August 31, 2024 • 32 mins
Dr. Betty DeLass, a pelvic floor health specialist, discusses the importance of pelvic floor therapy during and after pregnancy. She emphasizes the need for prehab and rehab to prevent and address pelvic dysfunction. Dr. Betty explains that the pelvic floor is a sling of muscles that supports organs and helps with various bodily functions. She highlights the impact of pregnancy on the pelvic floor and the need for rehabilitation to restore its function. Dr. Betty also addresses the differences in care between cesarean and vaginal births and the importance of individualized treatment. She emphasizes the connection between the pelvic floor and other areas of the body, such as the core and glutes. Dr. Betty recommends early intervention and individualized care to optimize pelvic floor health.
CHAPTERS
00:00 Understanding the Pelvic Floor 07:53 Different Care for Cesarean and Vaginal Births 10:00 The Importance of Prehab and Rehab 16:02 The Connection Between the Pelvic Floor and Other Areas of the Body 25:47 The Six-Week Mark and Beyond
RESOURCES Belly Binder Book - The Body Keeps the Score Come As You Are Reborn Health Pelvic Rehab Website
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:05):
It's the Best Birth Podcast, wherewe interview experts that elevate
you as you prepare your heartand mind to have the best birth.
Each episode will interviewprofessionals so you are prepared
for pregnancy, birth, and postpartum.
Our experts will build your confidenceand empower you to trust your
intuition throughout your pregnancy.
This audio is takenfrom videos on YouTube.
(00:27):
Watch the entire episodes onYouTube at Birth Made Mindful.
Thank you for tuning in thisweek to the best birth podcast.
We're excited to have Dr.
Betty D 'alas with us today.
A pelvic floor health specialist.
Dr.
Betty is the founder and owner ofReborn Pelvic Health and Wellness.
She is extremely passionate aboutchanging the standard of care
(00:47):
before, during, and after pregnancybecause postpartum is forever.
Betty is a world -classpelvic health expert.
and has built a center of excellence inUtah for pelvic floor physical therapy.
She is a physical therapist by tradeand has helped thousands of people
throughout her 12 plus year careerto function, feel, and move better.
(01:08):
And knowing firsthand how difficultit can be with two children of
her own, she wanted to help othersget back to living their lives
to the fullest without shame orembarrassment about their pelvic health.
Unfortunately, more often thannot, pelvic dysfunction can lead
to postpartum mood disorders.
secondary to an inability to get backto activity because of unexpected
(01:28):
physical changes, pain, discomfort,leaking and or painful intimacy.
What if we worked more upstream?
What if we worked onpreventing dysfunction from
happening in the first place?
And what if we provided true rehaband prehab to our birthing people?
And that was where Reborn was derived.
As the business continues to grow,we are adding more specialties
(01:51):
outside of pregnancy and postpartum.
Dr.
Betty DeLass, PT, DPT [01:01]
.The Best Birth [01:24]
as Reborn recruits and retains top-notch pelvic floor physical therapists
in men's and pediatric specialties.
As a doctor of physical therapy, shebelieves one -on -one care is best.
She is also passionate about findingthe why behind your symptoms, optimizing
your body, and empowering you to becomethe expert of your own body so that
(02:12):
you can live life to the fullest.
When not at work, you can find Dr.
Betty hanging out with her husband, twodaughters, and two fur babies, dogs.
Dr.
Betty DeLass, PT, DPT [01:31]
.Thank you.
Thanks for the fabulous intro.
The Best Birth [01:52]
She also spends her time enjoyingendurance sports like marathon training,
triathlon training, lifting weights,hiking, and cross -country skiing.
Welcome, Betty!
That is fantastic!
(02:35):
Yes, we are excited to jump right inand talk about pelvic floor therapy.
So just beginning, whatis the pelvic floor?
Dr.
Betty DeLass, PT, DPT [02:14]
Yeah, pelvic floor.
So most people are like, hmm,pelvic floor, what's that?
It's a sling of muscles that sits inbetween your pubic bone and your tailbone.
It supports your organs, ithelps with sexual function,
pooping, peeing, things like that.
(02:55):
And so if you don't know that youhave a pelvic floor, that probably
means it's like working well.
Most people don't know they have apelvic floor until something's wrong
or dysfunctional and they're like,this is not right, I need help.
So it's the area underneathwhere you sit on between your
sit bones, pubic bone, tailbone.
and it's like a hammockunderneath there of just muscles.
The Best Birth [02:46]
And would you say pregnancy iskind of like the number one reason
(03:18):
someone would come to you and say,hey, it's not working anymore?
Dr.
Betty DeLass, PT, DPT [02:51]
Sure.
I think there's a variety of reasonswhy people would come to see us.
The business primarily started inpregnancy postpartum because that
was what my passion was aroundwhen I went through those things.
And obviously there's many other reasonswhy you would need pelvic floor therapy.
There's plenty of people who have neverhad babies that need pelvic floor therapy.
(03:40):
Men can need pelvic floor therapy.
Kids can need pelvic floor therapy, right?
So we're adding those arms tothe business in as we grow.
But that's where the passion,that's where Reborn started was
truly like pregnancy postpartum.
And if you think about it, like ifyou were to have a knee surgery or
shoulder surgery, you would go tophysical therapy before and then you'd
have your surgery and then you wouldgo after immediately and you would
(04:03):
go for months and multiple sessions.
And when we grow a human inside of us,it changes multiple areas of your body,
your rib cage, your core, your lowback, your glutes, your pelvic floor.
and all of these things changerapidly over nine to 10 months.
And then you go from being extremelypregnant to not pregnant at all, and
then you have to recover from that.
(04:24):
And so it's just this hugemusculoskeletal change.
And I would argue the biggestmusculoskeletal change, even more so
than a knee surgery or shoulder surgery,because that's like one area of your body
and you can like recover and rest from it.
Like your pelvic floor, you can't,like you still have to poop and
pee and sit and carry and liftbaby and take care of family.
And like, so you don't actuallylike truly get to like,
(04:44):
rest it, it's still being used.
And so it just it's mind -blowing to thinkthat like we wouldn't be doing the prehab
and the rehab during this time of life.
And some of us do itmultiple times, right?
And so it's like what are we doing?
We need to do this for our for our ourbirthing So that's kind of like what
we what we started out specializing in.
(05:05):
Other areas that we help with ispeople who have painful intercourse
or conditions like vaginismus wherethe vaginal canal is tight and
and hard to have either a tampon in,speculum, intercourse, then baby coming
out if that's the route that it comes.
So there's areas with that or likeendometriosis or painful periods,
(05:26):
we can help with those things.
Constipation, leaking, prolapse,diastasis recti, separation of the
abdominal wall, which is primarilydue to pregnancy and things like that.
And then there's other...
facets do that too.
A lot of orthopedic conditionsare underlying with that.
So we have like low back pain orSI joint pain or pubic bone pain,
(05:48):
tailbone pain, anything that's there.
It's often a combination of thingsboth inside the pelvis and outside
the pelvis that creates issuessurrounding pelvic floor things.
And then you could add in the wholefacet of men, but this is about
the best birth podcast, so we'llkeep it focused on that for today.
The Best Birth [05:39]
Sounds great.
(06:09):
How does care differ when it's acesarean versus a vaginal birth?
Dr.
Betty DeLass, PT, DPT [05:44]
Yeah, great question.
So with a vaginal birth, itstretches the pelvic floor.
With a cesarean birth, it's amajor abdominal surgery that cuts
through seven layers in the abdomen.
And so there's differences becauseof the surgery that happened.
So like when you have a vaginal birth, thebaby's still grown on top of your pelvic
(06:31):
floor, all these other changes happen.
Same thing with the C -section.
Like baby still grew on top of thepelvic floor, body still changes.
So you have those both things happening.
When a baby comes through, itstretches your pelvic floor muscles.
two to three times their lengthand they survive to tell a
story most of the time, right?
But there could be tearing orscar tissue or things like that.
Prolapse might be more of a commonthing or incontinence might be
(06:52):
more in the vaginal delivery.
Where in a C -section, it depends onif they push, didn't push, how long
did they push, things like that.
So they might have both depending on wherethat happened or if it's an opted in C
-section or preventative measures and theydidn't push at all, then it might just be
the recovery from the abdominal surgery.
but on top of like being stillgrowing inside your body.
