Functional Fourth Trimester
Functional fourth trimester is a podcast series for new parents- covering common postpartum challenges, practical strategies, and featuring conversations with parents and healthcare professionals.
Functional Fourth Trimester
Pelvic Floor Recovery: Why "Just Rest" Isn't Enough
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Have you ever been told to "just rest" after having a baby? In this episode, we talk with Dr. Lacy Woods all about pelvic floor recovery. We discuss what the pelvic floor is, how it is impacted by pregnancy and birth, and what you can be doing to help promote recovery. Link to our blog post with more resources and Dr. Wood's contact information below.
https://www.functionalfourthtrimester.com/blog
Welcome to Functional Fourth Trimester, a podcast created to support new parents as they return to daily life after having a baby.
SPEAKER_02Each episode will talk through common postartical challenges, share practical education and strategies, and hear from our real parents and healthcare professionals along the way.
SPEAKER_01Whether you're listening during a feeding, a walk, or a quiet moment, this space is for you.
SPEAKER_02I'm Lauren and I'm Melissa, and we're excited to jump right into today's topic.
SPEAKER_01So many women are told to simply rest and heal after birth, but few are actually shown what it takes to truly support and restore their bodies postpartum. Today we're diving into the often overlooked world of pelvic floor health, talking about what your body is really going through after birth and how to support recovery. Today's conversation is here to remind you that physical recovery after birth can be a long and challenging process, but there are things that you can do to help your body heal.
SPEAKER_02I am happy to introduce our guest today, Dr. Lacey Woods. She is an occupational therapist, educator, and women's health advocate, specializing in holistic perinatal pelvic health. Through her private practice and maternal milestones, she supports women throughout pregnancy, third, and beyond the postpartum period. Her work and research are grounded in clinical expertise, strong community connections, and a deep commitment to ensuring women feel seen and empowered. Dr. Woods is also a wife and mom of two boys ages five and two. Thank you so much for joining us today. Thank you both for having me.
SPEAKER_00I'm excited to talk to you.
SPEAKER_01Yes, thank you. We're so glad you joined us today. I would love to just start off with talking a little bit about your background and what led you to become a perinatal and pelvic floor occupational therapist.
SPEAKER_00Sure. I'm sensitive with how I approach this topic, but it is my experience that I became a mom unexpectedly. I was about one year into my career as an occupational therapist. Um, and my husband and I, we were not married at the time, but we were just kind of figuring out adult life together at that time. And it also happened to be when COVID locked down. Um, we were one month into COVID lockdown. So a lot of uncertainty and changes. And I think my way of gaining control over that situation was just reading and researching everything that I possibly could about pregnancy and birth and postpartum and parenthood. And I found that I was really, really interested in that area and really passionate about it. But unfortunately, the care that I was receiving through the traditional medical system didn't really allow for a lot of questions and conversation. So I very quickly realized the lack of holistic care and saw a role for OT, but didn't really see a path until much later when I was getting my doctorate degree. I was taking continuum education courses in perinatal mental health to get the that certification and working towards uh continuum education for pelvic floor therapy as well. And it was through my capstone project that I was creating a model for OT to be integrated into midwifery care. And through that process, I ultimately started my business maternal milestones where and launched that in June 2024 and started seeing clients yet, women uh all the way from pre-conception into many, many years postpartum to work on really holistic health.
SPEAKER_01Yeah, I love that like you saw from your personal experience a gap in care, and you were like, well, let's just come up with something to help fill that. Um, I think that's awesome. I would love to hear a little bit more about your practice as well, and like what kind of things do you do? I know you said it's like a range from preconception all the way to postpartum. So, kind of what are maybe some of the typical things that you do within your practice?
