S1:E9 | Pregnancy Care: USA vs Europe with Jenica Domanico

Apr 01, 2022
 

[00:00:47.150] Welcome & Introduction to Jenica Dominico

[00:01:39.180] The healthcare gap for postpartum mothers

[00:02:55.980] Insurance and the first 3 week visit

[00:04:39.420] The role of an occupational therapist with pelvic healthcare

[00:07:00.800] Pelvic care and the vagus nerve

[00:08:11.830] How pelvic floor dysfunction relates to mental health

[00:10:40.620] Defining sensory processing

[00:12:38.970] Perception & childbirth trauma

[00:18:49.030] Transition into motherhood for adoptive parents

[00:21:30.190] How Jenica can help people discover their needs, wants, hopes and goals.

[00:25:28.440] The use of intuitive practice

 

GET IN TOUCH WITH JENICA:

You can in get in touch with Jenica via email: [email protected]  

Or you can go to her website: www.momplusme.com 

 


 

HOW DO YOU GO FROM STAGE FRIGHT TO SPOTLIGHT & BEYOND CHANGING THE WORLD & CREATING A LEGENDARY LEGACY?

How do you fine tune your body to fine tune your voice to convey what you're you might not understand, but your heart does?

 

  • Melanie

    Hello, everybody again. This is Melanie Weller, and I am excited to be here today with Jenica Domonico.  Jenica is an occupational therapist with nearly a decade of experience and training and crisis mental health, trauma informed care, perinatal mood and anxiety, breastfeeding education, and physical and cognitive needs for rehabilitation. She helps moms design and implement a plan for the parenting life journey that supports mom and family. I am very proud to call Janika one of my students.

    That we've studied together and become very good colleagues, and it's always great to collaborate and learn new things.

    So welcome, Jenica.


    Jenica

    Thank you. And thank you for having me here.


    Melanie

    I would love for you first to talk about the healthcare gap for postpartum mothers. And this is certainly something that I think if you're a mother or even if you know a mother that you've experienced, we all see this gap. But I'm really curious to know where you see the gap and where more care is needed.


    Jenica

    Sure. So typical Western medicine, postpartum is a six month appointment, six week appointment after birth. In the last year, I've talked to many moms where that six week appointment is via a Zoom appointment. So if mum has any physical concerns, it's only being addressed very superficially, that can be anything from breastfeeding to pelvic health to mental health. If a mother is seeing a midwife, she might get more postpartum care, though that's not the main way that a lot of women in this country get pregnancy care. But a midwife will do a 24 hours visit another time in the first week and a three week visit. I know that ACOG is recommending a three week visit, but I don't know how well that is being implemented and I haven't heard any mom say that they're having more visits.


    Melanie

    Interesting. That's the American College of Obstetrics and Gynecology.

    Do you know, does insurance typically cover a three week visit? Because that's the other side of this. Even when they make recommendations.


    Jenica

    I don't know the ins and outs of all the insurance. I know that they're making recommendations for Medicare to go from 30 days postpartum to a year postpartum. In Minnesota, we just passed some Minnesota state insurance coverage to go for a full year. So that will change now that there will be more postpartum care, now that there is coverage and somebody's going to pay for it. The three week was more about catching some early postpartum mental health pieces.


    Melanie

    This is such a problem that is very specific to the United States in many ways, because I know that, for example, in France, when you have a baby, you automatically get ten or twelve pelvic floor physical therapy visits as part of your that's just part of the care. All mothers get to relearn how to fire their pelvic floors, how to use it after they've had a baby.  I don't know how many other European countries or other countries do that, but here in the United States, it seems like we're really just sort of thrown to the wolves at some level.


    Jenica

    Well, I think it's underneath the perception that in order to be a tough, independent woman that it's birth is not a big deal, and we just go back to doing whatever we were doing before we had a baby. There's so much that changes spiritually and cognitively and physically that it would be great to honor that in any way. Starting with some public health care visits would be great.


    Melanie

    Absolutely. I know, when I think about occupational therapy, pelvic floor health is not the first thing that comes to mind. Can you talk a little bit about the role of an occupational therapist with pelvic health?


