Why You Should Care About Your Fertility Health
by Katie O’Connor, Founder Shine: A Light On Fertility
First I’ll hit ya with some stats
Infertility is far more common than most people think. According to the American Society of Reproductive Medicine, approximately 7.3 million couples in the United States—about 12 percent of the reproductive-age population—experience fertility problems and have difficulty achieving pregnancy.
The truth is that hundreds of variables must coincide precisely for conception to occur and for a woman’s body to successfully maintain a pregnancy for nine months.
There is no “typical” infertile patient.
Second I’ll bust some myths
Infertility Myth: It’s easy for most women to get pregnant. Most women/couples think, we’ll just get off the pill and try for a few months, we will for sure get pregnant.
Fertility Fact: For instance, a healthy 30-year-old woman has about a 20 percent chance of getting pregnant each month; while by age 40, her chances drop to about 5 percent a month. But infertility can affect women of any age, and from any background. It’s recommended to see a specialist after you’ve been trying for a year unsuccessfully and you are under 35 years old, and after 6 months and you are 35 and older.
Infertility Myth: If you’re young and healthy, you don’t need to worry about infertility.
Fertility Fact: Age is only one factor of many when it comes to infertility. While certain unhealthy habits, like smoking, may speed up the effect of age on fertility, living a healthy lifestyle will not stop your biological clock.
It’s true that as you age, your chances of facing infertility increase. But even a couple in their early 20s has a 7% chance of dealing with infertility. Fertility begins to decline in a woman starting at age 27. At age 35, that decline speeds up, and after 40, it declines even more steeply. A healthy lifestyle cannot stop the natural process of aging. Another misconception is that age isn’t such a big deal since we have IVF, but IVF and other fertility treatments cannot reverse the effects of age related infertility.
Other potential causes of infertility include:
- -irregular ovulation or anovulation caused by something other than age (for example, PCOS, premature ovarian failure, or an underlying medical condition.)
- -blocked fallopian tubes
- -irregular uterine shape
- -male infertility, caused by low sperm count, poor sperm motility, or problems with
- sperm shape.
Infertility Myth: Infertility is a “woman’s problem”
Fertility Fact: In actuality 30% of the time it’s the woman, 30% of the time it’s the man, and 40% of the time it’s a combination of both.
Infertility Myth: If you just relax, stop trying, and go on vacation for a while, you’ll get pregnant.
Fertility Fact: Infertility is not a psychological disorder. Infertility is a physical disease, not one that will resolve on its own if you vacation in Hawaii. While stress itself does not cause infertility, infertility causes tremendous stress for a couple. Research has shown that women going through infertility experience many of the same emotions and mental stress as those with cancer, HIV, and chronic pain.
Infertility Myth: STDs affect my health, but they don’t affect trying to have a baby.
Fertility Fact: For both men and women, sexually transmitted diseases can affect the ability to have children. STDs can cause scarring and blockage of the male reproductive structures. If STDs go untreated in women, they can lead to an episode of pelvic inflammatory disease, which is a leading cause of infertility.
Finally I’ll give you my two cents
I got married to my high school sweetheart at 24. We were worried more about getting pregnant when we weren’t ready, then worried about fertility health when the day came when we wanted a family. We were like any other 20-something couple! Living life, working hard, and going out with our friends, we were care free! Come our late 20’s, our friends starting having kids, and we even had a few friends having to deal with infertility issues. That definitely woke me up to the thought that, “getting pregnant might not be easy for us.” But it didn’t speed up the timeline I had in my mind of starting a family.
Come 30, I finally got off the pill and we started trying, and much to our surprise, my period never came. I went in for a check-up with my OBGYN and she said to keep trying and see her again in 3 months if nothing happened. Months passed and still no period. I went in for my follow-up with my OBGYN, they performed some tests, and I got on clomid to try and jump start my period. Still nothing. More testing, more meds, and I had exhausted the help my OBGYN could provide.
Fast forward 6 months and we were sitting in the office of our RE (reproductive endocrinologist) having our first introduction to what infertility is all about. Long story short, I learned I have PCOS (polycystic ovarian syndrome), and it took a full year of meds and poking and prodding to get my period to come. We went through 3 IUI’s (intrauterine insemination) and then moved onto IVF with ICSI (in-vitro fertilization where the sperm is directly injected into the egg for fertilization) where we were finally successful, and welcomed out baby girl into the world February 2011.
