Episode 240 Abby's VBAC + Choosing Your Birthing Location

Abby Inman is a pelvic floor therapist, a soon-to-be mother of four, and one of the authors of the book Baby Got VBAC: An Inspiring Collection of Wisdom for Better Births After Cesarean. Located in Milwaukee, Wisconsin, Abby is advocating for hospital policies to make pelvic floor therapy more accessible to all birthing women. As a VBAC mom herself, Abby talks with Meagan about why every woman should have a pelvic floor physical therapy consult in the hospital before going home. Abby also tells us some obvious as well as more commonly missed signs indicating that you could benefit from pelvic floor physical therapy. Additional LinksBaby Got VBAC: An Inspiring Collection of Wisdom for Better Births After CesareanAbby’s WebsiteHow to VBAC: The Ultimate Prep Course for ParentsThe VBAC Link Facebook CommunityFull Transcript under Episode DetailsMeagan: Hello, hello you guys. This is Meagan with The VBAC Link. I apologize that I sound a little hoarse today. I have totally caught a darn bug. I have been trying to get away from it all year not getting sick and apparently, I couldn’t get away with it. So here I am. I sound kind of froggy today but that’s okay. We’re still going to carry on. You guys, we have our friend, Abby, with us today and I’m really, really excited because I was just telling her before we started recording, she is just a big ball of everything. She’s got a lot of amazing things to talk about and share so it is such an honor, Abby, to have you on our podcast. Abby: I am so excited to be here. Meagan: Yes. Oh my gosh. I just want to talk a little bit even before we jump into the review. I don’t want to talk too much about your story because I want to give you all of the time but have you guys heard, Baby Got VBAC? Have you guys heard of that book? If you haven’t, go check our highlights or on our blog because we have it on there and it is such an incredible, uplifting book. And guess what, Abby? I don’t know if you know this. I don’t know if you were actually the one that contacted us, but forever ago, someone contacted Julie and me about being in this. We had so much going on. We were in our course and we were like, “We can’t take anything more on,” and we declined the opportunity and now we are kicking ourselves in the pants. We’re like, “Dang it. We should have been in this incredible book.” It has so many incredible people and stories and information in it. I mean, it’s amazing, right? Do you want to tell us a little bit about it?Abby: Yes. Baby Got VBAC. I don’t exactly know what is the subheader. It’s like, “A Collection of Wisdom for Better Birth After Cesarean.” Meagan: Yeah. “An Inspiring Collection of Wisdom for Better Birth After a Cesarean.” Abby: And it was the brainchild of a VBAC mom herself who is also a writer and an independent publisher, so she just got us all together, found us likely through various social media channels as things are done these days–Meagan: Yes, yes. Abby: And yeah. It’s a combination of VBAC stories from all different kinds of people as well as some awesome chapters done by various birth professionals so some birth educators, some doulas, some chiropractors, PTs–Meagan: Brittany is in it and we love it. I’ve taken her course. She’s on our podcast. She’s in it. Brittany Sharpe, yeah. Abby: Her chapter is awesome. So even though the stories are all VBAC stories, I mean really, a VBAC is the first time going through the whole process and having a successful vaginal birth so I also think it’s a great resource for first-time parents who haven’t necessarily had a Cesarean in their past as well. Of course, it’s awesome for if you’re preparing for a VBAC. Meagan: Yeah. I love that you touch on that. We talk about this on the podcast. This is a VBAC-specific podcast. We discuss vaginal birth after Cesarean, but all of us on this podcast– I’m telling you, except for maybe the providers are people who haven’t had a Cesarean, but all of us were in that spot of preparing and had these Cesareans. It is a way to learn how to avoid a Cesarean, your options for birth, your options for location, and all of that. So yes, it is VBAC-specific, but just like this book, it is for all parents that are expecting and working and wanting to learn and grow their education. I love this book. It’s amazing and it’s so fun to have you today on the podcast. Review of the WeekMeagan: Before we jump in, we have a Review of the Week so I want to hurry and review this and then I will introduce you. Abby: Sounds good. Meagan: Okay, guys. This actually came in 12 days ago via email and this is from our friend, Jessica. She says, “Hello, VBAC Link. I wanted to write about my appreciation of The VBAC Link Podcast. I had a C-section in September 2020 due to an arrest of descent. It definitely affected my postpartum mental health. When I found out about being pregnant in July 2022, I Googled VBAC resources and found your podcast. I signed up for your emails, read your blogs, your Instagram, Facebook page stories, and listened to your podcast on my morning jogs and walks. I cried. I smiled. I empathized with the moms telling their stories and more