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Are you a new parent or parent of twins and multiples? Do you want to thrive, rather than just survive?
Welcome to our show - a modern, step, by step guide to get you best set up for thrivival!
No outdated, frumpy or stuffy content - we're for NEW parents, we are new parents and we have found the best of the best experts, research and stories. If you're time poor - look no further - community and support building, efficiency hacks and tools, pregnancy, symptom management, partner support, body, bust, skin, hair, postpartum recovery, PND, logistics and travel, parenting twin psychology, childcare need-to-knows, returning to work and more!
I'm Emily, a twin and twin mum. I have researched extensively the best tips, efficiency hacks, expert advice. Books, white papers, medical papers, online groups, articles - sifted through it all, for you. I hope this podcast helps you best navigate this exciting time.
If you have guest recommendations or ideas, feedback - please DM my on socials or email hello@dwoh.group
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Podcast: Hey There Thivival
Hey there.
This is Emily Haigh.
Welcome to the Hey
There Thrivival podcast.
Today we are diving deep into the world
of pregnancy and postpartum body care with
someone who knows the body inside out.
Literally, she's a highly accredited.
Pelvic Floor Whisperer and go-to Guru
for new parents, a multi-location
physio owner who is also passionate
about enabling a holistic wellness
experience for mothers with their
medical professionals as well as physios.
She's also running her third
conference and just to ensure
she's not bored, she's a mum to two
and currently studying medicine.
Emily: Jo it's great to
have you on the podcast.
Could you give the audience
a overview on who you are and
why it is you do what you do?
Joelene Murdoch-Ward: Sure can.
Thanks so much for having me.
my name's Jo Murdoch and I am a pelvic
health physio and I've been, practicing
that for a very long time now.
incidentally landed there, as a sort
of young physio, I guess the reason
why I stayed there was 'cause I quickly
learned that a, the female body is
really quite complex and, b when you do
things well in terms of, preventative
management, but also treatment, you
can really have an enormous impact on
not just the woman's body but her life.
So.
it's that impact that we continuously
keep having and the feedback we get from
women literally changing their lives
by doing what seems to us simple things
is really powerful and really important
because women are really important.
And I have two girls, that makes me even
more motivated and ambitious to make sure
that female health is high on the agenda.
Emily: Fantastic.
I love that passion.
And we're going to get in a little bit
more, into some of the things you do
and your insights as we go through.
can't wait to, run through all of that.
And do you want to go through a
couple of your accreditations as well?
'cause I know you are highly
educated, so I'd love you to share
that with the audience as well.
Joelene Murdoch-Ward: Oh, sure.
I suppose I am highly educated.
I've done, the postgraduate
training in pelvic health, which
is what we need to do as physios.
And then I went on to do a master's
in, women's health medicine.
It's called UNSW, which
is excellent, I suppose.
Just more detailed information
for us to understand.
I'm doing a PhD at the mument as
well, which is because we have this
enormous question, which we can maybe
get into later that we've had in
physio land for a really long time
that really just needs answering.
So I'm busy with, lots of my colleagues
helping to try and answer that.
I'm in my third year of.
Four studying medicine.
So the hope to go on and, study
obstetrics and gynecology one day
Emily: Mm-hmm.
So you just love to, be bored
Joelene Murdoch-Ward: love,
Emily: sounds of things.
Joelene Murdoch-Ward:
I just love to learn.
It's good fun.
Emily: Yeah.
absolutely.
Especially in your field, I imagine
there's many, new things coming through.
Opportunities to find much
more, holistic and impactful.
So that's, fantastic.
I think that's the best
way to do things, isn't it?
Joelene Murdoch-Ward: I think so.
I mean the more you learn, and
I'm sure it's the same for every
profession, the more you learn, the
more you realize you don't know.
So
Emily: Mm.
Joelene Murdoch-Ward: as you're opening
up more, learning opportunities, you Dive
into that, and then you're like far out.
I really didn't even know that.
I didn't understand that.
And then so it keeps growing and growing.
So it is pelvic women's health.
Female health is as I'm sure all of
your listeners hear all the time because
it's kind of out there in the media.
it's that we really, it's an
understudied, we're an understudied
phenomenon, the female body.
And there's just truly so much we
don't know about how we function.
and so it's a cool, exciting place
to be, to really be part of trying to
understand it really well so we can do
a better job for our, girls growing up.
Emily: Yeah, I have heard that, I actually
heard recently a scientist saying that
one of the reasons women haven't been
studied, instead of studying women,
they've done men and then applied it
to a smaller body shape or, or things
like that, which is, you know, wild.
because we are hormonally and physically
so different and proportionally
weighted, have heard it's because we
are so much more complex to create
control groups because of hormones and,
Joelene Murdoch-Ward: exactly.
Emily: the time in your menstrual cycle.
And so it's just being
completely ignored, which is
Joelene Murdoch-Ward: yep.
Emily: absolutely wild.
lucky to have someone to
help, that's doing it.
And there's some great stuff
happening, I'm excited for the future.
I think it's good times ahead,
Joelene Murdoch-Ward: mm
Emily: Let's jump in.
the first, piece I'd love you to go
through is just a high level overview of
the main categories of which, physios help
pregnant or even preparing to be pregnant.
And then postpartum mothers and families.
Okay.
Joelene Murdoch-Ward: Yeah, sure.
I'd love to, physios are.
big on preventative health.
I don't know if any of your audience
have been to see a physio, but
our favorite thing is to try and
catch something before it happens.
because you might treat an injury
or a dysfunction and that's fine.
We are good at assessing and treating
that, but often in doing that, there's
a big part of the, gee, we could have
prevented that if we did X, Y, and Z.
So, I love that you brought up even
pre-pregnancy because there is a piece
there I think, for all pregnancy, whether
it's pregnancy with a singleton or you
or you're pregnant with twins, but that
pre-pregnancy piece, if there is any
dysfunction, in your system, in your
body, particularly your pelvic floor.
'cause I guess that's our area.
But it's excellent to have all
of that assessed and sorted
even before pregnancy Now.
It probably will surprise most of
you that the biggest population
of women who leak urine, so stress
urinary incontinence, are female
athletes that have never had a baby.
So think that's really important.
