Excruciating Pelvic Pain in Pregnancy? Why It's NOT Normal & How to Find Real Help

Oct 28

Hey there, mama! If you've ever felt like your pelvis was literally splitting apart during pregnancy, or if standing up to cook dinner brought tears to your eyes, this conversation is for you. I'm sitting down with Dr. Kate Smith, a pelvic floor physical therapist who specializes in prenatal care, to talk about something that affected me deeply during both my pregnancies: severe pelvic pain. After being told repeatedly that my excruciating pain was "just normal," I discovered there was actually help available—and that's exactly what we're unpacking today. Whether you're currently struggling or want to be prepared for future pregnancies, this episode offers both validation and real solutions.

Some links on this page are affiliate links, which means I may earn a small commission if you choose to purchase through them—at no additional cost to you. I only recommend products I truly love and believe support a beloved birth and beyond!

🎧 Listen to the Episode

My Story of Pregnancy Pain

Before we dive into my conversation with Dr. Kate, I need to share something personal. During both of my pregnancies, I experienced pelvic pain so severe that I would collapse on the couch in tears nearly every night, telling my husband Brian, "I cannot be pregnant again. I cannot do this again."

The most shocking part? When I was in active labor with my son Daniel—dilated to 8 centimeters—I remember telling my birth team that these contractions were literally nothing compared to the pelvic pain I experienced daily. Let that sink in for a moment. My active labor was easier than my everyday pregnancy pain.

And yet, every time I brought this up to my providers, I heard the same dismissive response: "That's normal. Pregnancy is painful. Sorry."

Understanding What's Really Happening in Your Body

Dr. Kate Smith, owner of Nurture You Pelvic Health, brings over seven years of experience helping women understand and address pelvic floor concerns. What I love about her approach is that she doesn't just treat symptoms—she gets to the root cause.

The Different Types of Pelvic Pain

Dr. Kate explains that what we often lump together as "pregnancy pain" actually has distinct causes and locations:

SPD (Symphysis Pubis Dysfunction): Sharp pain in the front/center of your pelvis, often worse with single-leg movements like getting dressed or climbing stairs
SI Joint Pain: Pain in the back of your pelvis (where those little dimples are), typically aggravated by bending, lifting, or sleeping on one side
Pelvic Girdle Pain: A broader term encompassing pain throughout the entire pelvic region

The key insight? Each type requires different approaches for relief, which is why getting the right assessment matters so much.

The Hypermobility Connection I Wish I'd Known About

After my second pregnancy, I discovered something that changed everything: I'm hypermobile. Dr. Kate shares the signs to look for:

Being called "double-jointed" as a kid
Hyperextended knees or elbows
Ability to bend your thumb back to your forearm
Flat feet or fallen arches
Joints that constantly pop and crack

"If we are considered more hypermobile," Dr. Kate explains, "that's going to set you up for more of a chance of instability or increased mobility in the pelvis, which can lead to more pain."

I remember being able to put my leg behind my head as a child (and embarrassingly, I still can at 30-something!). What seemed like a party trick was actually a sign of hypermobility that would later contribute to my pregnancy pain.

Why "Just Deal With It" Is Never the Right Answer

One of the most powerful moments in our conversation was when Dr. Kate validated what so many of us have experienced: being gaslit about our pain.

"Any pain is your body telling you something," she emphasizes. "We have to listen to that."

The impact goes beyond physical discomfort. As I shared with Dr. Kate, the daily pain took a massive toll on my mental health. The quality of life during pregnancy matters—not just for those nine months, but for how you view your entire journey into motherhood.

Simple Changes That Can Make a Big Difference

While working with a specialized pelvic floor PT is ideal, Dr. Kate shared some immediate strategies you can try:

Posture Reset:

Put a soft bend in your knees (stop locking them out)
Shift your weight slightly forward—think "chest over toes"
This takes pressure off your back and allows better core engagement

The Hip Hinge:

When bending to pick something up, shoot your hips back instead of just bending at the waist
This keeps your ribs stacked over your hips and reduces pressure

Sleep Support:

Use a pillow between your knees—but not just your knees
Support from your vulva all the way to your ankles for proper alignment

The "Exhale and Hug Baby" Technique:

Before rolling in bed or lifting: Take a deep breath, then exhale while gently hugging your baby
This stabilizes your pelvis before movement

The Surprising Truth About Kegels

Here's something that might shock you: Dr. Kate rarely recommends Kegels during pregnancy.

"With pregnancy, those muscles are already being overloaded," she explains. "If they're already shortened, then doing Kegels might actually create more pain than helping anything because they're overworked."

Instead, the focus should be on proper breathing, pressure management, and whole-body movement patterns.

Preparing for Birth While Managing Pain

What blew my mind was learning how prenatal pelvic floor PT prepares you for birth. Dr. Kate actually helps moms practice different pushing positions—checking the pelvic floor's response in real-time.

One of her clients discovered through this practice that hands and knees felt most natural for her body. She went on to have a beautiful, unmedicated birth in exactly that position. Another realized her hypnobirthing breathing wasn't as effective as she thought and was able to adjust before labor.

"It really empowers our mamas because they can feel what's happening," Dr. Kate shares.

📖 Scripture for Your Heart

While this episode focused on the physical aspects of pregnancy pain, I'm reminded that God cares about our whole being—body, mind, and spirit.

"He heals the brokenhearted and binds up their wounds." - Psalm 147:3

Your physical pain matters to God. Your quality of life during pregnancy matters. And seeking help for your body is not a lack of faith—it's wise stewardship of the temple He's given you.

