Prolapse, Pelvic Floor & Postpartum Mental Health: What Every Mom Should Know — with DR. KIMBERLEY JOHNSON

🚨 She’s back! We’re thrilled to welcome the incredible *Dr. Kimberley Johnson, PhD*, aka @wildmatrescence, back to the show for our Season 3 Finale! 🎉✨  

Kimberley is a psychologist specializing in perinatal and reproductive health concerns, including:  
🌟 Perinatal Mood & Anxiety Disorders  
🌟 Perinatal trauma & loss  
🌟 Pelvic floor conditions  
🌟 Infertility  
🌟 Reproductive transitions  

In Episode 14 (May 2022), she shared her journey navigating postpartum prolapse & a pelvic floor avulsion injury as a pro cyclist & PhD student. And now? SO much has changed! 💪  

This episode dives into:  
➡️ Kimberley’s growing family (hello, 2 kids! 👶👦)  
➡️ Juggling pregnancy, parenting, & professional growth  
➡️ Moving TWICE & staying active with a toddler & kindergartener 🚴‍♀️🎿  

We also get into her groundbreaking research on childbirth-related pelvic floor injuries, mental health, & improving patient-provider communication during pregnancy and postpartum.  

And, of course, Kimberley opens up about her adventures as a mom—mountain biking, hiking, camping, & (hopefully) Nordic skiing her way through New England with her family! 🏔️  

✨ Topics we cover:  
✅ Birth injuries & recovery  
✅ Deciding to have another child after prolapse
✅ Staying active with kids  
✅ Pessaries & prolapse treatment  
✅ Medical gaslighting & finding the right provider  
✅ Prolapse grading, education, & informed consent  

This episode is packed with valuable insights for moms, providers, & anyone passionate about perinatal health. 🎧 Take a listen now & join the conversation!  

💡 Tag a friend who needs this!  

Time Stamps

1:00 introduction

5:11 getting pregnant after prolapse

11:20 treating birth injuries

17:45 pain as physical, mental, and emotional 

24:17 where people are finding information

33:10 exploring what is “normal”

36:55 dealing with compulsions

43:50 anatomical versus symptomatic prolapse

47:10 was it there before birth?

54:45 how providers can support in mental health

65:05 how to find a mental health provider

67:05 developing pelvic health literacy

72:10 rapid fire questions

CONNECT WITH CARRIE

IG: https://www.instagram.com/carriepagliano/

Website: https://carriepagliano.com

CONNECT WITH KIMBERLY

Instagram: https://www.instagram.com/wildmatrescence/

The Active Mom Podcast is A Real Moms' Guide to pregnancy, postpartum, perimenopause & beyond for active moms & the professionals who help them in their journey.
 
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Transcript

SPEAKER_01 0:14

Trainers or physical therapists looking for answers on how to get back to running across the field of a lot of these things. You name it without the fear of public course issues or doing something wrong. This is the podcast for you. Let's start the show. All right. So we have round two with now Dr. Kimberly Johnson, who joined us back literally a separate lifetime ago, um, back in 2021, 2022. Um whole new baby. If you guys haven't checked out the the initial episode, I think it ran in May 2022, so season one. Um, but Kimberly, you might know her um on Instagram as Wild Matrescence. And she is the very reason that I now know what the word matrescence means. But I feel like um she's just a dear Instagram friend and just a lovely person. And um, a few things have happened in the last couple of years. So we thought we'd bring her back on the show to talk about um being a mom of two, her life with prolapse, becoming, you know, getting her PhD, all that good stuff. Um, so Kimberly Johnson, Dr. Kimberly Johnson, welcome back to the show.

SPEAKER_00 1:20

Thank you so much. It's great to be here. And yeah, like you said, it feels like it's been a whole second lifetime, or maybe third or fourth or fifth. I don't know what lifetime this now is. Uh, but I over the last few years since I was here, I finished up my graduate degree, which was a long haul, seven-year doctoral program, culminating in a final uh clinical internship year at Rush University Medical Center in Chicago. So before that, I had a second baby, as you mentioned. So we moved our entire family to Chicago for a single year. And now we are in the Northeast, where I am a postdoctoral research fellow at Dartmouth Hitchcock Medical Center. So most of my work, my research has been focused on the mental health and quality of life implications of childbirth-related pelvic floor injuries and conditions. And as I discussed in my initial chat with you, a lot of that was shaped unexpectedly through my own experience of a birth injury and pelvic organ prolapse. I don't like to say that it was serendipitous that I was uh kind of pulled into this research area because I don't think anyone who's experienced a birth injury would call that serendipitous. But I was already a clinical health PhD student, so in a clinical psychology with a health psych emphasis prior to my own experience of a birth injury. So I was in the right place at the right time to make a pivot to address what I experienced as a pretty major gap. And my work now is targeting both provider communication patterns and how that communication shapes mental health, as well as developing more comprehensive and accessible mental health treatment resources for people with birth injuries and prolapse.

SPEAKER_01 3:08

Yeah, no, there's so many good things to talk about. And then also in a prior life, and I'm gonna say this wrong because I think I got it wrong last time. In a prior life, you were a like semi-pro biker on gravel, yes, no trail, something.

SPEAKER_00 3:26

Very close, very close. So I did professional bike racing on the road. So I actually have used mountain biking and gravel riding as a balancing effect for me. I never, well, I did a couple mountain bike races and a couple of gravel races, but as a whole, most of my um athletic endeavors in kind of a competitive sense were on the road. So I transitioned away from that as I started graduate school. So my last, I did a race in 2018 on the gravel race, and that was my last bike race. But I think I would like to try to do another gravel race because it's just super fun and I love reconnecting to that athlete part of my identity. I've also done a fair bit of Nordic skiing and a bit of Nordic racing. So happy to be in a part of the country where that is a dearly loved sport.

SPEAKER_01 4:16

Yes, that Chicago was not good for that.

SPEAKER_00 4:20

Chicago was a challenging year for a number of reasons, and uh being pulled out of nature in the way that is so beneficial for our whole family unit was probably one of the harder parts of it. Yeah. Obviously, that was a part we were anticipating. We knew that it would be a very different environment and would take much more effort to get outside. Uh, but it was just a single year. It went you know quickly in ways, and so we're we're glad to be moving forward and back in nature.

SPEAKER_01 4:47

I'm so happy you're back in the trees again. I can't even tell you.

SPEAKER_00 4:50

Um you can see them in the background, right?

SPEAKER_01 4:52

They're right there. And your little trails on the weekend and the farmers' markets. It's like you you totally deserve this. Um, no, so if we backtrack a little bit, um, you've been incredibly open about just staying active with your kids. Um, your oldest is kindergarten now, which is insane. Um, yes. So let's let's back up a little bit about kind of even before your second was born, um you know, you were thinking about kind of you you were getting more active, you were navigating your prolabs, um, you were looking ahead at, you know, continuing to kind of shift over your focus work-wise into mental health and birth injuries and that sort of thing. Um, I think one of the big questions that comes up, and I don't think we talked about this last time, yeah, was when you've had a birth injury, and I'll take the professional and the personal answer on this. One of the biggest fears is is it okay to get pregnant again? Am I gonna hurt myself? Is it gonna be worse? Um so maybe you can talk us through kind of how you navigated that personally, and then, you know, from a professional aspect, like what should we know as providers kind of working with our clients on how to navigate that or help people work through that question?

