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Anita: Oh, thanks for having me on, Trish. So excited to be chatting on your podcast. 


Trish: Oh, I love it so much. So today we're gonna talk about. Three powerful ways that Mamas can prepare their pelvic floor for birth, but we're not gonna leave them there. We're then gonna talk about three ways that they can heal their pelvic floor post-birth. And so can you go ahead and tell everyone who you are, what you do, all 


Anita: that fun stuff. 


Yeah, so I'm a pelvic health physiotherapist. I'm here in Ontario, Canada, and yeah, my focus is preconception pregnancy and then postpartum and really, 10 to 15 years after having your little ones. Are those I see in clinic. And and then I also have a podcast two birth and beyond that. 


And so that really takes those key strategies, exercises that I teach my clients in clinic. And puts the put it's in an online program format. So you do it at your own pace, really helps you, address some of the things we're gonna talk about today. Pelvic floor pain issues in pregnancy, prepare for birth, and then that first, initial six weeks postpartum recovery that no one hears about really what to do. 


And then you're in it postpartum and you're like, what does no one talk about this? So that is also what I do. In my online program. So really, as you can tell, my passion is really around that, trying to conceive pregnancy, postpartum stage in life and really incorporating that pelvic health side that again, no one hears about. 


I highly recommend learning about this before you have the baby. Go after you have the baby. All of that to really learn key information that we all should be hearing about way earlier. We don't learn anything about the pelvic 


Trish: floor. No. And what's so maddening about that? Is it goes across the board when it comes to. 


Marked change that I see now is that women are getting more and more aware that they don't just have to deal with it because it, and I'm putting up quotes, it's part of pregnancy, and so I really love what you're doing because. We shouldn't just say, oh, you had a baby, you're gonna pee on yourself. 


Or, no more sneezing. Without peeing, or any of those things that we were previously told just comes along with having a baby. And I am so glad that you're here because, and go you to everyone who's listening because you're taking. You're taking your power and utilizing it by gaining knowledge because knowledge is power. 


And forgive us cuz we may go off and add more. But the three top tips that you give to a pregnant mama who is preparing for birth pelvic floor wise, pelvic 


Anita: floor wise. Yeah, I know cuz Cause we could go on about all the ways, right? Yeah. Yeah, I'd say, number one, learn where these muscles are and how to use them. 


Because again, we, there's this kind of blanket statement, everyone, not everyone, some people get told, go do Kegels and that's it. And then they're, what does that even mean? And you start Googling or you don't, you just try to start squeezing muscles somewhere. Yeah. Hoping that is what you're supposed to be doing. 


You're not motivated to do anything. That I would say would be the first thing. So I'll describe it cuz I know with podcasts it's a little bit different, but these muscles, so they attach from your pubic bone in the front and they go right to your tailbone in the back and then side to side sit bone to sit bone. 


So if you can picture, that's like a diamond shape under your pelvis, that's why it's called the pelvic floor. There's actually three layers to these muscles and really important, like they stop us from leaking pee stool and gas. They support our pelvic organs or our bladder, uterus, rectum and baby, while you're pregnant. 


They support our back, our pelvis. They also help with circulation within within our pelvis and also have a sexual role. So they, contribute to pleasure, but also if there's tension in these muscles, it can contribute to pain. And when we talk about postpartum. So 


Trish: I'm totally interrupting you. 


We have to pay attention. Like this is so important. 


Anita: It is. And like I always think back to like health class, right? And it's like you, we would talk about, and I mean before I did my physiotherapy, my masters in that we did, I did kinesiology and even within all that it wasn't touched on a lot. 


And you think back to health. Class, throughout elementary and high school is always you're back and then they skip over this like pelvic area and you go down to like your quads and your hamstrings, right? So even if we could start just learning like these are muscles, it's, not something that we should be ashamed of learning about. 