🙏 A Prayer for Your Birth Journey

Dear mama, if you're reading this through tears of pain, know that you're not alone, you're not being dramatic, and there IS help available.

Let's pray together:

Lord, we thank You for the miracle of pregnancy, even when it comes with unexpected challenges. For the mama in pain today, please guide her to the right help and healing. Give her wisdom to advocate for herself, courage to seek support, and hope that relief is possible. Remind her that You see every tear, You know every ache, and You care about her wellbeing—body, soul, and spirit. In Jesus' name, Amen.

📎Resources & Links Mentioned

✨ Christian Mama Birth Prep Library - Free birth prep tools, worship playlists & more

✝️ Online Christian Childbirth Education - Explore my complete birth preparation self-paced course

💛 Work with Me 1:1 - Personalized pregnancy and birth support that integrates faith and evidence-based care, including virtual coaching, doula support, and comprehensive childbirth education

✨ Follow Dr. Kate Smith on Instagram: @nurtureyou_pelvichealth and @drkatesmith_pfdoc

🏋️‍♀️ Body Ready Method Programs: Pregnancy-specific workout programs you can use from home

🎯 Schedule a free discovery call with Dr. Kate on her website www.nurtureyoupelvichealth.com

📣 Let’s Stay Connected

If this episode encouraged you:

Hit subscribe and leave a review on Apple Podcasts or Spotify.
Text a friend and share the show with a fellow mama.
Grab your free birth prep tools at the Christian Mama Birth Prep Library.

**Meet Your Host —**

Natalie is a certified birth doula and childbirth educator serving families in Jacksonville, FL and virtually worldwide. After experiencing two births marked by severe pelvic pain, she's passionate about helping Christian women find both physical support and spiritual encouragement for their pregnancy journeys. Through her podcast, virtual doula services, and childbirth education, she equips mamas to experience peaceful, faith-filled births.
About Me | Services

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📄 Full Episode Transcript

Natalie: Hey there, mama. Welcome back to the podcast. I'm so excited to have Dr. Kate Smith with me today. Dr. Kate is the owner and founder of Nurture You Pelvic Health, and she has over seven years of experience as a pelvic floor physical therapist specializing in prenatal and postpartum care. What I love about Dr. Kate's approach is that she takes a holistic, full body perspective to really get to the root cause of pelvic floor concerns. Not just treating symptoms, but really helping women truly understand what's happening in their bodies.

And today we're diving deep into a topic that I know affects so many during pregnancy: hypermobility and pelvic pain. If you've ever had that sharp stabbing pain in your pelvis during pregnancy, or if you've wondered whether what you're feeling is normal or something that you can actually get help for, this conversation is going to be so valuable for you. Kate, I'm so thankful that you're here with us today.

Dr. Kate: Yes, thank you for having me, Natalie. I'm super excited.

Natalie: Me too. And this is so near and dear to my heart because I shared during my birth stories that I had really bad pelvic pain during both of my pregnancies. And so for the mom that's experienced or is currently experiencing sharp, stabbing pelvic pain, can you help her understand what's actually happening in her body? And you know, maybe why some women might be more prone to that pelvic pain than others.

Dr. Kate: Yeah, absolutely. So I think one of the biggest things, or I guess educationally to take away here would be, when we're talking about SPD pain or symphysis pubis dysfunction, or honestly, I usually call it just pubic symphysis pain. For me, it's easier to say it that way versus SPD, I guess in the medical terminology. Or there's also pelvic girdle pain, which is obviously pain within the whole pelvis or SI joint pain. And so I'll find a lot of times when people reach out, you know, even to talk with me for pelvic floor physical therapy, they'll say they have SPD pain, pelvic girdle pain, SI joint pain. But it's really up to me to determine, okay, what exactly is going on and what does that look like?

But just for, you know, any mamas at home, if we have say, a sharp pain in the front of the pelvis or directly in the center of your pelvis, that could be more likely, of course, SPD pain or pubic symphysis pain or some form of dysfunction there. I usually find it's most often obviously towards the second and third trimester. However it can occur of course in that first trimester, but also people can have this even without ever having children or even prior to pregnancy.

And we usually see symptoms that are more asymmetrical, I guess you could say in the sense of more pain with maybe walking or stair climbing. Or you might notice that sharp pain when getting in and out of the car, rolling over in bed, trying to stand on one leg to put on your pants. Anything that's gonna create more of a single leg stance or an asymmetry within the pelvis is gonna create more dysfunction or more pain in the center of that pub bone or pelvis.

One thing I always like to note though, too, with pubic symphysis pain and SPD is that if it is off to one side, because that's what people will say, "Oh, I have SPD but it's more right sided." I always, for me as a pelvic floor physical therapist, I wanna look at the round ligament too, because the round ligament also attaches into that labia. So you might think that you have SPD dysfunction, but it could actually be related to that uterine ligament. So that's just one thing to side note if you're hearing this and that's you because that's something we would look at.

But then if we get into SI joint pain or more of that pelvic girdle pain, we usually see that more in the back of the pelvis. So where you have like those dimples, I guess you could say, if you were to reach behind you and feel, you know, where your low back is and where your low back meets the buttock area. That's gonna be more SI joint pain. I see that more often, of course, with bending or lifting. Sometimes yes, rolling in and out of bed, sleeping on one side. It can still affect you obviously with like single leg standing or a lot of times, you know, with walking and things like that. But it doesn't present exactly the same as SPD or pubic symphysis dysfunction, I guess you could say.

So it just depends on what's going on within the pelvis. And then I guess also with that being said, when it comes to SPD pain and the SI joint pain, it's being affected differently as far as different musculature. And that's where, for me, with my practice getting to the root cause of what exactly is going on.

