May 12, 2021 • 30 mins
Your pelvic floor is a hammock of muscles that support your vagina, uterus, bladder, and bowels - and not surprisingly, your pelvic floor muscles are pivotal during pregnancy, labor, and delivery. Pee when you laugh or cough? Had back, hip, pelvic or pubic pain or pressure? That’s likely your pelvic floor muscles talking. This week, Heidi is joined by ‘The Vagina Whisperer’, pelvic floor Physical Therapist, Sara Reardon. Heidi and Sara cover everything you need to know about managing your most common pregnancy aches and pains, the truth about kegels, preparing your body for a smooth labor and delivery, and so much more
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Episode Transcript
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Speaker 1 (00:00):
Oh, baby, baby, belof I need you, Oh how I
need you? What do you expect? As a production of
My Heart Radio, I'm your host Heidi Murkoff, and I'm
a mom on a mission, a mission to help you
know what to expect every step of the way. Sure,
(00:27):
you've had a vagina your whole life, but how much
do you really know about it? If you're like most women,
not all that much beyond some of the obvious stuff.
Chances are you know even less about the miraculous muscles
that support your vagina. Along with your uterus, your bladder,
and your bowels, your pelvic floor muscles. Not surprisingly, your
(00:52):
pelvic floor muscles are pretty pivotal when you're pregnant and
when there's a lot more that meets supporting. And even
if your baby doesn't end up exiting the building via
your vagina, pregnancy can take a toll on your pelvic floor.
Pee when you laugh for cough, had hip back, pelvic
or pubic pain or pressure, that's your pelvic floor muscles talking.
(01:17):
It's time to listen up and to listen to today's guest.
You may have heard of the vagina Whisperer, but her
real name is Sarah Reardon, and she's a pelvic floor
therapist and she's a mom of two boys, so she
and her pelvic floor have been there and done that.
Today she'll talk about pregnancy aches and pains, what's normal,
what's not, and how to prepare your pelvic floor for childbirth,
(01:40):
postpartum and beyond. So welcome Sarah, Hi, Heidi, Thanks for
having me, Thanks for being here. And I have to
say our vaginas and pelvic floors also, thank you. Happy
to be of service. I have to say it's the
first person to say penis on national televisi. I'm really
(02:01):
jealous about your title. How did you become the vagina Whisperer?
So it was actually a title given to me, so um.
I started in the field of pelvic floor physical therapy
right out of grad school in two thousand seven, and
there weren't a lot of pelvic floor physical therapist back then.
And I would see my college friends every summer and
(02:22):
I would end up in the hot tub with their
moms talking about bladder issues and leakage. And all of
my friends said, she's like the vagina whisper. And then
when I started my Instagram account a few years later,
it was for that group of friends. So I kind
of started, you know, just as a joke, and then
here we are, you know, four years later. Today we're
going to focus on caring for your pregnant pelvic floor
(02:44):
and all the wise in house. But before we get
into that, can you give us just a little bit
of pelvic floor? One oh one? Like, what's down there
on the floor? Why is it there? Why do you needed?
I mean, is it a case of you don't know
what you god till it's gone. So a little bit
of all of those things, And I think this is
a great place to start because a lot of people
(03:06):
don't know what is the pelvic floor, what does it do,
and how the heck is their physical therapy for it.
So all people have a pelvic floor, female, male, all genders,
and the pelvic floor is actually a basket of muscles
that sit at the base of the pelvis. So we're
all familiar with, you know, the bones of the pelvis,
but at the very basis a hammock of muscles that
support your organs like your bladder, your rectum in females
(03:30):
uterus and ovaries and males to prostate, and those muscles
support those organs and they also have stinkers that help
hold in p hold in poop and then assist with
vaginal birth and vaginal intercourse. So how do you know
if you need to see a pelvic floor therapist? Is
it something that should be routine for all pinnor women?
Is it covered by insurance? Is it something your your
(03:53):
doctor should refer you or your midwife? Right, so, you know,
we see folks coming in if they find us online,
if they hear about us from our friend or oftentimes
referred by physicians O b G, y m s and midwives.
The way that you should see one is that if
you have any issues with bladder health like urinary leakage,
overactive bladder difficulty emptying your stream, chronic urinary trucked infections,
(04:16):
pooping issues like constipation, fecal incontinence, or sexual health with
respect to painful intercourse or the inability to have intercourse
or painful orgasms. So the muscles play a role in
bowl health, bladder health, and sexual health, but they also
go through a huge transformation during pregnancy and birth, as
you and I both know. So that's really where I
(04:37):
feel like physical therapy should be standard care for women
during pregnancy to prevent issues, help them prepare for childbirth,
and then postpartum to help with recovery. So helveic for
physical therapy really falls under physical therapy. So if your
insurance covers physical therapy, which most of them do, and
you find a clinic that does take insurance, and you
can absolutely go and see a physical therapist and it's
(04:59):
covered under insure rents. Oftentimes some clinics or what we
call out of network, which means they don't contract with insurances,
but we provide you or receipt or what we call
a super bill that you can send into your insurance
for out of network reimbursement. So there are a lot
of options out there to help support moms if you
have insurance, and also if you're working with a therapist
who doesn't accept it. And you know, I talk a
(05:20):
lot about keygels, and in fact I'm doing them right
now because I can't talk about them without doing them.
But can you explain from a physical therapists perspective, how
keegel's work, who they're right for, and how we can
make sure we're doing them correctly. It's a great question
that could be an entire episode because but to start
(05:44):
with the basics. Keegels are contractions of the pelvic floor.
So when we think about a muscle in our body,
like our bicep, you bend your elbow and your bicep
contracts with the pelvic floor. A kegel is like you're
squeezing and lifting that hammock of muscles. So you're closing
the sphinc or where you're an exit, closing the anus
where gas or poop exits, and kind of you know,
(06:04):
lifting up. My favorite queue to tell people is think
about your sipping up a smoothie with your vagina, because
it's not a tightening, it's really kind of a pulling
up and lift and it's a totally weird que but
it somehow works. Um, So you know, that's just strengthen
the pelvic floor. And you bring up a great point, Heidi,
that not everybody maybe needs to do strengthening. A lot
(06:25):
of us have weakness, but a lot of us also
have tension, and kegels would not be the appropriate exercise
for that person, so they need to relax instead. Yes,
and I would say that a lot of folks out
there have pelvic floor attention and need to relax before
they start strengthening. That's a great point. Does that mean
that a mom moves already had a baby or two
(06:45):
will benefit more from keegeles than the first time mom that.
