The blog NewMomWellness.com previously curated health and wellness advice for new mothers.
The Most Important Word You’ve Never Heard
During her ten years in practice, reproductive psychologist Alexandra Sacks had heard concerns from hundreds of new mothers that something was off, that they weren't good at motherhood, that they weren't enjoying it the way they should. When postpartum depression had been eliminated as a possibility, a sort of phantom x factor remained in the equation.
Sacks decided to investigate. She wasn't looking for a disease, so medical texts were of little help. After two years of working the problem, she found the piece that completed the picture in the field of anthropology. Buried deep in a now out-of-print essay written by Dana Rafael in 1973, was a word that few of us have heard of: matrescence, defined as the process of becoming a mother. Sacks understood that it would help to frame a discussion about postpartum wellness that no one was having. "There are entire textbooks written about the developmental arc of adolescence," says Sacks, "and we don't even have a word to describe the transition to motherhood."
I stumbled upon Sacks' TED talk by accident, and within moments, felt breathless. How could this unfamiliar word (pronounced something like adolescence), not a beautiful word but a powerful one, be something that had never before been uttered in my presence? As a mother of two, how had the epic physical, psychological, neurobiological passage to motherhood never had a name in my mind?
To name something is to give it the shape it needs to be contemplated, understood, discussed. For me, hearing the word matrescence helped me to understand why I sometimes have trouble finding my feet as a new mom. Becoming a mother saw me injured with a dash of trauma, experiencing a fundamental shift in my priorities, covered from head to toe in bodily fluids, and unsure of my place in a brand new world. I see it so clearly, now. Of course I am unsteady; I have been re-born.
To learn more about matrescence:
The Birth of a Mother - A New York Times article by Alexandra Sacks.
When a baby is born, so is a mother -- but the natural (and sometimes unsteady) process of transition to motherhood is often silenced by shame or misdiagnosed as postpartum depression. In this quick, informative talk, reproductive psychiatrist Alexandra Sacks breaks down the emotional tug-of-war of becoming a new mother -- and shares a term that could help describe it: matrescence.
Greater Expectations
Babies don't come with warning labels, but beware: having your own children can cause a monumental shift in your relationship with your parents. Even the highest functioning parent/child relationships will face a dynamic that has never existed before. With grandparenthood on the horizon, your parents and in-laws are suddenly toting an entire Santa's sack worth of expectations. While you are busily preparing for the upheaval your baby will bring, grandparents are dreaming. And sometimes scheming. And often helping! But mostly dreaming.
Grandparents used to be the sages of the family, full of helpful anecdotes and conventional wisdom. Now there's Google. And mom groups. And we find that many of the tactics our parents employed with us are no longer en vogue, up our very own alley, LEGAL.
During my first pregnancy, I was puzzled as to why I was suddenly in conflict with my MIL, and even, on occasion, my mom. Everyone seemed a little touchier than usual (was I really so hormonal?), and I felt way, way less inclined to deal with it. When I mentioned it to some friends just a couple of baby years ahead of us, they looked at each other and put down their cards. In the middle of a game.
"Oh yeah," they nodded fervently. "Grandparent fantasies." My husband and I laughed. Our couple friends did not. They began to regale us with tales of previously rather normal parents grossly overstepping where the children were concerned. Nothing was too small or too big. Everything from age appropriateness to travel in the car, from oversharing on Facebook to sugar. Policies poked, prodded, tested, questioned.
"If you think things are bad now," (OK, they weren't so bad!), "wait until the baby actually comes out." My husband and I sat back, feeling blindsided. On the way home, the car was silent (cause, you know, no babies yet). Were things only going to get worse? Were we powerless to stop this? Were we ready for it?
Turns out we survived. Old issues die and new ones are born and we have made a sort of peace with it, locked in this seemingly perpetual cycle. But I think about that night often, and how key it was for me to hear about their struggle before getting into one of my own. That glimpse into the mind of the soon-to-be grandparents and an idea of how their expectations might manifest made me feel compassion, even where I felt my toes were likely going to be stepped on (if not severely stubbed). That, and a sense that Winter Was Coming and I was probably going to need a coat.
Some ideas:
Acknowledge the transition
Whether or not you're already knee deep in MIL and FIL muck, or about to come to blows with one of your own parents, a big, healthy first step is simple acceptance. Not only will this (power) dynamic change, it must change. At some point, boundaries will be tested by the patriarchs and matriarchs of your family, and some Game of Thrones action is coming to a relationship near you.
If you have a partner, talk it through with them
My husband and I had long conversations (regarding both sets of parents) about the issues that would most likely crop up, and how we planned to field them. We identified boundaries we were going to have to put in place, and others that were slightly more open borders. Bottom line: we formed a phalanx before the siege was due to begin.
