Kim (00:01.258)
Hi, Jeanette, thank you for joining me today. I'm excited about this conversation. We recently reconnected in person unknowingly. Well, we knew that we reconnected, but we didn't know each other was gonna be at this specific conference in Arizona. And it was so nice getting back in touch and catching up and spending more time than just a quick little hello at a fitness conference randomly here and there. yeah.
Janette Yee (00:25.744)
Absolutely. And literally the blessings of Instagram, I think we've kept in touch on and off for like four years over COVID and everything. But wow, it was so good to share space with you for so many days. Yeah.
Kim (00:35.934)
Yeah, yeah, yeah. So now here we are on the podcast and caesarian section is not something it's something that a lot of people in my community are either experiencing currently like acute or it's something they've had in their past but it's not I haven't talked about it a lot on the podcast and this is your area of specialty and I knew it was
important for us to have this conversation. So can you start off by telling us a little bit about who you are and what led you to becoming a Caesarean section support coach person? How do you, what do you call it yourself?
Janette Yee (01:14.478)
I'm actually laughing my head off because it's, yeah, I'm an athletic therapist, but really I played around with it a lot. What do I call myself? I'm a perinatal athletic therapist, but I do focus almost exclusively on C-section prep and rehab. C-section therapist, how about that? I'm a C-section therapist, yeah. You know, I got here totally organically and by accident.
Kim (01:30.838)
Alright, how'd you get here?
Janette Yee (01:37.873)
Because as someone that's had no C-sections, had two vaginal births myself, I did a lot of work with athletes. I mean, being a sports therapist for, what is it now? 24 years? my God. Is it? I can't even count anymore. Anyways, so the point is, you know, I worked a lot with female athletes and when they retire from their sports and they would start families, you know, I invariably be asked for, know, Jeanette, hey, what do you...
So I'm pregnant, can I still squat 200 pounds? Like keep in mind this was like early 2000s so like the internet was just invented. Like you couldn't really Google any information. There was no Instagram. So you know, there was no information. There was no information. I don't know, did you used to squat 200 pounds? I squatted, whatever, more. Okay, well I mean guess if you feel good, because that's what...
we would tell someone if they were, you know, unloading in the gym, right? And then afterwards, some of these athletes would have vaginal births. But one athlete that really stuck out for me was someone, she was a good friend of mine at the time. She was one of the first athletes out of all of us to start a family, to have babies. And...
She was a sprinter for the national team, Kim, and she had an emergency caesarian, completely wasn't even on her radar when she was pregnant. She was deadlifting, ridiculous weights. She was still running.
and was completely sidelined when she had a surgical birth and she came to me very upset. goes, Jeanette, you're the only therapist I trust. Even my doctor won't help me. What can I do? I'm in so much pain. I have this new baby. I can't sleep. I can't do anything. What do I do? How do I heal? And same question, Kim. I had no idea.
Janette Yee (03:39.515)
I don't know, we didn't learn about this in school like you went to physio school. We didn't say boo about pregnancy and certainly not about childbirth. There were no studies at the time except for like out of progressive countries like Sweden. We didn't study those studies. Anyway, and all I could say to her was you know what follow your physician's suggestions and we'll deal with it when you're discharged. And the physician's suggestion Kim was do nothing for the first six weeks.
Like do nothing, like don't lift anything heavier than your baby, don't drive, do nothing. So that's what she did and it was very not easy to do for anybody, but especially an athlete who's used to training at high levels every day. At the six week mark Kim, she was discharged and was told you can go back to your regular routines. Well, she wasn't asked what her regular routines were.
Her first going back to her work house was an easy 5K run. And Kim's laughing because she knows exactly what happened next. She hurt herself so badly. She badly injured her incisions, plural, and she was backtracked for at least another eight weeks. And I felt so awful.
Here I am, the athletic therapist, the orthopedic specialist. Yes, I'm the therapist for the national rugby team. And here's an athlete who under my advice had hurt herself so badly she could even get out of a chair.
So I stumbled into this by accident, Kim. mean, long story short, I'm like, this is the care that our moms are getting? How do I, as someone who's gone to school for this for the past three years, have never heard of this? What the heck is a C-section? What is that? What is that?
Kim (05:37.641)
And if you had, if you, if that person had come to you with an ACL repair, they'd had an ACL repair, you would have, you have a very well established protocol of what to do, what not to do. Here's your guidelines. You certainly don't sit around for six weeks doing nothing. And yet we have these surgical interventions from a birth perspective and it's people are sent home with high five and a baby and no, no guidelines, no protocols, no nothing.
Janette Yee (05:44.721)
my gosh, yeah.
Janette Yee (06:07.091)
A baby for sure, sometimes not even the high five. Like, let's be real, you're just discharged later. What's your name again? You know, like that. A lot of women that I work with feel just so dismissed, their complete experience is invalidated. They're literally going, what do I do? And they're just like, go home, I'll see you in six weeks. Or maybe if they're under the care of a midwife, maybe in few days. But still.
Kim (06:09.846)
Yeah.
Janette Yee (06:34.289)
You know, it is shocking in comparison to any other orthopedic surgery. And let's be real, a C-section, a caesarean birth is an orthopedic surgery in that it requires intentional rehabilitation, intense intentional rehabilitation. For all my listeners here, don't hear me by saying, Jeanette's saying it's intense. my God, it's gonna be really hard. It's actually not complicated at all. I'm saying intense because you ain't sleeping.
You gotta keep a human alive. And for the most part, you're doing this all by yourself. That's what makes it really intense. But you know, if you had, if we treated our caesareans like any other ACL surgeries, like here is your rehab program. You are starting on day one. These are the exercises that you are doing.
