Revitalize Physical Therapy Blog

While it may not be self-evident, NOT all bacteria are created equal. Like good cop-bad cop, there are good bacteria and bad bacteria. In fact, this discussion has recently become relevant to a different conversation, namely, the pros and cons of vaginal delivery vs. cesarean section (c-section) delivery. Vaginal delivery introduces the newborn to vaginal fluids which help develop a healthy newborn microbiome (the collection of microscopic organisms which live on and in us).

These microorganisms exist on the skin, in the mouth and saliva, in the eyes, and in the gastrointestinal (GI) tract. It is believed that many of these organisms, especially ones in the GI tract, contribute to healthy gut flora and function. In other words, exposure to the mother’s vaginal fluid, bacteria and all, helps develop a healthy newborn microbiome. Furthermore, it helps develop the neonatal immune system, prevents growth of negative bacteria, and produces certain vitamins.

Babies delivered via c-section are deprived of the maternal vaginal fluid along with its corresponding health benefits. Furthermore, c-section delivery is often accompanied by antibiotic usage which may also interfere with healthy infant microbiome development. In fact, it has been hypothesized that the recent rise in childhood asthma, immune diseases, and obesity may be associated with the increased rate of c-section, which nowadays is approximately one in three births nationally.

This has led researchers to explore the field of vaginal seeding, the artificial introduction of maternal vaginal fluid to the infant’s mouth, nose, or skin. This exposes the baby to the same bacteria he or she would have encountered through a vaginal delivery. This progressive and creative solution is still in its initial stages, and the American College of Obstetricians and Gynecologists (ACOG) is recommending, “Ladies, don’t try this at home.” In fact, they only recommend undergoing the process as part of an IRB approved clinical trial. The reason for this is because they still lack adequate research to support this procedure routinely. It is still unclear if the benefits outweigh the risk of exposing the infant to pathogens or other dangerous maternal bacteria.

However, it won’t be long before we have more data, and clinical trials are well underway. In fact, microbiologist Dr. Maria Gloria Dominguez-Bello’s pilot study compared the microbiomes of infants born vaginally with those of infants who were delivered via c-section followed by vaginal seeding. Dominguez-Bello found that the microbiomes of both groups appeared very similar after one week. This is promising, and longer-term studies with larger sample sizes will determine if vaginal seeding will become par for the course within the c-section community.

To learn more about this fascinating research, I encourage you to listen to Dr. Aviva Romm’s interview of Dr. Dominguez-Bello. Dr. Romm is a physician, a midwife, and an herbalist with over thirty five years of experience. She has an amazing website replete with valuable information, including her blog and podcasts. This is the link to her website, and this is the link to her interview. I hope you find this information as exciting as I do!

Dominguez-Bello MG, De Jesus-Laboy KM, Shen N, Cox LM, Amir A, Gonzalez A, et al. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nat Med 2016;22:250–3.

I recently read a fantastic piece in Healthline Newsletter (link to article) about a young woman’s experience with pelvic floor physical therapy. While reading this article, I found myself thinking on several different occasions, “Yes. Yes. YES!” Everything that the author, Allyson Byers, described resonates with the sentiments expressed by my own clients. She hit the head on the nail in her description of the common emotions and fears experienced by pelvic pain patients. I made a mental note to share this extremely validating article with my clients…and what better way to start sharing this gem than with a blog post?

On that note, I would like to address several powerful points that Byers raised:

1. Byers first describes her failed attempts to use tampons as follows: “I tried many more times, but the pain was always so unbearable, so I just stuck to pads.” Using pads by choice is different than using pads due to necessity. This point segues into the next relevant point…

2. After describing her first attempted (and failed) gynecological examination, Byers asks: “How could this much pain be normal? Was there something wrong with me?” Her doctor at the time downplayed her pain and suggested that she try again in several years. With all due respect to this doctor, there WAS something wrong, in fact. Pelvic floor muscle overactivity is an actual physical condition, and young women should be able to tolerate speculum examinations. I have had clients suggest at their initial evaluations, “Perhaps my vagina is just too small for a speculum? Or for intercourse?” I set the record straight and remind them that the vagina is designed for the emergence of a baby, assuming all other relevant factors are present (ex. proper fetal alignment, progression of labor, etc). Regardless, the point remains- if a young woman cannot insert a tampon or tolerate a speculum examination, she is probably an appropriate candidate for pelvic floor physical therapy and should request a prescription from her doctor.

3. Byers goes on to describe how her physical pain affected her interpersonal relationships. “If I went on dates, I’d make sure they ended right after dinner. The worry of physical intimacy led me to breaking off potential relationships.” Unfortunately, I have heard this story too many times. Too many of my clients have shared that relationships have terminated due to their pelvic pain and/or fear of intimacy. Others have admitted that they avoid relationships altogether because it is easier than having to explain their condition to a potential partner. Every person deserves to love and to be loved. Every person deserves the joy of a healthy relationship. I feel blessed to work in a profession that helps foster and promote physical intimacy and interpersonal connection.

4. In addition, Byers states that “doctors told me there was nothing physically wrong, and the pain stemmed from anxiety.” Unbeknownst to her, Byers touched upon one of my personal soapboxes. Pelvic pain usually doesn’t stem from anxiety. It stems from musculoskeletal overactivity and tightness. I am a big believer that our minds can affect our bodies, and psychological stress can have an impact on our physical health. That is why downtraining programs which are initiated to address pelvic floor muscle overactivity often include diaphragmatic breathing, mindfulness based stress reduction, yoga, and other forms of relaxation. However, this is a far cry from “your pain is all in your head” or “this pain must be stemming from anxiety,” which are very discouraging and invalidating comments that no patient with pelvic pain should ever hear. This point leads into my fifth and final article highlight…

5. After her initial evaluation with a competent pelvic floor physical therapist, Byers said, “I felt so hopeful on my way home…I was so happy to know that the pain wasn’t ‘all in my head.’ It was real.” Most clients who visit a pelvic floor physical therapist are completely unaware of the existence of their pelvic floor muscles, let alone understand how they work or how they impact their pain. Most have never seen a model of a pelvis at prior medical visits. Patients are generally extremely appreciative to learn about their bodies and their pain. They are grateful to be validated and to meet someone who understands their condition. They are thankful to finally meet a medical care provider capable of helping them. In addition, knowing the pain’s origin allows clients to feel hopeful about the prospect of healing. It is an honor and privilege to be the harbinger of good news to clients who have been suffering, often for many years.

It probably isn’t easy to describe so openly what pelvic floor physical therapy must feel like from a patient’s perspective. On behalf of the many woman who will hear her story and be inspired to participate in pelvic floor physical therapy, I thank Allyson Byers for courageously sharing her experience.

Planting a Seed

A Patient’s Powerful Perspective