By Cora Tomowich, MScPT, HonBKin
After having a baby, your life changes in incredible ways. Not only do you now have a remarkable little person in your life, but you also have changes to your social life, your sleep habits, and most significantly to your body. Pregnancy, childbirth, and postpartum recovery are three of the most challenging tasks that the female body can undergo. Ligaments and joints become more lax, muscles stretch and strain, body weight and uterine size increase, and posture is thrown out of alignment. Even though we have the avenues by which we can seek help with these changes, most women do not use them. Pelvic floor physiotherapy during pregnancy and postpartum recovery is not a regular practice in North America when it absolutely should be! It is time to break the silence, redefine ‘normal’, and talk openly about how to best heal a postpartum pelvic floor.
Pelvic Floor Physiotherapy During Pregnancy
We all know that pregnancy has certain inherent challenges for women to endure. Carrying a baby means increased pressure, stretching, and possible strain to the muscles of the lower torso; resulting in pain around the pelvis, tailbone, hips, belly, and low back. There’s also hormonal changes that increase the likelihood of constipation and dietary sensitivities. But hey, if our foremothers could do it without complaining, then we should too right? Wrong. Previous generations of North American women were far less likely to openly discuss the physical and hormonal challenges associated with pregnancy and opted to suffer in silence. Well, it does not have to be this way. You do not have to ‘suck it up for nine months’ and manage the challenges of pregnancy on your own.
Pelvic floor physiotherapy can help new mums recognize and prepare for bodily changes and rebalance muscular activity in the deep core. Corrective exercises can also help improve mum’s posture and strength to better support her growing belly. I see a lot of women who experience incredible pain in the hips, pelvis, and bellies as a result of posture and fetal positioning. They also often have difficulties with sleeping, eating, and toileting because of not being able to get comfortable. With pelvic floor physiotherapy, I help new mums prepare the deep core to better accommodate for fetal growth thus preventing negative postural changes. We also prevent and treat pain during sex, improve bathroom habits, and prepare the body for delivery.
Preparing for Birth
When it comes to labour, many new mums tend to feel nervous or anxious; and North American pop-culture hasn’t helped with this anxiety. Think of all the TV shows you’ve seen where the mother is on her back with her legs in the air and screaming in agony while a bunch of nurses run around the delivery room. Well, it doesn’t necessarily have to be that way in real life. We never see TV moms deliver in the several other (more optimal) labour positions that are available.
As a pelvic floor physiotherapist, I spend a lot of time educating new mums about different labour positions that might be more suitable to their birth plans. During early labour, for example, I encourage movement, walking, leaning forward, and even dancing! This helps to keep the tailbone out of the way of a descending baby’s head and prevent painful back-labour. During active labour, also known as ‘the push phase’, I encourage delivery positions such as squatting, supported standing, side-lying, or wide-kneeling. These alternative positions help protect the perineum and allow mum to be in better control of her body during vaginal delivery. If an epidural or a C-section is required, I educate mums about the most appropriate ways to treat post-operative scars, prepare the core pre-labour, and optimize core recovery afterwards. Please do not be fooled by North American pop-culture, know your options!
What Happens After Birth
Now, we get to the aftermath of childbirth: postpartum recovery. Unfortunately, many new mums experience a lot of body and pelvic issues after the baby is born; which is no surprise because, regardless of how labour went or which birthing method was used, there was still a rather large baby coming out of a rather small opening. This will inevitably take a significant toll on the body, one in which many new mums ignore. Culturally, we tend to accept that once born, all focus should be on baby, making any extra attention for mum seem like an inconvenience or an unnecessary luxury. With all the changes that accompany a new baby, it’s common to ignore ourselves and forget that postpartum struggles are serious but do not have to become our ‘new normal’.
During postpartum recovery, many women experience urinary or fecal incontinence, pelvic organ prolapse, significant pain during sex, and pain in the low back or SI regions. Many new mums also suffer from residual birth trauma, and are terrified to even look ‘down there’. Some of these women may seek medical or surgical interventions, which rarely correct the problem long-term; while others ignore the problem altogether and continue to suffer in silence. Truth is, ignoring or staying silent about the problem is never the answer. When the pelvic floor does not rehabilitate properly after childbirth, the deep core tends to stay in a prolonged state of dysfunction. This is why I often see women who delivered babies 30-40 years ago with the same pelvic issues as women who delivered 30-40 days ago.
In North America, some of our most-trusted medical professionals further perpetuate the silence by fluffing off our concerns – not believing these issues are of real consequence – or by giving us misinformation about how to cope. Very rarely is a new mum asked detailed questions about her bladder control or comfort during intercourse. I’m sure many of you have heard your doctor say: “Well you’ve had kids so you are going to experience incontinence, that’s just the way it is” or “If you’re having pain with sex, just try lube or drinking a glass of wine beforehand”. This is not an acceptable level of care. We cannot continue to ignore our postpartum struggles and simply accept incontinence and painful sex as our ‘new normal’.
A New Way of Thinking
In North America, we are more comfortable seeking help for a shoulder injury or an ankle sprain than we are for urinary leakage or prolapse. It’s time to start thinking of the pelvic floor as though it is like any other part of the body. In my practice, I talk about the pelvic floor using language that is not intimidating or alarming; while also explaining its role and how its function affects the rest of the body. During hands-on work, I encourage open communication and feedback from patients so they always feel engaged and in control of their treatments. I ensure that all patients are aware of their rights to informed consent as I explain what we will be doing and why. I will never push anyone beyond their comfort level and I will never do anything that I haven’t had done to myself.
When it comes to openly discussing the pelvic floor, we are still a bit under-evolved here in North America. European countries, on the other hand, consider pelvic floor physiotherapy to be a standard form of care. France provides funding for new mums to undergo postpartum pelvic floor physiotherapy; while Britain requires six weeks of pelvic floor physiotherapy prior to conducting any type of corrective surgery for prolapse or incontinence. It is time to behave like our European neighbours and start thinking about and treating the pelvic floor as though it is like any other part of the body. We need to talk openly about it, learn about its role in the body, and optimize the way it works. Enough with the silence and enough with just accepting postpartum problems as our ‘new normal’. Having pain during sex, living with uncomfortable abdominal or vulvar scarring, or leaking when we run, cough, sneeze, or laugh should not be accepted as a postpartum inevitability.
Everything (and I mean everything) is related to pelvic floor functioning and deep core health. For instance, someone who is experiencing constant headaches may not have an issue in their head or neck but instead with their body’s internal pressure system, created by the diaphragm and pelvic floor, that is posing a negative influence on intra-cranial pressure. The pelvic floor is responsible for many things including supporting our organs and regulating uterine, bowel, and bladder function. Fortunately, more and more health-care providers in North America are recognizing the importance of the pelvic floor and adopting new ways to treat it; however, the change is slow. There are still many health care providers who are not fully aware of the many benefits of pelvic floor physiotherapy, especially for women in postpartum recovery; and so it is up to us to seek out and advocate for these alternative therapies and redefine what the body’s ‘new normal’ should be after having a baby.
If you have any specific questions about your care or would like to book an appointment, please do not hesitate to contact me here at Darou Wellness… I would love to hear from you!