So if you are sitting there going, oh
yeah, I, I guess I did leak a little bit
when I played tennis, or that's a thing
and that's, I guess a little sign for you
to be, well, maybe there's something that
I could fix in my body pre-pregnancy.
So, because pregnancy and childbirth have
always been blamed for incontinence, I
think as a general understanding, but in
our clinic, we see so many women who've
never had babies with other things and.
the incidence of leaking
is really high, and I
Emily: Wow.
Joelene Murdoch-Ward: people
don't necessarily really
think that hard about it.
it's not that bad.
It's, it's the, one of the things you
can either ignore or you just stop
playing tennis or you just, you know,
and so then you fall pregnant and
suddenly you're leaking in your pregnancy
and it's a pregnancy related stress
incontinence, but actually it's not.
If you really understood
that patient's history, so
pre-pregnancy, if you've got any.
Symptoms in your body, like stress urinary
incontinence, even fecal incontinence.
We see in athletes,
pelvic pain's a big one.
So pain in and around the
vagina, pain with intercourse.
Emily: Mm-hmm.
Joelene Murdoch-Ward: if you have a
history of endometriosis that you know
about, or even polycystic ovary syndrome,
all of these little things have nuances
within your pelvic floor that it's
really amazing as physios, if we can
meet you before you fall pregnant and
fix all of that or help you fix that.
And then I, and then hopefully we pr
we prevent the leaking in pregnancy.
We prevent the per pelvic girdle pain
in pregnancy, which is often quite
debilitating for a lot of people.
So that would be probably
the first message I think.
Emily: Okay.
Joelene Murdoch-Ward: And then
the second one is the top tips in
pregnancy is also about, really about
preventative healthcare, if you can.
get to your pelvic health
physio after your 20 week scan.
'cause it's at that point we know
exactly where your placenta is or
placenta, plural, if there's two, and
that they're out of the way of the
cervix, which means we can do an internal
exam and then we can, and that's how
we would assess your pelvic floor and
whatever else we need to assess in your
body with the view to prevent, again,
pelvic girdle pain or any incontinence
or any issues through the pregnancy.
And then Later in the
pregnancies towards the birth,
Emily: Mm-hmm.
Joelene Murdoch-Ward: assess the pelvic
floor again, with a different, sort
of purpose, which would be more around
understanding whether the pelvic floors,
doing what it should be doing for birth,
which I can talk about now or later.
but the highlight, that
would be the highlights.
And then the third thing
would be post, oh, sorry.
In pregnancy we would also be assessing
your abdominal wall we would be
figuring out how Yeah, really important.
because like exactly
what you did to Emily.
the big diastasis or separations that
happen postpartum, are really preventable.
even with multi Pregnancy.
So even with two babies or three,
it's, it really depends on what
you're doing with your abdominal
wall in pregnancy as to, how well we
can control it and basically stop it
becoming a big deal for you postpartum.
Emily: Yeah.
Wow.
I mean, it's crazy listening to
you talk about this because I, as a
example, just had no idea about how
you could prepare and avoid things.
I knew about Kegels, but.
most of the other things.
that stomach, that that
is a preventative thing.
And, and then the birth, a great
call out to the audience you may have
no idea if you haven't had another
pregnancy, what might be coming for
you in terms of, physical impacts will
then go on to affect your life and
potentially your mental health as well.
Joelene Murdoch-Ward: Mm.
Emily: getting those checks with someone
who, is a, an expert is definitely
worth it because the cost and the
time that it then takes to fix it
later, which is doable, you know, I
imagine is lesser than preventative.
Joelene Murdoch-Ward: absolutely.
That's right.
It's time well spent preventative
Emily: yeah.
Joelene Murdoch-Ward: as you know.
And just in case, I forget on the
Kegels thing, because everybody
Emily: Yeah.
Joelene Murdoch-Ward: about Kegels,
which of course was some American doctor
way back when that discovered that the
pelvic floor, muscles actually have
a function and we should make sure
that, that they maintained and strong.
but we don't really use that
term Kegels in Australia.
but I, but it's good for you
to use it because that's,
people know what that means.
would say even if you think you know
what you are doing when you do a pelvic
floor muscle contraction or a Kegel.
I would still get that assessed the
amount of people we meet, we are
like, oh, no, no, no, no, no, no.
That is not it.
and you, it's a real skill to understand
how to use your pelvic floor muscles well.
so it can be just a simple
assessment to really make sure
you understand how you do it.
so just, I'll just get that in there
in case I forget to say second later.
Emily: Very helpful.
I mean, it is a little bit
of a mystery, I will say.
we'll dive into that a little bit
later, but really good call outs
at the start around, the high
level areas that physios work with.
Let's jump into pregnancy by trimester.
let's say we've got a new parent or
expectant parent or maybe someone
that's doing it for another time and
they just never had the information.
with the three phases.
So trimester one, two, and three, three
obviously just about to pop trimester.
One, you're preparing
two, I mean, on the way.
what would you say other specific
kind of muscular changes, and how
it impacts the physical state?
Joelene Murdoch-Ward: Yeah, sure.
Good question.
The first trimester, not tons, you
get a, a big dose of hormone, right?
So big dose of, estrogen that, and there
is, there's another hormone called relaxin
that you also get a bit of a dose of.
it's funny, it's always been
blamed for ligament laxity.
So if you talk to someone who doesn't
know really what they're talking
about, they'll say, oh, that's just
the relaxin making you all floppy.
And, well, it's not at all the relaxin,
I think because of the name of it, it's
taken on this responsibility, but it's
not, it's the estrogen is the bigger part
and maybe a bit of relaxin, but it does
make your ligaments in your entire body.
because it can't, estrogen's a great
hormone, but it can't target things
exactly specifically, but it will make
all of your ligaments a little bit
floppier, which means that the ligaments
holding your pelvis together, can become
a little bit more mobile and your pelvis
is suddenly a little bit more mobile.
so that can happen in the first trimester.
Nothing much is happening to your muscle
system, unless you are really sick and
you can't get off the couch, which I'm
sure lots of people are or have been,
and so know what I'm talking about.
And that's hard.
And obviously you're gonna lose
a little bit of muscle there.
But not a big deal.
I would say the first trimester is a
little bit like, just get through it.
if you are suffering early with
pelvic girdle pain, then again.
Don't put up with that, that even if it's
a little bit of pain at the front of your
pelvis or a little bit of pain at the
back, it's exactly what you said before.
