Twin Talks
Common Pelvic Problems after Twins

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

KATHERINE DAHL: Having twins? That is so exciting, but what about after the birth of your babies? It seems that often the focus shifts entire to the new babies and the health of the new mother is overshadowed by their needs. She may go to the standard six week postpartum check up with her care provider and still feel like something is off. Or, worse yet, she may experience pain and be told that this is normal after having a baby.

I am Katherine Dahl, a physical therapist specializing in women’s health and I’m here to talk about common postpartum problems that are not normal and can be fixed. This is Twin Talks.

[Intro/Theme Music]

CHRISTINE STEWART-FITZGERALD: Well, Welcome to Twin Talks, broadcasting from the Birth Education Center of San Diego. ‘Twin Talks’ is your weekly online, on-the-go support group for expecting and new parents of twins. I'm your host, Christine Stewart-Fitzgerald. Have you heard about the Twin Talks club? Our members get bonus content after each new show and special giveaways and discount.

Subscribe to our monthly Twin Talks newsletter and learn about the latest episodes available, another way for you to stay connected, is by downloading our free Twin Talks app available in the android, iTunes and windows marketplace. Well, before we get started let’s introduce our panelist. And, I’m also going to go over to Sunny and she’s also going to tell us about our special program.

SUNNY GAULT: Yeah, so, there are several ways you can get involved with Twin Talks besides, just listening to the show, of course we love that you listen to the show, but if you actually want to become part of the show, we have different segments you can be a part of. We have a segment called ‘Twin Oops’, where you can share your funny, twin stories of parenting your twins.

We have a segment where you can share the funny things people have said to you when you are out with your twins in public and some of the, maybe more inappropriate stuff that you have heard. You can ask our expert questions you can send us emails, about the show, or you know different episode ideas that you have. We’re all about integrating you guys and making you part of the show.

So, if you want to do that just head on over to our website at www.NewMommyMedia.com , you can click on the contact link and you can send us an email or if you would like to actually submit for these segments and for us to use you voice on the show, you can submit via our voice mail. No one is going to pick up the phone when you call us. It’s going to go straight to the voice mail. That number is 619-866-4775.

CHRISTINE STEWART-FITZGERALD: Alright, let’s introduce ourselves, so, Sunny.

SUNNY GAULT: Yeah, so, I am, I am a twin mom of course, but I also have two singletons. My boys are my singletons, they are my oldest, I have a five year old and three year old, and then I have identical twin girls who are about 22 months, right now.

CHRISTINE STEWART-FITZGERALD: Alright, okay and on the phone with us, Brandi.

BRANDI WALLACE: Hi, I am Brandi Wallace. I’ve two sets of twins, I have identical boys that are five and I have fraternal boy-girl twins, they just turned three.

CHRISTINE STEWART-FITZGERALD: Two sets of twins is a lot of stress on your body. So, I can only imagine, I mean, I’ve got, so, my girls are six years old and I’ve to say, I’ve known Brandi for a while. So our first- her first set is the same age as my only set and then she went on to have a second set and I had a singleton. So, and when I found out she had her second set of twins, and they’re- I’m like, “Oh, my God, please, please, please let’s not find another one in there for me.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: We’re going to look at a headline today. So, there was a story, that came to the New York Times, just a few days ago, and since, we’re talking about postpartum health, this, this stood out to me. Now, in China, there’s a long standing practice that goes back, I don’t know, hundreds, thousands of years, where women go into what’s called confinement, so basically after they have- they give birth, they would usually stay in their home, they don’t go out, they have to stay warm, they have to eat special foods and so, this has been going on for you know, age old time.

And, now, I was just reading in the Times that there is a new fancy alternative to staying at home and being confined, but it is a luxury version of the confinement. And, if you are willing to spend more than $900 a day, for 30, that’s something like $27000, you can be pampered. And apparently, the women get, I mean, have chefs that, that feed them, you know these special diets that are, you know, helps their breastfeeding and bring back, you know, the blood and of course the Chinese medicinal tea.

