Ep 184: How Pelvic Floor PT and Prenatal Chiropractic Care Can Impact Birth, interview with Dr. Kari Roberts

In this episode Dr. Shannon chats with Dr. Kari Roberts, a pelvic floor physical therapist, about the importance of pelvic floor therapy and how pairing that with prenatal chiropractic care can impact labor, birth and postpartum.  Dr. Kari shares her own journey with pelvic health issues and how it led her to specialize in this field. The conversation covers various aspects of prenatal care, including the significance of physical preparation for childbirth, postpartum recovery, and the role of internal and external pelvic floor therapy.  Dr. Kari emphasizes the need for women to be proactive in their health and the benefits of tailored physical therapy during and after pregnancy.  Understanding pelvic floor dynamics, the differences in experiences between first-time and seasoned moms, and the critical role of support systems during birth is something Dr. Kari is passionate about. She also shares insights from her practice, emphasizing the need for proper breathing techniques and the significance of feeling in control during the birthing process. The conversation highlights the holistic approach to prenatal and postpartum care, advocating for movement and education as key components of a positive birth experience.

Transcript

Dr. Shannon (00:01.811)
Hello, hello, you are listening to the Align Birth podcast. Today is an interview day. I am so excited for our guest today. I've actually met her in real life because sometimes we have guests on that I only know in the interwebs world. So I'm so excited to have a pelvic floor physical therapist on today, Dr. Carrie Roberts. She's local in this metro Atlanta area. She's wonderful. And the title, the focus of the show is going to be

how pelvic floor PT and prenatal chiropractic care can help prep the body for birth. She and I have worked with several moms together and so it's been really, really cool to see that. And so I really wanted to hone in on some of the prenatal aspects of things for today. So I wanna introduce Dr. Carey here. She is, like I said, a physical therapist specializes in pelvic health dysfunction for women.

And she specializes in that because she's kind of been in the shoes of having pelvic health dysfunctional issues. And so after dealing with over five years of chronic pelvic pain, not being satisfied with that standardized care she received, she became interested in pelvic health for her own journey and then turned it into a lifelong journey and a career. This is what we do when we find these things. So that journey led her to becoming a doctor of physical therapy, also being a certified pelvic health specialist.

Kari (01:16.782)
Right.

Dr. Shannon (01:25.307)
and also a pregnancy and postpartum corrective exercise specialist and the owner and founder of Maroon Pelvic Health. So when she's not working as a physical therapist, she enjoys watching sports with her husband, walking in the park, listening to podcasts, sampling tasty bourbons. I'm there with you at crocheting and catching up on reality TV. I am so excited to have you on the show today. Dr. Carrie, how are you?

Kari (01:37.815)
Yeah.

Kari (01:50.882)
Good. Dr. Shannon. It's good to see you. Yes, we have met in person. I know, I know. Yes. Yes. Thank you. It's, feel like I'm a local celebrity because I've listened to your podcast and you've had amazing guests. So it's nice to be in the ranks with some of the others that you've had.

Dr. Shannon (01:54.819)
But it's been a minute and I've been dying to have you on the show. So finally here we are.

Dr. Shannon (02:11.517)
I love it. You know, that's the fun thing with the show is I didn't realize how much of a local flair it was going to have. And so here we are, our local celebrity. Okay. So Dr. Carrie is joining us today. Like I said, I want to go over the prenatal prep for body in that pelvic health world. I'd like you to touch a little bit on...

your health journey a bit and kind of what got you there and then how the office has kind of ebbed and flowed into this prenatal world as well too.

Kari (02:34.456)
Hehe.

Kari (02:42.35)
Okay, so my journey to make a long story short, I've been a physical therapist for 20 years actually, and I have had interstitial cystitis for, I don't know, maybe dozen or so years. And you're right, I had chronic pain for five years. I went through the conservative approach and everything got better. The pain got managed after a couple of surgeries and rule procedures.

Dr. Shannon (03:00.123)
Mm-hmm.

Kari (03:10.43)
But the peeing didn't. And I was just that person that always had to pee all the time. then, you you get tired of having to pee all the time and being an outpatient physical therapist and managing, you know, you're juggling multiple patients. Patients are coming in and coming out and juggling their plans of care and juggling who's getting hands on and who needs a note and who needs a note to the doctor and who needs a call. And then while you're juggling all of this patient care, you're juggling how often you're going to the bathroom.

Dr. Shannon (03:12.157)
Mm-hmm.

Dr. Shannon (03:39.017)
and your bladder's like, hey, yeah.

Kari (03:39.4)
And it got exactly, yeah. Like, okay, if I go to the bathroom now, then I could do manual on this one and get this person's note before I have go back to the bathroom. just got to be too much. So I did some digging and I have thyroid disease also. And so I just have kind of become my own advocate. I don't mind reading if I think it's going to help me. And I came across a book for people with interstitial cystitis that was written by a pelvic physical therapist. And I'm like, what does a physical therapist know about

Dr. Shannon (03:46.479)
Mm-hmm.

Kari (04:09.322)
interstitial society. She has no business writing this book because I'm a physical therapist and I have no idea what's even going on. Read the book, changed my world, understood there was this whole idea of pelvic physical therapy that didn't know I existed, went through all the fields of, my goodness, how did I not know this? I'm a physical therapist myself. I could have been treating myself. I could have been feeling so much better. I could have helped so many other people.