This is the therapist that you are seeing. Your appointments are already scheduled in. You're taking this many weeks off of work. Work already knows and we've dealt with that whole whatever, the whole financial budgeting part, right? Like it's, and then you enter into it less overwhelming.
But that's just not the standard of care here in Canada, not in the US. I don't really know anywhere in this world where there is any kind of standard of care where someone who's had a cesarean and discharged from a hospital saying, here's your rehab program. It's not a thing.
Kim (08:02.421)
Yeah. Yeah. And there are, don't know if you know, Dr. Rebecca Seagraves, she was recently on the podcast with me as well. And she's an occupational therapist and, and is bringing light to occupational therapy is playing a role in, pelvic health and things like cesarean and post pelvic surgeries, but also collaboration amongst the different professions. And, and we need more voices like that. So I think we are
conversation has started. I would say that this conversation is kind of like where the overall pelvic health conversation was 20 years ago where it was there wasn't a lot of information there was a couple people talking about it and now I feel like a lot of people know about pelvic floor physiotherapy and a lot of people are using that as part of their care so but now the nuance of the caesarian piece and considering it as you say as an orthopedic surgery that is we just aren't considering it.
Janette Yee (08:40.401)
Mm-hmm.
Janette Yee (08:54.837)
Mm-hmm.
Kim (09:01.099)
that way. I think that it will. I can see the light at the end of the tunnel, but it's going to take a little bit of time. can you explain what happens in a caesarian birth? I remember the image shared on social media of the multiple layers. And even though I knew that when you see it, it gives you a different appreciation for exactly
Janette Yee (09:19.39)
Yes. Yes.
Kim (09:27.305)
what is happening in this procedure and it starts to give you also a little bit new appreciation for the need for different healing and as you say more intense and intentional healing. So what happens in a caesarian?
Janette Yee (09:41.258)
This is such a good question because I think a lot of folks who want to do the rehab and have heard of C-section scar massage, yeah, Jeanette was talking about this, I heard about that, and they want to do it and so they try it. Let's talk about where that scar tissue is by understanding the surgery. Can I draw on my stomach? Let's just do this. All the listeners, I will...
Kim (10:10.188)
The video will be on YouTube for those of you that are just listening.
Janette Yee (10:10.252)
walk you through this. my gosh. Good thing I my good bra. So here's the thing. Here's the thing. When we talk about...
Janette Yee (10:24.075)
Hang on a sec.
Now, okay, now I'm ready, now I'm ready. When we talk about the surgical birth, I think a lot of folks, myself included, think there's one cut, like one incision made, because that's kind of all we see outside, don't we? So here we go, and do this, we're do this. So this is typically what we see.
that usually it's a horizontal incision somewhere above the pubic bone, close to the pubic bone, right? And so we think, okay, well, if I do scar massage, I'm definitely gonna be massaging this. I wanna make sure that this is moving. I wanna make sure this is not stuck down. That's awesome. That's super awesome. Anybody who's doing that right now, that's great. But did you know this incision is only skin and fat deep?
So after that cut is made, you pull that open, there is actually a second horizontal incision, like an inch above that, inch or two above that. And that is through something called the myofascia.
So for the listeners, myofascia is basically like this, the covering or the skin, the connective tissue over the muscle, myofascia. And so a lot of folks who've had caesareans, they might be able to relate to this, which is the external incision, while originally very painful, actually isn't so painful after a while, but an inch or two above that.
Janette Yee (12:01.165)
For some reason, it's just sore for weeks and even months. And they're like, what is going on? And they talk to their doctors about it, talk to their friends like, yeah, you'll be fine. It's just whatever, it's just part of it. Well, this is why. That myofascia is so richly innervated. It's got so many nerve endings that it actually can hurt for a lot longer. Now, it also hurts for a lot longer because it's covering your muscles. So the myofascia is pulled apart and then your muscles are exposed. And then we have a blunt incision.
right down where the diastasis is, the linealba. That's what kind of holds the whole muscle wall together. Well, that's pulled apart with the surgeon's bare hands. It doesn't even require a scalpel. So that's how thin that is. Then your entire muscular wall is pulled open and then your uterus is exposed. And for the most part, if it's a full-term baby, you have another horizontal incision.
That's the surgery. That's three-dimensionally right into the very middle of your body. This is not superficial at all. And folks, if you can imagine this, the uterus is stitched up, the lineal alba is not, the myofascia is not, and the external incision is stitched or stapled or glued or subcutaneous stitches, seri strips, a lot of different things. But this is not just an incision.
It's a surgical area. And when I refer to this, you know, I talk about this in my programs, my courses, I say this is a surgical area. You have to think about a zone when you're thinking about scar massage. Fashion mobilization actually gets all the way around this, but this would be not a bull's eye, a bull's zone. Be like a bull's zone, right?
Kim (13:28.386)
Mm-hmm.
Kim (13:47.289)
Yeah, that was super helpful. it's important to show as you say, it's a zone, multiple layers, multiple incisions. It's not just the one little, as you pointed out, the one little horizontal line that we see on the outside, that's the external, superficial, what we see, but we don't see it's like the iceberg, right? We see the tip of the iceberg, but we don't see all of the rest of it that's underneath. So what are the implications of that?
Janette Yee (14:06.711)
Yeah. Yes.
Kim (14:17.035)
surgical intervention. from a, let's say somebody like the person that you were talking about earlier, they weren't prepared, they didn't know, they went into birth, end up having a cesarean, they're totally like, what do I do now? They weren't expecting to have a cesarean birth. What would you recommend from a recovery perspective for that person?