(07:15):
But you might not have as much likeleaking or prolapse, but a lot, there
are usually more pain with intercourse orsymptoms of UTI like things because of the
fascia that gets stretched and the scartissue that forms causes a pulling on the
front half of the pelvic floor and cancreate symptoms like frequency, urgency,
pain with intercourse, things like that.
(07:35):
So we work on that.
And that would be a generalization ifI were to like categorize differently.
But a lot of that could overlapand you could have none of the
C -section, you could have allthose things and vice versa.
But that would be like ageneralization if I could split it.
The Best Birth [07:21]
It feels so important though, to mention,because a lot of people think that if you
have a C -section, then you're kind ofspared from some of these problems, the
(07:58):
incontinence or the painful intercourse.
And that's not the case, in some people'ssituation, it's actually worse, if they
have one or the other type of delivery.
And so this is so great that youare walking us through and telling
us kind of what to look out for.
And just to evaluate like therisk and the benefit of, of
some of these modes of delivery.
Dr.
Betty DeLass, PT, DPT [07:26]
Yes.
Exactly.
Yep.
And same thing with like, I mean, everyoneknows that mom butts a real thing.
(08:20):
And so like when you're pregnantand postpartum, right, you're
like, turns into a pancake.
And so if you think about it, goingback to the analogy of like the knee
surgery, usually if you have a kneesurgery, your quad or the front of your
leg gets inhibited and it gets weakerand you have to like get that activated.
Same thing happens when you grow a baby.
That's your core, yourglutes, your low back.
pelvic floor so it's like multiple areasand so we have to realize that like we
(08:43):
do need to re -engage those muscles getthem back on activated especially the
glutes because they're a big muscle thatsupports the pelvis and the cornerstone
of movement there so it's really reallyimportant to make sure that we're like
for both types of deliveries focusingon those things and the core on top
of that to get people back so they can
(09:03):
pick up their kids or give their kids abath or lift the Costco box into the car.
There's so many functional thingsthat we need our bodies for and
if we don't rehab them, it can bedetrimental to the quality of your life.
The Best Birth [08:47]
And can we talk a littlebit about the prehab?
So I am so curious, I have had threebabies and I have never once done any
sort of prehab for my pelvic floor.
(09:25):
Can you give us just a couple of examplesof what we could be doing if we don't
have access to a pelvic floor specialist?
Dr.
Betty DeLass, PT, DPT [08:49]
Yeah.
Yeah.
Totally, totally.
So there's a couple thingsI'm gonna add in there.
So most people are like, I'lljust wait till after I have
a baby, then I'll come in.
And it's like, we can doso much ahead of time.
So a lot of times we can do that prehaband we can catch things that are either
there that you don't know are there.
(09:46):
They were subclinical before, meaningyou had no symptoms, but we're finding
them and catching them early so that itcan prevent things further down the line.
And so when we think prehab, we often getpeople coming in before they're even like,
becoming sexually active before they'rewanting to get pregnant, just like you
would have a preconception appointment.
(10:06):
You would go in and be like,how does everything look?
How are my hormones?
How is this going?
We do that from a musculoskeletallens of how are you moving?
How is your low back moving?
Your hips moving?
Your pelvic foot?
How is everything moving?
Is there anything there thatwe can work on ahead of time
to prep and get you there?
We also do fertility work as well.
So from a mechanical perspective,obviously we can't change someone's
(10:27):
hormones, but we can make the...
abdomen in the pelvic floor area, ahospitable environment, meaning like
there's no red flags, there's no firesgoing on and everything feels great
and moves well, has good blood flow,organs are moving well, so like we
can help set up a great environmentto set that up for pregnancy.
And then labor prep and delivery as well.
(10:49):
So like we will help with hip mobility,sacral mobility, low back mobility
so baby can get into a good position.
turn babies, like we don't turn babies,but we can help set up the environment
for babies to be turned, to be headdown, and then also prepping for the
pellet floor to get out of the way.
A lot of people are like, Ineed to do Kegels to prep my
(11:10):
pellet floor for delivery.
And it's like, actually, you need tolearn how to relax your pellet floor so
your pellet floor can get out of the way.
Your uterus is gonna push your baby out.
And that way, you have a mobilepellet floor that knows how to relax,
so it decreases your tearing risk.
and things like that too.
So like there's so much upstreamthat people just have no clue about
that we can help prep from like a,if you consider it a prehab approach.
(11:32):
Honestly, it's still rehab becausewe're finding stuff and working on it.
People just don't knowthat they were there.
So.
The Best Birth [11:10]
That is fascinating.
I have been going to physical therapyfor diastasis recti and as I was
in the appointment we uncoveredall these other layers, fascia and
you know, the pelvic floor itself.
I didn't realize I neededpelvic floor therapy.
(11:53):
So do diastasis recti and pelvic floorgo hand in hand or are they really just
separate things to work on and note?
Dr.
Betty DeLass, PT, DPT [11:30]
Yeah, that's a great question.
So for my clinical lens and ethos,I believe that diastasis recti,
and I will even put prolapse andincontinence and all these conditions,
they're a system problem, really.
And so you can have diastasis recti,but why do you have the diastasis recti?
(12:17):
Getting to the underlying root cause?
And some people, and there'sa spectrum of this, right?
Some people, it's just poor genetics.
Your parents gave you the genetic, like,
code for like really elastic skid andlike, sorry you got dealt with that.
But usually that's notthe only case, right?
And so sometimes there'stightness in the low back.
And so I like to use the shirt analogy andI don't know if people will be able to see
(12:40):
this video or not, but like if your shirtis really bunched in the back and it's
tight back here, this is not stretchable.
And so what stretches is that middlepart they'll call the linea alba and
that's where that diastasis happens.
But if you get this moving,then this can all stretch.
and then you don't have thatseparation as much there.
(13:00):
And then see, I don't write mind blown.
And then same thing onlike the pelvic floor.
So like if your pelvic floor isreally tight and you're pushing and
pushing and pushing or your chronicconstipation, the only place to go is
the vaginal canal because it's open.
And so that's where things go.
And so if you can loosen the pelvic floor,loosen the low back or loosen the core and
have everything in a system working wellwith strength, mobility, coordination,
(13:24):
all of these things like that.
it ends up resolving a lot of thesethings or prevents those things
from happening because we're lookingat it from a system approach.
And it's usually multifaceted,like you said, Jen, like you're
like, wow, I didn't know this orthis or this, and it's all related.
And that's, I think, some of the hardestthings that we struggle with is like,
people are like, tell the floor, youjust do Kegels and you do this and
(13:46):
that, and then you're like, good,and it's like, whoa, let's back up.
It's so much more than that and somuch more in depth of like how all
these things interplay on each other.
So I don't know if that answers yourquestion, but that's what I want to say.
The Best Birth [13:29]
And will you actually prescribe differentexercises depending upon what you find?
Right?
So for some people, like the plank iswhat they need to help get all of their
(14:06):
system back in place or to prepare.
And then for others, are they able todo, sit -ups or other type of exercises?
Is there anything that we shouldbe avoiding during pregnancy?
Any exercises?
Dr.
Betty DeLass, PT, DPT [13:31]
Yep.
Yep.
Yeah.
That's a multi -loaned question there,so I'm gonna dissect it a little bit.
So,
from an exercise standpoint,
In my opinion, all exercises can begood and all exercises can be bad.
(14:29):
It all depends on how you do itand the form you do it with and
how your activation and likeknowing what your body is doing.
And so like here at Reborn, wereally, really focus on like helping
you become the expert of your ownbody because you need to know how,
am I activating my core right?
Am I breathing right?
Am I getting my pelvic floor?
Do I have my glutes on?
Like how do I engage all of thosethings in an appropriate way?
(14:51):
depending on the loadthat we're placing on it.
So if we're just doing like a sitto stand, that looks different
than a plank, which looks differentthan a deadlift picking like a
kid off the ground or a squat.
Like we will break all of those downinto foundational movement patterns,
teach you how to do that within your ownbody and work on the other parts too,
where if like you can't get there, wemight dry needle something or we might
(15:13):
mobilize this area or we do some manualtherapy techniques where it's like,
okay, now you can get to that position.
and then we reintegrate thosemovement patterns back in now
that you have the motion to do it.
And so it's all those layers ofbuilding that foundation, because
people, honestly, people are just havepoor foundations and they didn't learn
like things early on, or they have badmotor patterns because of a pain or an
(15:35):
injury or whatnot, or just gave birth.
