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Ep. 96- Pelvic Physical Therapy and Lactation: Interview with Dr. Kaeli Gockel

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This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way. So join us for another episode.

Heather: Hey Maureen.

Maureen: Oh, Hey, Heather. Are we back on the podcast?

Heather: Yeah, we’re here together in the same room. Just FYI, our recording outfits are on point today.

Maureen: Oh no, we both are wearing leggings as pants, which is my favorite. I have a dirty shirt that I thought was clean because I got dressed in the dark.

Heather: I’m wearing the Land’s End sweatshirt robe that my husband got me for Christmas to try to encourage me to stop wearing my actual bathroom around the house all the time.

Maureen: I almost wore something very similar. I like, I picked up my giant oversized cardigan that goes down to my knees and I was like, no, I’ve been wearing this every day for a week. And I put it back.

Heather: Well, you could have worn it and you would have fit right in. I also wore my fuzzy socks, but I also wore my running shoes with the fuzzy socks that go halfway up my calf. So, you know, we were a real vision coming in here to the studio today. And we want you to know we did it for you guys. Bringing our best forward.

Maureen: Absolutely. Yeah. I walked out of the house without looking at a mirror this morning, so you get what you get Heather.

Heather: And you don’t throw a fit. But didn’t you see something else when you walked out this morning?

Maureen: Oh, yeah. Well, okay. So it is lambing season.

Heather: Lamb watch 2022. I just found this out by the way. So if you didn’t know that it was lamb season, it’s not your fault.

Maureen: Okay. Well it’s usually later because I like make it happen later, but I was, you know, taking care of an infant this year and I just left them all together so they had sex when they wanted to. But I looked up in the field through the kitchen window and I was like that sheep is acting funny, but it is seven in the morning and I have to leave and I don’t really have time to do anything.

So I drove away. And when I got here, my husband texted me and he was like, so there’s a lamb in the field.

Heather: Just a regular old Monday.

Maureen: I was like, ah, and he’s like, I can’t get out. You know, I, so most it’s just like human birth. Most of the time it’s normal and fine. And sometimes it is a terrible disaster.

Thankfully, this is my most experienced mother and she had twins again. This was her third year in a row having twins. And I’m slightly worried cause she had horrible mastitis last year and one of her babies actually died. But she cleaned them, she’s nursing them. So for now I’m just like, okay, I will definitely go spend three hours in the barn tonight when I get home, but I’m kind of antsy sitting here right now thinking about it.

Heather: Well, how’s her pelvic floor? I sure it’s fine. Because she’s on all fours.

Maureen: Because it’s like up, it’s not her pelvic floor is like, not under her. It’s like behind her.

Heather: Hm. I wish my pelvic floor was behind me. Yeah. We were actually obviously today, we’re talking to our, our friend, our new friend, Dr. Kaeli Gockel, and we will get to that. But first we had just a couple of things we wanted to talk about. First of all, being for those of you that have listened for a while, you know that I have pelvic floor issues, which is why we’re bringing her. It’s near and dear to my heart. But I have a serious issue with keeping a tampon in while running.

And there’s nothing that really makes you feel super gross than when you’re in the middle of a decently long run and your tampon falls out in your underwear. Plus if it comes out just enough that it like rubs that’s even worse, I’d rather it just completely come out. And yes, I’ve tried different sizes.

Okay. And I can’t wear the cups. The cups don’t work for me because my uterus is tilted mixed with my rectocele and cystocele, it’s just like a disaster mess.

Maureen: It’s a dumpster fire is what that sounds like.

Heather: My pelvis is a dumpster fire. Yes. So I came up with a solution and I have started wearing the Thinx underwear and also I bought the off-brand, which worked just as well. Sorry, Thinx.

Maureen: That’s nice. That’s good to know.

Heather: But it worked just as well, and I’ve decided to free bleed into those underwear during my runs and just not worry about it.

Maureen: How does that feel?

Heather: It actually feels amazing.

Maureen: Oh, I’m so glad to hear that.

Heather: Yeah. Yeah. It felt really liberating. And I just kept thinking about who was that runner that decided to free bleed at a marathon and then everyone gave her so much shit about it? And I get it now because I’m like, listen, this is not comfortable. And like, if it’s one of those really heavy days where you’re super crampy, the last thing you want to put up there is a tampon. So I’m all about this. So if you guys struggle with that, and even if you squirt a little bit of pee out while you’re working out, these might be great for you just to catch that little residual urine without having to put a pad on, because there’s nothing worse than running with a pad.

Maureen: I have to say, I found out who it was. Her name is Kiran Gandhi. At the time in 2015, she was 26, a Harvard graduate and she free bled through her first marathon.

Heather: Yeah, hell yeah. A marathon is a very long way to run with a tampon in and it’s like, screw anybody else that can’t deal with it. Like so sorry that my period lined up with my marathon that’s publicized, you know, God. Anyway, so that’s a little solution for you if you’re struggling with that and you’re not alone. And hopefully this episode gives you a little bit of a tactical advice, as well as some inspiration.

Maureen: That may not be her first marathon. That might be wrong. Sorry. Anyway. Anyway, she’s great. You’re great. All of you guys have a pelvic floor out there, so hopefully we can help you make it the best it can be.

Heather: And also your partner has a pelvic floor and maybe they could improve theirs alongside your journey.

Maureen: Whether or not they have a penis or vagina in that pelvic floor. Like maybe they need some PT too.

Heather: They can show you support by doing the pelvic PT with you. And did you know men can do kegels? Did you know that I awkwardly make my nursing students do a kegel in pre-conference one day?

Maureen: Love that.

Heather: I, yes. And I said, okay, everyone do a kegel and they look at me and I’m like, now do it correctly. And they’re like, what do you mean? And I’m like, you’re probably not doing it the right way. And after I teach them how to do it, their faces are just like, oh yeah, we definitely did not know how to do a kegel the correct way. So these are the things that we’re trying to cover today. Why won’t you listen to us you guys?

Maureen: Okay. Well, I guess we should probably introduce our guest, huh? We shall. Okay. Oh a side note, we’re going to skip a question right now because we have one that is specifically for our guest so you can pay attention to that at the end.

Heather, did you know I have an Etsy shop? Yes, I creep on there regularly.

Well, listeners, if you didn’t know out there, I have an Etsy shop with my personal artwork on there. I have stickers, posters, t-shirts, but my favorite items are my surprise mugs. I have a couple of color changing mugs featuring my little illustrations of volvulus and breasts.

And boy, are they a surprise, especially when you give it to your boss that you do not like, and they pour hot coffee in it and labias abound. I like to give them to like my mom or dad when they visit them a cup of tea and watch their face. And really, I think everybody needs these in their homes. So if you would like one for yourself or anything else that I make, you can visit wandering w O M six that’s, but with the six instead of a B. And of course that link will be in the show notes. Thanks.

Heather: All right. Today’s guest is Dr. Kaeli Gockel and she is a Doctor of Physical Therapy and pelvic health specialist in Seattle, Washington. Whoop whoop Seattle, she’s also the founder of the site,, where she offers virtual visits and online pelvic health courses.