importantly, learned so much. I followed many of the tips from you and the moms. “On 3/14,” which was not that long ago from the day that I am reading this today, “I was on my morning walk listening to the last VBAC Link episode and switched to my birth music playlist. Five minutes later, I started having contractions. After getting home and calling my doula, my husband took me to the hospital and I was able to achieve my VBAC and had a baby girl. Thank you for setting up this resource. I will continue to listen to the stories even though I don’t plan on having more children. I love the stories, the information, and all of the passion for helping women like me. Thank you, Jess.” Oh my gosh. Jessica, congratulations on your VBAC, and a little part of me is so happy that we got to be a part of your birthing day. That is so awesome that you were listening to these amazing stories and went into labor. So congratulations, Jessica, and yes. Just like Jessica, you guys can too. You can VBAC too. Just like she said, we have blogs, Instagram, and Facebook. We even have a private Facebook group so if you are looking for a special space that is protected and filled with people just like you wanting to learn more about your options for birth after Cesarean, head over to Facebook and search “The VBAC Link Community,” answer the questions, and then we will get you in so you can start learning. Abby Inman, PT, DPTMeagan: Okay, Ms. Abby. Abby: That was awesome. Meagan: I know. Wasn’t that so awesome? That was such an awesome review. I got it and I just left it in the inbox unread because I’m like, “That’s going on next week’s podcast.” It was so amazing. I was like, “Oh my gosh.” And we love reviews. We love the reviews so I always encourage people. Maybe you don’t want to drop it on the podcast app. That’s fine. You can send it in an email, but we would always love a great review so that we can read it on the podcast because it makes me smile so much. So much. I remember when Julie and I were together, we would get a review and we would just be texting. Our cheeks would hurt. They would hurt because we were like, “This is what we are wanting to do. We are wanting to inspire and motivate people to find their options,” because so many people around the world feel that their options are taken away or that they are robbed of them and that is not how we ever want anyone to feel. I do feel that through this podcast, you get to learn your options and you get to take back that power that maybe once was lost. Abby: Mhmm. Meagan: So oh my gosh. Well, Abby. You guys, I tell ya. She is just a ball of it all. She is involved in pregnancy and postpartum and pelvic health, writes in a book, and teaches classes. She works in the hospital system. Abby, you’re just amazing. I’m going to turn the time over to you. You’re in Milwaukee, is that right? Wisconsin? Abby: I am. Meagan: Tell us it all. Share your story. I would love to know more about working in the hospital system and teaching birthing classes and stuff like that as well. You guys, she does this all while having little kiddos and is expecting. So seriously, good on ya girl. You’re killing it. Abby: Yeah. I like to describe my life as beautiful chaos. Meagan: I love that. Yes! Can I just take that with me and be like, “Yes. Beautiful chaos. That is what I live.” Abby: So yeah. I am a physical therapist. I specialize in pelvic health. I’ve been doing that for almost 8 years. Crazy how time goes by. Nobody at the time that I was going to PT school goes into PT school thinking they want to do the pelvic floor. People definitely do because it’s becoming more common which has been such an awesome progression in the 8 years that I’ve been doing this. But I was lucky in that I was able to do an internship in pelvic health before I graduated which again at the time was super rare. I’ve been treating, again, in pelvic health my entire career. Really now though, my specialty or even my niche is pregnancy, birth, and postpartum just because that’s the season of life that I’m in and just where my passion is drawn and where there is such a need. I could for sure argue that there’s a need for all pelvic health, but this field is growing so there are a lot of other people doing all pelvic health and there are not quite as many people focused pretty fully on pregnancy and postpartum and just that specific time. Meagan: Yeah. I was talking to a friend of mine the other day and you know how we have a six-week gap like, “Oh, you have your baby. Okay, see you in six weeks! Hope you’re doing okay.” The two things that I wish that we could fill the gap with are mental health and pelvic PT. Abby: Yeah. Meagan: Right? There’s such a gap that needs to be filled so it’s so good to hear that there’s a little bit more and that it’s starting to come around where people are focusing a little bit more on pregnancy and postpartum. Abby: Yeah. I have a lot of theories about different things related to how we get here but I just think that there is still this saying, “It takes a village,” but a lot of people really don’t have the village–Meagan: I know. Abby: I think that’s what has created the gap. You used to have your