Oh didn't see you there. You caught me preparing to record an interview with Julie wiebe. Who's a sports medicine physical therapist with a special interest in the pelvic floor. And I just poured myself a glass of 2017 Malbec from zaccardi wines. We're about to get freaky and I'm glad you're here to join me on this on this little journey will get right into the interview here in a moment, but first a quote from Pittsburgh native and environmental science extraordinary Rachel Carson, those who dwell among the Beauties and Mysteries of the Earth are never alone or weary of Life those who contemplate the beauty of the earth find reserves of strength that will endure as long as life lasts the more clearly We can focus our attention on the Wonders and realities of the universe the less taste we shall have for Destruction. Cool after the interview, I'm going to have some shoutouts some personal stuff as well as some information on an upcoming breach conference that I have helped facilitate here in Louisville, and I really can't take much more credit than that's Rick's of fries and David Hayes of have been so kind as to bring their workshop that I talk so gratefully about they're going to bring it to Louisville at the end of February. It's going to be the End of February 28 29 and then March 1st. It's a Leap Year everybody 2020 is and we'll talk a little bit about that and some have some registration info but without further Ado. I hope you enjoy my wide-ranging conversation with Julie wiebe. The official OB guy know why no podcast pelvic floor spiritual advisor. Joey welcome. Hello. I have been trying to I think we've been trying to make this happen for for quite some time ever since we were both on the west coast and now here we are on opposite. That's right. That's right. That's right. How's everything going? Tell us who you are? My name is Julie wiebe. I am in Los Angeles former neighbor to Nathan down in San Diego. It's raining here and usually today in Los Angeles. Well lucky you well, although it's great. We don't mind a little rain around here. So yeah, but physical therapist. My specialty is pregnant and postpartum women and helping them return to Fitness and Sport after injury and pregnancy. So love to talk about all things related to ladies curious how your wife's feeling these she's doing great. Let's see today is Wednesday. So we were we're right around the 27 week Mark. Oh my gosh, I've learned is the size of like a what did we say like a cabbage or something? I don't know what whatever one of the one of the veggies were doing it right? She's doing great. Like she has like an easy pregnancy. Oh, it's hot. Are you dropped out? Not men. Oh, we're good. So having some technical difficulties. So yeah size of a Cabbage. It's one of those one of the that's the vegetable that we're at and I love cabbage. Personally, so sounds are big delicious. Yeah sleeping. Well, she's still exercising. She's still you know, we're still eating healthy. She's hadn't really had a remarkably easy pregnancy so good for her. That's great. When we met you we were talking about a lot of your piston breathing exercises and whatnot. And we were we still talk about some of those things. I think it's it's been harder and harder for her to it's been easier and easier for her to imagine. What all of that means now that she has like the weight like she's like everything's heavier now and so we still talk about, you know, getting out of bed and not holding your breath for every single movement. And I know that we're going to get into that. But yeah, that's great. But yeah, thanks for asking. We're super excited. We did get a king-size bed. We got one of those box mattresses. I was I was just telling you about tufton needed the company like a memory foam mattress, and she has her body pillow and it's awesome. That's awesome. I did not have that luxury when I was in her shoes. It was a lot longer to get to her our big bed. But yeah, but that's that's I'm so glad for you guys. Yeah. Well, thank you. Thanks for engaging us early on in the process to worse. You are a physical therapist extraordinary and you are very popular. I have to say so you have a fan club and I've learned that because because your name came up in my previous podcast with Ryan Stewart who's a physician and a Euro no way. We call a public medicine and oh gosh, what is it pelvic pain and it was a very long destructive surgery. Yeah, it's this long acronym but you're a gynecologist and he and I have got to be very close friends. Very good friends easy friends. That's you heard that episode. That was our two episodes ago or something. It was terrific. Well, thank you. Thank you. Yeah, actually it was really nice to have another person who's and he's clearly an expert in the medical medic to truly medical and surgical stuff, but he obviously appreciates the The caliber of care that is that is providing when we have multiple people kind of weighing in on these albums. So I thank you for being here. I think it's this is going to be a very colorful conversation with you Julie. I've looked through so normally we have five pearls this conversation is so deep that we have six pearls and you know, normally I start by listing them, but I was thinking why don't we start with each one read? Why don't we go through each Pearl and then we can elaborate as we Go and then at the end it's like six separate many conversations and we'll just see how things go from there. Sounds great. I meant so the first one is also we're drinking wine and yeah, Joey, what are you drinking? Somewhere like a somewhere. Yeah in Kentucky It's Five O'Clock in Kentucky. So you can drink for me definitely time to drink so that's right. Okay. Sorry. I am detracting from this important job solution. Julia Bell gets good. Here we go. Let's start with number one you said and I do you mind if I read the point and then you can maybe he's collaborated. Okay. Yeah go for it. So we are first going to talk about serpro number one low back pain incontinence and painful sex aren't able after pregnancy. We have new tools to help. What are you talking about? I think it's really about the messaging. We're sending across the board in medicine my from the top down that that we can start communicating from the top down this idea that your body doesn't fall apart after pregnancy. Like I think that that's sort of our cultural norm and if we can have that conversation out of the gate that this doesn't I mean that your life is over and you're doomed your body's going to fall apart because I had so many patients come to me with that message either from culture or through medicine or rehab or family. I like there's just this sense that it's just your kind of it's over and they yeah, of course you have lower back pain you had a baby course you will you know what I mean? And so and and I think that's part of what I appreciated so much about your conversation with dr. Seward was it was so clear like I think so many women have haven't heard carrying messages from their providers. They've heard fearful messages like that. And so I just was so grateful and I wanted to share it with my people to say, you know, listen, please listen, there are people out there that really want to help you through this process. And I wonder if we can communicate like that how out of the gate how different their perception that will be for our women that they would seek help they wouldn't just accept it, but they know that there's options out there for them. So And I think that's and we really do have new tools. Like we have so much more to offer women as we do more research as we ask more questions as we demand more as we actually demand this can't be the result of the most important thing. I do like I got to get become a mom. But that doesn't mean you have to fall apart like we need to we need to start getting that message in that hope yeah. Yeah, you know, I think society as a whole in our role in supporting one another as people. We often times jump to like those negative anecdotes that help us relate in some way. It's sort of like, oh the old ball and chain or the, you know kids tell me about it and like yeah sitcoms and through that sort of conditioning we all get comfortable with this idea that like everything sucks because of X Y or Z and it just simply doesn't have to be like that like like you talked about my wife is training to become a pilot and every time she brings it up people are you know, they'll say something like oh, yeah. I had a friends whose dad died. Flying a small plane and stuff. He's like, why is that what you're leading with? You know doesn't make me want to talk more about this. Yeah, and I'm sure like as a pregnant woman. I can't tell you how many people told me their stories while I was pregnant with my first and I was like and I try very hard to say very positive things when I see when I see new moms, but it's there is a culture around it and especially when you think about parenting I really believe that kids live in to what they fear your parents like. If they hear that there is bad news or oh what a pain or you know, you see those pictures on Instagram. Yeah of moms, like rolling their eyes while their kids struggles to get in by themselves to the car seat or whatever and I think come on like they're trying to be shamed. They're being shady, you know stuff like that. I just think kids live into that we all do there's so much strength to messaging and and I it's I think that we in, Our positions you and I have a role that is very powerful and it's powerful and I don't mean powerful potent maybe is a