Of course we know that we're already at an increased, I don't wanna say risk, but we have increased chances of SPD pain and pelvic girdle pain and SI joint pain during our pregnancy just because of ligamentous laxity, right? Because all of those changes within the hormones are doing what they need to do to obviously make changes for baby, for labor and delivery. However that can create more mobility within the pelvis that can lead to more pain.

I always, I'm a big advocate too for pelvic floor physical therapy prior to conception, and I think part of that is because, I hate to say it, but pregnancy and postpartum really highlights your imbalances and your weaknesses. And so if we already have those imbalances and weaknesses, and then you add hormone factors into it, you know, postural changes, more weight from baby, placenta, fluids and all the things, those muscles have to work to stabilize. And it's not just the pelvic floor and it's not just the core, but it's all those muscles surrounding the pelvis. It's how we even move within like our feet and our ankles because that's gonna affect how we squat and how we hip hinge to lift up our little ones.

And not to mention if this is also a subsequent pregnancy, you know, we have sometimes, or even a little bit more of an increased risk if we haven't worked on those imbalances postpartum. Hopefully that makes sense.

And then also leading into, you know, other factors are hypermobility. I know you and I have talked a little bit about this. If we are considered more hypermobile or even if we might have something called EDS or Ehlers-Danlos syndrome, that's going to even set you up for more of a chance of instability or increased mobility in the pelvis, which can also further lead to more pain. And so I really, usually that's something that I know we'll dive into a little bit more, but ask clients about, especially during pregnancy and postpartum.

Natalie: I stumbled across the idea of hypermobility after I had Daniel. So this was my second pregnancy where again, I was dealing with excruciating pelvic pain, like it hurt just to exist, and I came across hypermobility and realized, oh my goodness, I think I'm hypermobile, which maybe is the reason why I experienced this really intense pelvic pain during both of my pregnancies and even into some of the postpartum period. So for someone who is unfamiliar with this idea of hypermobility, what are some signs or symptoms that you might be hypermobile or have one of those hypermobility disorders?

Dr. Kate: Yeah, that's a great question because I feel like obviously there's a lot of variability with that too. There's different levels, like some people might be slightly hypermobile, where then we also have that extreme of actual like connective tissue dysfunction, so that's like your EDS, your Marfan Syndrome and stuff like that.

And so what I usually will do is, you know, as I'm looking at my clients and even just standing and looking at their posture, I'm like, are they hypermobile? If you can see that their knees are hyperextended or even as they're moving, if you can see that hyperextension within the elbow, or if you remember back when you were younger, if everyone was always like, "Oh, you're double jointed. Oh, you're so flexible." You know, all of that. Yep. Then that is gonna be more, you know, likely that we have hypermobility.

But then we can also just do some small things like, can you pull your thumb all the way back to your forearm? Can you extend your thumb all the way back? Can you take your pinky finger and can you pull it all the way out to 90 degrees? Those are just like a few classical signs of that. But then also we look at, again, the elbow. If we're hyperextending there, if we have really flat feet, flat arches. Are you someone that constantly pops and cracks or have you ever had your kneecap go out of place or even to like, you feel like your elbows get a lock or go out of place or just things like that that we notice. Of course, like those other connective tissue dysfunctions, usually they most likely know about that just because it is a more severity of that hypermobility.

Natalie: I did a post where I showed all of the ways to tell. It's like that just basic assessment to know if you were hypermobile and yeah, I'm pretty much, I had all of them. Yeah. Personally, and so I was like, oh my goodness, I am like self-diagnosing hypermobility and it's all kind of making sense after the fact, some of the things. Because yeah, I remember as a kid, I, and I still can, which is crazy. I had the ability to put my leg up around my head. And like I said, I can still do that. And I'm like, that is like not normal for a 30-something year old to be able to dislocate your leg and do that. Yeah. But yeah, it's very strange because for the most part in my life it has not presented as issues until I became pregnant.

And I right now even have some clients that are dealing with really intense pelvic pain. And I posted that thing about hypermobility and they're like, "Oh wow, I'm hypermobile." And I'm like, yeah. I also did not know this until after the fact, which I, whenever we were speaking, when we connected, I remember us talking about this and your recommendation to start physical therapy even prior to conception. And that is so empowering and I really wish that we had connected sooner, like before I had my second pregnancy, because you're right, after my first pregnancy with my second pregnancy, things seemed even more intense and I thought it was bad the first time.

And so yeah, just that period after having Ellie, I was not working out regularly like I was when I was pregnant with Ellie and going for a walk became excruciating, like truly excruciating to the point where if I tried to walk for longer than, I don't know, 10 minutes, I would ache and then I would of course go into this mode of, okay, I don't wanna keep moving because I end up feeling way worse for days after the fact. Yes. And so to get in that spiral, that, you know, hamster wheel of like pain and then pain and then not wanting to get out of it.

You know, I'm curious, your approach as a therapist, if a mom comes to you in pain and you know, she's experiencing what I am describing, where it's like she's just so frustrated. Like she can't even do basic things. Standing up to just cook a meal is excruciating. So what do you recommend to help her shift her mindset to just give her some hope, you know, during that season, especially if you're listening to this right now and that's where you're at.

Dr. Kate: Yeah. I think it's for one, validating what you're feeling, right? Because a lot of times, you know, I hate using the term, as far as like women and you know, pregnant mamas not being necessarily well or yes, being like gaslit, so to believe that, okay, pain during pregnancy is normal. That's just part of pregnancy. That's just what happens. Some people have more pain than others. You know, all of that.

