Pelvic Floor Health as a Lifelong Practice, Not a Postpartum Fix

Introduction and Welcome

Britta: Hello folks, and welcome to transformed by birth, a podcast about the rite of passage of pregnancy, birth and new parenthood. I'm your host. Britta Bushnell, author, mythologist, childbirth educator and an all around deep diver with a side of goofball. I'm so glad you're here. Today's episode explores the deep interconnected importance of your pelvic floor. So grab your comfy beverage of choice or take us along for a walk as we connect with Dr Sarah Reardon, before we begin, we start the way we always do, by lighting a candle. If you want to join me, please do so or take a breath as I light mine. Today's candle is an invitation for a moment of awareness to your pelvic floor.

The Transformative Nature of Becoming a Parent

Britta: When we talk about preparing for birth and early parenthood, there's often this heavy focus on the mechanics, the body, the baby, the logistics. But what I've learned over my years of supporting families is that becoming a parent transforms everything about who you are. Your relationship to your body changes, yes, but so does your sense of self, your intimacy, your confidence, your connection to your own power. And what's interesting, your pelvic floor sits right at the center of so many of these transformations. It's not just about avoiding leaks or recovering from birth, though, those things do matter. Your pelvic floor is connected to how you move through the world, how you experience pleasure, how you feel in your own skin, how you hold and release tension, and ultimately, how you show up in your life as a parent and as a person. Which brings me to the importance of today's conversation with Dr Sarah Reardon. You might know Sarah by her Instagram handle the vagina whisperer, because that is the catchiest name and handle ever. Sarah is a pelvic floor physical therapist, founder of the beehive and author of the new and best selling and awesome book, floored Sarah has spent nearly two decades helping people understand that pelvic floor health isn't just a medical issue, it's deeply connected to our whole selves. So in our conversation, we'll explore how the journey through pregnancy, birth and parenthood changes not just your pelvic floor, but your relationship to your body, your sexuality, your sense of strength and your identity. I promise you, this isn't just about Kegels or kegels, tomato, tomato, however you say it, it's about reclaiming parts of yourself that often get lost in the transformation of becoming a parent. Welcome, Sarah. Thank you for joining me.

Sarah: Thanks for having me. Britta,

Defining the Pelvic Floor and Its Critical Role

Britta: so before we dive too deeply, I feel a need for a shared definition. What are we talking about when we talk about the pelvic floor and why is it so deeply interwoven into so many aspects of our lives? In other words, why does your work and this conversation matter so effing much?

Sarah: I am a pelvic floor physical therapist, and as physical therapists, we work with muscles and tissues and nerves throughout the body. And as a pelvic floor physical therapist, I work with muscles and tissues and nerves in the pelvic region of the body, at the very bottom of that ring of pelvic bones that we often see on anatomy models or skeleton jammies, that bottom of your pelvis is actually covered by a group of muscles called your pelvic floor muscles. So they are literally the floor of your pelvis. Those muscles act like a hammock for your pelvic organs. They support your bladder, which holds urine, your rectum, which holds poop, your uterus, your ovaries. They support a growing fetus during pregnancy, and that group of muscles also has three openings in the female body. The first opening is the urinary sphincter, where urine exits. The back opening is the anal opening for bowel movements, and in the center is the vaginal opening for vaginal intercourse, menstruation and vaginal birth. So there are muscles responsible and connected and influencing all of these different systems of our of our body, from bladder health to bowel health to reproductive health, sexual health, even core support and, you know, movement, and we don't often talk about these muscles until something's wrong with them, which is when people often find me in my clinic or online. And so there are three times in a woman's life when their pelvic floor muscles go through a very big transformation, and it's pregnancy, birth and menopause. And so if we know that our bodies are transforming during these time periods, pelvic health care and education should be really integrated into those different transitions of life, and yet they're not which is why I'm such a huge advocate about helping women and birthing people better understand their bodies and getting them the help and resources they deserve.

The Emotional and Physical Complexity of the Pelvic Region

Britta: Yeah, kind of important when you start speaking about those times in our lives, as well as all of what occurs and happens in that region of our bodies, and how much emotional intensity is connected to that region as well, is there's a lot going on there. I mean, if we're talking sex and pooping, I mean, this is gonna be a juicy conversation if we get to talk about sex and birth and poop. I mean, I'm here for it, right? These are important aspects, and, you know?

Sarah: And it's interesting, because this part of our body is what makes us a woman or a birthing person, and yet we don't talk about it, and it's often neglected, not because of fault of our own, because it hasn't been integrated into medical education and therefore health care. And so it's really wonderful to be able to have conversations like this, to bring light to this really important part of our body, to demystify it, to to help folks feel less embarrassed about any experiences that they're having, and to lead them to resources that could be helpful.