Advocate for yourself
You can advocate for yourself without being selfish. You can push back without being pushy. You can put the needs and priorities of your new family unit above everything else without being a jerk. And you must seek a balance. Wearing a chip on your shoulder and fighting every battle will leave you exhausted. Playing the submissive doormat will have you seething, resentful, and likely engaging in passive-aggressive behavior (the battle that no one ever wins!). Boundaries are essential. But so is respect for a very complicated process and everyone involved in it.
Get thoughts from friends who’ve been through it
Ask friends and family about their experiences in this arena. Make it understood that you don’t intend to stir up trouble. It’s just research.
Separate the fantastical expectations from the healthy, practical ones
Talk with your parents or in-laws about some of their ideas. You can mine these expectations from the fantasy realm and work to make some of the more reasonable ones a reality. One by one, you will decide how best to handle each situation, which hills are worth dying on, borders that must be defended at all costs, and battles best fought another day.
Finally, think back to some of your own pre-parenthood fantasies
Admit it, some of them were beyond ridiculous! I think back on mine and just laugh (OK, and sometimes cry a little). New phases in our lives invite expectations, and some of them can be downright silly. Give the old grandies a break, if you can. A smidge of empathy goes a long way!
Demystifying the Pelvic Floor with Celeste Compton, PT, DPT
We all believe that peeing a little when we laugh, jump, or sneeze is just a reality of aging or having children. But that's just not true; there are things you can (and should!) do about it. Meet Celestine Compton, a physical therapist at Bebé PT specializing in women's health and the pelvic floor.
Celeste loves to walk (“exactly what our bodies were built to do”), has explored a number of America’s national parks, and yearns to see Alaska. Her go-to drink is earl grey but she loves a good cappuccino. She has lived in New Orleans, where “the whole city seemed to agree that whatever ‘it’ was, could wait”; New Jersey, where she loves “the food, the sense of humor and the seasons,” but there is “a sense of urgency—in the northeast, winter is always coming”; and LA, where “nothing measures the passing of time. You can go for a hike or to the beach or have a picnic in the middle of December or July, so I just don’t sense that same level of urgency. Much of my work is reminding my patients that the time to address their body is now.”
NMW: We are so excited to talk to you about the pelvic floor, and how it fits into the overall postpartum wellness puzzle. What experience, if any, made you personally aware of the importance of the pelvic floor?
CC: You know, I am one of the few pelvic floor physical therapists who have not had a personal pelvic floor story (yet). For me, the moment I learned that pelvic floor physical therapy existed, while sitting in a classroom with a room full of other soon-to-be PT’s, I was intrigued. I was also not “weirded out” by vaginas, unlike many of my classmates, so I honestly felt it was my duty to become involved, because I care about women’s health and because I could.
NMW: I didn’t even know Pelvic Floor Therapists existed. Can you tell us about your job?
CC: So, I am really just an outpatient orthopedic physical therapist like the ones you see for an ACL repair or neck pain. Except my area of expertise is the group of muscles that surround the pelvis, including the core, hips, and of course, the pelvic floor. I happen to work at a women’s health facility now where I primarily treat prenatal and postpartum patients, most frequently for pelvic floor dysfunction.
NMW: I have a vague idea of what the pelvic floor is but perhaps you can paint a clearer picture?
CC: The pelvic floor is a collection of muscles at the base of your pelvis. And like all muscles, they contract and relax. But because of their location, when they contract they help to stabilize your pelvis (a tough job while pregnant due to all the ligament laxity), lift and support your internal pelvic organs, and hold back urine, gas or feces. When they relax, they allow the passage of urine or bowel movements, they allow you to have sex, and they allow you to deliver a baby.
NMW: I have heard that pelvic floor issues can lead to back pain, is this true?
CC: This is true because your pelvic floor works in conjunction with your hips and core musculature in order to help support your pelvis while you move. If one muscle group does not work well, this means that the other muscle groups will have to pick up the slack. Over time, they may become overworked with this extra burden and can stop functioning well too. This domino effect can lead to less support and stabilization for your low back and pelvis which is one of the main causes of pain.
NMW: In the simplest terms, why does the pelvic floor deserve every woman's time and attention?
CC: Your pelvic floor is made up of a very important set of muscles, and if they stop functioning well, you may notice dysfunction related to voiding, having sex, exercise, etc.
NMW: How can I determine whether or not I have an issue with my pelvic floor?
CC: Some questions to help determine if there is pelvic floor dysfunction are:
Do I leak when I sneeze or cough?
Do I have a hard time making it to the bathroom in time?
Does it hurt or feel uncomfortable when I have sex?
