I have always been so grateful for other practitioners in the Women’s Health field. Not only because their work can also benefit my patients but because they inspire me through their work in teaching and showing women alternate ways in taking care of their bodies, mentally, physically, emotionally and spiritually.
For this series, I am excited to introduce you to Dr. Rebecca Nelken. Dr. Rebecca Nelken is a double board certified OB/GYN and Urogynocologist. I have had the chance to experience Dr. Rebecca Nelken’s treatment and I am excited to announce that we will be having her as a guest speaker for our first #aconversation series this Friday, May 10 at 10am at Plumb Line Studio. This specific conversation series with Dr. Nelken will bring to light the topic of pelvic floor health postpartum, painful sex, incontinence and prolapse. To sign up for this free event, you can RSVP here.
I know that I truly enjoyed learning from Dr. Nelken and have found her work to be so beneficial not only for my patients, but also for myself and I hope that this will be beneficial to you too.
AO: What's one thing you have had access to before, during or after pregnancy that has positively influenced your experience? (product/professional service or treatment/class/book etc...)
RN: Vaginal estrogen cream! Sex was so painful after pregnancy. Even though I had a C-section, my vagina was so dry because I was breastfeeding which suppresses estrogen. Vaginal estrogen cream allowed me to have sex again without pain!
AO: What are you surprised by (that no one ever talks about) that happens to your mind or body during or after pregnancy?
RN: Unfortunately most women are embarrassed to discuss the pelvic floor symptoms that are so common after pregnancy.
Women come to me in the postpartum period (which is already so complex), and because no one talks about it, they assume that they are the only one suffering with urinary incontinence, prolapse, or even fecal or flatal incontinence. I always encourage my patients to share their experiences- when women open up about common experiences we can support each other.
I’ve seen women who are unable to return to exercising because of their incontinence. This in turn can contribute to depression at a time when women want to get back to their normal routines and bodies, and need those great endorphins.
The good news is that there are many treatment options available (see below).
AO: With your experience, what knowledge would you share with a new mother?
RN: Make the time for self care. We all feel guilty taking time for ourselves, but it’s so important to model this for our children. And we are better moms when we are happy!
AO: How has your body amazed you on this journey of pregnancy and/or motherhood?
RN: The magic of the human body is what originally drew me to the field of medicine. As an OB/GYN initially, and then later as a Urogynecologist I have supported women through their pregnancies, deliveries and postpartum period, all based on my extensive studying. But living through it myself really took my appreciation to another level. I was blown away by the experience of my body growing a baby, delivering it, and then being able to nourish that baby.
AO: Fill in the blank: My current self care must do/have: _______________
AO: Fill in the blank: Motherhood means: __________________
RN: Letting go & accepting that everything will not go according to script, but that it will end up even more beautiful than you imagined
Additional Questions Related To Your Practice
As a urogynecologist we have a few bonus questions for you since your knowledge and expertise is so pertinent to our audience.
AO: Prolapse after baby is a common issue I see in my practice. When do you consider surgery as the best option? And if that is the case, do you still recommend pelvic floor PT to prepare for surgery?
RN: I always recommend Pelvic floor PT as first line therapy for prolapse. Especially in the postpartum period, when the tissues are still healing and hormone levels have not returned to baseline. I try to avoid surgery in this time unless absolutely necessary.
I encourage women to start with PT, and vaginal estrogen, and possibly a pessary. It takes about 3 months after completing breastfeeding for hormone levels to return to baseline. If prolapse symptoms are still present at that time, then we discuss surgery.
I always recommend pelvic floor PT both before and after surgery, as we have good data that this improves surgical outcomes!
AO: I know that you fit women for pessaries if they have a prolapse. Do you ever use a pessary temporarily for women postpartum as they heal? If so, for how long and is it accompanied with other therapies?
RN: A pessary is a plastic device (similar in size to a diaphragm) which can be placed in the vagina to help lift up a prolapse. These are a great option for postpartum women who are very uncomfortable from their prolapse. As I mentioned before, most postpartum prolapse will resolve with time and PT, so a pessary is often just the thing to alleviate discomfort in the interim.
I always teach my patients to insert and remove it themselves, so they can be in control of when they use it. Some women say their prolapse only really bothers them during a workout, so they can simply use the pessary when they need it. Other women want to wear it all day, but like to remove it at night so they can have sex.
AO: I am always reminding my patients that incontinence is common post pregnancy, but not normal. Obviously I am a huge advocate for pelvic floor and core rehab, but are there other treatment options that you perform/prescribe in your office? (ie. laser, estrogen?)
RN: I think the distinction between common and normal is so important! Both prolapse and urinary incontinence are common postpartum, as the pelvic floor heals from the trauma of pregnancy and childbirth. But just because it’s common doesn’t mean that women need to live with it. We have a lot of treatment options to improve these symptoms. I offer a radiofrequency treatment called ThermiVa. This is an in-office, pain free treatment that accelerates the body’s natural healing by tightening existing collagen and stimulating deposition of new collagen. This can improve symptoms of prolapse, urinary incontinence as well as vaginal laxity (looseness), which are all common postpartum.