If you knew then what you know now...


I am feeling a bit overwhelmed by trying the articulate the many things I am hoping to learn more about on this forum, so I will start with a simple question for all of you. A bit of background: I am an independent homebirth midwife and work with women one on one throughout pregnancy, birth, and the postnatal period (weeks, months, and often still have contact years down the road). Thankfully, many factors are often in the favour of the women I work with to allow their pelvic region to usually be fairly unscathed (quality health, unhindered non-drugged normal physiological birth, etc). I realise that problems may arise many years down the track, and this thought troubles me greatly. So that is what I am curious about hearing form all of you...with the gift of hindsight, what do you wish you had known about or been told or tried? What can you tell me that will help provide the women I work with more tools, etc for keeping the integrity of their pelvic organs. Obviously the book and DVD are on my shopping list but I am really drawn to anecdotal info and personal experiences as well.
Gee, I hope this question, my second post, doesn't get me tossed into the weirdo box ;)

Hi Aza

Nah! You sound pretty normal to me, but I am probably weird too, so that's two of us.

I wish I had not eaten the chinese meal I ate the night before my 38 week checkup with the Ob during my first pregnancy. I went to the appointment all puffed up in the face, which chinese food always seemed to do to me, and ended up being hospitalised with pre-eclampsia. Is there a connection? I will probably never know. (That was a rhetorical question.) What followed a week later was an induced labour, a big epidural to bring my BP down, stirrups, forceps, and massive episiotomy, all in a semi-reclined position which really p***ed me off after planning on a gentle natural birth. I was a passive observer of the birth of my first baby. He was handed to me like a Christmas present. Thankfully I took charge a bit more for the lovely births of my other two babies, so I did get to birth in the proper way, twice!.

I also wish that there had been a strong 'earthy' woman culture with a welcoming of puberty and womanhood, in the early 60's before I hit puberty and hated the belly that grew on my body. I was OK with boobs and menstruation, when it came, but the belly was not acceptable to me. My mother's generation were heavily into corsets, firm bras and control of the body. The earthy woman culture did come in time, but not from mainstream culture, and I think not even with hippie culture either. Sadly, we all still needed to be slim, tanned and beautiful.

I wish Jane Fonda had been black with bountiful, full body, in the 1980's, and had a relaxed belly, and had used her enormous lycra-clad influence to teach the women of the world to love their bellies and booty, instead of sucking them in and tucking their booty away between their legs like a frightened poodle. Angry? You betcha I am! We were all betrayed by the fitness and fashion industries, with their testosterone-driven marketing ideas, into trying to look like innocent-looking little girls instead of the proud women we are/were. We ruined our bodies because we could not think for ourselves. TV did it.

I wish my Mum had let go of herself enough to show me that she enjoyed being alive and enjoyed being a woman, and rejoiced in her sexuality and reproductive ability, instead of just showing me herself as a good Mum and devoted wife to Dad. That generation carried so much pain with them through their whole lives after the Great Depression and two World Wars. It is so sad. But she is a cool little old Gran now, who is teaching me how to be gracious in old age and losing her faculties.

That's enough rant for now. I am sure this will end up a really long thread!



Awww, I hear you, Louise. Sold a bad bloody bill of goods SO much along the way, eh And for women and birth, it goes to the core like nothing else ever can. That is what modern medicine does not realise, the ties to the core, to the heart, to the sacrum, to the fascia :) No organ is left dangling on its own in there, and no experience of birth is ever just about the baby getting to the outside world. That is only the start, and the rest will influence us all for the rest of our lives. Some more than others:(

The posture and belly thing is a huge one (clearly this is not news to anyone here :) )and something that I am applying already. It is an easy lightbulb moment for people, like when I explain that many believe babies get into bad positions if we sit in bucket seats, sit reclined, etc (I think it is a lot more involved than that, personally). To show the posture and why we need that bulge is SO effective. I have never been fussed about my slightly rounded belly but now I like it.

Also really like Christine's blog about why we believe what we do about the pelvic floor, corpses examined laying down, etc. Great stuff.

What else women?

After thinking about it, when I was eight my mother's sister delivered her third child, and had a hysterectomy on the spot because her uterus came out of her body with the baby. I was not told about this until a couple of years ago, by that same daughter, now in her forties.

My own mother's labour with me (only child) was 36 hours, and of course twilight sleep was the analgesic of choice, so she had no memory of, or part in the birth of her baby. She birthed in the stranded cockroach position. Dad was well and truly kept out of the process, 1000km away, and doulas and birth companion/advocates were not allowed. She wore abdominal binders for the time she was in hospital postpartum, bed-ridden (10 days). She saw her baby only at feeding time every four hours, even though she could hear me screaming for food in the nursery, then I was whisked away by angels wearing starched veils, flowing habits and vows of poverty, chastity and obedience. They were lovely women, acting on orders. Mum was petrified of the child health nurse and her Truby King theories, and was scared to even pick me up between the compulsory 4 hour feeds when home from hospital, though she eventually cheated and gave me orange juice (which I now hate) between feeds.

