The 6th Trimester

This is a very long post, so consider yourself warned…

Here’s my official “6th trimester” update.  This day– June 7th– is significant to me because now my baby Todd has been alive “on the outside” for the same length of time as he grew “on the inside”…

= 41 weeks + 3 days.

It’s taken me hours and hours to write this post, and before I started it (a little more than a month ago), these thoughts were floating around my mind for months.  I’m divulging personal information here.  TMI?  Perhaps, but getting all this written down is therapeutic for me.  Hopefully I’ll help someone else by sharing my story.  At the very least, I want other women experiencing similar issues to know they’re not alone!

In this post I detail my 9.5 month post-partum (PP) experience.  Technically it covers the 4th, 5th and 6th “trimesters.”  I’ve had a difficult time healing from childbirth and I’ve had lots of (monkey mind?) time to think and reflect on the whole experience.  Where do I even start?  I’ll just dive in…

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One day it hit me that I was traumatized by childbirth.

I still haven’t physically (or emotionally) recovered from the experience.  No– it wasn’t the excruciating pain and profound exhaustion during labor/delivery that traumatized me.  The real trauma came afterward, as I waited…and waited…and waited to heal.

My unmedicated childbirth was brutal.  The searing pain did feel like a form of torture that lasted for so many hours.  However, the trouble began with the pushing phase.  I pushed for well over 4.5 hours.  Pushing was frustrating right from the beginning, because it never felt natural, effective or empowering for me.  With each passing hour, my husband and sister got increasingly concerned (they later told me) as they could only watch, helplessly.  By the final hour, all I felt was total desperation.  I was mentally and emotionally checked out.  My baby just would not come out, no matter how hard I tried.

Ultimately, I was transferred to the hospital and cut with an episiotomy incision.  After so many hard hours of pushing and after Todd was crowning “God knows how many” centimeters for an hour plus, it was bizarre how fast he came out once the cut was made.  Suddenly getting him out seemed so easy.

My healthy, beautiful baby Todd was finally born.  Unfortunately, circumstances prevented me from having that euphoric moment of birth that I hear other women talk about.  I didn’t feel a flood of euphoria, an overwhelming happiness, a rush of emotion, a burst of energy, or a feeling that “everything I went through was worth it!”

When Todd was born, I was just done.  I was utterly and completely spent.  It was over and all I could feel was RELIEF.  I felt really defeated, too.

I felt defeated at the time, but I do need to give myself some credit.  While I was experiencing the worst pain ever, I do know that I handled that pain very well.  I was tough.

During my 6-week post-partum (PP) appointment, my midwife shared her opinion that Todd “barely fit” through my pelvis.  She said that I was strong and effective with each push, but something had him hung up.  (I recently started wondering if the bad fall on my coccyx I had many years ago played any role.)

It only occurred to me while writing this post that maybe pushing never felt instinctual to me because– on some level– my body knew all along that delivering Todd vaginally wouldn’t “work out well.”  As I pushed with what felt (to me) like such frustrating incoordination, perhaps my body was trying to tell me that I should have been spared all the trauma and been wheeled into the OR for a c-section delivery instead.  Plausible?

Now– if I had healed up fully, and in a reasonable time frame, then I absolutely wouldn’t be feeling traumatized now, all these months later.  I was traumatized by the birth plus the aftermath.  Todd’s birthday might technically be “in the past,” but my body makes me feel like it all happened very recently.  Until I feel normal again, it feels like I’m perpetually freshly post-partum.  It seems impossible to put the experience behind me when sensations in my perineum serve as a nearly constant reminder of my ordeal.

I suppose at this point, my need for further healing is as much an emotional process as it is a physical process.  My birth experience was traumatizing in part because the experience gets replayed in my head.  I go back in time and I can “see” the damage happening, but I can’t determine when it happened.  That drives me crazy.

