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Ep 94 Holistically Preparing for Pregnancy and Postpartum with Dr. Haggerty and Dr. Wall

Interview with Dr. Michelle Haggerty and Dr. Michelle Wall, perinatal providers who specifically provide home visits to birthing patients, discussing holistically preparing for pregnancy and postpartum support and healing.

Dr. Michelle Haggerty, DO, MPH, ABOIM, IBCLC, PMH-C, RYT is board certified in family medicine, integrative medicine and lactation. She is the founder and owner of Fourth Trimester Doc (www.fourthtrimesterdoc.com), a private practice that provides in-home care for mothers/birthing people and their newborns during the postpartum/4th trimester.  She also provides consultations for lactation complications and perinatal mental health concerns.

She completed a two year fellowship in Integrative Medicine at the Andrew Weil Center for Integrative Medicine.  She has extensive training in yoga, mind-body medicine, nutrition, Reiki, osteopathic manipulative therapy (OMT), and integrative perinatal psychiatric care.  She also has an interest in public health and has a Masters in Public Health and Nutrition.

She is Co-Founder and Co-Executive Director for the Center for 4th Trimester Care (C4TC) (www.c4tc.co), a national nonprofit whose mission is to revolutionize 4th trimester care so that all people have access to high quality 4th trimester care through education, business development, advocacy and community building.  She is a founding board member for the North American Board of Breastfeeding and Lactation Medicine and serves on the Medical and Health Sciences Advisory Committee for the Minnesota Milk Bank for Babies.  She has been recognized for several years as a Rising Star Top Doctor by Msp/St. Paul Magazine and a Top Doctor and Top Doctor for Women by Minnesota Monthly Magazine.

website: www.fourthtrimesterdoc.com
website: www.c4tc.co
Facebook: Fourth Trimester Doc
IG: fourthtrimesterdoc
Tik Tok: fourthtrimesterdoc

Join the Free Well Connected Community to gain access to Dr. Michelle Haggerty’s Pillars of Postpartum Workshop.

Dr. Michelle Wall and her husband, Ryan, have two daughters, Madelyn and Ellie, ages 3 and 1. Michelle is a pelvic floor physical therapist with a special focus on the pregnant and postpartum population. Just because she is a pelvic floor physical therapist doesn’t mean she just treats the pelvic floor. She takes a holistic approach with her patients to determine the underlying causes for symptoms and pain, which often lie outside the pelvis.

Michelle owns Moms in Motion PT, a mobile physical therapy practice where she treats all her clients in the comfort of their own homes. She is an athlete and became passionate about helping other moms after rehabbing her body after the birth of her first daughter and navigating the challenges of the medical system firsthand. In her free time, Michelle enjoys spending time outside with her family, going on walks, and experimenting with new recipes in the kitchen.

Social media:

Instagram: @moms.in.motion.pt

Facebook: Moms in Motion PT

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Transcript

Cynthia: [00:00:00] Hey, it’s Cynthia here with your preview for today’s podcast episode. This one is a little bit longer than usual, but trust me, it is worth the whole listen, I got to speak with not one, but two incredible perinatal providers who specifically provide home visit. To birthing patients We’ll get to hear from Dr. Michelle Haggerty, who is board certified in family medicine, integrative medicine, and lactation. She’s the founder and owner of Fourth Trimester Doc, a private practice that provides in-home care for mothers, birthing people, and their newborns during the postpartum fourth trim.

She also provides consultation for lactation complications and perinatal mental health concerns. She is co-founder and co-executive director for the Center for Fourth Trimester Care, a national nonprofit whose mission is to revolutionize fourth trimester care so that all people have access to high quality fourth trimester care through education.

Business development, [00:01:00] advocacy, and community building. You’ll also be hearing from Dr.

Michelle Wall, a pelvic floor physical therapist with a special focus on the pregnant and postpartum population. Just because she’s a pelvic floor physical therapist, doesn’t mean she just treats the pelvic floor. She takes a holistic approach with her patients to determine the underlying causes for symptoms and pain, which often lie outside the pelvis.

Michelle owns moms in motion pt, a mobile physical therapy practice where she treats all her clients in the comfort of their own homes. She’s an athlete and became passionate about helping other moms after rehabbing her body after the birth for first daughter, and navigating the challenges of the medical system firsthand. From discovering the unfortunately outdated origins of the six week checkup to learning so many useful tips to cultivate your own personal village of support to hearing all about the unique, physical, mental, and emotional benefits of having in-home and truly humanized support [00:02:00] in those postpartum months.

This conversation opened my eyes to what is possible. I’m excited for you to learn along with me.

 

 

Cynthia: Welcome to the Well Connected Twin Cities podcast. It’s your host, Cynthia Shockley, and today we get to have a conversation with two Michelles who are specialists in postpartum care. But they come from slightly different backgrounds, so it’s really exciting to have both of them.

Here. We’ve got Dr. Michelle Haggerty, who is a doctor of osteopathic medicine, [00:03:00] and we also have Dr. Michelle Wall, who is a physical therapist. And so they come with a wide range of expertise and they both travel to their patient’s homes. And so I’m excited to dive in. Welcome, both, both Michelle’s

Thank you. We’re excited to be here. Yeah. And for ease, I’ll be just calling Dr. Michelle Haggerty. Dr. Haggerty, and then calling Dr. Michelle Wall, Dr. Wall so that we don’t have to throw all the Michelle names out there. . That sounds perfect. I was able to share some background on what you all do, but why don’t we hear directly from you What is it that you do and why do you do it the way you do it?

 How about we start with Dr. Haggerty? 

Michelle Haggardy: Yeah. Great. So I am Michelle Haggerty. I am a family physician.

 I’m boarded in integrative medicine, family medicine and lactation. And I see families in the home postpartums during the fourth trimester. I wanna practice called fourth trimester doc. And it is all [00:04:00] home-based care. So I see the mothers or the birthing people and the newborns in the home postpartum.

