Episode 22

#22 Your Pelvic Floor in Pregnancy, Birth and Beyond with Caitlin Dunsford The Matrescence Podcast

In this weeks episode we chat to Caitlin Dunsford who is a women’s health physio working across both the public and private sectors in Sydney. Throughout this episode we chat to Caitlin about some of the normal changes that your core and pelvic floor undergo in order to grow and bring a baby into this world, how to take care of your pelvic floor in pregnancy and in the early postnatal period, and how to know when things are not as they should be. We also discuss what a women’s health physio does, when and why you should see one and what to expect from your appointment. Lastly, we grill Caitlin with some rapid fire questions from our Facebook group members. This conversation was fun and informative. The information we covered should really be required learning for anyone who has a vulva, whether they plan to, hope to, or have already had children themself. Regardless of what stage of your journey you are at, this conversation will hve you feeling more informed about your pelvic floor. To connect with Caitlin:Instagram: @pelvicfloorwithcaitlinLinktrwe: https://linktr.ee/PelvicfloorprojectCaitlin’s Pelvic Floor Project: https://thepelvicfloorproject.com/our-programsLinks to resources  mentioned in the episode: https://www.continence.org.au/@coreandfloorrestoreTo continue the conversation connect with us: Follow us on Instagram: @matrescence.podcast Join our Facebook group: Matrescence Matters Head to our website: http://www.Matrescence matters.com.au 


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Bree: All right. So today we are here in the wardrobe, Kelly and I, now I’m going to be leading the majority of the interview because I am still very early postpartum. I’m just coming up three months postpartum. And as I’ve shared on social media, I’ve had plenty of vagina was for lack of a better term, knowing the birth of Emmy.

So I’ve been seeing a women’s health, physio, and sharing my journey along the way. And it came to my attention that so few people actually do get around to seeing women’s health physios, which is a shame because I’ve always had incredibly positive experiences and found them to be remarkably helpful in my postpartum journey.

And I did actually put the question up to ask how many people had seen one after having their baby and only only 60% said they had. Now. I think it should be an absolute standard part of postpartum care if I’m honest. We’ve got a women’s health physio with us here today. Kaitlin. Now I’ve started following Kaitlyn on social media a few months ago.

Just after Emmy was born. And I was concerned that I had a prolapse and I’ve since been assessed and found out that I don’t. Great, but many people do. And I actually loved your highlight Caitlin on your page when you go through prolapses. So if anyone is concerned that they have one or have been diagnosed with one, I’d highly recommend you head over to her page.

So we’re going to go quite general today and talk about the early postnatal period, what you can expect from your core and pelvic floor. What it’s like to see a women’s health, physio. And we’re also going to answer a few questions. So we do have a Facebook group it’s called Matrescence matters.

And I put it out to the group members to come back to me with some questions about the pelvic floor and postpartum. So we’ve got those at the end. And while of course you can’t give us specific advice. We’d love to hear your thoughts on some of those. So if you wouldn’t mind, Caitlin, would you introduce yourself and tell us a little bit about you, where you’re from and what you do for work.

Caitlin: Yeah, for sure. So thank you for having me. And thank you for, that little bit of a background about why this is important. I am super surprised that 60% of your following have seen a women’s health physio. That is it’s probably not good enough. And I agree with you, but 60% is fantastic and probably not the percentage that I see because I work across public and private health.

But my name is Kaitlin. I’m a physiotherapist with special interest in further training in women’s health physiotherapy. I work, like I mentioned, across the public and private sectors here in Sydney where I’m based in Australia, I work at Blacktown hospital, which is one of the busiest hospitals for birthing women in new south Wales at the moment.

So it’s a very exciting place to work. And I’m very passionate about public health. And I also work privately my husband and I own a physiotherapy practice in Kellyville Ridge in Sydney. It’s called the Hills physiotherapy and I see some women they’re private. I also treat pediatric continents there as well.

So some kids, which is exciting I’m also a mum, I’m a mum to a one year old boy, his name’s low-key. And I’m really enjoyed the conversation you guys have started about Matrescence and I, I’m sure lots of people come to you and have said, I wish I knew that earlier. I felt very well knowledgeable before I had Loki, but it definitely, I think no matter how much you’ve read before you have a baby, you there’s, no, there’s no amount of preparation you can do to still dip your toe in and getting in the shallow end.

End of motherhood. I think you have to dive in. Nobody allows you to get in the shallow end. And I thought that I would be allowed to do that because I had done so much research. I love that you’re having that conversation so that so many people out there don’t feel so lonely and struggling in that postpartum period.

Bree: Absolutely. And it’s something we say often that, we do talk about Matrescence and we’re really passionate about that message, but you still have to go through it a little bit of awareness about what it is and what it might feel like can really help, but you just have to dive in. Now you are actually in locked down at the moment.

We are just coming out of hours and I’m curious to know, how does that affect your practice? Are you still working? Are you still able to see patients? Because we’ve been in lockdown for the last week and I was able to still see my women’s health physio, but I know that other people have had trouble accessing those services.

So I’m curious. What you doing work-wise at the moment? Yeah,

Caitlin: so it’s definitely in Sydney, we’re in a lot worse of a situation currently than any of the other states in Australia. And there’s a difference in what’s happening both pub versus public versus private. So if you deliver it in a public hospital and you were referred to see a physiotherapist, if you have an acute traumatic injury, like an obstetric anal sphincter injury, so a tear, then we would prioritize seeing you face to face and you would have a six to eight week follow-up face-to-face in the hospital.

But for a lot of those chronic conditions, or if you’ve had say, you’re struggling with leaking, so stress, urinary incontinence and it’s been happening for years and. Youngest child is say, five years old, then you would either have to have your consult via telehealth. And then wait until the restrictions are easing.

And that’s just to reduce the burden, because I guess as a physiotherapist working in a public hospital, we’ve been told that last minute we may be pulled or relocated to be used or serviced in a different area of the hospital. So whether that’s actually seeing COVID patients in intensive care or assisting in other things like giving out vaccinations so public health has a little bit different to private.

And in the private world, you can definitely still access services. It’s, we’re considered an essential service. I think lots of private practices and us too, having that burden of not necessarily the burden, but we don’t. Add to the stress. That is the what’s going on with coronavirus and COVID spread.

So we’re trying to reduce the amount of face-to-face and if somebody doesn’t have to come in for a face-to-face appointment, then we don’t bring them in and we do a telehealth session. But Blackwell got into later, a lot of women’s health. Physio is a physical assessment. So if that’s needed and we’ll certainly do that

Bree: beautiful before we dive into the topic properly Kell’s very interested in career progression and how people get to where they’re going.

So I’m curious, I imagine that you had you got into women’s health, physio prior to having your little boy, since he’s so young, what kind of led you down that path?

Caitlin: Yeah. So I was I did my cert three and four in personal training and group exercise classes to pay my way through university.

So being a personal trainer was how I paid for my university degrees in physiotherapy and the nature of having, because I was a university student and I had this time in the middle of the day that some other part-time personal trainers, it didn’t have, I was naturally doing the 9:30 AM gym class and group fitness classes, which happened to be a large proportion of mums.

And I did a lot of mums and Bubs classes. So just through the nature of being exposed to lots of mums and Bubs classes and women returning to exercise after having kids, I think I listened to conversations about tummy muscles separation and conversations about leaking when they exercise and all of these issues that they were having, they were impacting their desire to participate in exercise.

