Welcome to the latest Feature Friday interview, with Rakhi Srivastava! Rakhi is an Occupational Therapist and the Owner of Queen City Pelvic Health and Wellness. She’s also an advocate for women’s health and a relatively new Mom. Scroll down to read Rakhi’s impressive bio, and listen/read our interview along the way :) - Laurel
I would love to hear more about your business - Queen City Pelvic Health and Wellness.
It's so interesting because I think oftentimes we enter entrepreneurship by accident in a way - because you can't do your work the way you think you need to do your work in a setting working for somebody else.
That's how it was for me. I worked in a hospital setting for 11 years. And I finally got my public service loan forgiveness - the remainder of my student loans were covered in that deal I made with the U.S. government to work in public service for 10 years.
It was interesting to watch healthcare change over that decade. I think it's everywhere - it's not just where I was - but every hospital is becoming more productivity-based, more billing-based, and not so much focused on the people anymore, or the staff.
So I was there for a really long time and I did think I would be like a lifer, I thought I would retire from there. But something in me started to be like, okay, at every turn I'm getting more micromanagement as far as what to document and how to say this and what I can do and what I can't do … and it's a lot more of what I can't do than what I can do, and insurance is dictating what therapy looks like and it's just not in the best interest of people.
When people are only getting granted a certain number of visits by insurance and I'm having to spend my off time calling insurance companies and doing peer-to-peer reviews in order to get more appointments approved, that is just not a great use of time.
It was also kind of towards the end of the pandemic. I started my practice in 2022, and I had my baby in 2020. So I went back to work in the pandemic and it was just a lot. And the program had grown so much. I was part of building the program and growing it. And then it grew out of control. By the time I was leaving, it was taking clients three months to get in for their initial evaluation after a referral. And then another three months to get in for their weekly visits. So it would be all in all six months before they were really getting care.
I had 90 people on my cancellation list. And that was something I managed myself because the front desk didn't have the manpower to do that. So anytime somebody canceled or called in for whatever reason, I'd be scrambling to see who's nearby, who would be best served in this one spot that may not be a weekly spot.
But so it was all just a lot. And hours-wise, I couldn't see my kid. I'm only having this one child, I'm not having any more and I was missing it. I was missing his mornings a couple of days a week, I was missing his evenings a few days a week. He would be in bed and I didn't see him.
So, when I realized that I might be getting that loan forgiveness - it was earlier than I expected it was going to be. There was a waiver that the Biden's administration and his education department put into place that basically realized how poorly managed that program had been, and was giving credit for much more than they were previously giving credit for. When I saw that I started thinking - if I'm not bound to public service anymore, where else could I go? What can I do?
I realized, in all my reviews every year they’d say “you need to follow the chain of command.”
I thought, maybe I don't need a chain of command! And maybe I should just go out on my own.
I’d built a program once for the hospital, I can build a program again. So I did. And it was only me for a long time. Not a long time actually, a year and a half or so. I had a student who joined me for a three-month rotation, about three weeks into my practice. I didn't know if that was a great idea or a terrible idea, because I didn’t know if I was going to have patients for her to see. But it turned out to be great. And I'm still really close with her. And my students, I've had two, both of them have ended up getting jobs in pelvic health immediately after graduating.
I have students lined up already for later this year and then one for 2025 potentially one for 2026 already so there's just so much interest of people getting into pelvic health and I'm just here for it.
I rent a room in a yoga studio in my own neighborhood and so I live where I work and I can connect with my clients. People come still from all over the place - I am in Anderson Township so I'm on the east side, but I'm getting people who come from more rural Ohio, Indiana, etc.
I got too big for my britches quickly. I was really, really full, more full than I wanted to be. So it was almost the same thing, I'm still not getting home and missing some of my son.
And so it was probably eight months later when I finally was able to hire and expand because you have to take the process of getting over that hump of like, you have to learn how to hire somebody. I don't know how to do any of this. I'm a therapist, I'm not a business person. Everything I've learned is from podcasts and making it up as I go.