SPEAKER_00 6:10

Yeah, there is a lot of uncertainty in that decision, and there is no one right answer, right? And I think one of the one of the things that I really reflected on going into even thinking about a second pregnancy was, you know, what are my reasons for wanting to be pregnant again and wanting to do this again? And I've heard a lot of discussion about second births being a way of redeeming birth trauma and having like a better experience. And for me, and for the way that I would advise people that I work with, that is not a great reason to get pregnant again and go through a second pregnancy and delivery because we just can't guarantee what the outcome is going to be. And that's this has ties into everything I do really, but it's when I really don't think that providers should be communicating that we can directly control outcomes, right? Because then that sets people up for disappointment and betrayal and feelings of being let down by their own bodies and the medical team. There are, of course, things that we can do to reduce risk, and I did a number of things very differently during pregnancy, because even though I don't know exactly, you know, why I experienced a birth injury and an otherwise really uncomplicated labor and delivery experience, I was equipped with a lot more knowledge and information to make proactive risk-reducing strategies. So that's the first piece, is that I didn't want it to be something that I was doing because I wanted to like prove that I could or prove or try to have a better experience. Of course, I wanted that, but that wasn't the reason why. Yeah. Um I think ultimately I got to a point around two and a half years postpartum where I felt like I was managing my prolapse and my symptoms fairly well. I unfortunately have never been someone who's been become completely asymptomatic. And for me, I think potentially a reason for that is that I do also have a levator revulsion injury, which complicates things in other ways. Um but I got to this point where I was like, I think I've rehab this to the point that it probably is not getting much better. Right. And I feel stable, and I also really wanted a second child. And prolapse has taken enough from me. I don't want my whole ideal family situation to be just one more thing that I always look back and feel resentment and regret about. Of course, there was also the uncertainty of not knowing what would happen with my prolapse, like it couldn't get worse, but the research doesn't suggest that it's guaranteed to get worse or that it's even super likely to get worse, right? Some people experience worsening, some people actually experience improvement, and some people have stability. So um, I know this is kind of jumping ahead to how things went for me, but I did experience improvement in some ways and stability in most others. So I had a lot of pelvic pain between Juniper's birth and getting pregnant with my second, or I should say having my second, but after his birth, almost all of my pelvic pain went away, which was a very unexpected shift for me. And I have, you know, my own hypotheses of what might be going on, but it still was a very unexpected outcome. Uh and with that shift came the ability to use a different kind of pessary in a more helpful way. Uh so I've I've now been using a cube pessary since he was born. Um, not immediately, right? As soon as you have that enough, sufficient tissue healing to feel comfortable using a pessary. But prior to his birth, I couldn't use other pesseries because of my avulsion. They didn't stay in in the right way. And a cube pessary was really uncomfortable and provoked more pain and tension. And after he was born, it has been something that provides good support without the pain. So it's been a great option for me. And that wasn't the case prior to him being born. So for me, I did experience improvement in my pain, my prolapse symptoms without the pessary, and my like the grading of my prolapse is the same. So that didn't improve or worsen. Uh, and I I'm careful when I talk about this because I I don't want to put this out in a way of like if you do all these things that I did, you two can do control, right? And there are factors we can control and factors we can't control. But it was something for me that I I don't regret, and I am happy that I didn't let my prior birth injury be the prime decision maker there.

SPEAKER_01 10:31

Yeah. No, I I feel like there's like an evolution of that conversation, um, because inevitably that's one of the first questions that comes up when I'm working with a patient. And there's like that initial counseling where we're like, hey, this is what we know. But here's the other thing too, which you you kind of shed a light on, is you're kind of an end of one. And that's where I think your story is is so unique because you know, just in five years, we're looking at prolapse incredibly differently. We're having conversations about avulsion. And if you guys don't know what that is, basically it's a a birth injury where you can have the muscle tear away from the bone or um something along those lines. So it makes it really hard. So if the muscle contracts, you're not generating tension and support. Um, and there's still a lot of work to be done there on good diagnoses of it and treatment for it. And there's just not a clear pathway forward on it right now. There's there's lots of people trying a lot of different things. Um, and then pesteries too. I feel like the conversation around pessaries back when you had Juniper was like, okay, last resort before surgery. And we didn't even really have within our field a conversation of pessary and whether it would work or not in the context of evolsion, because we weren't even talking about avulsions five years ago. So I feel like there's such an evolution just in that short period of time in her tiny little life, and that we're just looking at it so differently. But it really does have to be, you know, this is Abby, by the way, in case you guys um she's she's my co-host today, and she is not happy on my lap right now. She's gonna curl up on my fleece on the floor. Um, no, I feel like there's been an evolution, but at the same time, it very much is this nuanced conversation of what are we walking in? What are the variables? We're not quite sure where this is gonna go. We don't have an algorithm for this yet, but let's see how far we can get, which is really essentially what you did.

unknown 12:28

Yeah, yeah.

SPEAKER_00 12:29

And one of the things, thinking about kind of your second part of that question is what should providers know? This is also, I guess, a recommendation for people going into a potential second pregnancy is one thing that I did that I think was a great idea and helped me select a provider that I think did a good job for me was be having like interviewing in a way, interviewing a number of different providers and being very transparent and upfront about the fact that you experienced a birth injury, whatever it was, that you have prolapse, however, you want to describe what you're dealing with. Um, and see kind of how they respond to that and see how they discuss that. And for me personally, I decided that the red flag wasn't going to be a provider who didn't have like a high level of expertise, right? Because they're unfortunately it's very rare to find a provider with a high level of expertise in managing birth injuries and pregnancy afterbirth injury, because this is such a relatively recently expanding area of emphasis and research. So that the red flag wasn't going to be, you know, provider who didn't have a high level of expertise as much as that would be ideal, but rather, you know, looking for a provider who responded with intellectual humility and not dismissiveness and not acting like it didn't matter or it have no implications for another pregnancy, and who respected and valued my input on kind of what I've learned and what I shared that I wanted. So for me, that was and I had a number of different encounters with different providers that made it pretty clear that these responses vary a lot, right?

SPEAKER_01 14:04

Across Yeah, which is really it it's very cringe worthy as a professional. We're like, wow, this inconsistency is really not okay. And I think of all birth injuries, probably prolapse is the one that there's so much fear surrounding. Um, and then there's also, you know, again, we always talk about the double-edged sword of social media. Good good news, we're talking and we're friends. Bad news is not great information. Um, what really gets me, and I would love your thoughts on this, is um this approach or these exercises, this will fix your prolapse. What are your thoughts around that sort of marketing verbiage and what that can how that can impact somebody navigating a birth injury?

SPEAKER_00 14:55

I think that to be honest, it's pretty harmful messaging because one, we don't have the research supporting the idea that anything can fix a prolapse, unfortunately. I wish we did. Um, but this is a really there for P and I'm sure everyone who has a birth injury who's listening to this can probably can connect with this, that there is a lot of desperation in these early periods of coping with a birth injury or a prolapse diagnosis and just wrestling with what this means and what are the implications. And one of the things that was hardest for me that you know was actually a pretty traumatic experience as this kind of all unfolded, is like, oh my gosh, like this can't be fixed. Like what? Like there is no clear answer. Like I can't just reverse this. And like were it, you know, 2020 when it happened with me, it was like 2019, what can't be fixed, right? Like I fractured my cervical spine and bike, like I broke my C2, and I'm okay, right? Like, how can this not be fixable? Yeah, and so I think there is such this like inherent desperation and experiencing something that feels so um fundamentally broken, honestly. Like there's this feeling of being fundamentally broken, and we can talk about all the layers of that maybe later, maybe different today or later, different time. But this is the reality, right? For many people who've experienced a birth injury. And so when you have someone that comes in and says, buy my program and I'll fix you, right? There's this desire to say, like, I'm willing to do anything, right? I'm willing to do any possible thing that might fix this. And so even if it maybe won't, like, I'm gonna try it, right? Because I don't want to think that I left any stone unturned, right? And so I think that it's harmful for providers to really take advantage of people in an incredibly vulnerable time of the lifespan and in navigating this type of injury. And you I mean, you see that as there's been more awareness and discussion of pelvic floor symptoms, there has been also more kind of capitalizing on that for marketing.

SPEAKER_01 16:54

Oh, very much. You know, yeah. Right.

SPEAKER_00 16:56

And so what I would rather see is providers or professionals saying, you know, here are some things that we know can help do XYZ. And, you know, we don't know, you know, some people might experience positive changes in their prolapse, some people might experience changes here, um, but like focusing on what we can't actually do, right? Yeah, and not making promises to fix something that for many people won't be fixed. And that's in a really uncomfortable reality to sit with and to say to you today is it's it's uncomfortable to say like not everything can be fixed, right? Yeah, but it's worse to believe everything can be fixed and then not be able to fix your prolapse and then feel like I must be doing something wrong. Because if this is fixable and this is not fixed for me, then clearly I'm missing something, right? And so I think that this messaging can actually foster a lot of really like hyper-vigilant obsessive thinking around prolapse. Because if you are primed to look out for any potential symptom so that you can make any possible modification, because if you don't make this modification right, you're not going to fix your prolapse. That really feeds into that. And one of the things that I've been thinking a lot about is as this conversation has grown, there has been, you know, and grown and as we've included, you know, more providers and talked about the ways that medic the medical system has let people down. We really started to push back as kind of a collective society on all the ways that there have been, you know, medical gaslighting and women who've been told, you know, this is just in your head. And so I think the challenge the tricky thing though is that if you pull too far on any side of this pendulum, right, when you swing too far, I think we're risking swinging too far to saying, like, no, it's not in your head and everything's physical, right? To the point that we actually forget that the brain and the body are interconnected. Right. Right. And so we can't say, oh, it's all in your head and this is not physical, but we also can't say it's only physical and nothing mental and emotional, right? Right. Because even like the International Society of Pain has defined pain as a physical and emotional experience, right? Yeah. And so I think we're airing towards a too far pendulum swing where we take out the psychological component, right? Which is unhelpful also. Because whenever we hyperfixate on anything, it's going to feel worse, right? Right. And that doesn't mean that it is only caused by our hyperfixation, right? But it's certainly not made better, right? Which is why I think, and this is what I'm working on in my research and my postdoc, is we need to both improve the ways that this is addressed and discussed and treated from a physical standpoint. And we also need to develop better resources to support the mental health and the coping processes for people who've experienced this. Yeah.

unknown 19:54

Yeah.

