Women’s Health Postpartum: An Interview with Dr. Ginger Garner
In this interview with Yoga U Online, Dr. Ginger Garner, founder of Professional Yoga Therapy Institute and author of Medical Therapeutic Yoga, discusses her webinar on common postpartum health issues and the potential role yoga might play in helping new mothers relieve and prevent postpartum problems. Also check out Ginger’s course on Yoga U.
YogaUOnline: In our society, we have this story that although giving birth is a challenge, once you give birth, you have your baby and that’s where the story ends. We never hear about all the women who have ongoing postpartum issues for three, five, even ten, twelve years down the road.
Ginger Garner: Yes. And if you look at some of the actual statistics on this, they should be nothing short of alarming. If we speak about the United States, we have the highest postpartum first day infant death rate and also maternal mortality. So more women and their babies die the first day in the United States than any other industrialized nation. We have no standards of postpartum care in the United States.
One study in Ireland, in 2014 looked at about eight hundred and seventy-two women at fifteen weeks postpartum and one year postpartum. At one year, 73% of them had urinary incontinence. 49% of them had fecal incontinence. 14% had pelvic organ prolapse. 58% had sexual dysfunction that continued to persist at one year postpartum. Of all those different diagnoses, more than 71% of those women had multiple diagnoses. I think these statistics are not being reported because we don’t have any standards of care, internationally. With the exception of France, there are no standards of postpartum care in any industrialized country.
YogaUOnline: The fact that such a huge percentage of women end up with problems five, ten, or even twenty years down the road is just mind boggling. I wonder if part of it is that there is simply a lack of knowledge of therapies that could help.
Ginger Garner: I would agree with that. I’ve had many patients come to me postpartum and say that when they tried to tell their caregiver they were having problems with intercourse or sexual dysfunction in general, and they were dismissed. This is unfortunately common but it’s not normal, and it’s not something that you have to suffer with and put up with. It’s not “just the way it is” because your mom or your grandmother had the same thing and they didn’t get any help either.
So there’s a lot of hope in it but there’s a lot of work for us to do, too – Clinical work, work in yoga and yoga therapy, and also policy work in order to change things.
YogaUOnline: Tell us a little bit about the mechanics of why these things happen. What are the changes in the body that happen that predispose women for incontinence, prolapse, sexual dysfunction, or just generalized pelvic pain?
Ginger Garner: One risk factor is multiple pregnancies and births. Most women do have more than one child, and the risk increases each time. For example, the risk of diastasis rectus abdominis (DRA), which is that splitting of the abdominals at the linea alba, is 100% in pregnancy. You’re not going to get out of having that split in the abdominal region of the linea alba. For some, DRA resolves by eight weeks after birth. But when we look at the scientific literature, if at eight weeks that DRA hasn’t spontaneously resolved (and for most women, it hasn’t) then these women go on to develop other related issues related which can include incontinence, pelvic organ prolapse, sexual dysfunction, pelvic girdle pain, and pelvic floor dysfunction in general.
It isn’t hopeless. It just means that we need more attention. Women’s health can be improved and, with a little bit of effort, we can prevent a lot of issues that would otherwise just snowball.
I’m hoping that through the webinar series and practice that I’m doing for Yoga U Online, I can help introduce yoga professionals to the litany of issues that can happen not just postpartum, but carry on into the next prenatal phase and into other pregnancies, which then snowball. It’s important that we identify these things, and the sooner the better.
YogaUOnline: Yes. And one of the things that we seem fairly often in the media is discussion about postpartum depression. Is that something that you work with as well?
Ginger Garner: Absolutely. It is pervasive. In my lectures when I’m teaching I ask, “So, we’ve got all of these pelvic pain and pelvic girdle issues. But what’s the biggest risk for women? The risk that has the highest incidence?” And though many wouldn’t guess it, it’s postpartum depression. It’s heavy. It’s labor-intensive, and it’s exhausting. It’s also not isolated to the neonate/newborn time span, as many belief; it can happen when children are toddlers and middle schoolers. So this goes way out beyond what we thought to be true even five years ago, much less ten years ago.
YogaUOnline: What, as a yoga therapist or physical therapist, do you see as a path towards resolving these pervasive postpartum issues?
Ginger Garner: I think that now, more than ever we can make a difference by creating awareness. If every yoga professional that ends up taking the course goes back into their communities and their home town and helps even fifty women in that home town, it will make a huge difference. Those women will tell their friends and their daughters and their nieces, “You don’t need to go through this. There’s help for this.” Whether it’s going to be yoga or yoga therapy or whether it’s a medical form of therapeutic yoga where a PT or an OT or an MD delivers it, there’s so much that we can do.
YogaUOnline: That’s wonderful, and inspiring. What inspired you to embark on this path of integrating yoga?
Ginger Garner: The turning point for me was when I was in my first year of practice, working with a patient in chronic pain with women’s health issues. She was a post hysterectomy mom, and even though her kids were in their thirties, she was still acutely postpartum with a lot of issues that could’ve been prevented. She was driving three hours round-trip just to see me because access to physical therapy in her area was poor. And furthermore, access to specialized physical therapy was even less accessible, especially in the area that I work in, which is an underserved lower income area. So I began to focus more on yoga as a way to deliver PT.
YogaUOnline: How you use yoga in your practice? And could you explain why you’ve chosen to work with yoga, why not just physical therapy?
Ginger Garner: Yes. Right now, it seems like a lot of the research pits one thing against the other, whether it’s chiropractic care or PT care or one treatment for low back pain versus another. But what we need to realize is that if we work together, if we use multiple strategies, we can be much more effective. It’s a privilege to be able to weave yoga and PT together, especially when you see the faces of your patients when they leave. In just a few sessions, versus many, many sessions, they’re much, much better.
There are a lot of healthcare professionals out there who are embracing and using yoga now. It’s a powerful way to change healthcare, for everyone to come together and work harmoniously.
YogaUOnline: Ginger, you have a course on YogaUOnline, as we made reference to for postpartum issues. Please tell us about the course and what people will learn.
Ginger Garner: I’ve been teaching prenatal and postpartum maternal health work, as well as childbirth education for quite some time. In this course, I talk about evidence-based care and practice. There’s a host of issues that we need to address from urinary incontinence, fecal incontinence, pelvic floor dysfunction in general (with can encompass all of those things), sexual dysfunction, and prolapse. I think that the topics have been taboo for too long, so much so that women have more than accepted these issues as normal, and they don’t have to be normal.
So my aim and passion and goal is to empower every yoga professional or healthcare professional, whatever they are, with a skill set; to be able to say, “Hey, I can make a difference whether I’m teaching a yoga class, whether I’m seeing an individual client in a yoga or physical therapy session, whether I’m seeing a patient or I’m responsible for, or whether I’m working with a whole floor of postpartum obstetric and gynaecological patients in a hospital. That is the course in a nutshell. Then of course, we have the practice, which is included and gives some very practical hands-on tips.