Kristin Revere and Lynn Schulte discuss postpartum healing including hemorrhoids, fissures, and tears as well as preventative steps to take during pregnancy.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am thrilled to chat with Lynn Schulte today. Lynn is the founder of the Institute for Birth Healing, and our topic is all about postpartum healing and recovery after birth. Welcome, Lynn!
Thanks, Kristin, so much! I so appreciate any opportunity I get to be able to share what I know and to help moms.
So happy to have all of your wisdom here for our listeners! Would you start by filling us in on your extensive bio? I was looking over all of your skill sets, and you have a wealth of experience in not only pelvic floor physical therapy but also just healing in general and body work.
Yeah. I’ve been a physical therapist for over 30 years and have taken lots of different continuing education courses, but I would say that my specialty really is connecting a person to a deeper part of themselves and really trying to tap into – my gift is being able to understand why the body is doing what it’s doing and getting to the root cause of tension in the body or why a muscle won’t let go. That is just something that I’ve discovered and developed over the years on my own, not from necessarily taking a particular course. So I love that deeper healing work, and really working with trauma, because that’s the trauma response in the body that can sometimes cause a freeze response in the body and then the tissues don’t really know that the trauma event is over. That freeze response is still held in the tissues. I love that deeper dive.
When we talk about postpartum healing, there’s healing on many different levels. There’s physical healing, and that’s what we really want to talk about today. Emotional healing, and there’s energetic healing, too. I want people to recognize that there is more. When the physical healing isn’t really working, there’s a deeper issue that may be at play that’s keeping that physical healing from happening.
Makes sense. So what are your top tips for our listeners when they are preparing for birth, and then we’ll talk about healing.
So really we need to understand that what we bring to our birth that’s being held in our body is going to impact that birth. It’s really about getting your body assessed prior to going into labor and making sure that the baby has the space and the balance within your uterus and your abdomen to get into a good position to come on out, making sure that your pelvic bones have the ability to move, open, for baby to pass through, and then releasing your pelvic floor muscles as well and making sure that those are like trampolines: able to bounce and give and lengthen to allow the baby to come on out. And so I think every pregnant person should not only just be seeing an OB-GYN or a midwife but also a body worker, someone who is trained in what to look for and how to help create balance and space for baby and assess the body so that baby can come on out. We go into birth just assuming the baby will come on out, and I think that we should be assessing the body more to make sure that it’s ready for birth.
And I feel like there are more and more trained body balancing practitioners, especially in my area, so it is a great referral source, in addition to physical therapy, pelvic floor therapy, not only during pregnancy but also immediately postpartum.
Right. And it’s really important – I think the most important aspects of the body is the uterine ligaments, making sure that those are nice and released and balanced, but also making sure that your pelvic floor muscles have the ability to lengthen for birth is critical. And that you know how to push a baby out. Too many people that I work with in my practice come in and I ask them to push – I’m intravaginal and I ask them to push my fingers out. They actually tighten their pelvic floor. That happening at birth can create those stage 3 or stage 4 tears that go into the anal structure. We really want to try to avoid that, and we do that by making sure the muscles lengthen when you’re pushing.
And tearing is one of the biggest concerns my childbirth students have, as well as my birth doula clients. That fear of tearing is really overwhelming to them and they want to know how to prevent it.
People talk about doing perineal massage, and the research isn’t confirming one way or another saying that it’s helpful. But my thought is that we need to be focusing on the pelvic floor muscles themselves, not just that perineal area, like the opening of your vaginal space. That opening is not where we need to focus. We need to be getting our fingers in deeper and working with the pelvic floor muscles because I feel like the skin is going to follow the muscles. So if the muscles can lengthen and relax, the skin is going to follow.
That makes perfect sense. So after delivery, then, let’s get into concerns. You mentioned tearing, of course. Let’s talk about healing and what your tips are, whether it’s a minor tear or you’re dealing with something fourth degree.
