It’s no secret that growing and birthing a child does a number on your body. Yes, we’ve been doing it since time immemorial, yes, we’re technically genetically programmed to do it, yes 85% of women will go through it at some point. But there’s no point pretending that childbirth - no matter how you get the baby out - doesn’t increase the risk of suffering a host of health and well-being problems.
Almost immediately after you give birth you’ll start to be asked about your ‘downstairs’. This isn’t a euphemism for hired help by the way - it’s an obliquely British reference to your vagina. I was asked about my downstairs by many a well-meaning relative and friend - and generally I lied and said it was all ok. Mostly because I just didn’t know how to describe what I was experiencing but also because it felt massively embarrassing to actually admit there might be a problem.
One of our biggest issues as women is that we totally lack the vocabulary when it comes to our own anatomy - and that’s a big problem when it comes to the post birth body. Pushing a watermelon through the birth canal understandably has an impact on the surrounding area. While you might have been warned you might experience stress incontinence (especially urinal) after birth and you’ll have probably been told at some point to do your pelvic floor exercises (without being shown how or knowing really why), the lack of understanding of what could happen ‘downstairs’ and how to fix it is pretty universal. I got an A in biology A level and yet I was totally lost. Meiosis I’ve got covered, the vulva less so.
You’ll start to be asked about your ‘downstairs’. This isn’t a euphemism for hired help by the way - it’s an obliquely British reference to your vagina.
The basic issue is that carrying a baby (and this is true whether you give birth vaginally or have a C) puts a massive amount of stress on your pelvic floor muscle which is a magic hammock-like muscle which holds your vag, uterus, bladder and bowel in place. If it gets weakened, these organs can drop in position, known as a prolapse (the word ‘prolapse’ simply means to slip or fall out of place). The one most associated with childbirth is an anterior prolapse or cystocele where the bladder drops, often putting weight onto the vagina. You can also have a uterine prolapse where your womb drops down into the vagina, a dropped cervix, a prolapse of the recriminations or urethra, an enterocele where the bowel (small intestine) descends into the lower pelvic cavity and pushes at the top part of the vagina, creating a bulge. All of these slips come in varying degrees and the most severe require surgery.
About half of all mothers will experience some symptoms of prolapse either after birth or during menopause and around 25% will have some level of urinary incontinence. No one who has experienced either would say it’s not a big deal, but it’s not rare in any respect, so it certainly shouldn’t be a big deal for us to talk about it. And yet it remains whispered, often tearfully with layers of shame.
Other post birth ‘downstairs’ issues include Diastasis Recti where the abdominal muscles split (often associated with pelvic floor weakness), problems with stitches and healing after an episiotomy and problems with healing at the site of a c-section incision. All require in-person assessment to confirm. Which is why the pitiful post birth support offered to women by GPs needs to be highlighted.
After every night feed I would lie awake thinking that my insides were going to fall out.
Prior to COVID, the 6 week post-natal physical check had already become perfunctory. In 2018 after the birth of my giant first baby, my GP didn’t even crack my pants, and when I described my symptoms (it felt constantly like I’d put a tampon in the wrong direction and could feel it 24/7) she said it ‘sounds like you’ve had some kind of prolapse probably because your baby was so big.’ I was already on the edge of sanity and it completely pushed me over. After every night feed I would lie awake thinking that my insides were going to fall out. I didn’t do any exercise because I was so scared it would make things worse, I’d relentlessly google ‘can you still have sex with a prolapse’ and ‘can you have another baby with a prolapse’. I felt like I had lost every ounce of appeal and that overnight I’d waved goodbye to my youthful self.
That vague diagnosis had huge ramifications for how I coped with early motherhood. After that appointment, I was referred to a hospital consultant for what should have been a standard physical exam, then the appointment was cancelled and rebooked four times taking me from March to September without any assessment. At which point I gave up, paid for a private gynaecologist and was promptly told there was nothing to worry about. I’d spent all those nights, weeks and months in turmoil for nothing a routine check-up couldn’t have covered.
How on earth is a first time mum meant to know what’s normal and what isn’t?