And I think that, you know, of course any pain is your body telling you something, right? You know, we have to listen to that. And so for me, when I see my clients, and if they came in, you know, again, frustrated, just in pain, for one, you've already made the first step to improving that. You know, I am here for you. I am here to support you. And regardless, yes, we might not be a hundred percent completely pain free, but I'm gonna do everything that I can to improve upon that and to help manage that throughout your pregnancy and give you, keep you moving and give you that overall quality of life during your pregnancy and postpartum that you deserve.

And just knowing that there is, I guess, for one help out there, if you never even realize that because I talk, you know, obviously I do discovery calls with my clients and I always like to speak with potential clients before I see them, just to get, again, some more information, talk to them just like I'm doing here. Getting to more of the root cause of what is causing that and knowing that there are improvements.

A lot of clients think that they just wanna start pelvic floor physical therapy postpartum, and they don't even realize that during their pregnancy that they can see me. Yep. I'll get calls and be like, "Oh, I'm just calling to maybe talk to you a little bit before I set something up postpartum." I'm like, actually it would be really great for us to work together now. Because the sooner that I can work with you, the better. You know, overall you, things will feel throughout your pregnancy, and it's really just either managing your pain or allowing you to not have any pain.

So like sometimes I'll see clients again, preconception or really early on in their pregnancy, we can still work together, you know, during that first trimester. Of course, it depends on how you're feeling, you know? And I usually don't do any internal work, obviously in that first trimester. But there's so many things that we can be doing to help with that.

And yeah, it's just knowing that there's hope out there. There's, you know, obviously myself here in the Jacksonville community, but also if you're listening to this, like elsewhere, there's so many pelvic floor therapists out there that are at least now specializing in, you know, prenatal care. So there's hope and it's just finding the right person and reaching out to them to be able to, you know, improve those symptoms and knowing that you don't have to just live with it.

Because if we just live with it during our pregnancy, the chances are that you'll also still experience that postpartum is pretty high just because of still those hormonal factors with nursing, producing, pumping, whatever that might look like for you. But then also, if we were to get, like you said, like we were to get pregnant again, and we haven't worked on some of those imbalances, then we usually see them worse in that second pregnancy or third pregnancy.

I just, for example, I had worked with a client in St. Pete. And I was working with her through a pregnancy and I was so happy that she had found me because she was like, "My first pregnancy was like you said, really bad. My second pregnancy was even worse." She's in her third pregnancy. She's like, from the moment I got pregnant, she's at five weeks, she's like, "I already started experiencing symptoms." And it's because of, again, those hormonal factors, but she was absolutely hypermobile.

And so for her, yes, we weren't able to completely eliminate the pain, but it allowed her to continue to do CrossFit, continued to take care of her kids at home, you know, work as well. She was a vet in the area, so she had to do surgeries, you know, all of those things. And we were able to like, keep her moving throughout her pregnancy because in her past pregnancy she had to stop and she's like, "I don't wanna do that." And so it's really getting, again, to like the root cause of all those imbalances to be able to support the body and the pelvis. So yeah, so there's hope out there.

Natalie: I love that you're validating it because I did not feel validated whatsoever when I went through this the first time. My provider, every time I brought it to their attention that I was in a lot of pelvic pain, they did exactly that. They just said, "That's normal. Being pregnant is painful. Sorry."

And then, like I said, I was doing research on my own because I was like, this cannot be normal, like this amount of pain, like how can this be normal? And that's whenever I started seeking for myself some physical therapy and I wish I had connected with somebody like you that really knew pregnancy and like the perinatal period, postpartum period, because I just was like with a general, you know, physical therapist that just like my insurance covered. Yeah. And not that there's anything wrong with that, but again, they were not able to support me in getting me to a more comfortable place in my pregnancy.

And then eventually I just fell off the bandwagon doing the exercises and the things that they assigned to me because I was in so much pain. It's not like they weren't willing to help, but they just didn't have the tools to be able to really carry me through the pain that I was experiencing. And so that's, I think one of my biggest regrets is not only, you know, choose a provider obviously that is listening to you, that's huge. But then secondly, if you are not getting the care that you need, know that you can seek that for yourself. Like you can go out and find the people that will help you if you're not getting it from the current places that you're looking for help.

Yeah. And that it really is, it's more than just experiencing pain in the short term. It's the quality of life. It's the quality of how you view that pregnancy, and it really does even affect like mental health. I shared a little bit about this, but because I was in so much pain during my pregnancies almost every day at the end of the day, I would throw myself on the couch and almost be in tears or be in tears and tell Brian, "I cannot be pregnant again. I cannot do this again." I was so mentally and physically worn down by just feeling so awful.

And then there was part of me that was just like at least I'm not like throwing up constantly. Like I would try to just, I don't know, situate myself to where I wouldn't be completely down on myself about it, but it was, it took a huge mental toll on me. And so if you're listening to this, and that's where you're at too, just knowing that there's help. And like I said, I wish we had connected ahead of my pregnancies because I would've had so much more hope knowing that there was help for me out there. I just, I didn't even know that was available to me, that was possible for me.

You know, another thing that I want you to touch on is for the mom that is currently experiencing that, is there anything she can be doing at home even ahead of, you know, starting therapy, which I highly would recommend, I had those bandaid approaches, you know, wearing the belts and stuff. But what would you say are some helpful things that she can be doing to just mitigate some of that intense pain?

