Awhile back someone asked if I could suggest what I wish I did to avoid prolapse and levator avulsion. Here is a top ten in no particular order -
1. Have a coach or doula in the room who knew the method I chose for birthing (Bradley, hypnobirthing, whatever it is). Be aware that the doula is often trained to encourage you to stick with your birth plan. Talk to the doula beforehand about what she would do if you said “I really need to change the plan” Will she support you?
2. Listened to my instincts (hard to do when the birth is so intense and unknown) – a Dr who specialized in high risk birth told me to keep an open mind about a c-section after trying for 12 hours. After 27 hours I asked for one, but the dr and midwife on duty told me I could make it on my own. I believed them, even though I had doubts. My body was desperately saying no, you can't do this. Listen to your body.
3, Had an enema before I went to the hospital. I wish I knew to ask the nurse to make sure the catheter I acquired at hour 28 when I got an epidural - was emptied. This lack of space (my bladder was never emptied during labor) contributed to my injuries. Many women with avulsion noted that they were also told after the birth that their bladders were full to the brim. A big baby needs as much room as possible to slip out. Further to this point, research the hell out of the quality/reputation of the nurses at the hospital where you plan to birth.
4. Maybe this is the most important one - not to push, under any circumstances, for more than two hours. A prolonged pushing stage is highly correlated (along with over 40, large baby, etc) to prolapse.
5. Seeing a pelvic floor physio for the entire 3rd trimester.
6. Lifting nothing and doing nothing – as much as reasonably possible - for 30 days after the birth. This is common in China, and other parts of Asia. The pelvic floor muscles are so weak. Get everyone, everywhere to do stuff for you. Lie flat whenever possible. Your baby will love the extra snuggle time too. Everything else can wait. I realize if you have other small kids this may be impossible. Or work committments But try as much as you can.
7. Asking the physio what pelvic floor exercises you can do as soon as the birth is over (or the next day) – the midwife told me to do them, the dr did not, and I did not know who to believe.
8. Making sure you don't get constipated after the birth. Hormones go bonkers and it can happen. You can use stool softeners but they tend to stop working after awhile. Drink tons of water with the nursing, and try all natural ways to keep things moving. Buy a squatty potty from amazon to take pressure off your pelvic floor when you go. No bearing down in this, or any other, activity. I'd have that for the entire last trimester and 6 months after.
9. Understand fully what the risks of ventouse, episiotomy and forceps are to your body so that if a birth plan does not go according to plan you know whether or not those choices are right for you, or whether a caesarian is best. You don’t want to decide this after enduring 24 hours of labor.
10. Have a full understanding and open communication of how your husband/wife/partner/person supporting you in labor will advocate for you in the delivery space, and ensure they look out for preeclampsia signs, etc. The best most calming thing about my birth was the mobile baby monitor - I almost always knew my son was ok. My husband, on the other hand, was a well-meaning deer in the headlights. He did, however, let me squeeze the bones of his hand together for 34 hours.
11. I know I said 10 points, but frank discussions with the women in your family about their birth. What does it mean when they say they had no prolapse? Or did? Episiotomies? Forceps/ Etc? Why? How was menopause and their pelvic floor?
12. Insist on a pessary, pelvic floor PT, a urogyno referral and IMAGING (either 3/4 d ultrasound or an MRI) if you feel prolapse, or you feel bone on one or either side when palpitating. You deserve to know exactly what happened, just like any part of your body. Ask the urogyno to assess your prolapse while you are standing up, since we dont go through life on our backs.
If this string helps one person - just one - I've done my work. But I really hope it helps more, and that it bears witness to an understanding that respect for womens bodies includes how we birth, rather than just throwing up our hands and saying "it's a mystery! there is no way to predict! we're screwed no matter what!" We need every muscle in our pelvic floor to support us for life.
13. Know the risk factors for avulsion: https://www.ncbi.nlm.nih.gov/pubmed/24593314 http://onlinelibrary.wiley.com/doi/10.1002/uog.9251/pdf

Anonymous wrote:Sorry but this is simply not quite right. Yes pregnancy does contribute but it’s not correct to say that the majority of causes is pregnancy. Pelvic floor disorders are extremely common. They are more common in women who have had vaginal births than Caesareans. They are more common in women who have had children than who have not. Mode of delivery has an impact. For example, forceps deliveries result in a 2 to 5 times increase in developing a pelvic floor disorder.