I think it's hard to say. We do know that
more often we have weakness postpartum, because again, if we
think about those muscles like a hammock, a hammock holding
an avocado and week ten is different than hammock holding
a watermelon in week forty. So just by the course
of pregnancy, our muscles get lengthened and relaxed and aren't
(07:08):
as supportive or strong. However, again, a lot of folks
still have tension after a cesarean birth, after paraneal tearing,
there can be muscle tension. Um Again, keels may not
be the first thing to start with. So we see
second time moms a lot who want to prepare for birth.
Oftentimes they have weakness, but then they also may have
tension and want to kind of just prevent some issues
(07:29):
along the way. So we've talked about just about every
pregnancy symptom at some point in this show, and I
can say pretty much most of them suck. Most of
them are not a fan of pregnancy symptoms. UM. Maybe
with the exception of bigger boobs or better hair um,
(07:51):
but a lot of the hair. The hair is definitely
a good side effect of pregnancy. But let's get into
some of the symptoms that might be impacted by your
pelvic flour. And of course there's peeing, and there are
lots of reasons why you p up a storm when
you are pregnant. I mean, there's all those hormones. There's
the position of your uterus, which is one of the
(08:12):
reasons why you piece so much early in pregnancy. And
you know, if you're peeing a lot, or you have
that urgency all the time, or you're having burning sometimes
you might have a U T I. So there's lots
of different reasons. But what is normal and what is
not when it comes to pregnancy p and how is
it related to your pelvic floor? Yeah, urinary function is
(08:35):
a big one when it comes to pregnancy, and we
often do find ourselves going more often again because of
pressure on the bladder, more fluid in our bodies. Urinary
leakage is a common symptom, but I wouldn't say it's
a normal symptom. So when you start experiencing urinary leakage
with a call for a sneeze or with exercise, it's
those muscles aren't holding in p as well as we
would want them too, So that means there's a muscle issue.
(08:57):
And that's when I would really say start working with
a physical therapist, because that means that's not necessarily going
to get better after childbirth and then postpartum, and so
it's something that you want to start addressing what it happens,
and it won't necessarily just go away. So I think
urinary leakage is probably the most common. Another common issue
is prolapse. So this is sounds scary, and it's not
(09:20):
as scary as it sounds, but the bladder shirts to
kind of drop down a little bit into the pelvic
floor muscles, so it feels like pressure, heaviness, something's falling out.
That's again common because of all the pressure from above,
or if we have a high intensity athlete who does
running and jumping, it's just more pressure over time. That's
another common bladder symptom that people may experience. How common
(09:40):
is that and how would you know? So we go
often based by symptoms and then of pressure, heaviness, back pain,
it feels like there's a tampon in your vagina when
there isn't And then we do a pelvic floor assessment
where we look through the vaginal opening, asked them to
bear down, and we can often see the kind of
the wall of the vagina where the bladder is supported
kind of pushing through. So you can tell by symptoms
(10:01):
and then again confirm with an evaluation, because lots of
pregnant women and you know, when they reach you know,
maybe thirty five, thirty six weeks, they're feeling that pressure anyway,
they're peeing a lot again anyway, but the leaking. Is
there really a way to train a pregnant bladder to
do new tricks like cold in p you'd be surprised
(10:22):
how to the pelvic floor can always do new tricks. So,
I mean, it's it's gonna be hard, But I think
a lot of what we want to do is help
prepare women also for postpartum. So teach them to contract,
tighten those pelvic floor muscles before a call for a sneeze,
so they get in the habit of doing that, so
postpartum they already have that maneuver in place. Teaching them
how to pee without pushing, So a lot of times.
(10:45):
A lot of moms are power peers, which means they
sit down and they like push really hard when they pee,
and that can cause more weakness so in muscles that
may already be weak. So we teach them to sit
and breathe and relax so that they don't cause more
weakness to their muscles. So teach them a lot of
really basic things that maybe no one's ever taught them,
but can help prevent issues from getting worse as well. Huh,
(11:06):
that's a lot of new tricks I just learned. Although
I'm not sure I ever pushed when I was paying.
I'm gonna have to think about that. So speaking of
things that are literally impacted by pregnancy, of course, you
know where I'm going. Constipation, Yes, and it's there for
a good reason. It's a purposeful symptom like most are
(11:27):
in pregnancy, and that's the slowing down of digestions so
your baby can absorb more nutrients. Also, you might be
taking iron, and iron can be constipating. And you know,
we know all about and we've heard over and over
about staying hydrated and eating the right foods, you know,
foods that are high end fiber, taking magnesium, but well,
(11:51):
we often don't talk about is how the pelvic floor
is associated with pooping, and clearly it is, so would
you like to enlighten us a bit us? And I
love talking about poop because I don't think we realize
the you know, no pun intended impact it has on
our health. I mean, if you take a good poop,
you're the rest of your day is can be amazing.
But if you don't take a good poop, then you're like,
(12:13):
all right, I'm already grumpy and it's eight am. So
you know, your pelvic floor muscles, just like with your bladder,
your pelvic flor muscles have to relax in order to
empty the balls where poop is kind of stored, and
if those muscles are not relaxing, well, it will get
backed up. What happens during pregnancy is again your colon
is slowing down, the poop gets really hard and difficult
(12:34):
to empty. So now I've got this really painful baseball
of poop and your muscles aren't relaxing to get it out,
and it can be excruciating. And that's another thing that
can lead to hemorrhoids, to fishers, to prolapse. So all
of the tips you mentioned probably taking natural call magnesium
is one of my favorites, staying hydrated, you know, avoiding
(12:56):
constipating foods, but a lot of us want carbs and
sweets and things like that. But the proper way to
poop is also helpful. So we teach folks to put
a little stool under their feet when they're pooping, so
that their knees get above their hip heights, so it
puts you in a squat, which is the best position
to relax your pelvic floor. And then we also teach
them to exhale when they're pushing poop out versus holding
(13:19):
their breath. When you hold your breath, you almost tighten
up a little bit, which makes it harder. So we
teach them to exhale and breathe out with their feet
on that stool. And that can make a huge difference
during pregnancy pooping. And it's really easy to remember because
stool for your stool, stool for your stool. You got it.
(13:46):
I would say everybody hurt sometimes, right, but pregnant women
seems to hurt a hole up more than anybody else,
especially in the third time ster that load you're carrying
gets bigger and heavier and pregnancy can be a pain,
a lot of pains. Yeah, it's a pain with a
purpose because your body is getting ready for childbirth. But
(14:09):
that's still must we accept it. Why does it happen?
What can we do about it? That is such a
great question, and you really nailed it that we don't
have to accept it. I think so often we hear
that leaking part of pregnancy, back pain, part of pregnancy,
pooping problems. But there are so many things that we
can do to help that we're just not automatically made
aware of. And that's where I think physical therapists are
(14:30):
really trying to advocate that there is support and help
for people during pregnancy. So we talked a little bit
earlier about the pelvis as that ring of bones and
then the muscles are at the very base. Well, you
have your abdominal muscles in the front, which we know
are getting stretched out, lengthening and offering you less support
during pregnancy, which can contribute to back pain and postural changes.
