September 2018

What should empathy in health care look like?  Why do parents so often have negative experiences with their health care providers?  Today we talk to Martelle of Mothership about empathy training and what her website provides for new parents.  You can listen to this complete podcast episode on iTunes or SoundCloud. 

Alyssa:  Hello and welcome to another episode of Ask the Doulas.  I am Alyssa, co-owner of Gold Coast Doulas, and today I’m here with Martelle of Mothership.  Hello!

Martelle:  Hello, Alyssa.

Alyssa:  So for those of our listeners who have no idea what Mothership is, can you describe it in a nutshell?

Martelle:  Sure.  So Mothership is a new nonprofit, and we’re focused on empathy and empowerment in healthcare for parents.  We’ve spent some time over the last two years trying to figure out how we can best do that, given all of the other great programs and organizations that are around town and in the state and nationally, and we are focusing on two programs.  One is a digital platform and community for parents that’s facilitated by parents who also happen to be health professionals, so it’s this health education platform where you can find information and support in the form of Q&A sessions, support groups, and curated resources based on your own family’s experiences and what you need.  We also train health professionals on empathy and empowerment and building connection during health practice, and all of our health professionals on the platform will be trained in this curriculum.  It’s called Mothership Certified.  We also train health professionals outside of the platform as well, including many of the Gold Coast doulas.  Many are Mothership-certified now.

Alyssa:  Yeah, several of us are.  So I think from an outside perspective, this website is really a draw for parents who are looking for resources, but then Mothership also helps the community healthcare providers to become more empathetic towards the people they are working with?

Martelle:  Yes, that’s the goal.

Alyssa:   Yeah, we did the training with you, and correct me if I’m wrong., but you kind of specifically tailored ours to be around doulas?

Martelle:  Yes.

Alyssa:  And I know there’s one specifically for lactation consultants or if you’re a group of nurses.  So it’s kind of in your best interest to have a group of people who are somewhat like-minded to that you can gear the training towards them?

Martelle:  Ideally; however, most of the topics are fairly universal.  The tailoring happens related to the different examples and what we focus on and the different activities and some of the detailed topical discussions.  But the general framework is really applicable to any group, so if you have folks that are working in the same office but may not be the same type of professional, that can work too.  We also are able to tailor it, like you said, specifically to a certain kind of profession.  But it’s designed to meet needs of a range of health professionals because it’s designed as a parent-centered training.

Alyssa:  So let’s say we have a group of nurses.  For somebody who still is going, hmm, I still don’t quite understand this, what does empathy training look like?

Martelle:  Sure, yeah.  Sometimes it’s hard to talk about this because a lot of people in healthcare are already very empathic.  People go into health professions because they want to help people, but unfortunately, the health system is often designed against them, where we’re not given very much time with our health professionals.  We’re putting a lot of burden with paperwork and completing tasks, which is all really important for other reasons, but it makes it really hard sometimes to build connection in that short amount of time that you might have to engage with the patient or with the client.  We did a lot of feedback sessions with different health professionals about what kinds of information and resources would be helpful for them, and we decided that we wanted to create a training that would put together, in one day, many opportunities for reflecting on the current practice, your current practice, including different topics.  We’re talking about many different topics related to empathy, empowerment, and connection, and focusing on group activities so that you can really think through how it applies to your own work.  For example, we do an introduction to empathy and compassion and set the stage for the whole day about what it means to be empathetic.  We do a section on self-care because when you’re hurting or struggling, it’s really hard to provide empathetic care, even if you are an empathic person.  If there’s a lot of other stuff going on in your life, it can sometimes be hard.  So we do a section on self-care.  We do a section on cultural and emotional intelligence.  We do a section on implicit bias; a section on storytelling; a section on building connection through facial expressions, gestures, spatial relationships, and intentional verbal communication.  So it kind of touches on a little bit of everything, and we drew from psychology and human behavior, and we also intentionally drew from the field of design, specifically human-centered design, because they actually in that field have a lot empathy tools that we have integrated into some of the other content throughout the day.

Alyssa:  Yeah, that part was interesting to me.  The way you’re facing somebody or how close or how far away, and if you’re far away and hands crossed — all these weird little things that make such a difference.  If you’re a healthcare provider and you’re standing either above or below – I’m really tall so I’m always above, but I don’t even realize it if I’m crossing my arms, which I normally do, because I have long arms, and it’s like, where do I put them, you know?  I could be giving off an impression of being standoffish or I think I’m better that them or who knows what, right?  Just by my body language.

Martelle:  Right, exactly, and what’s really interesting is that there’s not really a perfect formula on how to provide the most empathic experience that builds trust and connection.  What we try to do is provide tools to folks that participate in the training because not every idea or every practice is going to make sense for every single person participating.  Sometimes you might be more challenged based on the way that your particular clinic might be set up.  It might be set up in a way that makes it really difficult to use spatial relationships and certain gestural and body language because it’s out of your control, so maybe then you’re more focused on that intentional verbal communication because you’re sort of making up for the spatial relationship that might not be there.  What I mean by that is maybe you are in a position where you are towering over someone, and you’re not able to meet them at an eye-to-eye level for whatever the reason may be.  So the goal with the training isn’t that we have all the answers; it’s that we want to provide a range of tools that people can use in their practice.  And what I will say, also, is that I think in general, these ideas and these topics of patient-centered care and then trying to look at things like spatial relationships and certain types of verbal communication — these are trending right now, which is really great because the reason that we put this together is that we heard from a lot of families that they weren’t always having the best experience.  Some people had great experiences, so that’s great, but not everyone is having great experiences, so we saw that there was value in doing this.

Alyssa:  Do you have some examples of some experiences that you’ve heard of?  And then I want to know why Mothership; why did you choose that name?

