In this week’s episode of the My Sleeping Baby podcast, I sit down with my friend Nikki Bergen of the Belle Method to talk about everything you need to know about your pelvic floor and pelvic floor therapy after having a baby. We had a great time 🙂 Have a listen!
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Hey there, you’re listening to the My Sleeping Baby podcast, which is all about baby and child sleep. I’m so excited to teach you how you can get your little ones sleeping so that you can sleep too and enjoy parenthood to its fullest. I’m Eva Klein, your resident’s sleep expert, mom of three, founder of the Sleep Bible online coaching program, and lover of all things sleep and motherhood. If you’re looking for tangible solutions for your little one sleep woes or you simply want to learn more, this podcast is for you. For more information, check out mysleepingbaby.com and you can follow me on Instagram and Facebook @mysleepingbaby.
All right. Okay, Nicki, thank you so much for being here today. I’m so happy to have you on the, my sleeping baby podcast.
Nikki : (00:52)
This is gonna be a good chat.
Yeah. Thanks so much for being here. So we met, do you remember where we met? We met in a parking garage.
Nikki : (01:00)
I actually do absolutely remember that we were, we were both like running late for one of the mom’s to events. Yes
Nikki : (02:03)
It’s true. It’s true. I remember thinking like, I’m like, she’s going to the mom’s event. Like there’s a mom right there holding like a tiny little infant car seat.
Yes, yes. That was, that was 100% me
Nikki : (02:20)
Totally. So I am a Pilates instructor. I’m the creator of the bell method, which is essentially like a fitness program for women, for pregnancy postpartum and well beyond. So you don’t just have to have recently had a baby or be pregnant to actually do it. And it’s really about combining Pilates and pelvic health. So it’s not a traditional Pilates class. It’s it’s we take, you know, we’re inspired through Pilates, but we’re also infusing a lot of pelvic floor therapy within the workouts. I’m a former dancer too. So I promise you it’s not boring. Mm-hmm
Yes. And I can definitely, I remember when we were walking to that event together, I, I noticed, I knew, you know, how I knew that you were a previous dancer is because you walk, you were walking with your feet, turned out really, and a little bit, a little bit. I noticed it. And I was just because you mentioned dancing. And I was like, oh, is that why your walking turned out?
Nikki : (03:32)
It’s funny. I mean, I used to do that when I was in high school, one of my high school teachers also used to be a dancer and she noticed me walking with my feet, turned out and she was like, you’re a dancer, aren’t you? And I was like, how’d, you know, that she was like, was the way that you’re walking
Nikki : (04:11)
So, oh, thank you. We do play like lots of random nineties hip hop, so, you know
Yeah. Which is totally my jam.
Nikki : (04:58)
Okay. So first of all, everybody, even if you’ve never been pregnant or had a baby should be, you know, learning about their pelvic health. So there are people who have pelvic floor dysfunction and need pelvic floor therapy, who’ve never even been pregnant. So mm-hmm,
Nikki : (05:41)
Like leaking like feelings of heaviness, um, like, you know, something’s falling out of your vagina, that’s a sign potentially of pelvic organ prolapse. Yes. 50% of us in our lifetime will develop pelvic organ prolapse. It’s a very common thing. You know, if you’re dealing with, um, even abdominal wall laxity, diastasis, recta, feeling like your abs have separated. All of these things are very common issues, but we are not really given enough guidance on both either how to prevent them and also how to deal with them once we’re dealing with them postpartum. So, right. That’s kind of what we talk about all the time, every day.
Right. Right. And I think that also it doesn’t help when you see commercials for pads that you can wear if you’re leaking. Right. Yeah. Nor does it help, you know, when probably many people think like, oh yeah. You know, when my mom, when my mom was, you know, or is dealing with, you know, one of those issues, like, yeah, she has these pads that, you know, she wears and, and that’s just what you do. And that’s just what happens when you get older, after you had a baby and it’s just, you know, part of the circle of life. And you’re saying not circle of what
Nikki : (06:49)
Okay. Old disclosure. Like I would be probably fairly wealthy if I could accepted all the advertising offers for, you know, different poise and depends and tea, whatever I am, I’m pitched all the time. And I, it’s funny, I say to them, I’m like, okay, okay. I’ll do, I’ll, I’ll work with you under the condition that you’ll update the information on your website and actually direct women to pelvic floor physiotherapy and make sure that they understand that your products are, you know, part of the journey, but not the solution. And then I never hear back.
