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What Actually Happens During Hands-On Pelvic Floor Therapy

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Postpartum health has been a huge, buzzy topic lately, which is good. After all, pregnancy and birth take a lot of you, and mama needs to recoup. But there’s one area that’s been discussed but under-reported: what really happens during pelvic floor therapy sessions. I’m not talking about jade eggs or the usual kegel squeezes you do as you’re using the toilet. I’m talking about actual rehab with a pelvic floor therapist. Not sure what that’s all about? Don’t worry. I didn’t know either, but eventually got my own experience. So to help you understand what pelvic floor rehab really is about, TMI or not, here’s my story with pelvic floor therapy to get my downstairs back in shape after birth.

After my second child was born, I was diagnosed with a rectocele, a small divot in the wall of tissue between the rectum and the vagina that can cause discomfort when using tampons, difficult bowel movements, and not-quite-right sex. I tried to remember doing my Kegels, but after two years, my ladyparts still didn’t feel fully recovered.

So with the vague fog of babydom behind me, I returned to the midwife I was seeing before my children were born, and she suggested I see a pelvic floor specialist. Forehead smack. I knew that pelvic floor therapy was a proven method for postpartum recovery, but in the haze of caring for children I somehow didn’t see the forest for the trees — I was winning at caring for them, but utterly losing at taking care of myself.

In many parts of Europe, postpartum pelvic floor rehabilitation and therapy is compulsory — a built-in part of healthcare that women who have recently birthed babies have easy, often free, access to. Termed ‘re-education’, these therapy sessions help to reorient the pelvic floor and strengthen the muscles that worked to hold up, and then push out, a baby. Arguably, this is important, since your pelvic floor is integral in keeping your body stable, supporting your bladder, bowel and uterus. Paris-born yoga teacher and post-partum bodyworker Lara Kohn Thompson said it best: “I’d never seen an incontinence aisle before I moved to the United States — in France, they just don’t exist because everyone is much more aware of taking care of postpartum issues”.

As I entered the office of the therapist I ended up choosing, I realized that I had absolutely no idea what to expect. Was this an out-in-the-open, public kind of therapy where I’d lay fully clothed on a table and do Kegels while Bon Jovi played in the background and a geriatric woman used a foam roller nearby? I said a silent prayer for an alternative scenario, and upon being greeted by Gopi, my therapist, and ushered into a private room with a door that locked, I exhaled.

First, we went over my current physical state, both my pregnancies and deliveries, my fitness level (moderate), my diet (normal), and my alcohol consumption (yes, please, fill to the top). Then, with grace, care and utter practicality, Gopi explained that the first phase of her treatment would involve some internal work so she could assess the condition of my vaginal tissue and muscular ability.

She left the room, I undressed from the waist down; and we’d be ready to rumble, so to speak.

How strange it was to chit-chat about upcoming weekend plans with a total stranger who was gently probing your insides. But that’s what I found myself doing while Gopi informed me that she could feel the scar tissue from where the stitches healed, and that she could also feel the rectocele.

We then tested the strength of my pelvic floor muscles. “Squeeze my finger, like you’re trying to draw it up inside you”, she instructed. I squeezed. “You’re going to have to work harder than that”, she chided before giving me life-changing Kegel instruction. You know that ‘stop your pee mid-stream’ description for the Kegel exercise? Well… It’s not that easy -- your sphincter muscle is also integral to a productive pelvic floor squeeze. That’s right: you have to put your butt into it. What’s more, Gopi told me that I should do the Kegel exercises lying down first, because I wasn’t strong enough to do them correctly when standing up.

Gopi also assessed my hips, legs, lower abs and ribcage. While I thought about my pelvic floor as an area that was covered by my underwear, it actually encompassed a huge amount of my body, and doing abdominal work on my lower ribcage area turned out to shift things the most for me — it relieved tension in my shoulders, which made my lower body feel more comfortable.

I worked with Gopi once a week for about 6 weeks — the amount of time covered by my prescription from my midwife. During these sessions, I got to tune into my body, recognize sites of discomfort or weakness, and plot out a plan to strengthen said areas. By the second session, my body awareness was heightened, and by the fourth, my pelvic floor strength had improved to the point where we no longer needed to do internal work. By then, activating my pelvic floor while lifting or doing other kinds of activities became second nature.