And so I think the unfortunate part about it is when someone is dealing with those symptoms, it can sometimes be hard to even bring them up because no one talks about them. And then if you do bring them up and you get Skipped over being like that's just a part of how it is. 


That doesn't help the situation at all. And if anything, bur it further down. So to know these muscles are really important. They do all those functions, but then the other part to it is they work with the rest of our core My clients, my students know I don't talk about isolating the pelvic floor because just like any other part of our body, these muscles work as a team. 


To help us do, day-to-day things, but in pregnancy support ourselves. But again, even in pregnancy, our body is changing. Our center of gravity is shifting. And we want you to be able to still do all the things you enjoy doing and not feel like you're restricted. So we look at that whole canister, and that's where that deep breathing comes. 


Really, it's so impactful with the pelvic floor, so I often will teach your breath with your pelvic floor to get the most efficient way of connecting to your pelvic floor. And going back to that Kegel idea, yes. Pelvic floor muscle strengthening is what I tend to call a lot of physios, we'll call it, instead of Kegels because I like to look at the breath with your pelvic floor. 


It does not. It's essentially think of opening the door for baby to exit. We need to know how to lengthen these muscles. There is help in strengthening those muscles for different reasons, but not necessarily specifically for pushing the baby out. And I think that's where, when I see second, third time moms. 


They're like, no one taught me how to think of relaxing these muscles in any capacity. It was always about tighten tighten. And then I get to birth and that's all I know how to do. And then I get told my pelvic floor is too tense. And that's why, pushing didn't go the way they wanted it to go. 


All these things, right? So we really need to learn. Those muscles are meant to contract. And relax. And when it comes to birth, that relaxation component really comes in handy cuz that's what you wanna focus on during labor and drain pushing. I 


It makes so much sense that I love your picture. I'm such a visual learner, so I love the picture of this canister and how it all works together because as you were talking, I was like, this is exactly pushing, like all of those work together for pushing too. And for those of you guys, this is why like I love when people are pushing on the toilet because our brain automatically relaxes our pelvic floor. 


Like we have trained it from our. Early toddler days to relax the pelvic floor when you're on the toilet. So that's why that works so good. So for all of you guys listening, I tell all my students to at least three to four contractions per hour sit on the toilet. But I have done some really incredible toilet deliveries in the hospital with some really progressive midwives. 


Anita: Yeah, so I would say with, learning now what those muscles do, then it's okay, how do we connect? 


Like what do we do first? And I always mention before I talk about how to connect to these muscles, this is the start, right? Some people are like, okay, I'm just gonna learn how to breathe, connect to my pelvic floor, and that's all I need to do. There are so many more parts of preparing your body, including your pelvic floor for birth, but I wanna give you that foundation. 


In terms of the pelvic floor muscle training I mentioned. So I call it a more efficient Kegel cuz everyone again still hears about Kegels. But if you think of connecting that breath with the pelvic floor as you breathe in, The pelvic floor relaxes like your diaphragm. That deep breathing muscle has to lower to let air in, and our pelvic floor relaxes with it, so they both go down or relax. 


It is not just you. It can take some practice. So this idea, as you inhale again, pelvic floor relaxes as you exhale to engage your pelvic floor. I want you to picture two blueberries. That's usually the image I start with. Yes, you will look at blueberries differently, but it's worth it. That's okay. You're gonna picture a blueberry at your vaginal opening and at your anal opening, because remember when I first mentioned that diamond shape of the pelvic floor, the back of our pelvic floor goes right to the tailbone. 


So I'll go through that again. That's so fun in there. Thank you. I know. So whether you're sitting or standing, you can try this, you can try it lying down. But I usually get my clients, my students upright pretty quickly because that's where we spend our day. So as you inhale, Blueberries stay at the opening, and then as you exhale, you're gonna squeeze and lift the front and back, blueberry up and in, and then inhale to put them back down. 


