In response to [...]'s response to the option I have pursued for a
weak pelvic floor [Issue 2:3}: First, a gynecologist and urologist work
with the physical therapist. I go to their offices in order to receive the
treatment. Second, the Journal of Urology has published several studies
that indicate that 85% of women who have their pelvic floor strength
measured (via a pressure catheter in the rectum and vagina), receive
electrical stimulation and do pelvic floor exercises prescribed based on
the woman's strength, will avoid having to have surgery. Often women with
damaged pelvic floors will be doing too many "kegels" or doing them
ineffectively (using abdominal muscles). Another advantage to the
electrical stimulation is that you feel your muscle contracting the way it
did prior to the pregnancy/birth.
Remember, many women who suffer from this condition have been victims of
obstetrical routines such as episiotomies. [...], like traditional
obstetric beliefs, blames the woman's body or the process of birth as if it
were a medical event instead of a natural process. He commented on more
likely "reasons" for my pelvic floor problems: the size of the baby (6 lbs
8 oz), length of second stage (20 minutes of pushing to the point of
comfort), neglect of the muscle after birth (I began doing PC exercises
daily from the day of birth). I am quite sure that [...]'s comment
about estrogen deprivation has to do with that "abnormal" thing called
breastfeeding. And in response to his comment that "it tends to be a
familial problem," no it seems to be a problem of obstetrician-managed
birth as opposed to a midwife-attended birth. The belief that the woman's
body is defective is what allows the standard of care in obstetrics to
continue despite that fact that it is far from evidence-based.
Let's be honest here. Vacuum extractors are forceful. They bring a baby
through a birth canal that has not stretched at nature's pace. Recent
studies on vacuum extractors focus on the risks to the baby. Anything
capable of causing cephalohemotomas, retinal hemorrhages, skull fractures,
hemorrhage beneath the scalp, facial paralysis and Erb's palsy is certainly
capable of damaging the mother's tissues. Several paraurethral tears and a
penineal tear ought to be a clue that this vacuum birth was far more
traumatic than the size of the baby, length of second stage and neglecting
PC exercises after birth.
A woman can feel confident having a urologist manage prolapse, especially
when it is hard to trust obstetricians who have been known to cause routine
trauma to the pelvic floor with epsiotomies, forceps and rushing births
(instead of using effective pushing positions, patience and perineal
support). When a young woman is urinating every time she sneezes, coughs
and runs, a urologist certainly should be capable of assessing and treating
the problem. I commend the gynecologist and obstetrician in my area who
offer non-invasive therapy first and provided me with the literature
discussing the success that [...] claims does not exist.
-Cindy Schierlinger
Reprinted from Midwifery Today E-News (Vol 2 Issue 8 February 25, 2000)
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