Martelle:  Sure, yeah.  So I’ll give you one of the examples of an experience that wasn’t ideal, and this was from a mom that we interviewed for our blog.  We gathered information from all over the place.  We did in-depth interviews with some people; we also interviewed people for our blog, if they were just able to write in some answers for us and share.  And because this one was written for our blog, I’m able to share it, whereas some of the other ones were a little bit more personal and people weren’t as comfortable sharing.  But this one, I can just start with a quote.  So this mom says: “They made us wait for over three hours after four sleepless days in the hospital and breastfeeding challenges.”  So this was at her follow-up pediatrician appointment.  “The doctor came in and decided to give the baby a bottle, saying something about people wanting to ‘feed babies with spoons and droppers like damn goats, and there’s nothing wrong with a bottle.’  I remember I just sat there with tears rolling down my eyes, feeling like a huge failure.”

Alyssa:  So she was having some breastfeeding struggles?

Martelle:  Yes, and the way that the pediatrician engaged with her was not the way that she was looking to be engaged with.

Alyssa: No, I don’t think anybody wants to hear that kind of feedback or attitude, right?

Martelle:  Yeah, and I think some of this also has to do with changing — I mean, this particular example just sounds terrible regardless of what context you put it in, but millennial parents, in particular, are really looking to take ownership of their health and the health of their families.  I’m a millennial, so I relate to this personally, but I don’t want to make my decisions based on my own personal experiences and anecdotes.  But market research also shows that millennials are not really looking at their doctor to tell them what to do and manage their care in the way that previous generations have.  They’re looking to their doctor as a source of information, a source of support, but ultimately, they’re looking to be empowered to make decisions, informed choices, based on credible information and empowering support; that’s what they want.

Alyssa:  That doctor didn’t make the cut.

Martelle:  No, no, no, did not make the cut.  That’s one of the stories.

Alyssa:  So you just heard story after story after story of these new parents; and was it especially mothers?

Martelle:  It was especially mothers.

Alyssa:  Saying, “They’re making me feel this way,” or, “I feel like a failure before I’ve even started.”

Martelle:  Yeah, it was confusion and conflicting advise and judgement and not necessarily getting the advise and information that they felt was really personalized to their unique experience.  Another really interesting thing that came out of our discussions with parents was that there’s a lot of emphasis on the baby, which is really great, but not the whole family as a unit, like what makes sense for the family as a unit.  What makes sense for Mom and Baby, versus this is the best thing you need to do for your baby, but does that make sense holistically for your family?  And for a lot of the families that we talked to that had challenges, it was sort of this tension between what they thought they needed to do and what actually made sense for them, and so they were feeling this conflict and these feelings of failure as a result.

Alyssa:  Well, and there’s no one right answer for every family, so when you have a doctor who says, “This is what you do for this,” and that’s it…  I think that’s why we loved this so much as doulas because it changes every day, and every family’s so different, and you can’t just give one family one answer, and you have to take the time to listen.  So we thought the training was amazing.

Martelle:  Great.  I’m so glad to hear it!

Alyssa:  There’s been some stuff I’ve read and seen and talked to you about and seen on social media about your fundraising campaign.  What does that have to do with Mothership?

Martelle:  Sure.  So we’ve been working on Mothership as an organization, and we’ve been researching and developing our programs for the past two years as volunteers.  So this has been a very grassroots volunteer initiative because it’s resonated with a lot of people, and it’s been great because people have jumped in and offered their time and their talents to be able to create the training and the platform that we’ve been working on.  But now we need to, especially with the platform, put it out there and test it in real life with moms and with health professionals, and we need to collect data and do evaluation, and that takes a little bit of money.  Thankfully, not a ton of money, but enough money.  So we recently launched a crowdfunding campaign.  Our goal is to raise $12,500, and this is to run the pilot of the platform for one month with, hopefully, around 100 families; maybe up to 150 families.  It will support six to seven dieticians who are moms, and they’ll be teaching virtual classes, hosting support groups, live Q&A sessions, curating resources, blogging.  We developed a customized search tool that makes it really easy to find information and articles from anywhere on the internet that have been endorsed by these different mom dieticians, meaning that if you really like one of them or a couple of them really resonate with you, you can go into our search tool and search for the resources and information that they endorse, and it’s not necessarily just stuff that they did.

Alyssa:  So it’s kind of funneling your Google search into a trusted filter.

Martelle:  Yeah, exactly, but someone that you can trust both on a professional level because they’ve been training but also on a peer level.

Alyssa:  They’re moms, too.

Martelle:  They’ve been there.  They know what’s going on, and that was really important to us.  Something that came out early on in our research and development: one of the moms we interviewed said to us that her best mom friend is also a nurse, and she said, “She understands me and she doesn’t judge, but she also has medical knowledge.”  So that was a really unique and wonderful relationship, and we wanted to create that experience for more parents because we want people to be able to know and trust the health professionals that they’re getting their information from because they’re looking to get to know them.  So it’s a way that you can find things that are more relevant to you and your personal experiences.  We hope to grow in topics, but in the beginning, we’ll be focusing on nutrition for fertility, pregnancy, postpartum, and early childhood.  So we’re really focused on food and nutrition in the first round of this work, and the dietician moms involved have a range of their own personal experiences.  Some of them have kids with food allergies; some of them have food allergies themselves; some of them have had really picky eaters; some of them have had fertility challenges.  Some of them, even though they’re dietitians, were completely confused by nutrition for pregnancy and postpartum.  Very relatable stuff; feeling, postpartum, like how do I get back to my normal, healthy routine now that I’ve just been in this other stage in my body?  Replenishing those nutrients, that kind of thing.  That’s a long story to say that we are really excited to finally put this platform into real life with real-life moms and future moms.  And so we’re doing this crowdfunding campaign to do that.  And the way that it’s structured is kind of like a Kickstarter campaign, meaning that if you make a donation, you get a reward for backing the campaign, so some of the rewards are a recipe PDF from all of these dietitian moms.  We also have tote bags, because who doesn’t love another tote bag?  But the most exciting from our campaign is actually participation in the pilot.  So if you back the campaign at a certain level, you can participate in the pilot.  You can also gift participation to other people, so if you have a friend or family member who might be interested in participating, you can gift it to them.  Or you can just generally support, and then we will be recruiting families.  So if you’re out there and you think this sounds really interesting but might not be in a place to back this campaign, we’re also recruiting families to participate in the pilot.  It will run in November.