other female relatives around who would make you dinner and help you with your baby. Obviously, we just have to live in the reality and that’s why people need help and need services because that’s just not the norm anymore. Meagan: It’s not and we’re expected to just bounce back like, “Oh, you had a baby. Okay, great. Keep going as fast as you can.” That’s how it feels. We just had a mom hire us for 80 hours of postpartum and I was like, “Wow. That’s amazing that you are focusing so much on your postpartum.” She’s like, “I want continuous for 80 hours,” and we’re like, “Great,” so we made this work because her mom is from Korea. She was like, “People don’t leave their bedroom. They don’t leave their bedroom. They are with their baby and just like you said cleaning the house and making food,” but here we are. So many of our birth stories, our couples, and our parents, literally have to go back 3 weeks later to normal life or work. Abby: I know. It’s crazy. That’s not normal. It’s not how it was meant to be. Yeah. I work at a hospital-based clinic part-time and one of my projects is just now really coming to fruition. We’re still in the pilot phase but we’re already seeing really great results and an increase in referrals and again, these are people we would have otherwise not seen. The program is for a PT to see moms in the hospital before they go home, not necessarily as a rule, not as, “You can’t go home until you see the PT,” but just as a support service. We started it to be a standard or trigger a referral for anyone who has had a Cesarean and anyone who has had a third or fourth-degree perineal tear. I mean, obviously, this is The VBAC Link so we talk a lot about the birth after the Cesarean, but a Cesarean is a major abdominal surgery. Some people, of course, are expecting it and have been through it before and that obviously makes it easier a little bit because you know what is going to happen, but there’s just about no other surgical example that you can compare to the care of a Cesarean. It’s possible that you could have an appendectomy and see a PT in the hospital before you go home. Such a benign procedure is often done laparoscopically now. There is just nothing that compares to the gap in care after a Cesarean. It’s literally like, “Oh, we just cut open several layers of your body.” Again, whether you were expecting it or not, you’re also just recovering from being pregnant or if you labored at all and then having this major surgery. Oh, and you’re going to stay here for two days or three days, but now you have to take care of this other human. Meagan: Yeah. Yeah. But don’t forget to take care of yourself. Abby: But also, here’s no direction about how to do that. Meagan: Exactly, yeah. Abby: That’s slightly not fair because I don’t mean to imply that postpartum nurses–Meagan: They send you with nothing. Abby: Yeah, that they're not doing their job or taking good care of you. It’s actually that I’m making the argument that it’s why there is room for this kind of program because PTs are movement and rehab and recovery experts. That is what we do. That’s what we are trained in. All PTs graduating now are doctors in physical therapy. I have a doctorate. Just like your dentist is a doctor, I am a doctor. Like I said, it’s really an expertise in this area of care and that’s why we’re just the most well-equipped to do that. You don’t have to actually even be a pregnant or postpartum or even really pelvic health trained PT to do this work. You could be a hospital-based acute care or inpatient therapist it’s sometimes called because you really teach people the same sort of things that you would teach your other patients in the hospital like early things about scar tissue healing and scar tissue work. Meagan: Scar tissue massage. Abby: How to lay flat in bed because guess what? You’re going to have to lay flat in bed when you go home but sometimes they don’t even do that. Meagan: And then how to get up. Abby: That’s right. For sure how to get up, how to hold your baby when you walk, if you’re having pain, how to go upstairs. Again, if that’s painful, what to do? Just really practical things that people are going to have to do after they are discharged from the hospital and go home. I just think it is invaluable. Obviously too then part of our program is to at least get the scheduled for outpatient pelvic PT as well to make that transition really seamless. So yeah, it’s been really cool. So far, it’s going well. Meagan: That’s awesome. So awesome. I hope that all around the world, a program like this can be implemented as a standard, just as a standard thing because like you said, it’s invaluable. I also want to say that my nurse and my doc sent me home with a paper that was like, “Keep your wound this. Keep your wound that,” with wound care and instructions like, “Don’t lift more than 10 pounds,” and stuff like that. That is so wonderful but no one told me about the things I was going to feel or even encouraged walking. Abby: Or breathing. How to breathe.Meagan: Or breathing. It wasn’t encouraged. Yeah, get up and go to the bathroom, but it wasn’t like, “Get up and move as much as you can within a certain range