What Really Happens in a Postpartum OT Pelvic Health Session

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Transcript

Lindsey: 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, Lindsey Vestal, and welcome to the OTs in Pelvic Health podcast. 

Lindsey: One of my favorite parts of podcasting is sharing case studies. I think it is such a roll-up-your-sleeves, real-world way to be reflective and for us to grow as practitioners. I've done a lot of case studies inside the OTs for Pelvic Health Facebook group, and in episode 31 of this podcast, the feedback was really clear.

Lindsey: You guys want more real-world examples, more clinical insight and more connection to illustrating how OT shows up in pelvic health care. So today I am bringing you a postpartum case study that walks you through what a typical eval might look like through the OT lens. And while there's really no such thing as typical when it comes to our clients, this one does help illustrate some of the patterns I see most often and the kind of thinking that I think really demonstrates the power of OT.

Lindsey: Oh, and if you're listening, All right, let's meet Anita. She is an eight-week postpartum client who was referred to me by her midwife and her birth story included a 38-hour labor and three hours of pushing.

Lindsey: She had a natural second-degree tear, including the skin, which includes the skin and deeper muscles of the perineum. And when she came to me, she was really experiencing, her main concern that she really wanted to address was urinary frequency. She was urinating about once every hour.

Lindsey: She also was concerned about her leaking with coughing and her difficulty with bowel movements. She had not yet resumed intimacy with her partner and she was feeling really anxious about it. She also carried a certain amount of guilt, apologizing for not doing her key goals or returning to exercise yet.

Lindsey: So her three primary goals were just wanting to be able to have sex again without it hurting. She doesn't wanna leak anymore and she wants to get back to activities that she loves, which were swimming, spinning the elliptical and being able to walk around her neighborhood. So in our very first session together, I spent so much time listening to her full story and I really wanna emphasize that.

Lindsey: Clients often fall into what I refer to as like kind of an autopilot mode when recounting their birth experience, kind of hitting the usual highlights, whether or not they had an epidural, labor length, pushing time. I really like to try to slow things down and gently ask if there's more they'd like to share. Something unexpected, unspoken.

Lindsey: That's really where the healing often begins. And so when I ask that question, is there anything else you'd like to share? I pause and I wait. And sometimes that space can be a little bit awkward because we're both kind of sitting there in silence, but please don't rush that moment because honestly what they come up with next, what they decide to share is often what's going to be and make the biggest difference in their healing journey.

Lindsey: So once we've created that space, I begin to frame pelvic floor health in the context of whole body function. This is when I introduce concepts like breath mechanics, the diaphragm pelvic floor connection, and body literacy topics, right? Things that most people don't talk about such as the normal amount of times we should be peeing in a 24 hour period. I also explain how everything we're gonna do together from movement to posture, to really kind of helping with nervous system regulation plays a role in pelvic health.

Lindsey: Now, Elizabeth was open to internal work. I did present to her the menu of options that I teach in the Level 1 Functional Pelvic Health Practitioner Program as well as in OT Pioneers. This is not the typical, I am not a big fan of jumping right the internal exam and not giving clients an option to pick what would be most comfortable for them.

Lindsey: So in my menu of options, I teach four, everything from fully dressed to the internal exam, explaining it, providing you with a script so you feel really comfortable in your phrasing when you introduce these concepts to your client. And that value of choice, that ability to choose their comfort level is everything, right? So she was open to internal work. So we did do that.

Lindsey: And in that evaluation, I found an overactive right side, which was the side of her tear and an underactive left side, which that tension felt a little bit more longstanding. Her breathing patterns also showed limited pelvic floor coordination. She had difficulty really kind of softening on the inhale and was over-recruiting her abdominal muscles, the superficial abdominal muscles.

Lindsey: She had an oblique dominant core pattern. Her diaphragm was actually quite low and some residual perineal scar tenderness. So when we talked about the value of perineal care and I coached her through scar massage, we didn't just talk about the technique.

Lindsey: We talked about the when and where of doing it in her real life. And this is such an OT superpower, helping clients integrate care into their daily rhythms, not just checking a box, not just saying, well, You know, I shared with them how to do scar massage. And then didn't kind of take that moment to ask that next best step, which is, do you have a place in your home that you can picture yourself doing this really private work? Let's talk about healthy lotions and lubrication that you can use when you're performing this.

Lindsey: Let's talk about the type of pressure and how long you'll be doing it, really leaving them with almost a visual. They walk out of your office with a visual of what it is they'll be doing and exactly where they're doing it in their home. And I find this connection really ensures that they're actually going to do the work that we know is going to have such a positive impact for them.

Lindsey: Now, because she wasn't connecting well with that softening or that elongation of the pelvic floor while lying down, we shifted. I actually asked her to get dressed and we tried the same coordination work seated on a physio ball. That shift gave her instant feedback and a new sense of agency.

Lindsey: We also worked on gentle breath and rib mobility exercises, things like thread the needle and foam rolling, keeping her nervous system in mind the entire time. My main goal for this very first session was really to start reawakening proprioception and coordination. So we're not seeking perfection, just connection.

Lindsey: Now, remember one of her key concerns was those urinary habits, right? And so I planted some seeds about just in case peeing and how that habit often forms during early postpartum survival mode, right? So I asked her to start noticing what her bladder was telling her, something like you know basic things. Was it full? Do I feel nothing? Do I feel a little bit of urge, right? And even just that gentle question or building interception is something that we're going to continue to build on future sessions, but just kind of planting that very basic, simple question of checking in with herself because she definitely had that tendency to just think about baby all day long was sort of starting in a really gentle way to get into more of body awareness. Now, her fear around intimacy was another big one, right? And I let her know she wasn't alone, right? We talked through pain expectations, the role of healthy lube.

Lindsey: We talked about self-exploration and understanding that she may benefit and may appreciate spending some time understanding her new body before you know resuming intimacy with her partner. And then most importantly, we talked about that there's no timeline to follow, right? It's okay for intimacy to look and feel different after birth. And then we also talked about strategies for how to bring this up with her partner, how to actually address the elephant in the room, let him know how her concerns were impacting her ability to resume and be close.

Lindsey: And finally, we addressed her concern about exercise. I reminded her that rest is not regression, that waiting is not falling behind. We co-created a gentle return to movement plan that started with very short walks and very gentle swimming.

Lindsey: And I emphasized to her, this is just the beginning. She will get back to those things that she loves. So this case represents so much of what we often see in early postpartum care.

Lindsey: Yes, there's structure to our evaluations, but there's also space. Space to listen, space to adapt and space to let the client lead. As OTs, we don't just treat pelvic floors, right? We support people through transformation.

Lindsey: And that's why our lens is so needed. Thank you so much for tuning in to this episode of OTs in Pelvic Health. If you found it helpful, I would so love for you to take a screenshot and share it on social media.

Lindsey: Tag me so I can thank you and learn more about what's resonating with you so I can keep bringing you the content that you are interested in. And if you're not already part of the OTs for Pelvic Health Facebook group, join us. It is one of the most supportive online places for OTs exploring and expanding in pelvic health.

Lindsey: The link to that is in the show notes. Until next time, stay inspired and keep advocating for whole person care.

Lindsey: 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.