Pelvic Health Therapy in the Acute Care Setting: The Ins and Outs

• OT Pioneers: Intro to Pelvic Floor Therapy  opens Sept 16-20, 2024
• Introducing the Functional Pelvic Practitioner Levels and Certification - for OTPs Craving a Structured and Recognized Path to Specialize in Pelvic Health

More about today's guest:
Christy Kiesel is an occupational therapist who helps obstetric and gynecology clients improve their quality of life before, during, and after hospitalization.

Since 2008, Christy Kiesel has been practicing occupational therapy in various traditional adult settings, including outpatient pelvic therapy. Christy brings nine years of expertise as a pelvic therapist to her role. She is also a certified Perinatal Mental Health practitioner, demonstrating her commitment to providing the best care possible. 

In her free time, Christy enjoys being a mom to three school-age kids and exercising. You can reach Christy at (812) 870-1704 or Info@MaternalTherapyWellness.com.

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Transcript

Lindsey Vestal Today's episode is a really special one. I'm joined by none other than Christy  Kiesel, who is an O.T. who helps obstetrics and gynecology clients improve their quality of life before, during and after hospitalization. Since 2008, Christy  has been practicing O.T. in various traditional adult settings, including outpatient pelvic therapy. Christy  brings nine years of expertise as a pelvic therapist to her role. She is also certified perinatal mental health practitioner, demonstrating her commitment to providing the best care possible. In her free time, Christy  enjoys being a mom to three school aged kids and exercising. Today, I'm sharing a talk that happened inside my off social media membership called Pelvic Atp's United. Christy joined us there to talk about all things acute care, postpartum and pelvic health. If you're interested in joining us, membership is just $39 a month and its month to month meaning stay of it serves you. And of course we understand if it doesn't. You can find the link in the show notes for how to join. We go live four times a month, have curated forums and just hold space for all the pelvic health questions. I can't wait for you to hear today's conversation with Christy . 

Intro New and seasoned OTs are finding their calling in Pelvic health. After all, what's more ADL than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box, OTs. We are Pelvic health OTs. I'm your host, Lindsey Vestal, and welcome to the OTs and Pelvic health Podcast. 

Lindsey Vestal So happy to see you again. Thank you for being here. 

Christy Kiesel Yeah, of course. Thank you for having me. 

Lindsey Vestal Without further ado, I want to get into today's content because Christy  is just an absolute gem and source of inspiration for us all. Christy, thank you for being here. Would you mind sharing a little bit of your background with us? 

Christy Kiesel Yeah, sure. So I have been in O.T. since 2008. I went to State University of Saint Augustine down in Florida for for my o t degree. And I started doing pelvic health in 2015 when I was pregnant with my son after my after my first pregnancy and birthing experience. I think that really opened my eyes to the needs that we could fill in that space. So kind of been dabbling in it since then. And then my biggest, my biggest like, I don't know, I don't know what to call it, but my, my prized possession, I guess, of work right now is around acute care. So I developed a program for O.T. specifically working in acute care with obstetrics and gynecology patients. So I'm trying to make that a standard of care in every hospital that has any obstetric or gynecologic patients, because I just think it should be we should be there. So that's primarily where I practice. And then I also have a private practice that does home based pelvic health. And I think I told you, I told you, Lindsay, that I also teach pelvic health to mostly the DPT or the physical therapy students here at Indiana State. But occasionally I'll teach public health to OTs students around the country when I'm asked. So it's definitely a passion of mine. 

Lindsey Vestal So you basically have a dream job to be able to be teaching, representing acute care and changing the landscape of acute care and also having a private practice. Like that's just it. Talk about incredible fulfillment and having having such diverse experiences in your day to day that all kind of come back to this anchor of Pelvic health Kristie. That's so amazing. 

Christy Kiesel Yeah, it really is. I honestly I mean, if you have told me I would be sitting here ten years ago doing this, I would never would have guessed. Even five years ago, I think I was like, well, I'm just going to try and see what happens. So, yeah, I feel very honored to be doing this work every single day. Yes. 

