348 - Pregnancy, Birth and the Transition to Postpartum Recovery (Maria, PT, DPT, CBIS & Katie, PT, DPT)

Maria and Katie, physical therapists with St. Luke's, join Dr. Arnold to discuss an experience that touches so many women and families: pregnancy, birth, and the transition into postpartum recovery. Support is available from the moment a woman walks through our doors through our inpatient and outpatient therapy clinics. 

To learn more about Birth Care services, pelvic health therapy, and postpartum support, visit unitypoint.org. 

If you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.

Transcript

Dr. Arnold 0:07

This is LiveWell Talk On... pregnancy, birth, and the transition to the postpartum recovery. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health St. Luke's Hospital. Today we're talking about an experience that touches so many women and families: pregnancy, birth, and the transition and postpartum recovery. From the moment a woman walks through our doors to the follow-up support available through our inpatient-outpatient therapy clinics. Joining me today is Katie and Maria, physical therapists from UnityPoint Health, St. Luke's Hospital. Katie, Maria, welcome to the podcast.

Katie 0:38

Thanks for having us.

Dr. Arnold 0:39

Postpartum mortality has been an item that uh has been drawn attention to in the state of Iowa. There's a project, and uh as well as our um postpartum uh work that we've done here at St. Luke. So your your specialists kind of fall into that. Um, not one that uh I think about, you know, I mean occupational therapy to me is stroke patient, sports medicine, uh elderly patient, kind of from my world. So this is this is gonna be interesting. But first and foremost, do storks bring babies?

Maria 1:15

Not that I've seen. Not that you've seen.

Dr. Arnold 1:17

So you don't work with any storks at all? No, I'm fortunate. Okay, all right. Well, we got that out of the way. When when a a potential mom or future mom, or mom to be, let me say that way, uh arrives to deliver at St. Luke's. What physical challenges did do the pregnant patients have to begin with?

Maria 1:36

There's just so much. There's a lot of changes that come with pregnancy. Um, physically, there's a lot changing in their bodies. You know, it's not uncommon to hear women say they're having back pain, hip pain, uh, maybe they're having trouble controlling their bladder. And so coming in, they're already having that. Um, and then you kind of think about after they give birth, they are gonna have that physical demand of caring for the baby. So I think that's like unique to the birthcare center. Um, I'm used to seeing adults on the other floors, and maybe I see them after surgery, and we're just focusing on them and like making sure that they're safe to go home. The um, I think the fun side of being over at birth care is after they give birth, we're not only having mom move better, but making her feel comfortable taking care of this baby because it is a physically demanding task.

Dr. Arnold 2:22

And you know, being a father, specifically that first baby. A lot of unknowns, you don't know what you're doing, you know. By the third, you're just letting run around with scissors and really, you know, you whatever. But uh I imagine it is it's a scary time uh and you've just gone through a very physiological demanding experience, uh, birth. Um what what what is it? How do you approach these patients to make the transition of postpartum recovery? Uh well, let it let's start out. What is considered postpartum? How long does that go after pregnancy?

Maria 3:00

It really, I think it's the whole like your entire life. If you give birth, you are forever postpartum. Um, because that it's forever changed your body. Um, but like more specific, I would say that like that first year, your body is going through a lot of changes to kind of get back to um physiologically where it was before pregnancy.

Dr. Arnold 3:18

Okay. Uh, so how how do you approach these patients? I mean, I in my mind, occupational therapy, physical therapy, the therapy team, speech therapy, you know, they kind of have these milestones to therapy to try and achieve. The patient has a deficit, they outline the treatment milestones, and then they work to achieve those. How does that work in the postpartum field?