What I hope women and couples reading this take away is we need to start taking control of our health, and asking questions when it comes to our fertility health. It shouldn’t take going through infertility to learn about a condition you have that affects your overall health as a woman (such as PCOS, endometriosis, and fibroids to name a few). We need to end the stigma of talking about our cycles and our fertility health.
An excerpt from Fertility Fog, by Amy Klein for Aeon.com:
‘I think as a society no one tells women what fertility is,’ said the reproductive endocrinologist Janelle Luk, medical director of Neway Fertility in New York City. When it comes to women’s health, she said: ‘There’s a cultural barrier.’ Even a menstrual period is only discussed in terms of inconvenience, cramps and pain. ‘When you’re 15 or 17, you’re not planning to have a family, and you only learn about preventing pregnancy,’ she added.
‘Women don’t know there’s a limit: the message is equal, equal, equal. But our biological clock is not.’
‘Nobody wants to be told they’re infertile. Women are shocked when nature applies to them,’ she says. She wishes women were more informed. She recommends a woman start by talking to her mother.
So You Know.
It was a long year. It was a long year of ovulation calculating, ovulation sticks, 10 day windows, dutifully trying every other day in those ten day widows, vitamins and more. It was a long year.
It was a long year that began almost a year prior with leaving my beloved birth control pill behind thinking that without it, we would easily and quickly be on our way to starting a family. Well, we were on our way…sort of, but it certainly wasn’t quick and it certainly wasn’t easy. And so started a long year ahead of all the aforementioned jumps and hoops we try before we decide to know.
First, however, I flashback to a very ironic and distinct memory of walking through the huge entryway of our condo building joking with my now husband, then fiancé, that we were certainly living in the right place with a fertility clinic down our back steps. I think we laughed a little, but something inside of my head knew even then that there was a reason for that comment. But, you go on with the day to day…have your fabulous wedding, travel abroad, sleep in late, drink too much good wine and spend too much on decadent dinners in this beautiful city and push the looming thought aside. Until you have another pivotal moment of your husband saying it was time to go to the fertility clinic for a simple screening. It was time to know.
To be perfectly honest, I was way less nervous to know than I was to be poked or prodded by anyone. As a psych major, I was and still am totally convinced that the repressed memory of a terrifying blood draw experience at the age of 4 left me scarred for life and unable to face the needle. It is true…I had gone almost 30 years without anyone touching the bend in my arm and I was scared beyond belief at the idea of walking the proverbial fertility journey plank. But we needed to know. We needed to know that the long year of fruitless efforts to get pregnant was not just a bad batch of ovulation sticks. To be honest, even with my fear and anxiety growing, I was exhausted and I was ready to know.
And then one day you know. One day you get the call that tells you that barring a miracle, you will not be able to conceive without help. On one hand, the news is a relief. It takes the heavy burden of trying so hard to conceive on your own, it gives answers to questions, it makes you feel less responsible. And to be honest, there is truly something to that. But, of course, on the other hand it is scary, it is uncertain and it isn’t what you planned. But then again, how much in life really is as we plan it to be?
So now that you know, what do you do? In our case, we wait. We try to beat the odds with another long year of trying, mixed in with wine and travel and lazy weekends, and then it just happened. No, not a miracle baby, but a feeling that we were ready. We were ready to take our fertility journey head on and so it began.
I won’t bore you with all the details, but I can tell you that it is everything you imagined it to be and nothing you imagined it to be. I can tell you that you will find out what you are really made of and what your relationship is really made of. You will find that your deepest fears can be conquered more easily and with more grace than you would ever imagine. I can tell you that you will cry and you will get mad, but you will laugh and you will strive to find normalcy each day even when nothing about the process feels normal. I can also tell you that you will find amazing women along the way, just like you, if you allow yourself to open up.
I can also tell you that no one will be able to predict the end of your story, no matter how good you are to your body or to yourself. But you need to know. You need to know the answers to the big black hole of questions. You need to know that you have another way. You need to know that it is possible. You need to know that you can and will be a parent and if you have a really great doctor they will make sure you know that you will have a family is some way, shape or form one day. No matter what. Even if not by their hand. But you need to know. It’s that simple.