And modern deliveries using forceps are between 3-8.5% of all deliveries - and that seems high to me. I had pelvic floor issues even after my first birth and that was a section. There is no easy way to birth a baby.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

NP. If you're going to ask other posters to provide cites for their statements, you should do the same for yours. Obviously this is anecdotal, but I have 19 friends who had babies in the past two years, and zero of them had PTSD or any ongoing physical issues (probably around 2/3 were vaginal and 1/3 c-section). All were in their 30s. I find your 25% figure difficult to believe. And pointing out that someone's experience was not the norm does not invalidate it in any way.

Np...19 and not ONE with significant issues with birth/recovery?? I find that incredulous based on my group of friends, all mid thirties, healthy. Of about 10 in my circle in the past few years, 4-5 experienced lasting difficulties: one had extreme ppd (suicidal thoughts), 2 describe feeling ptsd from traumatic (48 hr+) births with midwives, one of those has ongoing physical recovery issues; another had an emergency premature c which left her with ptsd/nightmares. One experienced late onset ppd that contributed to a divorce. They all worked through it and are amazing moms, though. Fwiw c-sec vs vag didn't seem to matter, but the worst seemed the ones with the longest labors, who I suspect would have been better off with switching to a c after 24 hrs max. I personally only pushed for a few hours but it took me a month to fully recover muscle control enough to stop my pee mid- stream. Luckily that was my only lasting issue (which really freaked me out.)
Look, there's a lot that's not in our control with childbirth and it's a major medical event full of hormonal fluctuations. The best you can hope for is a reasonable, attentive ob and nurses. Openness to adjusting our best laid birthplans as things progress & seeking out help when we need it are the best tips I can offer, from what I've seen in my group.

Plenty of them had issues with the delivery - tearing, epidurals not working correctly, weird reaction to the epidural, blood pressure or heart rate spiking, significant blood loss, pre-eclampsia manifesting right after birth, temporary postpartum anxiety, etc. But none of them had any ongoing mental or physical issues that didn't clear up within a month or two. I agree with your overall assessment though. It's important to be flexible and to have attentive, observant medical practitioners around you.

I'm not doubting you, but as someone with lots of postpartum issues I don't go around advertising them to my 20 closest girlfriends. And at least 4 of my friends in their early to mid thirties all leak now when they cough or sneeze, several have back issues, and a few have confessed that their vaginas and sex lives are not the same. Just because no one has told you what they are dealing with doesn't mean everything is peachy keen. There is a lot of shame and stigma with pelvic floor disorders and most people just don't talk about them.

The vast (vast) majority of pelvic floor dysfunction is because of pregnancy itself, not method of delivery. It is also generally treatable! Consult a specialist physical therapist, you don't have to live like that

Sorry but this is simply not quite right. Yes pregnancy does contribute but it’s not correct to say that the majority of causes is pregnancy. Pelvic floor disorders are extremely common. They are more common in women who have had vaginal births than Caesareans. They are more common in women who have had children than who have not. Mode of delivery has an impact. For example, forceps deliveries result in a 2 to 5 times increase in developing a pelvic floor disorder.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

NP. If you're going to ask other posters to provide cites for their statements, you should do the same for yours. Obviously this is anecdotal, but I have 19 friends who had babies in the past two years, and zero of them had PTSD or any ongoing physical issues (probably around 2/3 were vaginal and 1/3 c-section). All were in their 30s. I find your 25% figure difficult to believe. And pointing out that someone's experience was not the norm does not invalidate it in any way.

Np...19 and not ONE with significant issues with birth/recovery?? I find that incredulous based on my group of friends, all mid thirties, healthy. Of about 10 in my circle in the past few years, 4-5 experienced lasting difficulties: one had extreme ppd (suicidal thoughts), 2 describe feeling ptsd from traumatic (48 hr+) births with midwives, one of those has ongoing physical recovery issues; another had an emergency premature c which left her with ptsd/nightmares. One experienced late onset ppd that contributed to a divorce. They all worked through it and are amazing moms, though. Fwiw c-sec vs vag didn't seem to matter, but the worst seemed the ones with the longest labors, who I suspect would have been better off with switching to a c after 24 hrs max. I personally only pushed for a few hours but it took me a month to fully recover muscle control enough to stop my pee mid- stream. Luckily that was my only lasting issue (which really freaked me out.)
Look, there's a lot that's not in our control with childbirth and it's a major medical event full of hormonal fluctuations. The best you can hope for is a reasonable, attentive ob and nurses. Openness to adjusting our best laid birthplans as things progress & seeking out help when we need it are the best tips I can offer, from what I've seen in my group.

