By Amber-lee Buendicho
A few hours after I gave birth to my first son which resulted in a childbirth injury after a forcep delivery, I had a hospital physiotherapist come and visit me (among many other professionals) to chat to me about the severity of my injuries and how to have the best recovery. In my haze of birth trauma, sleep deprivation and confusion, I intensely listened to this wonderful physio, because I quickly realised I did not know just how bad things were, I was somewhat under the assumption that this was birth - how wrong I was! In her chat to me she showed me illustrations of degrees of vaginal tearing, talked about my pelvic floor and the current damage, what to expect in coming days/weeks and how important it was that I start pelvic floor exercises right now! What?! I was in such intense pain the very thought of trying to clench my vagina made me shutter. But she wanted me to try, with her standing there and so I did, I tried to lightly connect with my pelvic floor and clench despite all the bruising and swollen bum, legs and vagina. It was actually shocking to me how incredibly difficult it was. I was able to do about 3 very light "kegels" with no pain, just absolute weakness and an easily fatigued pelvic floor. She explained that the consequences of a weak pelvic floor after such injuries could result in fecal incontinence (crapping yourself), urinary incontinence (peeing yourself) and/or prolapse (organs can fall into vaginal canal). She was with me for about 7 minutes in total, left me with the illustrations and a pamphlet and off she went.
My next thoughts, "what the hell has just happened to me and why didn't anyone tell me!?"
In the weeks and months that followed, I paid a lot of attention to my vagina, or rather my perineum. Like, a lot. I was constantly looking at it with a small hand mirror, I changed my pad hourly, I washed it with water from the shower head and let it air dry and I did my pelvic floor exercises every day because I was determined to get this muscle working again - I did not want to be crapping myself! And that was a reality in the beginning, my pelvic floor was so damaged that I crapped myself in hospital (the laxatives didn't help) and even the slightest inkling to wee turned into absolute urgency to get to a toilet before I wet myself. Safe to say, I did not leave the house for 8 weeks and when I finally did, I was never gone long. Thankfully I had a private midwife come and do home visits with me and you bet I got her checking my vagina every time.
Illustration from Reddit @babybumps
At the 8 week mark, I was sent to a Women's Health Physio program through my hospital for women who suffered severe tearing or a caesarean section. Again, we did some basic pilates moves to connect with our pelvic floor and talked about the importance of this muscle. I then had an appointment with a gynecologist who gave me a pap smear despite my terror, and talked to me about having a caesarean next time to avoid further damage. That's about all I can remember to be honest. I was still in the newborn fog, struggling with pain every day in my vagina and just lived in terror of something going wrong or weeing myself in public.
What I was not told, was that I should be working closely with a Women's Health Physio throughout my recovery so that my progress was monitored and have a personalised treatment and exercise plan. This was something I figured out much later. I was also not told about the amazing Australasian Birth Trauma Association and the work they do to help women like me. I was given no resources, no referrals and no references other than to have a caesarean section. What the!?
4 years on and 2 babies later (which was not via caesarean), I have done just that. I have worked closely with a WHP and concentrated on the strength, mobility and coordination in my body and pelvic floor. I have never known my body better than I do right now. But this is just my story. This blog post does not include the, what feels like, hundreds of women I have spoken to about their poor pelvic floor and lack of education and care. Some are still asking the question, where is my pelvic floor, how do I know if I am doing my pelvic floor exercises properly, if I had a caesarean why do I need to see a physio and even, what is a women's health physio? It's 2023!!! This shouldn't be happening.
Back in 2020 a friend and I got together to do a little bit of research about the pelvic floor and mental health and 599 women completed our survey and the results were what I suspected but still shocked and saddened me.
Only 55% knew how to do pelvic floor exercises
Only 5.9% do their pelvic floor exercises everyday
Only 23.9% have never leaked urine
44.1% are enduring painful sex
47% did not know what a Women's Health Physio was
Only 22% of participants knew what was considered safe exercise after having a baby
(see here for results: https://www.thepowerofbirth.net/survey-results)
Women's Health Physios are still unknown until either something bad happens or until it is "too late". The frustration is real. So many women live with preventable conditions, if only they just had the education and access to these physio's earlier on many would have been prevented or treated appropriately. We have the resources to be educating women and mothers about wonderful Women's Health Physios and yet women are still left in the dark and I can't help but wonder that aside from the underfunding and underresearching that goes with women's health, if vagina's are still that taboo we would rather have women live with these "invisible" conditions and disabilities and even go as far as normalising them, than to actually talk about it and prevent and treat them appropriately.
In France, Women's Health Physio's are so normalised in childbirth that every women receives 10 FREE sessions with a physio postbirth. Here in Australia, you may be lucky to have a quick chat with a physio while still in hospital postbirth, or if you have a severe injury you will be seeing one at your 8 week postpartum mark. Other than that, nothing. However, there is hope as wonderful people and organisations are fighting to change this. See https://www.change.org/p/pelvic-health-physiotherapists-to-support-birthing-women
I created a little pamphlet which you can download and send to family, friends, put up in your places of work, GP clinics, gyms, shopping centres - literally anywhere we can reach women about 'Why You NEED To See A Women's Health Physio'
So, what exactly is a Women's Health Physio and aside from childbirth injuries, why do women need to see one? Remember, you do not have to have had a baby to experience pelvic health issues.
Women's Health Physiotherapists are so much more than your regular physiotherapist. They have additional training in pelvic health and can treat a wide range of conditions through management, assessment and rehabilitation. They understand the complex and unique female anatomy and the effects childbirth and menopause have on women.
Here are some examples of what a Women's Health Physio can treat:
Pregnancy related pain and/ or dysfunction (pre- and post-natal)
Abdominal separation (rectus diastasis)
Pelvic floor strengthening, relaxation and coordination
Caesarean or perineal scar management
Pessary fitting & management
Pelvic girdle pain, back pain and instability
Urinary and faecal incontinence (leakage from both passages)
Pelvic organ prolapse
Vagina pain / Pelvic pain; pain with intercourse, vaginismus, pelvic examinations
Overactive bladder; excessive night time urination
Bowel emptying dysfunction and constipation
Post surgical rehabilitation
Postnatal advice & education sessions
Pudendal nerve pain (perineal nerve)
Perineal injury; episiotomy, 2nd, 3rd & 4th degree tear follow-up and rehabilitation
Guided return to exercise programs and exercise classes
I think it is really important we spread the word about the amazing work and education Women's Health Physios provide but also talk about what's safe to do / ways to exercise while pregnant or postnatal.
This information can be life changing for women of all ages, no one is exempt from pelvic issues. Let's be more informed and talk about the realities of being a woman and having babies. Being informed can be the difference in pelvic floor issues and provide better pelvic self awareness. If you are experiencing anything you feel is abnormal, go and see a Women's Health Physio!
For more information, tune in to my chat with a WHP on my podcast in episodes 6 & 7: https://podcasts.apple.com/au/podcast/episode-6-part-1-why-you-need-to-know-about-your-pelvic/id1572162194?i=1000525309178
- Amber-lee Buendicho