If we were to see you then, then
we might be able to sort you
out in one treatment, two tops.
The women that wait that we see
and they don't come and see us
until they're already with a
walking stick or on a crutch.
we can definitely help and we can
get you through the pregnancy,
but we could we could have stopped
that happening in the first place.
And the pelvic girdle pain again,
it's always been it's been a
bit shut down, like, oh yeah,
it's just part of pregnancy.
Of course, your ligaments are
all loose and blahdi, blah.
But again, not true.
There's heaps of women that get through
pregnancy with no pelvic girdle pain.
With the same ligamentous
Emily: Wow.
Joelene Murdoch-Ward: So it's not an
just expected thing of pregnancy, it's
a, something's not right with my body.
I need to get it sorted because I've
still got six months plus to go.
Emily: And then afterwards as well, right?
If it's exacerbated,
Joelene Murdoch-Ward: Exactly.
Emily: it's long.
Joelene Murdoch-Ward: It's a,
Emily: Babies.
That's what I never really thought.
Joelene Murdoch-Ward: Yeah.
And pelvic girdle pain is not,
it actually can be quite complex.
it's been simplified and shut down
I think a little bit, but, it can be
driven from anywhere in your body.
So it's, seen a physio and they just put a
belt on you without really assessing you,
I would argue go and see a different one.
because.
That's just a very
generic kind of treatment.
It someone to assess you your whole body
properly and try and understand where
this pelvic girdle pain, is coming from.
and then the treatment will be
targeted appropriately and you'll
get better and will keep it away
for the rest of the pregnancy.
It's really common for pelvic girdle
pain to be driven from the upper part
of your body, which sounds weird, I
know, but if you think about it, your
ribcage, your boobs, which are growing,
you are tired and you are, probably
still working and your top part of
your body's really heavy and it's often
quite dysfunctional on top of a pelvis.
It's gotta try and carry it.
So we find in our clinic
more often than not.
it's the upper part of the body that's
the problem sitting on top of the
pelvis, whereas that's not really
how it's taught to a lot of people.
So just really make sure if
you are, you've got pelvic
girdle pain, go get it checked.
Make sure you're not just put, someone
just puts a belt or tape around your
pelvis and tries to hold it together.
'cause it, it could be that
there's a more complicated problem
it should be getting better.
The way to know is it should be,
you should have one treatment and it
should be even a little bit better.
You might need another one and it
should absolutely be getting better.
'cause I think that's the other thing.
People are oh, well it didn't get
better, but I was getting heavier
in my pregnancy and la la la la la.
And I go, no, you just didn't
have the right treatment.
So, don't put up with pelvic girdle
pain in that first trimester.
But that's about all.
Nothing too exciting from
a physical point of view.
Emily: Some really good insights.
So, first of all, mind blowing
to hear that there's pregnant
mothers on crutches and walkers.
that is, that's wild.
And then quite interesting as well
around, the pelvic girdle pain or
any pain that it's a sign from your
body and it's driven from somewhere.
I think that's something I realized
postpartum finally, you know,
accidentally, we'll get into my story,
but accidentally getting assessed
that everything's interconnected
and your body gives you signs.
So, really interesting call outs there.
and what about, so what about those,
last trimesters as you go through?
Joelene Murdoch-Ward: Mm, second
trimester, often quite smooth.
It's a really good time, hopefully if
everyone's starting to feel a little bit
better to really get into your exercise.
So, there's plenty of evidence
now that there is just no harm
to keep exercising in pregnancy.
So, when I was pregnant, the, the
rule of thumb was, you can keep
exercising the way you've always
exercised, but don't start anything new.
And that's been challenged a lot in the
last few years because actually like
every health condition known to man,
exercise is often part of the cure, right?
So, it will prevent gestational diabetes.
You'll look after your
musculoskeletal system.
There's even some evidence that you,
you'll have better birth outcomes.
So.
If you're feeling pretty good in, in your
second trimester, it's get exercising.
So get walking or get running.
If running is what you do, get
back to the gym, do your resistance
training, get in the pool, swim.
Pilates, like you did
exercise floats your boat.
Do it and do it three, four
times a week if, if you can.
I mean, it might be tricky if you've
got other children at home 'cause it's
always tricky to find time to exercise.
so obviously take what I've said
with a grain of salt, but if you
know it's first pregnancy and you
just have yourself to look after and
try to get to the gym three or four
Emily: That blissful
time that we are, yeah.
Joelene Murdoch-Ward: Yeah.
Without, yeah, that's right.
but I suppose the point is, is now's
a really good time to exercise.
and as I said earlier, it's somewhere
in this trimester is when I'd
get to your pelvic health physio.
'cause we really wanna
assess your abdominal wall.
We want to make sure there's nothing
we could do in to prevent it.
And often there is.
So we'll watch someone and okay, alright,
your abdominal wall's really low in tone
or this part of the system's not working
well, I need you to do these exercises.
Or it might be, or often there's
a component of tightness or
overactivity somewhere because your
abdominal wall is four layers deep.
And it so it's not just one
Emily: Is it.
Joelene Murdoch-Ward: Yeah.
Yes.
So there's four.
Yeah, four tho.
And those four layers connect all
together in that centerpiece down
the middle called the linear elbow.
And that's the piece that will
sort of stretch and separate.
if you are trying to prevent that
separation, you've gotta consider the
function of all four muscles, right?
So just kind of look at someone's body,
analyze it, figure out what we can do
to make sure, for that woman we do the
best we can in that pregnancy to be as
preventative as we can with the dyes.
So it's good to start that
in the second trimester.
And then, as I said, we'd assess your
pelvic floor too, because again, we
don't know what we're going to find
when you assess someone's pelvic floor.
again, most people would just assume
you're assessing the strength, probably
'cause that's the most thing that talk.
But actually we are assessing
so much more than that 'because
muscles do more than just contract.
They, have to relax properly.
They have to time their
contraction properly.
they have to be able to work under
load and, and different speeds.
So we are testing lots of different
components of the function to test if
there's something that we could intervene
with and then optimize basically.
so the second trimester is pretty,
pretty smooth, pretty easy.
Usually don't need to see the physio
much unless there's something going on.
It's just like, this is your program.
