Birth Doula Physical Therapists are a Thing and You Need One

February 27th, 2024

55 minute listen

With Dr. Amber Brown and Dr. J Michelle Martin

In this latest interview, Dr. Ginger Garner interviews the Pelvic PT Doula’s, Dr. Amber Brown and Dr. Joanne Michelle Martin. We get an inside view into an inspiring conversation, where they discuss their experiences as pelvic PT doulas and the benefits of combining physical therapy with doula care in supporting women’s health and maternal wellness.

They share insights on the challenges faced in the healthcare system, particularly in maternal care, and provide valuable information on advocating for proper care during pregnancy and childbirth.

Here are some of the key reasons birth doula PTs are something we need more of in our maternal health care:

The unique combination of pelvic PT and doula care
The opportunity to advocate for their patients
Some of the causes of declining maternal outcomes and how we can make a positive impact
What kind of providers exist in the healthcare world
Why you or someone you love may want the support of a PT doula

Don’t miss this insightful discussion on the intersection of physical therapy and doula care in women’s health and maternal wellness. You can watch below on YouTube or check out the podcast on your favorite platform!

Watch Birth Doula PTs on YouTube

Biography of Dr. Amber Brown

Dr. Amber Brown has a strong passion for the field of women’s health and financial wellness. As the founder and proprietor of Root Physical Therapy and Wellness, she has created a nurturing environment where individuals delve into the root causes of their health concerns. Additionally, she leads the Healthy and Wealthy Community, dedicated to providing invaluable insights on both health and wealth for healthcare providers, all without burnout.

Dr. Brown’s academic journey includes a Bachelor’s degree from Washington University in St. Louis, followed by a Doctorate in Physical Therapy from Tennessee State University. She further honed her expertise through a rigorous Women’s Health and Pelvic Health residency program at Texas Woman’s University and Baylor Institute for Rehabilitation. Currently pursuing her PhD at Texas Woman’s University, Dr. Brown continues to be at the forefront of cutting-edge research.

With a Doctorate in Physical Therapy and a Board-Certified Women’s Health Clinical Specialist designation, Dr. Brown’s primary areas of focus are pelvic floor dysfunction and maternal health. She wears multiple hats, serving as a birth doula, certified lymphedema therapist, health coach, and registered yoga teacher. Her contributions extend to academia, where she enriches the educational experience as a guest lecturer in various graduate programs and as a contributing faculty at the University of St. Augustine.

Beyond her clinical expertise, Dr. Brown is a co-founder of The Pelvic PT Doulas, an initiative that combines the principles of pelvic health with compassionate doula care.
Dr. Brown’s mission is not only about providing exceptional healthcare but also about illuminating the path to creating a legacy and generational wealth—a philosophy instilled in her by her parents. She emphasizes the importance of finding an equilibrium between a fulfilling career, robust health, and avoiding burnout.

Biography of Dr. Amber Brown

Dr. Juan Michelle Martin is a practicing clinician of over 13 years. A former collegiate and international volleyball player, Dr. Martin has a wealth of experience when it comes to understanding the complexities of the body. She is the owner of JMM Health Solutions, a concierge pelvic health practice providing in-person and virtual care for clients. Additionally, she is a birth doula and serves families to ensure good and healthy birth outcomes.

Dr. Martin has also worked for the last 3 years in a consulting capacity and has helped many healthcare practitioners transition their businesses into the virtual space, a transition that has been extremely beneficial for these practices in light of the COVID-19 pandemic. She enjoys helping entrepreneurs to meet their goals as well as mentoring students and professionals alike.

Dr. Martin is passionate about birth especially as it relates to the plight of minority women and the travesty that is the Black maternal mortality rate. Her goal is to continue to help black mothers within her community and beyond and to positively influence the businesses of other birth professionals so that they can do the same because we are stronger together!

Resources

Pelvic PT Doulas
IG Handles: @thepelvicptdoula AND @drgingergarner
Doula Training for Clinicians: https://www.thepelvicptdoulas.org/courses/doulatraining
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!

Transcript

0:00 Dr. Ginger Garner: Hi, everyone, and welcome back. I am here with two fantastic guests with similar kind of parallel experiences in their practices. And I’m just really excited to have them on the show today. So first, welcome, Dr. Amber Brown.

0:22Dr. Amber Brown: Hi.

0:24 Dr. Ginger Garner: Yay. And Dr. Joanne Michelle Martin.

0:28 Dr. J. Michelle Martin: Hey, how are you?

0:31 Dr. Ginger Garner: Oh, I’m good. I’m good, because I’m happy that you guys are here. So before I get started, I want to brag on you guys just a little bit. So hang with me, because I love to go over your bios. I think that also gives our listener just some insight into, A: just how much work goes into doing what you do, and your level of education and experience. And of course, before the show ends, they’ll also know where to find you too.

So starting out with Dr. Amber Brown. Dr. Brown is dedicated to women’s health and also financial wellness. And I love that combo, because I don’t think that we can have one without the other. [Exactly.] And there’s some kind of deep roots in that, I think, that hopefully we’ll uncover as we talk. But Dr. Brown founded Root Physical Therapy and Wellness. She is a doctor of physical therapy with a lot of experience in pelvic floor dysfunction and maternal health.

But here’s my favorite part. She also is in addition to being board certified in, in women’s health clinical specialist (WCS), she’s a birth doula, which I just love. And there’s so much work that goes into that. So, I’m doulas biggest fan. She is also a certified lymphedema therapist. And as someone with lymphedema, I say, oh my goodness, thank goodness that you exist. You’re also a health coach and a yoga teacher. And my first book was on therapeutic yoga. So hats off to you doing all those things. It’s fantastic.