They have special kinds of physical therapy and massages and acupuncture and then, now, I got to say, probably the best part that I like is they have nurses that are just devoted to the babies, so the mother doesn’t have to lift a finger. I mean, so, the nurses, they see, diaper the baby, change the baby, they, you know, wash, they do all that, and it’s like, “Okay, it’s time to breast feed, okay, here you go, again you get comfortable.”

SUNNY GAULT: Okay, I would love to know, what you would do, like, if you came in with twins. Would it be $900 a day, or they be like, “You know what, we can’t really give you two for one, so, you have to tack on the next term, whatever, 450 bucks, so.

BRANDI WALLACE: I’m sorry, I wonder if they have a scholarship program.

CHRISTINE STEWART-FITZGERALD: Alright, I know, because, I would be, twice for you, you know what I mean.

SUNNY GAULT: I know, right.

BRANDI WALLACE: Yeah

CHRISTINE STEWART-FITZGERALD: That’s, I mean, something, you know, we all have to say

BRANDI WALLACE: I’d be willing to consider another pregnancy, if I didn’t have to lift a finger, and just to be pampered. Actually, I’d consider that now, do they, do they cater the older postpartum, like three years old.

CHRISTINE STEWART-FITZGERALD: I know, exactly. When does that confinement period end?

SUNNY GAULT: Yeah.

CHRISTINE STEWART-FITZGERALD: Like, yeah. I’m still postpartum, sure. Now, I love that, I love that.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Well, we’re here today with Katherine Dahl who is here to talk about common postpartum problems that might go undiagnosed. Thanks for joining us Katherine.

KATHERINE DAHL: Yeah, I’m really glad to be here.

CHRISTINE STEWART-FITZGERALD: In your observations, I mean, what do you know about you know, typical postpartum check-ups? What do they cover in the range of, you know, postpartum problems? What are they covering and not covering?

KATHERINE DAHL: Yeah, so, since I am a physical therapist and not a care, not a maternity care provider, I don’t want to give in something, some information, but, the only appointments that I’ve really attended are my own postpartum checkups. But, kind of in general, the maternity care providers are mostly concerned about the functions of the organ systems involved in child bearing.

So, they are going to ask about postpartum bleeding, and about scar healing and about pain in the specific areas. And then, they’ll ask about breast feeding, if a woman is breast feed and about mental health issues, energy level, nutrition and other general questions about function and health and they’ll check on vital signs and the function of the various organ systems.

CHRISTINE STEWART-FITZGERALD: And, so, they’re, so like, they’re covering really just more of the internal organs, but maybe not looking at things from more of a structural, or, more anatomical, I don’t know if that’s the correct word.

KATHERINE DAHL: Right.

CHRISTINE STEWART-FITZGERALD: You know, look at it. So, in your field, you know, what, I mean, how about those types of conditions that many women experience after giving birth? So, how are they, if a women says, “Well, I’m feeling pain in my you know, Pelvis”, or you know, “it just feel like the muscles are tighter”, you know, something that sort of thing, I mean, how is that type of complaint usually addressed?

KATHERINE DAHL: Right, so, that’s kind of the difference in what physical therapist do is that we’re specialist in movement system problems and so, most maternity care providers aren’t. And, so, they’re not asking about that or screening for that, so, issues such as a little back pain or urinary incontinence, they’re not necessarily routinely asked at the six week postpartum visit.

And, in the case of, like, painful intercourse, most women haven’t returned to intercourse usually by six weeks, somehow, but, they’re just not, it’s not a topic that comes up. So, but, in my experience once care providers are educated on these things, then they kind of incorporate those questions.

But also when women are able to recognize that a symptom they are having isn’t normal, maybe common, but not normal then they are able to bring it up with their care provider at that visit and then advocate for whatever treatment they might need. And, I just wanted to say, since we’re talking about China, taking about France, I don’t know if you guys know, but, in France every postpartum women gets twelve physical therapy visits as part of a standard postpartum care.

SUNNY GAULT: Wow!

KATHERINE DAHL: And, so, it’s, it’s on the radar of the maternity care system in France, but, it’s not really here. It’s coming, it’s getting better. But this is the type of thing that muscular skeletal issues that really affect pregnancy and postpartum and so, that’s why they get that care. But, women here can advocate for that care.

