Pregnancy and parenting for the perplexed
There’s a lot of pseudo-acceptance of the change that pregnancy and childbirth wreak on an individual’s body. For celebrities the public eye, this is painted as lip-service to a not-very-big-deal — provided, that is, that you can get back down to your pre-pregnancy silhouette quickly. For high-powered executive women (like Marissa Mayer: CEO of Yahoo) the ability to continue as though virtually nothing has changed seems to be a veneer of approbation, but underneath is the clear expectation: it should all go back to how it was.
Things shouldn’t change that much. You just have a tiny person to look after now. But physically, things should go back to how they were, give or take the odd stretch mark. Right?
When I was pregnant, I knew that my body would change. Over the course of the pregnancy, as a result of labour, breastfeeding, and having a lifestyle change.
But it’s surprised me how this process has continued. Exactly 16 months after I gave birth, I’m discovering new things about what it is that’s happened to my body. I don’t wish I had my ‘old’ body back; on the contrary, I’m proud of my body and what it accomplished, largely by itself, in bringing a healthy baby to term and delivering her under difficult circumstances. But it’s a surprise to me that some things can have changed so fundamentally, and that it is only now, having seen one particular specialist, that I can even identify what it is that has felt different after all this time. It surprises me, too, that the basic anatomical architecture of the female body isn’t more widely known. And, I know I know, people have babies all the time, and here I am in a pretty privileged society, with a strong educational background and good medical support. But then I think, well if I’m in this position, how many more women are affected by similar issues?
To set the scene, at the point of falling pregnant I was 30 years old, pretty fit, pretty healthy, and hypermobile. I have an old back injury from slipping a disc (a result of hypermobility) but otherwise am pretty fit. If I don’t exercise, then I get achey and sore very quickly — again because of the hypermobility, which basically means that my tendons and ligaments are too stretchy — so my muscles have to be fairly developed to help compensate for this and keep joints and posture in an optimal position. During pregnancy, a hormone called relaxin is released which helps loosen your body’s architecture to help make room for the growing fetus. In someone with hypermobility, as I discovered, this can easily lead to injury. I ended up having to wear a weird elastic belt/girdle thing to help keep my hips in place as I walked and sat, had to stop jogging and even stretching, and also couldn’t walk for very long. I was used to running several times a week and walking to work (~30 mins each way) so this was a bit of a pain; and of course my muscle tone diminished, which created something of a feedback loop. Very annoying. Sacroiliac pain is debilitating, and there were a few occasions where I had a terrifying glimpse into the chronic pain and immobility of serious back instability. I also have endometriosis, and just before falling pregnant had had surgery for that condition to ameliorate the crippling pain I sometimes suffered from during sex and periods.
But in order to really understand the physical change between my body 2 years ago and my body now, you need to hear about labour. My labour was pretty bad. I say that without trying to compete with or compare to anyone. It’s taken a while to accept that what happened was, by pretty much anybody’s standards, incredibly painful and long. The best thing about it — and it’s really a great thing — was that we ended up with a healthy baby. But the mechanics of my labour fundamentally changed my body.
You get told in antenatal classes that labour happens in stages; that there’s ‘normal’ but that normal is a pretty broad set of experiences. Usually irregular contractions start, then water breaks at some point, and then contractions become regular and closer together in ‘pre-labour’. Most first-timers are in pre-labour (no pushing involved, just getting through contractions while the cervix gradually opens) for a number of hours: we were told anywhere from 9-12 could be expected. Then there’s a ‘transition’ period, which is where you hear stories of women abruptly deciding that they won’t actually go through with this, thanks very much, and can I go home now? Followed by the ‘active’ stage which is, you guessed it, pushing the baby out.
The dynamic interplay between the mother and the baby is really important. For example, breathing through the pain to stay as relaxed as possible reduces not only the stress felt by you (and the baby) but also allows muscles to stretch and shift with the least possible pain. Babies generally move through the birth canal as helpfully as possible, presenting the smallest circumference of their heads (technically occipital anterior) to the cervix. The even pressure of this part of the head on the cervix is part of what helps the cervix to dilate evenly, and keep contractions coming rhythmically.
