Bringing Care to the Home: How In-Home OT Transforms Postpartum Recovery

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About today's guest: 

Melissa O'Neal is a postpartum occupational therapist with over a decade of experience helping mothers and babies thrive after birth. Through her business, The Postpartum OT, she provides expert guidance on baby sleep, breastfeeding, mental health, adapting to new roles and routines, and so much more while empowering other OTs to start their own postpartum businesses. Inspired by her own motherhood journey, Melissa is dedicated to transforming lives and creating lasting impact in the postpartum period.

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Transcript

Lindsey Vestal (00:00):

My guest today is Melissa O'Neill. She's a postpartum occupational therapist with over a decade of experience helping mothers and babies thrive after birth through her business, the postpartum ot, she provides expert guidance on baby sleep, breastfeeding mental health, adapting to new roles and routines and so much more, while empowering other OTs to start their own postpartum businesses. Inspired by her motherhood journey, Melissa is dedicated to transforming lives and creating a lasting impact in the postpartum period. I cannot wait for you to hear our conversation. New and seasoned OTs are finding their calling in pelvic health. After all, what's more a DL than sex peeing and poop? But here's the question. What does it take to become a successful, fulfilled, and thriving OT 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 OTs. We are out of the box OTs. We are pelvic health OTs. I'm your host, Lindsey Vestal, and welcome to the OTs in Pelvic Health Podcast. Melissa, I am really excited to be having this conversation with you today. I did a general inquiry on my OTs in Pelvic Health Facebook group regarding topics for 2025, and you are so incredibly generous in raising your hand and saying just how passionate you are in the space that you're currently working, which is basically with new parents and pelvic health. And as you know, my private practice got started in that same arena, and so I am just thrilled to have you on today having this really important conversation.

Melissa O'Neal (01:57):

I'm so excited to be here as well. I was a little nervous. I'm like, well, do I do it? Do I not? But I'm like, you know what? I feel like it's important to share value. And yeah, I've been in that area of postpartum care for over 10 years now, and adding some pelvic health support into it I found was so valuable because I remember after I had my son, they said, you can work out now. And I was like, but what am I supposed to do? I literally just pushed a baby out of my vagina. I mean, that's what pelvic health is. I'm like, I should be doing something different, something specific. And so I just always had that in the back of my mind that where was that extra support for moms after they had babies? Where was that guidance? You get pregnant and there's just, you go to this appointment and you get this checkup and you show up here and this happens, and then you have the baby and you just are supposed to figure it out alone. And that's how I felt after I had my son. I felt alone with so many questions. And so I love watching this area expand and I love watching moms get the support that they need, and I love seeing so many more OTs getting into the pelvic area as well to support moms after birth.

Lindsey Vestal (03:17):

Absolutely phenomenal. And I appreciate you letting us know that you felt nervous about it, and I think that's so, so normal. I actually still feel really nervous doing these interviews after having a podcast for a couple years. So I want to relate to you and also make a shout out to anyone who is interested in being a guest on my podcast. You don't have to wait for that open inquiry on the OTs for Pelvic Health podcast. If you're, excuse me, the OTs for Pelvic Health Facebook group, you can always send me an email and I'd love to feature you on the podcast just like you are today, Melissa. So let's get into it. You've already given us such a good background as to your motivations and a little bit of the work you do. I'd love to know how does working in the home environment change the care you provide compared to say, colleagues working in a clinical setting?

Melissa O'Neal (04:11):

That's a good question. So I personally haven't done work in a clinical setting with mom's postpartum, so I don't have that experience, but I do have other experiences that I feel like I could relate it to. So when you're working in their home environment, you have exactly what they're using, you see exactly what they're doing. You get to watch them in their daily tasks, even sitting down to feed the baby. You get to watch how they're sitting down and positioning themselves and what supports and tools and equipment they're using. What does it look like when they're doing their everyday tasks, their ADLs, and being in a clinic, you can try to simulate what it looks like in their home, but you don't truly know. You don't know what equipment they have. Some people might have, I know I'm kind of relating this to nursing, but I feel like it's easy topic, but some people might have specific pillows that they use or their chair that they sit in might be great support and other people might not. So they might need you to help them with, let's put this here and how about we try this and let's put a pillow right here and really support them in that occupation of feeding or whatever other occupation it might be. So I really find so much value in being in their home and being able to just use exactly what they have and make it work for them and to support them to have success.

