Pregnancy and Postpartum Myth-Busting with Dr. Michelle Little
An interview with Dr. Michelle Little about how Pelvic Physical Therapy can help us to better understand pregnancy and postpartum
Just before I had my fourth child, I interviewed Dr. Michelle Little about some of the most common myths about pregnancy and postpartum including exercise during pregnancy and postpartum, urinary leakage, Kegels, pain during sex, and Diastasis recti. Dr. Michelle Little is a doctor of Physical Therapy with specializations in Obstetrics and Pelvic Health and Orthopedics. She founded Women in Motion Wellness, which is an organization dedicated to helping women to achieve their movement goals during pregnancy, postpartum, and menopause. Dr. Little is a strong advocate for women’s pelvic health and shares free resources through her social media and website.
Source: Daniel Reche/Pexels
Listen to the full interview here:
Dr. Cara Goodwin: Hi everyone, welcome to the Parenting Translator Newsletter and Podcast. I'm Dr. Cara Goodwin and I am excited today because I am here with Dr. Michelle Little. Michelle is a Doctor of Physical Therapy who specializes in orthopedics, obstetrics, and pelvic health. She is the founder of Women in Motion Physical Therapy and Wellness, which is an incredible organization dedicated to helping women achieve movement goals and stay strong during pregnancy, postpartum, and menopause. She is also my personal Physical Therapist. I first went to see her in June 2020 right after having my third baby when I had neglected my own care to the point that I could barely walk and I was having such severe back pain that it was hard to function. She really helped me not only to recover from not being able to walk to getting back to running regularly. Michelle, thank you so much for being here. Could you please introduce yourself and tell us a little bit about why you started Women in Motion?
Michelle Little: Thank you so much for having me here today. I started Women in Motion in July 2020 officially as a brick-and-mortar clinic. I really saw a huge need. My work started in orthopedics. I worked a lot with runners. That's really something I'm passionate about and I noticed that a lot of women, after having kids, were having issues with leakage, prolapse or just pain and dysfunction in the pelvic girdle area. Even though I had all this training and a doctorate in physical therapy, we received no education on the pelvic floor. I thought I would take a weekend class and call it a day, but I just realized that there was so much more to learn. That's when I pursued a post-doctorate in Obstetrics and Pelvic Health
Dr. Cara Goodwin: That's amazing. I think that there are so many myths and misconceptions related to pelvic PT, especially when it comes to pregnancy and postpartum, which is something almost every woman who is a mother is dealing with. Can you explain what pelvic PT is and why there are so many myths and misconceptions? It wasn't until I got to a desperate point and finally went to meet with you that I learned a lot about pelvic PT. Can you explain to us what is pelvic PT and why isn't this something that more women know about?
Michelle Little: Pelvic health really encompasses all genders, all phases of life. When you think of the term pelvic PT, thanks to social media, we see that there's a lot of advocacy in the prenatal and postpartum period, but clinically I treat all genders, all phases of life. That encompasses anything--pee, poop and sex. I always tell people it includes any bladder dysfunction, sexual intimacy dysfunction or bowel dysfunction. Why I think it's not so well known, is that there's really two layers to this. First, I think generationally, we have been taught to not talk about that stuff. Those are taboo topics. When we're among our friends, if we have a really great pair of skinny jeans that we like, or we love our hairstylist, we tend to share that. But talking more about if someone is having pain with intimacy, or maybe they're having some bladder, bowel incontinence aren't things that we regularly talk about. And second, for most of our history, there was no research being done on women. It wasn't until 1993 that the NIH passed a law requiring women and minorities to be included in clinical research. We have this whole generation of medical providers trained before then and pelvic PT didn't exist back then. In some parts of our country, pelvic PT still isn't accessible. I think that also makes it where it's taboo to talk about and access is a big issue in our country.