And it's like, you getdysfunctional in there.
And so we re -correct all thosethings, and then you get to leave
being the expert of your body,knowing how to do all of those things.
And so.
Back to that original questionof like good, bad, it's like,
it totally depends, right?
I'm like, how are you doing it?
And do you have the mobility andmotor awareness to do it properly?
(15:55):
So we work a lot on that piece.
The Best Birth [15:30]
In talking about how all thesesystems are related, can doing
physical therapy on your pelvic floorimprove your energy and how does that
translate to other areas of your life?
Dr.
Betty DeLass, PT, DPT [15:40]
Yeah, great question.
I mean, I full 100 % believe the yes.
Like we're here to change the world, onevagina at a time is what I like to say.
(16:18):
And it goes back to like, if youcan function and move in your body
confidently, well, and withoutpain and dysfunction, you're able
to put that energy somewhere else.
Like whether that's to yourfamily, to a workout, to cooking
healthy meals, to going out.
it ripples out into thecommunity, you name it.
(16:38):
And so if you're able to work on thosethings, your energy is going to be better.
You're going to sleep better.
You're going to work out.
It ripples into all of these otherwonderful health and wellness
benefits that you then want to do.
But if you're in pain or you can't havesex because it's uncomfortable, that
can be detrimental to your relationship.
It can cause other emotional things.
(16:58):
So it can spiral the other way too whenyou don't have this where it needs to be.
The Best Birth [16:33]
I'm like, I'm thinking about my ownstomach, my own core right here.
And I'm thinking like,what do I need to do?
You know, I feel like I've had thatseparation in my abs for a while
since I've had those three babies andjust trying to put it all together.
Can you walk us througha first appointment?
(17:20):
I remember when I started to getpelvic floor physical therapy, I
wasn't sure what to expect, but Iknew I was motivated to get the help I
needed because my pain had gotten bad
Dr.
Betty DeLass, PT, DPT [16:48]
Yeah.
The Best Birth [17:00]
but I still didn't know what to expect.
So I think it would be helpfulto walk someone through that.
Dr.
Betty DeLass, PT, DPT [17:02]
Yeah.
Totally.
So when you come in for an evaluationahead of time for us, and I'm speaking to
what we do here, there might be differentother places, but you will fill out all
(17:41):
your online paperwork ahead of time.
So we get a very robust medicalhistory on you, all the TMI
questions of pooping, peeing, sex,babies, deliveries, all the things.
We want to know all that ahead of time.
So that when you come in, we ask themclarifying questions, go over your story a
little bit, and then we dive right into...
assessing and looking at you.
So we like to tell people we doa full body evaluation in the
(18:01):
sense that like we are PT's, we'reorthopedic PT's and we're pelvic PT's.
So we're like the nerdestnerds and we're gonna do it
all because it's all connected.
And most of the time it's insidethe pelvis and also the pelvis and
you need to be able to do both.
So we'll have you move all differentdirections, maybe squat, balance, lunge,
jump, run, depends on where you're at andif that's appropriate or not at the time.
And then we'll...
(18:21):
dive deep into each area of your body.
So we'll look at your lower back, we'lllook at your entire spine, your rib cage,
your breathing patterns, your abdominalmuscles, where are they at, diastasis
recti, we'll check visceral mobilization,which is how do your organs move.
So just like your joints move, yourorgans move on top of them too.
Sometimes we forget that wehave things inside of us.
So we want to make sure those aremoving well on top of each other.
And especially with pregnancy,postpartum, scar tissue, C -sections,
(18:44):
like that can be disrupted.
So we'll check that.
We'll look at your low back,
your SI, your tailbone, pubic bone.
all the way down to your feet.
So that's all external first.
Then we switch gearsand do an internal exam.
And most people are like, internal exam.
What do you mean by that?
It's similar to an OBR midwife in thesense that it's an internal pelvic exam.
It's different in the sense thatwe have no speculum, no stirrups.
(19:06):
It's just glove, lube, onefinger, like, and we're assessing
through the lens of a PT.
So we're looking just like wewould at any other muscles in the
body and musculoskeletal systemof range of motion, strength.
coordination, trigger points, scar tissue,pressure management, endurance, like how
are all these things working functionally?
And then taking what we find internaland external, we combine that together
(19:29):
for individual needs of like you and whyare you leaking or why do you have pain
with sex or why do you have prolapseor why, you know, why for you and then
make that very individualized to treatwhat we find so that you can get back to
doing the things you want to do and noteven think about your pelvic floor again.
The Best Birth [19:17]
That's fantastic.
And I've been working with one of yourPTs and I love how you have homework
(19:52):
every time and it's really spelledout and easy to follow the plans.
And I've had a very positiveexperience at Reborn.
So I'm so grateful for whatyou do for the community.
It's fantastic.
And I think it's so important to know,like once you have a baby, it doesn't
just mean that you'll be peeing your pantsfor the rest of your life or that you'll
never be able to jump on a trampoline.
And so knowing that this is theresource that we need so that if
(20:13):
we have any of those circumstances.
Dr.
Betty DeLass, PT, DPT [19:31]
Thank you.
Correct.
Yep.
Yep.
The Best Birth [19:47]
you know, we'll be able to get help.
A question to ask you, would you saythat this affects like kind of a hundred
percent of women who are pregnant?
is there anybody who walks awayfrom pregnancy and just doesn't
have any pelvic floor dysfunctionor problems or separation?
Dr.
Betty DeLass, PT, DPT [19:56]
Yeah.
Yeah, that's a great question.
(20:34):
I'm sure those unicorns are out there.
We don't see them, right?
Like, they don't come to see us usually.
And so I'm sure there's some peoplethat are totally great and fine.
But most of the time, I walk around witha lens of that every single person I meet,
even just walking down the street, haspelvic floor dysfunction, whether they
know it or not, until proven otherwise.
(20:54):
So there's usuallysomething going on, right?
We are moving, walking human beings.
You can't tell me at any point in time,you've never had pain or you've never
had low back pain or you've never hadthis or like, so there's something
there and your body is resilient.
Your body wants to heal.
It wants to be in its optimal state.
So it knows how to heal.
Sometimes it just doesn't heal correctly.
(21:15):
And that's where we come in tolike help facilitate that and get
you on the path to full healing.
But your body does want to heal.
So that being said, it's like, wow, like.
you could think that there'snothing wrong, right?
Like your example, Jen, of like, well,I thought I was just coming in for this.
And then it was like, wow,these are all related.
(21:36):
And I had no idea.
And so a lot of it's just educatingpatients on how everything is connected.
And there's also an amazing stat, butnot so amazing, depending on how you look
at it, is 97 % of people who have lowback pain have pelvic floor dysfunction.
So it's like, yep, almost everyone.
The Best Birth [21:29]
(21:58):
What I've learned is mypelvic floor was tight.
And so we've done a lot of needlingand movements to get it to relax.
And that seems to be a pattern inmy body is tight muscles, but it's
been interesting and great to learnto correct postures and how to
retrain your body for times that it'sovercompensated or learned incorrectly.
Because as you said, ourbodies are resilient.
(22:19):
They figure it out, but dothey figure it out correctly?
So I love that you canguide us in that path there.
I have a quick questionabout belly binding.
Dr.
Betty DeLass, PT, DPT [21:49]
Mm -hmm.
Mm -hmm.
The Best Birth [21:59]
So after birth, a lot of timeswe're told that we need to get
those organs back in place.
We need to, help themfind their form again.
What would you recommend forbelly binding after birth?
(22:40):
Dr.
Betty DeLass, PT, DPT [22:07]
Yeah, I'm gonna give a spectrum on that.
So there's the camp of like, everyoneneeds to belly bind and there's a
camp of like, no, absolutely not.
And I would say I'm in a true PT style.
It depends.
So it depends on like theperson and the individual.
Like are we binding to, from an aestheticsreason, are we binding too tight?
(23:01):
Are we...
Are we binding for a culturalreason and for closing of the bones?
And like, so like there's appropriatetimes and places to do those things
and it's, can it be appropriately done?
I personally did a little bit of bellybinding when I did my core exercises,
because I wanted that proprioceptivefeedback of the like bracing on there for
my core to be like, okay, yep, I got that.
(23:22):
And then as soon as I didn'tneed it, I got rid of it.