    Jenica

    Well, I would say that most occupational therapy schools when I was going to school didn't cover a lot about pelvic health. However, we do a lot of work with toileting and intimacy, and knowing how the pelvic floor works in movement is really important for making sure that all sides of the core are working together. 

    So all occupational therapists should have a general knowledge of pelvic health, but especially working with pregnant and new moms, understanding how the pelvic floor works in pregnancy and how the load changes during pregnancy and being able to offer clinical advice on ergonomics with an actual knowledge of the public floor. There's an amazing public floor therapist, she's in France,  her therapy is in New York called the 'Functional Pelvis'. Her name is Lindsay Vestel, and she is training other OT's on the ins and outs of pelvic floor anatomy and addressing all of the more delicate concerns with talking about intimacy. Intimacy is something that we talk about in school, about sexuality of people with all sorts of chronic illnesses. So I think expanding into working in pregnancy and postpartum just makes sense.


    Melanie

     I love that as a PT, I find it's so awesome to have OT fill in all of those gaps, because when somebody has an issue sometimes, especially in an insurance based model, you need multiple disciplines to really get a more holistic approach and holistic outcome because of the time constraints.

    I had zero intimacy training in physical therapy school or talking about that kind of stuff that was not part of my education at all.  I really just want to highlight the sensory processing aspect that OTS are so good at addressing. Can you talk a little bit more about that with respect to the pelvic floor and to the vagus nerve? Because I know you do a lot of work with that as well.


    Jenica

    Sure. Well, one thing with pelvic health is really validating and acknowledging the pain that someone might have with their pelvic health and saying, that is something that can be supported and remedied and lessened so that any sensitivity that someone's having in their pelvic area, we can address that with pelvic health exercises with desensitizing and really gentle treatment.  The pelvic floor, for me, and the Vegas nerve, are  twisted together with mental health

    Whenever I start doing an intake on a client and listening to what's going on with them, I can always see how the pelvic floor is involved in that piece. When your pelvic floor isn't strong, then you're not taking great breath. When you're not taking great breaths, you're not getting all of the oxygen intake and carbon dioxide outtake so that your whole system is working optimally. When your core doesn't feel strong, then you don't feel confident and able to do the movements that you need to do every day.


    Melanie

    So I know you know, I love this connection between the body and mental health.  I want to talk a little bit more specifically about how the pelvic floor ties into that. Certainly your pelvic floor and your diaphragm make kind of a container. So if one isn't moving right, the other one is not going to be moving right and you can definitely get altered mechanics in there that affect the breathing and the stability. But what kind of patterns do you see? How does pelvic floor dysfunction show up in mental health? Mostly. Is it anxiety, depression?


    Jenica

    Yeah, a lot of anxiety. Depression, I feel like, is more connected to not having as flexible as a diaphragm, at least when I see it. But definitely anxiety or fears of doing something, fears that something is going to happen and getting closer into that freeze response as well. I have all these rules in my head of how life should be and when we work on the flexibility of the pelvic floor and the flexibility of the diaphragm, I see more flexible thinking.


    Melanie

    I love that.  I completely agree, I see that as well, that a rigid body or a severe lack of flexibility will manifest as a lack of not just physical shock absorption, but emotional shock absorption, spiritual shock absorption or  agility - that ability to change.  If we were going to talk about it kind of an archetypal terms, do you think that not feeling solid in your pelvic floor kind of leaves you not feeling rooted or grounded or feeling kind of like the floor has been pulled out from underneath you when it's not really there to support you.


    Jenica

    A little bit like they're floating and they don't know where the boundaries are. So with the pelvic floor, their floor is not there to support them, but connecting that to sensory processing and also just in general, giving their body more physical boundaries. Usually when we're working with anxiety and sensory stuff, we recommend a lot of weighted not a lot, but some weighted materials maybe to help feel calmer or a lot of more heavy work activities of jumping Jacks, push ups, moving furniture around so that you're getting that joint compression that then sends the message to the brain of where is the boundary of the body and where is the world?