Britta: Yeah, I feel like that's so important. I I read in your wonderful book, and this is like on page 11, can I read your words back to you? Will that bum you out? Okay, you said nearly one in three women suffers from a pelvic floor disorder. I mean, that's huge.

Sarah: That's right, that that's and I think that's an underestimation,

Britta: yeah, and then you go on in the next paragraph to say these conditions comprise our self esteem, mental health, intimate relationships, ability to exercise, and even our pocketbooks. And I was like, Oh, wow. I mean, these are, they're all really woven in. It's more than just somebody saying, Oh, you had a baby and and you want to make sure that any tears or lacerations have healed. Well, go see a pelvic floor physical therapist. There's a lot more going on here.

The Far-Reaching Impact of Pelvic Floor Health

Sarah: There is and, you know, I think that kind of bringing it down to a very physical level. It helps us be, you know, from a medical perspective, from a healing perspective, that something needs attention and care, but it does go far beyond that. And you know, I've been working as a pelvic floor therapist for 18 years. I have two children of my own, and have gone through the pregnancy and birthing and postpartum experience, which is incredibly challenging from a physical and emotional and psychological perspective, and I felt physically equipped. And I thought, Oh, my goodness, if I'm having this much of a challenge, and I know all of this stuff, and I've prepared physically, we birthing people need so much more support in different avenues. And again, I just think that it's, it's something that is, it's easy for us to overlook because we don't see it. You know, we have clothes on. We don't talk about it. We don't even know who to talk about it to. But yet, it impacts so many different areas of our lives, from work and sexual health and relationships and exercise and you just so many facets that, again, we the ripples of these, you know, conditions go really far,

Britta: yeah, and they, they go deeply into how well we can, how well we feel in our own bodies. Like, yeah, I'm remembering I was in a small community and a very sort of transparent community, like we talked to each other a lot, you know, how, how new parents often will be like, let me tell you about this thing and let me tell you about that thing. And you're like, wow, I didn't used to talk about peeing and pooping and sex with my friends, necessarily. But suddenly you're a new parent. You're like, here it is. It's all open. And I remember the conversations about laughing or sneezing and peeing and the more or less just brushing it off as normal. Yeah.

Normalizing Common But Not Normal Issues

Sarah: Yeah, and that's not uncommon, and that that's a whole other thing. Yeah, it is. And I think that we brush it off as common because we've been told, as birthing folks that that's our future, that this is just the inevitable part the sacrifice we have to make in a very physical way for being pregnant and having babies, and it's one not true. And I also think that it is embarrassing. You know, these are kind of very embarrassing, intimate issues. So how else do we handle them? Do we kind of just wither up or and shrink, or do we just say, Oh, it's just another thing, and sometimes that's the best coping strategy we have to keep moving forward? And so I think it's okay to laugh about them, but I also think the next step is say, Okay, what now am I going to do about it? Because these issues typically don't improve on their own. The research is very clear that if it's three months postpartum, you're still experiencing urinary leakage or back pain or painful sex at one year, there's a high percentage chance that you're going to still be experiencing those issues. So when we tell, you know, women or moms after birth to just give it more time, that's major gaslighting, because time is not going to be the factor that improves them. It's therapy,

Britta: yeah, and I that's part of, I mean, I've been working with pregnant folks since 1999 pelvic floor physical therapists were not talked about like it was not something that was Even as somebody who was educating others, it wasn't part of the conversation. It's taken a lot of awareness and bubble popping to bring what it is that you do into more of a mainstream awareness and out of the shadows. And there's a lot of shadows when it comes to female reproduction. And you know, I mean, I can remember when I was going to have sex for the first time, and trying to kind of make sure I understood everything that was happening in that lower region of my body. Or I remember when I got my period for the first time, and I happened to be on vacation with my dad and my sister, and it was like, Oh, great timing. Thank you, body. What am I going to do? And my older sister was like, here's an OB tampon without an applicator. Go put it in. And I was like, put it in where? Like, there's so much there's I share that that story, because there's a lot of shadows and unknown about this part of our body, that and stigma that we're actually working against to come into relationship with us, with it. And so some of that conversation and humor and being like, ah, that's just normal is a way to also be like, brush it off. Brush put it back in the shadows. Put it back in the shadows. I don't want to I don't want to deal with it, but I don't want to deal with it can lead to other problems.