and that’s going to help recovery and breathing and scar massage.” Never. Not once in either of my C-sections did anyone ever talk about the adhesions that could happen and the scar mobilization and things like that. That is where it lacks. We just lack so much so I would love to see programs like this happening all over the world. So if you are listening and you are in the medical world, this is something that you could try because it is so important. Abby: I’ll send you some articles that are being published about it. There is just a handful of PTs who are really pioneering this work and again, trying to get stuff published because obviously, that’s how it works in this medical world, so yeah. Just to have some scientific journal articles. Meagan: Yeah. We’ll drop them in the show notes too. Awesome. So yeah. You’ve got the PT. You’re influencing this amazing program. You’ve had a VBAC. In the book, you talk about– and this is not word for word what you are saying– recognizing your birthing plan and then also recognizing your birthing location and making sure that they match because if you are wanting certain things and then you choose– say you want an epidural. You’re not going to have a home birth. You’re not going to have a birth center birth. Maybe you’re like, “I absolutely do not want to be induced with Pitocin. I don’t want it to be discussed,” then a hospital birth may not be your best option. I want to also say that sometimes it is possible to avoid that, but it doesn’t always go super easy. It’s often times where you have to fight about it. So yeah. I would love to know if there are any highlights of your birth story or talking about birthing location and how it impacted your– remind me, you were induced with your first for, was it IUGR or was it preeclampsia?Abby: Yeah, I think it was a pretty common story. I was trained in pregnancy, pelvic floor, and postpartum before the first time I got pregnant. I had taken some coursework about all of this stuff so I don’t want to say that I was cocky at birth, but I felt like I knew more than the average person. Meagan: Confident. You were confident. Abby: But as we know, birth is a very humbling experience. My first daughter was, I think I went to my 38-week appointment and I had been measuring fine. Her 20-week ultrasound was fine. I don’t think I had another one since then, but it was 38 weeks. My OB did the portable ultrasound to see if she was vertex. I don’t even know. I really should probably ask her. She probably doesn’t even remember at this point because my daughter is about to be five. She saw something that she didn’t like. Her suspicion was that maybe the amniotic fluid was low or something. So she wanted me to have a real ultrasound which I ended up doing. All of those things came back fine. The blood flow was fine. My fluid levels were fine, but of course, they measured her as well in the full ultrasound and they said that she is very small and we don’t know why. That was their reason for wanting to induce me. Again, being the stubborn person I am, I was scheduled to give a presentation at the Wisconsin State PT conference later that week. I was like, “Well, I’m not staying to be induced because I have a presentation to give in four days so I’ll do that and then we’ll talk. I’m not having a baby before then.” I’m sure my team already didn’t like that so I gave my talk on Friday and then we went for the non-stress test on Saturday afternoon and that’s when they told me, “Yeah. You should stay and be induced.”I was really not super early or anything.Meagan: Two weeks?Abby: Yeah. That was a Saturday, so she would have been 39 weeks on Monday, I think. But really, I mean, my induction story is just that my body was not ready. I mean, I tried to do everything I could to make it slow. It just, like I said, that’s just really what it comes down to. My body really just was not ready. I did not progress. I was doing all of the things that I know how to do and teach people how to do, but at that time, because I hadn’t gone into labor myself, she just was nestled in there. I obviously have some qualms about the saying that you hear a lot, “Well, at least you have a healthy baby and at least the mom is healthy.” That should be the low bar. That’s the minimum. That’s not the goal. Meagan: I have feelings toward that comment too. I want to be honest. I kind of want to punch people when they say that because I’m like, “Yeah, duh. Duh.” Yeah. Abby: Yeah. The birth itself again, was not necessarily traumatic in that I did actually choose. They were like, “Okay. I guess you could keep going. I’ll let you do this for however many more hours, but we’re not getting anywhere.” I was tired and just was like, “Okay. I’m just ready to meet her. Let’s have the Cesarean.”Meagan: Let’s do this. Abby: It wasn’t like she was in distress and they rushed me to the OR, so it was not an emergency in that sense, but again, just like this is going to happen whether it’s right now or in a few hours and then it probably would have been more of an emergency things just because of the timeline of how that goes. I would say that my trauma from the birth was more just mental and