And so I did hire a physical therapist and opened a second location for her because we did a similar thing. She's renting a room from somebody who already had a space and we're just trying to keep our overhead low and build up. And then I don't know where we're going to go next. Maybe we'll get our own space, but I have no idea.
What I've learned is never say never because I never thought I'd own a business, much less have three people under me.
Now I have two physical therapists, one who shares the current space I'm in and one who's in that Northern Kentucky space, which is just 15 minutes from me right now, but she's in the neighborhood where she lives as well.
And then I have a part-time admin but that makes a huge difference because it was just all me doing all the things before. So yeah, it's been a wild last six months - it has been all growth and a lot of other things. All good things.
This is the year of settling. In 2024, I'm trying to take it easy a little bit and not make too many moves and kind of settle in, nurture what's already been built. That's the goal.
What are your thoughts on the state of women’s healthcare in the U.S. today?
Women's health care is abysmal but hopeful. There are a lot of us out here who are trying to make a difference and make things better and make things more individualized while looking at the bigger picture.
But overall, in regards to pelvic health and pelvic floor therapy, other countries are much further ahead of us in the United States. In France, anyone who has had a baby is referred to pelvic floor therapy. Whereas we have to seek it out here or ask for it. And even then sometimes it's like, “Oh, no, that's normal.”
Other countries have covered maternity leave, and longer leaves. They have better systems in place to provide support for breastfeeding, and women do not lose their positions at work if they have to leave or take time, and so on.
And on that note, there should be paternity leave too, because why are we doing all this? We're coming from way behind. In regards to federally funded research, women were only required to be included 30 years ago. That's recent in the realm of research. And there's so much that we do in women's health that is based on studies done on men, particularly white men. I think we definitely need to look more into studying women, in general, but not only that, but ethnicity and race-based care.
Because as a South Asian woman, I have very different needs than a Caucasian woman would. I metabolize things differently. My nutritional needs are probably different. There are so many different things that we have to look at in order to provide good, comprehensive care.
We're coming along in those areas, but there's so much that's been misunderstood for a really long time. Like menstrual pain, endometriosis, some of these really common conditions - that are much more common than we give them credit for because people have been silently suffering or misdiagnosed or things along those lines. They're just not well understood even by the physicians who are treating them.
There's a lot more that we can be doing in the realm of healthcare. But I think we're in a good position. And we have really good leaders in the field. So I'm hopeful.
You’ve been busy with advocacy work since Roe v. Wade was overturned. What led you to this work, and why does it matter to you?
What happened in the summer of 2022 when Roe v. Wade was overturned by the Supreme Court - the Dobbs decision - made me sit up. We knew it was coming. We had gotten that leak and then I was looking towards my national organization to see what they were going to say about it (the American Occupational Therapy Association - AOTA).
To set the scene historically AOTA has not really recognized occupational therapists as pelvic health therapists. We didn't previously have the support of our national organization.
They didn't really get what we were doing. Why is this OT and not PT? Traditionally, you will hear pelvic floor PTs, and they're also wonderful. Obviously, I've hired some. But we just have a different lens with which we kind of approach things and how we look at things. And I think both lenses are extremely valuable.
So when the Dobbs decision was made, and our national organization hadn't made a statement, but so many others had, like the American Medical Association, American Pediatric Association, American Physical Therapy Association, Nursing Associations.
Everyone was making statements basically saying this is a horrible idea. And our national organization didn't say anything until six days later. And when they had said nothing, I was like, in this place where my child has learned to fall asleep, but I haven't learned to fall asleep yet. I'm one of these nighttime doom scrollers and fritters about things because you just do this stuff when you have a kid.
And so I'm awake and I'm like, why is this? Why?
Why are we not saying anything? It was a keyboard warrior type of moment, where I commented on one of their Instagram posts, and I asked “When are you going to make a statement about the Dobbs decision? My pelvic health colleagues and I - this is really going to affect our work. What are we doing about this?”