She contributes in academia as well through guest lectures through being a faculty member at the University of St. Augustine. She’s a co-founder of the pelvic PT doulas. And she combines pelvic health with compassionate doula care. Her mission: promote a balanced approach to healthcare and wellness, emphasizing the avoidance of burnout while pursuing a fulfilling career. Which is an enigma for many of us, particularly women in healthcare and women in physical therapy, because there’s just so many, there’s so much pressure on us. And in her spare time, she’s working on her PhD at Texas Women’s University.

2:53 Dr. J. Michelle Martin: Just in her spare time.

2:56 Dr. Amber Brown: Hey, I still travel and sleep and, you know, enjoy eating.

3:00 Dr. Ginger Garner: Oh my goodness. All right. Let’s talk about Dr. J next. She is also a doctor of physical therapy with 16 years of experience specializing in orthopedics and pelvic PT. Which is, of course, I’m a little biased, but that’s my favorite thing too. She is also a birth and postpartum doula and a certified sex counselor. And we definitely need more of both of those in the world. [For sure.]

Yeah. She is the owner of JMM Health Solutions in the metro Atlanta area, focused on pelvic health. She is an adjunct professor within the DPT program at South College in Atlanta, and an instructor within the obstetrics courses for Academy of Pelvic Health. She is an evidence-based birth instructor and educator. And she is also an author, because she has spare time, too, apparently.

And those have been international pelvic and sexual health publications, texts, and in that kind of industry and vein. She’s a curator of Zero to Telehealth coaching program, which I want to know more about, which helps a lot of professionals implement telehealth in their practices. Which we were all kind of dumped into doing three years ago. She shares her expertise in many domains. American P.T. Association (APTA) is one of those. She served as a member of the Southeastern Telehealth Resource Center since 2019 and has just been helping medical and allied health care professionals within that region and beyond. So welcome. Welcome to you both. I’m so glad you’re here.

4:46 Dr. J. Michelle Martin: Thank you. Thank you.

4:48 Dr. Ginger Garner: So the first thing, this is my first question right out of the gate, because when I had my first, who will be 18 in December. Which that 18 years is just like fast, it’s gone. The concept of a doula was around, obviously, but I lived in an isolated area. There was no doula in the Tri-County area. There wasn’t enough of them. They weren’t easy to find. It was hard enough for me to just find a midwife that actually truly supported perineums and your birth plan, right?

And that’s when I started tracking birth outcomes and maternal health outcomes. So that’s almost 20 years ago. And as you guys already know, those outcomes are not great. And they’re actually getting worse. And I think our listener may not know that, that you would think with technology, et cetera, that these birth outcomes would be getting better. They’re not. We are in a steady descent and decline actually since the 60s, which is crazy. Totally crazy.

So I totally get why you guys are pelvic PTs and doulas, which I absolutely love. And if I was 20 years younger, I’d probably do the same thing. And, uh, but I feel like, you know, you feel like you run out of time at some, at a certain point. But, what motivated you to actually combine being a pelvic PT and then go get doula training on top of it? Because I think it’s just perfect.

6:28 Dr. Amber Brown: For me, my patients motivated me. So many people during pregnancy, when I was doing birth prep, which mind you, we could talk about it more. My birth prep now looks totally different than what it did before I was a birth doula. But when I was going through birth prep sessions with my clients, they’re like, “can’t you be by my side?”

And I don’t have kiddos. I’m like, no, I don’t know what goes on around, you know, like in the birth room, that’s not me, but they’re like “your presence, like your knowledge. I need that in that moment of, you know, whenever I’m going through labor.” And I was like, uh, I don’t know. But on the other side, when unfortunately people were just referred to me for postpartum, which of course these are two different categories of people.

They were like, why couldn’t you have been by my side? I went through so much and had so much trauma, and I wish you were by my side. So after about five, six years of practice and hearing this, of course, the pandemic hit. And that’s when both of us actually were in the same training. We didn’t plan it. And that’s really when it was boring. I was like, oh, well, let me see what I could do about this. It has made a world difference. So my patients influenced me.

7:40 Dr. J. Michelle Martin: I actually started supporting birth even prior to taking the training. I used to work for a hospital and worked in L and D, mother, baby, and the NICU. And the stuff that you would see, the way that I felt some days that it was such a struggle just to even get a nurse to write an order for patients that you knew should have been seen. And the general consensus was, but they’re pregnant. Or well, they just had a baby. What do you expect?

And it was just really, really defeating at times. And I’m like, people don’t, people don’t deserve this. Like we need to do more. And if I’m in the hospital and getting this much, you know, resistance, then my goodness. So I, I decided I had supported the births of some friends and then I had had other patients ask me Hey, would you would you want to be there? And I was like, yeah, sure. You know, I’ll be there to support you and whatnot.

And I started doing that. And I wondered, well, how much different? Because I was doing it from the perspective of making sure that they were calm, making sure that they were relaxed, making sure that, you know, especially positionally. I had a few of them that were going into birth with musculoskeletal issues, making sure that those things were acknowledged and they were protected in that way. And so then I was like, well, maybe I should kind of see what the doula trainings are like and some of the other things that they focused on.

