Talk to me about pelvic floor damage and what you did to address it.

[Anonymous]

I would absolutely not blindly trust medicine. That would be stupid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pelvic floor physical therapy for 2 years with 4 providers. Had imaging to confirm muscle damage. Consulted several urogynecologists and a colorectal surgeon. Planning to have surgery once my kids are older and I’m not lifting them.

Wow 4 years!

It was over 2 years, not 4.

Here is my advice to OP and everything I wish I had known.

1. Talk to your mom and women in your family about their births, and lasting impacts. If they have urinary incontinence, anal or flatal incontinence, bad tearing, instrumental delivery, prolapse, or vaginal laxity (eg looseness). Ask them to be brutally honest. If there are a lot of issues, proceed with caution on a vaginal birth. Eg if mom, grandma and your aunt all had prolapses the genetics are not in your favor.

2. Consider your age. If you are an older FTM (say 33 and older) and only planning one or two
Children, I think a scheduled C section is a reasonable choice. Or you can do a trial of labor but have a low threshold for going to a C section.

3. If baby is not moving down well with pushing or is in a bad position, have a C section. Do not have forceps or vacuum. Tell your doctor you don’t want those and you want them to do whatever possible to avoid an instrumental delivery and an episiotomy.

4. Do pelvic floor physical therapy before birth to work on optimizing chances for a successful vaginal birth. Also do Spinning Babies, One Strong Mama, and see a chiropractor who does Webster technique.

5. Don’t go long past your due date - the last few weeks babies can can like a half a pound a week and get huge. Get induced instead.

6. Have an epidural and get it early. Labor is insanely painful and unless you are a masochist there’s no need to experience bone crushing agony.

7. Don’t push for hours. If you are approaching 1 hour or 2 hours and it’s not getting close, go to a C section. Pushing in excess of 3 hours is really bad for your body and can cause damage to your nerves, rectum, fascia and pelvic floor - each contraction cuts off blood temporarily to the area. It’s ok for a little while but hours of this can cause irreparable damage.

8. Know you can tear in many ways beyond first, second, third, and 4th. You can tear your urethra, labia, clitoris. You can tear inside the walls of the vagina and your anal sphincter. These injuries are things you don’t hear much about but they can and do happen so make sure you see a pelvic floor physical therapist after birth regardless.

9. Know a c section is not a panacea. It can cause many issues including infection, serious blood loss, infertility, placenta issues in future pregnancies.

10. Know there is NO good way for a baby to be born. There are different choices but all have risks and benefits and what is right for you should not be a one size fits all approach but a discussion with your doctor about your unique circumstances.

11. Don’t believe the lies that you should not hear Women’s bad birth stories or that pain in labor is caused by fear. It is normal to have a fear of childbirth - historically it was a leading cause of death among young women and children. Hearing different stories gives you a more realistic idea for the realities of birth thst you don’t get from fake social media pictures of gorgeous women with blowouts and full faces of makeup right after they deliver, Childbirth is hard, painful, and sweaty and bloody work. There will be body fluids and needles. And it can be scary. But you are strong, you can do it, and having a beautiful baby is the reward for your pain and suffering.

Jesus Christ I’m glad I didn’t read or do anything like this before giving birth. See my biggest takeaway from having a baby is you have ZERO CONTROL. What good does knowing all these possible horrible outcomes do? I read absolutely nothing about birth beforehand, and I’m glad. If I’d known I would end up pushing for 5 hours and be too tired to even hold my baby, I probably would not have wanted to have a baby. I honestly think it’s best not to dwell on all these things because it gives you the illusion of control and choice and makes you feel bad and responsible if things go badly. Find care providers you trust. Have a partner you trust. Be flexible. Trust medicine. Deal with decisions and negative outcomes as they come, no sooner.

I find your perspective highly offensive. Maybe you did not want to be educated before hand about these things - fine, that is your choice. But I promise you, if you ended up sustaining major pelvic floor damage because you had a forceps or a vacuum—the kind that cannot be healed by pelvic floor physical therapy and which makes your life miserable due to the resulting issues that can occur (incontinence, diminished orgasm, pain with sex, inability to hold in stool or difficulty emptying stool fully, prolapse, inability to wear tampons or cups, inability to do impact exercise) I promise you would not feel this way.