CHRISTINE STEWART-FITZGERALD: Wow! Yes, and then you know, I’m just wondering, now, especially for twin moms, I mean, you know, twin moms, they’ve, we’ve carried more babies, had more weight, maybe we had more weight gain, so, there’s just, just the volume of change I guess

KATHERINE DAHL: Right.

CHRISTINE STEWART-FITZGERALD: Is, is greater than most, you know, most pregnancies and so I think often throughout the pregnancies we might experience more intensity of pain, and so, I think sometimes afterwards, you know, we might have some sorts of pain and we just don’t know is this normal, is it not, even if we’ve had singletons there’s that sort of thing, well, I’m, I, it feels more intense than what I remember, so, how can twin moms, you know, kind of figure out, you know, is this normal part of the postpartum recovery process, or, you know, do they need additional help?

KATHERINE DAHL: Right, so, obviously, anyone, who gives birth, whether it’s vaginal, or a cesarean has participated with, in having stretching of the body tissues and increased amount of stress on the body, like you were talking about. And, if there are any surgical procedures in cesarean birth or any type of episiotomy or tearing or something like that, that’s going to require some time for the tissue to heal, obviously.
And, I think that a great rule of thumb is that your symptoms should gradually get better over time, like every week, they should get better and if they stay at a same or they get worse over time, that’s a message that the stress on your body is higher that your body’s level of resilience, and that’s when you need some additional help in addressing the problem.

CHRISTINE STEWART-FITZGERALD: You know, Brandi, since you are on phone, it’s what I, what was your experience in your postpartum follow up, I mean, did you, you know have any types of you know, pain and discomfort and, and feel like you need to bring that up to your doctor and how did your health care provider respond to that?

BRANDI WALLACE: I did not have any perinea discomfort that I thought was unusual. I had abdominal weakness, certainly. Had I known that there was a therapy called physical therapy probably, I would have taken advantage from that, because I did have, I did have some back strain because again, for the lack of abdominal muscle but I feel like that’s different from what we are talking right now.

CHRISTINE STEWART-FITZGERALD: Yeah, I think, that, that’s probably pretty common and we’ll just get into that. As far as you know, and so, so, Katherine may be you just can talk about what are the most common complaints that you see in your practice, when you’ve give birth and, and you know we can just talk about each of the different complaints and, and what might feel like, you know, symptom wise for each woman?

KATHERINE DAHL: Yeah, so one of the, one of the common complaints that we see in our practice is painful intercourse, and I could say that, of the list that I’m going to, that we’re going to talk about today, that’s the only one that’s really normal.

CHRISTINE STEWART-FITZGERALD: Okay.

KATHERINE DAHL: I would say that the others are common but not normal.

CHRISTINE STEWART-FITZGERALD: Okay.

KATHERINE DAHL: Painful intercourse is going to be normal, because of the tenderness of the perineum after vaginal birth.

CHRISTINE STEWART-FITZGERALD: Okay.

KATHERINE DAHL: And obviously the tissues are really stretched and so here can be issues with the skin of the perineum or also there can be some underlying muscle problems where the muscles might be too tight and that can cause some pain during intercourse and also not just with intercourse, but insertion of tampons or GYN, exams, anything like that.

CHRISTINE STEWART-FITZGERALD: And is, is this going to be applying just for women who have had vaginal birth or does this also apply for women who, who have had cesarean as well.

KATHERINE DAHL: I think it’s going to be more common in women who’ve had vaginal birth.

CHRISTINE STEWART-FITZGERALD: Okay, so more, more common. And, then is it, and is the, let’s just say, the pain is, you’re talking about you know, let’s just say, pain that extends beyond the six week period, or is there sort of a period of time, that’s where it’s not normal?

KATHERINE DAHL: Or, pain that doesn’t get better, like I said with my rule of thumb. So, if it’s getting better, maybe it’s going to be a little bit slower than six weeks and that’s okay. But as long as it is getting better that’s fine, but if it’s not getting better or if it’s really interfering with your function, then, I think that’s time to have it looked at, so.

