Post-Birth Plan?

Post-Birth Plan_ (1).png

There is a lot of pressure on women, post-delivery, to just “snap back”. There is also a lot of conflicting info out there on how to go about healing and strengthening after having a baby.
.

Getting a postpartum musculoskeletal assessment is a crucial step in helping to identify weaknesses, dysfunctions, and help with your post-delivery recovery. Best of all, this assures that you are being proactive against common issues like diastasis, bladder leakage, pelvic pain, painful intercourse, and prolapse.
.
Does insurance cover this? The short answer is, YES! This assessment and therapy are covered under most insurance’s physical therapy benefits. If you want to know if your plan covers this, please feel free to contact us!

You really want to join in but … leakage.

thanksgivingdinner (1).png

 

➡️”Mom, come jump with me on the trampoline!”⬅️strikes fear in your heart😱, you may benefit from a little pelvic floor TLC!
.
.
If this is you, you’re not alone …. bladder leakage is common but NOT normal! There are many other options available, that do not require surgery, medication or wearing pads everyday. (Important note: ⭐Most insurances cover this therapy!)
.
.
If you are experiencing bladder leakage, pressure in your pelvis, uncomfortable/un-pleasurable sex, “mummy tummy”, and/or low back pain . . . Get a Musculoskeletal Exam with a pelvic floor physical therapist!
.
.
Pelvic floor physical therapists are specially trained to evaluate your specific needs and come up with a plan that will help you reach your goals (and get you back on your trampoline game!) 🤸‍♀️

Ensuring Support for Breastfeeding Families

Breastfeeding is an amazing commitment that comes with many challenges and rewards. The benefits of breastfeeding are endless for both mother and baby, from protection from infectious diseases, to cardiovascular health benefits, to improving mental health and confidence for parents (Horta, 2007).  In 2003, the World Health Organization recommended infants be exclusively breastfed until six months of age, with breastfeeding continuing as an important part of the infant’s diet until at least two years of age.  To ensure families have every opportunity to meet this recommendation and their individual breastfeeding goals, families need support.

180709-mother-breastfeeding-child-baby-ac-516p_29470c762d6c13e3bbd5f88ed6211003.fit-760w.jpg

When serious questions arise, such as pain, infection, low milk supply, or variety of other concerns, the 2011 Surgeon General’s Call to Action to Support Breastfeeding recommends that all families have access to services provided by Internationally Board Certified Lactation Consultants (IBCLCs).  With the teamwork of IBCLC’s, pediatricians, and close family and friends, breastfeeding mothers can find confidence in reaching their breastfeeding goals.

It is an honor to be serving families around the Richmond Virginia community.  Through the Happy Latch breastfeeding program, parents can gain confidence in breastfeeding with baby led techniques, individualized to each mother-baby couple.  Respecting the needs and feelings of both mother and baby is essential to making the breastfeeding relationship successful.

Tips for mothers who are interested in breastfeeding

Mother breastfeeding her baby

1) To have the best outcome, a breastfeeding mother is encouraged to breastfeed her new baby a minimum of eight to twelve times daily.  Mothers who continue to nurse their babies at frequent, unrestricted intervals are more likely to establish a good milk supply then mothers who nurse on a restricted feeding schedule.

2) Be sure your baby is nursing effectively.  Do you feel your breasts are softer and lighter after you baby nurses? Can you hear your baby swallow?  Do you feel a gentle tugging at your breast?  It is important for mothers to look for signs of productive milk removal at every feeding.  If you have sore or cracked nipples, this may be an indicator of an incorrect latch.

3) Look for dirty diapers as a sign your baby is getting enough.  By day 3, your baby should be having a minimum of 3 stools per day, and 5-6 wet diapers per day.  If you think your baby is not waking up for feedings, try skin to skin care, and breast compressions to keep your baby interested in breastfeeding.

4) If you are separated from your baby due to prematurity, illness, or other condition, milk must be removed from your breasts by means other than your baby’s feeding, otherwise your milk supplying hormones will shut down.  In these situations, remember to pump your milk with an electric/ or hospital grade pump a minimum of 8 times daily.