Dr. Cara Goodwin: I can see that. I'm so glad that you're breaking these taboos. On Michelle's Instagram, which is Women in Motion Wellness, she talks a lot about things that you may not have heard anybody talk about, like pain with sex. I think it's so important that you're breaking the taboos, you're breaking the stigma, you're getting this information out there. Let's start with pregnancy. I remember being pregnant with my first child. Like any dutiful first-time mom, I read all the pregnancy books. Some of them said exercise as much as you want— run a marathon if you want. Some of them said, do not exercise at all unless you want to hurt your baby. There's all of this conflicting information. Can you help clear that up? What is recommended when it comes to exercise and pregnancy?
Michelle Little: Absolutely. I always default back to ACOG--the American College of Obstetrics and Gynecology. When we look at their guidelines, they recommend 30 minutes of exercise, five days a week during pregnancy. In general, what they say is any exercise that you were doing pre-pregnancy, you can continue doing throughout your pregnancy.
Where we run into some complications is when women start to develop aches and pains. You’re absolutely right. What I hear clinically are women that will have pubic symphysis pain, SI joint, or low back pain, and they're being told things like that's normal, you're pregnant. I think it’s important to really identify that there's a difference between something being very common and something being normal, right? It is not normal to experience pain. In general, what I tell patients is, if you have any pain or dysfunction that is keeping you from participating in those thirty minutes of exercise, then that's something that needs to be addressed. Because we know that those recommendations and guidelines are set in place to reduce the risk of us developing comorbidities during pregnancy— things like gestational hypertension or gestational diabetes.
So thirty minutes, five days a week. Sometimes that could be running. And for some people, especially if you're in Charlottesville, pushing a stroller, if you have a child already, up a hill, like that could be moderate intensity exercise. The level of it depends person to person, but thirty minutes is what we're aiming for.
Dr. Cara Goodwin: That is so helpful to hear. I hear from so many friends who are pregnant, I couldn't exercise anymore because of whatever pain. A lot of times, even when you ask your OB, they say, that's normal. Yes, it's normal, but does it mean that I have to tolerate this for the rest of the pregnancy and maybe have ongoing pain in the postpartum period? I think that's so helpful to know that if you cannot meet this recommendation for exercise, you should seek help.
What core exercises do you recommend specifically? Before I started seeing you and your team, I decided I'm just not going to do any core exercises because I feel like I'm just going to do it wrong. What about core exercises? What is recommended there?
Michelle Little: The core is super important. It helps to stabilize our pelvis and our low back. It's an area that I think there's just so much fear around. Pregnant women wonder, how do we move our bodies now that we have this bump? I do recommend core strengthening. I think it's really important and can play a major role in reducing the risk of low back pain and SI joint dysfunction. We're seeing newer literature coming out that developing low back pain specifically during pregnancy can increase the risk of mental health dysfunction postpartum.
Usually, side planks are a better option because they take the direct pressure off of the umbilicus, that belly button area, especially if you already know that you've developed some diastasis recti. The other thing is if you think back to gym class, most of us learned how to strengthen our core by doing sit-ups or curl-ups, but really any exercise can be a core exercise. So working with a pelvic PT that has specialty training and obstetrics can be really helpful on how you can do exercises, maybe even while standing and work your core without putting pressure on the diastasis recti if you've already developed that.
Dr. Cara Goodwin: Okay, that's really helpful. I love the research that you cited, that low back pain is related to mental health, because I think having experienced pregnancy and postpartum, three and a half times now. I know how you feel physically does really affect your mental health. I think we all can agree with that.
Speaking of exercises, what about exercises specifically for the pelvic floor? We've all heard about Kegels. Should we all be doing like a hundred Kegels a day? What's the answer there?
Michelle Little: With the pelvic floor, Kegels are just an isometric contraction. What that means is the muscle contracts, and then it relaxes. So a good analogy for that would be like, if you wanted to strengthen your arms, like let's say your biceps, you wouldn't just squeeze that muscle and relax, right? You would lift different weights, you would lift weights in different positions. We would do it functionally. The pelvic floor is the same way.