And that’s where my interest sparked, but definitely being at university and. The experiences I’ve had at a physiotherapist, I’ve been exposed to a lot of inspirational women’s health physiotherapists. And so I think those mentors have really shaped the physio that I am today. So I think it’s a mixture of my interest for my previous experience as a personal trainer, but also the people that I’ve bumped into in my career.

Bree: I love that. And I, you can’t judge a whole profession based on your own experiences, but I’ve maybe encountered four, maybe five women’s health physios throughout my pregnancy and both of my pregnancies and postpartum periods. And they have always been exceptional. And I just rave about them all the time.

I’m the biggest advocate for you guys. So we are gonna go back to the beginning a little bit and talk about pregnancy. And of course we acknowledged that every pregnancy is going to be so different, but I was wondering if you can tell us a little bit about the changes that your body goes through in order to carry a baby.

Some experiences are going to be unique, but others are going to be universal. So what is happening and changing throughout your pregnancy in order to carry your baby and give birth?

Caitlin: Yeah I’m going to take this in the, I guess the context of women’s health, physio, and what we’re interested in terms of the pelvic floor and the abdominal muscles, but pregnancy is a massive, the biggest change a female body will ever undergo.

It’s a lengthy period of time. It’s not, labor labor, which is 24 hours. We’re talking about nine months. Growing and housing, a small human in the early days, most of the changes are hormonal related. In that first trimester, you get lots of people complaining about sickness or fatigue and all of those to do with your body’s reaction to maternal hormones that are raging at that point in time to help grow and keep that fetus alive.

At a lot of neurodevelopment of the baby happens in that first trimester. So that’s why we have a lot of I guess hormonal effects on us as the female. But from a physio point of view, we’re looking at the musculoskeletal system and it’s a combination of the hormones and the biomechanical changes that happen during pregnancy that plays such a role in impacting not just the pelvic floor, but your pelvis, your low back and your abdominal muscles.

If we get specific, you have this growing baby or this weight to change that alters your, where your center of gravity is sitting. So as your baby grows bigger, your uterus and the weight of that baby draws your center of gravity forwards and a little bit down. And what that does in many women is it tilts their pelvis a little bit forward.

And for every centimeter, your weight goes forward. Your center of gravity moves forward. That has to be impacted, or I guess, counteracted by muscles, working at the bar. So that you don’t fall over because we stay upright during pregnancy. And so that’s why a lot of women described that low back ache. Particularly from that 20 week mark onwards, when you start to notice big, very obvious to the naked eye changes in your biomechanics.

So you’ve got that abdominal change. You’ve got the stretch of the abdominal wall and the not necessarily splitting is a bad word, but the stretching of the abdominal muscles, not just forwards, but also laterally to the sides left and right. And then you’ve got all of those that pressure, that constant pressure onto the pelvic floor.

So the pelvic floor is under constant progressive load from the day you fall pregnant through to delivery. So lots of stresses on the, both the pelvic floor and the abdominal wall, but I always empower my women to say that, your body was meant to do this. Yes, it is. It may be symptomatic in certain ways.

So you might have that low backache or a lot of women more than, one in three women will experience what we call pregnancy-related pelvic girdle pain. So they might be experiencing that pubic synthesis pain. So right at the front down your pubic bone or that back lateral pain left, or right-sided pelvic girdle pain.

And that’s just your body’s way of reacting to the biomechanical changes. And some people might be more predisposed because of their occupation or their pre-existing medical history or what their muscles are doing, but there’s nothing we can’t help and help you manage. But also just empowering women and letting them know that their body is doing a thing that it’s supposed to be doing.

So a lot of, yes, whilst a lot of the pain in physio, we teach that we’ve got to get rid of the causative factor from physics, from that pain. So somebody has got acute pain. We’ve got to get rid of that, cause yeah. Factor. But for in this case, the cause is a growing baby and biomechanical changes and we’re not going to head up and get rid of that baby

Bree: for sure.

And it’s something that I’m really passionate about now, but throughout my pregnancy with Taj, my first baby, I did go to physio led polarities classes because I had private health and they were affordable and I was like, great, I’ll do this. And they were awesome. But second time around, I prioritize where I was spending money differently.

More so on my mental health and midwifery services. And unfortunately I didn’t have an unlimited budget, so that kind of dropped it. Consequently, I did pretty much nothing throughout my pregnancy to take care of my pelvic floor, which I know that’s not what you want to hear.

Caitlin: I hear it, but truly,

Bree: I actually didn’t really understand the importance at all.

So what should women be doing throughout their pregnancy to take care of their pelvic floor and why?

Caitlin: Yeah. So I think for a long period of time, physios have been banging on about the importance of pelvic floor, muscle training during pregnancy. But I’m really lucky to sit here and I’m grateful to a lot of researchers that have paved the way before me to be able to sit here and not just say pelvic floor, muscle training is important during pregnancy because of blah, blah, blah.

But to back it up with strong evidence. So we do have a growing body of evidence to suggest that pelvic floor muscle training done during the pregnancy period can reduce your risk of incontinence in that first 12 months postpartum and have an impact on reducing your risk of perinatal tearing during childbirth.

We already know if somebody could tell you, as a physiotherapist, it’s easy for us just to go out and say, do this, but as, unless we can match up the recommendation with why that’s meaningful to the female, we don’t get compliance with the exercises. So thinking about everybody often knows that they have to do pelvic floor muscle training because somebody, somewhere has said, squeeze your pelvic floor or do kegels.

But a lot of people are not really sure what that looks like in the pregnancy period. So how would you set that up? Am I, am I squeezing. Talking on the phone for five, five times and then I’m finished. What does that look like? So if I had to give an example of a pelvic floor muscle training program during pregnancy that I would give to majority of the healthy population, without any contraindications to exercise at this point, then it would be at least a period of six to eight weeks.

So the research says that the extent of pelvic floor, muscle training during pregnancy to get those results needs to be at least six weeks with the recommendation being three months of pelvic floor, muscle training, consisting of three sets of exercises with at least 10 repetitions in that, in those sets.

So if we would, if I was to talk you through it now, we’d say, squeeze your pelvic floor. Like you’re trying to hold it in wind tightened through that squeeze, that muscle, hold that muscle tight for two seconds and then relax. So you’ve got a two second hold a two second relax. And you would repeat that for 10 times.

Three sets every day. Now, in my experience every day at this point in time during pregnancy is I don’t think realistic. And lots of people in my profession might jump up and down and say, no, that’s what the research says. You have to do it. Because I’m not a researcher at the moment.

And because all of my work is on the floor with women, real women who have other kids and jobs and lives. And particularly if you’re a first time pregnant woman, you are overwhelmed with information. So I often bang on about making sure that the information that I give women is feasible and something that they could likely do.

So sometimes I’m saying every second day, or I’m giving recommendations based on what they current pelvic floor function is. But pelvic floor muscle training is definitely something that I encourage all women to do to help reduce their risk of worse of issues.

Bree: Yeah, for sure. And I think that if someone had even put it to me in those terms, I might’ve been more motivated.

Cause without the context, I was yeah. Added to the to-do list. Yeah. And I’m to said, actually you can greatly reduce your risk of incontinence or of prolapse. Like these are really tangible results you can get. Maybe I wouldn’t have done it every day, but I might’ve been a little bit more motivated.

