25 - Pelvic Floor Truths Every Pregnant Person Should Know (But Probably Wasn’t Told)(Guest: Dr. Mandi Murtaugh)

In this empowering episode of Doula Talk, Deb sits down with pelvic floor physical therapist Dr. Mandi Murtaugh to unravel the mystery of the pelvic floor — what it is, what it does, and why it’s essential to understand before, during, and after pregnancy.

Dr. Mandi shares her own journey into pelvic health, dispels common myths (spoiler: kegels aren’t always the answer!), and dives into the emotional and energetic layers of postpartum healing. From why you might be leaking urine even with a “strong” pelvic floor, to how birth trauma lives in the body — this conversation is equal parts science and soul.

For birth professionals, it’s a crash course in how to better support your clients. For expecting and postpartum parents, it’s a wake-up call to advocate for your body, your healing, and your peace.

In this episode:

• Pelvic floor 101 (anatomy, function, and what you were never taught in health class)
• How pregnancy and birth impact your pelvic floor — even if you had a C-section
• Why relaxing can be just as important as strengthening
• What pelvic floor therapy can do for trauma, painful sex, and postpartum healing
• The powerful energetic connection between the pelvic bowl, voice, and birth portal

🔔 Content Note: This episode includes discussion of internal vaginal work, birth trauma, and gendered language related to pregnancy and anatomy. We recognize that not all people who give birth identify as women, and while this conversation includes traditional terms, we hold space for all birthing identities and experiences.

Dr. Mandi Murtaugh - Contact information:
Website: https://www.drmandimurtaugh.com
Instagram: https://www.instagram.com/drmandimurtaugh
Facebook: https://www.facebook.com/drmandimurtaugh
Email: info@drmandimurtaugh.com
Schedule an appointment with Dr. Mandi: https://drmandimurtaugh.janeapp.com/
Thresholds Collective: https://www.thresholdscollective.com

Chapters

• 0:00 Welcome to Doula Talk!
• 0:54 Content Warning! Internal vaginal pelvic floor work, birth rauma and gendered language
• 2:18 Understanding the Pelvic Floor: Basics and Importance
• 4:21 Cultural Perspectives on Pelvic Health
• 7:09 The Role of Trauma in Pelvic Health
• 9:49 Anatomy of the Pelvic Floor: A Deeper Dive
• 12:38 Postpartum Recovery and Healing
• 15:30 Kegels and Beyond: Comprehensive Pelvic Health
• 19:33 The Functions of the Pelvic Floor
• 24:48 Kegels: The Myths and Realities
• 29:47 The Energetic Connection in Birth
• 34:08 Integrating Birth Experiences and Healing
• 35:25 Understanding Pelvic Floor Health During Pregnancy
• 37:25 The Myths of Pelvic Floor Weakness
• 39:55 The Connection Between Pelvic Floor and Bladder Health
• 40:55 Pain and Tension in the Pelvic Floor
• 42:34 Preparing for Birth: Perineal Massage and Relaxation Techniques
• 45:27 The Role of Relaxation in Birth
• 50:10 C-Sections and Pelvic Floor Health
• 53:46 Understanding Postpartum Changes
• 56:48 Physical Discomforts and Emotional Connections
• 1:00:25 Recognizing Pelvic Floor Issues
• 1:07:14 Taking Steps Towards Healing
• 1:12:22 Resources and Support for Postpartum Care
• 1:13:02 Final Wrap

Transcript

Deb (00:40)

Welcome back. This is Deb and today we have Dr.Mandi Murtaugh pelvic floor therapist. Why don't we just start with a little introduction of yourself and what you do, and what led you to specialize in the pelvic floor therapy.

Dr. Mandi Murtaugh (she/her) (00:56)

Yeah, thank you, Deb I'm really excited to be here. This is one of my favorite topics to talk about, so we will have a full time here. So I'm Dr. Mandi Murtaugh I'm a public floor physical therapist in Tacoma, Washington. my journey in brief is I fell in love with the human body in anatomy in college. And I was like, I want to do a job that gets to talk about the human body every day. And I taught anatomy one summer.

Deb (01:01)

Yay!

Yeah.

Dr. Mandi Murtaugh (she/her) (01:21)

and I had a couple non-traditional students in my class, so they were moms who were going back to get their nursing degrees. And I remember I had a pelvis, I can go into more detail with this, but I had an anatomy pelvis that was cut in half so you could see the uterus, you could see the bladder, and these women were like, wait, that's where my baby grew? And that's my vagina, and that's where I pee? And I was, you I'm 21, and I'm like, well, they don't like, yeah, they don't teach you this? Like, how did you not know this?

Deb (01:30)

Yeah.

Happy June. Yeah.

How did

you not know that? And how did you have a whole pregnancy with not knowing this? But it's possible.

Dr. Mandi Murtaugh (she/her) (01:51)

And yes, yes, I

just assumed that they would learn it at some point, that this kid is not teaching them about it. And they just were both like, huh. I have this memory, I don't know if this actually happened, but everybody else moved on, but these two were like, what? Yeah, so, and it was shortly after that that I learned that pelvic floor PT was a whole thing, and I was sold.

Deb (02:08)

I still want to process this.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (02:17)

I remember everybody was

Deb (02:17)

Yeah.

Dr. Mandi Murtaugh (she/her) (02:18)

like, you need to generalize when you graduate. And I was like, nope. So I, my first job was building a pelvic floor program. I did my mentorship right away. And this has just been my path the whole time. And I love it. Yeah. Yeah.

Deb (02:29)

Yeah, that's wonderful. And you've built a wonderful

practice as well. why don't we just start with the basics of anybody who is coming here and they feel like those moms that you just talked about, what the heck is a pelvic floor? do I have one? does everybody have one? Right? and why is that so important to know when you're growing your baby and having your baby?

Dr. Mandi Murtaugh (she/her) (02:44)

Yeah! one.

Yes, yes. Yeah, so yes, you have a pelvic floor. I wanna bounce back So when I first started, my first job was at a hospital-based clinic back in 2009, and all of my patients were getting referred by surgeons and their doctors because they had prolapse or because they were peeing their pants or because they were having bowel issues.

Deb (03:08)

Okay.

Dr. Mandi Murtaugh (she/her) (03:09)

99 % of the time I'd say, when did your symptoms start? these are postmenopausal people. And I say, when did your symptoms start? And they said, mm, it was back when I had my babies.

And they would always say, why didn't anybody tell me there was something I could do? And I wish somebody would have told me sooner. And so I kind of made it my personal mission of like, well, I'm going to go be that person and I'm going to go see your daughters and your kids. And I'm going to go treat people who are pregnant postpartum. And so even culturally, you can see this, like so many people find me on Tik Tok or Instagram because so many of us were like, well, wait, let's bring this to younger people.

Deb (03:30)

Yeah.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (03:46)

So now it's more of a conversation. I just recently had somebody who was like, well, can you talk to older people? Like, why should people come see you when they're outside of the baby making years? Which was a good, like, reflection. We like, we swung the pendulum. So everything I'm talking about today, like, obviously, like, we're gonna talk birth, but if you've had a baby, you are postpartum. You are forever postpartum.

Deb (03:46)

Mm-hmm.

You're like, interesting. You're like, wow. OK.

Right, right, yeah.

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (04:15)

And

if you live in a body with a vulva, if you live in a birthing body, then you have the hormonal fluxes, right? We know postpartum, our body is very similar to postmenopause. And so even if you're getting out of pregnancy and postpartum without symptoms, those symptoms can creep up later in life too, which is again, part of why I wanna see people younger so that they have more knowledge, so they know more about how to care for their body so that they aren't coming back in.

Deb (04:21)

Mm-hmm.

Mm-hmm.

you

Great.

Dr. Mandi Murtaugh (she/her) (04:44)

when they're 55, 60, 65. So, this is for everybody.

Deb (04:46)

Mm-hmm. That makes so much sense.

Yeah, and I think there's so much empowerment and just in knowing what is happening in your body and that this is dysfunction, right? And this is not normal and that peeing your pants is not funny and something to joke about, you know? Like it's maybe embarrassing, but like that is something we can help you with. You can get help with. Yeah.

Dr. Mandi Murtaugh (she/her) (04:57)

Mm-hmm. Yes. Yeah. Yeah.

Yes, yeah. I

mean, even I look at, know, I'm a fan of Depends. I'm a fan of like Pantyliners, like Pad Up and Play On is one of my MOs, but it's not an answer. You know, Poison Depends and Con... It's a bandaid, yeah. So it's not something you have to rely on. It's something that could be helpful, but yeah, there's something you can do about it. You should be able to jump on a trampoline after having four babies. Is your body different? Yeah. Do we have to just live with it? No.

Deb (05:12)

Sure, absolutely. Yeah. Right. It's a band-aid, right? Yeah.

Mm-hmm. Mm-hmm.

Absolutely. Sure.

Right.

Dr. Mandi Murtaugh (she/her) (05:36)

So

yeah, I think you're right. think that there's just so much that is missed or so much that is laughed about, but empowerment is in knowing about our bodies. When we are born into a female body, everything is internal, we aren't taught about it. We're taught to not think about it, not touch it. And so that kind of stays ingrained in us into adulthood, into starting to have a sexual relationship, into having babies.

Deb (05:52)

Mm-hmm.

Okay.

Dr. Mandi Murtaugh (she/her) (06:01)

And so quite often, the people that I see, the people find me after they had a traumatic first birth and now they're pregnant again. Like that's oftentimes when people are coming to me and saying like, I wanna do this one better. I wanna have more knowledge. So.

Deb (06:01)

Mm-hmm.

Hmm. Yep.

Yeah. Yeah. Yeah. And how do I

support and body through that process, right? So that it can be. Mm Mm hmm. Or and then the damage that's already done, right? Of like helping with rehabbing that and then preventing it and then also recovering and rehab after that other experience. Yeah.

Dr. Mandi Murtaugh (she/her) (06:21)

Yes, how do I prevent that from happening again within my power? Yeah.

Yep,

yep, exactly. Because there's, and I know we can get into this later too, like there's the physical healing, yes, and there's the getting stronger and recovering, but there's also this emotional, this integration, especially if there's trauma. Trauma at any point in life, that there's this integration of the trauma that we can do through pelvic floor PT and through working with the pelvic floor.

Deb (06:47)

yeah, huge. Yep.

Yep. Mm-hmm.