I want to pinpoint that time.  Was it an hour into pushing?  Was it 3 hours?  Was it during the last 1/2 hour of pushing?  When?  As if I could change the outcome if I knew, right?!  But part of me thinks I would find some closure by having this bit of information.  “If only” I’d had a c-section before that “mystery time”… then things would have been so much better.  Right?

Now you’re probably wondering exactly what I mean by “incomplete healing” and “sensations in my perineum” and “damage.”  I’ll explain in clinical detail…

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Six weeks:  That’s how long I expected my healing from childbirth to take.  Six weeks to “back to normal.”  Haha!  Six weeks…um…Rrrright.  At six weeks I was still feeling extremely uncomfortable and quite physically impaired.

I don’t know who what idiot gave me the idea that I should be 100% healed in just 6 weeks, but immediately after the birth, 6 weeks did sound like a long time.  Pain has a way of slowing down time.  The pain in the first several days was severe, but expected.

However– what didn’t help my early recovery was having to sit upright every time I breastfed…or tried to breastfeed…or tried to pump…which was every couple hours ’round the clock.  Despite having some help from Eric and my family, I wasn’t able to spend a significant time resting in the horizontal position, like my body so desperately needed.

Another thing that made my inflammation worse was having to leave the house for 7 appointments within the first 2 weeks– to see either the lactation specialists or the pediatrician.  This was due to problems with breastfeeding and Todd’s weight loss/inability to gain weight with breastfeeding.

For weeks, every time I stood up it hurt like hell.  There was a feeling of generalized soreness from my episiotomy, but the main problem was the INSANE amount of painful pressure in my perineum.  It felt like everything down there was engorged with blood and ready to explode.  Gravity was my enemy.  All I wanted to do was lie down and stay that way indefinitely.  Simply standing at the kitchen sink to wash all those damn breast pump parts felt like a new form of torture.

Leaving the house– just walking out to the car– was barely manageable in those early weeks.  Every time I had to carry the not-so-lightweight carseat out to the car (because I was alone going to appointments), I felt my healing being set back.

“Baby wearing” sounded like a good idea in theory, but it was completely out of the question for me.  There was no way I could tolerate carrying an extra 7+ pounds, when it was excruciating to perform the most basic self care activities under my own body weight.

Although I tried my best to remain patient and surrender to my body’s own healing timeline, my instincts very early on told me that something was amiss.  I’m very in tune with my body.  Even at 2 weeks PP, I suspected some sort of pelvic organ prolapse component.  I saw an ARNP on September 9, 2014 (2.5 weeks PP).  She check me out and said there was no prolapse and everything was looking as it should for that stage.  I left feeling reassured, but skeptical.

Six days later (almost 3.5 weeks PP), I attempted a short outside walk of just a few blocks.  Immediately, I regretted making the attempt.  I was in agony.  Two days later, I called my midwife, Jane, and she recommended doing sitz baths, so I tried that.

On September 23rd, I was almost 5 weeks PP and I saw my midwife, Brianna.  She commented that my OB must have done a thorough job with my episiotomy suturing, because there were lots of knots and pokey suture ends.  Brianna did some trimming.  She expected I would feel a lot better without those extra knots and pokey ends in there causing irritation.  She also recommended I get some organic “sitz herbs.”

When my order of Earth Mama Angel Baby Post Partum Bath Herbs arrived 2 days later, I started doing compresses with the herbs for the next 3 days.  Between the suture trimming and the herbs, my discomfort related to the episiotomy decreased significantly.  (I wish I’d known about those herbs sooner.)  At 5 weeks PP, I walked a short bit to our local library and I finally felt “somewhat capable” of slow walking.

Although my incision was starting to feel much better, the disproportionate amount of uncomfortable pressure remained.  Fed up, I attempted to ignore it.  I tried to proceed with my activities as if I was okay.  At this point, I was tolerating standing for household activities.  My next struggle was with doing light resistance exercise and walking.

I’m a very active and outdoorsy person!  So, it really got me down to be unable to do a fraction of what I was used to doing pre-baby.  It was late Summer/early Fall and the weather was still nice.  I longed for increased physical activity.

