INSPIRING MOTHER SERIES | DR. REBECCA NELKEN

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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. 
— Dr. Rebecca Nelken, OB/GYN, Urogynocyologist

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.

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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: _______________

RN: Meditation.

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.


Name: Dr. Rebecca Nelken

Occupation: OB/GYN & Urogynecologist

Website: www.rebeccanelkenmd.com

IG: @rebeccanelkenmd

INSPIRING MOTHER SERIES | JENNI KAYNE

The biggest thing I have learned about being a mother is to stick with your instincts. Your intuition is spot on, especially after becoming a mom. But at the same time, I had to come to terms with the face that you just can’t control everything.
— Jenni Kayne | Mother of 3, Designer, Entrepreneur

It has been a true pleasure to get to work with and know Jenni Kayne.  She is a successful business owner, wife and mother, and some how balances it all with ease and grace.  Not to say it doesn't take a lot of hard work and organization, but she has seemed to figure out how to juggle life so eloquently.  She has been a true inspiration in the last couple of years I've gotten to know her, and her support for other women is both admirable and sincere.  I am thrilled to be able to feature her as one of our inspiring moms so you can get to know her as well. 

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AO: What is 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...)

JK:  I would have to say working with you! Doing physical therapy before, during, and after I had my third baby made my pregnancy so much easier and bouncing back was much easier than my first two. Throughout my pregnancy and postpartum I felt stronger and more in touch with my posture and pelvic floor, which made recovery and pregnancy much easier and essentially pain-free.  

I also had a doula for my delivery and a few weeks postpartum which was amazing—I didn’t have one with my first two. I loved my birth doula, Erica Chidi-Cohen. She really helped me to hold out on being induced and listen to my intuition, and I was so happy that I went in to labor on my own because I was induced with my first two and I hadn’t had that experience before. When I went home with Trooper I was lucky to have Stephanie Matthias as my postpartum doula. Stephanie nourished me with delicious foods that helped the healing process our bodies need after giving birth. It made the first few weeks so much easier and much more enjoyable.  

 

AO: What are you surprised by (that no one ever talks about) that happens
to your mind or body during or after pregnancy?

JK: Honestly, everything. I don’t think anyone tells you the whole truth about having a baby, and even if they did I’m not sure you’d want to hear it, or understand it, until you go through it yourself.

With all three of my babies, I experienced a huge hormone-driven rush of emotions and anxiety the first few days at home. With each baby, it was like clockwork—literally, it would happen every day around 5 pm. When it first happened with Tanner it was really scary, and I felt panicked. I attributed it to being nervous about being up at night with him, feeling helpless and alone, even though I was surrounded by my family. Then when it happened with Ripley I spoke to someone about it who explained that the feeling is related to the hormones that make your milk. With all three babies, those feelings ended once my milk came in, and it was over faster with each, and thankfully this time it only lasted a few days. No one warned me about this and the truly felt helpless.

 

AO: With your experience, what knowledge would you share with a new mother?

JK: The biggest thing I have learned about being a mother is to stick with your instincts. Your intuition is spot on, especially after becoming a mom. But at the same time, I had to come to terms with the face that you just can’t control everything. 

 

AO: How has your body amazed you on this journey of pregnancy and/or motherhood?

JK: I am blown away that women’s bodies are able to create, carry, and deliver a beautiful baby. I am so grateful that I was able give birth to three healthy babies. Women can do everything. Making babies and being a mother is one of the greatest things we get to do in our lifetime. As hard as being pregnant can be, emotionally and physically, I absolutely love being pregnant and think it’s such a special time. 

 

AO: Fill in the blank: My current self care must do/have: _______________

JK: I have so many! Micro-current facials with Julie Civiello Polier, acupuncture and acupuncture facials with Sherri Matthews, bodywork with Lauren Roxburgh, and obviously seeing you for physical therapy! 

 

AO: Fill in the blank: Motherhood means: __________________

JK:  Loving someone else unconditionally and putting their needs above all.  