Janette Yee (14:40.132)
Well, first, let's just talk about what happens when all these incisions are made on one's body. Let's just talk, let's put a list down first and I'll get into maybe more descriptions. But basically, guaranteed everybody gets what's called a C-section shelf or that appearance of a really tight, you know, a really tight incision, but the tissues above and below bulge out past it.
Creating a shelf-like appearance. Everyone gets one. We'll talk about why in a second. Everyone gets a C-section shelf.
99 % of people have a lot of pain, a lot of pain. Don't expect to even sit out of bed by yourself. Like a lot of pain, a lot of dysfunction because of the pain, but also dysfunction because your muscles are actually not connected. Like they're trying to scar down. Okay, so a lot of weakness, dysfunction, a sensation of, don't think my legs are attached to my body. Like I can't recruit my abdominals. This kind of feeling, okay? So not strong.
There's so many emotional impacts of this too.
when you don't expect a caesarean, that emotional impact can be much greater and can be very traumatic. Even when you're expecting a caesarean, can still be the same. So I don't want to ignore that. That's huge. And then the studies show a whole bunch of interesting things too. So there's going to be pain in the surgical area, but there can be secondary pain due to dysfunctional movement patterns. There can be secondary injuries caused by this because the core isn't strong. So a lot of folks will experience, let's say lower back
Janette Yee (16:14.519)
because their movements are funky. They're going back into fitness and exercise without a proper core repatterning. secondary injuries. And the research was so interesting, talks about it can impact one's fertility, it can impact one's digestion. So, we're talking about completely different systems now, not just musculoskeletal, but reproductive and digestive, right? So, those...
Kim (16:27.556)
Interesting.
Kim (16:39.546)
I didn't know the link with with the reproductive. That's really cool. Not cool, but interesting.
Janette Yee (16:43.63)
Yeah, interesting. Right? I know I had the same response when I read that study. was like, if women knew, especially for the beginning of your reproductive career, right? You're at the beginning. You're like, I want two kids or whatever. Right? I want to have another pregnancy. Well, what's the implication of not healing fully from this one? And I'm not here to say, if you have a C-section, you're going to be infertile. That's not at all what I'm saying at all, folks. But I'm saying, you know, there's an, there are...
potential correlates here, like what? What if I don't rehabilitate from my first surgery and then I have a second surgery or I'm having a challenging time getting pregnant? What are the things that we're not considering? So that's a big list. I don't even think that's like an exhaustive list. There's other impacts too.
Kim (17:25.498)
Yeah, yeah.
Kim (17:30.286)
No. What about painful sex? That's something else that comes up for a lot of people after a cesarean where, yeah, and so we don't think of the pelvic, like immediate pelvic health considerations with a cesarean, right? We think of, well, I didn't give birth vaginally, so my pelvic floor is quote unquote fine, but many people will struggle with incontinence and prolapse and painful sex. So what is happening there?
Janette Yee (17:35.641)
I can't believe I missed that. Yeah. Yeah.
Janette Yee (17:48.795)
Mmm.
Janette Yee (17:56.752)
Well, I mean you said it the biggest myth is and I get a lot of laughs when I post about this It's like okay put up your hand if you had a c-section and you think thank God my vagina is saved Right. It was like me. me, you know, I got a lot of me's and then you know Then you read the captions and Jeanette says well guess what?
Surprise! Not so good news! Your pelvic floor is challenged by the bare fact that you were pregnant.
Kim, you probably know the stats better than I do, but I remember hearing, 25%. There was dysfunction at 25 % because it's under load for nine months holding up your insides. So, okay, we're gonna have to make sure that the patterning of the pelvic floor muscles at the very least are checked out. So everyone, if you had a cesarean, please go and get your pelvic floor assessed in person, like an internal assessment in person if you're able to.
So, but here's another thing. So pelvic floor, some folks have a cesarean after laboring, after a trial of labor for quite some time, has a lot of load on that pelvic floor, for sure. So now you might have some of the impacts of a, know, part of a vaginal birth, but now also a cesarean birth to heal from.
And then the third big thing that you mentioned, Kim, my gosh, painful sex. Let's talk about that. Let's talk about that because I know folks who are pregnant and maybe just newly postpartum, they're not thinking about having sex maybe. They're like, I'm more focused on the fact that I'm having the surgery or I just had a surgery. I'm in a lot of pain. But painful sex.
Janette Yee (19:43.534)
You know, the first time someone who's had a caesarean has penis in vagina sex, right, very specific, we're talking about that vaginal intercourse, might be really awakened to the fact that, my God, this hurts. And not because I'm nervous about it.
because yes, if you're nervous about intercourse, of course there's impact of that on pain as well, but I'm talking physically, it hurts. Physically, there's tightness or tension or, and let me explain.
what a lot of folks actually will describe it as, okay? And by the way, this can happen for months, even years after a caesarean. So the type of pain that one would feel after a caesarean with tight, deeper abdominal fascia is this. It will feel painful upon penetration or discomfort upon penetration that doesn't light up.
and it's the external third of the vagina. So it doesn't let up, meaning there's no, know, it's not like, you know, we warmed up for a bit and then it was fine. And it's got nothing to do with, you know, I didn't have enough lube, so we used some lube and it was fine. It's got nothing to do with that. It's got nothing to do with that. It's pain upon penetration and it doesn't let up. So.
A lot of folks probably be listening going like, my god, that's me. Why, why, why? Because I did pelvic floor therapy. I did my scar massage. I'm having this painful sex. Now Jeanette's like, wait a minute. This is common. What do I do about this?