I don't really recommend Kegels. In fact, I think that clinically what I see is women that have too much tension in their pelvic floor. There's too much tightness and dysfunction. When we're trying to push a baby out, that can actually be problematic. There's a really great study that was published in the American Journal of Obstetrics and Gynecology showing that with certain push strategies, if we activate the pelvic floor, it can actually lead to a longer pushing stage or a longer second stage of labor. It just speaks to the importance of a functional pelvic floor. We want it to be strong, but we also want to be able to relax.
Clinically I recommend let's incorporate some strengthening into the program, but let's also make sure that we're doing at least one or two stretches after workouts that are intentional for down-regulating the pelvic floor. As we get closer to that 35 week mark, really focusing on that— can you relax your pelvic floor and maybe even what does a push strategy look like for you?
Dr. Cara Goodwin: That is so interesting. I've never thought about the fact that during pushing, you actually want to relax. We think about the pelvic floor, how important it is to be strong, but not that we also need to be relaxed during pushing. I'm thinking of some really common pregnancy concerns like leakage is a very common one, pelvic floor pressure— these are things that nearly, by the end of pregnancy, nearly all women are experiencing, at least of the women I've talked to. The message that we get from society, I think, is just suck it up and deal with it, and just be grateful you're pregnant. This is just part of it. Leakage, pelvic floor pressure, these things that a lot of us are dealing with— is this just a normal part of pregnancy or should we seek help and how do we know when to seek help?
Dr. Michelle Little: A lot of leakage can be a result of where the baby is. So, as the uterus is growing and moving into the abdomen, the baby is now essentially sitting on top of your bladder. That can increase the risk of specifically stress urinary incontinence. That would be coughing, sneezing, or sometimes like lifting heavy weights or running. However, again, even though that's common, that's not normal. I work with patients all the time that are having their third or fourth baby and they're still running long distances and not leaking.
To me, it's a matter of whether the leakage is keeping you from exercising. Is the fear of leaking your pants at a boutique gym studio keeping you from working out? Or are you someone who says, this happens occasionally, but I'm still going to run through it. Then that depends on whether we need to address this during pregnancy or not?
The other component is that although again, we usually think of leakage as weakness in the pelvic floor, very often that's actually a sign of tightness. A tight muscle is also a weak muscle. It could be really beneficial to see a pelvic PT to see exactly what the cause of your leakage is. Is there some prolapse that started to develop? Is there a lot of tightness in your pelvic floor muscles? Is there a pressure management issue? So how you're breathing, and again, where the baby is might be impacting where everything is sitting in our abdomen. I always tell people I don't want it to ever be stressful. I want it to come from a place of education and empowerment. If the leakage or your pain is impacting your life, then schedule a visit, get it checked out, understand why things are happening and what you can do about it.
Dr. Cara Goodwin: That's really interesting. So think about it functionally, how is this impacting your life? Are you still able to do the things that you want to do?
Michelle Little: Yes, and is it bothering you?
Dr. Cara Goodwin: That’s helpful. Let's talk about labor and delivery next. I think the common misconception here is that there's nothing you can do. It's pretty much like it’s always out of our control Is there anything that birthing people can do to improve the labor process? And this might be a big answer. If you want to just give us like a few tips here, that's great too. How do you prepare your body for birth and what can you do during labor to make this process as smooth as possible and reduce the risk of complications?
Dr. Michelle Little: Absolutely, so there's two components here. First, supporting your body during pregnancy. So for that there are areas that we want to focus on, core strengthening, glute strengthening, and posture can be really critical. If we lay down that foundation during early pregnancy, then that just helps to reduce the stress that we're putting on the bony part of our anatomy.
