vaginal birth

What You Were Not Told About Birth: Part 3

Once the swelling and inflammation has gone down. Tearing or incisions have closed and superficially healed. The tissue has to continue going through a healing process which includes relearning how to function.

To better understand the long term effects we need to understand the roles of the pelvic floor.

The pelvic floor has four main functions...

  • To keep pee and poop in
  • To let pee and poop out
  • Sexual
  • Structural

These functions are influenced by the flexibility, contractility and coordination of the muscles and tissues of the pelvic floor. But they are also influenced by what is happening above and below the pelvis, daily movement patterns, and your habits.

A vaginal delivery not only stretches the pelvic tissues of the pelvic floor, but also widens our hips and pelvic joints changing how the forces travel through the body.

The pelvic muscles and tissues are attached to and support these joints. Your pelvic joints are affected by positioning, external forces from people pulling on your legs, or your inability to feel how hard your pushing from an epidural. So if your pelvic joints are injured the tissues that are attached to them can also be injured or guard to protect.

These changes can have lasting affects on the structure of your pelvic bowl and may alter the strength-tension relationship in the muscles supporting the joints and organs, most importantly the pelvic floor. The body needs to compensate by shifting your posture or you may unconsciously alter how you perform a task.

This results in changing forces within our trunk and pelvis.

When this occurs the functions listed above can be altered resulting in

  • Urine or fecal leakage
  • Urine or fecal urgency
  • Pelvic pain - front or back
  • Back pain - anywhere in the back
  • Painful sex
  • Reduced sexual arousal
  • Constipation, etc.
  • Prolapse

The longer the body compensates, guards, moves in less than desirable patterns the more the tissues will tighten, weaken and become imbalanced.

Resulting in:

  • That pesky twinge with sex now being a sharp chronic pain with sex.
  • No leakage with coughing or sneezing to every time you have a cold you have to wear a pad.
  • Once your baby starts to grow and get heavier your back aches or you can't bend over to lift the babe up because it hurts your pelvis so much.
  • Whenever you lift your leg to go up the stairs or get dressed you have pain in the front of the pelvis.

Really the list can go on and on.

The contractility and flexibility of the pelvic floor muscles in particular are most influenced by a vaginal birth and just like the short term risks, medical intervention can result in more dysfunction.

For example, an episiotomy rips more resulting in a fourth degree tear. This means the laceration affects all the muscles and tissue between the vagina and rectum, including a large junction point of pelvic floor muscles and ligaments. When this happens not only is the scar going to be bigger, which may cause increased adhesions and reduced flexibility and guarding in the tissues and muscles, but also weakness in the anal sphincter.  Resulting in increased risk of uncontrollable gas loss or fecal incontinence. On top of pelvic pain, prolapse and urine incontinence.

These issue will not be helped with just Kegels, ladies!

On a more global scale, the length of pushing during birth, regardless of medical intervention can increase the risk of pelvic floor dysfunction.

As I mentioned in Part 2, a short labor may not allow the time for the tissues of the pelvic floor to relax and stretch to expand for baby.  On the other hand a long labor and pushing can overstretch the tissues.

Not being able to relax may cause tearing, resulting in scarring. Leading to pain or inability to contract or relax the pelvic floor muscles.

Either of these can mean muscle guarding, muscle weakness, muscle spasm - which can all lead to incontinence and pain.

Over stretching the tissues also means increased risk of prolapse. What this means is your pelvic tissues are unable to support your pelvic organs and either your bladder drops into the vaginal canal, cervix or uterus drop into the vaginal canal or the rectum drops into the vaginal canal.

Prolapse is highly influenced by the support you are able to provide to the pelvis through muscular, fascial tensioning and proper pressures. This is really where the weakness of the core, pregnancy posture and any other trauma that occurs to the pelvis from vaginal delivery is be highlighted as a problem.

Another injury that is rarely spoken of is nerve damage. This can be caused by:

  • The amount of force placed into the pelvis during pushing
  • The position of the baby
  • The position of mom
  • Any external forces on mom (think partner holding onto one leg and nurse holding on the other leg while moms on her back)
  • Medicalization such as epidural so mom can't feel how hard she's pushing, or instruments.

It takes a long time for nerves to heal and if the surrounding tissues have also been injured, posture is altered, pelvic congestion or there are imbalances in tissues causing tension or guarding squeezing the nerve it'll take even longer.

The nerves that run through the pelvis not only control the pelvic organs and tissues but also the legs!

Ever wonder why it's hard to lift your leg or why your foot is numb after birth?

To recap:

Long term effects of a vaginal birth on pelvic health are:

  • Incontinence
  • Pain
  • Prolapse

These are influenced by:

  • Scarring (tearing, episiotomy)
  • Injury from vacuum, forceps
  • Length of labor and pushing
  • Ability to relax the pelvic floor during birth
  • Awareness and health of the pelvis prior to pregnancy
  • Nerve damage
  • Any other pelvic injury during birth

The good news is all of these are treatable in some way, with care from a pelvic health PT!

The sooner you are able to speak up and seek care the better.

The more women who do speak up about it and find out that these effects are not normal results of childbirth the women who will be able to live a fuller life!!

What You Were Not Told About Birth: Part 2

So now that we know the physical differences between a vaginal birth and a cesarean we can delve deeper into what these differences mean.

Part 2 of What You Were Not Told About Birth is going to be all about how a vaginal delivery affects your short term pelvic health.

As I described in the Vaginal vs Cesarean blog post, during a vaginal delivery the baby descends into the vaginal canal, pressing on the cervix for dilation then on the pelvic floor to stretch and improve pliability of the tissue before actually birthing through the vagina (technically the introitus, which is the medical term for the opening of the vagina, if you wanted to know).

Most of us take a birth prep class learning the different medical interventions during delivery to help the mom cope with pain and help the baby out. But most of us don't learn how these interventions can affect our long term pelvic health (which is Part 3)

So sit back, get comfortable, because here we go....

A natural vaginal delivery is one that uses no medical intervention. For most moms this is the goal and if you want to know more about why, here's a great article to read.

However, having a natural delivery doesn't mean you won't experience birth injury or complications.  This is not meant to scare you away from a natural delivery, because comparing all birth methods women with a non-instrument delivery have 30% less birth injury than instrument delivery. These findings do not include epidural side effects or injuries, which you can read more about here, but may increase the risk of instrumental delivery thus birth injury.

To get down and dirty, having a natural delivery, has the least amount of external variables that have risks and benefits. The more variables you add in the higher the risk of birth injury.

Immediately after a natural vaginal delivery your pelvic tissues are swollen, inflamed and sore.

Even if no major birth injury occurred during delivery, there are still micro injuries that happen as a result of the stretching of the tissue.

This micro trauma is influenced by the health of your pelvic tissues, the length of labor, your positioning during birth, and the amount of pushing you do.

Just like any trauma or injury to your body there are reactions within the tissue that cause inflammation and a cascade of pain mechanisms.  This is all totally normal! The larger the injury or trauma the more severe the swelling, inflammation, tissue dysfunction and potential pain.

How does this influence your short term pelvic health?

  • Peeing and pooping can burn, be sore or painful.
    • You may not be able to hold your pee or poop.
    • Or you may not be able to let your pee or poop out.
  • The area will be sore or painful to touch.
  • It can be uncomfortable to sit down.
  • Altered sensations.
  • Weakness in surrounding areas.
  • You may not recognize your vagina.
  • You won't even want to consider sex.

This dysfunction escalates when there is tearing, instrumental or medical intervention.

  • Epidural headache
  • Pelvic joint pain - Sacroiliac joint or pubic symphysis
  • Coccyx pain
  • Nerve damage

The degree of tearing, episiotomy and any injury from forceps or vacuum assist delivery means the more tissue involved, more scar tissue developed, the longer the body heals.

For many women these short term affects gradually go away and don't seem to alter the quality of life.

However, these changes in the tissue last a lifetime and if not addressed can cause long term problems.

The simplest and most effective way to address these short term affects is by being informed about the risks, knowing your options, understanding your body and how your lifestyle can influence how your body will respond to labor and delivery, and preparing your body for birth with appropriate exercises and birth skill practice.