CHRISTINE STEWART-FITZGERALD: Okay and that’s something that is, is, really can be addressed in physical therapy? I mean, you mentioned that in France it has become standard, either treatments in physical therapy for that type of a condition or is it primarily through you know, OB or midwife.

KATHERINE DAHL: Yeah, so it kind of depends on the underlying problem, sometimes pain is caused by a scar that hasn’t been healing well, and sometimes that needs medical attention and sometimes it needs physical therapy. And so, the physical therapist can recognize whether that needs a medical attention and usually the care provider can – will know also as well, which path is, it needs to taken to heal that, so.

CHRISTINE STEWART-FITZGERALD: Okay, and what are some of the other complaints that you see?

KATHERINE DAHL: So, another really common complaint that we see is really stress urinary incontinence and women of course can have that during pregnancy or postpartum and stress urinary incontinence is when you leak urine in situations where you have an increase in intra-abdominal pressure. And so, for example, it would be like coughing or sneezing.

CHRISTINE STEWART-FITZGERALD: Oh, yes, yes.

KATHERINE DAHL: Lifting, sudden movement, you go like, “I reached for something and oops”, and also when exercising and running, which most women aren’t running, you know.

CHRISTINE STEWART-FITZGERALD: Right, we’re a lot tired.

KATHERINE DAHL: Since the postpartum, as you, yeah, as you go further along postpartum, any leakage with any type of intense exercise, once again common, not normal sign.

CHRISTINE STEWART-FITZGERALD: Okay, and so, because I mean no, I’ll just say, coz, so here’s my sort of yeah, the embarrassing postpartum. I do remember those, those few times, yes, like, you know, coughing really hard and I’m like, “okay, I think I just”, you got a little wetness and I’m like, “okay”. This was, you know, maybe a month after giving birth and you know, I wasn’t worried about it, but it just, it was a little bit more of the embarrassment, “Okay I’ve read about this”. So, yeah, I don’t know if you know, really women, really talk about it, you know, that much, even among friends.

KATHERINE DAHL: Yeah, women don’t talk about it, but they joke about it.

CHRISTINE STEWART-FITZGERALD: Yes

KATHERINE DAHL: And that, oh, I’m like, “No, this is not normal”. This is something like to be addressed, so yeah, but once again as long as it’s improving and, and not very serious, then, then you could wait but otherwise you’d want to get it addressed, so.

CHRISTINE STEWART-FITZGERALD: Okay, now, good to know. Well, we’re going to take a break and when we come back we’re going to look at some other common postpartum problems that should not be dismissed and go untreated.

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[Theme Music]

CHRISTINE STEWART-FITZGERALD: Well, welcome back, today we’re talking with Katherine Dahl, who’s uncovering some common postpartum problems that are often missed or dismissed in follow up checkups. We’re just talking about some of the common complaints. So maybe you can kind of tell us more, what you see in, in your office.

KATHERINE DAHL: Yeah, another condition that we see in our office is poor recovery of the abdominal wall function or form. And, so, a lot of women maybe have heard of Diastasis Recti which is a separation of the rectus abdominis muscles that run down the front of your belly. And so, obviously the muscles of the abdominal wall are stretched during pregnancy, and with, with pregnancy with multiples that’s going to be stretched even more.

So postpartum that should gradually shrink and return to your pre-pregnancy size or pretty close to it and but, we have a sedentary society, you know and we have , our normal activities don’t necessarily provide what we need to get those muscles back to their proper form and function and so we do see, women who come in with issues with diastasis, they’re also diathesis and poor abdominal wall function are related to the next two things that we’re going to talk about is, which is low back pain and pelvic organ prolapse and so, I’ll save those, but all three of them are kind of related.

CHRISTINE STEWART-FITZGERALD: Right, now, I know diastasis is really big factor. We do have, we did a whole episode just on diastasis.

KATHERINE DAHL: Yeah.

CHRISTINE STEWART-FITZGERALD: Because this.