Lindsey Vestal That's so phenomenal. So our expert interviews are super low key and just fun. And, you know, we just roll up our sleeves together. So if anyone has any questions, feel free to to share them with Christy at any point during our conversation today. I'd love to kick it off with my question, which is how would you recommend any o.T listening to our chat to kind of get started? Perhaps they see a need in their local hospital to do this. What should be a good first step? 

Christy Kiesel Yes. Yes. Okay. If any of you know Rebecca, see Grace, you've heard her talk about this. And right now, I'm actually in my first professional OTV program at Indiana University, and my capstone project is writing a guidebook for OTs to start their own practice and working on that. Hopefully that'll get out soon here. But the first thing I would say to do is to talk about talk about it with your leaders. So I had to talk about it several times to several different people. The idea before it actually came about and started happening. So I got shut down. I don't know how many times, and I remember going to like the Alta Women's Health Community of practice meetings and kind of sharing my experience like, I really want this to happen, but I'm just not sure how to do it. So trust me, I have been there for those people that are wanting to start it, but keep at it, like don't give up. Because I think I think I believe and maybe I just am biased, but I believe that we have enough to show that, you know, we have a place in this space and we have value in this space. And so we do that by talking to people so that they know what we do as OTs and acute care especially. And we do that by looking at the current standard of care for obstetrics and gynecology and saying this is inadequate. Right? And there's all kinds of research that shows that. So it's not just coming from a place of like my personal beliefs or my personal experience, although there is that right. But a lot of times people don't leaders or the business people don't necessarily care so much about that. I hate to say it. They want to know about the bottom line. And I think we can show that when we look at the evidence and then we match that up with like, this is what O.T. already does. In this space. And so that's what I did after, you know, talking to 3 or 4 different people over probably or 2 or 3 year span. I finally just got somebody that was like, that's a great idea. Why haven't we done that before? And, you know, it's it's having those powerful people that listen to you or that get it that can help bring you in. I think because there were so many times where I felt like I'm in this by myself, like nobody understands. But once I was able to talk to you, for me, it was the nursing director for for Women and Children's Services in our hospital talking to her. I came in armed with an evidence based proposal of like all of this, you know, data to show why we should be there. And I walked in and she was like, I, I don't know why we haven't had pelvic health with this population before, like I've been paying myself since I had my kids. So she just got, you know, she understood already what it was. So once we get that message to the right people, I think it's going to be it's going to be easy or easier for us to to get in the door. But I think knowing that rapport is the first thing. 

Lindsey Vestal I love so much of what you just said, Christy. First of all, what I really just heard you say two things that stuck out. Number one is getting in front of the right person is incredibly important. And don't give up because once you do, it's almost like the door is open and then it just kind of probably happens more quickly than maybe maybe more quickly than you could imagine. And then the second thing is being prepared with evidence. And I'm really curious about that. Like, where did you turn to? I'm sure you spent hours doing it. Where did you go to to unearth this evidence that you were armed with? 

