Latest / Twin Mom Life / Birth Prep & Healing After: Dr. Betsey on Pelvic Floor, Ab Separation & Why Kegels Aren't the Answer
Transcript
- Jessielee Sittig: Hello and welcome to the Twin Mom Life podcast. I'm your host, Jess. I created this podcast to help build community, connection, and most importantly, friendships among moms of multiples. Being a twin mom can be amazing and magical. That twin bond is unlike anything I've ever witnessed, but it can also be isolating and overwhelming. I'll be chatting with other twin moms, diving deep into the twin experience. This episode is brought to you by Thrive Market. Looking for healthy snacks delivered straight to your door? I got you. As a mom of three littles, I'm always trying to find ways to make my life easier. I've really been enjoying Thrive Market. They carry all of my favorite organic brands I don't feel guilty giving my kids. it's not just a market for food. Thank you for taking the time out of your busy twin mom life to listen along. I hope this podcast shed some light on a topic that's been on your heart and gave you more confidence as a twin mama. If you know a twin mom, please send this her way. If you like what you heard today, please subscribe to the podcast and leave a review. Check out the show notes to be connected with today's guest and get discount codes for brands I love. See you next Thursday. Until then. thank you so much for coming on the podcast. Today we have Dr. Betsey. How are you doing? Betsey: I am so well. I'm excited to be with like my twin mom corner this morning. It's gonna be a lot of fun. Jessielee Sittig: Yes, me too. So can you tell us a little bit about yourself? Betsey: Sure, I am a mom of four kids. I have a seven-year-old, almost five-year-old, and then three and a half-year-old twin girls. So two boys, two girls, love that. ⁓ I used to work as a pelvic floor physical therapist, but now I have transitioned to online courses helping moms prepare for childbirth and postpartum. I help women heal their abs and recover after birth injuries. My heart is really in helping women feel empowered. Jessielee Sittig: I recently ordered a mineral sunscreen stick and fragrance-free bath bomb for my kids. Use my link in the show notes to get $20 off your first three orders and a free gift. giving advice on what works for us so you don't have to learn the hard way. Juggling two babies at the same time is challenging, but I'm confident we can learn from each other and figure out how to raise these babies together. You are made for this. Betsey: And get to know their body before childbirth so that they are not having to heal from a severe birth injury postpartum. was not a twin mom when I created my courses, but now that I am one, I have an even bigger appreciation ⁓ how important it is to focus on holistic health, to feel our best throughout motherhood. There's so many voices out there. I really try to be encouraging, compassionate, ⁓ realistic for my ⁓ community of moms that I teach. So I'm excited to be here today. Jessielee Sittig: Yes, me too. And I was telling you, I'm like very selfishly excited to be able to ask you questions. And my boys are almost three and I really suffered with ab separation that is still very clearly there. So I'm excited just to pick your brain and learn all the things. And I just hope that this episode will help moms get help sooner. I feel like with my daughter. Betsey: Mm-hmm. Jessielee Sittig: It just wasn't really talked about like pelvic floor therapy and things like that where I feel like it's becoming more common now, where women should really be getting those kind of services preventatively and not to fix things. So I can't wait. Mm-hmm. Yeah, I can't. Betsey: Exactly. I totally agree. And that's kind of why I segued to working online because I was seeing mostly women after they had the baby and after they had an injury. And I was like, you know what? I think we can be doing childbirth prep differently to help try to avoid some of these issues that women are having. And it's been, you know, hugely successful helping moms both in preparing for childbirth and then also that recovery piece. And you're right. Not everyone has access to pelvic core therapy. They may not have the funds. There may not be one in their area. It may not be covered by insurance. And so this is what's beautiful about our day and age is that we're having these conversations and that there are online options to help support moms too. Jessielee Sittig: Mm-hmm. Well, and you can help so many more people by offering an online course than you can, meeting moms individually. And that was the issue I ran into, is it wasn't covered by insurance. So it was like, is this something? ⁓ And, know, when I was seeking out the resources for pelvic floor therapy after my twins were born, we were also dealing with a lot of medical bills from their birth ⁓ and like that. So we kind of put Betsey: Yes. Mm-hmm. Jessielee Sittig: my pelvic floor therapy on the back burner in order to focus on the medical bills from the birth of my boys. Betsey: I honestly think there's as twin moms, we're in a very unique situation. It is incredibly different raising twins compared to one, as you know. And it can be very hard to f get out of your house to the time to go to an appointment. And then if you're breastfeeding or bottle feeding, there's just so many diff the mental math to get out the door as a twin mom, that first year of life and even beyond is very hard. ⁓ So there is this window of opportunity for healing your body six to 12 months postpartum. That's the science, but I always like to tell moms: here's the truth: it's never too late to begin to heal your diastasis rectus, to heal that cesarean scar, to heal pelvic floor dysfunction. I myself could not do the exercises that I knew as a PT that I needed to do until about 20 months postpartum with my twin girls. And I still had success with closing that abdominal separation. And feeling really good in my body now. So there's always hope. It's never too late. And I think one of the biggest things that we can do as twin moms is really not beat ourselves up about not, you know, getting in for the rehab, doing all the things, jumping back into exercise in this really tender time of life where we're just pulled and sleep deprived and, you know, trying our best. Jessielee Sittig: Well, and that's helpful for me to hear because not like I didn't necessarily feel like, ⁓ it's too late. ⁓ well. But as my boys are nearing three, I've thought, I'm not really sure if it's worth the effort or if I can even fix anything. So it's nice to hear you say that I still can. So even though the window of of ideal opportunity is the year after you give birth. So Betsey: Absolutely. Jessielee Sittig: we're already getting into the meat of it. And before we keep diving in, I would love to know if you've had the opportunity to fill your cup or if you have plans to do so later. Betsey: Yes. So I knew this question was coming. And I was going to say it was getting up before my kids. I have that blessing because they are now sleeping through the night. You will get their moms. If you've got little ones, you will one day feel refreshed. So I get up before my kids to pray, do little bit of work, and exercise. But what really filled my cup this morning was actually sitting in our den. morning, we had no screens, no phones. My husband and I both work on our laptop, so everything was put away. We were snuggling our twin girls, like the light was coming through the window and it was just quiet. And we were listening to the birds and the wind through the trees. And that intentional time and unplugging, I think, is like the biggest gift we can give to ourselves when we're just kind of in a really crazy time of life. Jessielee Sittig: Mm. Yeah, absolutely. That sounds so it almost sounds like picturesque. I'm like, ⁓ that sounds beautiful and so relaxing. Betsey: Yeah. There's not I know, there's not many picturesque moments. My two older boys were off playing nicely. My husband and I were just like, ⁓ my gosh, should our nervous systems just like totally go into the parasympathetic like rest and digest instead of like, you know, it's so easy to like go through life really stressed when you've got so many little kids and you're doing all the things. So it was beautiful. Jessielee Sittig: That sounds great. So I was telling you, we've had a little bit of a hectic ⁓ not hectic, but it's been a busy morning. There's been some tears over everyone's having growing pains. I'm like, are we all feeling achy? What do we need to do here? so we had some tears about that today. But this afternoon or this evening, one of my friends is hosting a TJ's and PJs get together with some girlfriends. So she has gotten snacks from Trader Joe's. ⁓ I thought that was yes. I have never heard that before. She's so creative. She's like the the friend in our group who does like balloons and all these arts and crafts with her kids. So that is tonight. And I'm looking forward to having just girl time. We do a lot of mom play dates and stuff. And you know, when you do that, it is so fun, but Betsey: Okay. I was gonna say, what's the T J part? That's cool. Yeah. Jessielee Sittig: The conversations are often segmented and you don't get to finish. And so I'm looking forward to having like uninterrupted mom time with some awesome snacks. And in PJs, I'm like, ⁓ that makes it so easy. You don't have to worry about what to wear. We're all wearing pajamas. Betsey: Cozy and good food. Like what more do you want as a mom? And good community. I love it. Jessielee Sittig: Yes. So I'm looking forward to that. And I feel like, ⁓ my gosh, I feel like there are so many silly reels about getting moms together and just the effort and calendar coordinating that it takes to do that. I think this has been rescheduled maybe once or twice. So it's finally here. Betsey: I'm so excited for you. I've like in my mom group chat, we are trying to find a couple's date for a boat ride and I'm like, just tell me what day, like I will clear the schedule to go on a boat with like all of our couple friends. But it is hard. Like it is so hard to find the time, especially in the summer when people get busier. So I love that for you. Jessielee Sittig: Yes, and the boat ride sounds so fun. That's cool. Betsey: I know. It's like, get me on a boat, please. Like get me out of my house. Like I want to have all of the fun this summer and I now can leave my kids. I'm not nursing anymore, you know, so we're not tied to the routine as much as we used to for so many years. Jessielee Sittig: Mm-hmm. Yeah, absolutely. Well, I hope you guys can coordinate and get that on the book soon. But even harder that you're ⁓ thank you. Yes. Betsey: I know. I hope so too. I hope so too. And have fun tonight. I know. I know harder with couples. I'm like, I've actually never done like a couples date night. Like that sounds impossible to plan. So who knows if it's happening, but one can hope. Jessielee Sittig: I know, I'm like, that's a lot of schedules to coordinate. And then you have to get a sitter. So it adds, yeah, it's complex, but so fun. So I hope that happens for you. Like ASAP. Betsey: Yeah. Yeah the whole Thank you. Jessielee Sittig: Okay, so I would love to talk about if a mom is pregnant right now with twins, with a singleton, what can she start doing to prepare her body for labor and just all the things? Betsey: Absolutely. There are so many things. I where do I want to start without overwhelming people? So if you are newly pregnant and you are feeling good, like the number one thing you can do is just start moving your body more than what you have been doing. So I love walking. It is so good for our pelvic floor. It is wonderful for our joints. So getting out for walks almost every day as the weather gets nicer. I'm in Michigan. We finally have the sun and warm weather. Getting out for walks is so good. Once you get into That second trimester, maybe you are not nauseous anymore, maybe you're not so exhausted. I love to build some bodyweight strength training in. The more you can focus on body weight strengthening or weight strengthening with good intraabdominal pressure, meaning that you're not doming or coning. So you're not noticing your tummy is coming forward, or you're not feeling that pressure downward on your pelvic floor. Jessielee Sittig: Mm. Betsey: is so great. I've heard this in the birth world we often say you need to train for birth like it's a marathon. And that is true because birth is harder and longer usually than a marathon. But that also can feel really like out of touch for some of us who just don't run marathons. I've never been a marathon runner but I've always been really into fitness. So I like to have different goals. We're working on strength training, upper body, lower body. And then in the third trimester, there