So one of the biggest issues that I find postpartum is that the bones of the pelvis actually need to open up for a baby to come on out. So the two sit bones that you’re sitting on, your tailbone, all three of those bones need to open up, so your sit bones go wider and your tailbone should lift backwards, which is really hard to do when you’re laying on your back, trying to push a baby out. So that position that the doctors find so convenient for them is actually not always the best position for a birthing person to be in because the sacrum needs to lift backwards in order for that baby to come on out, and if you’re laying on it, then the entire pelvis has to lift up for the baby to come on out. The pelvic outlet, from the tip of the tailbone to the ischial tuberosities, that needs to widen for baby to come on out, and I have found, what I want everyone to know, is that that not all the time do those bones go back to their original position. I find open birthing pattern in the majority of the clients that I work with in the clinic, whether they’re coming to me for back pain, pelvic pain, symphysis pubis dysfunction, pelvic floor tension or tightness or pain, pain with intercourse, prolapse, stress incontinence. All of those issues that are very common after having a baby can be attributed to the bones of the pelvis not being in their original position. And when you know what to look for and you know how to close the bones back up to help them get into their proper place, a lot of those problems go away, especially the back pain and the pelvic pain.
Now, some of the signs that your pelvis may be stuck in an open birthing pattern is when you lay on a hard surface, your sacrum doesn’t feel good. It hurts to lay on a hard surface on your back. If you’re sitting, sometimes sitting feels off balance or off kilter because one of your sit bones had to move out to the side more than the other one. One of the key factors that you know if you go see a pelvic floor PT and you’re working in the postpartum period and they don’t ask you what position you were in when your baby came out, they’re not going to be looking at the bones of the pelvic. And a lot of the pelvic floor PTs do not get this concept, unless they’ve trained with me. I’m the only one out there talking about this idea of an open birthing pattern. And so I do have a directory on my website of practitioners that I’ve trained so that you can go and see if there’s someone in your area. But this idea that the bones don’t always go back to their original position is not something that every practitioner out there is looking for.
Very interesting. I do have clients – we have postpartum doulas at Gold Coast as well as birth doulas who are working with our clients up to the first year, and they have that lower back discomfort, especially with breastfeeding in those healing first six weeks. So that sounds like obviously an issue that could be prevented and addressed early on.
Absolutely. And there is an exercise that people can do resisting their knees together and resisting their knees going apart. I have a video on my YouTube channel, which is Institute for Birth Healing. That’s the channel on YouTube. If you go on there and just search for closing the bones after birth and exercise to close the bones after birth – I think it’s titled that. But it shows you how to do it. And I believe in the video I show someone doing it to you, but if you just bend your knees up, you can use your own fists and your own hands to resist those movements, so you don’t need someone externally to help you. You can do this to yourself; just bend your knees up toward your chest and do the exercises. But we’re using the adductors of your hip muscles and the abductors to help bring the bones of the pelvis back together again. So sometimes that can be really helpful for some people. The sooner we do that, the better. I really wish every doula knew how to instruct their clients in doing that because that can be done right after birth. We don’t need to wait, as long as it doesn’t create pain.
If it creates pain, then try the opposite direction, and then if that’s still painful, that person needs help. They need to find a practitioner who knows how to work with the bones of their pelvis to help bring them back into place. And if you are a mom and you’re working with a pelvic floor PT or chiropractor, let them know. I have online courses. Treating the Postpartum Pelvis is an online course that I have that a practitioner can take. My courses are only for practitioners because you need to have a license to touch, to do these techniques that you’ll learn in these courses. Let your practitioner know, go take that course, and then come help me. That’s the best way for you to get help because in the Treating the Postpartum Pelvis course, there’s four different patterns I find in the pelvis after birth, and it teaches practitioners how to close up the bones, how to get rid of those patterns in the pelvis after birth. And I tell you, every day in my clinic, moms get off of the table and they feel so much better. So different in their body after birth, because I’ve adjusted their pelvic bones and gotten them back into a better position. The pelvic floor muscles attach to those bones, so if the bones are splayed open from a baby coming out, your pelvic floor muscles are now lengthened. They’re on stretch. And sometimes the tension or the heaviness that you’re feeling in your pelvic floor or in your perineal area could be because those muscles are trying to keep your bones together. They’re trying to help you out. And so if you go and you see a pelvic floor therapist and they try to release the tension without adjusting the bones, then it could make your pain worse. They’re taking the job away from the muscles. The muscles are trying to stabilize you, and if they try to release those muscles and they haven’t stabilized your bones, your pain can get worse. So please know that, and if your physical therapist or your chiropractor – I know chiropractors are adjusting the bones, but they’re not looking at the bones of the pelvis in the way that I teach. There’s different motions that the pelvis goes through that everybody agrees on, but nobody is really agreeing to this idea that the bones of the pelvis can stay stuck in an open birthing pattern. And it’s funny, Kristin, because so many laypeople and doulas, as well, are like, oh, that makes so much sense.