When it comes to birth prep, again, thinking more about relaxing the pelvic floor can really impact our labor and delivery experience. If the pelvic floor muscles are tighter, that's going to impact how our pelvis and our hips can move. When I hear cases where babies get stuck or women had a really long second stage of labor, you know, I always wonder, what was the component of that, that maybe the pelvis had difficulty opening up because the pelvic floor muscles were tighter. When I talk to labor and delivery nurses and birth providers, their number one question is, “When I have a woman in labor, how can I cue her to relax her pelvic floor?”. That's really, really hard in that moment. So being more in tune to that happening earlier on is key. Things like if you have constipation, that would be a sign that you are having trouble relaxing your pelvic floor muscles because you're not getting that stool out all at once. If you have pain with any form of penetration, that could be a toy, penis, speculum, digit. And then third, is there any kind of urgency. If you feel like all of a sudden you really, really have to go to the bathroom, then maybe you're having a little bit of bladder urgency or bowel urgency, those could all be signs that maybe your pelvic floor muscles have a little bit more tone in them.
Dr. Cara Goodwin: So if you're experiencing any of those signs, you would suggest going to see a pelvic PT before labor to get some tips for learning how to relax your pelvic floor, is that right?
Dr. Michelle Little: Exactly, exactly.
Dr. Cara Goodwin: Okay, that's so helpful. Because I feel like, especially for first time moms, you don't really know if you're going to be one of those people who has a really easy labor or one of those people who is in labor for days. Just having some clue as to the state of your body— I think that is really helpful.
All of us who've experienced birth know that in the immediate postpartum period, everything feels pretty weird and painful. It's not a very comfortable time of life, so how do we know what is “normal” and when to be concerned when maybe we should see a pelvic PT specialist during the postpartum period?
Dr. Michelle Little: I am very passionate that all women should have an appointment at around six weeks postpartum. Our bodies just go through so much during pregnancy and postpartum. We have weight changes. We have hormonal changes and not to mention the additional stress and sleep deprivation. All that impacts our body. When we're looking at going back to exercise, that early postpartum period really predisposes us to things like stress fractures and tendon pathologies because of all the weight changes and hormonal changes. I think at six weeks, everyone should get an evaluation by pelvic PT.
But the other thing to consider is, are you getting better every week? Especially during those early weeks postpartum. Everything should be feeling better each week. If you're having any burning pain, stinging pain, it's still not getting easier to control your bladder or your bowels, then that would be a sign to call your birth provider first, and then if they clear you so they don't see anything wrong with you, then that would be a good sign to move to seeing a pelvic PT. With our examination, because we do an external and an internal exam, we are able to look at general tissue healing, but also looking at overall how the muscles are supporting your body.
Dr. Cara Goodwin: I know for most mothers, at least in the United States, we don't have anything until the six week appointment, which is not ideal for so many reasons, mental health reasons as well. But if in that period of zero to six weeks, things feel off to you, it's okay to see a pelvic PT before six weeks rather than saying this is just healing?
Michelle Little: Absolutely. I would say before six weeks, usually what I'm seeing patients for is low back pain or SI joint pain. I'll have patients that can't even get out of bed because they're in so much pain or maybe they had an injury during the birth process. As a result, sitting on their tailbone is painful and that's the easiest way to nurse their baby. Again, anything keeping them from doing any caretaking activities or just living their daily life, if that's causing pain, then that's important to get it addressed sooner. In terms of pelvic floor specifically, we don't do an internal exam until at least six weeks because we need that general healing to occur. But from an orthopedic standpoint, I see patients sometimes as early as a few days post-birth.
Dr. Cara Goodwin: I'm trying to think back. I think I saw you when I was probably about two weeks postpartum. I was at a desperate place too, to call somebody because it was in the middle of the pandemic, but I could barely breastfeed. My back pain was so bad. It was really hard even just holding a newborn up to breastfeed. I had knee pain from the extra weight of the pregnancy and was having trouble even walking around. I think it's so important for women to know, if you are having trouble and having pain when caring for your baby, your pain is important too. A lot of women in the early postpartum period are so focused on the baby, but you can't be in a good mental space to care for your baby if you're experiencing a lot of pain.