are some excellent birth prep Exercises that you can do to help repair your pelvic floor, your low back, and your hips for childbirth. I have a freebie, which maybe we can link below on exercises that you can do instead of kegels. Because one of the myths out there is that you just need to start contracting your pelvic floor muscles and kegling, keegling, keggling, like Kegel at the stoplight, Kegel in the grocery store line. We don't need to be doing kegels. It's really one of my pet peeves because if you imagine. The pelvic floor, for those of you that don't know, by the way, is a hammock shape of muscles that sit at the base of your pelvis. They surround the openings of our pelvis. So for us, that is our vaginal opening, our urethra, and then your anus, where you are defecating. So these muscles contract to keep everything in, but they relax to let things out. So if we just spend nine months of doing kegels, when it comes time to birth, these muscles are going to tense up. ⁓ and then what's gonna win? Baby's head trying to come through or a tight muscle? And that muscle, if it has to stretch and tear in order for baby to be delivered, now we have a birth injury. And that's something that we want to try to avoid. So my specialty is helping women tap into what we call your deep core system. It's made up of your pelvic floor muscles. your deep core muscles and your diaphragm. So if we can learn how to breathe appropriately and connect with our core and pelvic floor in a very specific way. And it's so cool, Jess, because we can train this during pregnancy, it's then going to help us tap into these muscles during labor, whether or not you have an epidural, so that these muscles know how to relax and get out of the way. Cause they have to lengthen and move for you to birth that baby without injury. So let me just give you a couple birth prep exercises that I love. I love Jessielee Sittig: Mm. Hmm. Betsey: Happy baby, if you're not in the third trimester and you're not getting any signs of discomfort laying on your back. You can also do happy baby, which is just where you're your back and you're holding onto your legs. opening up that pelvis. You can also do child's pose, which is a very common yoga pose. hip 90-90 rotations. Getting a birth ball is an excellent investment, especially for moms, because as those babies grow. ⁓ You're going to wanna like bear hug this thing, being on all fours, just rocking back and forth, rocking on it. It's gonna help relieve pressure on the joints. So movement is key, especially when we're feeling good in our body, because there might come a time in that third trimester where movement can become painful, especially if you have pubic symphysis dysfunction. I had that with my twins, ⁓ where suddenly movement was very hard. And then you're kind of limited. So if you're feeling good in your body, like let's get moving now. ⁓ before those babies grow. So that was a very long-winded answer, but I think the key is to move, walk, and then strength train if you can, if you feel good, and then start those birth prep exercises. Jessielee Sittig: I think that's super helpful. And I really like specific instruction. ⁓ I need to be told exactly what to do. This is why I like going to workout classes or watching a video. Because if I'm just gonna like quote unquote work out on my own, I'm not gonna, I'm gonna end up holding laundry. Like I need specific instruction. So I think that is very helpful. ⁓ so the freebie, does that show those exercises? Betsey: Yes, freebies will go through five different exercises you can do. It's like the first step of birth prep. And then if you really want to layer on top of that, my birth class, the push lab, ⁓ is a evidence-based birth class. I like to say that it combines both physical, and then the spiritual side of birth prep and training because when you get to labor. ⁓ Your body will follow your mind. So if your mind panics and freaks out and thinks like, I can't handle this, I can't handle the discomfort, our bodies tense up. So I go through really specific birth prep training where we're exercising and then we're down on the mat and we're relaxing our bodies and we're focusing on relaxing the pelvic floor. So you're kind of putting yourself into more of like a stressful state and then practicing that relaxation. So it's almost like mimicking labor contractions. So for someone like you, Jess, we I need to be told what to do. Jessielee Sittig: Mm. Betsey: That type of exercise is in my birth class because as a physical therapist, I couldn't just teach you about, you know, the stages of labor and how to breathe. I've got to add that physical piece and the mental piece as well, because those were the layers that I did not receive in the hospital birth class that I took with my first. I went in thinking like that was a fun time, but then recognized that actually didn't holistically train me for. The discomfort and the mental event that labour is for many of us. Jessielee Sittig: I could not agree more. So with my daughter, I went into it, maybe medically not being able to have an epidural. I have a blood clouding disorder and I was on injection blood thinners. So they said if your platelet count is too low, then you cannot get the epidural. So we were kind of waiting for my blood results to get back. I was having labor contractions. They were obviously extremely uncomfortable. And I had taken like the prep course through. hospital that was offered. It was very minimal. It was more kind of understanding the process, but it didn't give tips on how to be mentally calm. I think that's such a good, like the spirit body connection is so unbelievably important. So I love that that's included in the course as well. And I feel like once labor contractions got really painful, I started tensing and holding my breath. And my husband is telling me, just breathe. And I'm like, that isn't specific. I am trying to breathe and it is so painful that I am tensing, holding my breath. And then the nurse had said something like, if you're not trying to do better deep breathing, then I'm worried that your baby isn't gonna get oxygen. And then hearing that, I'm like, ⁓ my gosh, like just give me the epidural then. So I got the epidural. And after that, I was like, wow, I did not handle. Betsey: ⁓ my gosh, yeah. Jessielee Sittig: that pain very well at all. And I didn't do any prepping when I was calm. And that's the key. Like in