 And I love it. It has been such a joy to to have this practice. It is a very unique practice. There’s only a few across the country that are similar. And I just felt like the system was working in the standard medical system and just felt like it was not really caring for the folks that needed it in the space that they needed it.

 I felt families were coming into the clinic leaking from all orifices, you know, I mean after, after having a baby. And it was like, what you know, why are they carrying this car seat in? And trying to do all the things and really they should have been home snuggling, skin to skin with their newborn and instead they’re coming into clinic and.

I just realized that we needed to make a change and the only way to do so was to do it on my own. Started this practice and it’s just, like I said, it’s been really life-giving. For me, I was on the verge of burnout and I’m very far from that at this point. So it’s been really good.

[00:05:00] Yeah. 

Cynthia: Beautiful. And I’m sure Dr. Wall, you can resonate with that since you also provide care in your patient’s homes. 

Michelle Wall: Definitely, yes. Yeah. 

Cynthia: So why don’t you share a little bit more about yourself dr. Wall and just what brought you into the work that you do. 

Michelle Wall: Yeah, so again, I’m Michelle Wall and I’m a physical therapist.

 And I have extra training in the pelvic floor, so designated as a pelvic floor physical therapist. And also have a background in orthopedics and some visceral training. And I also come to my client’s homes. It’s all mobile based. And when I had my first baby I realized how hard it was to get out of the house.

And I had friends and family that had babies and I thought oh, just throw ’em in the car seat and go do whatever you need to do. Naively . And then realizing that there’s so much more to it between. The healing that’s going on in your own body [00:06:00] and getting the baby to get in the car seat between blowouts and screaming and feedings and naps and just what a disaster it is to try to get outta the house, especially in that early postpartum phase.

 But even beyond that, and even during pregnancy too. And so that just lit a passion in me to serve moms in this way. And as Dr. Haggerty said I knew the only way that it was gonna ever happen is if I just did it myself. 

Cynthia: You both found a hole and you were able to fill that gap, and I’m so glad that you are.

I can’t even imagine just, gosh, after birthing a full child, like you said, leaking and , dealing with a little baby and having to navigate your way back to a clinic. Of course there’s the ease of being able to be it in your home, but I wonder if anyone can speak to what else is going on when you go into someone’s [00:07:00] home.

 That energy, that feeling, cuz I’d imagine it’s so different than being at a clinic. 

Michelle Haggardy: Absolutely there’s a lot of information that you can get from just going into somebody’s space. First of all I, just energizing for me and also sort of humbling for me that people accept me into their home space. And so I don’t take that lightly at all. I think going into somebody’s home is of sacred. And just crossing that threshold in the first place, allows for just a different and deeper connection right off the bat than somebody coming into the clinic space.

 They’re also as less of a power dynamic that happens like they are in their own space and environment, so they feel more comfortable and less vulnerable, I think. And so I’m able of come in and be accepted and invited and that just changes the dynamic

and then I also think we spend a lot more time. So instead of the 10 minute visits that happen in the standard medical system I’m spending 90 minutes to two hours in the home usually in the first visit. And usually over 90 minutes on, follow-up visits as well.[00:08:00] 

So it’s just a different time and space and energy that ends up ends up happening. The other thing I get a lot of information from is just walking into the home. It’s a home like pristine. What does that mean that’s happening with somebody’s mental health in the home?

Are they like really anxious and they’re just cleaning like crazy? Or cleaning crew just there maybe that was, maybe they have additional support, which is great. You can get more information around is there chaos? Is there other kids involved?

 Where’s baby sleeping? What is, what does that look like? Where are they getting their food? What’s the nutrition opening the refrigerator. Is there food? Is there food there? Is there food insecurity happening? There’s a lot of things that you can get just by entering that space.

Michelle Wall: Yeah, I was gonna say something very similar about the, just the physical space of being in someone’s home. It’s it’s a different tone and you get to set the tone when you go in there. And so I’ve had clients that are apologizing profusely because of the mess. And I said, I am never judging your mess.

You should see my house. You know, and I make that very [00:09:00] known that my house isn’t perfect, so yours doesn’t need to be either, and that should not be your priority right now. And just the ease that washes over people. Being, when you say something like that, and I had a client last week there were a few little toys on the ground or something and she’s I’m so glad you said that because now I don’t worry about it

I’m like, I’m sad that you were worried about it in the first place. But just you get to set that tone when you’re there and like you said, you can actually pick up a lot of what’s going on from seeing their space. And the beauty of it too is you get to see what’s happening in their natural environment.

So for me, and probably for you too, especially with lactation I’m always looking at what is their posture? What are their body mechanics like, oh, you need to feed your baby. Great. Let’s see what that looks like for you. And maybe I’ll give you some tips on how that could improve your posture.

And, oh, your baby is having a blowout, or you need to change the diaper. Let me see how you do that. And I can give them some tips on what’s gonna save their back in the long run and that kind of thing too. So you can use their natural environment as an assessment while you’re there. 

Cynthia: That’s wonderful and I feel [00:10:00] like I can imagine a physical therapy session the way that you’re explaining just being able to follow along with a mother’s patterns and, being able to help with practices, adjustments, exercises.

 Dr. Haggerty, with your work, you said you spend maybe about 90 minutes at a patient’s home. I’m curious what goes into that, just cuz all I know is the clinical space, right? Like in and out. Did you answer these questions? Check these boxes and you’re good to go. 

Michelle Haggardy: Yeah, absolutely.

There’s so much more. So much more. And I wish I could spend longer, honestly. For example I do a a postpartum planning session before the birth. I’ll come into the home and we’ll talk about nutrition and support systems and what do those first few days look like?

