What Your Pelvic Health Is Telling You with Dr. Tia Ukpe-Wallace

Introduction and Candle Lighting

Britta Bushnell: 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 happy you're here. Today we're exploring the interconnected nature of pelvic health, nervous system care, and community. So grab your comfy beverage of choice — I've got homemade masala chai in my cup today — or take us along for a walk as we connect with pelvic physical therapist Dr. Tia Ukpe-Wallace. Before we begin, we start the way we always do by lighting a candle. If you want to join me, please do, or just take a breath as I light mine. Today's candle is in honor of the wisdom of the body-mind.

It has been completely normal for most of us to go through life with barely any knowledge or understanding of some of our most intimate body parts — down to even their names, let alone their functions. We've been taught to stay quiet about this part of our body, to feel shame rather than curiosity, to disconnect rather than attune, and then we're somehow expected to show — somehow know...

Chris, let me just redo that piece.

...and then we're expected to somehow know how to care for ourselves through pregnancy, birth, postpartum, and beyond, often without any real understanding of what we're caring for in the first place. And there's that part — the self-care. Without knowledge or understanding, we're meant to care for ourselves in isolation, but self-care isn't just an individual practice. Without the support of community, maintaining and ensuring self-care can be fraught with tension. So much of what we're told is a personal responsibility is actually deeply collective, shaped by our community and the culture around us.

My guest today has spent her career shining a light on both the personal and the community issues that affect what she refers to as womb health. Dr. Tia Ukpe-Wallace is a board-certified orthopedic physical therapist specializing in pelvic health, providing a continuum of care from pregnancy loss through postpartum. Her own journey with her pelvic floor and personal experiences with loss grew into a deep love for understanding this part of the body that's rarely talked about and often misunderstood. Tia is a doctor of physical therapy currently residing in Portugal — so we're utilizing technology for sure here, folks, to connect — where she offers telehealth and clinic-based services through her practice, Self Care Physio. She's also the author of Tending to Your Womb, offering wisdom around caring for the womb through all stages of life.

A note before we continue: today's conversation will touch on pregnancy loss as part of Tia's personal story. As this can be a painful and personal topic for some listeners, I want to remind you to take care of yourself as needed — check in, pull in a somatic practice, pause. You get to decide how to proceed. I sometimes say to my kids, "Make good decisions for yourselves."

So, welcome, Tia. Thank you for being here.

Dr. Tia Ukpe-Wallace: Thank you so much, Britta. Thank you for having me.

Britta Bushnell: So I'd love to start with your story. How did you get into this work? I alluded, in the bio that you shared with me, that a personal journey brought you deeper and deeper into this work. So can you tell us your story, and how that led to this specific type of work that you do?

Tia's Story: From Military to Yoga

Dr. Tia Ukpe-Wallace: Yeah, thank you. So yes, it is definitely a lot of it was — is — a personal journey, and I would say, beginning in my 20s — I'd preface it as probably more in my mid-to-late 20s — I was in a monogamous relationship with my now husband. And it was during this period of time that I was definitely in between jobs. I served in the U.S. military — I served in the U.S. Navy for a period of time — and then went the yoga direction.

Britta Bushnell: Okay — military and yoga, that's a really big — wait, we just have to pause for a second about that.

Dr. Tia Ukpe-Wallace: Okay. I only did five years in the military, and for a reason. I thought I was going to be a lifer. I did ROTC when I was in college, and I thought, "This is great," but that was college, and I thought it was going to be kind of like college life. And then actually got into the military, and it's a different lifestyle. I was in the Navy, I was on a ship, I'm Black, I'm a woman — so both of those made it really challenging to be in a world of, you know, older white men, which I was primarily surrounded by, especially on my first ship. And so it was great because I got to travel, I learned a lot, I became responsible for a lot of things, but I knew that wasn't the career for me.

I had studied yoga my last — it was an elective course my last year of college — and I loved it, and I knew that was something I wanted to continue. But my first duty station was in Japan, so I didn't really have access, especially with language being a barrier. I eventually moved to California, and that's where I really got to focus on that and found a really great teacher.

Britta Bushnell: Yeah, in California there's yoga on every corner.

Dr. Tia Ukpe-Wallace: Oh yeah, yeah, it's hard to miss a yoga studio. So I was definitely very much immersed in that culture, all about caring for myself and eating well. It was also around that time — especially, I lived in San Diego, I was there for two years while I was finishing up in the military — and then I moved to the Bay Area, and there I was even more immersed. I became a vegetarian — a supposed vegetarian. I was still not eating great as a vegetarian; I was still eating a lot of processed foods, a lot of sugar, not a lot of vegetables.

Britta Bushnell: Which is a common form of vegetarianism, actually.

Dr. Tia Ukpe-Wallace: It is. I was avoiding meat, and a lot of it was for ethical reasons, but I know it was definitely showing up very much in my diet. My husband could say — when he would come over to my apartment, my snack of choice would be like a big slice of really yummy bread with some cheese and jalapeños on top, and that was what I ate as a snack or as part of a meal. I wouldn't say I was eating super well.

Yeast Infections, Painful Intercourse, and a Medical System Without Answers

Dr. Tia Ukpe-Wallace: So eating in this way, and also being super active and doing yoga, having a regular practice, taking two classes back to back — and then also being in this relationship where I started to experience yeast infections. I didn't really have that, maybe, on and off in my earlier 20s, especially in my earlier sexual experience, but it was becoming a lot more common. So I was having yeast infections, going to the doctor and getting treatment, and it would go away for a couple of weeks, and then I would get a bacterial infection, so it would go back and forth. I remember I was in the Navy Reserves for a period of time before I finally left, and I remember being on the treadmill, running, and just feeling this distinct burning and discomfort, and also this frustration of, "Okay, this has been ongoing for so long, why can't I get rid of this?" Feeling this discomfort but not really having a name for what was going on and why I was experiencing these infections and why they weren't going away.

