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With Dr. Kim-Parker Guerrero

Most common surgeries like a knee replacement, hip arthroscopy, and rotator cuff repair all have a rehab protocol, but there is no national postpartum protocol to ensure proper care and recovery for women after giving birth. While the birthing process is simultaneously magical and traumatic, regardless of the style of delivery, every woman needs physical therapy or occupational therapy to optimize their healing.

In this episode, Dr. Ginger speaks with Dr. Kim Parker-Guerrero, PT, who specializes in pelvic health (of course!). However, she also takes a special interest and active role in advocating for better postpartum care and postpartum protocols in conjunction with several other colleagues and healthcare providers. 

If you haven’t listened to or watched our other podcasts on maternal mortality in this country, it’s very obvious that change is needed. With new policy at the national level, better healthcare for moms will become much more accessible.

Fortunately, this episode is more than just congressional advocacy, you’ll also learn all the amazing reasons WHY having pelvic health PT or OT is so beneficial before and after birth/delivery.

Postpartum Protocol on YouTube

Biography of Dr. Kim Parker-Guerrero PT, DPT

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Dr. Kim Parker-Guerrero owns a pelvic health physical therapy clinic in Roswell, NW called Renew Physical Therapy. She has won many awards during her physical therapy career, including 2005 NM APTA Physical Therapist of the Year, 2015 ENMMC Clinical Director of the Year, 2018 NM APTA Physical Therapist of the Year, and 2021 + 2023 Academy of Pelvic Health President’s Award.

She has countless affiliations with prominent professional groups including being the Director of Practice at Academy of Pelvic Health, Delegate to HOD at Academy of Pelvic Health, Payment Chair of New Mexico APTA, New Mexico’s APTA Federal Affairs Liaison, and Director at Large for the International Organization of Physiotherapists in Pelvic & Women’s Health (IOPPWH).

Resources for Postpartum Protocol

1. HR 2480 Congressional Bill Information – It takes 2 minutes to contact your congress member and ask them to cosponsor or simply support this bill. It will save moms’ lives and quality of life. Love your mom and take 2 minutes, we thank you!
2. www.aptapelvichealth.org
3. American College of Obstetricians and Gynecologists 4th Trimester Guidelines
4. Connect with Dr. Kim Parker-Guerrero here!

Postpartum Protocol Interview Transcript

0:00 Dr. Ginger Garner: Hi everyone, and welcome back. I am here with an amazing guest with such an incredible rich experience in pelvic health and pelvic physical therapy. I want to welcome Dr. Kim Parker Guerrero to the podcast.

0:20 Dr. Kim Parker-Guerrero: Hi, thank you. Thank you. Yeah, I’m glad to be here.

0:22 Dr. Ginger Garner: Yeah, I always want to do a little dance. Yeah. Makes me happy. Oh my gosh, because we have a lot to talk about. And for everyone listening, I always kick it off with a little bragging on, you know, on our guest and who is here, and I’m going to do that. But I just felt really led to say that this podcast is important because I think that in the condition and nature of our country here in the United States today. Everything seems so divisive and partisan. And, you know, everyone is just kind of finding a reason to fight over politics. 

And you hear stories behind the scenes. I know several Congress members who say that’s not how it works behind the scenes. You know that a lot of people get into this kind of bit and bark and play because it garners media attention, which is kind of crazy, right? [Sad} Yeah, it is. 

I wanted to say that if you’re feeling a little disheartened and think that maybe your voice doesn’t matter, your vote doesn’t matter, or there’s no way that we can create change in this partisan climate that we’re in, this podcast is for you. because you can. You can and we will, and we’re going to talk about that and show you how. And we are going to do that in the context of pelvic health, specifically for women and people that give birth. So if you are wanting to see moms get better care, then you got to listen all the way to the end. 

Okay. So now I want to brag on Kim a little bit. She has, oh my gosh, done so many amazing things in the field of physical therapy, you guys. Kim, when you started, it was a bachelor’s degree, right? Correct. And then you saw it change when I came into the field in the mid-90s, it was a master’s degree. And then both of us saw the transition to a doctorate degree. So I find that, you know, we end up, we had to chase each one, right? Master’s degree and doctorate so you got your doctorate as well. And then accumulated racked up I like to say racked up a bunch of awards along the way. 2005, New Mexico, APT of the Year. Then 10 years later, Clinical Director of the Year, as well as PT of the Year again, right? In 2018. And then Academy of Pelvic Health President’s Award last year. 