And then I go to sleep, because I've gotten it off my chest. Then I wake up to lots more comments on the same line. So long story short, a statement was made, and it was very neutral, and it was very disappointing for us, and we're like, okay, that didn't say anything. It wasn't condemning the decision, it just said there will be changes in people's occupations and their lives, and we should be ready for that. And we're like, well, duh, but what are we saying here?
A side note - the President of the American Occupational Therapy Association took office that day. The day the Dobbs decision was made. This ended up being the first thing she had to think about. But we’d had the leak, we should have been ready, we knew this was coming months earlier.
But since then she's just been wonderful. Basically, they then offered to do listening sessions, asking “What do you guys think? What do you what do you want to have? What do you want to get off your chest? What do you want to say?” So I signed up.
For one session I stayed on to the very end. It was kind of a big group session and the AOTA board members were in there and all the different leadership of AOTA were in the meeting. We split into small groups and then came back as a large group and then split back and just, and I just stayed on. Because once again, I'm not a good sleeper. Let's just like, see where this goes.
So in the end, it’s me and like 10 people, including the president and some of the other board members and other people in offices. And I'm like,
“You guys are missing it. You're missing how much we're doing as far as pelvic health and how badly this is going to affect us. And I would love to send you some resources. You guys don't recognize pelvic health as occupational therapy, but this is the most occupation-based therapy I've ever done. This is in people's lives, in their homes every day. If they can't manage their pelvic health, they can't do life.”
And the president, Alison, was like, that was really impactful. The way you just said that. Here's my email address, can you send me some resources?
So I sent emails to her and the speaker of our representative assembly, and I kind of thought it was a way to get me off their back.
But then I see that they're doing things about it. I see that they're joining the groups, and they're commenting on the papers and whatever.
I don't hear anything for a few months, and what I realize later is they've been trying to work on it from the inside. And they realize they were just way out of their realm. So a few months later, I get an email that they’re going to create a task force to talk about the Dobbs fallout, and how that's going to affect OT and occupational therapists and the people who receive occupational therapy services, and would you be a co-chair?
I had a less than one-year-old business, and a two-year-old who was about to be potty trained. There's a lot going on, but I felt like I had to say yes.
So we do the task force. We gather data from all over the place, and we know it's not just an abortion issue. It is a precedent issue, and it affects men and women and intergenerationally it affects families.
We looked at it from a very broad, bigger picture, and we came up with a statement, and it was like recommendations. It was background, and then it was recommendations for what should we do. Two of those recommendations that we made were real stretch goals. We thought they probably won't say yes to these, but we can throw them on the list.
Those were the ones that ended up coming up for vote. They decided we should make a societal statement on reproductive health and a position statement on OTs and pelvic health, and how there is a role for us here.
We’d been asking for that as long as I've been in the field, but they don't just easily write position. But this year, both of those things got voted on affirmatively.
So those are just like the big things we're talking about. We're also looking at like just like greater advocacy areas. One is the House bill called the Optimizing Postpartum Outcomes Act. The goal would be to have more postpartum pregnancy care and, and perinatal care, pelvic health, included in Medicaid. So access could be more broadly across people who typically get left out of this type of stuff.
If you think about it, if we take care of moms, we take care of families. If we take care of families, then the children grow up and become good citizens so it's just good sense, right?
The goal would be we get occupational therapy also included in that bill and that we get it actually up for a vote and something done with it because right now it's one of these way back in the back burner type of things.
So a lot of things are getting attention right now, but the national organization (AOTA) has just embraced us now. The national president came and visited me at my practice and spent a day here to learn what we're doing. She has been visiting practices across the country as well. We just had a meeting last night. She's like, I just didn't understand it. And I can't thank you guys enough. We should be doing this. Of course we should be doing this.
So, it's been a big, big, big, big, big year.
What is one piece of advice you have for people regarding their health and well-being?
I think people know their bodies. I am a big fan of trust your gut and be a squeaky wheel. If you feel something is wrong and you're not being attended to find a different provider, if that's an option.