She received her doctorate at the University of Washington School of Medicine and her undergraduate in psychology and Spanish at Seattle University. She’s passionate about de-stigmatizing and prioritizing pelvic health, especially among women. And she enjoys making potentially awkward topics as comfortable and fun as possible for her patients, which as you know, we are all on board for. She’s an avid Mountaineer, and I wore my go mountaineers t-shirt today.

As in West Virginia, we are the mountain state. So we got to have a fellow Mountaineer on here. And in her free time, she volunteers for the Seattle Mountain Rescue. Loves to ski, climb, bike brew beer, kombucha, paint, play ukulele, and spend time with her dogs and partner. Thanks for coming to talk about pelvic floor stuff, but also can we be best friends?

Maureen: Welcome Kaeli I’m already obsessed.

Heather: Yeah. All of it like kombucha, painting. This sounds like an amazing girls’ getaway.

Dr. Kaeli Gockel: We can be breast friends for sure. Thank you guys so much for having me. I’m so excited to be here. Your podcast is super fun and informative. And I was like, oh, we just need to talk about pelvic floor and how this is all related. So I’m super excited to be here. Thank you.

Heather: Absolutely. And I think a lot of people are probably confused as to why we’re bringing a pelvic health PT on the show.

Maureen: Maybe, but also like we all have pelvic floors and we all probably just jack them up having babies. So, I mean, you can tell me how it’s related to breastfeeding, but I know how it’s related to all of us who’ve given birth.

Heather: Yeah. So Dr. Kaeli Gockel, please tell us why pelvic health is important for breastfeeding.

Dr. Kaeli Gockel: Okay, well, first of all, pelvic health and breastfeeding, I mean, motherhood in general is just a time when we are like, everything is changing in your body. And you’re just getting, a lot of moms tell me that right before they give birth, they’re just starting to get to know their bodies and love it.

And then all of a sudden everything changes, right? And so your pelvic floor changes, your breasts are changing. All your hormones are going crazy. And so how do breastfeeding and pelvic floor relate is that at the same time in your life, they’re both undergoing a lot of different changes. And I would say when you’re breastfeeding, you’re going to still have some relaxin in your system.

And so that hormone relaxin, aptly named relaxes the sphincter muscles, as well as the ligaments in the body, which can cause issues with pelvic floor. So it can make it harder to hold back your urine or feces or gas temporarily. And it can also make it harder to get back to like aggressive sports, like running, because the ligaments are just not as supportive in your pelvis, you know, kind of your base of support, where you need that explosive movement to come from.

And so until you stop breastfeeding, you are going to be a little bit more still on that flexible side and a little bit unsupported, but the good news is that the skeletal muscles of your body are not effected by relaxin. And so it’s super important and empowering to know that you can strengthen those and therefore support the pelvis and you can get back to your normal function quite well with the proper training even when you’re breastfeeding.

Heather: That’s really important. I think, first of all, there’s probably 50% of our listeners listening right now who feel like their pelvis just is loose and not really put together. I remember Maureen after she had Lyra, cause she kind of had more of a precipitous birth where she kind of just came out very quickly and her pelvis just got completely rocked.

And then for months after she was like, it just feels like it’s not connected. And of course it’s like a box shape, but when your box has like loose hinges, it can feel very odd. And then you have all of these new positions that you’re doing as a breastfeeding parent. Like maybe you’re sitting a lot more, you’re hunched over a lot more, your core muscles aren’t being utilized as well.

So first of all, backing up. Can we just take a second to fan girl over the pelvis and why you’re such a fan of the pelvis and how in the world you got to be a pelvic health specialist? Because I don’t think little girls are running around the world going, when I grow up, I want to be a pelvic health specialist, although they should.

Maureen: Yes.

Dr. Kaeli Gockel: Absolutely. Oh my gosh. If you told me that I would be a pelvic floor, physical therapist, like told any of my younger self that I would not have believed you. I had no idea that’s what I wanted to do when I applied to PT school. But in physical therapy school, I actually met this wonderful woman, Serena Fiacco and she had a doctorate in human sexuality and she was coming back to physical therapy school because she had this beautiful vision of sort of melding the human sexuality side with the physical side, the pelvic floor, physical therapy.

And so from the very beginning, she knew that’s what she was going to do. And she was not afraid to talk about it. And coming from the psych background myself, I was like, this is the perfect fit. I always knew I wanted to help people. I want, I didn’t want to just sit and talk, so we move, we help people get back to exercise.

We help them get back to function. You know, I did do some orthopedic, you know, kind of your bread-and-butter PT, where you’re helping people’s elbows and knees and get back to sport. And that is fantastic and really fun. And I might go back to doing that someday, but to me, it is so much more rewarding to help someone stop having pain with sex, or be able to stay continent, to not leak when they’re running or laughing or jumping or coughing.

And to help them, you know, have regular soft and happy bowel movements. These are things that are part of like human dignity and make people’s lives, quality of life so much better. So yeah, that’s why I do it. You know, every, all my patients ask me that at the beginning, and then I I’m like you just wait, because when we get you to the finish line, we’re both going to know why I do this.

Maureen: Can I just say, like, I, you know, I think it’s really important to like, wait a little until you figure out your career. Cause what, like 18-year-old understands how much of a problem peeing and pooping can be when you’re like 32? You know, like how many parents are out there just like being incontinent all freaking day long?

Heather: And not talking about it.

Dr. Kaeli Gockel: I know. And that is why I’m so excited that you guys wanted to have me on the podcast and that you guys are talking about things like this is, I really think we can make a big difference if we just start talking about this stuff, right? Half of the time patients tell me they don’t even know that I exist or they don’t even know that pelvic floor physical therapy is a thing or they, everyone in their family has always told them that, yes, after you give birth, everyone, that’s just normal. That you are going to pee your pants.

Maureen: You just cross your legs.

Dr. Kaeli Gockel: And so, so if the doctor or your, you know, your midwife or your OB asks you, Hey, is everything normal down there? Back to normal? You know, you might say, yeah, because you think that that is normal.

And the truth is that maybe it’s common, but it’s not normal and we can fix it. But I think even providers, unfortunately, we’re not always asking the right questions. And so as long as people know that it doesn’t, they don’t have to suffer through that and that you can fix it at any time. That’s what’s really exciting too, is like, you know, that it might be someone listening to this podcast that is thinking, oh, I wish I would have done that like right after postpartum. No, you can work on your pelvic floor and heal and get back to function at any age. I work with people in their eighties. I work with people going through perimenopause. So yeah, anytime.

Heather: Well, I really feel like this information is not only important, but invaluable for women specifically who have given birth. Because if you are like a high-powered person who wants to go back out to work, or you are an athlete, a previous athlete, and that’s really important in your life or you and your partner are very, very sexual people and that’s like a huge hub of your life and that gets disrupted and you’re, you know, incontinent constantly, or your sexual function has been compromised, your whole life can fall apart.

