The reality of what can happen to your body after childbirth is often not discussed. There is so much focus on the delivery itself, that the aftermath following the big moment is often overlooked.
It can happen when you cough. It can happen when you sneeze. It can happen if you go for a run. You should completely forget about jumping on a trampoline.
There are three horrifying, yet common things that can happen after childbirth, but no one seems to talk about them. The thrill of the baby and motherhood itself overlooks the fact that most mothers still suffer from embarrassing and painful bodily conditions as a result of childbirth.
Those three things are:
1. Wetting your pants.
The Continence Foundation of Australia (CFA) reports that the incidence of incontinence after childbirth is one in three. This is extremely high. If you look around at your girlfriends with children, chances are someone is having issues.
One of my patient's (let's call her Jane) was experiencing stress incontinence (leaking with coughing, sneezing and exercise). This started after the delivery of her son, Harry. She told me she couldn't wear a G-string because she couldn't wear one without a pad big enough to catch her leaks. She hadn't been able to wear a G-string for two years now due to needing to wear pads daily, and was terrified she was going to have a accident in public, all at the age of 36.
2. Something falls out of your body.
Pelvic organ prolapse is a condition where the bladder, bowel and uterus start to slip down into the vagina. And in severe cases, they will start to protrude outside the body. The CFA reports the incidence is as high as 50 percent after childbirth.
Having your bladder, your uterus or your bowel attempting to escape from your body is a completely unfathomable event that leaves the owner of said bladder, uterus or bowel feeling completely betrayed by their own body.
I see this often in my practice, and it is the reason I always have tissues on hand. In the words of one of the mom's I saw as a patient (who has two small children):
When I first felt like something wasn't right, I got my husband to look and he also thought my vagina looked weird. I got on Google and discovered it could be a prolapse. When the physiotherapist confirmed it was my bladder I could see, I cried nonstop for about two weeks. I can't exercise without feeling like something is going to fall out. I can't lift my children. I feel like it has ruined my life.
3. Loss of bowel control.
Research that was published in 2002, reported that fecal incontinence occurs in 3 percent of women three months after childbirth, and inability to control wind occurred in 25 percent of women.
Inability to control wind might not sound like a big deal, but another patient I saw five months after the birth to her second child (let's call her Mary) voiced the reality of this problem. She told me she couldn't go to the gym because since she gave birth, she couldn't control her wind. It's loud and it is humiliating. It tends to happen whenever she changes position, and at the gym, you change positions all the time. She would never know when it was going to happen, so she just doesn't go now.
If you are pregnant and reading this with your mouth open in disbelief, read on, There are a few things you should discuss with your doctor.
Research has shown that there any ways to know before childbirth if you're at greater risk of developing one of these problems afterwards. If you already have one or more identified risk factors, you are more likely to experience incontinence or prolapse after delivery.
Risk factors include: If you are already experiencing urinary or fecal incontinence, if you are small in stature, if you start childbearing later in life, if you are overweight, if there is a history of incontinence or prolapse in your family (particularly your mom or your sister) or if the estimated weight of your baby is more than 8.8 pounds.
If you are saying yes to things on this list, it might be worth discussing these risk factors with your doctor and what might be done to try to try to compensate. Yes, I am nicely suggesting you discuss whether an elective caesarean section might be the preferred option for you. Or at the very least, discussing whether going to a C-section earlier rather than later if things are not progressing well would be your preferred option.
The Cochrane database reviews research and writes reports on this research, making it the highest level of evidence we have in healthcare. When looking at their published papers, they have found several things that are worth discussing with your doctor about your birth plan:
1. Giving birth in an upright position reduces the duration of labor and the need for epidurals.
2. Immersion in water during birth reduces the need for epidurals and other pain relief, and reduces the duration of labour.
3. Epidurals have been shown in the research to increase the chance that you will have an instrumental delivery.
Now, here is the important one that ties this all together:
4. The use of forceps (compared to vacuum extraction) causes more severe tearing and vaginal tearing, and causes more incontinence. There is also more chance of facial injuries to your baby.
It would seem the research supports avoiding instrumental delivery to reduce the incidence of pelvic floor problems. We can do this be encouraging water births, not lying on your back and without the use of forceps.
The CFA tells us there are other things we can do to reduce pelvic floor disorders. Manage your bowels, and in particular, constipation. Straining in order to pass a bowel motion pushes down on your pelvic organs and can weaken your pelvic floor. Manage your weight, as well. The heavier the load you are carrying, the higher the demand on your pelvic floor and the more pressure on your pelvic organs.
You should avoid physically demanding jobs that involve repetitive heavy lifting and hard physical training, since they have also been linked to pelvic floor disorders. Exercising the pelvic floor muscles has been shown to be effective, since strengthening these muscles lifts the pelvic floor and increases support to the organs.
Let's start acknowledging that giving birth does not always give the outcome expected, and telling women they should be thankful they have a healthy baby when their uterus is falling out or they are wetting their pants does not necessarily make them feel better.
Let's start focusing on what we can do to try to decrease the dismal statistics we are seeing. Don't let it be the elephant in the room. Let's start talking about this.