Back Health During Pregnancy & Postpartum with Dr. Betsy Grunch

In this episode, Jacqueline is joined by Dr. Betsy Grunch, a board-certified neurosurgeon, and the famous ‘Lady Spine Doc’ on social media. Together, Jacqueline shares about her recent spinal surgery and Dr. Grunch gives some helpful and informative facts about the pelvic floor and the spine during pregnancy, delivery, and postpartum.

Dr. Betsy Grunch attended the University of Georgia and completed her Bachelor of Science in Biology. She then went on to the Medical College of Georgia and following that matched in Neurological Surgery at Duke University Medical Center. At Duke, she earned the synthesis spine fellowship from 2010 to 2011. And in 2013, Dr. Grunch returned to her hometown of Gainesville to join the Long Street Clinic where she still works.

In this episode, you’ll hear:

• Why educating yourself before delivery and throughout pregnancy are essential
• About pelvic floor during pregnancy and labor
• How to breastfeed and babywear safely

A glance at this episode:

• [3:56] About Dr. Betsy Grunch and how she got into the line of work she’s in
• [8:20] The impact of patient education
• [13:07] Weight gain during pregnancy and it’s relation to back pain
• [18:41] Pelvic flooring and pelvic pain
• [23:31] Tips on how to navigate the hospital
• [29:50] The fear of epidurals
• [37:36] How to nurse while seated and not hurt your back
• [40:42] Dr. Betsy Grunch’s opinion on babywearing as a spine surgeon
• [48:19] Dr. Betsy Grunch gives her best tips for moms

Related Links:

• Dr. Betsy Grunch’s Instagram
• Holistic Lactation Website
• Discount on Products Use Code ‘PODCAST15’
• Follow on Instagram
• Book an Appointment
• 🍼 If you are truly struggling with breastmilk production, check out our

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Transcript

Jacqueline Kincer  0:38  

Today, I am excited to bring you an incredible interview that I hope is really informative and about kind of some different topics than we normally cover on the show. But I feel super blessed and grateful that she agreed to come on and share her expertise with us. Because Dr. Betsy Grunch is who we're going to be talking to. And if you don't know her, she is lady spine doc on Tiktok and Instagram, and YouTube and she is a board-certified neurosurgeon from Gainesville, Georgia. I found her while just scrolling one evening Instagram myself. And she's really a really I gosh and inspirational person, quite honestly. So go check out just even a few of her posts and you'll see what I mean. 

But just a little bit more about Dr. Grunch. Before I introduce you to her, she attended the University of Georgia where she completed her Bachelor of Science degree in biology. She then went on to the Medical College of Georgia and following that matched in Neurological Surgery at Duke University Medical Center. At Duke she earned the synthes spine fellowship from 2010 to 2011. And in 2013, Dr. Grunch returned to her hometown of Gainesville to join the Long Street Clinic where she still works today. We have her websites and more information linked up in our show notes of course, and Dr. Grunch’s main professional interests are minimally invasive spine techniques and advancing the field of neuro trauma. She lives with her husband raise two children Riley and Beatrice, who she'll be telling you more about and her two dogs pancake and butters in Gainesville, Georgia. Dr. Grunch’s professional affiliations include the American College of Surgeons, the Association of Women surgeons, the American Association of Neurological Surgeons, and the Congress of Neurological Surgeons. So she's a wonderful expert, and I will introduce you to her now. 

Welcome back to the Breastfeeding Talk Podcast. I'm your host, Jacqueline Kincer. And today I'm joined by a special guest that I have the honor of interviewing and bringing to you today. Her name is Dr. Betsy Grunch. And she's a board-certified neurosurgeon. She's also known as Lady spine doc, where she creates kind con, where she creates content covering her life as a neurosurgeon, wife, and mom. In fact, the reason why she's here today is because I was scrolling Instagram one evening, and like the algorithm likes to do it showed me stuff about spines and surgery. And I recently had spine surgery. So I saw her profile, I checked it out, I started watching a bunch of her videos, and I was like, Wow, I love her message because she's a woman in medicine. And,then she's talking about spine stuff. And she had this one particular video that was about an annular tear in an intervertebral disc, which is what I had essentially but but a different degree. And then that video actually led into talking about pregnancy and postpartum. And I was like, I have to have her on the podcast. So thank you so much for being here. I'm super excited for you to give us a different perspective on things ofjust the perinatal timeframe and all of that. 

Dr. Betsy Grunch  3:56  

Thanks for having me. 

Jacqueline Kincer  3:57  

I'm happy to I'm happy to be here. Oh, yeah. No, it's exciting. So yeah, tell us a little bit about yourself. Because,I feel like you are doing some amazing work out in the world. And then with your content that you're putting out. Your message is just so so clear and inspiring for me as someone in in healthcare, obviously not at your level. But yeah, tell us a little bit about how you got started with even just the social media, but your a little bit about your career and your family. 