And now that I have had the third degree tear with it, I think I, I took it for granted and now I’m like, okay, I get it. I get the importance, but it really didn’t click for me throughout pregnancy. And I’m sure that’s the case for many women too. Now we’re going to lead into birth and again, it’s a spectrum.

There’s so many different experiences, but patients in what kind of window in the hospital setting, is it 24 hours after birth? Who are you

Caitlin: seeing? Yeah, so I’m seeing women on the ward within 24 to 48 hours after birth. So I’m trying to catch you before you go home. Yes. So I have, when I go into work, I have a little register of not my computer and I get alerted of the patients that have had third and fourth degree, perineal tears on my birth, on the birthing unit in the last 24 hours.

And then we would go up and try and see them before they went home. And then I’d be following these women up at about that eight wait, wake MOC.

Bree: Yeah. So you don’t see it. If a woman doesn’t have the third or fourth degree test, they’ve had a first or a second, or maybe had a Syrian or ideally no tearing or complications at all, do they see a women’s health physio in that period?

Or is that up to them to seek that out independently? If they’re birthing in the public system?

Caitlin: Yeah. If they’re birthing in the public system, it depends on their situation. So if they were having complications and it was affecting their discharge from the hospital. So particularly if you’ve had a scenario and section and you’ve got pelvic pain and you’re having trouble walking, then from a safety point of view and caring for your child, we can’t send you, we can’t send you home safely.

So then I would be involved in that patient, but unfortunately it’s not an I’ll deal. It’s definitely not an ideal way, but we don’t see every woman though.

Bree: Yeah, for sure. With my first baby, I didn’t get to see a women’s health physio in that period that I was in the hospital. And consequently, I felt really caught off guard honestly, by The symptoms and signs that we’re having, which were maybe not super important or super concerning to medical professionals.

But for me, I was really unprepared. Mainly just the perineal pain I was experiencing. I had a second degree tear and how that affected my ability to sit and feed for example, and what positions I should be feeding in. And fortunately for me having the third degree tear second time around, I felt that the follow-up care was incredible and they were so across supporting me in that regard.

But what are some of the kind of signs and symptoms that women may experience? If they don’t have severe tearing or a C-section, but just have a little bit of trauma to their paraniem and what kind of things are you advising that women do to take care of that area in that first kind of 24 hours afterwards?

Caitlin: Yeah, thank you for sharing symptoms. And I know there’s going to be a lot of people listening that most of what they take from this conversation will come from that sharing of personal experience and understanding that it doesn’t just happen to them and that they’re not alone. So thanks for sharing that.

So I guess I often say to my patients with third or fourth degree tears sometimes to make them feel a little bit better, but not to take away from the enormity of what’s going on for them. You would much prefer to have a third degree tear than a second degree tear, because as soon as you hit that threshold of third degree tear, you get all this extra care and all this extra information.

I do think that there’s currently a disparity in terms of, you have a second degree tear, you have any tail or any perinatal trauma, or you have a vaginal birth. There’s going to be aspects of care to that area that has been undergone so much stress that we need to look after, but you often don’t have the skills to be able to look after that area.

And you don’t even have the time to seek that out because you’re in that bubble now with a newborn baby that is so reliant on you.

Bree: Sorry. I’m totally going to interrupt you here, but I agree with you completely. In one regard like the, honestly, having a third degree tear is not ideal. I wouldn’t wish it upon anyone, but the pain from my second degree tear was just as bad and I had no support.

So I totally resonate with what you’re saying in that regard.

Caitlin: Yeah. So let’s chat about, let’s talk about what I would, the information that we give in the hospital about care for the parent am. And then you can say out of those tips, what was most useful? Cause I love talking to my patients when they come back at that eight week mark as to what was the best advice that they got given and what helped them.

So we can tweak the advice we give. Oh, wasn’t

Bree: that let’s

Caitlin: go. Yeah, I guess the muscle has gone undergone trauma. So in order for a skeletal muscle to tear or undergo damage, we say that at a stretch of 150%, that happens in most muscles, but the paraniem and the pelvic floor undergo stretch of up to 250% during childbirth during that crowning stage.

So you can say already that even if you don’t physically tear the actual muscle, that there is going to be some stress that occurs in that muscle and it needs to recover from that stretch and the event that is childbirth. So for women that don’t even have stitches, I think perinatal care is important.

I lack in it to any other muscle in the body. So if you have a hamstring injury during sport, somebody would run onto this onto the field or afterwards the medical, the physio would talk to you about rice management. So rest ice compression and elevation. And the pelvic floor is like a map, like a muscle in any other, just like a muscle in any other part of the body.

So we manage it the same, however, it’s just in a really awkward spot and you can’t rest it very well because it gets used. If we talk about how you would rest the muscle, I talk about position changes. So if you stay sitting or standing for a long period of time, then that will be pressure down onto the paradigm.

And that paradigm is already very swollen and tender. So I encourage my women as much as they can to take time, to be supine lying. So lying on their back, usually with something under their bottom to elevate that area. And it seems really simple. But if you don’t do it by the end of the day, you notice how much pressure you feel vaginally.

And I think a lot of women that don’t take that time to let the parent name reducing swelling often feel like they have that heaviness feeling that if you Google comes back with a prolapse, so you’re experiencing all of this vaginal heaviness, which is normal because you have a lot of swelling in the parent name after delivering your baby.

But often it can get confused with symptoms of prolapse and can send women in a big spiral after having a baby because they Google and then they call me very upset. Yeah. So I guess the first tip is position changes. I think the area can be really helpful, particularly if you’re having a lot of pain.

I don’t think it’s necessary if you don’t have pain. This swelling is designed to go down by itself, so you don’t have to ice the area. But some of the tips we give women is to place a cold pack, either over their undies and their pants, or they can put a maternity pad in the freezer so that when they’re changing their maternity pads, they’re going on cold.

Some people make the nursing staff on some of the wards will make icy poles. So they will put like the fingers of gloves, the filled with water into the freezer. And so that you can use that long, skinny finger of a glove that’s filled with water. That’s frozen to help reduce some of the pain and swelling in the perineal area.

And then one of the other pieces of advice I give is compression. And I don’t know if you were using a compression garment after birth. I

Bree: don’t think so. No.

Caitlin: And one of the advice I give to lots of women is to they can add in compression and that can help with reduction in swelling and almost a feeling like that.

Area of the body’s supported a little bit. So I type of compression would be like an SRC short. So that’s a common brand in Australia have a compression garment that you would wear after birth for recovery, and they can be worn if you’ve had a scenario in right. Yeah. And I

Bree: do want to note that we’re going to focus on vaginal birth, which we’re totally aware that not everyone has a vaginal birth, but I really do think that that C-sections deserve an episode in themselves.

So I think we’ll come back and do that at another stage. Do you have anything more to add or do you want my input

Caitlin: here? Oh we talk, I could sit here with somebody after having a perennial trauma for, or just any type of vaginal birth and talk about strategies that are meaningful to them for ages.

And you’ve already mentioned it, but the last one is talking about positions that are going to offload the paradigm. So often women will just take whatever position they can get into. But we talk about how to place, how to use towels or how to pat a position, their pelvis in a correct way so that you’re not in a lot of pain during feeding, particularly because you do a lot of sitting and then lots of advice around how long the pain should last for, and then toileting advice, weaning, pooing, what’s the best ways to do those things.

