Preparing To Push

In this episode, we chat with Dr. Kimia about how to prepare to push in labor. Dr Kimia Kardan is a pelvic floor physical therapist and clinic director at Origin Physical Therapy in Austin Texas. Origin has expanded to provide pelvic floor physical therapy in person and virtually across over 40 states! Origin treats people of all ages and genders with bladder, bowel, and sexual dysfunction.

Origin's website: theoriginway.com
Instagram and tiktok: @‌theoriginway

Please feel free to reach out to us with any recommendations for show episode ideas. If you'd like to be a guest, email us with some information about yourself and what type of podcast you'd like to record together. Thank you for all of your support and don't forget to follow and review our podcast, Birth, Baby!

Instagram: @‌BirthBabyPodcast
Email: [e-mail]
Website: https://birthbabypodcast.transistor.fm/

Intro and Outro music by Longing for Orpheus. You can find them on Spotify!

What is Birth, Baby!?

Welcome to Birth, Baby!, your go-to podcast hosted by Ciarra Morgan and Samantha Kelly, seasoned birth doulas and childbirth educators from Austin, Texas. Join us as we navigate the intricate journey of pregnancy, childbirth, and postpartum care, offering invaluable insights and expert advice. Through candid interviews, personal anecdotes, and evidence-backed content, we aim to empower families with the knowledge they need to make informed decisions. Whether you're seeking guidance on prenatal care, birth planning, or navigating the early days with your newborn, we've got you covered. Tune in to Birth, Baby! and embark on your parenthood journey with confidence.

The information provided on this podcast is for general information purposes only, and is not intended as a substitute for professional medical advice, diagnosis or treatment.

Always seek the advice of your qualified health provider with any questions you may have.

Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast.

Reliance on any information provided here is solely at your own risk.

Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a Birth Dula, Hypnobirthing Educator, and Pediatric Sleep Consultant.

Samantha is a Birth Dula, Childbirth Educator, and Lactation Counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

Today we're talking with Dr.

Kimia about how to prepare to push and labor.

She's a pelvic floor physical therapist and clinical director at Origin Physical Therapy in Austin, Texas.

Origin has expanded to provide pelvic floor physical therapy in person and virtually across over 40 states, which is so cool because all of our listeners can benefit from this.

Origin treats people of all ages and genders with bladder, bowel and sexual dysfunction.

Thank you so much for being here with us today.

Thank you for having me.

We're excited to dive in.

So tell us, how long have you been a pelvic therapist, pelvic floor therapist?

And what does that look like for you?

I have been a pelvic floor therapist for two and a half years.

So since I graduated from PT school, I am actually currently working at the clinic that my last rotation in PT school was in.

So all my training was done here as well.

That's really special to kind of get to be where you grew.

Yeah.

And day to day, we, like Ciarra said, we treat all genders and ages and we treat a large range of diagnoses, including painful sex, bowel and bladder control, diastasis recti, pelvic organ prolapse, endometriosis, and many others.

Well, one of the things that I, it was funny, the first time we talked, I was kind of like, gosh, I know I wouldn't have you on our podcast, but what the heck am I going to talk about?

Like, I just want to find the perfect thing.

And think something that kept coming up was pushing and like the breathing techniques and all of these things with having a baby.

And so I'm going to ask you a funny question, but people ask me this, is it really possible to teach someone how to push during labor while they're still pregnant?

How do you kind of connect those two things?

Is that possible?

Absolutely.

So pushing itself is driven by uterine contractions, but there's lots of benefit in preparing for labor and delivery itself by practicing different forms of pushing, different positions to push in, and just being optimally informed of all the different, you know, like tools and things you can have in your room while you're pushing, depending on the setting you're pushing in as well.

So lots of factors to consider.

I love that you say the different positions too, because that's something we talk to people about is, you need to kind of get into these positions before you're in labor, because if you get into them with a big old pregnant belly for the first time when you're in labor, it's gonna be really awkward and weird.

So practicing what those positions even feel like with the new weight on your body and the kind of balance of your body now is really beneficial during pregnancy.

Totally.

And especially if it's someone's first time going into labor, they might not have that experience of knowing, you know, like all the stressors that are going on in the room during labor and delivery, that there's just so much going on that it could be hard to even think sometimes straight and know, okay, like, how am I gonna get into that position or what exactly am I gonna do now?

So like anything, you know, like if you're gonna go run a marathon, you would train for the marathon.

So if you're going to have a deliver a baby, no matter which way you deliver, it's nice to know kind of exactly what's going to happen and what you can do yourself during that delivery process to give the patient their autonomy themselves as well, to be in control.

So what is the like ideal timing in pregnancy to start learning and practicing these techniques?

So I began doing labor and prep delivery specifically about four to five weeks prior to the due date, but a lot of my education that comes full circle while during the patient's pregnancy starts at that first session.

So regardless of the patient, that first session I'm starting to do training on breath, you know, like understanding that breath connection to the pelvic floor and to all the other muscles in the body and bringing on that mind body awareness so that when it comes to, and I always tell them in that first session too, I'm like, so when it comes to the time where we actually practice, you know, getting into those positions and doing more mobility exercises, you already have that foundational foundational my body awareness down.