Yes, having babies was ruled by fear and authority, controlled completely by medical staff, isolating and risky. Ignorance was considered bliss for the expectant mum, and the conspiracy of silence around childbirth was deafening for young girls' ears. The baby was the only joy in the room. No wonder these women were disconnected from birthing and from their own bodies.

Thank goodness birthing was clawed back by women, who now have all sorts of options, though women still seems to get dragged back into the dark ages by a medical system who will not leave the reins where they belong, (in wise women's hands) and be content to help in the background, with all the new knowledge they now have.


what I would tell my sister or daughter or best friend- except you are in an even better position as you can really influence many women over your career.
and before I start- I think it is actually very important to be slim and tan and fit :) Humans are not made to carry around massive amounts of body fat- it actually kills us and it hurts. And the tan part-well we are only now learning how important vitamin D is. But chances are if you have a little sunshine on your skin you are getting adequate amounts of sunlight and fresh air- and the fit part- Well- it was important for humans at one time to be able to run away from predators- now our only predator most of the time is other humans- but still- a fit body is more able to move. Now how you define this 'fit, tan, thin' is another matter entirely- I am not saying we all need to anorexic models- and up to 28% body fat is still thin in my book- especially if that person is able to move well and often- has the endurance to walk long distances etc....we are not cookie cutter after all- but part of our health crisis right now is that the government approves production of foods designed to make us sick and sicker. And this transfers right over to birth. Why do women end up in hospitals and considered high risk? oh high blood pressure, gestational diabetes, etc....I propose if women were walking 2-3 miles a day and eating well many of these risk factors would up and disappear.
and now on to my answer...Most of us women are so out of touch with our vaginas- I know I was-and in fact a huge part of the adjustment to having pop was actually thinking about my vagina multiple times during the day- looking, feeling- etc.. How I wish someone had encouraged me to do this before I had children- perhaps when I first started cycling. I have given my sister multiple diagrams of the vagina- encouraged her to find her bladder, cervix and intestine. I told her to look in the mirror- to kegal with her fingers inside- to feel the stool through the wall during a bm. To get to know this important orifice.
that is step one.
step two. poop. poop is important and we simply don't talk about it- but it is right to know what good bowel habits are- how to recognize when there is a problem and how to remedy this problem. So as a midwife you could have a handout purely about poop. You could ask each visit for a log of the past months poop-
step three- diet. directly related to poop- but also the health of the entire body and the tissues of the body.
step four- clothing-
step five- sex. I would talk about sex a lot- because I know how important it is for a first time mother to be prepared for some changes in this area and specifics on what these changes might look like.
step six- how to birth over an intact perineum. Midwives here in my town don't have a clue- most reading I have done about it also shows this same sentiment- no one seems to understand that tears really can be avoided.
Step seven- postpartum recovery- I love the idea of lifting only the baby for the first 2 months. No straining to have a bm. eating well- nursing lying down- long walks in the posture.
and most importantly - about wholewoman posture- the principles behind it and adopting it for life!
and very last- that pop is a continuum- some looseness and instability is VERY NORMAL in the first years postpartum (I often wonder if it even serves some purpose-the body usually does have a reason after all)- it clears right up over time- so child spacing is important if you want to avoid pop.
It is so hard to think as a young woman that your body is old. This is simply not the case. some degree of settling and change in the vagina must be normal. We should be told of this just as we are told of stretch-marks fading or the pelvis getting wider.

I know this all sounds very know it all ish-and a bit judgmental and overwhelming- but it is what I share with my sisters and friends and one day my daughter.

When I was pregnant with my first child, I visited an "illegal" midwife and considered using her to birth at home. I ended up deciding on the hospital birth with the Certified Nurse Midwives who worked with my OB. I had big discussions about avoiding episiotomy, wanting no IV, no meds, etc. and felt confident that I was getting the best of both worlds.

I got most of what I wanted, EXCEPT I got a big midline episiotomy. The birth was very fast and the CNM told me the perineum just seemed really tight; I'd gone so fast there wasn't time for the tissues to stretch.

NOW... if I could go back, I'd have used the illegal midwife and birthed at home. There is little doubt that with warm compresses, massage, maybe water birthing, that I'd have done fine, and MAYBE avoided some of my prolapse problems now.