My waters broke 12 hours before contractions started, and within an hour those contractions were a minute long and a minute apart. It wasn’t meant to be this fast! I thought, as we drove as fast-carefully as possible to the hospital. I laboured with a posterior (OP) baby firmly wedged into my pelvis, trying to change her position to anterior for over 6 hours. She was so firmly wedged into my pelvis that although she tried to spin around (those massive muscular movements were amongst the weirdest sensations I’ve felt), she couldn’t manage it — her head was caught between the spurs of my pelvic bones, and as a result her spine kept grating on my spine. The back pain resulting from this was the worst pain I have ever experienced or can imagine. On top of this, I had a ‘premature urge to push’. I was there thinking “don’t push, body, don’t push, it’s not the right time” (being only 3cms dilated) but my body just did what it did. I had no cognitive control whatsoever over the muscular coordination of my own body during those contractions. I had a ‘failure to progress,’ over those 6 hours, meaning I was still 3cms dilated which is exactly what I’d been when admitted.
I remember eating dry toast when I arrived, and drinking water, and leaning naked in the shower trying to ease the pain of my back while holding this wide-legged, butt-out, bent-kneed stance with my arms splayed above my head on the tiled wall, with the water running down over me. This was supposed to help. It was exhausting, but I kept switching from that position to leaning against the edge of the bath, and back again, with just the hot water and the gas & air to try to help manage the pain. When they examined me after 6 hours and I was still only 3cms dilated, and the pain of lying on my back so they could check made me tell me partner to just “turn me off”, I asked to be moved to the labour ward so I could have an epidural. When I say ‘asked’ I really mean ‘demanded’, as I lurched across the public hallway that connected the birth centre and the labour ward stark naked with a midwife running after me to throw a gown across my back. I needed relief from this pain, immediately or sooner.
It was only after the epidural took effect that I could see again, and it was only when I could see again that I realised that some key parts of my brain had pretty much been shut down since we’d arrived. About 12 hours after I could see again, B was born.
I needed stitches, but at the time was told it ‘wasn’t too bad’. I was given a local anaesthetic, which really hurt, and which anyway didn’t work, because I could feel the needle going in and the thread pulling through me. A truly horrible experience. I had a catheter (having had an epidural, this is required), which had to be removed, at which point we discovered the registrar who did the embroidery had, in fact, looped a stitch through my labia and around the catheter; it was stitched in place. Having been reassured that the catheter removal was basically not even noticeable on the pain scale, this was a horrible surprise. Four days later, during a home visit from a midwife, the idea that my nethers were not in too bad condition (the impression that the hospital midwives gave) was totally blown away by the expression of sympathetic pain on the visiting midwife’s face. “Ouch!” she said. “You’ve really been through the wars!” I was still in bad shape as far as my back and pelvis were concerned from the labour; I had oedema in my legs and feet from the labour and the after effects of pain, which made it hard to move around, and I had been sitting trying to learn to breastfeed approximately seventy thousand times a day, gingerly placing my derriere on a complicated topology of cushions and with a condom filled with frozen water down my knickers as an ‘intimate ice pack’ to soothe the area, or at least numb it.
Discomfort isn’t the word; and now these words of sympathy made me reluctant to examine my own body with the aid of a handmirror, lest I see something gruesome. I couldn’t help wonder whether sex would be okay again at some point; whether it would all go pretty much back to normal; whether I would be too tense or scarred for it to be pleasurable.