And now, after almost three long years, I am proud and I am grateful. I am proud of myself for facing my fears. I am proud that my husband and I somehow found a way to see past the negative and looked toward a bright future regardless of how things ended in a fertility lab. I am proud that I reached out to others on such a delicate and personal matter to make sure I knew I was not alone. And I am proud to share my story hoping others will find something in it to hold onto and to find it is possible to move forward with less fear and more hope.
And I am grateful. I am grateful for what I learned on a sunny April day two years ago, no matter how hard it was to hear those initial results. I am grateful for what I learned along the way about myself, about my relationship with my husband and about science and technology! I am grateful for the many friends I confided in that picked me up on a hard day or guided me along the winding and sometimes bumpy road. And I am most grateful for the road that led me and my husband to the here and now, to the place where we find ourselves expecting our first baby at Thanksgiving. Any due date would have sufficed, but I think there is something to be said for this one in particular.
So, while there are so many things to share once you have been thorough it, the best advice I can give for those of you standing at a crossroad is ‘to know’. Know your circumstances, know your bodies, make the best decisions you can and be ready. Just because you know doesn’t mean you have to dive in head first. It just means you can arm yourself with the best information, find positive energy and strength within you and around you and move forward on the timeline that is right for you.
And more than anything, it means you are one step closer to a dream realized.
THINKING OF FREEZING YOUR EGGS??
Since Facebook announced that it was going to include egg freezing in the medical benefits provided to its employees, the press around the procedure has steadily increased. It may even be something you’re considering yourself. When my husband and I split up in my early thirties, I immediately started researching egg freezing. I had so many questions and fears about my fertility. After months of deliberation I decided to take the plunge and by the time I turned 36, I had completed three rounds of egg freezing. While I still don’t know what my future holds in terms of building a family, it’s the best decision I ever made. Here are some things to consider as you reflect on egg freezing:
- Not only will you hopefully walk away with some frozen eggs, but you’ll learn so much about your own reproductive health that would have probably remained unknown. I discovered that I have polycystic ovarian syndrome but because I had always been on birth control I never really understood how irregular my menstrual cycles were.
- If you’re single, your outlook and attitude will shift. For me, it was very empowering to take proactive steps towards preserving my fertility. The weight of my biological clock sitting on my shoulders was lifted and I was able to go on dates and focus more on whether this person was right for me, as opposed to thinking solely about how ready he was to have kids.
- It will probably clarify exactly how important having a family is for you and what your life goals are. Was having kids something you simply assumed you would do because everyone else around you is having kids? Or have you really thought through all of the ways in which your life will change? Is now the right time? Taking the time to reflect on my goals in life and how family building fits in, and then putting time and money aside to freeze my eggs, forced me to really dig deep and engage in some much needed introspection.
- There’s no guarantee that freezing your eggs will lead to a baby but it does offer an insurance plan. Similar to trying to conceive naturally, there are no guarantees that you will become pregnant. Some things in life are simply beyond our control. Are your chances of getting pregnant better when you’re younger? Yes. Are the success rates with frozen eggs better with younger eggs? Yes. But do you have control over when things such as a divorce, break-up or job loss occur? No. Egg freezing has helped me find a balance between accepting the inevitable curve balls that life has tossed my way and doing something proactive and positive to keep me moving forward.
It’s my guess that within one or two generations, egg freezing will become very common. As the technology continues to improve, more and more women will be able to take control over their family-building goals and make smart and unhurried decisions. Having more information and more options was very empowering for me and my hope is that more and more women will have similar experiences!
Understanding Your Fertility Health: What You Need to Know Before Trying for a Baby
When you are ready for a family, will you be able to get pregnant? If you haven’t completed your family yet, this question should be on your radar.
When we’re young, we are counseled on how to avoid pregnancy. Many of us spend years on birth control pills, using condoms, or both trying to avoid conception until we are good and ready. Some of us are busy with school or other pursuits that put off motherhood. In my own case, I spent years in school, first at undergrad, then medical school, then residency. Then there is that fact that we need to find a partner.
For some, those years spent putting off having a child can lead to struggles conceiving later. Approximately 85% of people have no trouble getting pregnant after a short period of time. In fact, approximately 50% percent will be pregnant after 3 months, and 75% of couples will be pregnant after 6 months.
But what if you are in that remaining 15%? One in eight couples struggles with infertility.
Are you in that 15%? Are you that 1 in 8? I am.
