In France ALL women who have given birth, even normally, or who have had abdominal surgery of any kind are automatically referred to a physical therapist who knows how to work with the pelvic floor. It totally makes sense to me that this would happen routinely, because both birth and surgery can leave us with many issues to deal with afterwards that are not in the domain of doctors or obstetricians to understand or treat.

Unfortunately, this common sense practice is not happening in America, so we have to be resourceful and find our own support at these important times. For many women it is not possible to return to full health and comfort in their body without help.

It is for these reasons that I am highly recommending Isa Herrera’s book “Ending Female Pain: A woman’s Manual - the Ultimate self-Help Guide for Women Suffering from Chronic Pelvic and Sexual Pain.

Herrera says “… pregnant women need to be empowered with information and made aware that certain positions are less likely to cause perineal tearing (during birth).” She also strongly advocates for perineal massage started at 34 weeks in pregnancy, and finding a doctor that does not perform routine episiotomies. Obviously, finding a doctor who does not perform routine cesarean sections would be a great help too, because with surgical birthing your body is recovering from both birthing and major abdominal surgery.

Prevention where possible is the best option, so really educating yourself about birthing positions, finding a doctor with very low episiotomy and cesarean section rates (good luck with getting a straight answer out of your doc on this one!), and likewise a hospital with a relatively low c-section rate can help considerably in pelvic health. Although I advise finding out your docs/hospitals statistics in relation to these practices, you may in reality find it very difficult to get these questions answered. Hospitals and doctors are strangely reluctant to part with this information……

This book does require a strong commitment to self-care to be really effective, you have to do the exercises regularly, and so it is suitable for highly motivated people who can carry out a regime consistently on their own at home. The other resource is to find a Physical Therapist in your area who is trained especially in women’s issues. Some of these therapists, although they don’t advertise it, also offer inner-vaginal work, which can be crucial for some issues.

I also recommend acupuncture, especially after surgery, as it accelerates healing and re-balances the system. Che Nei Tsang (abdominal massage) could also help, and finding someone who can work with scar tissue once things have settled down enough in your body may be beneficial.

As with all these options, use your intuition to pick what is best for you and be discerning about your practitioners.