Lindsey Vestal (05:39):

Absolutely. I think that had to have been my absolute favorite part of providing services in the home. We just can't assume that the generalization is easy or possible, especially for a new parent. There's just so many other priorities and things going on that I just personally, I could not agree with you more. It is really my favorite way of providing care. Can you share a little bit about why you think pelvic health is critical for postpartum parents and more importantly, how do you introduce it in your sessions?

Melissa O'Neal (06:17):

Okay, so I think that every single mom should get pelvic health. It should just be you have a baby and now you get pelvic healthcare. And I really think that it should be somebody coming into their home and helping them after they have a baby, because a lot of times it can just be related to proper breathing and adapting. People can have different traumas and things related that they might need additional therapies and supports, but you grow a baby and it's pushing, everything's really weird and your breathing changes while you're pregnant, and so you have a baby. And even just educating moms on how to retraining their bodies to breathe appropriately. I feel like a lot of the ways that I support moms is related to their occupations, which is occupational therapy. So looking at, I was just talking about feeding, but looking at feeding, how are they positioning themselves?

(07:19):

Because even if you sat there right now and you imagine that you were feeding a baby and let's say that you were leaning forward holding your baby and you weren't supported, you can feel the tension in your abs and on your pelvic floor, but if you imagine yourself sitting there or if you were leaning to one side, you were holding the baby and not supporting your arm, you can feel it differently. So then sitting there imagining this new mom trying to figure out how to feed a baby and she's stressed out and leaning forward or leaning to the side or whatever it might be, where if you were able to get in there and provide her the support, the proper support in positioning, then she's able to actually relax and sit back while she feeds the baby, which is then not putting stress down on her pelvic floor on other parts of her body because it all just goes together.

(08:16):

Putting that stress in the area you don't need to is then going to impact other parts of their body. So then I also put that into other areas as they're picking up their baby. What about when you're putting your baby down in their crib or making sure that they're not holding their breath with everything that they're doing and really talking about, I feel like breath is one of my biggest things, but I think it's so important because I think it's common for moms to be like, yeah, I had a baby, so now I pee my pants every time I cough and every time I laugh and every time I sneeze, and it's almost a joke like, yeah, we had a baby, so now we just pee our pants all the time. And educating that that's not normal. Just because you had a baby doesn't mean you have to pee your pants every time you cough or sneeze or laugh or whatever. Some intense moment like that. And so really educating them on that, being mindful of their breathing and their core and their pelvic floor and that it's not just all about, it isn't actually just about I have six pack abs, that doesn't mean that you're strong and that you have the support that you need for your pelvic floor.

Lindsey Vestal (09:31):

Yeah, you're so spot on about that and I think that's such a beautiful way to talk about it and great examples. And of course, I adore that you focus on occupations. For anyone listening who would love to hear a little bit more of a very clear understanding of what that looks like, is there a client story that you can share that really illustrates how you do focus on occupations?

Melissa O'Neal (09:59):

I have a lot of stories, but I feel like since I'm going with this whole feeding thing, I feel like it's one of the biggest occupations after you have a baby, especially with nursing because they sit for so many hours doing it. So I have a client who came home from the hospital and she thought she wasn't going to be able to breastfeed. It was too stressful, I don't think I can do it. The hospital was, they were so forceful and just pushing the baby on my breast and it was overwhelming. And so she came home already feeling stressed and overwhelmed. So I think a lot of times we can relate that to anything that our clients can have so many pressures and so much confusion and anxiety and feeling overwhelmed, pushed on them in a situation. So when they get to their home environment, their safe environment, it's important to figure out how they relax.

(10:54):

How can you help take that anxiety or pressure off them? How can you help them just breathe and it's going to be okay, let's figure this out together in not making them feel guilty for any choice they do or don't make. And so for her, it was really focusing on how can we get her comfortably positioned? And at that point, it wasn't even about her pelvic floor. I wasn't like, let's make sure that you're feeding appropriately so that you're not putting pressure on your body in ways you shouldn't. It was just really about helping her feel comfortable in herself and in a mom, in her new role as a mom, and figuring out what worked for her. And she's like, okay, I mean, I'll try. Maybe I can get to three days. And so I'm like, okay, let's do it. We'll see if we can make it to three days, and then we get to three days and she's like, I'll see if I can make it to three weeks.