Dr. Betsy Grunch  4:26  

Sure. So I am a board certified neurosurgeon. I specialize in spine surgery, and I have been in practice in my hometown and Georgia for about 10 years. So I was born raised in Georgia. Kind of got into medicine, just I'll try to abbreviate my story very short. But my mom was involved in a car accident when I was younger, and was paralyzed and so I was very motivated by her injury and really became interested in medicine and particularly spine spinal cord injury and wanted to understand why an injury like hers could be so devastating. And ultimately I wanted to really take care of, of people in her situation because I thought that I could have something to share. And so I graduated college medical school, matched in a residency at Duke and completed my residency in 2013. And then came back to serve the community where I grew up. And so yeah, I've been here for for 10 years and have been a treat a wide range of patients or anything neurosurgical. So that means brain spine, nerve related. And I, I love what I do, I became a mom about two years into practice. So 2015, my son was born. And my daughter was born in 2018. So I have two kids married and, and two dogs, of course. And so I I really just love my job. I love taking care of patients, I really enjoy patient education. Andto answer your question about the social media is I really enjoy teaching I love I've always enjoyed social media period, but really didn't know how to kind of navigate that as a professional. And when COVID happened,a lot of folks were turning to social media for information and guidance. And so I kind of started utilizing at that time to just kind of I was had some extra time on my hands because we weren't operating during periods of the pandemic. And it just started to pick up speed there. And I just have them have grown tremendously from there actually hit 1 million followers on Tiktok today, crazy, but congrats. 

Jacqueline Kincer  6:58  

I saw you are close earlier today.

Dr. Betsy Grunch  7:01  

Today, super excited. But yeah, somy my message is just about the trifold message, what you kind of read is,  about medicine and spine surgery in my field, about being a mom and then just kind of a humorous side where I like to kind of share,express myself on my platform. And so I've learned as a as a mom and more relevant to your viewers in your podcast, that back injuries are very common in the in the perinatal window. And personally myself, I shared in that video that you mentioned, that story was about me. So I my son was Gosh about I think it was four weeks postpartum. I had a C section my first pregnancy was cleaning out I'll never forget I was Ben and I were in his bassinet to clean out he paid and it went everywhere because he's a little boy and that's a little boys. Yeah, no, leaning over the bassinet bending it was like a pack and playing why I had that. I don't know, because we'll talk about ergonomics, but it was not a good ergonomic setup. vintera were to clean it up and then pop my back went out. And andI learned personally a lot about back injuries during that time. I never needed surgery like you did, but But yeah, it was very enlightening. So so so yeah, we can jump into that a little bit. But oh, yeah, gosh, no, I yeah, I think,just a lot of us that end up in some form of health care have gotten there, because there's a personal journey attached to it. Like you said, with your mom. You know, I did not even know lactation consultant was a profession until I had a baby. 

Jacqueline Kincer  8:49  

So here I am. Right. And yeah, and to your point, too, you mentioned something I just wanted to capture this really quick because you talked about patient education. And that's one of the reasons why you've become a tick tock doc, but also your website I've saved was super impressed by I don't know if I told you that in the email. But I have been around the block a few times these last three years and figuring out,solutions to my issues, right? Yeah, lack of information, not only on somebody's website, but even like a handout, you might get a discussion you might have an appointment about even just like the surgery that I had, for instance,the patient education for me came from the nurses in the hospital where I was like, Oh, that's a very different expectation than what my surgeon sent set for me. Your website has some amazing information about procedures on it that I thought was so helpful. You probably are like, this is really basic. No, it's much more than most surgeons give. So I just wanted to say that that patient education been so important for me on the patient side of things, and I love that you're doing that through social media, but even on your website,I just was really, really impressed. And it's, it's very lacking. So shout out to you. But yeah, like you said,I was like, Wait, if I had read her sites, before I had my surgery, I would have been a lot better prepared. But it's, it's kind of the same thing with with pregnancy and birth, right? Like, we're, we're having moms take birth classes, and they're learning,maybe labor stages of labor, pain management techniques,coping skills, how their partner can support them,what to expect all of those things, but we're not really prepping their bodies for that experience in terms of those ergonomics, or,what you should and should not be doing. And I find,some people don't seem to have a lot of questions, but a lot do, right. And so, oftentimes, these questions fall on someone like me, where, when they're seeing the pediatrician with their baby, that they had three days ago, it's about the baby, right? Andthat mom is not seeing her prenatal care provider or postpartum care provider for six weeks. And so they're like, hey,I have this,never had a C section before. Buthere's what's going on. I'm like, No, that's really not my area of expertise. I mean, I could tell you what I've learned by virtue of the work I do, butthis is good question for your doctor. Well, I'm not seeing my doctor for six weeks. Yeah, I know. But you should probably still call them. Right. So to your point, like you did not know certain things about ergonomics,you're just trying to take care of your little baby. And you have this back issue. And yeah, back pain, back issues are so common during this timeframe. And we're just not we're not setting up moms, new moms for success with that. So yeah, I I'd love for you to just tell us a little bit more about that, because are a lot more. Because I feel like until it happens to you, it's not something you think about like I can't say that I was,really thinking about the right ways to bend, lift and twist until I needed to that makes sense. And I think that's true for a lot of people. 

