Why You Should Be Discussing Your Vagina Tears With All Your Friends Right Now.

I'm stepping up onto my soapbox because, y'all, I'm so sick of this crap. I only work a couple of days a week but nearly every week I see a woman who is postpartum and is shocked that her pain or her leaking isn't normal. IT'S NOT NORMAL. I'm not mad at you guys, I'm just mad at the state of our postpartum care. I will say that I read through the new guidelines put out by the American College of Obstetricians and Gynecologists and they sound great, in theory. But I'll also say that just last week I had a patient come in to see me in the morning before heading to her OB's office for her last follow up after childbirth. She sent me a message that afternoon saying that her OB told her that her pain and leaking were normal because "oh, of course, you just had a baby." Then sent her on her way.

Eye roll, mad face, eye roll, heavy sigh, irritated growl. If you know me you know exactly what those faces look like. I have no poker face and I don't hide my emotions well.

When I gave birth to my son, my first baby, I tore. Down below is a graphic illustration of perineal tearing with childbirth. I'm putting this in your face because we need to be aware of this and open to discussion with our loved ones. Or strangers. I have more discussions than you'd think with strangers about this thanks to the power of social media and it makes me so happy. I love meeting a stranger and immediately discussing their vagina. It means that we are breaking down some walls, at least here in Fayetteville.

Day 2 after our son was born, feeling rougher than I looked.

So anyway, at the time my son was born I was only dabbling in pelvic health physical therapy and I had only taken one of the three main courses, so I was very green. I was also exceptionally exhausted. I didn't know enough at the time to ask my physician about the degree of my tear. I remember her saying a few times that I was going to be sore because it was a "pretty good tear." In addition to being exhausted I am almost positive I had postpartum depression the entire year after his birth, so again, I didn't think twice about any of it. The tear had to be cauterized three times over the next few months before it fully healed but I was too tired to care. My MD asked me how sex was and I never told her that there was no way in hell either of us were remotely alert enough to even begin the process of that. She just assumed and I let her, I was probably embarrassed to tell her we hadn't done that since the baby but I can't remember. I knew nothing back then y'all. Not about pelvic health, or motherhood.


Years later I went back to work and devoted by time at work to pelvic health patients. Around that time that my friend gave birth to her son. I was accidentally present for his birth, something we hadn't discussed, but she was induced with pitocin and honestly I thought it would take forever, so I went to the hospital to sit for a couple of hours and no joke it was suddenly 8am and he was on his way any second. So I hid in this little closet with the sink in it in the delivery room because I was pretty sure I wasn't supposed to be there for the birth. Oops. I stayed long enough to snap some photos and ask her doc how badly she had torn.

Me (as a Pelvic Health PT): "Did she tear?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health PT): "How bad was it?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health Doctor of Physical Therapy): .....

Eye roll, mad face, eye roll, heavy sigh, irritated growl to myself. Look, when your friend has a baby and is enjoying the moment, you don't make a scene. I kept my mouth shut and just sat there updating her family with photos, then drove her husband's truck into a concrete post in the parking deck on my way to get her other car with the baby's car seat in it. Once again, oops. In my defense, that parking deck is a bear and also his truck is like a flipping tank. Also they knew I am not a great driver when they gave me the keys so...

Image from the University of Sydney: http://sydney.edu.au/medicine/nepean/research/obstetrics/pelvic-floor-assessment/English/sydney%20pelvic%20floor%20body/After%20Birth/Anal%20Sphincter%20Muscle/Anal%20Sphincter%20Muscle%20html.html

Anyway, at her follow up appointments with the physician he didn't once mention her tear, her recovery, her emotional status, her continence, her pain, sex, NOTHING. I wasn't surprised because this physician had made me cry ugly tears during a difficulty period in my nursing of my TWIN BABIES. Which, umm, may sound totally easy to a man who doesn't lactate or birth babies, but nursing two babies is the opposite of easy thankyouverymuch. Anyway, thankfully a couple of years later she was ready for us to work on her incontinence issues because that's what friends are for after all. She's good now, but if she didn't have me going into my tiny fits of rage and explaining what is normal, what's right, what's good care, what's going to happen after birth, she'd have been like the majority of women out there who have NO idea what is normal.

9 years at APTS where I have been able to develop
a Pelvic Health practice over the past 4 years. 

Now thankfully, many women do have doulas or PTs or friends or midwives/physicians who understand that we need to do better in our country when it comes to the postpartum period. Many of them get great care. I do realize that, but I also see first hand that most women aren't getting that. And it's just not okay. In France, Pelvic Health PT is the STANDARD OF CARE. As in, you have a baby, you go to your pelvic PT for a few visits (or more depending), but you always go. It's like the norm there. In the US, most women don't have a clue about what we are, what we do, or how to get to us and frankly don't end up begging for a referral until years later when they have suffered for years. That's unacceptable. It makes me super mad and frustrated. My patients who have come in to see me soon after birth tell me all the time that they are the only ones out of their girlfriends who don't have issues. Guess why. Because we teach them how to re-learn the right way to use their body, their muscles, their pelvic floor right away before things get worse. We start using the correct abdominal muscles, get the pelvic floor working well, take care of scar tissue early so it doesn't become a problem, we nip the painful intercourse in the bud right away before things progress to marital distress. It's the right thing to do after birth. Birth isn't easy and no matter vaginal birth or Cesarean birth, it's hard on the body. It creates changes in the body that aren't necessarily bad, but warrant a couple of visits with someone who knows what your body needs and deserves after birth.

In my last Facebook video I begged people to spread the word. I'll say it again. Please, please, pretty please talk about this with your friends, family, colleagues, strangers you meet at the next wedding you go to. It's too important to keep it all taboo. There is someone in your world who is suffering right now from leaking so much they can't work out and they feel depressed over what their body has become. Someone whose marriage is suffering because she can't have sex with her partner because it hurts too much. Someone who can't play outside with her kids because her back or pelvis hurts too much. You could change someone's life by talking about what's normal and what's not normal. I'm not being dramatic. This is what I do, I see it all the time. It can be life changing. Please help me make this stuff okay to talk about it at book club. Or at girl's night. Or even your next dinner party. I don't care when you discuss it, but discuss it. We all have pelvic floors. We all have some issues going on down there at one time or another. So let's help each other. Tell your people that LEAKING IS NEVER NORMAL, SEX SHOULD NEVER HURT, and there is help for it. Here's my latest video if you haven't seen it on Facebook yet. 

End rant. Happy face, clapping hands, little dance. Thanks y'all.

Here are the updated guidelines for postpartum care:
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care



Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

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