Studies in women who HAVE sustained major pelvic floor injuries from childbirth show these women have increased trauma and postpartum
Mental health issues precisely because they had NO idea these injuries could occur. So for most women, being educated about poor outcomes and risk factors or different delivery types is actually helpful. 1) because you are more prepared for a range of possibilities and decisions you might face and 2) you are not completely blindsided if you end up sustaining these types of major birth injuries

No one can control what happens in birth entirely but you can control things like not having forceps or not pushing for 5 hours or getting an epidural.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pelvic floor physical therapy for 2 years with 4 providers. Had imaging to confirm muscle damage. Consulted several urogynecologists and a colorectal surgeon. Planning to have surgery once my kids are older and I’m not lifting them.

Wow 4 years!

It was over 2 years, not 4.

Here is my advice to OP and everything I wish I had known.

1. Talk to your mom and women in your family about their births, and lasting impacts. If they have urinary incontinence, anal or flatal incontinence, bad tearing, instrumental delivery, prolapse, or vaginal laxity (eg looseness). Ask them to be brutally honest. If there are a lot of issues, proceed with caution on a vaginal birth. Eg if mom, grandma and your aunt all had prolapses the genetics are not in your favor.

2. Consider your age. If you are an older FTM (say 33 and older) and only planning one or two
Children, I think a scheduled C section is a reasonable choice. Or you can do a trial of labor but have a low threshold for going to a C section.

3. If baby is not moving down well with pushing or is in a bad position, have a C section. Do not have forceps or vacuum. Tell your doctor you don’t want those and you want them to do whatever possible to avoid an instrumental delivery and an episiotomy.

4. Do pelvic floor physical therapy before birth to work on optimizing chances for a successful vaginal birth. Also do Spinning Babies, One Strong Mama, and see a chiropractor who does Webster technique.

5. Don’t go long past your due date - the last few weeks babies can can like a half a pound a week and get huge. Get induced instead.

6. Have an epidural and get it early. Labor is insanely painful and unless you are a masochist there’s no need to experience bone crushing agony.

7. Don’t push for hours. If you are approaching 1 hour or 2 hours and it’s not getting close, go to a C section. Pushing in excess of 3 hours is really bad for your body and can cause damage to your nerves, rectum, fascia and pelvic floor - each contraction cuts off blood temporarily to the area. It’s ok for a little while but hours of this can cause irreparable damage.

8. Know you can tear in many ways beyond first, second, third, and 4th. You can tear your urethra, labia, clitoris. You can tear inside the walls of the vagina and your anal sphincter. These injuries are things you don’t hear much about but they can and do happen so make sure you see a pelvic floor physical therapist after birth regardless.

9. Know a c section is not a panacea. It can cause many issues including infection, serious blood loss, infertility, placenta issues in future pregnancies.

10. Know there is NO good way for a baby to be born. There are different choices but all have risks and benefits and what is right for you should not be a one size fits all approach but a discussion with your doctor about your unique circumstances.

11. Don’t believe the lies that you should not hear Women’s bad birth stories or that pain in labor is caused by fear. It is normal to have a fear of childbirth - historically it was a leading cause of death among young women and children. Hearing different stories gives you a more realistic idea for the realities of birth thst you don’t get from fake social media pictures of gorgeous women with blowouts and full faces of makeup right after they deliver, Childbirth is hard, painful, and sweaty and bloody work. There will be body fluids and needles. And it can be scary. But you are strong, you can do it, and having a beautiful baby is the reward for your pain and suffering.

Jesus Christ I’m glad I didn’t read or do anything like this before giving birth. See my biggest takeaway from having a baby is you have ZERO CONTROL. What good does knowing all these possible horrible outcomes do? I read absolutely nothing about birth beforehand, and I’m glad. If I’d known I would end up pushing for 5 hours and be too tired to even hold my baby, I probably would not have wanted to have a baby. I honestly think it’s best not to dwell on all these things because it gives you the illusion of control and choice and makes you feel bad and responsible if things go badly. Find care providers you trust. Have a partner you trust. Be flexible. Trust medicine. Deal with decisions and negative outcomes as they come, no sooner.

