Katie Moise | Prepping Your Pelvic Floor: From Preconception to Postpartum

In this episode of The Mama Making Podcast, host Jessica Lamb chats with Katie Moise, pelvic floor physical therapist and founder of ATL Pelvic Health, to break down what every mom actually needs to know about their pelvic floor.

They dive into the key phases of pelvic floor care - from preconception and pregnancy through postpartum recovery - including common myths, how to support your body before birth, and what pushing strategies can make a real difference in labor. Katie shares her personal birth prep journey and what surprised her most about becoming the patient.

Whether you’re planning a pregnancy or already postpartum, this conversation offers practical, empowering info to help you feel stronger, more informed, and less alone.

You can connect with Katie:

• On Instagram at: @atlpelvichealth
• On the web at: www.atlpelvichealth.com

This episode is sponsored by Collabs Creative - a digital marketing company supporting makers, creatives, and small business owners with all things digital and design.

Follow The Mama Making Podcast on socials on Instagram and Facebook!
Share and subscribe to the podcast: click this link
Want to be a guest?: message in here!

Transcript

Jessica Lamb (00:57)
Hello everyone. And welcome to the mama making podcast. If you're new here, I'm your host Jessica. If you're not new, then welcome back today. I'm very excited to have Katie Moe's on the podcast. Katie is a pelvic floor therapist and owner of atl pelvic health. today we're going to chat a little bit of how to take care of your pelvic floor while pregnant. And then also a little bit on how to prepare for giving birth.

So Katie, welcome. I'm so excited to have you.

Katie Moise (01:21)
Awesome. Thanks, Jessica. I'm excited to be here to talk all about pelvic floor. That's like my bread and butter. So excited to chat.

Jessica Lamb (01:27)
Yeah, I'm excited. us a little bit about yourself, who you are, where you're from, whatever you're comfortable to share.

Katie Moise (01:32)
Yeah, absolutely. So like she said, my name is Katie. I'm a pelvic floor physical therapist and also the owner of ATL Pelvic Health, which is a brick and mortar pelvic floor therapy practice in Atlanta, Georgia. So we see both men and women in our practice. But when I opened the practice in 2021, my passion was really supporting women throughout their pregnancy and postpartum journeys. felt like

When I got into the pelvic health specialty, I realized just the lack of care that this population gets. Throughout pregnancy, there's a lot of unknowns, there's a lot of Googling, but there's not a lot of knowing what to do and how to kind of support your body and especially postpartum, how to recover from that. And so that was really my passion with opening the clinic. And now we've grown, we have three other clinicians and we just love treating everyone with.

really address anything related to peeing, pooping, or sex problems, but also we have specific pregnancy and postpartum programs where we work with women throughout each trimester to kind of help them prepare their bodies for birth, stay moving and active as much as they can during pregnancy, and then recover postpartum.

Jessica Lamb (02:36)
That's so amazing. think, yeah, it's definitely an area. I mean, we really only talk about pelvic floor. It's changing a bit, but I feel like we really only talk about pelvic floor, like after it's been damaged from birth. So we never talk about taking care of it prior versus how to fix it when it's been, I don't want to say it'd be too negative, but my pelvic floor was definitely destroyed by my pregnancy. And I'm sure a lot of moms can identify.

Katie Moise (02:48)
Totally.

Jessica Lamb (03:00)
but how, tell me a little bit about your background. How did you decide on pelvic floor? What kind of drew you to this area?

Katie Moise (03:06)
Yeah, so I kind of had a roundabout way getting into the profession. When I graduated from physical therapy school, I wanted to work with athletes. I was really into rehabbing ACL tears and loved working with teenagers. But I also kind of in that space got my certification in Pilates.

And so I became comprehensively certified in Pilates, started teaching Pilates on the side and realized just kind of the overlap between pelvic health and your core and how Pilates can be integrated with all of that. And then I had my own personal experience where I was seeing a physical therapist. It actually started off her treating my shoulder and then she started treating my hip, which then from there she was like, I think you should go see a pelvic floor therapist. We have one on our team. And I was like, yeah, sure.

not really thinking anything of it. And then when I went and saw her, I realized that I had a very tight pelvic floor, which is very common among a lot of women that we work with. But I was kind of surprised. Like at the time I was probably like 26 or 27, had never had kids, definitely had symptoms that I didn't attribute to my pelvic floor. So like sometimes if I put a tampon in, it just felt like.

funny or like awkward and I thought that was normal. Like, I just put it in at the wrong angle. My education with tampon insertion when I was a kid was minimal. So I just didn't really know any different. And so as I was talking to this therapist, she was like, no, like, you know, your pelvic floor holding tension can then make tampon insertion uncomfortable. And that was just like a light bulb moment for me of realizing somebody like myself who

was well-versed in the anatomy of the body, so to speak, was a movement expert based on Pilates and my training in physical therapy. And I still just was so disconnected from that part of my body. And I, you know, as I started talking to friends, I was like, wow, like people are experiencing symptoms and we just have so much shame around it. We're not talking about it. And so that just really catapulted my journey into like becoming more interested in pelvic floor. At the time I was like, no way am I going to be like.

inserting my finger into the vagina is like, you know, again, I liked sports and rehab and ACL recovery. But after that experience, it just like completely changed the trajectory of my career. And I'm so grateful for it because it's something I'm so passionate about now.