(14:52):
And you also have little ligaments in that pelvis in
the very front at the pubic bone and in the
very back at the sacrum, and those ligaments are getting softer.
Because we want the pelvis to expand to accommodate the
growing baby, but that also means a little less stability,
a little more loosey goosey joins, and that can cause
pain with you know, getting out of bed, rolling over,
(15:13):
getting out of the car, you know, bending over to
pick up a toddler. And there are things that can help.
We really encourage people to learn how to use their
core muscles when they're doing those day to day activity,
so kind of doing a little pelvic floor and pulling
in their bellies to give them some core support. We
also teach people how to get out of bed so
they're not like hiking up with their abs, they're rolling
(15:34):
to their side, and you know, how to get out
of a car by keeping their knees together so that
not stressing the pubic bone. And then also I really
encourage folks to wear these little belly supports, you know,
that is so helpful. It's literally just like a little
back breath or a little belly support, but it takes
some of the weight off so that you're not carrying
this heavy load all the time and you have something
(15:55):
that can help make it more comfortable. So that can
definitely give your backup break Now, the hip pain, especially
at night, is super uncomfortable for a lot of bombs
and getting into a comfortable sleeping position, which you would
say is lying on your side with a pillow between
your knees down to your ankles, so it's kind of
(16:16):
sandwich the whole way through your shins um. I like
to have one to two pillows under your head, so
sometimes we need a little bit more support under the head,
a little small pillow underneath a belly, especially during the
third trimester. And then I always needed something behind my back.
I tended to roll into my back a lot, so
when I would kind of get into my cozy position
on my side with all of my pillows, i'd have
(16:37):
my partner like shove a pillow behind my back. So
if I kind of rolled over in the middle of
the night, I was just still like sideline a little
bit versus all the way on my back. So that
just gave me some more options. And again, if that
hip is in a position where it's kind of cranked forward,
or you know, your knees are pressed together, over time
those muscles get tight and tense, which can lead to
(16:57):
hip paint. But using some pillows for adjustment really help.
Was there room for your partner on that bed with
all those pillows? We got a bigger bed. Okay, good,
we upgraded to a king Okay. So um, what exercises
should pregnant women avoid that might exacerbate those pains in
(17:18):
the back end? Hips? Are there any you can really
exercise all throughout pregnancy? Some things to start avoiding kind
of right around the second trimester, or crunches, double leg
list when you're lying on your back, most exercises lying
on your back. We try to encourage you to lie
on your side just to avoid any compression down on
you know, your vessels down below baby, but really holding
(17:38):
off on anything that causes that kind of sit up
maneuver with your abdomen because that will cause it to
stretch and lengthen and sometimes lead to a separation called
the diastasis recti, which looks like a little football or
coning at the midline of your belly. So that's helpful.
And then you know modifications if you're doing planks, you know,
get down on your knees and do planks. If you're
doing push ups, to them on the wall instead of
(17:59):
the ground. And then avoiding like deep lunches, where you
might stress some of those joints that are a little
bit more lax. Like we talked about earlier, a lot
of moms complain about severe pain in their pelvis in
their hips, and how do you know when it's time
to get help for that. I always recommend by the
way that you go see a pelvic for therapist. That's
(18:23):
always my go to. But how do you know it's
not something more serious like pelvic girdle pain that can
be excruciating. I feel like your entire pelvis is ripping apart.
So a little bit about that, absolutely, and ideally I
think this is where we want to change the narrative
for pregnant moms that if you are having sciatic pain
or pubic bone pain, we know that, Okay, let's send
(18:45):
that mom to see a pelvic PT and literally within
one to two sessions it can be such a quick
fix so they don't get to the point of debilitating pain.
But my rule of thumb is if something is, you know, painful,
and it's causing distress in your life, if it's causing
psychological or physical angst changes and it's affecting you, then
it's worthy of your attention. It's worthy of you seeking
(19:08):
care for it. A lot of the times, I think,
you know, I can speak for myself as a woman,
as a mom, I think I just have to deal
with stuff and I don't have time for it. But
when it starts impacting my quality of life of socializing
with friends or having endemoucy, use my partner, playing with
my kids, that's something that I really should be addressing,
no matter if it's a one out of ten pain
or a ten out of ten pain. Absolutely, and you
(19:28):
know you can be strong but still ask for help. Yes,
I think that that's really what takes strength, is saying
I need help exactly. You can use that in you know,
when it comes to pains, when it comes to other
pregnancy symptoms, that also when it comes to your emotions,
don't forget you can be strong and ask for help. Absolutely,
painful sex. There are reasons for painful sex that really
(19:51):
you know that might not be involving your pelvic muscles.
Maybe you have an infection for instance, you know, having
had sexual trama in your life that can cause painful sex.
Is this something that you hear about a lot? You know,
the research is really showing us that one in four
women will experience painful sex at some point in their lifetime,
(20:13):
which is a pretty astounding number. And I think I
share that to let women know that it's much more
common than we realize, and we're just not talking about it.
And we read a lot that you may have increased
libido or increased sexual desire or more vaginal lubrication during pregnancy.
But if you're not having that and you even have pain,
(20:33):
you start to think, is something wrong with me? Is
everybody else like this? And some of the common causes
we see of painful sex or some of the things
you already mentioned hip pain, back pain, it's difficult to
get into some of those positions and just kind of
awkward and uncomfortable. The other thing is muscle tension. You know,
these are muscles that if they are tighter tense, it's
(20:54):
gonna make it difficult for something to enter the vagina.
It can feel like something's getting bruised or is tender.
With deeper insertion, you can have pain afterwards, so that
can be uncomfortable. And even if they're scar tissue from
a previous cesarean birth or a previous perennial tear, that
can also be a cause of pain even during pregnancy.
(21:14):
So if one and for experience it probably far fewer
actually get treatment for it. In that right, it shouldn't
have to hurt. It should never hurt. And you know,
I think even we start to think, oh, well, maybe
it's a little bit normal, but it doesn't necessarily just
go away. I mean, I am a pelvic for physical therapist.
I've had two kids, and even this year I started
experiencing painful sex and I was like, Okay, I need
(21:36):
to go see one of the therapists in my office.
I need to get worked on I've been doing too
much cycling. And it was you know, four sessions. But
and I was so grateful that I knew this, But
it goes to show you. You know, everyone's pelvic floor
is susceptible to pelvic floor issues. We just don't always
know where to get help. So um, it should not hurt.