Which like Amber said, really made a world of difference, especially when it came to educating them beforehand on some of the other non-clinical things. But I also think me being a foreigner helps a lot because birth, culturally, looks a lot different outside of the US than it does in the US. And unfortunately, even in some foreign countries, they get into a habit of, well, everything in America is great, so we should pattern things after them.

But I really wish that a lot of them would not and would stick to a lot of the cultural practices that they have, because it is completely different. Birth and immediate postpartum care are things that are definitely missing here.

10:00 Dr. Amber Brown: Absolutely. And I’ll definitely say even for J, if the listener stops and thinks about it, before I had my own private practice, I was a corporate outpatient. And so I was being required or waiting, this was before direct access. So I’d wait for referrals and only certain people, if you’re lucky enough, depending on your provider, you will refer to me versus J was also in acute, like she was actually on the labor delivery floor. So we’re coming with two different perspectives as physical therapists with what we were seeing.

10:31 Dr. Ginger Garner: Yeah, absolutely. I mean, that is huge. We could unpack that for the next hour.

10:38 Dr. Amber Brown: Yeah. Oh, I know.

10:41 Dr. Ginger Garner: Alone. And because I’ve had Rebecca Seagraves and Katherine Sylvester in previous weeks. Yeah, I think Dr. Seagraves podcast just dropped today. And that’s the beginning of a huge conversation that I noticed years and years ago, which then prompted me to pull together a group of international PTs to start looking at the outcomes on global maternal mortality. And then that led us to be able to present that work at World Congress in 2017, which was in South Africa.

And I learned so much from doing that little project, and being on that platform. And then so much being in that country appreciating and talking to the therapists from across the world, not just, you know, on the continent, right? To understand what they were missing, you know, inpatient versus outpatient, we talk about what we’re missing inpatient versus outpatient. And then I was flooded with all of these stories and also a lot of gratitude that we’re just bringing awareness to this issue. J what you were saying about honoring cultural traditions and kind of the social context of what goes on in other countries because that what you said just hit the nail on the head.

Following, you know, if you can even call it the culture of what we do in the United States, is not getting us anywhere. We are going backwards. We have less support. We have less cohesive communities. We have less…

12:31 Dr. Amber Brown and Dr. J Michelle Martin: We don’t have our village.

12:33 Dr. Ginger Garner: We don’t have a village anymore. And that is across the lifespan. But it’s particularly, I think, profound during birth when you want to have that community and village of support. And that’s what’s so beautiful about the practice of being a doula, is that you’re able to provide that village. And oh, I get upset just thinking about it. That’s such a beautiful thing that you’re able to provide, to provide that comfort for women, especially if they don’t have the family around to support them, too. Because in many ways, you become a family member doing that.

13:06 Dr. J. Michelle Martin: We essentially do. We’re at the birthday parties. We’re at the family events. We have, I mean, Amber and I could tell you a number of all the stories. We’re at the second births and the, you know, whatever the family’s got going on sometimes, you know, I’ve got kids too. So sometimes it might be just for a play date, you know, because you truly do become family. You do become a part of their unit.

13:33 Dr. Amber Brown: You were there during like one of the most vulnerable moments. you know, and you provided the support that they needed. Like, I just came back from, I’m in Dallas area, I just came back from Cleveland because I celebrated the first birthday of a virtual doula client, right? And so they’re like, please come out to the birthday. I’m like, I’ll be there. So you definitely develop that bond. And I want people to remember when it comes to birth, there’s a difference between birth doula and postpartum. But I’m just, I’ll put quotes in that, just a birth doula.

But even with that, I’m following people for the first year postpartum. I’m checking in with them because as we all know, things jam up, right? And so they have that person who was with them during pregnancy, during birth, And then also, I’m following, making sure, oh, we need to refer here. We need to do this. They just had that year round and beyond support.

14:29 Dr. Ginger Garner: It’s a model that I wish that it was inherently provided, let’s see, by the women and families decades and decades ago, but not anymore, I think, today. And it’s a model that If only we were able to provide that in the context of covered care of a standard of practice of care that we don’t currently have, you know, in the United States, that would be amazing. Because not everyone has access to, you know, having a doula and I’m sure we can talk about that too, you know, having access and how that looks, you know, as a continuum across, cause some people can afford it. Some people can’t, what does it look like to help people access it who can’t afford it? Um, which brings up the topic of being in private pay clinics too. I mean, I own one, I think Amber, you yours is hybrid. You’re hybrid. Okay. And J, how about you?

15:31 Dr. J. Michelle Martin: I’m completely private pay.

15:32 Dr. Ginger Garner: Completely private pay, yes. So we’re private pay here at my practice as well. And people often, I think there’s a misconception about what private pay is because, for example, the reason that I went into it is because insurance wasn’t paying me anything to work for people with chronic pain. So then I couldn’t legally see them because they were insured. I took insurance, therefore I can’t help them. And when you’re offering a specialized service for a particular pelvic health diagnosis, then your hands are tied.

And so it forced me out of the system. That was back in 2004, when I actually had to write letters to get out of insurance contracts. It was like pre-internet. So I think that, you know, if you’re listening and you’re wondering, huh, it’s private pay, does it mean I can’t access it? Does it mean it’s just too expensive to, you know, to access? The answer is no.

We, you know, we go into this in order to make it accessible, in order to make it affordable so that you can get the care that you need and your hands are not tied by an insurance company saying, Oh, you’re not allowed to do that. You’re not allowed to give them the care they actually deserve and want. And then the other positive thing about practicing the way that you do is you get to spend one-on-one, 100% of your time attending to their needs. And I think that’s a common misconception, too, is that, oh, I’ll go to a big system, and I’ll get the same level of care that I would at a private pay clinic. Go ahead, Amber. I know you’re going to say something.