Katie 3:40

Yeah, for outpatient-based, because that's where I am, um, seeing patients mostly like their chief of complaint, like pelvic pain or leakage, or we're really working on like the handoff from Maria to the outpatient for the mom, working on like, okay, we're here to help you progress as you feel ready. So each patient is different as we know. Um, but working on making sure that they know that it's common to have leakage after having a baby and even years after having a baby, but that's not normal. Like, we can help you not have that or any of this pelvic pain that you're having because quote unquote you had a baby, but that doesn't mean that's forever. Um, so it can kind of look different based on like what the patient's coming in with or the mom right after having your baby.

Dr. Arnold 4:25

And with the leakage, you mean urinary environments? Yep. How is that treated? That I'm not I know it kegel. I don't even know what that is. I just know it's the taggle exercises. Yeah. What what what are those?

Katie 4:38

Um, so you have your pelvic floor muscles. So they're all internal and they kind of create like a bowl shape within your pelvis. And the Kegel is just working on engaging those muscles, like activate activating them for like strength, and you have muscles around your urethra where your urine comes out, which also helps strengthen that to be able to engage those on command if you were to have like an urge to go to the bathroom. Okay. Um, so as you have a baby via vaginal delivery or even like C-section, you're carrying this and growing this baby for nine months. That it puts a stress on those muscles. Absolutely. And they might not be activating or engaged as they normally would be. So you have weakness after um either births and just kind of working on regaining that strength, or maybe they didn't even have strength to begin with, and now they really don't have strength to stop.

Dr. Arnold 5:27

Okay. Um, does it like do you approach the patient differently? Like, oh, this is her sixth, this is her first. Is there a difference in that approach?

Maria 5:36

I feel like because I'm seeing the women, I see all c-sections, um, patients before they go home. So going into that room, it really does vary. Um, and it can vary between like how many birds have they had. This might be their sixth trial, what might be their first C-section. Um, but really every session is so different, and I I love that we're meeting the patients where they're at and giving them what they need for that day. Um, because there is a lot for us to go over. We cover lots of things. Maybe they're really having they're really uncomfortable having a lot of pain. There's a lot of tools we have in our toolbox as physical therapists to help manage that along with the medical team who's managing medications so we can help them with pain, help them feel more comfortable moving around. We always teach people best techniques to get in and out of bed, making sure that they're safe walking around and their blood pressure is safe with those very functional tasks, which kind of leads back to your morbidity mortality kind of programs to try to improve those. So by monitoring those vitals with just daily activities, can give the medical team some good insight if there's something going on that might not be seen at rest. And then we also, if you know someone has stairs, we make sure they do stairs. Really the goal is just to make them feel comfortable and confident moving around because you walk in and oftentimes the patient is um they're painful, but they're also really scared and nervous to move, and just giving them the confidence to know, oh, you can move, it's safe to move, um, it goes a long way.

Dr. Arnold 7:05

Yeah, I I think that you know, a C-section is a big surgery, it's a big abdominal surgery, big incision. Um, it's sometimes done urgently, if not emergently. So there's always those complications to the procedures that are emergent. What what is the transition though from inpatient to outpatient? Then how where do you pick up? What what do you do when you see them?

Katie 7:28

Yeah, so when I see them, kind of will depend on how far out they are from having their baby, or like what are their chief complaints? Are they just wanting to, or their biggest goal of therapy? Are they just wanting to get back to their active lifestyle that they are living before um having children? Are they having some pelvic pain since like during pregnancy or since birth? Um, if they're having leakage or anything like that. So it changes a little bit. We do a lot of education. Um, I feel like females are not educated properly on their body and like what occurs before pregnancy event and even after pregnancy, and like what's normal for you and what's common and what's the difference and how can we help you? Um, so a lot of behavioral modification or patient education helping strengthen those muscles, whether it's not even doing any internal assessment of their pelvic floor muscles, but maybe it's just um really working on strengthening and getting them back to what they want to do.

Dr. Arnold 8:22

Getting those mom muscles. I was always impressed. I mean, my wife's pretty fit anyway, but I mean, the ability to like carry that car seat just in one arm, you know, and then I would go pick it up and be like, well, how did she do that? Cook meals with a baby on your hands. Yeah, yeah, exactly.