emotional. Yeah. Really from there, I knew I wanted to basically get pregnant again relatively soon. I knew as we were starting to grow our family, we were going to do that by several children if we could. I knew I was not going to elect to have a repeat Cesarean. So basically, my mindset was, “Well, I have to be somewhere where that’s essentially not an option unless it is absolutely necessary.”Meagan: It’s an emergency, yeah. Abby: I made the choice then when I got pregnant again. My two older ones are almost 18 months apart to the day, so also about as close as you’re supposed to have babies after a Cesarean. I chose to have my care with midwives at a birth center in town which is not an option for everyone because sometimes it doesn’t exist. Meagan: I know. Yes. We’ve got states right now taking midwives away from the hospital even. Abby: Oh, totally. That’s all kinds of crazy. I’ll get on that fight. Actually, so now I’m pregnant again. We are expecting our fourth in July and that’s why I’m still with the midwives at the same birth center and preparing for my third VBAC. Even though I’ve now had two successful vaginal deliveries, I’m always considered a VBAC patient which is just crazy. Meagan: We’re always going to be a VBAC, yep.Abby: I mean, it’s not crazy. Obviously, it’s a definition but it’s crazy that there is risk associated with it. Meagan: It’s hard to think that it’s still considered, yes. Abby: So that risk, I don’t know. I mean, I’m assuming that this is just the insurance that my midwives use but their insurance company charges them $1500 just for accepting a VBAC client. Meagan: Are you serious?Abby: Right? It’s completely insane. That’s new. That wasn’t true for my last two. It’s new for this one. So that’s crazy. Like I said, it’s a definition but it’s always going to be with me no matter how many children I have. I just think that’s one of the things that’s sort of a part of informed consent, too. You just don’t realize how that’s going to affect you. You know? Anyway, not that again, I would have chosen differently in the moment but things that you don’t think about and don’t realize are going to affect your childbearing experience for then the rest of that time. Meagan: Yes. And on the other end, could potentially affect a provider’s ability or choice to accept, right? These midwives could say, “$1500 a person, we’re not going to do this because we don’t want to up our prices,” or whatever. “We can’t take the risk that the insurance is putting on us.” Not that they're scared of the risk of birthing out of the hospital with a VBAC, but that could change. That could impact things so much as well. Abby: Very much. Meagan: Yeah. Abby: Yeah. Meagan: Interesting. It makes me sad. Abby: Yeah. When my kids are maybe a little older or just after I have this one and can think about things, after that, that’s my next thing. I need to get embroiled in the legal battles of this then I can be like, “This is totally ridiculous.”Meagan: That is what I want to do. I always say that I have a bucket list of if I have all of the time in the world type thing. I have this bucket list and there are so many things surrounding it. It’s birth. It’s where I’m at in birth. I’m even done having kids, but as a doula and stuff, I’m seeing this. I’m listening to these podcast stories and I’m like, “We need to make a change.” I’d love to start facilitating more change in policies and things like that. One day when I have all of the time in the world, we’ll get there together. Abby: We’ll get together again. Mhmm. Meagan: Yes. We’ll get together again and start to make some changes. I mean, we are moving in a forward progress. There is change happening. Abby: We are. Meagan: Okay. I’m going to bounce really quickly back to some PT. I would love to know any tips that you would like to share with your listeners. You mentioned, “Yes. We’re The VBAC Link so we’re talking about birth after Cesarean,” but what kind of PT things can we do prior to? Because I know for me I didn’t even think. It didn’t even cross my mind that I should consider a pelvic floor PT before giving birth and then of course, after having my Cesarean, again, I told you that there was nobody to tell me anything about anything and then here I go, and have another Cesarean and then even with that, nobody. So I had two Cesareans without knowing anything. Any tips for previous and/or after that you can give anybody?Abby: Yeah, so really in my ideal world, every person sees a PT in her first pregnancy and the reason for that is because your body, of course, just has to make these natural changes in your posture. Your various muscle groups have to change to accommodate the growth of the baby. That changes your center of gravity and center of motion which affects how you move and aspects of movement. Again, like I said before, PTs like me are the experts in movement. Again, it’s not to imply that somebody currently is not doing their job, but nobody else is looking at that. So right now, I would say that providers are generally pretty good about offering a PT referral, and again, with things like social media, people are advocating for themselves better as well. But they’re