So these visits with you are so important. These conversations are so important. So people don’t just give up like, oh, well I used to be an athlete. Now I just pee myself all day, you know, and that’s not a part of my identity anymore. Because when you have a baby, everybody knows you go through an identity shift and you have to grieve the loss of something.

You know, even if it’s just being able to take a nap, like, oh, remember when I used to be able to take naps, let me grieve that a little bit at a time. And then you add this onto it and it’s just compounded. So thank you for this important work that you’re doing and for coming on our podcast and making it so public because this field, I get the sense from an objective point of view, that this is kind of like a newer field that is becoming much more important and standard.

Maureen: Because it, it helps women. Exactly. Like medicine surrounding motherhood and parents is pretty much like the, what? The last 10 years, 20 years, you know, we try to look at like research and I’m sure you struggle with this too. You’re like, oh, so there’s one study that for what I’m looking for.

Dr. Kaeli Gockel: Male’s body. And we just sort of use that as a proxy.

Heather: Yeah. And, you know, we just need to go further than, make sure you do kegels 10 times a day, have a great day. Bye. As you leave your postpartum visit.

Dr. Kaeli Gockel: Yeah, this is, people are like, one, what is a kegel? So am I, do I even know what that is? And then two, why is that important? And is that a reverse kegel is learning how to relax a pelvic floor, maybe actually what that person needs. And it, at least in my experience with people that are coming to me in almost like almost 50% of the time I’m teaching people actually how to let go of kind of the perma-kegel that happens. Because anytime that we are stressed or in fear, or have worry, even healthy, normal people are going to be tightening their pelvic floors.

We’ve done studies where we put surface electrodes on their pelvic floor and then had people watch a movie. And the movie has happy parts, sad parts, scary parts, funny parts. And everyone is tensing during those scary or worrisome parts of the movie. And then we think about the pandemic and stuff that’s going on in people’s lives right now.

And I’ve seen an increase in people with pelvic pain, and I’ve seen an increase in people with urinary urgency as well. Not only is our pelvic floor getting tight because they’re tense because of all the stress that’s going on in our lives, but they’re also, the bathrooms are all closed.

Heather: Wow. That’s really interesting. I’ve actually never thought of that.

Maureen: So I have had this experience as a provider and my teachers have mentioned it as well, that when we have people who have had some kind of high stressors, trauma in their life, particularly sexual trauma, that we see this excess of tension in the pelvic floor, which, you know, as birth providers were like, oh yeah, like we have to sometimes work through that to get them to release so they can birth.

Is this something that you’ve experienced in your practice? You know, we we’ve had elders and teachers tell us like women hold their trauma in their pelvis. It doesn’t sound like a very scientific thing. I feel like my experience supports it, but can you speak about this from a physical therapy point of view? Like, and then also what happens with that after we’ve had this opening of birth, which is, can be equally traumatic?

Dr. Kaeli Gockel: So, yeah, that’s a great question. I think in my line of work, I am seeing a lot of people postpartum holding tension in their pelvis, and I would, I would liken it to after you get in a car accident.

So when you get in a car accident, your head goes through this big whiplash motion and your neck muscles get incredibly stretched out super-fast. And what our bodies do in response to that is they guard and protect. They don’t know when you’re going to get in the next car accident and so you’re walking around trying to hold that tension, protect that head and neck from potentially the next threat. Right. And what actually causes the pain after you get in a car accident, and you know how it often doesn’t set in until like later that day or a couple of days, even a couple of weeks later? It’s that muscle tension is slowly creeping in.

And that’s why you go see massage and chiro and PT because we have to teach those muscles how to relax and release that tension. How to allow gentle stretch again without guarding. And it’s so similar. I think in the pelvis, after you give birth, there is a quick stretch to the muscles and there’s a shock of corticosteroids to get you through that process.

And so your body thinks it just experienced a microtrauma, right? And even if the emotional experience was wonderful, your body still has sort of this memory of whoa, like that was stretched really fast and moms are confused because they’re thinking, well, I don’t understand why I would need to learn to relax.

I’ve been doing tons of kegels thinking a baby came out of my pelvis, it must be stretched out. But it doesn’t necessarily mean that it stretched out. In fact, those muscles can kind of overcompensate by saying, okay, now we’re going to really, really tense up and your muscles can be, can be long and tight.

They can also be short and tight. So it’s not just one or the other. And I would say similarly to after a car accident, we have to honor that trauma, that it, that we experienced and try not to ignore it. Talk about it, realize that you’re not alone. Similar to a car accident, we have to learn how to breathe. When we learn how to properly breathe, which I noticed sounds so simple, but I swear it is life changing.

And it was for me even. Wasn’t until PT school, when someone put their hands on my rib cage and said, breathe, laterally, breathe forward and backward. Act like you have a tire around your waist and you’re trying to fill that up. Meanwhile, telling me, stop using your neck, stop using your upper chest muscles to pull that air up and in.

That kind of breath, when we’re breathing low into our abdomen is going to send a message to our nervous system that everything’s okay that we’re in rest and digest that we’re now safe and can start to unwind some of that tension. Similarly, when we start to breathe deeply, our diaphragm can drop low and actually at the end of the super deep breath, that’s when your pelvic floor is going to be the most relaxed. So we always, almost always start our pelvic floor treatment with just learning how to breathe properly so that your pelvic floor is kind of naturally coming up and down. And it’s only a couple, I think it’s like five millimeters max, but it does move naturally.

So if you can’t really feel that that’s totally normal, but just knowing that it does sort of move like a canister with the diaphragm can be really helpful to start to visualize that down and open stretching and breathing. So another thing is to practice addressing your body like you would a friend and again, sounds kind of hokey, but it’s so powerful.

We know this through mindfulness research that it can really change our brain. It can change our perception of pain and it can improve our body’s ability, our muscles ability to loosen that tension.

Maureen: Sure. Okay. So we talk about this all the time in the podcast, how sex changes after birth and certainly while breastfeeding. And now we usually focus on the hormonal side of things and like, oh, this is a low estrogen state and there’s a lot of dryness and tighter tissues. Can you touch on that some? You know, when, when do we expect things to be quote, back to normal? How does this pelvic floor or breastfeeding relationship work when it comes to sex?

Dr. Kaeli Gockel: Yeah. So if you guys have already covered, you know, making sure you talk to your doctor about if you’re a good candidate for using an estrogen temporary topical cream, to help get your hormones in that area, back to normal, to help plump up the tissue and make it less friable then, you know, after that, then we’re looking at treating the underlying muscle guarding or dysfunction that’s happening as a result of the tissue changes.

So a lot of times the driver, like the initial assault on the pelvic floor will be the tissue change, maybe in other cases, an infection or a trauma or something like that. And then in response to that tissue being more delicate, let’s say you do try to have penetration and it’s painful, and you think, okay, well that’s normal.

Everyone says that’s normal, right? So then you try a few more times and you feel maybe guilty that you haven’t had intimate time with your partner for a while. So you’re really trying to push through that pain. Like I can, I’ve done childbirth, this is no big deal, right? So what that’s doing though, is it’s building up pain pattern in your brain that starts to think every time I’m touched in this area, it’s painful.

