Pelvic Floor Health with Rachel Schacht DPT and The Importance of Comprehensive Care

Julie Pernikoff: Hi, Rachel, and welcome. It's

Rachel Schacht: Thank you so much for having me. So excited to be here.

Julie Pernikoff: so great to have you. This is Rachel Schacht and everyone, welcome to Into Motherhood. Rachel and I have known each other for a very long time. Like really long time. I think, I think, like over yeah, 20 years.

Rachel Schacht: Like probably twenty twenty. Yeah.

Julie Pernikoff: Probably over 20 years. Right.

Rachel Schacht: I think probably o yeah, I think probably over twenty, which is really you can't say that a lot of people these days. Like it's it's really

Julie Pernikoff: Really crazy. That's so cool. my gosh. I know. So we were in NCSY together. And I'm originally from Ohio. So we were in Central East and Rachel's from Detroit. And yeah, we started NCSY when we were really little. Like I I was really young for sure. Yeah, like literally like 10.

Rachel Schacht: Yeah, so definitely at least twenty plus years ago.

Julie Pernikoff: Yeah, it was really fun. It was a really good time. It was actually amazing. Shout out to

Rachel Schacht: The best times ever. Thanks.

Julie Pernikoff: Central East NCSY. Amazing.

Rachel Schacht: Sally.

Julie Pernikoff: Amazing Sally. My own little introduction to Rachel is that Rachel is so much fun. It's like so much fun, so talented. I think that you did dance. Do I remember that correctly? Yes. Okay.

Rachel Schacht: Yes, I danced. Yeah, my whole life. Mm-hmm.

Julie Pernikoff: Yeah, Rachel's very talented in the dance arena. and then now as adults, I'm getting to know you as this really like skilled, talented, well versed in physical therapy and specifically in pelvic floor at this point. So I'm really excited to talk to you about this. this is great. I'm gonna jump in and read your bio, okay? Rachel Schacht is a doctor of physical therapy with specialized training in pelvic floor physical therapy. She lives in Sharon, Massachusetts with her husband and two kids. And Rachel has experienced treating a diverse patient population, including pelvic health, orthopedics, post-surgical recovery, and geriatrics. She has always been passionate about human anatomy and exercise science, which serves as the driving force behind the desire to help people overcome their health challenges through movement. Rachel, welcome to Into Motherhood. That was awesome.

Rachel Schacht: Thanks, Julie.

Julie Pernikoff: talk to us about your journey

Rachel Schacht: Totally. So we can start with like the credentials that are just like the sort of the the basics. So going to PT school, it's a three year like doctorate program that's post grad, post undergrad. once you finish that, then you can opt in to to take pelvic floor specific training. So there are A few different avenues you can pursue in terms of like companies that offer the clinical training. There are two big companies. the APTA, which is the which is like a they have a lot of courses to offer, and also something called Herman and Wallace. either way, there are different tracks that you can take. You have to basically, in terms of both of those organizations, there is level one pelvic floor, which you need to take. And that is what you need to take in order to start treating patients. So right, you you you've you've gone through PT school, you've taken your your national board certification past that, then you, you know, then you can take the you can do you can take the pelvic floor lit level one certification and then you can start treating patients Monday. So that is what I did. I the other certifications I have are in orthopedics, different sort of like manual techniques or manual therapies, treatments, dry needling. I've taken a few courses for that. But there

Julie Pernikoff: Well.

Rachel Schacht: are other trainings in the pelvic floor umbrella that you can take for treating male patients, for treating complex patients. Oftentimes for me, for example, I've I've learned sort of like a lot of the stuff on the job. So it's not like I'm like seeing patience and like guessing, but in having I I have a I think I that I I have a very unique work team that we have lots of time for collaboration, complex case discussion, working together, trying, you know, honestly trying things on each other and teaching each other things. because you all you need is that like is that level one. So I don't have the formal male or complex training, but I I mean I don't treat male patients, but I certainly treat more complex cases.

Julie Pernikoff: Mm-hmm.

Rachel Schacht: so it really is just the level one that you need. There are also other more formal pelvic floor certifications that you can go through and there's more testing, but that is not required to do this job.

Julie Pernikoff: Okay. And I I did recently discover this and I want to clarify it on camera also. O Ts can become pelvic four therapists as well. Okay.

Rachel Schacht: Absolutely. So they go through a lot of these courses are offered to NPs, PTs, OTs. I'm probably

Julie Pernikoff: Okay.

Rachel Schacht: someone in there, but but certainly I mean, I think that in if we're talking about OT versus PT, schooling is similar, but it's also very different. I mean, they don't have the gross motor my OTs are gonna come for me, including my sister. But The gross motor training, the is just in terms of orthopedics is a little bit different. I think OT touches on a lot of things, but PT will go more into like lower extremity function and and and that sort of thing, which is really important for this work. So I think that OTs in this line of work have to work a lot harder to to to get up to speed on those. types of things. because again, we're treating not just the pelvic floor. We're looking beyond that and seeing, you know, your lower extremity function, your your deep core function. So it's just touched on differently and potentially less in OT school versus PT school. So

Julie Pernikoff: Mm-hmm, uh-huh.

Rachel Schacht: that can be challenging for OTs, but there are plenty of extremely, extremely skilled OT like pelvic floor OTs in this field. So it's

Julie Pernikoff: Yeah. Yeah.

Rachel Schacht: they give a lot more than we than we do in certain areas. So yeah.

Julie Pernikoff: Okay. Yeah. I and it's and it's it's okay if you're if anyone comes for you or not. Like it's it's

Rachel Schacht: Yeah.

Julie Pernikoff: it we're here for some transparency, so it's okay. And they are welcome to come on and talk from their perspective. So we want to hear from

Rachel Schacht: Totally. Totally.

Julie Pernikoff: you now. thank you so much for sharing all that. That was really, really helpful. to know also just like the two the two big schoolings you said, A P T A.

Rachel Schacht: Yeah, there's the APTA and then Herman and Wellness. These are two

Julie Pernikoff: Then we're going to walls. Okay.

Rachel Schacht: organizations that offer like continuing education.

Julie Pernikoff: So that might be something someone would ask potentially if they're like betting someone. Okay. Okay.

Rachel Schacht: Absolutely. Yeah. Yeah, you could say like what certifications do you have? Just curious. Yeah.

Julie Pernikoff: Yeah. Okay. can you tell us where you worked before and then where you are now. Yes, thank you.

Rachel Schacht: Totally. Totally. So after so I went to PT school in at Hunter College in New York City. finished there and then moved to Boston once I got married to my husband and then started working at a at Bay State physical therapy, which is a a large chain in in the Bay State area. So like on the East Coast. I worked in like outpatient orthopedics. Where, you know, it's sort of like the typical like run-of-the-mill PT practice that you can envision. an insurance-based large operation where there's 20 tables in a big gym area and you've got a few physical therapists running around, treating a few patients at a at a time, kind of jumping from table to table, with machines and and and things like that. So that's where I worked for almost five years and loved it. became a very well-rounded PT because I was, you know, we we see, you know, patients who are post-operative, we see patients who have an ankle injury, an a knee dysfunction, hip surgery, spine surgery, concussion, you know, neck pain, arm shoulder and arm dysfunction. So there's a lot like we're really looking at we're s we're seeing everything in this setting. so to have that To have to have that experience and then move into pelvic floor PT was, I thought was critical to my like evaluative process and also treatment. So to kind of taking a lot of what I learned working in that setting, you know, applying it in pelvic floor PT is has been amazing. the reason I moved, I mean, in school we had this hour, hour long lecture. it was so interesting to me. I didn't even know that it really existed. And I was just like super intrigued. but just never sort of had the confidence to admit, like, I can do this. I was just like, this is so cool for someone else. Like, how cool is this? But I'm just gonna like do the classic sort of outpatient ortho thing. then I got pregnant and then l just became a little bit more educated and I was just like, Okay, I gotta do this. Put myself through the through the training. It was like a weekend in Ohio. and then came back and started seeing patients through a public floor lens. I got a lot of pushback from the higher ups in the company. And just logistically in the clinic, it was really hard to make work. Cause again, it is a really private, intimate thing. You want to create that atmosphere for the patients. It was, it was not, it just didn't work well. So for that reason, I was starting to kind of look and just kind of like look at jobs. And a good friend sent me this listing and was like, this looks amazing for you. You should you should jump on it. And I did. And this, so that's where I'm working now. It's a place called Mom Life Health and Wellness. We are a pelvic floor PT clinic. we see male and female patients. we are out of network, so private pay. and we spend a lot of time with patients. We spend like an hour with with each patient. and it's really, really, really good care. I think in a place the first place I worked, it was hard to give sort of next level quality care because of the time constraint and the billing pressure. You know, you have to really try to bill for these things and you want to be able to do it was just you know, insurance unfortunately kind of dictated a lot of what we did.