Jessica Lamb (05:16)
Yeah, I feel like the word shame is like the first thing that came to mind that like, it's just a part of our body, but I feel like there's so much shame around pelvic floor and like embarrassment and the whole gamut of emotions around it. But I feel like once you get into learning more, you're like, this is why my hips hurt or, this is why my lower back is bothering me. And then you start to realize like,

my core is very tied to my pelvic floor or whatever the other connections are. start to like piece it together. And like you said, it's not just women, it's men as well. And so I think having more education on your pelvic floor and how it is affecting you and how like getting it right can, can make a huge difference on how you feel in general.

Katie Moise (06:01)
Totally. And I think it's so interesting. It's getting better. But like when I was in physical therapy school, the pelvic floor, we had two lectures total across three years of education. So it was kind of glossed over. And it's just such a crucial connecting point in our body to think that it can affect your low back, your hips, like so many other

areas and for some people that have been dealing with like hip pain and low back pain that aren't getting better maybe with traditional physical therapy like sometimes there is an underlying pelvic floor thing going on that's important to check out. So it's fun to kind of put those pieces together for people.

Jessica Lamb (06:32)
Yeah, for sure. And I think even when it comes to like athletes, like breathing well for your sport or athletic endeavor, I think also ties to your pelvic floor as well. Like there's so much tied to it that I think people don't realize.

Katie Moise (06:46)
Yeah, definitely. And I think for athletes too, what we're kind of learning is that I have so many patients who like started having leaking, so stress incontinence symptoms, because they were competitive gymnastics gymnasts, or they were competitive cheerleaders, and we're doing all this tumbling. And just because of the demands that are placed on the body, we do start to hold that tension. And then there's going to be breakdown and you start to leak. And it's like, oh, wow, this started when you were like 14 years old.

But again, there's embarrassment, there's shame, there's like, we're not talking. Maybe you told your parents, but you're not really sharing like, yeah, I do a back tuck and I kind of pee a little bit. And so just making that connection for them too and breaking it down to the fundamentals of breathing can be really fun.

Jessica Lamb (07:28)
what other areas do you see people being affected by their pelvic floor outside of like pregnancy and postpartum?

Katie Moise (07:36)
Yeah, so we, I mean, there's so many different things. So we can see younger females who are dealing with like painful periods. So I think again, something that we've normalized in society is talking about just like, it's not normal to have to miss a day of school because your period pain is so severe. Or you're like passing out from period pain and things like that. And so sometimes that can be an indicator that somebody is dealing with something like endometriosis. We see a lot of constipation.

or just kind of like irregular bowels. either constipation or kind of fluctuation of IBS, like diarrhea constipation. A lot of females who are also having just pain with intercourse or maybe haven't been sexually active, but can't, like I said, like the tampon insertion is uncomfortable or can't tolerate like a gynecological exam, which again is super important for your health to screen for cervical cancers. And so if the, your OBGYN can't insert a speculum to be able to do that, then that.

can create challenges. So we see kind of pelvic pain related things. And then just like any kind of like urinary urgency frequency, so like overwhelming sense of needing to go to the bathroom, not being able to hold it and getting to the bathroom in time. And I think, you know, there's a common misconception that it can really affect anyone. So while we do see a lot of pregnant and postpartum women in our clinic, we see people who have who are

preconception who have don't want kids and are maybe entering perimenopause and menopause experiencing these symptoms. So it's really kind of across the lifespan. When we think about pelvic floor therapy, like our focus is on bladder, bowel and sexual health. And those are, you know, daily activities, like we're hopefully peeing and pooping every single day. And so everyone has a pelvis and when things can go wrong, that's where we can step in.

Jessica Lamb (09:14)
Let's get into You mentioned like preconception

Is there any maybe let's start at preconception go through pregnancy and then like preparing for birth.

Katie Moise (09:20)
Mm-hmm.

Okay, yeah, that sounds great.

Jessica Lamb (09:27)
Yeah, so when people are in that preconception area of time or lifespan, what are some of the considerations that they should have for their pelvic floor, getting it ready for pregnancy? And we just mentioned if there was any like sexual quote unquote dysfunction, what are some other considerations people should have for that timeframe?

Katie Moise (09:47)
Yeah, so when we work with somebody preconception, we want to go through like a deep dive of like, what has your menstruation history been like? Do you have normal periods? What is your bleeding like getting a good understanding of that, because that's going to really impact like whether or not you're ovulating, which we see a lot of women who have irregular periods or they're potentially not ovulating, which is then going to make it difficult to conceive.

So we kind of do a lot of work on the menstruation history side of things. And then the other things that we're going to focus on are just kind of like, what's the baseline function of your pelvic floor? So are you able to contract those muscles? Are you able to relax those muscles? Is there any tension and underlying tension that we would want to address that can then set you up for more success while you're pregnant?

And then we want to make sure we're optimizing bladder and bowel health as well as sexual health. So if anyone's coming in and they're already experiencing like leakage symptoms or they're already feeling like they have a small bladder and are running to the bathroom like every 30 minutes or deal with constipation, we want to try to kind of optimize all of that to really set them up for success and kind of know all of their systems are working well before they start trying to have a baby.

Jessica Lamb (10:53)
Yeah, I'm automatically thinking about like prior to having kids, I've always had issues with like bladder leakage. Maybe it's from dancing forever or being a dancer and then doing CrossFit and not knowing how to breathe correctly. but my mentality was like, I'm going to get pregnant and be peeing myself all the time anyway. When like, it doesn't have to be that way. Like you can get started on a better foot, prior to like carrying a seven pound baby in your body.

Katie Moise (11:06)
Yes.

Yeah.