SPEAKER_00Um, the two most common services that I'm providing right now are pregnancy and birth preparedness. So, with that, I work with clients. Um, with if we're doing pelvic floor therapy, I do a long evaluation, but at some point in that process, I ask how they're feeling about birth, and we work on creating a really personalized resource for them to help them develop a plan and just get prepared for birth. So um I give them a survey that asks them about their values, what they're expecting out of birth, what are their big questions, um, what are their fears? What do what does a successful birth look like to them? And I help them design a plan that fits those needs because I really, you know, in a lot of the research that I've done as well, tries to look at the birth experience and tie that into occupational performance, you know, or the things that we're doing in postpartum. And, you know, we found that there's a big connection. So your birth experience definitely plays into your postpartum recovery, not just physically, but but mentally as well. So that's kind of one bucket of services is very much focused around pregnancy and birth. And then I do uh just regular pelvic floor therapy as well. And for that, most of the time I'm traveling to clients' homes because they're in that early postpartum phase. That was something that was really important to me was making care accessible and meeting them where they're at uh because I know how difficult it is to get a newborn or possibly multiple newborns into a car and come to a clinic. And while you're navigating those really challenging things of like your breastfeeding schedule or when you're gonna feed them, when you're gonna, how are you bringing formula and traveling with that? So there's just a lot of logistics in that. So I provide in-home services for pelvic floor therapy.
SPEAKER_02I love that you made the access, like really thought about the access to care, because I think that many times can be a barrier to moms getting the support that they need and providing that not only that mental health aspect that you were talking about is really I love that you started there because that's really important through all of it, you know, from pregnancy through postpartum, and then adding that aspect of that pelvic more health where you're really able to support them as a whole. Do you have a few things that you commonly um suggest to moms that they like if there's a mom who doesn't have access to having you come or the the people that she questions she should ask to maybe find the right person to help her after that period?
SPEAKER_00Sure. I think I always try to start with like what are you what are your values and what are you really looking for in care? And if you're asking about like, you know, finding a therapist or um a service that really meets your needs as a newly postpartum mom. Um so I think really getting clear on what your what your values are and what you're what you want in your interaction with the healthcare professional. I really feel that we don't, as clients, as patients, I don't think we put enough thought into choosing our healthcare professionals a lot. I think there's a little bit more now than what I would say there was 10 years ago. But really doing the research and and calling and just asking questions. Um and if somebody's not willing to answer your questions and kind of uh tell you what their approach to care is, that should be maybe a little bit of a red flag. Um, because you know, in the medical world, I think sometimes we forget that our medical professionals are working for us and we are in charge of that care. So that's the biggest recommendation that I have when seeking any kind of service is really just pay attention to who your professionals are.
SPEAKER_01Yeah, I think that's such a great point. Like switching the emphasis kind of back to like what do you value, what are you looking for in your own care. I also love that the component you do of pre-birth and pregnancy care. I love how it's focused on like really providing tools and education for parents to help advocate for themselves. Because I think that's a huge something that can be very difficult for parents to do, especially like if you're in active labor and you're trying to just focus on all the other things going on. It can be really hard to like advocate for wait, this was what I was wanting or this was what I was not wanting. So to have that included in your service versus just postpartum services, I think is really cool.
SPEAKER_00Oh, absolutely. And that's something that I'm I realized very early on in my first postpartum experience when I would look back, because I did all of this prep work. I mean, I was so immersed in planning for my birth and thinking about all the things that I wanted. I was taking classes, I was informing my partner about it, we were doing things together. And then when things came up in the moment when I was in the medical system, I felt like I didn't have the tools to self-advocate. So I had all this knowledge, but really not the ability to bridge that gap and tell the professionals what I needed and what I was expecting. And so, you know, my birth experience was not necessarily a positive one that first time around. And um, it really colored my postpartum recovery as well, because I had a lot of feelings of shame and guilt and and kind of regret too. So yeah, thank you for bringing that up because it is such a huge piece, is you can have all the knowledge and information, but the ability to self-advocate is necessary, not just in that pregnancy and birth phase, but it carries through all through parenthood. We're constantly having to advocate for ourselves, for our children, and not just with healthcare professionals either, with family and you know, childcare services.