And usually we'll say, I'll see you
at about 34 weeks, all being well.
that's when we, again, look at the
abdominal wards or anything else I
need to do because sometimes we will
put someone in tubi grip or some sort
of compression stocking in pregnancy.
So if we've done all we can do,
but there's two babies in there and
this abdominal wall's really, really
heavy and it's really stretching, we
might compress someone with a tubi
grip, which is just like a piece of.
I think everyone knows what's like
stretchy compression stocking, but
it goes over your abdominal wall.
So it comes in sizes, big
sizes, we usually double it up.
And so sometimes we'll see some at
thirty four weeks and be like, far out,
I need to give you some more support.
Put this on.
This will make you feel loads better.
And it's also plugging the abdominal wall
in and trying to stop that linear elbow.
Just, stretching too much.
there will be space, the linear
elbow is going to stretch.
It can't not stretch.
There's just, there's just this
point with we're like, Ooh, we
just don't wanna go too far.
It's hard to come back from too far.
So we like to watch that We have measures
that we take both with our hands and
with a real time ultrasound just to
be like, okay, where, where is this?
How are we going?
What else could I do?
yes, we'll assess that again and then
we'll assess the pelvic floor again.
And the main.
measurement that we are really
interested in this point is how
well the pelvic floors lengthening.
So this is in the case that someone
is electing for a normal vaginal
delivery, so going for a normal vaginal.
If you, at that point that you're electing
for, um, section, then there's some sort
of dysfunction in the pelvic floor, then
that, that assessment's not so necessary.
This is if we need to make sure the pelvic
floor is doing exactly what it should
do for your labor and birth, which is
stretch three times its resting length
Emily: Very important.
Joelene Murdoch-Ward: Yep.
And essentially get out of the
way of the baby's head to descend
down and through vagina and out.
we, we just need to know that these
pelvic floor muscles can switch on.
can switch off and then they can
lengthen under the load of what's
called the bearing down maneuver,
which is like pushing in labor.
So we are, are huge advocates for
teaching women how to push in pregnancy,
which, which has been proven in the
evidence now that, that's a good idea.
But we've done it for a long time.
'cause physios, we think
about muscles all the time.
So we've always thought, gee, it wouldn't
be great would it if you had this group of
muscles that just didn't stretch very well
and didn't know how to get out of the way.
And surely if that's the case, there'd
be some sort of trauma or some sort of
issue during the birth if it didn't.
And so that's, that has been proven
now that your second stage of labor,
for example, the pushing phase will
be longer if you don't push well.
And if your pelvic floor muscles
don't know how to get out of the way.
So, now the problem with a long
second stage is that that's
not, that's stretching all of
your tissue inside your pelvis.
So over and over again.
Now what we worry about are the, now
the ligaments and the fascia that
are holding up your pelvic organs.
So your bladder is in there, your
uterus, and your rectum are all held
up by these nice, strong ligamentous
structures if they get stretched
and stretched and stretched over
and over and over and over again.
Longer than two hours, let's say.
Then they don't bounce back as
well as we like them to bounce
back and therefore they don't hold
up your pelvic organs very well.
And what we worry about is pelvic
organ prolapse in the future.
So that's why we are a bit obsessed
with the length of that second
stage, how long are you pushing for
and could we make that a bit more
efficient if you knew how to push well.
And the other thing is, is for years
women would come back and, you know,
tell us about their birth, which is
like our favorite part of our job,
listening to people's birth stories.
And they'd be like, but they kept
telling me I was a terrible pusher.
And you hear that thing
over and over again.
I'm like, it's not that helpful
to learn that you're a bad
pusher in the middle of pushing.
whilst you're trying to push your
baby out for someone to say you are
not pushing well and you're thinking,
well, I've never done this before.
No one taught me how to push a baby out.
I don't know.
And it's really painful.
Emily: Yeah, I imagine it's a
little bit too late to be told,
and you'd be so exhausted.
So definitely timing.
Yeah.
Joelene Murdoch-Ward: Yeah.
So that's what the third trimester
looks like, really from a,
from the, our point of view.
Emily: Okay.
Well.
Joelene Murdoch-Ward: by
the way, you're all still
Emily: Yeah, I've got a couple questions
there, but yeah, my mind is boggling
a little bit there, but I've got three
questions that I wanna follow on with.
So just give me a quick
mument and I'll get this
Okay.
So, Jo, those are some really interesting
points you've just gone through.
And, I think specifically
for, I'm thinking again about
multiples and, and birthing, a
few babies you've talked about.
the abdominals and basically preparing
that, I think that's a really,
really relevant call out to people
having multiples is that preparation,
especially if there's that added weight.
Load.
Joelene Murdoch-Ward: Yes.
Emily: that.
and then the pelvis, stretching for
birth, I mean, I just had no idea, which
probably a lot of people don't, but going
in and having a birth and not knowing
that it was probably never gonna go well
if your pelvis wasn't able to stretch.
It's actually quite concerning
and it's almost like that
should be the first check.
I, yeah, I'm quite surprised that
that's, maybe not more well known or it
isn't and you can potentially prepare.
And then the other one was, you
talked about a long berth and that
kind of overextension of the muscles
and then that bounce back and if
it doesn't bounce back, you've got
issues like, incontinence, et cetera.
So, I wanted to highlight that to
the audience as they're listening.
Some really.
Really interesting, points there.
And again, I think for multiples
those would be quite important.
Was there anything you
wanted to add with that?
with multiple specific, muscular
considerations or things to know
about for those sorts of birth,
Joelene Murdoch-Ward: maybe just
with the abdominal wall piece, I
think, if it's your first baby, and
maybe if you've sort of just not.
Been around much chat around abdominals.
It's, it, it do, it doesn't necessarily
sound like a big deal and it can be again,
washed over as like an aesthetic issue.
and it is an aesthetic issue, but
it makes you feel really awful.
So because your abdominal wall can end
up looking really of low in tone and
floppy and doesn't make you feel good.
And it's definitely been proven
to women with a bad diastasis
or abdominal separation.
it has strong links to postpartum
depression and obviously body image.
From a mental health point of view,
from a physical health point of view,
physios, we argue it's absolutely
important because those structures are
holding you upright, this is important.
but it's definitely been washed over I
probably medically because it doesn't
cause any massive issues medically, but
mental health wise, absolutely it does.