better word like and we can use that power. Well, like we need to recognize also incredibly. Yes how the potential of our words it carries so much weight and yours carry more weight than mine, like ultimately that and that's just the truth is this point the reality the reality like it? It's up. I didn't go to eight years of school and residency and you know, I had I don't have like there's a reason why there's this this leveling, but but I think Doc's need to hear, you know, some of the things that I hear Downstream are like gut-wrenching that they've heard from their docks. And so again, like like with great with great power comes great responsibility, you know, and again Spider-Man. Yeah, we we in medicine, you know, there's this D of gaslighting I didn't really understand what that was until you realize that every single patient who's had a baby comes back with these Notions of what may happen in this pregnancy, even though that didn't happen in their prior pregnancy because they've been programmed to be afraid of this whole thing including and especially related to how things change to their bodies in, you know, like during and after pregnancy and into the next pregnancy. So yeah, I think you're I absolutely agree and I think I huh. Bubbling part of actually sitting and being present for that. You know for those patients is realizing, you know, maybe we don't have all the tools. Maybe we need to have actually some people help us, you know provide the best care possible and you people like yourself or obviously a big part of that. Yeah. Well, I know that's what I did appreciate that that came up. So kindly in your previous conversation, but it speaks a lot to who you are anyway, like The fact that you and I have had lots of behind-the-scenes conversations is already indicating to me that you're a new breed. Like this is a new breed of physician that recognizes, you know, you don't have all the answers. I don't have all the answers like by and and you know, I will say to my patients like I think that's one that you need to flip back to your dock because that's not my department. You know what I mean? And a lot of my patients will say well, why didn't my doctor tell me about this? Why didn't he tell me that diastasis was possible or Pro? Slaps or whatever and I was like, it's some point this becomes not his or her job like her job and his job was to get your baby out safely. Like that's what his his or her job was now yeah, it'd be great if there was more information out there, but but I can't do everything and you know, so maybe up is really where hopefully we can make that happen. And I know one of the things we're hoping to talk about here. Is that the changes in the ACOG fourth trimester? Sex or whatever it is opinion is the guidelines around the that fourth trimester and that one of those things there are things in there that Doc's simply don't have time for training for that. I think Petey's could partner and help with so yeah. Yeah and and one final little tidbit about that I interviewed and She interviewed me as well Lisa Hendrickson Hendrickson Jack. She's the author of a book called The Fifth Vital sign in her whole expertise is around fertility awareness methods and whatnot. Yeah, she is. Very much not a doctor and she's proudly not a doctor but she also has an area of expertise that we are not trained in any stretch of the imagination to do but when you know one big part of her messaging is if you go to a doctor asking for advice on physical therapy on nutrition on whatever like you have to realize you're not going to the right person you're going to somebody who has limited knowledge in fertility awareness methods. So what did they expect like, they're not bad doctors. They just don't have That knowledge, you know, right and you know, I'm happy. I'm proudly a doctor but I could never do what Lisa does or what you do. I mean this is we are all Specialists now and we have to recognize that so I'm actually sorry I actually didn't see medical responder course meaning like so that I can handle emergencies because in the main reason I took it as I have a 14 year old boy in my home who is a regular Like a frequent flyer at the emergency room and I thought I need to have a better understanding for tonight the boys I gotta figure out how to help him. But one of the things you learn is how to deliver a baby and it's literally like I'll have to send you the picture. It's in this creates like a Red Cross thing that's for Lay people to Medical people and it's a to paragraph thing about the simple and I'm putting in the air quotes the simple procedure of being a baby coming and I'm like I should not be delivering babies. There's no way so anyway, so we just we need to respect each other's expertise. And we I and know that there's so much we could do to help together optimize the outcome for all these ladies. Absolutely. You mentioned a whole bunch of tools that we have to help Julie. And yes, I know that your tool bag is far deeper than mine with regards to pelvic for physiotherapy. Your second point is that and I will read it, but I think you're a maniac kegels are not the Inning and end of what we can offer patients. What are you talking about food a growing understanding that the pelvic floor doesn't act alone to maintain continents. I don't know. Yeah, I know sounds like crazy talk but the good oil. I know I know it's but it's really good news. So I'm in the Middle East and I was talking to an obstetrician. They're helping her with her own. I don't know is your knee. And I said, well, you know how Kegel you know about kegels and this OB in Oman says to me. Oh, well, they don't work and I thought that was fascinating because that's what happens when I talk to Obie's here, you know, they but it's like we just said like you were trained that's all we had to offer. And so what we're starting to learn in the research is understanding and this is actually been in the research since like 2007 like this is not new. This is been in there. A really long time understanding the role of the pelvic floor as a component of the core system, which I'm putting in quotes because that also is poorly defined in the research but it works together with some of the muscles in the abdomen. It works together with the diaphragm all of those things work together to help us with core stability, but that same system of muscles works together to help the pelvic floor do its job to maintain continents. So it's this dual system of stability and - I know and there's and I'd be and I've supplied some research for you. I can give you more to help people understand start thinking it has more to do with the way but listen strengthening the pelvic floor can absolutely be important. So kegels I'm not throwing kegels out not throwing the baby out with the bathwater but understanding that there's more to it and that gives us actually new options on how to help women as opposed to just saying here to strengthen your pelvic floor, you know, we can say we have to understand how How the pelvic floor is interacting with the rest of that system because it may simply be because they're holding their breath like you mentioned with your wife getting out of bed. Like if she's holding her breath every time she moves the pelvic floor can simply become overwhelmed. And so that's a great place where we can intervene and ask patients to change up how they're using their breath to change the intra-abdominal pressure and we get that related to prolapse. Right? Like we want to avoid high intra-abdominal pressure with those patients and so breath strategies is a great intervention. Tool teaching women that the abdomen being tight all the time. That's a ton of force down the time. So I always use a balloon in my examples with my patients and if you think about a filled balloon, if you are squeezing the balloon in the middle, that's a ton of pressure down in the ABS are in the middle. And then if you hold your breath on top of it, you're going to comes down away push that piston right down on the pelvic floor. Yep, exactly and then add to an impact like running and you have to deal with impact forces and all the Force from above it's a recipe no matter how strong that pelvic floor is sure. It's a recipe for so we can intervene in all sorts of places there which gives us incredible new tools. And so there's so much more we can offer ladies especially in there in regards to helping them get back to Fitness because I think that's the leap that most of our Mamas are asking for at this point. It would have a fitness and we want them to be fit. So we'll be healthy. You know what I mean? There's just this sure it's beautiful thing and just saying to a runner squeeze your pelvic floor makes no sense for running things like snow. It makes no sense. If anybody has tried that running while squeezing those kegels like it doesn't it does it does not compute like that's not that's not what you're supposed to be doing when you run. It just doesn't make sense. We have to get that the pelvic floor is a group of muscles. And so we have to drain it for athletic activity. And so the reality while I appreciate you called me a pelvic PT as I'm really a sports medicine physical therapist who just happens to love the pelvic floor and so I I'm an a traditional and Therapist I don't do internal work. I only do all of my work externally and I influence what's happening with the pelvic floor in conjunction with what I would do for you for your knee or your back or whatever it is while you're running and the pelvic floor needs to bounce. That's what it needs to