My First Second Trimester and Everything You Never Knew You Wanted to Know About My Pelvic Floor

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Looking back, I can hardly believe my second trimester has flown by so quickly.  Living through it, however, was like time was standing still.  The night my pregnancy tracker flipped over to show I was in my second trimester, was one of the happiest nights I have had in a long time.  It was just after midnight and I hurriedly flipped through all of the different options that let me compare the size of my baby to various fruits and objects and read all about how our little one was developing.  I think it was that moment that I let my pregnancy start to feel a bit real.  Even with my new-found optimism, I was hooked to my app and religiously checked every morning to see that one more day had successfully ticked by.

Our next big hurdle was our 20 week ultrasound, which is the only ultrasound we would get during the pregnancy here in Manitoba.  It was only a few weeks away, but it felt like an eternity.  I tried to be content with all of the progress we had made so far, but uncertainty and doubt were creeping back in.  I felt once I could see baby and know that everything was okay, I would maybe, just maybe, let myself start to get excited.

 We showed up far too early for our ultrasound appointment, because I was so nervous about being late.  My wife and I chatted light-heartedly in the empty waiting room.  I was so glad she could be with me.  Even with all of the hardships of moving and not finding work as a nurse, I was so grateful to be close to her.

The first portion of the ultrasound was done without my wife in the room, so that the technician could focus.  I laid flat on my back, which was already getting a bit uncomfortable underneath my little baby belly, and got the familiar warm squirt of ultrasound gel on my tummy.  I was so nervous.  She used much more pressure than I would have expected and quickly got to work snapping pictures from various points on my belly.  I felt like I had hit a huge milestone having an abdominal ultrasound, as the rest of my many ultrasounds had been of the invasive vaginal variety.  I was finally living the classic TV/movie ultrasound scene that I had been so fiercely jealous of for the last year.

I hoped maybe the technician would leave the ultrasound screen tilted so that I could see what she was looking at, but of course she didn’t.  I stared intently at the technician’s face (and probably freaked her out a bit) to see if I could catch a glimpse of my baby in the reflection of her eyes.  I tried to read her expression to glean any information I could about how baby was doing.  Is he in there?  How is his heartbeat? Is he okay?  But she was like a statue.  I would just have to wait.  So I stared at the ceiling trying to have patience.

 After 15 minutes she called my wife into the room and I immediately took her hold of my wife’s calm hand.  The technician’s demeanour softened considerably and she swung the ultrasound screen towards us.

 And there he was.  Our little boy.

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 She showed us all of his limbs (there were four!) and his little heartbeat (fast and strong!) and I even saw him swallow a bit of amniotic fluid (go baby go!), preparing for breathing outside of the womb.  He was just perfect.  He was swimming around like crazy and moving his little hands and feet.  I could have watched him forever.  My heart exploded with joy and relief and my eyes welled up with tears.

 I left the hospital walking on a cloud.  And for the first time my wife and I started talking about names and making plans for meeting our little one.

 Maybe we were going to be okay after all.  So powered by hope and the sight of our son, I let my type A personality take over and start planning for the future.

 I had already been reading books, listening to podcasts and generally absorbing any information I could get my hands on regarding birth and pregnancy since well before my miscarriage.  So now I was lucky enough to have the opportunity to put some of what I had learned to good use.  I had my diet and exercise pretty much under control – my diet was 99% plant based since becoming pregnant again and I was walking about 30 hours a week with my job.  I was de-stressing with meditation a few times a week.  Though my sleep pattern was irregular due to work, I was sleeping a lot, and felt rested most of the time.  I took time to connect with baby, rubbing my belly and having little chats with him.  And more importantly, the fatigue and nausea from my first trimester faded into the back ground and was replaced with renewed energy and a solid appetite.  I felt really lucky.

One of the themes that kept coming up in my baby research was the prevalence of pelvic floor issues in the post-partum period.  It’s kind of become become the norm for a woman to lose bladder control while laughing or sneezing after having a baby.  You see this reflected often in our pop culture and various TV shows.  As it turns out, peeing your pants isn’t really normal.

Everyone has been talking about Kegels for a while, but now we are starting to have a more in-depth discussion about the mysterious muscles of the pelvic floor, which is really what we are trying to target with Kegel exercises.