Right, yeah. And I always tell people too, it's like if it's happening now and then you throw in like first trimester nausea and you're vomiting all the time and then you're leaking even more, like it's not just going to go away. And then your pelvic floor is now supporting the growth of your baby. And then yes, it seems like, let's just write it off until after this baby is born and then we'll deal with it. But it's like, who wants to be peeing themselves, you know, for 10 months, essentially.

while going through all the other changes your body's going through. So we always like to tell people like, let's get this under control now. Let's kind of nip it in the bud, get you a strong foundation because you're going to have a better birth, have a better postpartum recovery if we can lay that foundation early.

Jessica Lamb (11:58)
Yeah, I think that that's like the perfect way to say it. Like laying a foundation now of being as optimal as you can be is way helpful on the back end. So going into, so say someone gets pregnant, what are some of the areas that they need to start focusing on or paying attention to when it comes to pelvic floor?

Katie Moise (12:07)
Yes, yes, definitely.

Yeah, so we kind of break it down into trimesters. If we're seeing somebody early in their first trimester, we're not going to do any internal work at that point, but we are going to be focusing on their breathing. We can see how their pelvic floor is working externally. And then we also really at that point want to be laying down a strong strength foundation. So I think a lot of women when they get pregnant become really fearful of movement or exercise. You can Google things online and it's like, don't do this, don't do a sit up.

don't raise your heart rate over this amount and it can just be a lot of fear mongering. And so people just become pretty sedentary. And really again, laying that foundation, if we can work on building your glute strength, so your hips, your hamstrings, your core strength, that can again help to hopefully mitigate some of the common symptoms that can pop up later on in postpartum, like hip pain and low back pain, pubic bone pain, some of the things that we

unfortunately, just like think is normal with being pregnant. But it's not, you know, your pregnancy shouldn't be miserable. Like you should be able to still move and go on walks and be active if you want to be and not be in pain. And so in that first trimester, we can really lay out that foundation of strengthening, seeing kind of laying the groundwork of your pelvic floor, breath work, all of that kind of stuff. And then we're also going to focus on

bladder and bowel health. So it's really common in the first trimester with like progesterone and some of those hormonal changes for you to be really constipated. And so that can be really frustrating, annoying. You might be sitting on the toilet straining a lot, which is putting a lot of excess pressure on your pelvic floor. And so working with people on ways that we can talk about fluid intake, fiber intake, getting some mobility through their like thoracic spine and their lumbar spine to kind of open up

rib cage and all of that area to create more movement in the GI system. And then talking about bladder health too, because again, some of those hormonal and like your HCG levels rising is going to cause you to wake up needing to pee more often, which we can't control your hormonal changes. However, we can give you the tools on how to try to navigate so that we're not waking up every, you know, two hours in the middle of the night to pee. So it's a lot of like that kind of stuff that we're working on during the first trimester.

Jessica Lamb (14:24)
So then going into the second, obviously your body's changing a ton, your hormones are changing, your belly's getting bigger and so is your baby. What do you think it's gonna look like in the second trimester?

Katie Moise (14:36)
Yes, so in the second trimester, we're still kind of focusing on some of the same things. So we're gonna be addressing bladder health and bowel health. Again, you could argue really at every stage during pregnancy, your body is just rapidly changing day to day. And so we wanna kind of stay ahead of those changes. So we know with posture, we start to kind of stand with a little bit more tilt in our pelvis. We get a little bit more of a curvature in our back. The front of our hips get really tight. So those muscles like your hip flexors get really short and tight.

And so what can we do to, and then your glute muscles and hamstrings get really weak. We also know your abdominal muscles are getting weaker because they're just getting stretched out to make space for your growing baby. And so what can we do to kind of help with those changes? Like what core exercises can we do, maybe modifying, I love doing exercises like hands and knees or kneeling or standing or different things like that to make sure we're giving your body that support, essentially support the changes that it's going through.

as the pelvis is shifting and expanding, making sure that your hips are strong to kind of help hold it together essentially so that you're not getting low back pain or pubic bone pain. So the second trimester, I would say a lot of it is focusing on strengthening and then addressing anything that comes up. So like, again, maybe you didn't deal with constipation in the first trimester, but it starts to pop up in the second trimester, making sure that you know how to breathe and poop.

correctly so that we're not increasing your risk for hemorrhoids or things like that. Some people start to notice pain with intercourse in the second trimester, things just like feel different. Your pelvic floor is working harder because it's again supporting the weight of your baby. And so as it's working harder, maybe it's developing more tension. So now that there's more tension, there can then sometimes be pain. So can we do some internal release work to address that?

So those are kind some of the things that we're working on during the second trimester.

Jessica Lamb (16:20)
feel like in the second trimester, you really start to like, feel your body changing. I think there's a lot of changes to be seen in your first trimester. But I feel like, especially with your first pregnancy, you're like, what is normal? What isn't? Then by the second one, you really start to feel your body changes. What are some of the things that people come in with that are

like challenges that they have. I know I specifically had pubic synthesis dysfunction. Unfortunately, mine started about 10 weeks. So mine came pretty early, but I know a lot of people will start to feel it in their second trimester and be like, wait, what's happening? What are some of the including that? What are some of the other things that people come with that are like, wait a second, this is not fun.

Katie Moise (16:49)
Okay.

Yeah.