Alyssa:  Let me boil this down to make sure that we all understand.  Your pilot program starting this platform is going to focus on nutrition, and that’s why you have the dieticians?

Martelle:  Yes.

Alyssa:  And you want to get all these families involved.  Part of it’s just to start getting feedback and seeing how this is working and what’s not working, and then you’ll start phase two, whatever that looks like, later?

Martelle:  Yes, exactly.  The goals of this pilot are to get feedback from families so that we can improve it and make sure that it’s meeting the needs of the modern parent.  We’ve been doing feedback sessions so far, but this will be the first time that all of the pieces happening at once.  So we’ll hopefully be gaining some information about that.  The second piece is that it will help us collect some data so that we can seek out additional grants, partnerships, sponsorships, to sustain an equitable nonprofit business model where everyone has access.

Alyssa:  We still haven’t talked about why you call it Mothership.  Where did that come from?

Martelle:  It actually came from one of our board members who is in design.  He was just doing a brainstorm for us of what could we possibly call it, and some of us were like, Mothership, that’s really great because it’s really strong.  People think of things that are really strong.  It’s connotes a headquarters or a foundation which is kind of what we wanted to create.  We wanted to create this headquarters for empathic and empowering resources and support.  And then also it has the potential to redefine itself into something that’s friendship or kinship, related to parenthood or motherhood with Mothership, so we decided yeah, let’s give this a go.  We checked out the trademarks, and no one had it in this space, so we were like, okay, we’re going to go forward with this.  But I’m curious what you think of the name, because it can connote a variety of different things.

Alyssa:  I like it.  It’s not one of those I see Mothership and know what it is right away.  But I like the friendship, the kinship; down the road, having all these other “ships.”  I think it’s really clever.  I like it.  For everyone who’s interested or wants more information — let’s say it’s a pediatrician’s office who would love to have the staff takes this empathy training; if it’s someone who wants to help with the fundraising campaign by donated money or if they’re a family who can’t afford it but wants to get involved.  Are there three different places those people have to go, or do you send them all to one?

Martelle:  It’s pretty much all coming to our website, so you can go to our website, which is ourmothership.org.  On the dashboard on the top, you can see the campaign; you can see our program, so you can see Mothership Certified as an option.  And then you can just generally see more information about Mothership.  We also have a pretty active Instagram account; also Facebook, but more active on Instagram if people are interested.  So that’s @our.mothership on Instagram.  And if anyone is really interested in talking more about it or sharing their experience, we’re always interested in interviewing more families for our blog.  We’ve got some great families up there already.  But we’re one of the things we teach in our training is storytelling and the value of storytelling, so it’s something we try to keep up with in general with our organization as well, so if you’re interested in being interviewed for a blog, if you’re interested in participating in the pilot or in the training, go to our website.  You can also email me directly.  I’m the contact on the website.  It’s going to go to me, anyway.

Alyssa:  Thank you for your time!  Hopefully you get some feedback from this.

Martelle:  Yeah, thanks so much, Alyssa.

Alyssa:  Good luck with everything!  We will talk to you guys again next time.

Today we talk to David Fisher again.  He is a dietician and helps plan nutritious meals for LifeFuel in Grand Rapids.  We asked him to give us some pointers specifically related to children and getting them to eat healthily.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa:  Hello.  Welcome to Ask the Doulas.  I am Alyssa Veneklase, your host, and today we’re talking to David Fisher again, who is a registered dietician.  So last time you were here, you mentioned you have two little boys.  They’re one and three?

David:  That’s right.

Alyssa:  So as a dietician, what do meals look like in your home?  Are they even allowed to eat cereal?

David:  So I will add the caveat that I’m a very busy dietician, and for that reason, cereal does make an appearance at times in our home, yes.

Alyssa:  I’m glad.  I’m glad, so this will be realistic.  You have a realistic expectation of a busy parent with kids, who you want them to eat healthy, but — you know, there’s always a “but…” So how do we as parents — because I’m busy, as well, and my daughter loves cereal.  She would eat cereal for breakfast, lunch, and dinner if I would let her.  But I try for 80% of the time.  I have an 80/20 rule.  We’re try 80% of the time, we try to be really, really, really good, knowing that there’s going to be times where she’s going to have a cupcake or at school something will come up.  But how do you manage that?

David:  Yeah, I mean, your approach sounds appropriate.  The most important thing for people to understand is that you control what you offer and when you offer it.  And the kid controls whether or not he or she eats it.  You have no control whether a child eats a food or doesn’t.  You control whether it’s presented to the kid or not.  So it’s very important to start right away, like when you are introducing foods to a kid.

Alyssa:  Like at six months?

David:  Yes.  Just set the precedent that the family eats together most of the time; not every single day, but almost every single day, and the kids get the food, the same food that Mom and Dad eat.  And if they eat it, good.  If they don’t, they’re going to be hungry.  Kids do not starve themselves, as long as you’re offering appropriate foods.  You can’t expect a two-year-old to eat a kale salad; that’s unreasonable, but you can expect them to eat healthy foods.  Now, the first time you say, “Oh, you don’t want to eat that?  What do you want to eat?” or “How about this thing that’s much yummier?”  That was a big mistake because that kid knows now that there’s another option.  And so if I take him over to Grandma’s house or something like that, they’re going to know right away if that’s something they can get away with there.  And that’s fine, but at our house, we eat together, and these are the foods we’re eating.  Feel free to eat them, and if you don’t, that’s okay.  So with our three-year-old, he is a very good eater.  But he will sometimes get up because he wants to go play or something, and if we say, “Are you full?” he says, “Yeah, I’m full,” — which he might not be.  So okay, you can go play.  And he’ll go play, and an hour or so later, “I’m hungry.”

Alyssa:  Story of my life!