And if you are having pain with sex, I would
(21:56):
encourage you to report it to your medical provider and
seek the help of physical therapists. Certainly men would if
they had painful I think about that all of the time,
and even with respect to like periods and menstrual health,
and like if a quarter of their lives were affected
by their periods or something in their public floor, it
would be a different story. I'm not male bashing, by
(22:19):
the way. I'm just supporting my mom's sisters here. I'm
with you now. The separation that you spoke of, a
lot of people associate the separation of your abdominal muscles
with a postpartum sometimes gets diagnosed, sometimes it doesn't even
but you mentioned um doming and coraine shapes, which you
(22:40):
can also get when you're having bracts and hicks. Though, so,
how do you know the difference, How do you know
you have a separation, and is it too early to
start thinking about healing it? So during pregnancy, one of
the telltale signs is that you know, I tell we
have people lying on their back and they do a
little curl up. Their legs are straight, they're lying on
their back and they curl up their head and shoulders
off the ground. And if you look down at your
(23:02):
tummy and you see like a little cone in the middle,
you'll know exactly what it looks like. It looks like
a little red loaf in the middle of your tummy.
That's likely a separation of your abdominals and there's a
little bit of pressure coming through behind it, So it's common.
There's research to show seventy to ninety Some studies show
a hundred percent of women have it during pregnancy, which
I think that that's a little bit of inflated number,
(23:24):
but it shows us that the pressure isn't being managed well.
And I think about diastasis rector your abdominal separation the
same way I think about proaps or pelvic floor weakness.
The hammock is getting stretched. But are there things that
we can avoid to minimize that, Not doing the sit ups,
not getting out of bed, curling up, you know, watching
your core exercises, and then learning to kind of tighten
(23:46):
and engage those muscles during day to day activities when
they could be getting stressed. You know, that's one way,
and then Brexton Hicks is a little bit later. We
typically have that happening during third trimester. The Brexton Hicks
would just be showing you that it's there versus it
causing it. So it just kind of shows you, well,
there's more pressure in the tummy. You may see it happen. Yeah,
they are not fun sometimes not fun. Ever, I don't
(24:09):
think that's true. That's true. Well, they can be entertaining
to watch, like at least they were for me, but
they definitely were not fun to experience. So you also
(24:33):
work with women on how to prepare for birth. Yes,
what do you think helps most when you're trying to
get your body ready for the big day? Should you
get a birthing ball, should you do stretches? What are
your best tips? So I think a patient of mine
actually put it best when she said, gosh, it's actually
(24:53):
nice to learn what to do before you actually have
to do it. And during birth, what we are asked
skiing women to do, our birthing person to do is
to relax their pelvic floors and open them up so
that a baby can come on down the birth canal.
But if we've never been taught, first of all, we
don't even know that there are muscles down there sometimes,
and if you've never been taught how to relax them
(25:15):
and voluntarily push them open, and you're in the middle
of this really vulnerable birthing situation, it's a really difficult
thing to do. So during our childbirth preparation and we
do this virtually and we also do it in person,
is that we teach women a couple of things. We do.
Teach them how to do parenneal massage, which is kind
of softening the tissue at the base of the vaginal opening.
(25:36):
That's in an effort to just help relieve some muscle
tension if they do have tightness down there or some
previous card. Can we talk about that real quick before
you may do it? Sounds like a crowd pleaser, you know,
massage peneum, but lots of moms just can't get behind
the idea. Can you just give us a little tutorial
on peranneal massage and would you say it's a d
(25:58):
I Y project or you know, should you enlist a
friend kind of thing? Both you can do both, so
you know, at the start of COVID a year ago,
we actually did an online course teaching people how to
do this because all of the childbirth classes were canceled
and so it really showed us that, wow, people really
don't know how to do this. And the paradeum is
the area between the vaginal opening and the anal opening.
(26:21):
There are a lot of nicknames for it. However, the
way you massage the paradeum is actually by inserting a
finger into the vaginal opening and pushing down, so you're
kind of pushing into that muscle through the vagina. And
I like to think about the vaginal opening like a clock,
so you're thinking about from three o'clock all the way
to nine o'clock that lower half. You insert your finger
(26:41):
and just kind of push at different points in those clocks,
pull down, take a couple of deep breaths. It will
feel a little bit burnie. Once that burning starts to
soften and the muscle relaxes, you go to another spot
between three to six until you can kind of sweep
all the way across, almost like you're making a little
smiley face. I have folks do it starting around thirty
four weeks of IVAN. See. You can do it to yourself. Um,
(27:02):
you can do it while you're in the shower with
one leg up and like that Captain Morgan position. Or
you can enlist a partner and friend and have them
do it to you as well. So a lot of options,
and it's not a must. You know, the research is
showing it's variable the effectiveness. But I think any way
that we can learn how to connect with our bodies,
learn how these muscles work, is beneficial, and you know
you will be using these muscles. I mean, unless you
(27:25):
have a c section, but still those muscles are impacted.
So I feel either way you win. I agree. I agree,
And it's something commonly performed during childbirth, so it's it's
also helpful for them to know what to do prior
to birth exactly. And if nobody's giving you a perennial
massage during childbirth, should you ask for one? Is that
one of the best reasons to have a duela for instance?
(27:48):
You know, I think if it's something that you feel
like is effective for you, I don't see why not asking.
Other things that have been helpful to soften the pyreneum
are using a warm compress or even a warm wash
cloth over the area. Uh. And again, you know, back
to what we teach women what to do to prepare
for birth, as we teach them how to breathe when
they're pushing, we're finding that a lot of folks are
holding their breath when they're pushing, and that's not helping
(28:12):
the muscles relax to get out of the way. And
so we're teaching them to push while they're breathing. They're
not exhausted or they're not giving themselves hemorrhoids and prolapse,
and they feel like they can effectively relax these muscles.
Your pelvic floor muscles don't push your baby out. Your
uterus does. And we just want the muscles to get
out of the way. And so that's what we're trying
(28:34):
to help women do well. I guess that's a wrap
for pregnancy. We just had the baby leave the building,
so we're gonna pick back up with you when it's
time to talk postpartum. But we can't thank you enough
for being on today with What to Expect community. This
is so great. Thank you so much. Thank Sarah, baby
(28:58):
baby Off, need you, Oh how I need you. Thanks
for listening. Remember I'm always here for you. What to
Expect is always here for you. We're all in this together.
For more on what you heard on today's episode, visit
what to Expect dot com slash podcasts. You can also
(29:19):
check out What to Expect when You're Expecting, What to
Expect the First Year, and the What to Expect app.
And we want to hear from you. Connect with us
on our community message board or on our social media.