Breaking the Silence and Stigma Around Pelvic Health

Sarah: Yeah, and it's, you know, again, I think it's no fault of our own. It's the narrative we've been given of you have to deal with Absolutely. What other option do you have? Do we shine the light on it? Do we, you know, again, just kind of hide, you know, I think that we've, been I wrote about this in my book for it, as well as, like, your first experience of kind of, quote, unquote, you know, becoming a young woman is when you, you know, reach menarche and start menstruating, and we're slipping tampons up our shirt sleeves, you know, and we are wrapping shirts around our waist to hide everything. And it's, and it's one of the times, I think, because when we start very young, not understanding this part of our body, all genders, understanding how the female body works, and we're just, we're supposed to hide it. We're not having open conversations about it. We're not being taught about it, and we don't we're not talking about it. So that innately breeds this, you know, sense of, it's shameful, it's embarrassing. We need to brush it under the rug because we're not talking about it. And so I think a lot of what I try to do is have open conversation. So, you know, peeing and pooping and sex are dinner table conversation for me. Because, you know, I think it's I work with hundreds and 1000s of women over the past 20 years who they've all had these issues, and yet they feel like they're the only ones, right? And so I think a lot of it is, you know, not normalizing the problems, but normalizing the conversation. I think it's step one. And then to your point about if we're able to learn better ourselves and the next generation.

Educating All Genders About Pelvic Health

Britta: Education can also be more informed and more empowered and caring for their pelvic floors and not hearing for the first time it's, you know, at 40 or 50 or whenever that it even exists because they're leaking now or having painful sex right now. I think that's that's really important, and the work that you are doing dressed up in vagina costume with with your head and the clutter is above your head and right that, I mean, if you're taking one for all of us to it's so great. But it brings such joy to see those, those Instagram stories, and I'm guessing it's probably tick tock too. I'm just not on tick tock. It's important to be having these conversations. And as women in my era of life, I'm in that menopausal generation. You're in the mothering generation, and then passing it down to our children and being able to have conversations with them. You and I are both moms of boys. I believe you have two boys, right? I have two boys. They're eight and 10 right now. So I have two boys that I gave birth to and then a bonus daughter. But my boys are the ones that, you know, I raised with the learning about pooping and all of those things, because it matters for them too. It's just different than what, what we've got

Sarah: it does. So there's general pelvic health stuff I teach my kids and and, you know, it's funny, because we have I live here in New Orleans, which is my hometown. I moved away for 17 years, and then moved back here after I had my two children, and we were at a Mardi Gras parade a couple years ago, and one of my friends, her daughter, who's a middle schooler, said, Oh, Miss Sarah, do you you have two boys? And I said, Oh, I do. And she goes, Well, that's a missed opportunity for a daughter, you know, in a funny way, as in, like, ah, would have been great for a young girl, for you to have a girl to teach this stuff too. And I thought, oh, but it's great to have two young boys to teach this stuff too. And so they, I mean, we clearly have an open household, because I'm pretty open about most things. But but, I mean, they know. And you know, even prepubescent boys like, what a period is, what a tampon is, that mommy bleeds every month, they're like, does it hurt? I was like, No, it doesn't hurt. And so it's even just these trickling of little things. I'm curious as to what this will evolve into as young men. But when we just talk about it really openly, it's not it's just normal the way the body works, versus like, Oh, what is that? You know? And so my hope is that just normalizing the daily functions of what we do, peeing, pooping, menstruating, just becomes just like, you know, brushing your teeth,

Britta: yeah. And destigmatize. Destigmatizes it in a way that is important regardless of your gender, right?

Sarah: Exactly.

The Ripple Effects of Pelvic Floor Issues

Britta: I think that regardless of gender piece is important, because as much as it is very important for us to educate the next generation of vagina owners, shall I say, it's also important for all folks to understand their pelvic floor health. Every person has a pelvic floor. Every person will, you know, be birthed from a vagina, which is part of the pelvic floor. And I think it's important for us to understand how this, these, you know, issues in the pelvic region, affect all the aspects of our life. Because it's not just physical, as you mentioned in the beginning, it's very much psychological and emotional and occupational. And, you know, there's so many ways that this affects I mean, I've had moms who come in like, I can't work anymore. I physically cannot stand on my feet for this long and teach a class. Or, know, my discomfort with intercourse is causing relationship challenges, and we're not doing great, or I'm leaking, and I was part of a running group, which was so good for my social life and my mental health, and now I can't do that anymore. And so we see how these effects, how the ripples of these things, can go really far and really impact us, which is why I'm so passionate about helping folks get support sooner, or even if it's later, letting them know that it's never too late.

Britta: I love that, and I love how you just wove together so many different parts of identity to talk about. I mean, here we're like, okay, we're talking about a physical part of the body, but it is not just a physical part of the body. It is a region that impacts and a functionality that impacts so many aspects of our of our identity. And so I want to also pull in to speak specifically about what. Pregnancy and Birth and postpartum, because that is a big part of what this podcast focuses on. And I was really impressed with those chapters in your book, because they were dense. And I mean dense in a good way, like in the best of ways, because you, you spoke about hormones, you know, and there was a part of my brain that was like, wow, why didn't I expect there to be an element of hormones being discussed when talking about the pelvic floor? But it surprised me.

