How One OT Created a Maternal Health Protocol That’s Changing Lives

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Transcript

Lindsey Vestal:
New and seasoned OTs are finding their calling in pelvic health. After all, what's more ADL 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 seasoned 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, Lindsay Vestal, and welcome to the OTs in Pelvic Health Podcast. My guest today is Marlee Sisler. She's an occupational therapist and a perinatal health specialist working on a level four maternal health unit.

 She's been working in acute care for three years and started working on the birthing center unit in her hospital a little over a year ago. She became passionate for working with acute antepartum and postpartum moms after working with a few during the COVID pandemic. She created an antepartum and postpartum rehab protocol as her post-professional doctorate capstone project, used that protocol, started her own program within her hospital, and now sees all postpartum patients after delivery, both C-section and vaginal delivery patients. And these are all automatic orders for occupational therapy. She is a powerhouse. She lives in Western Maryland on the border of West Virginia with her husband, two dogs, and a cat. She loves living in a rural area and getting to make personal connections with her patients through small town commonalities. While not working, she loves reading, baking with sourdough, and traveling. She'll be welcoming her first baby in September and is so excited to personally experience the pregnancy and postpartum journey. I can't wait for you to hear today's episode. Marlee, thank you so much for being a guest on the OTs for Pelvic Health Podcast today. This is going to be an awesome conversation.I'm really excited about it. Yeah.

 Marley Sisler:
Thank you so much for having me. I am honored to just be here, to be in this space and talking to you about a topic that's become really passionate to me over the last couple of years.

 Lindsey Vestal:
Yes. And that with my interactions with you, that is so clear. And I think let's kind of go back a little bit to the beginning, if you don't mind sharing with us a little bit of your background and really what led you to specialize in maternal health and occupational therapy.

Marley Sisler:
Yeah, absolutely. So I went to school at Towson University in Baltimore, Maryland, where I did my bachelor's degree and master's degree. I did a five-year kind of combined program. Finished that, got my first job in acute care at a hospital that I did my level two in and absolutely fell in love with it. It's a level one trauma center. So there's always a bunch of really fun and interesting things happening there. So I was working there for a couple of years, but it was actually during my orientation that my introduction to maternal health kind of got started. So I started working in acute care in 2021 when COVID was definitely still pretty rampant, not as bad as it was in 2020, but I think the Delta virus had just started making its way around. So on my orientation to the hospital, we were seeing a lot of pregnant moms who got COVID and needed to have very early C-sections to be put on ECMO, which is a life support measure that essentially oxygenates your blood for you because their lungs were just so decompensated. They weren't able to do that for themselves. So we were seeing moms that were delivering babies as early as like 23 weeks gestation on. And my first interaction with a patient was a mom who had a baby very early emergency C-section was on ECMO and we were walking her on ECMO with a trach ventilated. And I was just completely mind blown. I was like, this woman is a superhero to be able to do this. And I still remember her name and I will never forget her. But she was kind of the one for me that I was like, we're doing our normal OT things, our ADLs, her roles that she's going to need to be doing when she gets out of here. But we weren't really focusing on childcare. How is she going to need to be positioned to hold her baby when she's able to do so? We're trying to get her to her baby as quickly as possible. So that kind of the ball rolling for me in saying, you know, we work with all these other acute care patients that have general surgeries, knee replacements, and they all automatically get OT, but we have moms who have these major abdominal surgeries who don't. And I, you know, just was kind of thinking, what could we be doing to better serve the postpartum population? So that was really what got the ball rolling for me. And then just kind of went down a rabbit hole of, you know, OT's role in maternal health. And this was, again, in 2021 to 2022, wasn't a whole lot of research back then, either, just a couple of years ago. So then I went back to Towson to do my doctorate, my post-professional doctorate and made that my capstone process or project. Started out with, you know, moms who were on ECMO and COVID. And then luckily that, you know, COVID got a lot better and we didn't have a lot of moms on ECMO, which was a good thing. So then just kind of focused it on what can we just, you know, do on our labor and delivery units and our birthing centers? How can OT's be integrative in those units as everyday care providers? 