Of course there are other management tools for swelling, inflammation and pain, like soaking a menstrual pad in witch hazel and freezing it to wear, using witch hazel wipes for toileting, sitting on a backward Boppy, diluting honey and gently massaging into the healed scar (once the stitches are gone).

I understand that even being proactive, things can happen that are not within your control like if baby suddenly changes position, contractions are coming fast and furious making your labor super short and your body doesn't have as much time to prepare for pushing, or your life and your baby's life are threatened and an emergency cesarean is required.

Just know having prepared your body for the changes that occur with birth, even if the birth does not go as planned can make a world of difference in the long run.

 

 

 

 

Vaginal Birth versus Cesarean

To continue the What They Don't Tell You Series we need to talk about the differences between birth methods so we can understand what happens to our bodies during each.

Most of us know the two ways babies are birthed: vaginal and cesarean.

You may be thinking, "well of course I know the difference" and if you've experienced both then you have a leg up on the rest of us.

However, most of us don't really know the physical differences each has on our body.

Let me help clear that up.

A vaginal delivery is just that, the baby is birthed through a small hole in the pelvic floor, aka the vagina.

A cesarean delivery, the baby is birthed through an incision made in the abdomen and uterus.

Now, let's look a little closer at each.

VAGINAL DELIVERY

A vaginal delivery may be natural with no medical intervention or have medical intervention.

A natural delivery means the woman's body went into labor on it's own, chose or was unable to use medication for pain relief, and did not need any equipment or intervention to remove the baby from the vagina.

Medical interventions during a vaginal delivery may include: induction (which may include membrane sweeping if not consented), pain relief medication, IV, fetal monitoring, forceps, episiotomy, and vacuum.

Without getting extremely technical what our bodies need to be able to do for a vaginal delivery is the following:

  • Open and expand the upper pelvic rim and SI joints
  • Use the power of the uterine contracts to help the baby descend into the vaginal canal
  • Open and expand the lower pelvic rim and coccyx
  • Relax the pelvic floor

This process may be affected by the position of baby, pregnancy complications (preeclampsia, placenta position, etc), pain management, medical interventions, distractions or actions that may slow moms progress.

This is where I can get super detailed about what happens to the body, especially to the pelvic floor, but that is for future posts.

Ultimately, our body will either be able to pass the baby through the vagina or the decision will be made that a cesarean is required.

CESAREAN

There are two ways a cesarean is the birth method... an emergency after pushing is not successful or the life of baby or mom is at risk and a scheduled cesarean.

Before an emergency cesarean the mom's body goes through the same processes as a vaginal delivery and may even have other medical interventions performed prior to the cesarean.  She may even push for hours, which can  affect the pelvic floor almost as much as a vaginal delivery.

For those who have a scheduled cesarean, the mom knows exactly when she will be birthing the baby.  A cesarean is scheduled for many reasons, a few of these are pregnancy complications like placenta privea, baby's position, being "over due" and for some a previous cesarean.

This is what happens to the body during a cesarean:

  • A catheter is placed so you can pee
  • The mom is given a spinal block or epidural to numb the lower half of the body. In some emergency situations general anesthesia is given.
  • Horizontal incisions are made just above the pubic bone - cutting through skin, fat, and fascia.
    • The muscles are not actually cut, however the the fascia that connects them are and then separated to pull the muscles apart.
  • The uterus is then cut and the baby is eased out
  • The uterus is massaged to help the placenta release
  • The incisions are stitched or stapled back up layer by layer
  • Then you are in recovery - where you catheter is eventually removed

 

So what really happens to the body during a cesarean beyond the steps of getting the baby out. Again, this is the topic of another post.... so stay tuned.

To recap...a vaginal delivery requires a full stretch of the pelvic floor to birth the baby & a cesarean is major abdominal surgery.

Regardless of the birth method your body just went through intense changes during pregnancy which affect the structure of the pelvis, spine and soft tissues in the abdomen and pelvis...not to mention other joints like our feet and shoulders. Which means your body has already undergone changes that have nothing to do with birth method and can affect long term health and fitness.

To be continued...