‘Pelvic Floor Stories: Vanessa A.’s three births’

The suelopelvico.eu blog is a place to share information about women’s intimate health. I usually cover topics related to pelvic floor care, recovery before and after birth, exercises for pregnant women, and conditions such as vaginismus, dyspareunia or endometriosis… For a less ‘technical’ and more ‘human’ approach, from now on I’ll also publish interviews with patients who I think have something to contribute on this topic.

The personalized treatments I offer give me the chance to get to know my patients better. To launch this section, I spoke with Vanessa A., a mother of three who trusted me with some of her postpartum recoveries. From her I’ve learned how a woman prepares for and goes through three births, each different from the other: a cesarean, a birth with an epidural and a natural birth without anesthesia. In addition, she lives abroad (in Switzerland) for work, so I’ve also learned about differences in the protocols used in another country.

I hope you find the interview with Vanessa A. interesting and informative. I’m very grateful to her for her time and for being willing, during lockdown, to answer my questions and share her experience in such detail:

If you’re reading this interview, you’re my patient and you’d like to tell your story, write to me and we’ll put it together.

It’s not very common for women to look after their pelvic floor preventively. In your case, when and how did you become interested?

I’ve always been interested, although it definitely grew after I became a mother. When I went for my check-up with the gynecologist a month after giving birth to my first child, he talked to me about the importance of pelvic floor care. He recommended I see a physiotherapist for an effective postpartum recovery. I did, and with my second birth I looked for a clinic that offered not only a pelvic floor assessment but also group and individual hypopressive abdominal exercise classes I could go to with my baby. That’s how I met you, Ágata!

Your profile is very interesting because you’ve had three very different births. How would you compare them?

All three births were a life lesson. I went through the first one feeling a bit overwhelmed. For my second birth I was calmer; I knew what it was like. But with my previous cesarean, I knew there were some risk factors that could lower the chances of a vaginal birth. I did my research and gave birth to my second child in a public hospital with a wonderful doctor who respected me, without altering the natural process of labor with acceleration techniques or doing a cesarean, since the conditions for a vaginal birth were there. That’s so important these days! With the third, I felt even more in charge of my birth, without an epidural.

And during these three pregnancies, were there also differences in how you prepared?

Yes, there were differences. With the first two I focused more on swimming and prenatal yoga, and I also walked a lot. In my third pregnancy I had some bleeding in the first months, so I couldn’t exercise, but in the third trimester, after checking with my gynecologist and physiotherapist, I was able to do prenatal Pilates. So during the last three months I did exercises that helped me mobilize my pelvis and tone my pelvic floor. I feel this helped shorten my third labor.

Have you had any perineal trauma?

Episiotomies, basically: half a superficial stitch in my third birth and two stitches in my second.

And what recovery did you do?

To avoid weakening and discomfort from the scar, I followed a personalized plan of pelvic floor retraining exercises.

Why was a vacuum used in one of your births?

After pushing and pushing, the baby wasn’t moving down the birth canal, so the doctor decided to use a vacuum.

How do you remember it?

The doctor gave me the right information and explained what it involved and how he would do it. That reassured me, and in my case the use of instruments didn’t cause any problems.

Why did you decide to give birth without an epidural the last time?

Birth is a unique moment in life, and after a cesarean and a second birth with a vacuum, I wanted with all my heart to have the birth I’d always dreamed of. I worked in Africa for many years, seeing women give birth naturally, letting their bodies give birth and express themselves as they know how. Those women were an example of strength, connection and wisdom for me.

Also, during labor, my husband reminded me in moments of weakness that what I wanted most was a birth without an epidural. I couldn’t have done it without him. And it was without doubt the best way to welcome our baby.

How did you manage the pain?

The public hospital where I gave birth had a bathtub, and it really helped me relax, which helped dilation and reduced the pain. When someone runs a marathon, people cheer them on and support them to keep going, and it’s the same in labor. The key is to focus on moving forward and working with your baby when the pain gets sharper and the contractions come closer together. Don’t focus on the pain. I also had my husband, the midwives and the doctor, who gave me calm and strength and were with me along the way.

Could you describe which movements or exercises you found helpful?

Figure-8 movements with my hips; I used the large rubber ball to do exercises on my knees, and I also rocked my pelvis from side to side as if rocking the baby, standing with my legs slightly bent and my hands resting on the table. Above all, I used my intuition and let my body express itself.

What abdominal and pelvic training routines do you do now?

Mainly postpartum hypopressives and Kegel exercises. Hypopressives are helping me correct my abdominal diastasis. I started hypopressives gently after the birth; my physiotherapist helped me design simple exercises for the first weeks, and little by little I’ve moved on to more complex ones. I also do Kegel exercises in different positions and at different times of the day, for example while breastfeeding. And I combine all this with neck and back stretches. No pressure and no goals I can’t reach. I don’t have much time with three children, so if I have ten minutes here, five there and fifteen somewhere else, I make the most of them and look after myself.

If you use a vaginal device or trainer, which one? (Kegel balls, Kegel smart, electrical stimulator, vaginal cones, etc.).

Not right now, but I have used Kegel balls and an electrical stimulator.

We haven’t mentioned that you live abroad. What differences do you see in pre- and postpartum care between Spain and Switzerland?

I gave birth to all three of my children in Switzerland, so I can only tell you what happens here. When you leave the hospital, a midwife visits you at home at least three times to weigh the baby, check any scars and answer all your questions about breastfeeding. In my case, from the very first day the midwife showed me positions for carrying the baby without harming my pelvic floor. In addition, after the postpartum appointment, the gynecologist refers you to a physiotherapist specializing in the pelvic floor for an assessment and recovery exercises. This helps women be aware of their perineal health.

As for prevention and exercise during pregnancy, in my case it was more my own initiative to see a physiotherapist than a doctor’s referral.

“The views expressed herein are those of the author and do not necessarily reflect the views of the United Nations.”