a lot of regulation, like if you're not practicing when you're calm and when you're not in the, you know, intense pressure moment, then you're gonna get stuck and you're gonna get tense. So I love that that is included as well because I feel like a lot of people aren't prepared for the pain that comes with birth and they're not really sure how to handle how to handle that as well. Betsey: Exactly. I I had a similar experience with my first, even though I was a physical therapist and I helped people with pain. I wasn't mentally prepared specifically for labor. So after that event, I just went through a year of learning everything there is to know about pain science and calming your nervous system. We really have to reframe pain and not like run from it. So women, we have this beautiful ability to handle these contractions. Like the contraction Jessielee Sittig: Mm. Betsey: is part of you, right? So like your body's generating this contract and we can learn how to like fried it and how to breathe through it. And it's I'm so sorry to ha to have a birth class, like I you and I both took the hospital birth class, no education on how to actually handle the discomfort, the pain, and then to have a nurse look at you and say, Well you're not doing this correctly and you're ba like now we're worried about baby. That's so frustrating 'cause it's like I'm th I'm a first time mom, I'm trying my best and your class, your hospital class did not prepare me for this. So My hope is that we have all these tools in our birth toolkit, as we call it, to help lower that pain response, even if you want the epidural, because even if you go in like I don't care about any of this, I'm just gonna get the epidural, but you still have to cope with discomfort before that epidural is placed, and then it's never a guarantee. It may not work the way that you're hoping for it. So I had an epidural with my first two. It really did help my body calm down because I was in that sympathetic nervous system, that fight or flight where I really was trying to like run from the whole situation. So if we can help moms not be in that situation, their birth is going to go so much differently. Jessielee Sittig: Mm-hmm. And that's such a good point about the epidural. so I don't know what it is about my spinal anatomy, but with the epidural with my daughter and the epidural with my sons, I only felt it on the right side. So it helped. Yeah. They were able with my sons to kind of like give a little bit more of the pain medicine and it helped, but I could absolutely still feel the contractions, especially on my left side. Betsey: Interesting. Jessielee Sittig: It was just more manageable and I could breathe through what I was experiencing. And it was definitely at like a much lower threshold than before the epidural. But yeah, that's a great point. And sometimes things happen so quickly if you're not able to get the epidural. But yes, I think knowing how to breathe through. And even then, when you have an epidural, you're still going to need to be pushing through these contractions in order to get your baby or babies out. So being able to breathe properly through that is so important. And I wish that I would have done a better job at prepping myself for that. And I thought with my daughter that I did, I'm like, ⁓ I took the the hospital birth course and it really, it really didn't go over what I needed. Betsey: Yes. Yeah, I I hear it time and time again. And a lot of the moms or couples who sign up for my birth class, the push lab, are second time moms who recognize like that didn't go how I wanted it to. I didn't feel supported. I didn't know how to advocate for myself. I didn't prepare the way that I wanted. ⁓ So I really do see as this beautiful method that I've put together to help moms feel confident and excited for birth and not fearful of what's going to happen. So ⁓ it's really been it's like signature. course, I created it back in 2020 and it has been such a gift to hear the birth stories of women who have taken it and then have not had a severe injury or they did with her first, took the push lab and then they didn't. And I actually went through and polled everyone. So in the US, the of having a severe birth injury, which is where the tear is going back into your anus and sometimes into your rectum, those are really that's a big ⁓ rehab process. So that's like a three to eight percent of that happening in America and with women who take my birth class, it's less than one percent. So we're seeing this method works ⁓ if I can help even a few women avoid those severe injuries, especially with twins, because now you're carrying two babies. You don't want to be healing ⁓ a severe birth injury. It's just a lot. Jessielee Sittig: Mm-hmm. Yeah, I really wasn't prepared for how sore and how uncomfortable I was going to be after tearing with my daughter. So I had a second degree tear with my daughter, which, you know, there's four tiers, right? I was thinking, ⁓ that doesn't seem that bad. And I remember my husband said something that was funny, like the day after I gave birth. And I was like, it was so painful to laugh. Betsey: Yeah. Mm-hmm. Jessielee Sittig: And I had to get one of those like donut pillows because I could not sit down on even a couch without having space in between where I was sitting down. Like if you've seen those those donut pillows, that's how ⁓ uncomfortable I was postpartum with just a degree tear. So the moms who have so a fourth degree tear is when it goes through to the anus, is that right? Betsey: Yes, yes. It goes through the external anal sphincter, which is a muscle, and then it's going through the lining of your rectum. And so when we have that fourth degree tear, you know, physical therapy, pelvic for PT is definitely indicated. But I think this is a good place to talk about, you know, how do we heal from a grade one, grade two, three or four tear? Like you use that donut pillow, that can be really helpful. Learning to sideline nurse, so you're laying down on your side to nurse, can help alleviate pressure. Jessielee Sittig: Mm. Mm. Betsey: And I love Epsom salt baths for anyone who maybe is listening and they're in that healing phase. So you just take Epsom salts, you can put like a cup or so in a shallow bathtub, or you can buy off Amazon this sit bath. It's this contraption that goes over your toilet seat, and then you're putting Epsom salts and warm water, and you can do that