Birth, pelvic health, Pregnancy, Prolapse

Pregnancy After Prolapse – Pelvic Floor Physiotherapy

If you’ve read anything else on this blog you’ll know I am a massive advocate for pelvic floor/pelvic health/women’s health physiotherapy (or physical therapy as it’s called in the US). I believe ANY woman who has given birth, or is going to give birth can benefit from it, even if it is just a one-time assessment.

So obviously, I am not the exception to this recommendation. I’ve talked about my previous experience with PFPT as a postpartum woman and when dealing with my prolapse, but this is the first time I have seen one as a pregnant woman. I wasn’t quite sure what to expect, or even sure if I needed to go! I had seen some posts on Instagram from women I follow about seeing PFPT in their pregnancies (Brianna Battles & Michelle Coels of One Tough Mama) and wondered what their trigger was to actually book an appointment to see them. Then I finally got my head out of my own ass, and realized I am legitimately having symptoms that I would be telling my clients to go to physio for. I was having some minor leaks and heaviness, which in and of itself is enough to warrant physio, so I just got down of high horse, and booked an appointment.

I was a bit nervous. Was she going to think I was wasting her time? Was she going to just tell me everything I am feeling is normal and look at me like I’m an idiot? I know, irrational, but those were my fears. Luckily, the physio I saw was one of the nicest women I have ever met, and let’s be honest, I’ve never met a physio I didn’t like! She heard and validated my concerns, assured me that what I was feeling was common, but definitely not normal, and then we jumped right into an assessment.

She was so thorough, it made my nerd heart happy! She had me stand and felt my abs and glutes, she had me squat, then single leg squat on each leg, and me do side bends each way, then had me lay down and contract my TA and then coordinate that with movement. She assessed my diastasis and we discussed how to monitor that moving forward. She examined my PF muscles, and had me do some contractions and assessed where I was feeling pain, how my prolapse was doing and gave me some exercises to work on.

We discussed strategies to deal with my symptoms. One of which was some leaking, or stress urinary incontinence, which I had never experienced before I got pregnant the this time around. Even when I was full term with Bruce, I never leaked, nor did I postpartum. She mentioned bladder irritants, which I had heard of and discussed with the physician at the Pelvic Floor Clinic when I was diagnosed with prolapse. I knew they could contribute to frequency, but what I didn’t know is that they can also contribute to incontinence! The way she put it is, if your bladder is already irritated by certain foods, then when you add a cough or sneeze on top of it, you’re more prone to leaking! This totally made sense to me, because otherwise I could not find any sort of pattern or correlation to my leaking. It was so infrequent, and didn’t seem to relate to my activity level or even the fullness of my bladder when I put any pressure on it, but I hadn’t taken my diet into consideration! And after chatting with a few friends, they all corroborated these thoughts anecdotally.

We also discussed the strength of my muscles. She rated my PF muscle strength a 3+ out of 5, whereas previously I’d been a 4 out of 5. So I mean, considering I am 23 weeks pregnant, those tissues are so swollen and loosened because of relaxin, I’m pretty happy with a 3+! I mean, obviously, I’d love to be 5/5, but I gotta take what I can get! She gave me a few things to work on, and we found while the front half of my muscles were weaker, the back half was actually quite tight.

The we discussed preparation for labor & birth. She had some suggestions on positioning, like don’t lay flat on your back, which I mean, is kind of common knowledge these days, I think? Isn’t it? Or maybe that’s just for birth & pelvic health junkies like me! She suggested I try to squat or be on all 4s as much as possible and also encouraged me to avoid pushing using a crunching motion, which a lot of women get sucked into. She suggested I focus on keeping my arms up, at least shoulder height if not overhead with something to hold on to. She said this stops the crunching motion and allows the TA to aide pushing better. We discussed things like perineal massage and EPI-NO, but not in depth. Overall we both agreed that I am in a much better place going into this labour because I actually know how to relax my PF muscles, and that was probably what made my pushing experience so drawn out the first time. I remember feeling SO vulnerable when I actually did relax those muscles, and not feeling encouraged or well coached by my midwife when I did.

This is the #1 reason I suggest all first time moms (or any pregnant woman who hasn’t delivered vaginally, but wants to) see a PFPT in pregnancy! They will help you learn how to connect with those muscles and how to know what it feels like when you both contract AND relax those muscles, because relaxing them is key when it comes time to allow baby to pass through them.