So there's a time and a placefor each individual person,
depending on what the, the,
surrounding environment is around that.
So the only thing I would caution peopleto is like don't do it too tightly and
like cinch it all in because your pelvicfloor is very, especially if it's been
(23:44):
a vaginal delivery, has been stretchedout and prolapsed and things like that.
So you know those like squishy toyswhere you like squeeze them and
then like poop comes out, right?
It's like that.
You're basically like doing thatto yourself if you're just like
cinching things up and it's justputting so much pressure down on
the pelvic floor that it can...
it can exacerbate prolapseand things like that.
So I caution people with like the extreme.
But I think it's a beautiful thingto do like the closing of the bone
(24:06):
ceremony and like things like that.
So like, yes and no depends.
The Best Birth [23:43]
Well, and like you said, because ourbodies are so resilient, there is
a time after birth that everythingis tightening up and the organs
are finding their place again.
And so my question, I think, was wonderingif we have kind of like a pocket, a
window of time in which we really needto capture so that all of our organs
(24:30):
and our pelvic floor can kind of revertback to that pre -pregnancy normality.
Dr.
Betty DeLass, PT, DPT [23:52]
Mm -hmm.
Yeah, there's no research on any ofthat stuff of like what it should be or
should it be or is there a time window.
We do know that like with pregnancy andpostpartum that if you're breastfeeding
it drops your estrogen and thathelps kind of stiffen your tissue.
(24:50):
So there is a positive to that ofbreastfeeding and estrogen drop.
to stiffen the laxin tissues, soit is protective in that sense.
And then as soon as you stopbreastfeeding, estrogen goes back up
and that increases laxity a little bit.
So there's a little bit of evidenceon like that stuff, but other than
(25:11):
that, it's, I personally, and again,from a preventative measure, is like
if you can come during pregnancy andanywhere two to four weeks postpartum
to like start working on these things,you set yourself up for success.
And so our clients and patients thatcome in and do the work pregnancy
and then postpartum right away, we'rein the best position in the sense
(25:32):
that like we're often holding peopleback because they feel so great.
We're like, well, you still, but you stillneed to respect tissue healing timelines.
Like that doesn't change.
That is like very reliable,measurable and like research.
So like you're doing well,but don't do too much.
Right.
And versus like the other wayaround when people don't do anything
and they're, you know, waving thered flag and they're like, help,
please help women so much pain.
(25:53):
we're not holding those peopleback, we're just trying to get them
back to wherever they wanna go.
So that's a little bit oflike the perspective on that.
The Best Birth [25:34]
Speaking to that, I was in thecamp of, I have diastasis recti.
I'm going to ignore this area out ofcaution to just let it do its thing.
And that ended up beinginhibitory because I ignored it.
(26:15):
And so it wasn't moving.
It wasn't getting allof that flow back in.
So we look at that landmark of six weeksafter pregnancy, our checkup, and what
would you say if a woman is there at thatstage right now where she's had her six.
week checkup, what would youencourage her to do to move that
area and get it going again?
Dr.
Betty DeLass, PT, DPT [26:01]
Yeah, so we, I'm gonna touch onone thing before I answer that.
(26:37):
So the six week post -partum checkupis for OBs and midwives from an
infection healing standpoint of theuterus, not for movement because you
go home from the hospital, you haveto carry that baby, you have to lift
that baby, you have to put the babyin the crib, car seat, all things.
So it's like, we should start that inthe hospital or at home or ahead of time.
So rehab starts before six weeksand goes well after six weeks.
(26:59):
The six week mark is really from a tissuehealing, uterine healing infection risk.
And so that's that piece.
And then from, if someone's comingin around that time anywhere, newly
postpartum in there, we focus a loton just connecting back with breath,
getting rib cage to come back anddown, core online, glutes online,
(27:19):
pelvic floor connection of all thosethings, not max contractions or like
one rep max or anything like that.
It's just, can we connecteverything back with our breath?
Can we get our body in a safe spot?
Can we engage thingsin an appropriate load?
And then as each patient is able tokind of like, almost like a checkbox
list of like, okay, now you cando this, then we move on to this.
(27:41):
So that timeline can be veryvariable for some people.
So like some people are back torunning at six weeks postpartum.
Some people are not even closeuntil like two years postpartum.
It just really depends on like whereare they at and what were they doing
and what were they doing before.
So we have kind of aprotocol checklist of like,
at these certain things and can youdo these things like can you do a
(28:01):
single leg sit to stand with goodglute control and good knee control
and can you do jumping without anyprolapse during continents before
we would ever start someone running.
So we're working through those checkliststo make sure like okay yep you can do
this now you can move on to this, yep youcan do this now you can move on to this.
But if someone's at the at thisthreshold and they just can't get
past it well they have to stay therein that work zone we like to call it.
(28:22):
You gotta work here for alittle bit until you get
strong or stable enough or yourtissue is ready for that load
and then we can progress on.
The Best Birth [28:01]
And thank you for clarifying thatsix week, because a lot of times
we're looking at that as a landmark.
We're looking at that as totalhealing and back to normal.
And it's just not the case.
We should be doing things beforeand afterwards, helping our body.
(28:44):
Dr.
Betty DeLass, PT, DPT [28:09]
Yeah.
Yeah, and that's honestly what made me,what I like to say, righteously angry when
I had my first child is I was like, okay,I'm a PT, I know what to do, I'm doing
all the things, and like six weeks wassupposed to be this like magical, okay,
you can go back to sex, you can go backto working out, and I got to six weeks
and then I was like, who in their crazymind thinks that this is an appropriate
(29:04):
timeframe to do any of these things?
So I think it's important to knowthat like six weeks is not magical.
It is like, yes, you're
your uterus is healed and that's about it.
There's plenty of people wholike way after that are not
ready to have intercourse.
They're not ready to be even liftingweights or anything like we have to
make sure that we're individualizingthat care to everyone and not blanket
(29:26):
stating like it's six weeks you'regood to go everything's great.
It's just a huge disservice.
We would never do that againgoing back to my original analogy.
We'd never tell someone with an ACLrepair it's six weeks you're good.
Rotator cuff repair goahead everything's great.
It doesn't make sense right so.
The Best Birth [29:13]
Yes.
Thank you so much foryour conversation today.
It's been so informative.
(29:47):
Every week we share a mom squad secretalong the topic of today's episode.
So we will share from Jean.
She says, even if you pee whenyou sneeze or cough, keep doing
glute bridges, zipper hips, anddeep pelvic floor core exercises.
They do in fact help withdelivery and recovery.
What would you say to that?
Dr.
Betty DeLass, PT, DPT [29:38]
(30:07):
I think she's on the right track for sure.
Yeah.
The Best Birth [29:41]
We also love to share any resourcesthat you might have to help our
moms in this specific topic.
Do you have any books, any podcasts,any other experts or any personal
things that you would recommend?
Dr.
Betty DeLass, PT, DPT [29:53]
Yeah, well if I can toot our own horn,we do have a website that you can go
to that has a bunch of free resources.
(30:28):
So
it's just www .rebornphw .com.
We have free resources on there.
We also have an app and a membershipthat people can do if they're
not local to us to come see us.
A website where you could find someonelocal to you is called pelvicrehab .com.
And then that way you can just put inyour zip code and see who's close to you.
And then as far as otherresources, I feel like...
(30:50):
Instagram has exploded with likepublic health and so there's
a lot of good ones out there.
I would caution people to make surethat you're following someone who is a
public floor PT or an OT that actuallyhas expertise because there are people
out there in the influencer world thatare saying they are experts in this when
they really are not and we see thingsand I have to put blinders on and be
like, okay, don't pay attention to that.
(31:11):
So I would just make sure you area educated, cautious consumer of
what you're ingesting and knowthat you're following quality.
quality people that have thecredentialing behind them to be
saying the things that they're saying.
But other than that, yeah,there's a ton out there.
I think a couple books that are goodto read just in general is Come As You
(31:34):
Are and then The Body Keeps the Score.
Those are two really profound books thatwe recommend a lot to our patients to
really help through their healing processand their journey to health and wellness.
Yeah.
The Best Birth [31:16]
I love that book, TheBody Keeps the Score.
We'll definitely link to thatin our show notes and the other
resources that you provided today.
Dr.
Betty, this has been afantastic conversation.
