Kim (00:01.569)
Hi, Dr. Segraves, thank you so much for joining me. I am excited about this topic. You and I connected, I think you had messaged me, maybe it was somewhere kind of close to my post-op journey, I think maybe, and we were talking a little bit about how post-op, postpartum recovery is so grossly underserved, overlooked, and we kind of had this similar mission about starting rehab and therapy.
much sooner than it actually, excuse me, much sooner than it actually happened. So I love chatting with people obviously that share my same passion for that. But if you can tell us a little bit about you, what brought you to the world of pelvic health and then now kind of coming into this niche of trying to optimize caesarean hysterectomy pelvic surgery recovery.
Dr. Rebeca Segraves, PT, DPT (00:51.325)
Yeah, absolutely. We actually connected in 2022. And it was about, really about the realm of just pelvic surgery recovery in general. And I remember you had this either course or offer or something that caught my attention, pelvic surgery success. And I said, my gosh, this is the professional I've been looking forward to talking to probably my whole career. And so, and that's really not,
holding back anything. think that I knew I wanted to work early on with the post-surgical population, but especially women. Even in PT school, there was an opportunity, and with physiotherapy and physical therapy education, we're able to optionally go through a residency program. And so that may change. It may be that we're required to actually choose a specialty.
you know, for entry-level providers. But at the time, I was thinking, you know, I really was drawn to the neuropopulation about three months before I started PT school. My mother had a massive stroke. And it was actually 24 hours after going through what's called a PT mill, just being put on machine after machine after machine with a physiotherapist treating two other people at the same time. And I knew I didn't want to practice that. But during the course of my education, I just saw
opportunities to do more within the realm of women's health that kind of spanned birth to earth. And I thought, well, if there's an opportunity, let's take it. And I went through a residency program with Duke. And ironically, I treated men two weeks after prostatectomy on a regular basis in that program. And for people who don't
Kim (02:25.326)
You
Dr. Rebeca Segraves, PT, DPT (02:47.475)
realize the prostate is about two inches in length. It's mostly a robotic surgery. There are some instances where they'll open the abdomen or pelvis, but it's a relatively, I would say, less invasive procedure. I think most people would actually agree, than a cesarean section. We were not treating that patient population to any sort of regularity. And then also women after a hysterectomy,
and that's about a non-pregnant uterus, is about three inches in length, so slightly larger than a prostate. We were not seeing them routinely for their recovery plan within the same two-week span that we were treating men. And I said, how ironic is it to be in a women's health residency program pursuing a specialty within physiotherapy, physical therapy, and not treating this patient population that's defined as women.
under a women's health residency program after a hysterectomy. And we know now hysterectomy is the second largest procedure that's performed on women, at least in the United States. And I said something has to be changed. And so within two years out of that residency program, I helped to form a team that routinely treated women within the first two to three weeks after mastectomy and hysterectomy. And I think that's probably more the foundation of what launched me into this career.
more than anything. My own mother's experience of just not being treated as an individual, but then also just seeing the span of just women throughout their womanhood journey not being treated even with the same dignity that we would treat other patient populations after major surgery.
Kim (04:30.915)
Yeah, hallelujah. Like I, I'm sorry for the journey in us in some ways, like with what happened to your mom and what you witnessed, but we all have, many of us have this, you know, the people say pain to purpose or something that we needed, we saw really needed to change. And you're right. That's shocking. I've never heard that before as part of your story with being in the women's health residency, and yet you're treating men and they are applying the principles that we see being so valuable to men, but
women are sent home from cesarean sections, from hysterectomies, from other pelvic surgeries, days, like not even hours after their procedure with no guidelines, no support, no nothing. And we both have a common passion that that needs to change. So now here you are. And I guess, first of all, can you just kind of, for those, most people probably have heard the term C-section or cesarean section, cesarean birth.
you highlight what that is for those that may not be aware and then also just a brief description of hysterectomy and I guess just to for time purposes will kind of lump many of the principles we talk about with other pelvic surgeries so prolapse incontinence that type of thing but I think we kind of want to specialize or at least let's focus on hysterectomy and caesarean if we can.