SPEAKER_02That's so true. And I think like you were saying, it's not just during that pregnancy and birth, but after postpartum care is slowly becoming more common, which I think that every single person, and I feel like I almost say this every episode, should be getting care after they have birth. They should be getting the public care, they should be getting the support because having a baby is one of the hardest things, and I believe it's one of the biggest life changes you can go through. Also, it's amazing as well. It's a mix of hard and amazing at the same time. Pelpic floor therapy is becoming more common after birth, but it's still not like the norm, right? So when we look at that, what are the things that you could tell moms that would help them understand the importance of them finding somebody to give them that care? How it's gonna support their recovery, how it's gonna support, you know, their future, or even if they're planning on having more children, what does that look like for them if they're getting that care? How do they advocate to get that care that they need after the outbirth?
SPEAKER_00Sure. I mean, the pelvic floor is so important for everything that we do. It works, you know, and what the pelvic floor is is a group of muscles and tendons and ligaments that work very much with the rest of the body to provide stability through movement and of course also supports sexual function, the ability to achieve an orgasm, to be able to pee and poop regularly. And so it's extremely important for our day-to-day lives. And in the postpartum period, it's really, you know, of course it's recovering, but I think, you know, we can kind of talk about what the pelvic floor, what happens to the pelvic floor rather in pregnancy. And that I think in itself kind of highlights the importance of seeking care afterward. So in pregnancy, the pelvic floor is under more pressure. You know, you're the uterus sits within the pelvis and the uterus is growing because you're growing a baby or possibly multiple babies. And so there's a lot of shifts, not just in the muscles, but also the bony structures as well. And so through pregnancy, your posture is changing, you're compensating for things. Um, your feet are impacted, your entire body is really impacted by simply the fact that you're growing a human being. Then you give birth, and that is a, you know, I don't want to say this um without giving any sort of connotation, but it's a tra it's a trauma to the pelvic floor itself, right? Those muscles need to really stretch and hold the pelvis stable through the process. Um, and that's even true whether you had a vaginal birth or a cesarean section. And so in that immediate postpartum phase, if you think about your pelvic floor has just carried your body through an entire pregnancy, nine to ten months, even for those of us who experience a pregnancy loss really early on, your body has still made those adjustments and still shifts. So, regardless of how long you're pregnant for, any sort of pregnancy puts strain on the pelvic floor. And now it has the job of recovering while you are taking on this new role of taking care of a whole other human being and navigating all of the other challenges that come with that new role. So, in that newly postpartum phase, we need a lot of support and I think education in terms of how to move our bodies safely, how to start to get back to our quote unquote normal activities that we were doing before pregnancy. And it's not as simple, unfortunately, as just kind of going about our day-to-day lives and expecting it to happen for us. Um, I think that's one of the biggest myths or maybe misconceptions that have been passed on to women or passed down over generations is, you know, women 20, 30 years ago or even 10 years ago weren't getting pelvic floor therapy after giving birth. And so it's just kind of been normalized that we accept these challenges and go about our lives, either, you know, whether or not we have incontinence or we're, you know, we're peeing ourselves, we're constipated, we have this sense of pelvic floor like pressure or heaviness that we haven't been able to um, you know, fully go back to things that we were doing before pregnancy. So I think that's kind of been passed down through generations and it's kind of the expectation now that um you just kind of go about life and and handle it. But I would encourage women that that is that should not be the norm, just because even if your professionals are not immediately recommending it, um it's likely that you could benefit from it.
SPEAKER_02I know that after I had my son, he's 16 now. I, you know, go to my six-week checkup and they say, you can work out now and you can have sex. And I was like, I remember thinking in my head, I literally just heard an eight-pound six-ounce baby. Is there not something that I should be doing to help my body recover? Like there should be some, like, people should be telling me something like do these specific exercises or help yourself in this way or that way. But it wasn't it, and I love how it is becoming more common. What are your thoughts on pelvic lore therapy during pregnancy? Because obviously there's so many ships. I, you know, I kind of think that it should be common then too, just to kind of look at how things are going. So I would love your thoughts on that as well.