 

In regards to Insurance coverage for breastfeeding care:

Private healthcare insurance companies are all doing different things with the new ACA Breastfeeding regulations, as specified under “Women’s Preventative Services”; since the law is not specific, as well many insurance companies don’t know about IBCLCs. They know little about lactation or how to best comply with the new law. Differences in how insurance companies are trying to comply with the new law are being reported with no consistency; many differences by insurance company or different policies by the same company, even differences from state to state are being reported.

You may want to call your insurance company and ask them what they can offer you under your plan in accordance with the ACA Women’s Preventative Services for “comprehensive lactation support and counseling.”

240_F_206425607_WZBBvGUzinS9MBVBGhV1vjw3iWNAWyit.jpg

 

Knowing your rights to obtain coverage for breastfeeding care goes a long way to ensure you have access to care throughout your breastfeeding journey.

For a list of breastfeeding professionals in your local area, you can use the IBCLC directory:

http://www.ilca.org/why-ibclc/falc

or

https://uslca.org/resources/find-a-lactation-consultant-map#!directory/map

happy latch.pngAll women should be offered support to breastfeed their babies with an individualized support system to include family, friends, employers, and medical professionals.   By affording this standard of care to all breastfeeding women, we can increase the duration and exclusivity of breastfeeding.

 


 

A little bit about the author of this blog post . . . !

pricilla moorePriscilla Moore, owner of Happy Latch, is an International Board Certified Lactation Consultant (IBCLC), the gold standard in advanced practice lactation care!

She’s served families all over the world through nursing and lactation support, both in the hospital, and at home with long term care plans.

As a nurse, she utilizes evidence based practice to care for each family.  As a private practice provider, she is available 24 hours a day to your family. Priscilla is passionate about helping to implement an effective, and healthy feeding routine for you and your infant!

 

A New Paradigm for Postpartum Care!

ACOG Redesigns Postpartum Care

Given the urgent need to reduce severe maternal morbidity and mortality, the American College of Obstetricians and Gynecologists (ACOG) released today a revised Committee Opinion to reinforce the importance of the “fourth trimester,” and to propose a new paradigm for postpartum care. Redefining postpartum care is an initiative set forth by ACOG President Haywood L. Brown, M.D.

Previously, ACOG recommended a comprehensive postpartum visit take place within the first six weeks after birth. ACOG now recommends that postpartum care should be an ongoing process, rather than a single encounter and that all women have contact with their ob-gyns or other obstetric care providers within the first three weeks postpartum.

Timely follow-up is particularly important for women with chronic medical conditions. The initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. This visit should serve as a transition to ongoing well-woman care and the timing of the visit should be individualized, woman-centered and the follow-up should include a full assessment of the following:

• mood and emotional well-being
• infant care and feeding
• sexuality contraception and birth spacing
• sleep and fatigue
• physical recovery from birth
• chronic disease management
• health maintenance

All women deserve to recover from birth and nurture their infant..png

 

The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. During this time, a woman is adapting to multiple physical, social and psychological changes. She is recovering from childbirth, adjusting to changing hormones and learning to feed and care for her newborn. Postpartum care visits with ob-gyns or other obstetric care providers can help women navigate the new challenges of motherhood. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.

“New mothers need ongoing care during the ‘fourth trimester.’ We want to replace the one-off checkup at six weeks with a period of sustained, holistic support for growing families,” said Alison Stuebe, M.D., lead author of the Committee Opinion. “Our goal is for every new family to have a comprehensive care plan and a care team that supports the mother’s strengths and addresses her multiple, intersecting needs following birth.”

1 in 10 postpartum depression.png

Currently, as many as 40 percent of women who have given birth do not attend a postpartum visit. Underutilization of postpartum care impedes management of chronic health conditions and access to effective contraception, which increases the risk of short interval pregnancy and preterm birth. Attendance rates are lower among populations with limited resources, which contributes to health disparities.

“This revised guidance is important because the new recommended structure is intended to consider and cater to the postpartum needs of all women, including those most at risk of falling out of care,” stated Dr. Brown. “As the nation’s leading group of physicians providing health care for women, we must use the postpartum period as gateway opportunity to counsel women on long-term health implications.”