Yeah, something else we talk to people about is, because I am a hypnobirthing educator and in hypnobirthing, we often talk about breathing your baby down.

And so it's not like this forceful push that you have to do.

Of course, you can push if you're feeling the urge to push, but not having to just push arbitrarily without that sensation.

So we talk about breathing your baby down.

And then sometimes I say, I'm gonna take off my hypnobirthing hat and I'm gonna put on my doula hat and also say that doesn't always work for everyone.

And sometimes you do need kind of more of a holding your breath push.

And so you'll hear that called open glottis versus closed glottis pushing.

Can you kind of explain what that is and then what the heck is a glottis?

Because when I use that word, people are like, what are you talking about?

Totally.

So I'll start with the last question.

The glottis is the part of the throat that contains the vocal cords and the space between them.

And it's also the passageway for air into the trachea.

So if you're thinking of air getting through that area into the trachea, if that glottis is closed, then that will cut off that air, that flow.

And that's why when you think of someone who is closed glottis pushing, they're not able to speak because they're holding their breath.

They're Valsalva-ing down and that creates increased pressure into the abdomen.

Whereas with open glottis pushing, the goal is to exhale and to, just as the name is, to keep that glottis open during, to assist with pushing baby down.

So there is no research that shows that there is a major benefit of one over the other.

So I love that what you just said about, telling the person in front of you, the birthing person that one, that they might want to do one over the other in the moment.

And that's exactly why when we are doing labor and prep delivery, it's important to teach both.

Because again, it's so that the birthing person knows and is prepared, okay, I've practiced both of these types of pushing already.

So ideally, they'll be better prepared for whatever their body best feels like it needs to do in the moment.

Because really, there's no way to prepare for exactly what their body will need in the moment, just knowing, okay, I've practiced both in the past, so this isn't something that's totally new to me in the moment.

Now, and for people listening that maybe haven't been through labor before, our experience is especially in a hospital setting with an OB, the doctor pretty much hands down always says it's best to do closed glottis pushing.

And there are times when they may say, okay, well, slow down, hold on, because you're crowning and they're trying to help you go more slowly so you don't tear as much or something like that.

And they're saying, okay, now breathe through this one.

And that would be more of an open glottis pushing.

But it's not that black and white that you always need to be open glottis or always need to be closed glottis.

And sometimes that's just instinctual for someone.

So I love that you're teaching people both because that's really important.

For years, I taught only open glottis pushing and that you never need to close glottis push.

But then I'm sitting there going, okay, well, with my in-person practical experience, sometimes people do to get past that pelvic bone spot or whatever, sometimes you gotta put some stank on it.

Sometimes you really gotta forcefully do it at that point.

So I think that that's a really important distinction for people to understand that it is not just one or the other, it's not black and white.

Yeah, on that note too, I'll always encourage the patient to tell their whole birth team.

So if they have a doula, tell the doula.

If they have a midwife or an OB, whoever's gonna be in the room with them, if their partner is gonna be in the room with them.

Informing the whole team, this is what I've been practicing, not just as far as the breathing practice goes and the pushing practice, but also the different positions.

So that way it's not their first time either hearing you say, okay, can I switch to this now?

And again, advocating for themselves and saying, you know what, can I just try some open glottis breathing now after I've been pushing and doing closed glottis breathing, which also closed glottis breathing involves bearing down for a count of 10 seconds, two to four times in a row, or throughout the duration of uterine contraction.

So it's okay to switch off between the two as well and say, okay, wait, now can I just practice some open glottis breathing before I do the closed glottis again or vice versa.

Exhausting.

Yeah, it's pretty crazy.

And I think a lot of it can be really instinctual too, right?

Like if we're just kind of like leaving moms to do what they want to do, we see people doing that more open glottis pushing and then they get that really grunty hard push going.

And if we were just kind of sitting back and letting people do what they want to do, a lot of times that's what I see happening.

And sometimes they do need some encouragement there of like, well, hey, maybe we do got, like Ciarra said, maybe we got to put a little stank on it right now.

Or it seems like you're getting pretty tired.

Maybe we need to do some more laid back ones, some more chill ones right now.

So I don't know, it's just, it's all about teaching people to get in touch with their instincts, I think a little bit, right?

And teaching them that anything, whatever feels best for them is the best way to go.

And that way they're associating that positive, it's a more positive experience, right?

If they know that they're doing what feels good for them.

Yeah, absolutely.

I mean, we're all about that.

Just instinctual birthing is huge.

So, can you give us just a little sneak peek into some of the suggestions that you give?

So, I talked about how I'll start that specific labor and prep delivery, four to five weeks before the patient's due date.

In addition to talking about pushing in different positions to push in, and we'll actually get into those different positions, I will practice, if the patient is comfortable with an internal exam, that gives us both some tactile feedback for, okay, what is actually happening when we cue differently?

So, another thing to think about is different patients respond to different cues.