17:15 Dr. Amber Brown: No, no, no. Again, this is my money side coming out, but I’ll limit that a little bit. I think also there’s a misconception. One, a lot of people don’t know what we do as physical therapists. And then if their only interaction with physical therapy has been, Oh, my grandma had a knee replacement and she had to go three times a week. There’s no way I could pay cash price three times a week. The difference is when we’re in private practice one, cause again, I came from corporate healthcare. The difference is our numbers are different. Like we’re not under a different system where it’s like, oh, you have to meet this quota. I have to see this many people, this many.

I got zinged because I was too efficient with my treatment, if that tells you something. Because we were supposed to see people for 4.6 visits and people were getting better in three visits in corporate. And I got zinged for that. So just because, you know, you’re under insurance doesn’t always mean that you’re going to really get the care you need.

Sometimes you’re a number. This is not a, by the way, I love my corporate colleagues. It is not their doing. It is the system we are in in health care in the US. I always put that out there. Someone has to do that. And so, unfortunately, because we are under a corporation and you have these numbers and quotas and everything to meet, providers get burned out. I had people follow me from corporate to my private practice and they’re like, your practice is so different now. I’m like, yeah, because we have that flexibility. That’s right.

18:43 Dr. J. Michelle Martin: The other thing is, is when you are able to, my evals, for example, I spent an hour and a half with my client. And if I don’t have someone booked behind them, I might take a little bit longer. just because. I have had clients who might have just come in, they’re like, listen, I don’t know if this is something that I can do consistently because of funds, but I at least would love to get evaluated.

And I would spend the extra time beyond the hour and a half if I can, just so that they get all they need and so that they know that they’ve been heard. It is really difficult to watch someone come in for something that hasn’t been diagnosed, when they’ve been ignored, they’ve been gaslit, you name it. And they’re now in a vulnerable state. And they’re in tears, either because of what’s going on with their specific concern, or because you’re the first person to have put all the things together and figured it out.

And they’re in tears. I’m not rushing you out. I want you to take your time. This is your moment. This is not for me. I’m just glad that I get to be on the journey with you. But this is about you. And I think the difference in the way that we work is we are able to do that for individuals, which is, again, as you both said, it’s not something that we see consistently or much at all in health care, traditional health care.

20:19 Dr. Amber Brown: And I also tell patients, don’t limit yourself. Many providers have complimentary consultation, if you will, right, where maybe they meet virtually to see if it’s something that they can work with you, you can get the pricing, and there’s a way to budget. Again, I’m not going to get into that, but don’t limit yourself because we don’t want people waiting. I often tell people, think about if you had an ankle injury, and you waited 18 years until your kids were out of the house.

Well, we’ll say 20, right? So 20 years until your kids were kind of out the house, and now you’re going to work on your ankle. Think about how much longer it’s going to take for that recovery, because we’ve developed a new pattern. So I often remind people, just ask. Ask for that support that you need, and we can see what we could do to work towards it. We have that flexibility in the cash world.

21:08 Dr. Ginger Garner: Absolutely. So that brings up another question, because when we are mentioning maternal outcomes declining, there’s also another really important factor in that, which is that for women and people of color giving birth. Those outcomes are worse, sometimes up to four times worse, meaning for people and women of color giving birth, your risk of dying is up to four times higher.

And that’s always been a touchstone for me since I started following birth outcomes, which I started to do when, of course, when I was pregnant, like, oh, let’s see what the outcomes are like, let’s look up the hospitals around. And I just was like, Oh my, that is so not acceptable. Seeing c-section rates rise, et cetera. So with that knowledge in hand, so as a listener now, you know, like these are what the statistics are saying, that our birth outcomes are getting worse.

And our patterns for referral, when you think about countries like France, for example, who are going to have a measure of postpartum pelvic PT covered, and we don’t. What are some of the things that you guys see in terms of women and people being medically gaslit? And here’s a classic example, and I hear this one all the time. And J, you had a good paraphrasing of the story that I hear a lot in practice, too.

Mom comes in the door, sits down, and I say, oh, how did you find me? Well, it wasn’t through a referral. It was through word of mouth of their friend. Or I actually had a mom whose daughter just gave birth. And this is what she said. I’m so glad my daughter just gave birth. Who knows how much longer I would have waited to address this leakage thing, because I just thought, that it was what should happen when I’m in my sixties, right?

That’s what happens to everybody else. That’s what should happen to me. And so that’s how she found out. But the classic story I hear is that mom comes in, sits down. How did you find me? It was a friend or a family member or reading online. And, she said, well, I went back for my six week, one single six week checkup, which is another can of worms to discuss, to open. And I asked for pelvic PT, but they said, I just had a baby and I don’t, I don’t really need it. So what have you guys heard? What are some of the typical things you heard? Just so our listener gets a feel for what they have a right to in terms of pelvic PT.

23:52 Dr. J. Michelle Martin: I want to plug first that when it comes to the stats, even though, according to media outlets and so on, it shows that the maternal mortality for black Americans is 3 to 5%. That is actually not across the board. In a lot of metropolitan areas, it is way worse. In the state of New York, research came out, I believe it was around 2019, sometime between 2018 and 2020, and the maternal mortality was as high as 12% in New York City.

