"Slow Down + Offer Help" with Dr. Rebeca Segraves and Lara Desrosiers

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Learn more about Dr. Rebeca Segraves' work here. 

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Transcript

Lindsey Vestal I am so excited to share today's episode with you. I am joined by Dr. Rebeca Segraves, who is a Pelvic health educator, a pelvic floor physical therapist who works with health systems throughout the United States and Canada to expand access to O.T. and services to clients and their families who are in the hospital for birth and surgery. She believes that informing people about their health and recovery options when they are in a vulnerable state is a sign of human compassion. Dr. Segraves is probably Occupational Therapy's biggest advocate. She is a incredible source of joy and wisdom, and I cannot wait for you to hear our chat today. I'm also joined by none other than Lara Desrosiers, who has worked as a registered occupational therapist in community mental health settings to support individuals living with mental illness and addiction, to manage difficult symptoms, build relationships and find a sense of meaning and purpose. Lara and I joined forces this year to create the first and only trauma informed Pelvic health certification, and Dr. Segraves is actually not only on a faculty for this program, but joined us for our inaugural cohort in 2024. New and seasoned OTS are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But here's the question. What does it take to become a successful, fulfilled and thriving OT 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. 

Dr. Rebeca Segraves It's such a pleasure. I just I'm so in all really of the work that that you both have done and the impact it had on me. It's incredible. Like I. I think that I've been needing of retreat like that, but I didn't realize it would have a personal impact and then a professional impact. I mean, trauma informed. Just just in content in general. It's just been lacking. I'll be be honest with you in my own professional journey. And so this has really been quite transformative. Thank you both. 

Lara Desrosiers Lights. It. Lights me up. Lights are supposed up, I think, to hear that. Rebeca, we're so grateful that you decided to join us for it. 

Lindsey Vestal Really thanking you, Rebeca, for for two reasons. Number one, for being on our faculty for the first ever trauma informed Pelvic health certification. We actually just had our call last night, and so that's like so vivid and so, so potent for, for me to have to have had that conversation. And that was an important part of our vision for this certification was to have faculty members come in with a variety of expertise that Lara and I couldn't speak to. So first, thank you. Thank you for doing that. And also to Jenna, who joined us, and Dr. Josie Jarvis, who joined us and as faculty members. But also thank you for being and trusting us to be a part of the first inaugural cohort. So you were not only a faculty, but you were part part of our student body. So we just have to thank you so much for both of those incredible contributions. 

Dr. Rebeca Segraves Yeah. Yes, no, thank you both for having us. I mean, really, I think that I like probably the most that that Josephine Jarvis said last night was that to be the first is exciting is is a little trepidatious. But it's also how we evolve. We have to start somewhere. And you started probably in one of the best areas that you can in expanding pelvic health health care and access to it is really starting a foundation from a trauma informed lens to me was what I needed in my own practice. And so to be on faculty and to just be kind of giving more ideas of where practitioners could really start and start changing health care, you know, we focus on the maternal health population and the public health population. But, you know, in general, I mean, I think that this trauma informed education is going to be seeded in our Deped and our OTD programs. I mean, I really think that what you started is going to to start a chain reaction for how we're approaching rehabilitation, education as a whole. I think that you're starting something major. 

Lara Desrosiers Thank you so much for saying that, Rebeca. And I'm curious, I would say I think Lindsey and I were both so thrilled when Dr. Jarvis and you put your hands up and said, yes, we want to come and speak and talk about how OTs and PTs can collaborate, improve access to trauma, informed care. I mean, we have both kind of seen the work you've been doing, your visionary work to improve access and improve outcomes for moms after giving birth in the hospital. And so I'm curious, I'd love to hear a little bit more. You said that you felt it was something you were needing in your practice as well. What what what were those missing pieces that you felt was missing from your practice and drew you to put your hand up and say you wanted to join us as well as a participant? 