(11:47):

And I'm like, good, let's go for three weeks. That's a great goal. And really encouraging that what they are doing, the steps they are taking forward and how things are progressing, because sometimes people can't see the progress when they're in the moment. So for us as therapists, it's important for us to be able to really notate and remember where they started in the baby steps that we see happening so we can be like, look where you are. Remember when it hurt to do this and now you're able to do this and it's not hurting. And so really being able to show those baby steps in progress to them. So then we get, I'm going to make it to three months, and I'm like, let's make it to three months. And then from there, it was just off to the races. She made it to whole year and it was amazing.

(12:40):

But I guess that story is just to say you really have to make sure that you meet the client where they are. You have to be able to understand their needs, what's stressing them out, what's making them feel overwhelmed, and what's keeping them from being able to progress in whatever that occupation is, whatever that task is. And I feel like this all bleeds into it all goes together. It's hard for me to separate feeding and sleep and pelvic floor and mental health because it all comes together. And I feel like mental health is one of the biggest aspects, one of the biggest barriers in my opinion, to every occupation. And two, even if you're thinking about pelvic floor things, because if they're not able to relax, if they're feeling too anxious, if they are feeling too overwhelmed and not confident in being able to take a step forward, it's hard to lead them into progression. Does that make sense?

Lindsey Vestal (13:47):

Oh, absolutely. I mean, I think that's the cornerstone of it. As you said, it's that foundation because if the nervous system, if the resilience, the mental health, just stability isn't there, giving them the most incredible home exercise program or the best manual skills that you perfect it are literally not going to move the needle if the client's nervous system isn't regulated.

Melissa O'Neal (14:16):

Yes, that's a good way to put it. I just talked for five minutes, you said it in two sentences. So I think you sometimes aren't really going in there and providing these exact things. You're really just looking at their occupations and where are they struggling? How can I help them feel more confident and relaxed and less anxious so we can move forward? Because if they're bringing all of that stress, anxiety, tension into manual therapies or whatever it might be, your success is going to be limited or it might not happen because that's holding them back.

Lindsey Vestal (14:55):

Yeah, exactly. Exactly. I have a couple practical questions that I think anyone listening who may be considering offering in-home services or concierge or mobile visits might ask. And I would be curious as to how you would answer them things. Where do you provide these services when you walk into a client's home?

Melissa O'Neal (15:19):

It just depends on where they are. Sometimes we're just sitting in their living room, sometimes they are eating, sometimes they're doing their daily tasks, doing stuff with the baby, getting the baby ready for bed. And so it's really, honestly, it's every time I walk into a client's home, it's different. I mean, many times, especially when the baby is new, they'll be sitting there feeding or something in those first couple weeks. I feel like you're just constantly feeding, that's what you're doing all the time. But it's really like it's mobile around the whole house doing all sorts of things. We could be sitting on the baby's bedroom floor changing a diaper or playing with the baby or whatever it might be. So it's really, it's different all the time. It is kind of hard to say or explain if that, does that make sense? Definitely. But just looking in their everyday occupation and fitting that moment. So some days they might be doing the dishes and they're like, how can we support them in this moment? I see that this is bothering them, or some days they are giving the baby a bath. Let's talk about different positioning while we're giving the baby a bath to support your back. And for them it might just be thinking about, this hurts my back when I do it, but that's also related to your pelvic floor. So it's really taking every day is different.

Lindsey Vestal (16:52):

Totally. What about pelvic health services specifically? Where are you offering them in the home?

Melissa O'Neal (16:59):

That's what I would say. I don't do any manual therapies. And a lot of mine, because I do a variety of, I focus a lot on infant sleep and mental health and feeding and all of those occupations that you think of that relate infant development play and all of all those things that relate to a mom and a new baby. And so my therapies, a lot of them, like I said, are related to breathing and not holding your breath, doing proper positioning so you're not putting that pressure down on your pelvic floor. And so I really am just incorporating all of those into whatever occupation they're engaging in when I walk in their home. But if they are like, oh, my back is hurting when I'm giving the baby a bath, then we can talk about what could we do differently? What if we adapted it in this way or could you try this different positioning or can we do it in a different area or whatever it might be. So it's really truly based my services that our provider based on whatever occupation they're doing of that day or whatever occupation that they're struggling with in that moment that they talk about that day. Does that answer your question?