Janette Yee (21:21.789)
Can I do a demo? Now that I know that everybody can watch this? Okay, so this is why potentially a caesarean can cause painful sex. And please folks, I did not say if you're having a caesarean, you'll 100 % get painful sex. That's not what I'm saying at all. But if you have gone through a trial of internal pelvic floor therapy, you have done superficial abdominal massage.
Kim (21:22.895)
Yeah, please.
Janette Yee (21:45.778)
you might have missed the deeper fascial layers. So the deeper fascial layers of your abdominals, the deeper connective tissue in other words, is actually continuous with your pelvic floor. Like it's, I'm doing this, for the listeners, I'm actually running my hand over the front of my.
pubic bone in between my legs. And it's also continuous upwards and sideways in all the ways. But specifically, I should have worn a different color of pants. So basically what happens is when you have all those incisions, remember all these cuts, well the cool thing about scar tissue is it closes them down within like four days. And it does it by making sure it's really glued down tight, tight, tight. So if anyone watching this on YouTube, I'm bunching up my pants really tight now, but from like 3D for my uterus all the way out.
What you'll see is I'm giving myself a frontal wedgie. It doesn't feel comfortable right now, Kim, but I'm just demonstrating for the glory of women's health. Listen, I'm pulling up on the front of my pants, so it's not comfortable already. My pelvic floor is not comfortable. Now imagine if I was like this and I was having penis and vagina sex on that penetration. That's gonna hurt. Sorry, pulling up from the front. Now it's gonna push in from between my legs.
That's not cool. And it won't let up because it's this. It's the fascial restrictions in the front of your body that's causing pain between your legs. And yes, you can mobilize that.
Kim (23:14.51)
One thing that you've ever heard you say a few times is is scarred down or you you just said glue down and that there's so there's a response of the body after an incision or an injury where there's there's adhesions that form and that's we need that we want that to happen but that's when you use the term like scarred down it's sort of like it's it makes it seem heavy and permanent and stuck and that's sort of what you were demonstrating with.
the image you just shared and that's where we now become restricted in movement. Is that accurate to say?
Janette Yee (23:50.204)
Yeah, and you know what? I'm gonna, I'm gonna...
Describe it in a way that I want everyone to feel empowered and not feel like, my God, this is like doomsday, I can't do anything about it. Listen, folks, the human body is incredible at one thing and that is adaptation. It can change at any point in time if you just kind of load it slightly in a different direction. You my favorite story is my grandpa, who was 102 at the time, said to me, I think I'm too old to walk outdoors, it might be unsafe. Maybe I should learn to use the treadmill.
to use a treadmill at 102.
So it's never too late is what I'm trying to tell everybody here. Your body can learn different things. you know, yeah, are things stuck down? I mean, kind of. And I'm showing a book here. It's got maybe like 100 pages. But if you can imagine every page as a layer of, let's say, tissue in your body, you know, it's not like this where I'm flipping through the pages of the book and they're completely separate. But what I'm trying to get you to think in your mind's eye is that, you know, all these layers of tissues kind of are,
They work together, but they're kind of separate as well. So when we have scar tissue, it's like if you cut through all the layers of this, all the pages of the book, and then you glue it all 100 pages together, you're not gonna be able to flip through them. But the idea is this, if you do the right kind of massage, you can get those layers to move again. You can. You're not gonna get rid of the scar tissue. But you can definitely get everything to move again.
Janette Yee (25:23.561)
And how we do that, there are different tools.
We can use our hands. It depends on how many, let's say weeks or months or years post-surgery you are. It depends on different techniques. It depends on the rest of your body and how maybe you've adapted. But there are tools, are machines, there's acupuncture, there's cupping, right? So friends who are listening, it's never too late. Your body loves to adapt. You just have to teach it a new message, a new afferent message, and it will adapt. That painful sex, if it's caused by deeper fascial layers
that are stuck down or adhesed or not moving, that can be changed. It can be changed.
Kim (26:02.725)
And you're saying it can be like if somebody was having painful sex and if they're hearing this and they're thinking, okay, tight restriction it yes, maybe some internal self massage could be with a wand could be with hands could be with a therapist. But you're also saying it's the whole that that zone you were talking about the abdominal massage releasing tension in the hamstrings the inner thighs like all of the parts are going to
Janette Yee (26:14.495)
Yeah.
Janette Yee (26:23.552)
Kim (26:29.947)
It's as you say, putting different inputs in, in multiple different ways so that we contribute or kind of stimulate an adaptation. Yeah? Yeah.
Janette Yee (26:38.336)
Sure thing, absolutely. And I want to highlight by saying that, you know, I was just talking specifically about the fascia and the scar massage, but Kim, you bring up a good point. We're talking about other muscles like hamstrings, adductors, like everything around it. The body, like movement is medicine. So when we do, let's say, a deeper fascial massage, like that's not the only thing that you need to do. So you would want to follow kind of like a mini program at least, where after you do your massage,
You wanna keep the changes of that massage by doing a specific kind of mobilization technique specific to what your body needs. For example, massage is passive, right? You're passively getting your abdominal area to move.
but then you have to actively get your abdominal area to move in that new range of motion that you just taught it or else it's just gonna maybe even within the hour go. And then it's just because it's like I've been this way for the past few months, years even. I think I'm safe here. You're like, no girl, I need you to open this up. This is safe. This is normal. This is okay. Right? So.
I mean, maybe I'm getting ahead of myself here, but when I talk about...