 And really just prepping around education, around lactation initially expectations around normal newborn cares and things. So we spent a lot of time prepping. And then the first postpartum visit, I actually the majority of that visit they tell their birth story.

And it’s not just yeah, I get, I gave birth vaginally, [00:11:00] like baby came out, I pushed for three hours or whatever it is. And that’s, it’s like there’s so much more to the story than just that. And so I really encourage the the partners so the birthing person and their partner or whoever their support person was, if they’re there to tell the whole story.

And I say, don’t leave out any details. I am here. We’re gonna go through it all. And what I love about it is that it can be incredibly healing because there’s so many little, nuances and things that come up that maybe were a little traumatic for somebody, or 

maybe there’s some spaces that were a little scary So we can kind of go through the whole process. I love having them do it as a partner or as a pair because what tends to happen is, for example, the birthing person maybe has a c-section for whatever reason and needs to go into the OR 

and so then the partner is seeing what’s happening and maybe they’re afraid because they had to be back in the room waiting, or maybe the baby came out and the birthing person didn’t actually hear the cries right away.

But the partner did, the partner saw the baby’s eyes were open. They were looking around and they’re like no, things were great. Baby looks [00:12:00] really good. When they came out, they were they brought over the warmer and looked around and looked right at me and it was so cool and all these things.

And the birthing person didn’t get experience any of that, right? And so now \ what you’re doing is you’re filling in those gaps, those scary gaps that can happen for a lot of folks. That can then resonate and move into a traumatic space later on and can cause more anxiety and depression.

 So I love that. But on the other side of it though, is like somebody who is a birthing person that’s going through their transition stage, and baby’s coming down the birthing canal and they’re just like you know, screaming. All these things are happening and the partner is thinking that they’re the birthing person’s dying.

This is just a chaotic , moment where the birthing person may feel like the most powerful moment of their entire life. They may feel like they were so just in it just raw and animalistic in the whole thing, right?

So then they’d be like no, like that was a really cool experience for me. I really felt like I was transformed in that moment. And so then the partner sees that, or hears that and says, oh my gosh, it wasn’t scary. It wasn’t a terrible thing.

This is actually a good thing. And so then it heals those [00:13:00] those moments of Being afraid or whatever, what was going on. And so I think doing that together is really powerful. And honestly, this is the first time and only time a lot of people will even be able to tell their birth story in that depth.

 Nobody else gives them that space or time to really be able to process all of what had happened. And the whole journey of it. And that there’s a lot to be said about just being able to sit and hold space and listen to it and maybe answer some questions here and there,

but it’s just allowing that, space and time and energy. And then and then I also offer to either write it down for them as they’re doing it or recording it so then they can have that as a gift for themselves or for their baby later on. And that there’s some way of documenting that this was their transition.

 It can be incredibly powerful. So yeah, that takes a long time you know, that, and that’s the first visit, right? And so even subsequent visits after that, we just go into more a depth than everything. The mental health aspects, the pelvic floor, the community aspect, the you know, sleep, all the things.

Even if Lactation’s going really well, there’s always [00:14:00] something that we can kind of support and work on. 

[00:15:00] 

Cynthia: Wow. Mm-hmm. , The holistic approach of recognizing the power of even sharing stories and being able to speak that out loud.

I just really appreciate [00:16:00] that. I did not expect that was a part of the package with working with the doctor in your home, so that’s incredible. I wonder, Dr. Wall, in your experience how navigating that space has developed, right? Because I’d imagine even though it’s physical therapy, there’s a lot of emotion that comes up.

There’s a lot of stories that come up. So what have you noticed in your patient interactions especially in that tender time postpartum? 

Michelle Wall: Yeah. There’s definitely. A bond and a relationship that happens. I’m seeing my patients for an hour and it’s usually a pretty long-term relationship. It depends on what’s going on with the patient, what their symptoms are, why I’m seeing them.

But it can be anywhere from six weeks to six months that I’m working with somebody. And we really build that trust. And so people I think do feel comfortable to, to share things. And even on our first visit, we’re usually [00:17:00] going through birth story two and a whole history of.

Other things that might be playing a role in whatever symptoms they have going on. And just giving them that space too. And so that usually takes over half of our first visit, just gaining information and listening. And then more always comes out down the line too that they didn’t share right away or things they didn’t think were related.

 Start coming up. For example, I had a patient who started seeing me during pregnancy and then had some postpartum symptoms. She’s, like, I think I have prolapse. Should I see you right away? Should I go back to my doctor? What should I do? And I could tell she was just like, spiraling. And I’m like, you’re gonna be okay.

Let’s wait for our visit. It’s coming up I know what this feels like. I’ve been there too. There’s no magic fix. We’ll see what’s going on. And then once we were there, she was so focused on those symptoms and then a couple visits later she started telling me about something else that was going on.

And I was like, oh, it sounds like you have an anal fissure. Let’s check that. And she was like, okay. [00:18:00] This is weird. And we done some treatments for that. And then the next visit. She said, I was so surprised after we did that, I had full resolution of symptoms. And I’m so glad you said something, because I would never have put two and two together.

I wish I would just think those darn 

Michelle Haggardy: poops, . And 

Michelle Wall: so, um, She was like, I never would’ve thought that was what was going on. And most people are not telling those intimate details about what’s going on, and they just think just deal with it. Maybe hit up Google or Instagram to see if anyone else is dealing with that too.

But yeah, so there is just that trust that gets built. Hmm. 

Cynthia: And what a blessing to have that professional to hold your hand through the process and to be that resource. Because Google can be a scary place when you’re looking up symptoms. . Yeah. But to be able to have that go-to person, that you can ask the questions and get the reassurance and just have that [00:19:00] checkpoint, cuz I know it can feel really lonely to be in that postpartum period. It’s hard to show up vulnerably with family, with friends sometimes. And so that to have a professional who’s there. to help you. Body, mind, and spirit is such a gift. And so it sounds like both of you have the skills and the wherewithal to support your patients through that emotional aspect of postpartum.