Dr. Rebeca Segraves, PT, DPT (05:55.729)
Right, so cesarean section is a surgical delivery at the time of birth that can only happen with an open abdominal surgery. And so that's a surgery that's performed through at least seven layers of tissue from the skin all the way down to the level of the uterine muscle, which is a three-layer organ, to deliver the baby. And typically, it's performed under
some type of duress, some type of reason that's medically necessary to either save the baby's life or the mother's life. There are very few cases where it's actually performed as an elective surgery, where mom, for whatever reason, wants to avoid a vaginal delivery and wants to opt in for a C-section. There's actually less than 10 % of cases that's truly emergent. Most of the cesarean sections that are performed are non-emergent.
or either due to, you had a C-section before, let's just go ahead and deliver that way. For a hysterectomy, just to kind of add to the C-section, a lot of my background in the hospital was actually treating women after a cesarean hysterectomy. So that was the surgical removal of their uterus at the time of delivering their baby. And so with a hysterectomy, for the most part, I believe it's over 85 % of cases are performed.
non-invasively. So that's through a vaginal procedure and then also laparoscopically where there's tiny incisions made throughout the abdomen in order to access the uterus in the abdominal cavity and then remove it vaginally after incisions or a separation of ligaments have been performed. And so even with an uncomplicated hysterectomy, it's usually a four hour
length procedure or less and a C-section is usually a 30 minute to maybe an hour procedure in length. And so with hysterectomy now, most likely you will see that those individuals are able to go home within the same day or within 24 hours because most of those procedures are performed vaginally. Occasionally those procedures are performed abdominally where again, seven layers at least of tissue are being
Kim (07:53.931)
C-section is usually a 30 minute to maybe an hour procedure. so with hysterectomy now, most likely you will see that the...
Dr. Rebeca Segraves, PT, DPT (08:20.435)
cut in order to remove the uterus.
Kim (08:24.792)
And, you know, there's many people who've shared the visual image of those layers as you're cutting through all of the different layers. And I think there is just, again, we just so much in women's health has just been like, well, just suck it up or just that's just the way it is and you'll deal with it. And when you when you see that visual of how many layers we are now cutting through to get to the uterus to remove babe, and then all the multiple layers of
adhesions like the scarring that's left afterwards. So I want to touch a little bit on scars. think this is a good time that the influence of scarring, need adhesions to happen. That's part of our healing process. But what is the influence of that scar tissue in terms of how it could hinder potentially function for that person going forward?
Dr. Rebeca Segraves, PT, DPT (09:18.193)
Right, that's another point I want to make is that those tissue layers, we hardly recognize like each individual layer just in its normal function, but it's a beautiful glide that happens between our skin and right beneath the subcutaneous fat and then right beneath that the fascia that overlies the muscle layer and then of that muscle layer is usually not just one muscle, it's a bundle of muscles that make up our abdominal cavity, our core and then right beneath that
that peritoneal cavity, is its own layer of just thin lining, almost like saran wrap that just glides over the organs that include our uterus if we have that. And then the layers of the uterus. I when you think about seven layers, we're not thinking of that just in normal daily function. We're not thinking of that beautiful glide, but we think about it in terms of how it's sewn together after the surgery is performed. And
We can't, in terms of surgeons, they can't sew each layer individually like it was. And so a lot of times when you think of an incision, you're actually thinking of several tissue layers being sewn together, any one of the ones that we mentioned. And so the muscle layer might be actually sewn to the fascial layer instead of those layers being individually repaired, they're now sewn together and there's a tight knot where there wasn't before.
and some women will actually experience just bumps along their incision. They're asking, well, what is that? Is that a problem? And those are not just the sutures, but it's several layers sewn together. And what we know about wound repair, wound healing, and wound recovery is that at the most we're gaining a fraction of what that wound integrity was or what that skin or fascial or muscle layer strength was prior to.
the surgery. And so when I say a fraction, the most that we might expect of the strength of that tissue, of its ability to resist strain, stretch, pulling, or force, may be 80%. And that's over the course of recovery, which could be three months, 12 months, or even several years to actually get even 80 % of strength of the original skin. And so when I think of a mom,
Dr. Rebeca Segraves, PT, DPT (11:42.643)
The ones that I've seen, we didn't really start our program until it's almost like when you see a traffic light placed at an intersection, you think, well, how many accidents needed to occur before they actually instituted that traffic light? Unfortunately, our program didn't start until three mothers, all first time moms, all first time cesarean section deliveries, were readmitted back to the hospital. Two of them needed wound vacs, so that's a suction device that's put onto the wound.
