WARNING: I do not shy away from descriptions of my birth injuries in this blog.  I feel like too often women, myself included, are caught unaware of the reality of giving birth as postpartum education mostly focuses on baby care and does not include maternal self-care.  So many women that I have talked about my experience with, wish they had known more about the possible outcomes. So if you think this is going to be TMI for you, stop reading here.  I also want to acknowledge that every birth story is different; I just hope that by sharing mine I might help another new mama know she’s not alone.

Immediate Aftermath

Immediately after being born, Eva was encouraged to work for her food.  She was placed on my belly, and amazingly, slowly (over the course of about 15 minutes), wriggled her way up to my breast, where she latched on and started feeding.  My placenta wasn’t coming and I didn’t feel pushy/crampy, so after an hour the midwives gave me a shot of syntocinon (a synthetic version of the hormone oxytocin) to encourage the birth of the placenta.  My one regret about the whole birth process was that I didn’t get to see the placenta / noone took a photograph of it.  We knew we didn’t want to keep it, but sadly I have nothing, not even a memory, to honour its passing.

The midwives inspected my vagina and suspected third degree tearing (which means the entire length of the perineum and extending into the muscle that surrounds the anus).  They did not feel comfortable repairing this at my house, and so we packed everything up and went to the hospital.  The obstetrician diagnosed (and repaired) a complicated second degree tear (full length of the perineum) with a lot of internal trauma (torn pelvic floor muscle).  I have nothing to back this up, but I suspect that having a strong core actually worked against me in this case. In retrospect I probably pushed too hard and caused more damage than was necessary.

Days 1-10

The first few days were incredible from a parenting perspective (what love! what perfection!), and just horrible from a physical perspective.  I could barely walk, couldn’t sit up straight and put weight on my perineum, and every time I peed it stung/hurt so much that I had to remind myself “you can do this, you just gave birth!”.  I couldn’t engage my pelvic floor at all, and there was so much heaviness that every time I stood up I felt like all my insides were going to fall out.

I really tried to take it easy to start with – I didn’t really leave the couch much – but as soon as I started feeling better I probably pushed things too hard (anyone else have a heavy mattress that takes effort to lift to put a clean sheet on?). I wish that I had had a rehab program right from the start. Even something as simple as breathing and engaging the diaphragm-pelvic floor connection.  Instead I tried to do the only thing I knew – kegels – to start to feel the PF (pelvic floor) ‘knitting’ again. I now know that I should have been doing breathwork in those early days, to reconnect the diaphragm and pelvic floor neurologically as well as physiologically. I wish Joy Black’s (@calliejoyblack) baby was born a few weeks before mine, rather than after, as her recovery exercise posts and stories are the bomb.

I found it very useful to get an in-home massage to release tension from birth, especially as I had a nerve pinch in a spasmed neck muscle from labor (which didn’t resolve for months).

Weeks 2-6: Getting started

Without exercise, I kept myself mentally grounded by doing one thing each day that marked the day – whether something productive like stacking the dishwasher, a load of laundry, or a grocery shop, or an appointment that got me out of the house, or having a call with a friend or a visit. This kept me from feeling idle, took my mind off my injuries, and also importantly I chose activities that didn’t take much brain power! 

At 2.5 weeks Eva started purple crying. How we handled that is a story for another day, but relevant to this story is that the exercise ball became my best friend.  Because I suspected that I had pelvic organ prolapse (POP – Dr Google diagnosis), it didn’t feel healthy for me to spend hours walking, bouncing, rocking, and risk further weakening of my pelvic floor or exacerbating the prolapse bulges.  Neither was it a great idea to have her in the carrier for long periods of time where the pressure was pushing down on my lower abdominal cavity. Holding Eva and bouncing on the exercise ball both supported my pelvic floor, and allowed me to move with her (rocking in a chair wasn’t enough for her apparently).

Around 3.5 weeks I started short walks and by week 4 I felt ready to get back into exercise. To be cautious, I wanted to be assessed and guided by a pelvic floor physiotherapist before engaging in activity that could potentially make my suspected POP worse. I guess due to the amount of damage and inflammation from the birth trauma, noone would see me early for the fabled, ‘six week clearance’, and I wasn’t able to get an appointment early anyway.  My first mistake was thinking that my birth injuries would be healed by six weeks, and the clearance would be to resume ‘normal’ (for me) levels of activity. 

In reality, the six week clearance is just to resume ANY activity. At least it was for me.  I was fortunate to work with a PFPT (Diane Rizzardo, also a Pilates specialist) who did in-home visits, and who also worked as a sports physio so understood my athlete mindset approach to recovery.  She confirmed that I had grade 2-3 rectocele and cystocele (bowel and bladder prolapse). This means that the tissue on the front and back of my vaginal walls had become lax – probably either from downward pressure from the baby during pregnancy, or from pressure during the pushing phase of childbirth…or a few other possible causes – and those two organs have ‘fallen’ into the vaginal canal.

