Breaking the Silence on Obstetric Injuries with Kary Gillenwaters

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More about my guest:
Kary’s professional roles include being an occupational therapist, entrepreneur, consultant, and educator/guide to future OTPs, to name a few. A role central to today's conversation is her role as the Director of Community Engagement at SOLACE Foundation.

Finding a way (and ways) together is central to her work.  She credits a small town upbringing and starting her career in healthcare as an addiction counselor with laying the foundation for her passion for working in settings and on projects where resources may be less obvious (or even limited) and yet infinite possibilities exist by noticing, building and maintaining relationships and networks.

It also has guided her focus in the occupational therapy profession. The learnings from these experiences have led her to her latest endeavors that are focused more on collective occupational needs than individuals alone; recognizing the interconnection of these occupations requires increased community-level collaboration and attention.  It is this awareness that fuels Kary’s commitment to convening and participating in spaces where being in process (as opposed to reaching solid conclusions) is expected, welcomed, and celebrated.   

Collaboration and curiosity are two things she values most. If you have questions or collaboration ideas, you can reach her at lifewelloccupied@gmail.com.

For more information about SOLACE, or to register for the summit about birth injuries like 3rd and 4th degree tears during childbirth.

https://www.solaceforwomen.org/summit

Find SOLACE on socials at:
https://www.instagram.com/solaceforwomenorg
https://www.facebook.com/solaceforwomen.org
https://www.linkedin.com/company/solaceforwomen/posts/

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Transcript

Lindsey Vestal My guest today is Kary Gillenwaters. Her professional roles include being an occupational therapist, an entrepreneur, a consultant and educator, and guide to future occupational therapy practitioners. A role central to this conversation is her role as the director of community engagement at the Solace Foundation. She credits a small town upbringing in starting her career in health care as an addiction counselor with laying the foundation for her passion for working in settings and on projects where resources may be less obvious or limited. And yet infinite possibilities exist by noticing, building and maintaining relationships and networks. It has also guided her focus in the occupational therapy profession. The learnings from these experiences have led her to the latest endeavors that are more focused on collective occupational therapy needs rather than individuals alone. Recognizing the interconnectedness of these occupations requires increased community level collab and attention. It is this awareness that fuels Kerry's commitment to convening and participating in spaces where being in process as opposed to reaching solid conclusions is expected to be welcomed and celebrated. 

Lindsey Vestal New and seasoned OTAs are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving oat in pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired Oats. We are out of the box Oats. We are Pelvic health Oats. I'm your host Lindsey Vestal and welcome to the Oats and Pelvic health Podcast. 

Lindsey Vestal Kerry, what a pleasure. I am so fortunate to be having this conversation with you today. Thank you for being a guest on the Otis for Pelvic health podcast. 

Kary Gillenwaters Thank you for having me, Lindsay. It's always a treat to be able to talk with you and talk about things that matter. 

Lindsey Vestal I want to just kick it off right away with getting kind of to the heart of the matter. Can you start by sharing the mission of Solace with our listeners and a little bit about what inspired its creation and primary goals of the organization? 

Kary Gillenwaters Yeah. So solace really began as a result of people recognizing who had birth injuries that there was a need for, just like the name says, Solace, that many people who've had a birth injury. So solace I should just back up for a second to say is really an acronym for severe obstetric laceration awareness and community engagement. So it was a recognition by a physician assistant by the name of Caroline Stadler that there is not enough knowledge or support out there for people who've had these injuries. And she was part of a fourth degree tear support group. And Facebook put the call out to people to say, would anybody be interested in starting a nonprofit? So it's been a little over a year and a half, probably approaching two years here soon, and the nonprofit formed. So why what's the mission? There's really four kind of key points. So one of them being to raise awareness with this injury, so many people don't realize you can have a severe tear with a birth that results in a tear all the way to the rectum like that is shocking to people. So one, to know that they even exist. Two is promote prevention. We want to have maternal education. We want research. So the research really needs to start kind of both for prevention and also for what do we do after an injury has occurred. So having the people collaborate is part of what we're looking at doing and then also driving a standard of change, our standard of care, a change to that. So I'll say that over, but to drive change toward a standard of care that takes relationship building, that's part of my role. I'm on the board at Sally's and really looking at relationship building with all the different parties involved with births and birth injuries. So and then lastly, we really want to provide comprehensive support to those who've been injured. So as people are going through their healing journeys, oftentimes they don't know what's next, they don't know where to go. And that's really a site and a number of very dedicated people who are willing to listen. And then we create solutions together as we go. So that is solace in a nutshell. 