Your volunteer work spans, it’s too much. It’s too much to go over. So if you want to know everything that Kim has contributed to the profession of PT, which directly impacts particularly anyone with a pelvis, then you can go and find that easily online. You’ve also been a clinic director, obviously, and a clinic practice owner, which is important because that just provides so much insight into things that we’re not really introduced to. So if you’re listening and you’re a PT, you might get a little bit of the entrepreneurial business, you know, clinic practice side. 

And if you’re listening as, you know, a person with a pelvis, then of course, you’re definitely going to get an earful on that. So there is something for everyone in this show today. So let’s get started. [Sounds good.] All right. 

So we think about things being rather complex, when we talk about advocacy like everyone listening you’re passionate about something. And I think that because, you know, we all have a mom, we may or may not know that that mom or a mom figure. We all have people that we love and care about. And I think we all can agree that we want moms to get better healthcare. Because if you look at the statistics on maternal health in the United States and worldwide, but particularly in the United States, we have the highest maternal mortality rate. 

We have all this amazing healthcare, and then we have the highest maternal mortality rate. And it’s even higher for people of color. And along with that, a very sad similar statistic is that we have the highest first day infant death rate. So we’re not getting it all right in terms of the care that moms are getting. And it’s not that it’s not available. It’s available when you can find it, if it’s in your area, and if you can afford it. 

And what I’d like to talk about today is how we can change that. But we think about passing bills and things like that in congress is, oh my gosh, that is a complex. process. And you’re right, it is a complex process, but you have so much power and agency as an individual that your voice matters. And so I would love to hear from you, those of you who are listening and your stories, please reach out when this is live on YouTube and Instagram. 

But I just want to say that you have a sense of agency and power and that your voice can make a difference. And that’s a simple process. But before we hit record, Kim, you were talking about a story, an experience that you just had that is kind of a catalyst for everything we’re talking about. Share that, share that with me.

6:09 Dr. Kim Parker-Guerrero: Yeah, so, you know, I just opened up my private practice in, started about June of this year, and I’d been in a hospital setting, a director, thought I had a big voice there. I live in rural New Mexico, and so I live in a medical desert. So patients drive two to three hours to see me. So even though I was over a therapy department, I had a very healthy, pelvic health, physical therapy practice. And a lot of providers were, you know, referring to me. The hospital decided, first of all, during the pandemic, they furloughed all of us. So they shut it down. So I had, I treat a lot of pelvic pain patients. Also, my patients didn’t have access to care. 

And then when we came back, The hospital wasn’t really supportive of my practice. So I made the decision to open up a private practice. And so I was telling Ginger where all {came from}, I have these aha moments of why I’m still doing this and why I’m an advocate for our patients. I had a referral today from a midwife, an area midwife who refers to me and mom walks in with her baby that she delivered in September. It’s her second baby. She had complications after her first delivery, a four-year-old that had never been addressed because guess what? Small universe. She had been referred to me during the pandemic with the first one and we were closed. So she never got care for that. 

She comes in today and I said, I always ask, you know, what are your goals? You know, what, tell me why you’re here. I have the referral, but tell me why you’re here. And she said, I’m, I never got an exam after my baby was born. And I said, what do you mean? Did you go back for your six week visit? Because, you know, and we’ll get into this a little bit, you know, about some of the things when people are saying you don’t need PT postpartum because midwives or the gynecologist are checking and doing all of that work. This was just, sounded to me, I was like, are you kidding me? You didn’t. And she said, what did you do for that visit? She said, I went, we went back in and she said, they verbally asked if I had any issues. I said, no, I, you know, I had hemorrhoids. I had this, I still had some issues from my first baby. 

And they said, we’re going to refer you to PT. But now luckily that midwife knew I was in practice. If they did not know that, then they would have sent this mom home for the second time with nothing, you know, no advice. And she said, I just, I don’t know if everything’s normal down there. I’m having some breastfeeding issues. I’m having a little depression because my four-year-old isn’t sleeping. And I had this new baby. Those are things that we can all address.

09:24 Dr. Ginger Garner: Yeah.

09:25 Dr. Kim Parker-Guerrero: And it just again it just brought it home how important we are it is for our patients to have access to us in the fourth trimester. Because for those of you who haven’t had a baby i’ll just say that you know for nine months you get a lot of attention. While you’re pregnant the focus is on you, also on the baby, but really on you. Once you deliver the baby the focus goes to the baby. So you’re kind of left on your own. And it used to be in fact, she brought up, she said, my mom even asked me, didn’t they check you? Didn’t they tell you it’s okay to go back to having sex? 