And so I think just really have a good
think about it because it, is often very
preventative if you do the right exercise
and, it will be worth it for you to come
away from your pregnancy with an abdominal
wall that you're still happy with.
and we, I think you said, Emily, that
you are happy with your abdominal wall
past postpartum than your wall before.
Yeah, and
Emily: Yeah,
Joelene Murdoch-Ward: too.
Emily: I thought it would be.
Joelene Murdoch-Ward: Yeah, so
there's on the, yeah, there's also the
argument, and I've got patients the
same, who actually go, my abdominal
walls are better ever been because
I guess you pay attention to it.
Like, as I said, if you rock up to
a physio who's good, they're gonna
analyze it and figure out where the
dysfunction is and try and piece
your abdominal wall back together.
Often we get really grippy, overused,
dysfunctional, superficial layers.
So the external oblique is one of the,
like of the fourth, it's the fourth layer.
well, it's actually the third,
then there's rectus abdominis, but
more superficial and it, it can get
really overactive and dominant and
tight, and people end up with what
we call a little pressure belly.
So they just sort of say, oh, I've
always had a little pot belly.
What that says to us is your abdominal
is actually very dysfunctional and
your deep core is not working at all
because it's being shut down by the
overactivity in the superficial system.
So
Emily: Wow.
Joelene Murdoch-Ward: those, I suppose
the biomechanics of your abdominal wall
we can fix and, if you've got time in
pregnancy, it's a great time to fix it.
'cause we can also prevent the big
diastasis through the center and
hopefully turn out like us and be
like, actually my abdominal wall or
those babies better than it ever was.
yeah.
And, but it's, yes, it's not, yes,
it's US aesthetic, but it has far
greater consequences when it's bad.
so pay attention and the,
there's the stretching piece.
Pelvic floor mobility, I suppose,
for birth is isn't, as you
say, very well known about.
it's because it's taken us a
long time to get the research
to show that it's important, and
that's part of my PhD as well.
And, as such, it, it's not taught in,
in obstetrics or midwifery practice and
it's only it will be taught in the coming
years because we now have enough evidence
to say, yeah guys, this is really,
actually, this is really important.
And it's actually very easy to
assess, obviously in the, in the
hands of someone skilled, But it's
not a difficult thing to assess.
That has, again, a bit like the
abdominal wall potential to prevent
something really bad, like stress
incontinence, pelvic organ prolapse,
bad peroneal tears, et cetera.
So something seemingly basic.
Certainly in our world as
pelvic health physios, it's
quite a basic assessment now.
It's not a difficult thing to do.
And then if someone needs treatment, the
treatment is also not difficult, then we
can prevent some really terrible outcomes.
I think in the next decade or so,
it'll hopefully be more mainstream.
But we have to, like everything in
medicine, you have to get some evidence
behind you before it's taken seriously.
So it's happening.
It's good.
Emily: That's great.
Well, I'm glad you're leading the charge
on that because, yeah, I'll certainly be
spreading the word through this podcast,
but also I'll be telling everyone I
know because that's just, yeah, that's
terrible that it's not more widely known.
thing that I would also, highlight,
is I do, know that in the multiples
community on the, on the group pages,
there are just so many posts of people
that, like you said, they're just
really, are so upset with their bodies.
It's really sad.
You see someone post, I hate my body.
I'll never go to the beach again.
I'm always covered up stretch marks,
et cetera, stretch skin, abdominals
dropping, and you see people post under
and under and it's the same thing.
And that's one of the things which
to be honest, drove me to want to
create a podcast, originally a book,
but now a podcast, to try and help
people get more information because
And I accidentally, as you said, have
better ads than I did before I had babies.
And that's purely I'd started, Pilates,
which is very deep core focused.
Prior to that, I didn't.
I didn't really have
strong abs to be honest.
but I happened to get pregnant after
that with the twins and, and then did
Pilates through the pregnancy, which can
be quite expensive for some people, but
we'll talk about some cheap options later.
I think talking about the mental
health and even for any partners
listening, why you might advocate
for that, I think is really, really
important, especially in this community
of, of multiples or new parents.
Joelene Murdoch-Ward: Yeah, absolutely.
And I think it's, hyperemesis
gravitas, which did you have as well?
Were you sick through your pregnancies?
Did you tell me?
Yeah, and I mean, it's far
more common, obviously when
you've got multiple, babies.
So, I do like my heart goes out because
I was the same, so sick, and I knew all
of the things that I should have been
doing in terms of exercise and what I
shouldn't, shouldn't eat, and I just
couldn't any of it because I couldn't.
I just couldn't get outta bed,
you know, the, all the things.
So, it's easy for me to sit here and
say, get up, go for your walk, go
to the gym, eat well, la, la, la.
but I just wanna say, first of all,
I appreciate that for some people,
pregnancy is not the time that you can
even think about looking after yourself.
And all you've gotta do is
get through the pregnancy.
So that's fair.
So it's just for those that can you
exercise and get to the physio, best
case scenario for those that can't,
then you'll feel a million dollars
once you've birthed these babies
and you'll be back to yourself.
And then you get to the
physio straight away.
So there's a bit of a six
week check at the physio.
We've sort of moved that
forward over the years.
We are like, you know what?
I'll see you at three because.
Yeah, I know.
Well, it's sort of a, it's a
bit of, I don't even know where
the six week thing came from.
It's probably on the back of the
six week check with the midway.
Emily: Oh.
Joelene Murdoch-Ward: Yeah.
I, I don't know.
'cause you know, midwives, gps I know,
but if you think about it, I'll, I,
if I, if you have no, if you've got
an abdominal wall that I'm worried
about, we've got no time to lose.
So you can get out of the door and
get to the clinic at three weeks,
then I wanna see you then because,
I know you've got, you're trying to
still get your feeding established.
I know you're really tired.
I know all of that.
But I also know there's a few
little things that we can do.
And start it really early.
That's gonna be really helpful.
again, we might get you in a
chewy grip, we might order you a
specific pair of shorts or tights.
we might get you, we not my, we'll
get you started on your exercise
program, which will be we're not silly.
of us, not all of us, but you
know, a lot of us are mums, right?
So we've all been there.
We get it you have zero time, but we do
cheeky little fun things well it, the,
the TheraBand that we might be giving
you to, which is a resistance band.
an abdominal exercise that we might
have got you doing lying down.