Fast forward to now. The feedback between brain and body is incredibly sensitive. I’ve known for a long time that things are not, in fact, ‘back to normal’ or even approaching normal. My cervix feels centimetres lower in my vagina than it used to. It’s also a different shape, and a stitch in my vagina has left scar tissue. This has made sex uncomfortable to say the least. While I haven’t had post partum incontinence, I have been very aware of having to strategically pause and tighten my pelvic floor before sneezing. Things have just not felt right. When I have gone running, trying to build my cardio fitness back up, it’s felt sometimes as though my insides will just drop out from between my legs. It’s felt… loose, unstable, and sensitive. I’d been doing pelvic floor exercises post partum, and holding everything as consciously tight as I could, to try to rebuild strength, but I couldn’t tell if it was working. In a frank, drunken conversation at a bar with some friends from my mothers’ group, I told them about this stuff, and they told me to go to a Women’s Health Clinic to get checked out, or to try to make an appointment to see a midwife.
I went and saw a physiotherapist at the WHC near me shortly afterwards, having not even known that physio could help with these kinds of issues. I will say that while I am pretty relaxed about my body, privacy, and physical function since labouring and giving birth, internal physiotherapy is one of the weirdest treatments I can imagine. That said, the conversational anatomy lesson I got while getting pressed and prodded was fascinating. The pelvic floor and its function is much more complex than I had realised. As it turns out, on the right side my pelvic floor muscles have been in deep spasm probably for over a year. This tightness of the muscle, and the unevenness of it, has probably been causing some of the discomfort during sex. In addition, I have two partial prolapses, which is why my cervix feels lower — it is — and why I need to consciously tighten my pelvic floor when I sneeze, because I feel like I might wet myself — I might. It’s probable that in my case the fascia which support the pelvic floor muscles were damaged during birth. There isn’t any way of repairing this connective tissue, but my physio gave me exercises to do which will consciously improve the co-ordination of my pelvic muscles again, and their stamina, which will hopefully stop anything getting worse. I still won’t be able to run for a long time, though. There’s heaps of other complicated and very deliberate exercise I will need to do first.
And should I fall pregnant again, a c-section might be the best way of delivering in order to avoid doing more permanent damage.
I’m well aware that I live in a country with great healthcare and am proactive myself in looking things up and doing a bit of research. It simply wasn’t a part of postnatal care or information when or where you’d expect it to be — in the hospital after birth, or at home during a midwife visit, or, for that matter, at the 6-8 week post-partum GP check. My friends telling me where I should go is the only reason I know all this now — and with one exception, they are all first time mums themselves! I feel like there is a lot of useful information and support lacking around new mothers, and a lot of language that is unhelpful. For example, in labour, the phrase “failure to progress” or “failure to dilate” implies a level of physical responsibility and simultaneous lack of control which is very disempowering for a women who is doing a really complex thing under enormous pressure and in pain for the very first time, over a course of hours. And don’t get me started on breastfeeding — I think this McSweeney’s article summarises that pretty perfectly. There’s so much other stuff, mostly centred around the baby, to think about that it seems natural — normal, necessary — for the mother’s wellbeing or self-knowledge or adjustment to take second place, well behind the needs of her new baby. But holy hell do I wish I’d know about this last year. I wish it wasn’t at the point of me confiding my issues with female family members that they said “oh, yes, that happened to me as well”. It feels like we find our solidarity, our reality, after the fact, not before.
It’s been a real eye-opener to learn all of this well after the fact. The lack of coherent, integrated information about what can happen, diagnosis, healthcare and management options, has truly surprised me. Certainly at the time I didn’t feel as though anyone was holding anything back; but then again, professionals can only give you information based on an idea of normal that is, as I’ve said, really incredibly broad. But the medical information based on this mythical ‘normal’, combined with the media’s representation of successful women ‘bouncing back’ works together to create an atmosphere of self-doubt and uncertainty, sometimes even shame, about the individually specific realities we face after labour and birth. What we lack, culturally, is openness and conversation about real birth stories — not for the purposes of throwing a pity party, or one-upping anyone; not for any reason to do with ego or prestige, but just so that we know, before it happens to us, that there isn’t really a ‘normal’ — that normal is an aggregate, an average, rather than a person. It certainly won’t be ‘normal’ when it happens for the first time.
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