You know, how do we heal from a caesarian? There are multiple parts to it. And I always say, well, you got to spend five minutes a day on this. You can't just be like, I massage once and know, Bob's your uncle. have no more painful sex for the rest of my life. So that's not how that works. Exercise doesn't work that way. Better nutrition doesn't work that way. It's little inputs regularly, you know, every day, every day, little little inputs. So five minutes a day. What are you doing in those five minutes? And to keep it super simple, you're doing one massage and you're
Janette Yee (28:29.634)
one movement and sometimes doesn't even take five minutes but if you did those you know those two things you know one of each in each of those categories one right after another it's literally impossible not to have a change of some kind it's literally impossible not to right
And then your body will adapt to that. And yes, of course you're going to have to change your five minute routine. You're going to have to progress it just like at the gym, right? You can't just do five pound bicep curls and then expect after three months of doing it, you could do chin ups. No, no, girlfriend, you're going to have to progress that workout. But it's the same thing. It's the same thing. And then the results is along with internal assessment, making sure nothing else is happening from a bio-psycho-social standpoint because of your pain.
that can make a really big impact. And can I tell you something that's even more crazy, Kim? I to tell you this, because I don't even believe this myself. So Kim knows this. I've been working almost exclusively online, almost exclusively virtual, coming from an entirely 100 % in-person practice. I now teach moms how to do their own massages and how to get rid of their own painful sex themselves.
Kim (29:23.527)
Mm-hmm.
Janette Yee (29:46.696)
with their own hands. Kim, it's not, it's so not complicated that I wanna scream it from the rooftops and be like, no woman should be suffering. This should be just standard information. It is so not complicated to do. The complexity lies in knowing what to do and actually doing it. But that's it, that's it. You could do it yourself.
Kim (30:11.569)
Yeah, yeah.
Do you have any preferred, would somebody use lotion or oil? I've always heard that castor oil has the best influence from kind of breaking up really stuck tissue. What are your thoughts on that?
Janette Yee (30:30.58)
Very interesting. So because I stay my lane as an orthopedic therapist, I do not recommend things like castor oil for softening scar tissue. I quite frankly don't know much about that. I hear about it and even if I read about it, I would need to have my own experiments, right Kim? need like a bunch of my athletes do the massage with this to see what their results were before I would even say, yeah, this is something that might be good. because most of my techniques that I teach
are entirely online and virtual, meaning you're doing it yourself, I keep it simple. Virtually none of my techniques require any lotions at all. None, right? Not because lotions aren't good. mean, there's so many reasons why massage therapy works with massage lotion. That's why we use it. But when someone has just had a baby and they have to also do scar massage,
Kim (31:08.423)
Hmm, next.
Kim (31:28.253)
Keep it simple.
Janette Yee (31:28.306)
If the barrier to getting it done means you gotta go and find your scar massage lotion, honestly, Kim, a lot less women would do their scar massage techniques. So I don't recommend any scar massage lotion. Now, that being said, later on, like for more advanced techniques when we talk about cupping, yes, there's lotion. Because if you ever cupped yourself with no lotion, it's not cool. No, no, it's not cool.
Kim (31:52.21)
Doesn't feel good. Yeah. And cupping for those that don't know, that's like they're like little plastic cups. You grip them, you put them on the skin, you let go and it creates a little bit of suction and then you can kind of move it around. And for those of you that are listening, Jeanette just went to go and I'm assuming find her cups. So she's going to demonstrate for us.
Janette Yee (32:10.228)
Hahaha
Yes, yes, I know your YouTube friends will see this now. A of different types of cups, but yeah. They are big. Where's my little guy? Probably in the wash. no, no, here, here she is. So it's the size of like a loony, a toony, I would say a toony. And for all my American friends, that means like, I don't know.
Kim (32:19.878)
Yeah, those ones are big actually. I haven't seen big ones like that.
Kim (32:31.731)
Yep.
dollar coin which is like yeah no they
Janette Yee (32:38.528)
But Americans don't have $2 coins. What is this? A big quarter.
Kim (32:44.124)
A bit.
Janette Yee (32:46.72)
It's not a small quarter. An inch, how about that? A one inch diameter. Let's go with standard measurements, Jeanette. Right, so cupping is an advanced technique and friends, you can learn to do this on your own at home. And this.
Kim (32:50.3)
Yes. Yes.
Janette Yee (33:02.472)
is something that treats fascia. So if we go back to, okay, what are we doing to help ourselves heal after cesarean? We talked about scar massage, and we talked about exercise, but scar massage is an interesting thing because it's just an easiest way of describing massage, but really you're not changing your scar in so far as decreasing the amount of scar tissue that you have. Like you're not getting rid of scar tissue. It's impossible. Like you're not getting rid of it, but what you are doing
Thank
especially in the first six months, is you're teaching it as it's lying down to heal, not tight, right? So when folks are like, gosh, C-section shelf, Jeanette just said, everyone gets one, am I supposed to, am I like gonna have this for the rest of my life? Well, listen, in the first six months, a big part of that, you know, tight scar, well, that can be changed. That scar is still very much in, influential, influence, influencing, influenceable.
Kim (34:02.224)
Influenced? Influensible?
Janette Yee (34:03.594)
Influenced, my God. Influensible, it's influenced easily, easily with your own hands, right? If you tell it, hey, listen Scar, I need you to not be so tight. I need you to move more. And you do this every day. It's just gonna do this. That's just what it's gonna do then, okay? Also in the first six weeks specifically, that C-section gel has been caused by swelling, swelling.