Yeah, I can totally relate. also dealt with pubic bone pain, which was humbling as now being like the patient rather than the therapist of like, this is what you guys are complaining about when you're talking about pubic bone pain. So that can be a common one. I interestingly enough, which it resolved quickly, but in my first trimester two, I started having like SI joint pain. like kind of lower glute, low back pain, which was surprising at how early it started for me. And it like,

I don't know if I was like, did a lunge or something and then like there was some instability anyway. So some people will have like that SI joint low back pain is super common. That's one that can be frustrating because I think we just equate being pregnant to having low back pain. Some people will have rib pain, mid back pain, even symptoms that we treat, which feel like very unrelated to the pelvic floor, but like carpal tunnel.

type symptoms. So if they're getting like tingling in their feelings or their arms feel like they're going numb, there's a lot that we can do as physical therapists to help with those types of symptoms. Any kind of like, most of them are pain related, I would say. So like your hip pain, pubic bone pain, low back pain are going to be like some of the biggest ones.

And then we do see people in the second trimester, again, because your body is changing so rapidly at that point, that do start to have symptoms pop up, like leaking urine or feeling like they can't hold it and need to go to the bathroom like every 30 minutes. And constipation is another big one that we're seeing during pregnancy.

Jessica Lamb (18:21)
And I think the moms who are like on their second, third, fourth, can attest to like you look and feel pregnant way earlier than you might have with your first. So I feel like that's when like the round ligament pain starts pretty early. and then anything that's like, has to do with your belly growing. that like lower back pain, the rib pain sounds weird, but like I felt that on my first, ⁓

Katie Moise (18:31)
Yes. Yes.

Yes.

yarn.

Jessica Lamb (18:47)
But yeah, that round ligament pain is like so crazy.

Katie Moise (18:50)
Yeah.

Yeah, like round, it's like the abdomen stretching, front of the hips, round ligament, which again can start, the round ligament can be very connected to why the pubic bone is hurting. And that's what, you know, makes our job fun is like figuring out like, okay, why are you having pubic bone pain? A lot of times it can be from the round ligament. But yes, people will just start to feel like stretching and discomfort and pretty much anywhere from like shoulders to knees.

Some people are even having like foot pain because it's common for you to start having like flatter feet so your foot kind of starts to go inward a little bit and so when they're walking they might notice like Achilles tendon type pain or plantar fasciitis where it feels really painful when they first get out of bed in the morning. So really head to toe you can start having symptoms that especially in the second trimester start to pop up.

Jessica Lamb (19:35)
Yeah, I was going to say for those who are listening that are not pregnant yet or very early, all this stuff is just information to know. It doesn't mean it's going to happen, but I think it's good to know what you could expect from it. But yeah, I was shocked that plantar fasciitis or like foot irritation is something that happens. I just had no clue that that would be a symptom of just being pregnant.

Katie Moise (19:59)
Being pregnant, yeah, I know. It's always surprising. And I think really the biggest takeaway too is just like, if you're experiencing pain, knowing that it's not normal, like it's common, a lot of people experience it during pregnancy, but it's not something that you just have to power through and deal with and be miserable for the next, you know, X number of months of your pregnancy.

Jessica Lamb (20:17)
Yeah. And I think, like for me, I really had to like, reframe what pain was for me. And I think that like using pain as an indicator is like key. doesn't have to be painful, but like I started the, the pubic synthesis pain, like pretty immediately in my, in my pregnancy. And, there wasn't a ton. I was going to a chiropractor regularly.

I think I was going like twice a week for a really most of my pregnancy and it was helpful, but then I just had to like readjust the way that I was viewing it. Like part of it was like, this is my body preparing itself for birth and holding this baby, but on the flip side, I think knowing that it doesn't have to be super painful and that there are things that can be treated or supported is like kind of key for, for,

not like white knuckling it through your pregnancy.

Katie Moise (21:08)
Exactly. And we see a lot of people too where like they're either white-knuckling it or it has really started to impact their daily life. like they can't, maybe it is their second pregnancy and they like used to walk.

pick up their older child from school and they no longer can do that comfortably because of the pain. And we really know from research too, like if we can stay active during our pregnancy and active can look different for different people. So it can literally just be going on walks. It doesn't have to be like the cross fitting type exercise. But we know that that leads to easier births and easier postpartum recoveries. So things that we can do to kind of help mitigate those pain symptoms so that you

can do those daily things. Like you should be able to push a stroller and go pick up your kid from school without feeling like you're suffering during your pregnancy.

Jessica Lamb (21:51)
Yeah, and I think staying active is huge and I think adjusting what that looks like based on how we feel is key. I remember like fully expecting to be like the the nine-month pregnant like cross-fitting mom and like expected to like do a workout on my delivery day and like all of that stuff and it just was not in the cards for me. So I I love yoga, but I wasn't doing it for a long time and that wound up being like my

main movement. And so I think it wound up being helpful for me for like, getting through that like consistent discomfort of the pubic symphysis pain, but then also like preparing for birth and paying more attention to my body changes and kind of getting ahead of things so that it wasn't something that was an issue for me. That's kind of where I discovered like, I'm having foot pain, or like,

very quickly noticed that my balance was off and I couldn't really like place what was happening until I went to a yoga class and I was like, I can't even stand on my own foot right now. I'm only like halfway through and I still like my balance is super off. So I think all that to say movement is incredible during your pregnancy, but I think adjusting what that looks like might have to be an option for you. So I think any movement is, is great movement.

Katie Moise (22:48)
Yeah.

Yeah.

Yeah, and that's why I say movement can be going for walks. There are some people who are running and lifting weights the day they give birth. I was also not one of those people where previously I loved group fitness, I loved a good sweat.