Lindsey Vestal That was such a concise answer. I know there's so many additional parts to that are rolling around your mind that you would love to share with us. That was so concise. And you know, I want to just briefly reflect on in my notes for Pelvic health Facebook group. You and you join me so, so graciously for a live. When we did get to talk about this, this was several years ago now. And I want to just reflect on all the hard work that you've done to make this a reality, because I feel like back then it was a bit of a budding idea. It was something I could feel your conviction for. And so just such a beautiful gift to be having this conversation with you today, knowing all that you've been able to accomplish in that time. I also hope you don't mind me sharing that you and I also can relate personally because we both have had first degree terrors in our own birth experiences. So this is also a very personally, you know, fire topic for us where we want to see that awareness raised. We want to see that prevention promote it, we want to see that standard of care and we want to give them support. So, again, blown away with what you've been doing and I'm so grateful for what you are accomplishing. 

Kary Gillenwaters Thank you. Thank you. It's it's a journey that takes just a few group of, you know, a small group of committed people and coming together. It's been amazing what can be achieved in just it's only been, like I said, a little over a year and a half and to see a summit rising up and to know that this is now going to be something that happens annually is very exciting news. So we'll talk more about that eventually, too. 

Lindsey Vestal Actually, let's if you don't mind, Let's let's talk about that now. Yeah. What is the solar summit and what can attendees expect? What is the event? Who is the event designed for? Give us all the details. 

Kary Gillenwaters Yeah. So the summit is going to be an annual event, as I mentioned, and it's going to coincide with what will become OSA or Obstet obstetric Anal Sphincter Injury Awareness Week. So the first week in February will become that awareness week that those injuries occur. And it's a place where everyone involved, whether you've been injured, you love someone who is you provide health care, you're an educator trying to prepare the next generation of health care practitioners to be able to manage what happens during birth. All of those people are coming together in the same space. We're offering it for free. So and it's online. So really trying to reduce the barriers of access that come with having to all be in place in person or having challenges with cost. It is free to attend. So so it's one of those things that I think people can mark their calendars for and look at and it's our very first one. So right now we're really just looking at one to know what exists and and to have people sign up for that so I can give a few details about that. You can learn more about it at Solace for women.org. And I'll give you the more specific link to that you can put in this. Even if somebody can't attend live, it's still wise to sign up because you'll get access to resources after the fact. So we've got about six speakers who will be talking from a variety of personal narratives experts in the area. We have your gynecologists speaking. People who operate at the intersection of health care and law will be talking about informed consent standards of care. And we'll also hear personal narratives from those who've experienced injuries themselves. And we'll have time for Q&A. And probably my favorite part about it is that they're asking for your questions and comments before we even get there. So if you're nervous that we know this is a topic that people don't necessarily want to be known as, the questions coming from them, you can submit those questions ahead of time and we're ready for you. So if we don't have time to answer them after, they'll be some FAQs posted to the website eventually, too. 

Lindsey Vestal Absolutely fantastic. So is the first one happening in 2025 or 2026? 

Kary Gillenwaters 2025? So February 5th, we are just over a week away from our first ever summit. 

Lindsey Vestal Absolutely incredible. So lucky to be talking to you at this at this period when you probably have 1001 other things that you can be sure. As someone who hosts summits, I completely get. 

Kary Gillenwaters Yeah. Yes. Well, I'm just glad to to have people get the word out and know. Yeah. Like I said, know that it exists. So whether listeners end up listening to this after the fact or beforehand, it really won't matter because there's always benefit. 

Lindsey Vestal So we can get access to the recordings after it's happened. 

Kary Gillenwaters Correct? Yes. And just may take a couple of weeks because we are an all volunteer organization. But yes, we. 

Lindsey Vestal Just go to your website that that's solace for women, not common. Okay. Perfect. And again in your. In your mind, who was the event designed for? 

Kary Gillenwaters Anyone who is interested in this topic. Really? I mean, it is meant to be. It's for health care professionals, but it also is for people who've been injured. So, you know, there may be people it could be a 5050 split. We're not really sure yet who's all going to be attending. But you will be in a room with people who are both living with these injuries and people who are involved in treating them or preparing to be students are also are welcome as well. And educators. So really, everybody who is a stakeholder is invited. 