SPEAKER_01 19:54

No, I think back to how I was originally trained, you know, 25 years ago and how to address this. Um, and I think it's very similar to the average person's introduction to prolapse is that you know it's it's taught that it's very mechanical, organs out of your body. That's, I mean, I was also 22 when I was learning this. So I didn't really have a good reference point. Um, so you're horrified. And of course, then you do Google search. And of course, if you're in a class, you're given all like worst case scenarios. Um, and then, you know, 25 years ago, our instructions were basically anything birth related, you're gonna do public floor muscle training, aka keggles.

SPEAKER_02 20:42

Yeah.

SPEAKER_01 20:43

Or when that doesn't work, they're gonna do surgery. And we weren't fitting pessaries back then. Um, we weren't even remotely talking about exercise and being active back then. Um, and so that was my introduction. And it wasn't literally until I'm gonna say five to eight years ago because that you realize there's nuance to this that's far more relatable to treating patients with chronic pelvic pain, where it very much is this holistic um, the brain makes decisions based upon the information that comes in. It's not, you know, this is a paper cut, you feel pain. It doesn't work like that at all. Right. Um, but being aware that, you know, on one hand, we have people that literally vaginal wall is out the door, massive prolapse, they're not aware of it at all. It doesn't bother them, no heaviness, no pressure. They just stuff it back in to get out of the way when they go to the bathroom, versus the person who you can put them in any position to assess them. You barely notice any sort of prolapse, but they're feeling it all the time. So the only way that those two realities can exist is if it's not straightforward mechanical. And but again, I don't think that's that's too nuanced when, you know, you're sitting in a OB's office, you're hopped up on, you know, crashing burning hormones and and you know, your baby's crying and all this stuff, and they say the word prolapse, and the first thing you do is go home and freak out. It's like that's that we we gotta do a little bit better.

unknown 22:21

Yeah.

SPEAKER_00 22:22

I mean, do you yeah, right now the way that providers are discussing prolapse, both prenatally and you know, in response to diagnosis postpartum, uh, it's it's not cutting it, right? It's not good enough right now. And it needs to improve and it needs to shift. Um, so that's something that I'm I'm really passionate about. And at the same time, I'm in an interesting position of being someone who's integrated in the medical system, right? I'm a reproductive health psychologist. Uh, well, I should clarify the term because I'm not a licensed clinical health psychologist until I pass my H triple P, but that is coming. Then all the things, right? So uh very quickly, I will be a licensed clinical health psychologist, working as a postdoctoral fellow right now, uh, taking referrals from OBs, pelvic floor PTs, urogyns. And it's hard because I see, and I also have the unique perspective of being someone who's experienced this, right? And who's had so I'm both seeing the patients for therapy, I'm working collaboratively with the providers, and I'm also someone who's experienced this personally, right? Which give me a very unique front row seat to all the things. And it's tricky to be honest, because I have experienced a lot of really disappointing interactions with providers that felt left me feeling very let down. And I know from my own experience and talking with patients that the way that providers are communicating is not great, right? Not saying that all providers are bad, but by and large, there is a lot of room for improvement. And also the medical system and the healthcare system, and especially in our country, and that's what I can speak to, makes it really, really challenging for providers to do better, right? And I think that that's a part of the discussion that I haven't seen much on social media, is it's really easy to say you should do better. And yes, right, but the systems that are currently in place do not really support providers and being able to do better, right? Because providers are really overworked and burnt out and working super long hours and also only given 15 minutes to see patients, right? And not given time for continuing education. And a lot of these things weren't actually taught in medical school, right? And that's shifting. And I'm hoping that you know this next generation of medical students and residents will start to have better information, but it's not as simple as just saying you should be giving this information. And so I think both realities are true, right? On one hand, providers need to be doing a better job. It's not as simple as just doing a better job. And so, like, where are these gaps? And that's what I'm researching actually right now in my provider-focused research is actually doing um focus groups and interviews and surveys to find out like what are the biggest gaps and how can we actually address those gaps and fill these gaps so that you are support, like you as providers can be supported in making these changes to benefit your patients, right?

SPEAKER_01 25:17

Yeah. No, I I think that's it's a tricky conversation, like you said, because we don't have the systems in place to support a lot of this stuff. And then on the other hand, we have this huge surge in information that's available to the average person. Um, and I have to believe that there's some parallels here. I was just reading um Jill Crabb this morning. She posted a paper about um so they were looking at basically like information on lichen sclerosis on TikTok. And, you know, who puts information out? Is it providers, is it patients, is that sort of thing? Over 50% of the information in this particular sample was incorrect. And so then it's like, oh crap, um this can't be the only diagnoses that this is happening with. It stands to reason that there's there's parallels in other diagnoses. I think we can all agree to that. Um, so how do we ensure that, you know, while the system's still broken, you've got patients that are trying to arm themselves with information. It's really hard to vet quality information. Like, do you go to a provider and say, all right, well, you you're not up to date on this stuff. I'm out, I'm gonna get a new one. And maybe you live in a place where there's not a lot of other options. Or, you know, do we partner up and say, hey, you're not up to date, but here's some things, and at least give them the opportunity to help. But I again it also it shouldn't have to go back on the patient to educate their provider. But good Lord, like I feel like there's so much work to do. I mean, what are your thoughts on that?

SPEAKER_00 26:58

Yeah, I think one of the things that I've been thinking about is, you know, ideally, there could be it's like an embedded patient educator, right? Because then that could be someone whose whole role was to comprehensively, you know, have these education discussions with patients and help get them connected to the right resources. Um, you know, healthcare systems would have to decide that they wanted to invest in that. So we'd have to show that this is a good idea, which I believe it is, and you just have to show it. But I also think that this is a reason why it's valuable to have resources for providers. So that's like even if you don't know all the information, here's what you can still give patients.

SPEAKER_02 27:32

Yeah. Right.

SPEAKER_00 27:33

And so almost like a library or kind of a resource bank of, you know, if this, then this is a good resource. So that at least you have something, right? Um, and you know, I'm gonna be speaking with a group of residents this year. So I'm doing you know, mini presentations for family medicine and uh OBGYN residents, and it's a start, right? It's not gonna cut it, but it's a start. And so I think integrating this into the going back in time and integrating this into both primary care, um, you know, medical education, residency, all that. But I think you know, my fellowship is actually housed in primary care. And when I've talked to some people about that, they're like, wait, what? Uh, because it seems like a very clearly OBGYN issue, or you know, specifically like a pelvic health specialty issue. But I actually think that that's part of the problem, right? When this is so siloed that only a few providers can speak to this, it leaves a whole lot of people without any resources or treatment options. Right. Um, because we know already that the wait lists for pelvic floor PTs and Euroguins is really, really long. And so I do think a part of the problem is or part of the solution is equipping more providers with kind of base level knowledge and referral resources and treatment resources. So I'm working closely with OBGYNs, but my kind of where my fellowship funding comes from is actually primary care.

SPEAKER_01 28:52

Yeah. Um utilization, I think, is um for for somebody who's in and cash based and has been for I think like eight years now, and having worked in insurance space for for a really long time, utilization for me, I think is incredibly important. Like the average person, I'm like, if if you have symptoms that are very straightforward and you'll respond to basic stuff, please go to your basic local clinic that has basic level training and you're probably gonna be just fine. Um, it's the ones that um are either complex. So I would put yours in that complex situation just because the evolution's involved, um, you know, those sorts of things. And also your your activity level and whatnot. Not that every person doesn't deserve that, but I think that was um almost like a pre-situation. Um, but like I think there's ways to use cash based out of network more efficiently. Um, because what I hear on podcasts and and stuff all the time, and they're like, oh, pelvic PT is so expensive. I'm like, bullshit, it's not. If you have insurance and you have physical therapy in your insurance, guess what? It's covered. Now that's gonna give you a base level, but to save, save us for the stuff that nobody can figure out. Um, and again, it it it shouldn't have to be that way, but unfortunately our system is set up that way. But again, it's utilization. Um, let's really use the basic stuff to its full capacity. Let's refer to them more, let's clear a lot of this stuff up. Um and I I think that would help a lot with the the wait lists. Um, I think it would again, it's just referral to the to the appropriate providers, make sure that there's comprehensive care. If you're somebody's not getting better, don't hold on to them. Refer them out to getting comfortable here. Um refer them out to the people that um can handle that. But again, that's a huge evolution. Like when I started, there was maybe nine of us in the DC area and I knew everybody. And now I couldn't begin to tell you who's here. I really couldn't. Like there's just so many, which is a great problem to have. But again, with the awareness, I think hopefully we're using more efficiently too.

