Transcript: How to Prevent Pelvic Floor Dysfunction Postpartum

This is a text transcript from The First Time Mum’s Chat podcast. The episode is called How to Prevent Pelvic Floor Dysfunction Postpartum and you can click on the link to view the full episode page, listen to the episode and view the show notes.

Helen Thompson: This is Helen Thompson. Thank you for being here today. If you are already subscribed to the show, thank you so much, mums, you always are amazing and if you are here for the first time, make sure you subscribe to the show.

Google Podcasts will shortly be closing permanently, so if you are subscribed via Google, please subscribe via another platform so you don’t miss out on each episode. You will find First Time Mum’s Chat on all the main platforms, including Apple Podcasts, Spotify, Amazon, as well as on YouTube and don’t forget to subscribe.

Today, like in every episode, I’m bringing you an amazing woman, Birth Healing Specialist and Pelvic Health Physical Therapist, Lynn Schulte. Lynn is on a mission to improve postpartum care worldwide and her whole mission and passion is in helping mums have smoother births and faster recoveries. With more than 30 years experience, Lynn has successfully healed thousands of women from all the issues experienced after birth.

During our chat, you’ll hear Lynn talk about topics including, what happens to the pelvic bones in order for a baby to be born and what keeps them from returning to their original position? How this affects the pelvic floor muscles? How can you strengthen your pelvic floor muscles after giving birth?

And much more.

Hi Lynn and welcome to First Time Mum’s Chat. I’m delighted to have you here today and I can’t wait for you to share your expertise with our listeners. So before we get started, please tell us a little bit about you and your background and what you do.

Lynn Schulte: Thanks, Helen, so much for having me. I’m so appreciative of any opportunity I get to share what I’ve learned about the body, especially postpartum. So I’m a pelvic health physical therapist. I’ve been one for over 30 years, and I have my own practice in the Boulder, Colorado area.

I have mainly been working with pregnant and postpartum women for the last, oh, three quarters or a third of my practice. So I’ve been a PT for over 30 years. Since 2008, I have mainly been working with pregnancy and postpartum women.

I approach the body differently than most practitioners. The way I treat the body is very, very different and I’m excited to share that with you all today.

Helen Thompson: Thank you. It’s good to get a different approach because there’s so many different approaches and it’s always good to hear other approaches.

Lynn Schulte: I started just working with pregnant or postpartum moms and I learned how to listen to the body. So I allow the body to guide my treatment sessions, versus me imparting into the body what I think should happen. By listening to the body and really learning to listen to the bones of the pelvis, because the pelvis needs to open and widen for a baby to come on out.

The sit bones, the bones that you’re sitting on in your tailbone, need to widen for the baby to come on out. The tailbone needs to lift backwards to open up for baby to come on out. So I was listening to the pelvis and realizing like, wait, one sit bone feels more out to the side than the other one did and I was like, well, wait a minute, how can this be, doesn’t baby just come right on out the middle of the pelvis? It doesn’t, it doesn’t always and it depends on the position a person was in when the baby came out.

Let’s say someone lays on their left side. They’re laboring on their left side and they’ve got that right leg up higher and the baby comes on out while they’re inside lying. Well, the left side of the pelvis is anchored to the bed, to the floor, whatever they’re laying on and the right side has to open up more for that baby to come out. So it creates these asymmetries in the pelvis and it can cause mom’s pelvis, is what I found in palpating and feeling into these pelvises is that the bones of the pelvis don’t always return to their original position after birth and so by listening to the tissues and feeling what was really going on in there is how I discovered what I’m coining the open birthing pattern in the pelvis after birth and there’s so much that happens because the bones don’t go back together, the pelvic floor muscles attached to those bones, that are now wider and in a different position and the muscles are on the stretch. They’re not as strong. They can’t activate as strongly as they should, and there’s several different things that happen after birth that keep the muscles from being able to really activate strong and the bones being stuck in what I’m coining, the open birthing pattern is a part of what keeps them weak.

So a mom may know that they’re in the open birthing pattern, if they lay on a hard surface and their tailbone or their sacrum just hurts. They don’t like it, they can’t lay on a hard surface, their sacrum is too far backwards from the birth. If you’re sitting and you feel like, the person who labors on her left side, that right ischium, their sit bone is going to be far out to the side, so they’re going to feel like they’re sitting unevenly.