I know from POP forums that this diagnosis is heartbreaking and emotional for many.  For me it was largely analytical. Having healed from so many injuries in my life, I have faith in my body. I also understand that after trauma my body adapts, and is never the same again. So I have learned to live with the new ways that my body operates, over and over. I also know that the rehabilitation path is not linear and that change is positive, even if sometimes it seems to be going backwards.  It is unchanging, static, chronic situations that scare me most.

Other than cosmetic changes, the biggest risks of POP are functional – for me, potential lack of ability to fully void bladder or bowel, and/or incontinence. The higher the grade, the more likely the issue. And I didn’t want to make any potential issues worse.  So I was careful.

The day of my six week clearance I was raring to go. I got the green light to resume exercise and I went for a hike that afternoon.  I had been watching a mom’s hiking group meet up for weeks prior, and was super keen to get out in nature.  Thankfully the group was very supportive, and I was able to hike to my capabilities at that time in my recovery. I also got a reality check when the other moms thought it was impressive that I was hiking at 6 weeks postpartum.  I think that’s when it finally sunk in that this was going to be a loooooong recovery.

I also started climbing routes once a week, with the focus on reconnecting my pelvic floor muscles with breath at the correct part of each movement. I climbed slow and easy.  And even so, I felt downward force on my pelvic floor from the internal pressure if I held my breath or did a move with lots of body tension. Everything felt WAY harder than at 39 weeks pregnant.

Weeks 7-17: The hump + the gains

This period was probably the most challenging for me.  I was recovering and could do some things, but I couldn’t push myself, and things didn’t feel at all normal.  My POP symptoms were improving, but not consistently and not as quickly as I wanted. I was getting antsy. 

At week 8 I faced a pretty big mental challenge. I went out with my moms hiking group on a fairly flat, easy circuit, and I floundered.  Everyone was super supportive, and they weren’t going very fast, but I just couldn’t keep up.  It wasn’t a case of I didn’t want to push myself, I just couldn’t make my muscles work any harder than they were working (and coming from someone used to pushing themselves in training, that’s saying something).  Not sure if it was fatigue or something else, but it was a blow to my confidence and self-esteem, and I had to work through the inner critic in my mind to soothe my ego – what would the other moms think of me? Was I being a burden because they had to wait for me? Would they think I was super unfit and didn’t belong in this group? In the end, I just had to accept that that was where my body was at, and if someone thought less of me because of that, that was their problem.  This same day there was also lots of heaviness in my pelvic floor and that probably didn’t help my mental state at all – it felt very discouraging.

The following week (at 8.5 weeks)  I did my first bouldering session. It was a super controlled session (no falls, no difficult problems that would create much pressure in my abdomen), and I was worried about urinary stress incontinence so I wore period underwear. Being back in that powerful discipline really ignited in me a goal to compete again.  I wasn’t sure how I would feel about competing again post-partum – I thought perhaps my competition days were over – but apparently not.  I decided that I wanted to compete in the first local boulder comp of the season (usually in mid-October, 9.5 months post-partum), and that I wanted to feel well enough with my prolapse that I could do a six week training cycle beforehand.  My goal is not to ‘perform’ per say, but to feel the best I can in my body, in the competition setting that I love. I am hoping for a little confidence boost that says ‘I can still do this’.

At around 10 weeks, climbing once a week and hiking once a week with occasional other walks was not cutting it for me.  I started swimming as a way to get in a more strenuous whole body workout without the risks that come with gravity and impact.  Swimming worked my upper body and back which sorely (pun intended) needed engaging as antagonist to the ‘mamas hunch’ I was developing, and there was no abdominal pressure as I was always breathing in or out – never holding my breath.  It was a good cardio workout as well, increasing my lung capacity again, and I was pretty much done in 30mins so it was also good from a time perspective.  I also generally find swimming quite boring, but since my ‘mom’s brain’ was stopping me from thinking too much anyway, it wasn’t as bad as I usually found it.