So there's so many names for that. I call it the core canister breath. You may hear so many different kind of versions of that, but I like calling it that versus a Kegel, because then you're always gonna pitch your breath with your pelvic floor. And what we go beyond that, we won't dive into it today to keep it foundational, but then you bring it into movement like squats and lunges and any type of strengthening movement or sometimes symptomatic movements during the day, like lifting. 


So there's no blueberries, you're not squeezing and lifting anything. It's all not picking up blueberries during labor. No picking up. 


Trish: So just releasing a big old blueberry. Yes big blueberry. 


Anita: And what I like to do, the image I like that works so well for clients is this flower bloom broth idea. 


As you inhale, you picture a flower blooming out of your vaginal opening, and then as you exhale, you picture it staying open, and then you inhale open another flower. Nice and wide exhale. You keep it staying open and as a pelvic physio, so we are trained to assess clients' pelvic floor internally. 


So this is really helpful. When you think, again, of birth with a vaginal birth, you wanna think of lengthening. It's staying open. You don't wanna be thinking of clenching. So that image I find really helpful in just practicing that. Sitting like Trish mentioned on the toilet, that's one of the most common places my students and clients will practice, especially initially when you're having a bowel movement. 


They might say, come back to your flower, bloom breath, but your nervous system has done it so many times. It's not something new for your system to do. You just may need that reminder. 


Trish: I love that so much because I teach a very similar thing for labor coping. Technique breathing techniques, but I'd love for you to just walk through the breath again, because I know a lot of people get confused, so I just thought maybe you could do it one more time for them. 


Yes. 


Anita: Do you want the flower bloom one? Yeah. Yeah. I think it's a really important one. Yes. Yeah, this one I would say if you're listening to this, if you're standing, if there's an option to sit, it will be easier to do versus standing. Our muscles are on a bit more to us cuz we're against gravity. 


Now something a lot of co or commonly a lot of people do is they wanna push the flower out. And when I say you're practicing this, not during pushing, like when you're actually just practicing this, you don't wanna push it out. This isn't a bearing down, it's an opening and a lengthening. So you won't feel a ton happening. 


And likely, if that's the case, you're probably doing it right. That is good to know. Yeah. It's just a, it's a relaxation type of breath. Versus there's no squeeze and lift. You're not bearing down. It's a very much an opening and a relaxation breath. Yeah, so sitting I would say initially is probably the best place to practice. 


Okay. 


Anita: Yeah, definitely postpartum and often with my clients too, when I see them one-to-one for some we are starting with the breath because sometimes adding on the pelvic floor component to it, it's a lot for their system. 


And rather than doing the opposite of just doing the pelvic floor and then adding the breath, I don't find it as beneficial. That breath is like number one for it because when we get the diaphragm moving better, All the other moving parts work way better later. And I just find breathing is not, again, we always hear about ke go Kegel, that aspect of it, never about the breath. 


And that's where I find things are a bit backwards because when you get to for example, postpartum, back to running or jumping. If someone is leaking with those movements, I'm actually more focused on their breath than their pelvic floor. Because it's such a quick movement, you have more effects on your pelvic floor using your breath during those versus engaging your pelvic floor during those movements. 


Trish: breath. I love that so much, and I feel like we're gonna have to split this episode into a two part because it's so full of good information. I have a student right now, she's six months postpartum and she's had leaking issues and it has been just a really difficult journey for her and I'm. 


She's been doing all the things, but I will have to say that it took her, she asked for a pelvic floor referral during pregnancy. Could not get it. Could not get it. They ended up referring her to a, like a gyne or urologist or something. And it took her until postpartum to get that referral and it's so maddening. 


So anyway, that I, that, that's a whole nother story. So tip number three. Yes. Where do we go now? 


Movement in general. I'll go through, cuz this actually does impact the pelvic floor too. And I would say mobility work would be key. So I talk about strength work is helpful in pregnancy for lots of reasons. So I'm talking about Using weights with that really helpful to do. Strengthening helps with aches and pains. 