I was seeing my OB/GYN, who was a male doctor at the time, and he wasn't really sitting down with me and having a conversation as to what was going on. Nor did I feel very comfortable to go in depth as to why this was occurring and what I could do to make it better. And just to preface the timeframe — this was in the early 2000s, so pelvic floor PT wasn't a big name.

Britta Bushnell: No, it really wasn't. Yeah, that was when I started teaching childbirth classes, and nobody was talking about it.

Dr. Tia Ukpe-Wallace: No one was talking about it, or even pelvic floor in general. So I'm pulling resources, trying to find some information about what I'm experiencing. I didn't really find very much on the pelvic floor side, but it was more so diet — realizing, okay, well, potentially I might have candida, and really looking at my diet and trying to clean that up as much as I could.

But also during that time, as I was experiencing it — it was about three years, while in this relationship — also having uncomfortable, painful intercourse, and knowing that wasn't what I had experienced in earlier experiences with other partners. So wondering, "There's something wrong with me, what's going on, why can't I have intercourse and not have it be painful?" And this was also having an impact on my relationship with my partner, and not really having the words to explain, "This is what's going on, thus I need to go and do this." It was just kind of, I grin and bear it.

Britta Bushnell: I want to pause you for a second, because there's pain in hearing you speak about that, and a recognition — the number of people I know who have had some kind of experience like that, where there's pain, there's discomfort, there's frequency of infections, and no information.

Dr. Tia Ukpe-Wallace: Yes, yeah, it's hard. It was very, very hard to find information about what was going on.

Britta Bushnell: And information is only one part, right? That's the help in the head. There's also then the referring to help that can actually help change what's happening. And so I'm following a thread here of how you got to the work that you do now. Okay, so that was necessary — there was a real lack of information, good information, and a lack of good care. So you found yourself in this hole of that — what's next?

Finding Community-Supported Nutrition and Healing Through Food

Dr. Tia Ukpe-Wallace: Yeah, there's more, there's always more. So, like I mentioned, I was very much into the yoga world, and I think around this time I was also really interested in prenatal yoga, and I feel like that's really what got me started — I was enjoying teaching, and I wanted to explore, "Okay, well, what other populations can I teach to?" I think it was doing a prenatal yoga course that really helped open my eyes as to the pelvis and the pelvic floor, and what occurs reproductively, with the sexual organs, and what's happening in that space. I mean, I'm 46 years old, so that's like 20 years ago — it's hard to know exactly the timeframe. But I think when you learn one thing, then the floodgates open, and I started to go down a rabbit hole. I remember hearing about abdominal massage — I believe this was after I had my first loss — and I do remember that being very significant as a form of body work that could actually help with my pelvis and my uterus.

But, so, I had these bacterial infections, yeast infections, back to back, and then they subsided after a period of time. I did some work around my diet — I ended up working at Three Stone Hearth, which is a community-supported kitchen in Berkeley, and they're all about grass-fed, bone broth, where sourcing your meat is coming from. I felt safe enough to start eating meat again, knowing that a lot of the meat sources are ethically sourced. And a lot of the menu is based off of Weston A. Price — and going into Weston A. Price and understanding nutrient-dense food, eating fermented foods, and how all of that was really helpful, which I didn't understand as much. I only heard that yogurt was the thing — that I could soak a tampon and insert it up my vagina to help.

Britta Bushnell: That was talked about for a long time. Yes, as a remedy.

Dr. Tia Ukpe-Wallace: Yeah, definitely. But then drinking kombucha, having fermented vegetables, having bone broth, and really helping my gut. I learned a lot more about how my diet was really influencing my vaginal microbiome, even though a lot of those terms weren't talked about very much back then, as much as they are now. But really seeing how food was really instrumental for decreasing a lot of my symptoms.

Pregnancy, Fibroids, and a Misshapen Belly

Dr. Tia Ukpe-Wallace: And then, I'd say a year or two went by — I ended up getting married to my partner at that time, who's now my husband. And then within just a few months, I got pregnant, and it was great because I was ready to start a family. I didn't know if it would take a long time. I should preface — I didn't really take birth control pills. I did a little bit when I was in college, had a short period of time with the copper IUD, and then I think I tried the patch. So it was a really short amount of time that I did birth control pills. But when I was with my partner, I wasn't using any form of contraception, so I know there was a little bit of concern for me — "Okay, how long is this going to take?" So I was very surprised when I was able to get pregnant fairly quickly.

A couple months before I got pregnant, I had a regular OB/GYN Pap smear visit, and they had palpated my belly externally, and mentioned that I had fibroids. I was really surprised because they didn't even do an intravaginal ultrasound or anything like that.

Britta Bushnell: It was just on the outside.

Dr. Tia Ukpe-Wallace: Externally. And I was surprised because — how could they actually feel that? I also wasn't regularly touching my belly or my uterus, feeling for that. So I was surprised I didn't even know that was there. Not knowing what fibroids were, I was told they're non-cancerous, just these growths on my uterus. I remember getting an ultrasound, they got measurements, they were very small, and I was told not to worry — that I would still be able to get pregnant, it shouldn't have any impact on my pregnancy. That's what I was told.