And she said, they used to do that. So why don’t they do that anymore? Oh my gosh. So yeah. So in her, in her exam, I mean, it’s all I told her, I mean, if you could have seen the relief in her face and her body, you know, when I was like, this is all stuff we can work on together, you know, and while she’s here with the baby, you know, I’m talking to her about how she’s lifting and how she’s breathing, how she, you know, how she’s left in the car seat. So it was very validating to have her today. And I thought, really interesting, since I had this call scheduled with you, Ginger.

10:42 Dr. Ginger Garner: Yeah, absolutely. I, um, When you said a couple of things that we should kind of do like a, it’s like, they’re like mic drops, right? One is, it’s going to be two part here. So one is we have protocols for like, I see lots of people with hip arthroscopy. We have a four month protocol, which is a nice suggestion, but for my mom’s who are postpartum, it’s like a nine month protocol. Right. And that’s for hip arthroscopy. We have one for ACL. We have one for rotator cuff and we have nothing for postpartum. [Yeah.] Nothing. 

Moms get one six week visit as you were saying, which we know is it covers hardly nothing. They’re looking for catastrophic things. I don’t even know that ACOG really is requiring because the last time I looked, they weren’t, suggesting that it was mandatory to do, you know, and screening for depression, right?. Yeah. In fact, American Academy of Pediatrics was recommending it. But then you have the stigma of how many moms are going to go into their pediatrician’s office and say they’re having thoughts of harm, right? Yeah, that’s hugely questionable. 

We’re a great safe space to be screening for all of these things. So on the on, I want, you know, everyone listening to just hear that we have ACL protocols, we have total knee protocols, we have total hip protocols. And, you know, Kim saying all the focus is on mom until she gives birth. And then after that traumatic event, which is also miraculous and wonderful and amazing, life changing, nothing. 

And so that requires us to define the fourth trimester, which is the second thing that you mentioned. So for our listeners, define and describe like, what does that really mean, you know, for moms?

12:43 Dr. Kim Parker-Guerrero: Well, and that is, you know, you when you’re pregnant, they break it up into your first, second and third trimester. And so, you know, it’s also called your postpartum period, but it’s after you give birth. It’s that period after you’ve finished your pregnancy, you delivered, and then you’re now kind of for most intents and purposes, you’re no longer the patient. 

In the insurance world, in the medical world, there’s no longer any need for you to have any care. But what studies have shown is that that’s really when you need that focus, to look at those things like depression, how you’re eating. I mean, this woman wasn’t drinking enough water and had some issues with her milk supply. I mean, those are things we can spend more time on with them than they are spending with their gynecologist or midwife, whoever. 

We’re trained to look at the whole body, to look at the total patient and not just, this is your pregnancy, but it’s more, you know, she wants to get back to running. She wants to get back to exercising. That’s what she does for her mental health. This person is extremely, extremely intelligent. She was an engineer and she was nearly in tears because she said, I feel so stupid. I don’t know my body. 

How many of us hear that a lot of times because no one except us has taken the time to explain, you know, here’s why you’re still having hip pain after delivery. Here’s why, you know, she said, I don’t know why I’m sore because I didn’t have an episiotomy this time. And I didn’t care, but I did four years ago. But on her exam, that tissue was still very tender, you know, just once I was explaining these things to her and what we could do and she could help herself. It was just like this weight was lifted off her shoulder, you know, because she had been worrying about so many different things on top of, you know, again, she’s going back to work. 

So she’s in her mind trying to figure out my body doesn’t feel right. I have this new baby, a four-year-old who doesn’t sleep. And she said, I’m very detail-oriented as an engineer. I want to make sure I’m doing everything right. And nobody’s told me anything. So during our one-on-one session with her today, I was able to really explain that whole postpartum fourth trimester adventure, I called it. And told her how everything’s going to keep moving along, but she has to pay attention to her body and not just the baby and the four-year-old and the job and the husband.

15:48 Dr. Ginger Garner: Lots and lots and lots of stuff. [Lots and lots of stuff.] Goodness, you brought up several pieces of the argument that saddles women and people that give birth And that’s the cultural and social conditioning and burden that we haven’t yet even begun to address because we haven’t had leadership with the parts that give birth, because if we had, guaranteed, there would be help for that. 

So if we don’t have any advocates, you know, now is the time that we’re changing that. There are solutions and we’re going to get to those in just a second, but for that mom to come in. That new mom, second time around, to come in and to hear from you. Everything that you’re feeling is part of the “abnormal normal.” Meaning we’re going to fix it. It’s not okay, but it is kind of part of the process of getting better is vindicating, validating. It is the opposite of the gaslighting. Whether a medical professional is deliberately overtly or covertly medically gaslighting a mom or person that gives birth. It’s happening. 