I need everybody to hear this. my gosh. I was talking to one of my, one of the mums I'm working with recently and she had a hysterectomy. And for those who aren't familiar with the surgery, it's very similar to the C-section, to the cesarean that I just drew on my belly. Except what doesn't come out is not a baby. It's a uterus, in her case, a part of a uterus. And she had, you know, the privilege of hiring a plastic surgeon to close her up. Well, you know what the plastic surgeon did that
Obstetricians don't do after a cesarean. I even brought this for this podcast. could see a drain was put into her. A drain. You know what comes out of that drain? It's fluid. A lot of fluid. A lot. I brought my measuring cup, Kim, because I wanted everyone to see, even though it was a podcast. But I'm holding up this cup, friends. This is a 500 milliliter cup.
On the first days, you can expect a whole cup of fluid. A whole cup, 250 to 300 mils.
Kim (35:36.093)
Yeah, that's crazy.
Janette Yee (35:40.34)
Like if you pour that into a bowl, okay, so you got whatever, five of those every day, right? And then it starts to decrease and every body is different of course, but by about the end of two weeks, you're still getting rid of fluids from the surgery by the way, but also swelling because you had surgery, your body's bleeding and the rest of it, it'll be down to about 30 milliliters. And by that time when the fluid is clear and it's not so much, they take out the drainage tube. But two weeks of that much fluid, I'm holding it
10 bowl here friends you can't see but basically that mixing bowl if you're someone makes cakes that's full of water that was all inside your abdominals you can't tell me that won't cause a c-section shelf like appearance the scar is tight but everything above and below it bulges out because of that swelling
Well, if you're not having a port put in like the mom I'm working with that worked with a plastic surgeon, well, all that's stuck inside of you. You better get some compression on that. You better start gentle movements. You gotta cycle that out, Right? You got to. don't...
Kim (36:45.491)
Yeah. So what sort of movements, so even if the person didn't have the drain, whether they have the drain or not, the benefit of having the the fluid draining out of you is important, but not very many people I would say are having that done. But what would your recommendations be for those early days post-Caesarian? We're not going to be right on the scar. You can be around it. So things like
you know, if I think back to when I was working with mainly pregnant women and postpartum recoveries, and a lot of the midwives would talk about skin brushing and, other different healing modalities from other parts of the world. Is that something you would recommend? And then elaborating on that, what's the general, you know, back to movement? Cause those initial days, it's hard to even move at all. And, you know, getting out of bed, you need help. And, but what sort of regressions would somebody be going through?
Janette Yee (37:38.96)
Absolutely.
Kim (37:45.311)
to get some more mobility, to get some pelvic floor activation, how soon, what's the timeline that people would follow.
Janette Yee (37:54.268)
So for folks who work with me, I start on day one. Like the day of surgery, folks are doing things like reconnecting with their pelvic floor. And reactivation of the pelvic floor looks like this. let's do a very quick exercise together, and all listeners, I there's nothing to see here, but basically you're gonna close your eyes, and one of your first exercises is, can you...
Squeeze your anus. It's just a yes or no answer. It's not how long, how many times, how fast. No, just can you do it? Can you do it? You could do that on day one after surgery. Can you squeeze your vagina?
And the third hole is can you squeeze your urethra? And that's a tricky one because there's a catheter in there. When there's a surgical birth, FYI, friends, you're going to have a catheter that helps drain the pee out of your body. So that's.
That's tricky. People think, you you're all probably sitting around listening to this podcast going, yeah, know, some of you will be driving and squeezing your urethras right now. That's pretty cool. But right after surgery, that's not a thing. It's pretty tough.
Kim (39:11.614)
Some people are told not to, don't do any pelvic floor activation afterwards. Some people are said, you know, not for at least six weeks, don't do anything because we don't want to disrupt the scar, don't want to disrupt the healing. And yeah, and I look at it differently and think, well, to optimize the scarring down, as you were saying, and to keep good blood flow circulation, I feel like that's...
Janette Yee (39:24.017)
Hmm, interesting. Interesting.
Janette Yee (39:35.826)
Yeah.
Kim (39:39.28)
essential component. So I'm glad, I'm happy to hear that you recommend that.
Janette Yee (39:39.582)
Huh.
Janette Yee (39:43.133)
Well, those people must also think, you know, definitely don't go pee or poop than in the first six weeks if they're saying don't use your pelvic floor. I mean, that's right. Because I mean, like, why? I'm being I'm being mean. No, you have to. How? What? OK, I've never heard that. OK.
Kim (39:50.976)
Sorry.
Kim (40:01.546)
Yeah. Yeah.
Janette Yee (40:07.163)
going to go off and say also that for the folks who have been told after a cesarean and from a vaginal birth to never do sit-ups or planks again, you have been misinformed.
It is not okay to never use your abdominals for what they were designed for after pregnancy, which by the way is not an injury. Like it's just an adaptation. The childbirth part, yeah, you gotta rehab from it, but same as a knee. It's like saying, have like a knee surgery. Never bend your knee again. What? Don't walk again. It's gonna hurt your knee. Listen, friends, your abdominal wall was made to brace?
It was made to bend. So, so.
If anyone is disagreeing with me, because that might be a provocative statement, yeah, Jeanette needs you to do sit ups and planks again, like planks on the floor, not planks on like whatever, not elevated, full planks. And if that's provocative for you, then I wanna say, well, if you plan on never getting out of a chair again, because that's a sit up, and if you plan on never laughing really hard, watching a funny ass TikTok again, because that's bracing.
Then you're right. Never do set up some planks again after your caesarean. Then you're right. Otherwise, I'm right. So we're gonna close that myth. Okay, that's it. Next, and that angers me by the way. That angers me. That is such an unnecessary fear-mongering guarantee to ensure a woman's lifelong weakness based on nothing at all.