We'll get you doing standing up with
the TheraBand and we'll get you to
put it around the doorknob in the
kitchen so that when you walk past
it, you can just do three of them.
So we try to be really creative
and clever with how we integrate
these exercises into your life.
'cause we're.
are not silly.
We know that it's just impossible
for you to lie down on your Pilates
mat with especially more than one
baby, and get your exercises done.
So we're integrating it through
your life, but the sooner we can
see you postpartum, the better.
obviously if you do have access
to physio, we will, I suppose,
be your guide, like your exercise
guide to build your body back.
And this is obviously in the case
that wasn't able to prevent all
of it happening in the pregnancy
because, because of whatever else.
So, yeah.
So it I suppose, 'cause there's also
the, you've had your babies, of course.
Of course your body's floppy and fragile.
And that my message is.
Don't accept that and wait until you
get to six months post and look in
the mirror and go, oh my God, my body,
again, easy for me to say, but if you
can just spare thought for yourself
in the early days just a little bit.
'cause if we can get working with
you sooner, I think for a lot of
women we can get, won't have that
same looking in the mirror at six
month hating your body situation.
'cause we've worked really hard with
you for six months and you'll feel
much, much better at six months.
So.
That's again, probably ideal if
you're listening to this and you're
already six months down the track
and you haven't done nothing, haven't
done anything, Then that's okay.
Get going now.
Like get going.
Because again,
Emily: Yeah.
Joelene Murdoch-Ward: over the years
where they come in two years post
and they're like, right, I'm ready.
Emily: Yeah.
Joelene Murdoch-Ward:
far out, this is okay.
But I'll say to them, this is fine.
it is what it is.
We are here now, but it will
take us a year, a whole year
to get to where you wanna be.
So you're gonna have to be patient with
me because we have to start from scratch.
So yeah, I guess the message is, is
where possible earlier is better.
Emily: Yeah, that's really good.
And I was gonna ask you about that
because I think it's, it's good to know.
I mean, I think my, my mother was a,
a twin mum in the eighties, and, she
didn't get her stomach fixed until
wheel four, but she said, look, I
just didn't, not necessarily the
knowledge, She was looking after the
twins and had another child as well.
so spreading the word as much as we can
about why you might prioritize that.
And also to partners.
'cause today partners are a
lot more aware of advocacy.
Joelene Murdoch-Ward: Hmm.
Emily: So knowing about the situation
so we can give you education, but also
knowing people have got those limitations
in terms of they've got other children,
maybe not support, maybe they're a
single parent with multiples, maybe
Located in the bush and not a lot
of options So hopefully this episode
today gives people information
and that, you do the best you can.
at the end of the day, as long as you're
taking a step forward, it's not backwards.
Or even if you go backwards
then you go forward again.
that's hopefully the main message to
go through today, we all do our best.
Joelene Murdoch-Ward: yeah.
Absolutely.
Exactly.
And you can't beat yourself up.
that's not helpful.
the things that partners can do is
maybe just take a bit of the like.
load, that's not the right word.
the cognitive load.
So for example, you might know you really
wanna get to the physio, or you might
know that you wanna do some research
on some great postpartum exercise.
but you just can't quite, I
remember that, just can't quite
execute the task when you've
Emily: Yep.
Joelene Murdoch-Ward: it's like,
I know what I wanna do, but I, I
just can't even, I just, I can't
even open the computer anymore.
I don't even know.
So, I feel like that's a good job for
partners to be like, okay, you know what?
I'll book that appointment for you.
Or, Hey, I've done this research that
looks like there's X, Y, and Z market.
What do you think?
And then, oh, why don't we make
a plan that at this time of the
day, every day you have your 10
minutes to do your exercise while
I do whatever with the babies.
like, you know, it's a bit like
in the birth as well, like.
The, we always advocate the partners
need to be the brains you are thinking.
You are thinking.
Your partner is way too busy feeling and
trying to just get through this labor.
You, she's got, there's, we don't
actually, in labor, you don't
want the woman to go to cognition.
You don't want her in her frontal lobe.
You want her weigh back in a
primal brain just doing her thing.
So they have to think.
And I think especially in those first
12 weeks, you just, all you can think
about is feeding your baby really?
So you need someone else
I'm going to prioritize you.
going to look after you, you look
after the babies, get them fed
and I'm going to look after you
would be, I mean, that's the dream.
Emily: Yeah, those are great tips.
I remember when I was at the hospital,
one of the nurses or the midwives had
said to me that the brain, goes into
a state where it's purposely takes you
further away from the logic of thinking,
which must be the parts of the brain,
which I have read about previously.
And more to that keep the child
alive, which is again, humanity.
Any animal that exists is that's
what the, the mother's job is,
apart from maybe the animals where
the male takes over after birth.
I don't, I don't know the mechanics
there, gen generally speaking,
but, that's a great call out.
that advocacy, and we talked about
this with the, the ob so you know, Dr.
Sarah, around what partners can do.
being that logical person.
And then something I thought of,
which I think you might like is gifts.
When people are thinking about
what they can get for new parents,
buy them vouchers for a physio.
Don't even know if that's possible.
Joelene Murdoch-Ward: it
Emily: Or like,
Joelene Murdoch-Ward: sure.
Emily: wouldn't that just be great,
services and it's pre-organized and
then you just, you don't have to think,
Joelene Murdoch-Ward: Oh
Emily: turn
Joelene Murdoch-Ward: Just make
Emily: I would, someone
should done that to me.
Joelene Murdoch-Ward: for.
Oh, what a great idea.
I've never really thought
of that, but yes, post your
Emily: Yeah.
Joelene Murdoch-Ward: check
with the physio voucher.
Nice.
Emily: Yeah.
Well I spoke to a breastfeeding,
expert recently, and she had said her
like, top tool was actually services.
So get a voucher, for, whatever
it is, whether it's breastfeeding
support, sleep training, physio.
Joelene Murdoch-Ward: yes.
Emily: is much better than buying
like 10,000 twin or triplet,
et cetera, feeding clothes and
Joelene Murdoch-Ward: Yeah.
Emily: oh my god.
Yeah, there's so many gadgets I think
that's a really nice call out and
people will note that one down guys.
so we've gone through the
pregnancy trimesters and we've
talked about some top tips.