During PP week 6, I tried to ignore, ignore, ignore the pressure.  I got impatient and I’d have enough!  I got out of the house with Todd to visit coworkers and residents at my workplace on Monday, and then I did 4 stroller walks in a row on Tuesday through Friday (2.5 to 3.3 miles each, with hills involved).

Yep– I way overdid it.  Stupid.

The next week, on October 8th (7 weeks PP), I saw my midwife, Jane for my final follow up appointment:  i.e., The Six Week Visit.  Obviously I wasn’t anywhere near fully healed at 6 weeks.  “Well, maybe I’ll be healed by 12 weeks,” I thought.  “That’s about 3 months.  Three months to heal sounds reasonable…”

At 10 weeks PP, I touched on the topic of my slow healing in my post, Body Image After Baby (2 Months Post-Partum).  That week, Eric got his vasectomy (November 1st).  So let’s talk about sex…

I felt ready for it.  I’d read on the internet that some women had painful intercourse after an episiotomy, but I didn’t think I would.  Internally, there wasn’t any pain to the touch.  Externally, my scar felt a little thickened but I knew it was normal for an immature scar.  (With time, scars mature and soften.)  I did some gentle scar massage.

But– even though I felt ready for sex, we absolutely did not want another pregnancy.  Todd was our greatest, most wonderful surprise, and we’re so glad we have him, but…we only want him!  We didn’t want to take any chances using our former birth control method.  (It did work for over 20 years, though!)

Eric had to wait a minimum of 6 weeks post-vasectomy before he could get a semen analysis done.  We used a condom to confirm that sex wouldn’t be painful (it wasn’t) and that it would be pleasurable (it was).  Obviously, that was a huge relief.  After the “trial run,” we decided to abstain until the vasectomy was declared a success.  Except– we waited…and waited…and waited.

It turns out that some men still have viable sperm even several months after a vasectomy.  Notice a theme here?  It took much longer than 6 weeks for Eric to get the “all clear.”  We didn’t get the news until March 19, 2015, which was more than 4.5 months after his procedure.  Good grief, by this time I was just short of 7 months PP.

The long wait was a bummer for both of us for obvious reasons, but I also knew that the abstinence from intercourse wasn’t helping my pelvic floor muscles increase tone and strength.  Use it or lose it applies.  I did what I could to facilitate those muscles, but it just wasn’t the same…

I kegeled night and day.  I squeezed for 10 counts.  I did fast contractions.  I engaged my lower abs.  I did them lying down, sitting, and standing.  Kegeling can only get you so far.  Then it occurred to me that maybe I needed to add some resistance.

I ordered a couple yoni eggs from a vegan company, Ashley’s Naturals.  You’re supposed to start with the larger size (size medium) first, and then progress to the small.  When they came in early November (11 weeks PP), I immediately found out how lax/weak my pelvic floor muscles were:  I could only retain the medium egg for a few seconds when I stood up and squeezed with all my might.  Even the small egg dropped out quickly.  It was an eye-opener.  After a couple weeks, I managed to hold in the larger egg in for about 1.5 minutes.

Between weeks 6 & 12 PP I was taking it real easy exercise-wise.  I did yoga, floor leg lifts, and several ~2 mile (or longer) stroller walks on level ground.  A couple weeks I didn’t do any specific exercise.

At weeks 12-13 PP (Mid-November 2014), I started spotting for several days before I realized it was maybe my first (light) period since giving birth.  What was significant about that was noticing how the tampon made me feel more “supported.”  I had my 2nd, heavier period in early December (week 16 PP), and I felt the same way wearing tampons.  (That gave me an idea for later.)

In early January 2015, I was motivated to try exercising every day.  Sadly, I very quickly discovered that the increased exercise (i.e. light weights, yoga, P90X Kenpo and a very modified P90X Plyometrics) made me feel way worse.  The intensity of uncomfortable pressure seemed to increase with each consecutive exercise day.  I became very fearful that I was making whatever degree of “prolapse” I had worse.  After 2 weeks, I quit.

