The first time I heard of Kegel exercises was from an episode of “Sex and the City” I saw in my late teens. After hearing Samantha rave about them, I walked away with the impression that their only benefit was tightening the vagina. And really, I reasoned, that only benefits men.
Turns out there is so much more to it.
But it wasn’t until I had my first baby that I understood the importance of perineum health. After 28 hours of intense labor, my cervix wouldn’t dilate past nine centimeters and my planned home birth became a nightmare as I was rushed to the Cannes hospital in the south of France, where I live. I was hoisted onto the delivery bed, surrounded by a team of masked strangers and my husband, James.
Without asking for my consent, the midwife performed an episiotomy — an incision through the area between the vaginal opening and the anus — to make room for the baby, and I was instructed to push. With my son’s head and shoulders already out, I began to shake from an eclampsia-induced seizure. My blood pressure skyrocketed and my heart flatlined. After medical intervention, I woke up the next morning alive but traumatized.
After eight days of recovery in the ICU, I was sent home with my son, Oslo, in tow.
I never wanted to go back to that hospital, but at my six-week postnatal check up, I had no choice. I walked through the automatic glass doors with my heart in my throat and choked back tears as I passed through the maternity wing.
In the doctor’s tiny office, with no barrier to change behind, I removed my jeans and underwear, and placed my legs in the stirrups on either side of the examination table. The 12 episiotomy stitches had healed, yet a deep rooted pain and shame lingered.
As we finished the examination, the OB-GYN handed me a prescription for 10 state-paid perineum reeducation sessions, something I knew many French mamans and expats like me swear by for postpartum care. I had no idea what they entailed, but I didn’t care. I didn’t want her or any other doctor or midwife touching me again. Outside the hospital, I searched for a trash can to throw the prescription away.
With the prescription in a garbage heap and no aftercare at all, I soon realized what can happen when these muscles are not strengthened again. I started peeing my pants. My urges weren’t of the funny I gotta go right now variety. If I had to go, I went.
There’s nothing like trying to acclimate to a new country while wetting your pants in the middle of the street. I suddenly found myself perusing the feminine hygiene aisle at the local grocery store for adult diapers and pads, at the ripe old age of 27.
Embarrassed to tell my French friends, I called my old ones in North America, and to my surprise they had all suffered from poor perineum health after birth. We swapped stories of our maladies over text, sending laughing emojis, as each one was worse than the other.
One friend revealed that at four weeks postpartum she was hit with extreme pain and the feeling like her insides were coming out. An ER doctor told her she had a prolapsed uterus. This occurs when the pelvic floor muscles become too weak to provide enough support for the uterus, and it slips down into or protrudes out of the vagina. She was told this is a fairly common occurrence for women after they have given birth. We stopped laughing at the stories shared after that.
New mothers have to navigate everything from breastfeeding and vaginal recovery to Cesarean healing and sleep deprivation. But countless other conditions including painful sex, uterine prolapse, constipation and urinary incontinence may be preventable with pelvic floor physical therapy.
The more mothers I spoke with, the more I discovered that France is one of the few countries to take perineum health seriously. Here, reeducation has been paid for by the government since 1985. In other countries, including America and Canada, women are suffering.
When I had my second son less than two years after my first, my doctor gave me the same prescription for 10 free perineum reeducation sessions, and this time, I held on tight to it.
After six weeks of healing and with my stitches removed, the midwife said I was ready to begin. She used what is called manual education, where she inserted two fingers into my vaginal opening to feel each muscle within. She explained women have nine muscles that attach themselves to the perineum, and that they weaken after delivery.
She had me envision my vulva like a flower, with each petal representing a different muscle, then coached me as I held and contracted each. It was bizarre at first, but after just a couple of sessions, I could physically feel a huge difference. After I got the hang of it, I found myself naturally doing the exercises at home when I breastfed my baby, changed diapers, or sterilized bottles.
Over lunch, my expat friends and I shared our stories. One friend said she was told to envision a ball being sucked up into her stomach, then bouncing it from side to side as she released her breath. Another friend explained that her midwife used the image of a grand chateau, in which her clitoris was the drawbridge, the labia majora were long velvet curtains and the moat, her anus.
Though we all used different methods to reeducate our perineums, we were all in agreement about how important it is to be cared for after we go through something as life-changing as childbirth.
Now having just given birth three months ago to my third child, I am back in the reeducation period, only this time I’m using technology.
I had heard French mamans swapping stories in the doctor’s office about a brand new reeducation device — a pink electric dildo that measures perineum strength with a video game. Instead of manually gauging my strength, each week my midwife inserts the sensored device and I select the game to “play” from a tablet.
I can be a race car, swimming fish or a rocket ship. It’s similar to how I play Mario Kart with my two sons (now 4 and 6 years old). Racing my character around the track, I use my internal muscles to maneuver them around different cyber challenges all while clenching, contracting, holding and breathing my way through obstacles.
If I have to take my vulva to the gym, it might as well be as fun as possible.
Now with six weeks of reeducation sessions completed, my midwife said my perineum health is better than ever (and I no longer need adult diapers).
Although it’s been nearly seven years since I had my first child, when I speak to my North American friends with babies, nothing has changed. Women are still expected to suffer through the lasting symptoms of giving birth. So while the French way may sound a little funny, it’s actually quite serious. “Not peeing your pants for the rest of your life” shouldn’t be a luxury afforded just to those women who are lucky enough to be living in a country that takes postpartum health seriously.
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