Recently at DTI, our team sat down with Sara Reardon PT, DPT, WCS, BCB-PMD, founder of The Vagina Whisperer, to record one of our expert affiliate videos (coming soon to DTI members!).

If you’re not familiar with The Vagina Whisperer, TVW is an online resource for pelvic health education and virtual sessions to help people worldwide with pelvic health conditions. Reardon is also a specialist herself, working to treat pelvic floor muscle dysfunction, including pelvic pain, bowel and bladder dysfunction, sexual dysfunction and pregnancy and postpartum recovery.

In the video, we explore preparing our bodies (and our clients’ bodies) for birth—and some of the takeaways were too good not to share with the birth world outside of DTI. Read on for five doula lessons from  The Vagina Whisperer (and stay tuned for an additional expert affiliate video if you’re a member!).

1.) Introduce your clients to their pelvic floor.
The pelvic floor is a group of muscles, nerves, and tissues that sit at the bottom of your pelvis like a hammock. These structures together have a supportive function to support your pelvic organs (your bladder, uterus, and rectum), a sphincteric function to keep the sphincters closed to keep in urine and poop, and sexual function as these muscles have the vaginal opening and contract during an orgasm. During pregnancy, the pelvic floor muscles act like a hammock to support the growing fetus. As the baby grows, the hammock gets lengthened and sinks lower, contributing to less support of your pelvic organs, decreased stability of the pelvic joints, and more difficulty holding in pee or poop. Here are a few things the Vagina Whisperer told us to look out for as birth workers when it comes to the pelvic floor during and after pregnancy (and where a pelvic health physical therapist may be able to help):

• Pain, leakage, abdominal separation are not normal parts of pregnancy. Pelvic Health Physical Therapists can work with individuals during pregnancy to address pain, leakage, or discomfort.
• The pelvic floor muscles are affected in large part during pregnancy, so individuals who experience a vagainal or Cesarean birth may feel compromised in their pelvic floor function postpartum. In addition, if an individual has a prolonged second stage labor, perineal laceration, or instrument assisted delivery that may also compromise the integrity of their pelvic floor muscles and tissues postpartum.
• Pelvic Health Physical Therapists also help with preparation for birth by educating on positioning for labor and birth to minimize low back, tailbone, pubic bone, or sacroiliac joint pain, on how to properly relax pelvic floor muscles in preparation for birth, education on immediate postpartum recovery for bowel and bladder health, and returning to exercise, intercourse, and the day to day tasks required to care for baby.

2. Discuss diastasis recti with your clients and determine whether a physical therapist is needed.
Abdominal separation, AKA diastasis recti, can be common during pregnancy and immediately postpartum. However if individuals are not properly guided on how to restrengthen and restore the core after birth, it can persist, worsen and even contribute to pain or pelvic floor conditions down the line. Diastasis Recti can range from a one finger width gap between the rectus abdominal muscle bellies to a several finger width separation that demonstrates coming or gapping when the abdominal wall is strained. (We often see this when an individual is getting out of bed, a chair or exercising and visible abdominal bulge is present above the pregnant belly.) A certain amount of separation, about two finger-widths between the rectus muscle bellies, is considered within normal range. However it’s not about how wide the gap is, it’s about how DEEP. When a phsyical therapist is attempting to determine whether diastisis recti has occurred, they see if they can sink their fingers between the muscle bellies or whether they feel tension across the muscle bellies. (Tension is good.) Depending on the tension, physical therapists then help individuals properly maintain strength during pregnancy and restore their abdominal wall and pelvic floor. This can be anything from teaching individuals how to properly roll over to get out of bed, safe exercises to prevent and manage a diastasis recti during pregnancy, exercise safely and properly postpartum, and educate on the day to day tasks such as lifting baby, carrying a carseat, loading a stroller, etc that can affect their abdominals.

