I have been reading and researching the post partum period, as a self study. I have noticed that many people talk about prolapse, uterine, cervical, bladder, as a common place event. Does it really happen that often? Anyone have a good jumping off point for researching this? I am having trouble finding unbiased information on this, it seems that people think if you have more than one child your body will be too worn out to function properly. I have heard many people talking about how chances go up with each child especially children who are close spaced. Anyone have info on percentages of grand multips who are presenting with prolaspe during the post partum period? Is this something that is noticed after the birth or is it usually found during pregnancy due to the weight of the uterus, fluid, placenta and baby? Any info or direction would help, thanks!
cervical prolapse and degrees?
I don't have a long time to answer so I hope you get what I am saying. I do think that it is a very common problem. 1 out of 5 I believe are the new statistics. I personally have a level 2 cystocele(evidently if everything else wasn't such a mess down there I would be fully incontinent) a level 3 rectocele, and between a level 2/3 cervical prolapse (my cervix in 1 inch in that is it). I am actually going in for a full repair and hysterectomy on Monday. My quality of life is terrible. This is truly a problem for many women. Intercourse is excruciating. Having a bowel movement is a complicated procedure. I think there are sevel things that lead to this being an issue today when maybe it wasn't years ago. Seems silly to think that women's bodies were designed to fall apart so here are my theories.1. Epidurals. Women push harder than they might if they could feel causeing major trauma to their pelvic floors. 2. Posterior babies. We are more sedentary than our ancestors increasing the chances of having a posterior baby. That does major damage. I had 2 posterior babies. 3.Women don't take it easy and stay down after they have a baby. If you talk to your grandmother she was likely not allowed out of bed for a week after giving birth. This allows things to settle back where they belong but we push women to get back to real life too early. 4. Running and lifting heavy things. Running is terrible for your pelvic floor and if the past we only ran when we needed to. It is hard on your girl parts which are only held in by ligaments and your knees etc. We carry those awful baby bucket car seats around putting undue pressure on the pelvic floor. 5. Poor diet leads to more problems so more fresh fruits and veggies plus fish for the omega 3's really helps. My personal issues came from a very hands on Medwife who had me start pushing with a posterior baby against a closed cervix. On the video you can actually see my cervix and bladder coming out with the baby. Evil midwife!
A few more things when dealing with multips with prolapse issues. It is very important that they don't push until it is the last thing they can do. In our practice we always check a woman with a prolapse before she starts to push (we often do no IE at a birth at all) because it is so easy to have a severe prolapse again. A great website to check out is hystersisters.com also I think it is called withwoman or wellwoman I don't remember but they have a lot of good info. IMO kegels don't really help once you have severe damage. Time, further spacing of children, taking it easy and allowing your body to heal, physical therapy, and surgery are all options. Surgery isn't really an option if you want to have more children and even at that is has a 50% failure rate. Estrogen therapy can also be helpful in the post partum period but it can cause issues with breastfeeding. This is a real issue that I wish more midwives and birth professionals understood.
Thanks so much for your input. I agree on your theories. I am very interested in this, as I can imagine that because of our lifestyles and the childbearing trends this may become a bigger issue as time goes by. I agree with the no pushing till you can do nothing else. Does it stand to reason that a women will only push when she needs to(ie when she 'should' be to avoid a severe prolapse?) or do you see many women pushing early in labor, perhaps due to pressure from the prolapse, baby's head, or forewaters(or a combination of all three?)? What about a tilted uterus? Does this effect prolapse Are you seeing more prolapse or more sever prolapse with vacuum or forceps? How about true shoulder dystocia? I wonder if pushing positions could effect it also? Thanks again for the information and your story!
A mother with a prolapse will often feel an urge to push sooner than when they are ready and end up with a good sized anterior cervical lip. If they push against the lip the cervix can be pulled down with the baby. So I guess my answer is no. That a woman may push and hurt her body, but that is only because of the injury. Vacuum and forceps wreak havock to the pelvic floor. Shoulder dystocia the same. We need more research and support in this area.
One thing to bear in mind is that when breastfeeding, estrogen levels may be low, and many women find that whatever degree of descent they have changes the farther out they are from having the baby and that it changes again with cessation of breastfeeding. Also, some descent of pelvic organs is found in most women by the time they reach their 50s and beyond, even those who have never had children. Western style furniture (recliners, poofy, deep sofas, office chairs, toilets) are bad for women's bodies. Much better to ditch the furniture and squat or tailor sit.
Complete Beginnings has good points.
