How To Heal Your Birth Scar

Our midwives and our ob/gyns take magnificent care of us while we are pregnant. And then we have our babies and *poof*, there are no weekly or even monthly appointments to check-in on progress anymore. No dedicated time to answer questions about our own bodies or even babies development. 

It can be a challenging transition for the best of us. As a pelvic floor therapist (and a mom!) I've thought long and hard about how we can make this transition easier on moms. How can we provide education to help answer the myriad of questions about a moms changing body?

I've created two free educational guides that I hope midwives, ob/gyns, nurses, and doulas can give women to help fill the gap of conversation and hands on care we receive postnatally. 

My two guides, "Caring For Your Back, Core, and Pelvic Floor: Your First Few Weeks Postpartum" and now "Heal Your C-section and Perineum Scar: Self Care Tips" is my attempt to bridge the gap between delivering our baby and helping expedite recovery and proper use of our bodies I order to connect to our deep core. 

I've always been perplexed about why the assessment for women post c-section stops at "it healed well; it looks good."  What about the way it feels? What about the emotional experience of how I had my baby? The low abs (where the incision occurs) goes directly through our true core (transversus abdominus) and right above our bladder and uterus. This is a part of of our body that must be able to move. Adhesions (sticky fascia that forms beneath a scar) can affect our ability to correctly use our low abs. It can also stick to the bladder and uterus (two organs that must be able to move to function well). 

After knee or hip surgery, it's standard practice to recommend rehab (which includes scar mobility). Why is this not standard for a mom who's had a c-section?

I want to change that. My latest guide "Heal Your C-section and Perineum Scar: Self Care Tips" will help start this conversation and give moms a tangible tool to help heal themselves. What we do in early days on recovery can have profound impact on our experience in our bodies for our lifetime. 

Rehearse for Birth

Have you thought about the ideal way to birth a baby? Yes, this could mean whether you want scented candles or your favorite soundtrack playing in the background. But I mean even bigger picture -- such as the universal desire for a delivery that is kind to our bodies and a robust recovery. YES! So how do we do that?

Let's begin by talking about how we actually get the baby out. Did you know that the healthiest way to birth a baby is not by using the core to push the baby out? That's the job of our powerful uterus. It knows how to contract to coax the baby out.  And baby helps too! Did you know that baby actually pushes his/her way out as well?

The job of the core and pelvic floor is to yield, open and relax to allow the baby through. This requires opening, relaxing, and letting go. That's the opposite of tightening, gripping and kegeling. The absolute opposite. 

The pelvic floor opens or relaxes for these other daily activities:

  • Peeing
  • Bowel movements
  • Penetration with intercourse. 

The pelvic floor muscles tighten, contract or kegel for the following daily activities:

  • orgasm (a rhythmic tightening and releasing)
  • continence (keeping urine and bowel movements in)
  • supporting our internal organs. 

When preparing for your birth, whether you participate in a birth class, take yoga or are an avid spin class attendee, remember that tension and tightening our pelvic floors is not what helps our babies out. 

Instead, focus on opening and relaxing your pelvic floor (perhaps next time you use the bathroom -- ask yourself how do I pee? Do I contract or squeeze out my pee or do I let it go? ) Just as many people contract or squeeze to pee (which actually discourages complete elimination), many people tighten or close their pelvic floors in birth.  So I suggest practicing with daily activities as a form of rehearsal for your pelvic floor for the big day. 

Yes, birth is a one time event, but it's implications on the body (and mind!) are enormous. 

Mental rehearsal can be so helpful. Yes, our bodies know how to birth our babies but we all know that practicing for an athletic event is always a good idea. 

Why is Estrogen, Testosterone & Progesterone Important During Pregnancy?

We hear so much about hormones during pregnancy - when I was suddenly hot natured instead of my usual cold self, my best friend said, "it's hormones." When I ate an entire chocolate cake (true story), my mom said, "it's your hormones."  What the heck? What are these mysterious hormones and what else are they doing to my body during pregnancy? Here's an overview of 3 big ones: Estrogen, Testosterone, and Progesterone.


Let’s talk about estrogen. Not just what you learned in high school biology, but how it affects your day-to-day life after you’ve had a baby.

Right after you give birth, the levels of estrogen and progesterone in your body dramatically drop. This is good news if you’re breastfeeding, as that drop allows a hormone called prolactin to be released, and it maintains your milk production. If you continue to breastfeed, your levels of prolactin will stay elevated and prevent you from ovulating. No ovulation means: low estrogen.

