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Hello everyone, and welcome. I’m Dr. Krystal Lynn Couture. The pelvic acu. And before we get started, I wanna say a special thank you to the American Acupuncture Council for hosting this vlog. If you haven’t been to the American Acupuncture Council website, you absolutely should go there because there are amazing vlogs like this one that are filled with little nuggets of gold for acupuncturists and.

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They do a really nice job of sharing those teachings in little bite-size bits. So let’s get started with today’s workshop. We are going to be talking about postpartum and the pelvic floor. I. So what’s inside our workshop today? We’re going to be talking a little bit about sitting the moon or sitting the month.

We’re gonna talk a bit about miscarriage and abortion. We’re also going to have a chat about some postpartum challenges that moms could encounter. We’ll talk about the healing process that one goes through. Through the postpartum process. We’ll talk a bit about the hormones, we’ll talk about the perineum, and we’ll talk about uterine involution.

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So here we go. Alright. Sitting the moon or sitting the month, lots of cultural traditions, including Chinese tradition around the globe, suggests that the mom and the baby really spend the month or the moon. Being protected, being nurtured, being nourished, bonding, and recovering with each other. That means there’s very little demand.

On the mom and on the baby, except for healing and coming together in harmony with each other and the outside environment, right? Western tradition suggests that recovery period postpartum after childbirth, there’s an acute period of 24 hours, a subacute period of 24 hours to six weeks, and then a delayed recovery period, which is six weeks to six.

Months. And so there’s a difference in how Western terminology and how Eastern terminology looks at the postpartum recovery period, and what is encompassed within that. So let’s get into sitting the moon. The traditional recommendations are lots and lots of rest for the mom, and this is really bed rest including 10 hours or more of sleep per night.

The body has just been through an immense transformation and a major outsourcing of. Energy or expression of energy, right? So rest and sleep are really important. During that first month, it brings in the support of family members, friends and nurses to maintain the cooking, the cleaning, and other household tasks.

It’s really not part of traditional culture that these things are done by the mom while she has the new baby at home. Another part of sitting the moon that is done in traditional cultures is abdominal binding, and that’s really to help reduce the laxity in the abdomen and restore the proper pressure.

Within the abdominal cavity. And we’ve talked a little bit about pressure within some of our workshops here, right? So the abdominal pressure directly impacts the pelvic floor pressure. Now you can imagine after the birth process that the pressure change is going to be pretty significant.

Abdominal binding helps to bring that pet pressure. Back to a normalized state, and it’s also going to help with the pelvic floor healing as well. And of course, eating and nourishment are going to be such a big part of this sitting the moon period. And also of course, for milk production, right?

We wanna make sure that moms are getting the right nutrition into their body. That’s going to be satisfying, that’s going to be nourishing, that’s going to fill the coffers with what might have been depleted. During the pregnancy and then during the birth. But of course, it’s also important to remember that balance, right?

So not eating too excess is another important facet to the postpartum dietary kind of idea. Okay. And then of course, maintaining warmth in the body, right? As Chinese medicine practitioners, it’s very rare that we recommend cold. We tend to go toward warmth. Warmth is particularly important for new moms postpartum.

It continues to help to support the movement and the consolidation. Of the qi, right? So again, it’s that harmonization. What is too much, what is not enough? Let’s balance that out and the right types of warmth are going to be supportive in that way. Okay, let’s talk about some of the traditional restrictions that are going to be part of sitting the moon in Chinese culture.

And these would include washing one’s hair. We know that is a restriction as well during menstruation. It continues, of course, into postpartum. Bathing avoiding a draft is gonna be really important. Lifting, especially lifting the baby. And in traditional cultures, actually even, so I’m Italian and looking back into Italian culture, this is also a, a philosophy there as well. So it goes across the sort of folklore and the tradition of medicines around the globe. So lifting the baby, all that weight can help and support the mom’s poor posture, right? So we have this laxity in. The body after the birth, right? So the abdominal muscles are stretched and they’re weak, and generally there’s this forward tilt of the pelvis, which means the back muscles are tightened and those glute muscles are stretched.

So there’s this imbalance, and until that balance is restored within the body, whenever the mom is doing lifting, she’s facilitating. More of that poor posture. So lifting whenever possible is something that should be done by the nurse, by the family members, by community. And I think that’s the biggest key when we’re talking about sitting the moon and cultural tradition, is that community is such a big part of these traditions.