You can find me at Heidi Murkoff and Emma at
Emma bing W t E and of course, at What
(29:40):
to Expect Baby Love is performed by Riley Pieterer. What
to Expect is a production of I Heart Radio. From
More shows from I heart Radio check out the I
heart Radio app, Apple Podcasts, or wherever you listen to
your favorite shows. In my Arms on Don't You Stand
(30:01):
Kneed Kneed Jo, Baby Little Baby Loo
Oh, baby, baby, belof I need you, Oh how I
need you? What do you expect? As a production of
My Heart Radio, I'm your host Heidi Murkoff, and I'm
a mom on a mission, a mission to help you
know what to expect every step of the way. Sure,
(00:27):
you've had a vagina your whole life, but how much
do you really know about it? If you're like most women,
not all that much beyond some of the obvious stuff.
Chances are you know even less about the miraculous muscles
that support your vagina. Along with your uterus, your bladder,
and your bowels, your pelvic floor muscles. Not surprisingly, your
(00:52):
pelvic floor muscles are pretty pivotal when you're pregnant and
when there's a lot more that meets supporting. And even
if your baby doesn't end up exiting the building via
your vagina, pregnancy can take a toll on your pelvic floor.
Pee when you laugh for cough, had hip back, pelvic
or pubic pain or pressure, that's your pelvic floor muscles talking.
(01:17):
It's time to listen up and to listen to today's guest.
You may have heard of the vagina Whisperer, but her
real name is Sarah Reardon, and she's a pelvic floor
therapist and she's a mom of two boys, so she
and her pelvic floor have been there and done that.
Today she'll talk about pregnancy aches and pains, what's normal,
what's not, and how to prepare your pelvic floor for childbirth,
(01:40):
postpartum and beyond. So welcome Sarah, Hi, Heidi, Thanks for
having me, Thanks for being here. And I have to
say our vaginas and pelvic floors also, thank you. Happy
to be of service. I have to say it's the
first person to say penis on national televisi. I'm really
(02:01):
jealous about your title. How did you become the vagina Whisperer?
So it was actually a title given to me, so um.
I started in the field of pelvic floor physical therapy
right out of grad school in two thousand seven, and
there weren't a lot of pelvic floor physical therapist back then.
And I would see my college friends every summer and
(02:22):
I would end up in the hot tub with their
moms talking about bladder issues and leakage. And all of
my friends said, she's like the vagina whisper. And then
when I started my Instagram account a few years later,
it was for that group of friends. So I kind
of started, you know, just as a joke, and then
here we are, you know, four years later. Today we're
going to focus on caring for your pregnant pelvic floor
(02:44):
and all the wise in house. But before we get
into that, can you give us just a little bit
of pelvic floor? One oh one? Like, what's down there
on the floor? Why is it there? Why do you needed?
I mean, is it a case of you don't know
what you god till it's gone. So a little bit
of all of those things, And I think this is
a great place to start because a lot of people
(03:06):
don't know what is the pelvic floor, what does it do,
and how the heck is their physical therapy for it.
So all people have a pelvic floor, female, male, all genders,
and the pelvic floor is actually a basket of muscles
that sit at the base of the pelvis. So we're
all familiar with, you know, the bones of the pelvis,
but at the very basis a hammock of muscles that
support your organs like your bladder, your rectum in females
(03:30):
uterus and ovaries and males to prostate, and those muscles
support those organs and they also have stinkers that help
hold in p hold in poop and then assist with
vaginal birth and vaginal intercourse. So how do you know
if you need to see a pelvic floor therapist? Is
it something that should be routine for all pinnor women?
Is it covered by insurance? Is it something your your
(03:53):
doctor should refer you or your midwife? Right, so, you know,
we see folks coming in if they find us online,
if they hear about us from our friend or oftentimes
referred by physicians O b G, y m s and midwives.
The way that you should see one is that if
you have any issues with bladder health like urinary leakage,
overactive bladder difficulty emptying your stream, chronic urinary trucked infections,
(04:16):
pooping issues like constipation, fecal incontinence, or sexual health with
respect to painful intercourse or the inability to have intercourse
or painful orgasms. So the muscles play a role in
bowl health, bladder health, and sexual health, but they also
go through a huge transformation during pregnancy and birth, as
you and I both know. So that's really where I
(04:37):
feel like physical therapy should be standard care for women
during pregnancy to prevent issues, help them prepare for childbirth,
and then postpartum to help with recovery. So helveic for
physical therapy really falls under physical therapy. So if your
insurance covers physical therapy, which most of them do, and
you find a clinic that does take insurance, and you
can absolutely go and see a physical therapist and it's
(04:59):
covered under insure rents. Oftentimes some clinics or what we
call out of network, which means they don't contract with insurances,
but we provide you or receipt or what we call
a super bill that you can send into your insurance
for out of network reimbursement. So there are a lot
of options out there to help support moms if you
have insurance, and also if you're working with a therapist
who doesn't accept it. And you know, I talk a
(05:20):
lot about keygels, and in fact I'm doing them right
now because I can't talk about them without doing them.
But can you explain from a physical therapists perspective, how
keegel's work, who they're right for, and how we can
make sure we're doing them correctly. It's a great question
that could be an entire episode because but to start
(05:44):
with the basics. Keegels are contractions of the pelvic floor.
So when we think about a muscle in our body,
like our bicep, you bend your elbow and your bicep
contracts with the pelvic floor. A kegel is like you're
squeezing and lifting that hammock of muscles. So you're closing
the sphinc or where you're an exit, closing the anus
where gas or poop exits, and kind of you know,
(06:04):
lifting up. My favorite queue to tell people is think
about your sipping up a smoothie with your vagina, because
it's not a tightening, it's really kind of a pulling
up and lift and it's a totally weird que but
it somehow works. Um, So you know, that's just strengthen
the pelvic floor. And you bring up a great point, Heidi,
that not everybody maybe needs to do strengthening. A lot
(06:25):
of us have weakness, but a lot of us also
have tension, and kegels would not be the appropriate exercise
for that person, so they need to relax instead. Yes,
and I would say that a lot of folks out
there have pelvic floor attention and need to relax before
they start strengthening. That's a great point. Does that mean
that a mom moves already had a baby or two
(06:45):
will benefit more from keegeles than the first time mom that.
I think it's hard to say. We do know that
more often we have weakness postpartum, because again, if we
think about those muscles like a hammock, a hammock holding
an avocado and week ten is different than hammock holding
a watermelon in week forty. So just by the course
of pregnancy, our muscles get lengthened and relaxed and aren't
(07:08):
as supportive or strong. However, again, a lot of folks
still have tension after a cesarean birth, after paraneal tearing,
there can be muscle tension. Um Again, keels may not
be the first thing to start with. So we see
second time moms a lot who want to prepare for birth.
