Like many others, I could name a lot of things I want to change. But here is one that tops my list every single time: please start recognizing that pregnancy and childbirth are monumental physical events in a woman’s life and implement the research, practice patterns and education (of providers and the public) that reflect this truth.
Approximately 80% of women in the United States will have at least one pregnancy resulting in a live birth in her lifetime – a prevalence statistic that at minimum should encourage us to take this event seriously.
Further, a woman’s experience of childbirth is the single greatest contributor to her lifetime risk of pelvic organ prolapse and stress urinary incontinence, pelvic floor disorders that lead to adverse quality of life changes and costs to society and the individual, including 300,000-400,000 pelvic surgeries annually (DeLancey 2005).
Studies of the newly postpartum and of women years to decades removed from childbearing have clearly documented changes in the pelvic floor muscles and nerves, changes that are uniformly negative: muscle strength loss, muscle tears, loss of nerve function, poorly timed and coordinated muscle contractions, and defects in the connective tissue (fascia) supports in the pelvis.
Additionally, the change in abdominal profile is the largest visible physical change during pregnancy and includes a thinning or separation of the vertical midline muscle attachment (the linea alba), a condition known as Diastasis Recti Abdominus (DRA) in over 60% of women by the end of their pregnancy. The structural and neuromuscular integrity of the abdominal wall is proven to be integral to optimal function of the body and its function is inextricably linked to the function of the pelvic floor.
Also linked to the abdominal wall and pelvic floor is the respiratory diaphragm, our breathing muscle. Well known to every woman who has ever been pregnant, this muscle runs out of room to descend into the abdomen during later pregnancy, which is felt as if we are unable to take a deep breath. It is an adaptation to the physical changes associated with being pregnant, but when not pregnant – and remember, a woman is not pregnant for most of her life – the diaphragm’s movements are also synchronous with that of the pelvic floor.
So in short and under completely normal circumstances, there is a constant and interconnected relationship with the diaphragm, abdominals, and pelvic floor (lower back, too, but I can’t go on forever in this post) that affects our pelvic organs, continence, respiration, and stability of our spine and pelvis. When pregnancy and childbirth can throw an obvious monkey wrench into all of these individually, it is unfair of us to assume that this would happen without consequence. Further, it is unfair of us to continue to dismiss these changes and risk factors and not even attempt to intervene in light of what is already known. Also unfair: “Women have been expected to pay a lifelong price for a baby’s birth” (Ashton-Miller & DeLancey).
There is a great phrase, “Don’t let perfect become the enemy of good.” It applies in this instance. “Perfect” is making sure that we have research to prove the right paradigms for intervention, education and screening for every single woman, so as to not dole out care to someone unnecessarily – and either because her injuries are too significant they are deemed permanent OR because she is thought to have emerged from the process unscathed, then it IS the enemy. “Good” is recognizing that pregnancy and childbirth categorically challenge a woman’s body and that improving access to care, collaboration amongst care providers and between providers and researchers, and empowering women to believe that they deserve this help. “Good” can lead us to action now. “Good” is good enough to start helping women NOW and to use what we learn by doing “good” to move us in the direction of “perfect.”