I’m curious on the physical side, what are some things that typically come up? Tools, exercises or just things that people usually have to learn about in that postpartum period. And , we can start with Dr. 

Haggerty. 

Michelle Haggardy: Yeah. All kinds of stuff, right? , I’ll leave some of the pelvic floor stuff for Dr.

Wall, but with lactation obviously there can be so many different things that come up, clogged ducts mastitis even just issues with initially latching low [00:20:00] milk supply, hyper lactation where there’s a high milk supply, all these kinds of, things.

I’m actually a breastfeeding medicine physician as well, so I of focus in on the high end complications of lactations. So folks have been seeing lactation consultants and just aren’t getting where they need to be. I sort of then take the next step in whether we need to do labs or other diagnostic things, other treatment 

 I’ve even drained breast abscesses on kitchen tables, trying to keep them out of the emergency departments. There is ways to support folks in the home. . Of course, perinatal mental health.

I do a lot with with herbs and supplements. I also use biofeedback and of course refer out to perinatal mental health therapists. And it really do a lot of support along those lines. We do yoga Nidra which I know you would really appreciate

Yes. Uh, Yeah. Um, And just like mindful movement meditation, mindfulness, getting outside working on sleep is a big aspect. There’s a lot of issues and concerns with sleep and how to navigate that with a newborn. So we talk a lot of techniques with that.

What [00:21:00] type of lighting to use, how to navigate that with a partner. How to make sure that you’re getting rest in between. If you’re not getting arrested, there’s some anxiety or scary thoughts happening that you’re ruminating on. So all of that is really. Also part of this whole process of what we’re looking at and treating.

 So that’s the maternal side of the birth person side. And there’s also the baby, right? So if there’s issues with the newborn weight gain or if there’s jaundice so where they’re yellowish and have high bilirubin levels, we can treat that in the home. Then we don’t need to send people back to the hospital for that.

If there’s any skin issues all the normal stuff that sort of comes up with newborns, and then also the other the other aspect is just the well child check.

So instead of having to go in at the two week time to go in for a well child check, I do that in the home. We don’t need to go into the clinic. And I’ll even do that at the two month check. And I’ll even give vaccines and things at that time too. So there’s, again, they don’t need to go into the clinic in the middle of winter and do this whole thing.

 You can do that at home. I’ll, come to you. Instead of having to go into the clinic and do that. Like they get to nurse right away. Baby falls right asleep. That’s it. Mm-hmm. , like They don’t need to then [00:22:00] try and shove them in the car seat and then send home after they got their vaccines and are screaming and the whole thing.

 So there’s ways of really supporting folks in this space that just, it does not need to be in these 10 minute visits in the clinic. It can be a lot more gentle and more connected and more holistic 

 I do also prescribe medications. I don’t have anything against medications. I think they’re fabulous and I think there’s space for them, but I also don’t think that they’re the be all, end all of of treatment options. I think we really need to think about all the different ways that we can support folks and then using other providers as well.

So like acupuncturists, massage therapists Ricky and Cornal sacral therapy, and there’s all these different really cool resources out there. So really I think being aware of those, and I’m connected with a lot of folks out there that are doing the work then I can support them with that too.

Cynthia: Ugh. The whole gambit. There’s so much . 

Michelle Haggardy: There’s so much There is. That’s the thing. There is so, so, so much. And I think that that’s I mean, how you can you know, bring that down into a 10 minute visit, six weeks is, that’s nine to me. It’s really, it’s [00:23:00] crazy, you know? 

Cynthia: that makes zero sense. And I know too, Dr.

Haggerty, you do refer out to Dr. Wall. So you two have a professional relationship. And so I’m curious now, Dr. Wall, for you, when you take on your patients, what are some of the typical things working specifically with physical therapy, pelvic floor that maybe people would typically learn about or do with you?

Michelle Wall: Yeah, so again there’s so much that can happen. And it sometimes seems like it’s all happening and sometimes it’s just minor. But anywhere from people are leaking urine maybe unable to control gas in the way they would like to having heaviness or pressure, which is sometimes a sign of public organ prolapse.

 And that can be from the bladder, the uterus, or the rectum that’s bulging in on that vaginal canal. Painful abdominal hernias or diastasis that is persisting. Just feeling like their core isn’t working right and just feeling unstable or just [00:24:00] figuring out how to move.

C-section scars, perineal scars pain with those. No one really teaches people what to do after they have a C-section. They just cut through a million layers of tissue and say, All right, go home, . And you’re still expected to take care of your baby and take care of yourself. And there really isn’t a lot of guidance with that.

And especially for a c-section, we’re spending lots of time talking about what clothes are important to wear. What should you do for the scar itself? When should you start doing some scar? Massage that you should do scar massage. No one’s telling people that they need to do these things.

And then with that there is a lot of times pain associated and people are having a hard time moving. And so we’re talking through strategies of this is the best way for you to get out of bed or go up and down the stairs. And so just quick for anyone listening who might be looking for a quick tip there is to roll all the way to your side and then use your arms to help you sit up.

We call it the log roll method is gonna be easier than like sitting straight up in bed. And then [00:25:00] one thing you can try, if you do have stairs in the home and have to go up and down them first of all, if you can try to avoid them, you should. But then if you need to walking sideways can actually be a little less stressful on the abdomen, so that can be helpful for decreasing some pain at that incision site as well.

[00:26:00] 

Cynthia: Yeah, this just makes me think about how Serious it is to give birth. What a serious trauma it is to the body. It’s, It’s something to really take into consideration as you heal. And I know Dr. Wall, [00:27:00] you preach on this, on social media, and I think it’s so true, but can you speak about the traditional six week checkup and oh you’re all good.