Lindsey Vestal (18:13):

Yeah, yeah. That's so fantastic. And in terms of the home exercise program, as you said, new parents are so busy, and so how do you approach what you give them

Melissa O'Neal (18:28):

For exercises,

Lindsey Vestal (18:29):

The home exercise program? Yeah,

Melissa O'Neal (18:31):

So I really try to just incorporate everything that they do into their occupation because a lot of moms don't have time to do, they don't have time to go do an extra exercise or they feel overwhelmed or it feels like too much. And so incorporating ways that they could do like a glute bridge or dead bugs or little things like that while they're playing with their baby, things that could help engage their pelvic floor or really thinking about while you're sitting here playing, let's think about breathing while we're playing. And being able to relax your pelvic floor when you're inhaling and everything pull are exhaling and everything pull when you're inhaling. And so it's not, I honestly don't, in my practice, don't put a lot of, here are home exercises that you could do. For me, it becomes if somebody, since I provide such a broad scope of care with sleep and mental health and development, all of that, if somebody is like, okay, we need some additional support and exercises, that's where I can call in somebody who has those expertise and those skills and that knowledge be like, let's go see a pelvic floor therapist because that's where I've incorporated.

(19:51):

I've taken your course and a couple others. So I know some good general basic ways that I can support mom and baby, but I also know that I'm not an expert in everything. And for me, it is that way in feeding and such as well, so I can support mom with feeding, but if we get to a point where I know she needs something more than I can provide, I'm confident in saying, Hey, let's get you some additional support in this area because I've provided the services that I can, and now let's go to somebody else that maybe has more knowledge and expertise than I do. So kind of taking that, having this really nice broad scope in my practice where I'm able to provide those areas that I feel like if a mom isn't breathing correctly, that's when things can really start to spiral out of control. So for me, that is one of my main things that I incorporate into my practice. And then we work on other little daily tasks and occupations, but if I feel as though she needs some hands-on work or exercises beyond what I know to provide her, that's where I will refer out.

Lindsey Vestal (21:01):

Okay. Yeah, that makes so much sense. How do you see the field of postpartum care evolving and what role do you think occupational therapy and pelvic floor therapy will play in the future?

Melissa O'Neal (21:17):

Oh, my dreams is for it to evolve to the place where every mom all over the United States gets at least three home visits a week for the first eight weeks to 12 weeks after birth. That is my dream. And for that, it would be incorporating all the things like feeding sleep, mental health, adapting to their new roles and routines as parents, pelvic floor, all of that stuff would be incorporated into this care. And that's where going into a home, I think sometimes we get stuck thinking, we have to know it all. We don't want to start anything until we know everything. I'll take one more course, I'll do one more certification. Once I do this, I'll probably know enough. And then you get done with that and you think, well, I should take something else. And you get stuck in the cycle of thinking you're not good enough to start.

(22:15):

So even if somebody was just going into postpartum care and their expertise area was pelvic floor, you could be frozen, not getting started because you just want to get a little bit more knowledge versus just jumping in there, taking your skills and your expertise and then learning, and then from there, building on it. So I think people working in postpartum care, especially working in homes, you don't have to specialize in everything. Pick your passionary. So some people, it might be pelvic health, some people it might be they're like I-B-C-L-C, some people it's sleep, some people it's mental health. But then as you get into the family's home, you have that OT mindset and you're able to analyze everything that's happening and really step into the situation and figure out where the client needs you that day. And so you might walk in and be like, today is a mental health day, and I'm going to take the skills and knowledge that I have to support, and if I don't know how, I'm going to ask somebody else, what would you do in this situation to get the support that you need to help this client?

(23:21):

Or you're going to refer them out. Then with time, your skills and knowledge and all those other areas will continue to build. I would say all those occupations, they go together with postpartum care in the home when you're meeting with families. So I would say remembering that all of that goes together. You can't serve a mom without also supporting her mental health without also realizing that she's feeding a baby without also helping her adapt to her new roles and routines without also focusing on development and different things she's doing with the baby. Those all just mesh together in one giant thing, but you can be really good at one area and specialize in one area and grow your knowledge over time in these other areas to where you can serve them more holistically. And that's where I think that it has to go. I don't think that any postpartum care specialists should be like, I have to learn it all and then I could do this.

(24:26):

I think it has to be, I'm going to learn about pelvic floor and not take every course, but get knowledge, get going, support moms, and then from there, continue to learn about other ways that you can support them to just create this holistic umbrella of care for families after birth. I really want it to change so bad. If I could change it in the next two years, I would. But the more people that are out there providing that pelvic floor support, providing that support for moms after birth, the larger the impact is. And I love watching it change and morph. And I love seeing these areas as emerging practice areas in occupational therapy.