Jacqueline Kincer  12:11  

Yeah, I agree. And to your point about prepping the moms, it's so important. I mean, I'm a physician. I'm do like I do brain surgery, literally. And I got this child, my first baby, I came up with this baby, and I'm like, I don't know what to do with this thing. I don't know how to feed it. I don't know how to do this for myself. Like, isn't there a manual and I felt so empty, like I didn't know what to do and unprepared and like tearful and like just freaking out. And I couldn't believe that I would like to have this responsibility without any preparation. And so I think that I think that everything that you do, and people like you do, is so important to prepare everybody that's willing to listen to some advice. So, so yeah, so we can talk a little bit about,why women tend to have problems with their back. And I think it really starts just withbeing pregnant period, of course, we develop a lot of weight gain very rapidly during pregnancy. Not only that, of course, there's a actual human being inside of your abdomen that as are as technically inside of your uterus that's growing. And,we're forced to have this kind of weird growth. And as the baby grows, it stretches our abdominal muscles, our rectus muscles, which are the main supportive part to our core. And those just get completely stretched out. So the biggest part of back stability in our spine, and I tell patients this every day, like if you think of your lumbar spine, your lower back, it's literally the only bones that connect your upper body to your lower body, where your ribs and, and your hips begin there is nothing in between. And so it's up your spine. And so the things that support your spine are very important. The muscles,your back muscles and your core muscles. So essentially, during pregnancy, all the anterior core muscles get completely stretched out. So you lose a lot of support. On addition to that, you gain a lot of weight and in a baby weight and waterways and etc. And thenstart to have laxity in your pelvis, not a lot of support there and the ligaments can stretch so,you're just kind of I think it really pregnancy in general just really sets up women to have a lot of back pain and I don't know many women that don't go through pregnancy without some form of of lower back pain. So I think it's an In order to kind of,prepare yourself, even during pregnancy to focus on ways of realizing that you're not able to do certain, or you shouldn't do certain things with your back to put yourself at jeopardy of injury. So basically,I think that working ontry not to lift too much heavy things were babies getting born and we want to like build all these things, we want to like prepare, we want to like wash clothes, we want to do all these things that is going to stress your back more. And so I think all those things are very important to keep in mind. Then,as we get towards the birth, we, a lot ofwomen will have a vaginal birth, which can disrupt our pelvic floor, stretch our pelvic floor, some women have C sections, and a C section is even more on jeopardising I guess to your spine, because you're actually cutting the muscles of your abdominal wall, stretching the rectus to get to the uterus to deliver the baby and then recovering from a surgery. So. So even if it is a vaginal delivery, or if it is a C section, the pure delivery process is something that will put your spine at risk. And then then you get into the immediate postpartum window so that first six weeks after delivery, whether it be like I said vaginal or C section, we're doing a lot of things that we never did before we're, we're bending over and changing a baby's diaper nonstop, like 10,15 times a day, leaning over picking the baby up, changing the bassinet leaning over and looking at the baby holding the baby in the front, trying to breastfeed trying to clean ourselves from all the  stuff, unfortunately, for delivery. And you're stressed out you're not sleeping, anda motional and you're gonna think forget about things that you should do because you're exhausted and on the brink of probably mental breakdown having a mint TV.

Jacqueline Kincer  17:23  

I mean, pretty much. Yeah, like that is really how it works.

Dr. Betsy Grunch  17:28  

It's just it continues to spiral more and more out of control the further out from you. Yeah, but

Jacqueline Kincer  17:38  

oh, my gosh, yeah. No, I It's a lot. You know, it's it's really a lot. And I see. You know, I see a lot of,moms, I mean, really, God bless you, if you have this kind of mentality, right? Like of just,I had a baby, and I feel great. And I can do all the things. Well, yeah, but like, let's not push it. Because,you may feel great, and that's awesome. Or maybe you're still like riding the birth high,but that doesn't mean that you need to go like hike a whole mountain right away. Or,because like you said, there's a lot of big changes that have happened in like a really small period of time. And I think one of the things you talked about in your video, what was about the hormones, right? So like you were saying those ligaments and things stretch. Maybe you could tell us a little bit more about that. Because I think that's a really important consideration because like you said, no matter what type of birth you had,there's there's always kind of some some common denominators at play. 

Dr. Betsy Grunch  18:41  

Yeah. Yeah. So during the delivery process, of course, our pelvis is structured the way it is you have your, your pelvis that's connected by your pubic symphysis, which is a cartilage right in the front of your pelvis above your,above your vagina, and then your as SI joints, excuse me, as sacroiliac joints are connected to your sacrum into your tailbone, and those are ligaments, his joints too. So essentially, your pelvis is structured as a rain, but that separated by three different joints to SI joints and one one pubic symphysis joint that are designed by nature to stretch open to allow the woman's pelvis to open up for delivery. And those hormones that are secreted during that process are going to happen regardless of what type of delivery you have. And so that asthe pregnancy gets further along those ligaments become more lacs and you've got pelvic symphysis type pain, SI joint pain and those kinds of sciatica from like the baby or things pressing on your lumbar plexus, which are those nerves deep in your pelvis. So a lot of women deal with sciatica from just compression and Um, and so those, those are the things that I was talking about in the video. Me myself, I suffered with my second pregnancy, my daughter with a lot of SI joint pain to the point where like, I operate as a surgeon. So I have like foot pedals that I use. So one foot pedal I used for the drill, and the other one I'll use for like a cautery device. But I got to where like, I couldn't even stand on one foot to push the drill pedal because the pure putting my way onto one side of my pelvis was excruciating. So I actually had to stop operating about two weeks before delivery, because it was I couldn't do it was so painful. Wow. Yeah. Oh, my goodness. 