You’re ready to just get back to normal life. Like, where did that come from, first of all, if anyone knows. And then why is that so wrong? Yeah. 

Michelle Wall: I actually don’t know who came up with six weeks. I don’t know how that was the magical number. 

Michelle Haggardy: Um, I actually do, I do know. I can talk about that. Oh, great.

Yeah. Mm-hmm. .Ok. so it, it actually comes from Back a hundred years ago or whatever, that people had support systems and so they had people that were caring for them in the home. And so it’s this sort of first 40 days idea where people were lying in

where they were home in the beds. They had grandparents or grandmas and aunties and the cousins and sisters and everyone taking care of them. And so the standard medical model actually acknowledged that and said you don’t really need to come in until six weeks because that’s Just wanted to check [00:28:00] in on people at that point.

So it really came from the fact that we did have support systems way back when, and that there was, and there was this acknowledgement of it. But now we don’t have that anymore. We don’t have our villages and our communities and things that are really doing that work anymore. And and so people are left in the dust and then we’re relying on the standard medical system to support us in that.

And it’s not meant to do that. It’s not well equipped to do that. At six weeks everything’s already happened. Either people are breastfeeding or they’re not. Either they’re depressed or they’re not. There’s a lot of things that have happened already and either they’re managing it and figured it out or they’re not and they’re struggling and it is really bad already.

 We should be seeing folks so much sooner than that six week visit. So that’s where it’s coming from. 

Michelle Wall: All right. That is fascinating. I did not know the history on that. But yeah, so now in our traditional model, we’re basically getting no guidance from zero to six weeks.

And then at six weeks we’re getting this all cleared. Do whatever you want to, you don’t have to come back . Which is just setting [00:29:00] people up for failure. And so really seeing people early in that postpartum period is really helpful for people. As I said, like people who have had c-sections don’t know how to move in their new body.

And even if they delivered vaginally, like a lot of times there is pain there and just difficulty, like I said, can’t quite connect to their core, right? Or just everything feels off. And so just teaching movement strategies and breathing strategies can be so important. And then starting that healing process too, working on breath work and connecting to their bodies again.

And then working up to a strengthening program where people are getting the foundational base strength back. So even if someone was really active throughout pregnancy, everything changes. You’re now having A, six to nine pound baby that was inside of you now, not inside of you.

You’re losing a bunch of fluids, you’re going through crazy hormonal fluctuations. And so nothing is the same as it was . And so going back to whatever activities you were doing is [00:30:00] just inappropriate for healing times from a tissue standpoint. And just from a strength standpoint too. Your center of gravity changes during pregnancy.

Your muscle strength just, it just changes even if you’re being active. And so a progressive program is really what makes more sense than a all clear. Okay, now hit the ground running. In my opinion, it should be, we see them before that six weeks anyways. But for anyone who’s not seen in that six week period, instead of an all clear, I think it should be a, here’s your referral to a public floor physical therapist who can walk you through this.

Next step, which is building up that strength until they’re ready for those, especially people who are hoping to go back to high intensity exercise, like running heavy weightlifting, intense plyometrics. If someone is just trying to get back into more gentle type exercise, they might not need that specific program.

Or guidance. It’s still probably suggested, but they’re probably gonna be okay on their own or doing some something that they find online. But if [00:31:00] people are trying to return to that more high intensity type of stuff I think it’s really important to get professional guidance to make sure that you’re doing it appropriately for the right timeframe for those healing timelines.

And painful sex is a super common thing for people, especially when we’re talking about that six week visit. People get cleared, they sometimes return to sex right away.

Sometimes people are not in any way. Interested in that, ready for it. And I always am on their side saying, that’s okay. You don’t have to be ready. Don’t try to return before you’re ready. Your partner can wait . But there’s a lot that we can do from a pelvic floor standpoint too.

A lot of people do experience pain first time, second time sometimes long periods of time afterwards. And sometimes it’s more profound than it was before if people were already having pain with intercourse. Sometimes it gets worse, especially if there was any perineal tearing and stitches that kind of thing.

But sometimes people just have like a. Response after birth, whether that’s from a direct birth trauma or something just that it’s a trauma in the body, whether or not it [00:32:00] was perceived that way emotionally. But your pelvic floor is a huge place for emotions. And pelvic floors tend to tense up when we have any kind of a trauma, and that is a physical trauma, whether or not it was a mental trauma too.

And so sometimes the pelvic floor is really tense after birth. And so sometimes we just need to do some release work on those pelvic floor muscles to make intercourse a little bit less painful. 

And then also just little things do come up where everything was fine and then you started doing X, Y, Z and now you’re feeling all this pelvic pressure that wasn’t there before. And one other thing that is so common that we don’t. Necessarily talk about, or really gets brushed under the rug, is constipation.

And that can be during pregnancy through that, early postpartum and even beyond. And a lot of people don’t even realize, a, they’re constipated, or b, that it’s any kind of a problem. But that can really play a role in pelvic health symptoms too. And so people who have prolapse that’s often aggravated if they’re having any constipation, [00:33:00] especially if they’re having to strain which can make that return to exercise really difficult for people.

 And so just wanna throw that in there too, as something that we’re always talking about as pelvic health PTs and something that’s important for overall health too.

Cynthia: It just feels like all these dominoes lined up, right? This affects, this, affects this. So I know both of you also do a little.

Prenatal as well. So just preparing for that postpartum chapter for anyone who is pregnant or planning on pregnancy, what would you say are some of your best tips or guidances on preparing for pregnancy into postpartum ? 

Michelle Wall: Uh, So my tips would be to make sure that you have the right team in place, first of all. And so you need to have someone who’s gonna deliver your baby. So your ob or midwife someone that you feel safe with, that you feel like you can trust their decision making, your decision making. I highly recommend having a doula.