Kim (11:52.079)
Mm-hmm
Dr. Rebeca Segraves, PT, DPT (12:12.167)
because their cesarean incisions had opened. And I think of how many moms are actually sent home with the incredible force of carrying a newborn, getting out of bed, going up and down stairs without ever someone really explaining that your recovery at this point right now is all about protecting your abdomen because that tissue is so weak compared to the original strength of your tissue before the surgery and you'll still have
weeks to months to even recover a percentage of what that original strength was. I think that education for me was the aha moment. Having to treat those individuals, one actually had to bring her baby back to the hospital with her. She had no childcare and she was facing social support services that really questioned her ability and her fitness to be a mother. was a tragedy for her postpartum mental health.
Kim (12:58.192)
Hmm.
Kim (13:04.439)
No.
Dr. Rebeca Segraves, PT, DPT (13:06.055)
but she didn't have anyone to care for her baby. So the baby was not a patient, but she still was responsible for caring for her baby and then managing around a wound vac to close her cesarean incision that had opened. And so when I think about recovery, I think about the tissue integrity really needs to be part of that education to moms. And there needs to be some type of movement education around.
doing the day-to-day activities while protecting their incision because the strength of that tissue is not the same afterwards.
Kim (13:37.805)
Yeah. What is the current standard of care in terms of recovery guidelines post cesarean or post hysterectomy?
Dr. Rebeca Segraves, PT, DPT (13:47.195)
to not lift anything over the weight of your baby. And then also to expect either a two week, at least in the United States, a two week follow up visit with your OBGYN to protect against risk factors, check your vital signs, wound healing, and then also a follow up at six weeks after cesarean section specifically.
Kim (14:12.321)
And what would you want to see changed in those guidelines?
Dr. Rebeca Segraves, PT, DPT (14:16.581)
Education around a person's environment, we term it social determinants of health. And it says individual factors around a person, whether they have ample support, or maybe this person is a single parent with multiple children at home, or maybe this person has a one level entrance to their home, they're fine, or maybe this person lives in a third story walk up of an apartment. It would be education within the hospital stay after a C-section.
that really individualizes our care and our education to what that person will most likely encounter in their environment. And so that may include an occupational or physical therapist or both to really evaluate that person's mobility, because those are the only specialists that we know of in the hospital that actually go through a person's home environment, their social determinants of health, their mobility at the time of their surgery, and their understanding of their own recovery in the context of things that
that we often take for granted, a mom who may have to return to the hospital to visit her baby in the NICU, a mom who may have transportation issues, or maybe they're going home in a really low vehicle that getting out of it really will stress their cesarean incision. And so those are the only individuals that we know of in the hospital that have the time to really go through that person's history, much like a combination of a nurse and a social worker and a case manager and a personal
kind of coach or doula would is the combination of all of those entities and one professional that could actually very easily within the span of 30 minutes or an hour understand a person's context and then give them the education that they would need to recover. And we do this for knee replacement, hip replacement, people after shoulder replacement surgery. This is not unusual for rehab professionals to cover this information. It's just unusual to actually expand access to our services to people after birth.