Dr. Shannon (04:14.653)
Mm-hmm.

Dr. Shannon (04:26.535)
Mm-hmm.

Kari (04:35.448)
thinking about the patients I've seen with low back pain and hip pain and SI joint dysfunction, thinking about the pregnant patients that I was taught in school, just don't touch them until they're six weeks post pregnancy. I my best friend who had SPD pain and all these missed opportunities and felt really guilty about it, coupled with being frustrated with the healthcare system and wanting a change, pairing that with having an entrepreneurial drive.

and throw in a pandemic and mix it all together. And it's like, start a business. Might as well do physical therapy on my own terms, help people that I feel like I can help, spend time working with people the way I want to help them, spend time learning about things that I'm really interested in. And that's really how I jumped into going from helping myself to helping others. And when I...

Dr. Shannon (05:07.753)
And what do you get? Start a business.

Dr. Shannon (05:16.978)
Mm-hmm.

Kari (05:33.848)
When I found that book and did a lot of those exercises and incorporated a lot of those things, at first I saw how pelvic physical therapy that approach could help me. And then the next step was to go back to your question, how did the journey, the next step was I really was incorporating it with my patients. And then when I was getting roadblocks in the traditional outpatient orthopedic setting with my documentation and insurance coverage and really getting a lot of resistance. And I'm like, there's,

Dr. Shannon (05:46.205)
Mm-hmm.

Kari (06:03.49)
there's this huge population of women that can be helped. I'm one of them. You know, I could have had this 10 years ago and would have had loads of benefits that, and I just was like, you know, it was, it's too much knowledge to have and not be able to help with others. And so as I learned more and more about pelvic physical therapy and going down that road and I could just see that there was this space that I just never learned about what

Dr. Shannon (06:11.166)
Mm-hmm.

Dr. Shannon (06:20.007)
Mm-hmm.

Kari (06:32.544)
a pregnant person, a pregnant woman. And it was so intriguing. And it made me think about when I was a kid, I used to watch firsts on TV, on the learning channel, just, was so interesting to me. I'm not, I'm not a mom. I've never been pregnant. It was fascinating to me. So to be able to go into pelvic health and help women with urinary dysfunction, and then have the opportunity to be a part of something so special, helping women bring in life into the world. That to me was, it's like such a beautiful gift that I get to have, but then a beautiful gift I get to give to others. So that's.

That's how I landed here.

Dr. Shannon (07:02.761)
I know. Well, you know, and it really is like you don't know what you don't know. And so because I'm very similar with my like, should have, could have, would have stories of like, well, if I had known this, if someone had said the word doula to me, maybe I would have known about this. And it's like, no, it was part of the journey, part of the plan. But it is tough because for someone in your position to be like, why did no one else in my circle tell me about velvet floor physical therapy? I know.

Kari (07:13.068)
Mm-hmm.

Kari (07:20.206)
Mm-hmm.

Kari (07:28.011)
Uh-huh.

Yeah, it's crazy. Yeah, it's crazy because when I really dug into it, I still have my anatomy book from undergrad. I use it all the time. And when I cracked it open, that middle section of the pelvis, you know, the internal part of the pelvis, it was like, it was brand new. That book's like 25 years old. It was brand new. We didn't even touch it. So when I saw that, I'm like, well, at least I feel better. It's not like I learned it and completely forgot. I just was never taught it in the first place.

Dr. Shannon (07:32.071)
because you were supposed to go this way, do it this way.

Dr. Shannon (07:56.819)
forgot. And so I do feel that we have come leaps and bounds in our care for the prenatal population and women specifically, but I do, you know, we still have a ways to go as well too, in the whole advocacy space and access to care. Being seen, heard, listened, respected, you know, all of those things. All of those minor details. I love

Kari (08:10.85)
Mm-hmm. Mm-hmm.

Kari (08:20.43)
All those good things,

Dr. Shannon (08:26.217)
I love that journey. now, okay, so we've opened Maroon Pethic Health. We've had our melting pot of the pandemic. And I don't even remember when we met or how we met. Was it something online? Did we find each other like on Instagram probably? Probably, yeah, okay. And now I wanna go into...

Kari (08:43.992)
think so.

Dr. Shannon (08:54.589)
some of the specifics. What do I have in my questions here? Like what do you see in working with prenatal clients? And then what does prenatal pelvic floor therapy look like? Because that might look different than other appointments. Yes. And so that's why I wanted to hone in on if someone's coming in in that prenatal space, what does that look like?

Kari (09:17.388)
Right. So what do I see with prenatal? I'll answer that as two questions. could, you can see everything in prenatal that you can if someone is not pregnant. So the pain with intercourse, the urinary dysfunction, the pelvic pain, low back pain, all that stuff, it can be there. Or they could be pregnant and then they have a history of it and they want to get better.

Dr. Shannon (09:32.125)
Mm-hmm. Mm-hmm.

Kari (09:45.666)
So it's like the folks that have an issue or dysfunction or pain, or you've got the other camp, which is they're proactive, they're healthy, they're doing well. They just want to be as involved as they can in their pregnancy. They want to do all of the right things so they can have a smooth pregnancy and a smooth labor as possible. with that first, well, let's talk about the second camp first. The one, the smooth, we'll call them the smooth, you know, proactive ones. For those folks, I put them through a six visit

Dr. Shannon (10:08.773)
Mm-hmm.