Yeah. Because all of that, all of that trauma lives in your body somewhere. And there's that connection, right? And we could go deep on that, but for now, we will not. Right, yes. We'll have to do, that's a whole nother episode. Yeah, absolutely. Yeah, for sure. Okay. Go ahead. Do you have any more? Yes, please.

Dr. Mandi Murtaugh (she/her) (07:04)

It does, yeah.

Let's play the groundwork.

It could be. Absolutely. Absolutely. Yeah.

Okay, let's start with the basics.

Yep, so back to your original question 10 minutes ago. Here's a pelvic floor. So here's the whole pelvic bowl, I should say. And I like to call it a bowl, because it really is, it makes it more three-dimensional. know, like a floor is a flat, hard thing, and that is not what your pelvic floor is. It's a really dynamic space, and it really is the muscular bottom of a bowl. So, here's your last vertebrae. And if you're standing with your hands on your hips, then you're right here.

Deb (07:23)

Yeah, great. Great.

Yeah.

Mm.

great.

Okay.

Dr. Mandi Murtaugh (she/her) (07:49)

Okay.

If you have a uterus, it sits right here on top of your bladder, right behind your pubic bone. It's so wild, isn't it? Yeah, yeah. If you had any pubic, little side note here, if you had any pubic synthesis pain in pregnancy, or if you've heard of this, that's where it is. I know. Go see a PT. Go see us. We can help with that. It's awful, it's awful. So.

Deb (07:53)

That's so wild to see in 3D.

girl. That was bad. Nice. It's like, yeah, just

remembering sneezing during pregnancy. That was really intense. Yeah. Yeah.

Dr. Mandi Murtaugh (she/her) (08:19)

Yeah,

there's, yeah, there's so much.

it's this dynamic bottom, right? That it's not a hard piece, right? Your bone is really firm, right? But the muscles are really dynamic. So when you cough or sneeze, it's a really strong abdominal contraction, right? Your belly is squeezing to push things out. So your pelvic floor, that pressure's all coming down. So, you know, at best, it's supposed to go boing, or else like stabilize against it.

Deb (08:31)

and

Yeah. Mm-hmm.

Mm-hmm.

Yeah.

Dr. Mandi Murtaugh (she/her) (08:48)

But

if it's not acting, then yeah, you can put a bunch of pressure on the pubic bone there. Yep, yep, and it kind of pushes it apart, yep. Not as far as you just went, just for anybody who's cringing at that. But it does, it pushes it apart a little bit, or that's why we leak, because the pelvic floor's not holding tight enough to keep the bladder from leaking. So it needs to have some give, but it also needs to have some strength.

Deb (08:51)

Yeah. Yeah. Yeah.

Yeah, obviously. Thank goodness.

Mm-hmm.

Mm. Mm-hmm.

Dr. Mandi Murtaugh (she/her) (09:15)

Okay, getting ahead of ourselves still. So uterus sits on top of the bladder and then sits in front of the rectum back here. The uterus also suspends the bladder.

Deb (09:25)

Mm, okay.

Dr. Mandi Murtaugh (she/her) (09:26)

So there's ligaments that go from the sacrum to the uterus. The uterus sacral ligament is the primary one. And then there's ligaments that attach the bladder to the uterus. And the highest level of support of the pelvic floor is actually at the level of the cervix.

Deb (09:31)

Mm-hmm.

Mm-hmm.

Interesting. Okay.

Dr. Mandi Murtaugh (she/her) (09:46)

Right, so we always talk about like, the baby's squishing the bladder, or the baby's sitting on top of the bladder, but also it's suspending. And this is something I really want every pregnant person to understand because this impacts our postpartum recovery. So for those of you, I will try to verbally, for those of you who are watching on video, so if your bladder is being suspended by your uterus, then as the uterus grows, it's very slowly growing, growing, growing, right, over nine months.

Deb (09:49)

Yeah. Yeah.

I

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (10:14)

And those ligaments are very slowly stretching, stretching, stretching. Anybody who's had one ligament pain, anybody who's had that ligament pain, that's a whole thing too. So they're all stretching really slowly. And the uterus is a muscle, right? So the uterus is what pushes the baby out. In a vaginal birth, the uterus contracts and it pushes the baby out.

Deb (10:21)

Yes? Right.

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (10:36)

And then as soon as the baby's out, pushes the placenta out and then it keeps contracting down over the next couple weeks to its new normal size. So if think of all those ligaments that stretched with it, those are not muscle. So now they're kind of like flack and stretchy things that are no longer suspending, no longer holding up the bladder.

Deb (10:49)

Yeah. Yeah.

Yeah.

Mmm. Kind of like a worn out rubber band. Okay. Okay. Right.

Dr. Mandi Murtaugh (she/her) (11:00)

So, yeah, yeah, exactly. Because it stretched really slowly, right?

And so it's gonna, just like a stretched out rubber band, if you stop stretching it, it's gonna slowly tighten back up again. Probably not to its original length, or original tension rather. But over time it's going to. So anybody who had a baby, vaginal or cesarean, who felt like everything was falling out was postpartum If I had a group full of people, everybody would be raising their hands.

Deb (11:13)

Yeah. Right.

Mm.

Yeah, same. I mean, I'll

raise my hand. It's fine. Yeah, for sure. Yeah.

Dr. Mandi Murtaugh (she/her) (11:30)

Yeah, that's why. Because

suddenly the pelvic floor is no longer supporting the way that it is used to because it's stretched or tore and those ligaments are no longer holding. And again, even in a Cesarean birth where the pelvic floor is spared, which we can get into myths about that in a bit too, even then it can still feel really heavy because the uterus that was supporting the bladder, those ligaments rather,

Deb (11:46)

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (11:57)

are no longer supporting it until they tighten back down.

Deb (11:57)

Yeah.

interesting.

Dr. Mandi Murtaugh (she/her) (12:01)

This is also why we tell people, you know, give it at least 12 weeks before you go back to like a HIIT class or jumping or running. Because we want to give these ligaments the optimal, you only have those first few weeks and months to heal. To heal this way, I should say. So if you are at six weeks going and jumping and running, you might be inhibiting those ligaments from getting to go back to their full or their shortest length.

Deb (12:08)

Mmm.

Mm-hmm.

Okay, that makes sense. I've never heard it explained that way. That is so helpful to understand like what's going on inside your body and why you might be feeling that way. so 12 weeks for that to essentially get to that. And then you can be doing like more strenuous exercise. Okay. Sure.

Dr. Mandi Murtaugh (she/her) (12:30)

So that's always my like.

Yup.

Mm-hmm.

Mm-hmm.

Yep, yep, and you can do strength training before that. You can do other exercise for sure, but it's that high impact

repetitive stuff that you just wanna, yeah, and that can impact it for life. It's just kind of a like, postpartum, as long as it feels, the longest, shortest time, Like it feels like it lasts an eternity, but it's really a blip in the radar. So if you're an active person, if you are an exerciser, if you are just one of those people,

Deb (12:57)

that impact your public floor and is like, yeah, okay. Yeah.

Right.

Hmm.

Dr. Mandi Murtaugh (she/her) (13:17)

who is like an exercise junkie, give it that healing time, even though it's gonna be hard, because you're gonna be setting yourself up for lifetime success for moving your body, especially if you're an athlete. Yep.

Deb (13:20)

Yeah.

Especially if you're an athlete, right? And that's like an important thing.

That makes so much sense. I'm just thinking about people saying, you know, pace your activity and build up. And that's like the end of the explanation. And how do you interpret that, right? And by having that timeframe, that actually just frames it so good to understand it's like,

Dr. Mandi Murtaugh (she/her) (13:45)

Mm-hmm.

Deb (13:51)

ligaments that take a long time to really just come back. Okay, well, you're already blowing my mind. This is awesome. So great. Yeah.

Dr. Mandi Murtaugh (she/her) (13:55)

Mm-hmm. Yep.

That's what I'm here for. Well, and

that takes some of the pressure off the pelvic floor too, right? Like in general, seems like everybody's told to do your kegels, right? For decades, it's been like, if you're pregnant, do your kegels. Postpartum, do your kegels, period. That's the end of what we get, right? And so this is that place of like pelvic floor is the base, the kegels are the base, but there's so much more going on up here.

Deb (14:06)

Right.

Mm-hmm. yeah.

Mm-hmm.

Mmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (14:25)

that's

contributing. There's so much more in the pelvis and above the level of the pelvic floor that's also contributing, which is why kegels aren't necessarily for everyone and why they aren't the answer to everything.

Deb (14:36)

Yeah. And let's back up a little. What is a kaggle? Yeah. Yeah, for sure.

Dr. Mandi Murtaugh (she/her) (14:39)

Yeah, yeah, well, okay, let's back up even further and keep going through

the muscles of the pelvic floor. the pelvic floor lines the base of the pelvis. And so I'm gonna flip this up so anybody on video is gonna see. If you are listening along, you can actually feel along. So if you feel your pubic bone in the front, and then you can feel your sit bones, just the bony bits underneath your butt, your pelvic floor slings between them.

Deb (15:00)

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (15:01)

So at the front, you've got your clitoris. Very cool organ, it's only purpose is pleasure. You could also do a whole other podcast on that, but we don't today. The urethra, where you pee out of the vagina, and then the anus is in the back. So all the rest covering that area, holding everything up, is muscle. And your pelvic floor muscles are just like any other muscle in your body, that you can tighten them, you can relax them, you can stretch them.

Deb (15:08)

Yeah, great.

Mm.

Dr. Mandi Murtaugh (she/her) (15:28)

They can also get too tight. They can actually have trigger points in them, just like you might get in your shoulders or somewhere else. That's always a little bit of a mind blowing fact. And so we can train it just like anything else. The function, there's four main functions of it. So first is sexual function. The most superficial layer helps to stimulate the clitoris, helps to bring blood flow in during arousal, and it contributes to orgasm. Very important, very important.

Deb (15:32)

Mm-hmm.

Yeah.

Good to know, right? It's

really good to know.

Dr. Mandi Murtaugh (she/her) (15:53)

Uh-huh, uh-huh, it's

excellent to know. Yeah, brief asterisks about orgasm too, especially for any of you who are postpartum. Orgasm is such a multifunctional thing, that it's such a, it's a mind thing, it's an emotional thing, it's a connection thing with another person oftentimes. And so a lot of people will say, well if I just do kegels will I have a better orgasm? Could it contribute to it? Sure. Is addressing the pelvic floor helpful for pleasure and arousal? 100%.