Oftentimes they have weakness, but then they also may have
tension and want to kind of just prevent some issues
(07:29):
along the way. So we've talked about just about every
pregnancy symptom at some point in this show, and I
can say pretty much most of them suck. Most of
them are not a fan of pregnancy symptoms. UM. Maybe
with the exception of bigger boobs or better hair um,
(07:51):
but a lot of the hair. The hair is definitely
a good side effect of pregnancy. But let's get into
some of the symptoms that might be impacted by your
pelvic flour. And of course there's peeing, and there are
lots of reasons why you p up a storm when
you are pregnant. I mean, there's all those hormones. There's
the position of your uterus, which is one of the
(08:12):
reasons why you piece so much early in pregnancy. And
you know, if you're peeing a lot, or you have
that urgency all the time, or you're having burning sometimes
you might have a U T I. So there's lots
of different reasons. But what is normal and what is
not when it comes to pregnancy p and how is
it related to your pelvic floor? Yeah, urinary function is
(08:35):
a big one when it comes to pregnancy, and we
often do find ourselves going more often again because of
pressure on the bladder, more fluid in our bodies. Urinary
leakage is a common symptom, but I wouldn't say it's
a normal symptom. So when you start experiencing urinary leakage
with a call for a sneeze or with exercise, it's
those muscles aren't holding in p as well as we
would want them too, So that means there's a muscle issue.
(08:57):
And that's when I would really say start working with
a physical therapist, because that means that's not necessarily going
to get better after childbirth and then postpartum, and so
it's something that you want to start addressing what it happens,
and it won't necessarily just go away. So I think
urinary leakage is probably the most common. Another common issue
is prolapse. So this is sounds scary, and it's not
(09:20):
as scary as it sounds, but the bladder shirts to
kind of drop down a little bit into the pelvic
floor muscles, so it feels like pressure, heaviness, something's falling out.
That's again common because of all the pressure from above,
or if we have a high intensity athlete who does
running and jumping, it's just more pressure over time. That's
another common bladder symptom that people may experience. How common
(09:40):
is that and how would you know? So we go
often based by symptoms and then of pressure, heaviness, back pain,
it feels like there's a tampon in your vagina when
there isn't And then we do a pelvic floor assessment
where we look through the vaginal opening, asked them to
bear down, and we can often see the kind of
the wall of the vagina where the bladder is supported
kind of pushing through. So you can tell by symptoms
(10:01):
and then again confirm with an evaluation, because lots of
pregnant women and you know, when they reach you know,
maybe thirty five, thirty six weeks, they're feeling that pressure anyway,
they're peeing a lot again anyway, but the leaking. Is
there really a way to train a pregnant bladder to
do new tricks like cold in p you'd be surprised
(10:22):
how to the pelvic floor can always do new tricks. So,
I mean, it's it's gonna be hard, But I think
a lot of what we want to do is help
prepare women also for postpartum. So teach them to contract,
tighten those pelvic floor muscles before a call for a sneeze,
so they get in the habit of doing that, so
postpartum they already have that maneuver in place. Teaching them
how to pee without pushing, So a lot of times.
(10:45):
A lot of moms are power peers, which means they
sit down and they like push really hard when they pee,
and that can cause more weakness so in muscles that
may already be weak. So we teach them to sit
and breathe and relax so that they don't cause more
weakness to their muscles. So teach them a lot of
really basic things that maybe no one's ever taught them,
but can help prevent issues from getting worse as well. Huh,
(11:06):
that's a lot of new tricks I just learned. Although
I'm not sure I ever pushed when I was paying.
I'm gonna have to think about that. So speaking of
things that are literally impacted by pregnancy, of course, you
know where I'm going. Constipation, Yes, and it's there for
a good reason. It's a purposeful symptom like most are
(11:27):
in pregnancy, and that's the slowing down of digestions so
your baby can absorb more nutrients. Also, you might be
taking iron, and iron can be constipating. And you know,
we know all about and we've heard over and over
about staying hydrated and eating the right foods, you know,
foods that are high end fiber, taking magnesium, but well,
(11:51):
we often don't talk about is how the pelvic floor
is associated with pooping, and clearly it is, so would
you like to enlighten us a bit us? And I
love talking about poop because I don't think we realize
the you know, no pun intended impact it has on
our health. I mean, if you take a good poop,
you're the rest of your day is can be amazing.
But if you don't take a good poop, then you're like,
(12:13):
all right, I'm already grumpy and it's eight am. So
you know, your pelvic floor muscles, just like with your bladder,
your pelvic flor muscles have to relax in order to
empty the balls where poop is kind of stored, and
if those muscles are not relaxing, well, it will get
backed up. What happens during pregnancy is again your colon
is slowing down, the poop gets really hard and difficult
(12:34):
to empty. So now I've got this really painful baseball
of poop and your muscles aren't relaxing to get it out,
and it can be excruciating. And that's another thing that
can lead to hemorrhoids, to fishers, to prolapse. So all
of the tips you mentioned probably taking natural call magnesium
is one of my favorites, staying hydrated, you know, avoiding
(12:56):
constipating foods, but a lot of us want carbs and
sweets and things like that. But the proper way to
poop is also helpful. So we teach folks to put
a little stool under their feet when they're pooping, so
that their knees get above their hip heights, so it
puts you in a squat, which is the best position
to relax your pelvic floor. And then we also teach
them to exhale when they're pushing poop out versus holding
(13:19):
their breath. When you hold your breath, you almost tighten
up a little bit, which makes it harder. So we
teach them to exhale and breathe out with their feet
on that stool. And that can make a huge difference
during pregnancy pooping. And it's really easy to remember because
stool for your stool, stool for your stool. You got it.
(13:46):
I would say everybody hurt sometimes, right, but pregnant women
seems to hurt a hole up more than anybody else,
especially in the third time ster that load you're carrying
gets bigger and heavier and pregnancy can be a pain,
a lot of pains. Yeah, it's a pain with a
purpose because your body is getting ready for childbirth. But
(14:09):
that's still must we accept it. Why does it happen?
What can we do about it? That is such a
great question, and you really nailed it that we don't
have to accept it. I think so often we hear
that leaking part of pregnancy, back pain, part of pregnancy,
pooping problems. But there are so many things that we
can do to help that we're just not automatically made
aware of. And that's where I think physical therapists are
(14:30):
really trying to advocate that there is support and help
for people during pregnancy. So we talked a little bit
earlier about the pelvis as that ring of bones and
then the muscles are at the very base. Well, you
have your abdominal muscles in the front, which we know
are getting stretched out, lengthening and offering you less support
during pregnancy, which can contribute to back pain and postural changes.
(14:52):
And you also have little ligaments in that pelvis in
the very front at the pubic bone and in the
very back at the sacrum, and those ligaments are getting softer.