You’ve got a lot of other metropolitan areas where it creeps up to just that amount. It’s really bad. The 3 to 5%, I think, really mask it. And then we get into nuances of society. Well, oh, it’s because Black women may not have childbirth education, or Black women are not smart, or all these different things. Well, the rate of maternal mortality for college-educated Black women is still 5.2 times higher than, let’s say, a white Caucasian high schooler.

So education has nothing to do with it. But that being said, when we look at some of the things that we hear, which is really awful, you know, it’s the same old, well, you had a baby, or you don’t need therapy, you just need to give your body time, it wasn’t that bad.

You know, but you had a vaginal delivery, as if, you know, just because someone had a vaginal delivery it somehow or another erases any particular type of trauma that they might have experienced during that process. Well, you know, it was a cesarean. You don’t have any, you won’t have any issues, any pelvic floor issues with a cesarean. Well, I did the surgery. It was great. Love when I hear that one.

24:43 Dr. Ginger Garner: You can see all our eyes. If you’re listening, whenever all our eyes getting bigger. Yeah.

24:50 Dr. Amber Brown: I remember when I was marketing way back when, and they were like, what do you do for C-section? I’m like, well, there’s so many things. We might work on the scar. They’re like, why would there be a scar? I do the surgery. Why would there be a scar? I did the surgery. You’re right. You’re right. I don’t know why.

26:04 Dr. J. Michelle Martin: I don’t know why. You know, it’s amazing the amount of things that you hear. And again, a lot of it just kind of revolves around, well, you’re a mother now. And I’m like, and what’s that supposed to mean?

So for all the listeners out there, if you’ve heard this, you’re definitely not alone. Definitely not alone. But yes, there is help. Yes, there is hope. No, you do not have to leak and wear liners and pads for the rest of your life. Yes, you can enjoy your time with your kids in the trampoline park, if that’s your fancy. There are options. And people need to be aware of that. The other thing I’ll oftentimes will hear is, I didn’t even know pelvic floor therapy was a thing.

26:54 Dr. Amber Brown: From providers as well. So some things I’ve heard, one person actually came in, she had a third degree tear, and she thought there was no help out there. She’s like, Oh yeah, my OB told me she had a third degree tear and she did fine. So she wasn’t even being referred because her, her provider said, Oh, you’re going to tear no matter what you’re going to tear.

Like, so, but luckily a friend referred her. I know we’re talking about pelvic floor, but I even think about mastitis. Cause I treat that. So many people have been like, Oh, just, just wean, go to formula. There’s no point. I’m like, There’s so many things that we can address that might be contributing to recurrent clogged milk ducts.

We can help with that. If that is your goal, we can help with that. And so, again, that’s something that’s common I hear.

I often tell people in my area, there are three type of providers. There’s one in the area who will be like, oh, you’re pregnant, congrats, go see Amber. There’s some who are like, oh, you’re pregnant, congrats. Oh, but you’re leaking, have some pain, go see Amber.

And then there’s others like, oh, you’re dragging your leg in the wheelchair. What do you expect? You’re pregnant. It’ll get better whenever you’re no longer pregnant and they’ll never refer out. And unfortunately for some people, it really depends on who your provider is.

28:14 Dr. Ginger Garner: Yeah.

28:17 Dr. Amber Brown: You know. Some could be lack of knowledge as far as the provider just doesn’t know. Because to be fair, they don’t get a lot in medical school about what we do for pelvic health.

28:24 Dr. Ginger Garner: They don’t.

28:25 Dr. Amber Brown: They don’t, which that’s a whole nother topic we could have on how we could change that component. So it might not be the provider just purposely not providing you the service that you need. They may not be aware of it.

28:29 Dr. Ginger Garner: Absolutely. I had a patient come in last week and thank goodness she was being proactive. She had gone to her GYN who said, oh, you have a grade two prolapse. She was like, huh, okay, what do I do about that? Oh, nothing, we’ll just wait and see.

And she thought, she said, I left the office and kind of her head tilted and was like, why would I wait? Why would I wait to do something about it? Same story. At the end of the week, I had another one who said, Oh, you know, we’re not going to do anything about it. We’ll wait until you need surgery. Then we’ll do something. Okay. Right. The exact opposite of what should happen. It should have been immediately, a referral.

So if you’re listening and you’ve gotten the same news, go see a pelvic PT. They absolutely, uh, can be helped by, by going to see them. You do not have to wait and you do not have to wait until you need surgery because there’s all kinds of things that can be done to conservatively treat it.

29:38 Dr. Amber Brown: And if you’ve had surgery and you weren’t referred, go to pelvic PT. We would never perform a surgery and not address things that may have contributed to the need for that surgery to begin with. We can help you not having to have a replacement or, you know, for them to repeat the surgery in a decade or so. Go to pelvic PT if you weren’t referred to one and you had surgery.

30:00 Dr. J. Michelle Martin: Or even things that might arise as a result of the surgery. Because if I see another hysterectomy that has not been referred for pelvic PT, I’m going to be like, my God. But I see them all the time. And then by the time they come in, they have this pain and they have this issue. And it’s like, well, I didn’t know that all this was going to happen because of a hysterectomy.

It can. And the least that should be done is that you should at least be evaluated so we can make sure that everything is okay.