Understanding Hormones and Pelvic Floor Health During Pregnancy

Sarah: So our hormones are powerful, and they have really strong effects on our tissue and our pelvic floor muscles and ligaments and tendons. So when you're pregnant, your body starts producing a hormone called relaxin, which it starts producing during the very beginning of pregnancy, and it's the highest during the first trimester and the third trimester, and what relaxin does, and there's a reason it's called relaxin, is it causes our soft tissues, our muscles, our ligaments, our tendons to become more soft and pliable. And the purpose for that is so your baby can move through the birth canal, through your pelvis. So during pregnancy, a lot of folks experience more pelvic pain, pubic symphysis pain, hip pain, joint pain, because they're more pliable now, right? You get stretched more, and so there are things you can do with exercise and strengthening and rehab to help support yourself during this time. And this this hormone lasts for six months after giving birth, which people never warn you about. So postpartum, we're actually way more vulnerable. I was walking from a further parking spot while pregnant can be a good thing, right? Like that movement is good, but then having a stroller and a toddler or a baby, and then being halfway in the back of the parking lot, I'm like, Oh no, no, can I have the parking spot like, right up front, right? And so I remember those very kind of societal messages of like, okay, this, you know, it you don't matter anymore, and it's unfortunate. And so I think again, that's mirrored in our medical care right now of postpartum moms, which I hope is changing. You know, my hope is that every postpartum person feeds a pelvic floor therapist. We see hours in our clinic between four to six weeks in person. Sometimes we do virtual sessions prior to then, but it should absolutely be the standard of care for birthing people, absolutely

Starting Pelvic Floor Care During Pregnancy

Britta: so is that when you often, people will say to me, okay, so I've heard about pelvic floor physical therapists. So I'll just go to one after birth, after I've, you know, made it through, and often I'm hearing it more around the six month mark or even a year postpartum, but I've been hearing from folks in your work start in pregnancy 100% so can you 100%

Sarah: Yeah, speak about that, because I'm hearing from the demographic getting the help that they're delaying, but I'm hearing from your group of professionals, don't delay. So what? Don't delay? Talk. Off talk us talk about that. So there's reasons for this. So what we do in the clinic, where I am now, and how I support moms, even virtually, is that we start during pregnancy, and I see most folks after their first trimester, that first trimester is just a little bit of kind of a waiting period, navigating symptoms, you know, feeling like you're kind of in a zone that is comfortable and you're confident. And then I started seeing people within their first try, their second trimester, and it could go through everything of you know, reviewing how you're getting in and out of bed and sleeping, and modifying movement for comfort, addressing any aches and pains and things you're think are just a normal part of pregnancy, but they absolutely impact you modifying exercise routines, like you can still work out. I absolutely encourage it, but there are some things that you'll want to modify. And I think often people feel lost, like, what can I do? What can I not do? Is this okay to do? And so being kind of a coach for them, and then most importantly, is working on strengthening the body during pregnancy, because think of this hammock of muscles. You know, it's supporting a growing fetus. And, you know, we're so used to getting those text messages that are like, your baby's the size of a line, then it's size of an avocado, then it's the size of a watermelon, watermelon. Well, hammock supporting, right? A hammock supporting an avocado isn't going to change that much, but supporting a watermelon is going to stretch the muscles, make the muscles sink lower, that can lead to leakage and prolapse and pain, and so pregnancy is an incredibly crucial time to start working with a pelvic floor therapist. We also help you prepare for birth, teaching you how to push different positions. HIIT, mobility, you know, just the kind of more physical mechanics of it. And then help you prepare for postpartum, because so much happens in those first four to six weeks that movement is key and rehab is key. But if nobody's giving you guidance on how to do that, you do nothing. And so I think every birthing person will experience pelvic floor changes, whether you have a C section or a vaginal birth, and if you are postpartum, you are still going through so many changes, but sooner, the better to get care, because, again, the research is very clear, you will have better outcomes the sooner you get care, including if you Get care during pregnancy, your postpartum outcomes are better.

Beyond Kegels: Understanding Pelvic Floor Flexibility

Britta: I love it, and it's not just about strengthening the pelvic floor, because one of the misnomers that I also hear is the idea that you got to have a strong pelvic floor. You got to have a strong pelvic floor. But I remember I got into this field as a yoga teacher, and so my whole community were yoga teachers, yoga practitioners, and frankly, a lot of them had really challenging labors and births. They had super strong pelvic floors, but they didn't have very flexible pelvic floors, right? So tell us about from your perspective, as a professional understanding this, what's going on there.