Deb (16:03)

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (16:18)

Is it gonna be the only answer? Not necessarily. So if that was a magic bullet. Okay so you got the sexual layer. The next layer is a sphincter layer. So sphincters are round muscles. You can think of like if you make your mouth into an O, there's a sphincter muscle around your mouth, there's a sphincter around your urethra, there's a sphincter around your anus. So are you peeing your pants right now?

Deb (16:20)

No. Or maybe other things. Right. Or wouldn't that be nice? Yeah.

Mm-hmm.

No, not currently.

Dr. Mandi Murtaugh (she/her) (16:49)

Great.

But you're not thinking about it, right? You're not thinking about not peeing. So one of those layers is smooth muscle, just like your digestive system, like your heart. Like we aren't, my God, can you imagine if we had to beat our own heart? Right? So this muscle is working in the background. If your pants are on, then that sphincter is holding you tight. Now, if you're gonna sneeze, you might volitionally squeeze in, or maybe even cross your legs.

Deb (16:51)

Right.

Mm.

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (17:16)

to prepare

for that sneeze, right? Or if you're an elevator and you have to pass gas, you might be like, I'm gonna go and hold this one in. This is not the best place, right? So we have control over one layer, but we don't have to control the other layer, which is really cool. When it comes to, so stress incontinence is probably the most common complaint I see postpartum, which is when I cough, when I sneeze, when I jump, when I stand up, I leak.

Deb (17:22)

Yeah. You're like, this is not the best place, right? Right.

nice okay yeah

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (17:43)

And oftentimes it's either a timing issue that your pelvic floor is supposed to automatically kick in before you sneeze, kick in before you cough, kick in before you pick up your kid. And pregnancy and birth just kind of knock it off track a little bit. And so training that back in by volitionally doing it, by saying, I'm about to sneeze, I'm gonna squeeze. Squeeze before you sneeze. Make a little sticker.

Deb (17:43)

Mm-hmm.

Okay.

So bringing it back to consciousness a little bit.

Dr. Mandi Murtaugh (she/her) (18:11)

Bringing it back to consciousness, if you consciously practice that, it helps to kick in the reprogramming, and then it's gonna become automatic again usually. So that's one take home. Anybody listening to this, if there's only one thing you get out of it, squeeze before you sneeze. Squeeze before you cough. Squeeze before you pick up your kid. Like that can oftentimes, I've had patients where I see them once, I teach them that, and they never have to come back. That's all they needed was to kick it back in.

Deb (18:13)

Mm-hmm.

Hmm.

Yep. nice. Yeah.

Nice.

Okay, good. And then it becomes automatic after a while.

Dr. Mandi Murtaugh (she/her) (18:41)

Yeah.

And then it becomes automatic after work. If you have another kid, you might need to practice it again. If you have a major change, yeah. Every time you have a baby, every time you become pregnant, your body changes. Once you have been pregnant, you will never again live in a body that hasn't been pregnant. Once you have birthed a child, you will never again live in a body that has not birthed a child. It is new, it is different.

Deb (18:45)

Okay, Practice again.

Mm-hmm.

Mm-hmm.

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (19:09)

There are

things that won't go back. There is space to grieve that. We need to create space to grieve that. We live in such a bounce back culture. Our Instagram and media is all gonna say, know, bounce back and bounce back and bounce back. And we need to, I think part of my little work in my corner is like trying to rebuild this culture around parenthood to say, don't live in that body anymore.

Deb (19:11)

Mm-hmm.

Yep.

Mm-hmm.

Yeah. Mm-hmm. Well, and making space for that beauty, right? Of like, you're a mother now, however you want to identify, you have a child and you made home for them in your body. And I think there's such beauty in that, in embracing that process, that when we just like, get your body back, hurry, get back to normal.

Dr. Mandi Murtaugh (she/her) (19:35)

I might not have a six pack anymore.

Mm-hmm.

Deb (19:58)

that's where we have problems with expecting for your body to just get right back. Yeah. Yeah. It's so damaging.

Dr. Mandi Murtaugh (she/her) (20:01)

Yeah.

Yep. Yep. Yeah.

It is. And I think it's such a, I don't know that I've ever, like even more than like grad school. Like I feel like motherhood and our culture around it is such a, from my experience, such a competitive place of where's my body? Where's my kid? Like how do I compare to the people I'm following on Instagram? And lots of sheds. Yeah.

Deb (20:20)

100%.

Should. Lots of shoulds.

Dr. Mandi Murtaugh (she/her) (20:32)

And I don't think.

Deb (20:32)

I should be able to not pee while I'm doing X, Y, and Z. I should be able to walk, you know, run a marathon by now. I saw somebody on Instagram at one month running a marathon. I should be able to do that too. I must be lazy. Yeah, and what does that tell the world about me? You know, it's a reflection about your identity and it's so damaging.

Dr. Mandi Murtaugh (she/her) (20:43)

I should be able to fit back into my pants.

Yeah. Yeah. Yeah.

Deb (20:58)

Yeah. Perfect. Okay. So do you have more to say about that? You're, you're still going. Okay. Perfect. Great.

Dr. Mandi Murtaugh (she/her) (21:03)

I do, we've only gotten through two of the S's. So

the layers of the pelvic floor, we got the sexual layer, we've got the sphincter layer, and then we've got the support layer. So the deeper layer, if we look into the bowl from the top, that's where we really think of the floor and the base of the bowl, that it's really supporting all those organs. So yes, your uterus is suspending from the top, but your pelvic bowl is supporting from the bottom. And then stability. So your pelvic floor plays a part in stabilizing.

Deb (21:18)

Okay.

Dr. Mandi Murtaugh (she/her) (21:31)

just like you can see that muscle crosses your pubic symphysis. Those muscles attach to your sacrum and your tailbone. And then they interconnect with your deep abdominal layers. So the deepest layer, kind of this corset layer of your abs, your pelvic floor contracts, or pelvic floor connects rather, they're like BFFs. So when we talk about coughing, sneezing, picking up your kids, stabilizing your core, your pelvic floor is part of that core.

Deb (21:34)

Mm-hmm. Mm-hmm.

Mm.

Okay.

Mm.

Okay.

Dr. Mandi Murtaugh (she/her) (22:03)

So, that's what your pelvic floor is. That's all the layers of it. And so when you ask about a kegel, a kegel is a pelvic floor contraction. So I'll give you a little list of cues for it, if everybody wants to practice here. So it's a pulling up and in of the pelvic floor. It's squeezing like you are gonna stop the flow of urine, or like you're gonna hold back gas. You can imagine squeezing it all together. Squeeze it.

Deb (22:11)

Okay.

Mm-hmm. Mm-hmm. Let's do it all together.

Do it all together, one, two,

Squeeze in. And then relax. Yeah. Perfect. Yep.

Dr. Mandi Murtaugh (she/her) (22:33)

And then release. Yep. You can think of squeezing something around your vagina.

you want to practice this, biofeedback is really helpful. So having some feedback, because they're weird muscles, right? I had a clinical instructor who said they're just another set of muscles with a funny little door.

Deb (22:44)

Mm-hmm.

Love it.

Dr. Mandi Murtaugh (she/her) (22:49)

So they're kind of like, I talk about it like there's like a tiny little trail to them, like this little path in the woods that you can't really see. But the more you travel that path in the woods, the easier it is to see the path and to travel down. So you can think about doing a kegel, you can pull it up and in. If you're by yourself, if you're home, if you're in the shower, you can put your hand just outside.

Deb (22:54)

Mmm. Mmm.

Mmm, that's a good description.

Dr. Mandi Murtaugh (she/her) (23:12)

The pelvic floor just out like over the perineum is what our external genitalia, the perineum or the vulva is the external genitalia. You could place a finger inside your vagina if you're comfortable with that. And you should feel a squeeze around your finger, maybe even a little bit of a lift.

Deb (23:22)

Mm-hmm.

Mmm, okay.

Dr. Mandi Murtaugh (she/her) (23:27)

Some other cues I've heard are to pretend like you're sitting on a blueberry and you're pulling it up and in. Or like you're gonna suck up some bubble tea through a straw. I think those are a little bit funny and weird, but some people it just clicks. Yeah, so pause your podcast, try that.

Deb (23:32)

Okay, there you go.

That's a good one. And it makes it a good visual, right? It's like, okay, I know what I'm supposed to be doing.

Yeah. Let's all have some bubble tea afterward.

I know what we're all thinking about now. Right?

Dr. Mandi Murtaugh (she/her) (23:48)

Could have like a bubble tea kegel club?

Yeah. Yeah. So that's a Kegel. And to my point earlier, it's not all about the Kegel. Right? So some of the...

Deb (23:53)

of it. Perfect.

Yeah, because guess what happens

when that baby needs to come out? If all you know is how to tighten, you're going to hold that baby in like I did with my first for five days. When you don't understand that you need to relax your bottom so your baby can pass through, right?

Dr. Mandi Murtaugh (she/her) (24:07)

Satan?

Did you?

Yeah, yeah,

yeah. I think this is one of the common myths is that I've seen people who are like, I need to have a strong pelvic floor so it can push my baby out. Your pelvic floor does not push the baby out. Like I said earlier, your uterus pushes the baby out. Your pelvic floor needs to get out of the way. Your pelvic floor needs to relax. Whenever I'm working with people, I always suggest like at 34, 36 weeks, we work on this downward energy.

Deb (24:30)

Mm-mm.

Yeah.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (24:44)

All right, so kegels

are pulling upward and they're kind of an upward energy. You're pulling energetically upward and physically upward. And once we hit 34, 36 weeks, we start to say, okay, let's start some of this downward energy. Let's just start to kind of invite some of that grounding downward energy. Not that we're gonna obviously encourage Libra that early, but just trying to turn it around. It's practicing.

Deb (24:51)

Mm-hmm.

Mm-hmm.

But it's like you said it's practicing right the muscles and understanding

when you're lifting up That's not the only way that muscles work. It's a relaxing as well the opposite So you mentioned the energetic connection there So I would love to just dive into all of that because I find all of that very fascinating in the birth world with as a birth doula we talk a lot about that and

Dr. Mandi Murtaugh (she/her) (25:10)

Yep. Yep. Exactly. Yeah. Yeah. Yeah.

Mm-hmm.

Deb (25:27)

you know, like the energy of like letting your baby come and birth is very physical. Obviously something physical is very happening, but it is also so such a mind blowing thing. And it's so important to do that training with your mind and like relaxing, learning to relax your body and your mind and your energy. So can we talk a little bit about that connection with the pelvic floor?