Pregnancy After Prolapse (4)

pelvic health, Pregnancy, Prolapse, Self Care

Pregnancy After Prolapse – The First Trimester

~Read where you left off here~

So the line was pink. I was officially pregnant. Again.

It happened so much faster than we had anticipated. It was no longer a debate of being ready, because ready or not, it was happening. One week after learning we were expecting our second little one, my husbands parents were scheduled to come for a visit. We debated whether or not to share the news, it was SO early after all, but we decided if this pregnancy ended prematurely, their support would be so needed, so we told them.

That just reinforced how great it was. They were ecstatic! Of course they were, what grandparents aren’t excited to learn they will be welcoming more grandchildren? I looked to my mother in law for support, my husband and his older brother are only 13 months apart after all. She reiterated what we already knew, it would be hard in the beginning, but so worth it. And we had planned it after all, it will all work out in the end!

Overall the first few weeks I felt pretty good. I still had energy, continued my workouts, and kept up with life. Things were great!

Then I was struck with vertigo.

I had cared for patients with vertigo, and knew it was awful, but I always thought they were over dramatic. But let me tell you, from first hand experience, it is all consuming. When you feel like the world around you is spinning, and closing your eyes just makes it worse, and you haven’t figured out what triggers it so it hits you randomly, it is hard. So hard. Even harder when you have a toddler to care for, and pregnancy nausea has hit. The vertigo was the worst in the morning, which, lucky for me, coincided with when I was feeling the most nauseated. The two just fed off each other and I felt awful. Caring for Nugget was even harder, because bending down or doing anything that required me moving my head out of vertical, set it off. Add that to nausea and it was a sure fire recipe for a trip to visit the porcelain throne. But I was lucky, after couple of weeks, it self-resolved. I didn’t really do much besides give into my salt cravings and drink as much water as I wanted.

But all the vomiting did a number on my core. The force required for that really puts some pressure on the pelvic floor, I now understand why some women leak when they throw up! I started having a lot of heaviness and discomfort. I freaked out. I was so worried that I was causing my prolapse to return and went to a pretty dark place. The combination of vertigo, with pelvic floor symptoms and exhaustion all added up to my headspace being all out of whack. I had a lot of very negative thoughts. There were many moments where I freaked out that I was damaging my body beyond repair. I even had really low moments where I hoped I would just miscarry so I could not worry about it anymore. I laid in bed crying, feeling like a terrible person and mother for wishing this very much planned, very much wanted, pregnancy away. The emotional turmoil you go through after being diagnosed with prolapse can really mess with you, and I didn’t realize how deeply, until then. It was like I was back to the day I was diagnosed, spiraling down a dark hole of ‘what ifs’, fearing I would never get out again.

I talked to some other moms they offered so much great support. They validated my feelings and helped me see what was really important – that I wanted this baby and I knew exactly what to do to get him or her here as safely as possible.

My symptoms waxed and waned over the next few weeks, and came to a peak around 11 weeks. I finally asked my prolapse support group, and they all suggested I talk to my pelvic floor physio. I mean, I knew I should, but I was in a bit of denial. I let my ego get the best of me, and thought I knew everything I possibly could, and there was nothing she could tell me that would help. But I emailed her anyway, and I am so glad I did. She replied quickly, and said it was totally normal to feel like that at the end of the first trimester. The uterus gets heavy, but has not come up above the pubic bone yet, so the entire weight of it is supported by the PF muscles. She reminded me to take it easy and it should pass, but to call her if I had any questions.

And she was right! Within a week, all my symptoms were gone! I even went on an 8 km hike up a mountain, and felt totally fine at the end and still the next day!

Then I was just tired.

So. So. Tired.

I never really noticed the exhaustion with Nugget, because I didn’t already have a kid and could sleep or nap whenever I wanted. Not the case when you have a 15 month old who gets up at 6 or 7 every morning. No sleeping in when you’re a parent, and even less so when your husband is working 6 or 7 days a week. This did not work out well with working nights. I work nights the majority of the time, and it was catching up with me. I started getting reflux to the point where I avoided eating because it felt like nothing ever left my stomach, I basically felt like my digestion came to a screeching halt. I started losing weight, which is the opposite of what you want to happen in pregnancy. Not to mention I was basically a zombie whenever I was not working. My poor toddler had the worst mom.