 [00:34:00] I had one and that was really helpful for me and my second birth to have someone that knew what my preferences were going to be ahead of time. I really love prenatal chiropractic, so finding a prenatal chiropractor to be on your team postpartum doctor that has knowledge in lactation and all the other things.

which would be Dr. Haggerty or someone similar. And then a public health bt. And so we do go over what kind of transitions they’re gonna make in their bodies and we go over some stuff ahead of time about what that’s gonna look like. We do some birth preparation to talk about pelvic floor considerations and what that looks like during labor and then what that very early, like first two weeks might look like for them.

 And then we talk about, okay, when should we follow up postpartum? What kinds of things would you wanna let me know about if they crop up? And then, . I would say get as much help as you can and take it from anyone who’s offering . Um, and so that looks like, a [00:35:00] meal train or anyone who’s willing to bring you a meal always say yes.

 If you have the capacity and the time to prep some meals ahead of time and put them in your freezer, I think that’s really helpful to be able to pull something out quick that’s gonna be nourishing to you. If you have someone offering to do your laundry, let them do it. Or if you can get a service cleaning service, anything that’s gonna help you be able to rest and just take care of your baby and not have any outside responsibilities.

If you have a other kids setting up some kind of childcare or having friends watch your kids so that you can rest when you have the opportunity to rest. Yeah, so take as much help as you can get would be my biggest. 

Cynthia: Yeah. Prepare a village of support. Yes. Oh, gosh. And then how about you, Dr.

Haggerty? What are some of your tips, advice for people preparing for post-pregnancy? 

Yeah. 

Michelle Haggardy: Um, so all, the above. Definitely. postpartum doulas, I, so even, so birthing doulas are fabulous. But then I also [00:36:00] encourage postpartum doulas. I do a lot of support and work in the home. And they can be anything from helping prepare meals to helping to take care of their kids, to helping with baby wearing and normal newborn cares.

And holding the baby while you take a bath. All the things. So I really encourage folks to, to get a postpartum doula if they can. And then sometimes people talking about support systems like are the in-laws gonna be coming in and staying with you or your own mother?

And what does that look like? How does that make you feel? Like maybe there’s some anxiety around that. And how can you navigate that? Do you want them to stay in your home? Maybe? Do you want them to stay down the street in a hotel and maybe they come only during the daytime hours? Maybe they help overnight.

There’s nighttime nannies or nurses that will also help with caring for baby overnight. And then nutrition is huge. Same thing talking about meal trains and preparing your own meals if possible. GrubHub is fabulous. I say get your favorite menus and have them available and highlight a few of your favorite meals so that you don’t even need to think about it.

You just say, Hey, grab one, one from such and such a place, and I already have it highlighted and somebody can order for [00:37:00] you. It’s easier for people out of town that just wanna get, get something for you easily. is huge. And exercise meaning like just moving your body.

 What does that look like? Getting outside, if you can get some sunlight moving throughout the home you know, in the first couple days, I like people to stay in the bed as much as possible. So just for skin to skin. I say diaper buddies, like you’re wearing a diaper.

Baby’s wearing a diaper. You’re just skin to skin, like hanging out doing all the things. Just a lot of bonding. Talk a lot about visitors and so people will want to come and meet baby. But what happens a lot is it actually disrupts the lactation and breastfeeding experience because baby is learning the birthing birth or mother is learning.

 And if you’re taking the baby from them and holding the baby or taking the baby away from that situation, you’re actually disrupting that. Really trying to limit and navigate what visitors look like. So are they just one or two a day?

And having somebody be the gatekeeper, the partner typically is a gatekeeper of that and saying, Nope, today is not a good day. We’re gonna have you come tomorrow. And then if they come in the home, I always say they have to do something. If they’re coming in the home before they can touch that baby, [00:38:00] they have to do something.

So they either they’re doing a load of your laundry, they’re doing your dishes. Maybe they’ll hold the baby. If you’re gonna be taking a shower, taking a bath and it’s something that you wanted to do or take a nap or they bring food, they have to do something for, you have to bring something into the home.

They have to bring energy into the home and not just take from the home. And from that space. So I really highly encourage that. And sometimes that can be really hard. So if people put like a list on the refrigerator or list on the front door that says, these are the things that needs to be done today.

Choose one . It’s lovely. And people want to help. They wanna do what they can to support, but they don’t know. And a lot of times the birthing person or the person the mother is just so exhausted they can’t even think what to ask. So if you have that already of listed out, that’s much easier just to be like, just choose one of those things.

That’d be awesome. Thank you. So it gives people some hands, something to do. And then they get to snuggle baby for a little bit and then they can. And well, and actually have a pillars to postpartum care. The five pillars of postpartum care through well connected is on their, site.

So that’s only like, I think it’s like 45 minutes or half an hour course. You know, Low webinar thing that people can go to [00:39:00] and find more tips and tricks and things, but there’s so much preparation that goes into planning for the birth and not the postpartum period.

And actually, my doula, Lindsay McCoy once told me who’s from the Twin Cities she was like, it’s planning for pregnancy and not postpartum was like planning for a wedding and not the marriage. So we really need to be planning for this space. you know, like There’s so much involved in this space.

We put so much emphasis on the birth itself, but there’s, it’s everything that happens afterwards that can really be setting the tone for a lifetime. And actually in, in Ayurveda, they talk about the first 40 days. Sets the tone for next 40 years of life. So if you’re really focusing in those first 40 days and really providing a very nourishing environment and a very nutritive space that just allows both the birthing parents to grow and go through their mesans and the newborns to sort of initiate their life then it just sets up the tone for the rest of their life 

Cynthia: there’s just so much value in everything. You just said, things I had never even thought about. I’m in the category [00:40:00] of planning for motherhood one day and you know, I’m on the hunt for sure for ways to make it as smooth as There’s a lot of information out there and a lot of, fear-based information out there.