Name: Jenni Kayne

Occupation: Designer, Entrepreneur

Website: www.jennikayne.com

IG: @jennikayne

INSPIRING MOTHER SERIES | IBBY SASSO

This inspiring mom is one that is very near and dear to my heart.  We have known each other as long as I can remember, and our parents even longer.  She is like another sister to me.  We have vacationed together, gone to school together and experienced so much of life together.  You can't not laugh when you're around her.  

Throughout the many ups and downs of life, Ibby has always come out smiling.  And when she began her journey into motherhood and things did not go "as planned" her attitude was no different.  Ibby shares more about her beautiful son Hank as she answers a few questions for us on the blog, but all I can say is that her resilience, strength and positivity are shining brighter than ever before.  She comes to mind for me on a daily basis, her experience and the way she has taken on motherhood inspire me each day.  I know that her words will inspire you as well. 

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AO: What is 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...)

IS: My most reliable resource as a mother is talking to other moms, new or seasoned, who have experienced similar journeys. Motherhood is a unique passage for every woman but with the same rewards. I definitely had a rare entry so finding other mothers out there that can share similar stories of the joys and challenges has given me great comfort that I’m not alone in this sacred journey.

AO: What are you surprised by (that no one ever talks about) that happens
to your mind or body during or after pregnancy?

IS: As we all well know, motherhood is a 24hr job from the get-go and I’m amazed by how quickly my body recovered from the major abdominal surgery that is an emergency C-section! I was walking with minimal pain just a couple days post- delivery and while I wasn’t expecting to deliver via c-section I actually appreciate the sight of my scar as a daily reminder of how amazing we are as humans.  

AO: With your experience, what knowledge would you share with a new mother?

IS:  My experience is definitely special and looking back I’m overwhelmed with emotion just thinking of how life-altering becoming a mother was for me in particular. We had an extremely wild entry into parenthood in that our son Hank was born with a rare genetic disorder called SCID characterized by having no T- cell function or rather a working immune system. Considered a pediatric emergency, we were swept into a world we didn’t know existed which included living in isolation at UCSF for the first 4 months of Hank’s life to protect him from catching even the slightest cold or infection. The treatment is a bone marrow transplant and in modern medicine miracles my husband happened to be a good donor match. Fast forward to Hank today as a happy, healthy 2 year old who gets to make a trip to UCSF each month for his “magic medicine” which is IVIG. This is our new normal and we’re adapting to it with every new day. My advice to any new mother, no matter the outcome, is that you are stronger than you know and
God does not give you anything you can’t handle. We feel so blessed to have come out the other side with a new life perspective, to never take these precious lives for granted and to cherish every single moment with Hank.

AO: How has your body amazed you on this journey of pregnancy and/or motherhood?

IS: I’m definitely not in my best shape but as a mother I have garnered a whole new confidence and appreciation when I look in the mirror....albeit much saggier boobs and terrible posture. And I actually weigh what my driver’s license says I do! 

AO: Fill in the blank: My current self care must do/have: _______________

IS: Oprah’s “Super Soul Sunday” podcast in my ears when I’m cleaning up the kitchen after a long day. Or NYT’s Dear Sugars!

AO: Fill in the blank: Motherhood means: __________________

IS: The most sacred, life- changing experience one can ever imagine! 

INSPIRING MOTHER SERIES | ERIN ERENBERG

Inspiring is only one of the many qualities that this super mama possesses.  I am thrilled to feature such a bright light of love and support on the motherhood scene, Erin Erenberg, for our Inspiring Mother Series.  Mother of three, former attorney and founder of Totum Women, Erin is supporting women with knowledge, community and delicious lactation cookies.

On Wednesday, May 16 please join Erin, myself, clinical psychologist Dr. Michelle Glantz and postpartum doula Stephanie Matthias for a Whole Woman Wellness event for the post partum mother.

Join us for an honest and open discussion on how to stay healthy and whole while welcoming a new life into yours all while meeting expecting and new mamas, munching on food from Thyme Cafe + Market, smoothies from Yumi and more! You'll walk away with a gift bag to assist your ongoing support towards motherhood.  To purchase tickets, click here - we hope to meet you there! 