They’re going to feel a little cattywampus in their pelvis as they’re sitting. That’s a sign that their pelvis is still stuck in that open birthing pattern. When the bones are splayed apart for that baby to come on out, the pelvic floor muscles are trying to keep stability in the pelvis. Them being apart is not a very stable position for the pelvis, so the muscles are trying to hold on and it creates a lot of tension in a person’s perennial body so that that pelvic area between the bones, it can feel really heavy for a person and that heaviness doesn’t get worse as the day goes on.

Sometimes practitioners know that if you have heaviness vaginally or you feel like a tampon is falling out, that can be a sign of a prolapse and prolapses will get worse at the end of the day. The heaviness will feel heavier by the end of the day. If that heaviness is the same when you wake up to when you go to bed, to me, that heaviness is because the muscles are trying to keep the bones together and that tension is happening and what happens is a lot of times they’ll go see a pelvic floor physical therapist and they’ll try to release the muscles and try to get the muscles to relax. Then their pelvic pain gets worse and the muscles are doing a job. They’re trying to keep stability in there.

When you learn to bring the bones back together again, it can relax the pelvic floor muscles. They don’t have to do as strong of a job trying to stabilize the person. Our pelvic floor muscles should be able to just contract and relax, like you’re turning on and off a light switch, like you’re opening and closing your hand. That’s how quickly and efficiently those pelvic floor muscles should be able to work but a lot of times after birth, they just can’t. It’s effortful for someone to get their pelvic floor muscles to contract and then relax.

Another thing that can cause the pelvic floor muscles to not be able to work well is scar tissue. We know that after birth, a lot of times their muscles can tear. That would be a grade three to grade four tear of those muscles. That creates scar tissue. Scar tissue is not as flexible as normal tissue, and so the scar tissue can inhibit the muscles from being able to contract well. You can massage that scar tissue if you put your finger in vaginally and your thumb externally, or your thumb internally and your finger externally, you can compress that scar tissue and compressing that scar tissue can kind of help it to melt and soften so that it might be able to help those muscles work better.

So massaging your scar tissue that is in vaginally can really help with that. That scar tissue can also cause insertional pain with intercourse because the muscles are already stretched and they can’t open up anymore to allow that to happen. So bringing the bones together and helping the muscles to relax, then they can open. Scar tissue needs to be released so the muscles can expand to allow penetration to happen.

Then the other thing that happens is a baby comes through the pelvis. The bladder has to get out of the way and a lot of times I find that bladder is smushed off to the left hand side. What I find is that when I get the bladder back into position and I help the cervix, the cervix needs to be like a piñata in their vaginally. A pinata is a paper mache thing that’s filled with candy and it’s held on a rope and you’re blindfolded and you hit it with a bat.

So the pinata, you know, swings 360 and sometimes they pull it up and pull it down and the cervix should be the same way. It should be able to move and be lifted up out of the way so that when we have intercourse and we have thrusting, the cervix can get out of the way.

If it can’t get out of the way, that can cause deep thrusting pain with intercourse. So when you get the cervix back into midline and make it a pinata, get the bladder back, the pelvic floor muscles automatically get stronger instantaneously. It’s like magic. It’s just so crazy when you do this and they go to do a contraction they’re like, whoa, that’s different, that’s stronger. So all those things combined can help your pelvic floor muscles to be able to turn on and off automatically and be stronger automatically.

So I just want moms to know that if, you’ve been told just do kegels, just do kegels, but you don’t feel like your muscles are getting any better it’s because they can’t. It’s like hitting your head against the wall, trying to get rid of a headache, it doesn’t work very well. You need to help the tissues out, you need to help the muscles to be able to function better and all those things that I just talked about there can help that.

The bladder, I was talking about how it gets smushed off to the side. That alone can cause stress incontinence. So that leaking urine, when you laugh, cough, sneeze, or exercise, there’s two reasons that cause stress incontinence postpartum. One is that the bladder gets smushed off to the side and so when you go to laugh or cough, the pressures from your abdomen should reach the bladder and the urethra so that we keep the pressure differentiation between those two structures the same. That’s what holds the urine inside because the urethra has greater pressure than what’s inside the bladder.

That’s what helped keep the bladder inside. But with a bladder off to the side, the pressures from the abdomen can’t reach the urethra. So all that pressure is hitting the bladder and that increases the pressure inside the bladder, which causes the urine to come on out. So some of my clients, all I have to do is reposition their bladder and then their continent again. Others need to work on their core activation more because a lot of times after birth, your lower part of your abdomen gets so much more stretched out than the upper part.