The perineal pressure was intense and disturbing.  Disturbing:  that’s the word that kept popping into my head.  While the pressure wasn’t a true “pain,” it seemed just as bad.  It’s distressing to feel like your insides are always on the verge of dropping out!  I had to move slowly and deliberately.  My posture was affected.  I couldn’t even take normal breaths because I’d constantly notice myself involuntarily holding my breath while I tried to internally “brace myself” by attempting to maintain a continuous kegel squeeze (an impossible feat).

Up until January 2015, I was emotionally coping surprisingly well.  I was in a depressing predicament, but miraculously I never really felt depressed.  In fact, many times I wondered to myself why I wasn’t feeling a whole lot more sad or angry.  It was kind of remarkable, actually.  But over and over, I knew that Todd was the reason.  He lights up my days.  I simply couldn’t get too sad with him in my life.  He’s the best anti-depressant.

Of course, I don’t blame Todd for this.  It’s not his fault.  He was the innocent passenger.  I was just unlucky (I guess).  I hope he doesn’t ever feel bad, because he shouldn’t.  But I’m never going to say, “All the pain and suffering was worth it,” either.  I will say that I’m so glad he came into our lives.  If I could go back and prevent the (unplanned) pregnancy from happening, I absolutely would not do it.  I can’t imagine my life without Todd.  I just think that it’s messed up that some women have to suffer so much to have babies.

Another thing:  Leading up to Todd’s birth, I was not fearful of childbirth.  I’d read Hypnobabies.  I was open to the possibility of a pain-free birth.  I was also realistic about the possibility of significant pain.  I wasn’t anxious in the least.  I wanted an unmedicated experience because– if I was “meant” to have a baby– then I wanted to feel everything, the good and the bad.  I felt mentally prepared, and I was confident in my strength and my ability to cope.

I guess my point is– I didn’t have a horrible experience because I somehow manifested it by being afraid or anxious.  I think that birth preparation can only get you so far, but in the end, you just don’t know how childbirth is going to play out until it happens.  There are way too many unknown variables at work.

Getting back to the story…

Eventually something in me snapped and all my sadness and anger about my situation just boiled over.  It was Mid-January 2015 and I was almost 5 months PP, and I was still feeling bad.  For the first time, I just cried my eyes out.  I was so sick and tired of feeling the unrelenting pressure every waking minute of every day– any time I was upright– from the time I got out of bed in the morning to the time I got back in a horizontal position at night.  All I wanted was some respite.  I longed for even a few moments when I couldn’t “feel my vagina.”

After I pulled myself together, I decided to do something about it.  I made an appointment with a GYN doctor.  Unfortunately, I would have to wait another month to be seen.

Then, I made an appointment with my GP doctor and I was able to get seen within the week.  I met with her on January 23rd.  I told her that I could feel with my finger an internal tissue bulge anteriorly in my vagina.  During her internal exams she said “it’s not that bad,” but she confirmed that there was some vaginal laxity and my bowel was “dropped down” a bit.  (It seems worth noting here that– thankfully– I haven’t had any problem with bowel or bladder incontinence.)

While waiting for my GYN doctor appointment, I decided to try a V2 Supporter.  It’s an elastic supportive garment that fits over your underwear and provides compression.  It was recommended to me by a Physical Therapist I know, who’d dealt with the pressure and pain of vulvar varicosities during her pregnancy.  In retrospect, I wish I’d had the V2 Supporter for my earliest post-partum weeks, because that’s when it would have benefitted me the most.

I did try the V2 Supporter while walking outside with the stroller, but mostly I wore my “girlie supporter” in the house.  In a way, I could get a similar result from wearing pads in my underwear (another thing I discovered after I started getting my periods back).  A little compression goes a long way.  (It’s too bad that it’s socially unacceptable to walk around with your hand pushing up against your crotch…).