And then you never hear back
Nikki : (07:31)
Right. You mean in a nutshell. Yeah. Yeah. And so, but
Why would we want people to go for pelvic floor therapy? Why would we want people to strengthen their cord? Then it means they’ll stop peeing their pants and then they won’t need our product.
Nikki : (07:43)
Well, you, you, I think you kind of nailed it. So, I mean, again, it’s, it’s not to say that there, there isn’t a use, especially like on your journey to recovery. Right, right. Like, you know, fine. And there are pessaries, you can use, there are different devices that you can insert into the vagina that can actually help support your, your organs mm-hmm
Yeah. Yeah, no, listen, I, I totally agree. So, and you know, what’s something else that I learned that I didn’t know was a reflection of pelvic floor dysfunction is lower back pain and that pelvic floor therapy can help. And, and I realized that, you know, when I was, when my son was maybe two months old, so how, how much did he weigh at that point? I don’t know, 10 pounds, 11 pounds, you know, something like that. Not, not much in the grand scheme of things, but I started noticing after holding him for maybe three or four minutes that I started getting lower back pain. And that was when I thought to myself, is this my pelvic floor? And it turns out it is
Nikki : (09:47)
Yeah. It’s true. A lot of women are, are suffering in silence because they don’t recognize the connection. I’ll give you the example of pain with sex, which is a hugely common issue. It’s called DYS Peria. And a lot of women are told even by their medical care providers, oh, just use more loop, PVA, glass of wine, you gotta relax, blah, blah, blah. Yeah. And, and then that sort of feeds into this, oh, I’m frigid or it’s my fault. Or I just need to relax when actually you’ve got like massive amounts of tension in your pelvic floor, maybe you’re dealing with C-section scar tissue adhesions, and that’s causing your uterus to not glide out of the way, like it’s supposed to during penetrative intercourse. And so, you know, these women are like, I’ll just use Merlo, it’s not getting better. And that, and then they can actually start like this feedback cycle of anticipating pain with sex. And then the problem becomes this biofeedback loop and it gets worse and it gets worse and they don’t talk to anybody about it cuz they’re like, oh, there’s something wrong with me. Meanwhile, mm-hmm,
Yeah. Yeah. And I think that, you know, this is, I mean, and this is probably, uh, this is for sure. I can tell you like a bigger problem, you know, with the overall medical system and you know, by no means, am I knocking medical doctors here, folks, like that’s, that’s not, you know, the purpose of, of what I’m about to say, but you know, generally speaking, the medical world is very focused on treating things that are clinical and making sure that you stay alive. Right.
Yeah. A hundred percent. It might not affect your lifespan in the slightest, but when it comes to thriving and being able to enjoy life to its fullest, that’s where, you know, I think the medical that’s, that’s just not the specialty of our Western medical world. And that’s where we need people like you to say, okay, here’s the good news. The good news is that you’re not dying. Okay. So we don’t need a medical doctor necessarily for this. Um, you know, and, and the also piece of good news is that we can, we can improve this so that you don’t have to deal with this anymore. Mm-hmm
Nikki : (12:14)
I know, I love it. You say it. So articulative, I love it. Like it’s not surviving versus thriving. It’s true. Yeah. It’s very true. And, and people ask me all the time, like, well, what, what should I get surgery, for example, for prolapse mm-hmm
Line of yes, you’re going under the knife. Like it’s not a, it’s not a, a little minute thing
Nikki : (13:04)
And it doesn’t have a huge success rate either. Like there’s a lot of, I guess what I’m saying is there’s a, a, you know, it’s common for you to go through that surgery and then, you know, less than 10 years later, you’re dealing with the problem again kind of thing.
