pelvic health, postpartum, Self Care

Your Vagina Needs Therapy

It’s true.

I’ve said it time and time again. Maybe in nicer words, but I’ve said it. If you’ve had a baby (vaginal or otherwise), you need to see a physiotherapist (PT). And not for your back or your shoulder or your knee. For your vagina. More specifically, your pelvic floor (PF), or the muscles that surround your vagina and hold up your bladder, uterus and rectum. Those muscles that are *supposed* to stop you from leaking urine when you run, and are *supposed* to help you hold in a fart, and are *supposed* to relax and contract when you have sex and reach orgasm.

That’s what they are *supposed* to do.

I am putting *supposed* in between asterisks because they don’t always do these things, in all women. And that, my friend, is why your vagina needs therapy.

If you saw my previous post about PF dysfunction, and you are maybe having some issues, you’re maybe considering going to see a PF PT (first off, yay!). But maybe you’re nervous, ‘what exactly do they do at PF PT?’ you ask? Well that’s what I am here to tell you.

First off, most physio’s will have you fill out a questionnaire, so they can get a quick grip on your symptoms, your obstetrical history, and what your goals are. Most often the start off with an initial consultation, that is longer than your regular visits, so they can get to know you and do a thorough interview to assess where you are at. They want to know how many babies you’ve had, how you had them (vaginal or c-section), whether or not you’re currently having issues with leaking, discomfort with sex, and any pain or heaviness.

Then they will most likely assess your posture or alignment, movement patterns and sometimes feel the muscles on your back or sides while you move, like squatting up and down. They may also pay attention to your breathing while you move, or have you pick something up to see how you do it. They may even just assess your movement patterns without you even realizing, they are professionals and have a keen eye, and a lot of people move differently than they usually do when they know someone is watching! Then they will assess your abs, have you lay and lift your head and feel your belly to see if you have a diastasis recti (separated abs) and have you contract your transverse abs to see how well you are able to connect with them and how strong they are.

Then comes the fun part.

Okay maybe not fun, per-say, but the meat and potatoes of the visit, so to speak.

The Internal Exam.

This is probably what most women are nervous about, but I promise you, it is nothing compared to a pelvic exam by a doctor, a PAP or, hello, giving birth. I’ve been to two different PTs and both of them made me feel so comfortable, it didn’t feel awkward at all. They assess your tissues from the outside, get you to cough and bear down before they even touch you, then they touch the outside to see if there is any tension or tenderness anywhere. Then they insert a gloved, lubricated finger into the vagina and have you cough and bear down again to see if there is any prolapsing organs. Then they feel all of the muscles in your pelvic floor from the inside if your vagina, and assess them for tension or tenderness again. Then they have you do a pelvic floor contraction (or kegel) and assess how strong your muscles are and how coordinated they are with each other. They may also use their other hand to feel your abs to see if they are coordinating properly with your pelvic floor.

At this point it varies between PTs, but some may do some myofascial release, or scar tissue release or massage. Then most will work on teaching you how to do a PF contraction properly (if you don’t already, which most women don’t if they have been to PT before). Then they will work on improving your contraction, maybe positioning their hand in different orientations to assess how all of the different muscles are contracting. Depending on where you are at in your rehab, they may have you do some minor exercises (think lifting one leg up, or lifting your hips, no jumping jacks!) while laying on the table and assess how well your PF responds to the movement.

After that, they will conclude the internal,  and leave the room to give you a chance to get dressed. Then they will come back and discuss what they thought of everything, give you some exercises as homework and discuss whether or not you need to schedule another visit (or two, or more).

That’s it! It’s really not as bad as you may have thought (I hope!) but I promise you will leave with a whole new appreciation and understanding of your pelvic floor, and your body as a whole! The pelvic floor is an integral part of how your entire body functions, and supports some very important organs, I hope you plan to take care of it the same way you’d take care of any other muscle in your body if it were to go through a trauma like the PF does in bearing a child.

Don’t neglect the pelvic floor!

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Birth, pelvic health, Pregnancy

Hold Your Breath, Count to 10, Push Your Baby out, and Your Uterus too

Have you ever heard the term ‘Purple Pushing’?

I hadn’t either, until after I was diagnosed with a grade 2 cystocele (bladder prolapse) and a grade 1 uterine prolapse.

You read that right ladies, all that preaching I’ve been doing about being safe to prevent prolapse, well it didn’t save me.

And I’m about 99% sure I know exactly why.

Two and a half plus hours of ‘purple pushing’. Now the details of the pushing phase are a little foggy in my memory, probably due to the extreme fatigue I was hitting by that point. But I do remember on more than one occasion, grunting through a push and my midwife telling me to stop ‘pushing into my throat’… READ: shut up and bear down. Well when you bear down like that, you’re not only pushing your baby out, you’re pushing everything out. It’s really a matter of what gives first.