Lindsey Vestal Perfect. Perfect. Let's talk a little bit more now about some resources that people can find year round on your website. So not just this event, which sounds incredible, but for day in and day out, you guys have you offer support groups and you also have. You offer support groups? Talk to us a little bit about how. How people have had these injuries, how they can participate, how what kind of support is provided, and then how can we, as health care professionals utilize these resources better to support our clients? 

Kary Gillenwaters Sure. So for those who've been injured, I would say that first, even knowing that you could search, you know, severe obstetric lacerations and or solace and actually find something that relates to your injury, that's a first step. 12 years ago, when I was injured, I couldn't find anything online about anyone who had had an injury. It was really not talked about. So one, knowing that it exists is huge. Two, I would say for women who've been injured, looking at the website and seeing all sorts of resources about when do you know when you need a specialist? When you know, what are some pelvic floor exercises that you can do. Listening to real life stories of people who've had the injuries or on there finding other health care professionals, and then also links to get information about signing up for the support groups, as you mentioned. So the support groups happen once a month via Zoom, can talk about them from the comfort of your own home. And so there's information there as well. And contact info if anybody ever wants to talk to us. We're more than willing to have conversations too. So that kind of dovetails into what do health care professionals need to know is that health care professionals want to know that this is a resource you can share with your clients. You may not even be aware if you're a health care professional about fourth degree tiers, what that means. Often we find that that is so sanitized in how we talk about it. We talk about it in big, you know, terms that really kind of distance us from the reality of what the implications are of having a fourth degree tear or third degree tear and just the urinary issues, the fecal incontinence, gas, incontinence, those kinds of things, and how that really changes somebody's habits, their routines, the roles they're willing to participate in. I think going to the site gives you clear visuals as a health care professional of what does that tier really mean? There's you can find graphic information there or infographic types of things to understand. This is not just a physical injury to understand that up to 78% of people who've had these injuries have traumatic memories of that experience. And to really get a sense of what is that into and to notice, what could your role be as a health care professional, as an O.T.? I think just dig into the site and see from your vantage point what how could you be of help? Because there's lots of different ways that we could do that as Otis. 

Lindsey Vestal I am so excited to really share this website. I think that I had forgotten Carrie that we also had our injury the same year. Yeah, as you said, 12 years earlier. 

Kary Gillenwaters Like it has been now. 

Lindsey Vestal It has been that long, although some days it feels longer. Some days it feels shorter. 

Kary Gillenwaters Yes, I get that. I get that. 

Lindsey Vestal I am so curious to hear your thoughts on what do you perceive as some of the challenges that people with Oasis face when it comes to standards of care? 

Kary Gillenwaters Yeah. So I think part of the challenge is that. There really isn't a specific standard of care in the US right now, in part. Why is that? In part, that may be because it's considered so rare and not a common occurrence that people don't necessarily see that as something that is priority for a standard of care. That would be one of the questions I would have of why is it not occurring? I think also one of the biggest issues with standards of care that people with OSA face is that informed consent, you know, that understanding what are the risks of a vaginal birth, what are the risks of a C-section? Any type of birth comes with risks. And I don't know that we currently have a standard of care that everywhere you go, you know, you're going to really understand what could happen to you. And I know for myself and many other people that I talk to, not knowing that that could even happen was so traumatic that that probably amplified everything that was felt by having the injury. Is that, wait a minute, I'm a health care professional. I've never heard of this. I don't know that it could occur. How did I not how did I miss this? So and and figuring out I think anywhere along that birth process, I think that comes from we don't have debriefing standards right now. You know, debriefing as a standard process. If an injury occurs, it's not considered an adverse outcome at this moment is my understanding. And so it used to be, if I understand correctly, an adverse outcome, but it is not currently considered an adverse outcome. So what we you know. What we measure tends to matter. And so if we're not measuring it, I think it gets missed. So what can we do to commit to yes, we are going to measure this as an adverse outcome. Is there anything that we could have done? Are we seeing trends in how this how this occurs with women? Those are some of the things that I really see as the need for collaboration and possibilities, for the possibilities, because often you see doctors and nurses at the front end of like at the birth process, and then the people who are most likely to see the outcomes of those injuries, like rehab professionals, pelvic therapists might even be mental health professionals or people who don't even realize that is part of this. They don't necessarily inhabit the same spaces. So we don't realize the whole thing that's going on and women who've been injured. Have a lot of stigma. Don't want to talk about it. So they often either it's not discussed or I think women end up serving in the role of their own patient care navigator at a time when they they need that to be apart. And they need partners in that not to be handling that ourselves. So those are some of the things that I would say. 