do. You're ready. Yeah, it needs to bounce and so holding it while you're running makes no sense. It would be like holding your quad while you're running you would never do that. That's right. The only advice that we know to give but not anymore we More tools we can do this. I know a metaphor. Yeah. I hadn't actually thought about it like that. Yeah, and the other tool that are the thought process. I like to give people is if you like if you're thinking about a bicep curl if your fist is already at your shoulder, and then I ask you to use your bicep it's unavailable to you to respond to the next challenge, right? And that's what's happening. When you hold your pelvic floor while you're running or while you're trying to do anything or your tummy your abdomen. It is actually not ready to help you with impact control either with your squeezing all of it all the time. It isn't ready. You got to open in order to close. If you got to let that elbow open in order to do the next bicep curl pelvic floor. Tummy. All Meats do the same thing. So we have some new ideas and we can really help change this up. So, well you already already kind of went through your third point which is that the pelvic floor is part of the team of muscles that provide core and I'm using air quotes stability and that Same system of muscles helps maintain countenance. We then then we you know, we can talk about what are some intra-abdominal management strategies and I'll read your fourth point just because we're there yet nominal pressure management strategies are critical for preventing pelvic Health considerations and need to be addressed in pregnancy recovery and return to fitness programs and Julie before you answer that what is your Fitness background? You're very fit woman yourself. So tell me a little bit about what you've done and maybe what even LED you into being so excited. About the pelvic floor. Yeah, so I consider myself an aging athlete at this point. My primary athletic activity is one-on-one with my son out or volleyball with my daughter, but but I yeah, but I played as a four-season athlete played Sports from I was the only girl on my brother soccer team when I was growing up because Title Nine was brand new like that's how old I am. And so yeah, so I started playing sports really young. I know actually in a way my dad. Original feminist to be honest to let me to push me to play sports. And so I played Sports my whole life. And now I'm just a huge mom fan for my kids and I keep myself fit with just random stuff. But but my background men is Orthopedics and Sports Medicine. That's the path. I took out of physical therapy school. And and then I had my first I had my daughter my daughter is 16 and I very arrogant we thought well, I'll just fix whatever happened like Well, you know, I mean literally my biggest concern was getting carpal tunnel because of being a PT like that was my biggest go first, and I thought I didn't I and I just thought I'll just fix it whatever it is. And then I found myself struggling to get my ACT back together again and get back into fitness and that was back to my daughter is 16 and that's back when the core and again in air quotes was new like there. You may not remember but some of us remember there used to not be a core. We didn't used to talk like that. We talked about trunk stability or trunk stabilization activities. We didn't talk about core. So we were just starting to learn about that when my daughter was new ionized fact, I am in fact not old enough to know about when we didn't talk about the core. I know that's correct. Yeah, it seems like that's like a like a pivotal like a like a Cornerstone of Fitness now. Yeah, I know and it didn't used to be so that's what's so when I think about my athletic past it was very much. I did Sports specific drills when I played soccer. I did sport specific drills in the fall in the winter. I played Sports specific drills for basketball, you know, I did gymnastics I did swimming like I just and so I was and we know developing athletic Talent the more Sports they play the better and the more Sports specific the drills are the better we can get carry over but that's not what we've done. We've now told kids as young as My daughter was told at 10:00. She needs to have a strong abdomen. Like she should have a tight abdomen. There is no reason no reason a 10 year old girl should have strong abs and guess what we're seeing leaking in girls as young as 11. We have documentation of girls as young as 11. We I know colloquially of young even younger girls having problems with athletic incontinence, which again has to fly in the face of what we've always understood because we've said Ed these things are related to parity they're related to BMI, which don't get me started that could be a whole nother conversation to talk about BMI because I'm not a fan of that conversation with this stuff but and BMI parody and oh my gosh, oah, but those are the three Biggie's that we think positive face. Yeah it totally so we have to have other Solutions. It cannot be that this 11 year old has we color for that cannot be it makes more sense to understand that she's been instructed. To use her abdomen and breath-holding strategies are another compensation that have created all this pressure from above that just overwhelmed the circumstances. It's no longer a balanced situation. So yeah, so, how do we like so how do we manage that pressure then apart from? Hey when you're getting out of bed or getting off the toilet, you don't have to have rock-hard ABS at that moment. Yeah, and and I think that's part of it. You know again, we're we started the conversation say Talk about messaging and I think that the message we've sent there's a couple that we sent one is the only way to have a strong back is to have a strong stomach and we've defined strong stomach as stiff. Like we've said that strength is stiffness, but the reality is dying there's a dynamic system in place led by the diaphragm. The diaphragm is constantly cycling muscular work and pressures that helps keep us stable. And that's like a kind of a brain cramp but We are that means we're stable on both inhale and exhale. So on inhalation, we have increased abdominal pressure because the diaphragm is coming down squishing organ South and the tummy and the pelvic floor have to kind of give in order to accept that pressure. There's a pressure gradient change so that we should see the abdomen move on inhale your abdomen supposed to go in and out on inhale and I would challenge people listening go look at yourself breathe and you're going to see not a lot of movement in your abdomen and a lot of movement up and Your chest that's just what tends to happen for a lot of my postpartum ladies not all and then and then on an exhale so it held everything goes down and out and on exhale when the diaphragm comes up in the pressures lifted we get this recoiling effect. That's more concentric. It's more of an active participation by the muscles. So it's this constant inter balance between balance. I'm sorry about between pressure and muscular force and if we can teach women to balance that better we see a like a lot of relief on things like incontinence or prolapse and you guys for example discuss the Pro apps surgical the reoccurrence weights and if part of in my opinion and again, I don't have like I'm putting this out there as a clinical thought is if we haven't repaired the strategy on how they use their intra-abdominal pressure system. They're just putting all that pressure back on the surgery. Right? Right. So it's like it's like starting somebody on insulin but not correcting their diet. You know for their their pending diabetes, yeah. Yeah man preach, but that's exactly the same thing. But we just haven't ever thought that way. We just say just keep doing kegels, right? But what I tell my patients is if your floor is great in your house, but your roof is crashing in your for could be pristine won't matter. So again starting to correct those ideas like you wonder if we can communicate to girls like you don't have to have rock hard ABS you have to have functional ABS you have to have abs that work well, And then if they're working well in their daily life and in their exercise, they're going to be and I'm only saying this because this is what the culture wants is flatter. You know what I mean? Like they're going to have the aesthetic if they're actually functioning in their day sure if we're holding them tight all the time. That's not actually functional that's literally walking around with your bicep engaged all the time with your fist on your shoulder. It doesn't that's not how we build it. That's not how we create tone. So, so anyway, I hope I didn't Talking to the guy Circle there, but the conversation needs to be around like giving up on this gripping your abs all the time, which is a real challenge for moms to do and the only way you can really get a good breath in as if you let go of your ads. So everybody listening can do that grab your abs and two men include a sorry go ahead and go what walk us through this walk us through this. No. No, but everybody squeeze your abs and take a breath It's really hard now relax your ass up and take a breath and the difference in terms of fullness is pretty clear. And and so and again men are the same. We've been we told men may have to like look like they've got this flat abdomen to and guess what we're seeing more and more what we think is prostatitis and we're seeing erectile dysfunction and we're seeing all these issues for men and and guess what they're having incidents