    Melanie

    I just want to back up a second and maybe kind of define sensory processing or sort of what that means, since that's kind of a technical term. And people that are listening might not all have that technical background.


    Jenica

    Sure. So the way I describe sensory processing is our body has all these systems to tell us information of what's coming in site, sound, taste, touch has multiple different receptors.  Then our brain processes that information based on our life experience. If we perceive something as being dangerous, then it's uncomfortable, we want to avoid it. So when I'm looking at how someone processes their sensory information, I might see that they need more information to be able to perceive something. They need a deeper touch to feel that touch. When I'm connecting it to that anxiety and feeling like they need to know where the boundary of their body is, they just need more input for their brain to know, okay, here's where my body is and here's where the world is. Does that make sense?


    Melanie

    Yes, absolutely. Let's talk about perception in terms of childbirth trauma because childbirth can be very traumatic for some women. I'll say specifically after the birth of my second child because my doctor nearly abandoned me and the backup doctor didn't want to take care of me. I had a lot of trauma after that, kind of like and I was angry mostly at myself for not walking out into the parking lot and having the baby there. But I totally recognize that it can really leave you in a very vulnerable position and leave you scarred, not just physically traumatized, but also emotionally traumatized.


    Jenica

    Yeah. One quote that I like and I don't know, I can't remember who said it, but that trauma happens when there's a lack of empathetic presence, when there isn't somebody there witnessing what you're going through and saying, I see this is hard, I see that you are experiencing something that you weren't expecting and being able to be there and listen to you as you're going through it. When something happens that you weren't expecting it and you aren't physically, spiritually able to be flexible to it. I have heard lots of women's birth stories where it sounds like it was very traumatic and they're able to move through it and say that, yes, it was hard, it wasn't what I expected, but I don't feel like I'm injured from it. Other women, they can have a birth experience that seemed fairly calm, very expected and if a provider says something to them that isn't what they're expecting, and they feel that it's judgment or critical or expecting them to do something that they didn't want to do that can feel very traumatic to them. When we experience trauma, then our brain likes to go over that experience over and over again and tell herself the story of what happened, and we can't move through it.

    That's why I love your exercises, because I see clients become flexible so quickly.


    Melanie

    I have a testimonial from you on my website from one of your patients who got more out of the exercises than she did out of years of psychotherapy, which warms my heart so much. I love it when I get enough of those profound responses in my own practice, it's so exciting to see it work for other people as well.

    The other piece of this that we were talking about before we started recording is how your perception drives the trauma, that something that might seem not seem like it should be traumatic, might not be. Something that might seem really little can be very traumatic.  I think this is such an important point to make that trauma is not as much about what happened to you as how you internalize it.


    Jenica

    Yeah. How you are telling the story of what's going on as you go through it. When you're thinking about how the body is perceiving sensations, the body is going to come into a sensory experience with certain preconceived ideas of how each sensation feels to that body. So when we're putting moms who are in a vulnerable state in their pregnancy in a bright, unfamiliar environment, the body is going to be primed to be looking for danger already. So it's going to be more sensitive to how people interact with that body, what they say to the body, what they're asking that body to do.  The brain is already going to be primed to perceive things as a trauma.

    A lot of women can move through that experience and not have any expectation, or maybe they're perceiving it as a trauma, but they're choosing not to acknowledge that perception. That's where a woman may find months later that, oh, there was something in my birth that was really hard for me to move through, and I haven't been able to connect to that piece of that story well.


    Melanie

    I think that women inherently, we tolerate a certain amount of trauma or we tolerate being minimized very often and having our power taken away from us and certainly any hospital situation, but especially childbirth, I think, creates a very significant rub there, because childbirth can be your most primal Mama bear kind of thing. Then to have your power stripped of you in that doesn't sit well in your body or your brain.


    Jenica

    Right. And then you have the providers coming in that are wanting to ensure safety, but then their bodies are primed to be looking for any little thing that might be off. A lot of times women complain that there was unnecessary monitoring or unnecessary interventions because the hospital is worried about their own risk in this birth and not necessarily think about this woman and this child as an entity that is going through an experience. The experience is forgotten is all about the bottom line of keeping things alive without acknowledging the mental piece of it.


