Postpartum: Can we just admit that our vagina’s feel different?
Play • 59 min

“You have to rehab your body to your new self and accept the changes that come with having a baby, but acceptance doesn’t mean you have to settle.” -Dr. Libby Trausch

First, let’s get 2 things straight. 

  1. Vagina is not a dirty word.
  2. Once postpartum, always postpartum. I don’t care if you had your baby 50 years ago or last week.

Let’s just go ahead and get number one out of the way. No vagina is not a dirty word. I know that we were hardly taught anything about our bodies or what happens to them throughout life in school, but I hope that the narrative is changing on this one.

The more we can normalize talking about our bodies and how they feel, the more we can learn about them and heal. 

As for number two, well what happens and how our bodies feel postpartum is only recently being talked about as we start to really connect the dots between things that happened to our bodies during pregnancy and birth with issues that may pop up 2, 10, or 20 years down the road. 


Dr. Libby Trausch is a pelvic physical therapist and co-founder of Breathe Physical Therapy and Wellness in Des Moines, Iowa. 

Libby started down the path of working with women after having two difficult births including a c-section, third degree tear, pelvic organ prolapse, and a diastasis recti (separation of the abdominals). Even as a PT she was not prepared for the challenges that pregnancy and birth would bring to her body as we really get little to no training on pelvic health in physical therapy school. This is post-doc training that we choose to seek out after graduating in most cases. 

Before having her third baby Libby made sure to get her anxiety in check, learned to more effectively breathe, connect with her body, and relax her pelvic floor. She found that this took a lot of mindfulness and retraining her body, but doing these things made her third birth and recovery so much easier!

She was able to actually feel her body push on it’s own, because if we get out of our own way, our body innately knows what to do. 

Through these experiences and working with countless other women, Libby has developed an integrative approach to physical therapy in order to look at the whole person and their past experiences. If you go to see her for a knee or shoulder problem 20 years after giving birth, you are still going to have a conversation about your birth story and pelvic floor because so often these issues can be related to a lack of core strength.

Even after 20 years your body may still be struggling with issues that actually started during pregnancy or delivery. As we approach menopause our estrogen levels begin to drop. The protective qualities it has for our bones and muscles begins to disappear and we are left with new aches, pains, and issues that we didn’t have before- but may have started years ago. 


One of the first and most important things that she teaches her patients is to breathe and reconnect their breath with their body. 

Our diaphragm and pelvic floor actually work closely together to manage the pressure in our abdomen as we breathe. As we inhale the diaphragm contracts and moves down into the abdomen, increasing abdominal pressure while our abdominal, back and pelvic floor muscles relax and stretch out and down. Exhaling then relaxes the diaphragm moving it up, decreasing intra-abdominal pressure, as our pelvic floor contracts pulling up and in. 

This rhythm is inherent when we are born, but as we age it becomes disconnected due to stress, anxiety, injuries, and trying to fit into societal norms like pulling our bellys in all the time and we lose the ability to effectively manage the pressure in our abdomens. 

When an area becomes weak, it will begin to bulge- like a soda can that’s placed in a freezer. Weak abdominal muscles can make you look pregnant or give you the dreaded lower pooch, weakness up high near the diaphragm can cause a hiatal hernia, and weakness in our pelvic floor can allow for our pelvic organs to fall and prolapse.

Sometimes just changing how we cough to shift that incrased pressure can make your leaking 50% better. Do you cough directly into your stomach? Try refocusing that into your back and see if it changes your leakage.


Learning to let go and release the constant states of anxiety and stress that our bodies have become accustomed to will often improve a lot of our physical problems also. 

In so many women, our pelvic floors are actually in a chronic state of contraction as we don’t know how to relax them. So, being told to “just do kegels” all the time will often make our pelvic issues worse and can make birthing a baby much more difficult if we don’t also know how to relax those muscles. 

Pushing the baby out with strong pelvic floor muscles is a myth of the past. These muscles actually need to relax and basically get out of the way while your contracting uterus does the pushing. 

Don’t get me wrong- a strong pelvic floor is necessary for a lot of things! You need these muscles to be strong for supporting a growing baby while pregnant, preventing pelvic organ prolapse, and sexual function, but it’s important to know how to BOTH contract and relax your pelvic floor in order to effectively utilize these muscles. 

It’s a balance to realign your system so it works together. If “just doing your kegels” isn’t helping, then remember- relaxation can be way more important than strengthening when it comes to leaking, pelvic pain, and pain with sex.

The key is finding a plan to get where you want to be with a practitioner who can help guide you along the way. 

Breath Info and Links


Breathe Physical Therapy & Wellness

Elvie Review by Dr. Libby Trausch

Breathe. Women’s Wellness Facebook Group

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