Like, you know, we don’t want to point fingers and say this profession or that profession is medical gaslighting. We can all do it if we’re not validating the one truth that these people are not getting the care that they deserve after they give birth. Like just to say that they are is huge. And so if you’re listening as a practitioner, please validate, please validate every single person that comes in and tell them it’s okay. You’re not crazy. I would have depressive feelings too. You know, of course I did. I’m a mom times three, right?

If I lived in a society with no maternity leave and where I’m self-employed and I have to go back to work at day five, People don’t take puppies away from their canine mothers until they’re six to eight weeks old. And here I am going back to work at five days with a human child. Like, how insane is that? Like, you know, new, is it Colts and their moms, and their mare and their moms? You’ll take the baby horses away, right? I don’t know what they’re called. I’m blanking out, but we don’t even do that to animals. It’s so important for them to be with the mom. And yet we do that. with humans, which is crazy.

18:24 Dr. Kim Parker-Guerrero: Yeah. And I, you know, I always with my moms, my new moms, it’s, it’s so funny because when I’m talking about on the phone scheduling, they’ll say, I have a favor to ask. Can I bring my baby with me? Like it’s this big ask and I’m like, I want you to bring your baby with you because I want to see, I can help you. There’s things because I always laugh and we talked about this today. Moms will say, oh, I’m not exercising. I’m not lifting weights. I’m not doing anything. And I’m watching them as they bring in this heavy car seat and huge diaper bag. And they’re lifting this baby, you know, and like that you’re lifting weights, you are exercising. Yeah, you are exercising. But even just in that short period of, you know, we did a pretty thorough eval. Then the short period of treatment that we did before we scheduled her visit next week, she just said, you know, you showed me that anatomy model and then you pointed out as you were doing it. And she said, I just thought I wasn’t normal. And I just, I want to have another baby, but I just, you know, I don’t know, you know, but this all makes sense and I will get better. I’m like, yeah, you will get better. You’re on your own. No one pregnancy is the same and no one’s journey is the same. And so that’s what I told her.

19:51 Dr. Ginger Garner: Amen to that.

19:52 Dr. Kim Parker-Guerrero: I said, we just have to work together and, you know, keep you moving forward and, and make it where it’s things that are meaningful to you that are you’re able to do. There’s no guilt. There’s no shaming on this. Cause she’s like, well, you know, sometimes my schedule’s off. And I said, this is not a shaming session, you know, we’ll tweak it, we’ll make it work. I think it was just such a relief for her, you know, to hear that, to be validated like that.

20:25 Dr. Ginger Garner: Those are all the green flags, you know, those are the green flags that you want to hear. So for listeners, if you’re looking at what your care should feel like and look like, it’s, it’s what Kim just described. It is that validation. It is a shame-free environment. It is please bring in your baby. We can help you, you know, get your crossfitting exercise in because that’s what you’re doing. You’re basically crossfitting, you know, especially once you get two and then three, you’re like, oh my gosh. I was stronger, you know, as a younger mom, because I was doing all that crossfit stuff, lifting babies and toddlers. And I have to actually do boring things to get that strong now, you know? But then I always joke with moms and say, actually, I get to get my baby fix, so yes, please.

21:16 Dr. Kim Parker-Guerrero: Yeah, same here.

21:18 Dr. Ginger Garner: Bring that baby in. I love to see the babies. And then there’s all kinds of things that we can do to help. You guys, all those things are the green flags that you want to say, yes, that feels right to me. I feel like I have a trusting, safe relationship where I can say anything. I can talk about painful sex or when I’m going to get back to sex or what else it could look like. It doesn’t have to be penetrative sex. I can talk about vaginal dryness. I can swear if I want. I can do whatever is needed. And it’s going to be that safe environment.

21:53 Dr. Kim Parker-Guerrero: Yeah, yeah.

21:56 Dr. Ginger Garner: So other green flags, what are some other green flags for people listening who might not actually know what the pelvic health process for a PT with PT or OT may look like in the postpartum. Because you spearheaded the, prenatal and fourth trimester task force for Academy of pelvic health for American PT Association. And we’ll talk about the direct efforts of that in just a minute. But I think a lot of women don’t know that frankly, 100% of moms and people who give birth need to have pelvic PT or OT after. 100% it’s not, if. Because I hear that too often, you know, patients will come in and say, Well, I asked my OBGYN for a referral and they said, “Well, you only gave birth. Why do you need a referral for pelvic?”

