pelvic health

This one thing may delay you feeling "normal" again after baby.

After having a baby there is all the talk about getting back to normal.

What is normal really?

Why is it so important to get back to anyway?

After having two children and working with countless new moms I'm here to tell you,

You're never going to normal again, and it's okay!

Normal is over rated.

Normal can be boring.

You, mama, are anything but over rated and boring.

You are wonderfully unique!

Let's embrace your non-normalcy.

If what you seek; however is feeling connected and in control of your body after having your baby, then that is a WHOLE other story.

Pregnancy and birth can be a joyous, unpredictable, whirlwind of a time. Your body changes so much that it can be hard for your systems to keep up.

Leaving you feeling disconnected and out of control of basic functions, like holding in pee when you sneeze.

I get it if that is what you mean by normal.

Of course you want to feel in control of you body again.

And over the next year after baby is born your body will naturally find it's way through healing and for the most part you'll feel normal.

Unfortunately, this is not the case for every mom, for various reasons.

Birth injury, medical interventions, csection, episiotomy, epiderals, long labors and pushing, really quick labors, these different factors play a role in how long your body will heal.

Not to mention all your past injuries and habits.

But the one thing that I've seen as a common thread despite the type of birth, injuries etc is breastfeeding.

After delivery your estrogen levels plummet. Then remain low if you breastfeed.

Why does this matter?

Estrogen plays a large role is tissue function, especially in your nether regions.

Just think a mini menopause after delivery, dry, thin, weak, itchy vagina (though really your vulva but you get the idea).

When this happens the pelvic floor doesn't function 100%.

And this can last the whole time you breastfeed.

I experienced it with my daughter. I breastfeed for 2 years, about 3-4 months after stopping, I felt like a different woman.

Now, I'm not telling you to stop breastfeeding, heck my little guy is nurse sleeping as I type. Only you and your baby can set the timeline.

But be aware that some of what you are experiencing with pelvic floor dysfunction or how your feeling may be partially due to low estrogen from breastfeeding.

Once I tell my patients this I usually see a wave of relief. That no you aren't crazy, yes you're doing everything you can do to mitigate the symptoms your having.

So I ask again, what is normal? Do you really want to be normal or just in control again of your body?

If you want help finding your normal reach out to me by setting up a free consult call. We'll figure out your next step together!

After Birth Care for Your Pelvic Floor

I've given birth twice now.

Each experiences has shaped how I view birth and my ability to reach deep down to the inner strength with in.

However, each birth resulted in different recovery needs.

My first delivery I needed to push for at least an hour, if not longer, I really can't remember. The umbilical cord was wrapped around my daughter's neck and every time I pushed the cord pulled tight and prevented her from descending. Then when I "relaxed" between contractions all the progress I made with the previous contraction was lost.

It wasn't until my midwives flipped me on my back and said "push" did I realize something may be wrong.

So I dug down and pushed with all I had left. This delivered her head. My midwife cut the umbilical cord then I was able to birth the rest of her body.

That push that birthed her head resulted in a grade 2 tear. I wasn't focusing on relaxing the pelvic floor as I had been previously I was just focusing on delivering my babe.

The tear needed a few stitches. It was uncomfortable to sit. It was uncomfortable to poop. It was uncomfortable to wear pants with a seam down the middle. I wore padscicles for several weeks around the house. I tried to reconnect with my pelvic floor the next day and couldn't feel much. And once I was feeling ready to be intimate with my husband again, there was a spot of pain.

My second birth was vastly different. I pushed twice to deliver my babe, taking only 8 minutes. I was swollen but did not tear. It was only uncomfortable to sit when I was transitioning from stand to sit to the reverse. I could wear jeans without discomfort. I successfully reconnected to my pelvic floor within 12 hours of delivery. And only being 3 weeks from birth I can't compare intimacy yet.

Looking back, even though I had prepared pretty much in the same way as the first birth, I trusted my body more the second time around. I followed the signals it gave me rather than what I thought I should do based on what I learned in class or what the midwives were telling me.