And now just the thought of being intimate with your partner could make your pelvic floor muscles be tensing in anticipation. So it can kind of be like a vicious cycle that we get into. And we want to try to, like my role of what I like to help people with is how do we sort of like start to break that cycle up so that at the very least you have control over the muscles again?

And then you can talk to your OB or midwife about getting the tissue changes under control as well. Does that make sense?

Heather: It does because, you know, there’s, there’s actually a myth or a rumor, I guess I should say out there that if you don’t breastfeed, you’ll be back to sexual peak performance sooner. So they think that breastfeeding is inhibiting their full repair of their pelvis. So can you just like dispel that myth for us?

Dr. Kaeli Gockel: Absolutely. I think it, I mean, there’s no evidence that I’m aware of that that’s a strong correlation. I think that the correlation is actually between the low estrogen levels changing once your menstrual cycle returns, but you guys could speak to this better than me, but as far as I’m aware, you’re breastfeeding doesn’t necessarily change your menstrual cycle returning that doesn’t change that timeline, right?

Maureen: It can, yeah, it can delay it quite a bit actually. So that’s the issue that people face with breastfeeding is that a statistically we’re looking at it coming back at six months or later, versus when we’re formula feeding it’s more like three months.

Dr. Kaeli Gockel: Okay. Okay. Well, so in regards to, I guess I can speak to the muscles and the ligaments and the tendons and things that the muscles are not going to be affected by the hormone changes.

Just the sphincteric muscles, which is a very, you know, so just these muscles that go like a circle around the opening of the vagina, around the opening of the anus. And the percentage that that’s going to change shouldn’t make a difference in your function. So even though there’s a small decrease in its ability to close, the rest of the muscles are all still able to work as normal.

And so in the right circumstances, there should be no dysfunction. There should be no leaking. There should be no trouble holding things back when you want to. And so kind of going back to what you were saying. In regards to the tissue, it does seem like breastfeeding would help you get back to having better sex faster in regards to it not having any sort of microtrauma.

And that I think kind of goes back to what you guys are always saying is like communication and lubrication, right? So is that something that is, is some delicate tissue something that we can work around when we’re using the right tools? Absolutely. Right. When we’re speaking up for our bodies and we’re communicating with ourselves and with our partners, when it’s painful and we’re adjusting. Can we adjust the speed?

Can we adjust the depth? Can we adjust the angle of penetration? Can we take the vagina off the table completely and open up the books to, oh my gosh, this is a time for us to explore other ways to be sexual with each other? And my one opening is not the only thing I can provide my partner in the area of sexuality.

Right. And so maybe this is an opportunity for us to try to explore other ways to be intimate with each other. And sometimes that involves orgasm and sometimes that doesn’t and that’s okay.

Heather: I’m glad you brought that up. And also we need to talk about the estrogen cream on the vagina. First of all, this is not something that providers prescribe standard for pelvic and sexual dysfunction postpartum. So I have not personally read all of the research on that, but we’re putting that on our list as of today.

So typically estrogen creams that are local don’t really affect you systemically. So like when you’re talking about hormone replacement therapy for somebody that’s going through perimenopause, you know, that’s a much more localized area for an estrogen cream to go to help with sexual lubrication and, you know, fluffing up of the tissues, like you said. With breastfeeding, any kind of estrogen, you know, I don’t know if it will, how much will actually get into your entire system when you put it on those mucous membranes. If the estrogen will affect your milk supply at all, but just knowing that someone like Kaeli is available to help you work through all of the other options, if that’s something that you’re not willing to risk, then that’s great.

Like we need to lean into that. It’s not just like, oh, you have pelvic pain with sex after a child, so therefore you get estrogen cream and if it hurts your milk supply, sorry, breastfeeding or sex. You know, it’s much more than that. You have a lot more options. And also I like to remind people that, you know, estrogen and those combo pills, yes.

They can affect breastfeeding, milk supply in, in particular, but so does pregnancy. And then, you know, usually it’s a temporary thing. Like when you get pregnant, you’re full of estrogen once again, and people successfully continue breastfeeding. It might just depend on how young your infant is. So if you’ve been struggling with pelvic pain for eight months, you know, you’re eight months postpartum and it’s really affecting your life, I’m going to be much more inclined as a provider to be like, yeah, let’s try some estrogen cream. Especially if you’ve already been to pelvic PT and you’ve already learned how to have an orgasm without penetration.

And you’ve already, you know, your partner and you are communicating and lubricating. But if you’re like six weeks postpartum, and it hurts, we’re not going to start with estrogen cream, probably. I’m going to be like, you need to meet my friend, Kaeli. We’re going to talk about partner communication.

Maureen: I just, I want to note that I think everybody, after any birth, particularly a surgical C-section needs a pelvic floor PT referral just automatically. Like, I think it should just go like it doesn’t hurt any doctor or midwife to put that referral in. And I think we should just do it automatically even if the patient’s like, Nope, I don’t need it. Thanks. Great. Then you have the option. It’s fine.

Dr. Kaeli Gockel: It’s standard care in other countries and prenatal also. When you think about how valuable it is to be able to have someone say, yeah, this is what, you are doing a contraction well. You can stay strong and stable and injury free during your pregnancy and continent during your pregnancy. And then near the end, we transition to let’s learn how to really stretch and really breathe and really relax and lengthen those muscles so that baby can come out with minimal tear.

Absolutely. We can’t promise no tearing, but we can do everything in our power to help those muscles not contract and try to fight baby coming out.

Maureen: Right. And I point out that among like all mammals, we have a very unique pelvis, like, and you know, a lot of people would be like, why do we need all this? You know, it can just happen naturally. Yeah, absolutely. Yes, we are animals. Most of the time birth just happens and it’s fine, but we’re really fucking weird animals where our entire spine is stacked straight on top of our pelvis. And then our legs are like straight under it and it is super weird.

Dr. Kaeli Gockel: And we’re just like, well, evolutionarily it’s beneficial for our heads to keep getting bigger and bigger because our main survival mechanism is our brain.

Maureen: And so we have this narrowed pelvis and these big heads and this weird vertical shit.

Dr. Kaeli Gockel: Yeah. So what about like, this is such a fun tangent, but have you guys heard of this interesting research in the correlation between when we invented C-sections and human pelvises, a female pelvis getting narrower and babies heads getting bigger? Because we have actually taken out a piece of natural selection.

Maureen: Yeah. And I mean, I’ve, I’ve definitely read a little bit about it with the biggest criticism being like, is that a long enough timeline to affect our evolution or not? It’s and it’s certainly, I mean, and it’s an argument you can make like a cross allopathic medicine, right? Like, are we fucking with the evolution of our species by helping individuals who would otherwise die?

And it’s a really interesting, also dark road to go down. Yeah. And it just kind of reinforces though the fact that like, yes, this is more complicated for our species and breastfeeding is more complicated for our species, frankly, too. And for all of the same reasons, you know?