So I guess I’ll let you talk.

Bree: For sure. I think the main ones that were really helpful for me were, as you said, I sing, which is sometimes I’d forget to do, you’ve got a new baby and you’re juggling. But when I did remember to do it, it really did help. The other thing was, as you alluded to running the two towels in like a train track configuration and sitting on them to just take some of the pressure off the Perry.

And the other one that I did not learn until second baby was feeding, lying down, which, because I had the third degree tear, they took the time to really encourage me and support me to figure out how to do that. Because it was just pretty much impossible for me to sit and feed. I was in so much pain and it can be really hard if you’re a first-time mom.

I. To try to learn a new breastfeeding position. You’re trying to learn breastfeeding in itself. But if you do have a lactation support available in the hospital, or if you can seek one out privately, that was an absolute game changer because in that early postnatal period, you spend so much time feeding.

And I was finding that this sitting was really aggravating it and making it really sore. So once I learned to feed lying down, that was a game changer. The other thing is just asking for help. We were lucky to have so much help, but I really had to dig deep and yeah. Access as much as I could to not be lifting things and carrying my toddler and all that kind of stuff.

And then obviously for me, with the third degree tear, I had to be really on top of pooing. Kell, instead of buying me a bunch of flowers, actually, I think he did that too, but she brought me a Squatty. I love going to the prime position,

Caitlin: like a women’s health present.

Bree: It was a very cold prison and I love it.

My husband loves it. And we also, I also used a peri bottle, which a lot of people have recommended and I was yeah, I can probably do without it. It’s just another thing, but it was an absolute lifesaver. Cause the last thing you want to be doing is wiping when you have a trauma to that area.

So I think they were probably the main things that were helpful in that postnatal period.

Caitlin: I think the peri bottle is great and some women, some of my patients find it hard to find peri bottles. They usually just recommend, particularly if I’m in the public system and I’m on the hospital ward and I’m just need to recommend something that patient can get on their way home or their husband can run out and get.

Then we talk about like an empty source bottle or just a bottle of water sitting next to your toilet or. If you’re not opening your bowels to do away in the shower. So actually, so that you can pull the water. If you have one of the shower heads that comes off and that you can pull the water whilst you’re waiting.

Cause it’s usually that acidic urine, if it touches your stitches, that can cause a lot of pain as well.

Bree: Yeah, for sure. And I’ve heard people talk about using, is it to reduce the pH shoe? I’m going to go my territory here. Tell me a little bit about that.

Caitlin: We’ll recommend different types of oral supplements to help adjusting the, the chemical content of your urine.

We don’t have any research behind it and it’s just hearsay and it’s what some people recommend based on clinical experience with their patients. So I think. If urinating is your problem. So if you come say you call me up and I make sure all the patients have a way to contact in those first six weeks, if the problems arise.

So that I think one of the hardest things in that postpartum period is if that you get worried, you’re not sure who to call. Particularly if you birth in the public system, you see so many different people and then you get sent home and it’s whoa who do I contact if I’ve got Perry pain, or if I’m worried about my stitches.

And so I just make sure that, some things might be out of scope of practice for me, but I can then at least refer on to somebody in the hospital. But in terms of, if we go back to the question about your all for the year, and if somebody had called me at two weeks and said, I’m just having so much trouble waiting.

Every time I wait, I’m getting excruciating pain and it’s quite stressful for me. And it’s impacting me every day. Then that’s when I’d probably seek out that recommendation. But I wouldn’t give it as a blanket. Absolutely.

Bree: And I think what you said is really important in that if you’ve given birth in the public system, it’s often hard to know who to contact.

And we had this question come up in the Facebook group. Actually a couple of weeks ago, someone was having some real difficulties with her a PCR to me, healing from memory. And I would imagine that’s out of your scope of practice. That’s more obstetrician territory. So what do women do if they’ve given birth at a public hospital and they’re having ongoing trauma in their Perry, who do they contact?

Caitlin: I always recommend women to have a really good relationship with a local GP, because if they’re having trouble with the peri, then I would recommend women two it’s. Usually if they’re having trouble with healing, going to be an issue with infection at that point in time, or they have to present back to emergency that’s usually the advice.

And even if you call the hospital up and get in contact with the birthing unit, they’ll usually just say, if you’re worried about an infection to go back to emergency, but sometimes it is just that concern about, I think there’s a stitch that’s sticking into, my external, anal sphincter. And every time I do a poo, I can feel that stitch, it’s affecting me.

I can feel the stitch of vagina when I wipe that is affecting me. Then that’s more of, from a women’s health point of view, that’s pain. And that’s something that is within our scope of practice and that’s something I can talk about. And we’re also really good at identifying if the wreck, if what you’re experiencing is red flags signs and symptoms of an infection.

So then we would refer you back to emergency or your GP.

Bree: Yeah. And so once we’re getting into that kind of six week mark, that’s the general recommended question of when to book in, to see a women’s health physio, is that right?

Caitlin: Yes. And I think that is based arbitrarily on the six week checkup that we have, has been ingrained in history with us, for your GP or your obstetrician.

It also mimics tissue healing time. So that’s usually why the six week mark is there.

Bree: Yeah. So if you’re having complications before that, you can book in earlier, but generally we recommend around that six week mark. Now, a lot of people had no idea what that appointment involved. They didn’t know what a women’s health physio did what they could expect from that appointment.

That kind of thing. Can you walk us through what a typical six-week postnatal checkup would look like? What kinds of things you’re talking to the woman about Specific the internal examinations from was really curious about auditing necessary. Why are they necessary? What do they involve? So can you tell us a little bit about those?

Caitlin: Of course. Yeah. So I’ll start with what the six week checkup would usually involve. And often women think they’re coming to me at six weeks for me to give them a big tick of approval of, for them to return to exercise and sex. Yes. Exercise. Although I think some women, the range of return to sex for a lot of women is so broad.

And I have some women that come to me at six weeks and say, what’s the logistics of this? How can I get it happening? And then I have women that come back at 12 months and say they still haven’t tried. So know that if you’re out there listening to this, there’s such a broad range of what is happening out there in the public.

And it’s super independent on your situation, which you have already alluded to as well in regards to how different everybody’s birthing experiences are. But so you come and see me at six weeks. Yeah. What we’re usually doing is we’re taking a lot of that appointment is talking. It’s an opportunity for you.

If you need to, to de-load everything that’s happened in your birth. And particularly if I didn’t see you in the hospital. So we’re talking privately, I don’t know your birth history yet. So we’re talking about how your birth went. How do you feel it went? And if I hadn’t seen you during your pregnancy, we’re talking about your pregnancy.

Did you have any issues with pelvic pain or back pain? So we’re taking a history, not just about what’s going on right now, but what’s happened before. Have you had other kids what’s your past medical history? And then the one question I always lead with is what would you like out of this appointment to make sure that we’re on the same page?

So understanding that lots of women are going to come to this appointment with different expectations and making sure I meet those expectations as a healthcare provider is important. For some people it’s can I return to sex? And can you teach me how that can ways that I can make that happen? For other people it’s, I have a marathon booked in six weeks and is that achievable?

And for some people that’s just, they want some relief of symptoms, so pain for other people they’re super worried about their tummy muscles. So I always address what their main concern is. Once we have done a full history and we’ve chatted, I’ll do a screening questionnaire for pelvic floor dysfunction.

