Author: Dr. Heather Kim
Mindful Breathing and the Pelvic Floor
It begins with the breath…
Healing the pelvic floor and breath awareness are intimately related. All mindfulness practices begin with the simple return to conscious breath awareness for a VERY good reason. Breathing is one of the most affordable healing modalities that we have available and it is always there waiting for us when we need it. No appointment necessary! Until this year, I had NEVER been taught how my pelvic floor could move in relation to my breath. I understood my respiratory diaphragm and its movement beautifully in relation to inhale and exhale but I never knew how each breath I took could contribute to a healthy relaxed and responsive pelvic floor.
I have practiced yoga since 1998 and taught since 2003 and I have never witnessed the natural movement of a relaxed pelvic floor taught. In fact, through yoga I had learned how to squeeze, lifting my already too tight pelvic floor into mula bandha choking off unruly sexual energy? If I had a penny for every cultural lie I’ve been sold… Thanks to trauma, autoimmune disease (IC pelvic pain) and a fine type A personality, I had cultivated one of the tightest pelvic floors in the world and squeezing my pelvic floor each yoga practice only worsened my pelvic floor discomfort. I further exacerbated this issue for years in Pilates. I studied with a highly regarded/expensive teacher and developed beautiful core strength and NEVER ONCE did she talk to me about the relaxation of my pelvic floor and how it could contribute to my overall core power. Nope it was zip UP the lines of the leg and an ENGAGE the pelvic floor constantly for an hour of practice. One crazy ass type A leading another will only lead to more tension. I am here to save you all from a world of mess. This is simply, wrong, horrible bad uninformed teaching. If you are seeking help for your pelvic floor it is CRUCIAL to find a practitioner that understands the importance of pelvic floor relaxation and responsiveness.
Understanding the theory of sliding filaments of muscle contraction may help the analytical mind understand what I’m getting at here…the ability to relax is also our ability to fire up the muscles of the pelvic floor!
If you have a muscle in a constant state of contraction (i.e. a hyper contracted pelvic floor) there is no further path to shorten the muscle filaments and no further power available to squeeze! Another great example for my kinesthetic learners is flex your bicep, (make like your showing your guns) and just hold that flexed state for awhile and watch what happens to your power. In that flexed state you are eating up the energy needed to contract the muscle AND your ability to move anything, your moving power becomes relatively limited in that continued contracted state. And lets say you stood there showing your guns for a decade? maybe two decades? Guess what would happen to your ability to lengthen those same bicep muscles back out? The same is true for your pelvic floor basket. If we walk around with our pelvic floor constantly contracted, we lose power for when that big sneeze or cough comes to call.
So easy enough right? Just relax your pelvic floor and the let the breath massage your pelvic organs and everything will be unicorns and rainbows and the best orgasms of your life! If you haven’t been promised these things then you haven’t been advertised to like I have. Here’s the hard and ugly truth, it can take years. YEARS to soften a pelvic floor. Who wants to hear this? How many of us want a quick fix, to be done with pain, suffering immediately? I did. Now though, by route of real and lasting healing, I’ve learned what the road to healthy looks like. Healing looks like a lot of slow steady changes and occasionally beautiful leaps forward and then some back pedaling. Pelvic floor relaxation is my ongoing daily investigation. I cannot force my pelvic floor to relax. Nor can you. I can however create a mindfully lived experience in which my body feels safe enough to consider a completely different way of being. I promise that even the tiniest shifts in the pelvic floor can have incredible effects on our day to day lived experience of being in our bodies. I am not out of the woods yet myself. I write and teach from the woods!
So what I’m going to describe today is a sip from my own practice this morning! We are journeying together. Teaching pelvic floor healing has made me 90% more accountable to my own healing. So I thank you for your interest in this journey! Lets begin with a simple exploration in the yin posture Anahatasana. This posture was designed as a heart/chest opener and it is an excellent pelvic floor stretch and places your body in an a perfect position to sense the breath moving through the pelvic floor. For the purpose of pelvic floor exploration you can put a bolster under your chest or cross you arms into a basket to support your head. Most important for our exploration is that the hips are above the knees. Make sure the area under the knees is very well padded with a blanket. To find this position without the help of a mirror, you can rock your rear back to a child’s pose type position and then raise the hips slowly back up above the knees. As you do this keep your breath and attention on the pelvic floor. Like the animation above as I breathe in I look for a feeling of my pelvic floor filling. As I exhale I look for a feeling of my pelvic floor emptying. This exploration is best experienced for 2-3 minutes. Set an Insight Timer and wiggle as your body needs to and keep returning to sensation in the pelvic floor. Rest anytime you need to. As you transition to your day and begin to move and walk, occasionally drop back to that awareness and see if you can sense your pelvic floor respond to your breath!