Towards the end of my pregnancy, I was doing a lot of Peloton bar classes because I was like, okay, I'm just getting a little bit of movement, but I can lay down, lift my leg on the side. I found trying to lift weights when it was hard to just move in general, it just didn't feel good for my body. And so I did also have to kind of adjust. I had done bar classes years ago, but that was not my choice of exercise at the time.

But it became my choice of exercise for a couple of weeks because that's really all that felt good for me to stay moving.

Jessica Lamb (23:50)
Yeah, for sure. And I think you have to make adjustments. So say you are like the cross fitting running pregnant lady, you're gonna have to make adjustments towards the end anyway, just because your belly's so big. So I think having the mind frame that like you're gonna have to make an adjustment somewhere, I think is a great segue to the third trimester where people are at, what they're feeling, all the things and what they should look out for.

Katie Moise (24:01)
Totally.

Yes.

Yes, absolutely. So when we we always tell people like when we get to the third trimester are and that was a great segue because it's like our focus does shift a little bit. So we still want you to be strong, we still want you to be active. We don't want to let go of those strengths gains that we've made because you're also about to have a baby that you're going to be like, squatting and picking up eight times a day. And we want to make sure that your body is strong and ready to do that. But we also want to make sure your body is ready to

birth that baby. So even regardless of vaginal or cesarean birth, there's things that we're going to be doing to kind of prepare your body for birth. And so in that third trimester, we really switch gears into really focusing on like opening up the hips and the pelvis. So that starts to lead into more of that yoga type movement. In your pelvis, you have basically an inlet and an outlet. So the baby descends into the vaginal canal and then has to come out.

if you're having a vaginal birth. And that inlet and outlet can be influenced by how open your hips are. So both hip external and internal rotation. And so we want to focus on both if people, if somebody has restrictions in one of those directions, we want to work on making sure that we get more mobility so that the baby has more room to descend through the vaginal canal.

We also want to look at the spine and make sure the spine and the rib cage and the thoracic spine so kind of like that mid back between your shoulder blade area is staying really move mobile and isn't getting stiff which is really common in the third trimester. So we're doing a lot of like cat cow thread the needle happy baby type movements.

supported kneeling but lunges in different directions so that we can really create space and openness in the pelvis and the abdomen, all of that kind of stuff. In the third trimester two, we start to think about perineal massage. So we introduce that, which is a technique to kind of help stretch the tissue, specifically that first layer of your pelvic floor to help it get ready for birth. There's not any research that shows that if you do this, you're not gonna have perineal trauma or tearing.

However, those muscles are gonna be stretching up to 200 % of their normal length. So my mindset is like, why not try to do a little stretching to kind of get them ready for that if we can. So we'll introduce perineal massage, teach patients how to do that, teach them how they can do it at home. Either some people can still reach, sometimes the belly's in the way, so it can be helpful to have a partner help, or there's really cool tools like a pelvic wand that you can use to kind of help get to that area if you're doing it on your own.

And then we're going over pushing strategies. So that's something I'm really, really passionate about because a lot of women show up to birth for the first time and it's like going to run a marathon without training. So you were like in labor in the midst of everything, adrenaline is pumping and you've got nurses and doctors and people giving you feedback on how to push and you're trying to figure this out for the first time actively while you're in labor. And it's a lot.

And that is, you know, sometimes I think why people have longer pushing times, which can lead to pelvic floor dysfunction postpartum. I think, you know, if the baby is not descending through the vaginal canal well, or sometimes you'll hear patients describe like the baby was like coming out, like they could see the head and then it was getting pulled back in or like different things where like, it's not descending through the vaginal canal and out easily. And I think so much of that can be helped by teaching people how to be effective pushers.

So there are kind of two different strategies for pushing. There's something called open glottis pushing, which would be like not holding your breath. So like exhaling while you push. More commonly, what you'll hear kind of coached, especially in a hospital setting is more of like that Valsalva, like hold your breath, bear down and push kind of technique. And that's more of like a closed glottis strategy. And we like to teach our patients both and teach them how to do it while protecting the pelvic floor.

What we find is that the first time I have somebody practice, a lot of times people are pushing and their pelvic floor muscles are actually tightening. And so in birth, for a vaginal birth, the role of the pelvic floor is to stretch and get out of the way. The pelvic floor is not involved in getting the baby out. The primary things that are gonna push your baby out is your uterus contracting and your abdominal muscles, which is again why we want strong abdominals going into your birth.

But the pelvic floor just needs to stretch and get out of the way to make space. And so that takes a skill to know how to do that well while trying to breathe and be effective at that. And it's something that we can easily teach people. And I think it just can make a huge impact on how long people are pushing for and kind of the outcomes of their birth. And with that, we also practice different positions. So depending on your birthing settings, so whether you're in a hospital or a birth center or at home.

there can be some freedom and movement as to like how you push, even with an epidural. I had an epidural with my daughter's birth and I pushed on my side. So I always educate patients. Like there's no one size fits all. Like there's lots of options and variability to like how you push, what position you're in. but when we're in their clinic, we like to have people push in every position so they can feel it in their body. because some people are really great pushers on their back and then we put them on the side and like they just.

because the change to positioning gravity, they just like can't quite get it. Or vice versa, people are having a really hard time on their back and then we put them on hands and knees and all of a sudden it clicks. So we like to practice in a variety of positions to get people really, really comfortable with like what that's gonna feel like. We get the question a lot about epidurals. So again, I had an epidural, I could still sense because the epidural is really taking away pain, but you're still feeling.

pressure. So I could still tell like what was happening when I was pushing even with an epidural. So I feel like the practice I had with my clinician who treated me while I was pregnant was really beneficial. And that was something I was worried about because again, I I tend to lead a tighter pelvic floor life. And so I worked really hard on my pregnancy to make sure things were open with the hopes of a vaginal birth. And I always tell my patients like, you know, the first

push that I had, could tell it wasn't it. Nothing happened. I could just tell that wasn't it. But I just refocused. was like, just need a minute. Next contraction came and I was like, okay, now I've got it. And I think I can attribute a lot of that to just the practice I had done. And so I just had that innate feeling in my body of what it should be like.