Lindsey Vestal:
I love that story. And I think it's so special that so early on in your career, you know, you encountered this, you know, it really feels a little bit like fate. And so what a wonderful, what a wonderful story and experience. And I agree with you. I think we all have those superhero clients in our brains that kind of help center us and ground us back to our why. So thank you for sharing yours with us. Can you share with our listeners just a little bit about what you have created, you know, what that process was like for you and what it looks like, you know, for the clients who get to experience it? 

Marley Sisler:
Yeah, absolutely. So once I decided to make it my capstone project, you know, there's a bunch of steps that go into a capstone project and a lot of it is research. So I spent basically an entire year just doing research on what are like other countries that integrate OT in pregnancy and postpartum care? What are their outcomes look like? What do general surgery, you know, outcomes look like with OT's who work with patients who have abdominal, you know, surgeries, again, orthopedic surgeries, neurosurgeries, what are these outcomes look like for these patients and how can we correlate these to postpartum patients? So I gathered a bunch of research, made a 99 page document and just kind of gathered all of that and reached out to one of the chairs of the OB department at my hospital and said, Hey, my name is Marley. I'm an OT. I work here. I would love to work with your patients and just kind of talk to you about what OT is and kind of explain what I think my vision could be for working with your patients. And she was very agreeable. We set up a meeting. I told her all of my research that I had found. And she said, this is great. I think you should present at, you know, our grand rounds in the fall. So that's what I did. I basically prepared my capstone project presentation, presented that to them with my research, my, you know, these are the gaps that I'm seeing. And I did a bunch of interviews with postpartum moms as well. And basically just said, what do you wish someone would have told you? Or what do you wish you would have been taught before you got out of the hospital and summarized all of that and said, here's what I think we could do. And I asked for automatic OT orders for all vaginal and C-section deliveries and somehow convince them to do it. And they said, okay. And they put orders in that day, which was absolutely fantastic. So now in my hospital, and we are a regional centered hospital. So the sickest moms with the sickest babies come to our hospital. So from all over, I work in West Virginia. So all over West Virginia, Maryland, PA, anywhere that this hospital is kind of closest for them. So now everyone that gets, gives birth gets an automatic OT order. I typically see them postpartum day one within 24 hours after giving birth, if they're medically stable, if not within 48 hours after giving birth and hopefully before discharge, if not, you know, before then. So that's kind of how that whole project got started. And to me, what I'm doing is not, it's not crazy in my opinion. You know, it's just normal OT things that we do in the hospital. We're just doing it with a population that we've never done it with before. We're focusing on ADLs. We're asking about the home setup and their social support and figuring out what they need to be able to do when they get home in the next couple of days. And how are they going to be able to do that with a newborn and focusing on what their needs are at that time while they're in the hospital and trying to prepare them as best as we can for when they get home within the next 24 to 48 hours.

Lindsey Vestal: 
Sounds like an incredible dream to have been able to take that capstone and repurpose it, those 99 pages that I'm sure were blood, sweat and tears for you at the time, and to then give it over to someone who was so receptive. And I'm sure you've heard stories of other OTs in our community who didn't have it as easy or still really struggling and trying to convince, you know, their departments that this is something that could actually help and be beneficial. So I love, I love the optimism in your story, but I am curious, were there any challenges that you faced in getting OT integrated? 

