It upsets me that there is no straight forward care for women following childbirth. There must be so many suffering postnatal problems in silence. A lot of the time I suspect new mothers wouldn’t seek help unless they are offered. And in my case even if I tried asking the GP, my problem was at first completely disregarded. Imagine I wouldn’t have had the knowledge I actually had. A new mum who may have no idea about what a women’s health physiotherapist even is, would probably just have moved on and dealt with her issues in yes, silence. Maybe for years, maybe forever… When my GP acknowledged I needed help, all she could do was giving me a name of a women’s health physio I could go and see privately. That was if I wanted to see someone earlier than my already booked appointment (in 4 months time). So there is definitely a glitch in the whole system. The physio I have been seeing (on and off for years) is incredibly stretched and she cannot help she doesn’t have much availability. She’s on her own on that hospital!!! Taking care of all women is similar positions like me and of course any other women’s health related problems. But why is she on her own? It must be because it’s an area not prioritised, right?!

Women give birth. They may get problems after. Life goes on. Deal with it. 

In some countries every woman will see a women’s health physio postpartum. I SO wish that this was the case everywhere! All women would benefit from it. With problems/pains or not, but for their future pelvic floor health. We can all benefit from learning correct pelvic floor training. Because believe me, it’s actually not as easy as it seems! And I put my hands up, I was not doing my exercises correctly until I first saw my physio. There is so much more to it than just squeezing. It’s all about squeezing the right muscles, relaxing the right muscles and breathing in the right way. Every new mum could learn from at least one postnatal check up. And in an ideal world also an appointment before giving birth… Amazing would be to have a regular checkup for the pelvic floor during life, starting from a young age and then continuously throughout life, having had children or not. In an ideal world. Because of course there can be problems also if you haven’t gone through pregnancy and labour. The focus in my writing is to do with postpartum problems, as that’s what is relevant for me, right now. But the above is what I truly wish for. For all my sisters out there.

In an ideal world.

Imagine you go through a pregnancy, labour and give birth to a little human being. Your world is turned upside down and from this moment on your life has basically changed forever. In a lot of ways! You are happy. Exhausted. Scared. Worried. Excited. You feel every possible emotion and it all goes around in circles while you are trying to figure out what this new life is actually going to be like. You are now a mum. You have given birth to a person who you now have full responsibility for 24 hours a day and in a way all you can do is to focus on this little one and everything that comes with them. But all of a sudden you get reminded of your own body, but wait a minute! It’s not the same body you once had?? It has changed – Dramatically! You have concerns, complications, pain. You may struggle with going to the toilet properly. You have questions. Wondering if what you experience is actually normal? But it’s all a bit private and difficult to talk about. Since your midwife discharged you day 5 post birth nobody has checked your healing or asked you anything so you assume it’s only you thinking too much. Maybe you have to expect certain things after giving birth, maybe every mother has their bladder positioned on the outside of their body by now? 6 weeks postpartum you have the baby and mother checkup at the GP booked. A chance to get some answers!

This is my story in the doctor’s office. And it went literally like this:

All the mandatory baby checks were done. My little girl was alert, healthy and everything was positive. The GP made her notes. Then turned to me: 

GP: ‘And how are you doing mum?’

Me: ‘Well. Not so good to be honest. I’m suffering a lot from two things – one being my coccyx which is an old injury. Although not as extremely after this birth as after my first – it was still aggravated I am in quite a lot of pain from it and struggle to sit too much which is hard when i feed the baby etc.. 

Secondly there’s the prolapse which is my biggest problem at the moment. I originally got it after the first birth but I think it’s been worsened after this as it feels very low… it definitely feels worse than last time and I’m struggling to…….

//I get interrupted//

GP: ‘Why are you telling me this?? There’s nothing I can do about that! That’s normal after giving birth!’

…………………………………………………….

She actually said those words: ‘Why are you telling me this?’

WHY AM I TELLING YOU THIS?????!!!!!

Well – I am at my postnatal checkup and you asked me how I am doing postpartum. I am sorry if you were hoping for me to say that I’m doing ok so that you could tick that box and move on to the next patient. I am actually clenching my jaw in anger as I am writing this and reliving the moment…!! The room around me got dark as I quickly snapped back at her that:

Me: ‘I didn’t actually expect you to do anything at all about it. But I thought that you as my GP could send me to the right person who might be able to help ’.

I think she then realised that I might not be that mother. That mother who would now say ‘ok thank you’ and leave and her GP life could go on. She mumbled something in a somewhat nicer tone. And moved on to if I wanted her to examine me. Again – excuse me but why is this a question? Of course I should be examined! Why wouldn’t she want to see that the healing is going the right way (even if I had come in without any concerns/symptoms) it’s 6 weeks postpartum!! So early days! I was so annoyed and angry at this point so I wryly replied to her that:

Me: ‘If you cannot do anything anyway, what is the point of you doing a vaginal examination?’

She would do one she said to at least check stitches etc. So even if I was very put off by the situation I agreed for her to do it. And here’s to the ironic bit. Upon examination she very soon realised that: 

GP: ‘Oh. You’ve got a quite severe prolapse here. You need help with this.’ 

…………………………………………………….

I just hope she regretted in that moment what she had said earlier. And that she will never say something like that to a new mother ever again.

It didn’t take long before I understood that the pelvic floor had taken a massive toll from the birth of my second baby. I knew my body so much better now and a bit more about what to expect (and what not to) after giving birth. 

But I also knew that even if the prolapse felt very low initially after the birth it didn’t necessarily mean it was a long term worsening. So I stayed positive. I didn’t want to ruin the good emotional feelings from the birth experience and I really wanted to just enjoy the moment. I tried to put any thoughts about my pelvic floor to one side for the time being, there would be time later to deal with my physical side of things..

Of course it wasn’t entirely easy to ignore my body, especially because that cough I suffered before labour kept lingering. And of course kept affecting the pelvic floor and my stitches.. Soon enough I ended up on antibiotics because of a diagnosed chest infection. At least that meant I could finally start to recover from that bit.

Midwife J came to do my Day 3 checkup at home. She straight away identified that my cervix was positioned too low to be considered normal at this point and referred me to women’s health physiotherapy. And that would be to the same physio I had seen lots both before and after my previous baby. 

However, there is really not enough of these type of professionals out there, and I assume there are not enough fundings for this area, women postpartum are basically not very much prioritised. This means that those few that work with women’s health get very, stretched. To give you an idea: I had my baby end of May, the referral to physio was sent through in the very early days of June. I got my physio appointment the 22nd of October…

Lucky for me that this was my second baby and I had done so much pelvic floor physiotherapy in the past so I kind of knew a lot of what I needed to do. Plus I had the cube to go back to eventually. But for a first time mother who may have no idea at all, and might be experiencing prolapse issues or other pelvic floor problems – imaging having to wait for that long to get any kind of help!!!? 

In my next post I will tell you what my GP said at my 6-week postpartum checkup. 

My second baby decided to come out two days before due date, and she came fast (as opposed to my first..!) 

The overall experience was pretty amazing. Emotionally it was beautiful and positive all the way through. I think it had to do with my own approach to it all but also the way we were taken care of by the hospital staff. Things were on our side from the beginning for most parts and I felt supported. For example – we tried the Birth Centre first, as my preference was to give birth there. (Last time I had been transferred to labour ward when complications arose). I was examined there and had the positive news that I was already open a few centimetres and things were progressing. But soon enough I was told I wouldn’t be able to stay there because of my history/complicated first birth. The midwife and her student however were friendly, supportive and assured me I could still have a natural birth on labour ward. 

I also had a very good approach to this change of plans myself, and took the news well. I knew there was a risk I’d be declined the Birth Centre (the midwife I’d seen during the pregnancy had told me exactly this – to try and go there and see if the midwife on shift would accept me or not). So we didn’t despair. And how right they were, I did have a natural birth even if I was on labour ward! With another amazing midwife. 

And pain! In terms of pain level it was something totally different from the first time around. I understood that the levels of pain I reached last time maybe in fact were not as normal as I had thought. It probably partly had to do with the unfavourable position my baby was in, and for a very long time. That time, I kept wondering how it was possible that it was SO painful, as I several times truly thought I wouldn’t make it through alive…. and on some level that time I knew it wasn’t quite right. But I kept telling myself that surely it must be, it’s probably just me. Probably just me having a lower pain threshold than I thought I had and therefore simply wasn’t able to give birth like one of those super women…. 