Dr. Mandi Murtaugh (she/her) (25:49)

Yeah, absolutely, absolutely. This is something I've come to learn in my, over the course of my professional career because of course in PT school we don't learn about energy. That's too, that's too woo, right?

Deb (25:58)

Right? Right. Right. We're gonna

get real woo woo here, guys, so buckle up. This is the best part.

Dr. Mandi Murtaugh (she/her) (26:03)

This is the good stuff, right? Because

the pelvic floor is a group of muscles, but like you said, it's holding life, right? It is literally the culmination of where the feminine and the masculine come together. And I say that as a true feminine and masculine, not even gendered, right? We all have this feminine, soft, flowy energy, and we all have this masculine, forward-moving, get-it-done energy in the most simplistic terms. And both are important.

Deb (26:11)

Mm-hmm.

Yeah, and both are important, right? Of like having that good balance and... Mm-hmm.

Dr. Mandi Murtaugh (she/her) (26:31)

Literally both are vital in terms like the sperm and the egg, right, to create a baby. And they meet in the uterus. So.

Deb (26:34)

Yep. Mm-hmm. Yeah. Which is so cool. If you just like take a second and think about the magic that happened, like how cool is that? Okay. I just love it so much.

Dr. Mandi Murtaugh (she/her) (26:45)

It's amazing. It's amazing.

It's not lost on me as we're talking about the sperm and the egg meeting. Today is, the day we're recording this is my fifth anniversary of my IVF retrieval. So my son was conceived on this day five years ago in a lab outside of my body. right? So not all of this happens inside the body.

Deb (26:58)

my gosh. happy conception day. That's so cool. Yeah. Which is, which is a good point,

right? Which is a good point is that life can be created in so many different ways. But one, the one true thing is that that baby is going to be their home. Their first home is going to be in that, in that space, which is magical.

Dr. Mandi Murtaugh (she/her) (27:20)

Yes.

Yeah, yeah.

We all come out of a womb. We have yet to be able to, we can create, right? We can do the conception outside the body, but you still need the womb to carry. So it is, it's just this magical, even in a non-pregnant uterus, like the fact that it's a self-cleaning organ, that every month it's like, nobody's here, nobody's home, I don't need this lining, let's let it go, right? Can you imagine if all of us were like,

Deb (27:32)

Yeah. Yeah.

Right? Yeah. That's Clean House. Yeah. Yeah.

Dr. Mandi Murtaugh (she/her) (27:49)

Instead of like dreading our period, if we're like, my body's doing that cool thing of letting go, what else can I clear out of my life right now?

Deb (27:51)

Yeah. Good job. Yeah. Yeah. Yeah.

And lean into that rest, right? About the cycle. Yeah.

Dr. Mandi Murtaugh (she/her) (28:00)

and lean into that rest. Yeah,

yeah. So yeah, so it's not just a physical process. It's not just a biologic process happening. It's also this energetic process of this little life being grown inside of you. And then yeah, birth is, it's this opening of the birth portal, whether it's this, you know, perfect, beautiful, everything went perfectly unicorn birth, which sometimes happens.

Deb (28:20)

Mm-hmm.

Yeah.

Dr. Mandi Murtaugh (she/her) (28:26)

and the baby comes out the vagina unobstructed, unicorn and yes,

Deb (28:27)

Dolphins are, you're in the water and seeing dolphins in the background and rainbows and leprechauns, right?

Dr. Mandi Murtaugh (she/her) (28:35)

yes, those do happen somewhere, sometimes. Or if you have, you know, a caesarean where that baby is taken out of you because it needs to be, because they need to be, which was my birth, then in either way, your, your, the home is,

Deb (28:37)

Sure, maybe.

Dr. Mandi Murtaugh (she/her) (28:56)

Let me go back, let me go back. I'm gonna put the cesarean to the side. But in a vaginal birth, that birth portal opens during contractions, during dilation, and then that baby passes through that portal. In a belly birth, we opened a different window to take the baby out. It's still a portal, it's still the whole process. There's still this energetic, yep.

Deb (28:59)

Yeah, there you go.

Mm-hmm. Mm-hmm. Mm-hmm.

there is a portal, right? There is, yep, something to follow through. Yep. Yep.

Dr. Mandi Murtaugh (she/her) (29:24)

Yep, and then quite often, right, if everything went well, we bring the baby up to the heart, right? We bring the baby up to the chest, and then there's this flow of energy that comes out of the womb, up to the parent's heart, to the birthing person's heart. And this is this energetic exchange, yeah. And so in an interrupted birth, right, in a birth where the baby doesn't get to come right to the chest, then that can be interrupted.

Deb (29:30)

Mm-hmm.

Mm-hmm.

Mm-hmm.

So, it's we, my mother's, I'm a.

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (29:54)

And quite often in our postpartum world, we just move on. Right? Baby's safe, mama's safe, parent's safe, we're good to go. Two days later, we're gonna check you out.

Deb (29:58)

Mm-hmm.

Which is one of my,

yeah, one of my biggest pet peeves. That's all that matters. That's all that matters. Healthy mom, healthy baby. Sometimes, that's like the bare minimum, guys. We want that, but that's, you know, it can be so much more.

Dr. Mandi Murtaugh (she/her) (30:10)

Yes. Yep.

It is, and it's beautiful, and it's great, like we want that.

It can be so much more. Yeah. Yeah.

Deb (30:22)

Yeah, with support.

With the proper support, I think.

Dr. Mandi Murtaugh (she/her) (30:25)

Yeah, yeah,

yeah. Yeah, and I want to acknowledge we're kind of going in. Births are so varied and there's so many different variables. And I think that's part of them. They're not controlled. We can do the best preparation as we want. I know so much about birth and I felt so prepared for birth. And my birth was wildly different than anything I'd ever heard of before.

Deb (30:33)

Right. That are not controlled. Yeah, like that you can't control. Yeah.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (30:50)

So we.

Deb (30:51)

So many things are out of your control, whether you have planned or not. And I was actually just at a prenatal and we were talking about the flow of oxytocin and like that can be interrupted. you know, what do I do if that happens? And I said, you know what, we're not going to worry about something that may happen. But the thing is, is that if that happens, we have so much time to repair that and to bond and to

Mimic that and and have all those wonderful moments with your baby that that can be a blip that maybe wasn't that ideal or what you imagined but there are so many other moments that will heal that and that will Replace that bond that maybe you felt like you missed out on and so I I'm glad that you stopped us there because we can wish for all the things and that goes perfectly and a lot of times birth does just happen and it's great and wonderful

Dr. Mandi Murtaugh (she/her) (31:29)

and

Deb (31:44)

But there are those times where, you know, baby needs a little help, mom needs a little help. You know, we have a cesarean birth because we just need the help there. And thank God that is available, you know? And then, once things have settled down and everybody's healthy and safe, we work on that, the bonding then. And that is completely fine. And the other thing with that, you know, we're kind of going down a different road here, but that bonding, that golden hour is...

Dr. Mandi Murtaugh (she/her) (31:52)

Yeah. Absolutely. Absolutely.

Mm-hmm.

Deb (32:12)

very precious and wonderful, but it's okay, we can have that later too. Yeah, yeah, it's not all.

Dr. Mandi Murtaugh (she/her) (32:17)

Yeah. And again, that kind of

brings us back to the grief too, to like create some space to grieve that, but also to seek out spaces that you can integrate that. Right? We only get that first hour once, but like you're saying, it doesn't mean we can't repair and it doesn't mean we can't get that bond still. Yeah. Yeah. Yeah.

Deb (32:21)

Exactly.

Mm-hmm.

Yeah, exactly, exactly. Yeah,

and having that space for being like, this, that sucks. That sucks that I didn't get that, you know? I can never have that back and that just, you have to be able to, you know, be okay with that and then move on and, you know, but integrating, you know, talking, telling your birth story and being with people who support that can be really healing. And if you have another baby, if you haven't dealt with it yet.

Dr. Mandi Murtaugh (she/her) (32:46)

Yeah. Yeah? Yeah.

Mm-hmm. Mm-hmm.

Deb (33:06)

You're gonna have to, because those feelings will come up. Yep, yep, we can put it away maybe for a little bit, but that will bubble up for your second birth. Yeah, or following, I should say. Yeah.

Dr. Mandi Murtaugh (she/her) (33:06)

Yeah, it's gonna come right back up. Yeah.

Yeah. Yeah. Yeah.

And so that's, that is where some of the energy work that I do. So I practice holistic pelvic care. that's, it's Tammy Kent is a physical therapist in Portland who created this and I did my training through her and it's about that integration. It's about that, that repair. Like we can never change what happened in the past, right? This is a conversation I'm always having with, somebody postpartum or preparing for a subsequent birth. You cannot change what happened.

Deb (33:32)

Yeah.

Yeah.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (33:44)

but

we can integrate it and change the story we tell about it. The definition of trauma isn't what happened, but it's the story about what happened. so through, and when I'm doing holistic pelvic care, it's often a combination of internal work, intravaginal work with the pelvic floor and some mindfulness, some guided. Tammy calls the fascia the boundary between the physical and the energetic.

Deb (33:50)

Mm-hmm.

Mm-hmm. Mm-hmm. Yeah.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (34:13)

And I just love that definition. For any of you who aren't familiar with fascia, it's the connective tissue that truly covers every bone, every muscle, and every tendon in our body. It's just this connective tissue that should be sliding, gliding. And when there's inflammation, when there's constriction, when there's tense muscles, when there's a scar, it all, it could get bound up. And so...

Deb (34:30)

Thanks.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (34:36)

through this care, we release some of that fascia, we release some of the story, and we help to integrate it into your body so that it's, you know, just kind of like part of the fabric as opposed to a tear in the fabric.

Deb (34:42)

of

Mm

hmm. Yeah, releasing some of that. Yeah, that makes sense.

Dr. Mandi Murtaugh (she/her) (34:54)

Yeah, yeah,

yeah. So that's a lot of the energetic piece of it.

Deb (34:59)

Yeah.

Dr. Mandi Murtaugh (she/her) (34:59)

kind of release it.

Deb (35:01)

Yeah. So why don't we go back a little bit toward how does pregnancy impact the pelvic floor and what would a birthing person do to optimize their pelvic floor health in preparation for birth?