Dr. Kaeli Gockel: Yeah. Whether it has to do with evolution or whether it just has to do with the fact that well, I mean, yeah. So whether it has to do with C-section, certainly like you’re saying our bodies are not really built for delivery the same way other mammals are because we prioritize big brains. I think. That’s for sure.

Heather: Basically one thing we can say for sure is that we have done everything possible as a species to make sure this shit is as complicated as possible, especially with breastfeeding and body mechanics.

Okay. Like we’re actually probably meant to move all day long and we’re meant to breastfeed on demand. That’s how it will ideally work. But what we typically do is sit for the majority of our day and we separate ourselves from our babies. And that’s not a judgment against our lifestyle.

Maureen: No I’m doing it right now. I’m doing it right now. I’m sitting, I have to pump in 30 minutes, like.

Heather: Yeah. But those changes and those complications that we have to accommodate for create some general aches and pains, and we need to kind of know how to prevent and treat these. So, you know, first of all, let’s talk about the giant knots between our shoulder blades from looking down while you’re nursing. So what is that actually from? We call it the, yeah, that’s just my breastfeeding shoulder blade issue. Like how do we prevent that? What happened to me and everybody else?

Dr. Kaeli Gockel: So this is so common and I feel like it can even start during pregnancy. So during pregnancy, you got that hormone relaxin, which is making your ligaments looser and your spinal curves start to change right away because your center of gravity or mass is getting pulled forward as your stomach starts to grow. In order to compensate for that, so that we don’t just fall over forward, you start to increase our low spine curve.

And then because we need to reach forward to reach the things in our lives, we are curving our upper spine a little bit more. Our breasts might be growing, our bellies growing. Now we have to reach even further around to grab those things. And then in order to look up at our world, now, our, our cervical spine is now increasing in its curvature as well.

So the spine gets more curvy. And why do we care about that from a pain perspective? Well, when the spine curves, now you have an imbalance in muscles, potentially. The part of the curve that gets bigger. So for example, take your mid back around your scapula around your shoulder blades, that those muscles are getting stretched out and they’re getting weak.

And the muscles in the front of your chest are getting tight and they’re getting shorter. And maybe over strong right. Now, enter baby and you’re deconditioned. And now you’re breastfeeding and holding and looking down all day long. Well, you’re exacerbating all of that, right? So the best thing you can do really is during pregnancy start to work on prevention of those imbalances by doing lots of chest openers, peck stretches, get your arms in the doorway and sort of gently lean forward.

So you can feel that stretch going across your sternum and right by your armpits. And then doing some back exercises. We’re doing so many biceps and holding forward, but if we can strengthen the triceps, the latissimus dorsi, the rhomboids and the lower trapezius. So just think your mid back muscles, the muscles that you use to pull weights up and towards you.

If you’re, let’s say like leaning forward and lifting a weight up with good scapular control, that’s going to start to rebalance you. What can you do if you don’t want to start just like pumping weights and doing exercises right away cause you’re just a busy mom? Well, first let’s get baby up to you as much as possible.

You might have a breast friend or a boppy pillow, but it may not be enough for your body. So you might need to add extra pillows underneath that. And instead of having your body come down to baby, do everything you can to bring them up to you so that you can be supported in your spine and your back.

You’re spending a lot of time breastfeeding or pumping and you want to try to make that time really easy time on your body where you’re not fighting gravity, where those curvatures aren’t getting bigger. And then another thing that you can start doing right away is anytime you get a chance in between typing and working or in between caring for baby, to make your arms into like a goalpost, right? So, or like a cactus. So you’re bringing, let’s do it together. So bring your arms out to the side. Don’t do this if you’re driving and listening to this. Arms out to the side, squeeze your elbows back towards the wall behind you, and try to imagine that you’re pinching a hundred-dollar bill in between your shoulder blades and that you’re pulling them down by your butt cheeks.

Right? So down and across and hold that for 15 seconds. Hold it for a good amount of time. When you released, it’s going to feel so much more balanced and good in the front. And if you could do that frequently, it’ll start to rebalance you as well.

Heather: I just did that. And guys, it was not easy. I am so tight in the front.

Maureen: So the problem I have is that I feel like my breasts are just like so heavy these days. They’re huge. It’s hard to find bras. They’re getting so large, still getting bigger. Hooray. What are some things we can do for the discomforts that come like simply just from having extra weight on your chest?

Dr. Kaeli Gockel: I hate to say it, but a lot of the things I just mentioned still apply, because essentially, essentially you just have one extra thing pulling you forward. Right. But all the same solutions apply. The other thing I might just mention I’m sure feels like low-hanging fruit, but just to make sure you have good support with a bra that has thick straps and maybe even like a cross in the back is going to be better than just straps that go down to the side.

Maureen: Oh, I hate those, but I’ll try it.

Heather: You know what I just keep thinking about is all those pictures, the, the beautiful photos of people from all over the world who are doing a back carry of a toddler and a front carry of a little baby. And I just kept thinking, like, that’s basically the perfect balance, right?

Like it’s a lot of extra weight, but if you’ve got the heavier kid in the back pulling you, pulling your shoulder blades back and the, the lighter kid in the front that actually might be evolutionarily, how we were meant to be. Maybe we just need to keep going. Just keep having more kids to just pack them on your body.

Maureen: I can no longer carry my older child. He is 55 pounds. He is too heavy.

Dr. Kaeli Gockel: He can walk. Bowling ball. I don’t know. We can get creative. Yeah.

Heather: Exactly right.

Maureen: But, but I feel like, okay. So I feel like this whole time we’ve been kind of dancing around a major connection, right? We’ve been talking about breastfeeding over here, pelvis over here, a couple of ways they intersect, but I want to kind of get down to it because at the heart of it, when we’re sitting down for a lot of our day and breastfeeding, we are sitting on our pelvis and everything above it is stacked on top of it.

So can things go wrong with breastfeeding when our pelvic floor is busted up? And what, what should we be looking for to know that that is the root of the problem we’re having? So I think I’m just kind of hoping for a more, a clear connection for people where we can say like, look, the pelvis is the root of your upper body.

Like it’s the foundation. So yeah, like some of these aches and pains might be postural from your upper body, but also you have to fix like what’s below it.

Heather: And also like the diastasis recti that a lot of people will have and like the weak core muscles that are connected into the pelvis. And so, and then like when you have a weak core, you lean over more. So that kind of thing.

Dr. Kaeli Gockel: Definitely. Okay. So the pelvis, I mean, it is our foundation, right? So when we, when I’m teaching people about posture, whether we’re sitting or whether we’re standing, when I think about building the foundation strong so that everything else just stacks easily on top of that, and we don’t have to use a lot of effort there.

So if you want to try playing along with what I normally do, put your hands on your hips and imagine that your pelvis is a bowl. And then I want you to imagine that you’re trying to pour water out the front of the bowl. So tip your pelvis all the way forward and now pour water out the back of the bowl.

So tuck your tailbone and tip your pelvis all the way backward. Now go forward again, this time, a little bit less and backwards, a little bit less. And so you’re moving smaller and smaller amounts each time until you kind of find your pelvic neutral. And yours is going to be different than mine.