Lindsey Vestal How can we get it back if it was on the adverse outcome list, how can we get it back? Like what an what a gross oversight? 

Kary Gillenwaters Exactly. No, and I do not. I mean, that's part of why I think the summit comes in to who are the players that we need in order to get this listed as an adverse outcome for. First of all, I think we have the right as people receiving care to ask, what is your policy? I think when we interview, where are we going to have our babies asking What do you have a policy if an injury occurs, if people don't even think about it? That's information, I think, for us about how. Yeah. Is it on their radar or not? Are they thinking about it? But I do wonder if places like the summit then give us the answers of how do we work together to say, Yeah, I'm bringing this back? Or how do we take our own personal account of accountability to say, like, if I'm interviewing a doctor, if I think about if I wanted to have a baby now, I would have probably thought of. Asking something like if I were to have an injury, can we agree that we are going to talk about this afterwards? Or if I don't, even better. If I don't. Because we've implemented these ways that work, Can we debrief that so we can learn from how does this work? Or I don't know. Those are some of I think the questions in my mind. Do you have ideas yourself about how you would do that? You're in the thick of it. 

Lindsey Vestal I was thinking like, you know, policy changes like a player, as you mentioned, I think you said a lawyer was good. You know, if we can get more of these these the people that can influence policy changes to be and when you're in looped in to this, I think that could be a huge step in that direction. And I would just love to understand a little bit more historically, how did it get on the list first and then why was it taken off? I think understanding a little bit of that trajectory and journey could be really helpful because I know there's something there are politically at play that influence those things. And so just doing a little bit of a of a moratorium on that, that history, I think, could be really important to. 

Kary Gillenwaters One of the questions that we have about what may be at play, what, you know, what has influenced those decisions is as the push for C-section rates to go down came in. And when we think about those rates or, you know, you're supposed to get those down, has that coincided or correlated with increased tares is part of the question. And as we do that, have has that just been sort of taken off the list of adverse outcomes? Because we're focused on this reduction of C section rates. And so. Did it get bumped for that? I don't know. But I think it's worth the question of how did this get off the list and is that part of what's increasing tiers? I do think that there's more tears than what we realize, too. And some of that is part of reporting, you know, that people are not always told, even that they've had a fourth degree tear or a third degree tear. And they find out when they have experiences later in life that those things were missed. So. 

Lindsey Vestal Well, you're exactly right. I mean, even in my own experience, I asked because she was spending a lot of time, you know, showing me, stitching me up and I and a midwife who I have incredible respect for and still do to this day. But I asked I said, what degree tear do you think I had? And she had said probably one, one and a half. And I know for a fact, because I went to my pelvic floor therapist, I went to a couple and it was definitely a fourth degree tear. So, you know, even even even when we're asking which so many people even ask, right? Like even when we're asking, we may not be getting the accurate information. 

Kary Gillenwaters Right. And whether it's, you know, the intention of that doesn't really matter. It's the outcome that we need to figure out and how how do. That's why I think having regular processes to come back together are structured days of okay this week where anyone who wants to know where we are right now with the websites, here's where you can find us. And looking at that, I think also looking at the international guidelines of how they do that gives us ideas of where is where women not having these injuries, where, you know, where have they had them and improve them, all of those things. There's a lot to be learned by going outside of us as well to see what we can do. 

Lindsey Vestal I love that. You're right. Why reinvent the wheel? Let's let's look around us. That's. That's brilliant. 

Kary Gillenwaters Yes. 

Lindsey Vestal If you could and this is maybe a hard question for you, but if you could improve one aspect of the current standards of care with a CI, with people who have experienced that, what would that be? 

