What Should Doulas Know About Referring to a Pelvic Floor PT?
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Kaely Harrod 00:04
Welcome to doula Tips and Tits. This podcast is a place where we answer one question about doula work, both to support you and to help you support your clients. I'm Kaely Harrod. I've been supporting families in this perinatal space since my oldest was born 12 nearly 13 years ago. I am a birth and postpartum doula childbirth educator, La Leche League Leader and a doula coach. I love guiding and supporting doulas as they work out their doula business. It is a tremendous joy to be trusted in this way. Thank you for joining us on this journey. Welcome back to doula Tips and Tits. I am super excited to be starting off this series of interviews with providers digging into what doulas need to know about these different professions because as doulas we're working with people in the perinatal and postpartum space, and it's very important that we know when and how to refer to other providers that are outside of our scope. So today, we're talking to Dr. Teiya Qualls, who is a doctor of physical therapy. I'll let her tell you some of her awesomeness. But a few things that I get really excited about is that she's a doctor of physical therapy, but also certified in pelvic health. And she's a doula. So she knows our world as well, which is lovely, and approaches this work with trauma informed care and kind of a holistic view of the person. And she's here in the DC area where I am. And so I actually refer many clients to her and my clients love her when they see her. So Dr. Qualls, could you just share with us how you kind of got to this place in your career?
01:50
Absolutely. So thank you for having me. First of all, again, my name is Dr. Teiya Qualls. And I have been a physical therapist for the better part of 17 years, I've worked in a variety of settings prior to starting my own company. And throughout my journey, while I was a student, physical therapist, I found out about what at that time, it was called women's health. Oh, this sounds really interesting. I always loved getting into how to improve overall fitness wellness, for those that identify as a woman, female. So from there, once, you know, once I was in my career, I would try to find places that offered at that time, again, women's health. But there was very few opportunities when I first started out. But eventually, I was able to get involved with the pelvic floor program and one of the hospitals where I worked, and from there continue to take variety of continuing education courses related to now what we call pelvic floor physical therapy, right. So as I, you know, went through some of the training, I just really wanted to get deeper into the birth working aspect of pelvic floor PT, because we work with and see a lot of pregnant and postpartum individuals. So as I work with a lot of my pregnant clients, I just found that the I was doing a lot of training for preparation for labor and delivery. Also, obviously getting them better on the back end, during the postpartum period, related to anything, it could be leakage, it could be paying within the course, whatever the case may be, but I was often missing that in between space. So some of my clients were asked if I can join them at the labor and delivery. And I didn't know exactly how to go about doing that. So I found out about doula work. And that's how I got interested in becoming a doula. So essentially, now I'm able to follow them through the whole journey, essentially, which is really nice, because I get to implement some of the techniques we may do in the PT world, during the labor and delivery, and then address anything that may come up on the back end. So it's just really nice to see them through the whole time. So that's pretty much my journey, you know, throughout schooling, up to now how I got involved. And basically what I decided to do in 2020, was start my own company. So I operate a mobile physical therapy practice. It's called quality touch, physical therapy and wellness. And essentially, we pretty much travel around the city, DC, Maryland and Virginia. We operate in people's homes depending on their location. We also have two clinic locations. One is in Alexandria, Virginia in Old Town, and the other one is in Rockville, Maryland. And for those that are appropriate, we also offer telehealth virtual services as well. So essentially, that's what I decided to grow and basically continue to nurture this this vision, this dream that I've had for quite a while.
Kaely Harrod 04:57
That's amazing. I also So really love that you have all those different ways for clients to connect with you because the postpartum time especially, it's hard for people to be able to come to an office sometimes or do like, in person. So the ability to have like, whatever kind of visit works well, is huge. So, okay, so today, we're answering a question just like we always do on this podcast. And so the question is, what should doulas know about referring to a pelvic floor PT. Now I have given Dr. Qualls just the freedom to as a doula and also a doctor of physical therapy to answer this, and I think every question that we talk about on this podcast is nuanced. So you're allowed to have more than one answer to this doctor calls?