Julie Pernikoff: Mm-hmm.

Rachel Schacht: whereas in this field, we can sit and talk for an hour with a patient without laying a hand on them. And that is if that is what we think is the best for that for that hour, we're doing that. And we're not

Julie Pernikoff: Yeah.

Rachel Schacht: bound by By the expectations of the insurance. So it's really, it there's a lot of pros. Obviously, you know, it can be financially challenging for a lot of people. It's not feasible for everyone,

Julie Pernikoff: Yeah.

Rachel Schacht: but it is well worth your money. I think, you know, for someone who's interested and just and doesn't know, I think trying an insurance-based public floor PT and seeing if you can get something out of it. That's totally worth it. It doesn't mean you, you know, you shouldn't go in that direction. But if you feel like you've tried things and it hasn't stuck, or it's just you feel like they haven't gotten to the root of the problem, I would explore a private pay option where they're looking at you and spending time with you. We're just dedicated. We're, we're really, we're dedicated to solving the problem, being super communicative, taking the time to do that. patients get better. They do. So it's it's

Julie Pernikoff: That's

Rachel Schacht: really it's really great. Yeah. So

Julie Pernikoff: amazing wow well thank you for thank you for that thank you for that there's a couple of things that you had said to me in our in our pre-conversation that really stood out that I wanted you to just like touch on for a moment as like to frame the conversation. So there were a couple there were a couple phrases. what's normal versus what's common? What should we live with versus what we

Rachel Schacht: Back to the

Julie Pernikoff: should work on? And do we have to live like X, Y, and Z? Those were like three separate phrases, but I feel like they're a similar theme.

Rachel Schacht: Yeah.

Julie Pernikoff: What are your thoughts?

Rachel Schacht: So for patients, friends, people who I talk to about pelvic floor symptoms, I always preface if it is, if the concern is something pelvic floor oriented or orthopaedically, you know, or ortho oriented, I'm having a conversation with people about what is normal versus common. So I, you know, people will say all the time, listen, I've had a baby or I've had an injury. Or I've been through this in my life, and you know, it's pretty normal to to pee when I laugh, or I've had a BB, so it's really normal to have heaviness or you know, X, Y, and Z. where and I I'm I'm quick to stop them to to correct them in terms of the language. It's not normal to have urinary leakage, to have fecal incontinence, to have pelvic floor heaviness. It is something that's very common. In different stages of life. So it's really, and the reason why it's important and that I stress like that like definition specifically, is because something that's normal is something that you should be okay living with versus something that's common. So to understand that these symptoms, while they're common, they're not normal, meaning you shouldn't have to live with them. There are interventions. you know, clinical treatments, you know, such as public floor PT that you can implement and practice, you know, that that's a that's huge. You shouldn't have to live with this type of thing. So that's

Julie Pernikoff: Yeah.

Rachel Schacht: that's why I clarify that because I'm like, no, no, no, it's yeah, while it's common, it's not something you need to to live with. So that's really important here.

Julie Pernikoff: Wow. Do you find that c like cli patients, clients find that to be very empowering? Are they like shaken by it?

Rachel Schacht: Yes, I think so. I think they're like and I think it like re it it encourages them and sort of reinforces the fact that like there is what we can do about this. You don't have to live with it. Like we can help you. Like these interventions work, you know, with a thorough enough evaluation. We can get in there, give you individualized treatment that will hopefully resolve this the symptom, the issue, the dysfunction. So that's important to

Julie Pernikoff: Yeah. Absolutely.

Rachel Schacht: yeah, it's important to explain.

Julie Pernikoff: Yeah. Yeah. Great. Sh do you is there anything else you want to say on those th or maybe you'll also like weave it in, but if there's anything else that comes to mind before I jump in.

Rachel Schacht: Totally. We can go on to the next thing. Yeah.

Julie Pernikoff: All right, let's do it. So we broke up our conversation in a couple different in a couple different like topics.

Rachel Schacht: we discussed talking about pelvic floor PT and interventions that we do into like sort of the lifespan. So we talked about you know, injury based or sort of pre-pregnancy, if you will, dysfunction. And then we talked about perinatal dysfunction, which we include it. We talked about pregnancy, sort of postpartum and postmenopausal,

Julie Pernikoff: Then like beyond.

Rachel Schacht: like perimenopausal and postmenopausal. So sort of like those, really those like four stages.

Julie Pernikoff: Yeah. Awesome. And then now we're gonna we'll delve into them.

Rachel Schacht: Great.

Julie Pernikoff: So starting with pre-pregnancy, and I'm really learning along like I'm learning along with our audience here. There's some things that I know some, you know, some a little bit more about and other things less. So I really I'm gonna just kind of bring up the topics and then we'll delve into them and just take us with you, Rach.

Rachel Schacht: Absolutely.

Julie Pernikoff: so we've got tampon pain. Maybe we'll start with that tampon pain and then we'll move into, you know, pre intimacy and intimacy wellness. But talk to me about that. What what yeah.

Rachel Schacht: Yeah, I mean we can absolutely. So there's a lot of people who come to me who are who have not been pregnant, who are, you know, who who haven't gone through sort of this perinatal phase in their life, who are here, athletes, non-athletes, people experiencing chronic pain, or dysfunction post injury. and a lot of what we're do a lot of what we see, at least in our clinic, is you know, pain driven diagnoses. So chronic pain, whether it's chronic pelvic pain, pain with penetration, which can which commonly includes like pain with tampon use, pain with any sort of penetration, whether it's intercourse or not. so there's a lot that we do with that. I mean the treatment can be in terms of something that is more chronic what I try to explain to patients coming in because they're often like, okay, like how long is this gonna take? like what are we looking at here? The chronicity of the symptoms often determine how long we're spending with with the patient in terms of the intervention. It doesn't mean

Julie Pernikoff: Uh-huh.

Rachel Schacht: that I need to be with you for a year or more. It's just you might need to implement these things independently for months. plus whatever that means. So, you know, we're we're the the common treatments, and I'm just kind of giving a a quick sort of like overview of this. It's more often more complicated and more complex depending on what's going on. But for pain with penetration, whether it's tampon use, intercourse, et cetera, we're working on desensitizing the vaginal opening in the vagina itself and not spasming And contracting with penetration. So oftentimes, you know, dilator therapy, pelvic wand use, desensitization of the area is something that we're working with patients on alongside them. So if people know anything about dilators and you're given maybe you're maybe given the advice by a physical therapist to start using dilators, it really is hard to know how to do this. what to do, just sort of the prescription for dilator use without someone holding your hand literally and and helping you doing to do that. So people come in with the dilators that I tell them to buy, and we're working together to desensitize the area and to work on the muscles in the vagina of the pelvic floor muscles that surround the vaginal canal. to relax with penetration. So that is the that is in a nutshell the treatment for penetrative pain. So dilators

Julie Pernikoff: Mm-hmm. Mm-hmm.