I find your perspective highly offensive. Maybe you did not want to be educated before hand about these things - fine, that is your choice. But I promise you, if you ended up sustaining major pelvic floor damage because you had a forceps or a vacuum—the kind that cannot be healed by pelvic floor physical therapy and which makes your life miserable due to the resulting issues that can occur (incontinence, diminished orgasm, pain with sex, inability to hold in stool or difficulty emptying stool fully, prolapse, inability to wear tampons or cups, inability to do impact exercise) I promise you would not feel this way.

Studies in women who HAVE sustained major pelvic floor injuries from childbirth show these women have increased trauma and postpartum
Mental health issues precisely because they had NO idea these injuries could occur. So for most women, being educated about poor outcomes and risk factors or different delivery types is actually helpful. 1) because you are more prepared for a range of possibilities and decisions you might face and 2) you are not completely blindsided if you end up sustaining these types of major birth injuries

No one can control what happens in birth entirely but you can control things like not having forceps or not pushing for 5 hours or getting an epidural.

YES! Knowing these things beforehand would have made postpartum much more bearable (also, would have caused me to opt for an elective c section given my pelvic floor structure and lifestyle). I wish I would have read a fantastic list like this in any childbirth book. Instead, I was fed the lie that vaginal birth is an easy recovery with no damage. (My provider actually said “vaginas are magic” — no, they aren’t. They are surrounded by very important muscles that sustain major damage during birth, and don’t often heal like one would prefer.) We should talk about the risks of either mode of delivery openly, but society doesn’t give much space to these sorts of injuries.

OP — still in weekly PFPT 20 months after a “textbook” vaginal birth and second degree tear (ps — 85 percent or so of FTMs tear their perineums, and the most common type is second degree, which basically means you tear into the bulbocavernous and transverse perineal muscles (and likely sustain levator damage as well that OBs can’t identify, let alone repair.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pelvic floor physical therapy for 2 years with 4 providers. Had imaging to confirm muscle damage. Consulted several urogynecologists and a colorectal surgeon. Planning to have surgery once my kids are older and I’m not lifting them.

Wow 4 years!

It was over 2 years, not 4.

Here is my advice to OP and everything I wish I had known.

1. Talk to your mom and women in your family about their births, and lasting impacts. If they have urinary incontinence, anal or flatal incontinence, bad tearing, instrumental delivery, prolapse, or vaginal laxity (eg looseness). Ask them to be brutally honest. If there are a lot of issues, proceed with caution on a vaginal birth. Eg if mom, grandma and your aunt all had prolapses the genetics are not in your favor.

2. Consider your age. If you are an older FTM (say 33 and older) and only planning one or two
Children, I think a scheduled C section is a reasonable choice. Or you can do a trial of labor but have a low threshold for going to a C section.

3. If baby is not moving down well with pushing or is in a bad position, have a C section. Do not have forceps or vacuum. Tell your doctor you don’t want those and you want them to do whatever possible to avoid an instrumental delivery and an episiotomy.

4. Do pelvic floor physical therapy before birth to work on optimizing chances for a successful vaginal birth. Also do Spinning Babies, One Strong Mama, and see a chiropractor who does Webster technique.

5. Don’t go long past your due date - the last few weeks babies can can like a half a pound a week and get huge. Get induced instead.

6. Have an epidural and get it early. Labor is insanely painful and unless you are a masochist there’s no need to experience bone crushing agony.

7. Don’t push for hours. If you are approaching 1 hour or 2 hours and it’s not getting close, go to a C section. Pushing in excess of 3 hours is really bad for your body and can cause damage to your nerves, rectum, fascia and pelvic floor - each contraction cuts off blood temporarily to the area. It’s ok for a little while but hours of this can cause irreparable damage.