SPEAKER_00I am in full support of pelvic colour therapy during pregnancy. I think that again, everyone can benefit. Whether or not it's like an absolute necessity is a kind of a different discussion. But I don't think that we should ever, as women or as human beings, be encouraged to just live with any sort of pain for an extended period of time. You know, and you talk about like 13 weeks. That's so early on. You had another, what, like 30, you know, 25 to 30 weeks to go, and you're just supposed to live with that pain. That's really not, in my mind, acceptable. And I think we have to stop accepting it. Um, it's one of my biggest pet peeves, is just the dismissal of concerns. Um, you know, I see women, a lot of times I see them for the first time postpartum, and I ask about how their pregnancy was, and I'm they'll say, Oh, it was fine. And I'm like, well, did you have any sort of pains or aches? And like, oh yeah. Like, and I'm like, okay, well, tell me more about those. And like I had back pain, I had pain at the front of my pelvis, I started leaking, you know, halfway through. And I'm like, that's so that's not um, that's not all okay, right? But they were telling their professionals that they were experiencing those things and like, oh, yep, that's normal. And it was kind of dismissed. And I don't think that that is malintent from the providers. I think it's truly a lack of awareness and education of just what resources are out there. And again, it's just been normalized. And I would love to see that change. I would love to see us, you know, in here in the United States kind of rise to meet what other countries are doing with that automatic pelvic floor therapy referral as soon as somebody is pregnant because why not provide them with more support? I just don't understand why we're allowing this to kind of continue. And I remember my first pregnancy, I had to advocate to get a pelvic floor therapy referral. And they were like, they're not going to see you in pregnancy. And I was like, I think they will. I had done my own research and I was pretty sure they would. And but I had to ask several times just to get a referral. Um, and that just in my mind shouldn't be a case, especially as a patient if you're advocating for it, just give the referral. It's not, there's no harm to it. Part of that is is too the preparing for the birth experience. I found that there's a lot of downplaying of the birth experience itself in the again, kind of that traditional medical system of just like, oh, you don't like some people will even discourage you from coming in with a plan because birth is, you know, a little chaotic and you can't really be meticulously planned. But I'm like, that doesn't mean that we can't prepare for it. Um, and it doesn't mean that you can't want something more for your birth. You don't just have to let yourself be at the will of whatever happens, happens. I really think that women should be allowed to desire a birth that is meaningful and feels good at the end of the day, because again, it really does change how we think about ourselves and how we start this journey of motherhood. Um, and so I would love to have that part of, you know, be part of the conversation more too, is yes, there's the, you know, taking care of the aches and pains in pregnancy, but there's also the preparing for this life-changing event that really does, in my opinion, have the potential to be something really profound and meaningful. And not that it always is that way, of course, you know, I acknowledge that, but we can desire more for ourselves.
SPEAKER_01I love like how you're mentioning that the birth experience can really kind of set the tone for somebody's postpartum experience. And I would love to talk a little bit about too like what are like some of the most common complaints or challenges that you feel like parents are coming in to sing you with, whether that's when they're pregnant or postpartum.
SPEAKER_00Definitely urinary incontinence. Um, so leaking when you laugh, sneeze, cough, jump, um, any sort of movement. That's very common a lot in postpartum, but certainly during pregnancy as well. And I would say the other thing is a lot of pelvic heaviness. So people that come just say, like, I have this, that's really what it's described as heaviness or pressure on their pelvic floor. Um, they feel it maybe all the time, or or even maybe with just when they start to return to exercise, they notice it. They feel like they can't jump as easily without getting that sensation and pelvic pain as well. And so with incontinence, you know, there is a time frame where that is within the realm of normal in the postpartum period. The first two weeks, it can be really difficult to control your bladder for multiple reasons. But anything kind of beyond that is worth seeking help for to get that taken care of because it's just an indication that maybe something else is going on. And again, you know, I kind of talked about this, but your posture shifts a lot in pregnancy. And those postural imbalances and the ways that you're moving, they'll stay there if you don't then work to address them and undo them. And so that's really important if you plan to get pregnant again or even just if you never want to get pregnant again, but you just want to have a long life where you are healthy and able to move in all the ways that you want to move, to keep up with your kids, to get back to running, to exercise. And that's something I'm really passionate about too, is helping women safely get back to exercise because Melissa, you had talked about like, you know, you get that six-week go-ahead and they're like, okay, you can have sex, you can exercise. And so many women take that, like, okay, well, I was running before pregnancy, so I can just go right back out and I can start to run again. But it's just not that easy, unfortunately. It really takes a more gentle approach and it just takes time uh for your muscles and all of that to um to heal and for you to learn this new way of moving your body and adjusting to the new um routine that you have. I love that so much.