As a trauma-informed teacher, I want to provide additional awareness on what can possibly arise in this position. For many women this position can feel extremely vulnerable. If you notice this and need to come down out of the posture into child’s pose, please do. Any gained awareness can become an incredible key stone to our healing. Please know that forcing the body into any position it doesn’t want to be in will result in tension rather than relaxation.
Quality of Movement
Recently my personal healing journey returned me to the study of the Feldenkrais Awareness Through Movement practice. This gentle practice frequently asks the student this beautiful question, “What is my felt sense of the quality of this movement?” The clear purpose of the Feldenkrais method is a more relaxed and a more connected neuro-somatic system. When we are able to explore ourselves and the quality of our movement in this way we begin to deepen our intuitive sense of the quality of not only somatic movement, but also our lived experiences.
This morning’s walk offered me a potent insight into real life application of the Feldenrkrais quality exploration. I am a daily list maker because like many women, I wake up in the morning with ~400 tasks available to me. In years past, I would spend my days fruitlessly attempting to do all the things. I spent most days resentful and exhausted and frankly, I was miserable to be around. Over the years, I have deconstructed some of the cultural and personal stories that landed me in that awful wrung out way of being. With my Clarity of Boundaries, I can now compassionately limit myself daily to what my body/emotional reserve tanks are capable on any given day. And, this morning another piece of the puzzle landed. I was walking the dog and making my Tuesday list mentally. I have habitually likely done this for years. Today however I heard the internal machinations of my busy mind come to a screeching halt because I asked myself this question:
What quality of movement would I like to cultivate today?
As a yoga teacher, I always invite students to set an intention prior to moving on the mat. The Feldenkrais question is a slightly different lens in that the question isn’t what I want to bring to my yoga mat. The question is specifically what quality do I want to bring to the my movement or in my case the doing of this list of stuff that needs to be done. I am a householder. I do not live in a quiet monastery. Yet, I find I often have vast access to Zen moments if I can slow down enough to allow them to arrive.
The final beauty I have for you is this great fact. Today I didn’t immediately know/have the answer to my question. But like a Zen koan, sometimes a question is simply enough to drop us more deeply into the moment of our lives.
What quality of movement would you like to cultivate today?
May these words serve our hearts and minds,
Heather
Healthcare for All: What does it mean?
I support access to medical care for all. I do NOT support the way in which it is being offered. Access to allopathic medicine without prior drastic changes to the system will not help this country be physically nor financially healthy. I do believe relieving the stress of not having access to emergent care is of absolute importance. I remember the nagging five years of fear during my mid twenties without health insurance. Despite being a healthy young person, I was active in the outdoors. In the back of my mind, I knew at home, I couldn’t even afford a broken bone. With regards to medical care, I felt the best when I was in Mexico, Canada or pretty much anywhere other than the States. On one of my trips to Cuzco, Peru, I got horribly sick from the altitude and emergently needed IV fluids. I was afraid to go in because of my American experience of medicine, but had no choice. The total ER visit was 15$. I was shocked that even with my meager savings, I was able to afford my own healthcare directly. This is where healthcare for all would be possible. It’s about stopping the racket of stuffing the pockets of greedy pharmaceutical companies and for profit medical corporations. Its about decreasing administrative costs by creating reasonable direct payment for services. Medicine cannot be part of unregulated capitalism and be affordable for all. It will not work. We have a disaster to clean up first and need voters to speak up now.
One of my favorite examples of the utter criminality of Pharma and rising costs of medicine in America is the story behind the treatment for pinworms. As a taxpayer, anytime I treat a medicaid child for pinworms (which is more common than you want to realize) it now costs upwards of $600 per treatment for an old and once generic drug out of my own tax dollars! Read the linked article and think what will happen if we create a system where everyone has access to a system with unregulated cost. We will bankrupt ourselves and our taxes will go to pay for this lunacy. And do note, that the tone of the Consumer Reports article is written that this is the fault of physicians for not paying better attention to drug prices. Guys, why did a generic off patent drug go from 6$ to 190$ per pill is much a better question to ponder? And better yet, how is this legal? This is simply criminal but no one is paying attention anymore. Again, the best solution I see is educating the community about the lack of regulation and beginning to clean up the great depth of corruption that the unchecked greedy few of our healthcare system have been enjoying. Once free from greed, healthcare becomes accessible to all.