So if you put your hand on your lower belly and you cough, the lower belly, did it go out or in? It should go in.

Helen Thompson: It did go in.

Lynn Schulte: Yes and a lot of times after having a baby and being pregnant, the belly juts out and all that pressure can put pressure down on the bladder, and that is what’s causing you to leak. So we get the bladder back into place, but then we need to learn how to activate our core and pull in our belly when we’re laughing, coughing and sneezing and exercising to keep the pressures away from the bladder, and that’s what can help you to stop leaking. The body really goes through a lot during pregnancy and labor and it needs help.

We just assume that it just comes back together and for some unique individuals it can, but for others it really does require some assistance, some help, some knowledge and understanding of how the belly works and how we can best support healing after having a baby.

Helen Thompson: I just wanted to go back to what you said about when the pelvis moves, whether you’re on the left or the right, because my sister when she gave birth with her second child, she actually broke her pelvis and when you were talking about how the pelvis moves, whether you’re on the left and how it stretches or doesn’t stretch in the bones, could that be why her pelvis broke?

Lynn Schulte: It’s possible. So ideally for birth, we want to get the baby into the best position possible, so the smallest part of the baby’s head comes through. That is all done by baby’s positioning in the belly. So your uterine ligaments and your lower abdominal fascia and your abdominal wall, all those need to be balanced and we need to create space in there for baby to get into the best position to come on out.

So then the smallest part of the baby’s head should come through the pelvis. When we have restrictions and tightness in the belly, then the baby can’t get in the most optimal position and then the larger part of the baby’s head comes through the pelvis. Then the pelvis has to open up extra wide and that’s why it takes so much longer. The birth is so much longer because a bigger part of the baby’s head is coming through. If the pelvis isn’t able to accommodate and open up as far as it needs to, that’s when the symphysis pubis joint, the joint down in the front of the pelvis, it can separate and It can completely disrupt. There’s ligaments that hold those two bones together and those ligaments can tear and rip apart and now we no longer have any stability in that joint in the front. It’s a really challenging thing to deal with. It usually happens because of baby’s position and the larger part of the baby’s head coming through that pelvis. An occiput posterior baby. That’s a larger part of the baby’s head coming through that pelvis.

Helen Thompson: So can you do anything?

Lynn Schulte: It depends on if symphysis pubis is completely disrupted or if it’s just out of place. If the pelvis is in that open birthing pattern, then we can close that back up. But the only way to truly know if that symphysis pubis joint is still stable is you have to go get standing stork x rays or pelican x rays. That’s where you’re standing on your feet, you lift a knee up to 90 degrees and then they take a picture of your pelvis. They take an x ray of your pelvis and if you have stability of that joint, then the joint will stay together but if you don’t, then you’ll see this massive shifting of the symphysis pubis bones and that will tell you whether the ligaments are still intact or whether they’re disrupted permanently.

Helen Thompson: That must be painful!

Lynn Schulte: Yeah, you don’t have stability. So it’s very, very challenging to lift your leg up in the air like that. If there’s no stability in the pubic bone. 30 percent of our weight bearing forces come through the pubic bone to transfer weight from our legs up into our trunk and if we don’t have stability in here, then it’s super, super painful to stand on one leg, to do anything unilaterally. So that’s what I’m trying to teach other practitioners, other body workers, how to better support baby’s positioning in the belly, creating space, so babe can get in the best position to come on out, so the pelvis doesn’t have to widen too much beyond its threshold and create those permanent dysfunctions because surgery is really the only way to regain stability in that symphysis, pubis joint.

Helen Thompson: I don’t think she had surgery, I think it healed. I know she found it really hard when she gave birth because she couldn’t get up herself to feed her. Somebody had to take Josie out of the cot and she found that really, really hard.

Lynn Schulte: So if she’s not permanently disabled, then she probably just had an open birthing pattern that I was talking about. There are exercises that moms can do and I have them on my YouTube channel, an exercise to close the pelvic bones after birth and you can squeeze your knees together and squeeze them apart, there’s 3 different ways you do that. That can help some people but we also need to get the sacrum back to its original position and if you are a practitioner or body worker, I do have a free course on my website, the sacroflexion course, and that teaches you how to treat the sacrum out of the sacroflexion pattern, and that can be super, super helpful for people who are still stuck in this open birthing pattern.