David:  Right.  So what we do is we pull out the plate of food, the exact same plate he had before, and say, “Here’s your food.”  And I don’t know that we’ve ever once offered some different food later at night, because if we did that, then he would never eat his dinner and he would always eat the other thing later.  And he almost always will eat that dinner later, and I will remind him, “You’re hungry because you didn’t eat earlier.”  And so I think we have, with that approach, with not offering something else, we’ve been pretty successful with that.

Alyssa:  What about with your one-year-old?  What is he eating?

David:  So he’s the same.  Texture becomes important for them because obviously I can’t serve him a whole grape or something like that; it would be dangerous for him.  But he always ate with the family, even before he was able to eat.  He would sit up there with us, and then as he starts to eat really soft things, he’ll be there with us.  And at very first, when they’re six months or seven months and they’re first eating, you may not be able to serve them exactly what you’re eating.  Sometimes you can because you can puree it up or use a baby blender with the food that you’re eating, which is a great way to do it.  Other times, we would, for us personally, we might use some baby food jars or some pureed-up food that we had made the weekend before or something like that, and he would sit at the table with us, and we would kind of feed him and eat.  And that slowly transitioned into him eating what the family’s eating.  But a one-year-old appropriate version of it, so maybe the carrots that we had, for him, are pureed up.   And then eventually he needs less and less modification, and now maybe I just have to cut it up in little pieces or something like that, and he can feed himself.  So he’s always been integrated into the family dinner, and he’s transitioning to just being able to eat like we are.

Alyssa:  What about food allergies?  We found out at around two that our daughter had some — not severe allergies, but she got really bad eczema and tummy aches, and it was the majors: gluten, dairy, eggs.  It’s really hard to find foods for her.  If I just make a mound of meat and veggies — she can eat meat and veggies, basically.  But I feel like I was making two different meals often, and then it got to the point where I was like, “Oh, you can just have this.  You can just have the chicken nuggets or something,” which I know are bad, but she couldn’t eat what we were eating.  I don’t know; what do you tell parents?  Or even if the adult has a food allergy, and they’re the only one in the home: how do you deal with that?

David:  It can be difficult.  I think I would try your best to get everyone eating the same foods when possible.  You can make it clear; oh, so-and-so can’t have this food because she has a food allergy, and kids will understand that eventually.  But I would try not to have separate meals for different people when possible.  And food allergies are kind of difficult, though, because it can be difficult to say, does this person have one and will they outgrow it?  A lot of times, they’ll outgrow it.  That happens, too.  You just try to get the family eating the same thing when possible.

Alyssa: I probably need to do a better job of that.

David:  It sounds like you’re working hard at it.

Alyssa: Trying!

David:  Give yourself credit.

Alyssa:  Trying!  So if you could give parents one piece of advice, besides, you know, eating together at the table, which I think is just good for family in general, and then eating the same thing, is there any piece of advice with nutrition?  What are, in general, kids lacking right now?  What are they missing out on?

David:  So the important thing with kids is just offering them healthy foods, and kids will typically choose to eat the amounts that they need over the course of a week or so.  In any given day, they might eat a lot or a little, and that’s okay.  If they’re offered healthy foods, they will eat what they should be eating.  I don’t worry about kids who are offered a variety of pretty healthy foods.  If kids are starting to be limited — and I see this with parents who are limiting them.  “Oh, he won’t eat that.”  Well, he’s never tried that, right?  So try not to be the one who’s causing your child’s limited diet.  Encourage those healthy eating habits, and the kid will be fine.  If you start introducing a lot of processed and sugary foods, and the kid starts to eat a lot those, that’s when I would start to worry about missing some nutrients.  But outside of that scenario, I don’t really worry about malnutrition in children in the United States.

Alyssa: Good.  So, obviously, it’s best to get our nutrients from fresh veggies and fruits, but what about supplements?  I know that these gummy vitamins for kids are just loaded with sugar, too, and are they even getting the nutrients that they need?  Do you have any thoughts or recommendations on these supplemental vitamins for kids?  And even adults, I suppose?

David:  Yeah, so I’m not aware of research with children and vitamins.  I would have to look into that topic.  From a theoretical point of view, I don’t see why a child would need that if, you know, with the caveat of what I said previously.

Alyssa:  If they’re eating healthy?

David:  If they’re eating a relatively healthy diet, there’s not any reason why a kid would need that.  So I wouldn’t choose to do that.  If there was some circumstance where you were having trouble getting enough healthy food into a child, or maybe a disease state like cystic fibrosis or something where you have difficulty absorbing foods, then maybe we would talk about targeted nutrition supplements, but I wouldn’t head that direction outside of that, personally.

Alyssa:  So as long as your kid is eating pretty healthily, you probably don’t need to try to force a vitamin down them, too?

David:  That’s my opinion, yeah.  And in adults, we do have research that says that taking multivitamins don’t really help your health.  But the interesting thing is that there’s kind of confounding variables, so people who tend to take multivitamins are healthier than people who don’t.  So what you want to be is the kind of person who takes a multivitamin — but you actually need to take the multivitamin.

Alyssa:  Right, it’s kind of like a placebo effect.  We don’t really need it.  I take one every day, but yeah, I don’t notice a difference in my health.  But I’m already a pretty healthy person.

David:  Yeah, exactly.  And it’s not unreasonable to take one.  It’s just that we don’t have data proving that it’s helpful, and we have some pretty large-scale studies.  But it may be helpful for you to feel like you have your bases covered, or even for someone to take one a couple times a week or something is not unreasonable.  It won’t harm you.

Alyssa:  Is this another market to just make money?  Is this, like, this whole multivitamin thing just to make us spend more money, to make us feel like we’re going to get healthier?

David:  Largely, yes.  But sometimes it can even be a distraction, and so I discussed before about eating food that’s close to the way it came out of the earth, and that’s where I start with every single person that I would talk to about nutrition.  Because they’ll come to me and say, “I’m taking my folic acid; I’m taking this; and I’m using my protein shake, and I’m still not meeting my goals of muscle gain or weight loss or whatever it is.”  And it’s like, hold on.  You’re getting distracted.  What’s your food intake?  How close is your food to how it comes from the earth?  If we answer that question, then we’ll come back to this stuff.  Don’t get distracted.