Thank you for giving us yourtime and your expertise.
(31:56):
We really appreciatethis conversation today.
Dr.
Betty DeLass, PT, DPT [31:29]
Absolutely, you're more Thanksfor joining us on today's episode.
We hope you've been elevated andinspired by this week's expert.
Subscribe today so you never missan episode and please share our
podcast or post on your socialmedia so that other moms and dads
to be can also have the best birth.
Please note that the informationprovided is based on the expert's
(32:19):
insights and personal experience.
It is not intended as medical guidance.
Please seek the advice of yourmedical provider as it applies
to your specific condition.
It's the Best Birth Podcast, wherewe interview experts that elevate
you as you prepare your heartand mind to have the best birth.
Each episode will interviewprofessionals so you are prepared
for pregnancy, birth, and postpartum.
Our experts will build your confidenceand empower you to trust your
intuition throughout your pregnancy.
This audio is takenfrom videos on YouTube.
(00:27):
Watch the entire episodes onYouTube at Birth Made Mindful.
Thank you for tuning in thisweek to the best birth podcast.
We're excited to have Dr.
Betty D 'alas with us today.
A pelvic floor health specialist.
Dr.
Betty is the founder and owner ofReborn Pelvic Health and Wellness.
She is extremely passionate aboutchanging the standard of care
(00:47):
before, during, and after pregnancybecause postpartum is forever.
Betty is a world -classpelvic health expert.
and has built a center of excellence inUtah for pelvic floor physical therapy.
She is a physical therapist by tradeand has helped thousands of people
throughout her 12 plus year careerto function, feel, and move better.
(01:08):
And knowing firsthand how difficultit can be with two children of
her own, she wanted to help othersget back to living their lives
to the fullest without shame orembarrassment about their pelvic health.
Unfortunately, more often thannot, pelvic dysfunction can lead
to postpartum mood disorders.
secondary to an inability to get backto activity because of unexpected
(01:28):
physical changes, pain, discomfort,leaking and or painful intimacy.
What if we worked more upstream?
What if we worked onpreventing dysfunction from
happening in the first place?
And what if we provided true rehaband prehab to our birthing people?
And that was where Reborn was derived.
As the business continues to grow,we are adding more specialties
(01:51):
outside of pregnancy and postpartum.
Dr.
Betty DeLass, PT, DPT [01:01]
.The Best Birth [01:24]
as Reborn recruits and retains top-notch pelvic floor physical therapists
in men's and pediatric specialties.
As a doctor of physical therapy, shebelieves one -on -one care is best.
She is also passionate about findingthe why behind your symptoms, optimizing
your body, and empowering you to becomethe expert of your own body so that
(02:12):
you can live life to the fullest.
When not at work, you can find Dr.
Betty hanging out with her husband, twodaughters, and two fur babies, dogs.
Dr.
Betty DeLass, PT, DPT [01:31]
.Thank you.
Thanks for the fabulous intro.
The Best Birth [01:52]
She also spends her time enjoyingendurance sports like marathon training,
triathlon training, lifting weights,hiking, and cross -country skiing.
Welcome, Betty!
That is fantastic!
(02:35):
Yes, we are excited to jump right inand talk about pelvic floor therapy.
So just beginning, whatis the pelvic floor?
Dr.
Betty DeLass, PT, DPT [02:14]
Yeah, pelvic floor.
So most people are like, hmm,pelvic floor, what's that?
It's a sling of muscles that sits inbetween your pubic bone and your tailbone.
It supports your organs, ithelps with sexual function,
pooping, peeing, things like that.
(02:55):
And so if you don't know that youhave a pelvic floor, that probably
means it's like working well.
Most people don't know they have apelvic floor until something's wrong
or dysfunctional and they're like,this is not right, I need help.
So it's the area underneathwhere you sit on between your
sit bones, pubic bone, tailbone.
and it's like a hammockunderneath there of just muscles.
The Best Birth [02:46]
And would you say pregnancy iskind of like the number one reason
(03:18):
someone would come to you and say,hey, it's not working anymore?
Dr.
Betty DeLass, PT, DPT [02:51]
Sure.
I think there's a variety of reasonswhy people would come to see us.
The business primarily started inpregnancy postpartum because that
was what my passion was aroundwhen I went through those things.
And obviously there's many other reasonswhy you would need pelvic floor therapy.
There's plenty of people who have neverhad babies that need pelvic floor therapy.
(03:40):
Men can need pelvic floor therapy.
Kids can need pelvic floor therapy, right?
So we're adding those arms tothe business in as we grow.
But that's where the passion,that's where Reborn started was
truly like pregnancy postpartum.
And if you think about it, like ifyou were to have a knee surgery or
shoulder surgery, you would go tophysical therapy before and then you'd
have your surgery and then you wouldgo after immediately and you would
(04:03):
go for months and multiple sessions.
And when we grow a human inside of us,it changes multiple areas of your body,
your rib cage, your core, your lowback, your glutes, your pelvic floor.
and all of these things changerapidly over nine to 10 months.
And then you go from being extremelypregnant to not pregnant at all, and
then you have to recover from that.
(04:24):
And so it's just this hugemusculoskeletal change.
And I would argue the biggestmusculoskeletal change, even more so
than a knee surgery or shoulder surgery,because that's like one area of your body
and you can like recover and rest from it.
Like your pelvic floor, you can't,like you still have to poop and
pee and sit and carry and liftbaby and take care of family.
And like, so you don't actuallylike truly get to like,
(04:44):
rest it, it's still being used.
And so it just it's mind -blowing to thinkthat like we wouldn't be doing the prehab
and the rehab during this time of life.
And some of us do itmultiple times, right?
And so it's like what are we doing?
We need to do this for our for our ourbirthing So that's kind of like what
we what we started out specializing in.
(05:05):
Other areas that we help with ispeople who have painful intercourse
or conditions like vaginismus wherethe vaginal canal is tight and
and hard to have either a tampon in,speculum, intercourse, then baby coming
out if that's the route that it comes.
So there's areas with that or likeendometriosis or painful periods,
(05:26):
we can help with those things.
Constipation, leaking, prolapse,diastasis recti, separation of the
abdominal wall, which is primarilydue to pregnancy and things like that.
And then there's other...
facets do that too.
A lot of orthopedic conditionsare underlying with that.
So we have like low back pain orSI joint pain or pubic bone pain,
(05:48):
tailbone pain, anything that's there.
It's often a combination of thingsboth inside the pelvis and outside
the pelvis that creates issuessurrounding pelvic floor things.
And then you could add in the wholefacet of men, but this is about
the best birth podcast, so we'llkeep it focused on that for today.
The Best Birth [05:39]
Sounds great.
(06:09):
How does care differ when it's acesarean versus a vaginal birth?
Dr.
Betty DeLass, PT, DPT [05:44]
Yeah, great question.
So with a vaginal birth, itstretches the pelvic floor.
With a cesarean birth, it's amajor abdominal surgery that cuts
through seven layers in the abdomen.
And so there's differences becauseof the surgery that happened.
So like when you have a vaginal birth, thebaby's still grown on top of your pelvic
(06:31):
floor, all these other changes happen.
Same thing with the C -section.
Like baby still grew on top of thepelvic floor, body still changes.
So you have those both things happening.
When a baby comes through, itstretches your pelvic floor muscles.
two to three times their lengthand they survive to tell a
story most of the time, right?
But there could be tearing orscar tissue or things like that.
Prolapse might be more of a commonthing or incontinence might be
(06:52):
more in the vaginal delivery.
Where in a C -section, it depends onif they push, didn't push, how long
did they push, things like that.
So they might have both depending on wherethat happened or if it's an opted in C
-section or preventative measures and theydidn't push at all, then it might just be
the recovery from the abdominal surgery.
but on top of like being stillgrowing inside your body.
(07:15):
But you might not have as much likeleaking or prolapse, but a lot, there
are usually more pain with intercourse orsymptoms of UTI like things because of the
fascia that gets stretched and the scartissue that forms causes a pulling on the
front half of the pelvic floor and cancreate symptoms like frequency, urgency,
pain with intercourse, things like that.
(07:35):
So we work on that.
And that would be a generalization ifI were to like categorize differently.
But a lot of that could overlapand you could have none of the
C -section, you could have allthose things and vice versa.
But that would be like ageneralization if I could split it.