Rachel Schacht: are a big are big players in treatment, but there's a lot of other things that we work on beyond the pelvic floor. So I have a model here that I can show. It's like my little paper model at home.

Julie Pernikoff: That's great.

Rachel Schacht: We've got the white is all the bony structures. The white is the pelvis and all of the colored you know, structures inside are the are the deepest layers of the pelvic floor here in this model. So we have the anal opening and the vaginal opening here that you can see. So when we work on when we work on pain with penetration that occurs vaginally, we are working in the vagina. And when we're working on pain with anal penetration, we're working So there are different dilators for the two sort of openings that we work with patients in the clinic on. so we're working on trying to get the muscles that surround the openings to relax and give them length with penetration. So that is what we're working on here. So that is the pelvic floor, the muscles inside the pelvis. Everyone has a pelvic floor, male and female. at we're talking about like women anatomy.

Julie Pernikoff: Yeah, yeah. Got it. Got it.

Rachel Schacht: So that is so that is that. sort of in a nutshell. that's pain with penetration.

Julie Pernikoff: And and and tampon pain you would say is like is a similar issue. It's okay.

Rachel Schacht: Yes, it is, I would say it's like one and the same almost.

Julie Pernikoff: Okay.

Rachel Schacht: functionally, it's a little bit different because with tampon use, we're just inserting.

Julie Pernikoff: Right.

Rachel Schacht: That's the end of the functional activity, versus with intercourse, it's more dynamic. So

Julie Pernikoff: Right.

Rachel Schacht: we so yes. So there's there's that differentiation. So what I was also saying was yes, we're looking at the pelvic floor specifically in those muscles to make sure that they're coordinated and relaxed. When with penetration and not tensing up and doing the opposite of what they need to do. But we're also looking at the whole person. So we're looking at the muscles externally to the pelvic floor that feed into and around the pelvis, the inner thighs, the hip flexors, the glutes, the you know, the deep muscles of the core. we have to look at the whole body. And not just the body, but also like hearing from the patient, hearing from the client what their activities look like, what they're involved in. So we can give the right treatment based on the whole person. So it's really, it's not zooming in onto the pelvic floor. It's really taking a step back and analyzing like the whole body. So having an ortho background. I mean, you go through a PT school and the pelvic floor is like, At least 10 plus years ago when I was in school, it was like an hour lecture. It was like sort of like a special, special lecture. Now it might be more integrated into schooling, but it's very much, it was very much a blip at that point, in terms of education. And so really we're using our our sort of more broad orthopedic training and looking at the whole body that way and then integrating the pelvic floor as

Julie Pernikoff: Wow. Wow. So you really have to be a good listener as a pelvic

Rachel Schacht: Yeah.

Julie Pernikoff: core therapist. There's no there can't be gaslighting. There can't be invalidating. Like you have to work together with the patient.

Rachel Schacht: Completely. And oftentimes on our initial evaluation, we I wouldn't say the majority of the time, but a lot of the time, we are sitting and talking for the full hour. So I

Julie Pernikoff: Wow.

Rachel Schacht: oftentimes don't even get the patient on the table. I'm like, I, it's so important for me to just, and you know, sometimes the patient's like, I'm so sorry, like I spoke too much, like maybe I shared too much. I'm like, everything you said is valuable for me. I need to understand you as a person, what you do, what your stresses are, what your home life is like. what your work life is like, what your commute is like. I need to know everything about your life as as much as you're willing to share, so that I can give the most individualized treatment to you.

Julie Pernikoff: Wow. yeah, that's amazing.

Rachel Schacht: So it's really, it's a very like special sort of like you have to build that trust on day one. be a listening ear, sit and look at the patient. You know, you

Julie Pernikoff: Yeah.

Rachel Schacht: know, sometimes I'm I'm writing some things down, but I'm really trying to make to make the patient feel comfortable. and then that being said, sort of on a tangent, nothing that we do is mandatory in terms of the hands on assessment. So I'm suggesting. Not to every single person. Depend it just depends on what they're coming in for and what they're coming in with. But I'm suggesting potentially an internal pelvic floor exam, an external a pelvic exam, sort of that whole body exam that I was describing before. and if you're not comfortable with either one, you tell me, and either we hold off. You can also let me know when you're ready. Maybe you're never gonna be ready, and that's okay. There's always something that we can do to influence. It's you know what's going on. So it's that's a really big thing to to to note for people who are interested. If if your pelvic floor physical therapist is telling you you have to have an internal exam, it's a red flag. It's extremely, extremely important information that can that can help immensely. But if the person, if the patient is not comfortable, you're that's just it's just it's over. You know, it's you're not gonna get anywhere. So building trust, working from, you know, working externally first and seeing what you can gather and then creating a a treatment plan from there, seeing how the patient responds. Maybe their their

Julie Pernikoff: Mm-hmm.

Rachel Schacht: symptoms are getting better. Okay, let's start there. So that's definitely something to note. Really important.

Julie Pernikoff: That's so that's amazing. I think because that really could be a barrier. Some people might really feel uncomfortable to even go to public court therapy if they're like, my gosh, I'm gonna have to do this thing.

Rachel Schacht: Totally. It's totally

Julie Pernikoff: Wow.

Rachel Schacht: not mandatory. It's very it it can give a lot of information, but not mandatory at all.

Julie Pernikoff: Are there ways to do like exams at like I think you touched on it, but just to clarify a little bit, like they can do ex you can do exams externally as well.

Rachel Schacht: You can, you can. You can get some information.

Julie Pernikoff: Okay.

Rachel Schacht: you so if I flip this model around, it it's showing the most there's three layers of the pelvic floor. This is layer one. So there's muscles that you can palpate or feel externally. So you're I mean, ideally we're not going through clothing, but we're to the sides of the openings. So I can assess sort of makeup this. hooked here. So this is the, you know, if you were looking at someone's vulva, these are the muscles that were that were able to palpate and to to assess externally. So, you know, with a gloved hand, I'm assessing these maybe for pain, maybe for tension. maybe I'm asking them to contract and relax and bear down and seeing visually what's happening from the outside. So I can get some sense of what's going on. layer one wise. but I can't truly assess this is the deepest layer again. I can't truly assess what's going on from muscle to muscle without

Julie Pernikoff: Mm-hmm.

Rachel Schacht: being internal with a and it's with a gloved lubricated finger through the vagina for for these for these more anterior structures. So

Julie Pernikoff: Mm-hmm.

Rachel Schacht: so yeah. So that is how I guess you can assess externally. But otherwise, right, we're looking and again we're looking at like Inner thigh, glutes, deep core in the front, back muscles that all sort of attach and influence the pelvis. We're also looking thoroughly at the abdominal wall to see, you know, how's the bladder moving? how are things feeling? Is there tension? Is there backup? Is there is there dysfunction? How are the how's the rib cage looking? So it's it's truly so thorough. We're just looking at

Julie Pernikoff: Yeah.

Rachel Schacht: these structures that Do I want to say directly indirectly but directly play a role in pelvic floor function? So it truly is, there's so much to look at if the pe especially if the patients, again, like I said, uncomfortable day one with anything internal, fine. There's plenty to look at. There's plenty for us to look through. So that is another thing to note, you know, if you're seeing someone and they're not looking at your whole body. how your hips are moving, what your abdominal wall is like, what your core strength is like, etc. You know, I would I would ask about that. I have a conversation about, you know, what else are you gonna assess? I don't know. You know.

Julie Pernikoff: so as you were going into everything, in terms of like anatomy, I couldn't help but jump, you know, jump to starting to think about pregnancy. And also if you don't mind sharing, that you are also pregnant right now.