RVA's #1Choice for Moms

While postpartum care visits occur after delivery, obstetric providers should begin counseling their patients during pregnancy. Prenatal discussions should include the woman’s reproductive life plans, including the desire for and timing of any future pregnancies.

Committee Opinion #736, “Optimizing Postpartum Care” is published in the May issue of Obstetrics & Gynecology.

The Committee Opinion includes the following link to resources: https://www.acog.org/More-Info/OptimizingPostpartumCare.

Source: https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/ACOG-Redesigns-Postpartum-Care

 

What Is Pelvic Organ Prolapse?

Pelvic Organ Prolapse (POP), is defined as weakness of the muscles, ligaments and connective tissues of the vaginal wall,  causing descent of the pelvic organs. This weakness can result in bulging of the urethra and bladder, cervix and uterus, small intestine or rectum into the vaginal wall.

Causes of prolapse are:

1) Childbirth

2) Weak pelvic floor muscles

3) Repetitive straining or bearing down

4) Heavy lifting

5) Chronic coughing

6) Family history of Prolapse

7) Hysterectomy

8) Decreased estrogen

9) Constipation

Signs and symptoms of POP are:

1) Feeling of something falling out of the vagina

2) Lower back painpainful bladder

3) Constipation

4) Painful intercourse

5) Groin pain

6) Heaviness, fullness or pressure  in the vagina

7) Incomplete emptying of bladder or bowel

Types of Prolapse: *diagram below 

Cystocele – (anterior vaginal prolapse) – When the bladder protrudes in the vaginal canal

Rectocele – (posterior vaginal prolapse) – When  part of the rectum pushes into the back of the vaginal canal

Uterine – (apical/superior prolapse) – When the uterus descends into the vaginal wall. In those women who have had a hysterectomy, the top of the vagina can descend into the lower half.

stages of pelvic organ prolapse

Enterocele – When the small bowel protrudes into the front or back of the vaginal wall.

A recent article published in the British Journal of Obstetrics and Gynecology, informed the readers that 50% of women undergoing a routine gynecological internal assessment, had an identified prolapse. Pelvic organ prolapse often significantly impacts their functional daily activities.

Childbirth (parity) is a well established risk factor for the development of prolapse. According to current body evidence, the alteration in pelvic organ support, during pregnancy and birth, may increase a woman’s risk for POP to eight-fold after one vaginal delivery, and a twenty-fold increase after three vaginal deliveries, compared to women who have had cesarean sections.

During pregnancy, due to circulating pregnancy hormones and increased weight of the expanding uterus and fetus, the pelvic floor muscles often relax. Pelvic organ prolapse at 36-38 weeks of gestation, first trimester body mass index, newborn birth weight and smoking status almost are variable with affect on POP development. More research is needed regarding mechanisms leading to persistent and/or progressive pelvic organ prolapse after childbirth labor.

Women’s Health Physical Therapy can offer the following care for POP (pelvic organ prolapse):

a. Pelvic floor strengthening, with supervised education. Recent research has concluded that a well adhered to exercise program for six to eight weeks will reduce prolapse one-half to a whole grade.
Pelvic floor strengthening, with supervised education. Recent research has concluded that a well adhered to exercise program for six to eight weeks will reduce prolapse one-half to a whole grade.
d. Femme - an orthotic that supports the pelvic floor and reduces gravitational pull causing descent of organs.
Femme – an orthotic that supports the pelvic floor and reduces gravitational pull causing descent of organs.
c. Electrical stimulation - a tampon sized probe is inserted into the vagina to stimulate, thicken and increase the activity of the muscle fibers of the pelvic floor muscles.
Electrical stimulation – a tampon sized probe is inserted into the vagina to stimulate, thicken and increase the activity of the muscle fibers of the pelvic floor muscles.
b. Trunk stabilization: The pelvic floor and deep abdominal muscles are linked. By activating the trunk correctly you can also strengthen your pelvic floor muscles and help support the pelvic organs.
Trunk stabilization: The pelvic floor and deep abdominal muscles are linked. By activating the trunk correctly you can also strengthen your pelvic floor muscles and help support the pelvic organs.
e. Pessary - an orthotic device which is designed to lift the pelvic floor muscles, connective tissue and ligaments.
Pessary – an orthotic device which is designed to lift the pelvic floor muscles, connective tissue and ligaments.

