You are dealing with painful intercourse, you know, maybe just pelvic pressure, heaviness, discomfort.

Like, we wanna take care of these now so that you don't have a problem further down the road."

Yeah, so I know I told you I like to keep the episodes to 30 minutes or so- Yeah

but I just had a question that I wanna ask you.

Okay.

What are some, like… And then, and then we'll kinda close out and tell everybody where they can find you.

But what are some, like, weird things that might be going on that someone is not relating to their pelvic floor?

'Cause I think everyone knows painful sex, they know, urinary leaking.

What are some things that could be- Oh, yeah … pelvic floor?

I mean, not necessarily weird symptoms, but you might not correlate that it's related to your pelvic floor.

Sometimes your upper neck and shoulder and upper back pain, even low back pain, can actually be related to what's going on in your, your core and pelvic floor.

So r- this, remember, this system got crazy stretched out and may not be working well, and so our body's like, "What's the next closest thing I can use?" So it might try and stabilize by using the shoulders and the neck, 'cause down below isn't doing its job well.

Yeah.

Or abdominal area might be really stretched out, so the back muscles are like, "Okay, I'm gonna hold on for dear life, and I'm gonna do- Yeah

all the work," and that.

And it's like if no one's assessing that whole core canister, your diaphragm, your- Yeah … pelvic muscles in your pelvic floor, that may be a huge contributor to why you're having continued back pain or shoulder or neck pain.

And so we get that a lot, where we've had people being like, "Oh yeah, you know, I have this low back pain since I had my baby, and I'm working with my chiropractor."

It was probably the epidural.

Yeah.

It helps.

My, like-

Yeah … you know, so a massage helps, but it never makes it go away.

My chiropractor helps, but it doesn't go away completely.

It's like, well yeah, we gotta figure out what the other muscles are doing around there- Yeah … um, to make sure everything's working well together.

So that would be kind of, I guess odd in that people wouldn't think about their neck- Yeah … and shoulder pain potentially being related to-

Yeah

… Brooke: their, their core and pelvic floor not working well.

All right, mamas.

You listening, I think the core truth that we have said throughout this is get a baseline during pregnancy and then a baseline in postpartum, even if you're doing well, because it's really hard.

Like, I was having a conversation with o- one of my adult sons yesterday, who lives in Florida.

He works out in the sun, and I'm like, "Are you wearing sunscreen?" And he's like, "Yeah, sorta." And I'm like, "Listen, these things compound." Like, you- when you're young and you feel seemingly good, you don't think about those repercussions down the road.

So we're saying, like, for you, like, listening, take care of you.

You are, like, the cornerstone of this family.

Like, you really are.

And you need to be healthy and you matter and your body matters.

So- Yeah … Dr. Brooke- Mm-hmm … we would love to, if you could share with everyone where they can find you.

I don't know if you have a social media presence- Oh, yeah

or… Okay.

So

share with us.

I love educating, I love educating people on pelvic health issues and what they can do about it themselves.

So yes, on socials, so Facebook, YouTube, Instagram, we are Legacy Physical Therapy STL.

The STL is for St. Louis.

We do lots of content educating on various pelvic health topics, and then our website is legacytherapystl.com.

Again, we have, we do bl- a blog post a week on different topics and we are very much on, like, what can people do to educate themselves to kinda get them moving in the right direction?

And that, so.

Yeah, because we, we all want the same thing.

We want women to be healthy and to take care of their bodies and be empowered with knowledge.

I, I always say this, "Knowledge is power if you use it."

Mm-hmm.

So take some of these tidbits today, ladies, and use it.

Well, thank you so much for coming today.

I appreciate it.

Thanks for having me.

All right, ladies.

I hope that you enjoyed this conversation with Dr. Brooke and this episode of The Birth Experience with Labor Nurse Mama.

And I have to say, that was enlightening for me.

Like, I honestly did not know exactly what happens during that postpartum visit, so- I'm glad we know.

She's doing the work, she's breaking down the stigma, and she's making sure that you actually understand what's happening inside your beautiful body, and that is so powerful.

So if this conversation opened your eyes, please share it with a friend, share it to your stories, tag me at labor.nurse.mama so that I can see it, and more importantly, so other moms find out that just because it's common, it's not normal.

Every share is so important to us.

Also, leave a review, please.

Thank you.

Such a huge favor, and it means so much to us.

So if you're pregnant, you're postpartum, or you're dealing with any kind of pelvic floor stuff, reach out to Dr. Brooke, this is exactly what she's here for.

And if you are in your third trimester or you're six weeks pregnant, you're here, and I'm so proud of you.

Don't ever let anyone dismiss what you're feeling or rush your healing.

As always, hit subscribe so you don't miss an episode, share it with a friend who's pregnant, and if you have a minute, leave us a review.

Again, it means the world to me, and it helps us reach more moms just like you.

Our mission here at Labor Nurse Mama is to change the birth culture one birth at a time.

I love you guys so much, and as always, I'll see you again next Friday.

Bye for now