The Best Birth [07:21]
It feels so important though, to mention,because a lot of people think that if you
have a C -section, then you're kind ofspared from some of these problems, the
(07:58):
incontinence or the painful intercourse.
And that's not the case, in some people'ssituation, it's actually worse, if they
have one or the other type of delivery.
And so this is so great that youare walking us through and telling
us kind of what to look out for.
And just to evaluate like therisk and the benefit of, of
some of these modes of delivery.
Dr.
Betty DeLass, PT, DPT [07:26]
Yes.
Exactly.
Yep.
And same thing with like, I mean, everyoneknows that mom butts a real thing.
(08:20):
And so like when you're pregnantand postpartum, right, you're
like, turns into a pancake.
And so if you think about it, goingback to the analogy of like the knee
surgery, usually if you have a kneesurgery, your quad or the front of your
leg gets inhibited and it gets weakerand you have to like get that activated.
Same thing happens when you grow a baby.
That's your core, yourglutes, your low back.
pelvic floor so it's like multiple areasand so we have to realize that like we
(08:43):
do need to re -engage those muscles getthem back on activated especially the
glutes because they're a big muscle thatsupports the pelvis and the cornerstone
of movement there so it's really reallyimportant to make sure that we're like
for both types of deliveries focusingon those things and the core on top
of that to get people back so they can
(09:03):
pick up their kids or give their kids abath or lift the Costco box into the car.
There's so many functional thingsthat we need our bodies for and
if we don't rehab them, it can bedetrimental to the quality of your life.
The Best Birth [08:47]
And can we talk a littlebit about the prehab?
So I am so curious, I have had threebabies and I have never once done any
sort of prehab for my pelvic floor.
(09:25):
Can you give us just a couple of examplesof what we could be doing if we don't
have access to a pelvic floor specialist?
Dr.
Betty DeLass, PT, DPT [08:49]
Yeah.
Yeah.
Totally, totally.
So there's a couple thingsI'm gonna add in there.
So most people are like, I'lljust wait till after I have
a baby, then I'll come in.
And it's like, we can doso much ahead of time.
So a lot of times we can do that prehaband we can catch things that are either
there that you don't know are there.
(09:46):
They were subclinical before, meaningyou had no symptoms, but we're finding
them and catching them early so that itcan prevent things further down the line.
And so when we think prehab, we often getpeople coming in before they're even like,
becoming sexually active before they'rewanting to get pregnant, just like you
would have a preconception appointment.
(10:06):
You would go in and be like,how does everything look?
How are my hormones?
How is this going?
We do that from a musculoskeletallens of how are you moving?
How is your low back moving?
Your hips moving?
Your pelvic foot?
How is everything moving?
Is there anything there thatwe can work on ahead of time
to prep and get you there?
We also do fertility work as well.
So from a mechanical perspective,obviously we can't change someone's
(10:27):
hormones, but we can make the...
abdomen in the pelvic floor area, ahospitable environment, meaning like
there's no red flags, there's no firesgoing on and everything feels great
and moves well, has good blood flow,organs are moving well, so like we
can help set up a great environmentto set that up for pregnancy.
And then labor prep and delivery as well.
(10:49):
So like we will help with hip mobility,sacral mobility, low back mobility
so baby can get into a good position.
turn babies, like we don't turn babies,but we can help set up the environment
for babies to be turned, to be headdown, and then also prepping for the
pellet floor to get out of the way.
A lot of people are like, Ineed to do Kegels to prep my
(11:10):
pellet floor for delivery.
And it's like, actually, you need tolearn how to relax your pellet floor so
your pellet floor can get out of the way.
Your uterus is gonna push your baby out.
And that way, you have a mobilepellet floor that knows how to relax,
so it decreases your tearing risk.
and things like that too.
So like there's so much upstreamthat people just have no clue about
that we can help prep from like a,if you consider it a prehab approach.
(11:32):
Honestly, it's still rehab becausewe're finding stuff and working on it.
People just don't knowthat they were there.
So.
The Best Birth [11:10]
That is fascinating.
I have been going to physical therapyfor diastasis recti and as I was
in the appointment we uncoveredall these other layers, fascia and
you know, the pelvic floor itself.
I didn't realize I neededpelvic floor therapy.
(11:53):
So do diastasis recti and pelvic floorgo hand in hand or are they really just
separate things to work on and note?
Dr.
Betty DeLass, PT, DPT [11:30]
Yeah, that's a great question.
So for my clinical lens and ethos,I believe that diastasis recti,
and I will even put prolapse andincontinence and all these conditions,
they're a system problem, really.
And so you can have diastasis recti,but why do you have the diastasis recti?
(12:17):
Getting to the underlying root cause?
And some people, and there'sa spectrum of this, right?
Some people, it's just poor genetics.
Your parents gave you the genetic, like,
code for like really elastic skid andlike, sorry you got dealt with that.
But usually that's notthe only case, right?
And so sometimes there'stightness in the low back.
And so I like to use the shirt analogy andI don't know if people will be able to see
(12:40):
this video or not, but like if your shirtis really bunched in the back and it's
tight back here, this is not stretchable.
And so what stretches is that middlepart they'll call the linea alba and
that's where that diastasis happens.
But if you get this moving,then this can all stretch.
and then you don't have thatseparation as much there.
(13:00):
And then see, I don't write mind blown.
And then same thing onlike the pelvic floor.
So like if your pelvic floor isreally tight and you're pushing and
pushing and pushing or your chronicconstipation, the only place to go is
the vaginal canal because it's open.
And so that's where things go.
And so if you can loosen the pelvic floor,loosen the low back or loosen the core and
have everything in a system working wellwith strength, mobility, coordination,
(13:24):
all of these things like that.
it ends up resolving a lot of thesethings or prevents those things
from happening because we're lookingat it from a system approach.
And it's usually multifaceted,like you said, Jen, like you're
like, wow, I didn't know this orthis or this, and it's all related.
And that's, I think, some of the hardestthings that we struggle with is like,
people are like, tell the floor, youjust do Kegels and you do this and
(13:46):
that, and then you're like, good,and it's like, whoa, let's back up.
It's so much more than that and somuch more in depth of like how all
these things interplay on each other.
So I don't know if that answers yourquestion, but that's what I want to say.
The Best Birth [13:29]
And will you actually prescribe differentexercises depending upon what you find?
Right?
So for some people, like the plank iswhat they need to help get all of their
(14:06):
system back in place or to prepare.
And then for others, are they able todo, sit -ups or other type of exercises?
Is there anything that we shouldbe avoiding during pregnancy?
Any exercises?
Dr.
Betty DeLass, PT, DPT [13:31]
Yep.
Yep.
Yeah.
That's a multi -loaned question there,so I'm gonna dissect it a little bit.
So,
from an exercise standpoint,
In my opinion, all exercises can begood and all exercises can be bad.
(14:29):
It all depends on how you do itand the form you do it with and
how your activation and likeknowing what your body is doing.
And so like here at Reborn, wereally, really focus on like helping
you become the expert of your ownbody because you need to know how,
am I activating my core right?
Am I breathing right?
Am I getting my pelvic floor?
Do I have my glutes on?
Like how do I engage all of thosethings in an appropriate way?
(14:51):
depending on the loadthat we're placing on it.
So if we're just doing like a sitto stand, that looks different
than a plank, which looks differentthan a deadlift picking like a
kid off the ground or a squat.
Like we will break all of those downinto foundational movement patterns,
teach you how to do that within your ownbody and work on the other parts too,
where if like you can't get there, wemight dry needle something or we might
(15:13):
mobilize this area or we do some manualtherapy techniques where it's like,
okay, now you can get to that position.
and then we reintegrate thosemovement patterns back in now
that you have the motion to do it.
And so it's all those layers ofbuilding that foundation, because
people, honestly, people are just havepoor foundations and they didn't learn
like things early on, or they have badmotor patterns because of a pain or an
(15:35):
injury or whatnot, or just gave birth.
And it's like, you getdysfunctional in there.
And so we re -correct all thosethings, and then you get to leave
being the expert of your body,knowing how to do all of those things.
And so.
Back to that original questionof like good, bad, it's like,
it totally depends, right?
I'm like, how are you doing it?
And do you have the mobility andmotor awareness to do it properly?
(15:55):
So we work a lot on that piece.
The Best Birth [15:30]
In talking about how all thesesystems are related, can doing
physical therapy on your pelvic floorimprove your energy and how does that
translate to other areas of your life?