Want to know your risk of pelvic organ prolapse, send us a message and mention this blog post and we will send you a free POP RISK FACTOR QUESTIONNAIRE. 

Natural Approaches for Infertility

10

Anyone can be challenged to have a family. No matter what race, religion, sexuality or economic status you are, infertility doesn’t discriminate.

Because you’ll never know how badly you want something until you are told that it may not be possible.

Together, we can change how others view infertility. It begins with being part of a national movement, National Infertility Awareness Week®. This week unites millions of Americans who want to remove the stigmas and barriers that stand in the way of building families.

NIAW begins April 22 – 28, 2018. Take the pledge to #flipthescript

Source: https://infertilityawareness.org/

 

jillThis week we are featuring Dr. Jill Zackrisson and her practice, Dignitas Health, in Richmond, Virginia.

A little about her . . .

She grew up in Charlottesville, Virginia, and attended The College of William & Mary for undergraduate studies in Biology.  She received her medical degree from VCU School of Medicine, and went on to complete residency training in Family Medicine at Lancaster General Hospital in Lancaster, Pennsylvania, earning an area of concentration in Obstetrics.  After graduating from residency, she completed a fellowship program in Obstetrics in Asheville, North Carolina.

Her passion . . . 

Her passion for helping women with fertility issues led her to pursue additional training in NaProTechnology (Natural Procreative Technology), offering her patients a more restorative and individualized approach to women’s health and fertility.  She served on the faculty of Virginia Commonwealth University St. Francis Family Medicine Residency program in Richmond, and practiced full-spectrum women’s health, Obstetrics and NaProTechnology prior to founding and opening Dignitas Health in 2016.

More than your typical MD . . . 

Her offerings go beyond the realm of primary care.  Dr. Zackrisson’s goal is to investigate and correct underlying causes, rather than just treating symptoms. This restorative approach mentioned above, NaProTechnology (Natural Procreative Technology), is also often abbreviated as ‘NaPro’.  NaPro is an individualized and detailed approach to evaluating and treating a myriad of health problems that women commonly encounter, such as:

  • Infertility
  • Miscarriage
  • Irregular or heavy cycles
  • Ovarian cysts
  • Premenstrual syndrome (PMS)
  • Polycystic ovarian syndrome (PCOS)
  • Hormonal abnormalities
  • Menstrual cramps
  • Postpartum depression

 

sex-love-life-2015-05-woman-1-main

 

To find out more about Dr. Jill Zackrisson and her practice, you can visit her website here.

 

4 Ways Pelvic Floor PT Can Help Your Endometriosis

#endometriosisawareness takes place across the globe during the month of March with a mission to raise awareness of a disease which affects an estimated 176 million women worldwide. (source: http://endometriosis.org) 💛

More and more people who suffer with pain related diagnosis are discovering the power of pelvic floor physical therapy in reducing their pain. PFPT’s are special in that they are specifically trained physical therapists who’s passion is all things pelvic floor and in many cases, highly trained in women’s health related issues.

If you have a rotator cuff injury, you’ll be sent by your doctor to see a physical therapist. This compliment to care will focus on the your musculoskeletal health (muscles, bones, fascia and ligaments). When it comes to pain in your pelvic area (Endometriosis), the same logic applies. A pelvic floor physical therapist will be focusing on the muscles, bones, fascia and ligaments in your pelvic area as well as your stomach, back and diagram, (AKA the deep intrinsic trunk muscles).

As it relates to Endometriosis, your PFPT will perform an evaluation and create a plan of care that is specific to your needs and goals.

If your shoulder or knee hurts, you see a physical therapist to treat the bones, muscles, nerves, fascia, and ligaments for some relief. Similarly there are bones muscles, nerves, fascia, and ligaments in your pelvis and abdomen that experience substantial adaptations from the disease process of endometriosis.

pexels-photo-262214

 

Pelvic health or women’s health physical therapists work with the pelvis, spine, and abdomen. They evaluate the alignment, musculature, fascial systems, and movement patterns in the pelvis and body for issues that activate your pain and decrease your quality of life.