Sarah: You know, these pelvic floor muscles are like every other muscle in your body. We need them to contract, to support us. We need them to relax, and then we need them to even lengthen, to open up the vaginal canal for vaginal birth. And when we don't have that coordination or flexibility of these muscles, because we've only been trained to tighten, tighten, tighten, then we don't have that full range of motion that helps the vagina elongate, helps the pelvic floor muscles open up and relax for a vaginal birth or even a bowel movement, for that matter. And so I think it's important to understand that just like every other muscle, strength is great, but so is relaxation, and it's the full range of the muscle. But again, if nobody's taught you how to work this muscle, if nobody's coached you and what it. Does and how to connect with it. It's hard. It's easy to feel lost. And it's particularly easy to feel lost when you are in a birthing room with fluorescent lights and 10 people and you've got, you know, medication running through you, and they're like, push. And you're like, I am pushing. You're like, No, you're not. And you're like, Well, I don't know what I'm doing. Well, we're asking you to run a marathon, but we haven't even taught you how to walk a mile, and so I think that there's just so much more education that can be done to help folks feel empowered in that experience, and again, to have better outcomes on the other side.

Demystifying the Mechanics of Pushing

Britta: Yeah, so let's talk about pushing, because I do feel like this is a spot where there's so much misinformation about even what it is that's doing the pushing, and what's happening and what can be helpful. So can you unpack that a little bit and just like, how do you talk about pushing with clients? And I mean, I know you can't put your hands up inside anybody's vagina right now and talk, you know, coach us specifically through it.

Sarah: I'll do the best I can. Give us the what you can, yeah, you know, I think we kind of throw around these terms when we talk about birth and, you know, we're like, Oh, your contractions and, oh, you're pushing, and we don't even talk about, like, what those really are. So your uterus is a muscular wall, obviously, kind of housing your your fetus. And that muscular wall is what contracts to soften, lengthen, dilate, the cervix. And the cervix is the opening to the uterus. So when you are having contractions, it's your uterus contracting to kind of thin a face and dilate the cervix once baby comes down, your pelvic floor muscles are not pushing your baby out. Your uterus is so we want that uterus to be active, but we also want pelvic floor muscles that can get out of the way. We don't want high, locked pelvic floor muscles again, we want them to contract when we need them to, but also lengthen and elongate to help baby come down the birth canal. So a lot of what we do in therapy is addressing the muscular issues of how do we coach folks into how to lengthen their pelvic floors to help the baby come out and you can increase your intra abdominal pressure by holding your breath or curling your trunk or, you know, pushing really hard and but also, you can also soften into these things and help your uterus, you know, just chill and do the work while you just lengthen your pelvic floor muscles and help them get out of the way. So it's interesting, because I think a lot of folks who are birthing in hospitals now are not when we introduce medications, it can absolutely help with pain relief, but it also can kind of minimize how much agency we have over our pushing, sensations, when we push, how we push, and what positions We push in. And it's such an individualized experience birth is, but yet, we're trying to kind of make everybody fit into this, like one slot of on your back legs up, you know, things like that. Yeah, yeah, medicated. So it's so tricky to kind of coach folks to do this in our clinics, but when they get into a hospital based setting, it's very standardized, so it's really a little bit of a negotiation about, let's talk to your provider, see what options are available. How long can you wait to get medication, things like that, to really just give them the best outcomes and experience. It's not even just outcomes, it's really experience.

Britta: Possible outcomes can be overused, because we're not just talking about how we get to the end of something, but the journey right, not just the end and and that can be really important. Yeah, so in in your clinic and other pelvic floor physical therapists, wherever listeners are, can actually help in the understanding and practice of that lengthening of pushing prior to those moments of being in labor

The Power of Preparation and Proactive Care

Sarah: 100% and they should. I mean this again, it's like, this is such a physical experience that I always say it's like, you know, I'm a runner. I've been a runner for years, but I don't just go run a race like I train my body to do it, and you you practice something over and over and over until it becomes kind of automatic or more intuitive. And I think when we go into something feeling like I've done all I can to prepare, or, you know, I feel like I I'm informed and empowered. It just it, the outcome is a better birth experience. Regardless of what method you birth. It's less trauma and it's a better experience. So I'm just a huge fan, also, of proactive care. You know, I think over the years about I've been practicing for 18 years. About 10 years ago, I was seeing a lot of older women. Women come into my clinic who had this mesh surgery, who they were getting prolapse repairs, and this mesh was causing a lot of extra complications and pain and surgeries, and a lot of their issues started around pregnancy and birth, and in my head, I thought, like, this is women deserve better, like there's so much we could have done to help prevent them to get to the point of needing surgery. Why didn't we help them sooner? Why didn't we empower them sooner, get them rehab sooner? So now we're kind of doing damage control. And I just, you know, if you go through this experience, I'm just like they women deserve better care, and that is really the hope that I, you know, want for them. And my hope is that that's what comes out of this book, and my work is that we're just better supporting them through these physical endeavors.

Britta: You and me, both, sister, I hope so gosh, that that would be really important. And I do, I do see the conversation expanding. I do see people having the conversation as somebody who's been teaching childbirth classes since 2002 nobody talked about seeing a physical therapist back in 2002 when I was first teaching. Now we talk about it every time.