I think we can take a lot of the fear away from birthing for women if we can give them those skills so that they feel more confident going into their birth, what to expect, things like that. So that's a lot of what we're focusing on in the third trimester.

Jessica Lamb (30:31)
Yeah. Do you want to talk a little bit about how you prepared for your births and how things kind of looked in practice? I think it can be helpful. I mean, all of this is great advice, but I think, like you said, once it's like game day, it's kind of hard to, there's a bit of a learning curve. So I think to illustrate like the different options and how things kind of change and flow as you go through your birth would be super helpful if you're comfortable.

Katie Moise (30:48)
Yeah.

leading up to the birth during my pregnancy, I kind of did a little bit of everything because I wanted to just make sure my body was as prepared as possible. So I was doing chiropractic pretty regularly to help with just the alignment of the bones of the pelvis to make sure baby was head down. I also saw one of

our team members for pelvic floor therapy pretty regularly as well. Again, addressing like some of the pubic bone pain I was having and also just with the tension that I knew I carried in my pelvic floor wanting to make sure that that was addressed prior to going into labor. I did some acupuncture. So I kind of like did all the things and then I was again third trimester. If you're familiar with like spinning babies, they have like a really great

kind of like here are some exercises you should do daily to kind of help open up the pelvis. And they're very like yoga based. They're similar to things that we do with our clients and pelvic floor therapy. But I was pretty consistent with doing that a couple of times a week as well, to just make sure that my hips and everything was were open and ready for birth. During my actual birth, I when I went into labor, I went into labor on like a Friday evening.

one of my regrets, they tell you to like stay moving, but they're also like, get some rest. So I tried to like go to sleep and that was not effective. Once I started having pretty regular contractions. And at that point, I wish I had like gotten up and started moving more because they say the more you're able to move and create space in the pelvis, that's just going to help the baby kind of descend down. My daughter sat really high. Even like, basically up until I was pushing, like she just wasn't dropping. So she just was a high sitting baby.

So I was doing all the things like the curb walking, the bouncing on an exercise ball, trying to kind of just get her down into my pelvis. Once I went to the hospital where I was giving birth, a couple hours later, I got an epidural. So when I was at the hospital initially, we were trying to do, I had a doula with me. So she was kind of coaching me through on like some squats and lunges or like kneeling on the bed, just kind of moving my pelvis around.

again, trying to kind of like manage contractions and the pain associated with that, but also trying to get my daughter to drop. I was really fortunate to have a great birth team. So I birthed with a midwife who I can remember at one point I was fully dilated. So I was 10 centimeters dilated, fully effaced. but my daughter again was just sitting really high. And she was like, we can start pushing now, but we might be here for a while. Or we can just kind of like

At that point, I was kind of making the decision to get the epidural and she was like, we can let you rest and see if she'll just kind of like descend down on her own and then we'll start pushing, which was the route I wanted to go with. So they put me in like the, I forget what they call it, kind of like the chair crown pose where like my legs were elevated, kind of like in a deep squat basically to kind of help support again, moving her down into my pelvis.

And then when it was time to push, I knew that I wanted to try to avoid pushing on my back. There's nothing wrong with pushing on your back. And I have tons of patients who do have great births and deliveries pushing on their back. For me, I just knew like when you're on your back, your pressure's on like your tailbone and your sacrum. That can't create space in the pelvis to get the baby out. And so I wanted to have more freedom in that movement. And so we started on my side.

And like I said, that I could tell like my first couple of pushes were just like not good. And so they were of course, and I was, and I was trying to like exhale and breathe and like do all the things to help support my pelvic floor. And the midwives and the nurses were like, okay, you're going to hold your breath next time. And my doula was like, she doesn't want to hold your breath. She wants to try to exhale and push. And I don't think they thought I could do it because I don't think they see it very often. And I was like, just give me a minute and

Then the next couple ones, think they like actually started my daughter like moving down and descending. And so they're like, okay, she's making progress. We're just going to like let her do her thing. And then 30 minutes later, she was born. So that was kind of my experience, which I feel very fortunate, you know, like there's a lot of things that can happen during birth. And I feel like I did have a pretty seamless birth. I vomited a lot during early labor, but other than that,

I felt like that I was supported. I was able to move a lot. I was happy that I was able to try to push in a different position on my back. I always tell people, if you start off on your side and it's not going well, like flip over onto your back or flip over onto hands and knees if you can, like just do something different. But for me, pushing on my side started to be effective. And so they just let me keep going. And then she was born.

Jessica Lamb (35:11)
Yeah, I think it's key to like kind of have an arsenal of tools and tricks that you can try because every hour is going to look and feel different. I feel like in your birth that having like a Rolodex of tools that you can use to, to try out, like, like you said, you didn't want to push on your back. so utilizing different positions to see what like felt best I think is key to like

going with your gut and seeing what what feels right. But then also with the breathing, I feel like breathing is so hard because it's like not intuitive. Almost if you haven't, yeah, if you haven't practiced it, it's not intuitive. So I think like you said, it takes a bit of time to like figure out the right groove. But I think, like you said, trialing an error and see like what breathing works, what doesn't. And then obviously, huge advocate for having a doula to kind of help you.