KATHERINE DAHL: It’s a hard topic

CHRISTINE STEWART-FITZGERALD: I hear about it just constantly within the twin community and I think Sunny, I mean I think, you know, when we talked about it, I think you were, kind of, I don’t think, diagnosed on the spot.

SUNNY GAULT: Yeah.

CHRISTINE STEWART-FITZGERALD: You didn’t know you had it.

SUNNY GAULT: Yeah, I didn’t even know, and I didn’t know anything about it. I just knew that after I had my girls, I just felt, the, the best way I can explain it is that, I felt like I had a little girl belly again. You know, you are, when you are a little girl and you kind of, it kind of sticks out a little bit, there’s not a gut, right, just like a little round belly.
And you kind of have the same thing like when you’re like four months pregnant or something like that, you know, but I felt, it, it was a totally different postpartum body than what I had after my singleton babies. I was like, “what is this?” and then when we did the episode I was like, “Oh, my goodness, it has to be the case, and then we looked afterwards and you know, Cindy did her thing and she’s like, “Oh, yeah, there you go”, and I’m like “What, I didn’t even know I had this, what is this?”. But I have been trying to get that belly down ever since.

CHRISTINE STEWART-FITZGERALD: I know, and I think, we’ve heard it just like somewhere that, I mean, it was like, what forty percent of all pregnancies are something to end up with some form of diastasis.

SUNNY GAULT: Right, it’s not just twins

CHRISTINE STEWART-FITZGERALD: Yeah, not just twins

KATHERINE DAHL: Right, for sure. Yeah, it’s very common. And, I just want to make the point that one of my mantras is, “It’s not what you have, it’s how you use it”. And so, even if you do have some separation, if you arenot having any symptoms, if you are not having any incontinence or back pain or anything, that, that may be fine, and your body can, can deal with that and so, but, everybody is different and so it’s kind of a different point about whether you need to seek treatment or not, for it. So, everybody is different I guess, is what I’m saying, so.

CHRISTINE STEWART-FITZGERALD: Yes, now, you mentioned so the abdominal wall, and that’s kind of also tied into, kind of the low back pain and pelvic girdle pain as well, so.

KATHERINE DAHL: Yeah. And that’s the next thing that we see is, we see a lot of low back and pelvic girdle pain. Pelvic girdle pain includes pain in your sacroiliac joint which are kind of at the back on the sides of your sacrum and also you can have pain in your pubic symphysis which is that cartilage in between your two pubic bones in the front and often those go together and once again it’s common but not normal, and especially during pregnancy as well.

Lot of care providers may not diagnose it, because they say, “Oh, yeah, every woman has back pain during pregnancy”, and it’s absolutely not true, it’s absolutely not true, and just like some of these, many of these other conditions that indicates an underlying problem with your movement function and so it’s something that should be addressed as soon as you notice that it’s a problem. So just because it’s common, it’s not normal, once again, so.

CHRISTINE STEWART-FITZGERALD: That’s good. Now Brandi now you had mentioned that you had kind of the, you know, issues with your abdominals and back pains. So, I am curious, did you end up getting any treatment for that, in either one of your pregnancies?

BRANDI WALLACE: No. You know, I just I’m just motoring around, taking care of my poor kids. I just, I remember thinking, “Oh, jeez for the first time, I should be have been working with a personal trainer, I was in much better shape, than I was, after having a set of twins, and I’m getting near their second birthday”. I thought, “Well, I guess, this is just something thing that you just have to deal with”. I literally, could not sit up in bed.

CHRISTINE STEWART-FITZGERALD: Ah!

KATHERINE DAHL: Oh!

SUNNY GAULT: Oh!

BRANDI WALLACE: After delivering them, I couldn’t sit up; I couldn’t get up to take care of them. I had to still roll overmyself like when I was pregnant, roll up myself, to get out of bed, for a while. And even now, my shape is still one of a woman that might be expecting. My body likes that form apparently, because I haven’t gained a lot of weight. It’s just that my shape is altogether different and it’s all just right there in my abdomen.

CHRISTINE STEWART-FITZGERALD: Wow, wow, so, I guess you know that at some level you could benefit from some PT. Yeah.

BRANDI WALLACE: On a lot of level.