Dr. Rebeca Segraves Yeah, I would. I actually have to say my path to just recognizing that collaboration with OT wasn't it wasn't like optional. It was a necessity. I so my path was really kind of from an oncology standpoint. I mean, I started with OTs in our clinic from a lymphedema standpoint, we didn't delineate necessarily are our services as OTs or Petey. Was oncology care the best oncology care or the best care that we can provide? I should say to a person who going through cancer treatment. And so when I started practicing in the hospital with individuals after birth and after pelvic surgery and hysterectomy and in unplanned cesarean delivery, I was looking to my right and looking to my left and I said, Where's the occupational therapist on the team? Like, this feels very like half care. Like it didn't feel like holistic care that we were providing. And here I was trying to figure out how do we get an assisted device for someone who's had this long vertical incision after a cesarean hysterectomy, whether it was planned or unplanned. How? How do I communicate to the team? This person can't be sent home. They can't tolerate standing. They don't have a shower chair. We have no one that's evaluated their function in these these activities of daily living that they're expected to do day one right when they're home and their vital signs are unstable. And so almost immediately when I transitioned from outpatient where I worked with a team of occupational therapists who were my colleagues in pelvic health care and oncology care, here I am in the hospital and there is no O.T. on the maternal care team. That was a problem and that was in 2020. And so come this certification, I said, yes, absolutely. Here's another opportunity to expand knowledge and how we're collaborating as a field. And I always quote Dr.atherine Silvester in saying this. She's a dear friend and colleague of mine, but you know, she says, you know, to provide physical therapy without occupational therapy or vice versa is is inadequate in terms of patient care. It offers an incomplete patient experience. And that's what I feel very strongly, that trauma informed Pelvic health practice is a complete patient experience because it's a collaborative effort from the start. There's no adding one on when you're in the the hole, so to speak. When you're in trouble, it starts that way. And that's how the certification has been. It's been from a standpoint of collaboration and it's been incredible. 

Lindsey Vestal Thanks, Rebeca. Yeah, I love that perspective because I think one of the things that I often hear from OTs is, is we get caught in the weeds around like, what's my role? What's your role? Where do I start? Where do you begin? But if we just think about it as how do we provide really quality wrap around care where we know each other's strengths, but we also appreciate that we just offer these different lenses and viewpoints that can really add to the client experience. We put the client front and center again and we can kind of lever you close up the door a little bit more. So I really appreciate your perspective around like, how can we expand the pelvic health fields in general regardless of our discipline or the letters? 

Dr. Rebeca Segraves Binder I, I totally agree. When, when I think of and I said this to Lindsey, but when I think of pelvic health care, I love starting there. I love starting from an area that we can all agree we need to improve or at least improve access to. And then from there we can define how we will do it or what we'll each focus on instead of pelvic physical therapy. And I had never, you know, just to kind of give you a little bit my background, I didn't realize that that's how it was being really marketed or advertised. I always thought of Pelvic health as pelvic health care. You know, I was on the team starting out in my residency with your gynecologists. They would introduce me with patient care if they were treating a patient I was following or observing or kind of working with the euro, going that day as one of their teammates, as one of their colleagues. And so to start at pelvic health care and then delineate from there, I think it makes a lot more sense to to the people that we're serving. It doesn't confuse them. It doesn't confuse our referring partners and our providers. And it just doesn't confuse us in terms of what do I do now, what's my role, what's my scope? You're providing pelvic health care to this person. You could be a point person, but you have a team behind you. And it doesn't. Also it for me, one of the the aspects of the trauma informed certification program that stood out to me the most at the Sedona retreat was when we evaluated our own self care, how we take care of ourselves as providers. And for me, having a team reduces burden. It reduces burnout, right? And so I'm not burdened to try to provide all the things right. I have a team now. And so that's really the collaboration piece that I think Dr. Jarvis and I wanted to bring to the certification program is that there's there's a way to collaborate and reduce burnout on all of us when we start here. 

Lara Desrosiers I have some super exciting news for you. O.T. Pioneers Intro to pelvic floor therapy is opening for enrollment January 13th through the 17th, 2025. This is your chance to dive into a 100% online course. With lifetime access, you'll get five group mentoring calls with me and two free months inside our off social media private community Pelvic OTP's United. Plus, we're hosting an optional in-person lab in Cleveland on February 21st and 22nd. Please come join over 1500 other OTs who have already taken the leap. I can't wait to see you inside OT Pioneers Enrollment January 13th through 17th 2025. 