Kim (16:14.447)
Yeah, yeah, it's a it's so grossly underserved. And today, actually, ironically, on my my group coaching call with my membership, somebody had said, Are you aware that there are occupational therapists who also deal with pelvic health? And, yes, I know many of them, but I've so I just am always saying pelvic floor, physical therapy, pelvic floor, I, I not on purpose leaving out occupational therapy. But as you're talking here, too, I'm saying, you know, I really have to bring that
more to lighten my conversations as well too, because it's that the physical therapists will see them in their clinic. Occupational therapists will also come and see them in their home, in their, see those activities of daily living, but we'll also bring that lens if they're seeing them in the hospital so that they can provide that education. so you're just basically confirming that this is another profession that we really need to highlight who is helping.
move the needle forward with regards to the pelvic health conversation. Would you argue as well, if I think back to the business I started with two other women, one of which was a pelvic floor PT, we started Belly's Inc and we were wanting to bring some postpartum recovery practices that are used in many other cultures around the world into more Western, into North America basically. And one of the
protocols was wrapping, but it was the rest, was the restorative exercise. It was kind of honoring that recovery. And we had the, kind of our little slogan was prepare, recover, restore. And we wanted people to buy the product when they were pregnant. We wanted people to start the exercises when they were pregnant. We wanted people to be preparing for, and of course not everybody knows they will have a cesarean. As you say, it's often an emergent situation. Well, not always, but sometimes.
But would you say that we could also do better with the information ahead of time when people are pregnant or when people are preparing for a hysterectomy?
Dr. Rebeca Segraves, PT, DPT (18:18.259)
100%. The work that you've done, Kim, is probably one of the reasons why I sought you out, is that it doesn't really take, and I've said this quite publicly, a licensed professional to disseminate this information. I think oftentimes in healthcare we're very reactive. Everything I've talked to you about up until this point has been reaction medicine. And so what we're talking about essentially is reacting to
a person after surgery, but if we actually do your model of care, which I think is preventative and proactive healthcare, what you're then essentially talking about now is just preparing that individual for any birth experience, but on the front end, you're taking into their individual context. So this could be a person who goes into a program that you're referring to, knowing already
what type of support that they'll have or either being aware, this is the support that I need. And I'm going into this situation, no matter what the birth experience could turn out to, we're not predictors, we really are just kind of reacting to what happened, but in your case, you're preparing, which is more of kind of the thinking behind a proactive medicine is that you're preparing an individual so that if they do have an us surgery that they
Kim (19:23.492)
Yeah.
Dr. Rebeca Segraves, PT, DPT (19:45.905)
did not plan for, know, in terms of just more of their expectation of what they wanted. They did plan, excuse me, plan for it in terms of their mental health preparation. They planned for it in terms of their social support. And then they planned for it in terms of knowing what to do, what positions to maybe be in, maybe an abdominal binder that could help them with compression. They almost have all of those supplies ready to go in their bag, hopefully without needing.
all of those things. But that is probably the most proactive and cost savings intervention that we could possibly be doing. And that's completely led by people who don't necessarily have to be licensed health professionals. They're absolutely competent, qualified experts in their field and in their knowledge area.
Kim (20:16.495)
Right. Yeah.
Dr. Rebeca Segraves, PT, DPT (20:39.537)
that could be leading these programs and actually alleviating the stress on us. You know, I didn't even mention this, but Kim, do you know the number one reason of why most occupational and physical therapists say they don't have the capacity or even the education to treat this patient population, even though we know that the capacity and the education is there? And when I say capacity, in terms of their own personal beliefs about their practice, not about the reason I'm going to give you.
Do you know the number one reason why occupational and physical therapists that work in hospital systems throughout North America today say they cannot treat the maternal population, specifically after C-section? Do you know what that is?
Kim (21:25.649)
Liability?
Dr. Rebeca Segraves, PT, DPT (21:27.812)
No is staffing shortage.
Kim (21:30.293)
Wow
Dr. Rebeca Segraves, PT, DPT (21:32.231)
So that's really where we're facing in the United States at least, and honestly throughout the world, the most commonly performed major surgery in the world and in the United States is C-section. It's performed twice as much as someone after a knee replacement. So we have the capacity to disseminate our rehab professionals to individuals after knee replacement surgery, hip replacement. But right now we're dealing with more of a
Kim (21:39.377)
Mm-hmm.
Dr. Rebeca Segraves, PT, DPT (22:00.509)
professional numbers issue. We just don't have the staff to provide rehab and recovery. So to me, it makes total sense for these recovery programs to be led proactively before that person enters into a hospital or birth center or gives birth at home to prepare them for whatever would happen. To me, that makes the most sense.