So we always go through symptoms of urinary function. So bladder function, sorry. Symptoms of prolapse. So my questions around are you experiencing vaginal heaviness or a sensation of dragging in the vaginal area, asking questions around prolapse symptoms. We talk about bowel function as well. So we cover bladder, prolapse, and bowel functioning in that questionnaire.

And then we go into a physical exam based on what the patient’s goals. And what their previous delivery was, if you’ve had a third or fourth degree parenthood tear and you’ve come to see me at six weeks, but you’re worried about so much pain and there’s a lot of stitches still there it’s very swollen.

Then we are not going to, I wouldn’t even recommend an internal exam at that point in time. Cause you’re just not going to get anything out of it. There’s lots of other things we can do in that situation. I always assess posture. So we’ll have a look at you in standing. We’ll have a look at how your back’s moving and I’ll assess your tummy muscles if if we’re seeing you at six to eight weeks.

And I, what I’m assessing for there is any major concerns or abnormalities in your abdominal wall? I’m sure we’ll get onto the topic a little bit later. It definitely is a topic in itself. Tell me my story. Tell me more. Diastisis but I will assess somebody’s abdominal wall and what the space is between the rectus abdominis muscles.

And then we go into, if a female is happy into an internal pelvic floor exam. And like you’ve mentioned on your page, Bri, I love that you just went through exactly what has happened. So often women’s health physios describe an internal pelvic floor exam, and then they move on as if that’s like something that everybody should know what happens.

But I liked the way you described everything down to, what happened when I take my pants off is the physio and put over my legs. So it’s exactly what if nobody has read that story, highlight on brace page. If you do consent to an internal pelvic floor exam, and I’ll sit there with you with a pelvic model and tell you what we’re looking for specifically and why I’m doing this in your case and you do consent, then I’ll leave the room while you’re undressed from the waist down, you place a towel over your lap and your legs are like you mentioned in a butterfly position, and then we’re looking at your parenting team.

So we look first and then we touch. So we feel for any scar tissue. I’m looking at what the scar tissue is doing. Is it soft, flattened, flexible. Is it raised and red? Is it tended to touch? Are there any stitches left? And what’s bothering you specifically. And then we look at pelvic floor function.

So what happens at the paradigm when you squeeze your pelvic floor? Some women, we talk about paradoxical pelvic floor actions. So some women, when they think they’re squeezing, they’re actually bearing. So we’re having a look at what happens when you think you’re doing a pelvic floor, muscle squeeze. And then what happens when I use the cues that I know from a research point of view will help you the best.

And then if we do an internal exam, we ask for consent again, and then we insert a single digit and I’m looking at the integrity of the pelvic floor. So other muscles where they should be, what’s the muscle bulk, like what’s the resting tone of the muscle. And then what happens when you squeeze so all up?

The actual assessment takes around five minutes, 10 minutes maybe 10, if we’re going through lots of different cues, because if we’re feeling the muscle and you can’t squeeze that’s okay. Lots of women in that first appointment don’t know how to squeeze that muscle. So we’ll run through a set of cues with you to find out which cue.

So w when I’m, what words can I use to help you squeeze that muscle. And once we find a cue that works for you, then that’s the Xs. That’s the cue that we write on your home exercise. I

Bree: love that you said when you think you’re squeezing, because I went through my whole first pregnant pregnancy, as I said, doing physio led Pilates classes.

We did a lot of pelvic floor exercises. And then I got to my postnatal appointment with my first pregnancy and she said, can you squeeze, can you engage it? And I did it. And I’m like, yes, I’ve nailed this. And she’s yeah, that’s not fair. I don’t like what I’ve been doing it this whole time.

And so I think that is some of the value, as you said. And as I sit on my page, it’s always optional. Everything in healthcare is optional, including the internal examination, but it can give you really valuable information about how it’s working that otherwise, you may miss certain things, but of course it is.


Caitlin: Yeah.

Bree: Now we do have some questions, as I said, from people in the Facebook group and one of them was regarding diastasis recti. Can you tell us a little bit about what that is, who it affects? And she was specifically interested to know if it’s something that can be healed or repaired what that kind of healing process looks like and how it will affect returning to exercise and future pregnancies.

Sorry, there’s a lot in that question, but I’m sure you’ll cover it.

Caitlin: I’ll do my best. It’s a very controversial topic. And as a physiotherapist, we’re very big on evidence-based practice. And I know you talk about that as being one of the pillars of values for you, both of you at your Matrescence podcast.

Th this is an area of physiotherapy that isn’t very evidence-based and a lot of people are running off either their own experiences or their experience as a clinician with multiple patients. But I will explain it on what we know is from a men’s health point of view. Now know that this is. Not I guess the word is rooted in science.

There’s not a lot of research to back it up, but what happens with the rectus abdominis muscle? The rectus abdominis abdominous muscles for everybody that can’t see me that, which is everybody the muscles that they start at the bottom of your rib cage, and they run down to your pubic bone. And if we oversimplify the rectus abdominis muscles, we can think of them as two cylinders.

So you’ve got one on the left-hand side of your belly button and one on the right running right down from your ribs to your pubic bone. And they’re connected by what we, I will what we call the Linea Alba, which is a connective tissue. And you can think of it like GRA glad wrap. It’s a very thick layer of glad wrap.

That’s holding those two muscles together, touching. Okay. And when you full, when you are pregnant and you have these growing baby, then these muscles need to stretch forwards and laterally. Like we said before to make way for growing baby. And in, in doing that, when the rectus abdominis muscles separate laterally left and right, that linear Alba, that connective tissue in between those muscles starts to stretch and thin, and that’s a normal part of pregnancy it’s supposed to happen.

For some women that will significantly impact them. Because of previous I guess pre-existing connective tissue disorders or previous pregnancies that have already weakened the Linea Alba. So it stretches more easily. Everybody in their second pregnancy will say, if you compare photos at your 20 week, mark, the size of your belly can change a significantly.

And a lot of that has to do with this connective tissue in between the rectus abdominis and how easily it can. During your pregnancy, the splitting of these muscles is very normal. Splitting is a bad word. Like I said, there’s a connective tissue holding it together and it stretches. And this is what records of dominance to assays is a space between the rectus abdominis muscles.

So in the first instance, it’s normal during pregnancy. And obviously after you deliver your baby, you’re going to have that space there. It doesn’t bounce back, straight away, over time, the rectus abdominis muscles contract themselves, they become stronger and shortened. And in that period of time, they come closer together.

And that linear Alba, that connective tissue. Strengthened as well. And in some cases that linear algebra, that connective tissue is overstretched and those rectus abdominis muscles stay far apart. So we might be assessing somebody at say the three month mark, and when they lying on their back and they do a head lift.

So if you’ve ever seen a physiotherapist then the way that they would assess your diastisis is they would get you lying on your back with no pillow under your head and your knees bent. And they would ask you to lift your head up off the bed. And they would feel the space between your rectus, abdominis muscles above your belly button and below your belly button.

And we measure that based on finger with or centimeters. Some women’s health physiotherapists will use calipers to actually measure in centimeters. And then some women’s health physiotherapists will ultrasound the abdominal wall to understand what’s going. All of that is not needed in your general population.