Dr. Kate: Yeah, and that's a great question. That's actually one that I get obviously in a lot of my workshops and stuff is like, what can I be doing like from when I leave here? And I will say, depending on SPD pain and SI joint pain, like it does depend. Of course, like you said, it's really getting to that root cause of what's causing it because SPD pain in one client is gonna be different in the other client and different in the other client as far as imbalances.

When it comes to the front of the pelvis, like we really wanna try to strengthen what we call like the anterior oblique sling. So like those frontal patterns to create stability in the front of the pelvis. Whereas in the SI joint or in the posterior aspect, we really wanna help to like strengthen and stabilize that SI joint from the posterior. So you think of it like your lats in your shoulder to like your opposite glute.

However, still with every client, it's gonna be a little bit different of how we work that because we might need to actually release the muscles before we strengthen them. Or some are like, no, we need to focus more on strength and stability. So it does change as far as you know, it is always individualized like person to person. However, there's definitely tips and tricks that I discuss with my clients, like from day one. And although this might not help a hundred percent, but it's something that you can start with.

So the first thing would be, it's crazy to even think this, but posture. You know, depending, and I do this even with my clients that aren't pregnant, right? So we tend to want to, you know, whether we are more hypermobile or not at all, but we tend to wanna extend our knees. So we lock out our knees and we push our hips forward a little bit. And, you know, we have a little bit more sway or I guess what we call our lordosis or extension into our back. And then of course, like our shoulders round forward a little bit sometimes.

And of course, as you know, we go throughout our pregnancy, that tends to get worse because it is a position that we can just hang on our ligaments, right? We can, we don't have to do much work to rest like that. However, it's not usually comfortable or that's why we, our back hurts, you know, to stand for long periods of time or even to, you know, I know we're not gonna get into this too much, but diastasis recti, right? If we're constantly in that posture and that's sway back and core isn't active and all, and you know we're not technically stacking our ribs over our hips, then that can also set you up for just more pressure into your abdominal wall, right? That can also affect like things like leakage and leakage with coughing, laughing, sneezing and stuff like that, but from a pain aspect too.

More so I see this more often with the SI joint pain, but say, you know, if you're listening to this and you're standing, you could stand up, right? See where you know that posturing is, and then I want you to put a soft bend in your knees and I want you to just slightly shift your weight. Not, you're not bending forward, but you're shifting your weight forward thinking toes over toes. Or chest over toes if you wanna use that. People usually remember that toes over toes a little bit better. Whatever you prefer, you know, whether that be that or chest over toes.

But you'll see even just that little bit of shift forward should take pressure off your back, allow you to engage your core a little bit better. And that's something that we should try to do. You know, if we're standing or if we are standing and carrying a little one, then we really wanna make sure, we want to get that trunk forward a little bit more. I call it like rib and hip stacking, and that's more of the front of your rib cage over the front of your hip bone. So it's like we wanna be able to engage the core and bring those points into a neutral position. I know it's hard, you know, being on the voice to explain it versus see it. But that would just be one thing, like trying that, see how you feel, because that's gonna prevent pressure from going down, and it's also going to allow you to activate a little bit more to not just hang on those ligaments.

Of course you're going to, there's gonna be times where you're tired and you're gonna do that. But when we have that pain, that's your cue to, oh, I really gotta change my position and I really need to start practicing this because that is gonna carry over to postpartum when those babies are out of our belly and now they're on our chest and you're having to control their head. And so you're leaning all the way back and thrusting your hips forward, and having more back pain and things like that. So that would just be one thing.

And then going into, again, the ribs and hips stacking, right? As we bend and we move and we lift, a lot of times we want to bend so much with our trunk, right? We wanna extend the knees out and we just wanna bend forward with our trunk, where any time we hinge or we go to lift our little ones, or we go to get something, you know, out of the dishwasher or picking up a laundry basket, we really need to hinge with our hips, so that would be shooting our hips back, which keeps the ribs and front of the hip stacked, so that way we're not having so much pressure on our back and also the front of the pelvis. So definitely more so on that SI joint pain, but it can also affect, you know, the pubic symphysis or the SPD pain.

With that being said, getting into more of those modifications for it would be if we're getting in, making sure that we swivel ourself, keeping our legs closer together when we get out of the car. Sometimes if it's really that severe, you're probably already doing this, but taking shorter strides. But again, we wanna get to the root cause because we need those muscles to work, so we don't want to be doing that. But if you know, you have to, then that's maybe a modification that we make.

Sitting, of course, to put on your bottoms, not getting into that single leg stance. Or just a few things, or even to rolling over in bed, making sure that we have a pillow in between our knees, but not just our knees. From literally, I guess you could say our vulva all the way to our ankle, so that way when we go to roll, it doesn't really change the pelvis too much or that positioning, making it more comfortable.

And then the last thing I would say, and again, this would help with either SPD or SI joint pain is when we go to, say roll over in bed or if we go to lift, we really wanna think of exhale, hug baby, or engage those lower abdominals because that's what's gonna stabilize the pelvis. Or same thing, rolling over in bed. We're on our back. We take a deep breath in, we exhale, we hug baby and we roll because again, that's gonna help stabilize the front of that pelvic area, but also the back.

As I know we're not gonna dive into this too much today, but as you could probably see, I didn't say anything about Kegels. Because obviously with pregnancy, those muscles are already being overloaded, and so I usually very rarely ask you to isolate those muscles and shorten them or contract them, because if they're already shortened, then doing that might actually create more pain than helping anything because they're overworked.

