Part 4: Pregnant with prolapse
Knowing the risks to my body, I still wanted another child. The doctors said that the damage is likely done with that first pregnancy, but it’s not guarantee that I won’t be worse for wear after the second.
Still, the ordeal has also made me understand that however you think our bodies were designed, gods or evolution, my body is expendable. It has begun to weaken, and it will eventually die. My son is probably the most important thing I ever produced, so in the grand scheme, I might as well have another.
The specialist gynecologist said women with prolapse had no extra trouble conceiving or carrying babies. That may be true from the baby’s point of view, but for me, the carrying is definitely harder.
Women on the web have said the first trimester is tough with the relaxin kicking in, then prolapse seems to ease as the uterus rises up in the body when it needs more space, and then in the third trimester it gets worse again supporting all that weight.
I don’t think it’s possible to know whether the pain I’ve had from the beginning is just a whole new level of relaxin vs my first pregnancy or the fact that my pelvis is not held together by the full complement of muscles. I suspect the latter plays a role. While I was able to walk without significant pain until the last weeks with my first, the poor alignment of my pelvis began shooting pain into my legs around 19 weeks. Also, prolonged standing and slow walking became problems by 14 weeks, with the sensation that my undercarriage was on the point of giving up.
So, what to do?
Support band
My midwife recommended a support band, which may have helped at first, but by 21 weeks was no longer necessary. I actually found one with groin straps to fight that bottom-falling-out feeling, but I’ve only used these a handful of times. Until the third trimester, I just avoided standing and walked at a minimum pace. Constant use of braces makes muscles lazy, and they need to get steadily stronger through the pregnancy. I use the brace only to do things I wouldn’t or couldn’t do without extra support.
But in the third trimester, basically everything except a normal work day (desk job), was something I couldn’t do without support. So I began wearing the band for most of the day on weekends as well as in situations where I had to walk from one building to another at work.
The midwife also sent me back to physical therapy.
PT for preggers
The physical therapist diagnosed me with pelvic girdle pain, which you definitely don’t have to have prolapse to be dealing with. I’ve been a lot lazier with the physical therapy this time around, only doing the stretches and exercises some days, but there are two things that I heed religiously. One is sleep positioning. I keep a rolled up towel behind my back, a thick or doubled up pillow between my legs (you can stick two in one case), and a folded towel under the pillow beneath my head. I don’t get pain in my belly overnight, so I have yet to use a towel for support underneath it as well.
The other is being very conscious about walking and lifting. I try to walk as normally as possible, even when my hips hurt. Also, I can’t get away from lifting my 2-year-old, so I always make sure my hips are square and carry him only against my chest, with both arms supporting. I had been preferentially carrying him on my right hip, which weakened a muscle in my lower back (gluteus medius) on one side. For a while, I did the exercises to strengthen that muscle on both sides. But between sleep positioning, conscious walking and lifting, and prenatal yoga DVDs, and taking time to rest, I could keep the pain under control until the third trimester.
She also had me on a course of kegels again, which I have mixed feelings about. I had very strong pelvic floor muscles when I gave birth the first time. Did that contribute to the damage? I haven’t been able to get a straight answer on this, and she tried talking to the prolapse gynecologist. Every time the PT seemed to understand the question, the answer I got back was in response to some other question.
Personally, I don’t think they know. There are a lot of questions that haven’t been asked about this condition because it’s been something that “just happens” to women for so long.
I ended up back in PT in my third trimester because of pain shooting down my legs. She performed muscle releases, and I became a lot more diligent about the exercises. Nervous about the state of my scar tissue, I began doing the stretches that the first physical therapist had recommended, pulling at the back of my vagina in 6 o’clock, 8 o’clock and 4 o’clock positions.
It hurt, but it wasn’t the scar tissue. It was a way to get at some of the muscles that were overburdened in my poorly balanced pelvis. Better to take care of that before they are forced to stretch by an oversized baby head! So those stretches came back into my routine around 34 weeks.
Finally, the physical therapist recommended swimming to strengthen the glut medius without the stress of all the extra weight. Kickboard and flutter kick down the pool, and then on my back for the return. I was not to use my arms because my cardiovascular system is already overtaxed with the extra blood volume.
At first, I didn’t want to make the time. I already feel like my time with my family is short as a working mom. But, it turned out there was a pool practically on my route home.
It made a huge difference. I felt really good getting out of the pool after having a break from the weight of my body. My pain levels were lower. Plus, it reduced swelling.
Incontinence
This has been a big deal for me this pregnancy — for the first time since just after birth, sometimes my bladder lets go and there is no stopping it. So far, it only happens when I get up from lying down, like in the middle of the night, or when I’m dehydrated.
For this, there’s nothing but kegels. Strength training, and in the moment when you’re at risk of having a problem, 5 or so “quick flicks”. The latter works most of the time. Still risking it with panty liners in the office — most days are no problem at all. But in the 9th month, a liner is required every night.
During the many colds with this pregnancy, I just gave up on stress incontinence and changed panty liners a lot. Sometimes, it’s just too much to ask.
Last notes
At one point, the physical therapist looked at my scans and was moved to high-five my post-partum therapist. Apparently, you don’t usually get the kind of urinary and fecal control that I had with that kind of damage. Which is kind of good, but on the other hand, if I’m already supposed to be worse, this next recovery looks scary.
Four weeks out from my due date, I feel saggy a lot. I’m pretty sure there’s some kind of callous on what the part of my vaginal wall that doesn’t stay in anymore. But soon I’ll have that baby, and she’ll be beautiful, and I can begin to rebuild what is left and think about surgery options.
Posts in this series:
Prologue
Part 1: Is this normal?
Part 2: Sometimes you won’t get better
Part 3: Menstruation
Part 4: Pregnant with prolapse
Birth plans and prevention