Where in Western society it’s almost mom’s gotta do so much. By herself and if she’s lucky, dad gets, a period of postpartum time as well. So dad can help a little bit, but it’s really leaning into community is so helpful. So as acupuncturist, if we can provide our clients with resources for accessing community for our postpartum moms, that’s such an amazing asset.

Okay. Another thing, climbing stairs, again that contributes to poor posture and also too much load on the body and change in the abdominal pressure. Nursing in sideline position is so important. Any watching TV reading or. Now we say scrolling as well. This is all going to be things that take the mom’s energy or put in energy that is going to impact what she is sharing with the baby, right?

And also shedding tears. And of course, we all know the Chinese proverb that says one teardrop from a postpartum women is worth 500 kilograms of gold. So just keep that in the back of your mind and share that with your clients. Let’s talk about miscarriage for a moment. Miscarriage is considered to be more serious than childbirth, according to Giovanni Macha.

And this is also true in a lot of the traditions, right? So women who’ve had a miscarriage or in abortion for that matter, the postpartum cycle could actually be extended. And the reason for this is because the natural cycle of pregnancy. Is interrupted, it is changed. The body has an expectation to complete a cycle when it is not going to complete that cycle.

That is a huge interruption in the cycle, in the energy of the cycle, and of course within the hormones. So not having completed the cycle can create quite a struggle within the body, mind, and spirit. Let’s look at some statistics here. Postpartum complications from a 2024 study actually showed that 35% of women experience pain with sex.

32% experience, low back pain, 31% experience urinary incontinence, 34% anxiety. 19% experience rectal incontinence, 15% experience pain I’m sorry, fear of childbirth. 11% peroneal pain, specifically 11% secondary infertility. Prolapse is 1.4 to 13.7%. So those numbers were a little bit varied depending on where the study was looking.

And then that’s with a vaginal delivery with a c-section. The prolapse is were 2.4 to 21.2%. So there’s a lot of variation there and that’s something I think that needs a little bit more research. But as you can see, there are pretty big. Statistical indications that show that there are a lot of postpartum complications.

And as acupuncturists, guess what? There are a lot of ways that we can support our clients, especially if we specialize in pelvic care, postpartum depression as a complication. I gave this its own slide, so in 2009. 2010, there was 9.4% of women reporting postpartum depression. In 2021, that number jumped by 104% to 19.3% of women.

Now, of course, during this time, there was the covid, so that was part of it. Also, women are talking more about what’s happening in their bodies, right? Women are starting to be more and more aware of what’s happening. This increase was noted across all races and ethnicities. There was also a substantial correlation between postpartum depression and obesity.

So these are all important things for us to be aware of with our clients. Okay, so I’ve included this chart for you to have a look at. You can go ahead and pause here if you like, to look at this interplay between the intrinsic and extr extrinsic predispositions to pregnancy, labor and childbirth, and medium term and long term maternal complications.

And you can see that these go out long after childbirth that we can still be seeing. Complications, which include prolapses and that sort of thing. So what does it take postpartum to heal, particularly to heal the pelvic floor? I shared a little bit of this slide in our pregnancy workshop, but we’re gonna go into more detail here.

First off is organ alignment and function. If you watch my pregnancy presentation, you know there are major changes within the organ systems in the body during pregnancy, which means that the body kingdom. Is out of order. There was a renovation that happened within the Body Kingdom, and that’s okay.

That’s not a bad thing, but balance needs to be restored. We need to help moms to find proper alignment and of course, utilizing the meridians. Is going to help those organs to come back into balance within the whole of the body kingdom. Now, the uterus size and position, we’re gonna talk about this more.

There are major changes that occur with the uterus size and position. It needs to expand, it needs to move up in the abdomen during the pregnancy, and now. We want the uterus to go back to size. I talked a little bit about ab abdominal binding as a strategy. That’s one way for sure, but there are also other ways that the body can naturally support itself in the uterus responding.

To its natural size and position. Then there’s the perineum that requires healing. There’s the ligamentous and joint recoil and positioning. All those ligaments in the sacrum and the hips and the back have stretched out. Why? They needed to support a baby and then they needed to push a baby through, right?