Natalie: Wow, that is so good. And some of those things I had heard of, some of those I had never heard of and I wish that I had known about them whenever I was pregnant. I don't know if we talked about this, but I am a certified Body Ready Method pro, and we talk a lot about, just the way, because it's obviously body ready for pregnancy, you know, birth, postpartum, and I do a body assessment with my clients. They can add on that service of having a body assessment where I assess their posture and I look at like, how are they doing a hip hinge? How is their mobility? All the things that we go over these principles. But have you ever heard of Body Ready Method?

Dr. Kate: You know, I remember when we talked, you had told me about it, but I hadn't like additionally looked into it.

Natalie: But yeah, so many of the principles that you're sharing are in the Body Ready Method because it was created by a physical therapist. And so she just took her love of birth and her love of physical therapy and, you know, melded them together. But check out her account. And also you need to be following Dr. Kate on social media because her stuff is phenomenal. But yeah, it is helpful to see the principles and things that you're talking about because obviously in a podcast format, you know, unless you understand the anatomy and like the things like, I can follow along with what you're saying because I'm seeing you, but I'm also, I have that kind of knowledge base. But it is really difficult to understand it if you're like what areas of the body are you even talking about right now? Yep. But it is very important to know again that having just not being in pain or avoiding pain or lessening pain in pregnancy is not just this isolated one-off just for this season. Like this is the longevity of your entire life.

I used to walk with my feet out like we call it like the duck foot, you know? Just like slightly. And when I was going through the Body Ready Method training, which was like a five month, you know, in depth training, like college level training. And we were learning about how, you know, keeping your feet straight ahead and so even me just slowly working on having my feet turning slightly out as just my normal posture to over time turning them more inward so they're straight ahead. And now I walk with my feet more straight ahead. But that was something that slowly over time I worked on.

So you know, from the time that Ellie was little and I was pushing her in the stroller, my feet would kick the wheels because my feet were out and now they go straight into that area where the wheels are, you know, in between where the wheels are because my feet are straight ahead. And so just to give a little bit of an example of, you know, the goal isn't to be like, and today you need to always be sitting properly and make sure to never jut your hips forward and when you're bending over, always make sure it's a perfect hip hinge. Like the point is not to be perfectionistic about all these things, but to just have an awareness is what I like to say.

Have an awareness of what your body is doing so that you can give it a different experience so that it can experience better posture compared to what it has been. And over time, your body does get more used to moving in a different way. I've started doing, or not started for the last year, ever since I had Daniel, I started doing body pump and we do a lot of deadlifts and things with the bar and even that movement where it's a really good hip hinge and like loading the glutes and the hamstrings. That motion, just constantly doing that motion has made it so much more intuitive to me to whenever I'm bending down to pick something off, you know, off the ground or picking up one of my babies or something where my body naturally goes into a good hip hinge. Because that's a movement that my body is used to working through, instead of it just being like this totally foreign thing that I'm asking it to do.

And that's really encouraging that our bodies can be so malleable, even though we feel like, oh, this is just my pattern. This is just the way I sit. This is just the way I walk. No, our bodies are so capable of change and our pregnant bodies are evidence of that. For sure. That there is so much change that can be made good, you know, and bad, but really good changes.

Dr. Kate: Yeah, absolutely. I mean, you hit on a lot of great points there that it, yeah. It doesn't have to be perfect, right? Because it's just the more that we practice it, it's not practice makes perfection, but practice helps a lot. And so I find, you know, going back to that hip hinge where a lot of people, so many people don't know how to, and you know, that stems from obviously like pre-pregnancy and stuff like that, if you've never looked at it or worked with it because I would say like 90, maybe 95% of the clients that I see with low back pain, they usually don't know how to hinge and it's because that's what they're doing all day, but they're doing it not quite properly or just not aware.

But then if you start to change those habits, then it really starts to become second nature. Then obviously to doing like the workouts and just knowing how to move that way in your body, you know, is really helpful. But also with that being said, if we have restrictions within the pelvis or within the rib cage and the diaphragm or you know, weakness in the core or even to limitations in the ankles, then it's gonna affect how you're able to do those things. And so that's where it's trying to again see why can't we hinge? Is it just motor aspect, like motor control, motor memory? Or is it because you're physically not able to because of other restrictions?

Natalie: I remember whenever I would do body assessments much more regularly than I've been doing in the recent past, but I would have a client do a squat. And it would astound me when someone would do a squat. And I would say, now I want you to bring your bottom back to where your knees are stacked over the ankles as much as possible so that your knees aren't coming, you know, far forward. And some people got it immediately. Others, they had no idea what I was even talking about.

And every time I would try to say, you know, okay, you're trying to bring the butt back. Unless I showed them like a modified, where they were holding onto something they could not physically get into that. And I always wondered that. I'm like, I wonder if that's like just they're not just understanding what I'm saying or is it truly like their body cannot get into that position effectively without assistance. Yeah. Unless, you know, because there are other issues. And that's obviously not my expertise, but it's fascinating to go back to think about, you know, those women that just have a hard time connecting with their body in that way and that it can be learned, but for some it comes very naturally. And for others you really have to work on that. Yeah. Because of the way your body has compensated, just the patterns we feed it and then the compensation patterns as a result of that. You know, what we've, how we've been using our body.

Dr. Kate: Oh yeah. No, absolutely. And I think too, because like you said, it could be a variety of different things. It could be hip mobility, it could be ankle mobility, it could be honestly, something going on within like the knees or the feet or not being able to stabilize well. But then, you know, obviously for us too, with the pregnancy aspect of things, we also have to look at all of those movement patterns for labor and delivery too, right?