The result of each birth and recovery has effected how my pelvic floor functions. After my first birth, there was pain effecting my pelvic floor's role in bowel movements and sex. After my second birth, my pelvic floor is functioning properly, thus far!

Giving birth has been said to equate to a marathon or an Olympic event.

I can't agree more. However, there are some major differences.

After a marathon or Olympic event (if all goes well) you come out of not much different than when you started. All the training you did pays off and your body will be tired, but otherwise unscathed.

After birth, even a natural, unremarkable birth, your body is not immediately the same.

There are so many variables that effect the outcome of birth and recovery. Your body is different from mine, your baby is different from mine, your medical history, location and pain tolerance are different from mine. These variables and others make each birth and recovery unique.

However, there are similarities that can be addressed in similar ways to get the same outcome during recovery....a healthy pelvic floor that functions properly for you for the rest of your life.

Here is what I did to recover from my births. Remember some of these things every mom should do and others are more of an individual basis.

1. Afterease

I took an herbal tincture made by my midwife specific for after birth cramps. These cramps are caused by your uterus contracting and shrinking back to pre-pregnancy size and are usually most intense while nursing. This can cause some significant pain.

After my first birth, even though the after birth pain was intense, I didn't not take anything. I didn't want to take any over the counter medication if I could avoid it, since I was breastfeeding, though there are some medications that are safe to take. Being a first time mom, I wanted to avoid everything. And I didn't know about an herbal tincture that could help.

Taking something appropriate for after birth pain, will greatly improve how you feel while recovering.

2. Peri Bottle

After giving birth wiping with toilet paper can be rough and uncomfortable. Especially if you are swollen or tore.

So using a peri bottle to rinse off your perineum will keep you clean and the cool water will sooth the area too.

3. Herb Sitz Bath

A sitz bath is a great way to reduce inflammation and promote healing of swollen, bruised or torn/cut pelvic floor tissue.

Adding in healing herbs like Lavender or Epsom salts boosts the healing power of the sitz bath.

There are some great herb mixes specific to postpartum sitz baths, like Earth Mama or you can look on Etsy or you can make up your own. Here's a good recipe!

These mixes can also be brewed and added to the peri bottle or to padscicles instead of witch hazel.

4. Padscicle

These are frozen menstrual pad. You add either witch hazel or an herb ticture to saturate the pad, then pop it in the freezer.  After birth wearing a padscicle is a great way to sooth a hot, swollen or injured pelvic floor and speed recovery.

Some hospitals give you an ice pack specific for post birth swelling.  These are great, but I'd suggest making up padscicles as well to add the extra healing power of the witch hazel or herb tincture.

5. Adult Diapers

Adult diapers are a necessary evil after birth. You will continue to bleed as the uterus losses the endometrial lining that protected baby. Diapers are much easier to use and provide more protection than pads immediately after birth.

6. Menuca Honey

Honey has antibacteria and antifungal properties that help promote healing. It's like a natural version of Neosporin, but safe for your pelvic floor.

Dabbing a tiny amount on the perineum goes a long way!

7. Lymphatic Massage

After my second birth I had a good deal of swelling. So during my sitz bath I would do lymphatic massage to promote movement of the inflammation. 

Lymphatic massage is a very light massage to very specific areas in the body directed toward the heart. It is a safe and very effective massage to reduce swelling when performed properly!

8. Pelvic Stretches

In addition to lymphatic massage to reduce swelling I did pelvic stretches after my sitz bath. Stretching out tight muscles around the pelvis, like hip flexors and adductors gives more space for the swelling to move out of the area.

9. Breathing Exercises

The last thing I did after giving birth to promote healing was to reconnect with my core. I did this through breathing exercises while I nursed.

Every time I inhaled I took a full diaphragm breath filling my trunk. Then as I exhaled I would follow the natural movement of my core inward, feeling my tummy and pelvic floor drawing inward.

By reconnecting and activating my core muscles I created a muscle pump. This pump improves circulation to the area, flushing out the inflammation and bringing in healing nutrients with each contraction.

I also found that this breathing helped me get through the after birth pains.

Since I gave birth vaginally my after birth care looks different from a mom who gave birth with a csection. However, initially there are only a few differences. For examples padscicles may not be necessary. But scar care is added.

I go more in depth for immediate after birth care and progressive care in my signature program for pelvic health, 4th Trimester Expecting Pelvic Fitness.

By taking care of your pelvis after birth you are encouraging not only short term relief but long term pelvic health.

Sex After Birth...Is it Normal to Hurt?

Okay ladies, let's talk about sex. Not just sex, but sex after having a baby. You've just labored, pushed and birthed a baby either vaginally or cesarean and your body is forever changed.

So now you have to reacquaint yourself to your new body...."Hello mama body, how are you feeling today? Tired? Sore?"

No wonder the thought of having sex for most of us is the last activity we'd chose to do with our new body.

So why is sex after baby painful?

Statistics range from 9 out of 10 women experiencing pain the first time after birth, falling to one quarter of women suffering long-term painful sex. Other studies find 45% of women experience pain during sex after birth

Nearly one in ten women who had an episiotomy, tear or other forms of intervention during childbirth suffer from painful post-birth sex – that’s over 35,000 women a year!

Here are the tops reasons sex is painful after baby:

  1. Shy about our new bodies
  2. Breastfeeding
  3. Hormones & the thyroid
  4. Scarring
  5. Injured pelvic floor muscles

For many women the changes that occur to our bodies make us self conscious of how we look...stretch marks, soft tummies, wider vagina. Even though a women's body is beautiful after having a baby, many of us just aren't comfortable with these changes.

Breastfeeding changes the natural mucosal lining of the vagina and reduces the lubricant produced by the body when aroused.  This in combination with unbalanced estrogen levels from the body readjusting from pregnancy can cause the vagina to feel dry....leading to major friction during sex.

These on top of being sleep deprived and focusing 24/7 on a new baby can really reduce the sex drive we may once had.

Scarring occurs in tissue when it has been cut or torn.  So for those who tore during delivery, had an episiotomy or a cesarean the risk of painful sex is increased.  Why is this...because when scar tissue is less flexible or elastic than the surrounding tissue.  This becomes even more apparent when the scar does not heal properly and creates more scar tissue than necessary or binds down neighboring muscle.  So then when you go to stretch the scar it doesn't want to give and creates a pain response.

No matter how you delivered, your pelvic floor has been forever changed from pregnancy.  The weight it supported during pregnancy, the strain it felt during labor and the stretch it went through during delivery all play a role. "I had a c-section" you may say.  You're pelvic floor can still be affected depending on if you pushed before your transition to the c-section.  If you had a scheduled cesarian your risks are more linked to scarring, hormones, and past history of pelvic floor dysfunction.

This does not mean you can avoid painful sex by having a c-section!  There are more risks that come along with having major surgery, so please let this decision be medically based.  That is a whole different post...I have worked with many moms who never delivered vaginally but had horrific pain during sex.

So what can you do about it now?

First listen to your body...if it is painful, slow down, adjust your position, or just stop.  You don't want your body to associate pain with sex..this creates muscle guarding and increased anxiety....which are easily avoidable.

Then try some lubricant. Natural oils like coconut and olive oil can help boost the bodies natural moisture, but if you go with store bought always go with water based.  If you have sensitive skin, you may want to stick with organic brands like Sliquid.

Massage, massage, massage!!!

So think of yourself as an athlete returning to your sport after an injury.  [Not that I consider birthing an injury...it is a natural process for the female body] but bare with me.  An athlete with ice, heat, get a targeted massage, do targeted exercises for the injured area.  These help the body heal!  So why wouldn't you help your body heal by using targeted massage and exercises?

Take out that coconut or olive oil and gently massage your perineum (that tissue between the vagina and anus), especially if you have a scar.  If you have a c-section scar gently massage it and the surrounding tissue.