Everyone’s a little bit different, but once you stack that pelvis properly, now just drop your arms down to the sides. And when I look at you from the side, you’re probably already stacked up. Your ears on top of shoulders, shoulders on top of hips. And if you can hold that position and then be supported with your back, you’re going to be an ideal alignment.

But if it’s hard for you to hold this position, because you have decreased core strength or diastasis recti, or you have pelvic pain or any other reason with the body, right. Then you’re probably going to be collapsing and having pain in the upper body, not having good excursion with your breathing. And that can start to have an effect on breastfeeding as well.

So essentially it is our foundation. It is the root as they say in, in yoga, even right, the Mula Bandha, it means like the root or the house center. Right. And so I dunno, I, I think it’s connected. What other ways do you guys think it’s connected?

Maureen: Well, I mean, a lot of what you said, just it affecting our baseline comfort while we’re breastfeeding is really important, right?

Because that affects how much you want to breastfeed, how much you’re going to sit down with your child to do that. And you know, all we ever talk about on this podcast is like consistency in creating a demand for milk from your baby, so that your body knows to supply it. And if we’re changing our habits because our body mechanics are not working right, like that can affect our supply.

And we’ve mentioned a couple of times, we’ve got some key nerves that are involved in milk production that kind of lay right between the shoulder blades and the spine. And if those are not in the right place, if our upper back is being affected by our lower back and our pelvis, it’s just like, it’s a very complicated physiology.

Dr. Kaeli Gockel: It’s all connected. Absolutely. Right. All the way up.

Heather: Yeah. And also let me say this alignment should be used for pumping as well. So if you’re about to sit down to pump, we don’t want you crumpled over like a Cheeto. You know, you got to actually do exactly what Kaeli just said. You know, like center your pelvis, do some belly breathing, try to get back in that mindfulness space and just get after it for like 15 to 20 minutes or however long your pumping session is.

And also, you know, while you’re here and we’re talking about pumping and alignment, can we also ask you, what is with the crazy wrist pain that you get from holding your giant breasts or your pump flanges? Because some people are like me and always say, they’re going to get around to buying a pumping bra, but never really do.

And then end up just holding the flanges on for nine months pumping. And before you know it, you have this like weird wrist pain and you’re, you know, you did it to yourself so you’re too embarrassed to ask anybody about it. So this is me saying I did this. Help me. What is it?

Dr. Kaeli Gockel: Yeah. So I think you’re talking about that pain right near the thumb side of your wrist.

Yeah. Yeah. That’ll be it. Yeah. So de Quervain’s tenosynovitis, or mother’s thumb lovingly.

Maureen: Honestly, I hate that name. I just, cause I heard a provider talking to a patient about it once and they were like, oh, you just have mommy wrist. And I was like, nothing makes me want to punch you in the face more than that sentence you just said to your patient.

Heather: But my wrist hurts.

Dr. Kaeli Gockel: Yeah. I’ll come back. No, I mean, I just use it. I, the reason I think it’s nice to say that too is to say, Hey, this is really common. This is so common and such a high risk for moms that we’ve called it, we’ve named it that. Right. So not to not to say, oh, you just should deal with it. But so, so that can come from, you know tendonitis is going to come from an overuse of that tendon across the bone, as well as a muscle imbalance.

So again, we’re doing all of this gripping, but we’re, we’re not really, so that works the flexor side of our wrist. And then we’re not really doing anything to strengthen the extensor side of the wrist. So that plus the overuse, just that repetitive use everything we’re doing all of a sudden, all these repetitive activities like opening bottles and closing bottles.

Just, I mean, the millions of different things.

Maureen: Lifting your baby and holding your pump. And like, I mean, even just the mechanics of moving an infant who can’t move themselves around all day, like.

Dr. Kaeli Gockel: Think about like when you pick up a baby, the immediate thing you do is tend to grab them with both of your thumbs up and out, right. So you can slip underneath their armpits. And so the first thing I would say that’s important to, to try to change is try to imagine that your thumbs are literally glued to your hand as much as possible. There’s a lot of stuff that you’re doing repetitively that you actually don’t need your thumbs for.

Granted, they’re great that they’re there, but try to use them only when you absolutely need to. So, so when I teach my classes to prenatal, I actually am having them practice like, okay, we’re going to like practice like your thumbs are glued and we’re going to do all these repetitive tasks ahead of time without your thumbs.

So that’s number one is try to decrease the use. Number two is see if you can find like an over-the-counter brace to try first something that’s going to keep your wrist in neutral, not flex, not extended, and also keep your thumb in neutral while you’re sleeping, because sleep should be a time when you’re not using your hands and you’re resting, but we rest in a flexed and curled position often, right?

And that’s just our natural resting state. So if we can at least be resting in neutral, that can help heal things faster. And then if those, those things, plus regular ice, you know, 10 minutes on, 10 minutes off, several times throughout the day, those things aren’t working, then I would say, ask your doctor if you can see an occupational therapist, because that’s exactly what they specialize in and they can make you a custom brace that will be perfect for you to wear at night and maybe even during the day, while you’re, while you’re lifting and doing these.

Heather: Hm. Got it. And if you have a chunky baby, like me or large breasts that you have to hold up in a specific way a lot, or you refuse to buy a pumping bra, definitely at least get yourself a brace to sleep in so you can actually heal overnight. Got it. Got it. We got it. Thank you. Paddle hands. Got it.

Maureen: It’s hard to do. I try to do that when I’m holding my daughter. Cause I have a habit of splaying, all of my fingers out as much as possible so I can like one hand her while she’s wiggling, but I’m like, oh no, I shouldn’t. I should like keep my hand like one thing with no fingers.

Dr. Kaeli Gockel: One paddle hand on the chest and the other paddle hand on the bottom.

Heather: That doesn’t look weird at all. Hey, do what you gotta do.

Dr. Kaeli Gockel: Pain is a big motivator.

Heather: Yes, pain is a huge motivator. And I think that’s why most people listened to this specific episode because they’re coming here today with pain or pelvic trauma or, you know, broken wrists, or they’re wondering how to navigate their new shaky pelvis that doesn’t feel quite put together yet. So.

Maureen: Okay. I thought when you were talking about that earlier, I thought of a good analogy for the way it felt for me for the first like two months postpartum. Do you guys know when you have a box that you flattened, a cardboard box, and you want to like open it up again and make it back into a box and it just doesn’t want to stay? Like it’s a box, but it’s kind of like a rhombus trapezoid thing. It just won’t quite stay where it should. And like two of the joints are a little too open and two are like too closed.

Heather: Yeah and you look at, and you’re like, maybe I won’t pack all the dishes in that box. I’ll pack some clothes.

Maureen: And that I’m just going to put a little extra duct tape on it. Right.

Heather: A hundred percent. That’s how it feels. Well, Kaeli, what is the one thing that you want our listeners to take away from this conversation today?

Dr. Kaeli Gockel: I think just knowing when and where to find a PT, you know, that there’s lots of tricks you can start with and there’s stuff you can find on the internet, but there’s no harm in just coming and seeing us.