Yeah. So yeah, a hundred percent. I mean, just on a, on a quick side note, I mean, I see this as no different than, you know, when the moms that I’m working with are chronically sleep deprived because their babies are not sleeping. You know, it’s so easy for someone to say like, yeah, this is just normal. This is just like normal part of being a mom. Like babies are just not meant to sleep and you’re gonna be chronically sleep deprived. And that’s all there is to it. And you’re not gonna die from sleep deprivation and you’ll survive and you know, you’ll sleep eventually, you know, when they’re 18 and suck it up. Right. And enjoy motherhood, cuz it’s so beautiful. Right. Not to, not to, you know, put a little bit of guilt in there. But um, when the reality is that okay, fine. Yes. You’re not gonna die, but on the other hand you also don’t have to live like this if you don’t want to. So, you know, it’s, it’s, it’s the exact same thing. It’s, you know, the surviving versus thriving thing. Like I wanna thrive. I want to be able to live my life to its fullest. And if there is something that, you know, I can do that we can do to help people live a better quality of life, like why the hell not? Right. Yeah.
Nikki : (14:20)
It’s true. And there’s so much, there’s so much there. There’s so many layers there and I’m sure it is the same with the people that you work with. And it’s, it is the same with the people that I work with. It’s also sometimes a belief that like it’s gonna work. So for example, a lot of the exercises we do at the beginning of a rehab in our say our level one postnatal class mm-hmm
Nikki : (15:06)
It’s not gonna be so boring. Mm-hmm
Yes. So what are the first steps? So someone they’ve had a baby and you know, they’re dealing with some of those issues, maybe, even just one of them. Um, they do wanna eventually get back to their CrossFit. Their OB told them at the six week checkup,
Nikki : (16:46)
Breathing, breathing and sounds again, people are like, really? I’m like, come on, gimme something juicier than that. No, it’s, it’s learning how to breathe using your diaphragm so that your pelvic floor is moving correctly. Mm-hmm
Yeah. Oh yeah. I just noticed that.
Nikki : (17:34)
Yeah. You’re just, I just watched you and the camera here. Right? So you’re inhaling and your shoulders go up to your ears. Well, when you breathe like that, it will turn your pelvic floor off. Essentially your pelvic floor goes on a little vacation. Yeah. And it’s not functioning and you’re dealing with more pressure in your core. And in side note, that breathing pattern is actually very common to develop in pregnancy. Mm-hmm
Nikki : (18:35)
It’s always a necessary step and a pelvic floor. Physio will teach you on that. However, they’re doing so many things that their assessment. So really you need to see a fitness person like myself who can actually teach you how to integrate that into your daily movement. How do you breathe during a workout such that you can retain pressure? You can create that tension in your pelvic floor. You’re not gonna pee your pants when you do jumping jacks, all that kind of stuff. So yeah, both, both a fitness professional who’s really understands pre and postpartum. Um, and also a pelvic floor physio. Yeah. But they’re gonna give you an internal vaginal exam, which of course is something that I’m not gonna be giving you. Yeah.
Nikki : (19:17)
Keels are, are given keels are very misunderstood. So essentially KES are the name for the lifting of your pelvic floor. It’s the colloquial term for lifting your pelvic floor. And they’re named Dr. Arnold Keal discovered them in 1940 during a gynecological exam and naturally named them after himself. Oh yes.
Nikki : (19:40)
Obviously, but the keel is just the lifting of your pelvic floor. So you may hear people tell you, oh, just go do your keels. But then you also might people, might people say like, don’t do them at all. So essentially you have to figure out what’s the state of your pelvic floor. So if you’re dealing with existing tension in your pelvic floor, then it’s important for you to learn how to lengthen the muscle before up training before Keeling. So you would wanna first focus on like reverse keels or pelvic floor drops or blossom breaths. There’s so many things we call them. It all means the same thing. It’s the sensation of get your diaphragm moving. So that, that toilet plunger visual, that jellyfish can drop down and expand your pelvic floor can expand before it can lift. So not everybody, but a lot of people need to first focus on that before they’re gonna benefit from keels per se. It’s kinda like if you go, you know, and I, you’ve probably heard this analogy before, but a bicep curl, what? Imagine your arm was kind of permanently bent and now you’re like, I wanna strengthen my bicep. So then you just do tiny little mini bicep curls. It’s not gonna give you results first. You need to learn to fully straighten your elbow before contracting it back. So that’s
The equivalent of like having a tight pelvic floor,
Nikki : (20:55)
Yep. And so if you’re doing KES with a tight pelvic floor, presumably that’s just gonna make matters worse,
Nikki : (21:01)
Yeah. Which is why, I guess going to a pelvic floor physio to be told your pelvic floor, you know, to get that diagnosis, your pelvic floor is tight. Your pelvic floor is loose. Therefore you should be doing this. Not that is gonna be essential
Nikki : (21:15)
And it is essential. But I also wanna say, it’s not so black and white, so you can have a combination of hyper and hypo tonicity. So just like you might have knots on one side of your shoulder, you can have knots on one side of your pelvic floor. Right. So you can have tension on one side and laxity on the other side. So wow. You know, you might be needing to do a combination of different things, right? Uhhuh
Feel like you need to go pee.