Dr. Mandi Murtaugh (she/her) (35:16)

Great questions. I've talked about Kegels, talked about the anatomy, we've talked about squeezing in, we've talked about keeping a strong pelvic floor. So we want a strong pelvic floor to keep us continent, to keep us from peeing our pants, to help us stabilize. As soon as we get pregnant, we start having relaxin flow through our body. And relaxin's job is to help muscles and tendons and joints relax in preparation to push a baby out.

Deb (35:18)

Mm-hmm.

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (35:40)

But for nine

months, you're not pushing a baby out, right? But your body is physiologically preparing for it. So it's important to have your pelvic floor strong enough to help stabilize that pubic bone and your SI joints to stabilize the pelvis and to keep us from having all that downward pressure impact us. So again, every time you cough, every time you sneeze, that pressure goes down to your pelvic floor and your pelvic floor needs to be prepared for it, which means a strong pelvic floor.

Deb (35:43)

No.

Thank you.

Mm-hmm.

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (36:08)

Now, some of us, like me, I truly mean us, tend to live in a body with a tight pelvic floor. So I'm pretty type A, I'm pretty driven, I hold my stress in my pelvic floor.

Deb (36:14)

Same. Same. Yeah.

So just full disclosure, I went to Mandi for my pelvic floor therapy and that was the most surprising thing that came out of it was because I'm leaking. I'm like having issues with that and she's like, well, that's because you hold it so tight all the time and I'm like, I am and from that point on I was all day long. Am I holding my

Yes, I am. Let's go ahead and release that a little bit. And it was, it just changed everything because I stopped leaking, right? Which was mind boggling. Can you explain why that happened? Yeah.

Dr. Mandi Murtaugh (she/her) (36:46)

Mm-hmm. Mm-hmm.

Yeah, I appreciate you sharing that.

Yeah, so yes, the myth, the myth is that, I'm leaking, I must have a weak pelvic floor. But sometimes, we're so tense all the time that by the time we need to get a little extra oomph for a cough or sneeze, our pelvic floor's like, I am so tired, I'm so exhausted, I can't give you anything else. So that's sometimes what's happening. Or, again, it wants to be like a trampoline, right? So it really needs to have a little bit of bounce to it.

Deb (37:04)

Yep.

Yeah.

I can't show you.

Bye.

Dr. Mandi Murtaugh (she/her) (37:24)

So if it really is being held more like a floor, like too stiff, then it's gonna kinda just like find a little crack and cause some leakage. So yeah, you are a great example of the opposite of it, that some of us were holding it too tight.

Deb (37:30)

Mm-hmm.

Yeah, well, because, you know, yeah, and the

fix in my mind was you got to hold it tighter. Why are you leaving tighter, tighter, tighter, Yeah, which is the opposite of what was helpful, right? Which is why going to health care therapy is so helpful, because what you think is helpful may be the complete opposite of what you actually need to do. And having that individualized care is so important.

Dr. Mandi Murtaugh (she/her) (37:42)

More Kegels!

Yep. Yep. And.

Yep. Yep.

Yeah. Well, and if we can go to the data really quick and all the bajillion studies they've done about how well a person in a female body does a kegel, if they're only like taught verbally how to do it, or they read it on a handout, 40 % are doing it correctly. So the other 60 % are either not doing anything at all or are actually pushing out instead of pulling in.

Deb (38:16)

Mm-hmm.

Mm-hmm.

Right?

Mm, okay.

Dr. Mandi Murtaugh (she/her) (38:28)

So I do get patients who are here for something else and we check their pelvic floor, they're asymptomatic, they've maybe never had a baby. I just had somebody recently, they've had a little bit of tailbone pain, never been pregnant, and their pelvic floor is opposite. It's like pushing out when she's trying to pull it in. And so there's this space of like, okay, well we need to retrain it to set you up for success long term. Even though you're not symptomatic now,

Deb (38:34)

Mm-hmm.

Mmm.

Interesting.

Mm-hmm. Mm-hmm.

This can cause problems later.

Dr. Mandi Murtaugh (she/her) (38:54)

Let's kick this into gear so that we're

setting you up for success in the future. Yeah. So yeah, this tight pelvic floor, also urgency and frequency. So I feel like I have to pee all the time or my gosh, when I have to pee, I really have to pee. Sometimes those are actually too tight of a pelvic floor too, that we're getting different signals. Your pelvic floor communicates to your bladder. Again, that's why you're not peeing right now, because your pants are on. So your pelvic floor has got that little bit of tension and it's actually tight.

Deb (38:59)

Yeah.

Mm-hmm.

Mm-hmm.

Thank

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (39:24)

telling your bladder to stay relaxed. So people who are tense all the time, their bladder's like, can I go now? Should I go now? And it's gonna give you an urge, even if it's not an appropriate time.

Deb (39:35)

Yeah.

Kind of like my daughter who goes pee all the time. remember? Yeah, she looks like different, right? Different. Different. But yeah, yeah, yeah. No, but she was, she was just feeling the urgency all the time and she'd go, I just don't have to go. And I'm like, there's something, we got to figure something out here. Cause her body was telling her, you had to go.

Dr. Mandi Murtaugh (she/her) (39:43)

Once we get into kids, it's like a totally different thing. Like, I'm not a pediatric therapist. Yeah.

Yeah.

Yeah, well and you know, and you could

teach her, just like you said, if there's one piece of advice that I have for people who think they might live in a tight pelvic floor, which you know, check in right now. If you're like, shoot, I'm tense right now, relax your pelvic floor. Any of you listeners, or me, or you. A big breath in, relax your pelvic floor.

Deb (40:05)

Okay.

Mm-hmm.

Mm-hmm. Yeah. Let's all just take a deep, big, big breath right now. Just relax your

pelvic floor. Okay, now we can continue.

Dr. Mandi Murtaugh (she/her) (40:25)

But you're

right, that's the check-in. That's the first thing I teach people when you're in the car, when you're at your desk, when you're sitting at the dinner table, when you're making a smoothie. Like all of those times, you might just be accidentally and you're like, whoops, let me let it go. Right, you're not beating yourself up for it. You're just like, whoops, that's a pattern I'm trying to change. Yeah.

Deb (40:29)

Check in.

huh.

Yeah. Yeah. Yep. Yep.

Yeah.

Dr. Mandi Murtaugh (she/her) (40:47)

And there's always, so one of the other biggest pieces that comes that we don't often talk about with a tense pelvic floor is pain, especially painful sex. And this is another thing that people, think, I can't tell you how many times I ask somebody, do you ever have pain with sex? And they say, just the normal amount.

Deb (40:54)

Mmm.

I'm like, no, there's no normal amount people. Service announcement.

Dr. Mandi Murtaugh (she/her) (41:06)

Like, no! There's no normal amount. It shouldn't be painful.

Public service announcement. There's no normal amount of pain with sex. So if you have painful sex, that oftentimes is because your pelvic floor is really tense, and if you've had repeated attempts of painful sex, then of course your pelvic floor is gonna be tense, because its job is to protect you. And so if it's tense,

Deb (41:14)

Yes. No.

you

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (41:31)

and then you add pain, it's gonna tense up even more which is gonna add pain. And when we're in this tension and pain cycle, it can actually change the amount of blood flow which can even cause painful skin. So if you have constant pain or even just really light touch. So this kind of wound up pelvic floor or this chronic tension can really just kind of be this self-repetuating problem.

Deb (41:40)

Hmm.

Hmm.

Mm-hmm.

Mm-hmm. Mm-hmm.

Dr. Mandi Murtaugh (she/her) (41:57)

And if we pull this back into pregnancy, if you don't know how to relax your pelvic floor because you've never thought about it, or you've been working so hard at doing kegels, then yeah, now you're having contractions. Now you're ready to let this baby out and we're having trouble. So that's where you're pushing against the floor. Yeah, yeah. And that's one of the biggest things that in preparation for pregnancy that

Deb (42:00)

Mm-hmm.

Mm-hmm. Yeah, you're pushing against the floor instead of... Yeah.

Dr. Mandi Murtaugh (she/her) (42:24)

Of course I'm biased. think everybody should see a pelvic floor PT before birth. I think everybody should see a pelvic floor PT after birth. That just is. But one of the things that I work on with people, and I always recommend prenatally, is that we do perineal massage, which any of y'all in the birth world who are listening, you know the research is crap as far as like whether it's gonna prevent tearing or not. So oftentimes we heard about perineal stretching or perineal massage as a way to prevent tearing. And we just...

Deb (42:31)

Same.

Mm-hmm.

Yes.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (42:52)

don't have good data about that and you know the person's genetics, the size of the baby, how fast they come, how slow they come, if they come with an elbow first, like there's so many factors that are going to contribute to tearing that are more than this. But what I teach is if we stretch the perineum, if we stretch the opening of the vagina to a tolerable level of discomfort, so usually I'm looking for like a

Deb (43:00)

Right, so many factors.

Dr. Mandi Murtaugh (she/her) (43:19)

three or four out of 10. So I'm stretching their vagina and saying, can you relax into this amount of discomfort? And usually if I hold it for 10, 20 seconds, maybe they'll say, are you still pushing? And I'm like, yeah, I am. But you just softened into it. We stretched your muscles. We stretched your skin. We let your nervous system know you are safe, even though this is uncomfortable.

Deb (43:25)

Hmm.

Okay.

and

Mm-hmm.

Mm-hmm. Is this okay?

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (43:48)

Yep, and then they're like,

oh, and then we can press more. I just had a patient, I love these, I love when I get the wraparound story. So I a patient who came in in preparation for her third birth and she said, during my second birth, I was so proud of myself that I felt the crowning. You can't practice crowning, right? Just like you can't practice contractions. Like there's some things you just can't, exactly, you can't practice it. But this is like a 1 % of it.

Deb (43:53)

Mm-hmm.

No. Yeah, we can talk about the ring of fire all the all day, but you just know. Yeah.

Yeah,

it's like a step in the right direction.

Dr. Mandi Murtaugh (she/her) (44:18)

Right, so she said,

yeah, she said, when that sensation came, when he was crowning, I thought, this is familiar. This is what Dr. Mandi and I did. And she even had dystocia, baby had dystocia. So she had a complicated birth with provider's hands in there. And her provider afterwards was like, you did really great and let your perineum stay relaxed that whole time.

Deb (44:28)

Mm-hmm.

Thank

Dr. Mandi Murtaugh (she/her) (44:44)

And she was like, it's cause Dr. Mandi helped me learn how.

Deb (44:47)

Thanks! You're looking!