at CrossFit, but they're coming out the other Yeah, yeah, so so we're we need to appreciate that. This is a system and we need to address it as a system and relaxing abs and getting a good breath in as a great way to start. Time out because I have to I have to plug my laptop in I just realized the battery is dying. So hang on one second. Oh, yeah. Yeah. No. No my gosh, my thing is coming off it took here. Can't find the cord. Sorry. Julie don't apologize. This is happened to me more often than you know, like you think I'd be super prepared by now. Would you say? Oh, sorry. It's happened to me to meet plenty of times. Like I totally get it and I think oh my gosh, I can't believe I forgot that I'd gone to lectures eight hour lectures without my lab my cord before which is ridiculous. It's like, oh my God. What was I thinking? I think I'm Just a Fool. Yeah, so I think we were ending at relaxing abdomen and taking breaths. Yes. And I can say some talk about something like blow before you go as it relates to stitches, like like early postpartum stitches like really early. Just getting rid of that pressure a before you get up or pick up. The baby is a huge help. Okay, let's start let's let's start right there. So we're gonna okay. Sorry, we had a momentary pause there because I had to plug my laptop in but Julie Julie, this is super interesting. Tell me. Okay. So let's let's maybe talk about in the immediate postpartum period what what are things that maybe women should start to consider maybe if they're pregnant or if they're going to be having a baby in the near future there is or even if they're in the immediate postpartum period yeah, so I mean there's a lot of things to consider and one is understand it takes time to recover. That's one. I think that the internet pushes women, too. I think that they need to recover more quickly and that there's more out there than kegels that you should be doing. But go ahead like start to connect start to feel that part of you. But also if we can get women learning how to breathe and connect the pelvic floor and the tummy all together. Like I you refer to as my piston idea legged said idea of just bringing those ideas those pieces of the puzzle together if we can do that in pregnancy, then it's something that I encourage my patients to start finding postpartum as quickly as they can as soon as Doc says you can do kegels. I tell my patients you can do pistons like start pulling those pieces together. If you've had a C-section deep breathing is going to help blow off the anesthesia the yeah anyway, and then also the idea of when you blow off that pressure I call it Blow before you go. So when if we understand that inhale sort of sets the system up it sort of elastically loads the muscles with that pressure gradient on exhale it recoils. Oils and it helps them come back into play the pelvic floor in the abdominal wall. So if we start our exhale before movement, we've blown off pressure that can push on stitches and push push on die Stacy's and push on organs that have shifted down during delivery and we can ask all that pressure to come off start that exhale pelvic floor and tummy or responding up against that pressure with that recoil and then we can move as we continue to Exhale keeping that pressure off those stitches. So that's like a Really pretty way to start to pull these pieces together. Yeah and protect these new situations like Mom has pushed hard like some of them had really traumatic deliveries, like some had extended, you know, final stages and all that stuff tour tour and if we can take keep the pressure off all of those circumstances by exhaling before you move start that exhale and keep it going through the movement just as you start to get pieces put together again and then over time, I'm you can transition that into other kinds of reading strategies that match Fitness but but it's a great place to start to start to reconnect with these pieces. Right and a lot of my patients that they've done kegels and tried kegels. But once they have the teammates, once the pelvic floor has its friends it actually easier to connect with it easier to put the pieces together and then they can feel it again and feel it working inside their movement. So that's sort of like, it's just a really easy place to start lots of breathing blow off that pressure and walk Like to start walking start walking now. Yeah, I can breathe. It makes me think of you know, I did cross that for years a lot of heavy heavy lifting. I'm not a big guy, but you know you had to work I had to work on mostly on my mechanics in order to put big weights up because I'm not like naturally Thor, you know throwing heavy weights around so in doing that, you know, you're always instructed and you're actually taught to coach as an instructor to tell people that they take a big deep breath in they go down for the Lift and then you tighten everything up and you stand up out of the heavy squatter you lift the heavy deadlift. What would you tell people who are maybe not even necessarily in the immediate postpartum period but maybe they are trying to get back to it and they're going back into the gym. Like you're telling them that they should be breathing out the entire time during the lift or I mean, what should we be doing? This is this is like very counterintuitive to a lot of the fitness advice for years. Yeah. Well and that here's the thing I'm going to say, but it's a two things one. Is it those ideas were built on men like women didn't used to lift. So men's pelvises men's pelvic floors. The fascial structures really set up so much better. I had to take just a deal. Yeah. Yeah, so we need new strategies for women. Like that's what we need. One of the things ways. I got to respond to that. The other thing is if my goal in the early period so remember I'm a rehab specialist, so I'm not you're coming to me if If you're coming to a postpartum I had to make sure you can tolerate a little bowed before I let you do a high load. And so so what I would say to you and coaches out there is if my patients Max, let's say 300 pounds. She can whatever deadlift back squat at 300 pounds and the strategy you're giving her is to hold her breath. I'm in if that's her Max load, but she shouldn't need to hold her breath because that's a huge intra-abdominal pressure muscular Force at 50% of her. Hundred fifty should feel easy to her. Do you know what I mean? Right though? So we need to in this is one of the things I teach out of the gate is motor control. I teach my patients as they learn to reconnect with this system how much pelvic floor or tummy do you think you need to pick up your baby? Okay, how much do you think you need to lift your toddler? Those are two different lifts. And when we talk about the core and strengthen, you know that we sort of drifted from that conversation a little bit. But you know, we've said that it's All or Nothing. Saying like you have to pull your navel to your spine and hold your tummy hard. And now let's pick up a pencil like no we can't do that. Like it doesn't make sense. We have to match the task. So I teach demand strategy reasoning like that's what I teach my other pts. Like we need to start thinking about what is the demand and what's our patient strategy to meet that demand and does it match. Yeah, if you are picking up a kettlebell that's 10 pounds and doing some like Romanian get up or something or what. Brett what's it called? Its called a Turkish Get Turkish. Get up Jack. Look I finally have something to contribute to your like brainy concert construction here. Yeah, he's got up. See I got a point I know but this is where people are like, I don't know what I'm talking about in CrossFit. But if you're doing something like a 10-pound whatever that's such a different movement and load than it is for us like a 300-pound back squat. So so we have to train in a strategy that makes sense and that goes for running like that Sports Medicine though, but we just never have applied it to how the health and so so what I do with my crossfitters is I train them with an exhalation strategy for lifts up with great mechanics. That's the other thing Mama's their mechanics get all wonky. They really do we have research around this now we're getting more but they're got to fix their Mechanics for lifts. That's number one. If you want to go back to CrossFit. You got to have great mechanics and then I'm going to teach you how to do an exhalation. And we do understand that we can get up to about eighty percent of your max load with an exhalation strategy. And guess what more muscles are on board. It's actually more. Mechanically. It makes more sense its protective and then at 80% I'm going to teach you how to hold your breath in there because I know you're asymptomatic at that load. I know you can handle it. You've got great mechanics there. And if I have you hold your breath under a load and with mechanics that I know or you can handle and are good and you have symptoms. Again, we need to back up and then but if you're tolerating it and I trade in that strategy and we're breath-holding it that load then we can start adding more and get you back up to your necks. So that's so it's yeah, is that 80% number? Is that your own personal experience or is that a we published this? I'm curious? Yes. That's a great question. It was my goat. Like it's just what I saw clinically made sense. And and then we do have one study that looked at it in men doing like a leg press. Yeah, and then we more recently and now I can't remember where it was. I read it but it was talking about loading man. Yeah, I