pretty good about putting something in if a patient raises an issue. “Oh, I’m having this back pain” or “I’m having pubic symphysis pain and I’m having hip pain. I’m having bladder leakage,” or whatever. XYZ things.Again, yes. If you are experiencing some symptom in your pregnancy like that that you think would be muscle or posture related, you should see a PT. But like I said before, I really think that everyone deserves that consultation because again, the natural changes that are happening are natural and we’re not going to stop them, but I can teach you strategies to mitigate the effects of that. How do you consciously move your abdominal muscles and the connection between your diaphragm and your deep abdominal muscles and your pelvic floor and your glutes? How are you sitting at your desk or how are you standing? Starting those things when you’re pregnant then carries over to how you move postpartum. Obviously, postpartum is a lot. It’s hard for a lot of reasons, but to also have pain or these other symptoms, any bladder or bowel/pelvic pressure sort of symptoms is just going to make it harder. Again, I really think by learning about these things consciously and applying specific strategies even if you’re the pregnant person who is exercising and running right up until the day she gives birth, that’s obviously wonderful and I support you. Maybe it’s just this one-time consultation sometime around, I usually say around the beginning of the third trimester is a good time to do it. You meet the PT. We talk about these strategies and things to implement for the rest of the pregnancy, and then now you’ve met that person and have a relationship with them, so you at least have a resource then postpartum to then be like, “Oh, Abby mentioned this could happen and guess what? It’s happening. Now I know that I’m just going to call her and get on her schedule,” instead of Dr. Google in the middle of the night when you’re nursing and all of this XYZ stuff comes up. Meagan: A lot of the time, it says that it’s normal. It’s normal to have these things. It’s like, “Oh, well duh. It’s normal. Yeah. You just had a baby. Yeah, it’s normal.” But it’s like, “No. No, no, no.” Too, I want to mention that sometimes athletes have these tighter pelvic floors and we need to actually learn how to calm and release for effective pushing so that we won’t have more damage. So one of the big things that I think is really good, even if it’s just once, is coming in and learning about your pelvic floor. Your actually pelvic floor, not just the pelvic floor in general. Your pelvic floor and learn where you’re at. Do some practice pushes and learn some breathing techniques and learn what’s normal. Learn what’s not so you’re not on Google thinking that your uterus is falling out. Do you know what I mean? It can go that extreme where you’re like, “I’m having this.” You Google it and it’s pure panic which is not going to help anything. It’s not going to help recovery. It’s not going to help our mental health. It’s not going to help breastfeeding if you’re breastfeeding because we’re stressed. It’s crazy how there’s a cycle. It’s a domino effect, so yeah. I think it’s so, so, so important as well. I wish I would have known that. I wish I would have known that.I did that with my son, with my VBAC babe, and yeah. There was a lot to learn. Abby: Yeah. You know, I mean while I’m so grateful when I get clients that are done having children and they’re like, “I’m finally prioritizing me. I’ve been having these symptoms since I was pregnant or since the birth of my first,” or whatever. I’m like, “Yes. Good for you. I’m so glad that you’re here.” But it also just breaks my heart because I really think that maybe the symptoms are not entirely preventable. The dysfunction is not entirely preventable, but potentially it could have been less. Or again, now these women have lived “x” number of years– 1, 3, 5, 15, 20 years–Meagan: I know. Abby: Like I said, I really think that early intervention is key. Again, the changes happen in your first pregnancy. Even if you don’t necessarily have symptoms in your first postpartum period. Meagan: Yes. Yes. That’s the thing. Is it possible to not have any symptoms but to have some pelvic dysfunction or pelvic issues or scarring? Especially with C-sections, I have a friend who was like, “I have never had a diastasis recti. I’ve never had pelvic floor issues. I’ve never had adhesions. I don’t have adhesions.” She’s had multiple Cesareans and is like, “I do not have adhesions.” I’m like, “Yeah. Yeah, you probably do.” But you know, she says she has no symptoms. Then sometimes I wonder, “Do you know what symptoms to look for?”Abby: Right. Are you just living with things?Meagan: Yes. Yes. Abby: Right. Obviously, yes. That can definitely be true. The symptoms don’t have to be so severe that they are really affecting your day-to-day life or quality of life. Of course, usually, people seek care when they’re so fed up with it. But there can be sneaky symptoms or again, things that people view as not that bad, I would consider as not normal. Meagan: It’s just our new normal because we had a baby and we’re being told that. Abby: Knowing