05:47
Absolutely. No, that's really good. I love this question. Because oftentimes, when I do receive a client, who is already seen a doula or has a doulas that they've hired, they will tell me that they've had these symptoms for quite a while. So I've often wanted to get in, you know, in touch with other doulas that I know, just to let them know, hey, you know, this, these are the things that we can work on with them during their pregnancy. So essentially, aches and pains, like some people may think, Oh, this is just the norm, but we don't want to really normalize pain. So I often will tell or what I would want to tell doulas is that if your client is having back pain, hip pain, pelvic pain or pubic bone pain, those are things that a pelvic floor physical therapist will be able to assess, and pretty much successfully treat to get that person through their their pregnancy journey. And address addition to that, they may have other things that are totally off the radar for some people, like they may end up having plantar fasciitis or foot pain, they may have carpal tunnel, a lot of times during pregnancy and definitely postpartum sometimes. So we definitely would recommend that you refer for those kinds of things. And then just like neck and shoulder, aches and pains because of posture, or things that may have been that they may have been experiencing prior to pregnancy. But as their body has changed, it gets exacerbated. So essentially, those are some of the basic musculoskeletal things. Now, the biggest thing that I think doulas do pretty good with this is referring for like leaks when someone's having any urinary leakage. That could be even if it's a little bit I often when I do an evaluation for physical therapy out here, my clients say, Oh, it's just a little bit, it's only when I sneeze, it's only once in a while. But I often want to let them know that those are precursors, so we don't want to ignore them. And you don't have to just live with it. So I definitely say if your client is telling you that they are leaking when they urinate, sorry lit leaking when they sneeze, cough, laugh, lift anything with pressure, that's we call that stress urinary incontinence. So that's definitely a reason why you would want to refer, if they are having leakage with just a strong urge, like, if they all of a sudden get an urge and they can't hold it. Those are obviously signs that they may need to see a pelvic floor PT. If they're complaining of pain with intercourse, if they're still sexually active, they definitely could benefit from some pelvic floor physical therapy for that kind of condition. And then some of my clients or patients who are saved for physical therapy during pregnancy can be related to bowel things. I don't think a lot of people know that the bowel function is definitely something we can treat. Hemorrhoid Pain, fissures, anal fissures, sometimes they may be having constipation, which is very common, especially as they get closer to the end. Sometimes I don't see this a lot during pregnancy, but like fecal incontinence, but that's usually sometimes maybe after if they've had any kind of injury during the labor process. But essentially, those are things that I would definitely recommend you all refer for during pregnancy. And then on the postpartum side, it's really a lot of the same. The same kind of conditions, urinary symptoms, such as leakage, the different kinds of pain with intercourse once they resumed intercourse. That's a huge one. Now, in addition to those kinds of things, you may want to also consider if they have had a cesarean, or if they've had a perennial laceration. You want to refer them for pelvic floor physical therapy so we can work with them on the scar tissue. We can work on mobilizing that tissue, getting it moving, making sure that things don't get stuck and round down because we know that that scar can really cause more problems with function. So we definitely recommend that if their hair if they had hemorrhoids due to the labor or even the progressive pregnancy. And now they're still having a hemorrhoid pain, you can definitely refer them for that. Sometimes if they've had a really severe perennial laceration, we would recommend that you send them in if they've had. Now fecal incontinence, they may have a hard time holding their bowels. Some people may say I have a hard time holding gas too. So those are things that I would say a pelvic floor PT would do really well with at least getting an assessment to see what's going on. And then working through some of the interventions to get that those symptoms to improve. Oh prolapse, that's a huge one, pelvic pelvic prolapse. And that's where the person may say, Oh, I feel heaviness in my vagina, or I feel heaviness in my, in my my butt. Or they may say I feel something coming out. They may say things like that to you as a doula. And so if they're saying that, definitely send them for pelvic floor PT, because we want to start working on those things ahead of time. I'm sure some other things will pop up in my head. But those are the main things that I would say. If your client is just complaining, even if it's just a little bit, definitely put that on their radar. Because I think that that's what a lot of lay people don't know that they have an option and someone can help them through it. So yeah, but that's what I would suggest for for referrals.
