Debbie Jabukowski fell in love with her husband in the outdoors. It’s where they built their life together, camping in the Sierra Nevada backcountry, winding along trails through their ten-acre property after they moved to New York. Debbie was most herself when she was outside. After years of unexplained infertility, Debbie finally got pregnant, and the future they imagined took place in these same wilds. Her son was due in the May, and all through her pregnancy, she imagined the New York spring, how it would burst forth from the long winter, how, son strapped to her chest, she’d walk under the sugar maples and the yellow birch, showing him the world she loved.
Despite a few complications during delivery (an unusual reaction to her induction medication, a strong epidural that made it hard to feel how to push, a tear), Debbie’s son Logan was born healthy, and the first few weeks after were pretty blissful. In the hospital, the nurses had told her that a certain degree of looseness was normal after birth, but that it would resolve. “Bounce back,” Debbie remembers. “They used those words. They told me that everything would bounce back.” But at the three-week mark after birth, her pelvis still hurt whenever she stood, and walking anywhere brought on a dull ache, like her body couldn’t hold her insides in. It bothered her mentally as much as physically, and she just couldn't shake the feeling that something was wrong. So, she decided to see for herself.
“I felt first. And even just feeling, it was like... it didn't feel like me. There was so much tissue. So I got out the little hand mirror. And when I looked, I just... I really felt like I didn't know what I was seeing. It didn't look like me, like what I knew myself to look like. There was a bulge, like something was actually like, coming out of me. And I remember feeling pretty panicked. Like, I had no idea if it was normal, or if this is what I should be looking like. Nobody had ever said anything about this to me. So, I did what we do now, when we have questions like this. I took to Google.”
Debbie had heard the word prolapse before, but only in relation to animals; she had never understood it as something that could happen to her body. After hours of digging on the internet, she came away with one understanding: that if she — a trained scientist — had never heard of what was happening to her, it had to be something pretty bad. She called her obstetrician immediately.
The OB’s office didn’t seem concerned. They told Debbie that yes, this sometimes happens, that it was a wait-and-see situation; it might resolve, it might not. She was given no guidance, no education. “I was so frustrated. Like, I really believe in the power of information, and I couldn't get any. They were so dismissive, so passive. And, I couldn’t see a way forward. I hated the idea that my body had an injury, and I had no course of action.”
At her six week appointment, the news was slightly clearer. After her OB examined her, she told Debbie that it didn’t seem like she was healing well, that she might need surgical repair to address some granulation tissue around her tear, and also to treat any possible prolapse. But still, it all seemed frustratingly run of the mill, cavalier, and surgery wasn’t something she wanted to think about yet. It wasn’t until Debbie asked the OB if she should still be taking painkillers — which she was around the clock — that the doctor seemed to understand that something was really amiss. They referred her to a urogynocologist, a specialty she’d never heard of.
In the weeks waiting for the appointment, Debbie started following pelvic health advocates and physical therapists online, trying to fill the gaps in what she knew, even calling around to try and find a local pelvic floor physical therapist in hopes they might help her. Everywhere she called responded with skepticism, dismissal, or even disgust. “No,” they told her, “we don’t do that here.”
When her appointment with the urogynocologist came, Debbie felt encouraged that the doctor was around her age. “I hoped she would be on the modern edge of things.” That evaporated, fast. “She took a look, and then just sort of shrugged. She told me it could be prolapse, or it could just be that I needed to heal more. She didn’t offer anything else, anything I could do. When I asked about a pessary, she told me I was too young. She just looked at me like — like, why would I be asking about that?”
Debbie started crying in her office. Even the specialist, the one who was supposed to have helped her, left her feeling like a pariah, like she was the only person in the world who had ever experienced something like this. She remembers the nights that followed, thinking back over her pregnancy, her birth, trying to dissect her previous experience for some explanation, some cause. Surely, if she could understand what she had done to make this happen, she could find a way to fix it. It was one of the darkest times of her life, and certainly of her marriage. She grew distant and depressed. She had trouble connecting with anything she had once loved. The identity she and her husband had built together, so centered in activity, in the joy of the outdoors, had vanished; the self she knew, the woman she had imagined who would raise her son and build her family, was gone. Even the thought of another child, the family she had always wanted, was impossible. The future was murky, strange, with no identity on which to anchor herself.
Around six months postpartum, Debbie decided to try again. She found another urogynocologist, highly recommended and based in New York, and told herself she would try one last appointment. She took the train into the city and got off in mid-town Manhattan. The office was about a mile east. In her pre-baby life, she wouldn’t have even thought about the distance; the walking, the hustle, the speed, it had always been something to love about being in the city. Now, her first time back in the New York since Logan was born, she stood outside Pen Station and didn’t know if she could make it. Instead of trying, she hailed a cab.
At the appointment, Debbie knew something was different immediately. This urogyn examined her, took measurements, told Debbie what she was doing as she did it. It was fast — maybe ten minutes — but Debbie was impressed with the efficiency of the clinical work. “And then she told me my grades. I had a stage two cystocele and a stage two rectocele.” Debbie had never had her prolapses named before.
“So,” the doctor asked, as a matter of course. “Would you like a pessary?”
Debbie was floored.
“It’s that easy?”
“Yep,” the doctor said.
She brought out a fitting kit. From the assessment they’d just done, the doctor picked a size she felt might fit, a ring with support, inserted it, and told Debbie to stand, walk down the hall, squat. It didn’t feel bad, it didn’t hurt; beyond that, Debbie wasn’t quite sure how it felt. She practiced taking it out and putting it back in again, and they set up a follow up appointment, so they could check in.
Debbie left the office wearing her pessary. As she stepped onto the streets of Manhattan, she made a deal with herself. I’m going to walk as far as I can, she thought, and when I start to feel pain, I’ll get a cab. “So I was like, okay, how many blocks? How many blocks can I go with this pessary?”
Block by block, she walked the entire mile back to Pen Station. She felt nothing. No pain, no heaviness, no aching.
“It was incredible. The world opened up. I was walking through the streets of New York City. I wasn't injured, or broken. I was a young woman.”
Bit by bit, she started to get out onto the trails. She strapped her son to her chest, like she’d always imagined. Two years after Logan was born, armed with information, a care team — including an OB, midwives, a urognynocologist, and a pelvic floor PT — and her pessary, she finally felt empowered to dream about the family she had always wanted to have. She's pregnant now with their second child, a girl, due in a few months.