Because we want the pelvis to expand to accommodate the
growing baby, but that also means a little less stability,
a little more loosey goosey joins, and that can cause
pain with you know, getting out of bed, rolling over,
(15:13):
getting out of the car, you know, bending over to
pick up a toddler. And there are things that can help.
We really encourage people to learn how to use their
core muscles when they're doing those day to day activity,
so kind of doing a little pelvic floor and pulling
in their bellies to give them some core support. We
also teach people how to get out of bed so
they're not like hiking up with their abs, they're rolling
(15:34):
to their side, and you know, how to get out
of a car by keeping their knees together so that
not stressing the pubic bone. And then also I really
encourage folks to wear these little belly supports, you know,
that is so helpful. It's literally just like a little
back breath or a little belly support, but it takes
some of the weight off so that you're not carrying
this heavy load all the time and you have something
(15:55):
that can help make it more comfortable. So that can
definitely give your backup break Now, the hip pain, especially
at night, is super uncomfortable for a lot of bombs
and getting into a comfortable sleeping position, which you would
say is lying on your side with a pillow between
your knees down to your ankles, so it's kind of
(16:16):
sandwich the whole way through your shins um. I like
to have one to two pillows under your head, so
sometimes we need a little bit more support under the head,
a little small pillow underneath a belly, especially during the
third trimester. And then I always needed something behind my back.
I tended to roll into my back a lot, so
when I would kind of get into my cozy position
on my side with all of my pillows, i'd have
(16:37):
my partner like shove a pillow behind my back. So
if I kind of rolled over in the middle of
the night, I was just still like sideline a little
bit versus all the way on my back. So that
just gave me some more options. And again, if that
hip is in a position where it's kind of cranked forward,
or you know, your knees are pressed together, over time
those muscles get tight and tense, which can lead to
(16:57):
hip paint. But using some pillows for adjustment really help.
Was there room for your partner on that bed with
all those pillows? We got a bigger bed. Okay, good,
we upgraded to a king Okay. So um, what exercises
should pregnant women avoid that might exacerbate those pains in
(17:18):
the back end? Hips? Are there any you can really
exercise all throughout pregnancy? Some things to start avoiding kind
of right around the second trimester, or crunches, double leg
list when you're lying on your back, most exercises lying
on your back. We try to encourage you to lie
on your side just to avoid any compression down on
you know, your vessels down below baby, but really holding
(17:38):
off on anything that causes that kind of sit up
maneuver with your abdomen because that will cause it to
stretch and lengthen and sometimes lead to a separation called
the diastasis recti, which looks like a little football or
coning at the midline of your belly. So that's helpful.
And then you know modifications if you're doing planks, you know,
get down on your knees and do planks. If you're
doing push ups, to them on the wall instead of
(17:59):
the ground. And then avoiding like deep lunches, where you
might stress some of those joints that are a little
bit more lax. Like we talked about earlier, a lot
of moms complain about severe pain in their pelvis in
their hips, and how do you know when it's time
to get help for that. I always recommend by the
way that you go see a pelvic for therapist. That's
(18:23):
always my go to. But how do you know it's
not something more serious like pelvic girdle pain that can
be excruciating. I feel like your entire pelvis is ripping apart.
So a little bit about that, absolutely, and ideally I
think this is where we want to change the narrative
for pregnant moms that if you are having sciatic pain
or pubic bone pain, we know that, Okay, let's send
(18:45):
that mom to see a pelvic PT and literally within
one to two sessions it can be such a quick
fix so they don't get to the point of debilitating pain.
But my rule of thumb is if something is, you know, painful,
and it's causing distress in your life, if it's causing
psychological or physical angst changes and it's affecting you, then
it's worthy of your attention. It's worthy of you seeking
(19:08):
care for it. A lot of the times, I think,
you know, I can speak for myself as a woman,
as a mom, I think I just have to deal
with stuff and I don't have time for it. But
when it starts impacting my quality of life of socializing
with friends or having endemoucy, use my partner, playing with
my kids, that's something that I really should be addressing,
no matter if it's a one out of ten pain
or a ten out of ten pain. Absolutely, and you
(19:28):
know you can be strong but still ask for help. Yes,
I think that that's really what takes strength, is saying
I need help exactly. You can use that in you know,
when it comes to pains, when it comes to other
pregnancy symptoms, that also when it comes to your emotions,
don't forget you can be strong and ask for help. Absolutely,
painful sex. There are reasons for painful sex that really
(19:51):
you know that might not be involving your pelvic muscles.
Maybe you have an infection for instance, you know, having
had sexual trama in your life that can cause painful sex.
Is this something that you hear about a lot? You know,
the research is really showing us that one in four
women will experience painful sex at some point in their lifetime,
(20:13):
which is a pretty astounding number. And I think I
share that to let women know that it's much more
common than we realize, and we're just not talking about it.
And we read a lot that you may have increased
libido or increased sexual desire or more vaginal lubrication during pregnancy.
But if you're not having that and you even have pain,
(20:33):
you start to think, is something wrong with me? Is
everybody else like this? And some of the common causes
we see of painful sex or some of the things
you already mentioned hip pain, back pain, it's difficult to
get into some of those positions and just kind of
awkward and uncomfortable. The other thing is muscle tension. You know,
these are muscles that if they are tighter tense, it's
(20:54):
gonna make it difficult for something to enter the vagina.
It can feel like something's getting bruised or is tender.
With deeper insertion, you can have pain afterwards, so that
can be uncomfortable. And even if they're scar tissue from
a previous cesarean birth or a previous perennial tear, that
can also be a cause of pain even during pregnancy.
(21:14):
So if one and for experience it probably far fewer
actually get treatment for it. In that right, it shouldn't
have to hurt. It should never hurt. And you know,
I think even we start to think, oh, well, maybe
it's a little bit normal, but it doesn't necessarily just
go away. I mean, I am a pelvic for physical therapist.
I've had two kids, and even this year I started
experiencing painful sex and I was like, Okay, I need
(21:36):
to go see one of the therapists in my office.
I need to get worked on I've been doing too
much cycling. And it was you know, four sessions. But
and I was so grateful that I knew this, But
it goes to show you. You know, everyone's pelvic floor
is susceptible to pelvic floor issues. We just don't always
know where to get help. So um, it should not hurt.