Katie Moise (35:46)
Yeah, no, it's not.

Jessica Lamb (36:05)
through positioning and movement and all of that stuff. Yeah, I think it's super helpful to know like, like practical usage of the skills and tools that you might learn in pelvic floor work or physical therapy to help you kind of like get into the zone is amazing.

Katie Moise (36:08)
Totally.

Yeah, and I always tell people too, it's like we practice all these things. I think that toolbox and like arsenal of things is so important because you don't want to go in with a fixed mindset. Like research does show less perineal trauma in pushing and sideline. But if you go into your birth and you're like, I have to push and sideline, that is the only way.

and it's just not working, you know, like we would rather you, I don't want you pushing for three hours. So if it's just not working, like let's try, let's be open to trying something else. And so that's why we really try to like practice it in all these different ways, educate on like, there is more than just one right way to do things. But there's also freedom and like, you don't have to just be on your back either, you know, I think can be helpful.

Jessica Lamb (37:02)
Yeah, I, I was like so set that I would not be pushing on my back. Like I either wanted to squat or like, do like hands and knees or side lying. And it was just, none of it was happening for my baby. And the only way that he was coming out was me laying on my back. So I was like, whatever, as long as I can get him out and it's like the optimal position. but it's so, it's so true that like, you could go in with one mindset and it's, it's.

Katie Moise (37:20)
Yeah.

Jessica Lamb (37:28)
going to go how it's going to go. So yeah, think having like a toolbox of things that you can kind of pull out as you're going is key.

Katie Moise (37:35)
Yeah, definitely. It's like we talk about birth preferences versus a birth plan of just like, here's some things I would like to do, and I'm open to doing them differently if needed. Because ultimately, you just want to have a safe, you want to be safe, you want your baby to be safe. And whatever means that means getting them out.

Jessica Lamb (37:51)
Yeah. Yeah. So anything that people can do immediately postpartum to kind of start being more mindful of their pelvic floor and making sure it covers smoothly.

Katie Moise (38:03)
Yes, so early on, the biggest focus is rest, definitely those first couple of days. However, some other things you can consider, people can be really fearful of that first postpartum poop. And so there's a lot of blood volume that can be lost during birth. And you're just in that kind of like fresh newborn haze where you might not be drinking enough water. And so I always encourage people to like, have your partner if they're

or if they're with you to like make sure you're drinking water and staying hydrated. Sometimes I'll recommend patients even taking like prunes with them to the hospital to like get a little fiber to get things moving and to keep your stool soft. But things that we can do to kind of help make that first couple of poops easy, because again, if you are sitting on the toilet straining, really trying hard to have your first bowel movement.

That's your pelvic floor so vulnerable, especially right after a vaginal birth. We don't want to be putting any excess force or pressure on it by straining to poop. So I had a foldable squatty potty that I put in my hospital bag. You can take some yoga blocks, turn the hospital trash can on its side, anything like that to prop your knees up so that you're in a more relaxed position for your bowel movements. Staying super hydrated. I'm also...

a big fan of magnesium. the hospital or if you're at a hospital will most likely give you col-A to help with that soft stool, but magnesium also does the same thing. So I like packed my bottle of magnesium and was ready to go. And then really with bladder health too, you want to just make sure you're drinking enough fluid. If you're somebody that's producing breast milk, so much of your water intake and resources are going to making breast milk that it can be just really easy to become dehydrated.

If the concentration of your urine is really, like if your urine is really dark and yellow, then the bladder can be more irritated, which is making you feel like you need to pee more often. So really staying hydrated is important. And then really early on too, you can start focusing on reconnecting your pelvic floor with your breath. So starting with just some basic diaphragmatic breathing, I like to have patients place their hands around their rib cage and just take some nice, slow, deep breaths. You can do that.

you know, hour one after you give birth if you wanted to. So that's something that you can easily do. And then in those first couple of days postpartum too, like if you start to just do gentle contractions of your pelvic floor when you're exhaling, that will start to reconnect the pelvic floor with your diaphragm and help that system kind of rebuild. So for some people, like starting that early on is super appropriate. But I would say in those, that first week, we're really working on

any kind of pain management that's needed. So using ice as needed if there was any tearing, using a Perry bottle to help with cleaning if you're having any kind of pain with urination, and then managing your bowel health to again, just avoid that excessive pressure. So we don't want to be sitting on the toilet to pee and like forcefully pee and push our pee out, but we also don't want to sit on the toilet and forcefully strain to have a bowel movement in those early days.

Jessica Lamb (40:51)
Yeah, those are all I can attest to that is a very fearful time. And so I think, yeah, I think the magnesium is amazing for sleep as well. Obviously you're in a really crazy sleep cycle, but it can help with sleep. It's really good for like your digestive system, all of that. So with a few minutes left, we've talked a lot about vaginal birth. What advice do you have for moms who have had C-sections?

Katie Moise (40:56)
Yeah.

Yes.

Yes.

Yes, so biggest advice is that we see a lot of people who end up having c-sections who assume because they have a c-section, their pelvic floor was spared. And I think we tend to forget that your pelvic floor changed over the course of those 10 months of carrying your child. So I highly recommend still following up with a pelvic floor therapist to see kind of how your pelvic floor is recovering, but also you had major abdominal surgery.