And I, I feel like I, there’s not enough. Of this, right? Instead of focusing on the fear, what are ways we can address it? What are ways that we can plan ahead? Like being proactive about making a list of things your community can do to show up for you when you’re too tired to think of a list in the moment.

And it’s just pro being proactive. And I love that analogy of the wedding versus the actual marriage, right? So how can we set ourselves up for success? 

Michelle Haggardy: One other thing I forgot to mention. This is really, actually important, but I really focus on, I think a lot of people don’t is the postpartum space.

So like, where are you and baby gonna sleep and spend most of their time. And what does that look like? Is that a bedroom, or is that like the couch in the living room area? Where is that space and how can we make that space as [00:41:00] nurturing?

And I love the word hga, like the warmth and coziness of life, right? And so what is HGA for you? Is it like a warm snugly blanket? you know, Snugly slipper is, is it candles? Is it plants and greenery? Photos of friends and family around all these good things cuz you’re gonna be spending a lot of time in that space.

You wanna set that up. 

 We wanna set up the coziness, the goodness all the ooey gooey warmth and not this like fear of oh my God, baby’s gonna be screaming all the time and it’s gonna be terrible. My nipples are gonna be bleeding and I’m gonna be leaking everywhere and all these terrible things are gonna happen, right?

But like you, it’s. It’s challenging there, things are gonna be coming up, but you, if you can prep yourself to be in a space where things are really feeling good, then a lot of that stuff melts away and you’re able to manage it a lot easier than than if everything is chaotic.

You, you don’t really have that space to, come back to you and heal. Beautiful. And you also used the word rien. Was that the word what? I’ve never heard of that word. So can you explain what that is? 

Michelle Wall: Yeah, so 

Michelle Haggardy: it’s actually [00:42:00] matress and you can, yeah.

 And it rhymes with adolescence, so that helps ent, adolescence, ent, adolescents, . And it’s really the, it’s very similar to adolescents. So in adolescence what happens, we go through this huge transition of physical changes, mental changes, emotional changes, relational changes. All these things happen to our bodies as we go through adolescence and adolescence is really fairly well studied and there’s even specialties in it.

And there’s a lot of research around what happens with the brain and the shifts and the brain chemistry and all of these things. And tressen is equally, if not more of a transition period for for birthing folks. And Tressen is actually comes from. Dana Raphael in the 1970s, she’s actually the same person that coined the term doula, which is fascinating.

 And then it was rebirthed by Dr. Early Ethan just wanna say maybe 15 years ago. And it means the birth of a mother. So it’s just that this transition of what happens with really from the time that you could even consider having a baby to going through the process of maybe [00:43:00] fertility to miscarriages, to abortion, to

being pregnant, having the baby, and then postpartum. And you keep going through this process every time you’re postpartum and you’re going through all these changes. And we’ve seen that with, there’s research around neurochemistry and brain changes. And obviously we know about the physical changes and the mental health and emotional and relational with family and friends and community and how you even present into the world and what that looks like even with work.

And and are you continue working or maybe you’re gonna transition to staying home or not. Or now you’re gonna be working parents. And so what does that look like? So there’s all these changes that happen and it’s not well studied, not well known about, and yet it’s this huge transition.

 We have got through men Cs, we go through trein and we go through menopause, right? So these three msms are these big, huge transitions in in women’s lives. it’s something that we need to know more about really identify and really appreciate, I think.

Cynthia: What a concept to give yourself more grace through that period, to have grace with yourself to know that this is a huge transition.

And [00:44:00] so I’m hearing just a lot of ways to prepare this space, ways to prepare mentally, ways to prepare your community. Dr. Wall, I’m wondering if you can share a little bit more about preparing the pelvic floor and like preparing your musculature for pregnancy and birth and postpartum. 

Michelle Wall: Yeah, so during most of pregnancy we wanna try to maintain as much core and pelvic stability as we can.

 Aches are something that are okay and pains are something that we wanna watch out for. And so if you’re having pain, that’s something that you wanna get addressed. So usually there’s something that’s going on that can be addressed whether that’s physically or some other way.

But something is, your body’s telling you something through pain. That’s our signal. That’s something’s not right. And yeah, just preparing that way. Trying to stay strong, but then when we’re getting closer to the end of pregnancy, we actually want to prepare that pelvic floor for opening, releasing, lengthening, that kind of thing.

So we’re actually [00:45:00] doing the opposite when we’re actually preparing for labor and delivery. And with that we’re working on breathing patterns, pushing strategies and then just getting in the, into that mental space of releasing and letting go which is what needs to happen.

During delivery for that baby to actually come out. A lot of times we’re holding tension, we’re holding energy, holding just stuff in our brains. And so we work a lot on what that feels like for them to Mentally and emotionally and physically let go 

and so we’re working on practice pushing and vocalization sounds, that kind of thing to try to work on that. As well as give ’em homework for specific stretches and exercises to do to open up that pelvic area. Cause it’s not just the pelvic floor, the baby has to go through the entire pelvis.

And so we talk about ways to open each area of the pelvis. And then as I mentioned earlier, then during that early postpartum phase, we’re just reconnecting with our bodies, with our core and pelvic floor. And so a lot of [00:46:00] times that just starts with breath work. And so just feeling what does your core feel like?

What does your public floor feel like? And I’m not a big. Key goal therapist. And so we don’t do, we don’t do any or many besides just a quick check to see can you do it ? But mostly we’re working on other exercises where we’re going to get co reactivation of that pelvic floor, getting that reestablished.

And then of course if someone’s having any kind of symptoms of leaking their pelvic floor’s, not doing what it should do then we’re looking a little bit further of why is that happening? That kind of thing. But then just after that first kind of initial period of time, then again getting back into more of that strengthening mode and working on core and pelvic floor stability again, so that you can get back to more higher level type of.