have one other one where I can extrapolate and that's it was something about the way that musket muscles respond to load or tendons. I care not who I am flub it on this one, but I'll have to dig it up and I was I literally wrote in the margin. Oh my gosh, this is 80% This is what I'm teaching like. So again, we don't have A lot of information because we just had one strategy, right? We've had one strategy forever. You just hold your breath and hold it, you know and so but here's the deal when you train that as your primary strategy in the CrossFit gym, they take it home and they pick up their baby that way and they and then they post partum that's what they go back to and it is a huge pressure down like then we end up with probably problems. You wouldn't necessarily have seen had they had better strategies going in. Yeah, so so It's like can we back up the truck start educating teenagers, you know, can we start training this differently? Can we start talking about it differently and really like future build so that when they get ready to go back, you know, we're just in a different place and and that it's become more natural to talk about men versus women women can still lift heavy, but we just need different strategies that our bodies are different we're structured differently and we're structured that way to have a baby like it's so we can perpetuate the species. You're welcome. Yeah, you're welcome everybody. Yeah, you're welcome women need to be embraced as goddesses because that's what they are these things that we can't do as men. Okay, let's just call it what it is. Yes. Amen. And so would we that's right, but we but we're so much research. I mean, you know this although it's crazy. I don't know what it's like in the literature for you guys, but they don't even include women in medication studies and then they give him the meds like it's like what's it, you know, we can't forbid to start. Yeah. We have to start thinking about this differently we - do and so that's what I'm suggesting and I am the first person to say we don't have enough research around it. I hunt. I'm the first person I want to I want to reiterate also that just because something hasn't been published doesn't mean it isn't useful. I just wanted I also want to give you know, Julie I want to give you the opportunity to talk about like this the sort of void here, right? And that's I know you're working on your doctorate now, right? Yeah. Yeah. Well, it's a clinical doctorate. So but I just have found out a research proposal we turned in In bam, no Brandon. I know it's okay. It's fine. We can do it without the grant we will find a way but it's case of Lacroix to get over that one. That's right. I know give me where Lacroix. Yep. But yeah, by the way the rejection it's just up in the air. I actually saved it. I thought this is great. This is my first one I'll take it. It's kind of fun. So So anyway, we just need more Quest the right questions, you know what I mean? And that's really part of it. Like we there's a Blog on my site that's called a ray of sunshine and it's about a diastasis study that actually looked at abdominal function not how how small is the gap which you know, I mean, that's what we want to know Clinic. I want to know how to restore abdominal function. That's the goal not can we close that Gap? And so, you know, we need to start asking the right breathe. Research questions and clinician fee to help us do that because we are in the trenches and could kind of go always is ahead of research. That's just the way that it goes. Yeah. Well, that's that's where you generate the questions. Amen. Amen. That's right, you know, you keep going back to also the importance of reprogramming society and to not necessarily needing every 14 year old girl to have rock-hard ABS. I feel like that's a big that's a big Come here, even though it's not technically one of our pearls that's a really it's an important thing that we don't expect women to not only have babies and feed them with their breasts and to be the head of the company and to be you know, a prolific researcher, but also they have to have rock-hard ABS despite the real difficulty that having a it is hard to have a baby. It's not all you know unicorns and rainbows there are strategies for refer recovering and repairing function and restoring it after that. Thereafter but we also have to just like get out of this mindset where everybody's going to be that like firm thin straight, you know abdomen. Yeah because I would suggest go ahead. Sorry go. Well because not only is it not not only is it not helpful for women to feel that they, you know have to achieve that but now you're actually telling me that that's actually a dysfunctional muscle pattern which is which is causing leakage. Both in the front and the back regardless of age parity and and BMI and gender and gender which is yes exactly. Yes. I guess we'll leave it at that. Yeah, why don't men men don't realize that it's not normal for you to leak urine while you're lifting weights. And he believes was I shirt a shirt. Yeah. I don't know if anybody saw a white man, I wouldn't date with Julie. Tell us what a Shard is. Is it's farting with a friend like having little extra baggage with your parts? And that's what happens to a lot of guys when they're lifting and they don't think they don't think anything of it and it's red Domino pressure overload. Just coming out of different hole. That's it. Right. And so and so we need to start if we start to think about it that way that it changes things and men have died csis like men get dioceses as well. And that's where we have to start changing our car. Feature on this this is its naturally occurring but you know, we need to understand how pressure plays into it and how muscular Force plays into it. There's just a lot we need to sort of expand that conversation and I don't want to get too far away from the cultural change that is is needed. But but our goal has to be to change this conversation for the Next Generation. It's like it has to be. Yeah, and and really that if I had to say what my main motivation was making this turn was that my daughter when she delivers I'm looking at a picture. Trooper here, you know, they didn't be different story it her like when she delivers what I'm suggesting here. Not just me. There's that there, you know, there's a community out there that's trying to suggest this the that it would just be standard of care for her. It would just be the standard. So she doesn't have to have Mom, you know, I roll it her own mother. I'm just kidding. See look speaking life into my own child. She's such a great kid. She says, it's this matter Julie. And but you know, she's is for her to hear it. Not just from me like this is just normal. We're going to teach you how to breathe like this. We're going to teach you how to connect with your public forum put these pieces together. This is part of your program. We're sending you home like that. Like that's so different than what I got. Really what you have is her name is Zoey give Zoey a full of life. Give her your message right now so she can always go back to this. It's going to be published out into the world forever so easy. Like your mom wants you to know racing to your mobile sheet. No, but the thing is is my kids already know. I've already taught my my kids how to breathe like this. I've already taught her that if a Coach ever tells you to squeeze your abdomen, you're going to breathe like Mommy told you and they're going to think you listen there because it's going to change how you're standing using your abdomen using your Center. They're going to think you listened, but you're going to actually do it in a healthy way, and I know that I just Acted her pelvic health for the for the rest of her life and and it's so and my kids used to rat on their coaches if they made him do crunches and I would like make my way over and say hi. My name is Julie, you know, I'm physical therapist and you know, and then it was Sports Medicine PT not anyone that doesn't even pelvic Health, but you know, my kids are already aware of this like I've already given given them these messages and and this is something that this is Pearl number 6 like I'm Jumping the Shark here a little bit, but it is one of the Is that we can partner our communities is the idea of helping us get baselines for mamas in around something like that. I stasis so I already know Zoe's die stasis Baseline. I'm not gonna share it but meaning a diastasis is a separation between the size of the abdomen and we have one study that has shown us that Norms of that separation up and down. The center is somewhere between 0 well I can't say zero one and three point five centimeters. So I know where Zoey Falls in that normative range and I can't wait for her to deliver and I would say to her. Oh my gosh, baby, you're like a centimeter off where you were when you were 16. That's awesome. And it's such a different conversation and a different message for her to hear postpartum than for her to discover after reading on Google. What did I say sis is and oh my gosh. I have a four centimeter second. Oh, yeah, and and I and I should be at zero. Well, you shouldn't be a zero. No one should because things Things coming you want to eat a big meal and you want your belly to expand that's what it's there for and men get them so they cannot be a gender specific pregnancy only thing and baby. It's normal like it's normal to have a little bit of a Baseline and I mean a little separation. That's how you were designed and it's so good that it's there so you can have a