My Broken Vagina
“You’re probably just going to leak a little pee sometimes. Like when you do jumping jacks… Or run… Or laugh”, my mother told me a few weeks after my first child was born. It had been a much more challenging birth than I had expected, as a young, healthy woman with no pregnancy complications. My daughter had apparently become very attached to her hand while in utero and decided to try to exit my body with that hand right up next to her cheek. Labor had been progressing well for most of the day and it really wasn’t until she started crowning that things seemed to go sideways. I remember the midwife telling me that she could see the head which in my mind meant, “ok, a few more pushes and this agony will be done” but an hour later, I was exhausted and in the exact same position. I looked at my husband, Andy, who is a family doctor and delivers babies regularly and mumbled something like, “I can’t keep doing this”. “Do you want to try an episiotomy?” he said, and one might think that the idea of cutting my vagina would sound unappealing but at that point, my entire vagina had felt like a raging fire anyway, so I eagerly said “Yes!” The midwife seemed hesitant and said “I think you’re stretching. Are you sure you want to do the episiotomy?” I vigorously nodded unable to actually form words because my tongue felt like an enormous, dry sponge in my mouth. The obstetrician was called in, the episiotomy was cut and our daughter Rosie came out with the next push. I ended up only needing a couple stitches and though the next day I felt like I had been hit by a MACK truck after all those hours and hours of pushing, it was my poor, swollen vagina that made me unable to walk without waddling. Like any brand new mom, I pulled on my mesh underwear and assumed things would get better.
At my 6 week post partum visit, I told my OB/GYN about my leaking pee and painful vagina and she furrowed her brow and said, “Well, we could try a surgical revision of your scar?” More surgery was the last thing I wanted. My poor vagina felt broken enough and I was not at all interested in subjecting it to more pain. I asked my doctor if I could try pelvic floor physical therapy. (As a graduate student studying Child Development, I had spent some time as a developmental intern in the NICU working alongside a physical therapist who split her time between doing physical therapy with the premature babies and doing pelvic floor therapy with the perinatal women. At the time, I had no idea what pelvic floor therapy was, but she explained how many women experience trauma to the pelvic floor muscles after 9 months of pregnancy followed by birth and how pelvic floor therapy can help re-train, strengthen and/or relax those muscles.) My doctor gave me a very skeptical look and said, “You can try it if you want,” the unspoken part of her sentence seeming to be “but I doubt it will do anything.” She wrote me a referral and off I went to PT.
In the waiting room, I was the only person under 50 without some kind of leg brace and carrying a newborn in a bucket carseat. Though people smiled and fawned over her, I felt like baby Rosie in her carseat was a sign to everyone that I was there to try to fix my broken vagina. In therapy though, the therapist made me feel like the muscles of the pelvic floor deserved to be cared for and healed just as much as any other muscle that was actually visible to the naked eye. She explained that urinary incontinence and dyspareunia (pain with intercourse) were common pelvic disorders that occurred after birth but were highly treatable. At this point, I hadn’t even begun to entertain the idea of sex but just the suggestion sounded painful. Over the course of our therapy sessions, through a combination of manual therapy (where the therapist inserts a gloved finger into the vagina to palpate the muscles internally) and biofeedback therapy (where the therapist uses a probe inside the vagina to measure the tension and relaxation of the muscles) along with exercises I practiced diligently between sessions, I began to see improvements. I’d walk out of the office with my bag of ice in one hand and Rosie in the other and head to my car where I’d slide my bag of ice down my pants and drive home. One time the bag leaked, which was unfortunate.
I didn’t return to therapy until the birth of my second child, my son Nathan. My optimism had struck again and I thought that first birth was just a fluke and surely this time would be better. I was wrong, very wrong. Thanks to the lingering scar tissue from my episiotomy, Nathan got stuck on his way out and tore himself a new hole, through my groin. I remember just being so relieved that he was out and healthy and that the pain had stopped, that I didn’t realize things were bad until the GYN surgeon was called in and after taking one look at my vagina which now had two openings, he looked at me with a pained expression, put a hand on my knee and said “We’re going to take care of you”. I waved goodbye to Andy holding newborn Nathan and they wheeled me into surgery where I stayed for the next two hours. They told me I was lucky that I hadn’t torn into my urethra or my rectum, but it was clear to me that I had broken my vagina again. A few days later I left the hospital with Nathan, more mesh underwear and my very own catheter. I called my pelvic floor therapist to book my first appointment as I adjusted the bag of urine strapped to my leg. This time my OB/GYN had put my referral in right away.
When I got pregnant with my third child, my OB/GYN told me that the surgeon who operated on me after Nathan’s birth had written in my chart, “Not recommended for future vaginal deliveries”. Andy and I were surprised to hear that, because unlike some situations where babies are too big to fit through pelvic bones, my issues were all caused by soft tissue. After many, long conversations with my OB/GYN, we came up with a plan to allow me to try for a third vaginal birth that included: an epidural (yes please!), delivering with an OB (gladly!) and doing pelvic floor therapy during pregnancy to stretch the scar tissue that was now on both sides of my vagina. Doing pelvic floor therapy without having to balance an unhappy newborn on my chest was a nice change and my therapist and I could see how my tissue was stretching and loosening over the course of our therapy sessions. I was encouraged that maybe the third time would finally be a more positive birth experience.
I ended up going into labor three weeks early with my third child, which was another first for me as my other children had both been born late. I tried to hide it from Andy, as he asked, “Are you ok?” and I breathed through a contraction telling him, “yeah, I’m fine”. But when I needed to grip the kitchen island with both hands, leaning forward and swaying my body from side to side as I exhaled loudly, it seemed the jig was up. “I think you’re in labor,” Andy said. “No, I can’t be. I’m not supposed to have the baby for 3 weeks,” I told him. “Well, the baby doesn’t seem to know that,” Andy said. Ben’s birth was a completely different experience. I had the epidural, I took a nap, I had to ask Andy if I was still in labor and he pointed to the fetal monitor to show me I was having contractions that I couldn’t feel. I was able to talk to the doctor and the nurse throughout labor and even ask for a mirror to see Ben’s head coming out when I pushed. He slipped out quickly without doing any additional damage to my vagina and I told him he was my favorite child.
After Ben’s birth, I returned to pelvic floor therapy one more time but I didn’t even need the full course of treatment. I would push Ben in his stroller and anytime I would see another new mom, I’d strike up a conversation and somehow work into it how normal urinary incontinence and pain with intercourse were after birth and how incredibly helpful pelvic floor therapy could be. It felt a little bit like preaching the gospel. I had discovered this amazing thing, that only seemed to be regularly available to French women because they live in a society that values sexual health, but if we ask for it and advocate for ourselves, we too can live without leaking pee and with enjoyable sex. My OB told me that after seeing my results, she began to regularly refer women for pelvic floor PT. I even got my mother to go. My kids are now 13, 10 and 7 and in the last thirteen years there’s been jumping jacks, runs and a lot of laughter, all with dry underwear.