KATHERINE DAHL: And, all of us could. I confess, I haven’t really done the postpartum rehab that I should have done, from my singletons, so.

CHRISTINE STEWART-FITZGERALD: Well, who has the time? I mean, I think, I think that’s. . .

KATHERINE DAHL: Yeah, it, really

CHRISTINE STEWART-FITZGERALD: That the biggest thing, and you know

KATHERINE DAHL: It’s very hard.

CHRISTINE STEWART-FITZGERALD: Yeah, for us the moms of twins, we’re like, “Okay, we’re, you know, we’re feeding them and we’re doing this and you know, and I’ll say from, from my experience too, I mean, I did have you know PT, on my, with my twins, but then on my singleton, I didn’t have as much help in regular child care. So, I, feel for you, Brandi.

BRANDI WALLACE: So, I want to say too, I feel like, it was sort of a, it’s sort of,when you have twins it sort of kids will warn you down kind of thing, because not only you should carry them - and for me I carried all four of themfull term andI had four vaginal deliveries. So, … on all those marks, you suffer the consequences on the back side which is now I have to carry these two children and I have no abdominal muscles and I have no back to strain them. My back is worn now because I couldn’t take care of lift double down the car seat and all, you know, it’s a lot.

KATHERINE DAHL: Right, Yeah.

CHRISTINE STEWART-FITZGERALD: It’s, it’s tough. Now, I wanted to, because, I think we’ve got one last sort of complaint that you see, I didn’t want to miss, because I think that’s . . .

KATHERINE DAHL: Yeah, so the last one that we see is pelvic organ prolapse and that’s when your organs are situated a little lower than normal in your pelvis and this actually is a condition that’s routinely checked by your care provider. So, I would say out of all of those they’re for sure checking that.

If it’s missed by your care provider, a woman might feel sensations of vaginal bulging or pelvic pressure and those are normal after giving birth and after being pregnant for a long time. And so, that’s another one that I would say, as long as it’s gradually improving every week, you know, and it doesn’t go on too long, than that is probably normal healing versus something that should be address. But if it continues or if it’s very severe or even if you’re concerned about, have somebody check it out, so.

CHRISTINE STEWART-FITZGERALD: And, is this kind of the result of like, the, may be the uterus I mean when it’s still contacting and it’s just sort of maybe in a different
place than where it was or you know, things are coming- trying to settle back to original pre-pregnancy form, or. . .

KATHERINE DAHL: Not, not really. It kind of is, it’s usually a sign that there’s some underlying movement dysfunction like I said. Usually it’s a sign that women have a habit of bearing down instead of lifting up, with their abdomen and their pelvic floor and so, as it goes on over time, the organs kind of just move lower and lower and lower in the pelvis. It can also be affected by pushing for a really long time during the second stage, so. But often there is an underlying contribution to that. But then kind of giving birth is the straw that broke the camel’s back, so.

CHRISTINE STEWART-FITZGERALD: Yeah

KATHERINE DAHL: Like, like most things.

CHRISTINE STEWART-FITZGERALD: Yeah, now, you know, for, for all these conditions that we were taking about. So, how are twin moms more susceptible compared to you know, women who just had singletons? I mean, do you, is it a more intense condition or more pain, you know, how does that?

KATHERINE DAHL: Yeah, so, just like, just exactly what Brandijust said that she had you know, increased weight gain and there’s an increased load on her uterus and also on her muscular skeletal system, right, and on her abdominal walls. So, because of those things I would say that incontinence are, are, might be more common, abdominal wall weakness might be more common and pelvic girdle pain or a little back pain and also prolapse so just, just for that reason. She articulated that very well, so.

And then I was also just going to say that twin moms are also more likely, to have cesareans and also then, there’s also the addition of the recovery from cesarean surgery as well. And, also Brandi said that the increased child care load, the physical demands of carrying.

CHRISTINE STEWART-FITZGERALD: Yeah.

KATHERINE DAHL: Two babies, oh, my Gosh, it’s twice, twice the physical work. And then also with, moms with multiple pregnancies, it, they are more likely to be on high risk pregnancies and might be on bed rest or restricted activities and so then there’s going to be some deconditioning that goes on during pregnancy, so that’s another issue, issue that you need to address postpartum, so.