Alyssa: T hat’s interesting.  It is a distraction, because I know my doctor would tell me I don’t get enough protein, so I’m taking a protein shake, but why am I not eating more protein, right?  The look — if you could see the look he just gave me!

David:  I am almost a physician’s assistant, so I will be prescribing things like this, and it is tempting for someone to say, well, take this targeted protein supplement or vitamin or medicine.  But we can address those problems a lot of times with food itself, but it takes a little more work on the part of the doctor and the patient, too.  Now, I do sometimes use protein supplements.  Just to be clear, there can be a time and space for some things like that.  I don’t want to say that they’re never useful, but they’re not the basis.  I want to add one more thing, if I may, about involving kids in eating.  If you involve a kid in the process of food, you’re much more likely to get their buy-in on eating a food.  And so this can go as far back into the food process as you can get them involved.  So I have a garden, and I helped my son pick out some seeds that we were going to plant.  So he was involved from the earlier possible step of picking which peas we were going to plant and helping us plant them.  Then he sees them grow; he can pick them, and usually he eats them while he’s standing right there in the garden, but then when he’s in the kitchen, he can help us cook, and now that he’s three, he old enough to actually help a little bit.  He’s definitely going to eat that food when it comes to the table.  He cuts the asparagus out of our garden, and he will definitely eat it, whereas if he just sits at the table and I just throw some asparagus on his plate, he might be like, what’s that?  I’m not going to eat that.  But he’s invested, so it’s important to get that process started.  Get kids in the kitchen.  In fact, I was at the farmer’s market, and they were giving out little kid knives.  I don’t know if you’ve seen these, but it’s a knife that a kid can use to cut vegetables or anything, and it really works, but it won’t come them.  And so now he loves to come in with me and help prepare dinner.

Alyssa:  That’s a really good point.  We had Katie from Kitchen Stewardship on our show.  She’s all about getting kids cooking in the kitchen because when they cook their own meals, they’re more likely to eat it.  But I’m glad you mentioned the garden, too, because I did the same thing with my daughter.  She helped me plant the seeds, watched them grow, and she’ll literally pluck a carrot out and go rinse it off in the house and just eat it like Bugs Bunny.  And I told her that we can eat beet greens and lettuce, so she’ll walk up and say, “Mommy, can I have a beet green?”  And my friends will look at me, like, did she just ask if she could eat a beet green?  I’m like, girl, you eat all the beet greens you want!  Yes, go!  So it’s true; if they’re in it from the beginning of the process, they’re much more invested.  “I grew these, Mommy, they’re mine!”

David:  And conversely, you mentioned having sweets or something sometimes.  We certainly have them sometimes, too, and so they have their place, and they’re kind of special.  Sometimes we’ll walk down to the ice cream shop.  We’ve discussed that it’s not somewhere we go every day, but sometimes we do, and we enjoy the heck out of it.  And then maybe sometime in the future, we’ll go again.  So those things are fine in their place.

Alyssa:  Right.  Okay, I’ve got some thinking to do with how I get my daughter to eat some meals with me.  But actually, some of the LifeFuel ones, she’s been eating.  Like those pancakes, she loved.  They were gluten-free vegan pancakes, and then she loves meat, so she just devoured the meat, too, so yeah, I probably need to order more specific ones like those that she will eat.  Well, thanks for coming in again.  It’s been fun.  And Genevieve, will we have you back on sometimes?

Genevieve:  Absolutely!

Alyssa: Okay.  You didn’t talk on this one.  Probably no one knew you were here!

Genevieve:  I’m just hanging out in the background.

Alyssa: Genevieve from LifeFuel.  Since you are here, why don’t you tell us your website and how to find LifeFuel if they’re interested in ordering?

Genevieve:  Yes, the website is lifefuelbyvault.com.  You can order meals weekly.  We will deliver them to your house, and they’re healthy and delicious.

Alyssa: I can vouch for that.  You can always find us at goldcoastdoulas.com, Instagram, and Facebook.  And you can listen on iTunes and SoundCloud.  Thanks!

Today we talk with Iona Ruiter of Pilates in East.  She specializes in pelvic floor health, prenatal and postnatal pilates, and diastasis recti.  She gives us an in-depth look at the health of your pelvic floor and what exercises actually work.  You can listen to this podcast episode on iTunes or SoundCloud.  Be sure to check out our Facebook post for before and after pictures!

Alyssa:  Hello and welcome to another episode of Ask the Doulas.  I am your host, Alyssa Veneklase, and today I’m excited to be talking to Iona from Pilates in East.  Hello!

Iona:  Hello!

Alyssa:  Thanks for coming over here on this very hot day.

Iona:  Thank you for having me.  I don’t have central air, so this is great!

Alyssa:  Is it cool enough?

Iona:  Today has been a little warmer than other days, but in here, yes, it feels great.  I always love going to work, as well, because we are air-conditioned in there, as well.  But home, not so much.

Alyssa:  Yeah, it’s not a hot pilates.

Iona:  No, no.

Alyssa:  Tell me a little about Pilates in East because I only found you through social media because somebody was talking about what you specialize in.  So we love, at Gold Coast, talking about pelvic floor issues and all these things that a lot of moms deal with, sometimes even during pregnancy, but then very commonly afterwards.

Iona:  Yes.  So at Pilates in East, in general, a lot of the group classes are more fitness-based.  Some people will have some issues with herniations of disc and osteoporosis, things like that, in our group classes, but personally, myself, I specialize in pelvic floor health, prenatal pilates, postnatal pilates, and diastasis recti.  But I actually discovered I had diastasis after the birth of my son, and he just turned four.

Alyssa:  And explain what that is for somebody who hasn’t had it.

Iona:  It’s becoming very common, so I think a lot more people are starting to learn what it is, but it was always defined as the separation of your abdominals, your rectus abdominus muscles, but that’s actually an inaccurate description of it.  It’s actually the extreme thinning of your linea alba, which is the connective tissue between the rectus abdominus muscles.  So it causes the abdominals to come apart, but it’s actually the connective tissue in between being extremely thinned.  And it doesn’t come back together after birth.