So, what does estrogen actually do for us? So what if it’s low? Well besides playing a significant role in the menstrual cycle, estrogen promotes blood flow and lubrication to the vagina/vulva, and it keeps vaginal tissue elastic and supple. If I didn’t have your attention before, I’m guessing I do now!

As women, our bodies go through tremendous changes across our lifespan. The drop-in estrogen that we experience after childbirth mimics the drop-in estrogen brought on by menopause. So in learning how to best take care of yourself after giving birth – how to care for your skin when it’s more fragile, how to moisturize the sensitive tissue of your vulva – you are getting ahead of the curve and learning how to care for yourself down the line. It’s a blueprint for the future.

I emphasize the importance of using moisturizer on the vulva (something pure like coconut oil or Vitamin E) and silicon or water-based lube during sex with every one of my female clients, but especially with new moms, perimenopausal, and menopausal women. Our skin is extra grateful to have a little buffer during those periods in life. This is important from a pelvic floor therapist’s perspective because if you’re experiencing pain during sex due to dryness, your muscles will be more prone to clench up. Comfortable skin opens us up to deeper relaxation – which, incidentally, leads to better orgasms.

A quick note about what you’re putting on your skin: choose wisely! The tissue of your vulva and vagina is the most sensitive tissue of your body – and it’s incredibly absorbent. It’s so important that we all choose vaginal products that are free from unnatural chemicals and mystery ingredients (which can lead to yeast infections and UTIs to boot).

Here are some of the lubricants that I most often recommend to my clients:

1.  Water-Based: (Safe with condoems; important that it’s PH balanced due to osmolarity) Pjur

2. Silicon-Based: Sliquid Silver


I’m going to dive right in here and let you in on a little secret. Let’s talk about your libido and your body’s sexual response. When you’re aroused, your tissues plump up and your clitoris and nipples become more sensitive. This in turn increases your partner’s pull towards you, as these bodily changes signal that you’re ready for action. Guess which hormone is behind these amazing changes in your body and your libido levels? Testosterone.

Say what?! We hear about estrogen and the ways in which that hormone affects us at various stages of life, so it’s about time we shed some light on the helpful role of testosterone for women. In fact, testosterone actually plays a key role in our body’s ability to produce estrogen. “The concept that one is male and one is female is completely incorrect,” says Dr. Irwin Goldstein, who has researched sexual function since the late ‘70s. Pretty amazing, right? We have testosterone to thank for one of the most vibrant parts of our physical experience.

As a pelvic floor therapist, I got interested in the role of testosterone in women’s health when I began to encounter clients who either over- or under-produce the hormone. You see, whereas estrogen affects the mucous membrane, testosterone works on tissues and muscles beneath the surface. This means that it may be a part of the puzzle when it comes to physical therapy and healing in the pelvic area.

Why am I telling you this? Because knowledge is empowering; it helps us to take ownership of our bodies and our experiences. Plus, who doesn’t need a healthy dose of wonder about the intricacies of our feminine biology! So next time you see a group of men trying to outdo each other at the gym, you can smile to yourself and know that you are – happily – in the testosterone club.

[Not sure if incorporating this paragraph would kill the mood, as it were - ha ha!]

I’m always a proponent of empowering women to know more about their bodies. But I’m particularly intent on getting this information out there because of how many women take a daily medication that significantly decreases testosterone levels: the pill. (This is why oral contraceptives are so effective in reducing acne!) Menopause also reduces our testosterone production, causing it to drop to half of its peak level.

For the geeks, here's more resources:


Meet a helpful hormone who doesn’t get a lot of press: progesterone. “That has something to do with periods, right?” Yes – and so much more!

Progesterone, which is made in our ovaries and adrenal glands, prepares the uterus’ lining for a baby each month. Essentially, it preps the guest room in your body for a visitor. If you do happen to have a little someone set up camp, progesterone then steps into the important role of suppressing further ovulation and cheering on milk-producing glands.

This gives you a hint as to why progesterone is also helpful for women who don’t want to have children: artificial progesterone (aka progestin) in birth control pills prevents the body from ovulating.

As recently as January of 2017, exciting new research has shown a link between progesterone and repeated miscarriage. Remember the effect the hormone has on your uterine lining each month? By giving women additional progesterone, it seems we may be able to create an internal environment that’s better able to hold and nourish an embryo in the first eight weeks of pregnancy (before the mother’s blood takes over the job of feeding). If you’ve had two or more miscarriages in your first trimester of pregnancy, talk to your doctor about progesterone and how it might help.


For the geeks, here's more resources: