What a difficult subject, and what historical road bocks we have to uncovering the truths! First of all, we have the sad fact that most women who we know and who are still alive in America, who have borne children, did so in a hospital. If we interview all of them and discover how many of their births were overmanaged, lithotomy-position, legs up in the air, flat on their backs, purple-pushing against their bodies and against their wills and against gravity and God knows what else kind of perineal disturbances were involved--scissors, sewing needles, stretching (the well intentioned perineal massage which has been shown to be very very damaging unnecessary and off base) forceps...we would be already facing such a large control group that it would be kind of hard to figure out what to even use as a control group.
Then factor in that noone wants to talk about this.
Then factor in the subjectivity and media-fueled mystery and self hate and all the taboos that surround the entire subject of women's bodies. (Ack! My study is so doomed before it even gets conducted!)
And what of our great grandmothers, and great-great grandmothers, who birthed with midwives, but in the era where "Hot water!" was called for--for the unfortunate purpose of holding hot, hot, often salt water soaked cloths against the perineum of the birthing mothers...in an attempt to help stretch the vaginal opening, what they did was to perform essentially, a waterlogging and destroying of skin and sometimes muscle tissue, which had permanent consequences for the women on which this service was performed. Plus, lets remember that a woman of this era, even if she were alive to interview, would be socailly conditioned to be very reluctant to discuss something so private with us.
So, does having a baby have to be destructive to our selves? To our sexual futures, our reproductive futures, our ability to be continent and whole? If so, why would we be designed so poorly, or does that direct us back to that same old bit about "humans have such huge skulls, so it is hard to fit out of the pelvis...."
Here is an excerpt from another Sara Wickham article, in discussing the rhombus of Michaelis, a portion of a woman's back that is meant to move and shift during labor:
I think we need to get women to understand that, although epidurals are great for pain relief, they actually get in the way of a spontaneous second stage and vaginal birth. In many cases, the reason they've got an epidural is that the baby wasn't in the best position when it started, and the baby in the less suitable positions needs all the space he can get to turn around in. The OP baby needs the rhombus of Michaelis to move backwards so he has room to turn round so he can come out as an OA baby. The woman should then get out without having her pelvic floor damaged. Pelvic floor damage is a major worry for women, but if they can be in an upright position with their weight well forwards so that the rhombus is free to move, very little damage is done to their internal anatomy.
So, now on to me, and my experiences. Specifically with my homebirth of my 3rd child, Casey.
This was my only birth that was not in a hospital bed, and to say that I was in an "upright position" is putting it mildly. I was everywhere! Early labor I waddled between the hot shower and the floor, the birthing pool, and the floor, walking around the house, leaning over, always forward, always forward, to work through each contraction. To lean backwards would have been as unthinkable as choosing to hang upside down on monkey bars while pooping. Truly. I wish I had a lovelier analogy but I do not.
I rocked and rolled that baby on down, and the VAST majority of the labor was spent with me on hands and knees, the only position even close to bearable for the proper descent of a child with a 15 inch head and a 17 inch chest. I pushed when I wanted to, my midwife did not coach or boss me in any way, and no one touched me whatsoever down there. My body slowly accommodated my baby, and it couldn't have been more natural, the whole sequence of the thing.
I know I have said it again and again, that he weighed 11 pounds, and this time I have a point: I have seen those little glances especially from a few men, when the tale comes out that I had such a big baby. that little look--the one that thinks, for a spilt, shameful, rude, curious second, I wonder if she can swallow whole chairs with that blown out coochie.
But the area that I am wanting to examine today is the somewhat unknown fact, that for many women, if given a chance, birth does not have to do this to us. I always hoped it was true before I had babies, and now I know it to be true. When given the safe space to birth our babies, our way, our bodies are not cheap pieces of elastic, as Ina May puts it in her Guide To Childbirth book. We are not lemons, and birth is a normal part of life that we are built to do. So why would having our baby be so intrinsically damaging? I don't think it has to be, even for big, big babies. So check out what I wish I could do:
I may never get to interview women and ask them about their "pelvic floors". But if I did get the opportunity to travel through the ages and ask every mother about this very thing, here is a sampling of what I would need to know before any conclusions could be drawn that baby-having, in and of itself, was a Destroya of Vaginas.
"Does vaginal birth negatively and permanently alter the pussy?"
(Ok, I would probably have a way more professional title but whatever, I am just a bloggin' mama, typing the way I talk, if only to my bestest friends)
Was your birth induced or spontaneous?
Was your labor "managed" or completely natural?
Was your pushing stage "coached" (counting, being told to push or not to push by attendants)?
Were you instructed to hold your breath or pant or blow against your instincts?
Was anything applied to your perineal area, such as oils, fingers, hot cloths prior to crowning?
Was anything done to your perineal area during crowning, such as episiotomy, counter pressure, internal manual manipulation by attendants?
Did you have a forceps or vacuum extractor used inside of you?
Was your third stage (birth of placenta) "managed" or spontaneous?
Was your placenta manually removed?
How big was your baby?
After the birth, were stitches, sutures or glue applied to your perineum?
After the birth, were you given instructions to actively perform any activities such as sitz baths, blow drying, sunlamps, applying oils or creams to the perineal area? Did you do so?
Were you pressured to have a bowel movement as a condition of your being allowed to leave the hospital, and if so, were you given any medications to accelerate this process?
Were you encouraged to force a bowl movement with either medications or conditions and threats?
Were you able to rest off of your feet for as long as you felt necessary after giving birth?
Do you feel that you were able to resume sexual relations only when you felt 100% ready to?
Do you feel that your vagina, perineum, pelvic floor is permanently, negatively altered, whatever that means for you, since giving birth? How so? Does your lover (if applicable) share this belief?
Do you feel that your vagina, perineum, pelvic floor is exactly the same as before you gave birth?
Do you feel that your vagina, perineum, pelvic floor has been positively altered, whatever that means for you, since giving birth? Does your lover (if applicable) share this belief?
Well, that's my big study. Does vaginal birth have to drastically change our bodies, and how much of a role does managed medicalized birth play a role?
If I remember correctly from way back in science class, it is now my duty to form a hypothesis, so I am going to venture to guess that a managed birth, on any level, plays A HUGE ROLE in the postpartum and permanent resultant state of the pelvic floor.
Because for me, my Casey didn't do any harm at all. (and yes, my lover shares this belief.)