SPEAKER_00 31:09

So yeah, yeah, I hope so. And I do think, you know, there's a number of different people have different perspectives on this, but if there are different reasonably high quality online programs, right?

SPEAKER_02 31:21

I would agree.

SPEAKER_00 31:22

Good options for people who otherwise don't have options, and especially, you know, we know that certain populations are harder to reach, right? Rural populations, yeah, there's you know, there's the same health disparities in public health as you see across healthcare, right? And so um, you know, there's some of these online programs can be more affordable, more accessible. And so I think absolutely including some of those, you know, evidence-based online programs as part of like a resource library for providers would actually be really helpful because then if there was six-month wait list for a provider, they could say you could get started. The wait list, and in the meantime, let's go ahead and get you started with this because I know that this is a pretty solid program and a lot of people benefit from it.

SPEAKER_01 32:03

Yeah, no, I agree with that a hundred percent. And and again, it's just but it again, it's going back to the system being broken of there's this assumption that it's 1970 and you plunk down your insurance card and it covers everything, which could not be further from the truth these days.

SPEAKER_02 32:17

Yeah.

SPEAKER_01 32:17

Um, and especially when you've got, I don't know if this is happening up where you are, but I mean, we've got so many people leaving medicine, period. Um, and I mean, I'm not even in a state that's outlawing, you know, anything in particular yet. Um, so um, I just feel like it's just it, it any medical issue, it just makes it really hard to navigate as um a patient. And so, you know, I think that's where a lot of those online programs came from, is just out of desperation for just some basic information, somebody to listen and somebody to validate. Um on that line, there's um one that I'm thinking of where she has a bank. Um, it's Margie. Um, she was on our show earlier this year. Um, she has a bank of prolapse photos. I have thoughts about that. What what do you think?

SPEAKER_00 33:12

I think it's one of those things that sounds very kind of like jarring when you first hear about it. Not jarring, it might be not the right word, but you know, we're so used to sanitizing and covering up all these sensitive issues that like, oh, you can go look at vaginas feels a little like ooh. But I think so. I think once you kind of let yourself get past that, I think there is benefit in knowing that there is a range of vaginas, right? And I mean this is this is similar to I think you've probably seen like the vulva projects of you know showing different kinds of vulvas, and this is not related to any type of birth injury or prolet, but just showing natural variation, right? Um and I also think there is something to be said for this being like the fact that it is a an and became like a necessary and helpful resource, says something about the type of care that people have been receiving, right? Where they can't get these answers from a healthcare provider, and they will get an exam and the provider will say, Well, everything's normal. And like turns out no, they actually have a grade two prolapse. And so provider could have said that, right? They could have said, you know, you have a grade two prolapse, and this is actually fairly common, and here are some resources, right? Yeah, like it doesn't have to be either or where you either don't talk about it at all or you are the most fear-mongering, distressing, inducing that's the challenge is providers like, oh, I can't talk about this. And you know, if I see a prolapse and they don't know, like if I tell them, then they're gonna be really upset and distressed, and like, yeah, maybe, but also do people deserve information, even if it would be distressing? I would argue, yeah. Right. And so I think if people want to look at these pictures, that's fine. Like that's that's their ocean. Yeah, right. And if they find that helpful, okay. Um assuming, I which I believe knowing Margot, she probably is, like being sensitive and careful about the privacy of these photos and ignoring things in a way, right? Like that's not a given, right? Healthcare providers all do their best to protect privacy and confidentiality. Um yeah, I guess I don't have a lot of in-depth thoughts on it, just that it can be helpful to see that you're not the only one when I think prolapse is tricky in that it's one of the few things that there's something to see sometimes and sometimes not.

SPEAKER_01 35:33

And so I I guess that the the the thread I'm trying to pull here is you know that that patient that they're looking all the time. And they never looked before. And again, if we're gonna draw these parallels in the the conversation, you know, with with pelvic pain, one of the things um there's a a whole um kind of line of what we call danger safe. This is all like uh Lorma Mosley, David Butler kind of stuff. Um, for those of you guys that are PTs, so like things that you say and do, things that things that you see, things that you think and believe. So I I will have patients sometimes where like if they're so like looking down and measuring, I was like, but again, we this is bias. We don't have a reference point to pre. But then also like when they look, they're they're not looking because they don't feel something. They're looking probably because they are. And so it's it's trick. I've again, I feel like it's so tricky. But what I what I've started doing with with patients is in the beginning, ask them, like, you know, you looking, is that make you more fearful or less fearful? Like, is this a piece of data that's going to be helpful or harmful to you? Is this something that um is gonna influence kind of what's going on? For you, kind of what was what was your experience? Were you a looker or yeah?

SPEAKER_00 36:59

I'll give like I guess a personal and professional response to this. Yeah. Um, professionally, this is not too dissimilar from how um a range of OCD-like behaviors show. Oh, yeah, yeah. You know, in the perinatal period, especially. You know, I worked with a patient last year who had experienced a miscarriage and she was having very compulsive checking her underwear, right? Constantly checking her underwear uh to the point that it was just pretty all consuming and distressing and actually time consuming, right? Because if you have to go to the bathroom to check your underwear constantly, that's actually gonna take time away from the rest of your life as well, right? So, you know, we talk a lot about the checking behavior with prolapse, but this is not unique to prolapse, right? This shows up in many different contexts, right? And it's not to say that everyone who is checking for their checking their prolaps has OCD. That's not what I'm saying, but what I am saying is that this is a common, commonly experienced behavior for people with obsessive compulsive related disorders and people and the perinatal period more generally. And one of the things that is really unique to the perinatal period is that our brains are really primed to be obsessive, right? Our brains undergo dramatic changes across pregnancy and postpartum, and it is biologically normal to be hypervigilant to threats, right? And I think this is an important piece that often gets left out of this discussion, is that we are in a really like neurologically primed state to be obsessive in this kind of period. And from like a developmental evolution, whatever you word you want to use, like from a whole human history perspective, this was adaptive, right? This obsessive tendency kept our babies alive, right? And so I think the challenge, you know, for those of us working in perinatal mental health is to recognize that a lot of this is normal, right? And I don't mean calm and not normal. I mean like actually normal, right? It is normal to be hyper-vigilant to whether your baby is sleeping and is hype or breathing during sleeping, it's hyper normal to be have these intrusive thoughts about dropping your baby or like all the things that come up postpartum, like that is normal. And the problem is not actually whether you have these thoughts and urges, it's what you do with them. And it is the meaning that you attribute to them, right? And so if you have an intrusive thought that you might actually cut your baby while you're cutting up potatoes in the kitchen, like that thought is not actually a problem. That thought is normal. The problem is if you respond to it in a way that is if you believe that that thought is true or could be true, and you stop cutting potatoes and you stop going anywhere, right? You have to look at the impact of the thoughts and the urges. And so I think the same is true with this, is whenever someone engages in a compulsion, that strengthens the obsession, right? That is the nature of obsessive compulsive disorders, is you your brain develops this idea that I'm okay because I engaged in this compulsion, right? Because if you always have an obsession that is paired with a compulsion, you never get the chance to learn that you can be okay without engaging in the compulsion, right? Yeah. So going back to the potato cutting example, if you always put the kit put the knife down and leave the kitchen, your brain develops a belief that my baby's actually okay because I left the kitchen and I put the knife down, right? Not my baby's okay because I wasn't actually gonna cut him in the first place. Right. Right. Um, so I think the same comes up with prolapse, where when we check our prolapse, it strengthens this idea that we need to check in order to reduce anxiety or to figure out what's going on or to be able to fix the problem, right?

SPEAKER_02 40:34

Yeah.