It is time to start paying attention and speaking up. This is the only way true change will come.
Safety Reset
As someone who has walked deeply within the shadows of trauma and who has sourced immense healing in those scary spaces, I want to speak on the concept of safety. As parents, one of our deep functioning instincts is to keep our children safe. Creating safety for my child has always been a guiding principle in my parenting. Specifically, I’m talking about emotional safety. That kid climbs super high trees. His physical “safety” is a whole other article. Thanks to being human and my lineage of unresolved transgenerational trauma, I sometimes fail to create the emotional safety I yearn for. I lose my temper. I have said things I regret. I have personally created an environment that was the utter opposite of an emotional safe harbor for my own child. And yes, thankfully this is the exception and not the rule of my behavior. I am so lucky to have had both the support and an immense personal bravery to step in and weed up and process the unresolved. I do this process every single day through my mindfulness practice. Yet, I am far from perfect.
Something I have learned very recently is this. If I get emotionally messy in the shared space with my child, I get to clean it up. The first step for me is this. As soon as I notice I am out of alignment, I stop. I force myself to actually fully stop and pause. My child is very, very sensitive to space and young enough that if I walk away, it lands for him even harder as abandonment. I have learned to be with myself simply in the space of the pause and still physically close enough to him that he knows I’m not going anywhere. This has taken a lot of practice both on the dance floor and in the living, breathing Dance of everyday life. Next, as quickly as I possibly can, I release the ever present feelings of guilt and shame over my behavior, speech, energy etc. Because I am a deeply loving mother, the ability to hold myself to perfection standards is always right there. Sometimes this act of release from shame and guilt has taken me days, sometimes it’s only a moment. Finally, I get to help my child’s and my own neural system through his sense of safety, reset. I have started teaching him the how to notice the difference between an activated nervous system and a resting nervous system. A great place to start is to learn to sense adrenaline moving in the body. The up-regulation and the down regulation have the potential to be both conscious and unconscious processes. When we big people freak out, our activated nervous system directly affects that of our children. They go with us. It is our job to notice and help each other come back to center together.
We had a doozy of a morning recently. I am proud to say that it takes a fair amount these days to get me to lose my sh*t. But, we got there thanks to lost car keys and a tight schedule. My son magically made my only set of keys disappear. Like truly disappear. As we searched for the keys, we quickly became late for school and the urgent care. Adrenaline poured out of my circuits and I started to freak. I kept asking my child questions as I helplessly searched under the car, in the car, the yard etc… prodding his memory and this is what he said, “Mama, I remember opening the back hatch of the car (to load stuff in ~3 mintues prior) and then I just blacked out.” What dawned on me, even there in the moment was that my stress response was actually causing him to drop into a freeze stress state. That is the “black out.” I didn’t hit him, swear at him, call him names, all the things that do happen to kids and yet, he was still in a sympathetic freeze. My child is beautifully sensitive.
I bear the responsibility of my young child’s sense of safety. Yet, I don’t have to be the Dalai Lama to raise a kid well. I simply stopped myself in my tracks and stepped into a big pause for us. I created a quiet space for both of us to find a lower level of activation. It took less than 30 seconds to create this. I didn’t have to land him completely. All I did was help him turn around from activation. A healthy intact body actually has a tendency toward calm. I took full ownership of the energetics. I explained to him, I had lost it. It wasn’t anything that he had done. And again, it is so much easier to take full ownership when I let go of the old ways of beating myself up. Blame, shame and guilt only drive the nervous system further out into activation. If we want to land, and if we want our child to land back in their body, their sense of safety, we get to let go of perfection over and over again.
Pause, ownership and reset.
Phew! Big deep breath.
May my messy serve our highest good and our darkest shadows.
-Heather
Melancholy Light
Every fall, I am moved by the changing cycle. I feel it, this soft type of grief. There is a palpable shift from the joy and freedom of summer to the dark and quiet corners of the coming winter. Beautifully today, I was able to sense this heart/throat squeezing sensation. This is my body’s way of expressing the discomfort of suppressed grief. There’s a big part of me that would rather just drink a bit more caffeine, grab a bit of dark chocolate and just rev past this uncomfortable feeling all together. (I tried both to no avail.) Thankfully, my writing has the magic ability to pull me toward the tough feels rather than away. Writing gives me courage to wander in the darker spaces. Writing helps me to slow down and sit with what’s there and work it outward from the ethereal emotional body into expression. I know that autumn affects more than just me and writing this for you, helps me be a better friend to us both.