Helps you to keep doing what you wanna be doing. Also I always talk about, in my head, I'm always thinking ahead and I don't know if that beca came before being a physio or since becoming a physio, but I think postpartum. I know how much you're gonna have to carry. I know all the awkward movements you're gonna need to do, and if we don't prepare your body and pelvic floor and pregnancy, then you get to postpartum and it's a bit of a shock to the system. 


Okay. 


Trish: Okay. I just have. Yeah, so I'm like sitting here going, is she talking about pelvic floor strengthening with weights and mobility? Oh, is, wait, where are we at right now, Anita? Talking 


Anita: about the whole body. Okay. Good terms 


Trish: of. Are, is there weights we could do in our pelvic floor? Cause this 


is 


Anita: interesting. 


That is another discussion. So there are weights that does exist for the pelvic floor. I find that is not typically something I use with clients just for multiple reasons. I think it creates more of a clenching with the pelvic floor. But some listeners may have heard of using weights with the pelvic floor. 


So I think there's plenty. 


Trish: Okay. So I just wanna make sure. Yeah, where we're at. Yeah, we're talking about our whole body. The 


Anita: whole body. Okay. But why I brought it into about the pelvic floor side of it is because again, we can't just isolate or think of the pelvic floor. Doing whole body movements actually helps the pelvic floor too, 


Trish: With that. 


Anita: interesting. Yeah, we do like whole body. Even before I became a pelvic physio, I was what we call orthopedic or I know in the US too, M s K physios. So I didn't do internal work. I was all external. Pilates, rehab, sport, rehab, dance, rehab was my background. 


So now I bring that into this population and the pelvic health side, you have to look at the body as a whole. So if you're seeing a pelvic physio and they're only zooming in terms of the pelvic floor, Really ask them to be, looking at your whole body and the whole body should be brought into it. 


So yeah, I definitely do strength training with clients. And then also the mobility side. So like I said, like the prenatal yoga, those things. Some people want to go and do classes, but even if those who don't, I will always give, just really honed in specific exercises, easy to fit in at home that you can do each day. 


So that's another reason why I bring a lot of that mobility work in is so then in labor you're not feeling restricted into what positions your body may wanna get into. 


Trish: Oh, that's so wise. I love that so much. And it just goes back to that whole like looking at pregnancy and all this journey as a holistic journey because I feel like with my classes, I do the same with mindset and mental prep and realizing you can't prepare for birth if you don't prepare physically and mentally because it, it takes all of it working together. 


So I love that. Okay. Yes. So now we have prepared by learning to work tip number one Yes. Was working this canister. 


And then tip number three is then bringing the whole body into it. 


Trish: Yeah. I love that so much. And I'm really curious. To go into the membership, into our pregnancy postpartum membership. Cause I have a lot of members and students who are seeing a pelvic floor specialist. I'd like to pull them and ask them if they've heard that because I don't feel like they've shared that with 


Anita: me. 


Cuz I think that. Probably would look different. And I would agree. I think if you only learn about the pelvic floor and not everything else, there will be things that are missing with that. 


Trish: Yeah, that it, it just makes so much sense. Okay. So now we've talked about preparing. Yeah. Now mama has had the baby. 


Yes. Now where do we go? 


Anita: Yes. Postpartum. So the great thing about that learning about in pregnancy is then we're gonna almost go back to. Kind of step number two, which is then, reconnecting to your breath and to your pelvic floor. So a lot of people get told, do nothing for six weeks and then magically at six weeks your whole body is healed. 


And then we can go back to running, 5k, all these things. And there's an in between. So there's actually lots you can do in that first six weeks for your body to help with healing. That is very safe to be doing, very effective to be doing. And again, it goes back to starting with your breath, right? 


You should not be taking half an hour out of your day for exercise. You just gave birth. Change baby's bum. Do five to 10 deep breaths feed the baby, do some blueberries, things like that. Bring in the, just the deep breathing, the blueberries, even the flour bloom afterwards. During that initial part, I would say that would be tip number one. 