Marley Sisler:
Yeah. So I, and you're exactly right. I feel very lucky and blessed that the doctors that I work with and the midwives and the providers were just, they pretty much just gave me free range and said, go for it, try it out. And it was fairly easy in the process. It did take a couple of months to get automatic orders for everyone. They were kind of starting with just the C-sections and the higher degree tears, understandably so. And then I, you know, would kind of look at our census and see there were patients admitted that I didn't have orders for. So I would say, Hey, you know, I noticed this patient's here. I don't have orders for them. You know, how are they doing? And they would say, Oh, well they were, you know, an uncomplicated vaginal delivery. They don't have any issues. They don't need OT. So that took a little bit to kind of explain, like, while they may not have acute issues right now, I do a lot of education for how to have a really good postpartum recovery. So while nothing may be happening now, I want to help them prevent things from happening in the future. And I find it honestly, very rare that there's nothing happening. I say that in quotes, there's always some sort of musculoskeletal pain from pushing epidural pain that is somehow impacting their ability to, you know, breastfeed, get comfortable in a chair, you know, get their underwear on fully independent. So I find it rare that there's absolutely nothing happening. And even if I don't see them move or do anything functional I have a packet that I give all of my patients from the, Oh shoot. What is it called? The pelvic health clubhouse. She has a postpartum packet that it's absolutely beautiful. And I got permission from her to give it to all of my patients. And I've added a couple of things in there as well, like adaptive equipment, some stretches from Rebecca Seagraves program that you get when you do her course too. So even if you don't have anything going on, these are the things that I want to help them, you know, with. And they said, Oh, okay. Sounds good. So that was a little bit of a challenge. We are currently working on trying to work more closely with our antepartum patients as well. So that way those that are admitted long-term they don't have, you know, really bad outcomes once they deliver postpartum because they've been in bed for months at a time. Right. So that's a little bit of a, you know, trying to recognize our role in that population as well. We're still working on that. But I will say that just getting my managers were really supportive in this as well. But me starting this brand new team was taking my role away from our department. You know, I was taking my current position out of what we were currently doing and starting a brand new one. So it was kind of getting their trust and being like, you know, I have a lot of faith in this. I think this will really work. And them trusting me and saying, all right, we're going to take your 36 hours away from what you're doing in general acute care and let you do this. So that was a little bit of kind of back and forth and figuring out the logistics from a departmental standpoint as well. 

Lindsey Vestal: 
Definitely. And you mentioned a team. Will you tell us a little bit about that? Is it multidisciplinary? 

Marley Sisler:
Yes. So from our rehab department, we have about 40 OTs and 40 PTs. So we are a very big department. And I really love how we run our department. So we have a bunch of different teams that we work on. I say teams, I mean, populations of patients. So we have our neuro, trauma, cardiac, orthopedic, med-surg, long-term infusion, and just anyone else that can be in the mix there. And we rotate these teams every four months. So for four months, you're on the neuro team and then the next four months you're on the cardiac team and then you'll switch to trauma. So it's really nice because we don't get burnout very easily at all. And whenever I, a lot of them are moms too. I'm kind of like one of the younger therapists. And a lot of people that I work with who are moms were like, this is fantastic. You know, we wish we know what our roles are, but we wish someone like us would have come in the room and said, you know, these are great things that we can work on. So my rehab department team is great. And then the OB team that we've kind of worked on, it is primarily just me, but I have been able to train a couple other OTs that are able to take over for me when I go on vacation or if I'm out, you know, sick for a couple of days or something. So that's been really nice as well. Just being able to educate and have a backup for, you know, the population isn't just completely stranded if I'm not there.

Lindsey Vestal: 
I love the way that you all rotate. I think that's so interesting intellectually, emotionally, like you said, it does reduce burnout and probably everybody's got their more favorite rotations, but I think overall it's got to make us a more well-rounded group of therapists to have that sort of rotation as well. 

Marley Sisler:
Absolutely. Because we're constantly being updated every couple of months when, you know, the neurosurgeons are doing this new surgery, so we need to know what this protocol is. And the orthosurgeons have started doing, you know, they want their patients out of bed at this time actually versus this time and really keeps us updated on our skills and very well-rounded there. But for our OB team, it is just OT right now. We only get automatic OT consults just because I felt like from an OT perspective, we were kind of able to cover everything we needed to without PT consults for every patient. But the OBs and the midwives that I work with are very good about if I say, hey, this person is having some back pain I can't figure out, they're having gait issues, balance issues, they're very agreeable to putting a PT order in, which is absolutely fantastic. 

Lindsey Vestal: 
Honestly, it sounds like a dream work environment.

Marley Sisler: 
It is. It really is. 

