If there is at least one lover of the Sex and the City series, perhaps you’ll recall an episode in which Charlotte learns that her vagina suffers from depression (Sex and the City, season 4, episode 2: The Real Me). Although the problem of the character leads (and will continue to lead) to bursts of uncontrollable laughter among women all over the world, it concerns a very important issue namely the feeling of being beautiful “downstairs” and translating this feeling (or lack of it) into a sense of femininity.
In the series, during a lunchtime conversation, Charlotte confesses that not only had she never looked “down there”, but she feels that “it” is ugly. Of course, not all women feel the need to know every millimetre of their bodies, but it often changes in the perspective of pregnancy and the upcoming birth. The fact that the most intimate part of the female body is supposed to be a window (or perhaps more of a door) to the world for a new human is terrifying (I respect the fact that for some people it is beautiful). Fortunately, birth pains minimize or completely eliminate thinking about how many people judge the condition of the birth canal, which was once the womb. And when we succeed, we bring this human miracle to the world using our strength (I completely don’t understand why this act is called the birth by “forces of nature”, since it happens more so by the absolutely supernatural strength of a mother-to- be, not by the unspecified natural force). And then what? Then a rough ride begins with no seatbelts whatsoever. Total psycho-physical rollercoaster – those who have survived it, know it.
In my opinion, the word “massacre” should be synonymous with the word “childbirth”. Are we the women prepared for this? Do we know how to deal with the changes that have taken place in our body, including “the place where the miracle happened”?
There are some individual opinions about what things can look like after childbirth: from the very general “nothing will be the same anymore” through “the end of sexual pleasure” to the absolutely extreme “soggy box”. But how to deal with such a state of affairs is not heard anywhere, nobody says anything, and if they do, it’s a warning.
After birth, there is little talking with women in childbed about their condition – the issue of neonatal care always prevails. Women have to cope with their own physical and mental state on their way home. The psychological sphere is gradually being discussed right now – we hear more and more frequently about baby blues or post-natal depression. According to the reports, from 2019 onwards every woman before and after childbirth will have to take Beck’s depression test, which enables early diagnosis of postnatal depression and provides basis for referral to a specialist for treatment. Such a change is of great significance, it is intended to be introduced in the Regulation of the Minister of Health of 20 September 2012 on standards of medical management and procedures during provision of perinatal health care to women during physiological pregnancy, childbirth and the puerperium, and neonatal care
(Journal of Laws of 2016, item 1132).
Unfortunately, the equally important issue of women’s physical condition after childbirth is not mentioned in the aforementioned regulation. There are no guidelines on the postnatal rehabilitation of mothers. We are talking to Izabela Żak, a physiotherapist specializing in the prevention and treatment of pelvic floor dysfunction, about why postpartum pelvic floor therapy should become a norm in postpartum care.
TMM: What ailments do women experience after childbirth? Are these problems specific only to women after a natural birth?
All women after childbirth suffer from various disorders – some of them will recede spontaneously, yet many problems will remain and the untreated ones will increase over time. These are a result of pelvic floor muscle injury that occurs during childbirth. From the point of view of physiotherapist, the black list includes above all: stress incontinence (unintentional leakage of urine during coughing, sneezing, lifting, climbing the stairs, dancing), urine accumulation in the bladder, feeling of insufficient emptying of the bladder, frequent inflammatory states of the bladder, urinary urgency, lowering of the vaginal walls (which may lead to aesthetic changes), pain and leakage of urine during intercourse, lumbar spine and hips ache, lack of sexual satisfaction, and intestinal dysfunction. According to studies, the type of delivery has no significant impact on the risk of these ailments – pelvic floor muscles work in contraction with deep abdominal and dorsal muscles, so damage to the abdomen during C- section will also affect the bladder and reproductive function in the future. Studies have shown that 5 years after childbirth, women’s complaints are similar – regardless of whether they gave birth naturally or by Caesarean section.