So we needed space for that. So that recoil. Needs to happen. The fascia, the diaphragms, and the postural alignment, there is going to be a whole new systematic alignment of the body that’s going to occur postpartum. I. Now if moms are not in a state where they’re able to take care of themselves, it’s really hard for that ligamentous recoil and those fascia and diaphragms to align and the posture to be appropriate for our clients through the postpartum phase.

And then, as it’s harder and harder to get it back as time goes on, right? What we have to put in is a lot more. The muscles of the abdominal the abdominal wall, the back, and of course the hips and the pelvic floor, they all went through changes as well. They were all stretched or tightened, so they need to return to some sort of harmony.

Okay. Blood and fluid leveling. We know about bloods and fluids in Chinese medicine. This is a big part of what we do. There’s a lot more fluid in the body when one is pregnant and then there’s a change in that fluid, so that’s going to be a pressure equalization once again, that occurs and it needs to be right.

For where the body is and what the body is going through. For example, a mom that’s nursing is still going to have an increase in fluids, different fluids, different energy, but they’re still going to have that increase. So we’re looking for the harmonization of where they’re at that moment. And then we’re looking at the energetic flow and the meridian flow, and then we’re looking at emotional harmony, right?

So there are a lot of things going on with postpartum moms. We talked about hormones in just about every one of our workshops here. We’re gonna talk about ’em one more time so we can see that at birth we have an increase in progesterone, estradiol, and cortisol. Those and those are all going and placental tigen.

So those are all going to increase. They’re gonna spike at the gradually increase and then peak at. Birth, and then they drop right off. That is a major change. Then we see oxytocin and prolactin come in and they have these peaks and valleys. These peaks and valleys are going to be impacting what is happening in the mom’s body and how her healing process is going to occur.

So when do hormones return to normal after childbirth? Okay. The common response is that, you’ll hear from your western doc is within six months, hormones return to pre-pregnancy levels. Period. Done. Okay, great. In theory except there is very little evidence-based research on postpartum hormones.

In a timeline form, there is research on postpartum depression being linked to decreased progesterone and decreased estrogen. There are studies beginning to emerge that show women who give birth at an older age may have different hormone responses. So basically what we’re saying here is there’s a lot of questions.

Each body is different, and I think when we’re able to transparently answer that question with our clients so that we’re not setting them up for an expectation that may not be reality, I think that’s when we’re going to be able to come in. With our compassion, with our knowledge, with our awareness, and really support them through the process and say, each experience is individual.

Your experience is your own experience, and here’s what we’re gonna do to help you in your process based on what in your clinic. Okay, so estrogen muscles. Let’s talk about the healing process. What we know is estrogen preserves muscle mass. It supports muscle repair. It helps muscles to generate force.

It increases collagen content. It plays a role in muscle metabolism, and it presents muscles against apoptosis. Okay, what we see, remember that gradual increase of estrogen and then that estrogen drops off after the birth right? So we are going to be in a diminished state of estrogen while the body is trying to recover those muscles.

The sudden decrease in estrogen can create decreases in muscle suppleness, strength, power, recruitment, and function. Of those pelvic floor muscles, and of course the abdominal muscles, the back muscles, all the muscles of the body are going to be impacted. But the pelvic floor in particular, because that is where the baby had to find its way through, now talking about progesterone, what we know about progesterone, it supports muscle relaxation. It supports protein synthesis within the muscles, and it maintains connective tissue elasticity. And what happened to progesterone? Same thing. We had that gradually increase and then a drop off. The sudden.

Decrease in progesterone can contribute to muscle weakness, proprioceptive confusion, and stiffness within the tissues, right? So we’re really at a disadvantage. The body is at a disadvantage to naturally recover on its own with zero intervention. Zero thought about the pelvic floor, zero thought about the abdomen.

The perineum tears occur in 80 to 90% of first time moms. A first degree tear is just the skin being impacted. Second degree impacts the skin and the muscle. Third degree is going to be a tear that includes the skin, the muscle, and it’s a partial tear of the external anal sphincter. Fourth degree includes the skin, the muscle, and is a complete tear of that external anal sphincter.

Now an episiotomy is when they do a surgical cut to try to control the the tear or to expedite the birth sometimes they’re done in emergency situations, sometimes they’re done to prevent serious tearing. The research on whether or not an episiotomy actually can prevent. Serious tearing is questionable at this point.