Do I have to strain to have bowel movements?
Do I ever feel like there is a tampon falling out when I’m not even wearing a tampon?
If the answer to any one of these questions is Yes, then it's important to know that, while these symptoms are very common, they are not normal.
NMW: Not all women experience things exactly the same, of course, but what is considered "normal" pelvic floor function?
CC: Peeing every 3-5 hours with a strong steady stream that lasts at least 8 seconds or longer
Not waking more than once a night to pee
Not needing to push or strain to pee or to have a bowel movement
Not having pain with sex
Not having tailbone or pelvic pain with activity or with sitting
If you have trouble with any of the above norms, reach out to your OB/GYN for a referral to a pelvic floor physical therapist because your symptoms may be due to pelvic floor muscle dysfunction. ("Normal" standards may change due to hormone fluctuations during pregnancy and menopause, but should otherwise hold true.)
NMW: When can you start with a pelvic floor PT? Is it different for C-section and for vaginal birth?
CC: If you’re currently pregnant, you will probably want to hold off on an internal pelvic floor exam; not because there is any evidence to suggest it is dangerous in any way, but because you may have a difficult time finding a medical provider willing to do it (most PT’s just prefer to be cautious with pregnancy). However, there are some circumstances where your OB may prescribe pelvic floor physical therapy in preparation for delivery. If you’re immediately postpartum, you will first need to be cleared by your OB at your 6-8 week follow-up appointment before beginning therapy. Based on how well your body is healing, your OB will be able to refer you to pelvic floor physical therapy at that point or they may recommend allowing more time to heal. C-sections or 4th degree perineal tears may take a little longer to heal, but 6-8 wks is about average tissue healing time.
NMW: Do pelvic floor PT's tend to accept insurance?
CC: Some do but, unfortunately, many don't. Larger physical therapy clinics or medical facilities may be more likely than independent providers to accept insurance. It really depends on the provider, so call around!
NMW: Can you break down how Kegels fit into the pelvic floor picture?
CC: “Kegels” are simply a pelvic floor muscle contraction followed by relaxation, just like bicep curls for your arms or heel raises for your calves. I personally try to avoid using the term “Kegel” because some dead white man decided that he invented a vaginal muscle contraction and would name it after himself. Imagine if a bicep curl was so named because a guy named Arnold Curl decided he invented that motion? ... it wasn't, that would be crazy. Anyway, sorry for the rant. Performing pelvic floor muscle contractions (a.k.a. Kegels) are important in building strength, endurance and coordination of your pelvic floor muscles. However, I always recommend that women see a pelvic floor physical therapist before starting pelvic floor muscle exercises as there is a lot of misinformation out there about how to actually contract these muscles correctly. And as with any other exercise, performing pelvic floor muscle exercises incorrectly can sometimes make things worse.
NMW: Are there any general exercises you would recommend to strengthen that area that women can do at home?
CC: Once you know how to do pelvic floor muscle exercises well, I think those are a great form of exercise to do at home! Also, if you are experiencing pelvic floor muscle dysfunction, there are likely a number of other muscle groups that might benefit from strengthening as well, like your diaphragm, core and hip musculature. But again, a pelvic floor physical therapist will be able to assess your whole body in order to help you get back to where you want to be without leaving behind any muscle groups in the process!
NMW: What do you wish every woman knew about her pelvic floor?
CC: I wish every woman would understand that her pelvic floor is made up of muscles, and muscles are adaptable. If your pelvic floor is not functioning properly, it can be retrained, strengthened and improved to restore function. Whatever may be happening with your body does not have to define you and if it is interfering with your life, you have the power to change it. I believe that it's never too early or too late to address pelvic floor muscle function. But women first need to know that this is possible in order to be able to do something about it.
NMW: Can you share a really impactful moment you’ve had in your work as a pelvic floor therapist?
CC: Everyday I have an impactful moment. Yesterday, I met a patient who, for two years, had been suffering with tailbone pain and fear of exercise because of a diastasis (an abdominal muscle separation that is common postpartum). By the end of our session, she said, “For the first time, I feel like I can do something about this.” I am so privileged to be in a position where I get to educate and empower women about something they should already know: their own bodies! I love what I do, but I honestly hope one day that my job will become completely obsolete.
NMW: Long-term, what do you hope to accomplish in your career as a pelvic floor physical therapist?
CC: I want to help as many women, teens, and girls understand their body as possible. I don’t feel that my level of knowledge should belong to just me or to just those who are able to access it due to location, finances or otherwise. I hope to help find a way to reach more people, which is why I was so happy to hear about your goals with this blog.
NMW: It’s been so fun getting to know you. Thank you so much for your time and expertise, and everything you are doing for women!