Then the pelvic health physical therapist develops a treatment programme customised to your specific needs. From alleviating pelvic floor dysfunction to improving your sex life, here are 5 things pelvic physical therapy can do for you:

1. Strong Pelvic Floor

Your pelvis is lined with a group of muscles called the pelvic floor.

These muscles help to stabilize your pelvis as well as support your pelvic organs (like your bladder, uterus, and vagina). Your pelvic floor also helps to facilitate bowel movement and urinary function, as well as sexual health and function.

Below, you will see a diagram of the pelvic floor, and you can see that it resembles a “sling” or “bowl”.

pelvic-floor-muscles

 

2. Relief For Painful Sex

Our actions and decisions today will shapethe way we will be living in the future. (5).png

Sex should never be painful. period.
.
.
.
Many women are advised to, “Drink wine and relax.”. While this may temporarily make things more bearable . . . it does not address the underlying issue.🌸 The pain associated with Endometriosis can be attributed to scar tissue, adhesions, and inflammation.

FACT: Pelvic floor physical therapy, to train and rehabilitate the muscles of the pelvic floor, is a highly effective treatment option for those suffering from Endometriosis. PFPT’s will focus on myofascial trigger points within the pelvic and abdominal cavity to

> More about painful intercourse <<

 

3. Other Pain

 

Pelvic floor physical therapists focus not only on your pain from your endometriosis, but other factors that may contribute to it. Taking this approach has been shown to be highly effective in reducing the symptoms you may experience.

In many cases, interstitial cystitis may be “bunded” with your diagnosis of endometriosis. PFPT’s take this into consideration when creating  your plan of care.

 

4. Endo-belly?

• brooks apparel • (1)

Oftentimes, women will get misdiagnosed as having IBS or other digestive disorders . . . but, this swelling, distention and heaviness is . .yes,  known as endo-belly.

endo

 

 

Picture Source: https://mylifemyendo.wordpress.com/

 
Pelvic floor physical therapy can help you alleviate the symptoms associated with this condition, such as painful intercourse, pelvic pain, frequent urination, bowel issues, “endo belly” and tense pelvic floor muscles. Want to know more about pelvic floor physical therapy . . . >>> click here.

 

 

 

Let’s Talk About Sex

Sexual Health Awareness Week is Wed 14th Feb – Wed 21st Feb 2018. Sexual health is such a big topic and there are many different things that come to mind for each person.

For those who deal with sexual dysfunction, this topic can be especially hard.

In honor of this very important topic, we’d like to feature Dr. Katherine Bettin in this blog post.

1

Dr. Katherine Bettin is one of the only AASECT-certified sex and relationship psychologists in Richmond. As a wife, mother, daughter, sister, aunt, friend, and grandmother, her life has always revolved around maintaining strong relationships with those around her.

So it wasn’t surprising when she followed a calling to become a therapist. Despite the challenges of raising four children while going back to school, Dr. Bettin recognizes that decision as one of the most important moments in her life.

Clients are frequently curious as to how Dr. Bettin became interested in the sexual side of individual and couples counseling. It began as a professional interest — a desire to give more complete and helpful therapy to her clients. As she worked with couples and individuals, sexual issues surfaced again and again. Most of her clients had never spoken with anyone about their sexual concerns, and it became clear that most marriage and family therapists hadn’t been encouraging that kind of open conversation.

Dr. Bettin soon realized that she had no such reluctance exploring sexual issues with her clients, and in turn, they began to feel more and more comfortable discussing this critical part of their lives. In order to help her clients more comprehensively, she became certified in this relatively new but growing field of psychology, challenging even her own inherited notions of sexuality in the process!

Today, Dr. Bettin continues to help individuals and couples conquer their sexual and relationship challenges, putting them back on track to lasting happiness.

2

Dr. Bettin was recently interviewed by RVA News. Check out this audio interview below:

Interview with RVA News

In honor of Valentine’s Day, Susan Howson of RVA News sat down for an interview with Dr. Bettin. In an audio version of the interview, they discuss what relationship counseling is like, what it can do for you, and how Katherine goes about helping her clients. Follow the link to listen!

http://rvanews.com/features/the-approachable-world-of-relationship-and-sex-counseling/121986

During a session with Dr. Bettin, she answers questions such as

 

bettin
Katherine V. Bettin, Ph.D.