Sarah: Love that and that's different. I mean, that's it's change, it's growth and and people are already aware they're not hearing it for the first time from me, yeah, so in the conversation, in a I love that kind of way, which is so fantastic.

Perineal Massage and Preparation for Birth

Britta: Now, another thing that often folks talk about is perineal massage, which I personally have, have my own opinions about it, about some of my teachers were heavily in the perineal massage camp. I'm a little bit less so. I'm wondering your perspective on perineal massage and what your take on it is.

Sarah: Yeah, and I think perineal massage has the best research. It's been studied well, and I think if you do it correctly and regularly and prior to giving birth, it can be helpful, not guaranteed, but like it can be associated with less lacerations. We see about a 10% decrease in lacerations or episiotomy when folks have done perineal massage. That being said, I think it's about 2% of folks who will actually do it regularly. So we say to do it starting at 34 weeks of pregnancy, about three to four times a week for two to three minutes. And it's a very specific protocol. I talk about it in my book, on how to do it. But it's most effective if you are a first time birther, delivering vaginally, and specifically if your provider will do an episiotomy. And I think if we're having conversations with our provider of like I want to avoid this or I don't want this to happen, then that often can also, you know, change what your birth experience looks like. So I think it's something that can be helpful. You know, I put it in a category of it can't harm it it's not harmful, but I understand if folks don't want to do it, or it's the last of your priorities. And I think what I try to focus on when I'm working with prenatal clients is, can we understand your pelvic floor? Can we get you comfortable controlling these muscles and their different functions, so then we can apply that for birth? I think if we only taught perineal massage, that's great, but if we don't teach you how to do the stretch, or, you know, really know how to connect with these muscles, then it's one kind of small element to a much larger picture.

Britta: Yeah, I think, I think your book summarized it quite nicely. And when I was reading that section, I literally thought, like, Sarah, a woman after my own heart. Thank you. So I'm so glad to hear that.

Navigating the First Postpartum Bowel Movement

Britta: I want to start talking a little bit about postpartum. And one of the things that you talk about in the book is that first poop. So can you tell us a little bit about that first poop postpartum? And you know what folks can do to minimize some of the physical tension and fear and all of the oh, I'm afraid. What am I doing?

Sarah: Yes, postpartum folks are often instructed to take a stool softener. That's about the extent of the conversation of, okay, here's what you need to do. And so it's very clear that, again, this is, like, the first step of like, we need to give folks more support. And so, you know, I share about like, you've got to take stroll sophomore, to use the squatty potty, support the perineum and vagina when you're bearing down, support the C section scar, when you're, you know, bearing down and breathing out. And just really, it's a kind of mechanical logistics. And I can't tell you how often I get a message in my DMs that are like, thank you so much. I saved your video and I did everything you said, and it was so much better than I expected. And you know otherwise? I mean, we're sweating in there, we're terrified and it we're in pain, and so again, it's like these first entry ways into motherhood, and we're like, okay, already this is, like, not what I expected. And nobody told me about this,

Britta: yeah, well, and that first postpartum poop is also, there's a lot of things are stretched out and are in an altered state that influences what's gonna happen in that first poop? Do I have that right?

Sarah: Right? So, I mean, your tissues are vulnerable. Your pelvic floor is vulnerable. Many folks have, you know, stitches or a healing tear, if you've had a C section, over 30% of people are giving birth via C section. So you're literally, like, stitched and recovering, and yet you're like, asking these tissues to kind of stretch to this capacity, again, to fit a baseball. And so, you know, I think it's again, just giving folks, like, tips on how to support their belly, how to support their perineum and vagina, because they are vulnerable, and you do need to exert some effort, oftentimes, to empty and but these are the conversations I have day in and day out at my clinic. And it's like, Who else do you ask? This is what I love, what I do. Because I'm like, Okay, let's just talk about it and help you get through it.

Postpartum Sexual Health and Intimacy

Britta: I love that. And it's yeah, it's so important. And then let's talk about sex, because there's a lot of stigma and shame, as well as expectation around sex after baby that can be physically there's a physical component, there's an emotional component, there's a relational component. There's a lot going on. So how do you address that intersection in your work?