SPEAKER_00 40:34

Um there really isn't a benefit in checking your prolapse 10 times a day from both the physical standpoint and definitely from a mental health standpoint, right? Yeah. Um the physical standpoint, and this is something I can say, even though I'm not a PT, but I've had a lot of you know consultation, professional work with them, both personally and professionally, your prolapse is going to change across the day, right? And change across scenarios. And it's also not going to change so dramatically, so quickly that if you check it five minutes later, it's gonna be different. Right. Um, so it's both problematic to check it consistently because you probably will notice changes. And by changes, I mean maybe worsening, right? Because if you check it in the morning one day and then towards the end of the day the next day, it might seem like it's worse, right? Um but it's also like you're not going to notice meaningful changes from like a rehab standpoint by checking consistently, right? And so for me, I pretty much completely stopped checking. Yeah. Um, it was something that wasn't helpful. It really increased my anxiety. I had a very visceral disgust response to as well. Like I would check it and I would both like with my fingers and also looking with like a mirror or and I had like a disgust response, which definitely increased my own sense of shame and brokenness. And you know, that comes with a whole host of other mental health implications. And so it was very helpful to stop checking almost completely. Yeah. I maybe check every few months at this point, and sometimes I'll check after, like not immediately after, but like a few weeks after being really sick.

SPEAKER_01 42:25

Oh, yeah.

SPEAKER_00 42:26

I will say that if you check immediately after, you'll probably feel like it's worse. And it's probably unhelpful to do that because it's probably gonna be worse forever, right? I'll stop checking immediately after being sick. I have asthma, and so I do tend to be hit pretty hard by respiratory viruses. Yeah, and that's a bummer as someone with a birth injury. And so I've had to come up, yeah, I've developed a lot of strategies for managing both the physical and the mental health aspects of respiratory viruses. Yes. Yeah. I hope that was like a good, like a helpful mini-crush.

SPEAKER_01 42:53

No, that was no, that was really good. I mean, I I it's it's an interesting conversation that I'll have with people. Um, for me, it it's an opportunity to provide consent, I guess, in in an odd sort of way, where um, you know, there's some people that having that information is valuable in helping them understand, but also having that information can be um triggering harmful, like that sort of thing. And sometimes people don't know what that information will do. And so I feel like I feel a responsibility understanding that it can go both ways to read the situation, provide that opportunity for consent and be like, hey, do you want to look or do you think that's gonna freak you out?

SPEAKER_02 43:40

Yeah.

SPEAKER_01 43:40

Um, do you think it's gonna be helpful? And and a lot of people like, nope, don't want to see it. I was like, great, perfect. I'm glad, you know, it's all fine. Um, but I I feel like the other part of the conversation that's similar here is when we talk about anatomical prolapse versus symptomatic prolapse.

SPEAKER_02 43:58

Right.

SPEAKER_01 43:58

And um I'm very much on the line of you can have anatomical prolapse, 17 different grades. There's only three or four depending on your scale or versions of it, whatever. But really, it it my my personal opinion, having navigated this myself, is it comes down to the symptoms. Like I personally do not care what's going on down there as long as it doesn't get in the way of my day and what I want to do and have those symptoms interfere. And I've had some people say that it invalidates their birth injury. And I'm like, I I and that one I did not see coming because again, I was like, I feel like they can coexist. Like, let's treat the symptoms, acknowledge that there's an injury, acknowledge that there's an anatomical issue. Um, but let's not let the anatomical issue be the sole thing that we're trying to change, because the thing that we're likely to change the most would be the symptoms.

SPEAKER_02 44:59

Yeah.

SPEAKER_01 44:59

What do you think?

SPEAKER_00 45:01

I think that I think I agree and completely understand kind of the intention. And I also ways that it's felt invalidating potentially. On one hand, if like you said, if we are only focusing on anatomical change, and that anatomical change can't necessarily happen, right? The research doesn't support that this always happens in a linear, straightforward way or at all, um, then that's going to be investing time and energy in something that is not actually going to plan out, right? So then that sense of like maybe kind of mentally and emotionally detaching from that is a goal and connecting to the goal of symptom shifting and symptom reduction, right? And living a meaningful quality, good quality of life despite whatever anatomical presentation is there. Like that is a really great goal and perspective. I think the challenge is that like again, it comes back to that pendulum, right? Where when you swing the pendulum of saying it's the symptoms, and then you say, Well, the the grade doesn't matter. What it looks like doesn't matter, right? That is the thing that I think then probably lands for people as invacinating. Um, because they can both matter, like, like like you said, like it doesn't have to be one or the other. And so it also doesn't have to be just focusing on symptoms, right? Or we can say, like, we can't always change the anatomical grade. Um, but we know that the same things that'll change the symptoms are also the same things that would probably change the grade for most people, right? And so, and we know that this is distressing, and I want to validate that, right? Yeah, it's um it can be upsetting to feel really blindsided and forever changed by an injury you didn't even know about. Yeah. It's a possibility, right? Um and I think you know this come this brings in a lot of the themes of intimacy and sexuality. And there are a number of reasons why for many people it does matter what their vagina looks like, right? No matter even even if the symptoms aren't interfering with daily activities in a direct way. Yeah. So I do think it's possible to kind of hold both in tension at the same time.

SPEAKER_01 47:03

Yeah. No, I I I think so too. And and and again, the other thing I always think about when we have these conversations, um, you having a a daughter yourself, is how do you like again, when do you ever start looking? In our generation, speaking for myself, that was not a conversation I had with my mom. Love you, mom. Um and so we now think, okay, how do we teach our kids plural? Um no matter what the gender, how do we teach them how to look and understand and be curious? Um and also be aware, you know, and again, trying to figure out how to to to present this to a kid is like the information that we have, we've got, I mean, again, I don't think this is had come out the last time that we chatted, but like if you look at the average prenatal organs, what some of the data is saying is like, yeah, the average woman's, you know, could have a grade one or grade two. So the problem isn't it's it's the grading system. It's like, well, why don't why don't we why don't we scrap that and call it a zero? Or what like does that whole s system that we're grading everything on, is it actually not reflective of normal uh physiology?

SPEAKER_00 48:28

Um and it's like how much of the kind of hyperfixation that happens is actually about a new injury versus something that was there all along that you just didn't pay attention to, which I think for some people that's true, and for other people that's very not true, right? For some people, there was a very clear birth injury and a very clear oh yeah. Some people say, like, I had, you know, incontinence and IBS symptoms or you know, constipation like all the way through, you know, my knees. And and so, yeah, I can kind of see the thread. And for other people, there is no thread, right? And right, like no issues, major issues. And so I think we have to be careful too in how we talk about this to not I I think that that can get close to gaslighting sometimes of saying, like, this was there before, right? Like you just didn't know, right? Because I think when we frame it that way, because I I've seen content on this that's I've had like like kind of that cringe response to it of basically invalidating that this is a birth injury or a birth-related change, and saying, like, oh no, this we this is probably there all along because this is you know the iceberg thing of that there was the you know, the constipation and the bearing down and bad pressure management. And so, you know, that was just kind of the last tipping point. And I think that that's true for some people and very untrue for others. Yeah, not saying it's untrue that there's an iceberg effect, but it's untrue that there was like a clear pre-existing issue that like linearly to prolapse.

SPEAKER_01 49:45

Yeah, that's I feel like the those conversations really do, and and it it has to be individual. It really does because when I'm asking questions, that's one of the things that I'm trying to figure out is how much of this was big baby, fast delivery forceps or whatever, and then how much was, you know, what there were there were some things, you know, genetics. Hey, that wasn't working in your favor, you know, your mom had that, or you know, had you had constipation or the things that you referred about. And so part of the conversations I try to have is um how we got here, because you and I can have the exact same symptoms and completely different ways we got there. And that's why our rehabs to some degree will be different, because you know, maybe maybe I can't change my genetics, you know. Well, I can't. That's a fact. But but that shouldn't necessarily I look at it as, and again, I feel like all these conversations can go both ways depending on how you put it, because I'll have people ask, well, what can I do to prevent prolapse? And I'll ask, well, you know, did your mom have prolapse? Yes, my mom had prolapse. I'm like, okay, knowing that, let's go in as aware as we possibly can, have these conversations on on how to approach a birth, considering, you know, you have this particular risk factor, which may or may not pan out. But again, like I would like to go into it with a conversation that's informative and empowering, but I can definitely see how it could go off the rails and be like, all right, well, sorry, you know, you can look at your problematic.