Jacqueline Kincer  20:40  

Yeah, that's, that's a lot for sure. Right. So. So you, you have this issue where you had a young baby, you bent over to pick them up? And you threw your back out? I guess, right, for lack of a better word, right? What was you thankfully had more knowledge than most of us. So what was what was that like? Like? I mean, what did you do in that situation? Or like,kind of what's ideal? If somebody has that happened to them? Where they're like, oof, Yeah, something's not right. They're, like,do they run to the chiropractor? Do they run to you, there's probably in between, like, because I think that's,again, a new issue, right? If you've never dealt with this before, you don't really know where to go. So yeah.

Dr. Betsy Grunch  21:29  

So I think the biggest thing would be talking about prevention. So,not trying to do a lot as we're in that post,pre partum, peripartum, postpartum window, not trying to do a lot of like real, a lot of bending. Because, I mean, you want to, we always teach, lift with your legs, not with your back. And that's true, like during this fall. And we should really take that to mind in journal as well as a good spine Health Initiative. Butreally trying to keep your spine straight. Anytime you do anything. Because your spine is straight, you're bearing your loads of gravity on your spine equally. But if you're doing a lot of bending, you force all the weight on the front of your spine. And so that back part of your spine, where your disk and Terrace is so much more vulnerable. So So yeah, and so I think a lot of people when they feel a twinge, or their back feels, I think a lot of patients describe it as feeling weak, or they feel something in their back, that's a warning sign that something's not right. It's not normal to feel like something weak and a focal spot and your back or feel like something's going to give or feel like you need to pop it, that should be a warning sign that okay, I need to take it easy, I need to be cautious about doing anything. Because if you if you continue to do that, like continue to bend with that warning, sign it, while you're probably feeling some,it may is a different number of possibilities. It could be but it could be a disk that's about to tear because you'll start to feel the annulus stretching, and that's a very innervated part of our body of our spine, the disc. And so that pop that a lot of people feel or that feels like a bat gives out is sometimes a tear and the dislike what I like what I described, which a lot of of people have, it's wear a ring, normally coats or this, our structure, hard part of our desk kind of gives out or ruptures. And in that that's what happens. So the answer to your questions, okay, that happens now what the best thing to do in that situation, assuming that you don't have anything else alarming, like no weakness in the legs, no bowel, bladder incontinence, not being able to feel a certain part of your body, those should be warning signs to go immediately to your doctor or to the emergency room. But assuming it's just back pain, or maybe a little bit of leg pain, or maybe a little bit of numbness, like in one leg or something like that, we typically recommend conservative treatment. So just,taking some over the counter, ibuprofen, some ice some rest, for sure. No BLTs, which you mentioned earlier that B LTs are bending, lifting, twisting, which is a spine patient, you probably have learned that but on the back end.

Jacqueline Kincer  24:19  

Every time that nurse came in every four hours at a minimum case. So no BLT is for a little for a while. They're like ideally forever, but like yeah, for a while. 

Dr. Betsy Grunch  24:33  

Right. I so. Yeah. So wewe try to take it easy and usually, I mean, almost 80% of those types of injuries just self resolve. The only real knees I mean, I'm I'm not an opponent to chiropractic management. I think they do good things, but I think most people just kind of self resolve on their own by a little bit a week or two or even a day or two of rest. But real realizing that that event is something that doesn't mean okay, my back gave out yesterday, it's feeling great. I'm gonna go lift a 50 pound bag of whatever tomorrow like No, like your back still has to, to heal. So kind of being letting letting your letting your body do its healing work for a few weeks is probably a good idea. Right? 

Jacqueline Kincer  25:19  

Yeah, I would say that's, that's a really good idea. And,gosh, I try to remind people to that,when you have a baby, you've got this little newborn, and you've just brought them home, like, there's no time in your life. That is going to be like, there's just no other time in your life where people are going to be as willing to help you as they are in that moment. Like they, they want to buy you stuff they want to come over. I mean, yeah, it's about the baby. Mostly right? But like, let them help you out. Take that chance to rest. Like, because if you want to ask for that same amount of support and care and taking it easy for months later is not as easy to get you feel a little weird about it. Like, milk it right now is what I usually tell people because, yeah,the I wouldn't say take it easy. I mean,I think there's also,this, women have become more aware that this is an issue, right? Of having the diastasis of the muscles and that that can happen. Like you're saying, I never thought of it that way that like what you just it's so obvious, but there's no other bones between your ribs and your hips. You've just got this lumbar spine, that's it, and then muscles. So if you've got muscle separation going on in this extremely important part of your core, what's happening to the dynamics of everything else, something else I assume, has to take up slack.