    Melanie

    Right. I'm familiar with some research with EMTs, where when they use a very reassuring script with patients, when they're transporting them to the emergency room, that they actually have increased survival rates and reduced levels of complications and better outcomes. So the words that your providers use with you are so, so important. As clinicians, it's always being clinical is our default mode very often versus being human or really addressing what I would call maybe the story aspect of what's happening versus just the mechanics of it.



    Jenica

    Right. Yeah. So having the script of this is what we're going to do. This is what will happen next, making sure that they're hearing you unable to reflect back. Any opportunity for choice is clear with risks and benefits of every choice. It's really abrupt to have somebody come into the room and say, okay, this is what we're doing right now. When parents in hindsight realized that that was a choice moment, but they weren't offered a choice.


    Melanie

    How does this transition into motherhood also affect adoptive mothers in ways that you assist with?


    Jenica

    Yeah. So I haven't directly worked with a client who's adopted, but I had a really close friend who adopted right when I was starting the business, and I didn't want to leave out that population. So if there was an adoptive mother, I would be interested in working with her. Because becoming a mother is not just what happens to your body, and it's also the identity change that happens in our society is once you step into motherhood in the US society, you become fairly invisible. There are a lot of unspoken expectations that women feel like they have to meet. That's where I see a lot of the anxiety piece as well, of being the one that takes on all of the house worrying of how to manage a household and how to keep track of kids medical care and clothing and all their health and parenting and discipline. I'm seeing more couple diets where there's a lot of communication and the male partner is very supportive. But those women have had to do a lot of work in their partnership to make sure the communication is clear and have different expectations than what many of us grew up in.


    Melanie

    Absolutely. I know that many of us did not get modeled a highly cooperative parenting relationship or the roles were very different and clear and split, and there was not a lot of overlap. My parents had very clear and traditional parenting roles. Of course, in my generation, dads were just not as involved as they are now.  It's what I love about my husband, he's just always been all in on the parenting thing, which takes a huge amount of pressure off of me to have somebody who will fill in the mothering gaps that maybe that are more challenging or not as interesting to me. Like, I haven't taken my son's clothes shopping in years. He does that.


    Jenica

    My friends experience that was unique, that I think is unique to adoptive mothers is also negotiating the relationship with the birth mother. If it's an open adoption and breaking down a lot of expectations and barriers and uncomfortable feelings around embracing the birth mother and her family who may want to still be involved in the child's life but can't be that main physical support to that child.


    Melanie

    Yeah. Those relationship dynamics are always a lot of work. So in that way, tell me how you help people then discover their needs, wants, hopes and goals.


    Jenica

    Sure. In occupational therapy, we have an evaluation kind of structure that we can use called the 'Canadian Occupational Profile Measure'. As we're talking to clients, I usually start with asking about a typical day and a typical week. We want to touch on morning routines and bedtime routines and meal routines, community getting out into the community, a really holistic picture. And then I ask them which ones that I hear in their story coming up, like, which ones are the most important? How would they rate them on a scale of one to ten? We ask about, like, how would they rate their performance in those areas and how satisfied are they with that performance? I like that structure to kind of give me an idea of where to start with occupations that they really would like to improve.


    Melanie

     I know one of the challenges that I have with my clients is just getting them to connect with what they want, what they desire in the first place.

    That can be a really obscure, obtuse question for a lot of people. So what are some common desires and goals as you help people connect? What are some of those foundational pieces that they want. And I'm curious if as their body, as they understand the boundaries of their body and they get that relationship with their body, do those desires and goals become clearer and more expansive and more fluid?


    Jenica

    Yes. So I'm going to answer first kind of examples of usually there is some sort of 'I want to do better self care', but they don't really have a clear of like, what that self care looks like. Usually there is I want to move my body more. I want to have better connections in my relationships.  Sometimes I want to eat better or figure out how to prepare meals better or have a better meal plan.