And you’re thinking ‘So what? Isn’t that what we’re supposed to do? That’s how it is in the movies, and on TV and in every birthing video ever

Nope. The research says otherwise. Actually, current UK & Canadian recommendations advise against directed pushing. Directed pushing is when the midwife or OB tells the woman when and how to push, usually at the beginning, middle and end of a contraction (that’s right, 3 full body, everything you’ve got pushes per 1 minute contraction) while they count to ten and you turn purple in the face (hence purple pushing).

I remember my midwife telling me 2 pushes per contraction wasn’t good enough. I remember thinking there was absolutely no way I had it in me to put that much effort in, 3 times, every couple of minutes. No wonder I was passing out between contractions by the time we transferred to the hospital. It just didn’t feel right. It felt forced, and painful, and wrong. Birth shouldn’t feel like you’re working against your body. It should feel like your body is doing this amazing thing and you’re kind of just along for the ride and helping out a little, which is what it had felt like for me up until that point!

The fact is that pushing like this not only is exhausting, it is not effective, it is damaging your body and sometimes can increase the risk for your baby to go into distress before they are out.

Boy can I speak to how exhausting it can be to push like that. It is essentially flexing every muscle in your body, while holding your breath, for 10 or so seconds, 2-3 times in a row, every 2-5 minutes. For those of you who’ve been through it, you feel me. For those of you who haven’t, imagine doing a 1 rep max squat, 3 times in a row. Not fun. This has also been found in the research, the effectiveness of the maternal muscles in contracting effectively to push out the baby is related to how frequently they are asked to contract. So if you contract 3 times per minute, rather than once, the muscle contraction gets progressively less effective, decreasing the efficiency of the push.

If a woman is allowed to push spontaneously when birthing (i.e. when she feels she needs to), it has been found that she instinctively pushes with the peak of the contract, once per contraction, thereby maximizing the efficiency of the push and making the most of the effort she is putting in voluntarily (if you can call it that). If you triple that effort, without any marked increase in effectiveness, it is possible the woman may become physically exhausted, before the baby is born, increasing the likelihood of an instrumental delivery.

This is exactly what happened to me. I was SO tired, and we intended on going to the hospital to use a vacuum to assist. So we took a break from ‘coached’ pushing, I was basically left to push voluntarily for about 10-15 minutes during the transfer, and I believe that, coupled with the moving around required to get to the hospital, helped Nugget get to the point where we didn’t need a vacuum after all.

I also believe that pushing like this is what has caused my prolapse. You see any time you bear down (think actively pushing out a poop, sorry if that’s too vivid for some, but I think we’re way past that if you’ve read this far!) you are putting pressure on your pelvic floor. The act of bearing down creates tension in the diaphragm, core muscles and directs all of the pressure created in your abdomen downwards, onto, you guessed it, your pelvic floor and all of those lovely organs sitting on top of it. So if you think, 3 pushes per contraction instead of one, thats 3x the amount of pressure placed on all of those muscles and organs. No wonder 50% of women who have given birth vaginally are estimated to have some degree of prolapse!

This act of holding your breath and pushing also increases the risk of harm to the baby. Let’s think about this logically: when you hold your breath, you are not taking in oxygen. Now, sitting on the couch doing nothing and holding your breath for 10 seconds probably isn’t a big deal. But when you’re literally flexing every muscle in your body and also you are the only source of oxygen for another human currently contained within your body, you are consuming oxygen at a much higher rate. And if there is less oxygen circulating in the mother, there is less oxygen getting delivered to the baby. There is even evidence that bearing down for more than 5 seconds can cause late-decelerations in the baby’s heart beat, often a precursor to an emergency c-section.

So why are we still holding on to the era of ‘we must actively push the baby out’? There are a lot of reasons. The medicalization of childbirth, where it is made to be the most convenient for the doctor, woman on her back, with an epidural working against gravity. Another is our bodies are no longer the bodies of ‘natural’ humans. We no longer hunt & gather, walk miles and miles each day, squat to forage and toilet. Our musculature is different than that of our ancestors due to the vastly different environment we live in. More often than not, we hold a lot of tension in our pelvic floor muscles, and those interfere with childbirth, especially when we are tense and scared of the event at hand. But if we were to take care of all of those variables, the fact is we wouldn’t have to actively push at all to give birth. Do you see elephants and lions and any other mammal that has a uterus holding their breath and grunting on those nature shows? No. 99% of the time the baby animals literally just fall out of the mother, after the uterus does all the work!

This is why we have to take care of ourselves in pregnancy, be educated about our rights and options, and choose healthcare providers that align with our goals and intentions. We have to be our own advocates and stand up (both literally and figuratively in this case) for what we know is right! We have to listen to our bodies, and I mean really listen. We have to get to know them in great detail, know every sensation, what is normal and what isn’t. That way when big events like this come along, we are prepared to work with our bodies instead of against them.

And above all, Squat!

Just keep squatting everyone.

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