I talked to my midwife, and we agreed it would be best if I stopped working nights. I felt so guilty coming to that decision. I actually quite enjoy night shift! Plus, as a nurse, working nights is a bit of a badge of honor. I felt like I was being a baby by giving them up so early in my pregnancy, but I knew I had to do what was best for me and this baby.

It was like the clouds parted. I was finally sleeping at the same time every night, and sleeping through the night again. Before, with such a wonky sleep schedule, I was waking every couple hours because my body couldn’t figure out it’s rhythm. My reflux resolved, I had energy to exercise and play with Nugget again, and surprisingly my skin almost completely cleared up!

Moving into the second trimester, I finally started feeling like myself again.

Pregnancy After Prolapse (2)

fitness, pelvic health, Self Care

Painless Periods are Possible

I got my first period at age 11. I was devastated. My mom and all of my aunts and older cousins didn’t get theirs until they were 14 or older, so it wasn’t even on my radar, or my mothers for that matter. I didn’t know what to do, and I didn’t talk to my mom about it until she approached me about my stained underwear. The conversation pretty much went, here’s some pads, don’t go swimming, there’s tampons too, but you’re too young for those. Welcome to womanhood.

I don’t remember my first period to be painful, but I do remember pretty much every single one after that to be. Menstruation was so awful, I was pretty much incapacitated for at least one day a month, from age 11 until the time I was 17. And up until that point, the only thing that would help the pain was drugs, or sleep, or a heat pack. Well, who can sleep or use a heat pack during classes in highschool? As much as I wanted to stay home and sleep all day, my parents weren’t a fan of having me stay home just because of my period, I mean, women get it every month and go to work and function, I should too. That’s just how it is. It’s like a badge of honor to brag about how horrible your cramps are.

Then I went on the pill for 10 years (side note: !!!!) and forgot about it. I went to university, moved in with my boyfriend, got engaged, got married, bought a house, moved across the country, got a great career, and then it was time to make another human. So I went off the pill. And OH. MY. GOD. My ‘regular’ periods came back with a vengeance! It was like my body was getting revenge on me for pumping it full of artificial hormones for all of those years. And there it was, I was back to having debilitating periods again.

But… Why? If you think about it logically, why did human females evolve to be completely incapacitated by this perfectly normal human function? If we were ‘wild’ it would leave us extremely vulnerable very frequently. I’ve spoken to many, many women who have similar experience to me when it comes to their periods. I am not an anomaly.

I listen to Katy Bowman’s Podcast regularly and she has an episode where she discusses menstruation, and it was mind blowing. To summarize what she says, when your uterus sheds it’s lining (the endometrium), it leaves a wound, of sorts, and the lining combined with the bleeding of the wound, is the bloody discharge we know as a period. Well in modern society, our limited movement means that the organs and muscles within our pelvis do not get the ‘movement nutrition’ that they require, which results in limiting blood flow to those parts over time. This results in the impaired ability of our body to heal the wound associated with menstruation, resulting in severe pain and excessive bleeding, also known as menorrhagia.

So what can you do about it? Well if you ask the mainstream, take painkillers or go on the pill. Or just deal with it. If you ask Katy, or a lot of ‘healthy pelvis’ movers and shakers out there, movement is the answer. I know, it seems crazy. How on earth can movement affect my periods? Well it’s almost a ‘use it or lose it’ sort of thing. You have to move those muscles and organs around in the way your body was designed to move, in order to signal your vascular system that they require blood flow in order for them to function optimally. Your body is very efficient, and only sends the minimum blood flow required to keep your cells alive, but keeping them alive doesn’t necessarily help them function at their best. Your cells have to be active and demand blood and nutrients!

In modern society, we basically stand or sit all day. Some of us walk a bit. But very, very few of us squat or sit on the floor or use our legs to their full potential in their full range of motion. Our bodies have adapted to this limited range, and stopped sending adequate nutrition to the parts we don’t use, like our hips and our pelvis. I wonder if this has some influence on the skyrocketting rates of infertility and hip fractures or replacements? Now, this is totally just my own personal theory, with absolutely no scientific evidence, but something to think about!