 

To schedule an appointment or have an introductory conversation, you can find her contact information here.

4 Ways To Make the Most Out Of Your Pelvic Floor PT Appointments!

We know as a mother, you are very . . . very . . . busy. It can be hard to make time for yourself, so you want to make sure your efforts are well worth the time invested.

With this in mind, here are 4 top ways you can make the most out of your appointments:

1️⃣Come prepared. We know you’ll have a lot of questions! Make a list of your questions and bring them in to your appointment. During your visits, ALL questions are welcome.  We want you to feel comfortable and well informed with each visit, each procedure, and each treatment.  When you have questions  . . . we will be well equipped to have an informed discussion with you.

* Also, bring in any prior doctors notes, test results or procedure results that may be relevant to your present condition. If you are not sure,  go ahead and mention any prior therapy, surgeries and procedures to your therapist during your first visit.

 

shakinghands
2️⃣ Be prepared to learn. All of those late night Googling sessions can offer up a lot of information that can be helpful but often confusing and/or conflicting. As specialty trained women’s health physical therapists, we want you to be well informed about your body and how it works.  We aim to educate, inform and empower our patients with the most up-to-date research based information on your particular diagnosis.

IMG_3678

 

3️⃣ Be patient with your body.  Healing and re-training your muscles can be a slow process. Every”body” responds differently to therapy and treatments.  Pain and musculoskeletal dysfunctions oftentimes contains many layers and requires a multi disciplinary approach.  Some patients require just a couple of visits while others require much more.  Trust the process and be patient with your body!

IMG_3686

 

4️⃣ Do your homework! Pelvic floor PT requires teamwork. Much of your therapy depends on lifestyle / ergonomics changes outside of your PT sessions. Make sure  you are setting time aside to do the home exercises your therapist prescribed. If you are not sure if you are doing them correctly, bring that up on your next appointment so that your therapists can review them with you.  We are working together to achieve your goals!

IMG_3695

One thing’s for sure . . . we absolutely love what we do. Equipping and empowering our patient’s with the tools and knowledge they need to reduce pain and increase strength is our passion!

“What can I do for my chronic pelvic pain?”

Definition of Chronic Pelvic Pain

Non-cyclic pain of 6 or more months duration that localizes to the anatomic pelvis,  abdominal wall at or below the umbilicus, lumbosacral back or the buttocks and is sufficient severity to cause functional disability or lead to medical care.

From a Physical Therapy perspective, patients who have chronic pain have often been under or over treated, yet have not received appropriate neuro-musculoskeletal care.

Picture2

Diagnoses Associated with CPP

  • Interstitial Cystitis
  • Dyspareunia—painful irritation
  • Musculoskeletal Dysfunction
  • Endometriosis

 

Signs and Symptoms

  • Abdominal wall pain and adhesions
  • Decreased delay in urinations
  • Frequency– increased urination
  • Negative Urine Culture
  • Pain/discomfort; pelvic, bladder, perineal, rectal

 

Causes of CPP

  • Pain with intercourse
  • Trauma: childbirth, sexual abuse, repetitive minor trauma, sports
  • Deconditioning/Disuse
  • Muscle Incoordination/spasms
  • Musculoskeletal mal-alignment

Picture1

 

Why We Care

Pain problems that are recurrent, becoming chronic, or do not respond to usually effective treatment should be checked for :

  • Muscular components
  • Multi-organ involvements
  • Nervous system changes
  • Emotional factors
  • Relationship factors

sad lady

 

 

 

 

Physical Therapy Treatment 

Pelvic floor physical therapy is highly effective in the treatment of chronic pelvic pain! Best of all, most insurances cover this type of therapy!

  • Pelvic floor exam: assessing pelvic floor muscle tone, strength, coordination, tend/trigger points, prolapse, pelvic descent
  • Neurological, musculoskeletal, abdominal exam
  • Pelvic floor training and exercise
  • Myofascial release techniques
  • Neuromuscular re-education
  • Internal/External Ultrasound
  • Heat/Cold Therapy
  • Muscle energy techniques

Picture4