Alyssa:  Is that just from the stretching?

Iona:  Yes and no.  So that can be an underlying issue, which it usually is, and then that stretching and the pressure on the abdominal wall from giving birth and the growing baby creates this extreme thinning where it doesn’t come back.  There’s also umbilical herniations which is very common with the diastasis, and that is where there is a tear in the linea alba, and your intestines can actually protrude out of the fascia, which is the linea alba.  It’s the connective tissue; it’s called fascia.  And that is supposed to be repaired only through surgery, but I am a big advocate for natural healing.  I believe the body can do wonderful things, and I think the mind can do wonderful things, as well, and I think that’s one of my problems with my own journey of healing.  I think I have a lot of anxiety, and I focus a little too much negatively on it, but the results I’ve seen on other women has been amazing.  And honestly, the results I’ve seen in myself have been pretty amazing, as well.  I have photos that I actually brought here, too, that we can look at after, because it is pretty amazing to see the before and afters, and I really like to document because I think for someone to see the results, sometimes we don’t always feel the results, but to see the results, I think, speaks volumes.

Alyssa:  We could even post those or post a link if you have them somewhere if you have approval to show those.

Iona:  Yes, I did get approval from someone who I did two private sessions with, and then there’s something we call a magic green ball.

Alyssa:  I see it right there.  It just looks like a green ball, so what makes it magic?

Iona:  It’s actually a myofascial release ball, so the first thing I like to start with – this is postpartum pilates, but I do this with women while they’re pregnant, as well, because it does help to relax the pelvic floor area, open up those hips a little bit, get them ready for birth.  But it’s especially essential for the postpartum recovery.  It’s a myofascial ball, so what that means is it’s a ball used to release the fascial tissue and smooth it out and help the body to realign because when we have pulls on our muscles in certain areas, it causes misalignment.  And most of us probably go to chiropractors.  If we’re doing a more natural birth, I feel like chiropractic care is very important.  I go to a chiropractor, as well, but one of the things with chiropractic care is it’s only your bones.  They’re not doing anything for your muscles.  And if your muscles are overly tight and working too hard in certain areas, they’re going to create that pull and pull that bone back out.  You know, there’s only so much.  So the ball really helps to release those overly-tight muscles.

Alyssa:  I’m picturing being on my stomach rolling around on it.

Iona:  So there’s an oblique release, which is essential for the recovery of the diastasis, as well.  I can’t do that one on prenatal women, but I do that one on postpartum and on menopausal women, as well.  For any woman with pelvic floor issues, the oblique release is amazing.  You can also do psoas, which is your internal hip flexor.  It is tight on a lot of people, especially if they’re runners and things like that, but it’s inside of your hip, and it’s really essential.  It helps with the function of the core and pelvic floor, everything.  All of that is connected.  We do release work on glutes, which is your butt, and the hamstrings, which is the back of your legs.  I also do release work on sacrum, which is a really important one for me.  I have some sacrum issues, which is the little triangular bone in between your left and right hip.  The tip of your sacrum would be your tailbone, and then the base of the sacrum is right around where those dimples on people’s backs are.  And then I’ll do all the way up and down the spine, doing some release work there, as well.

Alyssa:  And what does that mean, doing release work?  With this ball?

Iona:  With the ball.  So you actually roll on it or you just hold a pose with the ball in an area to do release in that area, and it’s amazing.  My obliques before I used this ball were very overly developed, and that’s partially because of my rectus abdominus muscles being weakened and overly stretched from my diastasis recti, and this ball has released my obliques so much.  And you notice, like if I show you pictures of me, with my belly button, I had a little bit more of a pull to the right, and so I’ve been doing this release work on my sacrum and the oblique release.  My right side’s much stronger; I have to hold that for a lot longer, but my belly button’s becoming more uniformly round, and that’s one of the things in the pictures, when I show them to you and then if we post a few of them, you’ll notice the difference of people’s belly buttons.  It’s really pretty amazing because there’s so many pulls from these muscles and everything.  So there’s a lot of realigning the body and releasing.  That kind of goes hand in hand, and then I put in some movement work for exercises that people can do at home.  They’re really gentle, easy.  I do all this stuff every night, and it takes me probably — I’m pretty quick at it now because my body has released more in areas, but it probably takes about 15 minutes to a half-hour, so it’s easy.  It doesn’t require a lot of time.  And, you know, you can keep adding on and making it harder, and then the more that your separation comes together or the better your pelvic floor health becomes, then you can eventually join group classes and everything.  But if there is enough interest after this podcast, I’d be more than willing to do some private group classes and if anyone wants to reach out to me, we do special pricing and everything with the more people we get for pelvic floor health, the diastasis, and everything like that.

Alyssa:  So what do you do with this magic green ball for pelvic floor?

Iona:  For pelvic floor, it’s very similar because, again, everything is kind of connected.  So with the diastasis recti and pelvic floor, really, the main source of fascia on your body is the thoracolumbar fascia, which is the fascial tissue along the center of your back, more or less.  And it fans out, and fascia really covers your entire body, and then there’s little pockets in the fascia, and that’s where your muscles lie.  But the thickest, largest part of your fascia is along your back, so that’s why it’s so essential to do that.  But then that fascia wraps around your pelvic floor and comes up to the linea alba, so if there’s some kind of disruption in the back of the body, the pelvic floor, or the front, it can cause the diastasis; it can cause some pelvic floor issues.  There’s just all these little contributors because the body works in funny ways, and everything’s really connected.  It really is, and it’s funny because a lot of times, even in my group classes, I’ll do stretching and I’ll just have everyone lift one arm up, and they’ll be like, oh, my gosh, why does that stretch feel so different?  And when I first started pilates, we’re always like, oh, don’t — people when their cores are weaker will lift their shoulders up, and it’s like, oh, your shoulders aren’t connected to your abs; you need to keep them released, but the thing is, everything’s really connected where these nice long lines and this fascia is all connected, it’s just the muscles might not be connected.  So releasing all of that one.  But a big one — some big stuff I do with pelvic floor work is I like to do a lot of working those external rotators of the hips.  I don’t know if you’ve ever heard of clam exercise.