So, a couple months later, got pregnant, and pregnancy was going really, really well. But then I remember it was around Thanksgiving, before I'd hit my 20-week mark, that I started to have some pain — pain I hadn't experienced before. No one had really told me, "These are things you're going to experience in pregnancy." I was monitored for the pain I was having, was told my fibroids were starting to grow, getting a little bit bigger. As I continued along in my pregnancy, my belly was misshapen — instead of being this nice round shape, it was more lopsided, one side bigger than the other.

Britta Bushnell: And the fibroids were causing the misshapen aspects.

Dr. Tia Ukpe-Wallace: Yeah, definitely — and also I think the degeneration of the fibroids was what was causing some of the pain. I remember I was still teaching at that time, still working. There was a period where the pain was pretty bad, I got admitted into the hospital. There was a risk potentially, or at least they presented that it might be helpful to get a cerclage — a cervical cerclage. They didn't recommend an abdominal one, but they mentioned there was a risk of me potentially going into preterm labor.

Britta Bushnell: And not wanting to tell people what that is — oh yeah, so what a cerclage is.

Dr. Tia Ukpe-Wallace: Yeah. So they hadn't diagnosed me with an insufficient cervix, but they had noticed that — I don't remember at what point, how many weeks — but I guess I was already starting to show some signs of thickening or shortening of my cervix, and so the cerclage — they do it surgically, but it's to put like a mesh in order to create some closure on the cervix, so it can help maintain the pregnancy for as long as possible. But yes, there's definitely a risk of infection, definitely a chance of losing the baby as well by doing a cervical cerclage. There's the option of doing an abdominal cerclage, another surgery, done abdominally, another mesh. I know with the cervical cerclage they would remove it a couple of weeks before you're actually about to go into labor, and they hadn't presented the abdominal one as an option, so I said no because I didn't want to take the risk.

Preterm Labor and Loss

Dr. Tia Ukpe-Wallace: And then it was going into the holidays, things were still going pretty well. Went into the new year, in January I traveled to Mexico for a drum retreat that my husband was doing — I was teaching yoga. It was in Yelapa, so if anyone's ever been there, it's a lot of walking, a lot of stairs. I was doing a lot of movement and also teaching, and I was feeling pretty good. But then that pain came back again — coming back a lot stronger, getting close to us heading back to the United States. I remember the pain being pretty consistent, and I didn't know the pain I was experiencing was actually contractions. No one had mentioned this is what could happen, or what preterm labor could feel like, what you could experience.

So I was in the airport, on the airplane, coming all the way back home, experiencing these contractions the whole entire time, not knowing — I thought it was just my fibroids degenerating and causing all this pain. Went home, went to bed. Sometime early morning, like two or three o'clock in the morning, my water burst — all over the bed. My husband took me to the ER, went to triage, they put the ultrasound on my belly. There was no heartbeat.

I just didn't know that this could happen. Especially being in my late 20s, I was able to get pregnant really easily, I was told fibroids wouldn't cause any issues or problems, and so for all of that to happen at 20 weeks was just — it was a real shock. So that was another instance of, how come I didn't know this? How come this is not just general information? Especially as a woman who wants to become pregnant, and is pregnant, and I was reading all the books — What to Expect When You're Expecting — and no one really talks about, okay, if you experience preterm labor, these are signs of what to look for, or even what it would feel like. Or if you have fibroids, these are some of the risks. Or even cerclage, or being diagnosed with an insufficient cervix — these were all terms I never heard of before. Even going through my prenatal yoga class, it was all about pregnancy, and — to be honest, it was so long ago I did it, but I don't even remember ever a conversation around, okay, what happens if you're supporting a mom in your yoga class and she had a loss. That just was not something I felt was really talked about, even in that training.

Finding a New Path: From Yoga to Pelvic Floor Physical Therapy

Dr. Tia Ukpe-Wallace: And so it was during that time that I had some time to grieve the loss. During that time I was also at a crossroads, because I had been teaching yoga for a period of time, I was kind of getting burnt out, and I was ready to do something else, and I didn't know what that was. And I always tell this story because it has such important meaning to me: I had found Jill Miller, done yoga tune-up for a couple of years, and was incorporating a lot of self-massage and corrective exercise as part of my yoga classes. I had three people, three students at three different times over the course of months, ask me if I was a physical therapist, because a lot of what I was doing in my yoga classes felt very akin to physical therapy. I never considered physical therapy. I looked into what that would require, prerequisites, and I remember during my pregnancy I'd signed up to take some prerequisites, like anatomy and physiology.

So January — January 21st was when I had my loss. I was already a week behind when classes started, and I remember just sitting in bed, and I could have made the choice to either stay in bed and wallow in my depression and grief, or get up and go to class. So I chose to go to class, and it was so interesting because — it was either anatomy or physiology, I don't remember which, but whatever week that was, I went to class and it was covering the reproductive system. And I remember going into class, already having missed a week or two, and just crying — I sat in the back of the class and was like, "Okay, how does the—"

Britta Bushnell: How does the universe order that one up for you? That sounds very intense.

Dr. Tia Ukpe-Wallace: Yeah, it was hard. But during that time it was great just to have a distraction and go to class and do something. I remember I had already purchased Wild Feminine by Tami Lynn Kent — had it on my bookshelf but never read it, because I love collecting books and don't always read all of them. And I remember just wanting to read it, and I loved hearing about her story, that she was a pelvic PT — and especially knowing that was the route I was going, I didn't realize, wow, you can actually be a physical therapist specializing in pelvic floor health. So that was really inspiring to hear about. And her book, just in itself, is such a wonderful book — it wasn't technical, it told a story, shared the anatomy, had meditations. It felt like just what I really needed to be able to really be in my body again, and figure out how to be in my body again, especially after suffering loss.