Kaely Harrod 11:28
I love that list. Because I hate that we've normalized so many of these things, right? Like, the jokes of like, Oh, you've had a baby. So you like cross your legs to sneeze? I'm like, it doesn't have to be that way. Bladder doesn't have to do that. So I would love to dig in a little bit to like, What is your perspective on the continuity between pregnancy and postpartum? You kind of hinted to this, when you were talking about your own work and how you kind of bridge those two times by being a doula in the middle now, right. But I think sometimes, I have seen at least in clients that they really benefit from seeing the same person prenatally and postpartum. Because of that, like, even just body familiarity, right of like, this is what your pelvic floor was doing two months ago. Now, you've had your kiddo and here's what it's doing now. So can you talk a little bit about the benefit of that to our clients as
12:25
well? Sure, sure, definitely. Um, essentially, you know, I know, it's always going to be up to the client and their preference, some clients and patients, they click with a provider and and sometimes they don't, I've had clients who are gel with really, really well, and then some that not so much. So it just depends on their preference. So that's what I'll preface it by saying, but if you do enjoy your provider, if you're feeling like you're getting a lot of gains from the services that they gave you during pregnancy, I would definitely suggest continuing with them on the back end, one because they know what your baseline was, or at least the baseline when you came in to see them prior to them getting better, or before they had the baby. And then also, they will be able to have more detailed records. So it's a little, you know, a little easier on you, you don't have to recite the same history over and over again. I think that that continuity can be good too, because you can really see your progress. You can see how you started and then where you are at this point in time. And then if you all continue for other goals, you can see how much you're progressing very easily. Now, of course, you can get this if you switch providers as well, but it's a little harder when you're trying to piece it together. So that would be my suggestion. Ideally, yes, it would be great to stick with the same provider.
Kaely Harrod 13:44
I appreciate that. Okay, I'm gonna ask you two more questions that I didn't warn you about, but are coming up as you've been talking.
13:53
One thing you just made me think about to arm about the referral question. One of the things, I will get quite a few referrals from my Doula colleagues. And I appreciate that one thing I may recommend, especially for your clients that may not have a lot of symptoms, so that so you're just referring them as a preventative thing, it's great. To get a baseline I always want to let clients know, you can get a baseline evaluation during your pregnancy is nothing wrong with getting a physical therapy evaluation, during pregnancy, or even a baseline postpartum. Even if you're not having symptoms. You don't always have to be in aches and pains or having bowel, bladder or sexual issues to see a physical therapist. So remember, your body has changed, it went through this Olympic event. So we want to figure out what is going on now so that we can prevent things from happening because prevention is really key for a lot of things too. Now, from the doula perspective, I would say if you are referring a client who doesn't quite have any symptoms, but you know that benefit of pelvic floor PT is important. To give them a better a good understanding of the why you're sending them, because sometimes I'll get clients and they're like a deer in the headlights, and they don't know why they're there. And so me trying to explain it to them on the back end, I do a very good job, I'm very thorough, but it's sometimes better when it comes from someone they had a rapport with. Or if you've kind of given them an understanding of prevention, for instance, you may let them know, hey, it's good to get a baseline physical therapy, pelvic floor physical therapy evaluation, because we want to prevent X, Y, and Z from occurring. Also, you may want to let them know it's good to get a baseline just so that they know the state of their pelvic floor prior to delivery, or prior to their pregnancy progressing a certain, you know, to a certain point, and then even after delivery, same thing, even if they're not having a whole lot going on, I would say it's so important to have them do that baseline pelvic floor evaluation so that they can know what their body is doing now, and then how to prevent things or start working on some things. Because sometimes things don't really present right away. Postpartum, some things will begin to occur. As you start moving around more when you start lifting, bending, twisting, pushing, pulling more babies growing your lifting and coding, the more you're going to start maybe noticing some things, and especially when you start going into your physical fitness regimen. If you're doing that, then that can definitely be a big turnaround point. So that's my suggestion about just making sure that they know the why. And they understand the benefit of it prior to coming just so that they feel more a part of the conversation more in control of their care, things like that. Yeah.
Kaely Harrod 16:45
So you literally just answered the question I was about to ask you. Which is amazing. Yeah. I love asking PTS when I'm just chatting with him anyway, like, What is your thought on people coming for baseline? And so you just thoroughly answered that question a plus on the fact that you read my mind. My other question was going to be is physical therapy, something that is licensed regionally meaning that like you do telehealth, can you do telehealth with someone who lives elsewhere and doesn't have access to an in person PT.