And, CB -- "On the video you can actually see my cervix and bladder coming out with the baby."
I want to talk about my experience of what I think is primarily a rectocele, and I have some questions. In Jan. 2010, I developed a bad cough which lasted about 2 weeks. Near the end of that time I felt "bulgy" in my vagina and became really uncomfortable, with pain in my pubic bone and hips. I was really upset about this because I'm only 41 and in pretty good shape. However, I have given birth to 3 children. While they were all homebirths, I did push in a very unpleasant, forceful way with my first baby. I had severe back labor with him and a cervical lip that persisted for about 8 hours before the midwife forced it back and I then pushed him out. Actually, I had a really cool dream that I pushed out a baby on one of those coughing nights! It was not so fun in the morning when it felt like I had just given birth but, in reality, hadn't! I went to an OB immediately who said, yeah, there was some movement in my bladder and cervix when I bore down( but wouldn't that be kind-of normal for most women?). Anyway, I proceeded to the chiropractor and had a couple of months of treatment which was very helpful. I also began doing squats and being more careful not to force bowel moments. During the summer and fall months I began in-line skating regularly, and felt that these exercises/habits really helped heal and possibly strengthen and realign my pubic area and uterus. I also learned to not pull in my tummy (as unfortunately I had been doing for many years), but pull my belly button up and do a kegel at the same time. I also allow my lower back to curve in the way it likes - for years I had also been "tucking" my hips in a mistaken belief that this was good posture. I try to be mindful about how I am sitting. These seem effective for me. I do not feel bulgy anymore, but I am cautious to not wear overly tight pants, as this feels like it pushes down (and out) on my organs.
I truly hope and am daring to believe that I can live without having this occur again, but I am realistic about the fact that I'm human and age can affect these things. I'm wondering about your statement that estrogen and weaning can affect prolapse. I had considered this, because I weaned my 5-year-old daughter at the same time that this occurred. I think I had a mild rectocele for years that really didn't cause any problems. Also, I had been sitting more and driving more during those months, with very little exercise. Please elaborate on if weaning would cause greater prolapse or remedy prolapse. Thanks, I am learning more and more on this topic, unfortunately due to personal experience!
okay so I may be naive here, but wouldn't squatting put more pressure on a prolapse of any sort? I agree that tailor sitting is great. Also I have heard the homeopathic sepia is good for prolapse and any weakness in the female reproductive organs. When would a prolapse be considered a problem then(apart from discomfort) at what degree does it not go away from kegels time? Does the 6 week postpartum period count? Or is it only after brestfeeding is over that a prolapse is considered a problem in need of surgical intervention? Just thoughts again, thanks for all your wonderful insight ladies!
I am talking about the kind of squats that are done as exercises to strengthen butt and thighs, etc. ( I don't know all the benefits). I do them in repetitions of 10. Strengthening the core abdominal muscles with exercise is supposed to help lift our reproductive organs. One of the midwives in our study group is also a personal trainer, and she warned never to do crunches or sit-ups, as they increase intra-abdominal pressure which then pushes down on those organs.
So sorry for not noticing your reply from the 15th. We are enjoying a lovely, wet snow which is sticking to all the trees in St. Louis on this Christmas day. Yes, side bends are good. As well, the personal trainer/midwife I mentioned also said that the yoga position called the plank is very good. I bet you can find video demonstrations of the kind of squats I'm talking about. I think they are very good in general, as well as for strengthening muscles that support the pelvic floor. And yes, I think the whole pilates philosophy focuses on strengthening the core for greater overall strength and conditioning. Paying attention to posture with whatever we are doing seems to be important with the issue of prolapse, and I guess even to avoid this problem. Hope you and your family are well!
I just reread all the posts on this topic and wanted to thank you all for your input. I really agree that we need more research on this from a holistic perspective, because when I went the OB she
only suggested surgery if it got too uncomfortable. Wow, not a single mention of anything in these posts! We had never discussed this in my midwifery group, but then only 1 of the regular
members is over 50. When I started talking about my prolapse, one midwife who is 36 then told about hers. She was immediately postpartum when it happened, and hers was primarily uterine
prolapse, but the discussion was really helpful. It sounds like urinary incontinence is one of the first symptoms for many women, not necessarily discomfort, so my experience was different - I
had no incontinence. I have no experience guiding women during childbearing who have this issue, so all of your comments about that are really informative. Thanks so much! This is a topic
that needs more attention.