Kim (22:23.334)
Yeah. Yeah. And the other, so there's the, the, healthcare system or the medical care system that we need to work. And we also need, it's the mindset of people as well. Within our culture, we don't necessarily, not everybody thinks proactively, not everybody thinks about prevention. We, we very much like the quick fix and the take a little pill and, and, and so it's, it's a, it's a shift on all parts to like when we were with belly zinc, when we had belly zinc, it was.
Our most common customer was the second or third time mom, the ones who were going, I wish I knew this before. I wish I'd listened to you before. now, cause now they're on the other side and people are more motivated to fix a problem that exists already kind of that reactive model, right? As opposed to prevention. So it's a, a, it's a shift that needs to happen, but I totally agree with it within, you know, yes, midwives are licensed, but doulas and personal trainers like myself, like there are so many other people.
who can help inform people ahead of time and set them up. And it's that collaborative kind of, takes a village, right? It takes a village. And if we can build a healthcare team that includes multiple different practices, I think we're best served, I guess. So prevention is one piece. And then if we can talk about what would your recommendations be bringing in prevention?
the prevention piece as well if you like. if we think of that, you know, kind of prepare, recover, restore, what would your recommendations be for optimal preparation, optimal immediate, kind of in those first few days and weeks recovery, and then that retraining or restoration so that the person gets back to optimal function?
Dr. Rebeca Segraves, PT, DPT (24:10.929)
I would hope that everyone actually has two members on their care team that we hardly speak about. One would be a personal trainer who's more or less qualified as subject matter expertise in birth preparation as well as recovery. And that's more of the physical preparation. And then someone like a doula, a birth professional and a birth educator. Ideally that person would kind of provide almost all in one service or when I say all in one service, it's not that person providing every...
every thing, but that person having a network of individuals that could meet the needs of this person, answer their questions, and really physically and mentally prepare them before giving birth or before having like a major surgery like hysterectomy. The first thing I'm gonna say probably to the audience who's professionals like me in PT and OT is that if...
Kim (24:57.5)
This came probably to the audience whose professional.
Dr. Rebeca Segraves, PT, DPT (25:03.663)
We had the capacity, and now I am speaking about the staffing shortages that we often hear is the reason why we're not on the team. If we had the capacity, we'd be there already. So this is why I'm really giving space for those professionals with that subject matter expertise to really be at the forefront on a person's team. One, the personal trainer is going to do this, is that they're going to have a knowledge of the physiological needs of what
Kim (25:16.25)
space for those professionals with that subject matter expertise to really be at the forefront on a person's
Dr. Rebeca Segraves, PT, DPT (25:32.125)
birth involves, that that person wants to deliver, saying naturally or with minimal interventions, there's a cardiovascular and cardiopulmonary component that must be trained for. We've seen cases where the heart rate exceeds 190 beats per minute. For most people, that's more than the heart rate maximum for any individuals over 20 or 30. And we're looking at now...
really trying to, at least the target heart rate points that we really want to keep people training in. And we're looking at now, at least in the United States, just incidences where those individuals are not allowed solid food to really meet their caloric expenditure during labor and delivery. And so if that's the expectation of the health system, that you're not going to be eating solid food, you're not going to get the calorie requirement.
you'll have to either drink only or just, you know, either get ice chips or whatever it is, that person really needs to be physically prepared and mentally prepared for that moment. And I just don't believe that is fair to say that there's only the select group of individuals who know how to prepare those individuals like rehab professionals. We need personal trainers. We need doulas on the care team, really for this population during pregnancy. The other thing I would say specifically to hysterectomy,
Kim (26:29.267)
relationships or whatever it is, that person really needs to be physically prepared and mentally
just don't believe that it's fair to say that there's only the select group of individuals who know how to prepare.
Dr. Rebeca Segraves, PT, DPT (26:53.147)
is that there are physical requirements for that too. There are going to be physical requirements for hysterectomy. And if you are a woman who's accustomed to doing more of the house-making skills, and I know that's very gender specific, but I'm just going to say it, a lot of the women that I encounter who are in their 40s or 50s are primarily doing a lot of the home-making, the cooking, the laundry. If you don't have that person on your care team or you're going at it alone, we would recommend a personal trainer.