Dr. Betsy Grunch  26:53  

And it's gonna be your spine. Yep, exactly. The spine. Yeah. So I think a lot of people I mean,when you said out loud, and you kind of reasoned through, you're like, Well, that makes total sense. But,so almost no one thinks of that. And even myself as a spine surgeon, until,till I went through all this, I didn't really know when they were told me that. And so it's something that I've kind of been very big on educating patients, because I don't think that a lot of people even think of that. And even you mentioned the diastasis issue. I mean, that's an issue that really can linger. And a lot of women are forever. I mean, you if you've got a you have twins or you have a large baby,the diastasis may not correct itself. And I think that I've seen, I have a plastic surgeon friend. It's amazing how many patients women get,the mommy makeover, and they get their diastasis corrected, and wake up and like, they don't have any more back pain after their diastasis is correct, because it really does strengthen your core. So I hate to keep using myself as an example. But I have learned a lot from my own body. But I did I mean, I had a mommy makeover when my daughter was one because I knew I wasn't gonna have any more kids. And I had the back pain since the injury with my son. So since 2015, I've had back pain wasn't anything I couldn't live with, but it was always there. And the moment that I woke up, I had a two inch diastasis that was repaired during my mommy makeover. And the moment I woke up from surgery, I never had another pain like I had, it was wild. I'm like this is I mean, wow, I couldn't even believe it. And it was all I'mhas to be because of diastasis probably a little bit extra skin. But I really do think a lot of it was a diastasis. And, and I've spoken to many of my patients that have been through that. And my colleague that does a lot of abdominal plasti and diastasis corrections that I think that really holds true. Obviously, it's not gonna be a cure for everybody's back pain. But if your back pain is a result of a weak core, either working on really aggressively trying to help your diastasis with physical therapy and core strengthening is super important. I'm not suggesting everybody get a tummy tuck. But I do think if you're contemplating that that might be one of the pros. 

Jacqueline Kincer  29:10  

Yeah, no, I mean,whether you want to do it for aesthetic purposes, oryou really just have this issue that is going to be helped by surgery. I have a family member, she's got two kids, she she probably I guess was sometime last year she had that done. I mean, she had like five pounds of loose skin removed. They did a I guess what you'd call an extended tummy tuck. It was so extensive, and she got that diastasis repaired and she is at the gym with a personal trainer. Finally, like that's what she wanted to do, and she hasn't been able to do it. So like to your point. I never asked her if she has had back pain before. But thatI will get to ask her now, but it's a huge limiting factor,so oh my gosh, wow. Well, I love to switch gears for a minute. Um, it because,we're talking about spine stuff andwhether it'ssomething you go into the birth planning to have or you decide last minute, give me the drugs. Lots of women are getting epidurals, I was I was one of those with my first like, I, I was planning all natural. And those contractions were come in hot and heavy for a really long time. And I remember,we get through triage, I'm in the room, I'm like, so like you've called the anesthesiologist, right? Like they're on their way. They're like, Yeah, but Oh, honey, do you have to give you an IV for like, 30 minutes before? What? No, we don't have 30 minutes. Oh, get into drugs. Butthere's I remember that in my birth class. There's a lot of fear about birth interventions. Right, and, and epidurals, in particular, and I'm not saying there's,not potential issues or side effects, or what have you. But I think there's this big, big conception about,back pain, and that that's lingering because you got an epidural, or it can,cause back pain. And you're obviously the expert in this. So I would just really love for you to speak to that. Because,I don't I don't think it's fair. I mean, for someone who's been in chronic pain, I get it like, you do not have to be tough, right? Like, do not put yourself through pain, that's not a good experience for your baby yourself, your body, like, I fully support anyone's choice in that. So I don't want anybody to have unnecessary fear over those types of things. 