As I gave birth again in January this year, due to the pandemic, my supposed physical examination was conducted ‘by phone’. Aside from the safeguarding issues around PND(it’s impossible to know if a woman is being coerced not to mention her depressive thoughts on the end of a phone), how on earth is a first time mum meant to know what’s normal and what isn’t? As soon as I realised my ‘exam’ was a phoner, I booked in with a private women’s physio through the Mummy MOT service. I’d seen a poster in Chiswick (old school) and then read more on Instagram via accounts including Ashley Graham’s about the service. For £140 the team offer a one hour ‘postnatal check you deserve’.
Through performing several exercises and a full pelvic exam, I was told I had a 2cm gap in my abs around my belly button, well healed perineum stitches from two rounds of tearing and a slight cervical slip. After birthing my first 10lber that was no mega surprise and it was a relief to know that second (terminated at 20 weeks) and third (full term) pregnancies hadn’t caused any more major issues. My pelvic floor was weaker around the back passage than the front, so I left with a routine of exercises to strengthen that, connect my lower abs to the ‘pelvic hammock’ and help reset the imbalance in my posture. It was like an incredible weight had been lifted in the space of an hour and I felt ready and safe to be a hands-on mum to my two kids again, with bathtime and the sling back on rotation.
I heard some heart-breaking stories of women who weren’t as fortunate as me.
Through my conversation with my physio, I heard some heart-breaking stories of women who weren’t as fortunate as me. Women who had been told after they’d given birth that they’d prolapsed, but they ‘couldn’t do anything unless it got worse’ at which point they were advised to go to A&E. Women who were hobbling 14 weeks after birth but had been turned away from their GP. Women who had been shamed, had their health concerns minimised and generally fallen through the cracks of the hotchpotch of health agencies which are meant to support post-natal women - between health visitors, GPs, midwives it seems no one wants to address the ‘downstairs’ issue.
Through the Mummy MOT service, I learnt about the treatment available for private patients - a chair which you can sit on and in 10 minutes performs as much strengthening of the pelvic floor as thousands of kegels, laser options, electric pessaries which can be fitted to help strengthen from within and a host of individually tailored exercises - all on top of the standard pessaries and exercises often prescribed. In news that will surprise no one, the MOT service has been incredibly successful over the past year and so oversubscribed with women desperate for help that the team behind it put together a petition to parliament to lobby for the reinstatement of in-person post-natal exams. The succinct rejection underlines the total lack of importance that women’s - and mother’s health in particular - is given: ‘It’s something that the UK government or parliament is not responsible for.’ A new change.org petition currently has 7,200 signatories - with a target of 10k.
These issues affect quality of life, sex, your fitness levels and are associated with a raft of mental health problems.
While my mind is at rest, so many thousands of women who can’t afford the extra care are left without the support, reassurance or treatment that they require. The symptoms of these issues affect are quality of life, sex, your fitness levels and associated with a raft of mental health problems. Urinary incontinence alone costs the NHS £233million a year. Yet at the point the pelvic floor could be rehabilitated women are left high and dry. Mention this to any of your French friends and they’ll look at you in abject shock. Across the channel, all new mums’ post-natal care includes a full abdominal check-up followed by a rehab programme. During the recovery process, some women are also given vaginal electrical stimulation and bio feedback via vaginal probes such as Kegel 8 to reboot the pelvic floor area and strengthen it after the trauma of pregnancy and delivery. And that’s all covered by the state.
So often when you’re pregnant you’re instructed to give in to the process and trust in your body. You know what would help with that? The reassurance that you’re not going to be left trying to see if your own vagina is hanging out of your body in the bathroom mirror. If British women knew that there would be a programme of aftercare as in France, perhaps the fears around childbirth might subside . Yes, things might go wrong with long term impacts on your health and well-being, but you can trust that you’ll be patched back together as close to possible as new. Instead, you’re left high and dry - with GPs seemingly only interested in getting you back on contraception and your baby vaccinated.
While the pandemic didn’t cause the slide in postnatal check standards, it’s certainly exacerbated them. Unfortunately, exhausted, embarrassed, vulnerable women aren’t the best at advocating for themselves - but the truth is we should all be appalled at how new mothers are being so horrendously let down. For the vast majority of women, everything will settle over time, pelvic floor muscles will recover, and most issues will resolve themselves. But for those who aren’t so lucky and for the mental health of those struggling through that process, it’s time someone took responsibility.