Kim (26:56.423)
Yeah.
Dr. Rebeca Segraves, PT, DPT (27:21.861)
a personal coach, a mental health coach, someone to kind of coach you through what do the first few days and weeks of recovery look like for you so that you're not actually causing pressure that would end in prolapse after a hysterectomy. And again, to my OTs and PTs colleagues who are saying, well, we do that, that's not appropriate for a coach to do that. And I say, we're not on the team. In order to play in the game, you actually have to show up to practice.
Right? And so I think that the professionals who are subject matter expertise are not really defined by their license. They're defined by their areas of expertise and knowledge. And that's who I would seek out for the individuals undergoing any procedure in the hospital setting, especially if they identify as a woman.
Kim (28:06.374)
Yeah, yeah. And then that immediate once they've maybe even well, let's talk about in the in the hospital, what would you ideally like to see in those first hours days before being discharged from the hospital?
Dr. Rebeca Segraves, PT, DPT (28:21.947)
Absolutely, and so those professionals, will have to be licensed if they're taking blood pressure, heart rate, measuring someone's oxygen saturation, so the oxygen that their organs are getting, including their brain, because we do have fall risk after a major abdominal surgery. That's not unusual for the maternal population. Our hospital actually had it so much that we were tracking the rates of infant dropping and maternal fall rates.
And so people really just underestimate that, as a cesarean section, there's quite a lot more blood loss than a vaginal delivery. And so those individuals are getting up, they're dizzy, their blood pressure drops pretty significantly. And so a professional that, again, can take into the context of that individual, their environment, their social determinants of health, and then actually monitor their response to activity. You know how you learn something from someone, Kim, and it's like an educator,
Kim (28:51.346)
Wow.
Dr. Rebeca Segraves, PT, DPT (29:21.073)
you maybe forget kind of all the education that you've gotten and you kind of start to just speak and then it comes from you as if it were original. You know, a lot of my first education was through occupational therapists and what I learned from them is that the most demanding activity that someone could perform after any hospital experience, but after hemorrhage specifically, this person was talking about those individuals after C-section was actually taking a hot shower. And that was an occupational therapist who taught me.
Kim (29:27.494)
Mm-hmm.
Kim (29:46.171)
Wow.
Dr. Rebeca Segraves, PT, DPT (29:47.963)
She used METs, which a lot of personal trainers are familiar with. I was a personal trainer before becoming a physiotherapist. We used METs to really define those activities that caused us to just expend more energy, you know, for kind of more the general understanding of what METs are, metabolic equivalency of tasks. And she would say that a hot shower, standing in a hot shower, was the equivalent as running at three miles an hour.
Kim (30:10.412)
She would say that a hot shower standing in
Kim (30:18.14)
Wow.
Dr. Rebeca Segraves, PT, DPT (30:19.123)
And so an occupational therapist taught me that and I have to always remember, know, give credit to the people that actually taught you and informed your understanding for what you're doing now. And it was actually occupational therapists who could break down activities that people would perform and determine if they were actually able to expend that much energy that day for that activity. And some women often will wait maybe up to five or six days before they take a shower after giving birth because they don't have the energy and the capacity.
Kim (30:28.413)
Mm-hmm.
Dr. Rebeca Segraves, PT, DPT (30:48.231)
to stand in a hot shower and we're often not giving them the tools that they would need to do that earlier, like a shower chair that could be rented and then returned. We're not even thinking about that population. So ideally, to answer your question, who would see them in the hospital after birth and immediately after a hysterectomy? It would be an occupational physical therapist. I think that if we could actually move to educating OT and PT professionals before they graduate to include this population.
Kim (30:48.879)
in the house.
Dr. Rebeca Segraves, PT, DPT (31:16.369)
the same way they would include someone after an ACL repair. I think that we could move into the realm of more preventative and proactive care, but we still need doulas and we need personal trainers. And I hope that pelvic health doulas becomes a thing in my lifetime because a pelvic health doula could provide post-surgical support to a woman after hysterectomy just the same as a postpartum doula could provide that post-surgical or postpartum support to someone after giving birth.