In many states, you don't need a referral to go to a private therapy practice. My practice in Ohio and Kentucky, you don't need a referral. Most of the hospitals and insurance-based companies will make you get a referral first, but you don't have to have one. You can just jump on my website and schedule an appointment. I think that is important to realize - that you don't always have to go through your doctor.
I come from a medical background. I went to medical school for two years before I did occupational therapy. I still also very much believe in alternative types of treatments. I've done acupuncture, I do reiki here and there.
There's just so much more out there than the medical model. The longer I'm out of the hospital setting, the more I see how much we were sort of not shown or offered. I think that's a disservice. I had multiple specialists and doctors who couldn't fix my migraines, but a Reiki provider did. I can't explain it, but I believe in it now. You know what I mean?
If you're not getting your results and something is wrong, go find somebody else, and there are so many virtual options now.
If you have to, find a different provider, but trust your gut.
For those who aren’t as familiar (like me!), what is occupational therapy?
Occupational therapy is poorly named. Occupations are not the job you go to every day. Occupations are the things that matter to you, that mean the most to you that you're doing in a day. So, for me, my occupations are wife, mother, business owner, daughter, you know, dance class buddy, whatever it may be.
What do you need to do, that something is getting in the way of? So basically, if there is a wall in front of you, and there's something that's keeping you from doing the things on the other side of that wall that you want to do, OTs can help you get a door open. Find a window to get through, bust through the wall, whatever method it takes, and maybe it takes a few different ways to like find your way.
We're amazing problem solvers. I always joke, if you have a problem, yo I’ll solve it.
That's how I think of OT. If you're a child who can't do handwriting OTs will find you ways and pediatrics occupational therapy very much looks like play. Because that's the occupation of childhood - play.
In geriatrics trying to keep people independent as long as possible, whether it be aging in place, or remediating an issue or adapting to an issue or finding an alternate way of doing something.
That's where OTs come in we look a lot activities of daily living bathing dressing, toileting, pelvic health, sex. All of these are things we do regularly, and need to do to survive. And other things like cooking, cleaning, childcare, driving, all of these other things we have to be doing in a day but a stroke could interfere with every single thing in your daily life.
So, how do we remediate? OT can be for anything - Autism, Alzheimer's, Parkinson's.
Wherever something is impairing somebody from their life goals - that's where OT should be.
Life outside of work! How is your family/how is motherhood? What are your favorite ways to spend your time outside of work?
I have been married for almost four years - it will be four years in April. And so that was 2020. We had a pandemic wedding and then a pandemic baby in December.
So that was wild. And I was also an older first-time mom. I was 39 when I had my son. With so many of us having babies later in life, a lot of us are coming out of postpartum directly into perimenopause, which is another really poorly understood area of women's health. Menopause itself is bad enough, but perimenopause, that's like a decade. Am I just going to have weird symptoms and a strange body for the next decade before I hit menopause? I don't know.
Raising a toddler in your 40s also has a lot of pros and cons. We get tired, he doesn't. So I do laugh about that. We would have been - body-wise - much better suited in our 20s to chase this child. But there are so many other benefits - financial stability and where we are headspace-wise. I don't feel like I'm missing out by staying home with him. I'd rather do that.
I am trying to figure out what my hobbies are. I think the pelvic floor is my hobby.
But you gotta step away sometimes and do other things, because it's very easy as a business owner to just do it all the time. There's always social media you could be doing there's always something you could be posting or something. You could be reading or connecting with somebody or whatever but tonight I'm starting a virtual class hosted by the Cincinnati Zoo Botanical Gardens - which is renowned - called Landscaping for the Homeowner.
It's a five-week virtual class. And I'm like, let's give it a shot. Maybe this is the year that we finally do the yard. I don't know if that's gonna happen. My next door neighbor always laughs because she says you two have done more in the last few years that you've lived in this house than we have ever seen anybody do. You got engaged, married, and had a baby within a year. I'm like, yeah, that happened. And then, they're like, the fact that you haven't touched your yard is OK.
What has been a pivotal moment in your life?
I would say it would be the year 2010. 2009 going into 2010. And I would say that if got through that year, I can get through pretty much anything.