I’ve had a client, she was a physical therapist actually, just gave birth and she called me up a day after the birth and she’s like, Lynn, my pelvis is not right, can you help me? She came in day two after birth and I just helped bring her bones back together and balance them back out and then she was able to walk out of my house much easier than when she came in. So this is a thing and not many practitioners know to look for this idea that the bones are stuck in this open birthing pattern and I’m trying to spread the word. So I so appreciate you, Helen, having me on this podcast to help moms realize that the bones of the pelvis don’t always go back to their original position after birth, and it can create a lot of pain, dysfunction, and problems in the body and people don’t feel stable. They don’t feel stable in their pelvis when they go to stand up. When you bring the bones back together, there’s like, oh, now I feel more stable again. It’s so simple as a practitioner to treat this, but if you don’t know to look for it, they won’t be looking for it.

I have online courses that teach practitioners how to do this. So if you’re seeing someone and they don’t know how to deal with the bones, please tell them to check out my courses because they can learn.

Helen Thompson: So if a mother was going through what you’ve said, what would she have to look out for to know that that was the issue?

Lynn Schulte: Yeah. Well, I was talking about that, the heaviness and the pelvic floor muscles that does not change throughout the day. Feeling like you’re sitting uneven. Feeling like you don’t feel stable in your pelvis or your low back when you go to stand up. Laying on a hard surface and it hurts your sacrum, your tailbone.

Those are all signs that your pelvis is not back together where it was after birth. So back pain, pelvic pain symphysis, pubis dysfunction, all of that is a sign that your pelvis is still stuck in an open birthing pattern. Your pelvic floor muscles can’t contract fully. There’s tension in them, it’s painful to have penetrative sex, with insertion, there’s pain. All those are indications that the pelvis might be out of position and the bones, the muscles, the pelvic floor muscles are having to compensate and tighten to help hold you together. The pelvic floor muscles are trying to give you stability, but most practitioners are just addressing the muscles and they’re not addressing the bones and if you get the bones back into place, then everything else feels so much better. That’s why I can get people out of pain in one session, because you just get the bones back together. If you know what to look for and how to help those bones, you can help people feel better in their bodies in few sessions.

Helen Thompson: You don’t necessarily have to have given birth for that to happen, do you? Can it happen even if you haven’t given birth?

Lynn Schulte: No birth is the only thing that causes that. You can still have dysfunctions in your pelvis from falls or impacts or falling and landing on your tailbone or landing on your buttock. That can cause these dysfunctions, but there’s nothing that causes the bones of the pelvis to widen and open up like that, other than birth and so that’s why when you get the bones back together again, they typically don’t open back up again unless the birth was traumatic. If the birth was traumatic, you try to close those bones back up, they’re going to go right back out because the body is stuck in a trauma response from the birth.

So helping to heal the trauma from the birth is extremely helpful in helping the muscles in the bones to relax and to come back into their original position. So when we’re giving birth the trauma response of the body is fight flight freeze. Well, when you’re giving birth, you can’t fight the birth, you can’t flight from it. So the freeze response is really the only response left for the body to go into. When I’m working with my clients, it’s like it to me, the pelvis stuck in an open birthing pattern with that trauma response is like the pelvis is holding its breath and it hasn’t exhaled yet and so we need to help the pelvis and the bones and the tissues to let go of the shock and trauma and to realize that the birthing event is over and that the baby’s out and the tissues, there’s a trauma release statement, I use with my clients. As I tune into the frozen tissues, the tissues that are holding its breath, I just ask all the pelvic tissue to release any shock or trauma being held in these tissues, knowing that the birth is over, the baby is out and everyone’s okay.

A lot of times the body doesn’t realize that the baby’s out. The body doesn’t realize that the birth is over and you can feel it. I’ve trained myself to feel it in the uterus. The uterus is stuck in this frozen response and it’s still trying to birth the baby and a pelvis that is stuck in a trauma response from a previous birth is less open to becoming pregnant again. So the trauma response in the body can be preventing someone from getting pregnant again. The trauma response of an open birthing pattern in the pelvis, a lot of times the palaces open just a little bit and moms can function.

They may feel a little bit of pain here or there. They’re, yeah, it’s not the same, but they’re still able to function until they get pregnant again and then you add the hormones of pregnancy and now they’re developing pelvic pain in a subsequent pregnancy. So when someone comes to me and they’re pregnant and they’re having pelvic pain and it’s a subsequent pregnancy, the number one question I want to ask them is, did you have this pelvic pain in your first pregnancy?