So, you know, if person A responds well to their pelvic floor lengthening, when I tell them to inhale deeply into their backside, and then they get a good bulge by exhaling into a straw, but person B responds better to the cue of inhaling deeply through their nose and imagining their belly and their back filling with air like it's a balloon and exhaling by blowing out candles.

They know now, because now we've practiced it enough, where they know during their birthing experience and while they're practicing the pushing, like they know what cues work best for them to get in touch with what we actually want out of.

So that pelvic mobility with the breath work.

So we'll do a lot of cueing and just figuring out what works best for the patient themselves.

And then in addition to all that, also talking about perineal massage and teaching both patient and partner, if partner and patient are comfortable with that, to assist with perineal massage and just doing different hip mobility exercises.

So whether that be using a peanut ball or a Swiss ball, or doing a deep squat while holding on to the ottoman or curb walking or dancing with or without partner to help with pelvic mobility itself as well.

Those are all things that we'll talk about leading up to delivery and the due date.

So I'm gonna be just real honest and say, when I first started hearing about these push prep classes or labor and delivery prep classes, I thought it was really silly because I felt like being somebody who truly believes in the body's ability to do this and that we all really just get in our own way.

I thought we do not need an extra class to teach our bodies how to push.

This is just taking everything away from the primal instincts and the ability to go within and relying on another external thing to teach us how to do what our bodies actually already know how to do.

However, being a type A person myself, I can resonate with the, if I don't get to feel what it's kind of gonna feel like, I feel unprepared and I want to know more.

And some people just want that extra information and want that extra everything.

So then we had a couple of our clients who did these types of classes or preparations with a pelvic floor therapist.

And then we went to these births and then we were seeing really amazing pushing and shorter pushing phases.

And I was like, oh my gosh, there's something to this.

And then we started recommending it because once you see it works, you're more of a believer.

So I'm really thankful that we have this.

And I do want people to know, like maybe it's not for everyone, but there can be such benefit to practicing something and just getting more comfortable with it.

Like having your partner do some of these things with you prenatally just helps you get more comfortable with doing those things when you're in labor, just like with the positions, you know?

So I really love that you're incorporating all of that into this practice work.

Yeah, that's huge.

I think, I mean, there's just so many options out there that I don't think people really knew about before.

And I just, I don't know, I love having more options for stuff like this.

So what is one piece of information that you wish that everyone knew before giving birth?

So I would say that just understanding that your body is going through so many changes during pregnancy, which seems obvious, right?

But understanding that your body is continuing to go through so many changes immediately after delivery to forever postpartum.

And really just listening to your body in those early days postpartum and taking care of your body and taking the time to bond with baby but really rest because you just did so much to deliver this baby to the world.

And so that's why we talk about how it's so important to think about that five, five, five rule directly right after delivery.

So five days in the bed, five days on the bed, five days around the bed, really just to give yourself that time to really heal.

Like you have so much time after to slowly progress back into all those activities you wanna do and all the sports you wanna return to, but really taking the time to rest right after you deliver.

And we'll talk about that too.

So in those four to five weeks, right before the due date that we talked about, prepping for delivery, I'll also talk about, okay, and here are the things I want you to focus on postpartum.

And a lot of the things are the same.

So working on breathing, working on using the correct muscles as you're lifting baby and different breastfeeding positions.

So there's still so much that goes into it that then we say, okay, and then eventually come back in and see us once you feel ready, usually around six weeks postpartum to help you get back to your goals safely without leakage, heaviness, pain, et cetera.

I think that that's another huge benefit to doing this pre-labor, pre-birth work for these push prep classes or whatever, just even a couple of pelvic floor therapy visits.

Because again, it's connecting your mind and body and making you realize a little bit more what's going on within your body so that you're more likely to treat it well postpartum.

And you're becoming so aware of what those muscles feel like, and then you'll be able to be more aware of, oh, well, that feels a lot different than before I had this baby.

Something does feel different.

So connecting that mind and body, and some people are just more sensitive to their bodies in general.

Some people don't need anything to be able to make that connectedness.

We have some moms that feel every tiny little thing and they've always been that way.

And some that are like, sometimes I forget there's even a baby in there until they move, you know?

So everyone starts at a different place, but I think that that is really huge because we have so many moms that do too freaking much postpartum very quickly and they're harming themselves.

Well, I'm so thankful that you came on into this.

So if people wanted to find you, how can they learn more about your services?

I am personally located at Origins South Austin location in Rollingwood.

We also have a website, theoriginway.com and TikTok and Instagram presence as well.

So feel free to find us on there.

We need to up our game, Sam.

We don't have a TikTok.

I'm not doing it.

I'm 90 years old.

So if we're gonna get one, it's gonna be, it'll be Samantha.

We're gonna have to draw straws for that one.

Then I'm not playing that game.

Well, thank you so much for being here.

We will put all of your contact info in the show notes and I am so excited for people to learn more about how to push.

Thank you so much for having me.

It was wonderful speaking to you guys.

Thank you for joining us on Birth, Baby!

Thanks again to Longing for Orpheus for our music.

You can look him up on Spotify.

Remember to leave a review, share and follow wherever you get your podcasts.

See you next week.