Kari (10:15.256)
That's my pregnancy prep program. And it's usually two visits, one visit. Most folks usually don't come and see me until usually the beginning of their second trimester, sometimes the end of their first, but usually the beginning of their second trimester. So usually I'll see them the first two visits is during their second trimester. And I really use those visits a lot to do with exercise.

Dr. Shannon (10:27.527)
Mm-hmm.

Kari (10:40.072)
I love sports, so I'll use the analogy of the Superbowl. Even if you don't like sports, most people know what the Superbowl is. know, Superbowl is a really big, important game. Nobody just shows up at the Superbowl. They practice, they have, they have practice games, they have playoff games, they have all these things, they have practice and all these things to work up to that game. Same thing is true with your baby and the birth of your baby. Whether it's by vaginal delivery or cesarean, you...

Dr. Shannon (10:52.028)
Mm-hmm. Mm-hmm.

Kari (11:08.716)
That's main event. So we've got to prep the body for that main event. We want that body to be as strong as possible, as limber as possible, as much endurance as possible. We want that body as fit as possible. And so I take it from an exercise approach. So we want to make sure you're strong, you're moving, your body is used to loads and walking and stairs. And if you're exercising,

Dr. Shannon (11:20.957)
Mm-hmm.

Kari (11:34.168)
How do we maintain your exercise program? How do we safely grade it up as you're progressing? Or maybe some things have happened and maybe we need to maintain it or we need to slightly grade it down. Those are the first two visits really working on strengthening and fitness. The second two visits we move into more of the birth prep. And that's when we're talking about birth positions, pushing, perineal massage. And so now we're getting more into

We've done as much as we can to prep the body as far as strength and range of motion and endurance. Now I'm thinking more along the lines of the health of the tissues. So we really want to soften the pelvis, make sure that pelvis can start to open up and those muscles can start to lengthen, really increase blood flow because the pelvis, if you're going to have a vaginal delivery, the pelvis really needs to open up. And if we can increase blood flow.

Dr. Shannon (12:14.675)
Hmm.

Kari (12:31.5)
We can reduce the risk of a tear. If you do have a tear and you've got good blood supply, it will heal better. You'll have decreased pain with that. So that those second two visits is a lot more involved with stretching and mobilizing the pelvis. And then after the birth of the baby, it's kind of like a meet you where you are visit. So, sometimes I'll do a postpartum visit two weeks post-op and that'll be a virtual visit.

A lot of times logistically, I can see you right after your surgery or right after your birth of your baby, but there's a lot of logistics. You've got the visits with the baby. You've got your follow-up visits. You're tired. It's you've got a new human you're taking care of. Usually we're usually circling back around about that four to six week mark. And then I usually have two visits after the birth of the baby. And if you've had a cesarean section, we're talking about scar management. if you've had a vaginal delivery, we're talking about strategies to help.

Dr. Shannon (13:04.221)
Mm-hmm.

Dr. Shannon (13:13.063)
Mm-hmm.

Kari (13:28.686)
facilitate those muscles to kind of go back the way that they were. If you've had any sort of trauma, how are we dealing with that? Are you breastfeeding? Can we work with ways that you're holding the baby, positioning? Are we supporting the back? Are you clenching your booty? Are there ways that we can make you not clench your booty? So just kind of like whatever you're dealing with after the baby, how can I help you? So that's kind of like that no real issues, but just

Dr. Shannon (13:36.169)
Mm-hmm.

Dr. Shannon (13:51.72)
Mm-hmm.

Kari (13:57.794)
being a touch point and guiding you along the way. That's my sixth visit.

Dr. Shannon (14:00.595)
telling you the things that maybe you wouldn't hear in other places and because you're not going to get those birthing positions and that from your OB appointment and your appointments are longer. so that's sometimes too I love that because I'm like I need you to talk to Dr. Carey because I've told moms that when we've seen them together I'm like, okay.

Kari (14:12.866)
Right.

Dr. Shannon (14:24.487)
I need this to go over, I need to go over this in a longer appointment when she's got more time. Let's do belly taping, let's do these things a little bit more in depth then, because my appointments are shorter, you so I might see them more often, but they're shorter. So I think that's where it really can combine so well. And I love that you have those touch points on, it's the birthing positions, because if you're not getting in those positions prenatally, you're not doing yourself a service when you get to labor and birth.

Kari (14:27.597)
Right.

Yes.

Kari (14:34.966)
Right. Right.

Dr. Shannon (14:50.313)
because you haven't practiced those. So that goes in line with the Super Bowl thing too. think that sometimes you know in your head, okay, well I could kneel and I could squat and I could do this. Get in those positions. How does it feel? Birth might change you. You might be like, well, I thought I wanted that and I don't want it. But can you get in that position? Do you have pain getting into that position? Like those are huge things. So I'm so glad you do that.

Kari (14:51.99)
Yeah. Yeah.

Kari (15:01.272)
How does it feel?

Kari (15:07.48)
Mm-hmm.

And who's your support system? And whoever your support system is, I would love them to come to that, at least one of those birth prep visits. If they can't come, give me your phone, let's go through it. And now I'm recording you. I'm taking pictures of you with your phone, with me giving you the cues. And we're practicing pushing on hands and knees on the side with you on the peanut.

Dr. Shannon (15:19.911)
Dr. Shannon (15:28.189)
Mm-hmm. Yeah.