Dr. Betsy Grunch  31:32  

Right? Yeah, so I hear it all the time. And in women that see me for their back pain, and I cannot tell you how many times I've heard, well, I've had back pain ever since I had that epidural. And I think, I think that is so such a huge misconception that, that an epidural, can cause chronic back pain. And so we talked about, like, let's first talk about, like, what an epidural injection, or what an epidural catheter is. It's Think of it like an IV for your spine, so for your nerves, so when you have an IV, you stick a needle into your vein, and you thread a tubing into your vein. And that tubing is hooked up to,fluids or medications, and it's injected directly into your veins. And then when that proceed when your IV is ready to be removed, you pull it out, and then  that vein sews, it heals the hole itself, and your body heals that andyou don't ever think of chronic pain related to an IV site unless something really traumatic happened. Butyou never think twice about that. And so an epidural is very similar. You have a access point to your spine, anesthesiologist place a needle into your spinal canal, which is where your spinal fluid is, the three it thread a catheter into that space, and that catheter is used to deliver medicines. And then once the medicines are done, the catheter is removed, that whole your body seals up the hole. And there is no physiologic way that that,pending a complication that that can cause chronic pain, of course, are exceptions. And I'm not saying that's 100%. But I do think that the reason why a lot of people kind of associated with that is because a lot of people pass on that misnomer and hear somebody else say it and they're like, Well, my back has heard ever since I had the baby, it was the epidural. No, it's for all the reasons that we just talked about. It's the ergonomics is the lack of core strength and maybe injure your back. And you probably have some diastasis there for your back probably hurts. A lot of women, unfortunately,body changes after we have a baby. And they end up gaining weight, maybe keeping on a little extra baby weight. And so the recollection of the whole pregnancy journey may be not remembering so much about the back pain because the pregnancy was so overwhelmingly on the mind. But then once the baby's out of the pregnancy is done, dang, my back does hurt. So everything is related timely back to the birth. And the only thing that people remember of the birth that was associated with their back is that andit doesn't make any sense. I mean,I mean, it's no human nature to point to say, okay, that intervention causes pain, but they're just no physiologic way that it really causes chronic pain. And so I think those are a good way of explaining it, but 

Jacqueline Kincer  34:39  

Oh, no, that's that's a really good way of explaining it. Andfor for those who don't know, the anatomy that well, like you're talking about,where that epidural catheter is in that not in the same area where you're going to find the vertebrae in the disc, right? 

Dr. Betsy Grunch  34:58  

Correct. Yeah, right. So the the nerves travel in the center of our spine. And our spines role. The reason why we have a spine is a bony structure that forms a circle. And inside of that circle is where our nerves travel. So the spine is just the support to our nerves. And so the injury, the catheter is placed into the space and the nerves are nowhere near the desk, it's threaded between the bone and you don't really go into bone. And so it can causea catheter that's placed it is floating right beside the nerves. So some women do tend to have,sciatica pain from the epidural office threaten beside a nerve and kind of irritates a nerve, or they may only get really fun, one side and not the other, because maybe the catheter is off to one side, and so on. And so there are little variances with the way that the catheter can be placed. But you're right, there's no way that you can really place it into where the discs are causing injury to the disk from the actual catheter. So go for sure. And I'm not a spine surgeon, but I did have a disco gram done prior to my surgery, which is,they injected some medicine and some fluid into the actual disc itself.

Jacqueline Kincer  36:21  

You could argue about whether or not you want to do a control disc with that, or whatever. But we did a control disc and later imaging,that that hole healed up, it's not like it's leaking now because we poked it right. So,just to reassure people, even if it did get poked, it's probably not going to be hopefully a big issue. Our bodies are really good at healing itself. So that's good. Yeah, it is. We've talked about ergonomics, a lot, too. So,we talked about BLTs. But like, you're talking about the pack and play, andI had to pack and play with my first two, Why is that bad? Other than my kid would never sleep at it. Yeah, those ergonomics of things,cribs, oh, my goodness,I know, you can,oftentimes,kind of slide that,panel down, right, and maybe you don't have to kind of crane crane your body over so much. But anybody with a sleeping baby knows that you want to make as little movement and noise as possible. So you're probably not going to shimmy that thing back up and risk waking your baby up. So like, what do we do? How do we take care of these babies? You know, how do we how do we sit nurse? How do we sit and pump? How do we,  go about this life and protect our backs? 

Dr. Betsy Grunch  37:36  

That is a great question. So I think there's so many new innovative things that we have, in this day and age that even that I didn't have,eight years ago when I had my first and I think it's important to utilize anything that you can to help so those little, those little nursing pillows, a little U shaped things are fantastic. It keeps the baby's weight off of your arms, it helps support the baby and keeps them more ata level of high or it's good for your spine. I think that those are really good things in terms of, of nursing andtry not to we've been focusing a lot on the back but even the neck like craning over the baby turning your head always looking to one side, alternating is good to to kind of switch up the variety between how your neck moves and and in focuses. And then bassinets are huge. So you mentioned you had to pack and play I had to pack and play. I mean, I had a four week old baby, it's not like I need to dip him into a three foot drop off down into the floor to lay him down to sleep when a bassinet is just fine because they're not even rolling. And so bassinet,  it's it's, you can pull it up to a height where you're not bending and stooping. Or even the cribs where the mattress lifts up really high where you're not having to drop the side rail like you're mentioning, but keeping the baby higher, safely, of course, at a level to where you are doing things better for your back where you're not doing a lot of bending. And that even goes with changing tables. A lot of the changing tables are lower than they should be I was changing my son on a pack and play bassinet thing which is way lower than what a higher tanning table is. So it's ideal to try to change a baby at the level where you're not having to bend over so  changing the baby and the floor is not a great for your back either because you're leaning over. So an ergonomic changing table you can get one at Walmart for  under 100 bucks can really save yourself a lot. So I think of just few conceptually think about the layout of how things are gonna work in the first few months after delivery, and setting up your living space, because essentially that I feel like that's all I did for like the first six weeks is sleep, fee, change food and eat. So just think of your, your living area and how you can make them more safe for you. And for the baby. Is is really important for your back. So