Dr. Mandi Murtaugh (she/her) (44:49)

But

that's exactly what it was. As we taught her, this discomfort is okay. This is safe. And when this happens in birth, it's what's supposed to happen. So that's what I'm teaching people when I'm teaching perineal massage or perineal relaxation and stretching. So that when they get to that point, it's so important because your body needs to feel safe, right? Like this is, again, your pelvic floor is protecting some very precious cargo.

Deb (44:56)

huh. huh. huh.

Okay. And that's so important. Mm-hmm. Mm-hmm.

Dr. Mandi Murtaugh (she/her) (45:17)

a very intimate part of your body. And so when it comes to giving birth and when it comes to intimacy, it needs to feel safe.

Deb (45:17)

Mm-hmm. Mm-hmm.

Mm-hmm. Yeah, I mean, I had two natural births and the second one I was much more aware and present for and when everything was fine and you know, but then as the crowning happened, it was such a new and strong sensation. I instantly just like everything just went up inside my body and I was like, I think it's, you know, happening and they're like, it's OK. Like this is normal.

Dr. Mandi Murtaugh (she/her) (45:46)

Yeah.

Deb (45:53)

You're just going to breathe soft little grunts, soft little pushes. And I was like, do I have to push? And they're like, no, do let it do whatever you want. If you want to push, can. And I just I think I crowned for like seven minutes. It was the longest seven minutes of my life. But like you said, you can't prepare for that burning. But the more you relax and just stay with it, it just passes, right?

Dr. Mandi Murtaugh (she/her) (46:11)

Mm-hmm.

Mm-hmm.

Mm-hmm.

Deb (46:19)

And

I had less of a tear that time. Yeah.

Dr. Mandi Murtaugh (she/her) (46:21)

Nice. I

wonder if like as I'm watching you on the video, as soon as you like, were like that panic, yeah, like your whole body went up. And then as you're talking about them, like just relax, go your little grunts. Like that energy is real. So if you're panicking in birth, that's really upward energy. And that's why we say use those low tones or those grunts or those mm's because we want that energy to go low. So I love that as you're telling the story.

Deb (46:27)

Yep. Yep.

Mm-hmm. Mm-hmm. And when you focus,

yeah, and like as a birth doula, we're telling our clients that, use those low tones. And I want you to explain it because you're going to do it much better. But like why we do that with our vocal cords.

Dr. Mandi Murtaugh (she/her) (47:00)

Yeah, yeah. So the energy piece for one, like even if you're singing scales, like try to go la la la la without moving up. Yeah, like la la la la la, right? So there's the energetic piece of it. But then yeah, so if you look at a cross section of the larynx, your vocal cords, your respiratory diaphragm and the pelvic floor, which some anatomists do call a pelvic diaphragm, they are all so

Deb (47:04)

Mm-hmm. Mm-hmm. Without, you know, your body up. Yeah. Right?

Mm-hmm.

Mmm.

Dr. Mandi Murtaugh (she/her) (47:30)

almost eerily similar. So when we squeeze our pelvic floor in,

Deb (47:32)

Mm.

Dr. Mandi Murtaugh (she/her) (47:36)

there's a correlation between, and let me go back. Let me go with the respiratory diaphragm driving it. So when we take an inhale, our respiratory diaphragm at the base of our ribs comes down to pull air into our lungs and our pelvic floor follows. So if everybody does that, yeah, take an inhale, should. It is wired to. So if you take an inhale, you should feel your pelvic floor drop between your sit bones. And then as you exhale,

Deb (47:52)

Or it should.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (48:05)

you might feel it lift up a little bit. So an inhale brings it down and an exhale brings it up. Your larynx is the same. So if we're going really high tones, then the larynx is going up. And if we're going with low tones, the larynx is down. So it's moving that downward energy connecting to the pelvic floor, moving downward.

Deb (48:07)

Mm-hmm.

Mm-hmm.

Mm-hmm.

Mm-hmm. Yeah.

Dr. Mandi Murtaugh (she/her) (48:30)

There's a, if

you Google, if you Google like a MRI opera singer, there's a really fascinating, like an opera singer in a fMRI machine. So you can see him singing and you can see his whole tongue and his vocal cords moving up and down. It's wild. Yeah. Yeah.

Deb (48:38)

How cool.

That is cool. I'm going to have to look that up for sure. Yeah. So,

so it's like a hack, right? In your birth of like, if those low tones, it automatically should, just relax the other diaphragms, like your pelvic floor to help with that. So in birth doula training, one of those things, if you hear your client going,

Dr. Mandi Murtaugh (she/her) (48:50)

Yeah!

Yep. Yep.

Deb (49:04)

And you can just feel, even when you just practice that, you can feel your whole body just tensing up in pain. But if you, you can just feel your whole body just relaxing. Yep, I love that.

Dr. Mandi Murtaugh (she/her) (49:07)

Yeah.

Yep.

Mm-hmm. Even think of the sphincters, right? Floppy face, floppy fanny. Like your mouth just like

opened up and relaxed too, right? And so, even though it's interesting, I think Iname, talks about the cervix as a sphincter that you can relax, which as far as we know, we don't have any control over it. But the visualization of the cervix opening, so as your mouth is opening, relaxing, you're opening your sphincters, you're gonna poop during birth.

Deb (49:26)

I know.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (49:42)

You're just gonna poop during birth, let it go. If you're trying to hold in your poop, you're holding in the baby.

Deb (49:43)

Yeah, absolutely. Yep.

Yep. Yep. I did my whole birth story on the podcast and that was the biggest thing that I was like, I'm going to be the girl who poops in the tub. Like that's just going to be and right when I let that go, it wasn't poop, it was my baby. It was my baby. So as soon as I let go of that, I was like, you know what, it's just going to happen. Then I was like, here he comes. So take that as a...

Dr. Mandi Murtaugh (she/her) (49:57)

So good!

Yeah, yep, yep.

Yep, yep. And

that's part of it. You're like letting that sinker open. You're letting it all open. Yeah.

Deb (50:12)

Yep. Yep.

Yep. Because it just feels like that. It just feels like the biggest poop you'll ever have. Because it's the same sensations of your baby moving through outside of your colon. it's... Yeah. Well, something. Let's say... Yeah. My favorite explanation is the toothpaste. It's like, you know, your baby is just pressing on this tube.

Dr. Mandi Murtaugh (she/her) (50:22)

Yeah, yeah, a baby scraping up... scraping is not the finest word, but they're pushing right up, yeah, they're right up alongside it.

Yeah!

Deb (50:36)

And if there happens to be something in there, guess what? It's gonna just help you clear it out. But if we're lucky, we don't have anything in there, but you know what? We're just gonna plan on it. And most of the time, know, the birth in person won't even know. It's just wiped away and we don't even have to worry about it. Yeah, exactly. Okay, so I wanna go back to C-sections.

Dr. Mandi Murtaugh (she/her) (50:37)

Yep.

kind of push it out. Yep, yep, gotta go.

Sometimes you do, and that's okay. Yeah.

Exactly what I always tell them.

Deb (51:01)

because they're often left out of these pelvic floor conversations and they really shouldn't and I would love to hear more about what you think about that.

Dr. Mandi Murtaugh (she/her) (51:01)

Yeah!

You are.

If you had a cesarean, that still means you had a pregnancy. And that pregnancy, you still were holding the baby on your pelvic floor. Right? So if you had a, I accidentally called this a vagarian birth once, but it's stuck, so I'm just owning it. So if you were one of those lucky ones who got to push for four hours and then have a cesarean, all that pressure downward, I know. First of all, a little bit of love for you. A lot of love for you.

Deb (51:16)

Mm-hmm.

It's like, I'm so sorry. Let's take a moment

of solidarity to the beautiful people who had to go through that. I am so sorry. Yes, that sucks. Yeah.

Dr. Mandi Murtaugh (she/her) (51:40)

A little bit both. Yeah. Yeah. So

we still got all this downward pressure on the pelvic floor, even though it didn't stretch to its max. know, best case scenario in a birth is the pelvic floor just really stretches. It still changes though, So even if they didn't actually have a vaginal birth and then they had the cesarean, their pelvic floor is still impacted. Or if they had a cesarean and they didn't, I mean, let's say they weren't planning on a cesarean.

Deb (51:46)

Thank you.

Mm-hmm. Yeah.

Yeah.

Dr. Mandi Murtaugh (she/her) (52:07)

but they had an emergency cesarean, or they had a trial of labor and then a cesarean, or they had a traumatic cesarean. That again, we've got this physical component of, pelvic floor was still impacted by the pregnancy. And now we have this energetic component of, is there disappointment? Is there grief? Is there a sense of failure? Is there a sense of I wasn't good enough, or I wasn't strong enough, or I gave up, or...

Deb (52:09)

Mm-hmm.

Bye.

Mm-hmm. Mm-hmm.

with my son.

Dr. Mandi Murtaugh (she/her) (52:33)

I let myself be convinced. There's such a range of stories. Yeah, I was betrayed by my body. There's, there's, did I really need it? Yeah. Yep.

Deb (52:35)

Mm-hmm. So, graduate. Yeah.

Did I really need it? I get that one a lot. Did I really need it? I don't know. Like,

I get a lot of clients who my doctor says my baby's gonna be really big and we're just gonna elect for a c-section and they come out and they're seven pounds. So there's, you know, some disappointment or worry like did I make the wrong decision?

Dr. Mandi Murtaugh (she/her) (53:03)

Am I already a bad parent? Am I already a bad mom? Right? Like, yeah, I hear all of those stories. And again, that emotional energetic component, we hold all that in our bowl too. So there's something to be said for just holding space for that story and for processing that One of the other myths is that, again, pelvic floor spared, vagina spared. People come back, vagina spared.

Deb (53:05)

Yeah, I already messed this up.

now.

Yeah.

Dr. Mandi Murtaugh (she/her) (53:28)

But then they're like, wait, but sex hurts. Why does sex hurt? Right? And there's still changes, there's still hormone changes too. So especially if you're lactating, if you're chest feeding or breastfeeding or pumping. Again, bless you if you're pumping. Then there's still changes, there's hormonal changes with low estrogen. Our vagina's a little bit drier and it's less easily, well, we're less easily aroused for all of the reasons.

Deb (53:30)

Right. Yeah. Because there's still changes. Yep.

Yeah. Right.

Mm-hmm.

Yeah, exhaustion, stressed

Dr. Mandi Murtaugh (she/her) (53:54)

exhaustion, being touched out, covered in milk, disconnections, lack of sleep, all the things. But we have less, it's a whole other episode.