Britta Bushnell: Your book follows a lot of that as well — it has anatomy, storytelling, meditations, guidance for the inner self. So that makes so much sense, that a book that impacted you so much clearly impacted your book.

Dr. Tia Ukpe-Wallace: Yes, it definitely impacted me a huge amount. So it was Wild Feminine, and then Taking Charge of Your Fertility by Toni Weschler was another really great book — I loved it. This was before, I think, even cycling apps were a thing, and I was really just using pen and paper. I did that for a period of time before I went to apps — actually charting my cycle, because no one really ever talked to me or taught me how to track your cycle, and just to have an understanding of how my hormones are working, know when I can get pregnant. All of this was just for me to have a better understanding of how my body was working — why is it doing this when it should be doing that. So I was just soaking up as much information as I could, which was really great.

Why the Silence? Society, Control, and Women's Bodies

Britta Bushnell: Can I interject for a second, because you write in your book that it's been completely normal for women to live most of our lives with barely any knowledge of our most intimate body parts, down to names, functions — all of these things. And that part of your not knowing brought you into this work. So, what do you think — why does that silence exist, and what does it cost us that we don't have knowledge and understanding?

Dr. Tia Ukpe-Wallace: Yeah, I mean, I think it exists just because of society in general. We can look at Western society and the treatment around women's bodies, and the wanting to have control over what a woman's body is able to do — whether it's in regards to abortion, or birth control, or even IVF. And it's always some other entity — whether it's the doctor, or someone else, another figure who's telling that woman, "This is what's going on with your body," or "This is what you should do," or "This is what you're allowed to—"

Britta Bushnell: Or what you're allowed to do.

Dr. Tia Ukpe-Wallace: No, absolutely. And so where's the agency? Where's the autonomy that a woman has to actually learn about their body? Especially if, from a young age, as a young girl, you're seeing this with your mothers or your older sisters or your aunties, where they're not having that agency themselves, or not talking about, "This is what I'm experiencing in my body, this is what's occurring." So if you're not seeing it within your own family structure — this is where the collective, the community part is — then why would you want to go seek it out? And same thing in schools, where we don't want to teach young girls anything about puberty, or about fertility and when they can get pregnant. We're just saying, "Don't have sex," and assuming they're fertile all the time — we're not teaching the right information.

Britta Bushnell: Yeah, those are very impressionable — absolutely. And that collective message — not only is that collective message missing around the healthy side, the collective message of shame does exist.

Dr. Tia Ukpe-Wallace: Right, yeah, very much.

Britta Bushnell: Adds a whole other aspect to it as well.

Dr. Tia Ukpe-Wallace: Yeah, because we see it in advertising. I think of when I was little, seeing the Tampax commercials, where it's like hiding the tampon in your pocket, having it be sneaky, to be able to take care of your period — or that you can still be on your period and still play tennis, run your track meets, and pretend it's not even there, like you're not even having your period at all, and you're still able to do all of these athletic feats — which is defeating the purpose of what having your period is. It's supposed to be a moment of just being in your body, a moment of allowing rest, as your body is doing this work of having to clear. And instead we're told, "No, keep pushing, keep powering through, because we need to be at the same level as a man is," athletically or educationally, academically, whatever that is. And we're not actually allowing ourselves to be attuned to our bodies and listen to our bodies — we're just kind of pushing past that. So I feel like there's also that sense of shame as well.

The Nervous System and Womb Health

Britta Bushnell: Yeah, absolutely. And also — that's one of the reasons why in your book I love that you refer to the nervous system work as being really integrated. There's the community piece about the messaging and the holding of the wisdom and knowledge and guidance, and then also the individual piece of the nervous system, to be able to move through the shame, to walk into and engage. Can you talk a little bit about the intersection of the nervous system and womb health?

Dr. Tia Ukpe-Wallace: Yeah, in the book I talk a little bit about the parasympathetic nervous system — just a general breakdown of the somatic, the autonomic, parasympathetic, sympathetic nervous system, the benefits of both, why it's bad when we have too much of the parasympathetic and too much of the sympathetic. But I dive deeper into the parasympathetic and its role in womb health, and how a lot of it starts in the brain, and how that has an impact on our breathing and our diaphragm. And when we don't have that well-regulated or moving well — and even more specifically, the vagus nerve, and how it plays such a huge role in the functioning and movements of the diaphragm and how we're breathing, and how the connection of what the diaphragm is doing has an impact on the pelvic diaphragm as well — that the vagus nerve changes names as it makes its way into the pelvic bowl, and how it has innervations all the way down to the anus, or into the cervix as well. And to realize the importance — when things are just sticky and stuck, especially from trauma, from fear, from scar tissue, from lack of mobility, how that will also have an impact physiologically on our body.

A Primer: Sympathetic and Parasympathetic Nervous System

Britta Bushnell: Can you do a little mini primer for our listeners between the autonomic and the parasympathetic, so we make sure everybody's on the same page?