Doing Kegel exercises correctly brought a whole new level of sensation back to my lady parts -- a huge plus, of course. But the real reward has been the ease and comfort I’ve been feeling in my entire body. I have less back pain, I feel stronger, and I can exercise with a much deeper body awareness than I’ve ever felt before. And can we assume that the newfound definition in my abs is proof enough that I’ve been working my muscles as a deep, effective level?

Gopi says the true aim of pelvic floor therapy is to get the body back to basic function. You shouldn’t assume that feeling discomfort, peeing when you sneeze, or feeling pain during sex, is ‘normal,’ she says. “Pain is not normal; it’s disfunction.” And if you’re experiencing pain, then pelvic floor therapy could possibly help -- whether you delivered your baby a month or ten years ago.

I’ve shared my story here in hopes that it helps even a handful of women recover more quickly and completely after their babies are born. We give up so many things in the name of motherhood, and most of them willingly. But our pelvic floor health doesn’t need to be one of them.

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While breastfeeding might seem like a simple task, there are so many pieces to the puzzle aside from your breasts and baby. From securing a good latch, boosting your milk supply and navigating pumping at work or feeding throughout the night, there's a lot that mama has to go through—and a number of products she needs.

No matter how long your nursing journey may be, it can be hard to figure out what items you really need to add to your cart. So we asked our team at Motherly to share items they simply couldn't live without while breastfeeding. You know, those ones that are a total game-changer.

Here are the best 13 products that they recommend—and you can get them all from Walmart.com:

1. Medela Nursing Sleep Bra

"This fuss-free nursing bra was perfect for all the times that I was too tired to fumble with a clasp. It's also so comfy that, I have to admit, I still keep it in rotation despite the fact that my nursing days are behind me (shh!)." —Mary S.

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2. Dr. Brown's Baby First Year Transition Bottles

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3. Multi-Use Nursing Cover

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4. Lansinoh TheraPearl Breast Therapy Pack

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5. Medela Quick Clean Breast Pump Wipes

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6. Earth Mama Organic Nipple Butter

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7. Medela Double Electric Pump

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8. Lansinoh Disposable Stay Dry Nursing Pads

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9. Haakaa Silicone Manual Breast Pump

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12. Lansinoh Breast Milk Storage Bags

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This article is sponsored by Walmart. Thank you for supporting the brands that support Motherly and mamas.

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Orange Is the New Black star Danielle Brooks is pregnant and frustrated. The actress took to Instagram this week to lament the lack of plus-sized options for pregnant people.

"It's so hard to find some clothes to wear today....Although I get to pregnant I still can't find no clothes. It's so hard to find some clothes when you're pregnant," she sings in a lighthearted yet serious video.

"It's so hard to find cute plus size maternity fashion while pregnant, but ima push through," she captioned the clip.

Brooks has been talking a lot this week about the issues people who wear plus size clothing face not just when trying to find clothes but in simply moving through a world that does not support them.

"I feel like the world has built these invisible bullets to bully us in telling us who we're supposed to be and what we're supposed to look like. And I've always had this desire to prove people wrong—to say that this body that I'm in is enough," she told SHAPE (she's on the new cover).

"Now that I'm about to be a mother, it means even more—to make sure that this human being I'm going to bring into the world knows that they are enough," she said.

Danielle Brooks is the body-positive hero we need right now. Now can someone make her some cute maternity clothes, please?

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In prior decades, body image issues usually didn't hit the scene until kids reached adolescence. But thanks to social media, and our culture's relentless pursuit of thinness, we now have to find creative ways to teach young children how to develop healthy body images.

Before I dive into some practical tips to help kids improve body image, I want to first diminish any shame that you might be feeling if you have body issues of your own. It's so important to remember that you downloaded every internal message from somewhere else. Of course, it's critical to work on your own issues, but it's also important to know it is not your fault that you developed them in the first place!

So, whether you are struggling with your own body image, or you love your body, here are some tools to help your child feel better about the precious body he or she lives in:

1. Break the spell

How do you know if your child has a bad body image? Perhaps they've begun making negative comments about their size or shape. Maybe they are comparing their body to others. Maybe they are avoiding foods or activities they once enjoyed because they feel uncomfortable about their body.

Often the most common response a parent has is to reassure their child that they are “fine," or “beautiful" or “perfect." And while there is certainly nothing wrong with some reassurance, it simply may not be enough to overpower the cultural messages kids are surrounded by. Reassure them that they are perfect just the way they are.