As I dealt with these issues, I was so thankful to have a certain friend that I could confide in.  She has a baby a little older than Todd, and she was going through a similar experience with pressure symptoms.  Somehow we connected, and I’m glad we did.  Misery loves company- as the saying goes- but having her friendship and support was (and still is) a comfort.

Meanwhile, it was ski season (albeit a crappy snow year for the Pacific Northwest), and I found skiing to be easier on me than walking.  The same thing applied to rollerblading.  Small victories.

On February 20th (6 months PP), I finally saw the GYN doctor, and I inquired about a pessary.  I’d gotten the pessary idea because wearing tampons seemed to help.  I was vaguely familiar with them because I’ve worked in nursing homes as an Occupational Therapist (OTR/L) for the past 17+ years.  Some of my elderly women patients had pessaries.

Just like my GP doctor, the GYN doctor said “it’s not bad” about my condition, but he agreed that a pessary might help my symptoms.  He fitted me with a Bioteque ring pessary with supporting membrane.  (By the way, he also said that a tampon is a poor man’s pessary, which confirmed why I felt better with a tampon in.)  I left the office with a size 1 and size 2 ring pessary.  Wearing a pessary is supposed to both improve symptoms and improve the degree of prolapse (see article).

After some experimentation, I found that the size 1 (smaller one) worked best. It didn’t take away all of the pressure, but it did make some difference. It’s easy to insert and remove. I got in the habit of wearing it for about 24 hours at a time. Then I removed it, washed it, and kept it out for 8-48 hours, depending on how I felt, what time of day it is, and what kind of activities I was planning/doing.

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Fast forward to now.  Here’s my status at 9.5 months PP:

Overall, things have gotten better, especially in the past couple months.  With that said, I do feel some degree of pressure every day.  The severity can change hour by hour and day by day.  There doesn’t seem to be any predictability to it.  I suppose it all depends on:  1) my daily activities, 2) how fast my pelvic floor muscles fatigue, 3) hormonal influences, and 4) other unknown factors.  Along with the pressure is a nagging sensation that my pelvic “core” just lacks the full support it needs for my body to move normally.

The only “given” is that I don’t feel symptoms when I sit down or lie down.  Each full night of sleep in the horizontal position gives my body a chance to “re-calibrate,” as I call it.

Regarding the severity of my pressure symptom…

At best, I’ve had many “very good” days (or parts of days).  That means that the pressure is fairly minimal and it doesn’t bother me much.  It also means I can breathe normally, without catching myself holding my breath.  My pelvic/abdominal posture is more relaxed.  Every so often, the symptom will be so subtle that I’ll realize that several minutes passed and I wasn’t “aware” of my vagina…Hallelujah!!

At worst, I’ll have days (usually just parts of days) when I feel a “moderate” degree of pressure.  That definitely makes me modify my daily activities, and it makes me move slower and much more deliberately.  It can affect my posture and my breathing.  Emotionally, it can make me feel annoyed/frustrated or sad/depressed.  Rarely, I do break down and cry about the fact that I’m still dealing with this after all these months.

I’ve had mixed results wearing my pessary.  I’ve actually only worn it a little bit in the past month.  Most of the time I don’t wear it because I don’t feel like I need it.  For me, the pessary never completely eliminates my pressure symptom, so it’s not going to make “mild” pressure go down to zero.

The pessary can be worth wearing when the pressure increases because it brings the severity down a good notch.  Yet– other times it doesn’t help that much, or else the pessary itself will shift after a while and then cause discomfort.  It’s a mixed bag and it’s all trial and error.

Knowing my body so well, I’ve determined that my worst feeling of pressure comes from the tissue bulge/droop that I can feel anteriorly in my vagina.  (When the bulge/droop isn’t as bad, I feel noticeably better.)  It seems like that’s a cystocele (the bladder prolapses into the anterior vaginal space).