Plenty of them had issues with the delivery - tearing, epidurals not working correctly, weird reaction to the epidural, blood pressure or heart rate spiking, significant blood loss, pre-eclampsia manifesting right after birth, temporary postpartum anxiety, etc. But none of them had any ongoing mental or physical issues that didn't clear up within a month or two. I agree with your overall assessment though. It's important to be flexible and to have attentive, observant medical practitioners around you.

I'm not doubting you, but as someone with lots of postpartum issues I don't go around advertising them to my 20 closest girlfriends. And at least 4 of my friends in their early to mid thirties all leak now when they cough or sneeze, several have back issues, and a few have confessed that their vaginas and sex lives are not the same. Just because no one has told you what they are dealing with doesn't mean everything is peachy keen. There is a lot of shame and stigma with pelvic floor disorders and most people just don't talk about them.

The vast (vast) majority of pelvic floor dysfunction is because of pregnancy itself, not method of delivery. It is also generally treatable! Consult a specialist physical therapist, you don't have to live like that

PP - yes!! People don't talk about this because they are mortified.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

NP. If you're going to ask other posters to provide cites for their statements, you should do the same for yours. Obviously this is anecdotal, but I have 19 friends who had babies in the past two years, and zero of them had PTSD or any ongoing physical issues (probably around 2/3 were vaginal and 1/3 c-section). All were in their 30s. I find your 25% figure difficult to believe. And pointing out that someone's experience was not the norm does not invalidate it in any way.

Np...19 and not ONE with significant issues with birth/recovery?? I find that incredulous based on my group of friends, all mid thirties, healthy. Of about 10 in my circle in the past few years, 4-5 experienced lasting difficulties: one had extreme ppd (suicidal thoughts), 2 describe feeling ptsd from traumatic (48 hr+) births with midwives, one of those has ongoing physical recovery issues; another had an emergency premature c which left her with ptsd/nightmares. One experienced late onset ppd that contributed to a divorce. They all worked through it and are amazing moms, though. Fwiw c-sec vs vag didn't seem to matter, but the worst seemed the ones with the longest labors, who I suspect would have been better off with switching to a c after 24 hrs max. I personally only pushed for a few hours but it took me a month to fully recover muscle control enough to stop my pee mid- stream. Luckily that was my only lasting issue (which really freaked me out.)
Look, there's a lot that's not in our control with childbirth and it's a major medical event full of hormonal fluctuations. The best you can hope for is a reasonable, attentive ob and nurses. Openness to adjusting our best laid birthplans as things progress & seeking out help when we need it are the best tips I can offer, from what I've seen in my group.

Plenty of them had issues with the delivery - tearing, epidurals not working correctly, weird reaction to the epidural, blood pressure or heart rate spiking, significant blood loss, pre-eclampsia manifesting right after birth, temporary postpartum anxiety, etc. But none of them had any ongoing mental or physical issues that didn't clear up within a month or two. I agree with your overall assessment though. It's important to be flexible and to have attentive, observant medical practitioners around you.

I'm not doubting you, but as someone with lots of postpartum issues I don't go around advertising them to my 20 closest girlfriends. And at least 4 of my friends in their early to mid thirties all leak now when they cough or sneeze, several have back issues, and a few have confessed that their vaginas and sex lives are not the same. Just because no one has told you what they are dealing with doesn't mean everything is peachy keen. There is a lot of shame and stigma with pelvic floor disorders and most people just don't talk about them.

Anonymous wrote:For the PPs who found your Cesarean's traumatic, can you comment specifically about what aspects were traumatizing for you? I am just curious as I may need elective Cesarean section and many doctors are pushing me hard to get it because I had PTSD from my vaginal birth.

This is me Tom and I’d love to hear as well! Also, if a doctor recommends it it is stil elective.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:[...]
I note that in the posts above there are many examples of trauma. There is a link to a book on traumatic birth. There are many support groups on line with thousands of women who have experienced traumatic births. Please understand that we who have experienced them are trying to warn women that they are more common than we would all like to think so that they can make informed birth choices, and do thigns to prepare, like see a pelvic floor PT and have frank talks with doctors, get a late-term u/s, etc.