Those who followed my Olympic bid know that I typically do a 15-20min circuit of exercises each morning. I tried to do these early on, just as some kind of movement/exercise, but I think maybe I pushed too much – my body was executing with a memory of my capacity from ‘before’, rather than working with my new reduced capacity. All this aside, I found it almost impossible to do daily exercises anyway with the new unpredictable demands my baby placed on my time.  As someone who is vigilant about training prehab and rehab, it was challenging to find myself not even able to find the time to do my physio exercises daily, let alone any other kind of regular activity. I did find success incorporating my PT exercises into my daily activities though – squats while loading the dishwasher, pelvic floor exercises while brushing my teeth, a hangboard exercise each time that I walked through the doorway the board is hung over.  Breaking these exercises down into small chunks – an exercise here and there, rather than in a single block of multiple exercises – and having a particular routine prompt (dishwashing etc.) – gave a greater completion success rate.

At 12 weeks we visited my partner Simon’s family’s lake cabin, which has ~50 steps up a steep bank from the water to the cabin.  I didn’t feel great going up them – I could carry max 20lbs and felt lots of pressure on my pelvic floor. At 14 weeks I did an 8km hike. I kept up with the other moms, over a 500m elevation gain.  It was a great self-esteem boost.  At 17 weeks we went back to the lake cabin and things felt better from a steps and lifting load perspective, but I was really quite sick, and the associated coughing put a frequent explosive downward pressure on my pelvic floor which made it feel weak and fatigued, and resulted in occasional urinary stress incontinence.

 

Overall, during this period my recovery was two steps forward one step back – regular improvement but not completely linear.  Fatigue, oh so much fatigue, from sleep deprivation made it worse.  Then of course I didn’t feel that I could exercise, so I didn’t get the benefit of the incidental pelvic floor workouts that make the symptoms feel minimal.

4-8 months

I started doing a small strength and conditioning workout around 4 months, which went well and felt good for this stage in my recovery apart from two notable things – running on the spot in my warm up did not agree with my POP (gravity is a bitch), and I had a severe lack of power and strength when doing chin-ups.

I started doing yoga once a week around 4.5 months and that was great. I wasn’t swimming anymore so it was great to have something that worked my breathing and opened me up (especially chest and thoracic spine).  I started feeling somewhat good again in my bouldering from about 5 months post-partum, and posted a video of something that I was proud of sending.  (Go here to see the video: https://www.facebook.com/tiffany.melius/videos/796445814650863) It would have been so easy for me pre-pregnancy, but after every injury I’ve ever had I had to re-set the bar, and this bar for me was an achievement.

Around six months, the fatigue of broken, and lack of, sleep for months and months (I also had pregnancy insomnia) was taking its toll.  I felt like I was losing my mind. Although I had remained active, my activity wasn’t regular, and was nowhere near enough to maintain my level of strength and condition/tone. No regular exercise for months + fatigue = my body felt like it was breaking down / the cells were repelling each other. And losing muscle tone = muscle imbalances and painful spasms. I needed help.

We engaged a sleep consultant to help us train Eva to sleep better (read, give me better sleep).  We used a gentle method which meant Eva was never left alone to cry, and while it may not have been the quickest method, Eva adapted quickly nonetheless. I was also finally able to articulate what I needed from Simon, and he came on as a more equal night partner.  Her sleep may not be perfect, but it’s significantly better than it was, and heading into my pre-comp training, I now feel confident that I will be able to handle a program.

The other significant thing that happened when preparing for a program (I am working with @calliejoyblack) was I weighed myself for the first time since giving birth. With the little spare tire I am accumulating around my waist, I expected to be at the high end of normal for me, around 65kg (my competition weight is around 63kg). Instead I was a bit surprised and dismayed that I was down to 59kg, reflecting just how much muscle I have lost. :'(

We went to the lake again at 6 and 7 months, and with the steps as my recovery yardstick things have continued to consistently improve. But the greatest achievements during this 4-8 month period were actually those that DIDN’T register – inadvertently jogging into a store/across lights etc., realising that I had gone climbing without period underwear on, getting to the end of a day and not noticing heaviness in my pelvic floor.  It’s almost like life starts returning to normal without you even noticing.

Conclusion:

I may still not feel comfortable running; I may not have my power back climbing; I may feel my perineum push out when I cough, and my asshole touch the ground when I sit crosslegged; I may never reduce the size of the bulges in my vagina, even if I end up otherwise asymptomatic. But I am OK with it. 

Things are still changing for me. I am still breastfeeding so my hormones are still different to ‘normal’, and I am getting by on 4-7 hours of sleep a night (never in one, or sometimes even two blocks). Frankly the fact that I am still alive and mostly thriving when my body basically singlehandedly grew, and IS STILL GROWING a whole new human, is pretty miraculous. 

I try to have grace and compassion for myself when I get down about things, and remind myself that this is a tiny segment of my whole life; and even though it is my whole world right now, it won’t be forever. All my lessons right now are around impermanence, and that’s one of the nice ones.  Just remember, your job is to get through the day; the weeks and months will take care of themselves.