Katie is one of those women who absolutely loved her birth. The pain was exhausting, but purposeful, the moment her daughter rocketed into the world like a lightening shot to the moon. She labored at a local birth center, attended by midwives, all women with whom she’d developed a deep trust over the course of her pregnancy. Traveling home a few days later, driving over mountain highway to the coastal town where she lives, she cried from gratitude for her life. She was thirty-six, married to her high school sweetheart, bringing their baby home to the small trailer they lived in beneath the redwoods. It was a dream.
In postpartum, everything about her body was new and strange. It was hard to tell what was “normal” and what, if anything, might be wrong. Katie started to suspect something was up when, a month out, she has still having trouble standing for more than a few minutes at a time without her pelvis feeling loose, heavy, out of place. Walking the dogs kept getting harder, and then it was the baby wrap, which felt like it pushed her bladder down every time she put it on. “I was trying to clean the kitchen, and everything just felt... heavy. I couldn't wash the dishes, couldn’t lean forward over the sink. The next day it was worse – I couldn’t even stand for more than a few minutes. I'm kind of neurotic with cleaning, but also it's therapeutic; I really care about my spaces. I really love when they feel put together. I hated sitting in bed, staring at the messy kitchen, not being able to do anything about it. I hated having to stand there while the grocery guy loaded my groceries to the car. I felt like an invalid. I felt broken.” Worst of all was when she tried to lift her daughter. “All I wanted to do was hold her. I mean it's like any mom, right? I just wanted to hold her, to bounce her when she was crying, to walk her down the driveway and get a little sun. But I couldn't do that. I couldn't do any of that without feeling like I was going to pee myself, or actually peeing. I'd already stopped bleeding, and put away the big postpartum underwear, but then I started wearing pads again, every day.”
Late at night, exhausted beyond measure but keyed with the anxiety of what was happening to her, she would turn away from the infant sleeping next to her and bend over her phone, scrolling, face washed in the white glow. Words like prolapse, cystocele, life-long, permanent stared back at up her. She flicked through pages from Mayo Clinic and other med sites; they had some pictures, but most were cartoons, brightly colored side-profile cutouts of women's internal organs, some accompanied by captions that used metaphors about hammocks and fruit. She felt her chest tighten with every new website she read, and after she put her phone down, staring up at the ceiling in the dark, she would try to convince herself that surely, there had to more information somewhere. That someone had to know more about this, and when she knew it to, she'd be able to breathe again.
When she asked her midwives, they assured her that she was early in the healing process. At eight weeks, when they examined her, they said that she did have some laxity, but that they weren’t trained in evaluating prolapse, and she should seek the help elsewhere. When she did – with a local nurse practitioner, a former midwife herself – the nurse practitioner said the same thing, noncommittal, as if it were no big deal one way or the other. It might be prolapse. Not sure. When Katie asked about using a pessary — another of the words she’d since learned on her late-night information hunts, and something she hoped would help her control her bladder — the NP shrugged.
“They’re mostly for old ladies. And, most of my patients don’t like them. They get them, but then they’re too uncomfortable, so they don’t wear them.”
Katie had to hold back tears until she got back out to her car. She was thirty-six, a long way off from “old lady” years, but even if she wasn't, did this mean there were no answers for anyone? That life would be pads and peeing and walking around like a delicate flower until she was too old for it to matter anymore? She held onto the steering wheel, looked out into the fog, and cried.
In the months that followed, Katie's symptoms were a daily roulette; she could hold her stool, most days, but her bladder was less predictable. A tight, aching heaviness started the moment she stood up in the morning, and it stuck around until the next time could put her feet up, which she tried to do multiple times a day, wherever she was. Katie was a part-time professor at her local community college, and she could barely make it through a class without needing to run to the bathroom. Worse than any physical symptoms, the psychological toll prolapse was taking on her life. It looked nothing like it had pre-baby. Her favorite hobbies (SCUBA diving, beekeeping, long walks through her neighborhood) were a fantasy. The future stretched out in front of her, a void. Thoughts began to creep in, dark, sinister. She started to wonder whether her husband and baby daughter might be better off if she wasn’t around.
Finally, on a follow-up call, one of her midwives suggested a local pelvic floor physical therapist. Katie made an appointment. She drove the long mountain highway back across the hill. For the first time, someone sat with her, explained to her what was happening, how her muscles gotten so tight — a hypertonic pelvic floor, the PT called it — how when they were tight 24/7, they couldn’t strengthen. While some of her symptoms were certainly coming from the prolapse itself, the PT said, some of them might also be from all those months of tensing, stressing, trying to manage her sensations alone. A pessary would likely help with all of it. Over the course of several months, Katie would learn how to release her pelvic floors muscles, and then how to build back her strength. But she’d also return to the NP, emboldened, and ask for a pessary one more time.
“I just marched in there and I said, ‘look lady, I want this thing. If it doesn’t work, that’s fine. But I want to try it.’ I remember she kind of laughed. Like, in a good way. I think she was impressed I came back.”
After her pessary fitting, a ring with support, Katie waited a week for it to arrive. When it came, she opened the package, cleaned it, laid down on her bed, and put it in. When she stood up, she could feel the difference right away. She walked across her house, then down the steps out into the yard and back again.
“I really couldn't believe it. It was like... it was freedom. It was like for the first time in eight months, I could stand up straight and not think about my organs falling out of my body. And that mental space, that freedom from thinking, that's what really made it so that I could become myself again. Or, my new self anyway, which is what motherhood is. We don't leave room for that in American culture, becoming a mother, but we need to. It's a huge psychological, emotional, physical shift. And I think when you're so consumed with prolapse, with trying to navigate the isolation and the depression and all the horrible physical symptoms, it's impossible to understand that you're also undergoing this gigantic change. I think the pessary brought me the freedom to start to get to know this new version of myself. And that was so important.”
For Katie, her life looks different than it did before having a baby. Of course it does; as she says, there is no going back, only forward. But she can move through her days without worrying about her prolapse now. It's become something she manages, like seasonal allergies, or her trick hip. She's lifting boxes on her beehives, strapping a tank to her back and marching down the beach into the ocean. She's carrying her daughter in a backpack through the woods, or running with her through the yard, or spinning her in circles in the middle their living room. This last one is a favorite; they call it “flying.” Her daughter will ask her, “Mama, fly?” Katie will smile and say, “You bet, kid,” and lift her up into the air.
