Before my second child was born I had a vague awareness that some women suffer from pelvic floor
dysfunction after childbirth, but I didn't think it would happen to me. After all, I had a strong core and my first child was born via cesarean section, so I assumed I wouldn't need to worry about this apparently very common part of womanhood.
After my second baby was born, I found myself suffering from a prolonged postpartum recovery, very heavy bottom, and what I now know as typical pelvic floor dysfunction symptoms. (Why hadn't anyone told me about this?!) My midwife referred me to a physical therapist specializing in pelvic floor rehab. She also advised that I not lift weights, run, or do anything else to put downward pressure on my pelvis and abdominals until I recovered. What about babywearing? I regularly wear my 35-lb toddler in addition to my newborn, and as a Volunteer Babywearing Educator (VBE) I also teach babywearing on a regular basis. How would babywearing affect my pelvic floor recovery?
Luckily, Babywearing International’s network of volunteers led me to Jennifer Stone, PT, DPT, OCS. In addition to being a babywearing educator with BWI of Central Missouri, Jennifer is a board-certified physical therapist who specializes in pelvic floor function and women’s health. She is a Doctor of Physical Therapy (DPT) and an Orthopedic Certified Specialist (OCS). Jennifer has 2 children, aged 26 months and 7 months, and has been wearing since her elder child was born. Jennifer became interested in the pelvic floor after a traumatic precipitous birth (45 minutes from 1st contraction to baby on the outside) left her with what she jokingly calls a “shredded pelvic floor” and the need for both a repair surgery and physical therapy. Sadly, there were no therapists within a 100 mile radius of her who could help, so she decided to go get training. She feels her pelvic floor practitioner certification meshes extremely well with her orthopedic specialty and manual therapy focused residency program, and is passionate about helping women live healthy and full lives – free of pelvic floor issues! Jennifer agreed to be interviewed on the often silent topic of pelvic floor dysfunction (PFD), as well as how PFD interacts with babywearing.
Shannon: Hi Jennifer. Thanks for agreeing to share your knowledge on this subject. Could you briefly explain what pelvic floor dysfunction is, and how prevalent it is? Jennifer: The pelvic floor is a group of muscles that line the internal base of your pelvis and surround
your vagina and anus. It functions similarly to a “sling” which works with your core to hold up and support your internal organs as well as the bony structure of your pelvis and lower back, providing a strong supportive base for movement. Pelvic floor dysfunction is extremely common in women-estimates in medical studies range from 25-40%, but we believe it is likely underreported due to the sensitivity of the subject and our culture’s attitude toward the area in question. Pelvic floor dysfunction refers to anything that causes those muscles to not work correctly. Symptoms can vary from pain to prolapse to incontinence, and many women have more than one of these symptoms throughout their lifespan. It can be related to childbirth, but in many cases it is not. Shannon: What causes PFD? Jennifer: In general, PFD can be caused by a variety of circumstances. Risk factors include: precipitous birth; very fast or very slow pushing stage in labor; genetics; lifestyle factors (e.g. heavy lifting, poor core strength); age; gender (female); hormone levels; and a variety of other things. Sometimes we can't narrow it down to one specific cause. For example, I have worked with women with vulvodynia or vaginismus (pelvic pain and pain with female exams or intercourse) who have never had children. I have also seen children and women who haven't ever had intercourse who have PFD issues. This is an area where a lot of research is still ongoing; we know a lot more about how to treat it than we do about what causes it (in some cases). Shannon: Once diagnosed with (mild) PFD, I was advised not to lift or squat lest I aggravate the
symptoms. Was this sound advice? Will babywearing slow my recovery? Jennifer: The concern that most practitioners have with lifting and squatting is that when your core and pelvic floor are not activating correctly to provide that stable base for movement, you end up putting a lot of downward pressure through your pelvic floor, which could exacerbate prolapse (i.e. organs protruding through the vagina-can be uterine, bladder/cystocele, or rectum/rectocele). Theoretically, the ideal solution would be “never lift anything until we get your pelvic floor back to normal.” However, most of us moms live in the real world where we can’t do that! So I usually suggest that women try to limit themselves to lifting 12 pounds or less as much as possible. Also, it is easier on your pelvic floor if you pick your child up close to your body (to your chest if possible) in a seated position, and then stand versus leaning over to pick him/her up. Babywearing a newborn should not slow your recovery-I would try to avoid prolonged wearing of a toddler or older baby if possible, and especially try not to do things such as stairs and hills while wearing the toddler. Again, this is advice for prolapse. If you are having pain (tight or spastic pelvic floor) the advice is