I got divorced from my first husband in April of 2010. My dad passed away from cancer in July of 2010. And I finished school in the middle of that. So I finished grad school and then started my clinical, and then started my new role. It was just one thing after another.
And it was just a rough, rough time. But I think it kind of was a sink-or-swim type of moment. I had some really good friends who helped me get through that.
And I think it was actually a good way to start a career. I was like, okay, well, I guess if you're starting fresh, you're starting fresh. So that was 2010. And I hope to never have a year like that again.
But it definitely was a way to recognize what character I have under here.
What are resources that you recommend? A book, a podcast, etc.
There is an OTs and pelvic health podcast for anyone who is more interested in occupational therapy and pelvic health. I've been on it twice. The host Lindsey, she invites a lot of different types of therapists and talks about different topics that are just really interesting. So if there are any OTs out there listening and like want to learn more, that's a great one.
In public health, we talk about a lot of sexual health. One book I really like and I refer my patients to a lot, it's called Come As You Are by Emily Nagoski. She's a sex therapist, but she talks about the science of sex and the differences between men and women and different types of spontaneous desire versus responsive desire and how things can be really different for different types of people and couples and how to sort of find a better way there. She also has a podcast, I have not listened to it but it's on the list.
And then Fair Play by Eve Rodsky. Fair Play is about splitting roles in a marriage or in a couple. And finding equity in the roles so that somebody is not taking every emotional labor task of the household. It’s definitely a discussion my husband and I've had. We haven't delved into actually splitting the tasks or the roles or anything yet but it’s a discussion that's been started.
But - side note - my husband is amazing. If I can just add, for me to be doing all this, he is doing all the things. He is an amazing dad.
He does cooking and cleaning and all these things. So I don't complain often, but sometimes we still gotta tweak some things.
Then there’s Finding Your Unicorn Space, also by Eve Rodsky. She just has really nice ways of thinking about things like, self-care. Taking a warm bath isn't going to revitalize you. You can't share that with the world. She asks what's the thing that you're going to delve into and share with the world?
Rakhi Srivastava, MOT, OTR/L has been an occupational therapist (OT) for over 13 years and has specialized in pelvic health since 2018. In April 2022, Rakhi established Queen City Pelvic Health and Wellness, LLC, where she treats all genders holistically from head to toe and believes that “nothing is TMI.” She treats in Anderson Township on the east side of Cincinnati, OH, and has recently expanded with a second location in Fort Thomas, KY as well as two additional pelvic health therapists and an administrative assistant. Rakhi's experience includes 11 years at The Christ Hospital, where she worked in inpatient rehabilitation and acute care prior to outpatient pelvic floor therapy. In her last 4 years at Christ, Rakhi planned, developed, and executed the hospital's pelvic floor therapy program. From 2015-2019, Rakhi was also an Adjunct Professor of Occupational Therapy at Xavier University, where she previously earned her Master's Degree (but still holds a soft spot for her undergraduate alma mater, the University of Cincinnati). Rakhi has a passion for advocacy. In the last 1.5 years, Rakhi was a speaker at the OTs in Pelvic Health Summit (twice!), was a guest on the OTs in Pelvic Health Podcast (twice!), and was part of the small group of pelvic health OTs who established the Pelvic Health Community of Practice through the American Occupational Therapy Association (AOTA). She was the Co-Chair of the Post-Dobbs Task Force through AOTA, which explored the impact that the overturning of Roe v. Wade would have on the occupational therapy profession and consumers of OT services. In April 2023 presented a "Conversations That Matter" session at the annual AOTA Inspire National Conference entitled "Maximizing Occupational Therapy’s Impact in a Post-Dobbs World." She recently co-authored the AOTA Societal Statement on Reproductive Health, which will be up for a vote in Spring 2024. Rakhi hopes to continue to advocate at local, state, and national levels so that pelvic health services become more available to the many people who need them. Rakhi is married and has an adorable 3-year-old son.
Such a great piece! Really intrigued by her work and advocacy - and I learned a lot!