Interview: The Pelvic Floor & Its Connection to Our Emotional Health
Childbirth can be one of the most amazing experiences of our lives. It’s truly transformative in ways we could never imagine. It can also be anxiety-ridden, traumatic, and lonely. Understanding our bodies is so important. We sat down with Tara Morrison, doctor of physical therapy, women’s health coach, and founder of Inner Rhythm Wellness, to talk about our pelvic floor and its connection to our emotional health.
Tara lays it all out with a healthy dose of this is what’s up that we all need to know.
What is the pelvic floor, and how do we know ours is weak?
The pelvic floor is a triangular-shaped group of muscles that sit at the base of your pelvis and plays an important role in supporting your core, toileting activities, and sexual function.
It is made up of three distinct layers. The first two layers of the pelvic floor are associated with sphincter control (sphincters are the muscles in your body that either hold things in or allow things to pass), think peeing, pooping, and passing gas.
The third and most deep layer of the pelvic floor is responsible for providing core stability to your trunk and maintaining pressure within the trunk of your body. This layer is what we most commonly see affected by pregnancy and childbirth. (Yes..even if you had a c-section, just carrying a baby puts pressure on your pelvic floor).
Signs of weakness can include urinary leakage, prolapse or symptoms of vaginal heaviness, things looking “different” down there or bulging out of your vagina, fecal incontinence, pain with sex, low back pain, hip pain, and even jaw pain! (the hip bone really is connected to the knee bone!)
The best way to know if your pelvic floor is weak is to see a pelvic floor physical therapist who can do an internal assessment of your pelvic floor muscles. I believe that all women should have pelvic floor physical therapy following birth, and in many other countries, it is the standard of care after having a baby. The U.S. is still not quite there when it comes to providing adequate maternal health support, unfortunately.
What impact does the emotional and physical stress of childbirth have on us postpartum?
Childbirth can be an incredibly taxing time, both emotionally and physically. Forty-five percent of women report experiencing birth trauma, and this is only the reported number. Birth trauma is not just something women delivering in the hospital experience. Those who are survivors of a previous traumatic experience are also a risk for being triggered during birth.
We are not prepared for the significant emotional and physical stressors of childbirth. Which leaves women feeling like they are broken, or that something is wrong with them for feeling the way they feel. We go into childbirth blind and unprepared with a that won’t happen to me attitude.
The intensity, severity, and impact depend on a combination of factors that add up to make your birth experience what it is. These include the health of the pregnant woman going into labor (age, activity level, pre-existing conditions, pregnancy complications), the duration of labor, the number of interventions during birth, and a woman’s beliefs around birth, herself, and the world around her.
In a vaginal birth, perineal tearing, vaginal abrasions, and other tears from delivery or interventions (forceps, vacuum, etc.) can leave a woman with significant pain in the postpartum period. And if scar tissue develops, this can be one of the most common causes of pain with intercourse.
A woman who has a long labor experience that turns into a cesarean will not only struggle from physical exhaustion but will be recovering from major abdominal surgery while trying to learn how to tend to and care for a newborn. In the first few months, they will require more rest and support as their body heals from surgery. A cesarean scar requires care and tending in order to reduce scar tissue formation. However, many women have an aversion to their scar, as it is a sign of how her body betrayed her.
This emotional burden following unplanned cesarean births can cause a woman to disconnect from her body and often even her baby. Women who have cesareans or any complications with their baby, where the baby is swept away after birth, often report feeling like they can’t connect with or bond with their baby right away. This increases significant feelings of guilt and shame around not having the bonding moment she expected, often leading a woman to believe she has started motherhood off a failure. This can lead to mental health disorders such as PTSD and postpartum depression.
These traumatic experiences during birth live within a woman’s body; they get stored in the body’s tissues. And the limiting beliefs that are brought up during these challenging moments get anchored in the mind. The new mother then goes home to figure out this whole motherhood thing feeling completely shattered and broken. All the while, these traumas, and beliefs keep getting triggered over and over—a constant reminder of just how broken she is.