Lara Desrosiers I think it was such a beautiful way. And I have said throughout this process it seems like things have just fallen into place in the synergistic way. And I think your talk last night was just such a beautiful way to kind of pull everything together and provide that take home message that we can work in this beautiful team. Because I think when we and we saw this and a lot of our students, when we start to learn about trauma and the complexities involved in some of the symptoms that our clients are experiencing, it can feel really heavy, it can feel really overwhelming, and it can feel kind of like, where do I begin? Or do I have to address all of these pieces? So it's I it's I think so important to remember that we don't have to be everybody's everything and we can work as a team. 

Dr. Rebeca Segraves One of the things that you you that was one of the emphasis that I took away just from this whole course as a whole was the burden really is lessened when you first start with a team. The burden is lessened even more is reduced even more. When you give a person, agency and their own health care journey and biggest and your listeners, if they're mostly an occupational therapy audience, I don't know if I introduce myself, but I'm a physical therapist, trained very much in a biomechanical approach, and I'm almost like wired to start thinking of solutions. I'm not wired to stop, listen and ask someone what what impact does that have now on your life? What, what, where? Where do you want to go? What what do you feel about that? What do you want to do? Where do you want to start? I'm not wired to ask those questions. Is even feels a little bit foreign. Saying that out loud is because that's just not been wired into my evaluation. It's been about wired into my evaluation is to do the measurements, to do the range of motion to measure this strength, to see the distance that that that person can move. And so the fact that you really centered the person in this trauma informed certification program as the center, as the person who had the most agency in their journey, that completely felt less even in the heaviest cases that I can even say. And just, you know, you know, what we discussed? There were so many breakout sessions where we would really get together and talk about practices and about cases. The rewiring felt like it was less of a burden on me to come up with the solution. And so this this again, this this certification program had I had it in school, I really feel like that's where it needs to be seeded, needs to be a part of the curriculum for us as allied health care providers. But then even more so if we're going to be practicing in pelvic health care, we need a trauma informed lens to really practice through. 

Lindsey Vestal Rebeca Are there any are there any particular moments that you've had since the retreat? So, you know, we, we hope and, you know, have a vision that all of our students will be able to take this material back and and reinvent through these eyes of of care. And I and I'm just curious if there is anything any any moments realizations you shared the beautiful one with Jenna. Anything else that you're able to kind of take through? You're a very reflective person. It's one of the things I admire so much about you, but is there anything that you feel comfortable sharing that you've been able to take from the certification and kind of bring it forward to either the way you're supporting therapists starting their their practices in hospitals or even in your daily life? 

Dr. Rebeca Segraves There's one case in particular, and I've actually I thought about this and this therapist shared it publicly in our Facebook group, So I feel comfortable sharing it with you all. But it's something that, you know, people should be forewarned is very heavy. And so there's a therapist that I train and to give a little bit of context, I train occupational and physical therapist primarily in the hospital setting. So these are acute care therapists who are not pelvic health trained. Many of them have not taken any pelvic health courses at all. And I thought really intentionally about this, probably the most after the Sedona retreat in the trauma informed Pelvic health certification program, that I may even be doing a disservice by not giving a strong enough foundation for trauma informed care. And it was with this one particular case that happened after the retreat that this therapist. Shared. And so she wrote that she had an interaction and she followed her goat, our gut. And she's an trauma level one trauma occupational therapist that works in the hospital. And so she followed her gut in a patient interaction where the patient was about 24, maybe 48 hours after birth. And referring to her baby in the room as a pain in the ass, as a burden, and as as kind of glaring. And the therapist wrote this glaring at the child as being the cause for her not getting any sleep. And the interaction made the the O.T. uncomfortable, just enough to report it to the nurse. And thank goodness, because the next day she read from the psych avowal that this person is now being treated, you know, for for a manic for mania. And they were able to catch it in time. Now, granted, we know that in most cases, the chances of that happening where an occupational therapist could be the evaluating therapist and do a little bit of a deeper dive in cog and really, you know, coordinate with the team. Chances of that happening across the board are just slim. We just don't have enough occupational therapists that are in hospital systems that are able to serve on the maternity unit. And so she's following her gut and she's now seeing a lot more opportunities for us to be doing a deeper mental health cognitive as well on moms within 24 to 48 hours after birth before they're they're leaving the hospital and going home to manage everything on their own, to manage the lack of sleep, to manage the limited support that they're often given to manage, sometimes a major abdominal surgery recovery through a C-section or a hysterectomy that was unplanned. And so what I took from that retreat was I am now expanding an occupational physical therapy services a lot earlier to the maternal care population. But I'm qualifying therapists who don't have a trauma informed background. Yeah. Is that truly the best care? Luckily, I had a therapist who recognized that and who was open and vulnerable and shared her experience and reacted really quickly in that case. But how many therapists are we training that are still driven by productivity standards in their hospital and just intent on sending people home so that they're not having a longer than necessary length of stay? From a profitability standpoint, are they really being given the trauma informed tools? So now I'm rethinking kind of our whole program from the enhanced recovery after delivery standpoint. Should we be actually requiring that therapists have some sort of trauma informed module or background in some way or kind of competency, you know, through through the lens that now you've opened? You know, for for me, from my standpoint, you know, do they need some training with you all before they're actually seeing this population so acutely? Is is a huge moment. It's a little daunting, but it's necessary because since it's now helping me reevaluate how we're going about offering and expanding our services earlier and making sure that we're doing it to the patient's benefit and not necessarily to our traditional health care model, which isn't working. 