Kary Gillenwaters You know, I thought about one. One is hard, but if I could only get one, I would start with informed consent. Because if I don't know that, that's a thing that happens, then that, like you said, that is that much more damaging. And so and part of that informed consent, maybe this is my cheat answer, but part of that informed consent is when you think about I was listening to a webinar on sexual harassment and earlier this year and I was thinking about consent is given not just before, but at any step of the way. And so informed consent when it comes to birth also means she doesn't just sign a piece of paper before she gives birth. And that gives the you know, that's informed consent for the whole time. It's this ongoing process of here we are at this juncture, does this process still work for me? What are the risks of these decisions? And then having, you know, partners on the team that can help you truly make those decisions? Because when you're in the middle of birthing, it's really hard to make those answers when you're, you know, give those answers when you're in a lot of pain. So whether that's doulas educating significant others to help you that, you know, be that voice, having some more of those conversations with your providers ahead of time, there's lots of ways that you can do that. And it's it's happening because I don't know if you're familiar with Kathryn Sylvester's work at Operation Mist. She has ties to Rebecca C Graves is how I learned about her. She's amazing. And Rebecca and Rebecca story. Kathryn is is helping women to understand their vital signs, you know, using smart technology to understand their own, like really kind of do your own research on what do these what does the data mean about you? And she's teaching people about, you know, perinatal massage and different things that you can do to help reduce your risk of birth injuries, even though hers is not specifically about that, but just maternal injuries in general. And the last time I talked to her, I believe she had had 73 people give birth and not one had had a tear, not even a first degree tear. So there are people out there doing good work, I would say, that are having positive outcomes. They may not show up in some of the big literature studies, but there's there's good things happening. And that makes me hopeful. 

Lindsey Vestal Absolutely. And solace is a 100,000% part of that part of the year. Okay. So I asked you about the one current standard of care, but I know that was tricky. So I want to be fair. I think if you were to create like, let's call it a bingo card of topics that. Need to be addressed to improve the standard of care for women with these injuries. What would you include on that? 

Kary Gillenwaters You know, one of the things I think obviously this would be a whole nother conversation. Leslie, we have to talk about this one another day. But that is understanding a woman's nervous system and how nervous system during birth, prior to birth sets the stage for how you're ready to open and not have a tear, I think is one thing that I would like to see looked at more thoroughly. The debrief you've heard me say therapeutic relationships and relationship repair. Top my list of what do you do when, like you said as well, that you loved your midwife, you had a good relationship with this person. I really enjoyed appreciate my family doctor that delivered my baby. We had solid relationships within the confines of the health care system. It's not really set up to have a deep conversation about, well, neither one of us expected that. How do we how do we handle that? So figuring out what those spaces look like to build those relationships and repair and and build relationships across disciplines would be another thing that I would say in to make it a point. If you're working in this space with anyone who births to go to things like this summit, you know that those are places there. It it's not prohibitive by cost or travel like there's people there who are after the same things you are. So so that would be another big one of mine. And the adverse outcomes, obviously, that we've talked about is how do we get that back listed as an adverse outcomes so that we can no different than falls or embed error If a if we tear through somebody's rectum, I think that deserves a review of how did that happen and what can we do about it. 

Lindsey Vestal Yeah, it reminds me a little bit of a conversation I had with a dear friend recently, which is, you know, when when women give birth term, you know, pregnancy and maternal and maternal, what's the word when you take off work? 

Kary Gillenwaters Leave. 

Lindsey Vestal Maternal maternal leave is a recognized as an area of care. We whether it's as long as we wish it was, is another matter altogether. But what's coming to mind really briefly now which is related but also unrelated, is menopause. So menopause. 

Kary Gillenwaters Is. 

Lindsey Vestal Not a recognized condition in the same way. And so when high powered execs are going through brain fog and poor sleep, you know, sleepless nights and are having to step away from from these positions, and it's not a recognized area of health care. You know, we we have so far to go with maternal wellness, but we have even also so much more to go for the continuum of a woman's life because of when we think about what experiences are with menopause. So, so much work to do. Maybe that's something you and I can take up in a second or third chapter of our lives. 

Kary Gillenwaters Yes. Yeah. Well, I think you bring up a good point that menopause perimenopause is another big thing that is going we can anticipate that's going to affect somebody's experience who's had a way of size. And so one of the ways that we go about preventing more harm is I mean, I was I'm in perimenopause, full disclosure. So I think perimenopause and discovering, wait a minute, you know, that that I'm likely to have an increase in size symptoms. But yet again I, I wasn't told that. I had to discover that myself. I think those are not okay things to happen to women. And I think that ends now by conversations like these and others that are happening to say, yeah, we can anticipate that there are going to be junctures. And that's part of what Oats really bring to the table is we know certain life events are more likely to increase symptoms or to cause distress, and we can be part of proactively preparing people so that they they don't feel alone when those things occur. 