This can be hard to move away from, and often women go their entire lives without healing the stories of their birth.
Your mind and body go through so much, and such a transformation, during childbirth. Are there common misconceptions about the impacts of birth on our emotional health?
I want to cover three of the biggest misconceptions about the impacts of birth on a woman’s emotional health during the transformation that is motherhood.
1. “As long as the baby is healthy, right?…. ”
WRONG.
We need to be doing better for mothers. We need to remember that mother’s matter too. And that they often suffer in silence out of fear of being seen as not a good mother. This goes back to our previous discussion around birth trauma and challenging birth and postpartum experiences. Mothers struggle in silence, and their feelings are dismissed, especially when the baby is healthy. The statement “As long as the baby is healthy, right?” couldn’t be a further cry from the truth.
2. That a new mom is ready to jump back into her regular life at the six-week check-up.
Because women are only given ONE check-up at six weeks, there is the assumption that they MUST be all healed by that 6-week mark. This is just not true.
At the six-week check-up, a woman is being cleared to make sure her uterus is back to size, she has stopped bleeding, and they typically perform a mental health screen. The six-week mark is just the beginning. The beginning of slowly starting to increase activity, go back out into the community, and back into the workforce.
And when a woman isn’t feeling either emotionally or physically back to herself at six weeks, this can make her feel like something is wrong with her. What is wrong is that we only have one six-week appointment, and then all apparent support is stripped away.
Also, social media is doing us no favors by depicting well-dressed mothers and happy babies. As if THIS is the standard. I’m just going to say both my postpartum experiences were a far cry from this reality. Women enter motherhood with this vision and expectation of what motherhood will look and be like, without giving much thought to the after-effects of childbirth. This can blindside mothers, and just like traumatic birth experiences, can contribute to postpartum mood disorders.
It’s like we are all walking around with rose-colored glasses. And on the one hand, I wouldn’t want to take this experience away. The beauty, joy, and excitement that comes with all the preparation. I just wish that we were also preparing mothers for the hard stuff before we’re stranded in the deep end and struggling to ask for a life float out of fear of being perceived as a bad mother.
3. Postpartum mood disorders are purely a biochemical problem.
We now know that multiple factors go into a new mom’s experience with postpartum mood disorders. There’s a definite range in severity, anywhere from extended baby blues, postpartum depletion, burnout, anxiety, rage, bipolar, PTSD, and to full-on postpartum depression.
It’s important to look at all the factors contributing to a woman’s mental health in the postpartum period. Her level of support, stress management, prior mental health diagnosis, birth trauma, and navigating the identity shift of motherhood. To less thought of factors such inflammation and environmental toxins.
An integrative approach including stress management, nutrition, and mental health support is essential for treating postpartum mood disorders.
For those who have vaginally delivered large babies and had a traumatic experience because of it, how can moms prepare for another birth without being riddled with anxiety?
Working with a pelvic floor therapist can be a great way to help yourself prepare for another birth. As mentioned above, if a woman has significant tearing, she may also have scar tissue formation. A therapist trained in internal physical therapy can help perform specific massage techniques to decrease scar tissue, improve tissue mobility, and perform pelvic floor massage to help reduce any tension or muscle tone.
It’s also important to note that anxiety is correlated with higher levels of tension in your pelvic floor. So if you want to improve your outcomes of not tearing, pelvic floor massage and perineal massage can go a long way. But also addressing the root of your anxiety with a mental health therapist, counselor, or coach can be a great adjunct to pelvic floor physical therapy. And many pelvic floor therapists are also skilled in addressing this mind-body connection.
If the anxiety is being driven by a previous traumatic birth, working with a provider who offers birth story listening sessions can be a wonderful way to release the limiting beliefs and fears that are coming up. Finding peace within your first birth story paves the way for a smoother future birth. Holding birth story listening sessions is one of my favorite offerings!