I also suspect a rectocele (the bowel prolapses into the posterior vaginal space), but I don’t think it’s the source of the worst pressure.  Interestingly, sometimes I feel a temporary increase in my pressure symptom right before I feel the urge to have a bowel movement.  Then it decreases after I go to the bathroom.

One thing that provides a definite and immediate improvement in my pressure symptom is intercourse.  It’s remarkable, actually.  The improvement lasts for several hours.

Physically, I’m getting more active all the time, and I seem to be tolerating it well.  As I exercise smartly, I think it’s helping my long term progress.  What I can do for exercise is:  walk several miles at a time (briskly, more or less), push a stroller up/down hills, rollerblade, do yoga, and use weights (or body weight) for some resistance exercises. Of course, bike riding is the best exercise for me because it’s done in a sitting position!

Right now I’m avoiding quick, explosive and/or jumping type activities and exercises.  I also avoid squatting down on the floor.  If I cough, sneeze, or blow my nose, I have to “brace” myself against the strong distending force.  Throughout each day, I’m very careful and deliberate about how I go about carrying/moving loads.  Of course, Todd is the main “load” that I lift and move so many times a day, and that’s by far the biggest stressor on my pelvic floor.  When Eric’s home, he’s always happy to take over the “Todd handling.”

All in all, I think I’m coping well under the circumstances and I am a generally happy and optimistic person.  I try very hard to not let my “not-as-good” hours get me feeling down for too long.  Seriously, I have way too many things to be grateful for on a daily basis!  I know that things in my life could be a lot, lot worse in a thousand different ways.  I choose to focus on the positive.  I have hope.  And I’m daily manifesting, “I am healed.”

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Wrapping up…

The 4th, 5th and 6th trimesters haven’t been easy.  When I was pregnant, I never imagined I would go through this.  I thought that taking care of my baby would be the hard part about having a baby.  Taking care of Todd has actually been pretty easy (if you don’t count the first 3-4 weeks, when the breastfeeding struggle was real).  For that, I know I’ve been blessed!

I don’t know what I’d do if somehow Eric’s vasectomy failed (a <1% chance) and I found myself pregnant again.  I’d be no less than completely terrified to endure another vaginal birth!!  I’ve thought about that (highly unlikely) scenario, and I’ve come to the conclusion that I’d want a scheduled c-section.

I wish I knew how common my experience is.  Obviously this isn’t something that people openly talk about.  Even during my prenatal visits, my midwives never discussed potential complications of childbirth.  If I’d heard of pelvic organ prolapse before childbirth (vaguely), it was only because I’m a medical professional.

I also wonder if my age had something to do with my predicament.  I know that plenty of women have babies after age 40, but what percentage have first babies after 40?  Did it not matter that I was physically fit before I got pregnant and that I had a smooth, healthy pregnancy?

Without ever knowing for sure, I do think my age played some role.  Mostly, though, I’m sure I’m in this predicament because Todd barely fit through my pelvis (despite being only 7 pounds), he was somehow hung up, and yet because of my strength, and because I labored (pushing for a crazy long time) with a midwife in a birth center and not an OB in a hospital, I was somehow still able to deliver him vaginally (albeit with help from some scissors).

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How to end this post?

I’m glad that I’ve gotten all this baggage out of my mind and onto “paper.”  In doing so, I’m giving myself permission to complete the emotional healing and to put my traumatic childbirth experience in the past, where it belongs.  I declare that it’s no longer going to burden my happy present.  I want to LET IT ALL GO.

The present time is great!  I love Todd more than words can say.  I love our little family of 3.  And– Eric is the most wonderful husband.  We had a fabulous marriage before Todd came along, but during these 6 “trimesters,” Eric has really demonstrated the depth of his love and devotion.  I’m one lucky lady.

So– I’m now at the end of this ridiculously long post.  If you’re still reading, then I’m quite impressed I feel sorry for you!  I think I’ll just finish by saying this:

Thank God I won’t ever have to go through childbirth again!