Kari (15:38.656)
with you in the squat position, holding a bar, you know, we've got to go through all of those things. And, you know, if you're going to push with an open glottis for 10 seconds, how long really is 10 seconds? What does that feel like to push with an open glottis instead of, you know, a bearing down? You really have to know what that feels like so that you know what you're really going to be in for so that you can, you can go into that labor really confident, like, okay, I've got this. I understand.

Dr. Shannon (15:49.597)
Mm-hmm.

Dr. Shannon (15:57.321)
Mm-hmm.

Dr. Shannon (16:06.099)
Yes. Mm-hmm. Mm-hmm. No, that's perfect.

Kari (16:09.652)
I was going to say something else and then I forgot, but, if, if, if you're having issues though, I tend to see moms a little more frequently. usually like once a month, especially if a mom was dealing with more pain or a lot of women have, pelvic floor issues, regardless of if they're pregnant or not. And a lot of times pregnancy can flare those issues up. And so.

Dr. Shannon (16:18.865)
Mm-hmm

Dr. Shannon (16:22.291)
Mm-hmm.

Kari (16:37.772)
you might need to come in a little more frequently. And with those visits, like to your point, we might be doing KT taping every time you come in. We might be doing more soft tissue work on the abdomen. I might be doing more hands-on work with your hips, really more pinpointed. So we're not doing generalized strength and conditioning to foster healthy tissue for your pregnancy, but now we're doing more strength and conditioning for a specific pain point.

Dr. Shannon (16:44.925)
Mm-hmm.

Dr. Shannon (16:50.717)
Mm-hmm.

Kari (17:03.446)
And so for that, I need you to come in a little more frequently because as that womb is growing and your baby is growing and the weight is changing and your center of gravity is shifting on your body, then those pains can change too. and so I might have you come in a little more frequently. So there's some moms that'll come in once a month or once every six weeks to kind of adjust the plan as they are adjusting. And then some moms are just.

Dr. Shannon (17:03.526)
Mm-hmm.

Dr. Shannon (17:15.037)
Mm-hmm.

Kari (17:33.506)
busy. They like coming in here. I see all my patients one-on-one for an hour and some moms have children and jobs and husbands and they're like, this is my hour of peace. I already know I'm probably not doing any of this when I leave here. So I'm coming in here every three weeks to do everything I'm supposed to do with professional eyes on me. And I know I'm probably not going to do anything else until I come back and see you in three weeks. And that's fine too. I'm totally fine to meet.

Dr. Shannon (17:44.946)
Mm-hmm.

Dr. Shannon (17:52.232)
Mm-hmm.

Kari (18:02.518)
my clients wherever they are and whatever that looks like.

Dr. Shannon (18:03.641)
Mm-hmm. Mm-hmm. Yeah, you definitely have to, you have to be adaptable in that space with with moms to be. Now, I didn't know if you wanted to touch on some specifics of like the pain points that you see, but then it's, you can do internal and external like

Kari (18:10.946)
Mm-hmm, for sure.

Dr. Shannon (18:30.131)
pelvic PT work in that prenatal space too, correct? So maybe speak on that a little bit.

Kari (18:33.518)
Yes. Yeah. So for people that aren't familiar, your hip, your hip girdle, the big round part, I should have got my model looking at it anyways. the muscles on the outside of your hip girdle are you think about your glutes, your hamstrings, your quads, you can touch all of that. you know, right under your skin. That's no big deal. Those that's external, right? You don't have to go inside of your body to touch that, but your pelvic floor muscles live on the inside.

of the hip of that girdle or inside of that bowl. So we actually have to go inside of your body to get to those muscles. And with women, you have three openings. You have your rectal opening, your vaginal opening, or your urethra. The urethra is too tiny. that's not the orifice is not an option. So we would you go internally, either rectally or vaginally. Rectally is the

muscles around the rectum are designed to stay tight so we don't accidentally leak feces, you know, so those muscles stay on all the time for the most part. there's no, there's no trying to say contraindication in the layman's term. There is no reason to not do rectal internally other than the fact that it's a little more uncomfortable, but you can do rectal internal.

Dr. Shannon (19:54.685)
Mm-hmm.

But it's an access point as well.

Kari (19:59.596)
Right, is. And there's no reason to not do that on a pregnant woman, regardless of where she is in her pregnancy. Whereas if you are going to use the vaginal orifice, then we really don't want to do internal until after you've crossed that 12 week mark, just because things can happen with the viability of the pregnancy. So if you've got any muscle, those muscles, the pelvic floor, the inside of the girdle, they can get

Dr. Shannon (20:06.067)
Mm-hmm.

Kari (20:28.686)
cramps and muscle spasms and trigger points and they can get tight and weak, just like other parts of our body, just like your calf or your hamstring can get charley horses and stuff. Those muscles can too. And so just like if you get a charley horse in your, in your calf or cramp in your hamstring, you might want to stretch it out or massage it. We can do the same thing with your pelvic floor muscles, but we would just have to go inside one of those openings to do that. And so some patients.

We will go internally to try to release that tension in those pelvic floor muscles or even to activate them. Sometimes the muscles aren't turning on the way that we want them to, or they're not coordinate. Maybe they're turning on, but not when they're supposed to. So we might do an internal approach to help them coordinate with their partners. The pelvic floor, quick little anatomy lesson. The pelvic floor is called the pelvic floor because it's the floor of our core.