22:56 Dr. Kim Parker-Guerrero: It’s normal to have that pain, it’ll go away.

22:58 Dr. Ginger Garner: Right, right. Just wait.  You know, yeah, we’ve heard all of that nonsense, shenanigans and nonsense, right? So let’s talk about more green flags. What are the current standards? Ideally, what would the current standards of care be for, you just gave birth? We know we’ve got that six week one visit out there in the wind. But what can we do optimally and ideally, right after someone gives birth?

23:27 Dr. Kim Parker-Guerrero: Well, you know, and I know there’s a big push out there right now for, for PTs and OTs and the hospital to actually see the patient, the moms or the person giving birth before they’re discharged, because they can work with them. Now, you know, and try to It’s not, I think they think it’s all about, let’s get the patient up and walk them and make sure they can walk to the shower and shower themselves before we discharge them. That as those many of us know, there could be pubic symphysis problems. They could be having some back problems that they’re too afraid to tell the nurse because they just want to go home, where they might be more open to talking to the PT and OT about that. 

But so, I mean, ideally, that would be great if in a hospital setting, they could get at least screened. I know that in the rural areas, we never had enough staff so that the OB department, those referrals were on the low priority. If we got them. We started getting them when, again, I was the director and I could say, Hey, you guys, the nurses need to be screening, so we can help these patients before they go home. Because then what happened is they’re discharged and they did have problems. I wasn’t going to see them until they went to that six week visit. Right? 

So I think if we can educate the midwives, OBGYNs, primary care, whoever’s delivering and the patients to be their own advocate. I try to teach my patients to be an advocate, not be afraid to speak up and ask for a referral or if you’re in a direct access state like I am, then they can come directly to me is, uh, educating them on not waiting, necessarily waiting until the six week visit, uh, to try to, you know, especially if they’re having any issues, um, and so that we can get them in, we can see them sooner. 

Ginger and I were talking about, we look at the whole body. We’re not just looking at the birth canal, you know, we’re not just checking the episiotomy. Or, as I always say, giving the magic wand that they can have sex again. It’s more, it’s more than that, you know, and we can pick up on a lot of those things before the six week visit.

25:59 Dr. Ginger Garner: Yeah, I encourage the moms that I see giving birth that, like, for example, in my practice, I get booked out. So if you’re out there and you’re going to give birth, I would encourage you to go ahead and establish a relationship with a local pelvic PT or OT prior because I book four to six weeks out and if you wait till you give birth, you might actually have to wait several months to get in and then you’ve missed a really vital window where you can progress and recover really swiftly, safely, and you need less PT, actually, and OT, if you get in. 

So I try to get people in ahead of giving birth, because a lot of PTs are doing birth coaching, and OTs are doing birth coaching. So when I’m doing birth coaching, I say, go ahead, what’s your estimated due date? Let’s get you in for that first 30 day window with good relationships with our OBGYN and because there are so many things we can do without ever really needing to do internal, you know, until later. 

I know many of us, my clinic included, we have ultrasound imaging, we can, you know, non-invasively look and see how everything’s doing. Right. And then you mentioning we look at sleep, we look at feeding problems, we look at stress management, how’s their diet going? Are they getting enough fiber? Are they hydrated? Are there other endocrine disruptors in the environment that actually have an influence on hormone balance, which is such a huge issue when things are kind of going crazy postpartum? There are so many things that we can look at without ever having to look up in the vaginal canal. So don’t be afraid to establish that relationship early and go ahead and book that appointment early.

27:57 Dr. Kim Parker-Guerrero: Yeah. And I mean, and I, and I do try to see them when they’re pregnant.  I, you know, a lot of times, depending on, you know, I’m finding out from some of them, no one has talked to them about preparing the perineum, you know, doing the massage, doing some of that stuff. So like you say, there’s a lot of things that we can do to make their pregnancy, as good an experience as possible. Especially, you know, I, I do lifting techniques and stuff when they’re pregnant, if they have toddlers at home, if they’re, you know, so different things like that to help them get through the pregnancy. 

Like say, if we could screen them or see them before they’re discharged, but then definitely booking out, I have a wait list also. So they, there’s not a delay in their care. The other thing I was going to mention is, you know, if you have a very highly motivated, person that’s really into exercise, I’ve had some moms who they go out and they start running. I mean, they start doing stuff. 

They get out there and I’m just like, “Hey, we needed, you know, you can exercise, but here’s what you need to do to work up to that. It’s work up to it. Let’s work up to.” Let’s, let’s talk about your breathing and how you’re doing, you know, all this other stuff. So, and that was one of the things with her too. She said, I really had to hold myself back because I wanted to go out and run. 