So if we have all of these like restrictions or if we have limited hip mobility and or ankle mobility, like getting into a deep squat during, you know, labor might be a little bit more challenging for you. Getting those hips into a different position or being able to stand in a position for a period of time can also, you know, be affected for that. And so too, for me, obviously I'm looking at things for relieving their pain and their symptoms and improving overall quality of life during this, you know, pregnancy and things. But then I'm also looking at okay, labor and delivery. You know, we want to optimize everything that we can for that too. And that's just gonna carry over into that postpartum period.

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Natalie: Yeah, definitely. Yep. It's crazy because I just remembered whenever I was in labor with Daniel and I would have contractions like I was in actual labor, like I was like eight centimeters. But I remember telling my, like everyone who was there, the birth team, I remember saying these contractions are literally nothing compared to the pelvic pain that I experience every day. Like I just remember being like, and that blows my mind, that blows my mind that my active labor pain is a shadow compared to the pelvic pain I was experiencing. So that just, I don't know, randomly came to mind, but that leads me to want to ask you what are the benefits of seeing a pelvic floor physical therapist during pregnancy as preparation for birth? What are some of those studied or other benefits that relate to that instead of, like you're saying, the client who's like, "Oh, I'm connecting with you because I wanna just, I just wanna meet with you after for postpartum recovery." But what are the benefits for that, for the birth itself?

Dr. Kate: Oh gosh, so many. I think for one, obviously it just depends on when I see you. So if I were to see you early on in your pregnancy, looking at all of those imbalances, I wanna see how you move. I wanna see your posture, I wanna, I, again, I assess, yes, your deadlift or your hinge. I look at your squat. I look at your ankle mobility. I look at your calf strength because so many people don't realize that as we progress in our pregnancy because of those changes in center of mass and how we walk, or if we start to get that waddling gait pattern, which again, that's you trying to create stability because you don't have the stability there. So that's, like you said, we need to work on that.

But, you know, looking at calves, because a lot of times I actually see more of that calf weakness creating issues with like leakage with running postpartum, or jumping. So I always start to work on that during the pregnancy, make sure that stays strong just for that carry over into what the client's goals are for postpartum. But then we look into, again, diaphragmatic breathing, right? Because that's gonna carry over into our labor and delivery as well as core strength. I look for obviously any changes in the abdominal wall. We know no matter what a hundred percent of mamas at the end of their pregnancy are going to have a diastasis recti. That's normal adaptations during pregnancy. That's totally fine, but it's how we're managing our pressure, making sure we're not doing things that are creating even more pressure onto the abdominal wall and more so preventing things like umbilical hernias and stuff like that because of improper, you know, pressure management.

And then we go and we look at, of course, the mobility of the pelvis and then the last thing I will look at is pelvic floor, right? Because we find that as we progress in our pregnancy, we do have more tightness within the pelvic floor. We have more tone because of, again, it has to work really hard to stabilize the pelvis and support, you know, our bladder, our bowels, our reproductive organ, obviously our uterus and everything, so it has to work really hard. So we still need to be able to coordinate that muscle well, and more importantly, we need to be able to lengthen it with our breath and everything for labor and delivery. And so I start that even early on in that second trimester to say, okay, what are we doing to set you up for success throughout your pregnancy? Because that's not only gonna help with pain management, but it's also, again, working on that labor and delivery aspect of things.

And I think one thing that people don't realize too, at least for me and just the advanced training that I have is that I work a lot on the mama's belly. And you know, so many, you know, probably maybe for you when you had done physical therapy, you know, during your, because you did it during your pregnancy, did you say?

Natalie: Yeah.

Dr. Kate: Where they might have never even touched your belly. And so that's a huge component because if we have tightness in our obliques, so those are the muscles on the side, because obviously we're making all these changes, the front abdominal muscles can't do what they need to do. So all of the ones on the side are overworking. They get tight, but then we also, how does that play into baby too and its room to move and grow. And so I really dive into the fascia of the belly and also to looking at all of the ligaments of the belly. So your broad ligament, your round ligament, your uterosacral ligaments, things that people, ligaments that people don't even realize exist. Because everyone knows about the round ligament, but none of the other ones.

And so I will, you know, usually I'll start that about like 32 weeks or so, where we can really see where's baby's head, right? Because I'll find within the pelvis, if it's off to one side or the other, then we look at the restrictions of what's going on within the fascia, but also within those ligaments, and we can help release those to help optimize baby's position, right? We can't spin babies or anything like that, but we can at least create space for them to allow them to do what they need to do.

And so that's, honestly, that's probably my favorite part of treating too in the prenatal period, is just really seeing, you know, you make those changes and then seeing like the outcomes too of, you know, less pain, less symptoms as far as leakage, because we know that during pregnancy I think I had two yesterday that were like, "Oh yeah, I guess I leak sometimes when I sneeze, but that's just part of pregnancy." And I'm like, there's things that we can do to help manage that. Because it's not necessarily a weakness within the pelvic floor. It's improper pressure management. You sneeze, all that pressure goes down. Pelvic floor is already tight and is saying, I can't do anymore. So I'm gonna just do what I can, but it's not enough. And then we leak. And you know, things like that, that we work on.

And then of course I also do like labor and delivery prep. You know, when it comes to, I guess like whether, no matter what, like the childbirth education, I just do the birth prep more from like a pelvic floor standpoint. So why would these positions help our pelvic floor and what do we need to do for baby during that timeframe to allow pelvic floor to do and the pelvis to do what it needs to do to help progress labor and delivery.

And then I think the most effective thing that I've been getting a lot of feedback since doing more advanced training, it's been a little while now since I've done it, but is I actually go through and I feel the pelvic floor as you practice breathing techniques for pushing. So I'll do it supine. So lying on your back, I'll do it like I'll have you turn rotate sideways so you'll be side lying. I have you come into hands and knees, do it there. And then I have you come up into a tall kneeling position and I think that really empowers our mamas because they can feel what's happening.