several times a day, and it's going to help that area heal. And then that pressure downward, like when you were laughing at your husband. That can cause too much pressure on that healing area. So we're trying to exhale. We're exhaling as we pick up our baby. We're exhaling as I put the baby down. we're not holding our breath to have a bowel movement. You can splint that area. So you're putting pressure where the the tear was. So you might want to take like a tissue and just press there while you're passing urine or stool. And sometimes like it's just can be messy, but it's just providing support there ⁓ as healing. And most importantly knowing that this will heal and that you're going every week that goes by postpartum, you're going to feel better. So those are the things you can do to really help. It's staying hydrated and eating well nourished, good food will help with healing. Jessielee Sittig: I do have one question, back to prepping for birth. I know we talked a lot about movement. Is there any ⁓ behind raspberry leaf tea and dates in helping prepare for ⁓ birth? Betsey: Okay, the evidence, the last time I read that, the evidence on dates is pretty low. The raspberry leaf tea is a little bit better, but it's not great. So it's not going to hurt you to eat your dates and to drink your red raspberry leaf tea. I do want to say there are some people who shouldn't be drinking red raspberry leaf tea. It might be if you're more prone to ⁓ hemorrhaging, I haven't read that research in a bit. Jessielee Sittig: Okay. Betsey: But I want to say it's not like super evidence-based. I would say it's something you can add in to just kind of feel like you're doing more to prepare your body. But if you hate dates, like I wouldn't be suffering through eating dates because those are full of a lot of sugar. So you could eat it with a huge slab of grass-fed butter or peanut butter. And so you're getting some fat with that sugar. And that'll help you process it a little bit better. But it's not the most evidence-based. Jessielee Sittig: Okay, that's good to know. So if moms feel like what they need to focus on, it would be getting movement, making sure they're walking, doing those prepping exercises. And if they wanted to add in dates or tea, they can, but the evidence there isn't as convincing. Betsey: It's not as convincing, but it's not going to hurt you to do it. So I want to that to be clear. It's good to drink it. I will say, and this is just me, but I think I drank red raspberry leaf tea with my first two. I had a grade two tear with my first. And then with my second, it was like just the smallest grade one. And then with my twins, I didn't have any tearing. And I didn't even bother with red raspberry leaf tea. But this is just my own experience. And also like with each baby that you give birth, you know, you're incidence can go down if you've been preparing. So I think that that was a good question. I also think it's really important to just practice good pelvic floor health. So what that looks like is you're not pushing when you have a bowel movement. You're not power peeing. So you're like pushing as you pee. When you have a bowel movement, you have your legs elevated on a foot stool. You're relaxing. You can think of this as birth prep. You are exhaling as you pass dual. So when you do that, you're not bearing down. And then the breath work is so important. So you're working on diaphragmatic breathing, you're exhaling when you're doing things throughout the day. You're not relying on a breath hold to give you stability and to give you strength when you're just living your daily life. if you sit for your job, ⁓ getting up every hour to move around a little bit. You know, you can do some of your work with a standing desk or just walk around your office. Jessielee Sittig: Mm. Betsey: But getting up and changing position is so important too. it's just trying not to stay in that same position for hours on end, especially when we're pregnant. ⁓ all of those things will really help. And then the the key thing ⁓ really connecting with your pelvic floor and understanding this is what it feels like to do a Kegel. So when you contract up, ⁓ then this is what it feels like to relax. And if you can't relax, or if you do have to hold your breath and push to have a bowel movement. ⁓ these could be some indications that it'd be great to see a pelvic 4 BT. Maybe you need some manual therapy on those muscles to help them relax and also to help you learn how to coordinate those muscles so they can relax when the time comes to birth your baby. Jessielee Sittig: That's great. Well, and I love that you brought up that like there's more than just doing kegles. Like there's other because I feel like that's what you hear a lot. And I feel like that's what I I don't know from my Google search with my daughter. Like, okay, that's what I can do. ⁓ there's so much more that you can do for your body than ⁓ doing that. Betsey: Yes. Yeah. Kegels functionally, they're not great. They're not doing anything for you. Yeah, you want to know how to do a kegel. Like we want to know what it feels like to tighten down there, but also what it what we need to know what it feels like to relax. And when you Google, should I be doing kegels during pregnancy? It's probably gonna say yes. And then if you ask your OB, they're probably gonna say yes. I've even had PTs that I've met and they say, We love what you're doing. I always tell my female patients to do their kegels, and I'm like, Yeah. Kegels functionally, they're not great. They're not doing anything for you. Yeah, you want to know how to do a kegel. Like we want to know what it feels like to tighten down there, but also what it feels like to relax. And when you Google, should I be doing kegels during pregnancy? It's probably gonna say yes. And then if you ask your OB, they're probably gonna say yes. and I'm like, No, like it's not functional to just walk around squeezing these muscles all day, So the Kegel, when overdone, could be setting you up for a harder labor. No, like it's not functional to just walk around squeezing these muscles all day, right? Like if you want strong biceps, like yes, you're doing bicep curls, but you're not walking around just like doing that all the time. You also want to be able to straighten your arm. So the Kegel, when overdone, could be setting you up for a harder labor. You're gonna be fighting against pelvic floor tightness