Lara Desrosiers Thanks so much for for sharing that moment with us. Rebeca. I think one thing that I have valued so greatly in terms of having your perspectives throughout the Trauma Informed Care program and in bringing to your expert talk is we give a lot of tools in the program about how we can bring that trauma informed approach to the individual, to that individual client work and how we can show up, as you said, really making sure that we're taking care of ourselves and clear on our boundaries. And it's so important to think about that systems level, too. And your perspectives are so valuable in terms of how do we then disseminate this out in a way where we can improve access and improve the quality of care that people are getting? And in such a big part of trauma informed care is being able to kind of step back and do that reflection of like, where can we do this better? Where can we make some adjustments and shifts? And I, I hear you. I sometimes find I look at like all of the. The ways that things are working and it feels I feel frozen. I feel stuck. But yeah, you're you're such an inspiration in terms of like moving through that starkness and that feeling of being frozen and how we can look beyond to the systems. And you said something last night actually in our column. I can't recall it right now, but it was something that really helped me to kind of after looking at the birth outcomes in the United States, it felt really heavy to me. And what was it you said to you? It was something about stopping and like taking a step back and just yeah. 

Dr. Rebeca Segraves Yeah, yeah. I again, I have to quote you people who inspire me. And so Kathryn Sylvester, she comes up again. She is the founder of Operation Mist and she spoke at our National Physical Therapy conference a month before I was able to speak at Aotea. And she she rephrased social determinants of health. That's kind of our flagship for identifying that here are the potential outcomes that these people, because of their, you know, the, the kind of the acute needs that they have here, the potential outcomes that they could potentially face, you know, because of social determinants of health. And she very intentionally said, I don't think that they actually predict a person's health outcomes. They are actually a clue for us to slow down and offer help. And she used the same four letters, the acronym as d o H Social Determinants of Health, and she just changed it right there on stage. She said slow down and offer help. And that was so profound to me because I realized when you were talking about being frozen at the retreat, I my big takeaway was, wow, in this program, they're not talking about insurance barriers. They're not talking about kind of just barriers that we as are as therapists, as practicing therapists, we encounter when we're trying to provide good quality care. They didn't waste one breath. And I do I do a lot an enhanced recovery after delivery. I, I go through a lot of the barriers to just providing, you know, occupational physical therapy early on in a person's birth journey or surgical journey. And I realized you didn't do that at all. That was for us as practitioners to figure out what you gave us, the foundation, and you made us recognize this is where care needs to be different now. We have to figure out how to apply it in our communities. And that's why that acronym to me is so powerful, because when I slow down and offer help and I listen to a person's traumatic journey, if they had one around the time of their surgery or their birth or their pelvic health journey, I then can figure out how do I offer them the best care. I have these tools and I can navigate through those barriers, right? Because this individual to us all, but it's not first and foremost. That's shouldn't be how I provide care thinking about how I benefit my hospital and my insurance payer. And this, you know, other thing that I'm trying to navigate. No, the foundation is providing trauma, informed health care. And now we can figure out and kind of collaborate on the best ways to do that. And I love that about this course. I loved it. 