17:27
So we can do telehealth physical therapy services only in the states where we are licensed. So I'm licensed in DC, Maryland and Virginia. So for physical therapy services, I can do telehealth via those states only. But for wellness services, things that are more like coaching, or, like you said, more like prehab, or like I said, just a maintenance program fitness program. Some therapists who offer those kinds of services can do them pretty much any in any area. But you always have to like make sure that you're staying within your scope. Because if I started doing physical therapy with someone in there in Nevada, even though I'm supposed to be doing wellness, it just puts you know, people in a in a sticky situation. So I try to make sure I keep the lines really clear.
Kaely Harrod 18:16
Now that makes total sense. And I think we're a little bit spoiled in DC that we have more options and a lot of areas have still not enough like we still everywhere needs more pelvic floor physical therapy. Is there anything that you would add that you want doulas to kind of take away from this in terms of incorporating physical therapists into the perinatal team?
18:41
Absolutely, you know, doulas and clients actually, this is something like we talked about telehealth. And often I get a phone call from the variety of patients and they'll say, Oh, well, you have to see me in person, right? Or they really, they really want this in person experience. Now, one thing you find out a lot of pelvic floor physical therapists don't have a lot of availability right away. So you want to get in as soon as you can, so we can get the ball rolling. So with that said, telehealth services are excellent. We do a lot via the virtual platform. A lot of what we do as PTs in general is education. We do a lot of education, a lot of instruction, a lot of observation and guiding you through things that none of that requires me to put my hands on you. We when we're doing a pelvic floor evaluation, virtually the things that I'm going to look at are the same exact things I'm going to look at if I see you in person. Now there are elements that I may not do necessarily when I am working with you virtually, but it won't, it won't typically hinder the progress or the quality of the care. I've had some clients I've never seen in person and they progress very well. So I'll often will encourage them if you can't get in for in person with your provider. definitely considered a telehealth option if they have a little bit more space for that, so that you can start working on some of the things you're concerned about. Now, one thing I will say, if you have poor Wi Fi may not be the best platform. Or if you just have a hard time following instructions, like if it was someone who because I work with people who are older, as well, geriatric, or even pediatric. And so sometimes they may have a hard time of the virtual platform if they can't follow instructions, but for most of my clients, they do fairly well. So I would definitely encourage you all to let them know that that is a great option for them. And the some of the things that we would do, like I said, we're going to look at your posture, we're going to look at your range of movement, we want to see what your strength is for a lot of areas, particularly your core, and your hips. And then when we're trying to get ideas or information about the pelvic floor, we're going to mimic a lot of things through positioning and posturing. So we can see what the pelvic floor is doing. In this particular position, I have some clients who are comfortable, even do some self palpation, or touch of certain parts of their body dominant tissue, hip tissue, inner outer thighs, even pelvic floor, because I do a lot of instruction of the wand or dilators, and things like that through the virtual platform. So that's something that I would definitely say could be a benefit for your clients, especially if they're having to wait months to get in for some providers, or weeks.
Kaely Harrod 21:30
Now, that's really helpful. And I will say that's something I always tell people is like, it can take some time. So don't wait until you're ready for an appointment to call call now and set an appointment. Even if you're like, I don't really want to see someone until I'm six weeks postpartum, like call when you have your baby and get on their books.
21:51
To you just made me think of something Yeah, most clients were going to, or they know to come after their six week check. Now this is impersonal, virtual. But a lot of times I do I do a three week assessment, where I'll see someone at three weeks now for this is for a person who just wants to get a baseline generally, or know that they have gone through a really, you know, pretty difficult labor delivery process. And I'll work with them on early abdominal activation, early pelvic floor muscle activation, obviously, I'm not touching those areas, I'm just instructing them through it because I'm doing this virtually, because they're not going to want to come out. And I know that they're going to have really, you know, a tight schedule, or they have a lot of visitors. So we do that virtually, I work on scar tissue work, especially for those that are under when necessary. And I want them to start moving that scar around once it's healed. You know, certain level of healing has occurred, I don't want to wait too much longer. So I'll usually started that at the three week mark, doing some indirect work on that. I also will work on other musculoskeletal things that the hips or the spine that may be occurring. And then for some I've seen some clients in person for like a week or two out because they had a birth injury. So pubic symphysis separation sometimes will occur. And that was had to see them a little sooner. We're working on different things, not necessarily strictly pelvic floor, we're working on the the joints themselves, but I'll see them earlier, especially if they're in a lot of pain. If they're having a lot of pain after delivery. I'll see them beforehand. We generally don't do anything internal until you've had that six week check.