Alyssa:  No.

Iona:  It’s where you lie on your side and your knees are bent.  Your feet stay flat together, and your legs are about a 90-degree angle, so they’re straight out from your hips.  And you have to make sure that your top hip does not roll back.  That’s very important because if it does you’re not giving yourself the exercise you need, but you just work by opening and closing that top leg.  That’s a great pelvic floor exercise, and everyone listening could do that at home right now, even.  But realigning the body, again, really does help with getting everything to function as it should.  So that’s why the myofascial ball is so important, or the magic green ball, as we call it.  But the pelvic floor release is another great one for pelvic floor issues because, again, just because someone has pelvic floor issues doesn’t mean that they have a weak pelvic floor.  It just means it might be weak in certain areas.  There’s certain areas overworking, probably, and other areas underworking.  So we want to get it to work together, and so that pelvic floor release is really important to that.  I love squats.  I think squats are another great thing.  It’s a natural pelvic floor engagement, just lifting up every time you stand back up, but making sure you come up all the way tall.  A lot of times I watch people do squats, and they come up, but they don’t come up all the way.  That last little bit’s important, just for your whole entire body, for your kneecaps and everything, getting that last little lift.  But yeah, those are just a couple simple little things that people can do at home and everything with that.

Alyssa:  I’m curious about that.  You have a deflated balloon looking ball.

Iona:  Yeah, so this is called a soft gym ball, but yes, it’s deflated.  A lot of times with pelvic floor issues, as well, and possibly with diastasis recti, just all kinds of postpartum issues, we’ll place this in between their thighs, but not their knees.  You want it pretty high up, closer to the pelvis.  And we don’t ask people to press into it, but your legs naturally will press in and engage.  So if I have someone doing a bridge, which I think everyone knows what a bridge is, probably — a pilates bridge is a little bit different.  It’s not so extended; your ribs stay in.  But a lot of times if people have weaker pelvic floor, their knees tend to fan out as they do a bridge.  Their legs don’t stay inward, and so it creates this uneven tension in certain areas, wrong muscles overworking, weaker muscles underworking.  So if you place this ball in between, you can’t open your knees out because you’ll drop it, but you’ll notice this natural inner thigh, your adductors, working, which is going to help work the muscles inside the pelvic floor and everything as well, because all of that is attached to different areas of your pelvis.  In the past, women were always told to do Kegels to strengthen the pelvic floor, but looking at this photo of your pelvic floor, there’s actually two layers of your pelvic floor.  The two areas are your pelvic diaphragm area and then your urogenital triangle.  So the pelvic floor is more intricate than a lot of us realize, and when you’re doing just a Kegel, you’re only working actually the superficial muscles of the pelvic floor, which would be more of the urogenital triangle.  So if you’re doing that, you’re really just strengthening the sphincter area, but there’s all these muscles here that aren’t really engaging.  So this would be the pelvic diaphragm, which actually, it’s called the diaphragm because like our breathing diaphragm, it actually does move.  So another good exercise for people with pelvic floor issues is pelvic tilts, so getting on hands and knees and then bringing the tailbone to pubic bone, pubic bone to chest.  That’s a really good movement of the pelvic diaphragm.  It’s getting to move; it’s getting to slide, so you’re getting kind of a Kegel, but you’re getting more than a Kegel because you’re actually exercising the entire pelvic floor, especially by adding that little bit of tilt.  And that’s something pregnant women can do, as well, because that will help if your baby is either occipital-posterior or breech.  So those pelvic tilts are really important, and I think they’re just important for women’s health in general.

Alyssa:  Now when you do the pelvic tilt, I’m picturing like a cat-cow, but you don’t have to do so much?

Iona:  Yeah, you’re actually not going to be going between the cat-cow.  It’s more of a hands and knees, and then you just want to really let your neck relax.  If it wants to hang down, that’s fine.  Just let your upper body relax more, but then your body is going to be more in a neutral position, so more of a flat back.

Alyssa:  And try to just move your pelvis?

Iona:  Yeah, and just move your pelvis.  A lot of times when people do cat, it goes into their upper back, which is called their thoracic spine, and it’s more of the lumbar spine which is your lower part of your spine.  But again, it’s more of the pelvic floor and the tailbone, sacrum, hip area that’s moving.  So it’s a really easy cue, and it’s one I learned when I did my pelvic floor diastasis course, but it’s just coming into hands and knees and then bringing tailbone to pubic bone; very gentle; you’ll feel a little glute engagement as well.  And then pubic bone to chest, where your low back should go more flat.  Because our backs — if you look at anyone standing, their low back naturally dips in.  That’s the natural curve of the lumbar, but you’re getting your low back to come more flat.

Alyssa:  So all of this stuff — let’s say someone hears this and says, oh my gosh, I have to do this.  You only do these in private classes, or you also kind of talk about it in group classes?

Iona:  So the great thing about Pilates in East is we are given kind of an outline for our class on how every class has to go, so there’s certain things we have to do.  We have to do arms, legs, standing, abs, things like that, but we are given free rein on what we do, and we all have our own specialties and different things that we’re interested in, so all of our own personalities come across in the classes.  And then the other great thing is every single class, we kind of have, whether people realize it or not, a little lesson that we talk about in the beginning of class, and we kind of stick with that for our theme as we teach the class.  So there’s other parts of the body — if you have low back pain, there’s this area along your spine called the multifidus, and that’s something I really like to do as well because I suffered from low back for a little bit after the birth of my daughter.  She liked to be held a lot, and the way we hold our children isn’t always the best for our body, even if you’re doing a baby carrier.  It can be hard, so the multifidus is a nice way to create more length in your back to help cushion.  You can kind of think of it as the balloons that they do balloon animals with, and you think of them being one on either side of your back.  And a good way to find your multifidus is if you place your fingertips on the center of your spine, so where you feel the bony part that protrudes, that’s your spinous processes.  And if you just slide your fingertips off to the side where it dips in a little.  And then the best way to feel is actually if you walk around.  You can feel the muscles kind of puff, puff.  Do you feel that?

