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):
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:
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:
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.