And so I just actually had a mama deliver three weeks ago. She had also worked with chiropractic in the area. But we did that. And she goes, "Man, like hands and knees just feels so good. It feels so natural. This is how I wanna deliver my baby." Yeah. And she delivered unmedicated on her hands and knees. Beautiful. With full circle. And she, it was amazing. She was like, that helped. She's like, "Something just clicked with it."

And like even back, I had a mama that I did a labor and delivery, or we did that, last week and she went through some of her hypnobirthing and that's what I tell them. I go, let me feel what, you know, especially if you've done some of that education and go through all of those different breath works. You know, we talk about like open glottis, closed glottis, all those different patterns and then we did that and she was like, she thought that, "Oh this, I feel like this feels really good." But then when we actually checked she was like, "Oh wait, like that doesn't feel right." And she's like, "Now," and then, so I changed this a little bit and tweaked it and she was like, "This is eyeopening. Like now I feel it."

And that's good for whether we have an unmedicated delivery or if we have an epidural, because your body's gonna remember what we practiced and went through too. Like I said, lots of things. I know that's a long-winded answer, but I love it. I'm passionate about it.

Natalie: I can 1000% see that you are blowing my mind right now because it is so important. All the things that you're hitting on, just being able to be in tune with your body. Pushing in the way that your body is telling you to push that's most effective. Because that's what I really try to tell my clients is, oh yeah, you can certainly have an idea of the way you would like to push, or the way you just imagine yourself pushing. But until you are actually physically doing that or testing it out like you're describing, you will not know what will feel best and will actually help move the baby down. And so that's amazing that you're doing that ahead of time. I had never even heard of a provider doing that, so that is like blowing my mind. Incredible. Yeah.

Dr. Kate: It's a lot of fun and you know, yes. Baby's also gonna dictate some of that, right? So if it doesn't feel good for you, then we're gonna change positions. But at least, like you've seen what that looks like to some degree, right? Yeah. So if you're in a tall kneeling position, that's similar to if you were standing or, you know, a lot of times I don't go through it in a deep squat just for, you know, other reasons. But we go through all those, you know, again, other positions and stuff like that because yeah, it's just easier to feel and that way you have an idea. But of course, as you know, yes, I tell my moms, lean into what you feel, right? Baby's gonna dictate some of that. It's also about what you feel, but just know that it's tools in your toolbox.

Natalie: Absolutely. That's the exact verbiage that I use is tools in your toolbox and just to know that preparation that you're doing ahead of time isn't guaranteeing a certain outcome, but it's certainly getting you more tools in the toolbox to know what to do when, and to just have access to more things that are available to you and that's absolutely such a beautiful way to experience your labor is to not look back and think everything had to go exactly perfectly. But that inevitably for everybody, there's gonna be some aspect of your labor and birth experience, your postpartum experience, all the things that are not going to go according to plan, but just knowing that you can pivot to some other option or choice. That's really empowering and so I love that's what you're providing for your clients. You are incredible. Thank you.

Oh, thank you. If someone wants to connect with you like I mentioned, follow you on social media, all the things, what's the best way for them to follow you and maybe even work with you?

Dr. Kate: Yeah, so I am in the process of building a website. Finally things have picked up here in Jacksonville very quickly for me in a very positive way. So I would say the easiest way to at least, if you're wanting to work with me or get more information or jump on that free discovery call, if you go to my Instagram whether that be @nurtureyou_pelvichealth or @drkatesmith_pfdoc, there is a link to fill out a form for that free discovery call. So that way I keep track of everything. And you're able to put in a little bit of information for you and what you're looking for. And so that allows me to have a better understanding even prior to us talking what you're wanting and what you're looking for or if it's just more information.

And so I usually take about 20 to 30 minutes to speak with all of my clients beforehand just to connect with you and get to know you better because just like any other profession, like I say, you want someone that you can connect with. I wanna make sure that it's a good fit for both of us, and that you're getting what you want, you know, out of it. And you feel like you're getting that support back.

Natalie: Yeah, absolutely. And are you working only with Jacksonville people, like local to Jacksonville, or are you working with people beyond just this immediate area as well?

Dr. Kate: So in person, of course, I'm just in the Jacksonville community. I have an office here in Jacksonville, but then I also do mobile services as well. Because of how crazy my schedule's gotten lately, but then I also do virtual so I can treat anyone virtually. I have some clients right now that are out of state, and so that's really great too. And everyone always asks like, "Oh, is virtual better than in person?" Obviously I do a little bit more manual work myself in person. However, I can teach you all of those tools in a virtual visit, so it's just as effective as it is in person. And yeah.

Natalie: Love it. Yeah. It's just based on preference and where you're at in your life stage. Like for me, like girl, I'm probably gonna be booking a consult with you, for me, like in my life stage, maybe doing the virtual would be a better fit with just what I have going on in my life or whatever. So yeah, I love that you have all of those options. That's just incredible. Yeah. Thank you so much again for coming on, blowing my mind, sharing some major wisdom here. I so appreciate you.

Dr. Kate: I appreciate you. Thank you so much for having me. And this was so much fun. And as you probably know, I could talk about things for days because it's my passion. It's what I love. Especially again, pregnancy and postpartum. It's just, it's so much fun. So yes, anytime you wanna chat about more things, we can do that.

Natalie: We will. I will have you back on, girl.

Dr. Kate: Oh, awesome. Thank you so much. Thank you again for having me.

Natalie Portman