Kim (31:16.871)
the same way they would include someone after an ACL repair.
Kim (31:31.507)
Mm-hmm.
Dr. Rebeca Segraves, PT, DPT (31:44.261)
I think doulas are really going to be more of those gap providers that we need in the healthcare system.
Kim (31:50.855)
Yeah, yeah, love it. So the person then goes home from the hospital, ideally in an ideal world, they would have done the preparation, they have their team, they've spoken to their OT and PT and they go home and then they would be taking principles from those professionals. Some of them maybe even do home visits, but they would be applying those principles. So what would you, if you were to tell the patient from an at home scar management,
rest, healing, wound recovery, what tips would you provide them that hopefully down the road will be communicated more, but what tips would you provide if this was an actual patient?
Dr. Rebeca Segraves, PT, DPT (32:30.267)
in the lowest level, at the lowest level, having a team of their friends and family to help. Really, if it's someone after postpartum, they probably already know a lot of these things exist, meal trains, having someone to help with newborn care, maybe care of slightly older children, toddlers. But for those individuals just at the low end, like what's the minimal amount of support?
it would be someone to help with sleep health and sleep hygiene. We know the body takes weeks, especially after C-section, but after any birth, there's something called cerebral dysautoregulation. That just occurs for anyone who's given birth. And that's why cognitive changes probably persist a lot longer in some individuals who might not have the support that they need early on. And then, you know, we call that brain fog, all hormonal derived. But a lot of that is just the brain is actually trying to
kind of get gathered the team together if you will, which is all the organs of the body that have been shifted or impacted. And so at the low minimal level, would be having their team in place, having a professional visit them that's a healthcare professional that could not only reinforce them taking their own vital signs and kind of monitoring their own activity responses, but actually doing almost a double check to make sure that that individual has not missed anything or their family and friends have not missed anything.
And then at the high end of the level is using devices that are available to those who can afford them. So those are the smart devices. Those are the smart blood pressure cuffs that could actually talk to a care team that might be able to remote in, see what that individual is experiencing physiologically, and then intervene that way or dispatch someone either to the home or get them to the care that they need. You know, my work is more on the levels of extreme.
And so we actually follow a lot of the stories and we've responded in some cases as an organization to those individuals who are in more distress. And we've been able to team up with organizations from states far away to make sure that an OBGYN could do a home visit for a mom who wasn't walking after a vaginal delivery or who needed an OT or PT within the home and that we were able to advocate and make sure that those services were provided for them. But that's more of the extreme.
Kim (34:23.476)
actually follow a lot of the stories and we've responded in some cases as an organization to those individuals.
Dr. Rebeca Segraves, PT, DPT (34:51.293)
We're talking about what can people do who are just after hysterectomy, after birth, really to have your team in place, but then at the high end of that, having devices that communicate to you if there's a problem that you should be more aware of or connecting with your OBGYN or care team about earlier, sooner rather than later.
Kim (35:12.853)
And what about from a return to pelvic floor muscle training? hear different schools of thought here when we think of it. It's the way that I hear it differently is if it's surgical versus not so post-op versus non. And if somebody has had a vaginal birth, then you could start doing pelvic floor muscle training as soon as you like really. And if it's post-op, so we can now consider cesarean or hysterectomy.
Obviously there's different routes of hysterectomy, which can sometimes influence the guidance of the professional. But there are some that say absolutely no pelvic floor muscle training for six weeks. Some say we want to start fairly soon because it's getting the blood flow in the circulation and sort of the nerve piece coming in there. What would your recommendation be in terms of optimize sort of regaining that deep core function, pelvic floor, breath, you know, all the things post surgery.
Dr. Rebeca Segraves, PT, DPT (36:10.811)
Yeah, pelvic floor function begins within the first 24 hours. If you're still with a Foley catheter, now I'm really speaking probably more medically, so stop this train before it leaves the station, But I'm very passionate about this because as soon as someone is having their first bowel movement, as soon as someone is able to avoid, their pelvic floor is functioning. And so when I think of pelvic floor muscle training, I think that we're kind of losing sight
of this incredible opportunity to start training people earlier that we already do with other patient populations, which is why I probably struggle with this question the most, is that we're already retraining bowel and bladder function in other populations by just actually talking about breathing mechanics and positioning to avoid that pressure, that pain that might be felt with the first bowel movement after a hysterectomy or birth. And so pelvic floor muscle training
Kim (37:05.972)
Mm-hmm.