Michelle Little: Especially in the United States, most women have, if they are lucky, 12 weeks off from work. If we're only focusing on the baby and not on ourselves during that time, it's like all of a sudden your maternity leave is over, you are back at work, and you're having to manage higher demands. A lot of times patients think there's always time later, but life just gets busier and then things start to accumulate. Even something as simple as carpal tunnel syndrome, early postpartum where women are having trouble holding the baby's head up or holding certain nursing positions, or they're having sciatica. All that can be addressed, the sooner the better. And again, we know the impacts of that on mental health. That's crucial.
Dr. Cara Goodwin: That's such an important point— given, in the US, unfortunately, we have such short maternity leave, you have to think about not only getting used to having a baby, but recovering yourself. It’s a hard process for so many of us. In the United States, we talked about the six-week visit. The general knowledge is absolutely no exercise until that six-week appointment. Then after you step out of that appointment, assuming you're cleared and there are no medical complications, it's like you can go run a marathon! I feel like there's a general misconception of absolutely no exercise and if you're cleared at that appointment like you're free to do whatever you want. That just does not seem right to me. Can you explain to us what the real recommendation is? What does the research really say about when you can resume full activities?
Michelle Little: Yes. Part of the problem is that we don't have enough research and that goes back to we haven't been studying this long enough. But it's crazy. If you have anyone in your life that's had an ankle sprain, they probably went to their primary care provider. If it was a bad enough ankle sprain, maybe they ordered x-rays and then they did physical therapy anywhere from six weeks to 12 weeks. That's for an ankle sprain, right? That's like one event where someone rolled their ankle walking down the street. Yet, we know during pregnancy we have all these changes our bodies go through. And then, magically at six weeks, you can go back to whatever you want. I just think the research hasn't caught up in women's health.
But that's not what we recommend. Again, understanding how to properly load your muscles, load your tendons, load your bones is so important. I especially think about that in my runners and women that are lifting weights. We need to consider when was the last time you ran--forty weeks of pregnancy, thirty-seven weeks, or your first trimester? With a typical athlete, if they haven't been conditioning for several months you wouldn't say, “Let's go run five miles.” That's the expectation that women have at six weeks postpartum when they're getting cleared for all activities. So having an assessment, understanding your body strength, and how you're healing is really important to work on a return to exercise program. Six weeks is a good time to start. Honestly, I work with a lot of patients that have a pretty smooth delivery and want to start moving their bodies earlier. I'm also an advocate for that. Exercise can look different, like it might just be like gentle core engagement, you know, gentle postural exercises. I don't think that six weeks is a magical timeline that we just start cleared for everything.
Dr. Cara Goodwin: If you are feeling up for it before the six week mark, can you go for gentle walks and ease into that exercise?
Michelle Little: We absolutely encourage that. I think walking is a great way to ease into it. I always educate patients, our babies should be doing tummy time. So that's a great time for us to be doing some gentle core retraining and glute activation with more floor or mat exercises. But big guidelines, if anything you're doing is increasing your bleeding or is causing you pain, obviously call your provider and that's when having a program from a skilled pelvic PT can be really helpful. But in general, it's not like doing nothing for six weeks and then jumping back at everything.
Dr. Cara Goodwin: Yes, and I know from my experience, from working with you, that strengthening your core in those early weeks can be so helpful for back pain. Every time I started breastfeeding my baby, it did cause a lot of back pain, because, especially in the middle of the night, you end up in postures that are not ideal. I think that if breastfeeding is painful or if holding your baby up is painful, it's hard to be in a good mental space.
Michelle Little: I've been so humble this time. I'm almost five months postpartum and Mia, my daughter, is 24 pounds and Daniel, the baby, is 20 pounds. He's massive. That's a big baby I'm carrying around all the time and my toddler now also wants to be held more because she sees me holding the baby so there's been so many times when I'm holding both. I remember even those early weeks coming home from the hospital when they say don't lift anything over five pounds. But all you want to do is hold your baby. Then I wanted to hold my toddler. I wanted to put her in the crib, pull her out. And I thought, every time in my head, “Oh my gosh, this is 24 pounds I'm lifting.”
