Your pregnancy stories matter. Your birth stories matter.

When I see a female patient I always ask about birth history, regardless of how old her children may be. Whether she is a new mom, a not so new mom, a woman who would very much love to become a mom, or a mom who has experienced the loss of never having the chance to meet her baby, all of these stories matter.

When looking at first time mothers, research has shown us that most change within the pelvic floor occurs during the 9+ months of pregnancy, despite whether delivery is vaginal or cesarean. As Elizabeth Banks said in the movie, What to Expect When You’re Expecting, “Making a human is really hard”! Your body goes through so many changes. So many. However, I will say that a difficult vaginal delivery with tearing or episiotomy will cause additional changes, as will scar tissue and significant abdominal weakening from a cesarean.  Hence, when a woman walks into my office for an evaluation, her pregnancy history is so important to consider. Her youngest child may be 45 years old, but if she had a traumatic delivery she is likely still restricted from scar tissue and adhesions built up within over time.  Not to mention the compensatory movement patterns she has developed and the weakness I usually see within the true core muscles, including the abdominals, glutes, and pelvic floor.  If no one has addressed or even considered these possible contributing factors before, it’s important that we do, no matter how long it has been since these muscles were last used properly.

Let’s compare something. If you had arthroscopic knee surgery you would likely be referred for physical therapy once or twice per week, maybe even more often depending on your goals. After these few hours of surgery, rehabilitation will include a full evaluation by a physical therapist and a progressive treatment plan with home exercises to restore the strength and function to all muscles involved. Thank goodness you have guidance and rehabilitation for this, right? Aren’t you glad the surgeon didn’t wake you up after the surgery and say, “Time to get up and get out. Your body should be able to heal on it’s own if you just give it time”. No way. You may have a short recovery time in an outpatient surgical suite, but there is almost always follow up to help you heal. Now, what if I said, “Just go have a baby and get over all of the physical, not to mention emotional, changes on your own. If you experience leaking, pain, pressure, etc, this is ‘normal’ postpartum. If it’s too painful to have sex again, well, just push through it”. Most providers will not say it this way, but our culture here has pretty much disregarded the importance of caring for mom after she brings a baby into this world. Nearly 10 months of growing and carrying a human being and after birth there is hardly enough attention given to mom’s recovery unless “significant” trauma is seen. If you had your baby in France you would likely be given six weeks, or 10-20 treatment sessions with a physiotherapist who specializes in pelvic floor rehab. Other than having better food, wine, and architecture, what makes the French so special? Well, their healthcare system may not be perfect, but they definitely care about the journey of pregnancy and birth status post delivery.

Now, as I step down from my soap box, let me close with this. Just because symptoms after pregnancy or birth may be “common”, it does not mean they are “normal”.  In a perfect society we would address symptoms the right way and definitely sooner than later. We would emphasize prevention and wellness. If you have unresolved symptoms that linger, or slightly improve after birth, it is still important to address the possible causes so that you can restore your body properly – it’s like planning for retirement. If you want great control when you’re 80 years old, you need to invest in proper planning and training of the muscles that will help you do so while you’re young. Now, is it possible to reverse symptoms even if it has been a decade, or four? Progress is almost always possible, in some shape or form. Whether it be complete resolve of symptoms or even guiding someone to another provider or specialist to address underlying causes that may have never been addressed.

You are your best advocate, but sometimes having a navigator is necessary, particularly one who shares the belief that your pregnancy and birth stories matter.

Best,

Dr. Sarah Capodagli