And if you are having pain with sex, I would
(21:56):
encourage you to report it to your medical provider and
seek the help of physical therapists. Certainly men would if
they had painful I think about that all of the time,
and even with respect to like periods and menstrual health,
and like if a quarter of their lives were affected
by their periods or something in their public floor, it
would be a different story. I'm not male bashing, by
(22:19):
the way. I'm just supporting my mom's sisters here. I'm
with you now. The separation that you spoke of, a
lot of people associate the separation of your abdominal muscles
with a postpartum sometimes gets diagnosed, sometimes it doesn't even
but you mentioned um doming and coraine shapes, which you
(22:40):
can also get when you're having bracts and hicks. Though, so,
how do you know the difference, How do you know
you have a separation, and is it too early to
start thinking about healing it? So during pregnancy, one of
the telltale signs is that you know, I tell we
have people lying on their back and they do a
little curl up. Their legs are straight, they're lying on
their back and they curl up their head and shoulders
off the ground. And if you look down at your
(23:02):
tummy and you see like a little cone in the middle,
you'll know exactly what it looks like. It looks like
a little red loaf in the middle of your tummy.
That's likely a separation of your abdominals and there's a
little bit of pressure coming through behind it, So it's common.
There's research to show seventy to ninety Some studies show
a hundred percent of women have it during pregnancy, which
I think that that's a little bit of inflated number,
(23:24):
but it shows us that the pressure isn't being managed well.
And I think about diastasis rector your abdominal separation the
same way I think about proaps or pelvic floor weakness.
The hammock is getting stretched. But are there things that
we can avoid to minimize that, Not doing the sit ups,
not getting out of bed, curling up, you know, watching
your core exercises, and then learning to kind of tighten
(23:46):
and engage those muscles during day to day activities when
they could be getting stressed. You know, that's one way,
and then Brexton Hicks is a little bit later. We
typically have that happening during third trimester. The Brexton Hicks
would just be showing you that it's there versus it
causing it. So it just kind of shows you, well,
there's more pressure in the tummy. You may see it happen. Yeah,
they are not fun sometimes not fun. Ever, I don't
(24:09):
think that's true. That's true. Well, they can be entertaining
to watch, like at least they were for me, but
they definitely were not fun to experience. So you also
(24:33):
work with women on how to prepare for birth. Yes,
what do you think helps most when you're trying to
get your body ready for the big day? Should you
get a birthing ball, should you do stretches? What are
your best tips? So I think a patient of mine
actually put it best when she said, gosh, it's actually
(24:53):
nice to learn what to do before you actually have
to do it. And during birth, what we are asked
skiing women to do, our birthing person to do is
to relax their pelvic floors and open them up so
that a baby can come on down the birth canal.
But if we've never been taught, first of all, we
don't even know that there are muscles down there sometimes,
and if you've never been taught how to relax them
(25:15):
and voluntarily push them open, and you're in the middle
of this really vulnerable birthing situation, it's a really difficult
thing to do. So during our childbirth preparation and we
do this virtually and we also do it in person,
is that we teach women a couple of things. We do.
Teach them how to do parenneal massage, which is kind
of softening the tissue at the base of the vaginal opening.
(25:36):
That's in an effort to just help relieve some muscle
tension if they do have tightness down there or some
previous card. Can we talk about that real quick before
you may do it? Sounds like a crowd pleaser, you know,
massage peneum, but lots of moms just can't get behind
the idea. Can you just give us a little tutorial
on peranneal massage and would you say it's a d
(25:58):
I Y project or you know, should you enlist a
friend kind of thing? Both you can do both, so
you know, at the start of COVID a year ago,
we actually did an online course teaching people how to
do this because all of the childbirth classes were canceled
and so it really showed us that, wow, people really
don't know how to do this. And the paradeum is
the area between the vaginal opening and the anal opening.
(26:21):
There are a lot of nicknames for it. However, the
way you massage the paradeum is actually by inserting a
finger into the vaginal opening and pushing down, so you're
kind of pushing into that muscle through the vagina. And
I like to think about the vaginal opening like a clock,
so you're thinking about from three o'clock all the way
to nine o'clock that lower half. You insert your finger
(26:41):
and just kind of push at different points in those clocks,
pull down, take a couple of deep breaths. It will
feel a little bit burnie. Once that burning starts to
soften and the muscle relaxes, you go to another spot
between three to six until you can kind of sweep
all the way across, almost like you're making a little
smiley face. I have folks do it starting around thirty
four weeks of IVAN. See. You can do it to yourself. Um,
(27:02):
you can do it while you're in the shower with
one leg up and like that Captain Morgan position. Or
you can enlist a partner and friend and have them
do it to you as well. So a lot of options,
and it's not a must. You know, the research is
showing it's variable the effectiveness. But I think any way
that we can learn how to connect with our bodies,
learn how these muscles work, is beneficial, and you know
you will be using these muscles. I mean, unless you
(27:25):
have a c section, but still those muscles are impacted.
So I feel either way you win. I agree. I agree,
And it's something commonly performed during childbirth, so it's it's
also helpful for them to know what to do prior
to birth exactly. And if nobody's giving you a perennial
massage during childbirth, should you ask for one? Is that
one of the best reasons to have a duela for instance?
(27:48):
You know, I think if it's something that you feel
like is effective for you, I don't see why not asking.
Other things that have been helpful to soften the pyreneum
are using a warm compress or even a warm wash
cloth over the area. Uh. And again, you know, back
to what we teach women what to do to prepare
for birth, as we teach them how to breathe when
they're pushing, we're finding that a lot of folks are
holding their breath when they're pushing, and that's not helping
(28:12):
the muscles relax to get out of the way. And
so we're teaching them to push while they're breathing. They're
not exhausted or they're not giving themselves hemorrhoids and prolapse,
and they feel like they can effectively relax these muscles.
Your pelvic floor muscles don't push your baby out. Your
uterus does. And we just want the muscles to get
out of the way. And so that's what we're trying
(28:34):
to help women do well. I guess that's a wrap
for pregnancy. We just had the baby leave the building,
so we're gonna pick back up with you when it's
time to talk postpartum. But we can't thank you enough
for being on today with What to Expect community. This
is so great. Thank you so much. Thank Sarah, baby
(28:58):
baby Off, need you, Oh how I need you. Thanks
for listening. Remember I'm always here for you. What to
Expect is always here for you. We're all in this together.
For more on what you heard on today's episode, visit
what to Expect dot com slash podcasts. You can also
(29:19):
check out What to Expect when You're Expecting, What to
Expect the First Year, and the What to Expect app.
And we want to hear from you. Connect with us
on our community message board or on our social media.
You can find me at Heidi Murkoff and Emma at
Emma bing W t E and of course, at What
(29:40):
to Expect Baby Love is performed by Riley Pieterer. What
to Expect is a production of I Heart Radio. From
More shows from I heart Radio check out the I
heart Radio app, Apple Podcasts, or wherever you listen to
your favorite shows. In my Arms on Don't You Stand
(30:01):
Kneed Kneed Jo, Baby Little Baby Loo
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