SPEAKER_00 51:21

We the value of these conversations aren't just in preventing birth injuries, right? There are many cases in which you know we can reduce risk and likely change the trajectory of what happens. Yeah. And I don't believe that we will ever be able to prevent all birth injuries because we can't control everything, right? Right. And so we need to have these conversations so that people can reduce risks that are within their control and not feel like they could have done something differently and didn't, right? Because that's really blindsiding contributes to betrayal trauma, right? This idea of like, if only I would have known, I could have done all these things. Right. Right. So empowering people to make the different choices that are within their control and also providing information and resources so that it doesn't feel like it's the absolute end of a life, an active life or a meaningful life. If they do still experience this and not framing it as if you do this, then you won't have prolapse, right? Because then if they think that they do everything right and then they still end up with a palpable or injury or condition, then there's a sense of like, I must have done something wrong, right? So being able to have this nuanced discussion in a way that reduces risk where possible and also creates space for the reality that not everything can be prevented and controlled, and that's hard, right? That is uncomfortable. And I think that that's why it's not happening, right? Because this is uncomfortable for patients and providers. And so providers need to build up a little distress tolerance as well. Yeah. And being able to have discussions that may actually bring up distress, right? Because I will never say these conversations won't bring up distress. They probably will. What I will say is that distress is not something that we need to be afraid of as providers, right? In the same way that you probably heard this in the parenting sphere, right? Our job as parents isn't to reduce our children's distress, right? Distress is a part of life. Our job as parents is to uh create space for the distress, normalize it, allow it to be there, and equip our kids with the coping skills to be resilient even when they're distressed, right? To manage that distress and know that they won't feel that way forever. Um and obviously we're not providers, not parents and patients aren't children, but like the analogy is that like distress is a part of life, right? And so when providers are making their decisions based on what will reduce patients' distress, and those choices are limiting information that provider patients should have, like that's yeah, right. Um, and that's where the mental health piece comes in too, right? Where when we know that there are resources for mental health, then it allows providers too to be able to give those resources.

SPEAKER_01 53:52

Yeah. There's so many questions here. Um living in a city, and I feel like I'm allowed to say this, having lived here for 20 some odd years, um, we like to control things down here, and I'm pretty sure we're not the only place. Um we have a lot of moms that would go into that geriatric over 35 category, very, you know, well educated, very um knowledgeable, and there's a certain um sect of people that and again, I'm gonna put myself in this category because I I thought that I was. I'm like, oh, I'll I'll do everything right. And then, you know, you think that you're doing everything right and it doesn't turn out as planned. Um how can we I guess as those of us that are in kind of the prenatal pelvic health space, what can we do to find help um when we have somebody that you know maybe they're at higher risk potentially for a birth injury, but uh an example I'm thinking of is you know, you get the the late 30s, early 40s. I'm gonna do everything naturally. And um that might not go as planned, or like I'm not they they demonize certain things like epidurals and c-sections, and and you know, they they've read all the the readings that says, you know, your doctor is actively working against you, you know, all that kind of stuff. Like how where do we go as providers? You know, I I mean we have our own experiences and and stuff that we can talk about, but how can we best support them maybe with another provider like yourself?

SPEAKER_00 55:37

Yeah, I think, you know, one thing a kind of a general recommendation that a lot of people would be more open to is that the perinatal period is such a transformative period of both risk and vulnerability. And so connecting with a mental health professional even proactively can be a great choice. And that can align well with people who would want that kind of natural wellness kind of experience. The idea that like I can do something proactively to support my well-being, right? Um I think it's helpful for people to be even people, I mean, and I say this is someone like I had a home birth, right? So like I could arguably be in that crowd you're talking to, right? Of I didn't feel like I needed to be in a hospital setting with my own unique kind of constellation of risk factors, but I also did have it, for example, for my second birth, I had a pretty low threshold for transfer, right? And so I think that that can be a helpful conversation is like this is a great goal, right? And no, not everyone needs to be in a hospital setting. You know, these are the cases in which this can be a really good, you know, this would be for like a birth, but someone who went to a hospital setting and they had their goals of certain types of delivery or birth preferences, delivery, yeah, birth preferences, you can validate those preferences, right? Because it's not helpful for anyone to invalidate what they want, right? Right. And also then talk about how for many people this works out well. For many people, it doesn't. And it's really helpful to think proactively about you know those potential decision points and how you'll make informed decisions so that you're not having to think about it for the first time when you're in a potential crisis point, right? Yeah. So I think that's what's really hard about the idea of informed consent during labor is that it's actually not a time in which people can inform consent, right? It's such a high-intensity, all-consuming experience that you can't actually think critically or logically all the time in those moments. And so I think encouraging and empowering patients to think through pros and cons of various decision points in pregnancy and labor before they get into a crisis is a really wise way to be thinking about and approaching labor. Um and I think that how providers talk to patients during those decision points really matters. Yeah, right. Because at the end of the day, and this come, you know, I we don't have probably time to talk about this with a few minutes left, probably, but the conversation of C-sections, right? And elective C-sections, and should people be allowed to have a C-section if they want to? And I think that providers have to or should I mean this is true across healthcare, right? Providers can give information about risks and benefits of different decisions, but at the end of the day, it is a patient's choice, right? And the patients are allowed to make decisions that differ from the ones a healthcare provider would recommend, right? Yeah and so I think as healthcare providers, working to give that information on all the options, right? The risks and benefits of all options, not just the one that you don't want them to choose, right? Right, right, right, right, is important and supporting patients and to the best of your ability and making decisions that align with their values and their priorities. Yeah. Knowing that those values and those priorities might not be the same ones that you hold as a healthcare provider.

SPEAKER_01 59:03

Yeah. Yeah. Those are the there's two conversations points that I like to have when people come in for for prenatal checks and there's not really anything going on. I'm like, you know, how married are you to your birth plan? That gives me a sense of like their mental flexibility. Um, and you know, what have you prepared for? What have you, you know, what do you want? And and typically if they're talking like demonizing C-section, um, that's always a funny one for for me, always, you know, because I went through two myself. The first one wasn't planned, the second one sort of was. Um and but what I learned from my situation is I did not prepare for that at all. And I think that impacted me hugely. So if I see somebody that has a gap that they're avoiding because they think that won't happen to them, I'm like, let's just get that information, let's understand what it is. Because again, you and I are sitting here having this very logical conversation in there, it doesn't work like that. Like it's just not. Um, and the other thing that I talk to them about is um again, how married are you to kind of the things that that you want? Um, are you feeling resistance from your provider? Please do not think that you're gonna be the person to change that provider's mind. And if you're feeling, if it's like the first check-in and you're not feeling the warm fuzzies, trust that feeling. Um, I had a uh a patient expecting twins, and they basically told her to stop exercising. And she's like, Well, why? And you're like, Oh, well, you're having twins. And she's like, Nope. And she texted me and she's like, Hey, so is this? I'm like, Nope. If you don't have warm fuzzies, move it along. And she's, you know, she hasn't delivered yet, but like she's doing great, has been able to be active the whole time on top of things, things have gone really well. Like, you're not going to be the person to change that provider's mind who's been doing it that way for that many years. And again, it just it's neither good nor bad. It just is. It's like align yourself with people, kind of like what you said, the values are similar. And it just again, you only can do the best you can with the information that you have at the time. And if you surround yourself with people with similar values and outlooks and things like that, that is the best support that you can set up for yourself. Yeah, but absolutely.

SPEAKER_00 1:01:19

And I think that providers also sometimes I mean, everyone needs to keep this in mind and interacting with the other human beings, that everyone has their own unique story, right? Their own unique story that's shaping their perspective. And a person who is very anti-C-section probably has a story that shapes that, right? Yep. And a person who is very, you know, people should always be offered an elective c-section probably has a story that shapes that, right? And so before reacting in a really kind of intense and kind of aggressive or volatile way to that, to something that differs from what you would choose, I I think it's helpful to pause and say, you know, where is my response coming from? Like why do I feel so strong? And also why might they feel so strongly? And you don't know, right? We won't know other people's stories, but we can guess what they do with a story, right? And so holding those different stories with a little bit more gentleness, I think, can go a long way to having these discussions in a way that leaves people feeling supported and validated. Because there is no one right way to have a baby, right? There's no one way right way to build a family. And um I think that, you know, it's a lot of providers are scared of talking about C-section as a valid as elective C-section as a valid option for reducing birth injuries. Research is pretty clear that it does, right? It's not the case that a C-section will be the best choice for everyone because it also comes with other risks, right? And so I think we have to be willing to have this nuanced conversation of like what are the risks and benefits of all these different choices? And what risks are you most willing to tolerate and what risks feel like absolutely not for you, right? If you have the choice.