Sarah: So again, I think the one thing for folks to know is that the nine out of 10 postpartum moms will experience pain with sex, so it's somewhat common some of the things I go through the logistics, like, I'm not one, take the pressure off yourself. Six weeks is just like, Okay, it's kind of safe. It doesn't mean you should do it or have to do it, like, give yourself as much time as you want, like you that is, take the pressure off yourself right away. Six weeks doesn't mean you have to do it, just means the doctor gives you medical clearance. The second thing is the logistics of you will likely have vaginal dryness because your estrogen levels are lower after giving birth, particularly for lactating and estrogen helps plump up the vagina and give you more lubrication. When you don't have that, there's dryness. So I say proactively use a lubricant, and a good lubricant, not just one that you're going to walk down the aisles of your local drug store. I prefer something water soluble. You can even use coconut oil, if you'd like, with something nice and clean. And the first you know time, I'm like, it's about discovery, like you're just gathering data points. Don't expect the hottest, steamiest sex of your life. You may feel less sensation, like things are a little bit weaker. You may feel some tension or discomfort even, but don't push through pain. Kind of see what feels good. Go for less penetrating positions like lying on your back or your side, and just get some data points about what feels good and what doesn't. And be patient with yourself. If you have sex two three times and sex is still painful, then I would check in with a pelvic floor therapist, because it can literally be I've had a patient who was 11 months postpartum, was having so much pain with sex, she wanted to get pregnant again. We had three sessions, and she was 100% better, and she's like, I just wish I would have come sooner, but nobody told me. And so it's one of those things that I think the earlier you can get help, the quicker your results can be.

Britta: I love that. And the idea that you have to suffer through it is not something we want to keep perpetuating. It's like, get the help, hopefully they're already seeing you prior, prior to that first, you know, hopefully. But you know, it's hard. I mean, seeing, getting in person care is hard, and I think that, you know, that's what I hope to provide with my book floored and my app, that IT resources are available and accessible, because in person care, particularly postpartum, just logistically, can be challenging. And I was 18 months postpartum when I saw my. Look for a therapist. I was like, Okay, I know I need to do this, but I've just kind of been struggling for a year and a half. But I also think that pain is information from our bodies that we should not push through. This is not a more pain more gain situation. This is a I'm observing. This is happening. Let me pause and take a beat and get some support to navigate this, versus push through and just kind of wish it away.

Sarah: Yeah, sometimes in my conversations with couples in the postpartum period, I'll even recommend that the first sexual experience postpartum is alone, where it's great totally by yourself, with your hands, or with a toy, or where it's an exploratory what feels okay for me before I invite my partner into that space that has felt foreign, often, because one of the things I often hear is the feeling of feeling that part of their body feels so foreign after they've given birth, like it's changed absolutely much that they're like, I don't even know what sex would be like now, and I can't even fathom it.

Britta: Yeah, yeah, that's a great idea. And I love that I might snag that myself and and I think we often feel like, is it going to feel different for my partner? Am I stretched out or things looser? And so, you know, your body has changed. I mean, as you mentioned in the beginning, it's a change in every way. It doesn't all have to be negative, but, you know, I one of the things I used to say that I have stopped saying, is I listen to your body. And now I'm like, our bodies are speaking a different language after birth, like it's just something that we don't even know what's being said or and so it's, how do we kind of, we just have to kind of start connecting, you know, and I think it connecting with yourself kind of going even to straight to self care versus other types of connection, I think is such a great idea, and so needed to encourage folks to do that, which is also dig, you know, we have to destigmatize self pleasure, because there's a whole purity culture around that as well, right? That touching ourselves.

The Connection Between Pregnancy, Birth, and Perimenopause

Sarah: So before we start wrapping up, I want to ask you about the connection in the pelvic floor around our journey through pregnancy, birth and postpartum, to these other parts of our lives down the road. So like the era of life that I am in, or you know, my mom, who is now in her 80s, like there's, there's a link here, and I want to hear you talk about it.

Britta: I love this because, well, particularly now we're having babies later in life, so this season from pregnancy to postpartum, and then postpartum to perimenopause is one blurry season. Where are we? Is this a postpartum issue? Or am I in perimenopause? I don't, I don't know what's going on. And so I think we get there quicker than we realize. So we talked about hormones in the beginning, our hormones start significantly changing in our period, menopause period, which can start as early as 35 but I would say on average, it's early 40s, and it can last for up to 10 years. During that perimenopausal period, our estrogen levels are declining, and we, when our estrogen levels decline, we also have less collagen. Estrogen is responsible for kind of laying down this protein called collagen, which we think about for our faith and our hair and our nails, but our tissues, our pelvic floor tissues, also are supported by collagen. So when we have less estrogen, we have more vaginal dryness, potentially more painless sex, more bladder issues, like urgency to urinate, frequency of urination at nighttime, before bedtime, during the day, more frequent UTIs,

Sarah: I'm hearing that,

Britta: yeah, and then more pelvic organ prolapse, which is when your organ organs aren't as well supported by that hammock. So perimenopause and absolutely post menopause or time periods, we have to be proactively training our pelvic floor. So that may be strengthening for some it may be relaxation work and then some strengthening. For others, but it's kind of this blinking yellow light of like, okay, the train's coming and you have a choice to, kind of like, be proactive and get prepared, or it's just going to come and you're going to feel like, whoa. What just happened? And your body is not in the place you want it to be so after menopause, we lose 2% of our Urinary Sphincter strength every year. So this is why women later in life start experiencing more urinary leakage. 50% of women over the age of 65 leak urine. And so diapers do not have to be our destiny, but we have to change. The way we're caring for our pelvic floors in order to minimize or even prevent those issues from happening, and that can start even as early as pregnancy, and how we're preparing for birth and preparing our pelvic floor for birth, right? Because there's a link between all of those.