Dr. Tia Ukpe-Wallace: Yeah, yeah. So I mentioned the autonomic and also the somatic — somatic is, I'm squeezing my hands, I'm moving my arms, that's the function of our muscles and our body moving. And then we have the autonomic, broken into the sympathetic and the parasympathetic. Most people know the sympathetic — that's the fight or flight — and the parasympathetic, that's the rest and digest, and we want to have both. Sometimes the sympathetic has been demonized as a bad thing, and we just want the parasympathetic, but the sympathetic incorporates the hormones of adrenaline and cortisol, and we want cortisol in a healthy form — when we wake up in the morning, we see the sun, that's what actually gets us going. If we have excitement about something, that's the adrenaline. Where it's a bad thing is when we're constantly stressed all the time, our cortisol levels are always at this high level, instead of, as nighttime comes and melatonin increases, cortisol decreases — but we're always at this high level of cortisol, then that becomes really bad. So we want some of those sympathetic hormones helping us. And it's the same with the parasympathetic — that's the rest, the digest. When we have those healthy hormones supporting us, we're able to sleep a lot better. I think of progesterone as one — in some cases, a very small percentage, some get more irritability than rest. But digestion too — when we have that parasympathetic regulated well, we can digest our food well, we're not as constipated, things are moving through our system instead of staying stuck, which then creates inflammation. But then also we can have too much.

Weaving the Basket: Why We Need Integrated Care

Britta Bushnell: I love — this was one of the things I loved most about your book, the way you make all of these connections. We're talking about the nervous system and how it relates to things like digestion, womb wellness, hormones, and often, especially in this Western overculture, medical-industrial-complex, we silo —

Dr. Tia Ukpe-Wallace: Oh yeah.

Britta Bushnell: — all of our medicine, our healthcare. So we have those working on our nervous system in a psychiatry, therapeutic mind, maybe a neurologist, doing that in its silo, and then we have the OB/GYN working on our reproductive, and we've got the gastroenterologist working on our GI health —

Dr. Tia Ukpe-Wallace: — and then the endocrinologist on our hormones and metabolism —

Britta Bushnell: — and we've got them all divided out. One of the things I felt in your book, and in what I understand of your work, is each of these being one of the factors of weaving together the basket.

Dr. Tia Ukpe-Wallace: I hope that — yes.

Britta Bushnell: I can see it in my mind — I'm very visual, Tia, this is how my brain works — but I start to see it like different parts of wicker woven together to make that basket. Did I get that right, from your—?

Dr. Tia Ukpe-Wallace: Yeah, absolutely. I find those professions — yes, they're so important, and the research they're doing is so important — but I feel like a lot of them aren't talking with each other, especially for a woman, whether going through postpartum or, gosh, hearing everything about perimenopause and menopause —

Britta Bushnell: Let me tell you, yeah, I'm past those at this point. You were talking about progesterone, and I'm like, we could talk a whole lot about progesterone.

Dr. Tia Ukpe-Wallace: Yeah, and I think it's so important — as women, we don't have to have such intense knowledge, but if we just have this general understanding — like, even just looking at digestion — if I'm really stressed and eating really crappy food, or all I'm having is coffee and popcorn as my diet, and my stress levels are so high, I'm not sleeping well, which is affecting my mood, and I'm not able to have regular bowel movements, and I'm creating inflammation in my body and my bowels, which is also putting pressure on my bladder, and now I'm having urinary leakage — but then also your stress means you don't have high libido, you're not interested in sex — it's just one thing after another. And instead, women are seeing lots of different specialists, whereas — let's take it to just the most basic foundational thing. My big thing is, what can we do — how can we teach women, girls, on just educating about their body, just the basics, so they can actually be proactive, can take action before pelvic problems become a big issue, or at least help decrease the severity of a lot of these symptoms. I think we can address a lot of these things when education, awareness, is a big piece of it, and we can actually see, okay, yes, there is a connection — the body is smart, it's giving us signals, it's telling us, "Hey, pay attention," but it's doing it through lots of different systems. So maybe we have to pay attention — I don't want to say pay attention to one system, but at least listen and see, okay, how can I just cover the basics, and then see from there, okay, now I need to work with a specialist to address this or that. But yes, I love the analogy of the basket weaving. It's absolutely true.

Knowing Yourself Through Touch

Britta Bushnell: So when you talk about listening to our systems — there's a lot in your work about listening through knowing, paying attention. It's not necessarily listening with your ears, although that can be an aspect, but we do talk a lot about touch. Can you talk a little bit about knowing oneself through touch?

Dr. Tia Ukpe-Wallace: Yeah, we have senses — being able to hear is one of them, touch is one of our other senses. And we are a touch-deprived culture. We don't want people touching us, or we only like certain types of touch — it has to be really hard, especially if it's massage, people want deeper, harder pressure. But even if it's just a caress, or a really light touch, that can put people off. Or we don't even touch ourselves sometimes — touching ourselves, but even touching our vulva, or touching our vagina, inserting our finger into our vagina — that's a no-no for some folks. And one of my teachers, which I love telling patients, is: when you touch the skin, you touch the brain. So if I'm touching my hands, massaging them on a regular basis, I build so much reception and attunement as to what my hand does — and it's the same thing we can do with our vulva, our vagina, our clitoris, our anus — all of those areas, we can build a lot of awareness of just by touching. So it's something I encourage.

Britta Bushnell: It makes me think of, in my classes, how often when I'm teaching about the cervix, how few people know that it doesn't open like the aperture of a camera, flat — that it's actually a bulbous part of the body — because they've never actually touched it or seen it, and it's really common that the first time they're getting a visual of what it might be like, they're looking at a model that I have ahead of them giving birth.

Dr. Tia Ukpe-Wallace: Yeah — I mean, you should be doing that even before birth, right?