Lindsey Vestal: 
So I love this. I love this. And this is another reason why I like having on the podcast. It's so special because I think once we know what's possible and that things are being done, like we have a vision of what we can create, right? And so I just hope that we hear more and more stories within our community of programs like this being developed. I'm curious, Marlee, if you could share like since implementing this model, what are some of the impacts you've seen on client outcomes? Do you have any stories that you can share with us? 

Marley Sisler: 
Yeah. So that it's been the most like meaningful population for me to work with because I think we as a society still view pregnancy and postpartum is just kind of this like pretty easy breezy thing that women have just been able to manage for our whole lives. And when I come in and I say I'm from occupational therapy, I kind of get the look at first where they're like, what are you doing here? This is my third kid. I've never had occupational therapy before. And I kind of explained the process. I'm here to see how you're doing, taking care of yourself and give you some education for how to have a good postpartum recovery. And then we start asking those personal questions. How does it feel when you're changing your underwear? How does your back feel when you're laying in bed or when you're sitting in the chair? Are you having any issues getting cleaned up in the bathroom? Does it hurt when you sit down? Here's a waffle cushion. And just an air filled cushion will absolutely change people's lives, which has been awesome. So a couple of stories that have just been really meaningful to me was I had a patient who with her last delivery dislocated both of her hips in postpartum and she was a runner. So this was really impactful to her. She was basically bedridden for a couple of weeks after. So she was really scared that this would happen after her, you know, this delivery that I was seeing her with. So we took a really conservative, you know, kind of approach. And I said, we're going to give you hip precautions too, because you seems like you have some laxity there. And I just don't want this to happen to you again, gave her a bunch of equipment so she wouldn't have to bend over as much, talked about how she could care for her other kids. And by the end of it, she was just in tears. She was like, I am just so thankful that you, you know, were able to come in here and talk to me about all these things, because I've just been so worried that this was going to happen again. And that just meant, you know, a lot to me to be able to be that person to give her the confidence to be able to take care of herself and her other kids and in postpartum. And as far as like data outcomes that we've been able to kind of pick up on so far, we've noticed that some, our readmission rates have gone down. So my program started in January of 2024. And now that we've been able to compare this data with 2023, that our readmission rates in 2023, I think we're 4.3%. And they were 3% in 2024. So that was really cool. I haven't seen any concrete data, but I've been told that our infection rates have gone down as well. I noticed when I started this program that we were using a lot of wound vacs with, you know, more obese C-section patients. And that has gone down. I don't know if it's a change in what the doctors are doing in their protocol, or if it's a combination of we're just preparing patients better for how to like take care of their wounds. And here's a long handled sponge, so you can actually like scrub yourself. And here's a shower chair, so you can actually get in the shower. And we have a lot more of like home health referrals and outpatient pelvic floor therapy referrals as well, just because we're there. And we're able to kind of see these, you know, implications that may happen once they're home and kind of catch that before they get out the door and say, all right, a home health therapist is going to come see you in the next two days to keep an eye on you as well. 

Lindsey Vestal: 
Absolutely phenomenal. That's incredible. Thank you for sharing some of those really monumental changes. I guess I didn't realize the program is just over a year old now. So congratulations and happy birthday on that.

Marley Sisler: 
Yeah, thank you very much. 

Lindsey Vestal: 
Marley, where do you see the role of OT and maternal health going in the future? What do you think is next for our field? 