Kaely Harrod 23:34
Yeah, that's really helpful. I think I'm encouraged to see like PT being normalized in the process of pregnancy and postpartum. But I know it took me probably six years post postpartum to even learn about PT and be like, is it too late? Can I go now? You know? And so I'm grateful. Yeah.
23:56
That's a good point. No, it's not too late. Even my postpartum moms that are 10 years out, or 15. They forgot teenagers. I tell you, if you're having symptoms, come and see a pelvic floor physical therapist, because I hear people saying, Oh, I thought that it was too late. No, you can definitely get benefit because it's just like any other part of your body. If there's an injury, you start working on it, and you see improvement. So that's definitely something that I would suggest. And then I forgot to mention this for in preparation for your labor and your delivery. You can also get a great benefit of working with the pelvic floor PT on labor delivery prep on how to push properly and do a safe push prep class that is going to basically teach the person about the elements of pushing. So this particular class, we're going over the breath, the breathing mechanics, so the breathing involved with pushing, we go over the muscle engagement of the core that's involved with pushing. Let's teach them how to do that properly. I teach them the actual Pushing mechanism now we're not pushing like you would if you were delivering, we're just making sure that you have the awareness of those muscles on how to lengthen them. Because it's not all about Kegel and and pulling in at that point in time, we're learning how to lengthen the muscle. So I'll teach you how to do that I teach you and if you have a partner or support person that could help you with this perineal massage training during that class, making sure that you all start working on that tissue around the opening, because we want that tissue not to be super tight and bound down. So I teach you how to do that. And then I also do some joint and muscle mobility training and provide you with the personalized exercise regimen that I want you to be working on in preparation for labor and delivery, that can hopefully get you to have an optimal pushing experience without injury or at least very little. So I often will recommend that clients see a pelvic floor PT for those kinds of instructions and training to hopefully prevent injury, especially because when as a doula, I will see things done in the labor room. And I'm like that isn't that's not what we typically recommend, particularly the breath holding part that that part, it concerns me. When whenever being instructed to you know, hold your breath, hold your breath, and might know, don't hold your breath. I usually try to keep, you know, give my client, my Doula clients, a pep talk and say, as best as you can, and going at some hospitals are going to coach you, even if you don't want coaching. So try to zone them out. If you if you want to do breath holding you are at liberty to do that, but I do not recommend that generally speaking.
Kaely Harrod 26:39
I love your phrasing of that. And that's concerning. This Yes. Yes, yes, it is. I would agree. I'm like, if you could see us on video, I'm just sitting here like nodding and nodding and nodding. And keeping myself muted. So I'm not just like yes, yes, yes. Okay, I want to, I want to wrap this up, just because I like to keep these episodes nice and short. So people can digest them like on a drive to a client or whatever they are in the midst of. It has been so lovely to have you on and you have shared a wealth of knowledge with our listeners, I will have some information about you and ways to connect in the show notes. Is there anything else about connecting with you that you want to share with listeners,
27:28
or I always encourage people to reach out to us, you can reach us at our offices, although all the offices have the same number 301-246-2353. Also, on our website, we have a ton of information, quality touch pte.com. And then we're on all social media platforms at quality touch PT. So you can find that anywhere reach out to us, we're more than happy to chat, you can set up a free virtual 15 minute consultation with me. And we can go over some of your questions as well and hopefully get you on to, you know, prevention or improvement.
Kaely Harrod 28:07
Yeah, amazing. I'll make sure all that information is in the show notes. Thank you again for taking time to be with us. And to everyone listening until the next episode. I wish you a well informed consent filled experience. Thanks for joining us for this episode of the doula Tips and Tips podcast. If you learned something today or had an aha moment we'd love for you to share that on Instagram and tag us at Herat doula, so we can celebrate alongside you. If you found this podcast helpful. We would so appreciate you taking a second to leave a rating and review on your favorite podcast app that helps other doulas find us as we do this work together. This podcast is intended as educational and entertainment it is not medical advice or business advice. Please consult your own medical or legal team for your own needs around
This is the beginning of a series for the whole month of July featuring various providers who are answering questions they want doulas to know about when clients can use their services and when/how to refer to them. This is a vital part of every doula’s work because there are many providers who should be referred to and who our clients can benefit greatly from.