Lara Desrosiers Thank you for that. I think that that's so profound and it's slow down offer help is something I'm going to anchor back to because isn't it really interesting when we do that and anchor ourselves back to the individual and what we can do to offer help? As you reflected earlier, it takes a lot of the weight off of our shoulders in terms of needing to find the solution. And I think personally it often expands my capacity to be able to see more opportunities to do more on a systems level, because it moves me out of feeling so daunted by all those systemic pieces too. So thank you. That that's so that's such an important reflection, I think, for, for us to hear, but also also for folks that are interested in and joining us. And so I guess that's that's a great question to kind of lead into. So I'm wondering, Rebeca, if you were talking to someone who was kind of on the fence about whether or not they wanted to join us for this certification, is there anything else that you would say to them to encourage them to put their hand up and jump in? 

Dr. Rebeca Segraves Yeah, I think I is my approach now to patient care is just so different. Right? We've talked about that quite a bit in terms of me finding that I'm coming from a background where I am expected to have solutions. Patients even expect go to physical therapy. You go to the pelvic floor therapy, they will tell you what the problem has been and they will help you find a solution. Providers have sent their patients with that expectation. Your pelvic physical therapist is going to help you. And so when I think about pelvic health therapies that are on the verge of burnout, two years and just like I was two years and this is after I did a residency in women's health physical therapy, I was ready to hang up the towel. I couldn't do it. There were too many patients that I had no solutions for. They had been struggling for too long. Not enough answers. My biomechanical approach. I would do the biofeedback, I would do the assessment, or I would do the dietary changes. I would do all these things. And I wasn't slowing down and actually asking where was their agency in all of this? Where was there? Where did they feel like they had the most control? I had not done that as a as a matter of course. And I realized this certification to me revealed a lot about my approach to health care, my approach to education right the way that we have even constructed enhanced recovery after delivery. I'm now rethinking am I giving therapist the agency to see where do I have control? My actually the forefront, giving them the tools and then they figure out the insurance reimbursement in the hospital barriers and that this and then that with the OB-GYNs. Am I really setting them up for success? Or if I'm very frank, throwing solutions at them, telling them what to do. And so now that I'm thinking about this question that you asked, well, what would I give someone in terms of like, who's on the defense of whether or not they need to add trauma informed education to their practice? It would be first to do a dive, you know, a deep dive into their practice as it is now. Are there any areas of your practice where you feel like you're burning out? Are there areas of your practice where you feel like you're not giving patients the care that they either deserve or that they need? Do you feel like you're working more for your hospital or your clinic or your private practice than you are for your actual patients and clients? And then they can really honestly, after doing that assessment, they'll come to the same solution that I did. And, you know, that same kind of moment that there's something missing, right? And so instead of me kind of doing what I've done historically for the past nine years as a as a therapist and kind of I talk about prescribing before diagnosing is malpractice. We know that to offer a prescription before we evaluate someone would be considered malpractice to offer the solution before we actually assessed what their needs are. Instead of me offering solutions to therapists is really to now ask them to just do an inventory check, you know, self care, check a self assessment of their own practice, see if there's any gaps. And then to really just have an open conversation about what's out there now that we didn't have before to help us fill those gaps. And a lot of it is was bringing us to the verge of burnout, you know, just not having the tools to take care of ourselves and to take care of our patients. And to me, the trauma informed Pelvic health certification fills that gap. It did for me. But it's not my role or responsibility to reveal that or to to give that solution to therapists. It's my role and responsibility to help them come to that understanding on their own. And I think I have the tools now just from your program. I have the tools now to do that. 

Lara Desrosiers Beautiful. That excites me so much. Thank you for. 

Lindsey Vestal Such a privilege. Rebeca. Thank you so much for sharing this perspective, spending this time with us and just being the force of nature that you are for all the good in the world. Such an honor to walk along this journey with you. 

Dr. Rebeca Segraves The honor has been completely mine. Thank you both. Thank you, Lara. Thank you, Lindsey. 

Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to 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.