SPEAKER_02So then I'd be curious if moms don't have access to go see a pelvic floor therapist, maybe there's not one close to them because it is a growing area, right? Are there a few things that you would suggest that they could do to kind of help them, you know, be mindful of their posture or of like certain movements or breathing, whatever it might be that they could do to support their recovery until maybe they have access to somebody that can help them, you know, just to be able to kind of get back to normal as easily as they can.
SPEAKER_00Absolutely. I'm very mindful not to give too much advice because I do think that again, everybody is so individualized. But, you know, to your point, this is one thing that social media I think has done really well is it has there's been a lot of education and advocacy. So I think more women are aware that they, that there is help available and they don't have to live with these things. The very first thing I often work with uh with new moms is reconnecting with their body. So I would encourage any moms who don't have maybe immediate access to a pelvic floor therapist to just simply work on that first, noticing their posture, noticing their tendencies of how they relax into different movements. Um, do they favor one hip over the other? When they're sitting down to feed their baby, do they notice any sort of shoulder pain? Are they noticing back pain, things like that? And start to just again take note of what is uncomfortable and what shifts they can make in their day-to-day life that that maybe fix that. One of the big things is you can do is look at yourself in the mirror and start to really analyze not your weight and not your like, you know, the change in your body postpartum, but look at like, are your shoulders even? Are your hips even? Um, do you have a really big anterior pelvic tilt where it looks like you're arching your back more? Because a lot of times after pregnancy, because you've compensated for a really, you know, a growing belly, you can arch your back and kind of sit into that posture more and just kind of see are you able to tuck your pelvis? Are you able to move out of that posture? How are you distributing your weight? On your feet. That's another big one. During pregnancy, you can start to shift where you're carrying your weight just to feel a little bit more comfortable and feel more stable. So you want to really try to get back to carrying your weight evenly throughout your foot. So those are, you know, two things that you can kind of notice within yourself. But then also we always we want as best we can to stack our ribs over our pelvis. Our pelvic floor passively lengthens whenever we inhale, ideally. And that really is supported when our ribs are stacked over our pelvis because we have the diaphragm that connects to the bottom of the ribs. And so when we inhale, it helps to, you know, the diaphragm moves down and that helps the pelvic floor respond as well. And so breathing is one of the first things we tend to work on. Really good deep inhale, focusing on getting length all the way through the ribs, through the back, and through the belly. Because again, during pregnancy, you have a baby growing in your abdomen. And so it makes it really easy to get into this shallow breathing pattern where you're really using your chest. And that can increase, you know, a rib flare where your ribs are kind of pointing outwards and not stacked directly over your pelvis. So if you can try to again be mindful about what your posture is like postpartum and get your ribs stacked over your pelvis and do some really good deep breaths and good exhales and start to regulate your nervous system because that's one thing I think we let go too in postpartum. We're so focused on as we should be, taking care of a baby, managing all the things that come with the day-to-day tasks of doing that, that we forget to connect with ourselves and we lose sight of our breath and what, you know, taking care of ourselves because we need to be well to take care of others, of course.
SPEAKER_01Absolutely. And I love how you're you're mentioning like the importance of breathing and kind of just observing your body and noticing your body again. Because I feel like especially during postpartum, your mind is just so focused on a million other things that like really pausing for a second to think about is there like you know tension here? Is there pain here? And just kind of taking note of that. I think that's a really great way to even just start becoming more aware of how your body is feeling.
SPEAKER_00Yeah. And I think it's a it's nice to shift the focus away from how your body looks. Because of course, you know, we can't discount, it's hard to see your body change during pregnancy and postpartum as well. Um, but focusing more on how your body feels, that's something that you can actively do something about right then and there. Um, you know, your body's gonna look different for a while, but it doesn't have to feel different forever. And I think reconnecting and getting into your body and not just kind of pushing yourself out of the way to be able to manage your day-to-day life is really important for long-term health and well-being.