Marley Sisler: 
I see so many things. Like I love being an OT. I call us kind of like the unicorns of therapists, because I feel like sometimes we're kind of hard to define like what we do, because there's just so many avenues that we can go down. And I just feel like there's so many things that we could be doing in the future of maternal health. My ultimate vision and goal is that for all pregnant and postpartum moms that we just are implementing so much more education in pre-pregnancy and pregnancy on just pelvic implementing pelvic floor therapy, pelvic floor therapy for everyone, better education for how to have a successful labor and delivery, you know, different labor positions that we can, that we can use to help prevent perineal tears and birth injuries and OTs and all the hospitals to work with patients to help address these injuries and these difficulties that moms are having. And then having someone come into their home, or at least on an outpatient basis that they're working with to continue the care for them. I hate that right now for us, it just kind of stops. Once we get, once my patients are discharged from the hospital, we don't have a set system where someone's going in their home and going to check on them in the UK. I believe every postpartum mom gets like a home health consult. That was like part of the research that I did, which I thought was absolutely amazing. And it's up for like six to eight weeks too. So they go in and do like a whole home evaluation and work with them for six to eight weeks to address whatever they need. And I was just absolutely mind blown by that because we don't do that here in the U S we barely get a maternity leave here in the U S. So to have someone coming in the home, or at least organizing an outpatient basis where people have a resource to check in with, and that can range anywhere from pelvic floor to lactation, to mental health, especially mental health, checking in with people so much sooner and for a much longer period than we, you know, we currently do now. Cause I found in my research too, a lot of moms don't experience postpartum depression or anxiety until they go back to work. And a lot more moms are having to go back to work a lot sooner now too. So the two and six week visit that we're doing, I think needs to be extended for whenever we're checking in, when they go back to work as well, and really seeing how people are doing. 

Lindsey Vestal: 
Well, I think we're going to have to have another podcast interview in about a year and see what changes you've been able to implement because you have no, there is no shortage of ideas for you.

Marley Sisler: 
Yeah, for sure. 

Lindsey Vestal: 
I love that. Are there any research findings or data that you've come across about OT interventions improving postpartum recovery? 

Marley Sisler: 
Yeah. So when I did my capstone project, I found just a lot of, I didn't find any that were like super specific to OT, but just like physiotherapy and rehab in general. But just like looking at my capstone PowerPoint that I had, that pelvic floor dysfunctions can affect up to like 50% or 56% of women. That increases at least one symptom of pelvic floor dysfunctions that increases their mental health and confidence in completing their ADLs. With preeclampsia, you're two times more likely to suffer from a stroke, which is a lot of education that I do with patients about signs of stroke symptoms, how to monitor their vitals with rest and with activity. So they know how to manage their own medical vitals. So that way, we're not waiting until they're actively having a stroke before they come back to the hospital. Things about mental health, you know, just postpartum depression, anxiety, and how that affects child bonding and confidence in taking care of yourself as well. There is a lot more research out there now than there was when I did my capstone. AOTA is posting a lot more articles about maternal health and OT's role as well. Rebecca or Sabina Khan is an OT that I'm obsessed with. She is a researcher and is constantly posting about OT's role in maternal health and Rebecca Seagraves as well. She has a lot of research articles out there, especially about readmission rates and, you know, the cost of rehab services and how these, you know, are justified in the hospital setting specifically, even though she's a PT, but she is a really big advocate for OT's role in maternal health as well.

Lindsey Vestal: 
Amazing. Amazing. That's so helpful. One last thought as I'm, you know, hoping and imagining a lot of listeners just getting so encouraged by our conversation. What advice would you give OT's or anyone listening to implement something similar that you've been able to do? 

Marley Sisler:
Yeah. So I would just start, you know, reaching out to other OT's that you may meet that are implementing these programs and just asking the questions of like how they got started and, you know, what they did to, to get started and start talking with the people that work on your labor and delivery floors and your birthing centers as well. So that was a big thing that, that I did, um, that I think really helped was I talked to our doctors and I talked to our nurses as well. So I could kind of get aspects from both sides to say, what do you need from me as an OT? How can I help better serve your role? You know, I don't want to come in here and bulldoze anyone or step on anyone's toes or think that I'm trying to take anything over. I want to be helpful. Um, and that's become a really good intercollaborative approach as well. So talking with OT's, talk to the people that work on your labor and delivery floor. And when you do that, try to find some research as well. Find some data that shows how our interventions are helpful to patients and what we could be doing better to help better their patients. Especially if you find those keywords, decrease readmission rates, decrease infection rates, because that's what the hospitals are always trying to, to better, you know, and anything with data, they, they love those keywords as well. So just trying to increase your knowledge as much as you can, um, take some courses in pelvic floor therapy and obstetric therapy, but I think you've said it best. I've seen you say it a couple of times. Like you don't have to take all the public floor courses because it is very overwhelming. There's a lot, luckily there's a lot of things that we can do now. Um, but I love your OT pioneers course. I recommend it to a lot of people because I just think it's a really nice introductory course to just, we don't get this education in OT school. Right. And I'm hoping that's another change in the future as well. Um, but just so you, I don't think you need to be a pelvic floor therapist necessarily, like have a certification to do this in the hospital setting, but you do need to have some sort of education on what the pelvic floor is, because that's what a lot of patients ask. You know, I'm peeing my pants still. How do I fix that? I have pain. I have heaviness. What do I do for that? And you want to be prepared and have some answers for them and, um, feel confident in the education and the knowledge that you're providing for them as well.