30:29 Dr. Ginger Garner: Yeah. So this brings up a really important, this brings, brings up a really important point, which you’ve heard. As listeners, you’ve heard many of the reasons why you do need to see pelvic PT preconception, pelvic PT, prenatal pelvic PT. You don’t need to have an active problem because half of what we do at least is about prevention. And then that cuts down on the need for you to see us later or for as long postpartum. Obviously, when a hundred percent of people should be referred, any leakage, any, any prolapse, any heaviness, um, any kind of abdominal surgery at all. You need to come and, uh, see a pelvic PT.

But now let’s talk about the special nature of what combining pelvic PT and a doula is all about. Right. Like that just like up levels everything that we’re talking about. So what, I mean, I’ve heard your stories about that, that combination, but talk just a little bit about how unique that makes you guys in terms of what you’re able to offer.

31:35 Dr. Amber Brown: I will just start off by saying as physical therapists, we are nerds, which is a good thing. We love to provide so much information, but we provide information overload when we do birth prep. Because we’re like, oh, but then do this, and then maybe this, and you have this option, and then you have this. But in that moment, people are like, I was given so many options, I don’t know what to do.

And as pelvic PTs, who are also doulas, we have the privilege of understanding like, oh, when we hear these words, we know which stage of labor we’re in. We know what positioning we could get people in. When we know the actual how labor progresses, we’re like, we can be there when people become nervous.

It’s like, oh, remember belly breathe. I also talk about the elevator where no one else knows what we’re talking about. Like, go to your basement, you’re good. Talk about your pelvic floor. But we’re able to be calm because we have that knowledge. And I say this too, because for those who don’t know, the doulas, being a doula is unregulated.

Technically, you don’t have to go through a training to be a doula. That’s not saying anything bad, but that’s just saying there are people who go through extra training versus not. So we went through extra training and we have the knowledge about the human body in our profession as physical therapists. And so we have a different kind of understanding of how we can support people without overwhelm.

So if you’re a PT out there who happens to be listening, I do think it’s a big…you provide better service if you fully understand labor, which that often is not discussed in our PT programs. So fully understanding that I think can help remove the system, the education or information overload that we sometimes give our patients, which can just lead to increased stress in that moment of need. So I think with combining that, it really makes us more efficient with it. Jay, what do you say?

33:31 Dr. J. Michelle Martin: I agree with that. And I also wanted to add that as a clinician, we, especially as pelvic PTs, we understand a lot. We understand the musculoskeletal system quite well. A lot of the times your OB may be very unaware that you had a history prior to pregnancy. You might have had back pain. You might have had lupus. You might have switched OBs. So this might not even have been the OB you saw with a previous pregnancy, right?

Then, you know, most people are going to make the assumption all on their own. Well, I’m pregnant. So those things don’t have any bearing on this. So oftentimes things are not disclosed. So your patient has a history. And a lot of the times, those things, whether medical or musculoskeletal, can influence and impact not only your pregnancy, but your delivery. So as clinicians, we understand that, and we understand how to manage those things, along with things that would be normally progressing during labor.

As a doula, you are very well versed in the biopsychosocial to the extent of especially the psychosocial part. You understand people, you understand how to read a room, which unfortunately a lot of clinicians don’t apparently know how to. You understand how to read a room. You understand when things are necessary. So it’s not enough to just have the knowledge, but because you are very versed in the process, in the flow, in the things that can halt labor, in the things that would encourage it to continue. Because you’re very well versed in that, you understand the time and the place for things. But you also are an advocate.

I tell people all the time, you cannot be a doula if you do not want to advocate for people. You cannot be a doula if you cannot get into a delivery room and stand up for the person or the family that you are serving. And it’s not about being contentious. It’s not about picking a fight. It’s not a we against the system type of thing. It is a your job in that moment is to serve that individual or that family. That is the one thing. You got one job.

And so you go in there with everything that you have. You go in there to ensure that that process is as smooth as possible. Cause we can only control so much at the end of the day, but you go in there making sure that all the controllables are accounted for. And that’s, so now if we can merge those two things. That clinical hat, and just that, that true psychosocial and advocacy aspect, you are a diamond.

36:22 Dr. Amber Brown: I often, if we give an example, I think about for advocacy, because I know some people are like, I’m not going to go and say, stop everything right now, listen to me. Something as simple, and I put those again in quotes, as me sometimes asking my patients, This is immediately fourth stage of labor, like the placenta has not been, you know, detached yet.

I could see, oh, they’re looking to see if there’s any tears, and I might see them getting ready for the stitches. I might ask my client, did you, did you want stitches? And then I’ll remind them because we had that conversation ahead of time where they’re like, oh, what degree of tear did I have? Like, they know to ask these questions. And then maybe it’s the first degree. They’re like, do I need stitches? Well, no. We just thought you might want to.

Oh, well then I don’t, right? I advocated because I just simply, they’re, you know, they’re happy, they’re holding the little one. I’m still watching what’s going on with my client. And I simply ask, did you want stitches? You know, or I see a big one that people talk about. This is not for like to cause a debate or anything, but often I hear people talk about epidurals and Pitocin.

Again, with us understanding, If, and when it’s medically necessary for certain things, we’re able to provide our clients with the support because they hear all the time again, social media have a love hate relationship with it. But the things that go viral people being able to go on, like, I had an unmedicated vaginal birth. It’s a badge of honor. And that is great. I’ve supported many people unmedicated and I’ve supported many people with an epidural with no tears. Right. Because we practice ahead of time.