Dr. Cara Goodwin: Yes. I think about that all the time because I still hold my three-year-old and I'm 33 weeks pregnant and I know this is not good for my back. This is going to cause me pain later because I have to hold him in such weird positions now. But as mothers, it breaks my heart to say no to the three-year-old that I can't hold him anymore. These are important things for us and it's not a simple answer, just like, don't do that. You know, it's more complicated.
Michelle Little: Yeah. And it's not just exercise, right? Our lives as mothers include lifting all day. You know what I mean? There's like groceries or our kids. That is exercise, right? We're lifting all day.
Dr. Cara Goodwin: It's a very physical job. There's no way around that. Something else I think is so bizarre is that at the six-week appointment, you get this exam and they say you're cleared for sex. Or assuming everything's okay, you get cleared for sex. And it's kind of like, after all you've been through in the past, it's almost like, are you sure about that? Are you sure that's okay? What are your suggestions for women who are trying to restart intimacy after the six week appointment? Is it normal for it to be painful? How do we know what is normal and when to seek help when it comes to sex?
Michelle Little: It is never, ever normal for sex to be painful. I think that message really needs to get out there. Women are often being told by their providers, “It's because you just had a baby, or use lubricant, or just relax a little bit.” That's really doing a disservice to figuring out why that individual is having pain. Thinking about if they had any kind of tearing during the birth, has that tissue completely healed, or is there some delayed healing or granulation tissue that has developed there. We can treat that. The other thing is, is there scar tissue? Is the scar tissue impacting the ability to have penetration? Or is it truly just hormonal? Or there's some atrophy of that vaginal wall causing pain?
To me, we can't just make a blanket statement that something is normal and not diagnose it, or at least give that woman the opportunity to get it treated. That could be getting pelvic PT, maybe getting topical estrogen, or if there's granulation tissue, there are different things that they can do to help address that tissue. I am a big advocate for if you're having pain, understand why, seek answers, because it's not normal to have pain.
In fact, like I treat a lot of male patients at the clinic where sometimes sexual dysfunction is one of their primary complaints. They always will seek care. They're calling our clinic, trying to get on the cancellation list to get in sooner. It makes me really sad when I talk to a woman that's been having pain with sex. Usually when I ask them like, when did this start? They'll say something like, like five years ago, my whole life. Very often they can even track it back to trying to insert tampons in high school, like that being painful. It just speaks volumes that amongst women, we're not talking about this and we're just normalizing it. Most women tell me in the clinic, “I didn't know that it wasn't supposed to hurt.” And that's sad.
Dr. Cara Goodwin: I think it's almost a common misconception that sex is just painful after having children. I think that's such an important point that you should never have to put up with pain. This is not an activity that's supposed to be painful for you and that we should not be ashamed of. I think a lot of it comes from the stigma around sexuality in women and we shouldn't be ashamed to seek help for those concerns.
Michelle Little: It can be a really big part in a relationship. So that's another thing I see with patients that's really important to them and their partner. And when those concerns are being minimized or they're being told that that's normal, that can have really big impacts on that relationship. So if that's something that's important to you and you're having pain, at least understand why, understand what's going on, and then you have the choice. Like mentally, am I in a state right now where I want to treat this or are there other priorities right now, but that's our choice to make as women, not a provider to tell us.
Dr. Cara Goodwin: Yes, that's such an important point. The other topic I really want to talk about is diastasis recti, which is abdominal separation. I'm sure you could explain it better than me. But it's extremely common. I know I've experienced it during my pregnancies. And I've read that it can occur to two out of three women. It's something that's extremely common, but I never heard about it until it happened to me. I've never had an OB screen for it. Can you explain what diastasis recti is and is there anything we can do to fix it if we do experience it?