2. Unkind mind, kind mind and quiet mind

This little menu of options encourages kids to identify and differentiate between three different thinking states within themselves. I refer to them as “mind moods." Try teaching your child about these three states of mind and brainstorming examples of each. For example, unkind mind = “I hate my thighs." Kind mind = “I love singing." Quiet mind = Peacefully resting or playing.

This will raise their awareness of their thoughts and help them to choose their mind moods more consciously. As they learn to turn up the volume of their kind minds and spend more time in their quiet minds, they begin to feel more present and peaceful.

Once you have helped your child identify their unkind mind as a distinct voice, they can then try on some different responses and see which ones help bring them some relief. Try asking them to write or say all the messages their unkind mind is saying and practicing using strong, soft, silly or silent responses. Kids can learn that their unkind mind is not all of who they are, and that it doesn't have to run the show.

3. Get to the root

This concept helps kids discover what triggers their body dissatisfaction. You can help your child by asking questions or taking guesses about what might have started their bad body image. For example, I helped one 7-year old get to the root of her body obsession by noticing it started when there was a death in her family. Right around that time, her best friend started talking about dieting, so she latched onto food obsession as a distracting coping tool.

Once we uncovered this, she was able to learn about healthy grieving and truly healthy eating (as opposed to what the diet culture deems as healthy—which can actually be unhealthy).

4. Mind movies vs. really real

Try asking your child to show you some things around them that are real (i.e. things they can see, touch or hear). Then ask them if they can show you one single thought in their minds. You can playfully challenge them to take a thought out of their head and show it to you or fold it up and put it in their pocket. This tool teaches kids how to be more present.

Of course, they might use their imagination to do this, but with some finesse, you can teach your child to distinguish between the mind movies that cause them stress and the really real things around them. This is an immensely helpful tool that will not only help them with body image (since body image is one long mind movie) but will also improve the quality of their lives in general.

5. Dog talk and cat chat

Many kids cannot relate to the concept of being kind to themselves but ask a child how they feel about their favorite pet, and a doorway to their compassion, kindness and unconditional acceptance opens. For non-pet lovers, you can ask your child to imagine how they would speak to a baby or their best friend.

Dog talk and cat chat can help teach youngsters how to take the loving words and tones they use toward a beloved pet, and direct these sentiments toward themselves and their bodies.

6. Do an internal upgrade

In addition to helping your child combat the messages they receive out in the world, you can also work on the messages they get in your home. Again, if you struggle with body image, it is not your fault, but you can work on healing—and not only will you feel more peace, but your child will benefit as well.

To the best of your ability, refrain from talking about foods as “good" or “bad." Refrain from making negative comments about your (or anyone else's) weight or looks. Refrain from praising someone (or yourself) for weight loss.

Practice welcoming your child's tears and anger without trying to change their feelings before they are ready. Practice eating all food groups in moderation. Foster a positive, grateful attitude about your body.

May you and your child feel comfortable in your bodies, eat all foods in moderation, move and rest in ways that feel good, and find abundant sweetness and fulfillment in life.

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Learn + Play

After a long day of doing seemingly everything, when our partners get home it kind of becomes a habit to ask, "How was your day?" In between prepping dinner, handing off the kids, finishing your own work, we don't exactly get much value from this question. Sure, it may open up the opportunity to complain about that awful thing that happened or excitedly share that presentation you killed at work—but it usually stops there.

I could do a better job of really talking in my relationship. After 12 years and two kids, sometimes all we can come up with post bedtime routine is, "You good? I'm good. Fire up the Netflix."

Here are 21 questions to dig deeper into your marriage after a long day—see where they take you!

  1. Did you listen to anything interesting today?
  2. If you could do any part of today over again, what would it be?
  3. How much coffee did you drink today?
  4. Will you remember any specific part of today a year from now? Five years?
  5. Did you take any photos today? What did you photograph?
  6. What app did you open most today?
  7. How can I make your day easier in five minutes?
  8. If we were leaving for vacation tonight, where do you wish we would be heading?
  9. If you won $500 and had to spend it on yourself today, what would you buy?
  10. If your day was turned into a movie, who would you cast?
  11. What did you say today that you could have never expected to come out of your mouth?
  12. What did you do to take care of yourself today?
  13. When did you feel appreciated today?
  14. If you could guarantee one thing for tomorrow what would it be?
  15. If we traded places tomorrow what advice would you give me for the day?
  16. What made you laugh today?
  17. Imagine committing the next year to learning one thing in your spare time. What would it be?
  18. Did you give anyone side-eye today? Why?
  19. What do you wish you did more of today?
  20. What do you wish you did less of today?
  21. Are you even listening to me right now?