CHRISTINE STEWART-FITZGERALD: Well, so, now, let’s just say, we find out that we, we need to get some therapy and we come see you so, just, just in general, what is that treatment look like? I mean, is it all external, internal, or kind of what length of time can it span?

KATHERINE DAHL: Yeah, it depends on what you are coming for, but, like I said, a lot of these problems are related. So, physical therapist, examine muscles and motor function, and skin and things like that and so we do it all over the body and with pregnancy and postpartum we of course want to look at the pelvic floor, because that has muscles and skin and organ and all sorts of things just like everywhere else.

And so, we examine the muscle’s, I would say the big three are the abdominal wall, pelvic floor and the lower back and actually the big four coz you have to do your hips, because hips are really related to pelvic floor function. So, we examine the function of those four things. If you are having painful intercourse, we’ll examine your skin really carefully and sometimes there is scar work that needs to be done and things like that.

Other than that all, all of the other situations are usually caused by issues with muscle imbalance, like some muscles are too weak, some muscles are too strong and doing too much work.

So, there is an imbalance of which muscle groups are doing which work. Often there are postural issues, pregnant and postpartum moms tend to stand with really flat low backs and that contributes to a lot of these problems and so, we work on posture. And then also muscles strength issue, especially the hips, sometimes with the pelvic floor.
And biomechanics is a big one. How are you lifting those babies? How are you sitting when you’re breastfeeding? How are you getting in and out of the car? All those things are really stressful on the body and you can do then with good biomechanics and relieve the stress on the body or you can do them with poor biomechanics, and over the time that causes increased problems. So, biomechanics is, is a big thing, so.

CHRISTINE STEWART-FITZGERALD: So, could be, so, it sounds like it could involve you know, different forms of hands on, you know, different type of therapy and exercises and then into the practical aspect of.

KATHERINE DAHL: Right.

CHRISTINE STEWART-FITZGERALD: Lifting babies, getting in and out of cars.

KATHERINE DAHL: Right.

CHRISTINE STEWART-FITZGERALD: Which we may not even think about.

KATHERINE DAHL: Yeah, right exactly.

CHRISTINE STEWART-FITZGERALD: Throughout our day.

KATHERINE DAHL: Exactly. And it’s our- physical therapist job to think about that stuff, so.

CHRISTINE STEWART-FITZGERALD: Well, now you know, I can say, I had physical therapy, you know for back issues, actually, before I was pregnant, and you know one of the things that did stay with me, as I remember, you know, my therapist came out to my car with me.

KATHERINE DAHL: Yeah.

CHRISTINE STEWART-FITZGERALD: And you know, I, and she had me sit in the car and it was a, it was a manual stick, manual transmission, and she had me show how I shift, where my seat was, and she said, “You know what? No, no, no, you need to move your seat back, your legs, you need to get your extra sheet, had me get a pillow and reaps, and you know, I’m not kidding, just like that one thing made a significant difference.

KATHERINE DAHL: Yeah.

CHRISTINE STEWART-FITZGERALD: So, I mean, I just love the fact that you know, you are from, your vantage point can say, “Wait, you know, this, may be this one repetitive the thing that we do throughout the day.

CHRISTINE STEWART-FITZGERALD: Is really affecting us.

KATHERINE DAHL: Right. Yeah, exactly, we’re detective in movementdysfunctions. We want to find out what’s causing the symptoms, and then fix that underlying problem. We want you to never come back to us. We want you to fix the problem. We never want to see you again.

SUNNY GAULT: In a good way.

KATHERINE DAHL: In a good way, exactly, exactly.

CHRISTINE STEWART-FITZGERALD: Yeah, yeah. Now, you know, no, I have to ask this, I’m thinking of Brandi right now. So, is there any time limit, so after giving birth in which you can do therapy, I mean, so?