Alyssa:  Yes!

Iona:  So that is your multifidus.  There’s more superficial muscles that are working, as well, but if you just think of when your drawing your abdominals in, puffing that area out just a little bit, even just breathing in and then exhale; just gently think of that area that you just felt puffing out a little bit.  It creates more space in that low back because that area typically is stronger.  It does run all the way up along your spine, but people don’t usually feel it up here.  But the low part of the back is usually stronger.  Those muscles are usually bigger, as well, so it’s a great way to feel less discomfort in the low back and everything as well, just thinking of that puffing up of the balloons or of the multifidus.

Alyssa:  It’s always funny when an instructor who knows what they’re talking about says something little, like puffing.  If you had just told me to puff up the back of my back — like, what?  And then you feel it and you move, and you’re like oh, okay, yeah, I do feel myself puffing up.

Iona:  That’s a hard one for a lot of peoples, so a lot of times I will have everyone feel it first, if I know it’s going to be something hard for everyone to comprehend at first.  It’s like, okay, I know most people are not visual learners; they’re hands-on learners, so how can I teach you where you feel it, and then see the outcome; get to understand that connection and everything.  One thing a lot of women do notice that have had a C-section is numbness down low, and part of the reason is — so we were talking about fascia earlier, and the fascia — think about looking at a piece of meat.  So the red part is the muscle, and then the white part is actually the fascia that we call fat.  So the fibers — we all know that meat has fibers, so there’s a direction; you know, when you’re cutting your beef.

Alyssa:  Against the grain or with it.

Iona:  Exactly, exactly.  So that’s the direction of your muscle, and our muscles are the exact same way.  They have these fibers that are in certain directions.  Your fascia is exactly the same way, so they have directions that they move and lie.  And just like our skin, our fascia, and the rest of our body, it’s all made up of a lot of water.  Now, what happens is when your abdominal wall and your fascia and your skin is cut into, everything — if you think of a book, where everything is this smooth surface where the pages are, and I’m thinking more of a soft-cover book, everything has this nice directional line.  If you end up being cut with something, like you have an appendectomy or a C-section, what happens is that fascia, as you put it back, it doesn’t live in its nice place.  It’s put together so that — almost like if you were to put your fingers together and lace them together, that’s how it normally is, and then when you’re cut open, it’s almost like putting your knuckles together.  So you notice that it doesn’t really fit.  So you really want to break that scar tissue up, so one of the first things I always ask women with a C-section is, do you massage your scar?  Because that is the number one most important thing that you could possibly do after having a C-section.  And it’s really a matter of when it feels comfortable for you.  They say your skin takes a full year to heal, and I think you can massage your scars sooner than a year, but if you don’t feel comfortable for a year, that’s completely okay.  You can start by just using two fingers and rolling the area that the scar is, but the best way is to actually get your fingers into the scar and then pull up or pull in towards the center line of your body.  Obviously, me doing it on someone is the best way to show someone, but yeah, with C-sections, diastasis is actually very common after that, as well, because of the uneven pull of the fascia system.  And that’s what I had actually learned with my diastasis, because I for the longest time was like why did I get this?  Why did I get this?  Everything I read says women over the age of 35 that are not fit, you know, have weaker abdominals.  I’m like, I’m a pilates instructor; my abdominals were strong.  I’m 32 years old.  I shouldn’t be having this issue.  Why am I having it?  And when I did the course that I had taken, it answered a lot of questions because I had also noticed a lot of women with C-sections having the diastasis, and what I didn’t realize is one, I had my appendix removed when I was seven, so that caused uneven pulls on my fascial system.  So my body had to find new ways to kind of move and shift.  The skin had to find new ways to pull, and the muscles, too.  And then I actually was in a car accident at 17 years old where my sacrum was fractured diagonally from the top all the way to the opposite side.  So my sacrum ended up not living in the place that it should have, which caused uneven pulls because you don’t get sacrum surgeries or things like that.  People do hip replacements, but they don’t do actually surgeries on the bones themselves.  You can’t do anything, and you can’t put your pelvis in a cast, so…

Alyssa:  Were you just sitting on a donut?  What did you?

Iona:  Yeah, when I had the car accident, I was given a claw to grab things, and I was given a donut to sit on, and that was basically it.  Yeah, so what I found was my body wasn’t aligned as it should, and that’s why that myofascial release, again, is so important.  So women with a C-section or anyone who’s had back surgeries, it’s really important.  They’re going to be more prone to a diastasis as well or maybe pelvic floor issues, things like that, because of that all being connected and wrapping up and around the pelvic floor.

Alyssa:  That makes a lot of sense.  Well, I think it’s encouraging for moms to know that if they have pelvic floor issues or even have back issues or have issues with their abs, that they don’t just have to deal with it or they don’t have to go get surgery, or there’s at least some options to try for a while.  How do people find you?  Is the best way through the website?

Iona:  The website or my email.   People email me a lot, or you can message me on Facebook.  That’s always a lot of people messaging me on Facebook through Grand Rapids Natural Parenting and a bunch of different sites, but my name is Iona Ruiter, so you can Facebook message me.  Otherwise, iona.ruiter@gmail.com is another great way, and that’s just my personal email that I use for the studio and everything like that.

Alyssa:  Awesome.  Hopefully we can get some interest through this.  I know that once we click stop here, I want to have you show me a couple things.   Thanks so much for joining us today!

Iona:  Thanks so much for having me.  It was great.

Alyssa:  Hopefully you guys will look her up!  As always, you can find us at www.goldcoastdoulas.com.  You can email us with info or suggestions at info@goldcoastdoulas.com.  We are on Facebook, Instagram, and you can listen on SoundCloud and iTunes.  Thanks!