Now, after giving birth a second time I understand that it can be very different. Of course I am aware of the theory that my body had by then gone through it once before and therefore it would maybe feel different etc – but nonetheless I was absolutely chocked when I understood the baby was ready to come out. I couldn’t believe we had reached that point already, surely I had so much more pain yet to experience?! I was by then only using gas and air for pain relief and in all honesty I probably didn’t even need it… 

So I guess I got that ‘revenge’ I had hoped for. A very positive labour. A birth where I felt in control and my body did what it was meant to do, without complications on the way.  The first few hours post labour I was in a state of happiness, a bit in chock over how quick and ‘easy’ it had been and of course I was in the obligatory postnatal hormonal-suddenly-living-in-a-bubble kind of state. I referred to the birth as ‘Incredible’ when asked by a midwife on the postnatal ward. She laughed and said that most women don’t describe it like that. I was over the moon!

But. (of course there is a but!)

Had this labour actually been too fast for my pelvic floor?

Ten days before due date I caught a cough. It was a really bad one that meant I couldn’t lie down without entering horrible cough attacks. I was full term in my pregnancy and inevitably exhausted already, and with that cough I was getting even more deprived of my sleep. And of course the worst part was how it affected the pelvic floor! Anyone with a weak pelvic floor or suffering stress incontinence or prolapse knows what I am talking about. The pelvic floor does not agree with coughing, sneezing etc… and with a 39 week pregnancy belly on that – well I wouldn’t wish that on my worst enemy .

I wanted to prepare myself for the upcoming labour in a positive way, resting myself up and getting ready. Prior to this I had entered a more calm state of mind and just wanted to go through labour and have a positive experience. Instead I didn’t sleep much at all and nearly coughed the bladder out of my body some nights – I was literally holding between my legs during the worst cough attacks to try and support the prolapse. At one point I coughed so much that I strained a muscle in my lower back. So there I was, a few days before due date (and who knew when the baby would decide to come out?!) and I could barely walk because of pain in my back. I was tired, I was coughing, my belly was big. I panicked. Broke down in tears one evening. I wasn’t ready to give birth yet. Not like this. 

Thankfully, my mum had decided to come over and stay with us for some time at the end of my pregnancy for support. As I also had my nearly 3 year old to look after this was very much needed and appreciated, especially considering the state I was in. 

What would I have done without her?

Knowing how the first labour and birth came to affect my life, unavoidably I wondered whether or not I should go for a c-section this time. In fact lots of people around me assumed I would. And some encouraged me to consider it – at least amongst friends and family. Most professionals around me instead seemed to suggest that it wasn’t the birth that would affect the prolapse, it was the pregnancy itself. Especially as the second labour would most probably be faster and easier. Most probably. Statistically that is. No one would be able to say for sure, and I didn’t expect anyone would of course (even if it certainly would help to have someone giving me ‘The right answer’)!!!! 

To begin with I just went with the flow. The weeks ticked by, I was tired and nauseous, my toddler kept me busy and my belly grew….and at first labour seemed so far away and I didn’t think much of it. But when I sat down in the doctor’s office and suddenly burst into tears when something regarding giving birth came up, that was when I realised I had a lot of emotions around this topic, more than I had in fact understood myself..

So I allowed myself to try and figure things out. I wanted to weigh my options against one another and try to understand what different scenarios could mean, and also what they would actually mean to me. I talked about it with my midwife, physio, obstetrician, family and friends. Considering my history I would be ‘okayed’ quite easily for a caesarian. So that wasn’t a problem… but yes, statistically this birth ‘should’ be easier. And as long as it was straight forward – my prolapse wouldn’t necessarily get worse. Apparently? A caesarian instead would come with its own risks. Apart from being a stomach surgery and everything that entails in terms of infection risk, bleedings, not being able to lift for several weeks after…. but my personal worry about a c-section would be the fact of laying on my back. And this had nothing to do with the prolapse, but my coccyx. The first time around my tailbone pain was so much intensified partly due to laying on my back for too long and this time I was determined to avoid that position to all costs..