And because I thought, well, if nothing else, you know, at least I’ll get back in shape. And she said, but something told me I should wait. I’m like, yeah, you know, let’s, let’s work up to that, you know, because I’m not talking, you know, running a mile. She’s like long distance to win it. She’s in it to win it. Very. Yes. Yeah.

29:44 Dr. Ginger Garner: I had a mom come in and this was a couple of years ago because now she’s already into her second and considering a third. But she came in after her first, no one had referred her and she’s got high health literacy so she knew she needed something and she knew it wasn’t right when her OB-GYN said, well you only had a baby, why do you need a referral? 

She had urethral tearing, she had labial tearing, she just didn’t have perineal tearing. Wow. Oh, goodness. Lots of things happening. That was creating prolapse, the bladder wasn’t happy, there was leakage when there shouldn’t be, and without even a lot of stress. And here was the key thing, because a lot of things can happen if moms do tear, which you don’t have to tear. It was fear. It was fear. It was fear of leaking and wondering, oh my goodness, what’s wrong? Or I have pain when I do this or just sit to stand or try to do a yoga pose or whatever it is. There’s a lot of fear that can surround it because you’re not sure what it is. 

And so after her first, we just worked on if she had that right hip pain I taught her to know that, you know, try releasing that obturator internus like I taught you, see if that’s better. And then she could kind of almost diagnose herself, right? She had a sense of agency of knowing what was going on. So I’d always give her two or three things to try. She had pubic symphysis dysfunction or, you know, for those of you who don’t know about SPD, it’s that pain in the front of the pelvis really low. It’s a bony pain. It feels sharp sometimes. And we, she had two or three things in her toolbox to pick out and go, when that happens, I’m going to try this. 

And so she went through her, we were getting through, you know, that first postpartum recovery. And she came in and sat down and said, I’m pregnant.” Which was like, congratulations. She was like, I know, but our rehab, like now I said, we’ll just shift it. Now we’re doing prenatal rehab. We’re going to finish your postpartum. We’re going to wrap it all up and do it together. Not a problem. Anyway, thing is, you know, her second is now a year old. So this has been, you know, some time has passed. She came in and she said, I just want to say that the second birth, which actually was a necessary c-section wasn’t planned. You know, nobody plans for it, but we plan tight, run loose. 

And so, you know, we talk about the stress of what kind of birth you want versus what might end up happening. And so that happened for her. She said, but I wasn’t afraid. I knew that I had prepared, you know, we did all the perennial stretching and everything to prepare for not tearing with a vaginal birth, she said, but when they listed the reasons and gave me the informed consent, I wasn’t afraid. I knew what was happening. And I started the prehab that I gave her for postpartum, like right away. 

And when she came in, within that first 30 days, she came in, we did imaging, we did all of the non-invasive things, and she was doing so well with tears in her eyes to say the biggest thing for her, she said, the biggest thing for me was I wasn’t afraid.

33:30 Dr. Kim Parker-Guerrero: You empowered her. You empowered her. Yeah.

33:02 Dr. Ginger Garner: And that’s a huge green flag for moms. She is not being afraid. She said, I tell all my friends now, if that’s one of the main things you can do is go find a pelvic PT or OT because they will help you know what it is, then you’re not afraid. You don’t have to be worried about tearing. If you do, you know what to do. And that was just like the biggest gift to hear about our profession. That it’s beyond just the technical stuff that we’re doing for people, you know, to not be afraid. Yeah.

33:34 Dr. Kim Parker-Guerrero: And one thing I’ve seen, you know, again, with the providers:OBGYN, the midwives. Again, in my medical desert, they really appreciate us all working together. I mean, you hear a lot of times about, well, somebody is being threatened because, you know, you’re kind of on our turf and, you know, PT shouldn’t do this or whatever. 

33:54 Dr. Ginger Garner: And all those turf wars. 

33:56 Dr. Kim Parker Guerrero: Yeah. And they really appreciate, because they know what their patients are going to get when they come to me, they know I’m going to have more time. And be able to look at everything, which is a little bit different than, you know, what their practice is focusing on. You’re pregnant, we delivered the baby and now, you know.

34:20 Dr. Ginger Garner: Yeah, they have an entirely different required scope from what we’re doing. And I think that’s important to impress upon people is that, you know, OBGYNs are trained to do so much amazing things and life-saving things and they’re trained surgeons. We are not. Yeah. We have a whole different skill set to look at the nuances of the musculoskeletal system. And how the musculoskeletal system is interacting with the endocrine system and other parts and pieces so that we can take a holistic approach that frees them up to do their job well. 