Christy Kiesel Yeah, that's a good question. This is the other thing that I'm hoping this guidebook that I'm working on will kind of take that work away for the next person. You know what I mean? So that we're not reinventing the wheel each time. But I have to admit, like my first proposal, when I look back on it, I'm like, Whoa, this was really not good. But it's okay. That's coming more from a place now where I'm going back to school, you know, and seeing, this is how it should be done. But I didn't know that, you know, it's coming from a place of as a clinician and it honestly didn't really matter. Obviously, I still got it. So basically I looked at back then that was in like 2020. I was looking at things like the Surgeon General's report and the call to action for maternal health. I was looking at our state, Indiana. I'm in Indiana. Our state is like one of the worst when it comes to maternal mortality. So I knew if I focused on those topics, those hot topics that are in the politics right now, you know, that are that are going to be the thing that those hospital administrators are listening for. If I focus on those and the data points associated with that and then again looking at, okay, what does O.T. do in the hospital setting for readmission rates, for example? So the study that always comes my mind is the one from 2017, if you guys know that one, it's about in acute care. I forget who does it, but it's it's like hospital, hospital administrators or something like that that put it together and show the value of O.T. and how we being an acute care because we look at that more holistic biopsychosocial aspect and not just the old school medical model approach because we're more holistic in our view. We actually save hospitals money and we reduce readmission rates. They were looking at that through more cardiopulmonary conditions, more. I think it was like a pneumonia, CHF, heart attack, those kinds of things. So even though it wasn't like the obstetrics gynecology population, I still felt like that is a great way to show like what it is that we do. It kind of gets the heart of what O.T. does. And then when you combine that with the maternal mortality issues and how a lot of those issues occur within the first six weeks after delivery and most a lot of them occur either because of cardio, cardio, pulmonary issues or things like suicide, mental health. Right. So I just knowing that, I think it helped me to really tailor, okay, I pull this study from, you know, that shows readmission rates in O.T. and acute care setting. Okay, pull what we do in mental health and what we can do to supplement that. So using kind of those the state report, the Indiana maternal mortality report, using the surgeon general's report and then using some of the O.T. literature, that's that's what I did to help kind of draw those connections. Now, the other thing I will say is that remember when I said that the nursing director that I talked to, she and me. At least saw me as Pelvic health, Right. Because of the medical model approach to acute care, I think leading with that is actually really helpful. Like if you have the pelvic health skills and in the skill set to say like I can treat pelvic floor dysfunction and not many other acute care therapies have that ability that already is going to help them to say, that's a new skill that would benefit this population. Because often those nurses or administrators, I think, are looking more at the physical rather than like the mental health piece. Right, If that makes sense. 

Lindsey Vestal Yeah, that's that's incredible. Thank you for sharing all that with us. And I love that your forthcoming guidebook is going to break this down and make us easier because I think there's just aspects to this that can be so intimidating. And I definitely think that, you know, for those of us that are less inclined to to know how to find evidence, that's one of them. So thank you for that work that you're doing. Christian has a great comment here. She says, I'm lucky to work in a hospital system that has medical librarians on campus. They navigate search engines better, faster, stronger than she can. It's always worth asking if that support is available. 

Christy Kiesel Yes. Yes, absolutely. When you work at a larger hospital organization, you're right. That's a huge perk. 

Lindsey Vestal Yeah. That's awesome. What drew you to this specific category in public health? 

Christy Kiesel Yeah. Like, do you mean like in acute care? Yeah. Well, I think that's. I think it's more personal for me just because I have been more of my practicing years have been in acute care and I just really love it. I think because of the fast pace of it, I'm definitely more of an evil girl than I am like like a treatment girl. So if that makes any sense. Yeah, that's great. Being able to see the big picture and like, where's this person need to go? But like, sometimes I can get in the weeds if I'm, like, treating someone for a while. So I think there's that. And then also my, again, my experience delivering babies. I've had three babies in three different hospital systems. And I mean, I guess I'm maybe I'm a I hope I'm not a judgy person like a critical person. But for each event, I know there were things where I was like, this could have been so much better if they just would have had a not come see me, right. So I think that piece, the personal experience and then the practice experience combined, I've done a little bit of outpatient pelvic health. That's where I started in 2015 for a couple of years. And yeah, it just didn't it just doesn't suit my I don't know, it's just not my comfort zone, if that makes any sense. And maybe it will be in the future. But right now I just know acute care and I could see the need for it. Yeah. 

Lindsey Vestal How have things grown since you developed? I think he said he'd develop the program in 2020. Is that right, Christy? 

Christy Kiesel So we started talking about it in 2020, and I started seeing patients in April 2021. 

Lindsey Vestal Okay. Okay. Kelly is asking outpatient pelvic. So she. Yeah, that's what she was just talking about. But she saying her passion is acute, but she does do home visits as as well. 

Christy Kiesel Yeah, I know. It's kind of probably very confusing, right? I'm kind of all over the place. No, I used to do outpatient pelvic health, but now I do primarily acute care and occasional home visits. Yeah. 

Lindsey Vestal So how has it grown since the initiation of. Of the program? 