and ⁓ The pelvic floor also does a really cool thing as the baby is descending down the birth canal. The pelvic floor is kind of like guide wires. So if there's you know tension on one side and the pelvic floor is lifted, now baby's coming out in a wonky position. So when we have good pelvic floor health, it's going to help the baby cut descend, rotate the way they need to, and come out without being in an odd position that could, you know, potentially cause a labor stall. Jessielee Sittig: Mm-hmm. Yeah, that's such a great point. And okay, I know we talked about healing from certain tears and what we can do. So what are other postpartum issues that moms face and what can they do to fix those? Like ab separation? Betsey: Yes, abdominal. We were talking about this before we started filming. So abdominal separation is called diastis recti. Some people call it diat diastasis recti. I can hardly say it myself. It's DRA. But essentially what that is, it's when your six-pack muscles separate to accommodate the growth of your baby or babies for us twin moms. And this is meant to happen. It allows the belly to expand. So I like to think of abdominal separation as necessary and good. As twin moms, we will probably have a bigger separation than most. So, postpartum, what does this look like? We've now lost some stability and strength in the front of our tummy. That is okay. We can use our abdominal binders to find that source of strength and stability, but we don't rely on that forever. I love using an abdominal binder, especially for twin moms. You might feel like even laying down at night, like your your guts, your tummy is just like spilling forward because there's that loss of support. So you can wear the binder at night if you need to. You can jam pillows up against your tummy to help provide support too. What we're looking for with a binder, I love the ones that basically look like spangs. So you're just pulling it up. My favorite is Love Steady. But if you already have the one with the Velcro straps, you just want to make sure you're not strapping it so tight that now you're putting a lot of pressure on your pelvic floor. We don't want to have too much pressure here and then it's causing dysfunction down below. So just Jessielee Sittig: Mm. Betsey: having it be gentle and it's not limiting your ability to breathe. So the binders are excellent. When you reach that six week clearance that you'll usually get from your OBGYN to resume exercise, we do not want to be jumping back into running, jogging, Strength training, HIT training. I understand the need to move. You just want to like get an exercise and you want to sweat. You want to feel good in your body again after having twins. But we really need to reconnect with that deep core system that we talked about. So we need to relearn how to use our diaphragm for breathing, relearn how to contract and relax your pelvic floor, and relearn how to use our core. These exercises are not rocket science, but they are the foundational work that you must do before you do anything else. And I have my class, the postpartum ab challenge. It's for any mom who hasn't done that intentional foundational work. It is imperative for us twin moms to do these exercises so that when we do get out and start running, jogging, strength training, that we are not injuring ourselves because our posture truly changes after carrying twins. It changes after carrying a singleton. And if we do not re strengthen and recoordinate those muscles, then we are gonna potentially injure ourself. I've had a lot of moms sign up for my app challenge after going right back into Pilates or circuit training or CrossFit. And they're like, you know what, I'm strong, but I still look six months pregnant or I my core doesn't feel the same. And I have to tell these athletic moms, you've got to dial back and we gotta start with this. Like give me six weeks of true core exercises and then we can advance it. I have a program that helps you do more advanced core training and strength training. Jessielee Sittig: Hm. Betsey: But this is so important. And it's like a such a gift to give yourself before you hit menopause. Because once we hit menopause, we start to lose muscle mass. And then rebuilding that core foundation is going to feel harder. So it's such a gift to take that time. And then the key word is time. It takes time to heal your core. And as twin moms, it can feel like I have no time. And I hear you. Jessielee Sittig: Mm. Betsey: I would never tell a mom to do this at six weeks if she can't find time to brush her teeth and take a shower. So there's this window of opportunity for healing between six and twelve months, but you can also heal your core after twelve months. Jessielee Sittig: Mm. Betsey: So we have this six to twelve month window of opportunity right the baby's born that first year ⁓ to really rebuild collagen and rebuild our core strength. That's a science. But the truth is can always heal your core, no matter if you are six weeks postpartum or six years, you can always rebuild strength. And I didn't heal my core until I was 20 months postpartum because I had ⁓ my twins were born, I had a three-year-old, an 18-month-old, and newborn twins. ⁓ was stuck in survival mode, even with help. I had family help. I had a nanny coming and helping me. I couldn't mentally get myself to a place where I could do these exercises. So for the mom listening who's like, you know, I really do want to take care of my body, but I simply don't feel like I'm mentally ready to do it. Jessielee Sittig: It's a lot. Betsey: Then wait until you are, because you don't want to sign up for something. Although when you sign up for my six week postpartum app challenge, which is wonderful for C-section moms or if you had a vaginal birth, you have it for life. So if you start it and then life gets busy, you know, you're thrown into a sleep regression, you can always pick up where you left off. So that's the beautiful thing ⁓ any intentional work that you can put in to start to heal your body, ⁓ if you want more kids, it will serve you in the long run. Jessielee Sittig: Well, that was gonna be one of my next questions is for a mom that had a C-section, of she still has the ab separation, but how does that affect her pelvic floor? what pieces of advice are different for a C-section mom versus a mom who had her baby or babies vaginally? Betsey: For a mom who had a cesarean birth, it's really