Dr. Teiya Qualls is our first provider! She is a wonderful Pelvic Floor PT in the DC area and is doing amazing work to bring better pelvic health to the area one client at a time. See her full bio below.
Doulas often think of Pelvic Floor PT for post-delivery, but there is much more to a Pelvic Floor Physical Therapist’s role in a pregnant person’s whole pregnancy as well! There are a wide range of issues treated by a Pelvic Floor PT from muscle pain in the pelvic floor to pelvic pain in the sacrum or hips! The pelvic floor is connected to the whole body, so there are many issues that can impact its health and tone.
Quote from the show:
“What I would like to tell doulas is that if your client is having back pain, hip pain, pelvic pain or pubic bone pain, those are things that a pelvic floor physical therapist will be able to assess, and pretty much successfully treat to get that person through their pregnancy journey. And address in addition to that, they may have other things that are totally off the radar for some people, like they may end up having plantar fasciitis or foot pain, they may have carpal tunnel, a lot of times during pregnancy and definitely postpartum sometimes. So we definitely would recommend that you refer to those kinds of things. And then just like neck and shoulder, aches and pains because of posture, or things that may have been that they may have been experiencing prior to pregnancy.“
OUR GUEST:
Dr. Tieya M. Qualls, PT, DPT, PRPC is the founder of Quality Touch Physical Therapy & Wellness, serving the DMV area. She is a licensed Physical Therapist with additional certification in pelvic health. She earned a B.S. in Biology from Hampton University, in Hampton, VA in 2002. Following this, she received both her Master and Doctoral degrees in Physical Therapy from Howard University, in Washington, DC in 2005 and 2012, respectively. Throughout her 16+ year career, she has attained experience working in a variety of clinical settings including, orthopedic outpatient, skilled nursing, home healthcare, and acute care. Dr. Qualls is also trained as a birth doula, providing education, emotional and physical support for the pregnant and postpartum population.
She values being a part of their birth team, whether it is educating, serving as an advocate, or simply holding space for her clients during a time when they are most vulnerable. She is always honored to be chosen by her clients, to assist them during this important period of ushering new life into their world. She has served as an Adjunct Clinical Assistant Professor at Howard University, in The College of Nursing and Allied Health Sciences. She is also an APTA Credentialed Clinical Instructor, utilizing her knowledge and skills to assist with educating the next generation of Physical Therapists.
After completing the pelvic floor course series with the Herman & Wallace Pelvic Rehabilitation Institute, Dr. Qualls earned the Pelvic Rehabilitation Practitioner Certification, also offered by the organization. This certification designates her as a pelvic rehabilitation specialist, possessing the knowledge and skills to accurately diagnose and treat pelvic floor dysfunctions for all genders. She has also served as a TA for the organization, assisting instructors as they educate other healthcare professionals on topics within the pelvic health field.
In addition to her passion for treating conditions of the pelvic floor, pregnancy, and the postpartum period, she also treats a variety of musculoskeletal and chronic pain conditions. She has taken multiple advanced manual therapy courses addressing not only the pelvic floor and pelvic girdle, but also other regions of the spine and soft tissues of the body, globally.
In an effort to maximize patient outcomes, she incorporates a variety of manual therapy techniques into her treatment approach. These include myofascial release, muscle energy and trigger point dry needling, including dry needling to the pelvic floor, when appropriate. She uses her specialized training and evidenced-based practice to create individualized treatment programs that focus on the whole person. She also values empowering her patients by providing them with exercises, education, tips, and other resources that will assist them with reaching the goals along their health/wellness journey. Dr. Qualls has a passion for assisting people on this journey from a holistic standpoint, taking into account the mind-body connection as well as implementing trauma informed care, when needed, to ensure her patient's utmost comfort. She understands the specific needs of each patient, implementing a treatment approach that is consistently provided with care and compassion.
CONNECT with Dr Qualls:
Website: www.qualitytouchpt.com
Instagram: @qualitytouchpt
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https://www.tiktok.com/@doulacoach
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Kaely Daily is produced by Kaely Harrod of Harrod Doula Services
It is sponsored by The Birth Prep Blueprint Childbirth Class
Music by Madirfan: Hidden Place on Pixabay