All of, I think all of that can be beneficial in the population that are suffering from issues with that space. And so we talk about anything over three fingers at that three months, mark being probably a significant diastasis and something that we would want to look at further. One of the roles of the abdominal wall is obviously to increase intra-abdominal pressure so that you can do things like lift your baby or lift a weight or return to sport.

So if you have a very wide gap at the front and you’re in between your tummy muscles and that connective tissue can’t generate tension properly, it’s all floppy. And you would see that in a head lift with that coning of your tummy muscles in between those spaces for that person, they might have trouble.

Like I said, generating intra-abdominal pressure. So I returned to sport or returned to exercises that require a lot of strength around the course around the core that would be impacted. I’m usually

Bree: just going to say, sorry, you actually have that in your highlights on your page showing the coning.

And that was something I experienced with Taj. I had a five centimeter separation and yeah, you could see the Coney in my stomach when I was lifting my head. And I’d never encountered that before. So if anyone’s curious if that’s what’s going on for them, you can head to Caitlin’s page and you can actually see that in action or I’m sure you can probably search it on YouTube as well, but please continue.

Caitlin: No. I was just going to say in terms of what the goal is after pregnancy. Cause I think a lot of women pining for that, there’s no gap. But if we’ve done studies where we’ve researched women that have never had babies and the space between the rectus abdominis muscle bulk is always, there’s always going to be a space.

And for that reason, when women get really lean, you see a six pack, not a one pack. So there’s always going to be a divot between those muscles. So we’re not actually looking for no gap. We’re looking for something between one to one to three centimeters. But know that there, you can have no gap and still have a poorly functioning abdominal wall and you can have a small gap and have a good functioning abdominal wall.

So we’re looking more at as women’s health physios now, not on what the gap is and not focusing on the gap as such, but using that as a component of our assessment combined with function of the abdominal. So in

Bree: the general population, unless you’ve been to a women’s health physio, and how did assess that?

Yes, there is a significant gap it’s affecting function and your life potentially. Then you actually don’t need to do anything. They will come back together naturally. For most people. Is that fair?

Caitlin: Yes. I think that’s very fair to say.

Bree: Yeah. Now you touched on what we were talking about earlier in terms of the return to sex.

And I think we are really big proponents of bodily autonomy, and women being able to make decisions that feel right for them. But I did want to understand a little bit about why that six week recommendation is there because I see people arguing about it online all the time, whether you have to wait, whether you shouldn’t, and we’re not going to tell anyone what to do with their life, but I think in order to make an informed decision, you need the information.

So can you briefly tell us about where that recommendation comes from your perspective as a women’s health visit?

Caitlin: Yeah. So I think that recommendation comes from tissue healing combined with the bleeding, the uterus reducing in size and the cervix closing. So some of that recommendation has to do with infection risk, and some of that recommendation has to do with justice.

Tissue healing times. It’s very arbitrary and it’s you’ve already mentioned it’s a hundred percent different from person to person. And for some people, obviously that have a big wound, that’s not healing properly. Because they have a pre-existing condition like diabetes. That means wound healing.

Time is poor then for them at 6, 7, 8, 9, 10 weeks. I may still not be recommending return to sex. Yeah. But we’re talking about penetrative sex. For that patient that isn’t returning to penetrative sex at 6, 8, 10 weeks, then I’m always having that open discussion about what are other ways that you can cultivate intimacy with your partner.

And I always am recommending women to not just cultivate intimacy and what their preconceived idea of intimacy, what may have been before falling pregnant but talking to their partner about other ways or opening up that conversation about other ways that they can show love and receive love.

And I always recommend women to go and look at that five lung to look into more of that five love languages. And I often talk about that during practice, because I think it’s important. I can’t just say I sit here as a medical professional and say, don’t have sex and then deal with all the ramifications that might happen to you emotionally.

And psycho-socially in your relationship after that, I always want to give women the platform to then go and have that conversation somewhere else. But if we go back. The recommendation. I think some people would have sex two weeks after having a baby. If they had no perinatal trauma and they feel fine.

And that’s probably happening a lot that we don’t know about and people are okay.

Bree: Yeah. And I think that’s the whole point is if we create shame around it, in terms of you definitely shouldn’t have sex between six weeks people, aren’t going to be honest. And then if something goes wrong, they’re not going to seek support.

So it’s take the information and then make the decision that feels right for you. And I asked this question on Instagram and normal was so large. There was people saying, yeah, we were back at it two weeks later. Many people said once I got the clearance at six weeks, we dive straight in. But it was very painful or it was very uncomfortable.

And then we didn’t revisit again until six months later and that’s normal too. Other people were saying, yeah, we were very intimate, but we didn’t do penetrative sex for almost a year. And when we were okay with that. So I think that there’s such a spectrum of normal around that.

Caitlin: And now I guess, no, that those recommendations are very medicalized and very based on terms like tissue healing or infection, risk and nothing to do with any other aspect of what penetrative sex involves.

And that w you would both know that it is very complex for lots of reasons. And they’re not also taking pain into consideration. So yes, some people will give the six week nod, but then not give you any pre-warning that about pain or how to reduce that pain or strategies to combat that.

Bree: Beautiful. Now we do have quite a few more questions.

Am I running out of time? Cause we could talk all day, but I know bias I’m at you. Cause I did promise that I would get them answered. So I’m going to fire them at you. And if you can do your best to give us a brief answer, I know that we’re both going to want to really dive in, but anything that really resonates with people, we would love to have you back on and we’ll properly explore it.

So the first one is how would someone know if they have a prolapse B even if they are pre childbirth, if they are, 20 years down the track, what are some of the common symptoms that you’re looking for in terms of that, that would prompt you to seek out it a physio appointment?

Caitlin: Yeah, I can definitely answer that one as a rapid fire question.

Because it’s very obvious in the research that the symptom that women experience is perinatal or pelvic floor heaviness. So vaginal heaviness or a bulging, a feeling like they’re sitting on an egg. And if you were to touch that area, you could sometimes feel a bulge or something sitting in the middle.

Bree: Beautiful. The next one is quite a couple of women actually in the group, asked me about the feeling of not being able to empty their bladder entirely and subsequent subsequently needing to week and two minutes later. So I guess that will probably be, you might be able to address that in a couple of ways.

I’m not sure if it’s a term, like I found after I had my baby, I was still in the habit of constantly. So I’m not sure if it’s from that perspective or more, the physical emptying of the.

Caitlin: Yeah. We coined that term incomplete bladder emptying, and there are a lot of reasons why somebody may incompletely bladder empty.

One of them may be bladder prolapse. So the bladder might be sitting and have full and back. And I’m using my hand for those that can’t see my hand give a balloon. And then you’ve got a little based on the balloon, if the balloon falls over, you’re going to have a section of that balloon that urine can pull into.

So when you open your bladder, when you do a week, then you’re emptying your bladder, but you had this little pocket of urine that sits in that little part of the bladder that’s fallen down. And so when you stand up that you’re in falls into the neck of the bladder again, and you feel like you need to go again.

So pelvic organ prolapse can be one of the reasons why you experienced that symptom, but needing to way within the next five minutes can also be associated with what we call overactive bladder syndrome. So those are two examples of what might be going on. Beautiful.

Bree: Now, do you want to restart the recording session?

Beautiful. Okay. Easy. Now the next one was in terms of overactive pelvic floors. A lot of people have never heard of them before I hadn’t. And when I got diagnosed with it after my first baby, what are they? Who does it affect? What can they do about it?