different, and it is also different if you are post-surgical for any reason. Shannon: Are there some carries/carriers that worsen symptoms more than other carries/carriers? Jennifer: High and tight is more ideal. Basically, you are trying not to drop your natural center of gravity (which normally sits a little above your bellybutton). This is similar to advice that you would hear for low back pain-“try to carry books or heavy items close and tight in to your chest, not at waist level with arms extended.” Also, having the weight of the baby as central as possible and evenly distributed over your body is better-generally a 2 shoulder carrier is going to do that a little better than a ring sling. I am often asked about back vs front carries-I do not think back carries are going to be significantly better than front carries, and in fact a low/sloppy back carry will drop your center of gravity WAY more than a front carry (plus you have to factor in bending over to get the baby into a back carry). Shannon: Is holding a baby in arms worse or better than babywearing for the pelvic floor? Why? Jennifer: Generally babywearing is better! You will usually not be able to keep your baby as snugly in to your body if you are holding him/her in arms, nor will his/her weight be as evenly distributed. If you are lifting something, in general it is best to have that thing attached to your body and not moving around-just as in the example above where I said it’s better to pick your baby up in sitting and then stand vs bending over or squatting to lift him/her-it’s even better to get baby snugly tied on, because then your pelvic floor treats his/her weight as if it were part of your body (the difference between you gaining 8 lbs vs lifting an 8 lb object). Shannon: Are there particular activities to avoid while recovering from PFD? Jennifer: Always defer to the advice of your pelvic floor therapist if you have one! Keep in mind that
everything I have said here is a very general tip, but that the practitioner who has evaluated you and had their hands on you is going to be MUCH more knowledgeable about what will help you specifically – all bodies are different, and all pelvic floors are VERY different. I would also welcome people messaging me for more specific advice if they like. (email: firstname.lastname@example.org) In general, activities to avoid for prolapse or a weak pelvic floor are: lifting, squatting, carrying heavy weights up steps, anything where you feel you have strain (take stool softeners if you need to-it is important that bowel movements do not cause straining!), and Kegels. Yes, I did say avoid Kegels. Studies show that 80% of NONSYMPTOMATIC women do not do Kegels correctly when they are asked to-and in fact, they usually do a motion that would cause worsening of prolapse! So until your therapist has literally taught you how to activate your pelvic floor from scratch, doing Kegels is probably counterproductive. Products or advertisements that suggest that you can fix this issue by just doing Kegels in a certain position are likely incorrect as well. Typically, people need someone to actually teach them with a hands on approach and verbal and tactile cuing. Shannon: Are there any other tips you would like to mention? Jennifer: In general, I am a huge believer in listening to your body. If something feels like it isn’t right, it probably isn’t! You are probably going to have to be your own advocate in this area until you find the right practitioner (aka: you may have to convince your doctor to write you a prescription for pelvic floor physical therapy as many doctors aren’t fully aware of what we do or how we can help-or sometimes they think we only work with incontinence, or only with pain and aren’t aware of the full spectrum). Don’t assume that it will just go away, especially if you want to have more children-I know how busy we all are as moms and how we can end up being the last in an impossibly long list of priorities. However, taking care of your health is the best way you can take care of your baby in the long and short term! Shannon: Thanks again for agreeing to share your knowledge and insights.
I was working on contributions to “A Meet the VBE” post. I came to this question
Tell me a story of a time that babywearing made a huge difference in the outcome of a family outing.
And as I started to write, I realized this post had been waiting and waiting to be written instead. Climb into the way back machine with me to late 2006. Blondie was born in December, just 15 short months after the birth of her older sister.
My mom’s health began to decline just after the birth. I called Mom a month later. It was the eve of her birthday and I wanted to make sure I wished her a happy birthday while I could just in case the day passed and I hadn’t called.
Mom thanked me for calling, asked how I was and as the call was wrapping up casually mentioned that she was going into the hospital the next morning and could I email the family to let them know? After smoking her entire adult life, artereosclorosis was damaging veins in her leg.
Those first few months of Blondie’s life saw: my mom in and out of the hospital; failed surgeries; recovering in my home so I could assist with her care; a stint in a rehabilitation unit, and ultimately an extended hospital stay, including an isolation unit before she finally passed away in July of 2007. Blondie was six months old.