Rachel Schacht: Yeah. Yeah. We've got like a month to go. this is my third and so I have two little kids at home. So it's definitely it's exciting being in this field because I work with pregnant patients probably every day.

Julie Pernikoff: Yeah.

Rachel Schacht: pregnant and postpartum, sort of the perinatal space. I mean, I work at a place called Mom Life Health and Wellness in Medfield, Massachusetts. so it is very perinatal heavy, I think, because of our name. So we get a lot of women coming in who are pregnant postpartum, years postpartum, looking, you know, looking to get pregnant, you know, trying to sort of get their bodies ready for pregnancy. So it is something that we deal with on a very regular basis at the clinic. so it is really cool being pregnant while treating pregnant women because it is a discussion sort of like back and forth. I mean I really try to make my sessions very patient focused and not talking about me. But I think patients are interested in hearing, well, how are you doing? How do you deal with this? Do do you have these symptoms? You know, so I think actually it's it's nice to be able to talk to patients about what they're going through from a perspective of like I've gone through it. So I can I

Julie Pernikoff: Yeah.

Rachel Schacht: can tell you, at least my perspective. I think that at that that that can help sometimes, whether it's calming or just giving insight. So It's been really exciting and also selfishly amazing to work in a place where my own coworkers can just treat me. You know, it's pretty it's pretty awesome. So yeah, that's really it's been really great. So yeah, definitely fun to share in that with patients. Actually, it's really funny. I have a patient who we have we share the same due date. So it's like she comes in and we're and we're she's like 35 weeks. Look at us. Like it's just cute. Like we have it's a very, it's a very like friendly, warm setting. So it just kind of brings that energy out in patients. It's yeah, I love where I work. basically bottom line. But yes, it is really it's been really nice to be pregnant in this line of work.

Julie Pernikoff: Yeah.

Rachel Schacht: and in pregnancy, I'm w you know, I'll I'll explain to someone whether they've been pregnant several times or this is their first time, just sort of like some of the physiological changes that like to expect. so patients can come in when they found out they've they're pregnant in their second trimester, in their third trimester, all throughout pregnancy, they can come in anytime. what I would encourage patients to do is come in before you're symptomatic, before you you have anything coming in c going on, to sort of just get an assessment, have an evaluate, have a thorough evaluation. You know, if you're past 13 weeks, if you're into your second trimester, we are able to do with your with your provider's consent, we can do an internal pelvic floor exam to give you. Insight into your pelvic floor. How's it functioning? You know, how is it strong? Is it tight? Is it weak? What's the deal? And here are things that we're recommending based on this assessment that you can do. Again, of course, if you're not comfortable with that internal assessment, we can we can assess the you externally and also talk about some of the changes that are that typically come up in terms of postural changes, in terms of, you know, you know, weakness, in terms of some. like strength issues that we often run into. So here, you know, we can kind of sp spell it out. Here are things that would work for you that based on your assessment. you know, if you wanna try that and come back to us in weeks, months, whatever it is, great. Some people like to have if they're even if they're not symptomatic, they some people like to have that, I'm blinking on the word, but some people like to have that consistency of coming in just to get an assessment or a reevaluation every X amount of weeks or whatever it is, once a trimester, maybe more. and we can reassess and and update the program. And then oftentimes what we're doing in the third trimester is like birth prep, like push prep and birth prep. so we at around 33 weeks, we start something called perineal massage, which is the goal of that is to give length and basically real trying to relax the muscles that feed into the perineum. I'm gonna pull my trusty diagram out again. So here again, vaginal opening and anal opening, here is the perineal body, aka the perineum. So the muscles that feed into this, we want to make sure that not only is this structure flexible and can can and you can connect to and give length to, but the structures that feed into it also they're not pulling and they're they're able to lengthen so that they're not influencing the perineum to be stuck and tight. You

Julie Pernikoff: Mm-hmm, mm-hmm.

Rachel Schacht: know, when the baby is coming out of the pelvic outlet, aka the bottom. the vagina, we want those muscles to not be strong. We necessarily that's not the goal. The goal is for them to for you to be able to tap into your pelvic floor and give it length so that it can move out of the way so the baby can come out.

Julie Pernikoff: Mm.

Rachel Schacht: with ideally less perineal damage. So we talk about like tearing and perineal tearing. Perineal

Julie Pernikoff: Mm-hmm.

Rachel Schacht: massage can, if done sort of properly, and for a good length of time, so 33 weeks on, can reduce the risk of severe tears. When we talk about severe tears, we're talking about tears that go down to the anal sphincter and through the anal sphincter. The per perineal massage does not reduce the risk of tearing, period. So it is something to consider, to heavily consider. it's also so not only is it helpful in reducing the risk of severe tears, but it also helps the patient learn to breathe and lengthen through pain. When I'm when we're physically doing this massage and trying to give length to these tissues, it's uncomfortable and it can be kind of painful. So being able to cue the patient, okay, think about this with your exhale and seeing if you can tap into your pelvic floor with. with a cue like a mental cue or physical physically making a low tone noise. That's something that we utilize a lot in terms of push prep. try try this noise versus that noise and I'll give you feedback and maybe you can see if you can feel that. Do you feel your muscles lengthening? Do you feel this part of your body lengthening when you exhale and make this noise versus that noise? So we're we're giving them things to try I often will have people go home and I'm and I'm telling them sit on the toilet, make these five sounds when you're pooping, push, exhale when you're pooping, and what is the most productive for you? Does this sound versus this sound help you relax your pelvic floor most when you're pushing? Practicing pooping with this mantra is a really functional way to prep for pushing. So

Julie Pernikoff: Wow.

Rachel Schacht: It sounds crazy, but we talked about it

Julie Pernikoff: Yeah it does.

Rachel Schacht: today, so it's like nothing for me, but it's you know, it's it's a very functional like practice for people. So yeah.

Julie Pernikoff: Yeah. What's if unless it's like weird to say, but like is it's like sounds or it's words like

Rachel Schacht: Yeah, so some of these low-tone noises that we that we teach people to try. I'm just gonna give you examples. It's mooing, hmm, like a humming, shh, gur, and I think I'm probably forgetting a few, but we have people take an inhale on the exhale, shh, or or I mean, it it's it it sounds crazy. And I'm like, maybe in the privacy of your own home you can practice this. Like, you're not gonna practice like at work, like in the stalls next to your coworkers. I mean, go for it if you want to. But

Julie Pernikoff: Yeah.

Rachel Schacht: and you can see, you know, I'm actually connecting most with this sound. Connecting meaning relaxing. Another

Julie Pernikoff: Mm-hmm.

Rachel Schacht: way you can so you can try it on the toilet. Another way that I have people try this is sitting on an exercise ball where you actually like. Spread your cheeks and sit on it. And you can feel your pelvic floor relax into this ball. And then you can try to exhale and make those noises and see what you feel. Cause the ball giving feedback up into your pelvic floor, it's easier to feel, my pelvic floor is actually relaxing versus lifting off this ball. So it gives you that tactile feedback that can be helpful in determining actually, this is the most productive for me. So yeah.

Julie Pernikoff: Wow. You've got a tough job because these are very like intricate areas. What what did you say?

Rachel Schacht: It's just intimate. Mm-hmm. Yeah. It's intimate.

Julie Pernikoff: Very intimate, but also it's like crevices. It's difficult and it's not like like my knee. Like you can't just like bend it, open it, look at it, feel it, touch it. Like it's not

Rachel Schacht: Breeze

Julie Pernikoff: as easy to just do that. You have to have like skills that are a little more like intricate, yeah.

