Dr. Courtney Weber is a Nyssa Network member occupational therapist, birth doula, and co-founder of OWN Your Pelvic Health, a two-woman company offering pelvic floor therapy and doula services virtually and in the Denver area. Dr. Weber specializes in pelvic health, and completed her doctorate project at a birth centre while under the mentorship of an occupational therapist, midwives, and doulas.
Nyssa’s Tara Stadnyk met with Dr. Weber to discuss how pelvic floor therapy can be a key to unlocking improved physical and mental health, sexual wellness, more ease in pregnancy and postpartum, and healthier habits and physiological functions in infants and children.
This transcript has been edited for length and clarity.
TS: Please tell us about yourself and your practice. What inspired you and Annie to start OWN Your Pelvic Health, and what services do you offer?
CW: OWN Your Pelvic Health offers pelvic floor therapy for women and children, birth doula services, and community and online workshops. We see clients in-home, virtually, and in a small clinic space in Denver, CO.
On the women’s health side of things, we specialize in pregnancy & postpartum. We work proactively to help people have a pain-free pregnancy, smooth birth, and fast postpartum recovery. Common conditions we treat include: diastasis recti, pelvic organ prolapse, pain with sex, c-section recovery, back/hip/pelvic pain, constipation, and leaking urine, gas, or stool.
On the pediatric side of things, we work with toddlers and children who experience bed-wetting, constipation, difficulty with potty-training, withholding, and anything else that impacts bathroom habits.
Annie and I met in graduate school for occupational therapy and each found our way into pelvic health in slightly different ways. We were inspired to create a private practice after working in the traditional healthcare system for a few years. We experienced our western medical model failing us and our clients over and over again. We decided that the only way to serve pregnant and postpartum people in the way they deserve- and in a way that actually helped them get better - was to work outside of that medical model.
Your typical outpatient pelvic floor therapy clinic will see clients for 30-45 minutes, with high productivity standards for therapists and pressure from insurance companies about how to treat and what to bill. This impacts how therapists practice. Having worked in this model, we know that it limits the quality of a therapist’s care.
Instead, we offer a variety of free and very low cost community and online workshops to increase general knowledge and education about pelvic health, pregnancy, birth, and postpartum recovery. We offer a free discovery call and individualized services when people need more care.
TS: What are some of the ways clients benefit from receiving pelvic floor therapy in their own home?
CW: When we work with clients - especially new moms - in their own space, we can observe and recommend changes to their movement patterns and routines in a way that actually impacts how they move throughout the day. New moms spend so much time on and off the floor, carrying a baby, feeding a baby, sleeping with or consoling a baby, carrying a carseat and baby gear - all movements that can be therapeutic exercise if you approach it in the right way. In-home services are also a gift to postpartum people who don't want to leave the house for yet another appointment.
TS: How is pelvic floor function connected to mental health, the central nervous system, and other areas of the body?
CW: Our pelvic bowl is the support system for our whole body. In that sense, it also holds trauma and the beliefs we have about ourselves. The pelvic floor muscles respond to fight-or-flight situations by tightening, in an attempt to support our body and hold everything together during stressful or life-threatening situations. Problems can arise when chronic stress or history of trauma lives in the pelvic floor and results in tight muscles, pain, or other pelvic floor concerns.
Our pelvic floor is also the reciprocal diaphragm to our respiratory diaphragm, meaning that during an inhale, both descend, and during an exhale, both return to their resting position. In this way, our breath can have a profound impact on our pelvic floor function and in calming the nervous system.
Pelvic floor function also impacts the stories we tell ourselves about our bodies. When we experience incontinence, pain with sex, or prolapse, we start to believe our bodies are broken or weak. This can impact our mental health, confidence, and what we choose to do.
As the center of our body, our pelvis impacts and is impacted by everything around it. Pelvic floor therapists look at everything from head to toe, because it's very likely that your foot pain or rib pain is connected to pelvic floor function.
TS: How do pelvic floor therapists support people during pregnancy and postpartum?
CW: Pelvic floor therapists who specialize in treating pregnant and postpartum people have advanced training to understand the changes that happen in the female body, the physiology of birth, and postpartum recovery. Throughout the perinatal time frame, we can help with any complaints of low back, pelvic, hip or foot pain, incontinence, pain with sex, constipation, diastasis recti, pelvic organ prolapse, and so much more. We also help pregnant people prepare their bodies for birth. There are benefits to balancing the body, lengthening certain muscles, and building awareness and connection to the core and pelvic floor during pregnancy. We can also work with postpartum people who don't have outstanding concerns but want to return to exercise and certain activities without risking pelvic floor dysfunction.
TS: When should parents seek a pelvic floor therapist to support their child? How do these therapies assist children in healthy growth and development?