So what did I do that helped me? First, went to pelvic floor physio. They helped me connect with my pelvic structures and learn how to move and activate them in ways that I hadn’t been. Second, in the midst of my prolapse diagnosis meltdown, I bought the Nutritious Movement for a Healthy Pelvis program from Nutritious Movement and started doing it immediately. I cannot describe how much I love this program. After just one day of doing the movements, I was sore in ways I didn’t even realize one could get sore, and felt so much more connected with my body, at a time when I felt like I was falling apart.

But I digress. I was surprised to find, two months after starting to incorporate my (new) PFPT exercises and the Nutritious Movement for a Healthy Pelvis program, I got my first postpartum period. I had heard horror stories from women about how the first postpartum period is the worst period ever. Like your body has saved up those 10 months (in my case) of periods to give you all at once. This was not the case for me! It was like the only reason I knew I was having a period, was I was bleeding. That was it. I mean, I was a little cranky, but other than that I felt great! I wasn’t buckled over in pain. I did not have to take one single pain pill. Not one! That is completely unheard of in my lifetime. Even when I was on the pill, I still had at least one day per period that I had to take at least 1 pain pill.

I really wish I had known this when I was a teen. If I could go back in time and tell myself what I know now, I could have saved myself so much pain and discomfort. I hope this information helps some of you better deal with your periods, and hopefully get to a pain free period like me!soup-salad

Birth, pelvic health, postpartum, Prolapse

How I Healed my Prolapse (Part 3)

Continued from Part 1 & Part 2

After seeing Kristen, I felt so much better. I wasn’t worried about picking up and carrying Nugget around, I wasn’t worried about carrying laundry up from the basement or hauling in groceries. I was able to actually live my life.

I started doing the ab work Kristen suggested, and I was absolutely astounded at how effective they were! Who knew such tiny movements like lifting your foot off the ground could have such a dramatic effect. The first day I did the exercise for a total of 6 reps. I know, barely anything, but I wasn’t able to maintain proper technique after 6 so I stopped. The next day I was blown away by how sore I was. We went grocery shopping and I was waddling around like I was 9 months pregnant because my TA was so sore! It was a total lightbulb moment for me. It made me realize just how much your TA functions in supporting your pelvis and trunk through every day movements, like walking! It made me understand further how diastasis recti can influence your movement and why it is so important to keep it in check if you have one.

I did the PF progressions she suggested. I was surprised to hear she suggested going PF contractions with a full bladder, but if you think about it, that’s like an internal load on your PF, and it’s like adding plates to the barbell! I was able to get even more in tune with my body, and really feel how and when my PF was contracting and monitor the forces at work.

I went back to see Kristen a month after our initial appointment feeling great. I informed her that a lot of my symptoms had subsided and other were explainable by reasons besides prolapse. She laughed “well you can go home now!” she said, jokingly, but I probably could have. She reassesed my abs, alignment and PF. After she was all done she said “Well you’re boring! There isn’t much going on here! Your PF is strong and contracting reactively and is well coordinated with your TA. Your anterior wall is ‘stretchy’ but I wouldn’t say you have a prolapse!”

I wanted to cry, again. But this time tears of joy.

But I hesitated. I was worried. Nugget was my first baby and I definitely had plans of having more, and hopefully sooner rather than later. So I asked Kristen what to do. I was nervous another labour and birth would do even more damage. Should I come see her in pregnancy? How does she recommend labouring and pushing from the perspective of a PT? Can I prevent prolapse with future babies?

So many questions.

We had a lengthy discussion about labour, pushing and delivery. It was so nice to talk to someone openly about birth who was about the function and physiology of the female body, and she gave me tools to go into my next pregnancy & birth feeling strong and confident.

And that’s how I want you to feel. Strong & Confident

Not broken, or fragile, or sad or depressed.

Strong.

We are all strong, we just need to see it within ourselves.

Now if you have read this series of blogs, hoping for a how-to list of things to do to heal your prolapse, I am sorry that I didn’t deliver.

However, I will give you this one To Do.

Find a pelvic floor physiotherapist. A good one. One that supports your goals and lifestyle. Not all physios are as open and supportive as Kristen, and you don’t have to accept that. If your physio refuses to give you progressions, or only tells you your options are to swim and walk, never lift anything over 5lbs (that’s realistic) and never spread your feet wider than hip width, find a new physio. There are good ones out there. If you don’t leave your appointment feeling confident you know how to live your life without fear and anxiety, you need a new physio. They should support your goals, not crush them.