SPEAKER_01 1:02:54

And that's, I think that's the hardest conversation the first time around because no one knows how that's gonna work out for you. You're making your best guess. Um, and even subsequent pregnancies, you've you you've got one data point, but like that's not necessarily gonna hold true for the subsequent pregnancies. Um, you're a little bit more informed, you can make those decisions. But again, there's still those things that we can't control. Um, and it can be really hard, I think, especially for us older moms that you know, we've controlled everything in our lives up until this point. And I I feel like it's like a crash course in parenting. Like you're gradually like, yeah, no, you don't have control anymore.

SPEAKER_00 1:03:31

Yeah, it definitely is. Uh, I mean, there is research that kind of more like perfectionistic, high control people tend to struggle more postpartum, right? Because whether or not you experience a birth injury, there is going, there are going to be so many things that are suddenly outside of your control that you think you do all the right things in all the right ways and things still change differently, right? Um and so come again, closing out that birth choice conversation, you know, the reason in terms of birth trauma and mental health implications, it's less about, you know, the research does show that it's less about what type of birth people have in terms of like C-section, vaginal delivery, instrumental, even like, and more about whether people feel supported and empowered and involved in the decision-making process. Right. And so it really just highlights that there is no one right way to give birth, but the one thing that we can be doing a lot better as uh healthcare system and providers and people who are working with patient or pregnant people is letting them into that discussion and not just telling them what to do, but helping them think through risks and benefits and giving them the full information so that they can think through risks and benefits. Absolutely. And not medical gatekeeping. Right.

SPEAKER_01 1:04:47

So if we're gonna throw open those gates, um, as a provider, let's say you're newer starting out working with pregnancy and postpartum, what's the best way to find a mental health provider who's experienced in working with birth injuries or pregnancy or things like that? What's the best way to find somebody?

SPEAKER_00 1:05:08

That's a really good question. And the answer is harder than I wish it was, right? I know. I think there are more providers who do a great job with birth trauma and less who have a background in birth injuries. And that's actually one of the things that I'm really trying to change in my fellowship is developing and being able to kind of disseminate or make more accessible resources for the mental health aspects of birth injuries. Because I, you know, I've had a number of patients that I've seen in people in my research studies that have said, you know, I did try to see a provider who said they specialized in birth trauma, but then I spent the whole first three sessions just like trying to help them understand what prolapse was and why it was impactful. And so then I was like, well, forget it. I'm not gonna pay to educate someone else, like pay my money to educate someone else. And so I think that's part of the problem is that there are actually a number of great birth trauma therapists and looking for that. And I think you know, PSI International has a good resource bank, so that would be a good place to start. Um, state by state resources, as well as you know, a lot of medical centers have a perinatal kind of specialty area where there's a group that's doing perinatal work. And so trying to connect with those groups, but there aren't a lot of providers who are trained in birth injuries. It's unfortunate.

SPEAKER_01 1:06:20

So you're gonna fix that, right?

SPEAKER_00 1:06:26

I'll I'll try to make it.

SPEAKER_01 1:06:30

All right. So as long as we're talking about your to-do list, uh, what's on your to-do list um as a New Englander in winter?

SPEAKER_00 1:06:36

Yeah, we are really excited to do more Nordic skiing this winter. Um, so they actually there's a center here, it's called Oak Hill, that is putting a ton of money into improvements and renovations of their Nordic center. I think Dartmouth's actually hosting the NCAA championships either this year or next year. So they bring snowmaking and lights for Nordic skiing, which is pretty unheard of. Right. And allows me to be cautiously optimistic that I will still be able to ski even with even if there is a low snow winter thanks to climate change.

SPEAKER_01 1:07:09

So yeah, right. Don't even get me.

SPEAKER_00 1:07:12

Just to add in another heavy topic at the end there.

SPEAKER_01 1:07:14

No, it's it's like skiing. Yeah, where I grew up in uh in western New York, um, we used to have plenty of snow, and now they have to go to a downhill um center that they have like a 1k loop that they'll make snow on. I mean, can you imagine just like 1k loop for 5k? It's just so boring. Like because there's no snow anymore. I'm like, this is ridiculous. It is pretty sad.

SPEAKER_00 1:07:39

We're looking forward to that.

SPEAKER_01 1:07:41

Good.

SPEAKER_00 1:07:41

Um oh, I'm one thing I even had in my back of my mind is that we kind of sped along in a different topic, but I want to just briefly mention that I think it is good and okay to integrate pelvic health as early as toddlerhood, right? And I think that that's part of the problem is that suddenly this is an issue for the first time postpartum. And I'm not saying that this will fix the problem or prevent all birth injuries, but I think that it at least will build some pelvic health literacy from a very early age. You know, I taught my daughter to move while she's on the toilet, right? And not strain and teach her proper toilet positioning and um teach her that she shouldn't hold her belly in, you know, like relax your belly, and that helps with various things, right? And so I think just integrating the developmentally appropriate pelvic health concepts is both helpful in developing like a better foundation for lifelong public health, but also destigmatizing these conversations and destigmatizing this as like an off-limits part of your body to talk about and seek help for, because that's a big problem with um support seeking postpartum, right? Because there is this whole like there are so many people with undisclosed, undiagnosed pelvic floor conditions. Yeah, and we know from the research that patients aren't bringing this to their provider to talk about and providers aren't asking, right? Yep. And there's kind of this assumption that the providers have an assumption that patients will bring what's what they what's impactful to them. Patients aren't bringing this because of stigma. And so we need to shift stigma. And I think part of that is starting these conversations really early.

SPEAKER_01 1:09:13

Yeah, no, I totally agree. I I love when uh Juniper gives a good uh pelvic injury, birth injury to her dolls. That's my favorite. I'm like, I colored too much, like maybe, but no, she says it in a very like calm, neutral way, which I'm like it's just a thing, it's very kind of normal and which I I she's like, yeah, you know, whatever, birth injury.

SPEAKER_00 1:09:35

Yeah, she's resting right now because she had a birth injury, and you know, she just had a baby, so it's important for her to rest. I'm like, Yes, it's true. She all didn't have a birth injury, but I I'm glad you've learned the importance of post.

SPEAKER_01 1:09:47

But if she did, you got it covered, right? Yeah, it is Ansel there yet as far as birth injuries or or no, not quite.

SPEAKER_00 1:09:55

Okay. Um, but he does moo on the toilet when he's starting the potty training. Excellent.

SPEAKER_01 1:10:02

We didn't move, we did um, we did poop. We just said poop. And she still does that and she's 11. Like if she's super constipated and she'll like try and hold her breath, and I just look at her and she's like, I know, I'm not supposed to do that in a very tween kind of way.

SPEAKER_00 1:10:19

Yeah, but my hope is that our children and this next generation broadly won't have to learn as many things the hard way as we did.

SPEAKER_01 1:10:28

Yeah, no, I I I hope you're right. Again, I I just just seeing how far things have come, even just in the past five years, you know, by the time our kids have kids, um, I should hope that a lot of this is is navigated um and at least in a much better situation that we're in now. So um, but again, I I think so much is we need to credit our, you know, women for talking about it. We need to credit our providers for being open and having conversations, our women in research, um, clinical practice, all that kind of stuff. Um, I think the other thing too is um just better understanding that the pelvic floor is more than this hammock and just understanding the three-dimensionality and the fact that when we're talking about birth injuries, we're talking about muscles and fascia and ligaments and all the things and not oversimplifying it and just seeing how beautiful and complex and intricate it is. Um, I think the more that we can be upfront and clear and not oversimplify our bodies, the better too. So um they're pretty magnificent, you know?

unknown 1:11:35

Yeah.

SPEAKER_00 1:11:35

And when we allow our brains to work for us and not against us, that can play a big role in how these degrees and the conditions and public health experiences um are embodied, really.

SPEAKER_01 1:11:48

A hundred percent.

SPEAKER_00 1:11:49

We need to integrate and not push out the mental health aspect, even as we push back against historic medical gaslighting.

SPEAKER_01 1:11:56

Yep. No, exactly. And I again I feel like it's just worlds apart from where we were when I first started. The fact that this just this very comprehensive approach to it. Um, hopefully it just keeps getting better. All right, we have a new uh little thing here since the last time you run the show. Uh, we have a couple of basic questions for you. Um, book your reading or podcast that you're listening to right now.

SPEAKER_00 1:12:18

Oh, I just started reading Enchantment by Katherine May. Um, yes. He's the one who wrote Wintering, which is another good book, many people may have already read, but I'm really loving Enchantment because it really tackles the kind of burnout and disillusionment, especially post-pandemic. A lot of us have experienced or are experiencing in some form. She's has a beautiful writing style and a way of um really authentic human experiences.