Michelle Little: Diastasis recti is thinning of the tissue that connects our front abdominal muscles. As the baby is growing, it’s normal that the tissue stretches, right? That is what happens. The tissue starts to separate. Now, when that becomes problematic is when the tissue stretches to the point that it starts thinning. That is when we start to see that there are more symptoms correlated with it, like low back pain, hip pain, pelvic girdle pain, pubic symphysis pain, because the abdominal muscles are having difficulty stabilizing our body. It is just thinning, it's not an opening. That's important because hernias are also really common during pregnancy and postpartum. The strong distinction there is that diastasis recti in itself, there should be no pain in the abdominal area. If you cough, sneeze, poop, lift something heavy, it shouldn't be painful. If it's painful, then we're screening more for hernias.
In terms of what we can do about it, is being proactive and building up our core during early pregnancy can really, really help. My first trimester with my daughter, I was throwing up multiple times a day. I was super sick. I had this idea of being super fit during my pregnancy. I could barely make it to work. By the time I got to twenty weeks, I remember having one of my therapists check me and I had almost a four-finger separation at twenty weeks. I started doing lots of intentional core strengthening. By the time Mia was born, I had it back to one finger and in six weeks postpartum, there was no diastasis.
I think an important point is like, yes, it's super common. That's part of the natural give that the body does as babies grow, but we can improve that even within pregnancy. And again, the core is so important to support the rest of the body. Just having a good group of exercises that are strengthening that area and aren't making things worse.
Dr. Cara Goodwin: Okay, that's so helpful to know that even during pregnancy this is something you can work on. I think I’ve heard about women getting surgeries to fix diastasis recti, but I think it's so important to know that you can improve on this through physical therapy. Surgery is not your only option and you don't have to wait until after you have the baby to address this.
Michelle Little: I've had patients that have done a tummy tuck or they've decided to do like plastic surgery in that area. That’s awesome if that's what you want to do, but still invest in the physical therapy piece because the surgery isn't going to fix the muscle including how thick the muscle is and the quality of the muscle there. But even if you decide to do surgery, the work that you put into building up those muscles will only make the surgical outcomes better. But I will say, I've worked with moms that have had multiple babies, like twins or triplets, and they have ten finger separation. And it might take a year or longer, but we can usually get that back within two or three finger separation. Then if there's extra tissue and cosmetically, they want to address that, great. But now you've built up your strength and that's what's actually going to support your body. For surgery, it's just going to make it pretty.
Dr. Cara Goodwin: That's a really good point that maybe surgery isn't even the best answer. We need to think about the muscles as well. So the final myth I want to address is why is pelvic PT so important? I feel like a lot of the issues we've talked about are framed by society as aches and pains that women are just supposed to deal with. This is just part of being a woman and if you chose to have children, you should just deal with this. So can you explain why it's so much more? Maybe give us, all of us mothers out there, like a little bit of motivation to take care of ourselves because I think we all really need it.
Michelle Little: Absolutely. It's never too late. I just want to get that message out. If you're listening to this and your babies are in high school or going to college, or you’re a grandma, it's never too late. Public health matters through all phases of life. And to add a little bit of drama to that, I did some PRN weekends at a skilled nursing facility and it was a really humbling time period where if you talk to individuals that are older or in a skilled nursing facility, their biggest thing is they want to be independent with peeing and pooping. They don't want anyone wiping their butts or taking care of them in that way. Yet their biggest risk factors are falls. They're rushing to the bathroom, right? We want to reduce the risk of falling. That just tells you how important public health is at all stages.
The pelvic floor muscles are the only muscles that attach our hips front to back and provide full stability for our entire body. They are also directly related to pee, poop and gas. Those are really big things that can impact our lives. I am a big advocate if something feels off, whether you feel like you have to pee too much or you're leaking urine, or you're seeing streaks of poop in your underwear, or it's hard for you to control your gas, or it's painful to be intimate, or it's painful to get a speculum exam and you find yourself delaying those gynecological exams, because you're dreading that speculum going in, those are all signs that you would really benefit from seeing a pelvic PT. And if you can find a pelvic PT that also has an orthopedic background, as all of our therapists at our clinic do, then that's magic because really, after having babies, the next big stage that every woman is going to go through is menopause. As we go through menopause, we lose our estrogen. That's going to impact our bone density, our cardiovascular health, our vulvovaginal health, and so working with a therapist that isn't going to look at your back pain as just not just like anyone's back pain, but take into account where you are on your women's health journey is so important.
