My Body After Birth
Twenty years ago I had a scary birth that had me spend some time in the ICU. In less than 5 minutes I went from early labor to a scene from “ER” with doctors yelling, 10 people in my room, and a George Clooney-esque doctor I had never met before wheeling me into emergency surgery. I had an emergency C-section (different from a standard C-section). We spent about 3 weeks in the hospital altogether.
I am a trained classical singer and have an intimate relationship with my abdominal muscles. Together with my voice teacher, we were able to get them to respond again after that birth, but after my next birth, that wasn’t the case. When I would try to do a sit-up, my abs would pooch out instead of pull in (which I now know is doming). I couldn’t voluntarily suck my stomach in at all. I asked doctors, they said it “was normal after birth, give it time”. This was a real problem for me. I couldn’t sing opera, I couldn’t lift weights, I couldn’t really get back in shape. But, I was busy with a baby and a 4-year-old, so I grieved, got on with life, and put it on the back burner.
Fast forward seven years, and there was more time to work on me. I wanted to sing again. I wanted to get in shape and started the loooong journey of getting in touch with my core muscles again. I worked with my brother who is a certified trainer. I asked my doctors again. I worked with my voice teacher who helped me. I asked my chiropractor who seems to understand the whole body. I did research online, which eventually introduced me to something called diastasis recti, something previously unknown to me. I self diagnosed and asked my primary care physician for a referral which she gave with a skeptical look on her face. Then COVID happened. So, just recently I made my first appointment, where my physical therapist who is certified in specializing in the pelvic floor and postpartum confirmed that I do have diastasis recti and it’s probably fixable. I wanted to cry. I told her I couldn’t engage the muscles much at all to do exercises. She said that I was a good candidate for something called dry needling that could re-stimulate the muscles as well as exercises that would start small and increase in difficulty as I progressed.
Now, as I lay here on the table and she inserts long needles similar to acupuncture needles into my lower ab muscles, I think about how I got here, and it makes me so mad. I’m actually outraged on behalf of women everywhere. Why did I have to self diagnose? Why isn’t there more support for women postpartum (it’s a hard time)? Why isn’t this kind of help standard practice? I don’t blame my OBGYN, she is spectacular, I blame the system. Now that I have finally found the help I needed after 15 years, I want to share it! I want to shout it from the rooftops for all women to hear!
SO, SISTERS, HERE IT IS, STRAIGHT FROM THE MOUTH OF MY PHYSICAL THERAPIST:
Q: WHAT DOES A POSTPARTUM PHYSICAL THERAPIST THAT SPECIALIZES IN THE PELVIC FLOOR FOCUS ON?
A: There are so many different diagnoses that we treat. The pelvic floor is a bowl of muscles at the bottom of the pelvis. We can be called Pelvic Floor Physical Therapists (PTs), Pelvic Health PTs, or Pelvic PTs because we specialize in that area of the body, but that area of the body is connected to a lot of different things. It’s not just in isolation, so we look at the whole body.
Q: WHAT ARE THE MOST COMMON THINGS THAT YOU SEE IN POSTPARTUM WOMEN?
A: It depends on how the baby was delivered. A lot of times we see any kind of pain, incontinence, or other urinary symptoms like urgency, frequency, difficulty urinating, constipations, weakness of the core or pelvic floor, posture-related problems because when the baby is growing the posture changes, pain with sex, and diastasis recti.
Q: WHAT ABOUT PROLAPSE?
A: We see prolapse a lot, too.
Q: WHEN DO OBS PRESCRIBE PT FOR THEIR PATIENTS?
A: I would say when they see dysfunction. Every doctor is different. Some doctors believe a little bit more than others in the benefits of PT.
Q: HOW SHOULD A WOMAN ADVOCATE FOR HERSELF?
A: Just ask her OB for a PT referral? Yeah, she can ask her OBGYN, her Primary Care Physician or any MD, Nurse Practitioner, or Physician’s Assistant. They can all make a referral.
Q: WOULD THERE BE ANY HARM IN COMING TO A POSTPARTUM PHYSICAL THERAPIST JUST TO SEE IF YOU NEED HELP AFTER A BIRTH?
A: No. There would be no harm.
Q: SO, THEY SHOULD, IS WHAT YOU’RE SAYING?
A: Yeah, I feel like every Pelvic Floor PT would say that anyone who’s had a baby should at least be evaluated by a Pelvic Floor PT because we feel like we have a lot to give, a lot of tools in our tool box that can be beneficial, but you’ll never know unless you get evaluated.
Q: WHAT ABOUT SOMEONE WHO HAD A BABY A LONG TIME AGO BUT NEVER HAD THAT OPPORTUNITY?
A: It would still be beneficial. We can work on all the same things because once you have a baby your body is always postpartum.
Q: TELL ME ABOUT DRY NEEDLING, WHAT IT IS AND WHY YOU USE IT (BY THE WAY, READER, DRY NEEDLING IS OPTIONAL).
A: Dry needling is essentially a way to reset muscles in the neuromuscular system back to homeostasis, and we can use it for a lot of different things. We’re kind of re-educating muscles that haven’t fired in the way they should in a long time to fire the way they’re supposed to with functional activities, with exercise. Dry needling is like a monofilament needle inserted into musculature. I like to hook them up to electrical stimulation so we have the muscles essentially firing. We’re re-educating the muscles to fire the way they’re supposed to.
Q: IS DOMING THE BIGGEST SYMPTOM FOR DIASTASIS RECTI?
A: Essentially diastasis recti is a separation of the linea alba. The linea alba is the connective tissue fascia that connects all of your abdominal muscles, so it’s in the midline. Diastasis recti is when there’s separation of that tissue, which is common and happens in 97-99% of 3rd trimester women. When that separation doesn’t go back and it persists, it can cause a lot of other dysfunction. So, coning or doming is poor pressure management of the abdomen. If you have poor intra-abdominal pressure management, it can cause a little dome through that linea alba.
Q: SO IT’S NOT JUST ABOUT LOOKS (THE POOCH IN THE BELLY), WHAT ARE SOME OF THE OTHER PROBLEMS THAT CAN HAPPEN WHEN YOU HAVE DIASTASIS RECTI POSTPARTUM?
A: All of our muscles have a job. Our core muscles are meant to support us and stabilize us. So it’s a problem if you’re not correctly engaging your abdominal muscles, specifically your transverse abdominis, because it has such a huge role in the stability of your trunk and your pelvis, but also how we’re moving our legs and arms. If your core muscles aren’t activating the way they should, other muscles will try to do more and that can create pain/tension/discomfort in other areas of the body. Like where? Back pain, hip pain, pelvic floor pain or dysfunction, etc.
Q: WHY DO YOU THINK I HAD TO FIGURE THIS OUT ON MY OWN?
A: In a perfect world every doctor would refer women to PT after they have a baby, but sometimes they don’t. Sometimes if you have symptoms, they say, “That’s normal after having a baby.” I would say postpartum dysfunctions are “common” instead of “normal.” Whatever your symptoms are, they may be common, but you don’t have to just live with them as “normal.”
Q: IF YOU COULD SAY ONE THING TO POSTPARTUM WOMEN WHAT WOULD YOU SAY?
A: I guess I would reiterate that once you have a baby you’re always postpartum, so it’s never too early and it’s never too late for physical therapy. Sometimes you’ll have symptoms right after delivery or maybe it’s 5 or 10 years later, maybe it’s 20 years later. Having a baby with any kind of delivery is a trauma to the body, but rehabbing it for whatever symptoms you’re presenting with is possible.