Kim (41:45.428)
I remember, so way back in the day again when we didn't have social media, the internet was around when you know the Belly Zinc story. So for those of you listening who don't know, I had a business called Belly Zinc, two other women with me, one of which was a pelvic floor physical therapist and another one was a trainer like myself. And we were wanting to optimize postpartum recovery and we designed a wrap. And at the time, so the main focus that brought us together was diastasis.
Janette Yee (42:12.501)
Mm-hmm.
Kim (42:12.544)
So diastasis recti is the separation of the abdominal muscles, which I think the term is misleading because there's always a separation there. anyway, sidebar, that was what kind of brought us in. And yet we were bringing the pelvic floor into the conversation. And at the time when we were designing these exercise protocols, the restrictions that were provided to women who had a diastasis or who had a prolapse was no twisting, no planks, no crunches, no no like
Janette Yee (42:27.647)
Mm-hmm.
Janette Yee (42:35.273)
Mm-hmm.
Kim (42:41.974)
It was this hugely restrictive list. And at the same time, I was also doing training with Katie Bowman, very much, you know, biomechanics, natural movement. And the two things were completely conflicting one another. And I had this internal conflict because I was going with what the pelvic floor physical therapists were saying. And at the time we didn't really have a lot of research. So I was like, okay. But then on this side, I was looking at it saying, we should be able to do all of these things. And
Janette Yee (43:03.019)
Mm-hmm.
Janette Yee (43:10.763)
Mm-hmm.
Kim (43:11.425)
really as kind of what you're saying is, those limitations are there maybe for a period of time while you are rehabbing, while you are putting in new adaptations, while you are managing your scar tissue. But there is no way in hell that we should ever for the rest of our lives and not be able to do a crunch or not be able to do a plank or not be able to do all the things if we want to. And so I wholeheartedly agree with you that at the time those
Janette Yee (43:24.865)
Yes.
Kim (43:40.373)
That big no list was so limiting and created so much fear. And Julia was at a course one time with another pelvic PT who had been using the same guidelines. Like we have to roll to your side to get up off the floor. And when it came time to try to get up off the floor another way, they couldn't do it. And that was their aha moment. They said like, are creating negative non-optimal compensations in our clients by telling them they can't.
Janette Yee (43:42.902)
Hmm.
Kim (44:08.791)
do these things. So let's help them build capacity in all the things. And I love that you're saying that. I totally agree.
Janette Yee (44:14.253)
my gosh.
So going back to your original question of like, well, what do we do on day one? Like, what does that rehab look like? It's shockingly similar to what it looks like return to sport.
I mean, just to give a little bit of a kind of a framework, I always talk about the four Rs of rehabilitation. And it's a chronological four Rs. So the first Rs reactivation, we all just sat around reactivating our pelvic floors together. It just means can you do it? Because the answer is no, a lot of times. Like, can you reactivate your transverse with let's say belly breathing? That's on day one.
Right, a lot of times the answer is no, because it hurts, because I'm scared, because of a lot of other things, and that's okay, but it's okay to try.
within the confines of pain and the confines of your specific experience. Right? But after reactivation, we got we got to go to repatterning. And repatterning is really what rehabilitation actually is, you know, for for therapy, we're in the business of trying to get that body to move with natural patterns again. Right? OK, I've got the C-section shelf. It looks this way. But, you know, part of the way reason why it looks that way isn't just the scar tissue and
Janette Yee (45:30.361)
and the swelling, but now it's like the actual muscles, which were not connected during your surgery, now has to figure out how to connect again and how to move properly. So that's repatterning. by the way, and this has to work with the arms and the legs and then them moving contralaterally, and maybe you wanna move your knees at the same time. So that's all repatterning.
And then the third R is re strengthening and Kim, so many women miss the first two R's after childbirth, me included. I'm totally guilty of that. And we will go straight back to the gym.
because the doctor, whatever we hear, week six, discharged, go back to your regular activities. And in the absence of any other guidance, we go back to what we know, which is go back to the gym and lift real light, right? I mean, that's responsible, doesn't it seem, right? I'll start doing arm curls at five pounds or maybe just body weight squats and not.
135 pound back squats, that seems to make sense. But if you miss the first two R's, your third R, your re-strengthening, will be capped. You will not run faster. You will not lift heavier. And you will, in a matter of time, hurt yourself. You just will. So that's the third R and the fourth R's return to sport.
And by the way, friends, sport requires the first three Rs.
Janette Yee (47:06.474)
It does. Sport means you're not thinking about, did I zip up before I took my step to tackle this girl? Like, it has to happen naturally. It happens right away. And that's why repatterning is so important. Repatterning means you don't have to think about it anymore. Your pelvic floor, your core, the whole thing, pelvic floor, transverse, diaphragm, multifidi, all do what it's supposed to do in the right order before you, whatever, swing your tennis racket.
Throw the ball, right? Punch. You can't think about it. It's a reaction. So, know, Kim, when we talk about, chronologically, what do we do in the first six weeks? What do we do in the next six months? What do we do? How long does it take? Well, the answer is however long it takes for your body to go through those four Rs. And I gotta tell you, I...
For some women it takes years for so many reasons and complications out of their control. For me, I didn't go back to the gym until eight months postpartum. And I tried to get back onto running on the track. I was part of a track team, track and field club for three seasons and hurt myself all three seasons. And it wasn't until the fifth season, so fifth year postpartum.
that I start, just said, you know what, I can't do the work required for sprinting. I'm gonna try swimming. And so now I'm, now I swim with a triathlon club, but that took six years, six years, right? So for some folks, I remember working with a mom who, my God, Kim, four months after her cesarean was back playing for Canada rugby.