 

how-i-1

Birth, fitness, pelvic health, postpartum, Prolapse

How I Healed my Prolapse (Part 2)

Continued from this post.

Luckily, I was able to score a cancellation with Kristen, otherwise I would have to wait months agonizing over my broken body. I was able to get in to see her two days later.

Now, I have never met a physio I didn’t like (true story), but there was something about Kristen. We just clicked. Our personalities were totally in sync and we had the same values and beliefs. She started the session by reassuring me, she could tell I was nervous. She said she knew many, many women who had a similar diagnosis to mine, and who live complete and normal lives, that I shouldn’t let this hold me back.

She assessed my alignment, my musculature, had me squat and stand while feeling my back and sides to assess how my muscles engaged. She had me lay down and assessed my abs and glutes, and informed me that my transverse abs aren’t as strong or coordinated as I thought, but gave me exact steps how to correct them.

She then did an internal exam (which I describe for you here), which I was most worried about. You see, the physician who had diagnosed me with prolapse had informed me that my pelvic floor (PF) muscles were extremely weak. She had rated them 1.5 on a scale of 5. She described it as barely perceptible with no endurance. The problem I had with that assessment is she didn’t allow me to coordinate my contraction with my breath, it was more “aaaand GO! NOW!” and I was a bit caught off guard. When Kristen assessed my strength, she allowed me to exhale with the contraction and take my time. She almost laughed when I told her the doctor told me my PF was weak, she rated me at a 4 out of 5!

I left the appointment feeling so much better, relieved that my PF wasn’t weak, and looking forward to moving on with my life. I booked another appointment for a month out, just to follow up with the ab work she gave me and the PF progressions she had suggested. Kristen encouraged me to call her with any questions, and unlike some professionals you speak to, with her I knew she really meant it.

The next day I had a thought. She never gave me any limitations for movement or exercise? Everything I have ever read online about prolapse is a list of don’ts. So I sent her an email, and fully expected it to take a week or two to hear from her, if at all. A few days later, she phoned me at home. The first thing she said was, stop Googling. She doesn’t consider postpartum prolapse in the same category as post-menopausal prolapse because there is so much at play postpartum. Your body has so much healing to do, and especially if you are breastfeeding, that can take a really long time, and to be patient. She told me to not limit myself at all because I have a strong PF and to trust myself, use good form and breathing and listen to my body. She suggested I do what I would normally, ease back into things, and if something exacerbates my symptoms, to maybe back off a bit next time. She didn’t see the value in restricting a young mother like myself.

This was the best thing I could hear. Instantly vanished any fear I had about carrying Nugget around, about doing daily activities, going for long hikes, or getting back into weight lifting.

I was happy again.

~Stay tuned for my progress with the exercises Kristen gave me, and how our next visit went and what she told me~

how-i

pelvic health, postpartum, Prolapse, Self Care

How I Healed my Prolapse (Part 1)

So I mentioned in previous posts that I was diagnosed with pelvic organ prolapse. This is a really common disorder in women, who have or have not had babies, though it is more common after vaginal childbirth.

I am sure mine was caused by 2+ hours of active, hard, hold your breath and bear down pushing, like I talked about in my post Hold Your Breath, Count to Ten, Push Your Baby Out and Your Uterus Too. Now, I’ll admit, I still struggle with my birth. It was not the birth I had planned for. It wasn’t perfect. It wasn’t the smooth, clean, athletic event in the way I had envisioned. That was all compounded 100x when I was diagnosed with prolapse.

After I left the doctors office who informed me my bladder and uterus had fallen, I cried.

You guys, I cried so hard. I couldn’t even make it to my vehicle in the parking lot. I was actively sobbing walking across pavement.

I couldn’t help it. I was thinking, how could I let this happen to myself? I knew better! (or at least I thought I did) I trusted my midwife and she let me down.

Listen, I know thoughts are illogical. But I was devastated. I felt broken. The doctor gave me absolutely no guidance as to whether or not I needed to alter my lifestyle. She told me my pelvic floor was super weak and basically told me I needed to do kegels, 10 x 10 seconds, twice a day. That’s it. I was terrified. I was scared to pick up my 21lb baby. Do you have any idea how awful it feels to be scared of picking up your infant when he needs you? I’m sure a lot of you do, and can agree, it’s fucking terrible.