where every bathroom is in the stores that you go to is actually not normal. That fact that you have a map of where the bathrooms are in your brain– now again, the same argument could be made for people that are potty training their children. But okay, they’re learning for the first time. Meagan: Or the second you walk into a store, the first thing you say is, “Where’s the bathroom?”Abby: Right. “Where’s the bathroom? I’ve got to go to the bathroom.” That’s a symptom. Again, it doesn’t have to be that way. You can change that. This was certainly true for me and I did lots of scar work and stuff, but I basically could not wear normal pants or jeans– definitely not jeans– until I was postpartum with my second, and that had been all stretched out again and everything was slightly less sensitive. That’s a modification that I made and that lots of people make. That becomes your new normal that you sort of forget about, but it’s like, “Oh, well I would just never wear jeans.” Well, that’s not normal. Meagan: Why? Is it because you didn’t want to or is it because you didn’t feel like you could or you weren’t comfortable? What types of signs? Just for our listeners because we’re in this spot of, “Do I have anything?”. What kinds of signs or symptoms would be a sure sign? If you are finding the restroom the second you walk into a store, this is a sign. Yes, 100%. Maybe we’ll go from an extreme guarantee that this is a sign to more of the subtle, hidden, could this be a sign? Abby: Sure. Meagan: Yeah. What symptoms and signs would you say for people listening? Abby: So anything obvious would be any sort of daily pain. Just pain every day anywhere. Related to pregnancy and postpartum, hip pain, low back pain, people will say SI pain which is your sacroiliac joint which is the back lower down in your butt, pubic symphysis pain, and tailbone pain. If you feel like you cannot sit on any surface for any given period of time and it’s because your but is hurting, again, not normal. Meagan: Yeah, or even pressure. I remember after I had my baby I would be standing up and I would want to sit. This is so weird, I know. But I would want to sit on the corner of something right at the vaginal opening to support it or feel my hand like, “Oh, I just look like a little girl that needs to go pee but I’m just pushing,” because I’d have this pressure after more than 30 minutes or standing after more than 30 minutes. Or sometimes even just going to the restroom, I’d be like, “Oh, I have some pressure down there.” Abby: To support it. So that’s a common symptom of the medical diagnosis we call pelvic organ prolapse so if you Google that, it can seem like, “Oh my gosh, things are falling out of me.” But again, that’s not necessarily abnormal especially in postpartum because all of those organs were shifted while you were pregnant so some of it is the settling back into place. Some of it is that your ligaments are still relaxed from again, what your body does in order for us to have babies. Some of that for sure continues postpartum especially if a person is breastfeeding, that laxity. But yeah, it’s like learning strategies about how to help that. So certainly, yeah. Pressure, heaviness, any obvious bladder and bowel stuff. If you for sure had to go change your underwear and pants after you sneezed, again, not normal. Meagan: Not normal, yes. Abby: If you’re a year postpartum or six months, a year, 18 months, 2 years, 5 years, whatever and you are one of those people that’s like, “Oh, I can’t go jump on the trampoline with my kids. I can’t run. I had to stop running.” Again, that’s not normal. We can help you. Meagan: Yeah. What about even the inability to hold your core? Abby: Uh-huh. Meagan: It’s like a big plumb line. It’s all connected. If we had this ability to maybe hold a plank or run or ride a bike and we were able to hold our core in and not feel it release and start taking pressure in our back, but now all of a sudden we’ve had this baby and we’re a year, two years, even three years or more down the line and we’re like, “Jeez.” Abby: Why do I still look pregnant? Where are my abs? Meagan: Why do I still look pregnant? Where are my abs? Why can’t I hold a plank for 60 seconds anymore when I could hold it for three minutes? Would you say that’s connected to your pelvic floor? I feel like I know the answer. Abby: Yes. You mentioned diastasis. It doesn’t matter how you say it. Meagan: I know. Everyone says it differently. Abby: That’s the condition you’re describing which again, almost everyone has a little bit of that the last several weeks of pregnancy because it’s related to the baby growing. But it’s a pressure management problem and tissue laxity, muscle coordination problem postpartum. Meagan: I recently was reviewing my op reports over some things and so talking about Cesarean, we don’t think pelvic floor naturally because we didn’t have a baby come out of our vaginal canal. We don’t think that. We don’t think about abs as much either. I think a lot of the time, even though we were cut down low, I feel like our minds are like, “I wasn’t pushing and using my abs in my Cesarean,” but listen and sorry as a disclaimer, it’s a little