Cynthia: I wonder if there are other modalities that you two work with that maybe potential patients might be interested in knowing 

Michelle Wall: about. So I have started doing some [00:47:00] visceral work, which means working on thes of the abdomen through the skin. And so it’s my hands on top of the skin of the abdomen and we’re looking at fascial restrictions and just tense.

Areas. And so the training that I have is in the urinary system and so we’re looking at the bladder, the uterus, the kidneys and some of the other connections that are there in the core. And so with birth a lot of things get smushed and moved around and our bodies really care about our internal organs and so they do what they can to protect them.

And so sometimes that’s tensing up in other areas. Or just not allowing as much mobility and sometimes in pregnancy that’s because we just don’t have a lot of that mobility left cuz the baby’s taking up so much space. And so we’re just looking at those fascial connections and taking our hands to try to [00:48:00] reestablish that brain to.

To organ relationship. And the body sometimes perceives that as a trauma. And so we’re just reestablishing this is okay, there’s no need to be tense here anymore. The trauma is gone now and we can move more freely now. Yeah. 

Cynthia: That’s wonderful. And how about you, 

Dr.

Hagger? 

Michelle Haggardy: 

So as a osteopathic physician, we are trained in osteopathic manipulation therapy and then also cranial sacral therapy. And so if as babies come out of the canal, they can be very tense and have tightening in various areas and tissues of their cranium, but also like their neck and jaw musculature and even all the way down the spine.

And so we work a lot with allowing to supporting the flexibility and extension and and releasing some of those those tight tissues. It’s very gentle. And it can help with lactation and then also help with tension and some of the restrictions and and if there’s uncomfortable latch and things like that, which can be [00:49:00] very very helpful. The other thing is that if people are having recurrent clogged ducts I have a therapeutic ultrasound that we can work with bringing down the inflammation.

And then also we can do manipulation techniques on the birthing parents as well, or lactating parent. Helping to of release some of the tension that’s happening in the shoulders and the neck and bringing some of the some lymphatic massage to try to help with bringing down the edema and things in the breast tissue.

That can al also be really helpful. So some of that, manual t. 

 

Cynthia: And there’s such a healing power in the laying of hands, you know? yes. Really safe, loving hands on the mother’s body. I know that’s something I incorporated a lot of when I was doing prenatal yoga classes and just making sure they’re getting that loving touch

so I’m glad that both of you are able to incorporate that into your practice. 

It’s so grounding to know that there are professionals like you two doing this work and that I can lean on you one day someday, , when I’m having my own experience. And I’m just so glad that we can [00:50:00] have this conversation so that other people out there know that this is an option, right?

You don’t have to go to the hospital and have this traditional style of prenatal, postpartum care. It’s something that you can really pick and choose and find a practitioner that feels right for you, a practitioner that serves you in a way that is right for your chapter,

to be able to come to your own home, to be at ease. Before we close out this conversation, I love hearing if. If you have one takeaway that you hope listeners walk away from this conversation with, what would that be?

Michelle Haggardy: I guess for me, I hope people know that they’re deserving they’re worthy of having somebody who really cares about them. People who are wanting to have the only, the best for them in this transitional period. People who wanna bring that village back I really want people to know that it doesn’t have to be scary and that they have people that professionals that can be on their side that [00:51:00] are really working to meet them where they’re at and And what, you know in the home, but then also like where they’re at physically and mentally and and you know what their story is and who really care and want to support them.

It doesn’t have to be scary. It doesn’t have to be lonely. And you don’t have to just survive postpartum. You can really thrive and we can do that. We can help you do that. 

Michelle Wall: In that same vein, I would say you are not alone. And there are so many people out there that can support you if you choose to call on those people.

Whether that’s professionally or in your community, friends, family. And sometimes when something’s happening to you, it feels like this is the first time that it’s ever happened to anybody ever. But that’s probably not true. and. So just know that you’re not alone, you’re not going through it alone.

And this is probably not the first time that this has happened. Especially having people who have experience working with lots of different pregnant and postpartum bodies and people . There, there’s a lot that happens, but it’s usually not shocking to us even if it feels [00:52:00] shocking to you and know that there are people out there that can support you.

And so I would just say to anyone who’s listening that might be pregnant or planning for postpartum to, to try to find those people sooner rather than later. It’s a lot easier to call on someone when you already have an established relationship than to be scrambling to try to find someone on the internet when you start having a problem.

And even if you’re established with a d. Medical group or OB or whatever it’s hard to contact them even when you feel like you have a problem. So you either go to the ER and see someone you’ve never met before or you’re trying to like MyChart them or calling the nurse line. And chances are you’re never even gonna talk to your doctor or really get a direct response back from them.

And so having someone in your corner that you can call on, even if it’s not related to their profession I get people who just cuz they know me, they figure I know somebody else that might be able to answer their questions. So even if it’s not public floor related they come to me and say, Hey, I know you’re really connected in the community.

Do you know a peral [00:53:00] therapist that I could go to? That kind of thing. And so we do have this kind of interconnected web of people and to just reach out and you’ll find a community. I will add in 

Michelle Haggardy: that vein both and I think Dr. Wall, you’re the same way that you, people can connect with us via, directly via our phone or email.

Oh, yep. Very different. On my website, medical system where you’ll get two weeks later or whatever, that somebody will finally call you back. You get us directly, which is really it’s awesome. I think it’s a very connected relationship. Yeah. 

Cynthia: Yeah. To have you in the village is such a gift.

So thank you both so much for your time and for all the work that you do. It’s so important and I know this conversation is gonna be valuable to a lot of people, so I appreciate your time and your energy today. 

Michelle Wall: Thank you for having us. 

Michelle Haggardy: Appreciate Yeah. Really appreciate being here. 

[00:54:00] 

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