Dr. Shannon (21:04.883)
Mm-hmm.

Dr. Shannon (21:27.049)
Mm-hmm.

Kari (21:27.212)
The diaphragm is the roof of our core and the abdomen is the sides and the front and the back and the sides. So those four muscles, the abdomen, the diaphragm and the pelvic floor, those four muscle groups all work together. And so if they're not working in coordination with each other, then you can have issues. And since the pelvic floor is at the bottom and those pelvic organs sit on top of the pelvic floor, and sadly for the pelvic floor, there's three holes in it.

Dr. Shannon (21:40.165)
Mm-hmm.

Kari (21:54.9)
you can have some issues with it and that is pelvic floor dysfunction. So if you've got issues with continence, with bowel continence, bladder and continence, pain with intercourse, those kinds of things, then you might have tight muscles or weak muscles or muscles with spasms or muscles that are not coordinated. And depending on what your public therapist finds on an internal exam, you might benefit from some internal work. And so, sorry for the...

Dr. Shannon (22:11.464)
Mm-hmm.

Kari (22:24.61)
for this segue, but getting back to the internal part, sometimes I will do internal work on the pelvic floor muscles to help with whatever it needs. Let's say the muscle is not coordinated. Sometimes I will do internal work to help those muscles get coordinated with the diaphragm and the abdomen.

Dr. Shannon (22:26.311)
No, yeah.

Dr. Shannon (22:37.789)
Mm-hmm.

Dr. Shannon (22:45.949)
Mm-hmm.

Kari (22:47.554)
That's really important if someone might, let's say they know they're going for a scheduled C-section, or maybe they've had a cesarean and they want to have a V-back, then that's going to be really important to make sure that those muscles are engaged. Or let's say someone is dealing with a lot of constipation, or maybe they had chronic constipation before their pregnancy and now it's worse, then she could really benefit from a muscle relaxation techniques from the rectal approach.

Dr. Shannon (23:09.373)
Hmm.

Kari (23:16.546)
because those muscles can be so, they're overworking and we need them to relax so she can empty that waste without having the discomfort. So yeah, there's a lot of things that we can do internally and that's kind of something that sets pelvic floor therapists apart from some of the other pelvic floor, pelvic practitioners out there.

Dr. Shannon (23:25.981)
Mm-hmm.

Dr. Shannon (23:35.401)
Mm-hmm, exactly. Two things come to mind because I recently saw this reel. don't know who it was. But it was really funny because it's like portraying all of like, it's like portraying the cervix and the pelvic floor muscles and the uterus and a mom and as they're getting ready for birth and the cervix is all like getting ready to open, the pelvic floor is like, yeah, I'm getting ready to work and the uterus is coming in and being like, no, no, I don't need you to work pelvic floor. What I need you to do is get out of the way.

And I think that's so important because I had a PT on and we talked about, I wanted to talk about how to push so that moms know it's not kegels, it's not a pelvic floor, it's not like, it's the breath, it's the uterus contracting, you know? And so all of that is connected to the pelvic floor. And there's some aha moments for moms when I'm like, yeah, you've got some stuff going on, I need you to see a pelvic floor PT because I need you also to work on this diaphragm, I need you to work on, it's all connected.

Kari (24:16.216)
Yes.

Dr. Shannon (24:29.927)
you know, in that aspect of things. So I'm glad you mentioned that.

Kari (24:30.254)
Yes, yeah. And just, yeah, like the pushing part, we don't push properly. A lot of times we don't, you're like, we don't breathe properly a lot of times, unless you're taught, unless you're, yeah, unless you're a musician or a singer and you've really been trained to do diaphragmatic breathing, we don't breathe properly. But if you're pushing, a lot of times you're thinking you're trying to generate as much force as you can.

Dr. Shannon (24:39.396)
Mm-mm.

Dr. Shannon (24:43.759)
No. Let's start at the beginning. Yeah, we don't breathe properly.

Dr. Shannon (24:51.154)
Okay.

Dr. Shannon (24:58.93)
Hmm.

Kari (24:59.128)
to push everything out. But think about it, the pelvic floor, one of its jobs is to make sure you don't prolapse and your organs don't pop out, right? So as you're generating all this force, the pelvic floor is tightening up like, girl, I got you. I'm making sure this uterus does not come out. So you're pushing and generating all this force and the pelvic floor is matching that force. What you wanna do is push so things can go through. And in order for things to go through the pelvic floor,

Dr. Shannon (25:13.737)
Mm-hmm.

Dr. Shannon (25:19.943)
Mm-hmm.

Kari (25:27.842)
The pelvic floor does have to relax. And so it's a pushing through. It's hard to do without the model, but something I learned in a class that I teach my moms that's really helpful is when you're pushing, you should be breathing out of your mouth and your belly should stay full. So you take a big breath in and you blow out through your mouth and put your hand on your belly, take a big breath in and blow out through your mouth and your

Dr. Shannon (25:32.605)
Mm-hmm.

Kari (25:55.512)
hands should still be full from the belly. If your belly is contracting, that means you're not pushing properly. Or like moo when you poo. And that helps you keep that right pressure.