Yeah. 


Trish: So how quickly after birth can you start picking up and laying down blueberries again? Literally 


Anita: the day of. You can because also think too, so going back to that blueberry idea, that squeeze and lift and relax, it's actually cre helping the circulation within your pelvis so it creates a pumping effect to actually help with healing. 


So technically, yeah, you can start literally the day of. 


Trish: Yeah, so I, on a side note, did start doing key goals immediately with all of my kids yeah. 


Anita: Yep, exactly. There's nothing, it's a very small movement and it just helps with so many things. So you can start with that, but you don't have to do it right away. 


You could do it after a little bit. And then the next step would be going back to that kind of strength and mobility aspect. So I often will have clients, I'll give them, Kind of a, like almost an exercise series. It's also my bump to birth program too, like a six week series. Super streamlined again, like couple exercises if that each day that are really working with where you're at in the healing process. 


So shouldn't take a lot of time, but that, I would say would be the next step. So these gentle strength or mobility exercises throughout that initial postpartum period. But again, to know beyond six weeks. Also really important. Our body is not fully healed at that time. So I would say that would be tip number two. 


And then when it comes to even knowing, like with that six week kind of postpartum appointment with your provider, again, everyone, it's gonna be different, what that's gonna look like. I would say typically they are not looking at your pelvic floor, they're not looking at your core. Even when someone has stitches, I find that's not even looked at all the time. 


Like your care provider, one of their main roles is to make sure, again, no red flags, no infection. Are things healing properly? Is there a stitch that needs to come out? So having that looked at. But if you do if you've had a cesarean birth or a vaginal birth and you have had stitches even learning a bit about scar massage really helpful at that point as well. 


And so with your care provider looking at that area, they'll be able to let you know, okay, the initial healing has happened. So you could start some scar massage with that, which is really gentle, but. I'm always surprised, especially after cesarean, no one gets told about scar massage unless they, as a physio, all my clients learn about it. 


But so many times people, it's like years later and they're like, no one ever told me to do anything with my scar. 


So I love that you're bringing that up as well. We're really passionate about that 


Anita: too. Yeah. Addressing the scar and then, if you can see a pelvic physio, that can be great. They can really give you that individualized information about the pelvic floor in court, how things are healing. If that's not accessible to you. 


To know six weeks is too early pretty much for anyone. We've, looked at guidelines in really six weeks. There's still more healing to happen. And how I guide clients is, that pelvic floor and core, I initially talked about strengthening mobility work. We need to get your balance to be much better before you're running, cuz you're landing on one foot. 


So running is usually three to four months postpartum at the earliest that we're back to 


Trish: running. Oh wow. Yep. I don't think many women hear that. 


Anita: No, it's six weeks, right? Everyone gets the six week green light. And for people to know too, like that green light pretty much everyone will get it unless there is something extremely, an extreme complication going on, how much merit does it have? What does it even mean? And every care provider is different with their background, but I would say majority do not learn about exercise. They do not learn about that component of bringing the pelvic floor health into movement, whether it's jumping, running, strength, training. 


There will be differences within that because of the compromise, but even without stitches, I always say like even at six weeks, our tissue is not as flexible, as strong as pliable as it was before. So if we're putting demands like jumping and running on it at that point, It may not feel great. 


So that's always exciting when they're like, I never thought I'd feel better after having a baby and running versus I did before. So 


Trish: what about, so let's say they do start running at six weeks and they're not ready. What are the results of that? 


Anita: Yeah, everyone's gonna be different. So yeah, for example, could be leaking pee, there could be pelvic pain, back pain, groin pain. 


There could be a number of things and that's really where, Seeing a pelvic physio could be really helpful cuz you're getting that individualized care. And before, like with seeing someone again ask in terms of find out if that's something that they work on, if they do help clients often get back to those activities. 