baby and guess what you're just a centimeter off of where you are in your 16. I cannot wait to deliver that message to her and and PS of for is not a bad diastasis at all if I could probably pretty normal post. Part of it. It's a good one. So I think that that's a place where docks have access to women. So early in pregnancy or even pre-pregnancy that they could measure that say that to the mama and then when she comes back at her six week and you retest it and you're like, oh, you know, you got a few centimeters to go here fashion looks good. Like you're on your way. Let me refer you to a PT. Let's get this so that you know how to use your abdomen again and your pelvic floor and you're breathing together. We're going to get you back on track. Let's do that first. Then you can get back into fitness. So that's what we need to like. We need to give better tools about six to eight week follow up. Well as normal, right the medicine is great at reacting but not sort of predicting and preventing from the beginning Point. Actually that you gave me was returning to activity and fitness postpartum in returning to activity and fitness postpartum women need more parameters than quote. Listen to your body. They also need to know what to listen for pain and leaks you gave are both signals that they may need to modify. If I movement or just wait all together to let their body restore back to function we kind of blazed through that bit, but that's that's an important part. It's not just oh listen to your body like it's not just a little pain here and there it's like you're having pain. But yeah, you want to be back to lifting, you know, 225 pounds off the ground in a deadlift. Right? Right, you know, and then of course if you're leaking urine, maybe we need to either modify that or we need to wait and you know, I think that this is important and also to bring you back to that. 80% men were able to achieve an 80% of their one rep max or whatever. However, you are measuring it 80% of their of their Max effort. They were able to achieve that using exhalation exercises. Meaning that they can actually preserve all of their pelvic floor and their their their core quote-unquote function. Up to 80% of what their what their with their Max effort is like that's a huge number for most people. Yes. That's it. That's exactly it during pregnancy. Let's not go about 80 right right with you. Yeah, you get to stay super fact Aviv and and listen like if you're but if you are so tired and beat don't go for the last round. You're going to be fine. Like it's a season. Please remember that the season and so during pregnancy I try to ask Patients don't go to a level that requires you to hold your breath and guess what your level may change during the pregnancy like as you're like things change you may have to alter what your 80% looks like. But but and I let my patients go back to the time. I'm in but you got to be honest with me. If you're having pain, right we had talked about let's figure it out. Do we need to back off the load when you change your are your mechanics different because suddenly you gained, you know you sometimes it's like you see a patient. I'm sure this happens jail time. You're like, oh my gosh all the sudden. They're pregnant. They're pregnant. You know what? I mean? They went from like just kind of showing to really showing write your mechanics have to change right? Let maybe the paint isn't yeah your pain isn't just because you're now 24 weeks. Oh, well, it's because for you the way you popped may be affecting your center of gravity and you're not getting your butt back big enough in the squad. Let's look at that. Okay, can we modify that? I can you do it without pain? No. All right, then we gotta bring the load down. You do it now without paying no, we might have to wait like that's like so that's our yeah, so this is an or let's do with dumbbells instead of a bar. Like what can we do to keep changing this to make it so that you can continue safely for you and we know that there's so much safety around like we've had lots of the fetus we know is great in most cases. Like there's definitely some parameters around that but the moms safety is what we haven't really had a lot of conversation and so and They were just told to just keep going and if you look on wine, you're either told stop and you're scared or you're told go for it and do whatever the heck you want. Like, what do the what are they called muscle ups? Like do muscle ups while you're pregnant muscles are hard for people without pregnancy. Ha ha ha, you know, it's like so it's really you know, how can we modify this? So my new mantra with my athletes is Monitor and modify, let's keep monitoring and then and and usually most people eliminate certain things like Impact activities around half way they just self mop. They just are like it just doesn't feel good. Listen, listen up your body's giving you a signal your body is giving you a signal you are not bouncing that balloon. Well, you've got pain let's figure this out. Otherwise, it's like we got to figure this out and that's just good coaching. That's just good. It's just smart. And so so those are the kinds of things and then on the other side of the pregnancy just because they pass six to eight weeks and the stitches of Good or whatever it is that you guys are saying. That's cool. She's good to go on medically. That doesn't mean they're ready to just lace up their Runners and go run. Right? Right. Right, right. You wouldn't do that with a knee surgery. Like you can't just say to someone like okay time has passed wait, let's go you say go see your PT and let's get you built build some muscular strength build some muscular coordination build some impact control. Like that's what you would do with a knee surgeries. So we need to start having that kind of mindset around they have, you know, your patient wants to run she needs to prepare for running. She needs to do muscle exercise and she needs to do she needs to do activities that look like squatting or they looks like split squats or that looks like pressure management and impact control, you know, she needs to do all those things then she's ready to return to run. Yeah. yeah, I mean, it's a we don't see it very I don't know, you know like in the OB/GYN world like as every anybody who listens to my podcast knows there's a whole bunch of very bad fucking problems with the OB OB Community because we deliver them. We don't deliver them God everybody's going to I've been trying to change language babies are birthed by a woman and OB whether or not they had to actually be at the birth. Well then. Then clear them medically to leave the hospital and then it's sort of like sayonara for about 6 weeks. Like you said they are then seen back by somebody in the primary Obie's practice or the prime mover be a primary be themselves. The primer OB will look at them. They'll put them in serves look at the vagina. Everything's okay there they'll look at the incision of theta c section. Everything looks okay. They're in their back to business as usual until things feel. Okay. Listen to your body, right? Well the reality is that every time I've been Inside an abdomen and we're talking about C-section specifically here, but this really goes for this sort of personalization of everybody in the postpartum period C-section obviously being much more of a recovery from the sense that you actually had a surgical procedure when you enjoy you've actually you and I talked about getting you into see a C-section at some point. I'm sorry that never happened in San Diego have to get you get you in there. I'm dying. I'm coming in coming on come on in. But but when we operate in the you know in the abdomen the way that we separate the muscles which you know, most people think like you cut into the abdomen and then you cut into the uterus and a baby comes out. But the reality is that you actually separate the rectus abdominus muscles down through the midline of the Linea there and you separate it. And then from there you then operate on the uterus, but those muscles in an pregnant patient are very are very flexible and and you can tell that physiologically the way We have adapted are such that these muscles lay over the uterus and they expand that compartment the Piston has natural space being accommodated there by this gravid uterus as opposed to those muscles remaining rock hard and all of that extra pressure being directed downward. And so so when we then close the abdomen some people think oh, let's fix the rectus. Let's put it back together like rectus Rector stress is bad bad bad. I have stopped repairing it because those muscles are going to they're going to sort of tighten back up there going to strengthen back out there going to shorten and they're going to re-emerge back in the Centre and that probably is what's happening. But physiologically, I think what we talk about is separation is bad and tighten the muscles abs are good. Got to get those abs strong so that after pregnancy they're back to normal and I'm actually finding that a lot of my a lot of haven't had many but a lot of patients that are doing a ton of the Court core work, which is let's get the that six-pack pop. And we have not only a hard time delivering because of the tightness of their core that they also actually have a tard time recovering because those muscles don't go don't really go back to where they wanted to in fact, they tighten them in such and such a way that they've sort of tightened but around the gravid uterus you actually you exact you exacerbate the diastasis. I don't you want