Rachel Schacht: Yeah, it's definitely there's definitely some fine tuning and attention to de to detail that's really important in this fields of work, whether it's you know, the muscles are har they're small in the pelvic floor and it's hard to differentiate, but also just like the details of like the patient's facial expression. Like mm, I don't know, like without them telling me something, I'm trying to like I'm trying to gather information without it being without them telling me necessarily. So just being very patient and slow and attention to detail is is really important in in this line of work. so patience. Yeah. Patience

Julie Pernikoff: Yeah. Absolutely.

Rachel Schacht: for patience.

Julie Pernikoff: Absolutely. So it really gets me thinking then. Like you're you're talking about preparing and like lengthening. God willing, birth should go successfully for people. Unfortunately, there are sometimes some side effects. Like people's birth fears, epesiotomy, tearing. So talk to us about that part.

Rachel Schacht: Absolutely. So I think, you know, I would say perineal tearing is very, very common post ventral delivery. You know, sort of we talk about grades one, two, three, and four. Three and four are considered, you know, more severe and one in in the grades one and two tears are are on the more mild side.

Julie Pernikoff: Mm-hmm.

Rachel Schacht: and it's just it is To simplify it, it's just the length of the tear and how far it goes. You can you don't have to, you it's not just tearing down. you can have tearing up. But when we're talking about the classic grades one through four, grades one and two are are just sort of like above a grades three and four in terms of length of tear. so So that is perineal tearing, again, which is very common during birth. when we're talking about appesiotomies are often these days less common. We're seeing them just like happening less. that is a like an incision made by the doctor to open up to create more space for the baby to come through. So it's a

Julie Pernikoff: Yeah.

Rachel Schacht: it's a forced tear, it's a tear that was done surgically. and then in terms of forceps or vacuum, so like forcep or vacuum assisted births, they have a risk for increased like perineal damage and tearing. So, you know, it can ha that can happen for a number of reasons. bottom line is the baby isn't able to come through in, you know, fast enough or efficiently the baby's getting stuck. So they're either doing a psiotomy or using sort of the vacuum or force assisted mode to get the baby out. so yes, that can that can lead to perineal damage. So postpartum when we see patients, they're often postpartum we typically, at least in our clinic, we're seeing patients before they're medically cleared at like the six week mark. So we see them at like three or four weeks postpartum. if we're talking just strictly vaginal delivery, what we can do at that point, right? They're not cleared for exercise or anything internal. So like you can't have intercourse, you're not exercising quite yet. we we can assess you externally, in sort of the ways that we talked about before, give you basically exercises that are safe to do pre-clearance. So I think a big misconception is like I haven't been cleared for exercise. Therefore, I just am gonna sit and I'm not gonna do anything. it's not going it just there are things that you can do and are things that you should do because during this time your body is at its weakest and you're having to do all of these new things that you've never done before. Caring for a newborn while recovering from something like this is just like it's totally this brand new thing. So Preparing your body in ways that are safe to support yourself during this time is huge. So we see patients as early as things come up, but often if we're sort of like, you know, if I'm with a a a patient that's pregnant and we're thinking about booking out postpartum, I'm often having them book around three to four weeks. It's pretty early to come into a clinic. Some people are like, I'm in this acute pa tailbone pain. I can't walk. So I'm gonna come in at two weeks postpartum, or I'm gonna come in a week later. Sure. Those are more rare. We do see them, but I would say for most people, they're not really ready to leave their house before four weeks. So oftentimes we're seeing seeing them around then. If they're not feeling like they're up for that, totally understandable. We can see them after they've been cleared at like seven, eight weeks, where we can do an internal pelvic floor assessment, give them individualized feedback. And give start them on a program based on what we're finding. So, in light of the of the tearing and the damp perineal damage at this time, what we are doing is desensitization of the tissue. So the scar tissue, once it's healed and once you're cleared, we can work on actually releasing some of that scar tissue so that things like penetration are. less painful. Oftentimes when there's a scar, when there's scar tissue at somewhere, that the area around there is set more sensitive. So often a lot of times people are post perineal, whatever perennial of perineal damage they have, they're having a lot of trouble with initial penetration. That is really, it's really painful or it's really uncomfortable. It's, it's, it's, it's irritating. It's it's a problem for them. So we're doing desensitization work to try to not only desensitize the tissue around that area to be less sensitive, but we're also trying to physically break up the scar tissue once they're cleared and once this healing has is done so that the tissue is more pliable and it's not so rigid, especially right at the opening of the vagina. So we're doing a lot of like physical massage release work to get those. to get the scar tissue to break down.

Julie Pernikoff: I have a few questions though about that. Like the scar tissue makes it tighter. Is that part of the issue? Like, okay.

Rachel Schacht: Yes. Yeah, I mean scar tissue is just inflexible. It's it's rigid, it's tight, and it can be sensitive because of the sort of the nerve endings that are that have been cut through in that area. So we're trying to desensitize the area. we're I can jump to post C section during this time as well. So we talk

Julie Pernikoff: Right. It's it kinda yeah, it goes there. Yeah, why not? Why not? I'm I'm curious about that in terms of scar tissue. Real fast before you jump in there. Scar tissue, what what exactly is scar tissue?

Rachel Schacht: So scar tissue is tissue that it that has been developed after there's been like an incision or Okay, basically scar tissue is this disorganized layering of tissue that is formed around, like in this case, an incision. and it's often hard, disorganized, and tight. It's it's not skin, it's deeper. It's well, the scar tissue, scar tissue can be skin level, but it's often, you know, sort of this deeper. tension, it's just this tissue building around a a wound or incision. So it

Julie Pernikoff: Hm, okay.

Rachel Schacht: that's what it is. So it's a it's it's tight tissue

Julie Pernikoff: Okay, got it. So with that in mind, then yeah, let's jump into C section recovery.

Rachel Schacht: Yeah. So during this time, you know, if you've had a C-section, we are really, really looking at the scar there too. So once again, once you're in the beginning before you're cleared, we're looking at the scar from a we're looking at it from like a healing perspective, seeing is there any are the stereo strip still on? is the bandage still on there? Are we that early? Or You know, and if we are, we are we're often not taking that off. let's say that let's say you're two, three weeks out and want to come in and you do have stereo strips along your scar or the the the tape still the the is sort of the the tape still on you from from the surgery, we are addressing the scar, but above the scar. So we are addressing the scar via the abdominal wall. So inches above where the scar is, we can start to influence. that area which should influence the scar inches below. So white, so sort of like swiping in different directions, different textures. We start with like light, soft textures, like a cotton ball or a makeup brush or a tissue. And we are swiping along the skin in different directions to sort of bombard the the t the skin with different sensations. Of like this is this is different, a lot of different stuff, but it's safe and it feels okay and we're we're not in danger. So we're we're trying to again desensitize that tissue. Once we can, you know, if the we can get pretty close to the scar, we're just not rubbing at such an early stage. We're not rubbing along the scar itself. Maybe we can tap along the scar versus really kind of pushing into it, but we're working above and then gently along and below the scar. onto the pubis. So so that is part of what we do. And then over time, you can get a little bit more aggressive with that and use more sort of like harsh textures. So like maybe a paper towel, maybe a hard sponge, maybe a a comb, to really again bombard the skin all over the belly and then at and below the incision itself, with different sensation. The reason, again, functional reason for that is oftentimes, with skin that's really sensitive that just like isn't touched, it can just be sensitive to air. You know, I have a lot of patients telling me, like, you know, if I if I'm near like an eight like AC or like wind, like it hurts me. So

Julie Pernikoff: Wow.

Rachel Schacht: we need to do desensitization work. Oftentimes we're also dealing with patients who are like, I really, I can't wear any tight fitting pants or jeans, forget jeans, forget leggings. I can only wear sort of high-waisted like stretchy pants because I can't have anything pressed up against me. So functionally, that's a that's a problem. So, you know, for those reasons, it's also really important to do this desensitization work so that your sensation is good and you're not hypersensitive to things on you.

Julie Pernikoff: Yeah.