important to do that C-section massage and to reacquaint yourself with your C-section, with that part of your body. Many women, you know, they just kind of emotionally disconnect from it. They're like, I don't want to look at it. You know, I'm mad I ended up having a C-section, I have all these feelings. So they don't even want to touch in that area. I understand, like that's a big thing to go through. It's a major abdominal surgery, right? So reacquainting ourselves. So when you get home. Jessielee Sittig: Mm. Betsey: You can use a cloth if you don't want it to be your fingers. You can just start to like touch and massage your tummy. So not even on the scar yet until you're cleared by your doctor to start touching the scar area, but you're just starting to do some massage in that area. That's helping the nerves in that area wake up again. It's helping your body and your brain find that connection again. ⁓ As as pelvic floor health, even if you have a cesarean, ⁓ you not exempt for potentially having some pelvic floor dysfunction postpartum. And that is because our pelvic floor worked overtime to carry twins and to they're basically the floor of our core so they're tensed up you know they're holding up your organs they're holding up those babies for nine months and then postpartum we do have to rehab the pelvic floor as well so don't be surprised if you have a C-section and you are experiencing some pain or discomfort in the pelvic floor you're not broken you can heal from that but it is worth noting I've had moms in my treatment room and they're like so distraught. They're like, what did I do wrong? They'll say, I I'm having pelvic floor leaking. ⁓ I have prolapse symptoms where there's just pressure and heaviness in the pelvis. I thought wasn't gonna have any of this. It can still happen. So we oftentimes as as a pelvic floor PT, we will treat these women very similarly. We want to assess the nerves and the muscles in the pelvic floor area, assess the muscle function. of your core and how those nerves are reawakening. And for a mom at home, just trying to not emotionally distance yourself is a really important piece, I think, of that early C-section rehab that you might not be hearing if you don't go see a PT those first several months. So once you're cleared for a C section massage, go ahead and start doing that. And then when you feel ready, start to do those core rehab exercises, whether through my program or one that you find that you connect with that Jessielee Sittig: No. Betsey: Teacher better and you want to go through there just but taking the time to find what works for you. Jessielee Sittig: And one of my questions was going to be about prolapse actually. So what exactly does that mean and and how is that treated? Betsey: So pelvic organ prolapse is where one of our pelvic organs, whether it's your bladder, your uterus, your urethra, or your rectum, start to shift position and fall downward toward the entrance of your vagina. So there are different levels, ⁓ and that depends on how much it's coming down. The more babies you have, the more suspect you are to pelvic organ prolapse. And it can sound like a really scary thing. ⁓ as someone who does have ⁓ small degree of pelvic organ prolapse, I want you to let you know you can live a wonderful life. You can run after your kids, you can weight train, you can live a life ⁓ feel good down there. But immediately postpartum, ⁓ you're noticing any symptoms like heaviness or pressure, ⁓ feel like there's a tampon falling out, but you're not wearing a tampon. Jessielee Sittig: Mm. Betsey: ⁓ you're noticing changes in your ability to empty your bladder or to have a full bowel movement. Maybe you feel like there's a stool stuck in your rectum, like you can't completely pass that bowel movement. These could be some indications that you might have prolapse. You can also use a mirror and look and see if it looks like there's any bulgy tissue coming toward the entrance of your vagina. Now, if you have this, pelvic floor physical therapy is definitely your first step. ⁓ learning to heal your core through the postpartum ab challenge, wonderful first step. If it is a grade three or higher, which just means that it's really descended down, there are different devices that you can have fit to you. So it's called a pessary, and it's something that you insert vaginally, just like you insert a tampon. It's like a sport bra for your pelvic organ. So it's helping lift things up so you no longer feel that heaviness and that achiness. And no matter the degree that you have. Pelvic fluorotherapy is indicated before you consider surgery. For women who have like a grade four prolapse, surgery is often indicated, but that we're not usually seeing that too much in pre-menopausal women. And that's why it's really encouraging to learn the good push techniques to learn how take care of our body during pregnancy through the childbirth and postpartum to help set us up for good pelvic health and try to avoid those. higher grade prolapses where it's really affecting the way we feel on a day to day basis. Jessielee Sittig: That's so helpful. And yeah, I like a lot of these things I feel like I have some symptoms of. So I'm very excited to ⁓ check the course and I guess still have hope that even though I'm almost three years postpartum, that I can heal these things, even though it might take a little bit longer. And it was a really interesting to me that you were saying that all of these things that you you really want to make sure that it's healed before your menopausal. Because then things get even more difficult to heal. And not that I'm in menopause or anything, but I feel like I'm getting towards like the perimenopausal age. So when you said that, I'm like, I feel like that gave me even more, yes, like even more motivation to get this healed. I feel like this has been something on my to do list for since they've been born. So I just Betsey: Save or yeah. Yes. Jessielee Sittig: Really appreciate all the insight and the tips and where can people connect with you? Betsey: They can connect with me on my Instagram, which is Dr. Betsey PT with two E's in my name. That's also my website. I can send you links, Jess, to give your community a special discount on my programs. If it felt like a good fit, but you're not sure, can always DM me or send me an email that you can find through my Instagram. I love to connect with women before they purchase