to in the like our final moments. You're going to talk a little bit about what people do in pregnancy that might make these things worse. Yeah. That's and it's It's yeah, that's a tough conversation. But it is for what I lateralization of the ABS because there it is. It has two separate like they and again you kind of hit on it. We called that dysfunction. No matter what and the same word. We use for pathology is the same word that we use for the naturally occurring separation that has to happen. And and I think we need to help women learn how to use their abdomen in the center, but they also need to learn how to relax their ad. And so can actually go through this corrosion. There's this so it's a little like the question is a little tricky some people in my community. Just you know, we both are walking a tightrope every time we do stuff like this people in my community to don't think you can affect a change like that. There's really not anything you can do in pregnancy to prevent it a diastasis and that telling people not to exercise actually, you know that there isn't a certain exercise that is going to make you get a worse diastasis. I don't disagree with that. I just double negative negative it it but basically the way that I look at it is I can optimize your outcome, especially if you're a you're a new mom like if this is your first pregnancy, I don't know what I think we're really starting understands its genetics like the way your tissue like you said it like I'm sure you feel different tissue quality. Some women are genetically winning the lottery and there but no matter what they do their bellies going to Guess what? Like that's you know, that's that's not the majority. Yeah, they did. They that's their genetics. And so the women that have genetics that don't need to dense connective tissue. They are the ones who have that wider Linea Alba and I see women with 12 centimeter die Stacy's and super thins faccia like a force and metered. I say system uses our early example to me. That's your that's great. We're business, you know what I mean? But when I see these super wide those people tend to come with like Active tissue that isn't super whatever ready to roll their it's hard to get that back. So but I don't know going into your first pregnancy what your genetics are. I can't test that now we so I don't know so my job is to help protect you and to help you say as connected and creating tension over that fascia and that Dice and keeping the as the size of the abdomen together as best I can and so there are interventions I use like Making sure your form is great. If you're lifting a weight overhead and your rib cage is popped up to help you get that final push of shoulder Mobility. You're using your rib cage hopping rabbit. Yeah flaring out and up to get the final range of your shoulder Mobility. You're literally taking the insertions of the abdomen and pulling them apart. So I if I don't know what's going on for you and I'm watching your diastasis pull apart while you're lifting overhead. To manage your load so that you don't have to flare or I going to limit your range so that you don't open the rib cage like that under load and train the abdomen to meet lateralized. I will limit your overhead work. I'll make sure your rib cage is staying in while you're working on those things manager alignment so that the the diaphragm sorry that so the size of the abdomen stay more approximated and then using them in that Central position versus using them lateralized God so those so that would be something I would do and if I see get to see a patient Patient and their subsequent pregnancies. I know better how their abdomen responded. I know better how their fashion responded and I can push certain patients knowing that their faccia is acquire quality and then I can also with my pull people back knowing, you know, we have other things in our history that tell me that we need to be really careful. We need to be more careful and optimize this outcome because again, genetically it may not matter what we do if you are prone to it you may end up with more of a diastasis than the person next to you. And like but again, let's optimize it. Let's not say you can't exercise. Let's figure out how to do it in a way that's safe for you right modify Monitor and modified, but that's what we gotta start doing. So does that make sense? I hope I answered that one tricky question from a rehab standpoint because everybody's so different like everybody is different right but that's that's an important Pearl, you know, everybody's going to be different genetics matter. Yeah. I think some other summary points soft belly let your belly And with breath as just even if it's just a practice you're doing when you're driving or watching TV or whatever whooping great one I getting out of getting in and out of bed. You don't have to have rock hard abs every time you do anything. Yeah and standing in a grocery line. Yeah, you don't need a record admin like start paying I actually go I generally go grocery shopping shirtless. So may help me get those disks. Yeah. This has been very helpful. This is a like tragically helpful because we don't learn anything about the real anatomical function of some of these things in OBGYN practice. I know a lot of midwives and doulas are not learning a lot of these things and that that sort of listen to your body message is very helpful, except we need to know what we're listening for and your percent and if you're leaking, you know, Ryan Stewart and I talked about this if you're leaking during just, you know, jumping jacks or laughing or coughing. It's not normal to fill your your your panties with with urine. If you just had like a good joke told to you. It's not normal, and we need to document stop normalizing that and actually normalizing the fact that hey, this is a problem that we have a lot of resources to fix. And yeah, and if it's a problem, if it's bothersome to you, then there are resources. We should be making referrals. We should be reaching out to people like you to help us solve these problems for patients. So I thank you. My pleasure. Well, thank you for being open to the conversation. I think I've been so grateful to it just been so refreshing to get to talk to an OB that is open to like is willing to partner and talk and I just really appreciate that and it's just so I really appreciate the opportunity. So thank you for sharing your platform. You're very welcome. Julie. What do you want the Physicians and the other Healthcare practitioners to know about how they can learn more about your resources and your sort of your methodology Yeah, so I have a website Julie weepy t.com is full of resources both there's lots of free stuff that you can share with patients. If you want to get in touch with me. We have some specific resources and free opportunities we can offer to to Doc's midwives nurse practitioners to try to help give you new tools and we just want to offer tools to you guys and the best way to reach Out to me is to try and access that stuff would be Julie at Julie. We'd PT.com. I am on all the socials. My social is Julie weed PT and wiebe is W IE b e thank you for clarifying that but but actually if you Google Me and You misspelled my last name, I still come up so that's kind of cool. But yeah, so I'm on all the socials, but if you want to actually have a conversation. He's coming it out behind the scenes on Instagram, like or personal messaging is a little trickier than just sending me an email but I have administrative support and I also have a tool on my site that has where you can find crows that have taken the course work that I offer that like have a broader understanding of how to address this with patients. So if there's you can look on that map and see if there's people around you that you can start to partner with to provide these kinds of ideas for your patience. So so lots of tools on my site. Yeah. Well, thank you. Thank you so much Julie. I think that my I'm interested is here sort of what the community what additional questions they have. We may have to have you come back because I think people are going to be like well what you know, because this is very different from what we normally are hearing about the pelvic floor. So thank you so much for being my pleasure. Thank you so much. That was so great. It was so great to talk with Julie. She had given me access to her video library and some of her coursework early on in our pregnancy and actually before we even got pregnant and I just found her her resources to be so useful. I don't do this podcast in order to like make people famous or to sell products. I really just want I'm out here with my limited free time pregnant wife three jobs million hobbies doing this podcast simply because I once good stuff out there and there's a lot of like bullcrap OBGYN birth related stuff out there and Julie is not in that category. She is the real deal and has a heart that is dedicated towards making lives better for the people that I care so much about so including my own wife and I really hope that any Healthcare professionals out there take her up on her offer. I will put links to all of her all the resources that she once Healthcare professionals to have access to so check the show notes for those links. I'll link it in the in the podcast description as well some shoutouts. Well first before shoutouts, I have to make a comment. There was a Madison breach conference. We're going to go talk a talk a little bit about the breach conference here. The Madison Bridge conference is was was held at a community college