SPEAKER_01I feel like one of the things I constantly am like thinking about and going back to is the fact that like for so many other like scenarios, whether you twist your ankle or whether you break something or have a surgery, like there's all this supportive care that's just like well established and well known.
SPEAKER_00It honestly drives me crazy. I still work in our local hospital system here, and I'm, you know, seeing any minor laparoscopic abdominal surgery, and then never seeing a woman who's just had a C-section who had multiple layers of her muscle cut through to deliver this baby and now she's got to go home and take care of this baby. We're not seeing those clients, but yet again, we're seeing every single patient who's had a knee surgery, um, a spine surgery, all of that. That's just automatic. Um, and it's been really challenging here to get people to see that this is important and necessary. I think, and everybody deserves the opportunity to process their birth. And I think we don't often get that opportunity either. Um, again, sometimes it's just again, you gave birth and now you're home, you're taking care of this baby. But do you ever get to talk about what that experience was like for you? I remind clients all the time that you are in charge of your care. You are allowed to go and pay for an evaluation from somebody and never follow up with them again. You can get the tools that you need, you can learn something, and you choose how you want to move forward with that information. And so I do, I encourage people just to look at what services are available near them. And I do offer virtual support as well, and the, but not necessarily public floor therapy because I'm not licensed throughout the country, but I can provide uh return to fitness coaching, um, things like that, just general, you know, maternal health coaching, which I think can be really beneficial again as you're navigating all of these new and unfamiliar challenges. Um, but you're in charge, you know, that's I think a really good take-home message is you're in charge of your care and um and what happens to you and your baby and your body.
SPEAKER_01And I know you mentioned like some you offer some virtual care, but for pelvic health specifically, um, you're, I believe, just Virginia and West Virginia?
SPEAKER_00Yeah, so Virginia and West Virginia, I'm licensed. Um, and I can provide virtual uh telehealth services throughout Virginia and West Virginia for pelvic floor therapy with a referral.
SPEAKER_01Awesome. So then, like if for somebody who's maybe listening who's outside of those areas and is interested in getting a pelvic health um specialist, do you recommend just like going to their primary care provider for a referral? Or is there something different they can do to kind of get set up with some support?
SPEAKER_00Um it depends on the area that you're in and if you are if it's easy to get into your healthcare professional. You can look um, some states uh pelvic floor therapists are able to be direct access. So you don't necessarily need a referral, though some um many will prefer one. So I think first line of the first action I would take, I guess, would just be Googling and searching for pelvic floor therapists in your area. What do they offer and trying to first find a practitioner that aligns with what you're wanting and yeah, what you yeah, you want to what you want to get out of therapy. And then if they require referral, going to your healthcare provider and telling them very specifically that you want a referral for this sent to this specific um practitioner. I'm really passionate about just connecting women to services and trying to make maternal healthcare more comprehensive, more holistic, and individualized, because I think the medical system doesn't always allow for that. So I'm always happy to talk to moms who just need to kind of talk through what do I need? Um, I'm experiencing this thing, where should I go? Um, and even I sometimes recommend other pelvic floor therapists in my area if I don't feel like I'm the best person for it. It's way more important that women are getting the services that resonate with them and what they need than it is that it's you know, of who it is that's providing that service sometimes.
SPEAKER_01I wanted to thank our guest speaker, Dr. Lacey Woods, for joining us today and talking all about her experience as both a mom and an OT in the pelvic floor recovery space. In the description to this episode, I will attach the blog post that offers more information, resources, and Dr. Lacey Woods contact information. Thank you all so much for joining us today. We can't wait to talk with you again next time.
SPEAKER_02I hope today's conversation gave you something practical to take into your day or simply remind you that what you're experiencing isn't normal. Returning to daily life after birth is a process and support matters.
SPEAKER_01However, your day continues from here, be gentle with yourself. You're doing important work. Thanks for listening. We'll meet you back here next time.