Dr. Shannon (26:03.099)
Mm-hmm. I've seen that on the internet too. Yeah. But that's the key stuff that you're not going to get in your regular OB appointment. You're going to have to go out into some other things, but then working on that. So don't wait until like, well, I think I'm going into labor. Let me work on those breathing exercises. Like, no, it's like work on that before and get familiar with what it feels like and then see if there is that dysfunction. I love it. Mm-hmm.

Kari (26:30.572)
And it feels, doesn't feel normal, because it's not something you've done normally. And let's be honest, having a baby, it's a stressful event. And whenever you're in any kind of stressful situation, you're gonna always default back to what you've always done. So if you've never done this before, don't think that in a stressful situation, that's the time you're gonna try something new. So yeah, that's definitely where you should practice it.

Dr. Shannon (26:35.045)
Mm-hmm. Mm-hmm.

Dr. Shannon (26:48.327)
Mm-hmm.

Kari (26:58.602)
Yeah, I said, move when you poo and put your hand on your belly. said that in what, 15 seconds? There's some patients where we're spending the whole hour just to get this going because, yeah.

Dr. Shannon (27:06.761)
Because there's a dysfunction, there's a disconnect and it's like, so, and I think sometimes too, well, a lot of times when I'm saying, I think some moms are like, well, I think I'm speaking from my experience where I was like, I'm like, we've been doing, have been giving birth since the dawn of time. Like it should just be innately, I should just know what to do. And it's like, there are innate things and then there's also like worldly baggage. And then there's also...

things that, you know, we've also had lots of support in the past birthing instead of going in and being by ourselves and generations passing down information. there's that aspect of there are things that you can learn in that space. It's not so much like just relying on, know, well, this is a natural process. I should know how to do that. Yeah.

Kari (27:40.718)
Okay.

Kari (27:53.417)
And.

Kari (27:57.878)
Yes, and also, I believe that bodies were created to move and we don't live in society where we're moving. It's not 300 years ago where you're milling your own corn and making your own bread and tilling your own field and harvesting your own food. so a day to day work was physical and your body was already fit. You know, most of us are

Dr. Shannon (28:08.243)
Mm-mm. Mm-hmm.

Dr. Shannon (28:26.364)
Mm-hmm.

Kari (28:27.714)
You know, a lot of us have these little smart devices on and we have to force ourselves just to get 10,000 steps a day. Because even if you're on your feet, you're still not really, you're not really that active. We sit a lot, we're in our cars a lot. a lot of people are on their phones or their computers or in the car. And so all of those times that we are not on our feet and moving is missed opportunities for our bodies to do what I believe it was designed to do, which is move. So.

Dr. Shannon (28:33.533)
Mm-hmm.

Dr. Shannon (28:38.6)
Mm-hmm.

Dr. Shannon (28:43.986)
Mm-hmm.

Dr. Shannon (28:56.297)
Know what to do. But you gotta give it the right.

Kari (28:56.982)
Yeah, our body's nature, it knows what to do, but it's not been crying because of the lifestyle that we live in a more modern lifestyle where we don't do those, we don't have to do those things.

Dr. Shannon (29:09.793)
Uh-huh. Yeah, I know. That's important. That's important to note, though. And I love that you do keep going back to the importance of movement as well. So I don't know if you can hear my dog barking in the background. Sorry about that. She's fun. She's fun. We're recording this around Christmas time, so it's probably Amazon coming to my house for the 18th millionth time.

Kari (29:24.462)
That's okay.

Dr. Shannon (29:38.769)
I want to know, I want you to speak real briefly on do you see a difference in working with a first time mom or a seasoned mom in some of the things that you see or go over?

Kari (29:53.482)
Yeah, I will say patients, most of my patients tend to be very motivated and very type A just across the board, whether they're first time moms or seasoned moms, but first time moms tend to be more, want a lot of information, have a lot of questions, have a lot, I wouldn't say needy, no, I wouldn't say needy, but lots of questions and a lot of fears.

Dr. Shannon (30:04.937)
Mm-hmm.

Dr. Shannon (30:13.449)
Are you saying they're needy? I know. I'm just kidding. I love it. It's different.

Kari (30:23.4)
and like, this is a safe space, like Dr. Carrie, I'm telling you something that I haven't told other people. And it's like, want all of the information, but at the same time are scared. So I'm like, okay, I'm giving you what you're asking for, but we got to make sure I'm not overwhelming you. cause there's, know, they've never experienced it before. They're type A, so they get comforted having had done it before. And since they haven't done it before there's fear. whereas my season moms are generally also type A, but they've gone through before.

Dr. Shannon (30:28.829)
Mm-hmm.

Yep. Yes.

Kari (30:52.8)
and something usually didn't go well. They had a traumatic birthing experience or the recovery wasn't good or the physician wasn't ideal or the baby came early or this time around they just want it to be better. Most of my moms tend to be really good patients though. I don't really have an issue with moms that don't do

Dr. Shannon (30:55.507)
Mm-hmm.

Dr. Shannon (31:01.598)
Mm-hmm.

Kari (31:22.636)
You know, that don't really follow the plan. But my biggest thing as a practitioner is with first time moms, I'm always very cognizant of, want to give them what they ask for, give them what they need. But I want, I always think in the back of my mind, words that harm versus words that heal. And I'm always making sure with first time moms, I'm not dipping into that words that heal on X, I mean, words that harm on accident, just cause I'm trying to give them the information that they want. Because sometimes just because they ask for it.