Nikki : (21:59)
Yeah. But like it’s not coming you, uh, constipation. Um, those are some pain like vulva pain, just pain in that whole area. Tailbone pain mm-hmm can be associated. I’m not saying it’s causal, but it’s certainly correlated with tension. Yeah. In the pelvic floor and then hypo or laxity, hypo, toity or laxity is more associated with like the feelings of heaviness, something bulging down, coming out, um, a tampon falling out mm-hmm
Nikki : (22:43)
Normally how does that work? Well, you go for a run and you leak and you assume you need to go do keels, right? Yeah. When, and you might need to, but you know, you might also be someone who’s already too tight and you’re leaking because you’re too tight. So it lo it works like this. So I’m going to, and I know people listening, aren’t gonna be able to just necessarily see my hand here, but I will describe what I’m doing with my hand.
Not at all. We’ve all been to, we’ve all been to Chuck cheese, cheese ones and our lives.
Nikki : (23:48)
Okay. So that’s an analogy for what your public floor is doing. So pretend like your public floor is this, this robotic claw trying to pick up like a stuffed giraffe. Mm-hmm
Nikki : (24:06)
No. So tension is equated to weakness in this case, because mm-hmm,
Relaxed. Yes. Yes. Because if the claw is just, doesn’t actually close, then you can’t grab the little stuff giraffe either.
Nikki : (24:55)
Yeah, yeah. Yeah. So when, when you have, you know, clients, people that you work with that say, but my OB said at my six week appointment, that I’m totally free to start resuming everything. Um, I mean, how do you feel? I mean, it’s, it’s very common messaging that, you know, people here at that six week appointment. So what, what’s your thoughts on, I guess how this system is set up right now?
Nikki : (25:23)
Yeah. I mean, doctors are doing their best, you know, they’re not, they’re not fitness experts. They’re not physiotherapists. They don’t have the training on the pelvic floor. Right. Um, they just don’t. I mean, I hope that that changes cuz it would make so much sense for them to have some training, to give you a quick assessment of, you know, prolapse or diastasis or whatever, ask the right questions. But they’re also like not incentive to do so they need to get a certain, especially in Canada and they need a certain volume and number of patients through their door, they don’t have a time to sit down for an hour with everybody to go over all these things. Yeah. So, you know, and, and as it relates to the six week postpartum checkup, I have friends, I’m friends with lots of OBS and I’ve asked them this question, like what’s up with the six weeks and they’re like, Nikki that’s cause it takes six weeks for stitches to dissolve.
Nikki : (26:07)
That’s it? That’s it. The only reason it’s the six week thing. It’s like, well, if you had stitches, they should be dissolved by six weeks so we can check them in. That’s the only, there’s nothing magical that happens at six weeks postpartum. And people seem to think that that it’s this magical like benchmark. It’s not, it’s not. So we actually recommend you start, if you are listening to this and you’re very early postpartum or pregnant start like pretty quickly after birth, you can start your core breathing literally the same week you deliver regardless of its vaginal or cesarean birth.
Yeah. No, I remember you posting about that on Instagram. Like after you had your son, you were showing everybody like your breathing that you were doing maybe seven days postpartum.
Nikki : (26:47)
Yeah. Yep, yep. Right. No. And it’s, you know, and it’s not to say, and this is so funny, like let’s go back to when we first met and you were in the parking garage. Yeah. Yeah.