Rachel Schacht: Another reason why it's important to address the scar is because tension from the scar tissue, which is important for healing, it's it's incredibly important to let that heal and let the scar tissue do its thing and bind down. Once you're once you're healed, we can become more aggressive and work on the along the actual scar. So we want to, again, once you're cleared, start to work on loosening the scar tissue. And decreasing the tension along and around the scar so that the scar tissue doesn't I feel like I say this word and it's kind of creepy, but like leach onto surrounding structures. So

Julie Pernikoff: Mm-hmm.

Rachel Schacht: oftentimes, you know, it can have an influence on the bladder because of its proximity. It can kind of be influencing the bladder maybe in one direction versus the other, depending on where your tightness is along the scar tissue, along the incision. it can influence hip flex retention. It can influence the pelvic floor. A lot of people are like, whoo, okay, great. I had a c-section. You know, that that was a trip, but I, my pelvic floor should be totally fine. Like I didn't push a baby out of me. Unfortunately, a misconception. There's a lot of influence that scar tissue in the abdominal wall, whether it's from a c-section or any other sort of abdominal surgery, can have on your pelvic floor. So, really important to address that. to get ahead of any pelvic floor-related dysfunction that could come up from this tension at at the level of the abdominal wall. So that's another thing that's really important to to note during this time.

Julie Pernikoff: Yeah. Wow. So much

Rachel Schacht: Yeah. So that's like immediate postpartum.

Julie Pernikoff: what'd you say?

Rachel Schacht: That's like immediate postpartum, C section versus vaginal, I would say.

Julie Pernikoff: Mm-hmm. Mm-hmm. Do you do the same thing for perennial post if it's a psiotomy or if there's tearing, you also break up the scar tissue? Okay. Okay. Wow.

Rachel Schacht: Yeah. Yeah. Yeah. The treatment is pretty similar there in terms of like scar tissue breakdown in a safe way.

Julie Pernikoff: Yeah.

Rachel Schacht: so yeah, we're really working on, you know, that in the clinic. I'm giving them exercises and stretches they can do on their own at home. There's a lot to do between sessions to

Julie Pernikoff: Mm-hmm.

Rachel Schacht: get some good carryover. So, so yeah, that's a good question though. That is similar.

Julie Pernikoff: With thank you. With perennial tearing and with C section recovery, I know that there's differences, but there also seems to be similarities in terms of the scar tissue. When is too late? Is there too late for p you know, massaging it?

Rachel Schacht: Good question. I think early intervention is best in terms of getting ahead of it and potentially making the process quicker. But I have patients who years later are coming back to me are coming to us and saying, Listen, I've had dysfunction and pain. I had a C section years ago, whatever it is, months, years, whatever it is. what can I do? We can make change on old scar tissue. It is definitely harder. Can take longer and maybe the potential for change is less, but there still is potential for change through a lot of different modalities, whether it's hands-on manual work or you know, dry needling or stretching, things like that, proper breathing mechanics. There's a lot that we can do to influence scar tissue. So

Julie Pernikoff: Yeah.

Rachel Schacht: at any stage, you should be able to get to get to to make progress.

Julie Pernikoff: Mm-hmm.

Rachel Schacht: Yeah.

Julie Pernikoff: Yeah. Wow. Thank you so much for that. That was phenomenal. are

Rachel Schacht: Ha.

Julie Pernikoff: we I'm just like, my gosh.

Rachel Schacht: Yeah.

Julie Pernikoff: are we do we feel ready to move into I wrote it down as post postpartum?

Rachel Schacht: Yeah. Like the slightly later years.

Julie Pernikoff: Slightly later years.

Rachel Schacht: something important to note is that so we're gonna talk about sort of perimenopause and temenopause time. something important to note, a few things. So when you're postpartum, it's sort of like a mini perimenopause. time. The hormone fluctuation that you that people experience postpartum is very similar to perimenopause. Perimenopause is this is not a formal definition, but it's defined as these peaks, these sort of random peaks and valleys of hormones and hormone crazy hormone fluctuation that can lead to things like hot flashes, mood swings, and genito urinary symptoms. Those symptoms are like the pelvic flow related symptoms, specifically vaginal dryness and irritation of the vulvar tissue and the vaginal tissue. The reason why that happens is with dips in estrogen. So especially when you're breastfeeding and postpartum, you're the you're there's this big depletion in estrogen. And a lot of people are coming to us reporting vaginal irritation and dryness and pain a lot of pain with intercourse. so something that will, I mean, we can work on something that basically will suggest and I'll suggest to patients is have a conversation with your provider potentially about topical estrogen. So that is something that can Really, really make a big difference in terms of these types of like vaginal dryness, irritation symptoms. And in a lot of cases, can just solve that problem. not to say that pelvic floor PT is not something that they'd need to do, potentially, yes. but that can be a big, big player, especially in this sort of acute postpartum time. It's something people just don't know about. So I think talk to your provider. They have your, you know, they they're gonna they have access to your full medical history. They, you know, they can assess medically if it is safe for you to use a topical estrogen during this time. In most, most, most cases, the answer is yes, but you know, you're going through your provider and they should have they should be able to provide a like a sound medical recommendation.

Julie Pernikoff: Mm-hmm, mm-hmm.

Rachel Schacht: That's big thing that we'll do. We'll, you know, we'll work with patients while they're using the topical estrogen and giving them stretches and exercises to support, you know, the goal of lengthening, relaxy relaxing the tissues while the topical estrogen is providing really a plumping and a a a moisturizing and lubricating effect. So that is huge. That can be really huge.

Julie Pernikoff: Yeah. Wow. Thank you for sharing that. Thank you.

Rachel Schacht: So that is sort of like acute postpartum, like this like faux perimenopause time. looking forward into the perimenopause and menopause sort of years, the may Perimenopause, again, like I said, it's peaks and valleys of your hormone levels and then sort of marked by like irregular periods and some of those other symptoms that I talked about. and then once you haven't had your period for twelve months, you're officially in menopause. So, and that's and then you're postmenopausal. So when you're in when you're in postmenopause, A lot of these symptoms are so now the the the hormone levels, the estrogen is there's just a depletion in estrogen. So that is a big part of menopause. so a lot of what we're doing with that population is working on is working maybe they are on hormone replacement therapy and maybe not. Either way, during this time, estrogen depletion can not only affect the lining of the bladder, the pelvic floor musculature in terms of how dry irritated and weak and thin it is, but it also affects joint health, muscle bulk. so we're working on strength, balance generally, plus also addressing some of like the the vaginal irritation and the and the dryness and the pelvic floor sensitivities. So You know, we're working with patients to battle prolapse, to battle incontinence, whether it's fecal or urinary incontinence. we're working on pelvic pain, pelvic floor discomfort. those are a few examples of some of stuff that we are are often addressing during that perimenopause and menopause and menopausal times.

Julie Pernikoff: What just define for me, exact like menopause means what? What exactly does it mean?

Rachel Schacht: Menopause, So in perimenopause, there's peaks and flows of the hormones. And then once you hit menopause, the hormone levels drop. So now you're

Julie Pernikoff: Yeah.

Rachel Schacht: in this your your the estrogen levels are are are decreased sort of significantly and they don't jump up and down anymore. They just stay down. So now this woman is going through. just sort of these constant, these changes are just they're just at a constant now. it's not like getting better, then getting worse, getting better, getting worse. It's just staying low So you know, joint health, pelvic floor health, strengthening, balance work. That's all really important to do on a regular basis to sort of battle what's happening in the body and what's staying at a constant.

Julie Pernikoff: This must be and so I thank you for answering my questions, cause it really some of it really is so new that I'm just really trying to understand it. Like this must be when the framing of the conversation piece really comes in. do you have to live with this? Just because it's common, does that mean that this is normal? I'm sure like

Rachel Schacht: Totally.