I am not trying to scare anyone, but I see women everyday who regret not having a family earlier. Others regret not freezing eggs in their younger days, and regret thinking they had more time. How much time you have is really out of your hands, and nobody can truly predict or guarantee that.
The ingredients for a baby: You need three ingredients to have a baby – an egg, sperm, and a uterus. Now, these three things do not need to come from you or your partner, but it’s a lot easier when it does.
Getting a check-up: A “fertility check-up” is something that I highly recommend even if you are not ready to get pregnant, not ready to start, not ready to have another, just not ready. It is important to evaluate these three things — uterus, sperm and eggs — and to understand your fertility potential.
At my practice, Fertility Centers of Illinois, we offer a Fertility Awareness Check-Up. This offers couples and individuals a semen analysis (are there sperm?), an ultrasound (is there a healthy uterus?), and some basic blood work including a follicle stimulating hormone level and estradiol (are there eggs?). These tests, blood work, an ultrasound, and a semen analysis are offered for $90, and that fee can be applied towards treatment if patients need to pursue anything.
This very basic work-up begins to answer those three questions. If you are ready now, a fertility check-up can help identify any problems that need to be addressed now. If you aren’t ready, maybe you want to freeze some eggs, so that when you are ready, it won’t be too late.
As a therapist specializing in women’s issues, I have regularly witnessed the struggles that many women and girls have with weight. After all, rare is the woman who has not felt the effects of our society’s obsession with thinness, on the one hand; and with food, on the other. I dare you to watch a television show that targets females or read a women’s magazine without finding ads for rich foods and recipes, interspersed with messages that we can, and should, achieve physical perfection – whose cornerstone is a standard of thinness most of us cannot attain.
For many, those mixed messages create contradictory attitudes and behaviors about body size and diet. We are tempted to eat, eat, eat; while we obsess about being thinner, thinner, thinner. As a result, some of us battle being overweight or underweight while others become caught in a vicious cycle of losing weight and gaining it back. Those fights are painful. They affect our body image and self esteem. And, as many women who decide to get pregnant find out – sometimes too late – they affect our fertility.
Body fat plays a critical role in human reproduction and either too much or too little of it can lead to infertility. According to the American Society of Reproductive Medicine (ASRM), the recommended Body Mass Index (BMI) range for women who are trying to conceive is between 18.5 and 25. A BMI over 25 is considered “overweight” and anything beyond 30 is considered “obese”. On the other end of the spectrum, a BMI under 18.5 is considered “underweight”.
Women who are overweight or obese have less chance of getting pregnant overall. One reason is an imbalance of the hormone estrogen, which is produced by fat cells. Women with more fat cells tend to have higher levels of estrogen. Higher levels of estrogen can prevent normal ovulation, in essence acting as a form of birth control which prevents conception. Even overweight women with regular cycles and otherwise no obvious fertility problems may have a hard time getting pregnant, taking longer (frequently more than a year) to conceive, compared to women of healthy weight.
Being underweight also can reduce a woman’s fertility. It too, can result in insufficient production of key hormones, leading to anovulation (a lack of ovulation), irregular ovulation, and irregular menstrual cycles. So even a young woman with plenty of healthy eggs may not be able to get pregnant if she is too thin. And for women going through infertility treatment, being too skinny may actually be worse than being too fat. A recent study found that underweight women going through in-vitro fertilization (IVF) were less likely to become pregnant than those who were overweight – including those classified as dangerously obese.
The good news is that, for many people, adjusting their weight toward the “healthy” BMI range often restores normal hormonal balance. More than 70% of women who are infertile as the result of being over- or under-weight will conceive without medical intervention if they gain or lose weight, as appropriate.
So what can you do? Whether you are trying to get pregnant right now or you are looking at building your family in the more distant future, it is helpful for you to establish a healthy weight before subjecting yourself to expensive, time consuming infertility treatments. Consider working with a therapist who specializes in fertility, eating issues, or both to create a healthy relationship with food and your body. If you use food and exercise in a way that may affect your fertility, a therapist can help you stabilize your behavior and your body in order to optimize your fertility health and put you on the path toward an easy and healthy pregnancy. Good luck!
To learn more about fertility health, join me on August 20 for “Sip, Shop, & Shine” – a night of pampering, shopping, and honest conversation about fertility and women’s health!