Christy Kiesel Yeah. My gosh. That's a great question and I love answering it. So, yeah, it started out with like some referral criteria that the nursing director kind of put together. So it's basically like five, five different diagnoses that would, would trigger a referral for O.T. and that was a BMI over 35. This is purely for obstetric patients, by the way, The BMI over 35, a perennial laceration, third or fourth degree C-section, like third C-section or greater. And anyone on bed rest. So. After a couple of years of doing that, I definitely. We're sort of recognizing we're missing a lot of folks that could benefit. And we're getting some folks that like, why are we, you know, like the BMI one, for example, Like, why this isn't necessarily relevant, although I liked that one because it was getting me all these other people that didn't fit the other diagnosis that were benefiting. So anyway, one of the big changes that we've made is now I screen everybody. So obstetrics and gynecologic patients, we come in and I say we because that was another improvement. We added a physical therapist to the team. So now she and I come in each morning and we screen everybody and we screen by asking questions about pelvic health and about mental health and then about basic like I ask basic adult ideal type questions too. So, so if they generate like a yes from any of those questions, then we get an order and we do a full on evaluation with that patient. But that to me seems so much better because there were so many women that were getting Ms. that, for example, had like leaking of urine during pregnancy or even before, and it was not even getting addressed because no one asks about it. There were women that had like a history of depression or anxiety or autism spectrum disorder or bipolar, right? That were, in my opinion, getting inadequate care. Like I could hear the nurses talking about some of their interactions and I'm like, well, that's because of their that's because of their history. But no one knows that because there's no mental health involved. So by screening everyone, it really helps to. To be more holistic? I think so. We have standing orders for all C-sections now and all hysterectomy patients as well. That was a big one that I pushed for because they're so I mean, their major abdominal surgery. So they should have full rehab, in my opinion. But beyond that, it really just depends on on the screen. 

Lindsey Vestal Congratulations. That is huge. I do really love those five diagnoses that you started with. I think you probably needed to have some very concrete suggestions in the beginning to get buy in from the program, and those makes so much sense. But huge. Congratulations for now. Getting a screen for everyone. So well deserved and then having an output team to go in and, you know, be able to. I'm a little I'm curious about the kind of the team mentality there in terms of do you guys talk about cases? Is there a collaborative approach or is is there sort of such a need that you guys are kind of going in your separate ways? 

Christy Kiesel Yes. Gosh, good question. Yeah, there is such a need. And honestly, she and I both are not full time workers were PR and workers. So we do tag team quite a bit right now. But I've I've written like all of our protocols and everything that I've written, I, I have written them with the idea or the vision that this is a standard of care. So just like an ortho protocol, I have C-section and hysterectomy protocols, you know, where we're ideally seeing that person from day zero of their surgery through day of discharge. So do we always get to do that? Absolutely not. But that's our, like I said, our goal and our vision. So we're pretty well tag teaming right now. We talk a ton and collaborate a ton. We know each other's strengths and skill sets. And I think we do a good job of complementing that in terms of like when we work with patients or when we know, hey, this person would benefit from O.T. or this person would benefit from. So that helps a ton. And I think, you know, that's true. I hope that's true for most acute care teams that you kind of know, not just acute care, but other settings too. You kind of know your team and you know, you know, when when another person needs to be brought in. But yeah, so to answer that, it's kind of both. Like we definitely collaborate and we, we are so busy that we kind of tag team as well. 

So my question was actually the screens that you're doing, are you doing those in-person in the mornings? 

Christy Kiesel Yes. Yes. So, yes, usually I spend about five minutes with each patient just doing that screen. But I've also done these enough that I think I kind of have it down where it's like, okay, I know what to ask and I know what to look for. I'm sure I'm sure that it's not perfect, but I guess the way I look at is like, at least I'm, I'm getting to everybody, you know? Whereas before it was really just targeted to a select few. 

Lindsey Vestal I have a question just a little bit off topic. If anyone else doesn't have anything about filming that they wanted to bring up in terms of once you screen and let's say you determined that they could benefit from services. My first part of my question is what does that look like in the hospital setting? And then, B, what are you making how are you making recommendations for discharge? 