Lindsey Vestal They don't feel alone. And in terms of like even the nervous system regulation you talked about, you know, it's very common for them to feel like their body has failed them that that it's host of a whole other bunch of symptoms that if company the perimenopause menopause journey when in actuality you had an OAS eye injury and so we are going to start talking about potentially going to a pelvic floor therapist. You know, as you start to see your periods become irregular, you know, and it's just all of this, as you say, informed consent or knowledge sharing that can happen, that can really reduce shame, reduce a sense of body mistrust and a sense of like what, what, why me? Why is this happening when in actuality there should be none of those feelings? And so I, I 100% agree with you. My last question for you is, are there any gaps in care right now where you think Otis specifically could step in to provide additional additional services or care? 

Kary Gillenwaters Yes, definitely. I mean, one of the that I would say is so much focus is only at the individual level that there's so much we could do at group and population level, both for education and prevention. And also just again, like we said, perimenopause is an example of that. We can look at whole groups of people who are going to experience perimenopause. Many women don't even realize perimenopause in itself is a thing. So until they start having symptoms, so what can we do to help educate the general public and not just women, but people who are around us, Right. Who think what is happening? This is somebody who's been like this their whole life and they're suddenly changes. And that it's not it's not about personality. These are hormonal changes. And then those things also affect lots of other things. So so I would say looking at as OTAs, where where can we show up as a more community level support and how do we build relationships? Because the reality is I think now and I don't know how you feel about this, but I should have had a note when I had my injury and it was all me. I am kind of embarrassed to admit this, but it was only in the last year that I really realized what a travesty that was. To not have Oti automatically see me when an injury occurs. So for those who are OTAs, I would say build relationships in your birth centers and all the different with midwives, doctors, anyone who's involved in the delivery of babies so that we it should be a guarantee that we at least have an evil because Royce Porter is one of those Otis out there doing great work like that who is is recognizing, Hey, if we don't have those relationships before they leave, they're tired. They're likely not to be having those conversations with us and and have the energy to reach out or even remember to do that. So I'm sort of asking to see those people when they've had injuries, I think is one of the big things that we can do to and I would say reach out to organizations like Solace. I'm I'm the director of community engagement. I welcome ideas that people have for podcast interviews or social media content collaborations, all of those kinds of things. The more that we can collaborate and look for opportunities to build support networks, because that support is not just one person, it's all of us. And like it or not, we together is where people feel the support. We're going to be judged on what other people do as well. So building those relationships and reaching out, I would absolutely encourage Otis to do and yeah, use what we know about. Helping people adapt there. There's a lot we can anticipate that. That isn't really being addressed right now that we can do. 

Lindsey Vestal So speaking of which, I love that open invitation for people to collaborate with you. How can people get in touch with you? 

Kary Gillenwaters Sure. So people can reach me. Probably one of the easiest ways to reach me would be through email. You can reach me at life, well occupied at gmail.com, and I'll give you that or contact information. And I would say to you can reach out directly through solace. If you want to have a conversation through our board, there's contact information right through there. Those would be the best ways to reach me. You can also look for me on LinkedIn and I can share that information as well. 

Lindsey Vestal Be wonderful. Send me everything that you can and I'll make sure to include it all in the show notes. Yeah. Carrie, I really can't thank you enough for all the incredibly meaningful work that you do. You're just such a joy to. To listen to and learn from so, so clearheaded. And I think that that while you have that personal passion for this topic area, you're really holding space for for all of us in this process. Not only our clients have been affected, but also us as professionals. You're really charging forward in such a powerful way, and I really can't wait to have you back on the podcast for updates because I know that not in a very long time we're going to see tremendous progress in this area, no doubt. Thanks to so much of the work you're doing. 

Kary Gillenwaters You know? Thank you. It's very exciting. And like I said, the days that I feel overwhelmed by how much work there is to do, I go and look for people like yourself and Katherine and Rebecca and Royce and all of these different people who are doing such good work. And it helps me feel motivated to keep going. We've got this together. 

Lindsey Vestal Thanks for listening to another episode of Otis and Pelvic health. If you haven't already, hop on to Facebook and join my group Otis for Pelvic health, where we have thousands of Otis at all stages of their Pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or. 

Lindsey Vestal Wherever you post your stuff. 

Lindsey Vestal And be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the Otis and Pelvic health podcast.