Misplaced anger on the part of the PP? I would not say so. Again, people with injuries in this string have made it very clear how this has affected them. It's hard. You need to respect that. It sounds as if you did for your friend.

[...] And would like to see a little more sisterhood, frankly. Because this is something that affects many more people than any of us would like to think.

[...]

Why should we? I have posted in other threads and I think this that I found my fairly straightforward c-section traumatic and that I found the experience of being cut open while awake so traumatizing that I would never again choose that. You don't seem to think my opinion or experience matters, just yours.

I'm sorry for your experience, PP. I also found my c-section extraordinarily traumatic, and have found no one wants to hear about it. Instead, I am constantly told it is a simple surgery and no big deal. I am sorry for your pain.

+1 my c section scarred me emotionally (...literally too!) for life. An awful awful experience; some days I cannot get those sensations out of my mind

Was it scheduled or emergency?

Anonymous wrote:

Anonymous wrote:

NP. If you're going to ask other posters to provide cites for their statements, you should do the same for yours. Obviously this is anecdotal, but I have 19 friends who had babies in the past two years, and zero of them had PTSD or any ongoing physical issues (probably around 2/3 were vaginal and 1/3 c-section). All were in their 30s. I find your 25% figure difficult to believe. And pointing out that someone's experience was not the norm does not invalidate it in any way.

Np...19 and not ONE with significant issues with birth/recovery?? I find that incredulous based on my group of friends, all mid thirties, healthy. Of about 10 in my circle in the past few years, 4-5 experienced lasting difficulties: one had extreme ppd (suicidal thoughts), 2 describe feeling ptsd from traumatic (48 hr+) births with midwives, one of those has ongoing physical recovery issues; another had an emergency premature c which left her with ptsd/nightmares. One experienced late onset ppd that contributed to a divorce. They all worked through it and are amazing moms, though. Fwiw c-sec vs vag didn't seem to matter, but the worst seemed the ones with the longest labors, who I suspect would have been better off with switching to a c after 24 hrs max. I personally only pushed for a few hours but it took me a month to fully recover muscle control enough to stop my pee mid- stream. Luckily that was my only lasting issue (which really freaked me out.)
Look, there's a lot that's not in our control with childbirth and it's a major medical event full of hormonal fluctuations. The best you can hope for is a reasonable, attentive ob and nurses. Openness to adjusting our best laid birthplans as things progress & seeking out help when we need it are the best tips I can offer, from what I've seen in my group.

Plenty of them had issues with the delivery - tearing, epidurals not working correctly, weird reaction to the epidural, blood pressure or heart rate spiking, significant blood loss, pre-eclampsia manifesting right after birth, temporary postpartum anxiety, etc. But none of them had any ongoing mental or physical issues that didn't clear up within a month or two. I agree with your overall assessment though. It's important to be flexible and to have attentive, observant medical practitioners around you.

Anonymous wrote:For the PPs who found your Cesarean's traumatic, can you comment specifically about what aspects were traumatizing for you? I am just curious as I may need elective Cesarean section and many doctors are pushing me hard to get it because I had PTSD from my vaginal birth.

If you need it, it isn’t elective, fwiw.

I am a needle and blood phobe, so the idea of surgery was nauseating enough, let alone being awake, LET ALONE everyone expecting joy at a baby when I couldn’t process the surgery aspect. My anesthesia did not work properly so I had no pain but full sensation. I had a panic attacking after the baby was delivered but before I was stitched shut because it felt like I couldn’t draw breath. I have worked very hard to forget much of this, but I was an anxious PPD wreck for months after. If I had to do it again, I would have done some heavy duty hypnotization, especially as I too had had ptsd prior to birth.

For the PPs who found your Cesarean's traumatic, can you comment specifically about what aspects were traumatizing for you? I am just curious as I may need elective Cesarean section and many doctors are pushing me hard to get it because I had PTSD from my vaginal birth.

Anonymous wrote:

NP. If you're going to ask other posters to provide cites for their statements, you should do the same for yours. Obviously this is anecdotal, but I have 19 friends who had babies in the past two years, and zero of them had PTSD or any ongoing physical issues (probably around 2/3 were vaginal and 1/3 c-section). All were in their 30s. I find your 25% figure difficult to believe. And pointing out that someone's experience was not the norm does not invalidate it in any way.