Dr. Cara Goodwin: Yes, that's such an important message that this is going to impact us for the rest of our life. These aren't just postpartum issues. These aren't just pregnancy issues. These are functions that we need for the rest of our lives. I just can't thank you enough for all this wealth of information. I feel like I continue to learn so much from you every time I talk to you. Can you tell the listeners where they can find more resources, if they want to know more about this? How do you find a pelvic PT in your area? What do you do if you feel like you need more help with this?
Michelle Little: Absolutely. In most states in the United States, you can see a Physical Therapist through Direct Access. So specifically in Virginia as of right now, we have thirty days of Direct Access, but starting July 1st you will no longer need a referral from a physician. The goal with that is to reduce the barriers and how long it takes patients to get an appointment. You can go to either theacademyofpelvichealth.org or American Physical Therapy Association | APTA. Both of these options have a button where you can click and it says find a PT, and then you can search by specializations.
I always recommend, if you are pregnant or postpartum, then the magic therapist would be pelvic health trained, obstetrics trained, and orthopedics, especially if you are someone that wants to get back to exercising or running. But there’s also just a great website to have on your radar as we're having babies and maybe they're having motor delays or have an older parent that needs specialty care. So that's apta.org, American Physical Therapy Association. When you're searching there, you can search by zip code, you can search by specialization. Looking at those specialties is really important because most of us will choose a provider that's convenient and close to us. But really, you're going to pay no matter where you're going, so it's important to see a provider that has the specialties that can best meet your needs.
Dr. Cara Goodwin: Okay, that's very, very helpful. I know that you provide a lot of free resources on pelvic PT and a lot of other important topics on your Instagram and Website. Can you share those as well so the listeners can find more information about you?
Michelle Little: You can find us on Instagram @WomenInMotion_Wellness. You can also go to our website, womeninmotionpt.com. Our clinic is in Charlottesville, Virginia, but we also have virtual services and we have two online classes. We actually have a prenatal and a postpartum class. I spend lots of time on social media creating free educational content and then frequently do free seminars in person at our clinic, as well as online via Zoom. So educating the public is something that I'm super passionate about.
Dr. Cara Goodwin: Thank you so much. I think providing those free resources for the public is so incredible. I can speak from my personal experience that all of the resources you provide are just so helpful for mothers who are experiencing these issues and want to learn more. I cannot recommend Michelle's Website enough and they're just a wealth of free resources there. Thank you so much, Michelle. I really appreciate you having you here and I've just learned so much and I can't thank you enough.
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Welcome to the Parenting Translator newsletter! I am Dr. Cara Goodwin, a licensed psychologist with a PhD in child psychology and mother to three children (currently a 3-year-old, 5-year-old, and 7-year-old). I specialize in taking all of the research that is out there related to parenting and child development and turning it into information that is accurate, relevant, and useful for parents! I recently turned these efforts into a non-profit organization since I believe that all parents deserve access to unbiased and free information. This means that I am only here to help YOU as a parent so please send along any feedback, topic suggestions, or questions that you have! You can also find me on Instagram @parentingtranslator, on TikTok @parentingtranslator, and my website (www.parentingtranslator.com).
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I have read so many great interviews on Parenting Translator but this is by far my favorite! I only wish I know about Dr. Little's work after the birth of my children. Everything she says makes so much sense and is so needed in maternal care. I still find it appalling that after the birth of a baby, which is a major event for the human body, mothers are not seen until six weeks as the standard of care. A pelvic consult and follow up should be part of birth follow up to eliminate current and future medical problems.