 So what is this pelvic floor thing all about?

 The pelvic floor is a sling of muscles that supports your internal organs and controls the opening and closing of your urethra, vagina and anus.  So it’s kind of a big deal.  And yet there is not a lot of knowledge out there about the impacts of pregnancy and birth on this important muscle group.  After listening to more than a few experts rant about how this is in fact not normal, I decided to do something about it.

 As it turns out, there are physiotherapists who specialize in the pelvic floor!  How cool is that?  And, as it turns out, there were a couple in Winnipeg, so I booked myself an appointment.

 I was called into a small office with an examination table and shook the physiotherapist’s hand.  She had a kind face, excellent posture and a calm demeanour.  She had her trusty pelvis model in her hand and some diagrams of the pelvic floor.  She began her explanation with a tone that sounded like I was the umpteenth patient she had explained the pelvic floor to, but I knew that I probably was the umpteenth person she had explained the pelvic floor to, so I didn’t mind.

 After her teaching, she explained the pelvic floor exam that she would perform.  How is she going to assess my pelvic floor, you ask?  Well, vaginally, of course.

I took my bottoms off and laid on the exam table.  She donned a glove with some lubricant and gently inserted her finger in my vagina.  She was very matter of fact about the whole thing and I appreciated her professionalism (though she did sneeze halfway through the exam, which was about as awkward as you might imagine it to be).  I hadn’t really had a health care professional get that up close and personal with me since my miscarriage, so I was glad that I felt at ease with her.  I reminded myself that this was nothing compared to what giving birth was going to be like, and that encouraged my embarrassment to fade away.

 She had me perform a few exercises to test the strength of my pelvic floor.  First, she had me perform what is commonly known as a Kegel.  Basically, it is fully tensing your pelvic floor (as if you were holding in pee) and fully relaxing your pelvic floor (as if you were trying to not hold in pee).  She rested her hand gently at the top of my baby belly, to assess if I was assisting my pelvic floor with my abdominal muscles.  This would be a sign of weakness or poor control of the pelvic floor, and it is really important to target the pelvic floor muscles specifically.  After that, she had me contract my pelvic floor for a full minute!  I managed to last the full 60 seconds and felt pretty pleased with myself.  The last exercise she had me do was to contract and relax my pelvic floor in quick succession.  The hardest part was being aware of fully relaxing between each contraction, which is an oft neglected part of the Kegel.  In fact, one of the keys to a smooth birth is being able to fully relax your pelvic floor to allow baby to pass through!

 At the end of the exam she said my pelvic floor was excellent and she couldn’t feel or see any problems with strength or coordination.  To be honest, I haven’t done anything out of the ordinary (not even Kegels on a regular basis) to maintain my pelvic floor strength, so I was pleasantly surprised to hear that everything was good.  I actually didn’t even know if I was doing a Kegel properly until she assessed me!  I found the description of elevators moving up and down that you often find in Cosmo-like articles really confusing.  Turns out, it’s really not that hard to do!  I have not had a lot of pelvic floor pain or bladder leakage during my pregnancy, but I wanted to make sure I was going into birth with my body in top notch condition.  The physiotherapist said that she wished more pregnant people would come in prior to birth, as a lot of terrible problems (like pelvic organ prolapse) could be prevented or at least improved if issues were addressed as soon as possible.

 At the end, I asked her if everyone should just be doing more Kegels and she said that the solution was not as simple as that.  Sometimes people can have a pelvic floor that is hypertonic, or too tight, which can cause just as many problems as someone who has a pelvic floor that is hypotonic, or too loose.  She said the best first step is to have an assessment done to find out what’s going on down there!  I’m a firm believer that prevention is so important!  One of the ladies I met in my hypnobirthing class said that she had a lot of pelvic floor issues related to snowboarding, and I’ve heard stories of dancers and yogis who have issues as well.  My physiotherapist recommended some exercises specifically for me, including Kegels, basic core movements on an exercise ball and some hands-and-knees core exercises.

As they say, an ounce of prevention is worth a pound of cure, so get those pelvic floors checked, ladies!

-K

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