    Then we kind of get into what kind of goals do we want to work around those? Very like a coaching style of what's one thing that we can do this week to work towards that goal. Then I in treatment, am looking at what's going on in their body - you want better self care, what does your self care look like right now? She will say that this part of self care is hard. In the shower, it's not comfortable because of something in my body. So we will do stretches and breathing. Another area would be, I want to get better sleep. So I'm looking at what's going on in their body and how they're using their body in that activity occupation.

    Then I use Vegas nerve decompression stretches and breathing, or I teach them a different way to do that activity. And as we work through it, they feel that the occupation is easier to do. Then we're refining, refining those goals to okay, now I'm taking three showers a week, so now I want to work on putting lotion on my body after showers. And the more they feel comfortable in their body, the more they identify that they want to treat their body better, the more comfortable they feel going out into the community and engaging in the relationships. I see it affects all areas of their life as we do this as a holistic body treatment and goals.



    Melanie

    Awesome. I know you have a strong intuitive practice for what you're doing as well. Can you talk a little bit about that piece of what you do? I know my intuition sometimes takes me down the clinical trail of things, too. You're so good at showing up fully with your people. I want to highlight the magic  for both clinicians and patients when somebody really does that for them.


    Jenica

    Yeah. Before I started working with you, I just thought that was my clinical brain. But I realized that a lot of it was my intuition of being able to really empathically feel what their body was feeling and listen to the pieces of their story that stood out to me. Whenever I highlight those pieces of their story, it's like, 'wow, how did you know that?', and 'that's so interesting'.


    Thank you for touching on that, I want to honor that intuitive piece in my healing  and usually intuitively when I'm going to meet with a client, I'll know what materials I want to bring without having checked in with them or even based on not even basing it on our last session of like, this is what I'm going to need. Or knowing that in the morning I'll wake up and know, well, this client is going to cancel on me. And they do.


    Melanie

    Yeah. Well, I work with so many clinicians, doctors and nurses and other allied health professionals as my patients, and they often will tell me about their intuitive perceptions, but they won't tell anybody else about it. It's such a powerful guidance from a clinical standpoint and that it's not that you throw out your evidence based training, but that it starts to really inform it and guide it and make it better and more powerful. I think no matter what our work is, that when you show up fully with all of yourself, that's really when miracles happen and when you create amazing change for others, that also then heals you.


    Jenica

     I think a piece of that is just being able to practice without fear of feeling like a fraud or feeling like somebody's going to say you're doing it wrong or somebody's going to challenge what you're suggesting and really listening to that, knowing this piece of like, I know this is what they need. And if I need to go back and take the time to clinically give evidence for it, I can. But I don't need to spend that time because I know this is what their body is telling me it needs.



    Melanie

    I love how you talked about how that careful and present listening to your patients informs you so much about what the underlying problems are in a way that you're able to really tune into that. A huge part of intuition and being a good clinician is being a good listener,  that you're also taking that into listening to yourself.

    Jenica, if people want to get a hold of you to work with you because you've been working with people online? I know for the pandemic. Who do you work with?


    Jenica

    Yes, I've been doing telehealth this last year, my license limits made of Minnesota. But I have a coaching program called 'Motherhood Flow' that I just launched that I can offer to people outside of Minnesota, specifically focusing on breath body and energy. If you are in Minnesota, I can work with you through occupational therapy.  I still am billing insurance, for now.


    My email is [email protected]  Or you can go to my website, www.momplusme.com  And there's a link to the motherhood flow coaching on that page as well.


    Melanie

    Fantastic. We'll put all that in the show notes, too. Thank you so much for being here today, Jenica and I will say I can't emphasize enough how brilliant, talented and magical Jenica is, so especially if you are a postpartum mother, whether having physical, emotional, or organizational issues in that transition of life, she is amazingly helpful and I encourage you to reach out to her.


    Jenica

    Thank you so much, Melanie. I really enjoyed the conversation.

 

There's lots more to discuss about pregnancy care!  I'm looking forward to bringing more episodes of Embody Your Star to you.

 

 

See you next time.

www.melanieweller.com

 


 

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