Nikki : (26:57)
Heavy was that freaking infant car seat and you were 10 days postpartum and yet you’re told not to work out and you’re lugging like probably at least a it’s a massive ketlebell that you’re literally doing like a unilateral core exercise where you’re holding all this weight on one of your hips and arms and walking like pretty far.
Right? Yeah. Like,
Nikki : (27:17)
And yet would tell women not to work out, gimme a break, come
On. Yeah. Yeah. I mean, we have this thing called life. Um,
Nikki : (27:45)
Yeah, we do. And it’s so this is where it’s like using the techniques that you can learn in pregnancy. We can also learn, you know, postpartum, it’s like protecting your core so that you’re not, you know, exacerbating issues. You’re in a very vulnerable state in those early. Yeah. You know, I’d say three months postpartum and there’s so much we can do to protect our core. Um, and pelvic Florida improve our own body’s healing. Yeah. Um, and, and it comes with gentle movement and this is much easier. Like the pressure load of picking a baby out of a bassinet is much higher than doing the exercises that we would recommend you do. I’m
I’m sure. I’m sure. And it’s, and it’s kind of crazy cuz when you think about any other injury or that someone might, you know, that someone might experience, um, first of all, there aren’t number one. There’s no arbitrary times when you know, oh, it’s been a month. All right. Time to get your cast off no matter what. Um, nor, and, and, and as well, most depending on the type of injury that we’re talking about, most people need some type of rehab, you know, they end up going to a physio as part of their recovery process. But for some strange reason, neither of those factors have been addressed when it comes to birth. We don’t see childbirth, whether it’s vaginal or C-section as an injury that requires rehabilitation.
Because I guess it’s also this beautiful thing. I mean, you do have you don’t I understand on the one hand, I mean, I don’t wanna think about my births as an injury per se. You know, the term is not, it’s such not such a nice way to describe the fact that, you know, you just birthed a life into this world. It’s a wonderful, amazing thing, but you’re zinc thing, but your, your body does go through it is the equivalent of an injury that your body had to go through in order to bring this child into the world. Right?
Nikki : (29:40)
Yep. A hundred percent. And, and it, I mean, I I’ve spoken about this before, so I had heart surgery at four months postpartum. Yes. It was like a catheter ablation. So it wasn’t like open heart surgery, but you know, it’s still like, and it’s a relatively, like pretty, literally it’s a day surgery. So I went in and they go and they put the catheter in your femoral vein to go up and put a wire in your heart. And I had to have an ablation for an arrhythmia that I’ve had since I was a teenager. And honestly the amount of street cred I got for this day procedure and it’s a surgery and you’re in like, you know, but still like I could have milked that, let me tell you, oh gosh. And yet everyone was like, oh my God, heart Sergia how are you? Take some time off.
Nikki : (30:22)
I’m like, do you realize this was literally zero on a scale of zero to 10 when childbirth was a 10 and I didn’t get that kind of street cred no. After, you know, or like that’s support or that like outpouring of like, wow. You know, but like that’s the way our culture sees birth. Birth is like, man, meanwhile, anything to do with your heart. It’s like, oh my God, your heart. Right. When literally I went home the same night, I felt like I could have gone out the night after. Right. It was fine. Right. You
Felt a lot, a lot better after your heart surgery than you did both of your births.
Nikki : (30:55)
Oh, it was like, yeah, literally it was, it was a non-event and yet, you know, and so this, I shared this to illustrate this sort of double standard. Right. Mm-hmm
Nikki : (31:11)
Is still by far the largest recovery.
Yeah. Yeah. So, you know, let’s, let’s take that six week milestone as, um, with a grain salt, you know? So it, your OB says that, you know, you’re healing well, okay. That’s great. You know, that’s not something to knock, let’s celebrate that. But, um, you did also birth a child six weeks ago in some way. And uh, and it’s just like, think of it as any other procedure that you went through. There’s no, you know, magical cutoff point where life just completely goes back to normal.
Nikki : (31:48)
And we tend to tell, I tell the students start your rehab early, but gently. Yeah. So one of the worst things you can do is do nothing for six weeks, wait for your clearance. And I’m using air quotes here. Yeah. And then go for a run cuz you’re cleared and go to, you know, your favorite CrossFit class again. Or you’re gonna go for a run around the block or whatever it may be because, and then this is such a common scenario. You don’t get any guidance, you don’t do anything cuz you’re waiting for that clearance. Mm-hmm
Yeah. Yeah. When really there is what that you can do during that six week period. You don’t just have to sit, you know, sit down and wait. Um, and then by the time you reach that six week mark, it doesn’t mean that your body is magically back to the way it was before you got pregnant.