And worst case is we’re going to give you an, A+ on your pelvic floor and your body and say, you’re good to go. And that’s going to feel amazing. But most of the time, there’s something we can help you with to live a better happier, healthier life. And, and you deserve it. After you have a baby, everything turns immediately to, is the baby okay? And I think we really miss out on that so fourth trimester, so to speak, to take care of mom’s body continually.

Heather: Sure. And by the way, can I just personal anecdote. If you are not ready to have any intimate time with your partner or even yourself after you deliver, and you’ve been cleared like that magic six-week date, you can start by just looking at it with a mirror.

And just like getting real with objectively what’s happening down there, because I had a pretty significant tear that had to be repaired and I knew it wasn’t right, because at one point I pulled down my pants to change my post-partum pad. And one of the stitches had come undone and was like, it seemed like it was an important stitch and it was just hanging out in my pad.

And I was like, oh, okay. I’m not going to call because I’m the worst patient ever. And I just kind of let it heal. And I figured, oh, my body will come back together. And now I just kind of have like a, quasi permanent vaginanus and I knew that I had done it and I just wasn’t quite ready to even touch myself. Right. So I just needed to look at myself and it took me all day to get the guts, to do it.

Maureen: I think it’s usually pretty reassuring because we have like,

Dr. Kaeli Gockel: It’s usually not as bad as you think.

Maureen: Yeah, yeah. You’re usually like, oh, okay. Most of it’s like kind of what it used to look like. Like, it’s not that. It’s not some like giant swollen labia hanging out in eight different places thing.

It’s, it’s usually like, not terrible, except for yours.

Heather: I thought it might be giant labia, but when I looked, it was my bladder that was hanging out and I was like, oh, that seems important. You know, I, now I know. So if you are that person and you’re like, you know something’s not right. Yeah. And you’re peeing yourself a lot and you just have that deep feeling of dread, just take the time to look at it .And know there are people out there that are dedicated and passionate to helping you get back to pelvic health. I did see a pelvic PT who was wonderful. Wonderful. And took me very seriously, spent a full hour with me and actually did a digital exam and assessed my muscular ability.

You know, like where is the weakness and how are we going to fix this? And meanwhile, I’m still breastfeeding on demand, like with no pelvic support just, and I had a diastasis recti. So I was really kind of like crumpled and a little sad, just having a really hard time supporting all of this weight that has shifted and emotionally it was rough. So, you know.

Dr. Kaeli Gockel: Yeah, get that support that you need. To say too, even if you feel uncomfortable, I think one barrier to going to PT might be, I just don’t want one more thing. One more provider poking around, we can absolutely start with just pants on. Let’s just teach you some stuff and start to, start to heal you even without doing an internal exam.

So that’s always an option. You should never feel. If a PT says they can’t fix you without an internal exam, then they’re not skilled enough and you should find someone else. That being said, we do get great information from a digital exam and it’s, we don’t use speculums or tools. It’s a lot more comfortable usually than a gynecological exam.

Yeah, but can we talk about pelvic organ prolapse just for a minute since you mentioned it? If you do feel like you’re, you know, something’s not right, it feels a little bit heavier than normal, or you can actually feel or see something kind of protruding from the vagina, this is quite common. A lot of times it resolves as you begin to heal everything else, right?

As your pelvic floors get stronger, as your tendons and ligaments start to strengthen back up, especially we usually see a little bump in the support from above once we stopped breastfeeding, not to rush you, but there’s something to look forward to there. But the things we can do before you even see a pelvic PT, how can you make sure this doesn’t get worse?

So, number one, we just want to think about it like a pressure system. We want to decrease the pressure going downward. And so the two times when, well, actually, I should say the three times when we’re going to have the most pressure going down where that we can kind of affect is when we’re coughing. So unfortunately with like with COVID that is going to have a temporary kind of extra pressure pushing down.

And if you’re able, if you kind of know what a pelvic floor contraction is, you know, kind of imagining that you’re stopping gas or stopping the flow of urine or squeezing your lips of your labia together, like you’re trying to suck a smoothie through your vagina.

So do that. Can you do that right before you cough? Right. Can you hold that squeeze while you cough and give yourself a little bit of support from below? And if that sounds like really high level and confusing, don’t worry about it. The other two things we can do is don’t go back to jumping and running right away.

So squats, lunges, all day long. You can do all your other strengthening exercises. You can do bike, you can do elliptical, but I would say that high impact, make sure you talk to your doctor and maybe see a pelvic PT before you start doing that. If you feel like something’s kind of protruding from the vagina, cause that’s a lot of pressure coming downward that you’d be adding if you did those.

And then the third thing that we don’t think about very often is constipation. If we’re straining to get a bowel movement out, that’s putting a little extra pressure on the pelvis too. So doing your best to talk to your doctors about how can you keep your stool consistency soft and easy to get out.

I know postpartum, it’s quite common to be a little more constipated. And so you might need to talk to them about things like MiraLAX, fiber, water, and exercise. Those are going to be the easiest non-pharmaceutical things that we can do. And then when you’re defecating thinking about making sure you’re not holding your breath, right. As soon as we close our throat, and then are doing that straining motion, that’s putting too much pressure down. So as long as you can just keep blowing in and out as you’re defecating, you’ll be helping out your pelvis doing a good favor to the pelvis.

Maureen: Okay. I like those suggestions. So our listener question today, is from one of our patrons and you kind of just have answered it, but I’m going to read it anyway and see if we can get her a little more information.

She is in a very common situation, as we just mentioned. She’s on her second baby. She feels like her pelvic floor is not the same, you know, coughing and sneezing causes her to leak pee. Right now she’s six months postpartum and at the recommendation of her doctor doing a lot of kegels. But it’s basically like, what do I do?

My pelvic floor is weak and I pee myself, you know, help. And I think we did a lot to help her in this episode but are there other like maybe one or two very specific exercises that you can say yes, no matter what your problem is, like these are going to help you.

Dr. Kaeli Gockel: That’s tough because that’s like a personal trainer saying everyone needs to do 30 pushups to get stronger.

I don’t know where this person’s strength is at or what’s going on and, and if, if she’s been doing regular pelvic floor contractions, kegels, and she’s not seeing any improvement in maybe two to four weeks, then I’d say we got to get you in and just look at your strategy. So a common thing that I see with postpartum moms that are really body aware, they’re doing like crazy kegels and contractions.

They’re sure they’re doing that right. But what they’re doing is they’re actually over dominant in their abdominal muscles. So if you think again about that pressure canister, or like, I think about a toothpaste tube. Okay. The abs or the sidewalls of the toothpaste tube, pelvic floor is the cap. If you squeeze the sidewalls before you get that cap on a little bit, it’s going to leak out, right?

So essentially sometimes we, sometimes someone can be very strong in their pelvic floor. They don’t really need more kegels. We just need to work on their coordination and how they’re breathing, how they’re moving, how they’re contracting their core and their timing. Right. And those are the most fun people to work with actually, because it’s quite fast.

I can make a big difference and maybe just one to four sessions.