Caitlin: Yeah. I muscle can be overactive or underactive.

It can be strong or weak or it can be all of those, many of those things at once. If we talk specifically about pelvic floor overactivity, for a lot of women, they have trouble. Relaxing their pelvic floor, or they might have trouble relaxing their pelvic floor at the right times. So women that experienced pelvic floor muscle over activity might be experiencing symptoms of incomplete bladder emptying constipation.

So the pelvic floor needs to relax to have a bowel movement. And one of the major symptoms of pelvic overactivity is pain. So they might have pain with inserting a tampon with having penetrative sex, or they might have pain all the time within, in that pelvic area of the vagina or the vagina without doing anything at all.

Bree: That’s beautiful. So what can they do about it in simple terms? So

Caitlin: pelvic floor over activity starts with understanding at assessment. First of all, to understand what’s going on is your resting tone high. So what that means is when the muscle is not doing anything at rest is the pelvic floor always on and is at tight.

So do we need to look at internal stretching things like a physiotherapist stretching that muscle or teaching you how to use there’s a thing called a pelvic wand or other things like dilators to help stretch that muscle? Or is it just a neuro tightness? So can we bring motor control back to that muscle?

And can you actively and consciously work on relaxing that muscle and we call that reverse key goals or the opposite of doing a squeeze.

Bree: So that leads me perfectly into my next question. Should every post-partum woman be doing key goals?

Caitlin: Yes. Even if you say that? Yeah. W when we talk about pelvic floor muscle, it’s like Creek giggles is just Okay.

The surname Cagle is one of the men that just coined the term around pelvic floor, muscle exercises, coined

Bree: the term, the

Caitlin: squeezing of the pelvic floor. So goals is it’s very American, lots of Americans use the term cables, but really in Australia and worldwide, we now use the term pelvic floor, muscle training, pelvic floor muscle training is so much more than just squeezing the muscle.

So when I do say yes to the, should everybody be doing it? Yes, everybody that’s had a baby should be doing some form of pelvic floor, muscle training exercise, and that involves coordination, strength, relaxation. So the whole aspect of it, whether you’ve had a cesarean section or whether you’ve had a vaginal birth, because a lot of the stress that the pelvic floor goes under is because of the pregnancy, not the child.

Bree: And I think that’s something that gets missed often is that it’s not always birth. It can just be the pregnancy itself. So even if you’ve had a C-section, your pelvic floor does still undergo a lot of changes that necessitate seeing a physiotherapist and doing that kind of rehab. The next one is why are pelvic floor examinations often done lying down?

And is it likely that things will be missed if they only assess this way? Now I’ve only ever been assessed, lying down despite hearing that we should do it differently. And I don’t know, I guess I just haven’t had the company, but it’s to tell a professional that I think they should do it differently.

So this is not my question, but I am curious to hear your answer.

Caitlin: Yeah, so we often will do, we will always do a pelvic floor examination lying down to start off with just because it allows you to relax. It allows your pelvic organs to be resting and not affected by gravity. And it’s just more, it’s easier for us to assess and it’s more comfortable for the patient.

Like I already said. We would, the times where we would assess in standing is further on down the track. A, if I’m trying to practice pelvic floor muscle training in a standing position, if my female can, is doing the pelvic floor exercise correctly on her back. But her concern is that she always leaks when she’s standing and we’ve done pelvic floor, muscle training for six to 12 weeks and nothing is changing, but in my opinion, it should, because she’s got the pelvic floor function laying down, then we’ll move to standing or workout different cues and standing cause it might change.

The other option might. We would do a standing assessment in women with pelvic organ prolapse, particularly if they’re most bothersome in standing. And so then we want to be able to, acknowledge that their symptoms are real. So often when they’re lying down, we might not notice the full extent of a pelvic organ prolapse, or if we’re seeing them in the morning and they’re lying down and they’ve had, the bitch has been resting then their symptoms aren’t going to be there.

But if I see them at the end of the day and I get them standing up, then we can replicate their symptoms and give them more advice on what to do. It’s definitely not necessarily a necessity to do a pelvic floor assessment in standing. Great. Yeah.

Bree: I think that again, pelvic organ prolapse deserves a whole episode in itself because am I right in thinking the statistics, the statistic is about 50% of women will experience it.

Is that right? Yeah.

Caitlin: So she we’ll be symptomatic, but we think that one in one in two women will have some type of pelvic organ. Yes, which

Bree: blew my mind when I heard it. And it might’ve even been on your page. I’m like one in two women have their organs falling out of their vagina for lack of a bit of a better term, which is just mind blowing.

But when I did fear that was what was going on for me, it was like, my world was falling apart. I was like, oh my God, what does this mean for me? What does it mean for exercise? What does it mean for sex? So if you’re listening to this episode and it’s bringing things up for you and you’re thinking, oh my God, maybe that is what is happening for me.

Firstly, I’d encourage you to head to Kaitlin’s page. She has a Q and a highlights on prolapse. So yeah,  another one is core and flow restore. She’s got an a highlight as well, talking through her own experience with prolapse. So definitely start there. Is there any, anywhere else you’d send women if they’re curious about that, of course, to a physio, but like just online resources around prolapse.

Caitlin: Yeah. I think. If you’re listening and you are in that situation, just know that there are options. And often women, they, before you get assessed and before, the full extent of what’s going on, you’re worried that you don’t know how bad it is and that in your head, you’re catastrophizing, you get into that catastrophizing stage. So I know that there is a whole body of conservative management that has really good evidence backing it up that can help treat your symptoms without surgery before you have to go to the surgery. Mark. If I paid for that, I would recommend other than B be and flow restore.

I think she’s fantastic. She’s Australian, she’s relatable. She’s fricking hilarious as well. But would be a a page called pop up lift. And particularly for women listening that are very interested in how their prolapse is going to impact their exercising life. And can they return to weightlifting and can they return to sport?

I fantastic resources pop up later.

Bree: Beautiful. We’ll pop that in the show notes. Now the last question we have for you from the Facebook group is around back pain and specifically postural back pain, carrying the baby all day. So she doesn’t think it’s related to I know it can be a symptom of prolapse and things like that.

She thinks it’s more just caring and feeding her baby. What can women do about that to get some symptomatic relief?

Caitlin: So I think symptomatic relief starts first with carrying the baby in the most ideal. Possible. And that is making sure that the weight that you’re carrying, whether it be a child, a baby, a bed, a bassinet it’s as close to your center of gravity as possible, and that your postural stacking when you’re standing.

B from core and floor restore talks about this a lot, but thinking as much as possible, how can you stack your ears over your shoulders, over your hips and your hips over your feet. So thinking about posture in that way, my number one tip is exercise and position change. So I try not to be in the same position for too long, whether that’s sitting, standing, lying, or hanging off one hip with your toddler on that one hip.

And that toddler hanging off one hip would come down to the postural stacking thing that we mentioned before. But postural changes and exercise are two of the key things that can significantly improve back pain in those first few years when you’re carrying too. Yeah,

Bree: for sure. And I think we’re so prone to poor posture.

When we have a baby we’re like slumped breastfeeding and, arching our back, trying to counteract the weight of carrying them. So I think, as you said, like for me, it was just awareness and if I need someone to grab me a pillow to prop my arm up while feeding, just asking for it and things like that.