because I want you to really feel like, yeah, this is the right next step for me. ⁓ we can chat. Maybe you need to try the PT first before you jump in. I'm here to help problem solve that because it can feel very overwhelming. And then one last piece on the prolapse. Those symptoms of prolapse, you can have those symptoms and not have prolapse, which is why seeing a pelvic floor PT is helpful. So if someone's like, ⁓ my gosh, sometimes I do feel like a heaviness in my pelvis, it pelvic floor hypertenicity, where the pelvic floor muscles are tight, can mimic some prolapse symptoms. So I never want people to sign off this podcast and start to doom scroll and look up pelvic organ prolapse. That's not what I'm asking of you. But just know that sometimes we can feel like we have those symptoms and we don't. All in all, my parting message, Jess, to your community is that we live in such a beautiful day and age. There's so much education and information for us. Now, women, you know, even 20 years ago who had prolapse were told there's nothing you can do, you have to have surgery. Jessielee Sittig: Mm. Betsey: Women who were leaking, we're told you have to have surgery, there's nothing you can do. So that we're honestly, I think birthing babies in such a cool time of life where we really have a lot of excellent education, excellent things that we can do to rehab our bodies. But on the flip side, there's also an abundance of too much information. So I caution you guys, don't doom scroll when you're feeling discomfort postpartum with each month with With each week, you will feel better in your body and how you're feeling right now is not your forever. And I think it's important to know that. Jessielee Sittig: I love that. And I feel like that is like the benefits and doom of social media. Like the benefits are the community and the connection. And then the negatives are there is too much information sometimes and it can get overwhelming. So I think that's really good advice, especially for moms who are up in the middle of the night and maybe go to check their phone, like stop, protect your mental health. So I think that's that's really great advice. Betsey: Yes. Yes. Jessielee Sittig: That was a lot of really good information. And I really like specific tips. Like I don't think it's helpful when people are like, make sure you exercise. It's like, what does that mean? I need. Betsey: Yes. Jessielee Sittig: Give me the details. I want the meat of it. So okay, then Betsey: Mm-hmm. Yes. And you can get the meat of it through my ⁓ free how to prepare down there guide, which will give you like five things you can start doing today. So that'll be really helpful for the pregnant moms. And then postpartum, I do have a postpartum healing guide, which beautifully sums up some of the ways that we can really take care of our body during those first weeks. So that will be wonderful for the moms who are about to give birth or just did. Jessielee Sittig: I love that. Well, I think this has been so helpful. I really appreciate all of your specific tips I know we didn't get a chance to talk lot about your twins, but I think a lot of twin moms will benefit from this. And I think this conversation needs to be talked about ⁓ more ⁓ because I think we are all suffering some. level of weak pelvic floor muscles, ab separation. There are so many things that we could be doing. And I hope a lot of maybe moms who are pregnant with twins listening to this kind of learn from my mistake and get help preventatively instead of trying to fix it once you already have issues like like me. So, but if you could have I know, right? I know. I'm sure a lot of moms are in that position, but Betsey: You're not alone. Yeah. Jessielee Sittig: There are so many things where if I could have gone back and done a redo, what I would do differently. And this is definitely one of them. So you could have a heart to heart with a twin mom or give her a piece of advice, what would you tell her? Betsey: I would tell her to start talking to herself like she's her own best friend because in that twin I'm thinking of like the early newborn life, like that first year, we are overwhelmed. We are doing all the things. It is so easy to compare us to moms who have singletons or compare us to who we were before twins and to really live in this state of frustration. So Jessielee Sittig: Mm-hmm. Betsey: I started to notice in my own body when I start to get really anxious or irritable or I'm starting to look at my twins like they are an inconvenience instead of a blessing. The first thing I do is number one, put my phone down. Number two, talk to myself like I'm my own best friend. So I'm like, hey girl, like, do you need to drink some water? Do you need a snack? Like, what do you need? And because I can be very cynical. I'm such a cynical person. Like I'm always thinking of like, you should be doing this, you should be doing that. Like, why is the kitchen a mess? And I've had to retrain how I talk to myself. As a twin mom, because there will never be a day where I look presentable, where my house is beautiful and my kids are like shining lights, right? There's something's gotta give. So learning to be kind in my own mind has been a skill that I'm still working on, but I think it's like such a quick fix to help us better manage the life that we've been given as twin moms. Because it really is a blessing. It's overwhelming, but it's a huge blessing. Jessielee Sittig: I absolutely loved what you said was like if I'm looking at my twins like an inconvenience, like what needs to what do I need to do? Because they are a blessing. And I think every twin mom has has felt that way. And typically you're right. It's like I need some water and a snack when I'm feeling that way. So I think it's good to be like, yes. Yeah, absolutely. And I feel like that's what always ends up circling back. You know, we start with the podcast with how'd you feel your cup? Betsey: Yes. Like I need to take care of myself. Jessielee Sittig: And then I feel like the advice typically comes back to that in some shape or form. So I absolutely love that. And I have loved our conversation. And I think a lot of moms will benefit from from hearing all of this information and how they can help their bodies. So thank you so much. I really appreciate it. Betsey: That's beautiful. You're welcome. Thank you so much for having me. It's been great. Jessielee Sittig: Yes, it was so fun.