Deb (53:55)

out, right? Like, all the things. It's fine. That's a whole other episode.

Dr. Mandi Murtaugh (she/her) (54:04)

We have less lubrication, we have more sensitivity. So sex can be painful just from that. But all of that disappointment, all of those other emotions, if we haven't really processed those, that can all lead to kind of just, like there's just a bunch of stuff in our bowl that we need to clear out.

Deb (54:06)

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (54:21)

And then we've got just the physical discomfort of the abdominal wall. I was blown away. treated, you know, I've done this work for 16 years and my son is four, so 12 years of doing this as somebody who's never been pregnant. And when I had my cesarean, I was like, I don't hurt so much at the scar. I hurt above the scar. Like my whole, like belly button downward was so sore.

Deb (54:40)

interesting.

Wow.

Okay.

Dr. Mandi Murtaugh (she/her) (54:45)

And it was kind of that kind of sore too after a while that I didn't know how uncomfortable it was until I went and saw my pelvic floor PT and she worked on my abdomen, that I was like, my gosh, I feel so much better. So it's transformed the way that I treat people post-Casarian, that it's not just scar massage, which is important, which I do recommend to everybody who has a Cesarean. Again, come in for at least one visit just to learn how to do the scar massage. Because if you learned anything, maybe you got a handout.

Deb (54:58)

Okay.

No.

Dr. Mandi Murtaugh (she/her) (55:15)

but let's work on it. And again, you can get your sensation back over time and then we mostly wanna keep it from having restrictions.

Deb (55:16)

Right. But you can get your feeling back, right? And like, by helping with,

Dr. Mandi Murtaugh (she/her) (55:25)

I was about nine or 10 months postpartum and was doing yoga and did like a down dog or something and felt this tug on my cesarean scar. Like I thought I had kind of freed it all up, but there's still some tension on the side. And again, there can be this big psycho emotional piece. I have a friend who had a cesarean, a preterm birth, a really traumatic experience, and she actually got nauseated.

Deb (55:34)

Hmm. Hmm. Interesting.

Dr. Mandi Murtaugh (she/her) (55:51)

anytime she would try to touch her scar.

So she had to do a lot of work through working with her therapist and doing some body work to even be able to get to a point of letting somebody else touch her scar and touch her scar herself.

Deb (55:57)

Mmm.

Interesting. So that's good to point out that that is something that can happen and to give yourself some time around it's you're not broken, you're not messed up because you have these feelings, that is a real thing and to embrace it and give it space and find the people that can support you through that. Yeah.

Dr. Mandi Murtaugh (she/her) (56:03)

So again, that big.

Yep, yep,

yeah, absolutely.

Deb (56:22)

So next I want to ask more about unexpected symptoms of the pelvic floor. So like we talked about leaking urine, painful sex. Is there anything else that, you know, we're postpartum or even in pregnancy of like, okay, something's not quite right and I could get some support with it.

Dr. Mandi Murtaugh (she/her) (56:38)

Mm-hmm, yeah, yeah. Heaviness is another one, or prolapse. I think those are probably words that sound really scary, actually. One thing I always encourage my patients is that, again, if we go back to that anatomy of the uterus is holding up the bladder, that after a pregnancy, whether it was a cesarean birth or a vaginal birth, your bladder's gonna be lower. Those rubber band ligaments just aren't gonna go back to how they used to be. But most of time, it's asymptomatic.

Deb (56:42)

Hmm.

Yeah, it does.

Hmm.

Mm-hmm.

Okay.

Dr. Mandi Murtaugh (she/her) (57:07)

So if you're like, I feel something in there, but it only bothers me if I touch it. Like, let's teach you about it. I want you to learn about it and be empowered, but also like, don't touch it. If it's only symptomatic, yeah, like it's only symptomatic when you touch it, then let's just practice not touching it. But reassure you, like everything is fine, everything is normal. Here's some ways to protect it, especially if there are subsequent pregnancies coming down the road, then we can manage it. So that's one of them.

Deb (57:11)

Hmm.

Right. If it bothers you, don't touch it. Sure. Sure.

Mm-hmm. Mm-hmm.

Dr. Mandi Murtaugh (she/her) (57:33)

SI joint pain, tailbone pain, back pain, that pubic symphysis pain. I've had patients who weren't even pregnant and it was this either like inner thigh pain, like a groin pain, or that pubic symphysis was painful. And they worked with their orthopedic PT for months and nothing changed. And as soon as they came in and I touched their pelvic floor, they were like, that's my pain. Even sometimes the pelvic floor can radiate down your legs. Menstrual pain.

Deb (57:34)

Mmm.

yeah.

Dr. Mandi Murtaugh (she/her) (58:00)

you know, we shouldn't have really painful periods. This is again, one of those things that, that we're just taught to live with, but that means something is out of balance. So we can do some work through physical therapy to help to, mobilize your uterus, mobilize those organs to help them to, be less painful during your bleed. Yeah. Lower back pain. Yep. Again, that core stability, right?

Deb (58:03)

Mm-hmm. Yeah.

Mm-hmm.

Yeah, lower back pain.

Right?

Dr. Mandi Murtaugh (she/her) (58:25)

So,

and diastasis, and we could do a whole podcast on diastasis too, but everybody's belly, everybody's abdominal wall needs to separate to make room for the baby. So in third trimester, everybody has a diastasis. And immediately postpartum, everybody's gonna have some degree of diastasis. the best research there is shows that one to two finger widths is normal. So if you put your fingers at your belly button, just above your belly button rather, and do a little crunch,

Deb (58:42)

Mm-hmm.

Hmm.

Thank you.

Dr. Mandi Murtaugh (she/her) (58:53)

One or two finger widths is totally normal. I think this is one of those things that social media has kind of sensationalized and made people feel like they're broken or that something's wrong or you should pay me all the money for my program. Sometimes good, but also I think sometimes it's a little bit, it's also a little bit kind of preying on people's weaknesses, preying on a postpartum body feeling like I'm not at home, like you can fix me.

Deb (58:55)

Okay.

Yeah. Right. Sure.

of scoop? Yeah. Yeah.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (59:20)

So some degree of separation is normal. my goal is always, can we make you strong though? Because you can actually be strong. That corset layer that I said connects to your pelvic floor. If your pelvic floor and your transverse abdominis, your deep low abdominals are coordinated, you're gonna have more stability, which is gonna help your back pain, which is gonna help to keep that abdominal separation strong. So even if it's separated, but it's strong behind it, then we're good to go.

Deb (59:25)

Mm.

Mm-hmm.

Hmm.

Hmm.

Dr. Mandi Murtaugh (she/her) (59:48)

then we're set. And that's going to set up that base so that you can go and pick up your kid. You can go and go for a run. You can go and lift weights. You can go and pick up a grocery bag with everything being nice and stable. So yeah.

Deb (59:55)

Mm-hmm.

Mm-hmm. Good.

Okay. So for any birth professionals and doulas listening in, how can they better support their clients in recognizing and addressing those pelvic floor issues postpartum?

Dr. Mandi Murtaugh (she/her) (1:00:12)

Yeah, yeah. I would say, you know, in those first six weeks, there's so much change going on. You know, I've had phone calls before where a patient calls me two weeks postpartum and is like, my gosh, this and this and this and this and this. I'm like, okay, let's follow up in a week. And a week later, they're like, no, no, no, that's fine. That's better now. So those first six weeks, again, are such an intense. Again, talk about mind blowing. So nowhere else, barring a traumatic,

Deb (1:00:28)

Actually, we're good. Yeah.

Dr. Mandi Murtaugh (she/her) (1:00:40)

surgery or a traumatic event. Nowhere else is there a normal physiologic thing that happens in a human body that has such a vast amount of change in such a short period of time. To go from being.

Deb (1:00:52)

Mm-hmm. Let's just sit with

that for a second because I feel like we don't give enough weight for people in the changes that are going through your body. It took nine, ten months for your body to have this baby and we're expecting that. Yes, and then we're expecting.

Dr. Mandi Murtaugh (she/her) (1:00:58)

No

They slowly grow.

Deb (1:01:11)

That's, mean, a lot of women, when I tell them like, you're going to have a belly still when you have your baby. What do you mean? My baby's out. And I'm like, no, no, that's a big part of it. Sure. But there's so many other structures that now have to figure out where to go back to. Yeah. And like giving yourself that time to just be and then see what your body does and slowly integrate back into what your body is going to be now.

Dr. Mandi Murtaugh (she/her) (1:01:11)

Yes.

Yep. Yep. Yep.

Yes.

Deb (1:01:38)

Yeah. So when do you see people then?

Dr. Mandi Murtaugh (she/her) (1:01:43)

Yeah, great question. So I give two answers to that usually. So if somebody wants to come see me earlier on to do some belly support, to do just some like processing, I like to call myself a touchy feely pelvic floor PT, which could sound really weird, but I get into the emotional stuff. I get into the energetic with consent. So early on, it's more like, let's talk about your story. Let's hold space for it. Let's do some external energy work.

Deb (1:01:54)

Mmm.

Yeah. With consent, With consent.

Dr. Mandi Murtaugh (she/her) (1:02:08)

I don't do any intravaginal work until six weeks, either for cesarean or for vaginal birth, which quick note about the six week checkup, six weeks is the normal tissue healing time. So six weeks is the amount of time that you need for that dinner plate size wound that the placenta was on your uterus to heal so that something inside your vagina is not gonna cause a uterine infection, period, that's all. It is not a time.

Deb (1:02:19)

That's it.

If everything went normally, right?

Because if there were complications, it could be a little longer. Yeah.

Dr. Mandi Murtaugh (she/her) (1:02:36)

If everything went normally. Yep, exactly. It

could be longer. if a tear is not healing up, if something else is not healing, it could be longer. It is not at all the time that you should be ready to have sex. Can we do another whole podcast about sex? Because we haven't even hardly touched on it. So.

Deb (1:02:49)

Absolutely. Amen.

100 % No, yeah, and I think it's

really important for everyone, parents, as a team to understand. Yeah.

Dr. Mandi Murtaugh (she/her) (1:03:01)

Yeah, yeah,

yeah. So yeah, so in that six weeks, as far as to your question about doulas, so if you're supporting somebody and in that course of those first few weeks, they're not improving, they're like, I'm still peeing my pants a ton or this pain is not going away, this pain is keeping me up, this pain is keeping me from being able to care for my baby. Those are times, send somebody in early. Again, we don't do anything intra-vaginally for the first six weeks. For any of you who aren't familiar with your pelvic floor PT,

Deb (1:03:13)

Mm-hmm.