But there are times when I’m like, we need to be able to support you. And if this is what your body needs because you’re tired and you still need to push, maybe. You know, and then even Pitocin, granted, we try to avoid infections, but sometimes there’s a medical reason. And I don’t want us scaring people thinking if you have a Pitocin, if you get Pitocin, you’re going to have a C-section. That’s not the case. And that’s why we can, again, combine those two clinical reasoning and being able to advocate with and for our patients. It’s going to be a key part.

38:34 Dr. J. Michelle Martin: Yeah, I think in the hospitals too, just real quick, you know, it’s kind of like when you go into a doctor’s office, they only got so much time, right? They’re working with what they’ve got. A lot of the times people are being talked at, not talked to. And when you are in the midst of a contraction, And your brain is focused on that. And somebody is a level. So let’s go through, let’s make sure we get you admitted. And what’s your address again?

Meanwhile, all these things, and they don’t have the bandwidth, right? You need somebody that can help there. Or when people will we’re going to do this? Well, hold on. Not we’re going to do. You need to ask and you’d ask your client, is that something that you’re amenable to? Do you understand what that is? Let me help you understand that. So you are there to clarify, you are there, you know, you’re truly supporting this person, not only in the physical, but you’re making sure that they are aware of all that’s happening.

39:41 Dr. Ginger Garner: Yeah. And what it comes down to is, when we step back to the 40,000 foot view, because right when you’re describing, you know, the intervention and being right there, as a mom of three, it just, it takes me straight back to being there now. And, and I was prepared, right? But you still feel that overwhelm. And unless you have an advocate, one word comes to mind. It’s fear. Like, oh, they, whatever they say, they must know better than me because they’re in here doing it.

40:12 Dr. Amber Brown: They wouldn’t say this if I don’t need it.

40:14 Dr. Ginger Garner: Correct. Right. So then the default node begins to accept any and all intervention. Which in itself, we know the more intervention there is, the higher the risk of complication, just going into a hospital. you have a higher risk of complication because we’re very interventional, you know, in the United States. Which we know is not a good thing, actually.

When we need the care, we need the care. But doulas, midwives are the experts, you know, they are the experts in supporting birth, um, no matter what that birth looks like, um, until it reaches a surgical point. And then of course we have, we have trained surgeons for that.

40:54 Dr. Amber Brown: Um, and I think that I would say there are some, um, I’ll also say I have worked with some amazing OBs, very hands-off. I’ve worked with some who face up hospital policy. Of course I won’t say where, but hospital policy, you can’t do a delayed cord clamping. We’re having a talk. Oh look, the time has passed! We can now… Cut the cord, it’s been a while.

You know, so there have been some amazing OBs out there as well, but you have to be able to know the right questions to ask and to see what they’re actually, how, like, do they truly support a VBAC? Do they truly support you going as long as you naturally need to go as far as gestation? If you go past 40, what is the hospital policy? What is your physician’s policy? You know, so if you do decide to go with an OB, make sure you truly understand which questions to ask to see if they’ll be able to support the birth you’re desiring.

41:43 Dr. Ginger Garner: Absolutely. And I know there, um, you guys may have very specific resources on that. I wrote a few blogs years ago when I was teaching birth prep classes, through continuing ed providers. To PTs a long time ago on how to interview both your provider and your hospital. And I think that’s, that’s, you know, we’re all like on board with that you actually have to ask those.

They’re not that difficult questions, but they are hard enough that if the answer you get back isn’t the one that, you know, is open to listening to you as a person, that’s your easy red flag. You’re like, Oh, maybe, maybe that provider is not for me, or maybe that facility, you know, is not for me. So that’s a really important take home point is to make sure that you’re interviewing your hospital, and your provider. So that whatever kind of birth you’re seeking will be well supported.

42:45 Dr. Amber Brown: and Doulas can help with that.

42:46 Dr. J. Michelle Martin: Yeah I think really quick just to plug. A lot of hospitals, a lot of hospitals within the U.S. have closed down in recent years. Then the other thing that’s happening is a lot of hospitals are closing their maternity wards or departments and that’s going to prevent an even larger problem and it’s not one that the powers that be are talking about.

It’s being talked about at the grassroots and community level by the doulas and the midwives and, you know, those people who are boots on the ground and seeing what’s going on. But we’re not talking about how this is going to affect birth on a larger scale, where we have, you know, the remaining hospitals in metropolitan areas now are overloaded, right? We already have a nursing shortage. So there’s that. We already have a situation where persons might be in labor, but the L&E department may be completely full.

So now they’re in a waiting room. You’ve got people in triage and waiting rooms, very uncomfortable, no sort of care, proper care, all of these different things, and how there’s still a lot of states. There are only 31 states in the U.S. currently that have legalized home birth. And even though we know for non-high-risk pregnancies that this is a very safe option, there’s still some states that are dragging. And all these things are contributing to that overall maternal mortality problem that we have. So those are things that need to be mentioned out there and talked about more within our communities and within advocacy spaces.

44:32 Dr. Ginger Garner: Yeah, it helps us be aware. In general, those of us operating in the birth space, which includes people who are pregnant, you’re in that birth space too. To just be aware of reaching out and looking at what your facility options are. For example, in our area, we had a birth center that couldn’t make it and had to close down. The one in the next town over in Chapel Hill, the same thing had happened there. And there are all kinds of issues that swirl around that. We could do a part two on policy and advocacy.

45:05 Dr. Amber Brown: We might need to, because there’s so much.

45:08 Dr. Ginger Garner: I think we should, actually, because that is what will change things, so that when you’re out there looking for a hospital and a provider, that you don’t bump up against these realities that we’re talking about. So we will have to do that. We’ll talk about that. So, gosh. Because we could do part two right now.