Nikki : (32:42)
No, not even.
That’s just not how physiology works.
Nikki : (32:45)
No. And, and there’s even research like guidelines outta the UK regarding like when is it safe or recommended? I should say to go back to high impact exercise like running and they, they actually recommend waiting. No like really don’t do it even any earlier than three months postpartum. And I ideally better to wait until six months postpartum.
Your always seems to be a little bit further ahead.
Nikki : (33:21)
Few years in some ways,
In some ways when it comes to these sorts of things, I
Nikki : (33:24)
Think it depends on the country, I would say. Um, cause it really depends, but yeah, there’s some really great physiotherapists in the UK and they put together this guideline and, and it’s something we, we talk about a lot in, in our classes, but essentially yeah, making sure that you’ve got enough strength and function, unilateral, glute strength, like there’s a whole bunch of, of sort of benchmarks and tests that you can do on your own to determine is your body ready to go for a run? Right. That’s
So smart. Yeah. We need that. And it’s we do. It’s also straightforward. You know, it’s not complicated, but I feel like we, we need that. We need something more than just that six week benchmark. Um, to be able to tell us what we’re, what we’re safe to do, cuz I’m sure there are people that at the six week mark, they might be ready to go for a run it’s possible. No, no they’re not. No. Okay. Not
Nikki : (34:15)
Possible. They, they may feel they are, they may go for a run. They may not have leaking, but their body, they’re not doing their body any favors because okay. One of the things people don’t realize is like, when you have a vaginal birth, the axons of the nerves are actually stretched to a point of damage. Mm. So that’s partly why, when you’re, when you are doing quote unquote keels postpartum, it might feel like I lost my connection. I can’t feel my keel. Yeah. Cause your nerves were damaged. They will come back. Yeah. That neuromuscular connection will come back. But like it certainly hasn’t completely come back at six weeks postpartum and then you’re gonna go and do a very high impact exercise. Yeah. Adding more downward pressure and strain on nerves and muscles and fascia and connective tissue. That’s not fully rehabbed. So there are people who actually develop prolapse postpartum because they do things too soon. And this isn’t meant to be disempowering. This is just me. This is in on the contrary. It’s meant for me to say, you know what, like give yourself a bit more grace. Six extra weeks of your life is a blip on the radar, but it can make a lasting impact on your pelvic floor.
Yeah. Okay. Well I stand corrected
Nikki : (35:47)
So we offer live classes every two months. It’s an eight week session. So we have a level one postnatal class, a level two postnatal class. So level one can be started, you know, as early as I would say, three to four weeks after a vaginal uncomplicated delivery. Mm-hmm
Nikki : (36:36)
I’m gonna go back to my regular class. Mm-hmm
Nikki : (37:18)
But then the pandemic came and I was 35 weeks pregnant and the world shut down and I was like, crap,
Nikki : (37:25)
Out and like shut down all the locations and take all of our classes online. Yeah. And um, in a way it’s been a blessing because now we’re teaching women all around the world.
Yes, yes. You can serve so many more people, um, who need you
Nikki : (37:46)
The bell method.com it’s bell, B E L L E method.com. Yes. Yeah.
And on Instagram as well.
Nikki : (37:54)
Yes. Same. It’s all the same handle. Yeah.
Yes. Okay. All right. So that will all be posted in the show notes. Nikki, thank you so much for coming on. This is, um, gold. This is gold stuff that, you know, every, that everyone needs to hear and digest and apply to their life, however, which they need it. So thank you. Thank you. Thank you. And thank you everyone for listening. All right. Have a good day, everyone.
Thank you so much for listening. If you enjoyed this episode, please subscribe, leave a review and share this episode with a friend who can benefit from it. I also love hearing from my listeners. So feel free to DM me on Instagram @mysleepingbaby, or send me an email at firstname.lastname@example.org until next time have a wonderful restful nights.