Yes.

Dr. Mandi Murtaugh (she/her) (1:03:31)

We typically like to work introvaginally because that's how we can assess and treat the pelvic floor most directly. People still are surprised by that sometimes. But we can still work on that core connection. We can still work on some visceral mobilization to get your organs back home. Because remember that baby pushed them all out of the way. And we can work on some really simple, sometimes it's some really simple exercises, breathing exercises, just connecting with your core early on.

Deb (1:03:46)

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (1:03:57)

So if they're really functionally limited, that's a time to get them in early. If they're at six weeks, symptoms just aren't improving and it's really impacting their quality of life, then get them in. If they're feeling really anxious about returning to sex, if they're like, I'm terrified, I, like my partner wants it and he's so patient and again, we could get a whole thing about that. But if the last thing that happened to your vagina was that

Deb (1:04:00)

Mm-hmm.

Yeah. Okay.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (1:04:24)

eight pounds of head and shoulders came out of it.

How terrifying is a penis gonna be to go back in it? Yeah.

Deb (1:04:31)

be like, I feel like a virgin again. I mean, that's

the end all be all of like, I don't even know what that's like anymore. My life has changed so much. My body has changed so much. I don't even know. Yeah, I get it. Yeah.

Dr. Mandi Murtaugh (she/her) (1:04:40)

Yeah!

Yep, so,

and especially if nothing has been in there since then. If you haven't put a finger in there, you know, or maybe your doctor did a check at six weeks, which even that is kind of, I've talked to providers who in their attempt at, out of respect for trauma-informed care, they aren't offering internal exams at a six week, which I get, and also like I think I've also had patients who were like had to basically convince their doctor.

Deb (1:04:48)

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (1:05:11)

to do a check because they were worried, it's gotta be a little bit of both. But if you're coming in to see me, and I've had a lot of doctors who will say this, like, you're going to pelvic floor PT, are you going to see Mandi? Then I won't do an exam, she can do it. So as long as there wasn't a tear or stitches or healing to check on, then yeah, we're gonna do a lot more in-depth assessment and actually give you something to do about it with a vaginal exam. But I think having a pelvic floor PT, I mean, very least yourself,

Deb (1:05:11)

Right. We have to have the balance there. Yeah. I was like, yeah.

She got it.

Dr. Mandi Murtaugh (she/her) (1:05:38)

putting a something inside your vagina, putting a finger inside your vagina before your partner, or going to pelvic floor PT so that we can have this safe environment that there's no expectation of another person, that there's no need to like feel like you're aroused or like you should, should, should, any of that, that we get to say, what does it feel like to have something inside your vagina in a safe space?

Deb (1:05:47)

Mm-hmm.

Mm-hmm.

Yep.

Dr. Mandi Murtaugh (she/her) (1:06:03)

Because you can consent, you can want it, you can be aroused, you can say yes to your partner and know that you're safe and loved. But if it's painful, your body perceives that as a threat, exactly. So yeah, that's one of those places I really love to be with people to help bridge that, to bridge that gap in their return to typical life, postpartum. Or their new typical life.

Deb (1:06:11)

All right.

Mm-hmm.

Mm-hmm. And I think that's a very typical

conversation with a postpartum doula is like, you know what? I'm just terrified, you know? And we can give a little advice here and there, but it's just so good to have, you know, if there is pain to get that specific care, that's great.

Dr. Mandi Murtaugh (she/her) (1:06:39)

Mm-hmm. Well,

and in the neurophysiology of pain, if you're afraid of pain, it actually decreases your threshold. So if you're afraid of pain, you're more likely to have pain. Your body's preparing for it. So if we can help to decrease the fear, then that actually can lead to a less painful experience.

Deb (1:06:48)

Mm-hmm. Yes. Yep. Yep.

Mm-hmm.

Yeah. Okay. Well, we're going to wrap it up a little bit. We've taken a lot of your time. But the last thing I want to ask is someone listening right now is like, these things are not normal. I have pain, have heaviness, or maybe just that emotional disconnect from their body. What is one small step that they can take today on their healing journey? And then also following up with that, what should they do?

Dr. Mandi Murtaugh (she/her) (1:07:04)

I love it.

One small step is so hard to... You know what I would say is actually one small step, and you can even just do this right now is close your eyes if you're comfortable, not if you're driving or doing something that you need to revision. But just take a second and think of the center between your sit bones. Think of your pelvic floor. You can think of the vaginal opening, the aretha, the anus, and just breathe into it.

Deb (1:07:26)

I know.

Right.

Dr. Mandi Murtaugh (she/her) (1:07:55)

So as you breathe in, imagine it softening, maybe imagine your sit bones widening. And as you breathe out, just let it come back up. Even if you can't feel it, just imagine that.

Deb (1:08:04)

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (1:08:06)

We come back to that path in the woods. It's kind of like this is the first step of just knowing this part of your body. Imagining it, connecting it with your breath. If you feel comfortable and wanna put a hand over the perineum or a finger inside just to say hi. Hi part of my body that I've lived with my whole life. It's nice to meet you. I've never connected before. I love to give people like a hand mirror.

Deb (1:08:09)

Mm-hmm.

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (1:08:34)

to have them look with a hand mirror. And I give this a little bit of a range, because some of you might be completely cringing and like, ooh, I don't want to do that. And that's OK. You just kind of take it where you're at. But I think that's where we start, to say this is a beautiful part of your body. This is a part of your body that you might not want to call beautiful. But it is part of you. And you deserve to know it. You deserve to love it.

Deb (1:08:43)

Absolutely. Yeah.

Mm-hmm.

Mm-hmm.

Yeah.

Dr. Mandi Murtaugh (she/her) (1:09:03)

You deserve to be connected to it.

Deb (1:09:05)

And it's doing so much work for you and protecting you and safety and even when you don't even know it. It's so wonderful. Yes. So that is a wonderful place to end. So thank you so much for your time. This has been really educational and helpful. And I would love to, you know, I'm going to make little notes of all the times we said this could be a whole podcast.

Dr. Mandi Murtaugh (she/her) (1:09:07)

It's doing so much work for you. Yeah.

It is. It is. It is.

Mm-hmm.

Deb (1:09:30)

We can totally do those whenever we want. Yes. Be like, here's

Dr. Mandi Murtaugh (she/her) (1:09:32)

The series with Mandi. Yeah.

Deb (1:09:36)

the next one. So anytime you want to come back, you are absolutely welcome. And thank you again for your time. yeah.

Dr. Mandi Murtaugh (she/her) (1:09:40)

Yeah.

Deb (1:09:43)

if anybody's struggling with pelvic pain and they're in the Tacoma, Puget Sound area, I want them to be able to reach out to you and I would love to hear all the things you have going on, because this is just a little tiny portion of your business and it is such a wonderful blessing to our community, what you're doing. So I want everybody to hear all the things.

that you're doing and what's to come as well. So please let us know.

Dr. Mandi Murtaugh (she/her) (1:10:07)

Yeah, yeah. So my clinic is Dr. Mandi Martoff Physical Therapy and Yoga. And I do still offer telehealth. This is one of the gifts of COVID. So anywhere in Washington, you can do telehealth visits with me. I see patients here in Tacoma at Thresholds Collective. And Thresholds is a multidisciplinary space. We have doulas, we have a massage therapist, we have a therapist, and we also have a studio space. So I teach postpartum yoga and a core connect class on Tuesdays and Thursdays.

Deb (1:10:34)

which is very good, by the way. I have been, it's awesome. Yeah.

Dr. Mandi Murtaugh (she/her) (1:10:34)

Which is, thank you. And I'm

also a fan of Postpartum is Forever. But you can bring your baby up to age one or up to any walkers. Up to walkers I should say, because mine was a late walker so I could have brought him forever. Not forever. But you can bring your baby. It's a place to just be, to connect with other parents. We also have a free new parent support group on Thursday mornings. So you can find out all about that at thresholdscollective.com. I'm sure you'll link it.

Deb (1:10:40)

Yes.

Yeah.

Awesome.

Dr. Mandi Murtaugh (she/her) (1:11:03)

And then I have a new offering at the clinic. There's me and then another pelvic floor PT, Dr. Megan. And we have a new special that's just a one-time pelvic floor check-in. Because I get so many people who are like, I feel pretty good, I don't think anything's wrong. But then I also see people years down the road who are like, I wish I would have just like checked in. So just a one-time check-in, you're not getting a plan of care. We check your pelvic floor if you want. We check your abdominal wall. We give you some exercises.

Deb (1:11:22)

Mm-hmm.

Dr. Mandi Murtaugh (she/her) (1:11:31)

And then if you come and see me, then you also get a little bit of that energy work, a little bit of clearing the energy field from your birth, and some of the visceral mobilization, helping your organs find their way home. So you can also find that about that on my website, which Deb will also link to. So I'd love to care for you in whatever way feels accessible and feels good to you.

Deb (1:11:35)

Mm-hmm.

Yeah.

Great, yeah, that's perfect. I hear that often too, it's like, well, I just wanna make sure everything's good to go. And I don't feel like my OB really gave me enough of that confidence. And so having that offering is really helpful for families. And I always suggest like, oh, do you have a pelvic floor therapist? You don't? Okay, well go find one and right around six to eight weeks, even if things are fine, just check in.

Dr. Mandi Murtaugh (she/her) (1:12:03)

Mm-hmm. Mm-hmm.

Deb (1:12:19)

And it just the confidence that that empowers them in their body of like reconnecting. And it just, it's, you see a big difference when, people do it. So thank you for offering that. That's great. Perfect. And I will link all of that in the show notes. And if you do have questions for Mandi, I can include your email address. And then if you want to submit a question to the podcast, I will keep put that.

Dr. Mandi Murtaugh (she/her) (1:12:19)

Yep.

Yeah, yep. Yeah, absolutely. Okay.

Mm-hmm.

Deb (1:12:44)

link in there and if we have enough then we will just do a whole episode of questions for the pelvic floor.

Dr. Mandi Murtaugh (she/her) (1:12:50)

Absolutely. Bring it on.

Deb (1:12:52)

Perfect. All right. Well, thanks again for being here and have a good day.

Dr. Mandi Murtaugh (she/her) (1:12:56)

Thank you.