Christy Kiesel Yeah. So? Well, there's a lot of different there's a lot of different ways that Avow can go for me. I kind of. I kind of think about it if I kind of have like a visual framework where I'm thinking about where I put this, put this person in terms of the treatment that they need. And that usually is categorized as either like a pelvic health issue, a mental health issue, or like a basic idea or even an idea like whether it's breastfeeding or child care or like those kinds of things. Returning to work. Ideal, ideal activity. So I kind of categorize it in that way for how I move forward. If we're talking about pelvic health. Right. So a lot of times. The basic thing I'm I guess I'm trying to do is to see, have you had any symptoms before now? Now that you've delivered, are you having any new symptoms like difficulty urinating after C-section, which is really common, or, you know, pain with urination after having a perennial laceration or fear fear of having a bowel movement and like cleaning yourself up after you have stitches, right after you've just had a vaginal birth, which is a really common one and nobody tells you how to take care of it. So yeah, I think first I'm kind of wrapping my head around that situation where that person is at and what they're experiencing and then trying to give them the tools to be successful. So in my mind, like what that looks like for discharges, a lot of times I might only be getting 1 or 2 visits with these folks and then I know that they're going to be on their own for the next six weeks before they come back for their follow up. And so I'm trying to arm them with the information that they need or the resources that they want when they're home alone. So try not to overwhelm them with handouts and documents. But there is a really great like booklet that our hospital gives out to our postpartum moms. And this is another area I want to improve. I think they should be getting that way before they're actually just in the hospital. But anyway, they get that and so I'll open that up and like Dog Year, a few of the pages, especially around like Perennial Care and I explain to them there's some good information in here about taking care of your body. And then I'll add in a few written handouts based on their needs. So, for instance, if it's somebody who I've screened or identified that they have a history or issues with constipation, then I like to put in some really like some really good. I think it's really good information that they can actually use, you know, like when they get home. So like the Bristol stool chart, like you want that stool to be a number four. It should be like peanut butter circling that as I'm telling them, you know, like I'm giving them like a picture of the positioning on the toilet so they know what to what to try to strive for when they get home. And that was another thing we got added in our unit was when I first came in, we got every room with Squatty potty, so that was a big deal. Yeah. So I just try to I think I just try to give them like some tangible tools that they can use, like in the moment in the next day or two, you know, that's, that's realistic. So that piece, I think, is really important for me. And then I always try to give them contact information for me and all the other pelvic therapists that are in this area, which aren't many, but I give them that information and I say I give them a screening tool, the one from public poet, global global, that basically has like those four categories. It's like bladder, bowel, sex, pain. I give them that and I just say, look over this and check anything off that applies to you. Take it to your doctor at your follow up visit and have a conversation with your doctor, your doctor. If your doctor writes your referral, then insurance will cover all or part of those services. And I think people need to know that because I, I think they don't always know. First of all, they don't always know like what's normal or what's not. They don't know how to talk to their doctor about it. And then sometimes, even if you're like me, you bring it up to your doctor and they're still like, no, you don't need that. So really, I think one of my other roles is really just trying to help people to advocate for themselves and for them to know if you don't feel comfortable advocating, then call me. Reach out to me. I will help you get in there however I can. 

Lindsey Vestal I mean, amazing. I really love that you dog gear some pages. I think that helps to reduce the overwhelm. It's just like such a simple strategy but so effective. And we all could do that. I also really love that you say that they can call you, you know, that that advocacy doesn't stop there. You know that that you're going to be kind of that that that lifeline for them. I think that's really a beautiful extension of your job. I'm curious about the pamphlet that you guys give out. Do you know who developed it? 

Christy Kiesel I don't know right off hand, but I could definitely find out. It's something that they've been using before I got there. But I that's the other thing where I'm like, I have some additions to make to this. I need to know who to talk to, but I can get that. I can get that to you if you'd like. 

Lindsey Vestal It's all good. It was more, more out of curiosity. And I was also thinking you could you could reinvent it a little bit. Not that I want to add more to your plate, but in terms of your project for your OCD as part of the evidence base packet, including the guide or a version of the guide, an improvement your own, that again is reducing any of those stumbling blocks that those of us who want to start a program like this but aren't sure how to move forward. Just having that already I think would be it would be amazing. 

Christy Kiesel That's great advice. Lindsey, thank you. Yes. 

Lindsey Vestal Does anyone have any other questions for Kristy? Such a wealth of knowledge. 

Questioner 1 Christy. While we're waiting for Kelly, do you have any sense of the outcomes from your program at this point? 