If they say no, then I know this pelvic pain is from the open birthing pattern. When you bring the bones back to their original position, that pelvic pain during that subsequent pregnancy goes away in one session. So too many moms are walking around pregnant and, subsequent pregnancy, they didn’t have it with their first one, their pelvis is still being affected from that first birth. Too many therapists are thinking, oh, it’s a pain cycle. It’s up in your head, we need to calm down the nervous system. No, we need to close the bones back up and get the bones back into their original position and the pain goes away.

Helen Thompson: And how do you do that? Is it physically moving or is it what I call touch for health?

Lynn Schulte: It’s a physical mobilization of the pelvic bones. So I use my hands to mobilize the bones back into place. The first step of it is doing the closing of the bones exercise that is on my YouTube channel. So you guys can check that out on YouTube. Institute for Birth Healing is the channel on YouTube, and then look for the exercise to close the close the pelvis after birth, and you do that first and that can help bring the bones back together. Then from there, if you’re still having issues, then you need more manual mobilization skills to get the bones back together again. I have a directory of people that have studied with me. If you want to join my institute for birth healing community group, it’s a private Facebook group.

So we’re just trying to get the word out. I just want to help moms know that there is help, there is support in feeling better in your body after birth and one of the issues may be the idea that your pelvis has not gone back to its original position.

The other thing that can get expanded during pregnancy is your rib cage and some people may notice that the number size of their bra has increased and that number is the circumference of your rib cage. So if that number has increased in size after having a baby, that pregnancy has expanded your rib cage and they haven’t come back together from to the original position.

So one thing I like to teach my moms is just, wrap your fingers and your hands around your rib cage. Your thumbs are in the back, fingers in the front and just breathe in and out. As you breathe out, just really compress your rib cage down and towards the midline and on the exhale, really encourage the ribs to come back down towards the midline because that can help reset them back into that midline, more into their normal position and hopefully should help with that circumference and decrease that.

There’s a lot of healing that can happen after birth and I just don’t want moms to give up. If anyone has had a traumatic birth and wants healing with a traumatic birth, I do Zoom sessions, so if you go to the CenterForBirthHealing.Com, so that’s center and that’s C E N T E R forbirthhealing. com that’s my clinical website and you can schedule a time to do a Zoom call for you and work with that trauma response from your birth and help you to feel better in your body after birth. My whole mission and passion is helping moms have smoother births and faster recoveries. It is possible.

Helen Thompson: Well, thank you, Lynn, I’ll put all those in the show notes because it’s really important for mums to have that support, and I really appreciate you being here today and taking the time to come on to First Time Mum’s Chat and share all your expertise.

Is there any final tip that you’d like to give?

Lynn Schulte: Yeah, I just want moms to know that there is help, there is healing that can happen after birth. I think a lot of practitioners make moms feel like, Oh, well, you just had a baby, so deal with it. You don’t have to just deal with it, there is support and help out there for you to feel better in your body again after birth.

Helen Thompson: Thank you, you’ve given us a lot of tips.

Lynn Schulte: So if anybody wants to email me, my email is lynn@centerforbirthhealing.com or lynn@instituteforbirthhealing.com. Either one of those two, you will reach me there. Reach out, let me know how I can support you, we can set up a Zoom call. I do have a mom centered online course, Confidence in the Core Floor and More, is a course that moms can take on my website. It’s an online course that people can take to learn and understand more of what’s going on in the body, how to reactivate their core again and get their belly stronger after birth.

Helen Thompson: Well, thank you, Lynn, for being on the podcast. I’ve really enjoyed talking to you. You’ve actually taught me a lot. So thank you for being here.

Lynn Schulte: Thank you for having me helen, I so appreciate it.

Helen Thompson: Thanks mums, you’re amazing and I hope you enjoyed this episode. I’ve included the closing of the bones exercise, YouTube video that Lynn mentioned during our chat on the episode webpage along with the other links mentioned.

If you haven’t done so already make sure you hit that subscribe button because in the next episode I’m chatting with Katie Ferraro about baby led weaning. Katie is the host of the Baby Led Weaning podcast and as a mum of 7, yes, 7 children, she certainly had plenty of opportunity in her own family to put into practice giving babies a safe start to solid foods using baby led weaning.

The other thing I want you to do after listening to this episode is to get your Sleep Tips Quick-Start Guide to help you establish a sleep routine that works and helps you feel less tired, less stressed and have a happier, more contented little one who sleeps better. To get yours, visit MyBabyMassage.net/SleepNow, that’s MyBabyMassage.net/SleepNow.