I was not against c-section. But my heart wanted a natural birth. I think in a way I wanted to get some sort of revenge and just do it awesome this time. Without that epidural. Without forceps.

But was a caesarean the more sensible thing to do in my situation? What if it was too risky for my prolapse (and maybe also for the coccyx) to give birth vaginally again. After all I also had to think about my family, they needed me fit enough afterwards to get on with our life! 

So what was the right choice?

In the the first part of the pregnancy I used my pessary just as normal. (By the way, how did that happen? I’m referring to a blue silicon cube I insert every day ‘down there’ as something normal? Now that’s something I wouldn’t have guessed about my life a few years ago…). Anyway it helped a lot, especially as the prolapse felt A LOT worse in the first trimester. And my then 2.5 year old kept me busy, which meant I didn’t have many chances to sit down and relax. I consulted with the gynaecology nurse and asked her for how long I should continue using the cube, and she said that it was entirely up to me. That it was perfectly safe, and that theoretically I could use it throughout the whole pregnancy if I wanted to, BUT that I would most likely find it more and more difficult to put it in and out as the belly would grow. Which made lots of sense… And she said that whenever I decided to stop it shouldn’t be a big problem for the prolapse itself, it was more of an issue in my head: I was by now so dependent on the cube in my day to day life.

And she was right, I was really getting nervous about removing it. I would normally only go a few hours tops without it and would never leave the house like that. My bladder would fall out!! But the initial worsening of my symptoms thankfully only lasted for a few weeks and a little bit into the second trimester the prolapse actually felt a bit better. Having heard of this phenomenon it was a point in the pregnancy I was hoping I would reach, but would never believe until I experienced it. Amazing!

I was still stressed about taking away the cube though, so I decided to do it gradually. I went half a day without it. First day off the cube completely was a day I spent at home. And I increased the time without it day by day…. Around 16-17 weeks I stopped using the cube completely.

My prolapse was now unsupported but a little better (temporarily, most likely) – and I was nearly half way through my second pregnancy!

So what about running? How should I be thinking this time around? Knowing the end result of my first pregnancy and birth the sensible thing to do was probably to give running a rest and make sure to avoid further damage as much as possible? But all the work I had put in up until this point.. I felt as if it would all have been for nothing if I didn’t keep going. And maybe it would actually be good for my pelvic floor to keep ‘teaching’ it that kind of stress/impact…? But there was a chance this was only wishful thinking…

And of course the result of this second pregnancy was still a blank page. Regardless of if I ran or not now, there was a risk that after this birth my prolapse and pelvic floor were going to be in a state where running would be out of the picture completely. Forever. (Dark thoughts)

So the question was, keep going and enjoy running as long as it lasts? Just in case I won’t get the chance anymore later!? Or take a step back to limit any (potential) further damage?

The reality was that because my prolapse symptoms worsened so much in the first trimester, it came quite natural to take a step back with the running. Waking up in the morning with that heaviness down there made it impossible to enjoy it anyway. Both physically and mentally. I did a few 1-2 kilometer jogs over the first weeks – just for the sake of it I guess. For my cardiovascular fitness I would have to rely on spin classes again.

So when I put the running shoes on the shelf in pregnancy 2 I did it with a sincere hope that there will still be running in my future…

We were lucky and I became pregnant relatively quickly and I was curious (maybe more nervous?) about how my body would react to this. I didn’t have to wait long and already in the very first weeks the prolapse gave me a clear reminder of its presence down there. The heavy bulging and chafing sensation which I lately would only feel at the end of a particularly tough day for the Pelvic Floor – I now felt first thing in the morning!

The pessimist inside me wondered how I would cope with this for 9 months whilst progressively getting bigger and heavier.

The optimist had learnt however that often prolapse symptoms could improve somewhat in the second trimester, and I tried to cling onto that idea as I counted the days and weeks….

The realist in me though knew that even if the symptoms would improve in the middle of the pregnancy, surely it would only be temporary. Having the weight from the baby pushing down on the pelvic floor at the end of a pregnancy, realistically it could only go one way for the prolapse issue. And on top of that the labour and birth itself!

A pregnancy filled with emotions, thoughts and concerns had begun.

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