Vagina Therapy {Postpartum Pelvic Floor Physical Therapy}

As mothers, we go through our most intense and rigorous physical activity during the labor and birth of our precious babies. All too often, women are not given the proper knowledge and tools to heal and nourish ourselves after our births.  Postpartum pelvic floor physical therapy was vital to my recovery and my well-being after giving birth.  I am excited to share how this vagina therapy helped change my life, and I hope you find it beneficial.

Disclosure: there is graphic talk about childbirth and vaginas in this post.

My birth and tear

Before I became pregnant with my first child, I researched and decided that I wanted to have my babies at home with midwives, in a safe and clean environment. After 12 hours of labor, I began pushing for two hours. My baby’s head barely crowned for that long, but after one final push he came out. {John’s full home birth story is here.}  The pushing was the “ring of fire” moment, however, my “ring of fire” did not end after he came out. The burning continued – my vagina had a very intense tear. My midwife knew that she could not repair my tear with the scrutiny it needed, so we piled into the car and headed to my gynecologist’s office. My gynecologist supported my home-birth, and had four home-births herself, so at least I was in a comfortable place. She stitched my tear, from my cervix to my anus, with the utmost of care.

After five days, I tore again after attempting a bowel movement. I headed back into her office to get repaired again. Needless to say, this tear was was very traumatic. I was given after birth care instructions, including a postpartum herbal bath for helping my body heal naturally after my vaginal birth. {You can see my post on the Postpartum herbal bath and after birth vaginal care here.}

Pelvic floor physical therapy

My tear took more than the usual 12 weeks to heal. I had a lot of scar tissue and I was in an intense amount of pain. Movement and sitting were sometimes unbearable. Sex was absolutely out of the question. This was an incredibly hopeless time for me. When I spoke about this suffering with anyone, to my mother in law, my aunts, my peers, they all said that I would have to wait until I tore again with my next birth, or even have surgery. Ah, yes, surgery. That, and drugs, is what modern medicine has to offer.

But, thankfully, when I went in to see (a different) doctor, she referred me to a type of physical therapy. Postpartum pelvic floor physical therapy. She said that she had had it done herself after her births. I was willing to try anything, so I went to “vagina therapy” for 12 weeks.

When I went in, I didn’t know what to expect. Thankfully, the physical therapist (MSPT) was very friendly and instantly set me at ease. For the initial session, we talked about my health history and she really let me share all about my birth, as well as anything else I felt was pertinent. Then, she evaluated me completely, she tested my leg and hip muscles extensively before she left the room for me to undress. I wore a sheet over my lower half, similar to when at a gynecologist’s office. She waited until I was ready and comfortable, and she gently inserted her finger to assess my muscle damage and scar tissue. She spoke with me about everything she was doing.

She began work on this initial visit and took out the heat ultrasound. She placed it on my perineum for about 10 minutes. It felt warm, and actually quite refreshing. After that, she massaged the area for 20-30 minutes. This consisted of her gently pushing her fingers or thumbs on sore areas, inside the vagina and outside on my perineum and waiting for an internal mysofascial release, that is, the loosening and strengthening of the muscles. While doing this, she kept asking for my comfort level, and though it was difficult, the pain was bearable because it was done in a very professional and gentle manner.

You do what where

R.U. Steinberg, of The Austin Chronicle wrote an excellent article entitled “You do what where,” detailing pelvic floor therapy. She writes, “In its most basic sense, internal pelvic floor therapy involves a physical therapist using his/her finger to examine trigger points inside a person’s body that are affecting the bladder, tailbone, urethra, … and other organs. Through this physical examination and treatment, therapists can identify tightness and tenderness and gently stretch the connecting muscle.” And instead of enduring life with some of the following conditions, there is hope of living without pain or without surgery or medication!  Pelvic floor therapy can benefit those with: postpartum trauma, urinary incontinence, exercise-induced injury, interstitial cystitis, painful bladder syndrome, pelvic pain syndrome, pelvic floor muscle spasm, vaginismus, vulvodynia, endometriosis.

My MSPT showed me how I could massage the perineum and vagina at home — and I’ll admit that I was skeptical — I did not think this was going to work. Mostly because I had never known that this type of physical therapy existed. It seemed like something people would make jokes about. But my physical therapist changed my life. After 12 weeks of therapy, once or sometimes twice a week, I have my life back. I feel like a woman again. I can sit and move and enjoy sex with my husband.

All women should know about this. After having my experience, I have been given the opportunity to speak with other women who have childbirth tears or urinary incontinence after pregnancy and childbirth. Many mothers believe they are doomed to a life of painful sex, leaking bladders, and feelings of self-doubt.

Pelvic floor physical therapy resources

• Pelvic Pain Rehab is an excellent resource written by four female Master of Science in Physical Therapy. Tour of the Pelvic Floor is a helpful video to understand the female body.
• Columbia University Medical Center has many resources and articles about Pelvic Floor Physical Therapy.
• John Hopkins has a Women’s Health Pelvic Floor therapy Services page.
• Comprehensive Physical Therapy Center is a center with further resources.
• Women’s Health APTA, to find a specialist in your area.

