What Is A Pelvic Floor Physical Therapist?

by Tulsi Desai (Physical Therapist) A lot of birth workers have heard about pelvic floor. They know it’s important. Some are very well aware about what it exactly means either because they have been in the birthing profession for a long time, or have friends who are pelvic PT, or some have personally gone through pelvic floor rehabilitation after their babies. But there are so many others who think they kind of know what pelvic floor is? But not really. And they are not sure who to ask for more accurate answer. My name is Tulsi Desai. I am a pelvic floor physical therapist. You would ask why is pelvic floor physical therapy any different from regular physical therapy? Hope I can answer this as accurately as possible. Every physical therapist has to go through basic physical therapy degree either Bachelors, Masters (common degrees for more experienced therapists who graduated long time ago) and/or Doctorate in physical therapy/DPT (I won’t go into too much detail about the degree itself). Regardless of the designation, everyone has to take a board exam and get a PT license to practice in United States. Pelvic Floor or Women’s Health Physical Therapy is a super-specialization where a physical therapist has to go through advanced training in pregnancy, postpartum, menstruation, menopause and anything related to women’s health that includes reproductive system, urogenital system, gastrointestinal system, hormones and their effects on every tissue in the female body which is very different than the male. We get trained in unique needs of pregnant and high risk pregnant patients in order to provide them safe physical therapy treatment for back pain or any musculoskeletal problems they have. Human body is a complex structure and human pelvis accommodates a lot of organs mainly bladder, uterus, ovaries, fallopian tube, and colon as well as various nerves, blood vessels and lymphatic system. It also accommodates the growing baby during pregnancy. Pelvic floor is a termed used for a group of pelvic muscles that support all the above mentioned structures inside the pelvis and keep them in place. Pelvic floor plays a huge role in maintaining bladder and bowel continence. It also plays a role in sex and orgasm. Pelvic floor muscle problems or dysfunctions can lead to complications like urinary or bowel incontinence (varying from a few drop leakage to full incontinence), urinary urgency, urinary frequency, multiple chronic UTIs (urinary track infections),…

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Postpartum Depression Tried To Kill Me, Community Saved Me

by A. Jones Content warning: mention of traumatic birth, attempted suicide, postpartum mood disorders, unplanned cesarean, and failure to thrive in a newborn. My baby was born in the hospital that was across the street from my apartment. My OB was the first one that came up on my insurance’s website. They were convenient, and I trusted their credentials completely. They knew what they were doing, so I didn’t have to. I didn’t take a childbirth class because my doctor reassured me they only help women who are trying to suffer through without an epidural. I didn’t hire a doula because my doctor promised me they would start an epidural as soon as I had contractions and I would sleep through labor. I came in for an induction on my due date. I never went past 2cm dilation. I had a cesarean for failure to progress. After, a nurse reassured me that I would never have to go through labor again. Any other births would be scheduled surgeries. I had never wanted an intervention free birth, but I felt heartbroken. It all felt wrong. I developed postpartum depression, but didn’t know what was going on. I felt like a failure as a mother as all of my expectations went bust. I tried to kill myself. While I was hospitalized, my husband filed for divorce. I didn’t care. I felt like he and our son were better off without me. The fact that they were apparently doing okay without me cemented the thought. I had every intention of trying again once I was released. While I was still in inpatient care, my incision was not healing well. The nurse who came to help with wound care talked to me while she worked. She told me about her own cesarean, and how traumatic it was for her. She told me about the VBAC (vaginal birth after cesarean) she eventually had and the support she got from other VBAC parents. No one had talked to me before about how traumatic an unplanned cesarean can be. Everything before had been “but you have a healthy baby”. After a few talks, I broke down crying and released everything that I’d had bottled up since my son’s birth. She taught me that you can love your baby and hate their birth at the same time. She also put a flier for a VBAC support group in…