Just so you know, you're working with someone who, again, looks at the whole body because we can't just hone in on the pelvic floor. And get back to running. There's so many pieces to it because I'll give an example. Like I've had clients who are, let's say, leaking pee with running. I do full body assessment. 


We need to be able to land with much better alignment. It's the breathing, like their breathing patterns are poor, so there's more pressure on their pelvic floor. So sometimes the pelvic floor gets given the bad rep of have a week pelvic floor, but it's just the pelvic floor is required to do too much because other pieces aren't doing their job. 


And the only way to know that is when we look at the whole body and retrain the whole body. 


Trish: Oh, I love that so much. I get asked the question about when they can return to running a lot and I am not a runner and that is not my forte. I've spent more time with postpartum mamas now. Yeah. For, I tell people all the time, like a labor nurse, we spend two hours with you and then you go on to postpartum. 


Yeah. We already talked about. Yeah. That is so amazing. Like I love all of this, like this is so meaty. 


Anita: Yeah. I just think for people to know, again, it's like. The pelvic floor is one aspect, but it's it's part of our whole body. There's so many more moving parts to it, and I think we still have a ways to go for that to be the norm. 


But I've just seen over and then I've had two kiddos myself. It's like you gotta look at the whole body, not just the pelvic floor to get back to those activities and feel really good doing it. And then you think postpartum if you're planning or thinking you may wanna have another little one. 


And that can often feel better versus like them building on each other and dealing with the same symptoms throughout and then undoing it. It is never too late though, for people to know. But if you have the option of in between each one addressing those issues I've had clients who feel better in their third pregnancy than their first because they know way more about their body going into their third. 


Trish: I think that's so brilliant because I think that. Probably more often than not, and probably not from professionals, probably from like old wives tales, like people in our lives, we are told like you're gonna have more babies. So it's just, that's just part of it. So deal with it after. So I think that's brilliant to say no deal with it in between so you can have a better next pregnancy. 


Anita: So that's, yeah, no we've done a, I'd be happy to, we've definitely done a number on our podcast about it cuz Jess, my co-host who's a pre and postnatal fitness coach. It's really great cuz We'll we. We coach and she doesn't treat because she's not a physio, but how she approaches her clients very similar to what I do and a lot of the strategies involved as well, because yeah, running, I just think people just feel like just go run and it's there's so many things we could do before to make you feel so much better doing that. 


So for sure we could always do that because yeah. 


Trish: And I'm thinking that you said that a lot of times with these women who are leaking urine, when they're running postpartum, they come to you and their pelvic floor is fine. So my first thought was, wow. I bet a lot of people go to a pelvic floor therapist thinking then they're told it's fine, but the problem doesn't go away. 


When I assessed, I'm like, This isn't the problem. However, we did, I did teach her how to better effectively engage it, so that is part of her rehab. But when I looked at her like alignment with jumping and. Different things, like lunges is a big thing that kind of mimics running. And I could see all these pieces that I'm just like, no one has addressed these before. 


And that's where I think every time she like foot strike, it's all these forces are going through and like her pelvic floor is like having to deal with it. So it's one of those things where, yeah, you gotta look at the whole picture with running, with jumping, with any movements because otherwise you're missing a piece. 


And and then the pelvic floor has to be, the 


Wow. So that's very it. It makes total sense when you think of it that way. So that's so great. Thank you so much for coming on today. This was incredible. Yes. I'm super excited to hear feedback because. We just have to take care of our bodies, like our bodies are. It is just so important, and like I said, like a lot of my listeners and a lot of my girls know that I am like. 


When it comes to going poop and having gas, like I'm such a phobe. Yeah. For myself, if my patients poop or have gas, I don't care. Yeah. But I do not want to be having gas randomly in front of Steve Ware as I get older. That is not on my plan for retirement, so I appreciate you today. Thank you so much. 


Anita: Thank you, Trish. 


Do what you can. Alright, you guys, as always, we are so excited to have you here with us. Please hit subscribe, leave a review, and I will see you again next week. Bye for now.