Maria 8:41

All the things.

Dr. Arnold 8:42

Um because you you know, I think one thing that as an internal medicine physician, when I approach a patient that's either pregnant or or uh postpartum, you know, you were talking about medications. I mean, my first thing is, okay, can I give them this medication that I mean normally just give to someone? And particularly if they're breastfeeding, that's a narrow range, so I can imagine uh the physical therapy helps with pain and uh restoring that uh physiological capacity that they may have lost during their pregnancy. How soon after pregnancy can women return or like exercise? Is there what would it what's the timeline there?

Maria 9:26

Yeah. Um, I think officially they need to wait for the six-week follow-up with her provider. Yep, to return to exercise. Um, however, I right actually, when we're in the hospital with these patients, I do give them some very gentle, low-level exercises to do because you have to build up those foundational exercises. So, you know, maybe a mom wants to get back to running marathons. Well, we got to start from the ground level and make sure we're engaging these muscles that have been changed through pregnancy. Um, so we will start on the birth care floor before they even go home doing some gentle breathing, stretching, just activating some core muscles. We're not doing sit-ups or jumping jacks or anything like that. But then we do a really nice job of handing off to our outpatient providers like Katie. Um, we're always sending a direct message to them, being like, hey, this is what we're seeing. This is why I think this patient should be seen by you. I think that's really valuable for that patient too, because then they walk into Katie's clinic and they know that Katie already has the background on them and they feel really cared for and like ahead of the game.

Dr. Arnold 10:30

I do a marathon every weekend. I watch a marathon of shows like Netflix or other striping services. So I'm very familiar with marathons. Um now I wasn't aware this therapy team's recently received a certification for the program for women's health. Tell me about that.

Katie 10:46

Yeah, so a couple of my other coworkers that um is called pregnancy postpartum corrective exercise specialists. So pregnancy, postpartum, all like exercise-based um um certificate for that. So any mom that's pregnant or going through postpartum that may not need um more in-depth like pelvic pain help or whatever would go to my coworkers, Tara, Emily, and Jordan. And then I myself got um pelvic function certificate. Just I have the ability to do like internal assessments on females. So whether that's like assessing muscle tone, whether they're having pelvic pain, so we can figure out where that's coming from, um, muscle mapping, all of that stuff, um, just kind of gives another resource to help these women feel better and know that they don't need to leak, they don't need to have pelvic pain, they don't need to have pain with intercourse, anything like that. Um, so it's just another resource for women.

Dr. Arnold 11:41

What is the most common cause of pelvic pain for a postpartum female?

Katie 11:46

It's probably pelvic tightness, yeah. I would say pelvic tightness.

Maria 11:50

Yep. You think of um a tight muscle doesn't always mean it's too strong, it usually means it's too weak, so it's overworking. And after a mom's been carrying that baby for months, and um kind I think of it like a bowling ball, those little muscles down there, they're working hard to hold a bowling ball, they're probably really tight from working overtime, and so um a tight muscle can't function properly and it can be really uncomfortable causing pain.

Katie 12:13

Okay. So I tell patients with like internal assessment, just think of it as a massage for your pelvic floor muscles. It's just more intimate for women, so it's not always done if a patient doesn't approve of it or can give consent, but it's just kind of a light, gentle massage just to get see if we can release that muscle tension, and then once we can kind of release some of that tone, we can like fully strengthen it back up because it has the capacity to strengthen.

Dr. Arnold 12:36

Okay. Interesting. Well, we've talked about certifications, and as the chief medical officer and a physician, I I think certification, sport certification, ongoing education just demonstrates that culture of scholar scholar and and and inquisitive ongoing learning. So I think that's important. So we talked about the program, but I'm aware that you have an individual certification. Tell me about that.