Today I became super aware of the diminishing light and the increasing darkness. The new moon put me to sleep in darkness and I woke in utter darkness. And yet, I find myself participating just as intensely in our modern world. Unending demands and fluorescent lighting help blunt any chance of a natural responses to changing seasons. What if as the light changes I allow myself to slow down? Less light meaning, way less production and way more resting. What if I were to intentionally lower my overhead, lower the demands I put on myself in respect to the changing light? What if I were to sync myself with the coming change? These are the questions that came to me. But, not one of them would help me escape the deeper lessons of the darkness this time around.
Fall is a predictable teacher of decay and death. We are offered a simple practice run at our own release from this body, Every. Single. Year. If we choose to look in. I will admit, I’m not terribly excited about my own mortality. And yet, what I have found is that my resistance to this space takes more energy than just freaking looking at it. Taking the moment to pause, to feel that ache in my heart as I remember that my life in this body is not permanent. I too will will fall, like these leaves. And, yes, I will leave those that I love dearly behind. Uffffa. Tears. Ugh. Yes. This is the heart of my autumn blues.
I have spent years trying to figure out what was wrong with me this time of year. Turning on more lights thinking, “Oh this is seasonal affective disorder.” When in fact, it is just this light brush with mortality that brings actual, palpable grief. What I have learned is this: There is nothing to heal, change or subvert. Grief is simply another teacher that I am learning to welcome. This one needs a bit more space. This teacher needs for me to slow time way down. This teacher requires deep tenderness. And then, together standing authentically and kindly with my grief, I can be present to the beauty of this colorful play of transition before me.
The Smell of Rain on Dust is one of my favorite reads on grief. In this gorgeous book Martin Prechtel writes, “Grief is praise for this life.” The more willing I am to allow myself the tenderness I need for grief, the greater my praise for this life becomes. So if you see me this time of year, my radiant smile may be on pause, and my hand may be resting on my heart, so that I can truly be with this season of my life.
Anxiety and Clarity
I am raising a sensitive child. He’s beautifully aware of so much all at once. I see myself in him sometimes and it triggers the remembrances of the hardships and pain that being a deeply feeling being in our world can lend the soul. I was recently listening to a Zen podcast that was gifted to me by a friend on the Buddhist concepts of samvega and pasada. Samvega according to Thanisarro Bhikkhu is this: the oppressive sense of shock, dismay, and alienation that come with realizing the futility and meaninglessness of life as it’s normally lived; a chastening sense of our own complacency and foolishness in having let ourselves live so blindly; and an anxious sense of urgency in trying to find a way out of the meaningless cycle. So in other words, when we turn off laptops, pull out our earbuds and put down our phones, and we allow ourselves to become aware of the depth of suffering and pain the world contains, we get appropriately anxious. The beauty of the unrest of samvega is that this discomfort can become the driving force to deeper practice and spiritual investigation. And eventually if enough of us do this, I think humans may have a chance at survival. “For saṃvega to be an effective drive to practice, it must be accompanied by another emotion called pasada, a “clarity and serene confidence.” Unexpectedly, we find if we trust and appreciate our anxiety that it can become a rich source of energy for developing our own clarity and confidence. In my life, this has absolutely been true. Developing this flow between samvega and pasada has taken time and great amounts of mindfulness practices. I write this piece as a warning because I think there is so much out there attempting to lead us away from our anxiety and fears. Pharmaceuticals, alcohol, meditation retreats, Facebook, shopping, religion, righteousness, (this list goes on forever) all offering us a chance to be free from fear and dismay. There is simply so much in place culturally to numb us to the extraordinary force of our own discomfort. I am working daily to simply recognize when it is there and to not run. I currently take tiny sips of the news and human suffering. I feel for my planet, her waters and all her children as I can handle in any given moment. It’s pretty intense for me still. And, thankfully, I have my practices to bring me mindfully back to what is in front of me in this very moment. The feeling of the keyboard beneath my fingertips, the support of my chair. My warm cup of tea next to me. It sounds so simple right? But my ability to pull my mind where I’d like it to look has been much like training a wild horse. Sometimes I get to ride and more often I get to simply observe the beauty of my wildness.
In closing, I want to see us as a culture learn to trust our fears and discomfort. For me personally, I am working to not immediately turn away from pain and yet, be gentle with myself when I need to do exactly this. This has been my experience of these beautiful concepts. This is what I am teaching my child to help him navigate this crazy world with a tender, open heart.