Dr.
Betty DeLass, PT, DPT [15:40]
Yeah, great question.
I mean, I full 100 % believe the yes.
Like we're here to change the world, onevagina at a time is what I like to say.
(16:18):
And it goes back to like, if youcan function and move in your body
confidently, well, and withoutpain and dysfunction, you're able
to put that energy somewhere else.
Like whether that's to yourfamily, to a workout, to cooking
healthy meals, to going out.
it ripples out into thecommunity, you name it.
(16:38):
And so if you're able to work on thosethings, your energy is going to be better.
You're going to sleep better.
You're going to work out.
It ripples into all of these otherwonderful health and wellness
benefits that you then want to do.
But if you're in pain or you can't havesex because it's uncomfortable, that
can be detrimental to your relationship.
It can cause other emotional things.
(16:58):
So it can spiral the other way too whenyou don't have this where it needs to be.
The Best Birth [16:33]
I'm like, I'm thinking about my ownstomach, my own core right here.
And I'm thinking like,what do I need to do?
You know, I feel like I've had thatseparation in my abs for a while
since I've had those three babies andjust trying to put it all together.
Can you walk us througha first appointment?
(17:20):
I remember when I started to getpelvic floor physical therapy, I
wasn't sure what to expect, but Iknew I was motivated to get the help I
needed because my pain had gotten bad
Dr.
Betty DeLass, PT, DPT [16:48]
Yeah.
The Best Birth [17:00]
but I still didn't know what to expect.
So I think it would be helpfulto walk someone through that.
Dr.
Betty DeLass, PT, DPT [17:02]
Yeah.
Totally.
So when you come in for an evaluationahead of time for us, and I'm speaking to
what we do here, there might be differentother places, but you will fill out all
(17:41):
your online paperwork ahead of time.
So we get a very robust medicalhistory on you, all the TMI
questions of pooping, peeing, sex,babies, deliveries, all the things.
We want to know all that ahead of time.
So that when you come in, we ask themclarifying questions, go over your story a
little bit, and then we dive right into...
assessing and looking at you.
So we like to tell people we doa full body evaluation in the
(18:01):
sense that like we are PT's, we'reorthopedic PT's and we're pelvic PT's.
So we're like the nerdestnerds and we're gonna do it
all because it's all connected.
And most of the time it's insidethe pelvis and also the pelvis and
you need to be able to do both.
So we'll have you move all differentdirections, maybe squat, balance, lunge,
jump, run, depends on where you're at andif that's appropriate or not at the time.
And then we'll...
(18:21):
dive deep into each area of your body.
So we'll look at your lower back, we'lllook at your entire spine, your rib cage,
your breathing patterns, your abdominalmuscles, where are they at, diastasis
recti, we'll check visceral mobilization,which is how do your organs move.
So just like your joints move, yourorgans move on top of them too.
Sometimes we forget that wehave things inside of us.
So we want to make sure those aremoving well on top of each other.
And especially with pregnancy,postpartum, scar tissue, C -sections,
(18:44):
like that can be disrupted.
So we'll check that.
We'll look at your low back,
your SI, your tailbone, pubic bone.
all the way down to your feet.
So that's all external first.
Then we switch gearsand do an internal exam.
And most people are like, internal exam.
What do you mean by that?
It's similar to an OBR midwife in thesense that it's an internal pelvic exam.
It's different in the sense thatwe have no speculum, no stirrups.
(19:06):
It's just glove, lube, onefinger, like, and we're assessing
through the lens of a PT.
So we're looking just like wewould at any other muscles in the
body and musculoskeletal systemof range of motion, strength.
coordination, trigger points, scar tissue,pressure management, endurance, like how
are all these things working functionally?
And then taking what we find internaland external, we combine that together
(19:29):
for individual needs of like you and whyare you leaking or why do you have pain
with sex or why do you have prolapseor why, you know, why for you and then
make that very individualized to treatwhat we find so that you can get back to
doing the things you want to do and noteven think about your pelvic floor again.
The Best Birth [19:17]
That's fantastic.
And I've been working with one of yourPTs and I love how you have homework
(19:52):
every time and it's really spelledout and easy to follow the plans.
And I've had a very positiveexperience at Reborn.
So I'm so grateful for whatyou do for the community.
It's fantastic.
And I think it's so important to know,like once you have a baby, it doesn't
just mean that you'll be peeing your pantsfor the rest of your life or that you'll
never be able to jump on a trampoline.
And so knowing that this is theresource that we need so that if
(20:13):
we have any of those circumstances.
Dr.
Betty DeLass, PT, DPT [19:31]
Thank you.
Correct.
Yep.
Yep.
The Best Birth [19:47]
you know, we'll be able to get help.
A question to ask you, would you saythat this affects like kind of a hundred
percent of women who are pregnant?
is there anybody who walks awayfrom pregnancy and just doesn't
have any pelvic floor dysfunctionor problems or separation?
Dr.
Betty DeLass, PT, DPT [19:56]
Yeah.
Yeah, that's a great question.
(20:34):
I'm sure those unicorns are out there.
We don't see them, right?
Like, they don't come to see us usually.
And so I'm sure there's some peoplethat are totally great and fine.
But most of the time, I walk around witha lens of that every single person I meet,
even just walking down the street, haspelvic floor dysfunction, whether they
know it or not, until proven otherwise.
(20:54):
So there's usuallysomething going on, right?
We are moving, walking human beings.
You can't tell me at any point in time,you've never had pain or you've never
had low back pain or you've never hadthis or like, so there's something
there and your body is resilient.
Your body wants to heal.
It wants to be in its optimal state.
So it knows how to heal.
Sometimes it just doesn't heal correctly.
(21:15):
And that's where we come in tolike help facilitate that and get
you on the path to full healing.
But your body does want to heal.
So that being said, it's like, wow, like.
you could think that there'snothing wrong, right?
Like your example, Jen, of like, well,I thought I was just coming in for this.
And then it was like, wow,these are all related.
(21:36):
And I had no idea.
And so a lot of it's just educatingpatients on how everything is connected.
And there's also an amazing stat, butnot so amazing, depending on how you look
at it, is 97 % of people who have lowback pain have pelvic floor dysfunction.
So it's like, yep, almost everyone.
The Best Birth [21:29]
(21:58):
What I've learned is mypelvic floor was tight.
And so we've done a lot of needlingand movements to get it to relax.
And that seems to be a pattern inmy body is tight muscles, but it's
been interesting and great to learnto correct postures and how to
retrain your body for times that it'sovercompensated or learned incorrectly.
Because as you said, ourbodies are resilient.
(22:19):
They figure it out, but dothey figure it out correctly?
So I love that you canguide us in that path there.
I have a quick questionabout belly binding.
Dr.
Betty DeLass, PT, DPT [21:49]
Mm -hmm.
Mm -hmm.
The Best Birth [21:59]
So after birth, a lot of timeswe're told that we need to get
those organs back in place.
We need to, help themfind their form again.
What would you recommend forbelly binding after birth?
(22:40):
Dr.
Betty DeLass, PT, DPT [22:07]
Yeah, I'm gonna give a spectrum on that.
So there's the camp of like, everyoneneeds to belly bind and there's a
camp of like, no, absolutely not.
And I would say I'm in a true PT style.
It depends.
So it depends on like theperson and the individual.
Like are we binding to, from an aestheticsreason, are we binding too tight?
(23:01):
Are we...
Are we binding for a culturalreason and for closing of the bones?
And like, so like there's appropriatetimes and places to do those things
and it's, can it be appropriately done?
I personally did a little bit of bellybinding when I did my core exercises,
because I wanted that proprioceptivefeedback of the like bracing on there for
my core to be like, okay, yep, I got that.
(23:22):
And then as soon as I didn'tneed it, I got rid of it.
So there's a time and a placefor each individual person,
depending on what the, the,
surrounding environment is around that.
So the only thing I would caution peopleto is like don't do it too tightly and
like cinch it all in because your pelvicfloor is very, especially if it's been
(23:44):
a vaginal delivery, has been stretchedout and prolapsed and things like that.
So you know those like squishy toyswhere you like squeeze them and
then like poop comes out, right?
It's like that.
You're basically like doing thatto yourself if you're just like
cinching things up and it's justputting so much pressure down on
the pelvic floor that it can...
it can exacerbate prolapseand things like that.