Np...19 and not ONE with significant issues with birth/recovery?? I find that incredulous based on my group of friends, all mid thirties, healthy. Of about 10 in my circle in the past few years, 4-5 experienced lasting difficulties: one had extreme ppd (suicidal thoughts), 2 describe feeling ptsd from traumatic (48 hr+) births with midwives, one of those has ongoing physical recovery issues; another had an emergency premature c which left her with ptsd/nightmares. One experienced late onset ppd that contributed to a divorce. They all worked through it and are amazing moms, though. Fwiw c-sec vs vag didn't seem to matter, but the worst seemed the ones with the longest labors, who I suspect would have been better off with switching to a c after 24 hrs max. I personally only pushed for a few hours but it took me a month to fully recover muscle control enough to stop my pee mid- stream. Luckily that was my only lasting issue (which really freaked me out.)
Look, there's a lot that's not in our control with childbirth and it's a major medical event full of hormonal fluctuations. The best you can hope for is a reasonable, attentive ob and nurses. Openness to adjusting our best laid birthplans as things progress & seeking out help when we need it are the best tips I can offer, from what I've seen in my group.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:[...]
I note that in the posts above there are many examples of trauma. There is a link to a book on traumatic birth. There are many support groups on line with thousands of women who have experienced traumatic births. Please understand that we who have experienced them are trying to warn women that they are more common than we would all like to think so that they can make informed birth choices, and do thigns to prepare, like see a pelvic floor PT and have frank talks with doctors, get a late-term u/s, etc.

Misplaced anger on the part of the PP? I would not say so. Again, people with injuries in this string have made it very clear how this has affected them. It's hard. You need to respect that. It sounds as if you did for your friend.

[...] And would like to see a little more sisterhood, frankly. Because this is something that affects many more people than any of us would like to think.

[...]

Why should we? I have posted in other threads and I think this that I found my fairly straightforward c-section traumatic and that I found the experience of being cut open while awake so traumatizing that I would never again choose that. You don't seem to think my opinion or experience matters, just yours.

I'm sorry for your experience, PP. I also found my c-section extraordinarily traumatic, and have found no one wants to hear about it. Instead, I am constantly told it is a simple surgery and no big deal. I am sorry for your pain.

+1 my c section scarred me emotionally (...literally too!) for life. An awful awful experience; some days I cannot get those sensations out of my mind

Anonymous wrote:

Anonymous wrote:This has been such an interesting discussion and I really feel like I learned a lot from reading the pps stories. I googled levator avulsion and that brought up a lot more information on the topic as well as pelvic exercises and other research.

I had an incredibly simple vaginal birth with epidural. But I was looking for info like that while pregnant so I knew what to ask for and what to try to avoid. I'm pregnant again. I don't know how you avoid long pushing? When I dialated 10cm they told me to push. What should you do if you've been pushing for an hour and you don't know how much longer it will take?

I've worked with older women and my grandmas and great aunts were very candid. They all have pelvic floor issues. Some gave birth with forceps and most had twilight sleep. They all had multiple births. I'm an only child and my mom had me via c section- she has pelvic issues now in her 60s.

This is interesting because my mother also had two children, both via c-section but now in her sixties has uterine prolapse and pretty significant incontinence issues. This is a big discussion amongst her friends of the same age, and their experiences run the gamut, with most having given birth vaginally, and about half with some mild incontinence issues and/or the need for pelvic OT. Interestingly, my mom's closest friend gave birth to six children naturally, and now has zero issues in her seventies. Most experiences are more middle of the road, but she does have a friend who never even experienced pregnancy but has significant incontinence issues in her sixties. I wish there were a better way to predict and protect women's health in this area, regardless of childbearing status or birthing history, and more attention and better treatments available as a whole.

+1, prolapse has to do with the musculature (of the core! Which encompasses the diaphragm, pelvic floor, transverse abs, AND the glutes - these muscle systems are all innerconnected and when there is dysfunction in one, it affects the rest.) Weakness, over-tightness, balance and loading issues are prevalent in women who have been pregnant, but by and large the problems stem from the pregnancy itself; not from birth. However, given that having a c section seriously (further) compromises the integrity of these muscles, I would be more concerned about prolapse going that route