Christy Kiesel Yeah, that's that is a good question as well. So I don't I wish I had more concrete outcomes. That's something that has been a struggle along with the kind of the billing information. One thing I do know just from word of mouth is that outpatient pelvic health visits have gone up. Yeah, I know, right? Yeah. Yeah. There was one other thing. I mean, if nothing else, I think it helps the doctors to understand more about what we're. What we can do, what we're doing in terms of pelvic health. There was something else. We also put out recently a just a patient survey. Really? Like. I just really like low key. It wasn't anything I don't know in depth, but it basically helped us to kind of paint a picture of what patients want or what they are liking about the services, that kind of thing. So what we gathered so far is that they are wanting more education beforehand, and that's what I was hoping they would ask for. One of the things that we're hoping to do this summer is to start a prenatal pelvic health workshop for for pregnant moms. I again, I'm not good at memorizing studies, but there is this great study I read about doing this with first time moms and even just like a two hour workshop based on Pelvic health can help tremendously with their knowledge and ability of pelvic floor exercise as well as their adherence during pregnancy and after. There's just so many benefits to it. And I feel like it would be such a simple thing we could include. So. 

Christy, did you I wonder if this is the same one, but there was a study that came out. I feel like this was on the O.T. potential podcast a few months ago, but there was a study that came out that talked about like, I guess it's a feasibility study, that group, that group therapy for women, you know, pregnant women like prenatal education, like what were like it was basically saying like, yes, you can do this in a group setting and there's evidence to show that they're like the outcomes are just as good as if you do it individually and do it prenatally. If you do it prenatally. And the cost to the the organization is obviously a lot less. 

Christy Kiesel Yeah, I mean, it makes so much sense, right? Yeah. 

It's really cool. 

Lindsey Vestal Kelly's Kelly was able to text her question, so I'm going to share it now. She's wondering, Christy, what do your treatments look like for perineal tearing? 

Christy Kiesel Yeah. Okay. Good question. I mean, I feel like I do a ton of talking, right? Because these folks are so acute. It's not like I can I don't I don't feel comfortable doing a lot of, like, even external palpation on them. Right. When they're so acute. So a lot of times it's it's a lot of talking it's a lot of breath work. And then especially for. Tears I'm giving. We're talking about Perry care, essentially, like how to take care of those stitches to prevent straining and prevent infection. And I've just found that sometimes, you know, some people really take that information for granted, like, yeah, everybody knows this. But if there's some people that need a little more detail on that. And so I try to just to to be pretty detailed with it so that people hopefully leave feeling like they know what to do. So it's a lot of talking, a lot of education. I am sorry. I have a visitor here. She's hiding. Yeah. We do pelvic floor exercises, so I go through that with them. Because one of my big things with most people is I want to make sure that they at least know what the core exercise is. Right? They know how to contract and relax those muscles. Some women don't even know what those exercises are. And so a lot of times I'll simulate, like with my hands and we'll talk through that so that. They can. You know, as you all know, it requires a lot of different types of verbal cueing. Right. For people to kind of understand how to do kegels pelvic floor exercise. So I tend to spend quite a bit of time with that. Sorry. Sorry about my six year old in here. 

Lindsey Vestal Don't worry. It's all good. 

Questioner 2 Okay. I was just going to give a little bit of feedback on getting, like, patient summaries. I worked in marketing for ten years before becoming an O.T., and so making things very small and very call to action. Like it might be cool in the back of your business card to have a QR code that just says, Help me, help you. Five Questions to Better Care and just put your top five questions that you want to know about. And it can be like a scale, like on a scale of 1 to 5. Or it could just be like the short answer. But there's so many amazing things like platforms. I don't know if they would be able to put contact information. I'm not sure how hip the stuff for that would be, but at least if it was anonymous, like you could get some really nice feedback that way. 

Christy Kiesel Yes. Thank you, Kristen. Yeah, that's a good idea. So, the survey that we put out here recently, that was another thing we added at the bottom was contact information because we were trying to do follow up phone calls. So like two weeks after or following up with people to see if they needed anything, we weren't able to keep up with that realistically. But I think it's a great it's a great theory. And I found that people don't they tend to not reach out when I give them my phone number and say, call me, even though I am saying that, you know, we're talking about it. But when I would call people two weeks later, we would have great conversations about about things, and they're clearly not reaching out for that help. So that's a good I, I like that suggestion for that. 