5 Steps to finding Empowerment on Your Fertility Journey
by Sara Connell, LSC, CPC
In my practice as a life coach and therapist, I often coach women and couples who are going through fertility. A client told me recently “I picked you to work with because I don’t have to explain anything: you know what Lupron shots are what transfer day means. You know what how many good embryos we got represents”. I do know. I sometimes feel like going through fertility was akin to having been in a war. When we meet someone who has also been in “the field”, we have a common language. This is someone else who knows the eviscerating pain of loss, the jealousy and sadness at hearing yet another pregnancy announcement, the sometimes inability to show up at a social even crawling with children that seem as if they all popped out effortlessly from people “who weren’t even trying” (If I hear one more person tell me they’re pregnancy was a “surprise!!” . . . I thought once).
My journey to having a child took 7 years. Seven years, eight IVF cycles, 2 years preceding that of acupuncture, yoga, herbs, visualization (if an exorcism would have helped I would have done it). Most women I know who’ve experienced fertility challenges say the same.
So how, in the midst of a process steeped with uncertainty, the highest stakes imaginable, tension, pressure, anxiety, stress, loss, trauma and fear- a process that can pound our self esteem like waves on a rock, can we find a sense of tranquility, equanimity (the balancing of our emotions) and even empowerment?
It can be tough to find strategies that work. I’ve included here my top list-the things that consistently helped me and I’ve seen work for my clients again and again. You can try out any that sound appealing, or do a mixture of them all. At the end, I’ve included some links with more resources if you’d like to read further. While none of these can magically rush or eliminate the challenge of the process (I wish!), I’ve found both personally and professionally that they can go a long way to bring comfort, empowerment and the most successful outcomes as we go forth to the fulfillment of having a family.
- Honor Yourself - In Hamlet, Shakespeare said: to thy self be true. You are already going through a lot. Fertility is not necessarily a time to push yourself socially with family and friends. See if you can journal what you really feel up and what might be really being self-loving to give yourself a pass. You may want to take a Facebook break, send a card but not force yourself to attend a baby shower or other social function. If you give yourself a break, you are not rejecting the person/people. You are taking much-needed radical good care of you. In that space, see if you can replace that time/event with something really affirming, loving and empowering for you right now. Do you have another hobby or interest that inspires you and fills you up? Could you get a bodywork treatment, take a trip that’s just for you or you and a partner or really supportive friend. Doing things that celebrated where I was- as an individual- at the time I was doing IVF helped me to have a broader focus and feel good about all the aspects of me as a person. On days when I felt down regardless, I tried out a long walk, extra time in the steam room at the gym (that I liked going to), reading at the bookstore and looking at art. Your thing might be more physical- might like mountain climbing, sports, physical activities or travel, or doing service work, or going to see really supportive friends– whatever you feel some passion for- if you can identify something- build time for that in- treat yourself well, good foods, massages, flowers, a funny show or movie you like.
- Affirm Yourself & Your Vision! - Create a power statement for yourself of your vision. A fertility doctor I met started every consultation by reminding his clients that there IS a way for them to have a family. During the 7 years of fertility treatments, I desperately wanted someone to tell me it WAS going to happen. You can do this. Write it out. Affirm your statement many times a day as you need: Examples There is a way for us to have a family. This is going to happen! You deserve and are supported in having a family.
- Find Great Support – this may be the #1 factor in feeling good/better about ourselves and our path. Researcher Brene Brown shared a study that proved the most important factor in healing is to hear and experience: “you are not alone”. Connecting with a group or individuals with similar experiences, especially when facilitated with a positive intention, can radically alter and uplift our self-esteem, hope and positive experience. Experts can provide useful tools for coping with trauma, loss and fear as well. I like tapping (Emotional Freedom Technique), Power Posing and guided relaxation for free, simple and effective ways to shift our energy, mood, spirit.
- Laughter! – it can be hard to find lightness while we’re working through challenges. Do you have a favorite comedian, show, silly movie, you tube clip? Ask friends and colleagues who have a similar sense of humor to send you funny links. Studies show even when we fake laughter, that within seconds our brain start to join in the energy of humor and joy. There is a biochemical change in our bodies just from “pretending” to laugh or smiling. This is a fake it until you make it approach- even 1 minute a day of real or simulated laughter can release anxiety, depression and stress.