Jacqueline Kincer  40:24  

I love that. Yeah. And you said something about,kind of talking about different products and whatnot. It made me think of baby wearing, what are your thoughts on baby wearing as a spine surgeon? Um, I mean, I love baby wearing, I think that

Dr. Betsy Grunch  40:45  

I think that as an in that phase, it's so important for the,for mom and baby to baby be close. And I think that it's helpful. It is a lot of weight on the spine, butand that phase are under 20 pounds. So it's not the end of the world. And we can probably delve a little bit onto when they get a little older. And some suggestions I have, like, from six months and on because I have a few for that. Butbabywearing, I think I think is is reasonably safe, but wearing the baby 24/7 may not be the best for the back. So just keeping those things in mind. Whenever you're in that phase, particularly if you're having a lot of back issues, baby baby wearing. Less is better for you.

Jacqueline Kincer  41:36  

Yes, I I would agree. You know, I think you always have to take your individual circumstances into account, right? It seems like because the baby is held so close to you, though it's not. It's not the same as lifting something heavy, far away from your body. Right? So probably better. 

Dr. Betsy Grunch  41:55  

Yeah. And it's I mean, I'd rather have someone hold or wear the baby and let the baby sleep there then repetitively bend over and a bassinet to check them or something like that. Because that type of maneuver is way more risky to the spine. So, huh, yes.

Jacqueline Kincer  42:13  

Yeah. And, gosh,I think to what you're saying, it's all connected. And,there's there's the back and the core, which is not just your abs. And then you've got this whole,pelvic region and pelvic floor health has,gotten more awareness, which is wonderful. I just had Dr. Tara Sullivan on the podcast, she's a pelvic PT. She teaches at a local hospital here. She's wonderful. So I know, that's part of the core support to how do you see that working together with,the back and the spine? And overall, just,in terms of birth and pregnancy and postpartum? Because I know, that's, that's something that almost seems to get a little more attention than the back, which,I understand why we isolate things,to one specific area, right, you've got,hand surgeons out there and,all sorts of things. Right. But like, it's not all,it's not always that compartmentalized, I guess. Correct? 

Jacqueline Kincer  43:20  

Yeah, I think I mean, pelvic floor is obviously extremely important and is a big focus on postpartum care. Because, I mean, we think of birthing a baby, it comes out of our pelvis and, and there's so many muscles and support to our pelvic floor, there's over 40 muscles down there. And so I think the pure carrying the baby delivering the baby, and then the weakness that can ensue as a result of birth trauma or delivery, or,bladder issues related to pelvic floor weakness are so prominent, you're going to talk to urologist, they're going to talk about pregnancy and how it's related to pelvic floor weakness, you can talk to a spine surgeon, I'm going to tell you about the back but I think that pelvic floor is a huge component component to your spine help too. Because of if you have a weak pelvic support girdle, your pelvis really helps support your spine to so many of those muscles are really interconnected to to your lower lumbar area to your SI joints and SI joint pain sacral iliac. When I say yes, I mean sacroiliac joint is a huge component of back pain in women in their 20s and 30s. And a lot of it has to do with pelvic floor with issues weakness, etc. Or a little bit of instability that may be kind of sets in as a result of laxity that we talked about with the ligaments or, or just some ongoing ergonomic issues that don't get resolved and those ligaments don't really tighten up how they should. And I think thatwhen you do have pelvic floor strengthening it's going to help all of that as well, which may help with chronic back pain. 

Jacqueline Kincer  45:02  

So, Hmm, wow, that yeah, what you're just connecting all of the dots because there's so much sense. It's like, obvious when you say is it connected? Yeah. Thank you. Thank you for not speaking doctor to us. Because I think it's,sometimes that we just need things just really spelled out in everyday language. And you're like, oh, yeah, okay, now I get it,it's difficult to interpret all this stuff otherwise for the Layperson. So, yeah, and, and I think, like, what you're saying,there's, there's some things that are going to maybe come up anyway. And maybe it's age, maybe it's because that's when you're out of childbearing age. And I'm curious about that, because we've talked about, like, the annular tears in the desk, and,there's degenerative disc disease, which is really kind of a normal aging process, like, women these days are having babies at older ages than they used to,more are having them in their 30s, even later, 30s Is that a time when we're probably already expecting to see some of those degenerative changes in someone's spine? And it's coinciding, like,like it, would it be different,if, if you're 22, and having a baby versus 37, I guess, is what I'm trying to ask, because maybe there's something that's pre you're predisposed,by virtue of age or something. 