We could just keep going, but I want to give you guys the chance to kind of wrap up, you know, kind of into a little nutshell. What you feel like working together as PT doulas, um, is, is giving you for a vision and a mission. Like, I’d love to hear that in a nutshell. I’d love to, I know we talked about the importance of embracing things that we might not you know. Be completely comfortable discussing or embracing the not knowing, you know, of realizing we don’t all know everything at all points in time and that it’s important to reach out to your, to your village and, and to create that community.

So that’s kind of a two part thing. And then I’ve got one more question left, but we’ll start with that mission vision and, you know, us all being comfortable with the not knowing.

46:32 Dr. J. Michelle Martin: I think as I think, you know, um, for us forming the pelvic PT doulas, we know we can’t do it alone. Right. I’m one person. Amber’s one person we’re in different states and we see the landscape of maternal healthcare, pelvic healthcare, all the things. And so for us, our vision was to start creating more pelvic PT doulas.

Start creating individuals who can get out there in their communities and make a difference, because as one person we can only do so much, but when we band together with others, if we can spread that message far and wide and have other people now continuing to do that work.

Now we can reach more people, we can touch more lives, and that’s really what it’s about. Like, how do we get more people the help they need? How do we impact communities and births and make a difference? And so for us, that was huge.

47:31 Dr. Amber Brown: And we’re building our village, right? So we have had people where they are the only PT, and now the only PT who’s also a birth doula, within like 120 miles, right? So they’re the lone person. And they’re like, I don’t have any mentorship. We have a village. We have the support. We speak the same language. We know how to be able to help everyone, really.

And so just like J said, we’re growing and we want more people involved. And just because, as we mentioned before, we have a training, we’ve had people go through a training who aren’t actively at first. But they understand that they could be a backup.

They understand that they can still have that support. And so we talk about that in the course about how we can incorporate it. So we want people to, as I mentioned at the beginning, not burn out. We help people not burn out within this field so that they can have that longevity and provide more support for people a longer time.

48:29 Dr. J. Michelle Martin: So education, mentorship, all the support that you would need as a doula in this space, as a clinician in this space. You know, business support, how, how do I grow? Because at the end of the day, too, people still got to eat. So how do I, how do I make this happen?

Right. And so we, we focus on all of those things as a complete package to making sure that, you know, you’re not just going to peter out as you get out there into, into the field, the communities to do work that you can thrive and be existing for a long time.

49:07 Dr. Ginger Garner: And for our listeners who may be coming to understand the benefits of both pelvic PTs and doulas, there is another option, of course. That is searching for pelvic PTs who are trained as doulas. Because I think that’s an incredible, powerful combination. That was always, that was really something that I was passionate about when, you know, when my kids were little, but it was also, my kids were little, there’s a lot to do, you know?

So I’m just really glad to see you guys, you know, haven’t taken such an amazing concept. That has existed in the hearts of lots of us that are either mothers or pelvic PTs in general, or we love someone who’s a mom, and you just want to see moms better supported and women giving birth better supported. So just thank you for doing the work you’re doing. Thank you for the mission that you have.

And the last question I actually had was, well, it’s two. One’s fun, and one is more serious. The more serious one is please tell our listeners where they can find you. Maybe Instagram and your website would be fantastic, or any other resources you have. And then I have one last fun question.

50:23 Dr. J. Michelle Martin: Website, thepelvicptdoulas.org. Instagram, pelvicptdoulas. And you can always email us at info at the pelvic PT doulas.org, um, for any information that you want with regards to upcoming courses, mentorship, anything of the sort.

50:41 Dr. Ginger Garner: And do you guys have a registry there? People who have been through the training to help find people.

50:48 Dr. Amber Brown: We’re compiling it. So by the end of this year, we’ll be able, cause we’ve been doing this for a couple of years now. So we have a good number of people throughout the U.S. So, we’ll have it by the end of year.

50:58 Dr. Ginger Garner: Fantastic. Thank you. And we’ll have those links for you guys for the listeners in the show notes. And my final question is, what book are you reading? That’s just totally for fun, or maybe a new album that you’re listening to. That’s, that’s for fun. Yeah.

51:17 Dr. J. Michelle Martin: Hmm. Book that I’m reading. I’m currently reading a book called Living with Intensity, which I find reading fun. It’s, it’s maybe not as fun, but it’s about, you know, parenting gifted children. And I’ve got two who are completely different personalities. So it’s interesting. But I just did an audio book called Saving Nora. It had 1075 chapters. But it took me four weeks to get through. But God, it was amazing. Yeah.

50:50 Dr. Ginger Garner: So thank you. All right. Amber, what about you?

51:55 Dr. Amber Brown: I‘m not currently reading because I’m working on my Ph.D. and my reading from my articles. So those are fun. I do enjoy reading, but just not this moment. It varies. Depends on my mood as far as music goes. I am a neo-soul kind of person. So I listen to songs even back in the 90s. Depending on your age, if you’re listening, I know that sounds like forever and a day, but those are my childhood songs, you know, 90s, early 2000s. So that’s really what I’m stuck with right now, remembering my childhood.

52:30 Dr. Ginger Garner: That’s a good thing. That’s a good thing. Well, thank you. Thank you both so much. Thank you, Amber. Thank you, Jay, for being on today. And I can’t wait for people to find you guys and learn more.

52:45 Dr. J. and Dr. Amber: Thank you. Thanks for having us.