I went home, drank some wine, and told my husband. We tried to move on with our lives, but it kept creeping up on me. My husband wanted me to go get tires put on some rims for my car. I had that gross, helpless, sinking feeling, as I told him he would have to put them into the car for me, since women with prolapse aren’t supposed to lift anything heavy (or so the internet told me).

Luckily, the doctor had suggested I return to physio. She gave me a list with some suggestions, she said I could try and return to Michelle, but since I (apparently) didn’t have success with her, here are some other recommendations.

I liked Michelle, but there was something missing in our relationship. She didn’t seem all that comfortable guiding me back to the types of exercise I wanted to do. I wanted to lift heavy things, sprint, jump, and do the things I loved. She didn’t have much experience in that area, and to her credit she tried her best to guide me, but she didn’t give me much confidence.

I went over the list that the doctor gave me, and found one of the physio’s was based out of a sports medicine clinic. A light bulb went off, that’s exactly what I needed! I called the clinic, found out that Kristen had a cancellation in two days, and booked myself in!

~Stay tuned for my experience with Kristen, what I learned and how I healed myself, both physically and emotionally from my prolapse~

how-i-healed-my

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!

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.

makes-1

Birth, motherhood, pelvic health, postpartum

Don’t Put up With Leaking During Exercise

I’ve written a lot about my experience postpartum, and care I believe women should receive in the immediate postpartum period, but what about down the line?

What if you are 1, 2, 10 years out from your most recent birth?

What if I told you, once postpartum, always postpartum?

Growing a birthing a human fundamentally changes our bodies for the rest of our lives.

sneeze-and-pee

Do you relate? You would not believe how many women I’ve heard from who describe symptoms of pelvic floor (PF) dysfunction years after their last baby.

What do I mean by PF dysfunction?
Well there are varying degrees, but symptoms can include but are not limited to:

Peeing or leaking urine when you sneeze, jump, run, laugh or cough.
Feeling like you always have to pee, no matter how long it has been since you last went
Dribbling urine after you get up from the toilet.
Feeling like there is still urine in your bladder after you finished peeing.
Feeling like you have to bear down or push on your abdomen to fully empty your bladder.
Feeling like you have to push on your perineum in order to fully empty your bowel.
Pain in your perineum (the area between your vagina and your anus) with activity or prolonged standing.
Unexplained lower back pain.
Painful sex or decreased sexual pleasure.
Feeling as though the vagina is too tight or small for sexual penetration.
Feeling of laxity in the pelvic area.
Inability to consciously contract (or Kegel) or relax the pelvic floor .
Inability to distinguish between a bowel movement and passing wind.
Inability to control passing of wind or bowel contents.
Protrusion of internal organs out of the vaginal opening.

If you can relate to any (one, or more than one) of the symptoms listed above, it is possible you may be experiencing some degree of PFD.

mom-wet-pants

I know what you’re thinking; ‘But I’ve had babies, don’t all women just pee themselves after they have babies? Isn’t this normal?

The answer is a resounding NO!

If I could shout it from the rooftops, I would.

But what about all of those Poise, Always, and Depends commercials? They make it seem like it’s just something we have to accept.

mjaxmi1kmte3ytdmndfmotm2mtuy

Better buy some diapers, because you’re never going to keep your pee in again.

No.

No. No. No. No. No!

While urinary incontinence (one of the most frequent symptoms of PFD) is common it is not normal!

Some of you might now be saying “Well, that’s what I thought, and I told my doctor and he/she said ‘Just do your Kegels, you’ll be fine.

There seems to be a huge disconnect in the medical/obstetrical world when it comes to pelvic floor dysfunction. A lot of physicians and midwives seem to think that as long as your organs aren’t falling out, you’re doing okay.

This is not the case! There is help!

Can I get a Hallelujah?

So what can you do?

Do I really have to say it again?

I will. Because I can’t say it enough.

Pelvic Health, or Women’s Health Physiotherapy!

You’re thinking “But how? If my doctor doesn’t think anything is wrong, how can I get a referral?

Most Pelvic Health Physios don’t require a referral*!

Now you’re asking “How Do I find a physiotherapist?