- Inspiration! – hearing/reading/listening to people who have gone through challenges- fertility or otherwise- can uplift our spirit to continue and have faith that our vision will come. I read about Nelson Mandela, Sandra Day O’Connor at the start of her career, Maya Angelou- phenomenal individuals who demonstrate the power of the human spirit to transcend challenges and prevail. We can find interviews, books, articles and even sometimes here people speak live. You Tube, TED talks-even documentaries and films give us thousands of hours and pages of inspiration.
Sara Connell is an Author, Life Coach, Speaker. She has appeared on Oprah, Good Morning America, NPR and The View. Her memoir Bringing In Finn; An Extraordinary Surrogacy story about her 7-year journey to having her son and her mother that served as her surrogate is out now. www.saraconnell.com
Additional Resources & Links:
Laughter Yoga: http://www.laughteryoga.org/english
Emotional Freedom Technique http://eft.mercola.com
Brene Brown http://brenebrown.com
TED Talks https://www.ted.com
About Mercier Therapy
You’ve probably heard of complementary and alternative approaches to helping aid in infertility. Yoga and acupuncture chief among the most popular. If you’ve tried either of these modalities than you’ve probably realized at least one thing and that is that they promote relaxation.
In my practice I’ve noticed that most women that I care for are in a state of anxiety. Relaxation is crucial and if acupuncture or Yoga are the entry into meditative deeper breathing so than so-be-it. We, as Americans, tend to be higher strung when dealing with infertility and will do whatever means necessary to become pregnant. I was one of those women but knew that getting pregnant was going to be a slow process due to my diagnosis of stage 4 endometriosis.
At age 35 and never having been pregnant I had done multiple rounds of acupuncture, meditation classes, yoga for fertility, choke down numerous supplements, eat a clean diet and get plenty of gentle exercise. All of which helped me relax and feel a part of helping myself to become pregnant and deliver a healthy baby.
Mercier Therapy is a deep pelvic organ visceral manipulative technique in which the reproductive organs are mobilized and blood flow restored. Organ restrictions are relieved and movement replenished amongst the organs and surrounding structures to enhance their natural and most optimal function. Many women that I see have undergone some type of pelvic surgery or procedure that can be responsible for creating adhesive-like scar tissue. The example that I use to explain why organ mobility and blood flow are crucial for best functionality is to think about a shoulder injury and what would happen if that shoulder is not being properly rehabilitated? The injured shoulder joint and musculature would become very stiff, blood flow would eventually be restricted and pain may become the new normal. This same thing can happen anywhere in the body but now infertility arises for many reasons but could we simply apply some maneuvers to relieve the immobility? Does reproductive organ immobility contribute to infertility? I believe that is does and just to prove my theory I ask that you think about the shoulder scenario and apply that to your heart, lungs, stomach, liver ect. Can you optimally function with a semi-permanent restriction? All of our organs move against each other flawlessly upon inhalation. A restriction in that movement could cause damage elsewhere and a cascade of effects may occur.
Knowing that my past had included 3 laparoscopies I knew that there had to be a great deal of scar tissue in my pelvis. So moving forward I was told by my RE that I needed IVF and in my heart I felt otherwise. He told me that my organs were in poor condition and that we’d have a 19% of conceiving on our own. We felt most comfortable with trying Follistim and IUI in which we did 3 cycles and I did not get pregnant. I took my chances and after a group of my professional Mercier Therapy students worked on me we conceived without drugs or IUI the very next cycle. I did go on to miscarry that pregnancy and the second one too. The fact was that I was getting pregnant and this was a very good sign. My third pregnancy was the charm! I delivered a healthy baby girl in October 2011.
I fully believe that if I hadn’t had some of my own medicine than we wouldn’t have our beautiful daughter today.
Mercier Therapy protocol is a six hour regime broken up into one hour weekly sessions in which we work via the abdomen to accomplish our goal of releasing organ restriction. The fertility program can be used at a stand alone regime or to help prepare a women for assisted reproductive cycles. No one would run a race without the proper training and therefore should not go into IUU/IVF cycles without preparation to optimize the very first cycle.
Mercier Therapy has been validated by evidence based research and that was an ongoing study from 2009 to 2011. Our study was published in the Spring 2013 Midwifery Today journal and internationally with the World Congress of Low Back and Pelvic Pain.