So I caution people with like the extreme.
But I think it's a beautiful thingto do like the closing of the bone
(24:06):
ceremony and like things like that.
So like, yes and no depends.
The Best Birth [23:43]
Well, and like you said, because ourbodies are so resilient, there is
a time after birth that everythingis tightening up and the organs
are finding their place again.
And so my question, I think, was wonderingif we have kind of like a pocket, a
window of time in which we really needto capture so that all of our organs
(24:30):
and our pelvic floor can kind of revertback to that pre -pregnancy normality.
Dr.
Betty DeLass, PT, DPT [23:52]
Mm -hmm.
Yeah, there's no research on any ofthat stuff of like what it should be or
should it be or is there a time window.
We do know that like with pregnancy andpostpartum that if you're breastfeeding
it drops your estrogen and thathelps kind of stiffen your tissue.
(24:50):
So there is a positive to that ofbreastfeeding and estrogen drop.
to stiffen the laxin tissues, soit is protective in that sense.
And then as soon as you stopbreastfeeding, estrogen goes back up
and that increases laxity a little bit.
So there's a little bit of evidenceon like that stuff, but other than
(25:11):
that, it's, I personally, and again,from a preventative measure, is like
if you can come during pregnancy andanywhere two to four weeks postpartum
to like start working on these things,you set yourself up for success.
And so our clients and patients thatcome in and do the work pregnancy
and then postpartum right away, we'rein the best position in the sense
(25:32):
that like we're often holding peopleback because they feel so great.
We're like, well, you still, but you stillneed to respect tissue healing timelines.
Like that doesn't change.
That is like very reliable,measurable and like research.
So like you're doing well,but don't do too much.
Right.
And versus like the other wayaround when people don't do anything
and they're, you know, waving thered flag and they're like, help,
please help women so much pain.
(25:53):
we're not holding those peopleback, we're just trying to get them
back to wherever they wanna go.
So that's a little bit oflike the perspective on that.
The Best Birth [25:34]
Speaking to that, I was in thecamp of, I have diastasis recti.
I'm going to ignore this area out ofcaution to just let it do its thing.
And that ended up beinginhibitory because I ignored it.
(26:15):
And so it wasn't moving.
It wasn't getting allof that flow back in.
So we look at that landmark of six weeksafter pregnancy, our checkup, and what
would you say if a woman is there at thatstage right now where she's had her six.
week checkup, what would youencourage her to do to move that
area and get it going again?
Dr.
Betty DeLass, PT, DPT [26:01]
Yeah, so we, I'm gonna touch onone thing before I answer that.
(26:37):
So the six week post -partum checkupis for OBs and midwives from an
infection healing standpoint of theuterus, not for movement because you
go home from the hospital, you haveto carry that baby, you have to lift
that baby, you have to put the babyin the crib, car seat, all things.
So it's like, we should start that inthe hospital or at home or ahead of time.
So rehab starts before six weeksand goes well after six weeks.
(26:59):
The six week mark is really from a tissuehealing, uterine healing infection risk.
And so that's that piece.
And then from, if someone's comingin around that time anywhere, newly
postpartum in there, we focus a loton just connecting back with breath,
getting rib cage to come back anddown, core online, glutes online,
(27:19):
pelvic floor connection of all thosethings, not max contractions or like
one rep max or anything like that.
It's just, can we connecteverything back with our breath?
Can we get our body in a safe spot?
Can we engage thingsin an appropriate load?
And then as each patient is able tokind of like, almost like a checkbox
list of like, okay, now you cando this, then we move on to this.
(27:41):
So that timeline can be veryvariable for some people.
So like some people are back torunning at six weeks postpartum.
Some people are not even closeuntil like two years postpartum.
It just really depends on like whereare they at and what were they doing
and what were they doing before.
So we have kind of aprotocol checklist of like,
at these certain things and can youdo these things like can you do a
(28:01):
single leg sit to stand with goodglute control and good knee control
and can you do jumping without anyprolapse during continents before
we would ever start someone running.
So we're working through those checkliststo make sure like okay yep you can do
this now you can move on to this, yep youcan do this now you can move on to this.
But if someone's at the at thisthreshold and they just can't get
past it well they have to stay therein that work zone we like to call it.
(28:22):
You gotta work here for alittle bit until you get
strong or stable enough or yourtissue is ready for that load
and then we can progress on.
The Best Birth [28:01]
And thank you for clarifying thatsix week, because a lot of times
we're looking at that as a landmark.
We're looking at that as totalhealing and back to normal.
And it's just not the case.
We should be doing things beforeand afterwards, helping our body.
(28:44):
Dr.
Betty DeLass, PT, DPT [28:09]
Yeah.
Yeah, and that's honestly what made me,what I like to say, righteously angry when
I had my first child is I was like, okay,I'm a PT, I know what to do, I'm doing
all the things, and like six weeks wassupposed to be this like magical, okay,
you can go back to sex, you can go backto working out, and I got to six weeks
and then I was like, who in their crazymind thinks that this is an appropriate
(29:04):
timeframe to do any of these things?
So I think it's important to knowthat like six weeks is not magical.
It is like, yes, you're
your uterus is healed and that's about it.
There's plenty of people wholike way after that are not
ready to have intercourse.
They're not ready to be even liftingweights or anything like we have to
make sure that we're individualizingthat care to everyone and not blanket
(29:26):
stating like it's six weeks you'regood to go everything's great.
It's just a huge disservice.
We would never do that againgoing back to my original analogy.
We'd never tell someone with an ACLrepair it's six weeks you're good.
Rotator cuff repair goahead everything's great.
It doesn't make sense right so.
The Best Birth [29:13]
Yes.
Thank you so much foryour conversation today.
It's been so informative.
(29:47):
Every week we share a mom squad secretalong the topic of today's episode.
So we will share from Jean.
She says, even if you pee whenyou sneeze or cough, keep doing
glute bridges, zipper hips, anddeep pelvic floor core exercises.
They do in fact help withdelivery and recovery.
What would you say to that?
Dr.
Betty DeLass, PT, DPT [29:38]
(30:07):
I think she's on the right track for sure.
Yeah.
The Best Birth [29:41]
We also love to share any resourcesthat you might have to help our
moms in this specific topic.
Do you have any books, any podcasts,any other experts or any personal
things that you would recommend?
Dr.
Betty DeLass, PT, DPT [29:53]
Yeah, well if I can toot our own horn,we do have a website that you can go
to that has a bunch of free resources.
(30:28):
So
it's just www .rebornphw .com.
We have free resources on there.
We also have an app and a membershipthat people can do if they're
not local to us to come see us.
A website where you could find someonelocal to you is called pelvicrehab .com.
And then that way you can just put inyour zip code and see who's close to you.
And then as far as otherresources, I feel like...
(30:50):
Instagram has exploded with likepublic health and so there's
a lot of good ones out there.
I would caution people to make surethat you're following someone who is a
public floor PT or an OT that actuallyhas expertise because there are people
out there in the influencer world thatare saying they are experts in this when
they really are not and we see thingsand I have to put blinders on and be
like, okay, don't pay attention to that.
(31:11):
So I would just make sure you area educated, cautious consumer of
what you're ingesting and knowthat you're following quality.
quality people that have thecredentialing behind them to be
saying the things that they're saying.
But other than that, yeah,there's a ton out there.
I think a couple books that are goodto read just in general is Come As You
(31:34):
Are and then The Body Keeps the Score.
Those are two really profound books thatwe recommend a lot to our patients to
really help through their healing processand their journey to health and wellness.
Yeah.
The Best Birth [31:16]
I love that book, TheBody Keeps the Score.
We'll definitely link to thatin our show notes and the other
resources that you provided today.
Dr.
Betty, this has been afantastic conversation.
Thank you for giving us yourtime and your expertise.
(31:56):
We really appreciatethis conversation today.
Dr.
Betty DeLass, PT, DPT [31:29]
Absolutely, you're more Thanksfor joining us on today's episode.
We hope you've been elevated andinspired by this week's expert.
Subscribe today so you never missan episode and please share our
podcast or post on your socialmedia so that other moms and dads
to be can also have the best birth.
Please note that the informationprovided is based on the expert's
(32:19):
insights and personal experience.
It is not intended as medical guidance.
Please seek the advice of yourmedical provider as it applies
to your specific condition.
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