It may be difficult to find an MSPT in your area. However, if you do an online search for physical therapy in your area, you may simply have to call a couple of centers to inquire if they have a pelvic floor specialist. My hope is that, through requesting and sharing with others about this vital and life-changing type of therapy, more people will be informed and more physical therapists will become qualified as demand rises.

Episiotomies are not beneficial or necessary

Some women argued with me that an episiotomy would have prevented my intense tearing. An episiotomy is a vertical or sometimes diagonal slit an obstetrician cuts from a woman’s vaginal opening towards her anus, masking itself as an aid in a childbirth. Today, about 30-35% of hospital births include episiotomies, which is better than more than 60% in the 1980s. Women’s vaginas are sliced intentionally every day in our country. I believe this causes emotional trauma, in addition to the obvious physical trauma, similar to a woman who has experienced a caesarean birth. After an episiotomy, a woman has a 80% chance that she will tear in that exact place again for subsequent births. (See “Episiotomy, Once ‘A Little Snip’ Childbirth Routine, Curbed By New Guidelines” by Catherine Pearson at the Huffington Post.)

My midwife (who has attended 300+ births) told me later that my tear might have been the worst she had seen. This encouraged me, actually. Because if my body can heal, so can yours. I am proof. I do not believe an episiotomy is ever justified. If ever there would be a case for receiving one, I would have been that case. But my body tore naturally the first time, and, ever so slowly, healed naturally the first time.

When I became pregnant again, of course I was nervous about another massive tear. I did all I could to prevent a tearing again. I massaged my perineum about every other day in the last month of pregnancy. My MSPT and home birth midwives both recommended using Slippery Stuff Personal Lubricant and a medical dilator.  (Our Quiet Hope has listed detailed instructions on how to sanitize and properly use a dilator for in-home use, excerpted from The Sexual Healing Journey by Wendy Maltz, LCSW, LMFCC, Certified Sex Therapist.)

Two years ago, I had a wonderful second home birth, six hours this time – with only eight minutes of pushing. {May’s full water birth story is here.}  This time, I felt my daughter come out, her head, her arms, and her little legs, and I tore minimally – and not in the same place as before. Though my first birth’s tear was massive, my all-knowing and well-nourished body healed naturally. I was not forced to heal from an unnatural incision. My midwife stitched my minor tear up at home. I followed my after-birth care instructions very carefully and healed nicely with minimal complication.

Avoiding mis-information

There is a lot of misleading and poor advice on the internet. There are many forums on different pregnancy and mothering blogs and networks devoted to questions about postpartum surgery after a traumatic vaginal birth. It breaks my heart that these women are not given the proper advice – surgery is not necessary. Many hospitals and physical therapy departments have pelvic floor specialists!

There are many hospitals and doctors who profit from un-informed women who need dire help for their pain and suffering. In some cases, vaginal rejuvenation surgery could necessary; I am certainly not an expert, but I cannot help but think that many of the women that utilize these types of services would seek treatment from an MSPT if they were given the choice (many hospitals even offer “virginal restoration” surgery, which is absolutely appalling).

The First Choice OB/GYN Associates of PA describes their surgery: “In most cases it involves a simple excision of excess tissue either using a surgical knife with suture closure or lasers. Because of its simplicity, vaginal rejuvenation surgery causes very little pain and recovery time is short.” Having surgery in your most private and personal area can cause severe emotional trauma, and this should always be considered.

Pelvic floor care at home

Physical therapists stress the importance of proper pelvic floor care and exercise. My MSPT described our pelvic floors as being like a stack of tissue paper – with age or birth or other trauma, our muscles can weaken or tear.  We must lift them up again so our entire pelvic floor can remain healthy and support our reproductive and vital organs, and to prevent such  urinary incontinence and organ prolapse.

Every women could strengthen her own muscles through beneficial Kegel exercises. Oprah.com has several resources regarding Kegels and Pelvic exercices.  Her article entitled Pelvic Floor Rehab discusses prenatal and postnatal regimens. Though not all muscle-strengthening exercises are created equal, discussion about these exercises, and perineum massage, is helpful for women who are not familiar with the topic. My MSPT emphasized that doing Kegel exercises can often do more harm than good for those who have suffered vaginal trauma. If not done correctly, the muscles are weak and a woman could flex the incorrect muscle, therefore being detrimental to her recovery. It is best, as is stated in the article, to rely on the advise of a professional who can assess how your muscles are working and what exercises would benefit your specific needs

The Hab-it: Pelvic Floor Physical Therapy DVD is an incredibly informative collection of proper exercises for the pelvic floor.  It shares personal stories from its creators and diagrams of our anatomy and muscle function to illustrate our pelvic floor’s importance. The entire Hab-it.com site has a wealth of well-sourced information and testimonials.

 

I hope this post has been beneficial to you and your family.  Please share or pin, so others are able to get this information.  If you are suffering from a labor and birth of a child, be it months or years after, there is hope!!  You can get out of pain, you can have a good sex life, you can stop the incontinence, all without surgery.  Blessings to you and yours.