 Lindsey Vestal: 
Absolutely. And just so you know, it's one of my goals in 2025, and we're actively working on it now to give a lesson, give a lesson to basically OT programs. Um, and you know, just a very basic module that no one on staff needs to be an expert to deliver. It's actually, I'm delivering it for them. So my goal is that by, you know, 2030 pelvic floor therapy as is as ubiquitous as hand therapy is in our OT programs. Again, just an overview, uh, so that people know we can do this and that we have an active role in it. So, um, that's something I'm really excited about. And thank you for sharing OT pioneers with people. Um, you know, probably since you've taken the course, it now has developed into, so we still have the self-paced version of OT pioneers, but now we have the level one functional pelvic health practitioner program, which basically in four and a half months takes you from newbie to, to confident and includes a three day in-person lab. So lots of options coming out, but I agree with you. I think that, um, our clients are our best teachers. And so at some point, knowing getting out there and being in front of our clients is the best learning we can do. And ultimately why we became an OT to begin with it's to serve and to feel the same thing, Marley, that you're really radiating in this conversation, which is just joy in what you're able to provide your clients. So that's the, that's the quickest way to get there is just by doing it. Marley, where can listeners learn more about your work or connect with you? 

Marley Sisler:
Um, I will be very honest and I am not very good about, so I made an Instagram page like a couple of months ago. Cause I was like, just getting really excited about everything. I'm going to share things on Instagram about OT. Um, and then my husband and I ended up having to do IVF this last year. And, um, currently almost 14 weeks pregnant with our first child. So.

Lindsey Vestal: 
Congratulations.

 Marley Sisler:
So the Instagram page like I started that like right when this whole thing was happening, so that like hasn't like happened, but it is there. The handle is mountain mama dot OT. That's what I named.My protocol was the mountain mama's protocol for postpartum recovery, because in West Virginia, we're all mountain mamas. So that was just a little play on words there. But I am also hoping to get my capstone paper published. It's written. I've like submitted it for like my dissertation and everything. I just need to cut that ninety nine pages down so people will actually read it. But the first trimester of pregnancy has also humbled me in more ways than I could have ever imagined. So I'm hoping to get that out there eventually. But I'm also on Facebook and just I think my Facebook and my Instagram are just my name, Marley Sisler. So people can always message me on there. I've answered a couple of questions and like the there's an OB and OT like pelvic floor Facebook page. Your Facebook page, I've inserted a couple of comments and stuff on. So always available for people to send me a message on there and just kind of chat about anything OT and OB related. 

Lindsey Vestal: 
Oh, that is so perfect. Oh, I'm so I'm so happy for you and your growing family. Congratulations. And thank you for sharing your time and expertise with us today and your enthusiasm for occupational therapy. It's absolutely amazing, Marley.

  Marley Sisler:
Thank you so much for having me. I am happy to chat about these things that at any time. And just thank you again for inviting me. It's an honor to talk with you and to learn from you always. 

Lindsey Vestal: 
Thanks for listening to another episode of OT's and Pelvic Health. If you haven't already hop onto Facebook and join my group, OT's for Pelvic Health, where we have thousands of OT's 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 OT's and Pelvic Health podcast.