It does, absolutely. And I remember in my early years as a doula, I attended a Zulu workshop, and there was a closing of the bones ritual. Now, that was more symbolic and healing after birth. It wasn’t necessarily dealing with your topic, but that term was very familiar to me.
Right, and that’s a beautiful ceremony. It’s a beautiful idea. I love it. But it may not address everything because the hip bones are in the way to really moving the ischial bones back into place, and that sacrum being backwards might need some external mobilization.
I do have a free course on my website. It’s the Sacral Flexion Pattern. Again, this is for practitioners. The common postpartum patterns, anyone can sign up and take a look at. I go into more detail of all the different things that can happen in the postpartum body, but the sacral flexion pattern is really for practitioners. And I teach practitioners how to treat the sacral flexion pattern, and that is a game changer. Again, like I said, the pelvic floor muscles are on stretch. When we bring those bones back together, then the pelvic floor muscles are in a much better position to be stronger. And there’s a couple other things that can limit pelvic floor muscles’ strength, and tearing is one of those things that we talked about. When we have scar tissue in there, scar tissue is not as flexible as normal, healthy muscle tissue. And so the scar tissue can inhibit that muscle from being able to function well. But you yourself can get in there and massage that scar tissue. Just offer compression to it and squeeze it and see if you can’t get it to, like, melt between your fingers, because that can help minimize the amount of scar tissue in there.
The other thing I want to make people aware of is when we’re stuck in this open birthing pattern and these pelvic floor muscles are on stretch, trying to have intercourse can be really, really painful because the muscles – the vaginal opening is on stretch. It can’t open up more to allow the penis to come in. That insertional pain is the pelvic floor muscles are not happy. They need help relaxing so that the penis can insert without pain. We need to release that scar tissue, and we need to relax the pelvic floor muscles to help with insertional pain with intercourse.
There’s also deep thrusting pain with intercourse, which can be from the cervix not being able to move out of the way, and scar tissue from C-section scars can cause that.
Back to another issue for why the pelvic floor muscles can’t be strong after birth is that as that baby comes on out, it smushes the bladder out of the way, and it can smush it off to the side, and then the bladder gets stuck over there. And I can find the cervix in any position intravaginally after birth. It can be stuck to your right wall, your left side vaginal wall. It can be pulled back. It can be poking into your bladder. If it’s poking into your bladder, you feel like you have to pee all the time. So getting that cervix back into its midline position by balancing the uterine ligaments and getting the bladder back into place instantaneously changes the strength of the pelvic floor muscles.
That’s amazing, because that is a common concern is that, yeah, frequent urge to urinate after that postpartum healing phase.
And that stress incontinence. When the bladder is off to the side, the pressure from your abdomen can’t reach the urethra. And so that’s why the pressure only hits the bladder and so that’s why we leak. If we can get the bladder back into place, then some of that abdominal pressure can hit the urethra and the bladder and keep the differentiation of pressure inside so that you don’t leak. That’s a bigger concept than most people might understand there, and I’ve really simplified it, but there is a reason, with the bladder being off, that can cause stress incontinence.
Another thing that can cause stress incontinence is that your lower body is jutting out when you go to laugh, cough, sneeze, which increases pressure on your bladder. So your upper abdominal muscles are pushing down, causing your belly to jut outward, and that can increase pressure and every time you do that, you can be leaking urine. So you need to learn how to get your lower belly muscles activating stronger than your upper ones to keep the pressure away from the bladder when you laugh, cough, sneeze. So if people just put their hands on their lower belly and they cough, the belly should draw up and in. If it’s pushing out, that’s something that you need to work with for your belly.
Excellent tip. Another common postpartum concern is hemorrhoids. How would some of your tips factor in there?