Maureen: That’s great. Yeah. And I don’t know, you can tell me if this is right or wrong, but my gut, when somebody says I’m doing kegels all the time and it’s not helping, is I think maybe we’re over strengthening and actually that wasn’t what you needed to do.

So what if we paired kegels, cause you love them, with really nice squats and deep breathing and ways that we can just expand and relax and even that out?

Dr. Kaeli Gockel: That’s perfect. And that’s kind of something else I was going to mention is there’s good research to show that just straight strengthening the hips. So doing your, you know, your banded sidewalks and your squats, like you mentioned that that has crossover to the pelvic floor.

So when we take people, I mean, of course. Obvious. But statistically significantly improvements in pure pelvic floor strength with no actual pelvic floor training, right. With just strengthening the hips. So, so start doing that and see if that, see where that gets you, too. And especially if you can do it in ways that aren’t just jumping so that you are not just putting more pressure down without good strength.

Heather: That’s perfect. And I do love the bands by the way. And just to let you know, in case you haven’t listened to any other episodes where I’ve talked about this before, I am not completely a hundred percent, but I have come a long way and I just am running a 10K training program right now. And it’s taken me, I don’t know, six months to a year of slowly working up to it.

And lots of tears, lots of pee, lots of help from professionals. And I’m, I know a lot more now about it and I feel very positive about where I’m going. And I feel like you can also improve. So if you’re struggling know that, personal story sitting right here, you can maybe not get a hundred percent, but you can definitely get out of where you are right now.

Maureen: Right. We can get to a place of function, of comfort, of no more embarrassment. Cause I know this is a really embarrassing problem for people.

Dr. Kaeli Gockel: In control and empowered in your body. Yeah. That’s so inspiring, Heather. Nice work.

Heather: Thank you. I appreciate ya.

Maureen: All right. Well I think we have talked about everything I wanted to know, except we would like to know how we can find you, how our listeners can get in touch with you and keep learning.

Dr. Kaeli Gockel: Yeah. So you can find me at However you want to say it. That’s T H E K E G E L .com and then on Instagram at, @the_kegel.

Heather: Awesome. Thank you so much. Everybody go follow her. And if you’re like me and struggling with pelvic floor issues, leading to breastfeeding issues and general self-efficacy issues, please reach out to Dr. Kaeli Gockel and empower yourself through your pelvic floor. Love it. Hooray!

There’s nothing more stressful than having a baby that is crying incessantly and having everybody around you trying to tell you it’s your breast milk, or you have to just use gas drops. Yeah. Or maybe it’s something you ate.

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We have a very special award today.

Maureen: I am so excited to hear it. I’d have never, I don’t know who it’s for. Who is it for, Heather?

Heather: So this is one of our patrons, Alex. And Alex says that her husband and her have struggled for about five years with difficult sexual issues, which is very common, as you all know, and it should be talked about. We’ve been there.

It should be talked about much more. Her husband is actually a premature ejaculator, so she has a difficult time achieving orgasm through penetration, and also had some pelvic floor dysfunction after birth.

Maureen: Can I just say too, like even in the best of circumstances, orgasm through penetration is not easy.

Heather: Okay. Right. It’s not easy. These things take time. Time is not often something that you have as a parent. Thank you clitoris. So she says that her husband and her have worked for years now through like trying to open dialogue about their sexual relationship and what they actually want out of their sexual relationship, which is a really great place to start.

So Alex, great job.

Maureen: That part might be harder than achieving orgasm.

Heather: Yeah, no doubt. No doubt. And also having that conversation without having your partner feel less than, like they can’t satisfy you. Like, listen, we have the same goal. You know, the goal is to be together anyways. So after doing lots of pelvic PT and lots of partner communication, the other night they had sex, she was on top, which usually leads to a premature ejaculation instantly.

However, they are not trying to have a baby right now, but she is not currently on birth control and was ovulating. So she told him you better not come because we could get pregnant. And the stakes are high. Refused to get off of him. And so he somehow pulled it together and she squirted.

Maureen: I love it.

Heather: Now. Here’s what happened next. I love the story by the way. He was then so proud of himself for being able to not just pull it together, but help her achieve this squirting orgasm, which does not happen all the time guys. And yeah, it actually kind of hit the reset button for them. And now it’s like, you know what you’re shooting for. It’s like, once you’ve already been there, it’s easier to get where you’re going.

Maureen: It’s like in that Harry Potter book where Harry was like, I can do it cause I know I already did it in the future. Exactly.

Heather: I can squirt again. So it actually made her feel better about her pelvic health. Made him feel better about his ability to please her. And now he knows that he can actually last 10 minutes. Yay. A lot was achieved there. You guys.

Maureen: I love that. Thank you so much for sharing with us because also, how many people out there listening are going to be like, oh, that just pretty much described my whole experience with my partner?

Heather: Yeah. I mean so many. And I think we just don’t really talk about it. And when you’re postpartum and you’ve had so many issues like that, that you’ve been really working through and you have the goal of staying together and experiencing pleasure again and growing in your partnership, this is a great inspirational story. So thank you so much for sharing, Alex.

I hope you guys all stick in there and it could take years and that’s fine because marriage is supposedly forever. Perhaps, and as Maureen always says, it’s a lot easier to stay together when we used to die at 35.

Maureen: You know what? At this point, when we all live to be like 80 and 90, marriage is just like when you, like, when you see someone finish a marathon and like they’re sort of happy, but also maybe they’re going to throw up. And maybe they’re crying and maybe like their nipples are bleeding through their shirt or something like, yeah. That’s kind of how it feels.

Heather: Yeah. Yeah. So sorry. Like, my neighbors are super old. They’re I think in their mid-nineties now, and they fight like cats and dogs and the other day, seriously, just the other day. So it’s funny you bring this up. He walks outside to get the mail and she appears at the front door and she screams, get back in here you asshole!

And it was just like, this is it. This is where we’re headed I guess.

Maureen: We’ll be fine. Anyway, I guess we should give you an award since you shared such a personal story with us. Okay. Well, I would like to give you dear patron, The Pelvic Floor Princess Award.

Heather: Oh, I love that one. Yes, you are a princess. You should be treated like one and you should treat your pelvis like one.

Maureen: And yeah, you know, keep us updated on how your journey’s going.

Heather: Also, don’t forget that Dr. Kaeli does do private consults so you can get on her, yeah, virtual private consults. So you can get on her website and you can schedule a consult with her yourself. And also she does private classes.

Maureen: And you can find that at

Heather: And at the link in our show notes.

Maureen: Well, thank you guys for listening to another episode of the Milk Minute Podcast.

Heather: The way we change this big system that is not set up for lactating families is by educating ourselves, our friends and our children.

Maureen: If you found some value in our episode today, or any other episode you’ve listened to, please consider making a contribution to our Patreon or telling your friend about our wonderful podcast.

Heather: Yeah. If you know somebody who has just a little bit of a vaginanus or pees every time they cough, please send them this episode.

Maureen: And you can find out more about our Patreon at All right.

Heather: Have a great happy pelvis day. See ya.


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