3. Here are a few symptoms of pelvic floor conditions that doulas may hear from their clients (and should be looking out for) during or after birth:

• a client reports pain above the vagina that is sharp or achy exacerbated when rolling over in bed or standing on while leg while getting dressed can be pubic symphysis dysfunction due to ligament relaxation
• a client reports pain in the back or lower back on one side that is sharp is felt with a deep lunge or when standing for a long time can be sacroiliac joint dysfunction due to ligament relaxation
• you observe visible bulge or separation of the abdominals in your client
• a client reports heaviness or pressure in the vagina worst at the end of the day, after exercise or when standing can be prolapse of pelvic laxity/varicose veins/swelling
• a client reports leakage of urine or poop, constipation, hemorrhoids and straining with bowel movements, incomplete bladder emptying, urinary urgency
• a client reports painful sex or painful pelvic examinations
• a client reports any numbness, tingling, or pain in the back, shoulders, thighs, pelvis, tailbone, pubic bone, SI joint
• you observe scar tissue from a previous birth at the perineum
• a client reports pelvic pain lasting > 2 weeks after birth
• a client reports painful intercourse
• a client reports urinary or fecal leakage, feel like cant make it to the bathroom in time
  constipation or hemorrhoids, straining to poop after birth
• a client reports pelvic pressure, heaviness or prolapse after birth

4. Pelvic health professionals can help your client heal after Cesarean births.
Over thirty percent of women in the United States have Cesarean births—yet few get any education or support on recovery. Pelvic Health physical therapists can guide birthing individuals on how to decrease discomfort the first few days, everything from having the first bowel movement to picking up the baby safely to getting out of bed with less pain. Here are a few tips from The Vagina Whisperer on how to help clients heal as a postpartum doula:

• Encourage gentle diaphragmatic breathing (inhale –> belly rise, exhale –> belly falls)
• After the first two to three weeks of lots of rest and recovery, recommend some easy walks outside to start regaining some strength and promote circulation and healing.
• After the initial 6-week healing period, you can start gently massaging the Cesarean scar two to three inches above and below the scar to promote healing, blood flow and decrease numbness. Progress to massaging directly over the scar—up and down, side to side with extra time on the areas that are tight or tender—and perform this three to five minutes daily to help the scar soften, flatten, and help the scar from getting too restricted (which can lead to restriction contributing to pelvic or abdominal pain, painful sex, discomfort wearing pants, and peeing and pooping problems).
• It’s never too late to work on a Cesarean scar. Whether the surgery was six weeks ago, six months ago, or six years ago, it can help. (You can recommend your client work with a pelvic floor PT for one-on-one guidance.)
• Working on a scar may also provide emotional healing. Often Reardon hears birthing individuals say “I can’t even imagine touching my scar!” A step toward connecting with the scar is to use a makeup brush, cotton swab or soft wash cloth and brush it over the scar. This helps improve the sensation (the numbness is real down there!) and progress toward doing the scar massage with your fingers. Reardon is a believer that our bodies hold onto experiences and trauma. By working on the physical tissues, we tap into the emotional and psychological aspect of that experience too.

5. Help your client prevent Prolapse.
A prolapse occurs when our pelvic organs (bladder, rectum, uterus, small intestine) droop into the vaginal walls due to weakness of the pelvic floor muscles and ligaments. This may feel like something is falling out of the vagina, a simple pressure or heaviness, a bulge at the vaginal opening (or felt when wiping), feeling like you are sitting on something or discomfort during intercourse that feels like something is hitting an organ or a wall. A prolapsed rectum (rectocele) can feel like your poop is stuck at the opening or you are not emptying all of the way, so you can’t clean your bottom all of the way or bowel movements may be painful or difficult, while a  prolapsed bladder (cystocele) feels like pressure or heaviness in the front part of the vagina, a difficult time starting the urinary stream, incomplete bladder emptying, leakage with coughing/sneezing/laughing/running/jumping, or straining when peeing. To prevent prolapse for your clients, you’ll need to provide support for the organs during pregnancy, by using an external support during pregnancy to reduce discomfort, working with your client to strengthen their muscles, and to teach birthing individuals to avoid straining.

Want more tips from The Vagina Whisperer? DTI members, look out for the expert affiliate video that’ll be released in a few months! In the meantime, check out The Vagina Whisperer on Instagram, as well as DTI’s Instagram, for more information and little lessons.