blunt. It’s a little aggressive. Abby: It’s okay. I mean, all of the pelvic floor therapy is TMI. Meagan: Yes. Abby: It’s a no-judgment zone and no topics are off-limits. Sometimes you’ve just got to put it out there. Meagan: Yes. I don’t want anyone to feel triggered by the words that I’m using because the words that I’m using are directly from my op reports, but this is how they describe my first C-section. It says, “The fascia opened in the middle and extended laterally with mayo scissors. Fascia was separated from the rectus muscles superior and inferior with sharp and blunt dissection. Rectus muscles were entered sharply and opened and then extended bluntly.” Abby: Yep. Meagan: And then a low incision was made above the bladder. That’s where they go on. But I read I was dissected bluntly with sharp scissors. Abby: Yep. Meagan: Right? My abdominal muscles were literally stabbed and cut through. As I’ve been reading this, this was my first C-section and she’s 11. 9 years ago tomorrow as of this recording is the anniversary of my second Cesarean, the birthday of my second Cesarean daughter. 11 and 9 years later and I have abdominal issues and I have pelvic floor issues and I’m working on things. I have pain with intercourse sometimes that I would have never related to my pelvic floor, right? And sometimes I read this and I’m like, “Well, no flipping way. No wonder I have a diastasis recti way above my belly button because I was manually cut with sharp scissors.” Listeners, I want you to know that if you’ve had a Cesarean and you’re not having any pain, that’s wonderful but that doesn’t mean your body hasn’t received trauma like this. It means it has if you’ve had a Cesarean. You may benefit from pelvic floor PT more than you ever know. And if you haven’t learned about scar mobilization and things like that, it’s time. It’s time to learn about it. So yeah. Any other symptoms? I know we’re cutting short on time, but any other symptoms that you would say to listeners, “If you’re experiencing this, go check out your local PT”?Abby: Your C-section scar can cause shoulder pain because of that word you used “fascia”. Fascia means connective tissue. It’s basically the thing that connects the whole body. Any good pelvic floor therapist is going to look at your whole body. They’re going to look at you from head to toe. People typically, you mentioned pelvic floor tightness can have dropped. Feet issues, so plantar fascia issues. Your pelvis is in the middle of all of these areas. It’s a highway interchange for things to happen. So again, yeah. You might have a collection of weird symptoms that you maybe didn’t put together as related to pregnancy and birth and postpartum. Maybe you’re even seeing another PT and you’ve made some progress, but there’s still whatever sort of issue. You know, it might be worth it just to have a consult and have that area checked out. Or to just be looked at from that perspective. Meagan: Absolutely. Such good information. Always, women of strength, remember that you never have to deal. You never have to deal with this. You can take care of yourself and I encourage you to do things for you. Like Abby was saying, she’s like, “Yay! You’re finally coming in. You’re finally taking care of yourself.” But dang it, it’s taken so long. I am guilty of that in so many areas. Abby: Yeah. Again, that’s not your fault though. Meagan: Nope, nope. Abby: Like I said, it’s a problem with our healthcare system. Meagan: And not being informed. Abby: And not even the individual provider’s fault. That’s why I’m working so diligently and passionately to make it more of a standard because I think that everybody deserves this care. Just because you were pregnant, it doesn’t even matter how your birth went. How it went will mean different things, will do different things, and address different things. Some of it will be similar because the common denominator was that you were pregnant. You grew a baby in your body. Meagan: Yep. Your body changed. Your body made amazing changes and did amazing things. It is okay to give back to yourself and thank yourself. Thank your body for doing this amazing thing multiple times for a lot of people. It’s so important. Oh my gosh. Well, thank you so much for sharing these tips and a little bit about your story and choosing a birth location and all of the things. Abby: I didn’t really even get to my VBAC story but you can read it in the book. Just pick up a copy of the VBAC book. Meagan: A copy of Baby Got VBAC right here. You can find it in our show notes today. You can find it on our blog. You can find it on our Instagram highlights. You can Google it. We’ve got it right here. Baby Got VBAC. It’s an amazing one. So thank you so much and good luck for this next amazing journey, your third VBAC. And yes, thank you again. Abby: Yeah, thanks so much for having me. I could talk about this all day long. Meagan: Right? We could talk for hours and hours about this. We’ll just have to have you on again after you have your VBAC and we’ll just share about each VBAC. Abby: Sure. Yeah, that would be great. That would be great. Meagan: Okay. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands