Women with POP with find their magic again

POP at 29 / Story at 35

I went into childbirth with my eyes wide open – or so I thought. I knew the realities of delivery; I often covered the postnatal wards seeing new mums with third and fourth degree tears post normal vaginal delivery. I was also a participant in a study looking at the association of ethnicity and levator ani muscle elasticity with avulsion injury (pelvic floor muscle detaching from the bone) following vaginal delivery. It honestly just did not occur to me that it could or would happen to me… 

I am a physiotherapist, and right up to having my first child I worked in a tertiary hospital. I was on my feet all day, up and down the stairs and often physically assisting patients out of bed. My body was strong and supposedly fit for purpose.  

I had been told from a young age I had “child bearing hips”. I had lived in Nepal for six months and mastered the art of a full squat, I taught diaphragm breathing control to patients every day, my midwife had no concerns and neither did I. Nine months before delivering my first child I ran my third marathon, throughout my pregnancy I did ballet, walked, and swam AND I did my pelvic floor exercises.

Even though I felt physically prepared for a vaginal delivery I was more than prepared for the situation to change and a C-section to occur if it was indicated. I just wanted a healthy baby; I did not really have any regard for the state my pelvic floor could be in by the end of it.  

I had a prolonged second stage of labour, I pushed for four hours and during that time was moved from the birthing centre to the hospital where it was established he was too far down. After an episiotomy, the ventouse was applied and then the forceps – by that stage I was ready for a third degree tear and I was okay with that, torn muscles heal back together with exercise. I could handle that I thought – I knew how to rehab a torn muscle.

For me, the birth itself was not where the trauma lay, but came afterwards in the reality of the situation. I was prepared for the recovery needed postnatally, I knew how much the pelvic floor stretches to deliver a baby. Yet while I was pregnant I dreamed of buying a running buggy to take my son in when he was six months old. I was looking forward to sharing with my children the freedom that comes from running, and running with them for years to come. Post-delivery, I knew what I had to do to heal a third degree tear so I parked that running goal out further in my mind for at least 6–12 months and I was ok with that. I mean I could barely tolerate the pressure on my pelvic floor when standing…

Deep down I knew something wasn’t right and I thought I knew what it was too, but I didn’t want to be right. The pressure, the urgency and incontinence, the lack of sensation, the bulge. At six weeks the ultrasound of my pelvic floor muscles as part of the research study followup confirmed that I had a prolapse. The pelvic floor muscle was torn away from the bone, almost completely on one side and partially on the other. 

What was going to hold my organs up now? What was going to control my bowel and bladder? Unlike many other women I was well aware of POP and the role physiotherapy and pelvic floor exercises play. I just didn’t think it would happen to me at 29 years of age! Perhaps I would have accepted it better if it happened to me at menopause and could contribute it to all the years of running and the hormonal changes. Perhaps it would have been easier to accept if I was that bit older and less active and more content to no longer be able to run.

I was aware of my advantage, I had my knowledge, I am so lucky to have very close friends who are women’s health physios, I have friends and family who openly discuss the realities of childbirth and the postnatal period – but I still felt lost. I was also lucky that I would explore private options for followup due to the ACC injury from delivery, and I knew how to access what I needed and was entitled to. Not everyone is so lucky.

I had already started my pelvic floor exercises; I was lucky enough to get into the treatment arm of the research and get weekly physio for twelve weeks. I did thirty minutes of pelvic floor exercises daily at home, I got a pelvic floor biofeedback and e-stimulation device. While I was waiting to be fitted with a pessary I wore a sea sponge to relieve the pressure, alongside lying down and lifting my hips up often during the day. My vagina became very clinical, it had long ago lost its magic.

How was I going to exercise, let alone be on my feet all day for work, often physically assisting patients, if I could barely stand to do a job at home? At the nine-month mark I had a followup with a women’s health physio who was impressed with the strength I had achieved based on the injury I had. She was lovely, but her statement hit me with the reality that “this was as good as it was ever going to get until I stopped breast feeding” and I wasn’t ready to do that…

I work in a female dominated medical environment and childbirth always comes up in the lunchroom. Half-truths are told and others tell us to “not put the pregnant ladies off” when true birth stories slip out. 
In my work, and all areas of the medical field, there is the serious concept of informed consent. Are women truly informed, not just about the delivery and pelvic floor, but about the risk of prolapse during the postnatal or menopause period? I think not, based on the number of mothers I see running while their babies are still in capsules, the number of women doing classes/boot camps offering childcare for babies and toddlers but that are full of high impact circuit exercises.

If I had a sports injury that meant I had to give up running/high intensity exercise I would openly tell people about it. When I kept getting asked about returning to running or asked to join an exercise group I made excuses first, then I started saying I had a birth injury. I still don’t say “during labour I tore one side of my pelvic floor muscle completely away from my pubic bone and partially pulled the other side, now I have a prolapse and wear a pessary”. I will most likely wear a pessary in some way forever, even if I should have a surgical procedure to lift my prolapse. There is no way I can replace the muscle to offer the long-term support to lifted organs to ensure they don’t re prolapse (which is common).

There is grief – grief at the loss of what was and what could have been, grief at not being able to return to my running and ballet, grief that I won’t be able to run with my boys. I used to run with my brothers growing up; I cherished those times and looked forward to doing that with my children. The grief still is largely unprocessed, the “at least you have a healthy baby comment” doesn’t help. We are allowed to grieve, we have every right to be angry and sad and frustrated, we have every right to feel alone. We have every right to miss those activities we enjoyed or even those we wanted to enjoy with our children.

I was lucky with my contacts and knowledge, I am lucky to have such a supportive husband who lets me deal with this in my own time – not everyone is so lucky.

It is now six-and-a-half years since my bilateral pelvic floor avulsion post forceps delivery and four years post my elective (but emergency) C-section. I can run a short distance to chase a toddler but my 6-year-old is faster than me now…

I reluctantly took up biking, although it was never really my thing. I bike a 4km section of my commute to and from work each day. Now a year later, I do enjoy it and I miss it if I don’t do it. I am not sure it will ever replace running for me but it’s not a bad substitute. I do Barre, there is no jumping or leaping but again it’s a good form of exercise. I listen to my body and often do nothing or lie with my hips in the air to take the pressure off my pelvic floor. I still miss running; I miss my strong, powerful body that got me from A to B.

It’s a long, hard, lonely journey to some kind of recovery. We need to be realistic in the amount of time it takes to recover postnatally. If you have a birth trauma there needs to be time to recover from the injury and time to rehab it – just like a sports injury.  You need to give yourself a break and you need to give yourself time to grieve. We need to find ways to support open communication so we can truly support women with POP to find their magic again!