Britta Bushnell: So, this touch — I love also your one of your teachers talking about touch — say it again, it's about the brain.

Dr. Tia Ukpe-Wallace: When you touch the skin, you touch the brain.

Britta Bushnell: When you touch the skin, you touch the brain. Love that so much.

Touch, Shame, and Building a Relationship with Your Body

Britta Bushnell: So touch — and you spend some time in your work, at least as I know it through reading your book, helping people learn how to know their bodies through touch. It isn't just about going to a pelvic floor physical therapist, even though I do recommend that, right, and I know you do as well — let's do that — and you're talking about self-touch.

Dr. Tia Ukpe-Wallace: Yeah, absolutely. I'm an advocate, I want people to see a pelvic PT, but also I want people to realize I can help for so long — my goal is that you then have this knowledge and information that you can maintain for the rest of your life. Especially when people come in for certain conditions and think, "Okay, I have these symptoms, I do this, and it's one and done, I never have to think about it again" — it's like, no, this came up for a reason. So in the same way you're exercising for your heart health, or doing yoga to improve your flexibility, why not also maintain some level of self-care through touch — helping to encourage good elasticity of your vaginal tissue, helping to ensure — again, when you're touching, you're helping to encourage nerve growth, building proprioception of that part of your body. You actually find what is pleasurable, rather than relying on your partner to tell you, "Oh, this is where I should touch you, this is what feels good" — you've done this yourself, so you can help direct what pleasure feels like for you.

So I feel like, whether it's just to avoid urinary leakage down the road, or to help improve clitoral orgasm, or if you're looking to have a cervical or G-spot orgasm — you have to touch those tissues to be able to sense and know, "Okay, this is what's going to get me to climax." You can't just depend on your partner to do that for you. And it just pervades self-advocacy, because then something's going on and you don't have to just go to your doctor saying, "This is what's happening and I don't know why" — it's, you've been regularly touching your vulva, your vagina, noticing things have been changing over the last couple of months, and you can talk to your doctor with more knowledge to give them, rather than your doctor figuring it out for you. So in the same way we're touching and caring for other parts of our body, our face especially, we should be doing the same thing. I think it's so hard because we can't see it, it's covered up, a lot of it's also coded in—

Britta Bushnell: — in shame.

Dr. Tia Ukpe-Wallace: Yeah, coding — that's a big one.

Britta Bushnell: That's a big one. I remember, when I was reading my audiobook, recording my book for the audiobook, and I get to the section in the postpartum part where I'm talking about self-pleasure practices as a way to connect with your own sexual self before — because a lot of couples are like, "Oh, I'm not ready to have sex," and I'm like, great, but are you connected with your own sexuality, your own sexual desires, first? And I have this whole section — and I remember sitting there in the audio booth, reading this portion of the book, with two of the male audio engineers right behind the glass, right there. And I had this moment of, "Oh, well, look at me — I'm talking about this, and these two dudes are in there listening to me talk about this." And I'm very — I'm an open book, I have no problem talking about these things — and yet I had kind of a blush rise up on my cheek as I read my own words to this audience. And it's like, so here you and I are talking about this, and I imagine some listeners are like, "Oh, okay, wait, what?" Because that is one of the big threshold guardians of this — the feeling of shame, or "is this okay?" There's a lot of messaging about "can I touch myself" — and I love that you do a lot of work on the shame and the nervous system and the care for self, and the titration of touch, such that you help people work toward a point of relation — it's like building a relationship.

Dr. Tia Ukpe-Wallace: It is, yeah. It's building a relationship. It's reestablishing a relationship with that part of your body, especially if there's been some dissociation from it for whatever reason — whether it's traumatic birth, and things just look or feel different, especially if there's scar tissue, if it doesn't look the same way as it did before birth — there's going to be a disconnect there. "It's like, to feel like that looks pleasurable, or could feel pleasurable" — I know just any type of sexual assault, any type of abuse, all of that will also play such a huge role in it. But it starts with just—

Britta Bushnell: — yeah, and birth trauma too, as you mentioned.

Dr. Tia Ukpe-Wallace: Yeah. So I feel like touch is really that first step — or, again, like I talk about senses, even if it's just viewing, just looking at that part of your body. Because again, if touching it doesn't feel good or feels shameful, even looking at it is another thing as well — "I don't want to look at my vulva or my vagina," or take a speculum and actually look at my cervix. That's also a big one — I think people would be more okay with touching than even having to look at themselves. So that I feel is also a really big barrier.

Britta Bushnell: All of these senses used as a way to create relationship feels really important — and yes, beautiful, if not challenging at times.

Dr. Tia Ukpe-Wallace: Yeah, no, absolutely.

Healing Scars: Cesarean and Perineal Scar Tissue Work

Britta Bushnell: I'm also thinking about touch in regard to cesarean birth and scars, because that's also an area of your work. Can you talk about that a little bit? One of the things I highlighted in your book was about the three-part process of healing — inflammation, proliferation—

Dr. Tia Ukpe-Wallace: — proliferation — can you talk about those a little?

Britta Bushnell: Yeah.

Dr. Tia Ukpe-Wallace: Yeah, yeah. So I love doing scar work, and I studied with a student of Sharon Wheeler's, who is just magic when it comes to scar tissue work. I feel like you can change scar tissue, and it's important that you're touching your scars, no matter what the scar is — whether it's a C-section scar, whether it's from an appendectomy, whether it's from laparoscopic procedures.

Britta Bushnell: I have two hernia scars.