This was also the time period that I didn’t just casually wear because it was a good idea, it was a time I wore for hours a day because my family needed it so much. Typical First Child needed supervision during her normal if trying toddler antics. Blondie was an immobile nursling, and Mom needed visits and care. I practiced techniques daily, read online forums and attended monthly meetings.
During the meetings I got to sit, learn, chat with other moms and received support for a situation no one knew anything about and no one asked me for anything. It was--dare I say it?--therapeutic to go to a place with kind people willing to teach me skills that weren’t just useful, but essential for the life challenges I was facing.
Outside of the meetings there were a myriad of tasks awaiting me. Once a week, I would load the kids in the car and trek an hour south to my mom’s home. I would do the cleaning for her that she was unable to do and unable to afford to hire someone for. Usually my mom kept a watchful eye and ear out for a sleeping little while the toddler stayed on my back. We swept, vacuumed, dusted, scrubbed bathrooms, changed sheets and folded laundry for Mom. Mom wanted to do what she could for us, and that included a bath in the sink.
Several weeks later, Mom was recovering from a surgery and could not live alone while in recovery. Doctors, Mom and family all agreed that she would stay with me for a week. She was installed in a bedroom with bathroom access across the hall. I took the kids to the store to pick out a large tray and Typical First Child still remembers holding the napkins as she climbed the stairs to help deliver lunch. I would have Blondie in a sling and a tray laden with tomato soup, a glass of milk, saltines, a spoon, a sippy of milk, and a banana. Typical would share a snack with Grandma every day while I nursed the baby with them. Then we left with the tray for the kitchen and everyone napped.
A few weeks later, even in home care was not enough. Another surgery and then admittance to a rehabilitation center.
Seeing the children was very therapeutic –not only for my mom who got to see her grandchildren, but to the other women recovering on the ward, and even the nurses who spent hours upon hours tending to the needs of an aging population.
During one visit to the rehabilitation center, my family was lined up in the hallway waiting for my mom to be ready for a visit. A very jolly Blondie was in the same MT I mentioned earlier. Another patient was sitting in the doorway of her room and tapped her cane on the floor. Blondie let out a baby giggle. Another patient quickly wheeled over in her wheelchair and commanded her roommate, “Do it again.” Again tapped the cane, again laughed the baby.
The two women spent several minutes coaxing laughter out of the baby and coochie-cooing and remembering their own children as babies.
We went inside my mom’s room for a visit.
As we were leaving, a crowd of patients was in the hallway.
“We were sure we heard a baby laughing.”
We spent several more minutes coaxing laughter out of the baby and she was happy to oblige.
During another visit to the same facility a nurse looked me up and down and let out a wistful sigh. “We wear the babies in my country too. When you’re ready, put her on the back. You can do more. It’s good because you’ll be busy.”
Another visit and a different nurse pointed out that we wouldn’t have been able to bring the children so often if we didn’t have them in carriers. The kids couldn’t touch anything so they didn’t have to worry about the germs spreading and I could wash my hands before I had to touch the kids again.
The last time I spoke to my mom, Typical First Child played in the waiting room with her uncle while a newly sitting Blondie sat in the MT.
“Ah [Blondie]. You are so beautiful.” There was a pause as she took several deep breaths. She continued “You have such beautiful children, Ellen. I’m sorry I couldn’t hold them and be more of a grandmom to them. I’m so sorry I couldn’t….” She was in tears.
I hugged her and kissed her and assured her they were happy to have her just the way she was as their grandmother. Who else gave them straws to play with? It occurred to me to ask if she would like me to contact a priest for the Annointing of the Sick, a sacrament available for the ill in our religion. She consented.
It was time for me to go and I placed the call for the priest as I left the hospital. He was able to visit that evening and provide the sacrament.
She was in a coma the next morning. Mom passed away a few days later. I miss my mom. I imagine what my family's life would look like if she had recovered and continued to live with us. I would be a mama not wrapping and pushing a stroller, but wrapping and pushing a wheel chair. I'd be so glad to do it, if I could.
Instead, I am so, so grateful that I could be attentive to my children and to my mother. I don’t know that I would have managed without being able to carry them against my body and not still have the use of my arms and hands. It allowed me to provide care for multiple people, and across multiple generations. There was hard work in it, and a lot of deep love too. I don’t know that I have any great insight about carrying in general, but I can say every memory I have about doing something, a carrier was a quiet, but instrumental part in being able to do.
This post has been edited and updated to mark the anniversary of Ellen's Mom's passing. Has babywearing allowed you to manage during a difficult and trying situation?