Dr. Rebeca Segraves, PT, DPT (37:10.575)
really begins at the first time when we start thinking about oxygenation to the tissue, especially if someone lost a lot of blood at the time of their delivery. We're thinking, well, now that muscle has less oxygen, has less personal training, of exercise physiology principles, less ATP that can contract the muscles and give it the energy it needs to perform. And so to me, we trained acute care therapists in one hospital system,
Kim (37:29.801)
Yeah.
Dr. Rebeca Segraves, PT, DPT (37:40.071)
We started to now blueprint that model and say, well, we actually need to train occupational and physical therapists on what pelvic floor muscle function is. We have to actually establish a foundation because they didn't really connect the dots that this muscle system is functioning on day one. We don't wait until six weeks to train the muscles back. And so I think it was the definition of what pelvic health was that we had to actually start there.
And then it was an aha moment of, we need to be doing this now, right? For any muscle in our body, but especially the pelvic floor, because it's going to be functioning, whether we like it or not, that person has to avoid.
Kim (38:15.026)
Yeah. Yeah.
Kim (38:22.984)
Yeah, yep, yep. And they have to lift their baby and they have to do they have to walk around the house and you know, all the things and yeah, yeah. And you're now you're you have, if I understand correctly, you have programs to help train other PTs and OTs specific so that we can like your that's how you're changing this. The movement forward is to get more of these people trained and working in these conditions. Is that right?
Dr. Rebeca Segraves, PT, DPT (38:52.849)
That's right. A lot of it is probably introducing them to what doulas already know. So shout out to our postpartum doulas. It wasn't until I actually took doula training myself and I went through Dona for my training. But it was after I had gotten, of course, a doctorate in PT board certification as a women's health clinical specialist. And then I sit in a weekend doula training and my mind is blown away. I said, I need to actually train the professionals on what these professionals are doing.
Kim (38:57.662)
Yeah.
Dr. Rebeca Segraves, PT, DPT (39:21.543)
to bring us up to speed because we really, I mean, it doesn't really start with licensed healthcare providers. I think that that's a fallacy. A lot of people will say, well, I want an OB-GYN versus a midwife, at least in the United States. Our midwife ratio to patient ratio is so low compared to other high income countries, Canada probably experiences the same. But what I've realized is that we put so much emphasis on the professional and the licensure of the individual that we don't realize.
that it's actually these foundational subject matter experts that really should be on the care team. And so this program really is wrapped around what these professionals would otherwise be doing on the care team so that we can bring ourselves up to speed as to where we can fill the gaps. And a lot of it is acute care trained therapists, so those hospital-based therapists that otherwise could do those assessments that no one else is doing really quite diligently, taking vital signs with activity.
going over the home environment, social determinants of health of that person, are they a single mom, all of those things. I'm training the professionals in those hospital systems, OTs and PTs, to perform those evaluations, but then connect that person as soon as possible to a healthcare professional, a doula personal trainer, some type of, you know, a coach or birth support person, or even post-surgical support person, as soon as possible so that they're now aware of the help that they need before it's too late.
Kim (40:45.746)
Yeah, yeah, hallelujah. I love the work you're doing. Thank you so much. Thank you for sharing your wisdom today. Where can people learn more, potentially take that training, but also learn more about the work that you're doing?
Dr. Rebeca Segraves, PT, DPT (40:57.937)
Our organization is called Pelvic Health Network and the training is under enhanced recovery after delivery.
Kim (41:06.12)
Yeah, awesome. I'll have all of that in the show notes. Thank you so much for your time, for everything that you're doing to move the needle forward. You like you're speaking my language and I'm so happy that there's more people that are coming and joining on the bandwagon. So thank you so much. I appreciate you very much.
Dr. Rebeca Segraves, PT, DPT (41:20.029)
Chem has been an honor today. Thank you.