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Podcasts for Birthworkers

Looking for some new listening material? Check out a few of these birth, birthwork, and midwifery themed podcasts. The Full-Spectrum Doula Circle Podcast This podcast is an extension of the Full-Spectrum Doula Circle. The podcast started out in the fall of 2018 as a means of improving access to interviews that had previously been done for webinars by the same creator. Since starting, new content has been added also. past interviews include activists, authors, care providers, and more, including Melinda Morales, Indra Lusero, Mishka Terplan, and Renee Bracey Sherman talking about subjects like nonjudgmental support for pregnant teens, abortion doulas, and drug use in pregnancy. Find it on Apple Podcasts and Spreaker. Birth Kweens A doula and midwife teamed up to create this San Diego, CA based birth podcast. While their primary audience seems to be birthing people more than birthworkers, topics like the history of how menstruation has been managed, weight stigma in pregnancy, and nuances of practicing informed consent will likely appeal to both. Episodes include interviews with birth attendants, other birthworkers, and gestational parents sharing their knowledge and experiences. Find this podcast on Stitcher and Apple Podcasts. Masculine Birth Ritual Created by a self identified transmasculine birth parent, this podcast offers exceptional insight into the experiences of queer families, nonbinary folx having babies, and masculine leaning gestational parents. Episodes include topics like trying to conceive as a trans man, buffering the impacts of discrimination, and meeting people where they are. This is one of the few birth podcasts that uses language that acknowledges the broad range of people that become pregnant. This one also has written transcripts available if podcasts aren’t your thing! Dr. Stu’s Podcast Co-hosted by Dr. Stuart Fischbein, MD OB/GYN and Blyss Young, LM CPM, this podcast where the two interview various birthworkers about topics including coercion versus consent, community based birth, breech birth, and more. Find this one on iHeartRadio and Apple Podcasts. Birth Stories in Color Birth Stories in Color is, much like its name suggests, a collection of birth stories from people of color. The concept is based on a combination of the power of storytelling and the need for a space where birth stories that aren’t being heard elsewhere to be shared. Co-hosts Laurel Gourrier and Danielle Jackson are both doulas and reproductive justice advocates who share stories ranging from cesareans to unassisted births, and triumphant, empowering experiences to heartbreaking…

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Intact Cord Resuscitation: An Infographic Review

A new study out of Nepal has found what many a midwife already knows: babies can be resuscitated with their cords intact, and often fare better when they remain connected to their placentas during resuscitation. You can find the full study here. Of note in this study, while both groups had comparable rates of NICU admissions, the mortality rate was 0% in the group where cords were left intact and newborns were resuscitated at bedside, versus a 3.1% mortality rate among newborns where the cord was cut immediately and baby moved to a resuscitation station.

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Finding Connection Through Resistance

by Aliena “Ali” Davis, DC She was born in 1941 and died in 2013. Into those 71 years, she packed more life experiences than most could fit into three lifetimes. In all honesty, she is still influencing the world in a way that makes her unforgettable, mischievous grin surface readily in my mind. In fact, it’s her influence in large part that brought about the reason for this article. She proudly bore the title of my “Gramma” – although we had no blood relation, she was more a part of my family and my life than most who did share a blood relation, and continues to be even in her absence more present than some who are still physically present. As a child, I would marvel at her fascinating, and at times erratic, speech. Later I would learn that she had lived with mental illness in a time that was even less kind to people with mental illnesses than our own time currently is. In my battles with my own mind, I reflect on her experiences with awe and gratitude, drawing inspiration to tackle the next project, protest, and sometimes just the next day, as the reality often is for those of us who share this strange life companion. My teen and early adult years were filled with late night calls with my nocturnal Gramma, listening to her stories of resistance during the Civil Rights movement in the 1960s and her impassioned hopes and visions for racial equity. When I began to struggle academically, she was there, with the smile, encouragement, and advice that eventually leads us to the topic of this article. One day, in a moment of frustration, I expressed to her how difficult it was to quiet my anxiety and ask questions during class when I needed to. With a knowing look in her eyes, she said “Oh, honey. Look, if you have a question in class, just ask. Chances are that if you have that question, someone else has the same question and is just hoping someone else will ask!” While this conversation took place with the high school version of me, it is the exact perspective that led to the creation of an inclusive birth workers group in one of the largest conservative counties in Texas. In late 2016, I was a new business owner and I had brought my passion for racial equity, LGBTQIA+ equality, reproductive justice,…

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Babies Are Not Pizzas: An Interview With Rebecca Dekker