Dr. Shannon (31:24.851)
Mm-hmm.

Dr. Shannon (31:38.931)
Hmm.

Dr. Shannon (31:45.426)
Mm-hmm.

Kari (31:51.766)
doesn't mean that they actually can process it. Whereas the second time or the season moms, they've been through it before. So they're kind of like, all right, you're gonna plan and the plan's gonna go out the window anyway. So I just wanna do my best.

Dr. Shannon (32:04.585)
Mm-hmm.

You know, I was thinking of this question as I wrote it down before and I was like, well, if I had to answer it, you like read my mind. I was like, that's so funny. I was like, how did you know that, Dr. Carrie? But that's, I mean, that's what we see. You know, I'm looking at it from even from a chiropractic standpoint. Yes, the bones, muscles, ligaments and working with all that. But there's a difference in the nervous system I feel between those first and seasoned moms and even going there's so much fear in that first room. So a lot of times, yeah, I'm doing that. But I'm like in my mind.

Kari (32:16.75)
I'm

Dr. Shannon (32:37.159)
as we're doing the adjustments, it's like, what can we do to alleviate this fear, you know, and to let that go because that's connected to the pelvic floor, you know, and the diaphragm and all of that too. helping moms understand that, navigate it. I love when they have those touch points of a really supportive OB.

Kari (32:42.159)
huh.

Kari (32:46.478)
Thank you.

Dr. Shannon (32:55.817)
having a doula there too to help them get out of thinking brain and into birth brain, know, having their nervous system assessed with chiropractic care, knowing and having everything in that pelvic floor assessed with our PT, like having those touch points there can really help alleviate, you know, those fears as well too. But with my second time moms, it's yeah, there's still a level of fear, but yeah, you've done it before. It's just different. Yeah. So, mm-hmm.

Kari (32:56.316)
Ha.

Hmph.

Kari (33:04.556)
Mm.

Kari (33:17.079)
Mm-hmm.

Kari (33:21.166)
Mm-hmm. It is, it is.

Dr. Shannon (33:25.893)
Now, you tell me a little bit about, you do have a podcast that you do. So speak a little bit on your podcast and the subject and things that you go over on that as well.

Kari (33:34.327)
Mm-hmm.

Kari (33:45.24)
Okay, so I'll be honest, I'm not as consistent with my podcast as I should be. I do it in bursts. At time of recording, I think I have like 28, 26 episodes, something like that. I mostly do the podcast diagnosis specific or yeah, more like how can pelvic physical therapy help with painful periods or how can pelvic physical therapy help with chronic constipation?

Dr. Shannon (34:08.989)
Mm-hmm.

Kari (34:14.254)
How can public physical therapy, that's kind of how I'm going. And then I've had a couple of episodes where I like sprinkle in business and life. Like, okay, I took a break and this is what I've been working on guys, or this is what I'm working on. So I haven't all the way found my footing with the podcast yet, but like you said, it's Christmas time. It's the end of 2024 right now as we're recording and I'm on the brink of

really getting my footing with where my business is and where I want it to go. So I think by the time this airs, I'm going to really, my podcast is going to look different and it's going to really have a lot more personality. think I had a podcast in another business in another life and I would alternate between solo episodes and guest episodes. And I didn't know if I wanted to do that with my own pelvic health podcast, but I'm going to bring some of those concepts to my podcast where

Dr. Shannon (34:59.454)
Mm-hmm.

Kari (35:12.578)
Some will be more chitty chatty and then some will be more like clinical because that's what I like to do. I feel like, I think that the resistance with the podcast is I'm not that clinical. And I think it's been hard to produce the podcast because I've made it so clinical and I kind of left the fun stuff out of it.

Dr. Shannon (35:29.897)
Mm-hmm. Mm-hmm. But you can always get back to that. Don't shit on yourself with that podcast. You do so good. I love it. You know, and I mean, Rachel and I, even with this one is just coming into, okay, what's sustainable as well too? You know, because you run that podcast by yourself, which every time Rachel and I talk, if I was doing this by myself, there's no way we would still be doing it. there's, you know, that in itself, but it's finding that...

Kari (35:35.04)
Yeah.

Kari (35:44.067)
Mm-hmm.

Mm-hmm.

Dr. Shannon (35:57.213)
Yeah, that flow and the episodes that you want to do and not having that resistance with it, know, like wanting to put that time and energy. But I love that you do it because I remember that when we first met, we were talking about that. yeah.

Kari (35:59.425)
Yeah.

Kari (36:03.438)
Mm-hmm.

Kari (36:10.624)
Yeah, yeah. think the only reason I can do it is AI, because who I use to record it, you you click this button and it takes out all of your ums and you click this button, it takes out all of your long pauses. And then you click this button and it writes your show notes and it helps you create the show title. And I'm like, okay. So, okay, I can do this.

Dr. Shannon (36:31.155)
Uh-huh.

That's amazing. know. Yeah, I'm here for all that. was like, man, when I didn't, we didn't have to stop, keep writing our like show notes. I was like, this is a game changer. Let's see. What, is there anything else that you wanted to speak on?

Kari (36:43.308)
Yeah, yeah, yeah, yeah. Uh-huh, for sure.

Dr. Shannon (36:56.707)
in as it relates to what you see in the office, if there's any kind of specific people cases that you've had where I've had had some moms in the office be like, tell me about one of your miracle cases. I'm like, okay, that's kind of fun, know, little things like that. So is there anything else that you wanted to speak on as it pertains to like prenatal pelvic health?