Kim (48:41.324)
Yeah.
Kim (48:54.092)
Wow. Yeah, yeah. That's awesome. And I think the other thing I wanna just highlight too is for the people that aren't necessarily in a sport, I think we need to train for life. Like lifting a suitcase into the overhead bin could be considered a sport or wrestling, know, bags of groceries that you don't wanna do multiple loads so you try to get them all at one time into the house like that. Right?
Janette Yee (48:55.1)
So it can be done. It can be done. Okay?
Janette Yee (49:07.981)
Yes.
Janette Yee (49:11.758)
Yeah.
Janette Yee (49:18.396)
Yeah, how about lifting the thing you gave birth to, right? That's going to start running in a year's time, that child. And maybe your toddler as well. And then maybe you have two other kids. That's sports.
Kim (49:22.156)
Yeah, yeah.
Yeah, yeah, yeah.
Yeah, or maybe you are 75 and the person you gave birth to has now given birth and you have other little peoples and you realize that you had a caesarean 50, 40, whatever years ago and now this is also kind of chiming in. So it's not like this is only for that immediate postpartum or the immediate couple of years. This is if you've had a caesarean, you've had a caesarean and that scar tissue is always there and it's always something that can be changed.
Janette Yee (49:59.235)
to highlight the look what is it that you asked me earlier what does it take to return to sport and I'm going to make it so simple for your listeners they're going to be like why doesn't anybody talk about it like this so so many folks after giving birth vaginal or cesarean you know they just it's a career ending injury is what I'm trying to say they just never get back and there are reasons why they tell themselves and there's reasons that might be very true that it can't get back
But in my world, childbirth really should be nothing but a season-ending injury. And both sides of that coin means, yeah, you will be out of commission for this season, and please make no assumptions that you will. Like, no, you're out of commission. You're not playing this season anymore. But you gotta do the work so that you can get back next season. So please hear that. Childbirth is not a career-ending injury. It doesn't have to be.
You'll be back next year, next season, okay? So here are the seven exercises, movements, that all my, I call them athletes, I don't call them patients, all my athletes need to be able to do before they're discharged from my care, okay? So here they are. So simple. After you learn how to, you know, repattern your core.
alignment, breathing, core control, I call them the ABCs. You apply them to the following things. Pushing, pulling, squatting, lunging, bending, twisting, and running. At least walking. Everybody, even if you're not a runner, you gotta be able to walk.
You gotta leave the ground though. I need you to leave the ground after you give birth. Like gotta, even on the spot. So these are what are called the primal movements. And the definition of the primal movements means the movements your body was designed for. Your body was designed to do these seven things. So it would make sense that after this particular injury, a cesarean birth, that you should be able to do those seven things with great core control. That makes sense.
Janette Yee (52:19.93)
And it's not complicated. you should be able to, how many folks haven't bent over since giving birth? Months. Even years. And they're like, I have back pain. No girlfriend, you just never bent over before. Yet. Rather, since you were pregnant. It's been a year. Right? So.
Kim (52:37.103)
Yeah. Yeah. Or they've been avoiding certain movements because maybe they belong with their caesarean. Now they have a prolapse and they said, people tell us not to squat, not to bend over, not to do all these things. And so it's again, these limitations that we either put on ourselves or we have maybe heard through the grapevine or maybe even a care provider has told us that we then we take away that power and we take away that belief in the body's ability to adapt.
And so hopefully people get the message that adaptation is possible at any age, at any stage. And when you are consistent and when you are intentional, then with the right messaging or inputs as you're saying, change is absolutely possible.
Janette Yee (53:22.957)
absolutely possible. And folks, wherever you are in your journey, that's just your starting point. That is not your end point.
Kim (53:31.736)
Yeah. Yep.
Janette Yee (53:32.435)
That is not your end point. Please find the person who's gonna be able help you create that program for you that's gonna get this to maybe not be so stuck down and painful and so that you can do that squatting with no pain, because you love it in the gym. know, like there needs to be progressive overload so that your body can do it again. And barring, honestly, very few situations, your body can. Your body can.
Kim (53:47.054)
Yeah, yeah.
Janette Yee (54:02.632)
You're not broken.
Kim (54:05.422)
So where could people find you if they would like to work with you and where can they learn more? You have to follow Jeanette on Instagram, social media. She's amazing. Where can they find you?
Janette Yee (54:13.907)
I
I do like making videos, it's fun. Well, I am on Instagram. I'm Ask Janette on Instagram. I'm always in the DMs, just hanging out, talking to people. But specifically if you're interested in programs, there's a Preparing for Caesarean program, which also wraps into that Stage 1, which are the first scar massages and exercises you need to be able to do in the first six weeks postpartum. That program is huge.
And then for a lot of folks who are like, my God, I'm past that six week postpartum time span, like is it too late for me? The answer is no. There's a stage two program where you're gonna learn how to do your scar massages slash fascial mobilization, right? We talked about cupping, for example, and pairing that with the right exercises, going through a very simple structured program, but simple to follow to get you out to, here's my checklist of the things I need to do to go back to fitness, sports, active life with.
as little risk of injury as possible. So that's on, they'll be on my website. We can link it into the show notes, right? And there's a lot of free resources on my, yeah.
Kim (55:24.921)
Yep, yep, yeah, I'll have all your stuff in the show notes there as well. you're awesome. Thank you so much for your work and for joining me today. I laugh and smile all the time. You have such great energy and I really appreciate you and love you so much. Thank you for joining us.
Janette Yee (55:42.534)
Thank you so much, Kim.