Yeah, so the hemorrhoids are around the anal sphincter muscle, and the anal sphincter muscle, I find, knots in most every single postpartum person that I work with. And the anal sphincter muscle gets so stretched out from the way the baby has come on out vaginally. And those knots can create problems with hemorrhoids and also fissures. A fissure is a tear inside the rectal anal canal that every time you have a bowel movement, you’re opening up that wound, and it really feels like you’re pooping glass. It’s so painful. So any time anyone is dealing with hemorrhoids or fissures, you need to release the knot in your anal sphincter muscle, and it’s super easy to do the top half. You can just put your thumb in vaginally and your finger in on the anus and just kind of press around and see if you feel any knots or tenderness. But to do the lower half of the anus, you need to maybe put your thumb in on the anus and kind of push down. If you think about the anus like a clock, you should be able to push in all different hours of the clock, and they should feel nice and mushy and mobile. But if it’s harder or thicker, that’s a tension in that muscle, and it needs release work. Compression of that knot in that muscle can help it to release. And so if you can check that out yourself and try to release what you can – if not, one of my practitioners who have taken my postpartum course can help you out. They know how to release it, and then they can show you how to continue to do it yourself because you definitely – if you’re dealing with a fissure, you definitely want to release your anal sphincter muscle before every single bowel movement.
Excellent. So is there a point where it would be recommended to release some of that tension? Would it be immediately after birth or waiting for six weeks?
It depends on if you have any tearing. So you need to let any tearing or episiotomy scar tissue heal well because it’s going to be way too uncomfortable if you still have stitches in there or if you have an open wound. With a fissure, I find the open wound is opposite of where the tension is. So if you have a sense of where the pain is in your rectum as you’re having a bowel movement, try assessing the opposite side of that circle and seeing if you can release that tissue. That can help because it’s a circle muscle. It all needs to open up evenly to allow the stool to come on out. When we have those knots, that knot area can’t open up as freely, so the opposite side has to open up more. Something’s got to give in order for that stool to come out, and that’s why tears open is because too much pressure is happening there because the opposite side can’t open as well. So releasing that allows that sphincter muscle to open up more evenly, and it takes the strain off that open wound. And that’s what helps it to heal.
But I’m saying if you tore vaginally and you had an episiotomy, wait for that tissue to heal before you go messing around in it. But if you have a fissure and an open wound, you want to try to work with the anus outside prior to having bowel movements to help that to heal.
Okay. Thank you. Any other tips or healing conditions that we didn’t discuss?
Oh, there’s so much. There’s diastasis recti, and you need to release the oblique muscles for that. There’s an oblique release that needs to happen to help speed up the healing of diastasis. And then understanding how the belly gets messed up from birth – all that is covered in my Confidence in the Core, Floor, and More course. That course is designed for moms, so you guys can check that one out. All the other courses on my website are for practitioners. But that has a ton of information in it that can help you understand why your body is being the way it is and what you’re experiencing. And that Confidence in the Core, Floor, and More online course is appropriate for anyone to take. There’s more information there.
And then I really just want postpartum people to know that healing is possible. Doctors don’t give you that sense. So they’re just kind of like, oh, well, you had a baby. What do you expect? And there is healing that can occur, no matter how old your baby is. Please know that there is support for you to feel better in your body after birth. And if you’ve been working with a pelvic floor PT or you’ve been seeing a chiropractor for a while and you’re not getting results, please check out one of my birth healing practitioners on my website. Check out the link to the directory and see if there’s someone nearby. And also recognize that if you feel your birth was traumatic, you need to work with the trauma from that birth first. And that is something that I can assist people with via Zoom. You do not need to be in person to do that trauma release work. That can be done over Zoom. So you can reach out to me at the Center for Birth Healing. That’s my clinical practice. Just reach out and fill out a form and we’ll get in touch and we can set something up. That is how I would like to support moms, knowing that there’s practitioners that I’ve trained that know what I’ve talked about here today, and they can support you.
I also have a Facebook group, Institute for Birth Healing Community, that not all of my practitioners who have studied with me are on my directory yet. I’m working on it. But there are lots of others who have taken my courses that just are not in that directory. So find my Institute for Birth Healing Community group. It’s another avenue to try to connect with someone in your area. Ask the join that. And there’s practitioners and moms in there alike, and you can see if there’s someone in your area that people recommend.
Excellent. You shared so much wisdom in 30 minutes. Any other social channels you’d like to promote outside of the Facebook group and your website?
Yeah, @instituteforbirthhealing on Instagram. Join me there, and you can hear what I have to say on Instagram, too. And then I talked about the YouTube channel, as well. Those are the best channels for me. Thank you.
Thanks so much! We’ll have to have you on again, Lynn.
Absolutely. I would love that.
IMPORTANT LINKS
Lynn’s directory of practitioners