So you have given birth and things down there feel very different.. Or maybe you don't feel anything anymore and realize that you can't hold urine in for too long...
I remember the first week after Peanut's birth, once I was back home, even though the distance between the bed and the bathroom was very short there was a time in the middle of the night when I barely made it to the toilet. I put it on the fact that because I was drinking a lot of water for breastfeeding my kidneys were producing a ton of urine. Perfectly good explanation in my mind...
Another time I tried to stop the flow of urine to see where things were at... (please know this is not recommended especially if you have a history of UTIs) And nothing happened! I could not tell what I was supposed to do... Fortunately my midwife was coming over later that day so I would ask her about it.
She was very reassuring that things would get back to normal once I started pelvic floor rehab at 6 weeks postpartum. In the meantime I could try some exercises lying down with bent knees using my breath to engage both the abs and pelvic floor.
So I tried a few times. Someone else suggested to hold a pillow between my knees and squeeze. Tried that too. To my horror, I experienced a new manifestation of my vagina.. Air coming out!!! A queef they call it... As it turns out, it is perfectly normal to experience this after childbirth...
I became super paranoid that any movement could bring this on... Queefing or no queefing when I pick up the baby? Standing up? Going up the stairs?
The worst was during a yoga class doing bridge pose... Luckily it was a private class designed for postpartum... It turned out to my relief that I was the only one noticing. It was not as audible as I thought.
Despite that I was very worried. There has been a history of pelvic floor disorders in my family so I was hyper aware of that. And I had pushed for so long during Peanut's birth...
In France there are a few methods for pelvic floor rehab with or without a device for biofeedback. The one without the device is called 'Connaissance et Maitrise du Periné or CMP. I mean leave it to the French to come up with a posh sounding name for what is essentially vagina pilates :) But it is awesome. A combination of exercises and visualizations so that you work on all the different muscles of your pelvic floor.
I had seen Deborah Vignau during the pregnancy to assess my pelvic floor before Peanut's birth and once I was back in NYC I met with her for another session. I have yet to finish all my sessions and I have been doing the exercises on my own and at now 5 months postpartum things are mostly healed (I am still breastfeeding therefore still producing relaxin which can affect ligament laxity).
Read on below my interview with Deborah.
How long have you been a midwife? What brought you to midwifery?
I have been a midwife for 6 years, I studied in Belgium. What brought me to midwifery is my fascination with what a woman's body can do.
How many births have you attended?
I have attended more than 200 births in Belgium, France and Morocco as a midwife and once I moved to NYC, I started working as a doula.
And why did you decide to specialize in pelvic floor rehab?
When I studied to become a midwife, pelvic floor rehabilitation was part of the curriculum. In Europe taking good care of our pelvic floor is a routine and all women have access to pelvic floor rehabilitation for free. When I moved to NYC 4 years ago, I discovered that it wasn't that common and a lot of women had some issues without knowing that pelvic floor rehab was a solution. So I decided to offer this service to my clients.
What would you say are the main differences between the US and France when it comes to pelvic floor care pre and post-partum?
In France, every OB and midwife will refer you to pelvic floor rehabilitation once you get your first postpartum check up usually around 6 weeks. Whether the woman had a C-section or a vaginal birth the sessions are fully covered by insurance. Both midwives and PTs can provide this service. In the US there is more of an emphasis on the pelvic floor before labor, especially in yoga classes and with kegels exercises.
Typically when do you want to see pregnant women? When can they start sessions?
Ideally around 20 weeks pregnant since for most women this is around the time when the baby starts to weigh more which could affect the pelvic floor and at 6 weeks postpartum.
Can you give us a time frame on how long it can take for the pelvic floor to feel like it did before birth? Is it different for women who have had a cesarean? Do they still need a few sessions?
Usually women who have had a vaginal birth need between 5-6 sessions and those who have had a C-section around 3 sessions. It is different for everyone but the pelvic floor is supposed to be healed 1 month after the sessions are done.
Anything different for breastfeeding mums?
Breastfeeding can affect the vagina's lubrication and for some women their pelvic floor's strength because of all the hormones.
What are the signs that your pelvic floor is in need of care? Is it normal to leak a few drops of urine when you sneeze, laugh or even cough?
You will benefit from pelvic floor rehab if you were pregnant or/and gave birth. Even if you don't have any signs of pelvic floor weakness. If you have some pain during intercourse or in your daily life. Pelvic floor rehab heals but first prevents future issues and helps the woman understand her body better. Leaking a few drops of urine during pregnancy is a sign of weakness and it has to be treated in postpartum to make sure that it doesn't get worse.
Finally can you guide us through what a session might look like?
We go over your health history, the course of the pregnancy or/and birth during the first session. I will then do a vaginal exam to check the sensitivity and strength of the pelvic floor muscles. If the client feels comfortable and has not pain during the exam, we will start the exercises with visualizations to help her engage her pelvic floor. I use 10 different exercises to make sure that all the different muscles of the pelvic floor are moving and healing properly. A session lasts 45 minutes.
Find out more about Deborah's sessions Here