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AO: What's one thing you wish you had access to before you started a family, be it in doctors, healers, community, pain management etc.

EE: Maybe it's cheating to say a "hub of information," but really that's what I needed.  I felt adrift when searching for information about everything first-time-mom that wasn't based in childcare.  There are so many books on caring for your baby, and between my mom and my pediatrician, I didn't have a lot of blank space where infant health and safety were concerned.  The void that left me with a lot of anxiety was around issues more personal to me as a woman.  Things like: how can I prepare myself for the changes to my relationship with my partner and my friends, how can I find "mom friends" who will understand what I'm going through, how will I tackle the big question of whether/how to go back to work outside the home, and even how on Earth can I find answers to the strange things happening to my body in the first weeks after giving birth. 

AO: What are you surprised that no one ever talks about that happens to your mind or body before pregnancy or after pregnancy.

EE: Let's talk about constipation. It can plague a woman during pregnancy and make that full feeling so much worse.  But in my case, it made me absolutely miserable just after delivery.  I'd had the birth of my dreams, bringing our first into the world without drugs, husband by my side, doctor there to make sure we were safe.  But pushing was really difficult for me and left me with a massive (size of a baseball) bruise just beside my perineum.  I "needed" an episiotomy to ease our son's head into the light of day.  My doctor and every nurse I encountered urged me to take painkillers to stave off any pain related to the repair of my episiotomy.  Little did I know that narcotics would create major constipation for me that no amount of Colase could abate.  

A week into my recovery at home, post hospital, I couldn't move from a supine position without assistance.  I started to feel depressed because I was so confused and couldn't properly care for our baby without a lot of pain.  How could I endure the discomfort of childbirth but feel so much pain while healing?  I found nothing on the topic online, or in any book.  Finally, I asked my mom to look at my vagina.  She saw the bruise.  My husband, a veterinarian, suggested that my constipation was creating pressure on the bruise, and that was the source of my agony.  It was a really sexy moment for us.  To quote him, "if you were a cat, I'd run out and get you an enema."  That he did.  Me-ow.  I did the enema myself and emerged from the bathroom 35 seconds later with a smile on my face, ready to walk miles.  The anaconda I left behind in that bathroom is the stuff of legends. 

Lesson learned, I skipped narcotics after both subsequent births and avoided initial postpartum constipation entirely.  And by sharing my story, a number of friends have avoided this and/or known the quick treatment to abate the agony that constipation can create for a healing pelvis. 

AO: If you knew then what you know now, would you change anything?

EE: Yes, I would have engaged the team of helpers that I finally found when pregnant with number three from the very beginning of my transition into motherhood.  A skilled and loving physical therapist like Allison made all the difference for me in pregnancy number three.  In addition to treating a vulvar varicosity in my third pregnancy (look it up; it's no fun), she introduced me to an acupuncturist, Katya Mosely, who helped me with physical issues from baby-spinning to (see above) constipation and everything in between.  Most importantly, perhaps, Allison and some other health care providers outside of my OB-GYN practice made me feel like the weird things I was encountering were not uncommon but were also things I didn't have to live with forever.  That had a huge positive emotional and psychological impact on me.  

AO: What has been the biggest surprise post pregnancy?

EE: The good: how my love for my children absolutely split my heart wide open each time.  The bad: how a marriage can quickly turn into an employment relationship if unchecked.  The ugly: postpartum constipation and vulvar varicosities.   

AO: How has your body amazed you on this journey?

EE: We women are ALL superheroes for creating, nourishing, birthing and protecting new life.  It's astounding to me how our bodies can open and close to create children.  My stomach went out to the next zip code with each baby, and then naturally and gently returned back home.  My breasts, small and mighty, have provided complete and customized nutrition for three new people.  That's just awesome stuff.   

AO: Fill in the blank: My current self care must do/have: _______________

EE: A daily shower alone.  I don't skip it.