Dr. Tia Ukpe-Wallace: Yeah, so all of that, because that's definitely having an impact on some of the myofascial tissue in your pelvis, which then can affect the pressures and mobility of tissue, of nerves, that are innervating into your reproductive organs. So it's so important to touch your scars on a regular basis. That first phase is that granulation phase — as soon as the incision is closed up, thinking of a C-section scar, as soon as that's closed up, there's a period of time where there's fibroblasts, there's collagen kind of helping to create the basis, and the goal of scar tissue is to help hold together, connect, wherever the disruption took place. So it's going to be a lot thicker compared to regular healthy tissue. It's not going to behave and move and work in the same way as regular healthy tissue. So during that granulation phase, we want things to be quiet — that's where new blood vessels are being formed through tissue. And then the proliferation phase is where all that collagen tissue is building up, and then, more in the remodeling phase, is where we can definitely start to play a role. Usually anywhere between six to twelve weeks — and the proliferation phase can actually be longer than twelve weeks, depending on how deep the scar tissue is, whatever the scar is, and how the body is healing — how healthy it is, because for those who are smokers, or have autoimmune issues, diabetes, that's going to change and impact how well the scar tissue is going to heal.

But that remodeling phase can last a long period of time, and we can do a lot during that time, because we want to help influence how a lot of that scar tissue is laid down. I usually give the example of a matchbox with a bunch of matches — if you were to just throw the matches on the ground, it's a haphazard array all over the place, whereas ideally, how collagen tissue is aligned is more like a linear, complex structure, so that if we side-bend, if we twist, they're all able to move in that direction. But when there's scar tissue, it's going to be a lot more compression, a lot thicker, and it's not going to allow for rotation, twisting, side-bending — all those movements our body naturally needs to be able to do. We can help influence that by touching the scar tissue — because again, when we touch the skin, we touch the brain, we're going to help influence that as well. Even something as light — which I teach a lot of my patients — is like feather-light sweeping, that Sharon Wheeler teaches. It's using your hand like a feather, wherever the scar is, doing this feather-light brushing in this direction, in that direction — multi-directional movement — to help influence and shape how that collagen fiber is laid down, so it has a little bit more play, more movement.

That's especially important with C-section scars. We think about the tape on the C-section scar, the big wrap they'll have there too, and they're told not to touch it — but I encourage, even in those early weeks, you don't have to touch the scar, but you can work above it, work below it, work around it. Because when a C-section is happening, if you've ever seen a C-section surgery, they're using retractors, pulling a lot of tissue and also nerves. Nerves are getting compressed, stretched, and if it's in that position for a long period of time, and then we sew everything back and assume everything's going to work the way it's supposed to — I've had patients with neuralgia pain in their abdomen, around scar tissue, and a lot of it's because the nerves, as you're doing certain movement, aren't moving the way they're supposed to. So you can help encourage working with all those layers, from the most superficial to the deepest layer of skin, all the way to the deep fascial layer, to the nerve, to help encourage movement and smoothness and melting, so circulation and the nerves are able to move and flow a little bit better. So I'm a big advocate — especially for perineal scars, C-section scars, any type of abdominal surgery. It's so important, and it's another great way of helping to bring connection, because there's also shame and fear around touching the scars, because they don't know — it's something foreign, it's different, especially if it was an unplanned C-section.

Body, Mind, and Spirit

Britta Bushnell: Loaded with a lot of emotional connection, or disconnection, as well.

Dr. Tia Ukpe-Wallace: Definitely. Yeah, important.

Britta Bushnell: Which kind of brings me to a topic I want to make sure we address before we end, which is about body-mind. I love this, and that you speak about it in your book — do you want to tell us a little bit about how you came to know that terminology, and what it means to you?

Dr. Tia Ukpe-Wallace: Yeah, I'm thinking of the name — Resmaa, yeah. So in one of his books, he talks about body-mind, and for me it didn't even seem like a new concept, because I've been in the mind-body world, so for me it didn't seem new, but obviously for his population, who he speaks to—

Britta Bushnell: My Grandmother's Hands, I think, is the one — yeah.

Dr. Tia Ukpe-Wallace: My Grandmother's Hands, yeah, that book. And I think for people to have an understanding that there is a connection — there's no separation from the mind and the body — despite how much other people tell us, "No, we need to just address the mind," and especially when we make decisions, not thinking from the heart but thinking from the head. But they both influence each other so much. I see this so much in healing too — we can do so much of the physical stuff, all the scar tissue work, all the body work, but if we're not also addressing the nervous system, if we're not addressing our emotions, if we're not addressing how we're regulating ourselves as we're going through whatever trauma or experience — it's not going to matter. And I feel like it's so true when it comes to pelvic health, women's health, womb health. In the book I talk a little bit about — which I love, I'm not a traditional Chinese medicine practitioner, but I love TCM — and so much of traditional Chinese medicine, and even a lot of that type of medicine, is more than just the body — it's the physical, the emotional, and then also looking at the spiritual. All three of those realms play such a huge role in the overall functioning of our body, and we have to address all three. We can't just focus on the physical, because we're not going to get true healing. So that's where I see the body-mind — you can't just address the body itself, the nervous system, the mind, that has such a huge role.

Britta Bushnell: Such a huge role in perinatal health, postpartum health, and healing, with so many aspects of that. So I'm wondering — if there's somebody listening who's on a healing journey, body-mind-spirit healing, because I love that you also brought in the spiritual, I think that deeply matters too — where would you, as a pelvic floor physical therapist, have them begin in a process of healing, whether it's healing of grief, loss, infertility, birth trauma — what would be a place to begin?