So many great tips.
I can't believe how much I'm learning.
and then let's talk,
more about postpartum.
I want to go through my story 'becasue
I think that'll be a good illustration,
to educate people more why they might
want to see a physio, which I think
hopefully they're already on that journey,
So I had seen a couple of physios before.
I had friends who physios I.
I've done a lot of sport and, and
ballet and things over the years, so
I kind of knew about the body ish.
Well, I thought, Anyway, I'd seen
physios and I was just a bit confused.
It's, it's a bit uncomfortable as well,
let's be honest with, you've got doctors
and everyone's poking around down there,
Joelene Murdoch-Ward: Yeah.
Emily: and so.
I saw people, but never quite, I guess.
Got it.
And didn't think it was that
important, to be honest.
And then, so I had, twins,
really big twins, and my ribs
twisted, my spine twisted.
I didn't really know.
I just had bruising and,
and things like that.
And then what happened is, postpartum
and went back to my Pilates instructor.
And she just happened to be there that
day and she's really well educated.
And she looked at me, she said, you, your
hips are twisted and your legs turned out.
And we were looking in
front of her mirror.
I was like, oh, are they, obviously
clueless is still still in the fog.
and so she recommended I go and
get massage and stretching to kind
of balance the body from that.
I ended up seeing a chiropractor
who scanned my body, did a full
skeletal scan and I had scoliosis.
So my, jaw was twisted over, my neck was
twisted, my spine was twisted, my ribs
were lifted, I think is the right term.
Joelene Murdoch-Ward: Mm-hmm.
Emily: and I was getting
headaches and pain.
and so I ended up then going to see
a physio who was great and has been
working to straighten me out, plus the
Pilates instructed, they're constantly
like, let's flip your hips but all
by accident and, post that learning.
I, I really speak to a lot of
parents and even women that had kids
years ago, so my mum's generation
and they've never done anything.
They've got pain and they've
got headaches, but they just
keep going or they medicate.
So I guess, I wanted to share
that with people as an example of.
The fact that I understand it's
expensive, I understand it takes time.
So again, like let's, do what you can
or we'll talk about some options there.
But, you can get quite a lot of
issues, if you're not checked
or you can have preexisting.
I think for me, I was probably
pre-existing, maybe twisted, actually
don't know, but probably, and then
it was exacerbated by the pregnancy
and I was getting these headaches.
I was a runner.
I'd run and then I'd have
like three day migraines.
Joelene Murdoch-Ward: Hmm.
Awful.
Emily: Yeah.
And with these sorts of issues, I'd be
interested to hear from you generally
how you might approach someone like me.
and what you would explain to people
within that scenario as well as
to why they might want to consider
getting checked early or, asking
families voucher or doing a remote
check or something like that.
Joelene Murdoch-Ward: Yeah, I think it's
the, exactly the same that a theme that
we've got through the whole podcast,
which is if there's a symptom in your
body, it's telling you something.
And yes, we can just take a Panadol
and try and get rid of that headache.
But, if you do understand your system,
and I keep talking about the systems,
'cause the body's the whole system, right?
And as pelvic health physios in our
clinic, we still look at the whole
body from your feet to your head.
like in your case, you could have
had, with all of those twists and
turns in your system, you could
have had anything wrong with you.
You could have had a headache, you
could have had stress incontinence,
you could have had a right hip.
Pain.
You could have had rib pain,
you could have had anything.
So the symptom is, doesn't often
tell us much until we see the
body and then we look at you.
So yes, I would've looked at you too and
went, okay, wow, your pelvis is here, your
ribs are here, your head's here far out.
what can you do?
And then, and then we get you
to move and oh, good grief.
wonder you got your
headaches when you run.
Look at you stand on one leg.
but that's okay.
'cause then you understand the system.
oh yeah, that's all right.
it's all biomechanics.
Let's rewire your system a little bit.
And that always often involves
some sort of manual therapy
always involves exercise.
So an exercise truly is medicine.
it honestly, if you've prescribed
the right exercise program.
it's worth its weight
in gold and it's cheap.
So you are right.
the massive barriers for
everybody is finances and time.
And that is an issue when
you're going to see physio.
'cause usually you're gonna have to seek
out private physio, and you're gonna
have to give up an hour of your day.
but if we can see you as sooner
in the piece, rather than when
you've got migraines, when you're
starting to get some symptoms, or
in the case of postpartum, even if
you're asymptomatic, you have just
been through pregnancy and birth.
let us just assess you.
And that might be it.
You might get, or it might be that.
you say to us, listen, I can
afford to come back once.
And I go, alright, these
are the exercises you do.
do them every day, you will get better.
And then we see you one more
time to progress the exercises
or tweak it or whatever.
So it doesn't have to be
a commitment every week.
So, don't let that put you off.
If you think you're going to the
physio, don't roll your eyes and
think, oh, I'm gonna have to go
there every week for like 12 weeks.
It's gonna cost me $1,500.
not the case, especially if you're
postpartum and you're asymptomatic.
Might just literally be, Hey listen,
we need to work on X, Y, and Z.
You got a month, you do the
work, we'll get you better.
doesn't have to be as,
as costly as you think.
If you are kind of clever.
Emily: That's great.
Really great to hear that.
And I hope people, enjoy
getting that insight.
'because for some people
it's a real issue.
Certainly those who have multiples
and other children and they're,
just don't have the income, they
Joelene Murdoch-Ward: poor.
Emily: get
Joelene Murdoch-Ward: Yeah.
It's
Emily: early is another
common one, unfortunately.
Joelene Murdoch-Ward: gosh.
Emily: Anyway, we're,
Joelene Murdoch-Ward: And you know
Emily: we're getting.
Joelene Murdoch-Ward: like just
putting it out there, just, I mean,
we have kids in our clinic all the
time, babies and children are welcome
because obviously, and so our admin
team and our reception staff are unreal.
they're rocking prams.
They've got one on the hip and
they're rocking this pram, and
we're all in it as a team to help
facilitate the health of this woman.
so don't also let that put you off.
Just, it's hard.
I know.
But if you're going to a great
clinic, the babies will be welcome.
The children will be welcome.
Emily: That's really nice to hear.
And I have seen that even with like,
you know, going to Pilates classes as
well, if it's a good place, wonderful
people, if, especially if their parents,
they know, those people are amazing.