because at the last minute the department of Ob-Gyn decided it wasn't in their best interest to host or quote endorse or whatever a conference on breach and This is this is an academic hospital system and similarly here in Louisville. The University of Louisville was initially expressing interest and then, you know due to the fact that some MDS that support the reteaching of breach Etc have you know, maybe you can Google lawsuits or whatever based on what happened in a home birth scenario or whatever because of the fact that a cog doesn't overtly support these things are at least a day sort of skirt around the topic in the very very best academic institutions will shy away from from discussions around things that really impact the care of patients and I my impression is I wasn't alive, you know, several hundred years ago, but my impression was is that in the past academic institutions were were sort of leading the charge with regards to a progressive Leading Edge stance on not doing what is best for business or best for some sort of on clinical institution looking at you a cog. I can make institutions for really there to investigate Curiosities and it's a shame that we in the field of medicine could possibly justify shying away from a topic that is at this point profoundly in need of an open-minded academic conversation like like breach. When one giant study completely turns over a practice that is still practiced elsewhere in the world and had been practiced for years and years before without any major issues when we allowed that type of medical reversal to take place and then we expect that. It's not even appropriate to talk about it shame on us as as a as a discipline. This is why medicine is not trusted by the public because we're not willing to actually take take You know put our propeller head out there and actually ask the questions about why are we not doing things and more importantly when we actually have bigger data sets that suggests that something might be useful to talk about we don't actually go for that. We just need to make sure we get our butts covered and I get it medical-legal is a nightmare right now and we'll have to worry about it. But if every physician out there was like fuck this we're doing things a little differently because it's not right for the people. That we set out to serve the Democratic Republic or whatever you want to call it. If we all decided to do that things would change but instead there's a bunch of Physicians out there that are a little bit a little bit pansy about some things and that's a real shame. So anyways on to shoutouts we're going to have the breach conference. Anyways, it's in Louisville. It's in that on that weekend. I mentioned at the end of February come one come all if you can't join if you do if you missed out on a ticket because I think they are probably going to sell out really fast. I'm spreading the word so much, but if you want to join by live feed, that's also awesome. If you just want to reach out to me and and Like you don't have any power but we I did an interview with Rick send David back. I think it was a episode want to say 29, maybe 28, but there's really great show notes there that really kind of break down a lot of the research and a lot of the conversation and and again we are not saying that breaches is as safe as cephalic or anything, but if there's an absolute risk that Still Remains pretty low and a patient is a verse to to having a c-section despite your fears as the as the physician then maybe when a baby comes In but first maybe we don't rush them to the or and try to shove that baby back up in there. Maybe we just allow that baby to deliver. Is that is that a reasonable option when that scenario presents itself? That's what we're trying to talk about here. Anyways, I've had my moment let's do some shout outs. I had the pleasure of meeting Gael thali by video texting Allah, I guess it was enabled by Nicole Morales. One of my Midwife friends in San Diego guildhall. He started spinning. In babies spinning babies is this incredible program where you can learn how to use sort of external methods of positioning mom and and whatnot to to deal with some of the inevitable Mel presentations like breach and now positions positioning that we see in labor in order to facilitate, you know, vaginal delivery. So super big shout out to the to Gayle and her program spinning babies. I would love to take the course at some point Gail. You just let me know when you're in the area or I can meet you out in your in your neck of the woods. Maybe not maybe not go to think you're in I want to say in Minnesota or Wisconsin. I may not be able to make it out there in the winter because I am a spoiled young man who spent many many years in the Southern California area before coming back out here to the east coast. So well, I shouldn't say many many. I got the had the pleasure of living there for five years, but now even Louisville when it's hitting 35 degrees Fahrenheit. I am I am a little nibbly so but you know, the spring is is not far. I also met some great. I met Cassie Cunningham. She's a birth worker and Doula in Lexington one of her friends Shantae Perryman and I have been in touch we're going to do a show on Sean Hayes podcast Radio Show next week. So look forward to that. I probably mentioned Mary Catherine delaughter. Hi Mary Catherine. She is a lobbyist Mom amazing advocate for for the sort of autonomous practice of midwives. In the community here in Kentucky and God doing sorely need people like Mary Catherine Mary Catherine put me in touch through the breach conference with Rebecca Decker. Who's a PhD and that's like the most humbling part. Is she she is Rebecca of evidence-based birth.com and I would absolutely check recommend you check out her blog but she's so humble about the amount of time. She has spent learning how to interpret and present. Clinical research for better for worse, and she I think she gives a very by unbiased honest on this view on many things. I've been following her blog since residency and I highly suggest you check it out Rebecca Rebecca, and I had a an amazing conversation a couple weeks ago while I was on call and I imagine some really amazing collaboration coming out of that out of this new this new friendship. She sent me this amazing gift packages. Well her book by the way. Called babies are not pizzas. They're born not delivered. I am wearing the shirt in the in the this episode's Instagram post and and the photo of the wine on the show notes. Thank you so much Rebecca. That was very sweet. Very thoughtful. I will cherish it and I will wear it everywhere the T-shirt the Baby Onesie won't fit me. I grew out of that but for our baby to come I guess, you know, I guess if it won't fit me, it'll fit the baby. It's getting so late tonight. Who else have I been who died recently meet so many other people you guys are so great. I thank you so much for reaching on. I'm sure I'm missing somebody and I will get back at you on the next episode, but there's just so many good people out there doing great work on the behalf of women, and I thank you so much for reaching out and lending support in and just kind of promoting some of these messages. I Think they're so important. I guess one last shout out. I don't know if I mentioned Laura Doyle that she's the host of the ask Midwife 707 podcast cheese and humbled and she's incredible. She's had so much experience with death and personally and that really informs her Care for Women throughout their lives in her Midwifery care. And so we just did an interview together. I hope you'll sort of muse me and and check that out. It was such a special conversation and I really again think that at that friendships going to come is going to blossom into so many great collaborations. So I thank you so much Laura for for just allowing me in a little bit. I think that's all for now. I think I've talked enough Do no harm taking a shit. We will see you next time.
SPECIAL EPISODE - Interview w/ Julie Wiebe, PT (website, Instagram, and Twitter)  Six pearls:   Low back pain, incontinence, and painful sex aren’t inevitable after pregnancy, we have new tools to help. Kegels are not the beginning and end of what we can offer patients. Our new tools include a growing understanding that the pelvic floor doesn’t act alone to maintain continence. The pelvic floor is part of the team of muscles that provide “core” stability”, that same system of muscles helps maintain continence. Intra-abdominal pressure management strategies are critical for preventing pelvic health considerations, and need to be addressed in pregnancy recovery and return to fitness programs. Returning to activity and fitness postpartum women need more parameters than “listen to your body”, they need to know what to listen for (pain or leaking are both signals that they need to modify a movement or allow for more recovery). A place to partner between doctors/midwives and rehab/fitness is to help us get baselines in order to help women have more realistic expectations of what recovery looks like (ex: get a diastasis measurement early in pregnancy or pre-pregnancy). Shout-outs: - Chante Perryman, doula and birth educator - Cassie Cunningham, doula, birth educator, and birth photographer - Rebecca Dekker, PhD, and her website EvidenceBasedBirth.com (and buy her book!) - Gail Tully and her program Spinning Babies - Nicole Morales, midwife in San Diego and The Art of Opening  SHOW NOTES  This episode pairs nicely with the 2017 Serie A Malbec from Zaccardi Wines. Main theme music by my main amigo, Evan Handyside 