Deep tenderness to you. To our fears. May they serve our highest good.
Limited.
One of the most heartbreaking things I have to do, nearly every day now, is turn families away. I felt the pull again today to expand beyond my limits. The worst temptation being there is literally no one providing the type of care that I do that I can refer these families to. For children here where I live, it is either me or the standard of pediatric care. Which let’s face it, is truly awful. If you haven’t woke to this fact, you’re probably not following my blog anyways. When children cry at the urgent care, I hold true empathy around them. I tell them honestly, I hate going to the doctor too. And, what I actually mean is, I wouldn’t set foot in our current system of western medicine, unless I’m actively dying or bleeding to death and even then, I may check some other options first. I am disgusted by the white-coat paternalism of doctor versus patients I continue to witness. I use the word versus purposefully. The utter lack of mindfulness that our consumerist, pharma-driven medicine has become makes my heart ache and yet I trudge on.
So why not grow my private practice? Expand far enough to make room for everyone? Hire advanced practitioners to help with the clinical load? It is this simple. I am limited. The beautiful work of Shanti Zimmerman taught me this absolutely, fundamentally valuable lesson. I am limited. I am a human being living a physical existence and therefore, I am limited. There, I said it out loud. And boy howdy, do I feel how this flies in the face of so many of the narratives I have gathered over the years. From the dangerous western medicine sinkhole of working yourself to death, to the equally dangerous esoteric path to your “unlimited potential.” Nope. Double Nope. I am here to sing the praises of having the CLARITY of my limitations. What sweet relief it was to hear Shanti’s modern version of this concept. I love what I do, and what comes first, is my state of being. This is where my limits are dynamically decided. Over and over again, I return to myself to check in with respect and tenderness to how I am. If growth comes, it comes with respect to limits that can only be set by me with respect to what is happening right in this now. In the past my limits were the product of someone else’s narrative or equally powerful my transgenerational farmer trauma which quietly taught me I was only valuable if I worked until I collapsed.
I have experienced such deep healing over the past few years. I have witnessed my own autoimmune issues finally settling down into a relaxed and grounded nervous system. This is my priority. I heal from the inside out. This is what Western medicine is truly missing. Healthy physicians. So yes, it hurts to turn folks away, but understand if you have been turned away, it was the result of my hard-earned healing. It is what makes me the physician I am.
May my heartfelt no, make room for your own.
-Heather Kim, DO
Loneliness
Recently, my son and I were out standing in front of our home on the sidewalk and we met a young Mom from our neighborhood walking her dog and with her toddler backpacked along for the adventure. We started talking and I immediately remembered the loneliness of those moments of motherhood. These three were such a happy scene to behold but the deeper aspects of suffering were right there for me in the mother’s eyes. This super aware Mom and I actually openly discussed maternal loneliness and I told her to please stop by when she was out walking. If only for a few moments, I made sure she knew I was happy to hold her in an authentic space as she journeyed.
Although my child is now 6 years old and lovely to talk to, I still miss companionship with adult company. My husband is a surgical resident and gone a lot. When he is here, he is exhausted and my child is better at demanding his scraps of energy and attention than I ever will be. And so again, the loneliness creeps in. It is so much better than it was when my own child was a toddler but still the weight of loneliness is there.
As a society we don’t often talk about the Shadow Lands of Motherhood. All advertising dollars are spent to make sure that culturally no one sees any of it. It took thousands of deaths for our culture to begin to even have a conversation around postpartum fragility. And now, it seems that public conversation has simply turned lamely into Pharma “solutions”. What if the threat of isolation doesn’t end in the 4th trimester? Today I am writing to say that maternal/paternal loneliness is real and there is no pill strong enough to mask it. Loneliness deserves our attention. It may sound simple but just realizing that my loneliness deserves my awareness and my tenderness has helped me experience and move through it.
What I am wondering now is how do we better support each other in the journey? How do we experience our loneliness so that we emerge stronger and healthier rather than it eating us or further isolating us? How can we do a better job of forming community around ourselves and others? How do we ask for support when we need it?
I am journeying these questions myself and will write more as I discover. Today it felt like enough to simply pose the awareness and the questions.
Much tenderness,
Heather Kim, DO
In This Now
Though I plan to continue to work as a pediatrician, the focus of the second half of my career is going to be in what is referred to as embodiment work. For more information on my upcoming offerings both written, video and workshops, FOLLOW and bookmark the NEW Website!