SPEAKER_01 1:12:44

Yeah, she does. There's a third book, and I cannot for the life of me remember what it is. Um, and I forget which one where she did the hiking around um Do you know which one I'm talking about? I know, but I don't, I mean, I could run over and grab it and look. No, it's fine. It's it's on my it's on my nightstand at home. Yeah, I told you like I read wintering every year when because it's it's by month. And so I'll read September in September and October and October. And um, it she has a lovely writing style. I don't think it's everybody's cup of tea, but like if you are into just like slow, very thoughtful, um, introspective sorts of things, and she's navigated a lot of chronic issues and stuff as well. I I think it's a good read, especially if you're you're in this space and you have the mental space to kind of work through it. So huge fan there. Good. All right. Um, I'm gonna tweet this question. I was gonna say favorite activity since becoming a mom, but I'm gonna say favorite activity since becoming a mom and moving to New England. You get to change it.

SPEAKER_00 1:13:46

Okay, mom since the last two months, right? I'm thinking my favorite activity over the last two months. Yeah. Um man.

SPEAKER_01 1:13:56

Not getting your car broken into stolen packages.

SPEAKER_00 1:14:03

Or not be able to walk outside in the car.

SPEAKER_01 1:14:05

That was her welcome to Chicago, was you got your car broken into the first night, wasn't it?

SPEAKER_00 1:14:10

I had such a positive attitude going into the year and like very much rejecting all stereotypes, and unfortunately, experienced some very challenging things over the years. So my favorite experience becoming a mom not becoming a mom, mom in New Hampshire is uh seeing the fall colors in the White Mountains. Yes, beautiful.

SPEAKER_01 1:14:31

It's gorgeous. Um, is it okay? You you can like one, you can like both. How different is it from Utah, the colors?

SPEAKER_00 1:14:40

Very different in just the landscape is very different. They're both incredibly beautiful, natural landscapes, but very different. Yep. And I do miss the aspen trees. That's loved in the mountain west. Yeah, and we don't really have aspen trees here, but we have a really cool blend of evergreen and deciduous that creates like beautiful layering during the fall season. So they're both beautiful in different things.

SPEAKER_01 1:15:07

The northeast is more condensed, I think, and we have a a lot more different colors, I think, as opposed to like the west, I feel like is very just you know, aspen yellow kinds of stuff.

SPEAKER_00 1:15:17

So yeah, there are definitely more diverse color patterns here.

SPEAKER_01 1:15:21

Yep. Well, I'm glad they're putting on a show for you. Yeah, all right. One piece of advice for moms.

SPEAKER_00 1:15:32

Don't let the perfect be the enemy of the good. That's the one that I've really lived by as both a graduate student parent and now moving into you know next phase of my life and career. But I think even for anyone who wasn't in graduate school and didn't wasn't on the same track as I was, you know, it's easy to get caught up in trying to do things a certain way and have a vision of how you want things to play out, and oftentimes holding super tightly to those maybe rigid, excessively rigid ideas of how things quote, should be, can actually get in the way of being present and enjoying the good that can be experienced right in the midst of the mess. So I like that.

SPEAKER_01 1:16:14

And I like that better than done is better than perfect either. It has some nuance to it. I like it, it's more positive. Done done is just like screwed them out.

SPEAKER_00 1:16:22

Yeah, because it's you can take you can apply this to various contexts and situations in different ways.

SPEAKER_01 1:16:29

I like that. I like yours better. Thank you. It's been promoted. Um, who is someone in your space that we should know about? Who's got your attention right now?

SPEAKER_00 1:16:43

I always have a hard time with these questions because my anxiety says, like, oh, you have to pick the I just I just use my own blog with the perfect.

SPEAKER_01 1:16:51

Generally describe it, just it doesn't have to be anybody like particular. Like, who are you loving right now? And it can be bluey too, that's fine too.

SPEAKER_00 1:17:02

I I think it's another this is a hard question because I'm a lot of people. Um one of the people that I've always liked. This isn't this is more pelvic health, but yeah, impactful in my life, and she continues to be doing really meaningful things is Julie Web. Yeah. Um, because I think she's been part of the paradigm shift with managing pelvic injuries postpartum. Um I'm I might have to come back to this with my list.

SPEAKER_01 1:17:31

That's okay, no problem.

SPEAKER_00 1:17:33

Of all my favorites because there's just so many, there are so many good people.

SPEAKER_01 1:17:36

There are. There are. On a side note, um your professional thoughts on the Bluey episode where um, spoiler alert, uh, they were gonna move. And and there was no like heads up on that one. And my daughter watched it before bed and and she was broken.

SPEAKER_00 1:17:53

I that was emotional for me because it happened at a time when I was questioning everything about Utah. I was like, should we have just stayed there? Like, like, is Bluey making a better decision than we did? Right. Um, because yeah, because they decided not to move at the end. Yes. So I had I was like watching it and like feeling all the feels of having moved across the country with two kids and up roof from their childhood home to a place that was harder than we anticipated. I had a lot of my own personal reactions to that.

SPEAKER_01 1:18:21

It was awful, it was awful. There was no heads up on that one. And my daughter was 10 at the time, and I'm like, why is she broken? This quick little, you know, 15, 20 minute thing. And she's lost her mind before she went to bed. I'm like, Where's the parental advisor here? Okay, so so professionally, you're saying that that was an appropriate response for her and me.

unknown 1:18:41

Okay.

SPEAKER_00 1:18:41

We're gonna come back because there's someone that I was just thinking about for your question. Yes, this is an Instagram account. Okay, called Motherhood Untitled. And one of the things that I appreciate about this account is that they have this account has been talking a lot about career pauses. And not that I'm doing a career pause, but I've spent a lot of time over the last few years really intentionally reflecting on how to integrate my values and my like commitment to being a very present and involved mom with also having high achieving career goals and what that means for a long, kind of sustainable career, and giving myself permission to evolve a career in a different way, to look different than maybe I had envisioned at the beginning, and not see shifts in productivity as like losing ambition or laziness. And I think that she speaks to this topic of just like career evolution and pausing to stay home, returning to work, doing part-time, like just really flexing based on what your values are and aligning your life with those values. I appreciate the conversation there. Um obviously not as simple as stepping back from work if you don't want to work and going to work if you want to. Like there's a lot of nuance in this, and we could have a whole podcast about this. But I like what she's I like the conversation that she's started about, you know, leaning into motherhood in more ways in different phases of your life and leaning more into career in different ways at different phases of life.

SPEAKER_01 1:20:10

Um, so yeah, no, I I I agree. We could have a whole separate conversation about that and childcare and and all the things. We'll do another one another time. All right, and then last one, uh, what's it mean to you to be an active mom?

SPEAKER_00 1:20:27

To me, it means staying connected to movement and physical interests and goals in an evolving way, right? Not holding myself to the same standards, but also not um letting myself fall into the trap of because I'm not at this level, I can't do anything or I'm not active anymore, right? Like allowing my athleticism to shift and evolve over time. And right now that means a lot of trailer ride, like riding my bike and pulling them in the trailer. And maybe we ride to the farmer's market and um maybe we take a long stroller walk up to town. And maybe I'm not doing four-hour bike rides on the weekends right now, but that's okay. And that doesn't mean that I'm not active, it's just my activity looks different.

unknown 1:21:13

Um yeah.

SPEAKER_01 1:21:15

Yeah, no, and and give us another couple of years, and I'm sure it's gonna be different again. You're gonna be sidelines on games and all sorts of crazy stuff. So um we'll we'll we'll have to make a date of that um in a couple of years and see where the the kids are and and what you're up to then. All right. If you would like to know more about Kimberly, you can find her on Instagram, Wild Matrescents. Um, and this is our season finale. So congrats. I thought there was just gonna be such a good conversation to have. Um, but thank you so much. You're always so open and vulnerable and sharing your story and kind of what you've learned um and just kind of how to, you know, we're learning this every day as it goes, but at the same time, you're you're walking the talk and um taking what you know as a professional and sharing that back with us. So immensely um appreciative of that. So thanks for being on and all that you do.

SPEAKER_00 1:22:05

Thank you so much. It was wonderful to get to come back here and chat about all of the things that have happened since I was here three years ago.

SPEAKER_01 1:22:11

Yeah. All right, ski date, right? All right, thanks so much.

SPEAKER_00 1:22:16

Yeah.

SPEAKER_01 1:22:17

Did you enjoy the podcast? If so, leave us a five-star review on iTunes and tell a friend to do the same. Are you a postpartum mom or postpartum pro wanting to know more about getting back to running after babies? Check out all my free videos at Harry Python.com.