Julie Pernikoff: c cause it just and there's it's probably so challenging. I just know I just have an idea that it might be because I'm a woman and I've dealt with healthcare issues that it's probably very challenging for women sometimes to even validate themselves enough that something is wrong that they have to go see someone.

Rachel Schacht: Totally. I think people are they're in I think it's it's a population that really is underserved. They're like gaslit a lot. being told, hey, like this is normal for someone your age, but there is absolutely there's a treatment for that. You shouldn't have to live with these symptoms. These symptoms, yes, come. They are, they are They come with this time period, but there are interventions that are that are safe for you, that your doctor sh sh can and should provide you. I mean, of course they're looking at your medical history to make sure that there are no contraindications for you specifically. But there are option there are so many options based on your medical history that something you should be able to find some solution medically. to address your hormones and then sort of doing all these other in terms of the PT stuff on top of that. So yes, it's really and it's it's like if you're not sleeping, if you you can't function. You know, that is a hallmark symptom during this time. So that shouldn't be poo-pooed. I mean, you know, if you can't a lot of people feel like they're going nuts. They're going crazy. They're like, I can't sleep, my mood is crazy. I'm in pain. I have like joint achiness. Like what is going on? Well, you're in this, you know, you're in you're in this phase of life now. and absolutely it should be brought up to your provider. because there's so much that can be done for someone.

Julie Pernikoff: if people go to their OB with this kind of thing, are they gonna get the same response as if they're going to straight to a public floor therapist? Like, how does that work in terms of bringing up these issues? Cause some people might specifically just go straight to an OB. Like, why wouldn't they? So, but like,

Rachel Schacht: For sure. Absolutely. And

Julie Pernikoff: what are they getting from that versus going straight to you? But maybe they don't know where to go to you yet.

Rachel Schacht: Yes. I think we know we can provide different things. So I mean, I can't PTs can't prescribe medication. So you're getting you could be a candidate for hormone replacement therap hormone replacement therapy, HRT, in some you know, in some capacity, through your doctor. And that can be supported with PT. It doesn't mean every woman needs to who is in this phase needs to come to pelvic floor PT. but I think it's, you know. sort of addressing the hormone disruption or hormone variation is huge. And that often is like sort of the foundation. And then there's other things that you can do to support yourself in this time. So, you know, if someone's coming to me and have it and has not spoken to their doctors, I'm urging them to either f or or maybe they haven't gotten, they've been dismissed by their doctor. I'm ho I'm I'm giving them recommendations of Who they might be able to go to, someone who maybe has a menopause certification, who maybe specializes in women's health, that sort of thing. So I'm urging them to go find someone or go back to their doctor, have that conversation. And if they're based on what they're reporting, symptom-wise, I'm advising them to maybe come back to me. Or I'm saying, you know, go ahead and start that, and then we can kind of be in touch and see how you feel. So

Julie Pernikoff: Mm-hmm.

Rachel Schacht: There's a lot we can do to supplement them during this time, but I feel like oftentimes addressing them hormonally, which is not something we can do. it's something that a doctor could like could do, is is really a foundation. So that's really important to start with at a baseline.

Julie Pernikoff: That sounds like a really nice perspective coming like t that c is coming from you in terms of your disposition towards doctors. Like, because sometimes there can be discrepancies in care. and which we we discussed slightly on episode two. So feel free to tune in there, guys. No, but like it's real but we didn't at the time. No, that was more about that was about pediatrician and like kids. This runs the gamut though. That type of discrepancy is gonna happen in any part of medical care. So it's cool though to hear you say that like you're partnering with the doctor.

Rachel Schacht: Absolutely. I feel like what we like pride ourselves on is our community that we've like created. So we're not trying to we're trying to provide our patient population with this well-rounded community of providers. So, you know, we have strong connections with like lactation support in the area, with mental health therapists, with dietitians, with OBs. we To be able to give the patient it information where they where they might need it. so yeah, it's huge for us to partner and make good connections with like trusted OBs and providers so that we can, you know, oftentimes these people are coming to us and they're like lost. They just like have no idea. They they don't even necessarily people don't always necessarily identify. certain symptoms with a certain profession. They're like, this is what I'm dealing with. Like, how can I be helped? So it is really helpful for us to be able to have that network that we can that we can specifically refer to. it's huge. It's huge. Yeah. So it's it's pretty cool. It's pretty cool.

Julie Pernikoff: amaz sounds like a dream. Sounds like a dream. That's amazing. The vision is beautiful and it sounds like it's in action. So that's wonderful. Well, thank

Rachel Schacht: It's great.

Julie Pernikoff: you for going so deeply into all of those things. I definitely learned a lot. and we're way over an hour, but if you're okay with it, I'd love to continue a little more and talk personally.

Rachel Schacht: Yes. Totally.

Julie Pernikoff: so we'll dabble a little bit a little bit of chit chat.

Rachel Schacht: We're loud.

Julie Pernikoff: But also no, but like real it you know, I'm gonna ask you some real questions if that's okay.

Rachel Schacht: Great, hold it. Let's do it.

Julie Pernikoff: so Rachel, talk to us about your experiences and how your pregnancies and your role as a public core therapist and also as a physical therapist, how it's intersected what is that like for you in terms of also like how your pregnancies have gone and deliveries?

Rachel Schacht: Yeah, I think again, I feel lucky to be in this field because I have this like bonus education on sort of again common versus normal, what to expect, what the quality of care should be for someone who is going through any of these life phases. so it's been really it's been really unique as a woman to be able to again have this education. have these experiences being able to help people who are in like in my shoes.

Julie Pernikoff: Yeah.

Rachel Schacht: so it's been really, I just feel really lucky. and it's been really cool. I mean, talking about sort of my like getting into this profession, right, like I started sort of generalized ortho and then became pregnant, all these things started to happen and I was like, I gotta get more information. Not only for myself, but this is like just such a special population, sort of underserved, misunderstood, maybe gaslit. so to be able to to serve this population has been extremely, extremely rewarding. physical therapy is is very rewarding. but I think even more so in this field because it's so personal and it's we're talking about things that are so sort of untouched.

Julie Pernikoff: Mm-hmm.

Rachel Schacht: So it's it's really unique and very special and I feel very lucky to be in this field.

Julie Pernikoff: Yeah. And and such integral parts of the body for everyday

Rachel Schacht: Right.

Julie Pernikoff: function that we don't even always realize.

Rachel Schacht: Yeah, exactly.

Julie Pernikoff: talk to us about your pregnancies and deliveries, whatever's comfortable to share and what might shed light on things for us that

Rachel Schacht: Like yeah.

Julie Pernikoff: might be helpful to some for someone else to hear.

Rachel Schacht: Absolutely. So with my first pregnancy it was COVID. So there was i it was just a really interesting time to have a ki to be pregnant, especially for your first time for the first time. So

Julie Pernikoff: Gosh, that must have been so crazy.

Rachel Schacht: It was it was definitely a wild time. Lots

Julie Pernikoff: Yeah.

Rachel Schacht: of fear, lots of unknowns. I was not in this field at this time. So I just had like so many unanswered questions. I I did feel quite lost. I didn't see a pelvic floor PT until after my second. Because once I was in the field, I was like, great, I'm just gonna like I know exactly where to have get treatment and and I know what to expect and you know what to ask for. so very lucky in that way after my second after my second pregnancy. But I mean I was told at like 37 and a half weeks that the baby was breached in Sunnyside up. And I was like, whatever that means, I I don't know what that means.

Julie Pernikoff: This was the first pregnancy.