There is no denying that our bodies change during and after birth, but it can take some getting used to postpartum. What can we do to show ourselves some grace as we rediscover ourselves?
One of the hardest parts of recovering postpartum can be giving ourselves self-compassion, or grace, with our body image. One of my BIGGEST pet peeves is the statement, “Get your body back.” You know…the headlines “How so and so got her baby back in just three months.” Or workout programs promising to “Get your body back.”
Well, here’s the truth.
Your body is forever changed. It will never be exactly the same. So there is no point in going backward. We can only go forwards. And part of that forward movement is learning to love and accept your body as it is.
Here are some tips for showing yourself some love:
- Have a gratitude practice where you give thanks to your body for its powerful ability to create and sustain life.
- Take time to touch your body in loving ways. Such as taking a mindful shower! Slow down and actually be present with yourself, not with your to-do list, as you shower. You will be amazed at how often you usually zone out or rush. Send gratitude and love as you lather up.
- Get a massage, acupuncture, pelvic floor physical therapy, or other healing modalities is self-love practice and can go a long way in helping you feel better in your body, mind, and spirit.
- Move your body, but not too much. Start your return to physical activity slow. Start by walking, gradually increase your resistance to weight training. Hold off on running until at least three months postpartum; your pelvic floor will thank you. See a postpartum specified physical therapist, or if you feel overall good, a postpartum specialized personal trainer to help you gradually return to exercise. There are also some great online programs out there, such as the MUTU System and Restore Your Core. All good things come in time!
- Remember, this is not a race or a competition. Your body needs rest to recover. And depending on your pregnancy and birth, you may need more or less of it. It needs sleep, hydration, and proper nourishment. Focus on these first.
Traumatic experiences can be a result of trying to conceive, and they can take a toll on us mentally and physically. During the most challenging times, how can we still show up and give love to ourselves?
I will never forget witnessing my cousin’s wife go through struggles with infertility. At the time, I was in my early twenties and didn’t fully grasp the emotional struggle I was witnessing. It wasn’t until I started my own journey to motherhood that I even got a slight taste of what this experience can be like, including an early miscarriage between my two sons.
As with birth trauma, these struggles can shake your beliefs in yourself and leave you questioning, “What is wrong with me?” However, we know that a stress-free environment is the best environment for conception. Within The Resilient Mother Method, my signature group program targeted at unwinding stress and rewiring resilience in motherhood, the first two steps I teach women to heal from stress and trauma associated with becoming a mother are self-acceptance and self-compassion.
It can be challenging to accept reality, to accept the dark thoughts we have about ourselves and our ability to conceive. But by running away from them, we only create more. Self-acceptance and self-compassion are acts of turning towards our negative thoughts, beliefs, and feelings. To see them, accept them as they are, and show love to them. Through this process, healing is possible.
Self-compassion can take many forms. But checking the stories you are telling yourself is so important. What thoughts are running through your mind? Are they negative? Are you beating yourself down?
Consider how you would think of a friend going through a similar situation. I assume you wouldn’t tear her down; you would speak to her with empathy and compassion.
You would NEVER say to your friend, “There must be something wrong with your body; it’s totally failing you right now.”
You would say something more along the lines of, “You want so badly to have a baby, and it feels like a failure that you are struggling to conceive; that must be so stressful. Let’s go get our nails done and brainstorm some ways to de-stress.”
Writing down your negative thoughts and acknowledging them with empathy will help shift you from a state of negativity and stress to one of compassion and connection within any challenging life experience.
The net-net, it’s all connected. The more aware of our bodies, what’s going on pre- and post-natal, the better. Compassion and grace go a long way when we talk to ourselves about our bodies. We’re always busy checking in on those around us, let’s not forget to take stock of our own well-being on the regular. We really deserve it.