And so it’s very synergistic, you know, working with nurse midwives, urogynes, OBGYNs. And so that kind of is a good segue to talk about how, how we’ve, when I first mentioned that your individual voice can make a difference. Tell us about the bill that’s out there. Tell us about that movement that I know we’ve been working on for a couple of years now to bring all the professions together. So there’s not, you know, the OBGYNs are not fighting with the pelvic PTs or OTs. And so we have a movement to create harmony to create more synergy, and to make sure that no mom gets kind of left behind and that everyone gets the care they need. So tell me about that.

35:45 Dr. Kim Parker-Guerrero: So, yes, we started working a couple of years ago, the Academy of Public Health. With APTA, we were looking at some different issues and patient advocacy issues. And one of the things that came up and Ginger mentioned it, is with the fourth trimester task force. So we had a task force get together and they worked on looking at what was care, what’s lacking, what would be the best practice, how PTs could have a role in this. 

And it just happened that there was a legislator out of Washington that had wanted to have, or I think she’d had help me remember this Ginger. Cause it’s been, we’ve had several iterations of this, but she gave birth and then had some issues and was like, why don’t we have access to physical therapy? And so she had actually contacted someone at APTA. So we already right there had an advocate for us. [Huge.] 

So it just tied in with the work of the task force. And anytime you do a piece of legislation, and this was on the national level, you want to have a bipartisa support. And Ginger knows because she’s very legislatively astute, it’s hard on a lot of issues and especially now to have bipartisan agreement on legislation. And we’ve never had that problem with this piece of legislation. I’m really proud of our task force. The language and the information they provided was used by APTA and legislative assistants to introduce a bill in 2022. And it didn’t make it through to the final cut, not because there was opposition to it, but because it was just, as a lot of things got pushed to the side to, you know.

37:56 Dr. Ginger Garner: I remember when it was read, because we were all excited about it, when the notice came out, it got read on the floor of the house, I think in June. And then the war in Ukraine started. Yep. And that was it. And that was it. That was it. War took precedent over everything else, and then it got swept. But it was reintroduced.

38:15 Dr. Kim Parker-Guerrero: But yeah, so now it’s House Bill 2480, Optimizing Postpartum Care, I believe. I can’t remember the exact name of the bill, but so we worked with APTA again. We found two new, our Washington sponsor did not get reelected, so we found two new co-sponsors and we’ve had other people signing on as co-sponsors. And so it’s scheduled, it’s happening now, you know, and unfortunately, you know, right now, the whole focus is on funding the government shutdown. 

So I don’t know where this bill will go. But what I wanted to say real quick is, you know, for everyone on the call, if you’re a PT, go on to APTA’s advocacy website. If you have patients that have given birth or planning to give birth, you go on APTA’s advocacy website. You can go on there and plug in your information and it will, there’s an app also, but in the app, it will tell you who your legislator is. there’s already a script in there that will say here’s the bill name here’s the bill number and why you’re supporting it if you have a story about a patient or you are a patient that’s always great you know to share in this you know, email to your, to your legislator. 

But I even, you know, again, being in New Mexico, I reach out to, because they have their Washington staff, and then they have their New Mexico staff. So I’ve reached out to their New Mexico staff. And so when I’m asking my, like, because this is in the House, there’s not a Senate side. So when I’m asking my representative, to support our bills. I not only contact the Washington staff, I call her staff in Santa Fe and they’re great. So they have me on their list if there’s a question about physical therapy or about this postpartum bill or any of the bills that we have right now that are kind of PT specific, I’ve asked them to contact me. And so that gives us and our patients a seat at the table. 

And that’s what I always told people that are frustrated with government right now. And like, no, they don’t listen to me. There’s nothing I can do. Your one voice does make a difference. It really does. And if they hear from you as a practitioner, they hear from your patients, it brings a human face to that piece of legislation. And it kind of takes the, you know, cause they have to look at, it gets so into the weeds of how much is it going to cost and who’s this and who would oppose it and who would support it. But when we tell our stories and we tell, we share our patient stories, it just makes us stronger, our profession stronger, but it, it helps us advocate for our patients for better care and better access to care.