*Always wait for the scar to be fully closed before doing any massage*

Stretches and targeted pelvic floor awareness exercises helps your muscles find their groove again.  Because of the strain and stretch these tissues experience they loose some of their natural function to contract and may end of tightening up or weakening.

Reacquanting yourself to this area with breathing exercises to synchronize your diaphragms and create a new muscle memory will help bring back the sexual function of the pelvic floor.

Be aware though that KEGELS should not be done if you have tight pelvic floor muscles...this will only lead to more tension and more pain.

My best advice is to assessed by a women's health physical therapist who is trained in postnatal and pelvic floor care.  That way you will know exactly what your body needs!! No point in guessing when there are experts who can help!

Too many moms I have worked with waited months and even years experiencing pain with sex.  Don't wait, soreness and tenderness is totally normal the first few times you try.  But persistent, sharp, stabbing, burning, (I could go on here) is not!

Do yourself and your partner a favor and mention it the next time you see your provider. Or better yet find a local women's health PT near you..did I mention NH is a direct access state, so you can see a PT without a referral.  How cool is that!

Remember the only sensations you should be feeling during sex are pleasurable ones!

What Is a Maternal Pelvic Health Specialist?

Last week a patient asked me a very good question...

"Who should I speak with about staying active and exercise during pregnancy...because I don't feel comfortable doing that with my OB?"

I thought this was a very valid question, since she is not pregnant yet and is hoping to conceive in the near future. But then again, I must have failed at my job, for not educating her enough on what physical therapists, i.e. I do.

So here's the answer to her question: a women's health physical therapist.

Why? Physical therapists are specifically trained to:

  • understand the musculoskeletal system and our structure
  • knows the mechanics of the joints
  • how the muscles function together
  • how the nervous system plays a role in our function
  • what our mobility is suppose to look like
  • how to test for imbalances, weakness, dysfunction, tissue tension and much more related to our structure
  • distinguish best practice for diagnoses and problems to reach our patients goals with the most conservative path as possible
  • know what exercises are appropriate for certain diagnoses and problems [and which ones will do harm]
  • apply manual therapy techniques when appropriate to enhance the exercises needed to reach desired goals

Really the list can go on and on!!!

OBs and other medical doctors (not including physiatrists and DO) are not trained as in depth on the musculoskeletal system and certainly not on how to treat structural and mobility issues.  They are highly trained on knowing how to treat ailments related to the reproductive system and maternal care (or whatever the specialty is).

But their profession as a whole is lacking in knowledge about how to stay active, structurally pain free, and what exercises or manual therapy treatments are necessary for certain problems.

That is what physical therapists do!

More specifically when you are experiencing problems during pregnancy like:

  • back or pelvic pain [really any form of pain not related to the baby or reproductive organs]
    • Because really most aches and pains during pregnancy are related to our changing posture and joint instability causing tight and imbalanced muscles
  • want to stay active, but don't know how
  • pelvic floor dysfunction...incontinence, constipation, etc
    • Which may only get worse after birth
  • want more information about preparing your body for labor and delivery
  • nausea, swelling, headaches

...and want to do everything possible after birth to support your body in recovery

Then a women's health physical therapist, especially one who has been trained in maternal care and even better one who also has a deeper understanding of the fascial system and core cylinder is the BEST provider to go to of all your concerns about your body during pregnancy.

I've said it before, this country is well behind others in supporting expecting and new moms with the structural changes that occur in our bodies.  It's time to change that and offer moms the choice to see a physical therapist during all stages of pregnancy, regardless of specific diagnoses.  Because let's face it, even if we feel great, there is always something we can learn about our body that will benefit us in the long run (me included!)

a women's health physical therapist, especially one who has been trained in maternal care and even better one who also has a deeper understanding of the fascial system and core cylinder is the BEST provider to go to of all your concerns about your body during pregnancy.

To be clear my job is really to help all moms reach her greatest physical potential, it's not just to be a physical therapist.  So pass the word on to all moms [in all stages] you know, that I can bring the best out of their body!!