Here is a list of websites that offer search within Canada to find local physiotherapists who specialize in women’s health and pelvic floor:
Pelvic Health Solutions
Pelvienne Wellness
Physio Can Help**

Once you’ve worked with a physio to determine where you are at, in addition you can work with a personal trainer who specializes in postnatal training to get your strength back! That’s what I am here for! I am now taking on a few clients to start building my personal training career and experience! Feel free to contact me for more information, either through this website, or on my Facebook page or Instagram page.

download

And please, please, do not think you have to live with wet panties for the rest of your life!

*some benefits/insurance plans do require a physician’s referral to pay for the service
**General physiotherapist lookup – not specific to PF
fitness, pelvic health, postpartum, Self Care

Let go of the Ego

Let me tell you a story.

Doing my personal training classroom training, included a ‘fitness class’ for one hour at the end of the weekend. Our ProTrainer had the intention of teaching us some lessons beyond ‘how to exercise’ and she certainly did.

Now to clarify, at this point I was 3 months postpartum, had only had one session with my physio and wasn’t really supposed to be doing any sort of intense exercise. However, I love intense exercise, I am supremely competitive and cannot stand the thought of others thinking I was lazy or not ‘fit’ enough.

Before the class began, we were told ‘bring something with sugar in it, like fruit or juice. Do not bend over so your head goes below your heart at any point during the class, do not let your feet stop moving, and above all do not leave the room alone’.

I knew things were about to get serious.

I was excited. I hadn’t had what I would define as a ‘real’ workout in months. We get through the majority of the class, lot’s of squats and lunges and such, nothing I couldn’t handle. Then our instructor says “If you’ve had a baby, you’re going to hate me”.

Oh shit.

I literally JUST had a baby. This isn’t going to be good.

She coaches us to skip (without the rope). Continuously. For what seemed like forever.

Now for most of the class, this was an intense physical workout, that challenged their body and fitness.

For me it was mental.

I nearly broke down in tears during the class. She had taught us earlier in the course to ‘check our ego’. To not focus our training on ‘being the best’ or comparing our clients to anyone but themselves, and train them at the level they are at, not the level we think they need to be. It took every ounce of me to listen to that message for myself during that class.

You see, physically I definitely could have kept up with the class, no problem.

At the expense of my pelvic floor.

That could have easily been one of those moments you hear about where the woman leaves with soggy underwear, or worse, my uterus getting ready to fall out. But no one in the room knew that, all they could see was that I appeared as though I wasn’t trying. From the outside it looked like I didn’t care enough to push through the class, because I definitely wasn’t tired, and it was obvious.

This killed me.

I always prided myself on at least giving it my all. Busting my ass, so at least if I didn’t ‘win’ or keep up, at least I gave it my all when it came to anything physical. But this time I was faced with limitations. I had to have a frank discussion with myself:

Is this worth it?
Is ‘pushing it’ in this class with a bunch of people you may or may never see again worth potential life long damage? 
Is it worth sacrificing your body to prove something to these people who probably don’t actually give a shit?

And the answer was, obviously, no.

But it killed me. I hated that I couldn’t push through the discomfort. That I couldn’t just ignore what my physio said and jump until my calves gave out.

Eventually one of the assistants to the instructor came over and asked me if I was okay. “Are you leaking?” she asked. She knew. I explained I wasn’t but I was in physio and not willing to risk it, she understood and showed me some modifications to help me continue to participate without risking injury. It was at this point that I realized in my own embarrassment I had slowly moved to the back of the room. I was almost against the back wall, unconsciously hoping that no one would notice that I wasn’t fully participating. Trying to shrink back into the shadows and not allow myself to be seen as ‘unfit’ or not trying.

That was the moment I vowed to never allow any of my clients to feel like this. To never let them feel like they weren’t good enough to participate, or that their level of participation was inadequate. It was a terrible feeling that I hope I never invoke in anyone I am hoping to help. It was in that moment that I learned that training isn’t about the ego. It’s about where are you are here and now. Not where you were 6 months ago, where you were before you got pregnant, not where you were when you were 18. Right now. It’s about maximizing the abilities of your current body, today, in this moment. Some days, you might be able to bang out a circuit and feel like a rock star, other days the baby may have kept you up half the night and all you’ve managed to eat is a toaster strudel and a litre of coffee, and that same circuit feels impossible.

And that’s okay.

We have to learn to accept the here and now and forget about comparisons or being good enough. We can find balance between challenging ourselves and feeling inadequate because someone else can do it better.

We are strong even in our weakest moments.
We are enough today, tomorrow and every day.

 

Let Go of the Ego