Joelene Murdoch-Ward: Yeah.
Emily: thank you for that.
Jo, luckily my, my body
is in a much better place
So I highly advocate for
people to do what you can.
do you ever do virtual, checks or is that
just completely impossible if someone, say
they're in like remote northern territory
and there's just not a good woman's physio
there, could that person dial in and get
some sort of help or is that, a challenge?
Joelene Murdoch-Ward: oh, I mean, it's
definitely a challenge because of the
obvious, because we like to see and
touch and feel a body to understand it.
But, COVID taught us that
we can do anything online.
So we definitely do, do telehealth because
there definitely are those scenarios.
in the very least.
We can take a subjective history and
just try and get to the bottom of
what's happening from that perspective.
And we can certainly look at movement
patterns and things through the screen.
and then we will do our best for
that person to find them the most
accessible pelvic health physio we can.
So we're all very connected, we usually
know where they can find someone.
so we've certainly had that scenario
and often people will end up flying
into Sydney just for at least a one-off
assessment or something like that.
But there's some really
amazing pelvic health physios
around the whole country now.
It's become quite a strong
profession, we can usually find
someone close enough for people.
Emily: Great news.
Great news.
Okay.
And, I wanted to, for a positive piece
for the audience, what's an example
of someone who's come in had, a, had
a whole host of issues, maybe they've
left a bit late and you've been
able to turn that situation around.
So people really, feel that, difference
in terms of what it might make for them.
Joelene Murdoch-Ward: Oh, far out.
There's so many.
there's, I'll tell you one story 'cause
'cause it's fresh and it's actually
talks to your point around a remoteness.
And it wasn't a case of mine, but
we often within our team share.
Cases amongst each other,
particularly, well, we call them
winds, 'cause it, boosts everybody.
And this was a case she'd come from
like far north Queensland so she
had a pelvic organ prolapse, plus
incontinence so therefore couldn't run,
couldn't even do a whole lot of just.
Activities of daily living before
she needed to sit down from being
symptomatic of her prolapse, which is
a heaviness, dragging, awful feeling.
I'm trying to think what else.
There was another limitation,
but there were a couple of like
really life changing limitations.
And for a lot of women, exercise is
really important for our mental health.
We know that.
And when you can't do it because you're
limited by your body, it just feeds
this awful cycle of, depression really.
And so, for whatever reason,
the, assessment that was done.
wasn't, spot on.
And so by the time she saw my colleague,
she could figure out what was going on.
And all she had to do was feed
a pessary, which sounds really
complicated, but not, it's the most
basic little splint that we use.
And it does go in the vagina, so that
makes it sound complicated But essentially
it's a splint that we splint the organs
up and often the prolapse and the
incontinence piece are actually related.
So if we splint up the uterus,
we splint up the bladder, we can
close off the urethra a little bit.
We suddenly have this
woman who has no symptoms.
She's asymptomatic, she's
not incontinent, she
Emily: Wow.
Joelene Murdoch-Ward: have
any prolapse symptoms.
She can run ah, she had pain as
well, because That's right, because
once your organs are dragging,
it's heavy, but it can also.
wind your pelvic floor up because
your pelvic floor is gripping
onto this organ for dear life.
And that then creates a pain in
the vagina, in the anus, wherever.
So she had those three symptoms and
that pessary boom sorted her out.
And so within the case of 45 minutes
of just doing a assessment fitting the
pessary, the woman's back running, she's
asymptomatic, she is sent, I know about
it because she sent my colleague an email
telling her that she's changed her life.
Emily: Wow.
Joelene Murdoch-Ward: I think that's
a good story 'cause it demonstrates
that yes, we can make it work
if you're coming from somewhere
other than our clinics or around.
And b, often the treatment really
simple for symptoms that are really bad.
People always assume that when your
symptoms are severe, the treatment must
be equally difficult or challenging.
But honestly, the, treatment we do
is, is easy and o often really helps
some severe, debilitating symptoms.
that's one good story.
Emily: That's so impressive.
That's so impressive.
for anyone listening, or if you've
got parents that had, babies later,
or friends, aunts and uncles, that
whatever, that haven't been in a time
where they've fixed it for whatever
reason, or if you've had it, that's,
that's a really good news story.
Does the body ever go back?
To a pre-pregnancy state?
Is that a thing or what's
the timing as well?
Joelene Murdoch-Ward: I, I mean,
does the body ever go back?
Does the mind ever go back?
I, it's hard.
It's a hard question to answer because as
the same is true for you, often don't know
what the pre-pregnancy state was we have
had the privilege of seeing that woman
through her, adolescence and twenties
and really understanding her body.
We don't always know what it
was like because we often meet
them in pregnancy or postpartum.
So, like you said, I don't
know if I was twisted before.
You could have been.
I don't know either.
but we have this thing that
we are like, we make bodies
better than they've ever been.
So,
Emily: I don't doubt that.
Joelene Murdoch-Ward: yeah, and I you
go through your twenties and you really
probably destroy your body a little bit.
You don't care too much about it, and you
start really more respect for your body.
I think once you've watched yourself
grow a human and then birth a human
and you're like, wow, I'm amazing.
I should look after this
thing that I've got.
Yes.
so I don't know.
I don't really know the
answer to the question.
I would just say, embrace what you've got
and really build on it and look after it.
'cause As women, we just have
to keep ourselves fit and strong
for ourselves and our children.
We just have to, so, yeah.
Emily: I agree.
Fill your own cups so you can show
up better for, for your families.
Joelene Murdoch-Ward: Mm hmm.
Emily: Okay.
So many great tips there.
we've gone through that
pregnancy, postpartum, when
to get checked, some examples.
So hopefully people have
really enjoyed this.
I have learned a lot.
I thought I was starting to get
knowledgeable, but apparently not.
I've really, really enjoyed this.
Thank you so much for
joining, helping our audience.
we've done a deep dive, into all things
of the body, pelvic floor, abs, and
if they, if they could text you, your
abs and your pelvic floor they would
say, thank goodness you tuned in today.
So until next time, thank you
everyone so much for joining.
Jo, it is been an absolute pleasure.
I'll add all your details in the
bottom, really enjoyed having
you on today, so thank you.
Joelene Murdoch-Ward: No worries at all.
Thank you so much for having me.