If you were to have any other like a hernia repair or any other abdominal surgery or any surgery in general, they're going to automatically send you to PT for recovery. Yet for some reason, when we have C-sections, they kind of just clear you at six weeks like everyone else and send you on your way, which is kind of crazy. So, know, pain management in the early days of post C-section is really, really important. We want to be mindful about how we're moving to decrease

any kind of like pulling or strain across the abdomen. So that looks like maybe rolling in bed to your side before getting up out of bed. If you're sitting back in like a recliner type chair to like feed your baby, you might actually want, you know, whoever support system you have to like put their hands behind your back to kind of help push you to the front of the chair to make it easier to stand. Going to the bathroom again for bowel movements really important.

post-surgery to kind of keep your bowels soft and regular with hydration, fiber, all of those things. But also you may actually want to like splint or brace with a pillow just to kind of decrease that pressure on the abdominal wall. So those are kind of like some of the early things postpartum.

the other things too is like we want to start touching the scar around the scar on the scar. think that's something else that we don't really educate people on is scar massage. And that's going to be something really important

towards those like first couple of weeks, we can start like getting comfortable with placing a hand on the abdomen or using a cotton ball and just rubbing it gently like around the incision so that we can start to make that area less sensitive. And then over time, as that scar has healed, we can start to have more like hands-on direct techniques to help break up that scar tissue. We're gonna start really focusing on

core rehab and abdominal strengthening because again, several different layers of muscle and tissue have been cut through during your cesarean birth. And anytime that happens, the abdominal wall is in response just going to get weaker. Same as like if you had ACL surgery, your quad gets weaker after that surgery. And then coupled with the abdominal wall being stretched out during your pregnancy, like you kind of have a double whammy as far as weakness goes. And so we really want to make sure that we build up that strength.

It's really common for our C-section mamas to have low back pain, mid back pain because they're just lacking some of that support. So early on too, this is kind one of the only times where I might recommend a light abdominal wrap or binder type situation to just give them a little bit more support during those early days. It's not something we want your body to have to rely on long term, but early on.

Again, because you've had this space occupying baby that's now gone, so the stomach is pretty soft and mushy, and then you've had this major surgery. And so I think a little extra support there can help in those early caring for a newborn and also trying to care for yourself.

Jessica Lamb (44:20)
Yeah, for sure. And especially the moms who, pushed for a long time and then wound up having a C-section as well. Like obviously you experienced both types of birth. ⁓ so I think paying special attention to that is if you're a mom who had that experience, think, focusing on the

Katie Moise (44:30)
Totally.

Jessica Lamb (44:38)
repair that a vaginal birth requires and then same for C-section I think is key.

Katie Moise (44:43)
Yeah, and it's so interesting. Research actually shows us that post-Cessarian birth, women are more likely to have pain with intercourse rather than after a vaginal birth. So again, it's one of those things where just because your baby was delivered in a different way doesn't mean your pelvic floor isn't going to be affected. And so we have to really look at that whole picture when we're thinking about healing after a C-section.

Jessica Lamb (45:03)
Yeah, that's really interesting. I didn't know that. Okay, anything else that you think is important for people to know about pelvic floor health in general or during pregnancy and early postpartum?

Katie Moise (45:13)
I think we really covered it. I mean, I think the biggest thing and like how we kind of spoke in the beginning about not a lot of people think about going to see a pelvic floor therapist during their pregnancy, especially if they're not having symptoms. But our healthcare system, especially in the United States, is set up to be like very reactive. And I think what the role of pelvic floor therapists are trying to get to is like this proactive way to like stay ahead of symptoms to really optimize pregnancy. So it doesn't have to be this like miserable time where you just like feel crummy and are dealing with pain.

But like, can we proactively set you up for support, not only throughout your pregnancy, but then also hopefully to help with your birth outcomes as well. So just keeping that in mind and then knowing that you're not alone. These symptoms that you might be experiencing are super, super common, but they're not normal. And there are awesome pelvic floor therapists all over the country and world that can help with these things.

Jessica Lamb (46:00)
Yeah, that's great advice. And I think to piggyback that find a, if you, if you're not already going to one prior to being pregnant, find a pelvic floor therapist while you're pregnant, that is in your insurance, in your area, whatever. that postpartum, you don't have to go searching for one and you already have a care established. think that that's a, something that moms can to kick down the line is not a priority. but it can be so helpful to be connected to care immediately.

Katie Moise (46:25)
Totally. And it feels less scary trying to establish in a relationship that's pretty intimate during pregnancy than when you're in the thick of postpartum. So it's like, we always educate on doing the same thing with lactation or mental health therapists, but it's like getting that kind of team together that's going to be able to support you both in pregnancy and postpartum is super important.

Jessica Lamb (46:33)
Yeah.

Mm-hmm. Yes.

Yeah, I'm a huge advocate for like getting your laundry list of providers set up and established before even meeting them. Just so you, I mean, those first few days and weeks are so hard. needing to like go through insurance and figure out who's covered is like the last thing you want to do. So I definitely piggyback that. ⁓ so tell people where they can find you social media, website, whatever, you'd like to share.

Katie Moise (47:00)
Yeah. Yes.

Yeah, absolutely. So our clinic is ATL Pelvic Health. You can follow us on Instagram at atlpelvichealth and then our website is just www.atlpelvichealth.com. So you can reach out there if you have any questions. We would love for you to follow us on Instagram. We try to post lots of like fun educational stuff on there as well.

Jessica Lamb (47:25)
Yeah, awesome. Well, thank you so much for being on. This is amazing.

Katie Moise (47:27)
Yeah, thank you for having me. This was fun.