There is not good evidence to show that. That’s a topic for your client to have conversation with their midwife or their OB about. The stretching and expansion of the perineum is a natural process. The perineum will start to expand at the end of the pregnancy. That’s a good thing.

We want the perineum to expand. That’s going to help the process. Two to eight weeks after the birth, depending on the stretch and the tear. Intensity. The perineum generally starts to return to its pre-pregnancy state, to its unstretched state, and of course that varies significantly based on whether or not there is tearing.

There is some evidence that’s coming out, that perineal massage, that breath work, that relaxation can all really help with reducing the risk of perineal tearing. Now of course if the perineum does tear, that’s another implication, right? For what we have to do to address the pelvic floor. Okay, let’s talk about uterus, involution really quickly.

Okay, so this is the womb. Returning to its pre-pregnancy shape and size, involution begins as soon as the placenta is delivered. So basically the body just doesn’t get a rest. It does not get a rest. It goes through this pregnancy phase, which is a lot. It goes through the birth, which is an extreme amount of energy, and then the placenta is delivered, and then the body is oh, okay.

Now we start. Now we start again. So it’s the next part of the process. It’s that return as the uterus contracts to deliver the placenta and subsequently continues contracting, right? It starts to decrease in size. That contraction with nothing there to hold the shape kind of makes it start to shrinking.

Process. Involution, they say, takes about six weeks total. With more oxytocin in the body from breastfeeding, they say that the involution actually takes a little bit less time. Signs of involution include the Lok qia discharge, and of course postpartum cramping and contraction. Now pelvic floor muscle recovery postpartum.

A 2022 study found that at 12 months postpartum falling of vaginal delivery. The pelvic floor muscles are not yet fully recovered compared with their mid pregnancy values. Okay, so that’s not even talking about their pre-pregnancy values, that’s talking about mid-pregnancy values. This number should be concerning to you as a healthcare provider.

Some contributing factors that we see here are going to be a vaginal delivery, of course, versus a c-section tearing or episiotomy the size of the baby, difficulty of the delivery. What we know about the pelvic floor muscles is that it takes six to 12 weeks to build muscle. Muscles do not build themselves, so that means that it takes effort working with the pelvic floor to restore harmony.

And to restore balance. So where do we come in as acupuncturists? As acupuncturists, we have some amazing tools within our toolkit that can really support clients. And these tools are of course going to include using TCM. To help rebalance the patterns in the body and restore and nourish the system.

We, of course, have herbs that will do the same or whatever else is needed. We have moa, which really helps to consolidate and warm and activate blood flow within the muscle tissues. We have our gua, we have cupping, which, you know, cupping a little bit. Perhaps questionable considering there might be depletion, but it could be helpful in an isolated spot if there is particular tightness and over contraction.

For instance, if we have that imbalance that I talked about earlier with that serious anterior pelvic tilt and those back muscles are just. Squeeze down. The qls are just really tight. Those paraspinals are really tight and the abdomen is really stretched and the glutes are really stretched.

Cupping on that specific area could help to reduce the excess that’s in that area, distribute that throughout the body so that we can achieve a little bit more of a neutral tilt. We also have things in our tradition that are from the deep traditions of Chinese medicine, like pelvic steaming, like pelvic smoking.

Like abdominal binding, right? There are a lot of complimentary techniques that we can use to support our clients. Beyond that, if we get to know the pelvic floor in a deep way, then we’re gonna have the opportunity to support the pelvic floor, to evaluate the pelvic floor to. See where there are weaknesses to see where there are excesses, to see where we’ve got, stretch and tightening, right?

Because the left side and the right side might be different. Maybe the person who was having her baby had a leg length discrepancy, so everything on the right side, including the pelvic floor, is really tight. And then maybe there was a little tear going toward the left, and the left side is super duper weak.

So helping us to expand our practice by understand the pelvic floor really helps us to support these postpartum clients. So if you are with me today you probably know that this is my fifth workshop In my series we did a pelvic floor intro. We did a pelvic floor and menstruation, pelvic floor in fertility, pelvic floor in pregnancy.

This is pelvic floor and postpartum. We’ve also got a pelvic floor and menopause workshop coming up for you. Here are some references. I just wanna say, once again, thank you so much for being here. I really hope you enjoyed this workshop as much as I enjoyed sharing this material with you. Once again, I’m Dr.

Krystal Couture, the Pelvic acu, and this workshop has been sponsored by the American Acupuncture Council.

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