The Birth Mag connected with Rebecca Dekker, PhD, RN of Evidence Based Birth regarding her new book, Babies Are Not Pizzas, in which she shares her own birth experiences. We got the chance to ask her a bit about her journey in writing the book, experiences with birth before having children of her own, and thoughts about how the birth community can do better. Babies Are Not Pizzas is available now here! After years of sharing research through Evidence Based Birth, what inspired you to write about your own story? Rebecca Dekker: So, I’ve shared little snippets here and there. Most people know that I had a first traumatic birth where I was separated from my baby for hours, followed by an empowering birth several years later with a midwife who provided evidence based care. But for the most part, I kept my personal experiences to myself. For example, I did not talk publicly about how my traumatic birth occurred at the academic medical center associated with my own university, where I worked as an assistant professor. I didn’t talk about how I hired an underground midwife, how I had two home births, how I was afraid to go to the hospital for an induction at “42+4” weeks because I knew some of the nurses didn’t like me or my blog, how so many women were experiencing racism and obstetric violence in my home town. The nightmarish stories from doulas and parents in my town just seemed never ending. I poured out all my frustration into the Evidence Based Birth® blog—spending all my spare time reading research, analyzing research, and writing about it for the public. Then there came a tipping point, about 4 years into my blogging journey, when I had to decide—was I going to leave the security of a paycheck and do EBB full-time? Or was I going to continue working for an institution that had indicated they would censor me if I tried to speak up, and that was using pressure, coercion, and force to make women give birth on their backs, in stirrups? I ended up leaving my faculty job, and it was one of the hardest decisions of my life. It was also one of the best decisions of my life. Two years later, after leaving my job, I had begun writing a book. It was meant to be a “Guide to Childbirth,” all…

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Book Review: Babies Are Not Pizzas

Book: Babies Are Not Pizzas: They’re Born, Not Delivered Author: Rebecca Dekker, PhD, RN Review by: Vanessa Morales, D.C.  Had I not had experience with author Rebecca Dekker’s Evidence Based Birth®, I probably would have passed up this book in all honesty. The front cover is very cute, as is the title, but it does not lend a hand as to what is to be expected. Is this a book about the process of making babies? Perhaps about the childbirth process itself? Even reading the table of contents was unhelpful in determining what the book itself would be about. As someone who has followed Rebecca’s EBB® work, and even as someone who has taken her course to become an Evidence Based Birth® instructor, I was prepared to read about the evidence surrounding different perinatal procedures, along with tips on how to better decipher the evidence, and become a better healthcare consumer. While I was partly on track, I was pleasantly surprised with the contents.  Rebecca takes readers, as recommended by a friend who reviewed the book (thank you friend!), through the various journeys in her life that have led her to this point in time. You are taken through her birth and all of the turmoil she experienced within her own university’s hospital system, through her time as a professor trying to connect hospital personnel with the best available evidence on outdated procedures, as well as the birth experiences of others as they relate to these outdated practices and procedures.  I also quite enjoyed learning more about her personal struggles trying to manage being a mother to two, a full time professor and researcher (in a field not related to obstetrics, gynecology, or even pediatrics!), birth rights activist, and entrepreneur. I can greatly relate to her passion and mission to wanting to take her negative experiences, along with her areas of expertise, and use them to impact the health and lives of current generations and those to come.  Even though Rebecca has experienced a lot of push back and criticism from hospital staff and administration, she stands firm in doing what is best for all mothers and their children. Perhaps educating and empowering the public on the safest and most effective procedures can bring about a paradigm shift to where people can go back to being treated like human beings and not just a number in a system that is…

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Homebirth Birth Plans: Helping Clients Ask For What They Want

by Ren Lorio-Dominguez If you attend homebirths, you have likely witnessed a family prepare a long, detailed birth plan that addressed all of the common local hospital routines they would face if birthing in one of those hospitals. While extensive, these plans likely included very little helpful information about their wishes for a homebirth. Homebirth families typically come to this choice of birth location through extensive research. The result is that many are well versed in hospital birth standards of care. In choosing to birth at home, they may have a notable list of things they want to avoid. While being well informed about the available choices is always a positive, excessive focus on the practices clients want to avoid can create a lack of clarity about the ways they do want to be supported. Clients may need some help in designing a birth plan for homebirth that will help them have the birth they envision. Most available birth plan worksheets and online birth plan generators are targeted at hospital births. They may focus on things like not pushing medications that are outside scope of practice in a homebirth setting anyways, or not taking baby to a nursery that is not an option at home. Point this out to homebirth clients. It may even be worth creating your own worksheet with questions more relevant to homebirth. Misinformation and ignorance surrounding what homebirth is actually like abounds even among many who choose to plan one. Birth plan discussions can also create a platform to explore client expectations. It is also a means to improve informed consent by making the client more aware of their options before they are in labor. Discussing what is routine or protocol in the setting they have planned for and with the midwife they have chosen both addresses expectations and builds a foundation for further discussion of the client’s preferences. If a clients is comfortable with the routines and protocols their midwife already has in place, many may not know what else to include in a birth plan. A little guidance can go a long way. Consider what you would find helpful to personalize their birth support. A few questions to ask might be: Who will be at the birth and what are their roles? Will baby’s siblings be present? Who will be responsible for them if they need something? Is touch desired during labor? Are there…