Are women aware of potential perinatal injuries and how to address them?
I think that the women who give birth for the first time don’t have this awareness. Their thoughts naturally focus on the child. However, each mother should also think about herself in order to feel comfortable in her new role also from a physical point of view. The knowledge that your body needs assistance to get back to the state before pregnancy is of great value. It is worth remembering, however, that our body needs as much time to recover as it required during pregnancy to change. I’m deeply saddened by the pictures of celebrities, which show perfectly slim figures one week after the delivery. I find the approach pathological. The woman’s body simply does not work like this. However, unfortunately, many women are trying to follow their example. Of course, in the event of any postnatal ailments, you should talk to a gynaecologist who will arrange for a proper diagnosis, or to a
physiotherapist who will determine the appropriate conservative treatment.
Who can women turn to for information? Is the provision of information to women on potential birth-related injuries a standard postpartum medical procedure in Poland?
Many of my patients complain that no one was able to tell them what they could do and who they could go to. They often heard “get accustomed to it, it’s just like that after the delivery”. Of course, there are doctors who recommend rehabilitation and let them be praised for it, but the patient is unable to find a therapist who works on the matter – even so the time is running away, the ailments are escalating and the only solution is surgery.
Is there postnatal rehabilitation in Poland?
Something slowly begins to change, but it is a drop in the sea. I’ve had very unpleasant experiences – a few months ago I visited more than 20 Chambers of Midwives in Poland with a proposal to organise lectures on postnatal rehabilitation, which could be conducted by professional midwives. The interest in the subject was huge, midwives were very keen to learn, but the Chambers claimed that they would not be able to finance the training even in part, although the costs were relatively low. It seems that these issues should be regulated at a different level than that of local authorities.
And what is the situation in other European countries? Where is postnatal rehabilitation in the current world?
It’s a completely different story. Civilised countries look after their mothers. Women who have given birth, e. g. in France, have a refundable pelvic floor muscles re-education after each delivery, in Australia in turn, if there is a risk factor for the occurrence of perinatal trauma (i.e. high weight of the baby, incontinence during pregnancy, narrow pelvis, claws, a ventouse delivery, prolonged phase II of the delivery) – they are provided with perinatal care until the muscles return to form, sometimes even several months.
Can we prepare ourselves for labour so as to avoid or minimise the negative effects of childbirth?
It is important to give birth in a decent setting. You should also talk to your doctor or midwife about oxytocin, perineal incision and caesarean section beforehand. If possible, give birth with natural forces and treat the Caesarean section as a medically justifiable last resort. Learn to tighten the pelvic floor properly during pregnancy, cough and lift it up so that it is natural and simple after birth.
What do women gain from pelvic floor exercises?
Proper functioning of the urinary bladder, reproductive organs, healthy back and hips, and also POWER. In my opinion, the awareness of pelvic floor muscles gives women a sense of female value and femininity as an inner strength. In the past, the women passed on the mysterious art of special exercises from generation to generation, and now, by relaxing intergenerational ties, we have lost these opportunities, so we think that we are weak and look for confirmation of our own femininity in the eyes of others. A strong pelvis means a woman’s inner strength, this has an incredible effect on other spheres of functioning – in a relationship, at work, in all human relations. This is a completely different, higher dimension of the woman’s well-being, and her physical health only coincides with that.
Pelvic floor training is the absolute prerequisite for getting things right after childbirth. Moreover, it turns out that by taking care of our physical sphere, we can find the strength that we often lack in our everyday life. Unfortunately, for the time being, we cannot count on any advice from the hospital staff after giving birth. We need to make sure that our self-consciousness is consolidated and communicated further.
Let us not remain silent about how we look and feel after childbirth. If your vagina has depression and it is simply wrong – which will translate directly into your sense of femininity – look after it, heal it – because you can. And then “Keep calm and watch Sex and the City”.