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Love + Village

Alexis Ohanian has made a lot of important decisions in his life. The decision to co-found Reddit is a pretty big one. So was marrying Serena Williams. But right up there with changing internet culture and making a commitment to his partner, the venture capitalist lists taking time off after his daughter's birth as a significant, life-changing choice.

"Before Olympia was born, I had never thought much about paternity leave and, to be honest, Reddit's company policy was not my idea. Our vice president of people and culture, Katelin Holloway, brought it up to me in a meeting and it sounded O.K., so why not?" Ohanian writes in an op-ed for New York Times Parenting.

He continues: "Then came Olympia, after near-fatal complications forced my wife, Serena, to undergo an emergency C-section. Serena spent days in recovery fighting for her life against pulmonary embolisms. When we came home with our baby girl, Serena had a hole in her abdomen that needed bandage changes daily. She was on medication. She couldn't walk."

The experience changed the way Ohanian viewed paternity leave. It was no longer something that just sounded like a good thing, it was a necessary thing for his family. It was crucial that he take it and now he is advocating for more fathers to be able to. In his piece for the NYT Ohanian points out something that Motherly has previously reported on: It is hard for fathers to take paternity leave even when their government or employer offers it.

A report from Dove Men+Care and Promundo (a global organization dedicated to gender equality) found 85% of dads surveyed in the United States, the UK, Argentina, Brazil, Canada, Japan and the Netherlands would do anything to be very involved in the early weeks and months after their child's birth or adoption, but less than 50% of fathers take as much time as they are entitled to.

Dads need paid leave, but even when they have it social pressures and unrealistic cultural expectations keep them from taking it and they choose not to take all the time they can. Ohanian wants lawmakers and business leaders to make sure that dads can take leave and he wants to help fathers choose to actually take it.

"I was able to take 16 weeks of paid leave from Reddit, and it was one of the most important decisions I've made," Ohanian previously wrote in an essay for Glamour.

Ohanian recognizes that he is privileged in a way most parents aren't.

"It helped that I was a founder and didn't have to worry about what people might say about my 'commitment' to the company, but it was incredible to be able to spend quality time with Olympia. And it was perhaps even more meaningful to be there for my wife and to adjust to this new life we created together—especially after all the complications she had during and after the birth," he wrote for Glamour.

In his NYT piece, Ohanian goes further: "I get that not every father has the flexibility to take leave without the fear that doing so could negatively impact his career. But my message to these guys is simple: Taking leave pays off, and it's continued to pay dividends for me two years later. It should be no surprise that I also encourage all of our employees to take their full leave at Initialized Capital, where I am managing partner; we recently had three dads on paid paternity leave at the same time."

The GOAT's husband is making the same points that we at Motherly make all the time. Research supports paid leave for all parents. It benefits the baby and the parents and that benefits society.

By first taking his leave and then speaking out about the ways in which it benefited his family, Ohanian is using his privileged position to de-stigmatize fathers taking leave, and advocate for more robust parental leave policies for all parents, and his influence doesn't end there. He's trying to show the world that parents shouldn't have to cut off the parent part of themselves in order to be successful in their careers.

He says that when his parental leave finished he transitioned from being a full-time dad to a "business dad."

"I'm fortunate to be my own boss, which comes with the freedoms of doing things like bringing my daughter into the office, or working remotely from virtually anywhere Serena competes. My partners at Initialized are used to seeing Olympia jump on camera—along with her doll Qai Qai—or hearing her babbling on a call. I tell them with pride, 'Olympia's at work today!' And I'll post some photos on Instagram or Twitter so my followers can see it too," Ohanian explains.

"The more we normalize this, on social media and in real life, the better, because I know this kind of dynamic makes a lot of men uncomfortable (and selfishly I want Olympia to hear me talking about start-ups!)," he says.

This is the future of family-friendly work culture. Take it from a guy who created an entire internet culture.

[A version of this post was originally published February 19, 2019. It has been updated.]

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