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Electronic Pressure Cookers for Out of Hospital Midwifery Sterilization

by Jen Marlow LM, CPM With the increasing accessibility of electronic pressure cookers has also come an increase in questions about their viability for sterilization of instruments. In meeting with World Health Organization and United States Food and Drug Administration standards, sterilization in at autoclave at 121°C and 15 PSI for at least 30 minutes is generally recommended. Many out of hospital midwives already successfully use pressure cookers intended for canning, or oven sterilization techniques, so it does not seem like a huge leap to consider using an electronic pressure cooker that needs little more than a button push after being loaded with cleaned and packaged instruments. The simplicity of use is not the only appeal. Most autoclaves are at least 10 times more expensive than a typical electronic pressure cooker. There are several electronic pressure cookers currently available that reach the necessary pressure and temperature. It is entirely possible to see color change on sterilization package indicators that show these conditions have been achieved. The primary concern, however, is that indicators on packaging only show that those conditions were reached at some point during the sterilization process. To meet sterilization standards, that level of heat and pressure needs to be reached and maintained. Until recently, there hasn’t been any clear evidence as to if any of these pressure cookers are consistently maintaining the necessary pressure and heat for the entire time. A 2018 study conducted at Dakota State University suggests that, yes, it is possible to substitute an electronic pressure cooker for an autoclave. Their results came with one big caveat though. Only one of the pressure cookers they tested met the criteria they were looking for. A variety of fungal and bacterial cultures were packaged and run through Instant Pot, GoWISE, COSORI, and Gourmia pressure cookers then cultures were incubated for one week before being checked for growth. Most notably, they were tested with Geobacillus stearothermophilus spores, a culture known to be heat resistant and commonly used to test that sterilization devices are functioning as intended. An Instant Pot with a sterilization setting was the only electronic pressure cooker that was able to successfully pass the spore test. The Instant Pot required a sterilization time of 150 minutes or more before the spores were inactivated, but the other pressure cookers tested were unable to inactivate the spores even at 300 minutes of sterilization time. This longer sterilization time…

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5 Places To Find Inclusive Birthworker Training In 2019

1.) Long Beach Birthworkers of Color Collective The Long Beach Birthworkers of Color Collective is based is Long Beach, CA, and offers people of color (POC) only doula training. They teach full spectrum support, and are unapologetically trans, queer, and POC centered. According to their website, in training they “discuss birthwork as activism, trauma informed care, birth disparities, how to support pregnant people through all pregnancy outcomes, inclusive language, and so much more.” A limited number of scholarships are available, and donations from allies to help provide said scholarships are welcome. Their next training is being held in October, so hurry and sign up by emailing them at POCDoulaTraining@gmail.com if you’re interested! 2.) Birth Advocacy Doula Trainings Birth Advocacy Doula Trainings offers online courses teaching doula skills including supporting trans and queer birth and lactation, trauma informed care, supporting loss, and the realities of racial disparities in health outcomes relating to birth. The online courses include ongoing support as you work through the course with the rest of your cohort, and business training in addition to labor support skills. The course description states a goal of creating “a supportive, close-knit and radical community of doulas that are advocates, activist and change makers.” The next scheduled course can be enrolled in here. 3.) Cornerstone Doula Trainings Cornerstone Doula Trainings teaches courses for aspiring birth and postpartum doulas, as well as teaching business skills for birthworkers and a course specifically about support trans and gender nonconforming people who are giving birth. They offer courses that are open to the general public, as well as trainings specifically for birthworkers of color. Courses are offered in both Oakland, CA and Portland, OR. Topics covered in their trainings include trauma informed care, and the effects of systematic racism on birth outcomes. You can sign up for one of their courses here. 4.) Ancient Song Doula Services Ancient Song Doula Services teaches full spectrum doula support for both birth and the postpartum period. According to their website, the trainings they offer are “focused on the ‘whole’ and not just its parts and seeing birth as a human right incorporating an intersectional lens that encompasses reproductive and birth justice framework into our trainings centered on communities of color and pregnant and parenting individuals.” The associated doula service offers standard doula support, as well as bereavement doula support, and prison doula services. Ancient Song puts a focus on…

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