41:28 Dr. Ginger Garner: Yeah, thank you for that. So I’m gonna do a little summary statement on the whole piece of this. We have so many collective stories that we have shared because the stories that we have shared so far are the stories of thousands and more than just thousands, hundreds of thousands of women that need care right now. And more than that, because over 86% of women give birth, so we’re talking about millions. So what the bill would provide, because we don’t know where it’s going to go this year, but we do know we’re not going to stop. We’re not going to stop until it’s passed. So we’ll work hard to get it reintroduced next year. 

o what we do know is that the more people who contact their Congress members, the more likely it will be to get picked up. Because I believe the last time I looked at it, it had at least 18 co-sponsors. Y’all, that’s a huge deal. It’s not just one or two house members supporting this. It’s over a dozen. It’s nearing two dozen co-sponsors. That is significant in the house and it’s bipartisan. 

So what would the bill mandate? It would mandate access to that postpartum care that would start with prenatal screening so that every provider would understand what is necessary? What is indicated to refer someone and get that person to pelvic PT, which is incredible and doesn’t currently exist. So everyone knows a mom and most women become mothers and a lot of people become mothers. You know, someone that you love very much that deserves that kind of care, that deserves to be screened. Let’s just say it’s seven or eight screening items. 

I can’t remember what we had worked on on the task force, but let’s just say they’re looking at those screening items and they see three or four of the things that we’ve mentioned, that means they’ll get a referral. And right now it doesn’t exist. So I feel like I’m making a big plea, but we’re not asking for donations, actually. It’s not a commercial for a donation it is and we’re gonna put this in the show notes. There will be a very simple link in the show notes that will link to the bill. It will tell you what it’s about very simple in concept, just that it’s helping moms and people that give birth get the care that they need and the referral that they need. 

And all you have to do is shoot an email or a phone call, which is literally like two minutes of your time to say, I am your constituent and I care about moms or a person that’s given birth. Please support this bill. If they get 100, 200, 2000, 200,000 calls because you just follow the link and commit two minutes of your time.

44:26 Dr. Kim Parker-Guerrero: Right.

44:27 Dr. Ginger Garner: We have actually made a massive difference. And then we may come off of the statistical list as the country with the highest maternal mortality rate in the developed world.

44:42 Dr. Kim Parker-Guerrero: Right. And, you know, you may get the argument sometime, you know, like, okay, well, PT seeing them before their six week visit, you can’t treat depression, you can’t treat, you know, if they’re having excess bleeding or whatever. But that’s not the point. It’s that somebody has an eye and it’s focusing on that. And then we like Ginger, you’re saying we refer them to the appropriate person. Sooner rather than later. So those issues can be addressed to whoever scope of practice that is in.

45:10 Dr. Ginger Garner: Absolutely. And so early intervention and and a holistic comprehensive management that my friend and colleague, Dr. Joe Tata is very big in mental health. And we just finished our book last year on integrative and lifestyle medicine and PT. And we contributed a couple of chapters apart and together. And one of the ones that we wrote together was how much movement influences mental health and depression and anxiety. 

So, you know, there are so many tools that we have at our disposal, just not even talking about sleep, just talking about the old traditional thing people think PTs are responsible for, which is movement. Very encouraging that there’s such a strong evidence base that supports movement for mental health. We are excited to support the bill. We are excited to continue to support all the people out there giving birth. You guys deserve only the best care. And that early intervention is key. So check out the show notes so that you can make your voice be heard. And Kim, I just want to thank you so much for being on the show.

46:23 Dr. Kim Parker-Guerrero: Thank you for having me Ginger.

46:26 Dr. Ginger Garner: I appreciate it. Thank you. I’ve got one final fun question. Okay. What is the latest it could be song, it could be an album, it could be music, right? Like the latest book or the song that’s really or film that you’ve seen that you just really love?

46:43 Dr. Kim Parker-Guerrero: Oh my gosh. You stumped me on this. You totally stumped me on this.

46:51 Dr. Ginger Garner: Okay, well then I have a question.  Okay. I just watched Barbie movie for the first time. 

46: 58 Dr. Kim Parker-Guerrero It’s on my list. I haven’t watched it. 

47:01 Dr. Ginger Garner: Is it on your list? It just came out to stream. Was it fun? Okay. Yes. And I made my three sons sit down and watch it. Oh good. I heard it. Good. Good. It does address a lot of topics and it kind of segues into our, people listening to women in pain and women having issues. It’s a good message.

47:18 Dr. Kim Parker-Guerrero: Yeah. I have to watch that. It’s on my list. So yeah, anyway, but thank you so much for having me. 

47:25 Dr. Ginger Garner: Thank you. Thank you for being here. 

47:27 Dr. Kim Parker-Guerrero: Thanks to all your listeners. Bye bye.