Maria 13:03

Yeah, I have my perinatal health specialist um certification, and that was a training that really focused on pregnancy and postpartum and how physical therapy plays a role in that, but then also um gives more in-depth education on some of the medical complications that can occur with pregnancy and during the postpartum phase, and how SS therapists can help play a role in um monitoring activity and kind of giving the medical team that information so they can catch some complications earlier in recovery and then you know earlier detection is better um results.

Dr. Arnold 13:37

Yeah, absolutely. Well, that's it, that's very interesting. Congratulations.

Maria 13:40

Thank you.

Dr. Arnold 13:42

What what do you wish every patient you see? Or give me your most number one thing that you wish patients knew prior to you seeing them. We'll start with you, Maria.

Maria 13:56

Um that it's okay to move and it's good to move. Um, but we're always gonna meet you where you're at. So sometimes we walk in the room and you say you're the physical therapist, and they're like, I just had a baby, I don't need physical therapy. Right. You know, um, it sounds a little scary, but just letting them know like we're here truly just to help you, and we're gonna meet you where you're at, um, and we're gonna help you reach your goals. And so that might just be finding a comfortable position that you can be in when you're nursing the baby, or is it trying to get you back to your you know, athletic goals?

Dr. Arnold 14:26

When I trained in Detroit, we had this old doctor, and he would always say, Patients die in bed, get your patient out of bed, you know. And I think there's always been the myth I need to rest, you know, and there's you know prior to me starting medicine, but they're at a time that we know to cardiac patients, we say you need to lay down for a month. You know, now that sounds absolutely crazy, but that was the standard of care to bed rest for 30 days after a heart attack. We know that's just terrible. Um so that that's really interesting. Keep keep moving.

Maria 15:02

And I I will run into the occasional mom who I got a reigner in who wants to go do a lot.

Dr. Arnold 15:07

And when I start to, you know, I just we have patients like that.

Maria 15:10

We have both ends of the spectrum, but you know, that's the fun of it is trying to figure out what that patient needs in that moment.

Dr. Arnold 15:16

Yeah, you tell them you need to rest. Okay, but I can still lift weights. No, you need to rest. Yes. Okay, so just not delay, you know. No, you need to rest. You know, I have a daughter that's like that.

Maria 15:28

And we don't need to mop the floor. You just had a baby, you know, we can wait to do that.

Dr. Arnold 15:32

Um, because every husband's at home mopping the floor, just like I did. Fortunately, my wife doesn't look at these podcasts, or not very often. Excuse me. Um, how about you, Katie? What's what what's what would you like patients to know prior to meeting you?

Katie 15:49

Yeah, I want women to know that this, like us, we're here to help, and we want to help them. And I love what Maria said that postpartum is like after your first baby until like forever. Like moms now that are 50 or moms that are 70, like we can still help you, and like what you're feeling is very common. And I feel like most moms say that's normal since they've had a baby, but it's not normal. And like we can help you still 20 years, 30 years, 40 years after.

Dr. Arnold 16:16

So well, I I think that's that's that's a great closing comment because our opening comment, we talked about bidding mortality of postpartum. And when you look at the data, it's it's postpartum, they're not having the mortality two or three days post-delivery. It is within six months down the road. And um, I just like the fact that you know that these patients, they're not alone, but they have a team that's willing to support them. I think that's important. Um, this isn't, you know, just having that structure in place uh is the first step in having uh enhanced recovery to patients. Thank you so much for joining me today and sharing your expertise. It's been wonderful discussing how we support moms through pregnancy, birth, and postpartum recovery. Once again, this was Katie and Maria, physical therapist from Unipoint Health, St. Luke's Hospital, where four out of five babies in Seed Rapids are born. To learn more about birthcare services, pelvic health therapy, and postpartum support, visit unipoint.org. Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcast. We're available on Apple Podcasts, Spotify, Pandora, or wherever you get your podcast. Until next time, be well.