Dr. Betsy Grunch  46:33  

Right? Yeah, I think that everybody's spine ages differently. And a lot of it has to do with genetics, it has to do with what you do in your life,your job, if you're doing a lot of lifting, or if you sit a lot, or if you're someone that's very athletic, and strengthen the record every day, all those people's spines are going to look totally different. Some people have a significantly predisposed family history of having back problems, and they're more likely to have back problems as they get older. But I think the issue is not necessarily that women in their 30s, late 30s, are more likely to have at baseline disc issues. I don't think that's necessarily the case, obviously, most women in their 22 years of age, are not going to have any disk issues. But I think the longer you live, the more injuries that you may sustained to your back. And so any little,injury that you have to your back, may predispose you to another injury. So if you take a woman that's 20, versus a woman that's 35, they've lived 15 more years of their life, and have most likely done something to predispose them to injury. Sowe all try to be healthy and work out and lift weights and do all these things, and,lifting weights and properly can definitely cause an injury to your desk. So I think that a lot of a women in that,late 20s, a drink trying to get,trying to get bad trying to get healthy again, and, and do things that maybe subject them to injury, and then they get pregnant, and then maybe are a little bit more predisposed to re injuring themselves.

Jacqueline Kincer  48:16  

That, yeah, that makes sense. And I guess on that note, too, I've been asked this question a few times, and I'm really not the expert at all. But,for me, I'm still in my 30s Hanging in there. I'm done having kids, though, so I'm not worried about it. But I know other people in my position that have gone,the route of an artificial disc replacement or a fusion, but even lesser things,some some sort of laparoscopic, minimally invasive,lumbar decompression or something. For women, especially they these have this question that they feel like they're not getting answered by their surgeons, which is, if I have this spine procedure now, and I assume it,varies by person and what you've had done, and then the severity and all of that, like, what, what do I need to be aware of, if I get pregnant and have children or I want to have children? Like, I think they're worried about,messing up their back again, right? They've, they've done something to fix the issue. And now they're like, Oh, can I locate if I get pregnant? Okay, if I go through the process of childbirth, or like, am I going to cause problems? Andthere's no crystal ball, but I'd love your perspective on that. 

Dr. Betsy Grunch  49:29  

Yeah. So what agree with you that it really depends on the nature of what's going on, but for the most part, even a back surgery really wouldn't predispose you to changing your birth plans at all. I think that,lumbar disc replacement, for example, still preserves the mobility of the desk and,that shouldn't really affect it a diskectomy. Same thing. I mean, you wouldn't want to have a microdiscectomy and thenget immediately pregnant because you just you gotta bolt vulnerable. This thing So I do have patients that all recommend that,maybe they are trying to get pregnant like, okay, let's maybe if you could try to wait at least a year and let your back heal before you subject it to more strain that really maybe you need at this point in your recovery. And the really the only thing I think is super, even patients who have had scoliosis surgery as kids, we've seen there's just one like, cute little girl on Tiktok that I've been following this going through her scoliosis journey. I don't know if you've seen that on my page all the time. Like these, these these teenaged correct scoliosis crash and they can still have kids and not have to worry about anything, it's really the SI joint fusions is what I worry about. So anybody that's had their SI joint use their pelvis may not open up just as much as, as someone that doesn't have it use the SI joint. And so that's usually just tell them to talk to their gynecologist or I'm sorry, an obstetrician about what may be right for them in terms of their whether or not vaginal delivery may be appropriate, but for the most part, think it's fine. Oh, that's so reassuring, for sure. I'm gonna have to share that with some of my spine surgery Support Group presents.

Jacqueline Kincer  51:14  

Be like, Hey, listen, fast forward to this timestamp. Because,just right, it's easy, right? It's easy to worry about these things,lots of questions come up and what have you and,you, I love that you have a personal perspective. And that you're, you're bringing your story into this because I think it matters and you obviously,love what you do, like you said and have this,compassion for your patients. And, and,I think that really shines through and just obviously the content that you create. So I'd love to hear if there's,one piece of advice that you would give a mom who's either pregnant orhas a young baby. You know, anything in particular doesn't even have to be spine related, but some wisdom or solid advice you'd love to share with them?

Dr. Betsy Grunch  52:06  

Yeah, I think just understanding that nothing is perfect. And that,that is definitely, in my experience, and almost every single mom that I know, the most vulnerable part of your life, no matter where you are in your life, what you do for your career, that little life that you have given birth to, is so important to you. Andyou don't want to mess it up. And so I think we just tend to really be so hard on ourselves with everything we're trying to be perfect. Why for perfect partner, perfect,mom, a perfect doing our job the best. And like we get pulled in all these directions. And I think the biggest point of advice I would say is just really try to try to look and see what's best for you and outside of the baby and outside of everything else is going on that if you don't give love to yourself, you're not going to be able to give love to anybody else any much more. So you have to have a full cup before you can dispense it. Because if it's empty, there's nothing left to get. So that would be my one biggest probably piece of advice. 

Jacqueline Kincer  53:21  

Oh, I think that's such good advice for anybody. And you've, you're clearly walking your talk. So thank you for everything that you've shared with us today. I think this is so informative, and hopefully reassuring for folks listening out there. So thank you, Betsy. Thanks for having me, I hope but I hope I hope I've shared some wisdom with at least one person that will gain some knowledge from this. So thanks. Yes, andhead over to tick tock be her millions and one follower. I'm sure you've wrapped up even more while we're sitting here. But now she's got some awesome content over there. And it's it's not all boring, sciency stuff, so check it out.