Rachel Schacht: This is the first pregnancy. so I went in for for aversion, which is It's the external version where they try to like kind of turn the baby externally through the abdomen, which was unsuccessful. so baby stay breach had a c-section, which was really disheartening. I mean, I just I knew I didn't know much, but I just knew that I didn't want a c-section. So I think, you know, so I think getting over that was tough, but in sort of my education into this field. I was able to sort of like do what I need to do to address some of the dysfunction that I was going through. And then by my by my second pregnancy, you know, I was really looking forward to like a V back. It's really something that we you know, obviously if like it's safe you know, to do, then we're supporting it. You know, if if your medical team is is in support of you having a V back, like we're like, let's go. so I was really hoping to do that. Ended up being induced because I didn't go into labor and I was pretty far along. I was four 41 plus weeks at that point. was induced and then things just didn't go well, you know. BB's heart rate wasn't like where it needed to be. So they were, you know, baby was in distress. ended in a C in a C section. So that was my second C-section. Again, obviously not what I envisioned. I was really hoping for that V back, but luckily I knew I had the tools. I knew what I needed to do and I just did those things. So definitely challenging. but in the moment I'm like whatever is going to get this baby safely out in a healthy, safe way. That is my priority. And that I think, I think it's really hard to just tell people like, well, your baby is healthy and safe and it's fine. Like everything turned out fine. It's still traumatic and it's it can still be emotional and extremely traumatic to not have the birth you envision. But I really encourage all of my patients and any friends who I speak to about this to be open minded. I mean, you know, you have this vision for your birth, you have no control. There's a lot to do to prep the body for a vaginal delivery. Ultimately, it could be the core the, you know, the core wrap around the neck or the positioning of the baby via your, you know, it, you know, there is just so many unknowns and so many things that we can't control. So I think understanding all the options of what could happen. Is really important to go into the birth with. I think being optimistic going into your birth is important. You don't want to go in so anxiety, you know, with tons of anxiety and fear. But I think understanding these are the things that could happen. I can end up with a grade four perineal tear. I could end up with a C-section. What does that look like? I think preparing yourself is going to more as much as you can, sort of maximally, is going to help you. come to terms with whatever birth you have, end up having, hopefully a safe, healthy birth.

Julie Pernikoff: Yeah.

Rachel Schacht: the goal ultimately should be you and the baby end up safe and healthy. And I think keeping that perspective can help soften the blow a little bit. So

Julie Pernikoff: Yeah.

Rachel Schacht: it should. So yeah I think

Julie Pernikoff: Yeah.

Rachel Schacht: that that perspective is helpful. And I think, you know, I was lucky to be in this position so that I could Take a step back and say, okay, it could have been a lot worse. I'm okay. She's okay. It's all okay. So with this pregnancy, we're sort of still in debates of what we're doing. If we're doing a C section, if we're trying for a vaginal delivery this time around. So still in talk to the doctors. I still have a few weeks left to go. So we'll just kind of see how things progress over the next few weeks.

Julie Pernikoff: Is it?

Rachel Schacht: but I'm telling myself, whatever ends up happening, just want a safe healthy, I just want a healthy baby and I just want to be safe. So

Julie Pernikoff: Yeah, absolutely. And Massachusetts, I'm learning this. Massachusetts is very pro V back in general. Is that the case?

Rachel Schacht: Good question. I think the the clinic that I am a patient at right now is very pro VBAC. So people often flock to this clinic, this, you know, organization, if they're interested in VBAC because the doctors are more the it's it's a it's a doctor midwife practice and the team is very It tries to be very open minded with V VAC. so it's really nice getting that perspective. But it really is all about like weighing risks and things like that. So, so yeah, I don't know that I can necessarily speak to like Massachusetts as a whole. but

Julie Pernikoff: Mm-hmm.

Rachel Schacht: the practice that I'm at currently is actually very pro VBAC. So

Julie Pernikoff: And they're considering they would even consider after two C sections.

Rachel Schacht: They would.

Julie Pernikoff: Yeah. Okay. Cause that that's also is unique in comparison sometimes.

Rachel Schacht: Totally. That's possible. That's totally possible. But just understanding what the risks are and making sure that your team is in good communication with each other. as you make that decision, make sure everyone's on the on the same team. That can be something that you're

Julie Pernikoff: Yeah.

Rachel Schacht: asking your provider. It you're telling me that it's that you're pro this, but you know, is everyone on that on your team the sort of is everyone on your team on, you know, on board? So that's that's an important thing to to differentiate or To make sure that you're asking.

Julie Pernikoff: Yeah, absolutely. Wow. That was really amazing. We just we just wish you only good things and that you should feel so comfortable for the remainder of your pregnancy, that your delivery should go safely and smoothly and that you should feel good about it. And absolutely. And I just I want to reiterate like something that you said. I wanna just like bring that to light again that you said it's really helpful and important for people to go in knowing, all the possible different outcomes. Obviously you don't want to overwhelm yourself too much. And like you said, you want to be optimistic. optimistic, you know, realistic. I think that that's really powerful. And that's so much like the basis for everything that you do is really making sure that people are informed and aware.

Rachel Schacht: Yeah, it's I mean it's it is so true and it's so it's so great that you like recognize that. Like we are just providing as much education as possible to people every time they're in the clinic, especially on day one. Just like, what is this? Where does this come from? Is this normal? Is you know, what is going on? So just taking a step back, you know, talking about the anatomy and the physiology. Explaining the sort of dysfunction in a way that they can underst it, you know, anyone can understand. So that's

Julie Pernikoff: Yeah.

Rachel Schacht: it's really patient education is extremely, extremely important to physical therapists, whether you're pelvic

Julie Pernikoff: Yeah.

Rachel Schacht: floor PT or not. It's it's really that's huge. So if you're you know, another little tidbit is like if you if you leave all confused after your first visit, you know, you shouldn't leave confused. You should leave with an understanding of what's going on with you. you deserve any and everyone deserves that. Everyone deserves to have that education and to have that broken down. And hopefully, you know, if that's, you know, you can speak up and s and ask for clarification if you don't understand. But any, you know, anyone who ha who has any sort of, you know, whether it's public floor, orthopedic, whatever it is, neurological issues, sh deserves to have that explained as thoroughly as possible so that you can understand what's going on and how you can. Take charge? What does that look like? So that is that is not a privilege. That is something that every person deserves. No.

Julie Pernikoff: Absolutely. I was really also thinking, I'm like, this really applies to orthopedics, medical

Rachel Schacht: How yeah.

Julie Pernikoff: care in general. Like you and your colleagues like sound like just amazing. and you you have

Rachel Schacht: Really lot. Yeah.

Julie Pernikoff: like you've explained everything so beautifully and so well. It's so clear that you must treat your patients with so much respect and also with just like the understanding that they are smart people as well, just not in your field and don't know everything.

Rachel Schacht: Completely. Completely.

Julie Pernikoff: so they're really lucky to have you. So thank you for for being here. And yes,

Rachel Schacht: You so much for having me. Have fun.

Julie Pernikoff: of course you were phenomenal.

Rachel Schacht: Yeah.

Julie Pernikoff: and how can people reach you? I'm sure people are gonna wanna reach out to you, even if they're not local to you, like you're just approachable and so knowledgeable.

Rachel Schacht: And I I hope that people come find me with questions or, you know, anything specific. but in terms of my email, my email is rachel r a c h at mom life health dot com. feel free to shoot me an email with with any questions. I we we do we do offer like virtual sessions. It's really not super common. because getting our hands on your body is really important to us. But you know, even before that, just talking sort of via email, I can I'm happy to discuss, you know, giving you some resources, helping you just with some general information to get yourself started. I'm happy to do that. So I would love for people to reach out if they had any questions about anything we spoke about, anything in general that they're that they might be going through. Absolutely. So of course. Thank you for having me. It's been amazing.

Julie Pernikoff: Thanks, Rachel. Thank you so much. Amazing. Absolutely.

Rachel Schacht: Such an amazing time. So thank you.

Julie Pernikoff: Yay,

Rachel Schacht: too.