I was in the shower when I first noticed something didn’t feel right: a bulge in my vagina. Five weeks earlier I had delivered a healthy baby boy in the peace and calm of my own home. I was relieved to not be pregnant anymore and overjoyed that everything had gone so smoothly. The bulge was a sign of pelvic organ prolapse, in which one or more organs fall into the vagina due to damaged pelvic floor muscles. In my case, I had a cystocele, in which my bladder had fallen into my vaginal canal and was protruding out of my vaginal opening. After nearly a year of physical therapy, I felt stronger and more aware of how to take care of my pelvic floor, but I also knew that my body was never going to be the same and that rehabilitation would be a lifelong endeavor. I put my feelings to paper, journaling about acceptance, and after many tears, I finally asked my husband about having another baby.
The prospect terrified me, and my brain was on overdrive with worry: What if having a second child only worsens my prolapse? How will I be able to lift my toddler or a car seat without my vagina falling out? What if sex doesn’t feel good anymore? Above all, I was terrified what it would mean for my mental health if any of those fears became reality.
I strongly considered the possibility that we might simply not be able to go through with another baby. But my husband asked the question that changed everything: What would happen if I allowed my condition to rob me of the family I had always wanted? That thought nearly broke my heart. I deeply desired a sibling for my son. I thought about the thrill of feeling my baby move inside of my womb. I was not going to let prolapse dictate my legacy.
The prospect terrified me, and my brain was on overdrive with worry: What if having a second child only worsens my prolapse?
So we decided to try, my fears along for the ride the whole time. It wasn’t hard only on me, though. Being intimate with someone who feels like they’re broken, physically and emotionally, takes a heavy toll on a partner. My husband had to talk me off the ledge of anxiety and catastrophizing my bladder prolapse many times. I required reassurance that I was not broken. It was crucial to me that he was ready to accept what it could mean to have another baby. I couldn’t do this without his support and understanding.
On my son’s first birthday, I snuck into the bathroom before my family showed up for the party and quickly peed on the stick. Positive. We were doing this thing!
I mobilized immediately after finding out I was pregnant again. In order to give myself the best possible chance at a positive birth experience, I knew I needed to build a great team. Living with POP can be very lonely, because there is so much stigma and shame attached to this diagnosis. Most people don’t want to hear about how your vagina is caving in. I went on a search to find out who would support and nurture my pregnancy journey so I could feel confident that I could birth my baby despite my prolapse.
I luckily had already been working with a physical therapist who fully supported me and my goal to have another baby. I was able to meet with her once before COVID hit in March 2020; I was three months pregnant.
As the months wore on and chasing a toddler was my daily exercise, my symptoms worsened—and so did my anxieties. I needed to do something to prepare my body and my mind to overcome my fears. I hired a doula and she helped me process and reframe my fear. I reached out to other women on social media and joined groups to give me encouragement and hope. Being able to connect with others who were experiencing or had experienced pregnancy with POP was hugely beneficial to mitigate my feelings of loneliness and struggle. I also began to gain confidence and share my diagnosis with my family, my in-laws, and my friends. I shared my story in a vulnerable and real way with people who cared for me. It was one of the best things I have done for myself and my relationships.
In order to give myself the best possible chance at a positive birth experience, I knew I needed to build a great team.
The other factor that was particularly important in my decision to have another baby was to make sure my provider was supportive and knowledgeable about what I was experiencing. Most providers aren’t very well-versed in pelvic organ prolapse and unfortunately can only write a referral to a physical therapist or urogynecologist. My midwives always addressed how I was feeling, emotionally and physically. This gave me ample opportunities to discuss my fears about the pushing stage and to come up with a game plan with input from my physical therapist.
I visited my pelvic floor physical therapist about a month before my due date. Using an ultrasound machine, we did “practice pushing” in different positions to see which one opened the pelvis most and put the least pressure on my pelvic floor. Armed with the knowledge that hands-and-knees or side-lying positions were my best bets to avoid further injury, I felt so much more confident going into labor.
I also want to acknowledge that many women diagnosed with POP decide to not have any more children. In most instances, these women have experienced major trauma and injuries. It is hard to make peace with the feeling that POP has stolen something from you. Because it has. Not only are you postpartum, but you’ve been handed a diagnosis that you might have never been warned could happen. You must completely renegotiate your relationship with your body. And that’s a game for the mind.
What became the most influential factor in having a positive birth experience with pelvic organ prolapse was not physical at all, however. Rather, it was my mind-set. For all the doctors, the Kegels, reverse Kegels, support garments, and breathing techniques, it was my belief in my body that became my true source of strength. After my diagnosis and throughout my second pregnancy, I actively worked to heal my body image. Like many women, I had always believed myself to be not pretty, thin, strong, or tall enough to be desirable. There was always something about my body that should be better. I released my negative beliefs and replaced them with reasons why I should love my body; from breathing to fighting off illness, my body was amazing. I chose to cherish my body, prolapse and all.
It is hard to make peace with the feeling that POP has stolen something from you.
Today I am three months postpartum. I am delighted to report that I gave birth to a healthy baby boy, on my knees, surrounded by a team of birth professionals and my husband. I am even more relieved to say that when I visited my physical therapist at eight weeks postpartum, she was “impressed” at how my prolapse had improved and had complete confidence we could rehab my pelvic floor even after the second birth. I’m glad that I never stopped advocating for myself and for the family I wanted to have someday. I am not going to rush to have a third baby—but at least now I know that it’s a possibility!
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