Where to Begin Healing: The Breath

Dr. Tia Ukpe-Wallace: I think the easiest thing anybody can tap into is the breath. I look at it for several different aspects — yes, when we take a deep breath, it helps to let the guard down, let our shoulders relax. Being able to tap into the breath in that way. Earlier I mentioned the diaphragm and the vagus nerve, and how the vagus nerve pierces through the diaphragm — so when we're focusing on the breath, that's also going to help encourage regulation of the nervous system. And then, thinking again, this is kind of TCM — when we think of the breath, we think of the lungs, and the lungs is a place of — the emotion is grief. So when we actually help to move that physical structure of our lungs, that helps to move the grief. I love the word "emotions" — it's motion, we need to move it. And we can do that through our breath.

So I feel like that's the easiest place for someone to start — they don't have to do anything physically, movement-wise, with their body. They can be still, sit, or move, walk, and think about how their breath is moving, attune to that. Especially if they're stressed, if they're feeling sad, their breath is going to feel different, going to move differently in their body. So what does it feel like if you allow it to extend that inhale or extend that exhale just a little bit more? Or instead of the breath just being focused in the head and shoulders, if we actually allow it to move into our lungs, into our belly, into our pelvis space. So I feel like, again, it sounds like such an easy thing, but there's a lot of paradoxical breathing — people don't — they're breathing, they're alive, but how efficient, how is it really helping their body. So I feel like that can be one inroad that can be really helpful.

Britta Bushnell: I love that, and it can definitely be an inroad, and there's a misnomer that something that is simple is somehow not profound.

Dr. Tia Ukpe-Wallace: True. Yeah.

Britta Bushnell: Sometimes it's the simplest things, or the least flashy, that actually pack a strong amount of profound capacity.

Dr. Tia Ukpe-Wallace: Yeah, and actually sometimes it's the hardest for folks to do too.

Britta Bushnell: Right — and then it looks easy.

Dr. Tia Ukpe-Wallace: Yeah, it looks easy, but it's actually pretty challenging.

Closing: Where to Find Tia, and the Closing Question

Britta Bushnell: So, before we close, can you tell us a little bit about your work, your book, how to connect with you — I went on a little deep dive and saw such a plethora of resources you have available, and I would love our listeners to be able to access those. Can you share?

Dr. Tia Ukpe-Wallace: Absolutely. Yeah, well, the biggest, and the one I'm most proud of, is my book, Tending to Your Womb.

Britta Bushnell: So I'm holding it up, listeners, waving it around in the air.

Dr. Tia Ukpe-Wallace: Thank you. So that is available — the publisher is Uphill Books, but you can purchase it on Amazon, Bookshop, you can go to your local bookstore and request they carry it. I'm in the process of working on an audiobook, so hopefully that'll be available probably by the end of this year into early next year, if you prefer to listen to the book. But yes, that feels like such a plethora of resources — I'm on social media, on Instagram, so you can follow me there, where we talk a little bit about some of this work. I'm on Substack, my handle there is Tending to Your Womb.

Britta Bushnell: What's your handle on Instagram?

Dr. Tia Ukpe-Wallace: It's Self Care Physio, my handle on Instagram, and my handle on Substack is Tending to Your Womb — that's where I do a lot more writing, newsletter blogs, and Substack has Notes, little shares, which I think are really great, digestible and easy to take in. And I have my website, selfcarephysio.com, where you can find a lot of information if you want to work with me. Because I'm in Portugal right now, so if you're in California, I can work with you as a physical therapist virtually, but if you're outside of California, I can definitely offer pelvic health coaching — anywhere in the world, wherever you're listening.

And my goal, especially moving forward, is how I want my practice to morph and change — I'm hoping for more retreats. I'm actually doing a retreat next month, in September, at Esalen — if you're in the Esalen area, in Big Sur, it's very beautiful, it'll be my second year co-teaching there. And then I'm hoping to do a retreat in Portugal in April of next year, with a private tour or retreat place. My family and I are also in the process of trying to buy a little quinta — a little farm — somewhere around Lisbon, to actually have retreats, pelvic and herbal health-focused retreats, on our little farm. So hopefully sometime spring or summer next year I'll be able to share more on that. But yeah, there are lots of ways to work with me — virtually, in person, or through the book too.

Britta Bushnell: Love that. Thank you, Tia. So, as we bring our conversation to a close, I like to end with the same question every time — 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 period of their lives?

Dr. Tia Ukpe-Wallace: The one thing I would want them to know — I speak so much about education, and I don't want it to feel like it's — going back to school. I want you to have curiosity. I think that's the biggest thing, especially when things are not going the way you want, or your doctor, your provider, is telling you one thing — I want you to be curious. I want you to do that deep dive of wanting to have a better understanding of what is happening with your body — especially if you're given a diagnosis or a condition, to have that real understanding, and then also, "Okay, now what can I do about it?" You don't have to be identified or live with this diagnosis — like, okay, this is what's going on with my body, well now what can I do about it, because there are a lot of things that can be done, you don't have to live that way. So I think it starts with curiosity, and that's what I'm hoping people who are listening will take away, because there's such a plethora — you can go down the rabbit hole as far or as deep as you want, or it can just be at the surface level, and that's a great place to start.

Britta Bushnell: Curiosity — I love that. Let's end on a note of curiosity. Thank you so much, Tia, 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 produce 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. Now let's gather what we want to take away from this episode with Tia, on an inhale, and with our exhale, I'll blow out our candle. Until next time, bye, friends.