What If We Told Women the Truth About What Birth Can Do to Their Bodies?

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NEW MOM explores the brilliant, terrible, wonderful, confusing realities of first-time motherhood. It’s for anybody who wants to be a new mom, is a new mom, was a new mom, or wants really good reasons to never be a new mom.

I did not expect to have a C-section, but the next day — groggy, in pain, swollen — I was forced to adjust to my new reality. I was encouraged to get up and walk, so in the late afternoon, I mustered the strength to shakily walk to the bathroom and wash my face. I looked down at my body, which had been pumped full of fluids for a full day, and saw that the bandages over my incision were bulging. As I leaned over the sink, the dressing popped open, spewing a bloody liquid that landed on the bathroom floor with a dramatic and terrifying splat! I looked at my puffy face in the mirror, bags under my eyes, tears streaming down my cheeks, and thought, This is my life now.

I expected my postpartum body to be tired. To feel soft, weak, leaky, oozy. I wasn’t in any rush to “get my body back,” mainly because I could barely make sense of the body I now had. I was prepared for the fact that a tender wound would dominate my lower abdomen for months.

But here is what I was not prepared for: that after I healed, I would experience an entirely new pain. A pain in my hips — a constant, white-hot burning and tightening in the seam where my thighs met my crotch. It bothered me as I sat at my desk at work, as I stood at my desk at work, as I balanced on an exercise ball at my desk at work. It bothered me when I sat down to nurse, when I lay down in bed every night.

Pelvic pain and pelvic floor disorders are common after childbirth, but they are not normal. No one should have to live with this pain, nor the embarrassment, loneliness, and shame that often accompanies it. But even if a woman seeks help for her problems, she may not get the treatment she needs.

A survey published in 2016 revealed that the majority of primary care physicians didn’t screen for prolapse — when organs move to places they shouldn’t, which can happen after vaginal and C-section births — and that 50 percent believe that the condition is rare. (Meanwhile, studies show that prolapse may affect over half of all women and that some degree of prolapse is extremely common in older women.)

If a woman’s concerns are not addressed or are dismissed at her postpartum appointment, she’s probably less likely to raise the issue again. But when would she raise it? In the United States, the standard of care is one postpartum checkup six weeks after you give birth. That’s it. New babies get a one-week, two-month, four-month, six-month, nine-month, and one-year wellness visit. In countries throughout Europe, midwives make home visits to see how new babies — and mothers — are faring. But after six weeks, American mothers are on their own.

Women are often told to do Kegel exercises before and after birth, but that is just one repetitive motion. A single motion cannot solve a range of issues affecting a variety of muscles and organs. There is no magical, one-size-fits-all solution to our pelvic problems. However, in one consultation, physical therapists can assess the strength, muscle, tone, and tension of the pelvic floor and recommend exercises unique to each woman. Women with diastasis recti can be taught how to engage their transverse abdominals and pelvic floor, which is crucial to recovery.

These types of interventions are not only helpful for women who have given birth vaginally but also for women who have undergone C-sections. After the incision has healed, a therapist can mobilize and massage both the internal and external scar tissue. The more scar tissue is moved, the softer it becomes, and the less havoc it can wreak on your bladder, bowels, sex life, and lower back.

Some pelvic floor problems require the attention of a urogynecologist, who can fit women for a pessary, a sort of custom-made bra for the internal organs that can be inserted and used to help lift and support them. And, if necessary, surgery can be used to repair problems.

Internal organ bras might raise eyebrows in the United States, but in countries like France, where every woman who gives birth is referred for la rééducation périnéale, individual treatment to strengthen a new mother’s pelvic floor, no one bats an eye. This perineal reeducation, which is subsidized by the government, might also include biofeedback therapy, in which a small joystick/dildo with electrodes is inserted into the vagina and one plays video games with it as it measures the strength of muscle contractions. This is everyday life for new French mothers, whose government views physical therapy as a long-term investment in their health.

It begs the question: Why can’t we offer similar types of support and benefits to new mothers in the United States? The technology is available and there are a growing number of providers who specialize in pelvic floor therapy (they help meet the growing demand of mothers actively seeking help). But none of this is widely known, discussed, or promoted, even though some insurance policies cover rehabilitation.

You probably know someone who has torn their ACL (anterior cruciate ligament), a common knee injury. For the majority of people who want to maintain full range of motion, an ACL is repaired by arthroscopic surgery, a modern, minimally invasive method developed to reduce pain, complications, and recovery time. As part of their ACL recovery, patients are put on a program of physical therapy that includes multiple phases of exercises that can last up to six months. This is the standard care that the roughly 200,000 people receive who experience an ACL injury each year. There is no such standard protocol for the treatment of pelvic floor disorders, which a affect up to 1.3 million of the 4 million American women who give birth annually.

The majority of ACL tears in this country occurs in men. I have a hard time believing that the discrepancy in attention and care is coincidental.