Now the last question was one I’ve received multiple times on Instagram, not on the Facebook group, but it was in regards to shaving before seeing a women’s health, physio. So many people were like, I don’t know whether to do it. Does it look like I’m trying too hard if I do it, or should I just leave it as a women’s health?

Does it bother you? It doesn’t matter. Do you even notice? No, we don’t notice. And so many

Caitlin: people, they worry and they come in and they say, oh, I’m sorry. I caught me off guard. I didn’t know. This was particularly women. They get referred in the public system. I didn’t know you were going to do this today.

Cause nobody told me why this was happening. And it doesn’t matter. There’s nothing off limits in what we talk about. And for that reason, you don’t know.

Bree: I love that. And I said this to my husband the other day, as I was getting ready to go, I was like, I’m putting in more effort for the physio than you.

I just felt the need. Kelsey, I think I was going to jump in quickly and then we’re going to wrap up. Yeah. Just wanted to

Caitlin: say a funny anecdote because the other day when we were preparing for this episode, we were sitting at the kitchen table and one of my boys, who’s nearly 13, we’re sitting there and we were chatting away and he listened in.

And at one point he said to us, what’s a, what is a prolapse? And Brie just looked at him and said, it’s when your organs fall out of your vagina. And he just looked at me. Oh,

Bree: okay. Then that’s like eating. He’s okay, moving on. But

Caitlin: hopefully in the next 10, 15, 20 years, when he becomes a father, he’ll be right there going, listen, if you feel dragging in your vagina, it should be time to see a health physio.

Bree: So we’re starting. Yeah. Yeah. Changing the next generation one boy at a time. Oh. And my

Caitlin: son, he, I found him the other day playing with the fallopian tubes and the uterus out of my pelvis model. Lucky

Bree: 99. You’re on that. Perfect. My little boy lately, because I’ve been saying to him, mommy, can’t mommy, can’t do this.

I can’t pick you up at the moment. Cause remember my vagina’s still sore from having Emmy. It’s still healing. And he knew I was going to the physio. So I came home and he was like, mom, did the physio tell you that you can. Pick me up now. And I was like, yes, he’s did the lady tell you that you can play blocks with me?

And I was like, yes, you could just come through anything you can think of. So building that awareness for sure now to finish, I did want ask you the same thing. We ask all that, that I guess, are there any resources that you recommend that immediately come to mind that can help women in that early personnel period to take care of their pelvic floor or understand it better?

Anything along those lines or something left of center, anything you want to recommend where. Yeah,

Caitlin: I think the if, particularly if you’re struggling, the Australian incontinence foundation has a fantastic website with handouts not just for women, but if this conversation has sparked you as a male listening or as a female partner of a male that is struggling with incontinence, the Australian continence foundation have so much information from constipation, fecal incontinence through the urinary incontinence, prolapse for kids for men in more than 20 different languages.

So head on over to their website, they’re a fantastic resource on lots of people put a lot of work and effort into those free resources. And I think if you’re listening to this, then you’re interested in return to sport. I would love everybody to jump onto my page and download the return to sport document that I just typed up.

It’s the hopefully the most evidence-based type of information in regards to the risks and the benefits of returning to exercise after having a baby and what you should consider in relation to your pelvic floor and it’s free. So it’s there for everybody.

Bree: Beautiful. And I have actually explored that.

And it’s fantastic. And your page has lots of inspiring exercise when you were pregnant either. Even and I’m at the very start of my PostNet or return to exercise. It’s very motivating and inspirational to know that we can get back there. So definitely worth checking out. Last one is where can people find you if they’re not already following you, which they should be, where can they find you?

Caitlin: So I’m pelvic floor with Katelyn on Instagram, but I also have an educational platform online called the pelvic floor project. And that’s the pelvic floor, project.com.

Bree: Beautiful. Thank you so much. We’ve had quite a long episode, but I just couldn’t catch it at any point. I loved hearing everything you had to say.

So thank you for spending your Sunday with us.

Caitlin: Thank you for listening and thanks for letting me.

Bree: Beautiful. Thanks Kaitlin. See you later.

Caitlin: So Kaitlin I’ll chop that and edit it anyway. So thank you so much. That was such an awesome episode. I’ve learned so much and as you probably heard, my last pregnancy was more than 11 years ago and I’m going to go and read it all because I’m going, Ooh, I’ve said debris the other day.

I feel like I need to see a women’s health, physio, and it’s all these years later. So I’m very excited about going and having a look at some more resources. It sounds like your, your Nat might’ve woken up. There’s low-key come up awake as he, I don’t know, short came in for some reason. So yes, I

Bree: think he, he needs me.

We’ve done that many times where we’re like mapping, get out. I love that. No, thank you so much. That was awesome. We are obviously big fans of evidence-based research. So when we’re able to connect with someone who’s right across it in their field, it’s just magic. So that was awesome.

Caitlin: Yeah. I really love it as well.

Cause it’s so hard online at the moment and I dunno, I get so frustrated sometimes about the lack of evidence-based that’s happening and I want to try and make this space as loud as possible for women because it’s the louder pages that are getting all the attraction, but not necessary.


Bree: it’s so true. And that’s something I try to consistently emphasize I’m going, this is my experience. This is my experience. And I think that’s value in experience, but I’m not the expert. Let me refer you on to experts. So trying to draw that distinction between yes. Sharing your experience is valuable, but it’s not necessarily the best practice or anything like that.


Caitlin: absolutely. And that’s very much the focus of this is it is storytelling, but where there is research referencing it, 90% of people will never go and read it. That’s what we know. People want the story, they want the experience, but being able to say this. There is evidence behind this.

If we refer to something, which is why we love those resources in terms of the shed ruling, I think this episode’s

Bree: due to go to air Tuesday morning. Yeah. Yeah. I think we’re going to push it straight down. You guys are great. Good way. It’s just, it’s very relevant. I’ve already been talking about it on Instagram.

People are asking the question. So I think it just flows beautifully to have it out now.

Caitlin: So I’m going to probably work on the editing of that over the next 24, 48 hours. We don’t do a lot of editing at all. The only bit I’ll cut out is the bit where Bree asked about the recording. Other than that, we find that people actually.

Patient with the fact that it’s natural. And the only other thing is, do you have

Bree: the image from Caitlin that you would no. So if you don’t mind emailing us a photo of you we’ll use it to advertise on social media. We can’t really pull them from your Instagram page because the quality is really low.

So if you just choose one, any with your family, you’re working in practice, whatever you feel like is fine. You’ve seen

Caitlin: the podcast covers. So you know, the style that fits into that little bit perfect. And then you also know the style. So if there’s anything in that launch day that you want us to include, we always tag you.

But if there’s anything in particular that you want in the show notes, then ideally before Monday afternoon, like Monday 7:00 PM or something, cause I’ll normally have everything loaded up, ready to go and it scheduled Monday night and then I just get Brita. Double-check it. So anything you think of in the next 48 hours that you want added in to show notes or to the launch?

Or what have you just send us through? We’re pretty

Bree: flexible. Perfect. Beautiful. Thank you so much for your time and making this possible. It was really awesome to have you on. Thanks.

Caitlin: Thanks for reaching out. I really appreciate it. This was very smooth. Yay. He to

Bree: See you later. Have a good day.

Kelly and Bree


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