Lindsey Vestal (25:13):

Yes, so much I applaud you for bringing up. I think the thing that's resonating the most with me right now is this idea that we have to take all of the courses and really feel like an expert before we start to see clients. And I always say that our clients are our best teachers, and so while we know we need to take more courses than our intro courses, we won't necessarily know which direction we need to grow in until we're in front of our client. And so everyone listening to this episode like, please give yourself grace. Please know that it's an evolving picture. Both you and I, Melissa, I'm sure are still taking courses, are still learning, but know that pelvic health services are in such a dire need right now. There are not enough trained professionals to provide this care. And so it's one of those things that if we don't get out there and serve A, we won't know what we need to do next. And B, where the world's best kept secret. And so shameless plug, it really is the reason after supporting OT since 2018, seeing this sort of endless hamster wheel of needing more courses. It's why I've come out, Melissa, with the level one functional pelvic health practitioner program.

(26:30):

It is basically a five month long program where you graduate with a level one designation and you have no choice but to get out there and feel confident because the alternative is a weekend course. And we know we can't learn salsa dancing in a weekend, so why are we expecting ourselves to learn pelvic health in a weekend? So shameless plug, take the level one and then start seeing clients right away so you know what to do next.

Melissa O'Neal (27:00):

And the thing is, we all have support. I know you have your groups, and if you get into it and you don't know what to do, it's okay to say, Hey, I'm not really sure what to do for this next step or how to approach this, so let me figure it out. Clients, they're not going to fire you or think you're not good if you say, let me figure this out and I will get back with you. And then guess what? You just learned something new. You're figuring out something new. And I'm honestly surprised how many times a client will be like, I don't know what to do with this. And the words just come out of my mouth and that the ideas just come out of my mouth. And then after I'm like, wow, that was a really great idea. I just had, I'm like, where did it even come from?

(27:48):

But I do have, when I first started working with mom and baby postpartum in my head, and it's about mindset a lot too, I feel like mindset is so huge. I was always like, why would they even want my help? I don't even know that much. It was a lot of negative things in my head, but I just kept going forward. And then I would meet their friend and be like, oh, they talk so highly of you. And I'm like, why do they talk highly of me? I'm just Melissa. I'm not that great. And then they started coming up with nicknames like St. Melissa Magic, Melissa, and I'm like, why would they call me those names? I'm just Melissa. I don't have that much knowledge and skills. So I was downplaying all of my knowledge and experience and that hamster wheel of always trying to learn more.

(28:36):

And then it finally hit me when over, it was probably like five years ago when they're like, we just want you and your skills and knowledge are so valuable because you don't just bring one thing to the table. You also have, if you're specialized in pelvic floor, you also have all your OT skills and knowledge that you're pulling in there and helping them with their daily activities. And clients find so much value in that, that we really focus on them holistically as a person. And so that's kind of my calling to people is to not undervalue who you are, to not undervalue the education and the experience and the knowledge that you already have and think that you're not good enough, but to truly believe in your skills that you have and who you are and how those experiences have developed you to be able to serve your people and go do it.

(29:33):

Take that, take Lindsay's course and then go do what you're passionate about. Don't keep waiting for that perfect moment because that perfect moment will never come. It'll never be there. You just have to do it and continue to build your knowledge, your confidence, and you're going to be proud of yourself once you do it. But if you just get stuck in that hamster wheel of, if I learn one more thing, then you're just always going to be learning one more thing and thinking you're not good enough instead of going out there and using what you know and having mentors and people to support you and guide you when you run into those moments that you don't know what to do.

Lindsey Vestal (30:10):

Absolutely. Perfect. I literally could not have said it any better, Melissa, I am so appreciative of you sharing your experience with us today. And your passion is so clear and your passion and alignment to occupational therapy and our approach is so clear. So your clients are so lucky to have you, and we're so lucky to have you in our community.

Melissa O'Neal (30:32):

Thank you so much. I, I'm excited to see everything change over the next couple years.

Lindsey Vestal (30:39):

Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group OTs for Pelvic Health, where we have thousands of OTs 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 post it to ig, Facebook, wherever you post your stuff. 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 OTs and Pelvic Health Podcast.