CW: Common concerns that caregivers have when they seek pediatric pelvic floor therapy include: day and nighttime accidents (bedwetting), potty training challenges, chronic constipation, fecal and urinary incontinence, sensory processing challenges when it comes to toileting, pelvic pain, and so much more.
Pediatric pelvic floor therapy is specialized treatment provided by licensed occupational and physical therapists, and is a highly individualized service based on a specific child’s symptoms, needs, and goals.
As occupational therapists, we take a holistic approach when working with all clients. Our goal is to help children participate in meaningful daily activities without worrying about if they are going to have an accident or where they are going to poop.
TS: Could you please talk about your work with infant massage? What are the benefits and how do parents learn more?
CW: As a certified infant massage instructor, I teach caregivers the benefits of therapeutic touch with their infants. These benefits include: caregiver and baby bonding, caregiver confidence and decreased mental health concerns, as well as improved sleep, digestion, circulation, and neuromuscular development for the baby. Parents can learn more from www.iaim.net.
TS: Please talk about activities to engage in throughout your cycle - from menstruation, to the follicular phase, ovulation, and the luteal phase.
CW: This is one of those things I want every woman to know - something we should learn when we’re in middle and high school.
Menstruation: shedding the lining of your uterus. Can last 3-7 days. Progesterone and estrogen are at their lowest which likely means lower energy/ motivation. Shoot for yoga, swimming, walking, or a light bike ride.
Follicular Phase: starts the day of your period and lasts until ovulation. As estrogen levels rise, this is likely a good time for higher intensity workouts, strength training, and cardio. This is when metabolism is at its slowest.
Ovulation: tends to be between days 12-16 of our cycle and is marked by the release of an egg. Estrogen peaks & the luteinizing hormone is also released. This is a good time to try new things, get creative, and engage in more intensive exercise.
Luteal phase: lasts about 2 weeks. Estrogen levels start to lower after ovulation and then rise. Progesterone also rises, and this can be when we get some of those PMS symptoms. The luteal phase is a good time for strength training, walking, yoga, and swimming.
Of course we’re all different, and what works for you may not work for me and vice versa. The goal here is to tune in to what YOU feel fits with your cycle.
TS: How can pelvic floor issues affect peoples’ sex lives, and what are the steps taken to achieving healthy sex again or for the first time?
CW: One of the primary roles of the pelvic floor is to allow for comfortable and enjoyable sexual experiences, including penetration. Any pain, discomfort, bleeding, cramping, or mental disassociation happening during sexual experiences is a red flag. Barring any medical concerns (which we would refer to a gynecologist or uro-gynecologist), there is likely tightness, imbalance, scarring, or spasm in the pelvic floor muscles and surrounding tissues. A great first step is to see a pelvic floor therapist. Otherwise, I tend to recommend self-exploration and self-pleasuring before partnered sexual experiences. And I generally recommend lube (especially postpartum when tissues are drier), deep breathing, enough time to allow the female body to be aroused, and positions where one can control the depth of penetration.
TS: What are some of the most common misunderstandings and issues you see in the health care system around pelvic floor health, recovery, and awareness? How do we solve them?
CW: Most of the misunderstandings I see are related to care throughout pregnancy and postpartum since I specialize in perinatal pelvic health. The first misunderstanding is that a "strong" pelvic floor is a "tight" pelvic floor. In reality, the majority of clients I see have an overly tight pelvic floor - and that's not a good thing.
Most people benefit from an individualized pelvic floor therapy evaluation to bring attention and awareness to this type of movement.
Another huge misunderstanding is that everyone is "cleared" for exercise and sex 6 weeks postpartum. Everyone's bodies, births, and postpartum recoveries are so drastically different that we can't expect this timeline is right for everyone. Even when people feel excellent at 6 weeks postpartum, there is a very gradual return to exercise that supports healthy tissue recovery and muscle strengthening. Our society has a warped view of how the female body "bounces back" that can be incredibly detrimental to mental health and postpartum expectations.
Our answer to solving these misunderstandings is education! The more people know, the more they can be confident in their unique journey.
TS: Can you offer a few techniques for checking in with your alignment and breath during the day?
CW: I love to encourage clients just to build awareness of their body and their breath. There's no absolute right or wrong posture or breath - different movements and breathing techniques work for different circumstances. So I encourage people to bring attention to their body throughout moments in their day: when brushing their teeth, holding a baby, standing in the shower, waiting in line at the grocery store. Where is the weight in their feet? Are knees locked or soft? Is the pelvis forward or back, tilted up or down? Are the ribs moving with breath? Are the shoulders and head aligned? By bringing awareness throughout small moments, we can start to change habits and movement patterns in our bodies. It takes time and mindfulness, but it makes a world of difference for connection to our bodies and calming the nervous system.
artwork by antoni shkraba via pexels
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