Sarah: Yes, yeah. I mean, you get one pelvic floor that's the leg is that you get one. But I also think that better understanding your body during pregnancy and birth helps you know what's normal and what's not. So that when you're in your early 40s, and you're like, wait, i Is it normal to cough and sneeze when I wake your and you're like, No, I know that it's not. And so I know I need to get support right away, instead of thinking this is just kind of a normal part of aging, and there's a difference between what's common and what's normal.

Common Versus Normal: Understanding Pelvic Floor Dysfunction

Britta: Yes, and all of these issues can be common, but they are not normal function, and we have to tease those two apart, because especially when we're talking about women's health, they often get conflated as what's common is considered normal, but it's not it, or it isn't always. Well, back pain is common, but it's not normal. I mean, back pain gets treated with medications and injections and surgery and physical therapy, but, yeah, we don't get that same care for our pelvic floor. So I think it's, it's something that we really need to think about. We've the culture and the society has has normalized these issues for women, but they are not normal 100% hands down, pain and leakage, no amount of them is normal.

Sarah: Love, that love. How clear you are about that.

Sarah's Resources: Book and App

Britta: So as we start to wrap up, what are you offering right now? I mean, your fabulous book, floored. I'm going to read the whole it's a woman's guide to pelvic floor health at every age and stage. It's fabulous, folks. I've got tabs and notes. I love writing in a good book. It makes me so happy. I know that sounds sort of like I'm defacing it, but no,

Sarah: thank you. Speaks to well. And I saw you share about this, and I was like, Oh, I love that, you know. So my book floored A Woman's Guide to pelvic floor health is available, and it's, it literally is for women of every age and stage, whether you're postmenopausal, whether you're pregnant and birthing, whether you are raising a young menstruator, you know, whether you're becoming sexually active, it's really to help you. It's a guide for your body, I think, through every stage of life, and you can read it in entirety, or go to the chapters that you feel like are pertinent for you. The same year, I'm launching a book, I launched a fitness app. So it's called the V hive, and the V hive has on demand pelvic floor and core workouts in addition to birth preparation and pregnancy workouts and postpartum recovery. And it's really an effort to help folks better understand their bodies and also give them affordable and accessible resources to do at home. I mean, we have 1000 fitness apps out there, and yet we don't really have any pelvic floor ones, and this is such an important part of our body, so that's available now. And I hope folks check it out, and every you can it comes with the free trials. You can try it out and check it and give me feedback if there's something you know you want better. But it's really been a labor of love that's been four years in the works, and it's finally available.

Britta: I love that. And it's I love how accessible it is because, as you spoke about how it took you 18 months to see your physical your pelvic floor physical therapist in person, after having your baby as a physical therapy, as a pelvic floor physical therapist, to be able to have that accessibility that is available in an app is is amazing and super transformative. So I love that. Thank you.

Final Wisdom: Everything Is Temporary

Sarah: Yeah, so I have a final question, and my final question is, what's one thing that you feel passionately about that you want new or expectant parents to see, hear, feel or know during this profound rite of passage in their lives.

Britta: I think one of the things that I had to consistently come back to is that everything is temporary, whether it was kind of a physical experience of healing, whether it was challenges in my marriage that no one kind of told me what happened, whether it was like these sleepless, exhausting nights like, you know, bouncing a baby at 1am walking the hallways, I just kept thinking like, this is temporary. This is temporary, but it also fed into when they were, like, really joyous moments that I felt like I was cruising in motherhood and it was amazing. Or, you know, my husband and I went on these wonderful trips and reconnected, or my kids were doing their first milestone. It's all of those things are temporary, and so it kind of helps you get through those challenging times knowing they will pass. But it also helped me. Kind of try to be really present for those more joyful times. Because I was like, this will also pass. So I think even now with a 10 year old, I remind myself of that even more like, okay, these times are temporary, and so it just really helped me kind of try to be present as much as possible in the journey of motherhood.

Closing and Call to Action

Britta: Wise words, Sarah, thank you so much, and thank you listeners for sharing this time with us. If something shared today impacted supported or moved you, please share this episode with a friend. I produced this podcast myself, and your support makes it possible to show a little love for the podcast and these conversations, please follow rate and review if you'd like to continue the conversation, please join us on Instagram at transformed by birth. I look forward to being with you again on the next episode of transformed by birth. And now let's gather what we want to take away from this episode, so many juicy morsels, and we're going to bring that in with an inhale and blow out our candle with an exhale until next time bye friends,