I am 14 days out of my surgery. Starting to feel better finally. Surgery is not something I would suggest for most. My bladder was prolapsed but I didn't have incontinence issues. My doc said my uterine prolapse was so severe it kinked my ureter and if he lifted my uterus I would be fully incontinent both bladder and most likely bowel. My first issues came after a birthw with a terribly over zealous midwife. I could see my cervix at my opening. There was no hold left in my vagina it was just one big mass of tissues. I couldn't walk for over a month and never felt "normal". After my next baby it was worse when I got a cold immediately postpartum and that was just too much for those stressed tissues. I had constant back pain and was often in bed by the end of the day. I couldn't walk for more than 20 min with out being in too much pain. Intercourse was horrible! To have a BM I would have to scoop the vaginal tissue up and push it back into my vagina as it would fill with feces. It was horrible and painful. I was past PT or exercises. I hope to have a relatively normal life after all of this.
Sit ups are very bad. As is lifting anything heavy. There is a whole pelvic trauma thread on the birth trauma forum with a ton of info.
I am working on several articles on this topic as it is something that needs to be better understood by midwives everywhere.
Here's the link. The author is a well known urogyn
The BEST blog on squats and pelvic floor!
I'm not a birth professional (I hope it's ok that I'm posting here), but I read a study recently where selected women were checked for prolapse 6 months postpartum and 87% had a first degree prolapse, another 6% had severe prolapse and the rest did not have any visible pro lapse. The conclusion of the study was that prolapse should be considered a normal occurrence after childbirth. I think that midwives and obs should tell their new mothers that they should expect some form of prolapse after giving birth and that all women should have pt after birth. I think the hardest part about it is that women are totally blindsided and didn't see it coming.
Here's the link. The author is a well known urogyn
First--if you see my thread today "are you a birth professional", you will see that I am happy to have you announce your non-pro status. I think most of us welcome input from anyone, and appreicate insights and links from all. Just good to be clear about whether or not a poster is a birth pro or not...helps put a post in context for all readers.
Second, I can well believe the stats you posted. And I agree--a small degree of prolapse is probably pretty normal, considering the work that birth is for (and to) the pelvic floor. After my 2nd baby was born (2nd birth in 14months, precip delivery), I saw a doc for a 6wk pp checkup. I was 22 and very healthy and fit at the time, as well as planning a large family. She did a bi-manual exam, pronounced me prolapsed--and when I asked for elaboration, this is what she told me: that it was mild at present but would probably only get worse in time and with more births, would likely result in urinary incontinence by the time I was 40, and not to worry--I could have a hysterectomy then. No, no other 'known cure'.
Jeepers! Luckily for me, I did not believe her and immediately set about doing my yoga, kegels, etc (this was in 1980, before the pilates/core-work boom). Now, at 53, and 6 kids total, I still have my uterus and no issues. Since then, I've seen quite a few women with small degree of prolapse in postpartum, I take it as expectable and usually see improvement as time passes (unless the mom is simply overworked and overtired, then yes, it can definitely get worse over time)
Same doc also told me that I had a blocked tube (from a pp infection following my UC) and was unlikely to conceive again, except for ectopically--because even though the one tube was still open, it was also likely scarred and would not be able to help eggs get into my uterus. Nothing to do about that from a med perspective, either. I used homeopathic treatment a year later when I started cycling again...released the very type of 'serous fluid' that the doc had said was in the tube--and remained the fertile myrtle I'd always been. NO trouble conceiving (more like the opposite!) or carrying, ever. So much for allopathy....
But I will say this--as years pass and I work with more women through pregnancy and birth, I also work harder to get them to do some core work during pregnancy and following birth. It doesn't have to be major workouts--the simplest of exercises done 10 min a day quite readily help women to avoid prolapse, diastasis, and even SPD (the worst of SPD anyway), and to restore the pelvic floor quickly following birth. First, rest for a few weeks...then some toning. As for SPD, no, we can't do anything about pelvic tendency to be unstable due to relaxin--but when the surrounding musculature is sufficiently toned, that instability is lessened considerably--better controlled. Along with lessening of pain and mobility issues that plague some. Anyway--the more I learn about the pelvic floor and the musculo-skeletal system generally, the more I see how modern lifestyles harm us and the more I see how core work is needed by pregnant/postpartum women. I bought a book on Pilates for pregnancy that I've been loaning around--and seeing fantastic results with prolapse issues, even hemorroids and vulval varicosities.
Completed Beginnings...may your recovery be fast and complete, and may all for you improve greatly in the coming year. Your story has touched many of us, and I too appreciate your honesty in sharing it. We need to know these things, to help us and our clients avoid such difficult and enduring issues where we can.