8. Know you can tear in many ways beyond first, second, third, and 4th. You can tear your urethra, labia, clitoris. You can tear inside the walls of the vagina and your anal sphincter. These injuries are things you don’t hear much about but they can and do happen so make sure you see a pelvic floor physical therapist after birth regardless.

9. Know a c section is not a panacea. It can cause many issues including infection, serious blood loss, infertility, placenta issues in future pregnancies.

10. Know there is NO good way for a baby to be born. There are different choices but all have risks and benefits and what is right for you should not be a one size fits all approach but a discussion with your doctor about your unique circumstances.

11. Don’t believe the lies that you should not hear Women’s bad birth stories or that pain in labor is caused by fear. It is normal to have a fear of childbirth - historically it was a leading cause of death among young women and children. Hearing different stories gives you a more realistic idea for the realities of birth thst you don’t get from fake social media pictures of gorgeous women with blowouts and full faces of makeup right after they deliver, Childbirth is hard, painful, and sweaty and bloody work. There will be body fluids and needles. And it can be scary. But you are strong, you can do it, and having a beautiful baby is the reward for your pain and suffering.

Jesus Christ I’m glad I didn’t read or do anything like this before giving birth. See my biggest takeaway from having a baby is you have ZERO CONTROL. What good does knowing all these possible horrible outcomes do? I read absolutely nothing about birth beforehand, and I’m glad. If I’d known I would end up pushing for 5 hours and be too tired to even hold my baby, I probably would not have wanted to have a baby. I honestly think it’s best not to dwell on all these things because it gives you the illusion of control and choice and makes you feel bad and responsible if things go badly. Find care providers you trust. Have a partner you trust. Be flexible. Trust medicine. Deal with decisions and negative outcomes as they come, no sooner.

I find your perspective highly offensive. Maybe you did not want to be educated before hand about these things - fine, that is your choice. But I promise you, if you ended up sustaining major pelvic floor damage because you had a forceps or a vacuum—the kind that cannot be healed by pelvic floor physical therapy and which makes your life miserable due to the resulting issues that can occur (incontinence, diminished orgasm, pain with sex, inability to hold in stool or difficulty emptying stool fully, prolapse, inability to wear tampons or cups, inability to do impact exercise) I promise you would not feel this way.

Studies in women who HAVE sustained major pelvic floor injuries from childbirth show these women have increased trauma and postpartum
Mental health issues precisely because they had NO idea these injuries could occur. So for most women, being educated about poor outcomes and risk factors or different delivery types is actually helpful. 1) because you are more prepared for a range of possibilities and decisions you might face and 2) you are not completely blindsided if you end up sustaining these types of major birth injuries

No one can control what happens in birth entirely but you can control things like not having forceps or not pushing for 5 hours or getting an epidural.

YES! Knowing these things beforehand would have made postpartum much more bearable (also, would have caused me to opt for an elective c section given my pelvic floor structure and lifestyle). I wish I would have read a fantastic list like this in any childbirth book. Instead, I was fed the lie that vaginal birth is an easy recovery with no damage. (My provider actually said “vaginas are magic” — no, they aren’t. They are surrounded by very important muscles that sustain major damage during birth, and don’t often heal like one would prefer.) We should talk about the risks of either mode of delivery openly, but society doesn’t give much space to these sorts of injuries.

OP — still in weekly PFPT 20 months after a “textbook” vaginal birth and second degree tear (ps — 85 percent or so of FTMs tear their perineums, and the most common type is second degree, which basically means you tear into the bulbocavernous and transverse perineal muscles (and likely sustain levator damage as well that OBs can’t identify, let alone repair.)

Agree and I had a successful vaginal delivery, but only because my baby was small. If she'd been full term it would have been a nightmare.

[Anonymous]

I had a stage 1-2 prolapse and diastasis with my 9lb baby. My pelvic floors was uncomfortable during pregnancy. I started PT afterwards around 3 months pp, at VHC and only learned then that I could have been doing preventative PT during pregnancy so I tell my friends now to consider getting eval during 2nd trimester.