Kari (37:19.086)
Prenatal, I was, okay, I had someone in mind, but she was postpartum. So prenatal, I have a patient currently. She's been seeing me, she just made a year actually. She was very, had lots of fears. She came to see me trimester one, right? No, it must've been trimester two, because her baby was born in July. So she must've been trimester two.

Anyways, a year ago. And she had all the fears of all of the things, many visits where we closed the door and she's like, Dr. Carrie, I've got to tell you some things and lots of issues. And she had a couple of episodes where she had to go back to her midwife, you know, a little bit, some concerning points. wasn't a smooth sailing pregnancy. wasn't high risk, but it wasn't smooth sailing. And so she came to see me monthly.

We had to shift her pregnancy or her plan a couple of times. At first it was just going to be straight up like let's do a conditioning program. She had a constipation flare. She had a hemorrhoid flare. She had SPD pain. We did taping. We did internal work. We did rectal internal work. And then she had her baby and she had a pretty significant tear and she came back. And so

The cool part is I was one of the first people she called after she had her baby because she trusted me with some of the questions she had with her tear. And she knew that as scary as it was to have the tear, she knew she had done the work for her body to be in as good a shape as it was. So she knew even though the tear was bad, it wasn't as bad as it could have been. And when she got stitched up, her doctor said that she healed really well and she attributed it to all of the work that she had done.

Dr. Shannon (38:54.365)
Mm-hmm.

Dr. Shannon (39:03.016)
Mm-hmm.

Dr. Shannon (39:07.422)
Mm-hmm.

Dr. Shannon (39:14.76)
Yeah.

Kari (39:15.042)
while she was pregnant and she had a lot of pain and sensitivity with the tear and with it being sutured back. And so it kind of leads into postpartum. I couldn't resist myself, but she just came in and she was able to be intimate with her husband pain-free for the first time. So that was pretty cool. Yeah.

Dr. Shannon (39:26.345)
No, that's fine, yeah.

Dr. Shannon (39:34.525)
That's huge. That's huge. But I love the progression of that. And that's important to show. Because it's not that you have all these people on your birth support team and everything is going to go wonderfully. It's more of a it could, and it could be ideal. You could have those hiccups though. And it's nice to have that support. And it's nice to have those people where you're like, OK, I did everything that I could and within my knowledge and I supported them.

Kari (39:39.778)
Yeah.

Dr. Shannon (40:02.599)
myself and surrounded myself with these people. So I love that she had you as part of her bird team.

Kari (40:05.262)
Yeah. Yeah. Yeah. She, she had a good team. She had a midwife, a doula, a chiropractor, a different chiropractor. Cause she, she traveled about 45 minutes to come to see me. So, a little bit farther, but, one thing I learned in one of those classes along the way was one of the signs that makes a successful birth. Of course, people say healthy mom, healthy baby, of course, but a perceived

Dr. Shannon (40:16.785)
Yeah.

Kari (40:32.856)
good birth experience is not necessarily that everything goes according to plan, but that the mom feels like she has control and input. So I do keep that in my mind often. Like how can I arm her with the tools or the knowledge or the comfort so that she feels like she has the control? So if things go to the left, she feels like she has the control because if she feels like she has the control that however this goes, she,

Dr. Shannon (40:42.973)
Mm-hmm.

Mm-hmm.

Dr. Shannon (40:54.589)
Mm-hmm.

Kari (41:02.774)
In the end, psychologically, she'll feel like this was as good as it could have gone. And so that's kind of what I use to help guide me with some of the decisions that I make with my patients, with the moms.

Dr. Shannon (41:09.723)
to guide you. Yeah. I love it. That's why you're so good. That's why I love you, Dr. Carrie. Where can people find you and reach out to you? like website, social, podcast, all of that sort of stuff. And where's your office and everything?

Kari (41:15.566)
You

Kari (41:25.388)
Okay. So, so my office for folks in Georgia, my I'm in West Cobb off Dallas highway in Marietta for people that are familiar. my office is called Marrone pelvic health, A R R O N pelvic health, website, marronepelvichealth.com, Instagram, marronepelvichealth, podcast, marronepelvichealthpodcast. on Spotify, on iTunes and marronepelvichealth.com slash podcast.

Dr. Shannon (41:46.601)
I love it.

Dr. Shannon (41:54.209)
Yeah, you did that good. We're going to link everything into the show notes as well to try to make it easy. So for folks to reach out and find you and connect with you. So thank you so much. I want to have you on again. I don't want this to be our last time, but I really, really do appreciate you taking your time today and sharing your knowledge with us. And I love your kind and caring heart and all the lives and women that you've been able to impact with your services. That's huge.

Kari (42:07.938)
Yes!

Kari (42:17.878)
thank you.

Kari (42:21.848)
Thank you. And likewise, whenever we collaborate and we've collaborated on a few clients, it's always like always a good time. Yeah. Yeah. huh. huh.

Dr. Shannon (42:26.639)
Mm-hmm. I love it. It's so good. I know I'm like, did you see Dr. Carrie? They're like, yeah, I'm like, I love it. Well, thank you so much. Take care and stay tuned everyone for the next episodes of the Align Birth podcast. Thanks again,

Kari (42:42.744)
Perfect.