My husband, daughter, and I all see the same family physician. Our doctor cared for me after my miscarriage, he advised my husband on how to deal with the two-inch-long splinter he once got in his hand while dusting the house, and he delivered our daughter. When she was a baby, he treated both of us. At her one-week appointment, he took the time to look at my incision, replacing the dressing with little butterfly bandages. At her subsequent appointments, he asked me how I was doing. At her one-year checkup, I asked him about the pain in my hips and if it could be related to pregnancy and childbirth, as I was certain it was.

“Maybe,” he replied, adding that a lot of people had tight hip joints. He suggested stretching. He wasn’t dismissive, but that was the end of the discussion; our 20-minute appointment was over.

Little did he know that I was already doing pigeon pose every morning and every evening. That every day for weeks I had been lying on my dining-room table, my spine lined up with one of its outer edges, dangling half of my body off of it — one of the only ways to achieve the stretch that my hips demanded.

I left the clinic convinced that I was going to be living with chronic hip pain for the rest of my life. And I found myself thinking the same thing so many other women are made to wonder: What did you expect? You had a baby.

Remembering the pale, oozing, hospital gown–clad woman I had seen in the hospital mirror months before, I thought: This is who I am now. A broken person who no one knows how to fix.

Months later at a friend’s dinner party, as my daughter and I danced to Taylor Swift’s “Shake It Off,” another friend mentioned that the next morning he was going to a movement class called Dance Church. It was taught by a professional dancer but open to anyone — a guided improvisational class set to pop music. The next morning, I went. It was part aerobics class, part free-form movement, no mirrors in the studio, no rules.

When, at one point, we were instructed to “grind your crotch down into the floor” during a Drake song, someone near me giggled uncomfortably. I realized that this was the easiest, most liberating thing my vagina had been asked to do all year, so I threw my head back, grinned, and humped the floor.

Open up your underwear line,” the instructor said. I followed directions dutifully. As I moved the seams where my thighs meet my crotch, they creaked like wooden doors on old brass hinges.

Get it juicy.” I made a circle with my hips and looked over my shoulder to see that suddenly my ass had morphed into the ripe, round peach emoji.

Spread your crack.” I wasn’t entirely sure how to do this, so I closed my eyes and swirled my peach emoji ass around as though its cheeks might touch opposite walls of the studio.

Over the next few weeks, I was surprised to discover that a good chunk of the movements we did in class were geared toward the hips — the most problematic area of my body. Aside from sex and childbirth, when are you ever told to open up this part of yourself? In everyday life, it might be embarrassing, but, in the context of Missy Elliott, it’s necessary.

It took over two years after giving birth for the pain in my hips to fade. But even now, if I don’t move regularly, the discomfort comes roaring back. I think about how a friend, who gave birth vaginally, once told me her vagina didn’t arrive at its “new normal” until a full year later.

Perhaps health-care providers don’t tell us the truth about our bodies and what happens to them in childbirth because they are afraid of scaring us. And yet, the potential damage we could do to our babies in utero — by eating seafood, drinking a glass of wine, cleaning the house, relaxing in a hot tub — is lorded over us for nine months. Afterward, the medical establishment essentially tells us we’re on our own to figure everything out.

Maybe the reason we don’t tell women about the ways their bodies will change after they give birth is because, quite simply, health-care providers don’t know. They’ve been trained to prioritize the health of newborn babies but not newly born mothers.

Or maybe it’s something worse that skews our priorities: that we don’t want women to be connected to themselves, empowered, asking questions, demanding action.

Since she was a baby, my daughter has shown an instinctual curiosity about her body. During diaper changes, she would reach down, her little fingers exploring the area of her crotch. She would find her clitoris, hidden under the fleshy hood where her tiny labia meet, then rub, poke, and tickle it. It made her laugh.

We encouraged her to touch herself and told her what these parts of her body were called: clitoris, vulva, vagina. We asked her what she was doing.

“I touch my va-nina,” she replied.

She calls her arm her arm, her neck her neck, her hair her hair, and so she will call her vagina her vagina. It is what it is, after all, and it is all hers. We’ll talk openly about these parts so that she can tell us when they feel good, when they hurt. So we can teach her how to keep them healthy.

I don’t want her body to ever be a mystery to her, something that she fears or doesn’t understand. Becoming a mother may be one of our most culturally traditional acts, but it is also the place where we can break with our most limiting, oppressive traditions.

In our house, we call our parts by their names, and we dance in the living room nearly every night.

I lift my leg, Mama.

This my booty, I shake my booty.

I have no idea who my daughter will become, but I hope she will always be this free.

From the book LIKE A MOTHER: A Feminist Journey Through the Science and Culture of Pregnancy by Angela Garbes. Copyright © 2018 by Angela Garbes. Published on May 29, 2018 by Harper Wave, an imprint of HarperCollins Publishers. Reprinted by permission.

What If We Told Women the Truth About Birth?