Lindsey Vestal Christy it sounds like part of your protocol then once you discharge is you call every client two weeks later. 

Christy Kiesel No, no. Only the ones that consented to it. And so they had to write link that they consented and add their email phone number. Yes. And that wasn't enough. I thought it would be everybody, but it wasn't. 

Lindsey Vestal I was going to ask like how and part of your workweek about how much time do you think you're spending making those calls. 

Christy Kiesel Yeah, it was too much, which is why we ended up we had to stop doing it. But yeah, it would be, gosh, about an hour, two days a week was what I would spend on that. But the hardest part was actually reaching people, because that wasn't always a lot of people liked to text. They don't necessarily like to chat on the phone. And yeah, so that wasn't perfect, but that's something to keep working on. 

Lindsey Vestal Katie has a comment. She says, I had a postpartum client tell me today there's tons of unhelpful information out there. And then you give birth and you realize you didn't get any of the information you actually need for both birth and postpartum. 

Christy Kiesel Yes. And I found that many of many of our new moms are getting. Especially pelvic floor health advice from like tok social media. So I don't know like how evidence base for that is for them. I love that it's being talked about and it's it's definitely more of it's like more on people's minds than it ever has been, I think. But yeah, they definitely need us to be able to say, hey, this is the evidence based information, right? 

Lindsey Vestal Does anyone have any other questions for Kristy? 

I was just wondering if there was anything I know you said you spent a considerable amount of time talking about pelvic floor exercise after perineal tearing. Was there anything else that you're doing in that, you know, very acute stage? 

Christy Kiesel Yeah. So modalities is a big one. Like I said, Perry, care for like infection prevention, hygiene techniques, toileting techniques to prevent like constipation straining. We talk about sex especially because there they're even C-sections. Right. Are told like you can't have anything in your vagina for the next six weeks. So we talk about what can you do and how long are those stitches going to take to dissolve? And I always like to try to talk about. How before? Like before they return or resume sex that like with their partner that they should probably be exploring their body and getting comfortable with their body first. That way they can go back to their doctor and talk about any pain or questions that they might have. So yeah, the modalities are more related to like Sitz Bath. For example, I usually talk about doing Sitz Bath at home or getting like a handheld showerhead, but love sitz bath with like plain water, Epsom salt. Ice, of course. And then we talk about positioning as well. So trying to avoid things like donut, donut pillows, which I think many people think are a good thing after perennial lacerations. But anyway, so yeah, we talk about positioning and sensations that they might be feeling if they if they need to stop an activity. So I often talk about like when you're when you've had trauma to your pelvic floor from childbirth and pregnancy, you might notice like back pain, right? You might notice Covid pain or pressure. You might start resuming activities and find that you're bleeding more, right? Like you're bleeding lessened and then you're having more bleeding. Those are all signs that you're doing too much and you need to do some rest, like get horizontal or even get inverted. So yeah, we talk about we talk about positioning quite a bit as well, especially for those moms that have say, they have a perennial laceration and they're having a ton of pain like sitting to breastfeed. Then we have to come up with some modifications for how they can sit and eat and sit and feed. You know, I'm finding, too, that a lot of women are sitting or kind of in an upright position for much of their day. So really emphasizing like horizontal or inverted positions I think is super important. 

Lindsey Vestal Amazing. Christy, we are so grateful for your time and expertise and you're also just so effervescent and just so lovely to be around. So thank you for taking the time to share all this with us today. I hope that it just spins off so many ideas for for everyone listening. To recognize what a role we have here. And also, you're just such a model of diversification of how you're showing up between your teaching, your own private practice, and then being able to get your OCD and develop this program. It's just so inspirational. And of course, you've got a young family, so you're just you're just incredible. 

Christy Kiesel Thank you. Hey, so are you guys. Thank you so much for having me. Really, it's such an honor to be invited here. So thanks. 

Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop onto Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast.