Advocating for Postpartum Pelvic Health with Dr. Beth Henigan PT,DPT, OMPT, PCES

As part of our Expert Spotlight Series, our founder Lauren welcomed Dr. Beth Henigan DPT, OMPT, PCES who is the creator of Babies to Barbells, a hybrid program designed to help women with pelvic floor and core dysfunction return to the lifestyle they love.

She's a pelvic floor and orthopedic manual physical therapist who specializes in sport and performance training, and she's a mom of 2. Her personal experience with C-section and VBAC recovery, high risk pregnancies, and a NICU stay inspired her to move beyond traditional care to better support women through all stages of pelvic health and wellness.

Among other things, Lauren and Dr. Beth's chat focused on the importance of pelvic floor physical therapy in postpartum recovery, highlighting Dr. Beth's personal experiences and the need for better guidance beyond the typical six-week check-up.

Catch the entire chat on YouTube, or check out 5 of our highlights below!

 

 

1. “Postpartum is Forever” & The Challenges of Advocating for Your Pelvic Health

Lauren:

Tell us a little more about your background and what inspired you to become a pelvic floor physical therapist.

Dr. Beth:

When I was pregnant with my first, I had placenta previa, so I was put on pelvic rest. That's where the placenta covers the cervix so the baby doesn't have a good exit without a lot of bleeding risks. So I went from being this person that was running, weightlifting, doing all the things, living up in pregnancy to like, "Oh, what do I do now?"

I had an emergency c-section with a preemie, a NICU stay, life turned on its head, and in the midst of dealing with everything that we needed to for taking care of our child, my own health kind of got put on the backburner, and I just remember being so frustrated. I'm a clinician, I know how to take care of postoperative cases, but to then feel like there was no guidance, there was no protocol, there was just, "You're six weeks, your scar looks good, you can start doing some things again." I was like, "I rock climb, I run, I jump, I lift--where is the progression?" I dealt with lots of pelvic pain postpartum after that C-section for a long time. It took me a good 18 months to get back to where I wanted to be.

And then my second pregnancy was complicated in a totally different way. I was a lot more informed. I'd started doing more with pelvic floor, but I had pulmonary embolisms, blood clots in my lungs. My second pregnancy was on bed rest, essentially, for a long time, over three months, so I came out of that pregnancy feeling so weak and struggling a ton with prolapse symptoms.

I was finding a whole new recovery ballgame compared to C-section, and I just really felt overwhelmed with how constant my symptoms were in the beginning and frustrated with wanting to progress to getting back to a normal fitness level, but then feeling held back by those prolapse symptoms and not getting a lot of good guidance again from going into the OB and them saying, "I don't see anything," but wasn't checked in a ton of positions. Again, as a clinician, if I'm having to advocate this hard, what are patients dealing with?

Lauren:

Yes. A couple of the things you said jumped out at me, which is that 18 month timeframe that you talked about. I feel like so often, especially for our first babies, there's this feeling of, "Okay, six weeks and I'm going to be doing all these things with my babies!" And it is just so not the case and it's such a disservice. 

Thankfully there are so many people like yourself and others in this space who are really trying to advocate for that. Postpartum is forever. Six weeks is just that first check-in. It is months, if not years, for you to build the strength and do all these things. And so I think that's such an important part of this.

And then you'll have one situation with your first child, and then you go to your second, you're like, "Okay, I figured these things out. Now I've got all this new stuff." So it's definitely a constant learning curve.

And the other thing was you talking about having to advocate so hard for yourself. I had a similar experience with my first where I felt like I had prolapse. I had, thankfully, taken some pictures and took them in and even showed those, but they were like, "Oh, no, that's just tissue. You're okay." And I felt so frustrated and I don't have the healthcare background, and I was like, "Oh my gosh, how?" 

It is just disheartening when you feel like these things are going wrong with you and you're trying to get answers, figure out what's going on, and you walk away being with people saying, "No, you're fine. That's not what you think it is." It's really hard.

Dr. Beth:

For sure. It's one of the things I noticed so much in the pelvic health world. So many patients come in and tell you their story, and they're so used to not being believed or not being heard. They're so desperate for you to listen, and I'm like, "No, I get it."

Lauren:

Yeah. It's nice to finally have somebody be like, "Oh, yeah, this is exactly what's going on and I hear you and let's talk about options." It's like, oh my gosh. Yeah, you feel like you kind of have a renewed sense of working on these things. You get to start having real conversations about it.

 

 

 

2. The Benefits of Recognizing Your Pelvic Floor as Part of Your Core

Lauren:

So I know a lot of people haven't heard about pelvic health or pelvic floor health. How would you explain the importance of that to somebody that is maybe coming to it with very little or no knowledge?

Dr. Beth:

I think it's really good to highlight it as part of the core. People hear the term "pelvic floor" and they think of this mysterious part of our body and they don't totally know how it works, other than they know maybe what a Kegel is or they know, oh, so I don't pee.

I explain to them that there are all these layers of muscles and that one of their big jobs is actually to work with our core system. And so starting to engage with it and think of it, you would want to train your core. You want to make sure that you're taking care of that pelvic floor too. But just like we can't just do crunches to have a strong core, we can't just do Kegels all the time and have a healthy pelvic floor.

So it's really making them understand that we want to not oversimplify it, but think of it as this muscle that has a lot of jobs and that we want to take care of it so that we can be active through all stages of life because we want that good reserve when we're young. That way, when we do have children or when we do hit menopause and we see some of those structural changes that tend to come along with those periods, that we, in fact, have a good muscle reserve there, a good core strength there to carry us through.

 

 

3. What Makes a “Good Push” in Childbirth

Lauren:

What are some of the common misconceptions that you hear about pelvic floor health?

Dr. Beth:

Oh, there's so many. When giving birth, a lot of times people are coached to hold their breath and do what we call a "purple pushing." While there might come a time in a delivery that things need to happen faster and a provider might have a good reason to push for that, ideally, we're doing "open glottis pushing," which is where we can exhale as we bear down and lengthen that pelvic floor. So a good push ideally is letting go of pelvic tension, exhaling and pushing down so that air has two places to go, and pressure has two places to go to prevent that excessive tearing or damage to those ligaments that can tie into prolapse.

Lauren:

Yeah, I think that's a great one and one where that education really comes into play of understanding pelvic floor tension and your breath and then your diaphragm and how all of that comes into play.

For my first baby, I had read a book, I'm forgetting which one it was now. It was one of the hypnobirthing ones, I believe, where it was talking about all the different breathing techniques. And it was fun because my husband is a choir director, so all of his background's in music, and so he has a lot of experience with how you hold your mouth and breathing. And so it was funny, I was kind of going through it being like, "I don't really know about this." And he'd be like, "No, let me show you, and this is what's happening in your body for those breaths and when you move your mouth this way."

So it was interesting seeing, just how even with that different kind of discipline, his understanding of breath and your internal pressure, came into play for this with your pelvic floor and intention and all of that. So I feel like I was at an advantage going into that first one where he could help me understand that a little bit more before I knew as much about the pelvic health aspect of everything. So it was cool.

Dr. Beth:

Yeah, I love when I have somebody who has had some vocal training on the table because they are such beautiful 360 diaphragmatic breathers. Sometimes when I'm trying to teach it and people aren't quite getting it, especially on the exhale, I'll pull out a straw even and make them blow out a straw or a balloon to add a little resistance to make them recruit a little harder. I built a whole course on 360 breathing because it is such an important piece that I feel like people need that deeper dive in. When you do look at the mechanics, you start to see just how important it all is: the way that we breathe, the way that we hold tension when we're stressed out, just that tension creeps up in your shoulders.

Lauren:

Yeah. I'm like a fist clincher, so my husband will be like, "What's wrong?" I'm like, "What do you mean?" He'll say, "You're cleansing your fist." You just don't even realize it. Yeah.

Dr. Beth

And you do the same thing in your pelvic floor and you don't realize it

Lauren

Exactly. The glutes for me was another one in talking with my PT. She said, "Just notice how often throughout the day are you clenching your glutes and you don't realize it." And I was like, oh my gosh. All the time.

Dr. Beth:

Yeah, that was me after my second, after my VBAC, and I remember standing at the sink and I would stop everything that I was doing and literally just shake out the cheeks.

Lauren:

Exactly. Release them! It's interesting when you start to, you realize that stuff because then you're like, "Oh, I do this a lot." It makes a big difference.

 

 

4. Pelvic Organ Prolapse Isn’t a Life Sentence

Lauren:

Can you share a success story with us where you've worked with someone and they've had a positive outcome?

Dr. Beth:

Yeah, so one of my all time favorite patients, I love her so much. She came in with really constant prolapse symptoms and she worked long shifts, so she was on her feet for 12 hours a day. Towards the end of her shifts, that heaviness was really setting in. She was having a hard time picking up her little one, and before she had her baby, she was lifting all the time in the squat rack, loaded up heavy, doing deadlifts, doing squats, etc.

So when she first came in and we did her internal assessment, we realized how much pelvic tension she had and I got to educate her on why tension makes you feel these prolapse symptoms so much more because that outer third of the vaginal canal is a lot more sensitive than those deeper two thirds. So when you have all that tension and things are pulled up, it was pulled up into that zone where that prolapse was sitting.

So even though it was a lower grade prolapse, we felt it all the time. Very quickly we worked on her breathing, got her pelvic wand, worked on her tension and her day-to-day symptoms went away due to that and giving her some support wear for during her shift. From there, we were able to start working on that pressure management because the only time that she then had symptoms was when she didn't manage pressure well, like a breath hold with a pushup or a squat and getting into vulnerable positions. We were really focusing on that muscle hypertrophy, but eccentrically so that we added strength and length together instead of letting things tighten all the way back up. But by the end, she was back to running without symptoms. She was lifting a good 60+ pounds without symptoms. Things were really good for her, and that was just awesome.

Lauren:

Well, and that's huge. I think it can really feel like a life sentence when you first have prolapse, especially the first time because you're just like, "Am I always going to be like this?"

I know for me personally, I wondered if I could even have other kids. I just had no idea what it meant for me, and especially at first trying to learn about it and get help. So I think stories like that are so inspiring and can help provide hope for so many people to realize that how you feel right now may not be how you feel a year from now, five years from now, 10 years from now. It is a long journey, and it's a roller coaster for sure, but I love hearing stories like that. I think it just helps put more information out there that the way that you feel now is not how you always have to feel. And I think that that's so important in this space.

Dr. Beth:

It is. And I think just giving her back some sense of control, too, was really important. Early on, we talked about relief positions, and for her, for it being tension, a lot of it was actually breathing work and wand work too. But we talked about how hers was mostly a cystocele, so the legs up the wall trick might not work as well for you as getting into puppy pose with a wedge. And for her to even just have in her head thoughts like, "I'm feeling more symptoms right now. It's not that my prolapse grade has gotten worse, it's that I probably have more tension or I did that exercise wrong. Let me think about it and try it another way." There was no longer that impending panic and dread about those symptoms. It was like a, "Oh, I did this and I can do this about it."

Lauren:

I feel like that's such an empowering part of all of this is that knowledge is power and you have choices and can help start to control things when things begin to feel so out of control.

So I know pelvic floor health can vary from person to person, but if you were talking to the general population about what you could do today to help protect your pelvic floor and improve pelvic floor health, is there something that you would tell them?

Dr. Beth:

I think that one of the best things that any of us can do if we're feeling like our pelvic floor is off, even just investing in getting an evaluation to really understand what it is that you are doing. Is it a problem with coordination? Are you able to contract correctly? Is your strength good? Is your mobility good?

But in general, for us, aging successfully involves how we breathe and the timing of that breathing and having good strength programming. These are so vital to carry us through a whole lifespan, staying healthy, having adequate muscle mass to do the job. But like we talked about earlier, that diaphragmatic breathing and 360 breathing is such an important base coordination skill that we all could really invest time and effort in. It carries over into good core strength, better parasympathetic nervous system to keep us calm, keep us relaxed, not let us be in that clenched and fight or flight mode all the time.

 

 

5. Understanding Prolapse: What’s Within Your Control and What’s Not

Lauren:

I also wanted to ask: if you have prolapse or other pelvic floor disorders, could you talk about what's in your control and what's out of your control? I know a lot of times people will look back and they'll be like, "Oh, I should have done this differently. I should have done that differently. If I had only done this, maybe I wouldn't be in this situation." Can you talk a little bit more about that topic?

Dr. Beth:

Yeah. So I think that there are some things that are completely out of our control, and it's good to kind of know about them ahead of time to remove some of that blame game that we can all play.

So if you're somebody who knows that you have an issue with collagen, maybe you have Elders Daniels and a diagnosis going in, but maybe just in general that you're kind of a hypermobile person, your joints are double jointed, you feel kind of floppy. You might be somebody at a higher risk of prolapse just because your collagen is a little more stretchy than the average person. So that's not really in our control.

Also, if something in birth takes a turn that requires instrumentation. So a forceps delivery in particular, and just having an avulsion tear in general, which is where the muscle pulls away from the bone with a tear, that increases our risk of prolapse exponentially. We know that forceps are responsible for some of those tears, but again, if your birth takes that turn, that's not your fault. It's something that happens.

The things that are more in our control are things like how we breathe while we push and deliver, how we breathe and how we use our bowel habits on the toilet. That constant straining, especially during pregnancy, when things are loosey goosey or postpartum, we want to take good care of that. Making sure that we are, very early on, reconnecting to that pelvic floor and addressing any tension that might be there, addressing any coordination issues that might be there.

But so many things, even if we're going into a second delivery, like you talked about, you don't know if you can have another child. Sometimes when this has happened, something that might be in your control is, do I want to have another vaginal delivery or do I want to have an elective C-section? People have very strong opinions on those. I know as somebody who had a C-section first, I was like, "Please not another C-section." 

But when your story's the opposite and you're dealing with a large prolapse that you just got under control or a high-grade prolapse that you just got under control, the thought of going back sometimes a C-section is the right choice for our mental health. So there are just some things that are deeply personal choices.

I think the other thing that can be really good in our control is using support garments. So in your pregnancy, as you start to feel that heaviness at the end, wearing a garment that has the gusset support to let that pelvic floor have a little less stress on it.

And in those early days postpartum when there's all that swelling and all of that vulnerability from tissues having stretched and opened, give them support instead of just wearing an abdominal binder where we send all that pressure down, give them both some help and hold everybody together.

 

 

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**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.