KATHERINE DAHL: Yeah, so, postpartum never ends. Once you’ve given birth you are always postpartum. And, so, the answer is no, there is no end limit when these conditions can be addressed. Obliviously, the earlier, the better, but, like we talked about, especially, newly postpartum you have to balance, you know, going to these physical therapist and doing exercises with the other needs of your family, and your kids and all of that. So, there has to be a balance.

So, but, and, but sometimes, I mean, usually women only come and seek treatment when they have symptoms. That’s when all of us do it, right? Because it’s interfering with our life and now that it’s time for us to make that sacrifice and go get treatment, right? So, but, ideally you would treat the problems before they get severe enough that you actually need treatment, right? So, like I said, in my perfect world, we’d be like France, and everybody would get those visits, right and everybody would do that, and there would be childcare there for you and then, you know what I mean, it would, it would be an integral part of postpartum care, standard postpartum care, but.

The other comment I wanted to make on that is that, a lot of the conditions that we postpartum, once I take my history with the patient, I realize that, “Oh, they did have some of these symptoms, or warning signs during pregnancy and they had some symptoms, or warning signs before they got pregnant.

So, these issues aren’t coming out of nowhere, they’re really issues that were pre-existing but now the stress of the birth has kind of put the women’s body over the edge and now she has symptoms. So, the earlier, the better, meaning, really early, you know, as soon as you.

CHRISTINE STEWART-FITZGERALD: Alright.

KATHERINE DAHL: Yeah, as soon as you know that you are from.

CHRISTINE STEWART-FITZGERALD: And, I know, I will speak, I will speak from experience that, I think. I did have physical therapy during my pregnancy with the twins, and so, I, think, that did help significantly, just to lessen the pain after giving birth.

KATHERINE DAHL: Right, exactly, and I have that exact comment here yet, “Don’t let them become postpartum issues, address it during pregnancy”, because, you might have a little more time then, than you do postpartum, so.

CHRISTINE STEWART-FITZGERALD: Alright. Well, thanks so much, everyone, for joining us today and be sure to visit our episode page on our website, for more information about Katherine and her practice as well as links to additional resources. And this conversation continues for members of our Twin Talks Club. After the show, Katherine will talk about the dreaded “mombod” and for more information about the Twin Talks Club, visit our website www.NewMommyMedia.com .

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SUNNY GAULT: It is time for the segment on the show we like to call “Twin Oops” and it’s where you lovely twin parent write and tell us about some of the funny stories that you’ve experienced with your twins. So, this one comes from Cindy and Cindy lives in Delaware. She says,“When my twins were about four weeks old I was home alone with them and my just turned two year old Conner.

Everything that could possibly go wrong did in a matter of 15 minutes. Oh, been there, done that, right? First Conner threw his oatmeal on the floor, getting it all over him and the cat in the process. I was trying to clean it up, while listening to two babies cry. Then, Conner starts spiting up everywhere, so I left the oatmeal and tried to clean him up. In the meantime Conner throws a toy and hits Collin in the head, so he starts crying even louder. As all of this is going on, Kira starts to poop. It starts seeping out of her diaper and all over the bouncer.

I take her upstairs to clean her up after depositing Conner in his crib. Debate whether or not just to throw out Kira’s entire outfit, because it was completely covered in poop, put her naked on a towel on the floor, while I got to get a bag to put het outfit in, come back to see that she has peed through the towel and onto our new carpet. Later, when I’m done crying, I call my mom, to laugh about it all. Because honestly all you can do is laugh at that point. I figured things couldn’t get much worse than that after 15 minutes.”

Cindy I love your story. Thanks so much for your honesty. And yeah, we’ve all been there, right? Especially those of us with twins plus you have other siblings and involved and all I have to say is, “That which does not kill us, makes us stronger”.

CHRISTINE STEWART-FITZGERALD: Well, that wraps up our show for today. We appreciate you listening to Twin Talks.

Don’t forget to check out our sister shows:
• Preggie Pals for expecting parents, our show
• The Boob Group for moms who breastfeed their babies
• Parent Savers- your parenting resource on the go, and
• Our newest show- Newbies for new parents.

This is Twin Talks- parenting times two.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode arepresented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line-up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows, through a co-branded podcast, visit www.NewMommyMedia.com.

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