In hindsight... what I wish I'd known about... I wish I had not been put off by the sneaking and discretion needed in dealing with the underground midwife. I wish I had not been intimidated by the law, because the law does NOT know what is best for me. I wish I had known what I know now, but then, that's what happens when you get older. You get wiser.

This thread has given me something of an epiphany. I knew my cervix was too low during the last week of my pregnancy (I could see it after carrying home a big bag of grout for the bathroom at 39 weeks - IDIOT!!!!). I subsequently went on to have a normal (albeit bloomin painful) waterbirth where I delivered our baby myself. Some stitching and bruising afterwards, but nothing too extreme (although I did feel v sorry for myself). In my post-natal days of trying to come to terms with my substantial cystocele and UP (which no one seemed to recognise despite me saying SOMETHING IS NOT RIGHT), I always felt that had I had better support during the birthing process (ok, my fault, I didn't like the midwife and wouldn't really let her near me, but to be fair, with the system as it was in the UK, I had never met her before and didn't like her attitude - she prob didn't like mine either!!!), I would not have the issues I now have with my POPs.

Having got back into reading other people's stories, I realise how LUCKY I was that I didn't get bullied into a highly managed birth. I've just realised in how much worse a state I would potentially be having to claw my way back from.

But, Aza, to answer your question, I wish someone had explained to be exactly why it's not a good idea for pregnant women to do heavy lifting. I was all gung-ho about everything, and in retrospect, I don't think I was as sensitive as I should be been to the unique situation that pregnancy is. I also believe that women should be educated around how the choices that may make about their birth can impact on their long term health - tell them about prolapse, and looking properly after their pelvic health instead of the patronising 'are you doing your pelvic floor exercises', that seems to be the 'catch all' for anything 'down there'!

Oh yes, and I wish someone had taught me to let me body do more of the pushing work during labour. Again, gung-ho me was like 'THIS BABY IS COMING OUT NOW!', I could definitely have done with being better educated about knowing when to push, and when to try and chill a bit....

With my daughter I heard many labor stories from other women and I always remember them saying about this uncontroable urge to push. I never felt that!! I remember them breaking my water, going right to 10cm and my doctor saying ok if you would like to start pushing you can come on the bed and we will start. Ofcourse I wanted to push!! I wanted to meet baby. Although I only pushed for 45mins. I had no urges to push. I made myself push. Also laying down I couldn't really tell when a contraction was coming on or not by that time. However, I had heavy bleeding after and needed 1hr. 45mins of stitching. And now "my bulge" as I've named it. I think if I was able to have a midwife there to guide me I would of ended up in a lot better state.

First, thank you for being a homebirth midwife! And a good one, it seems, judging from your desire to have as much information for your clients as possible. My own homebirth midwife is an amazing lady and she facilitated an amazing birth for me. So yes, POP can happen even with the best, most natural birth. I think that we all have to remember that POP occurs from a *lifetime* of factors, not just a POOF when one gives birth, though that is often the biggest straw on the old camel back. I am a year pp now, and not sure I really even "have" a cystocele anymore. I have zero symptoms, no externally visible bulge, and only a slight convexity of my front wall. I expect that even this will resolve over this next year. I think it is important to reassure your clients that an enormous amount of healing will happen, though very slowly, because the body's reserves are all geared towards the baby's needs. Last year, no health professional could offer me that carrot of hope, but I found it over and over here. Someone once said that the only women who do not have pp POP are the ones who don't look. I think that may be true. I'm with alemama -- POP is a continuum, and probably some kind of natural body adaptation. Perhaps to make mommies slow down. If we could run off before the baby can walk (think cavewoman), then survival of our offspring would be severely hampered. Or perhaps it is a "child bearing years" type thing where what with the stress of pregnancy and birth, the body dosen't want to use *too* many resources to heal up in case another birth is around the corner and the energy is needed for pregnancy and nursing. I think the true danger is when we do not restore our structures to maximally benefit reversion (WW in a nutshell, only much less eloquently stated by me, ha).
What will I do "next time?" Probably birth on all fours, let my body do all pushing, and not look at my vagina for at least three months pp!!!

In hindsight I wish someone would have told me this can happen. There is a small risk of your pelvic floor becoming compromised and POP is a possibility so watch for these symptoms. I went to my midwife immediately following my first birth and she said it will be fine give it a few weeks, instead of giving me a plan that could help possibly reverse the prolapse.

I also think women should know they did not do anything or not do anything that caused the prolapse. Not to say you cannot do some preventive measure, but out of the many women who discover prolapse there are more women who do not discover a prolapse and they are those who do not have great posture who had forceps deliveries, who pushed too hard, Who lifted something to heavy...

Emotionally dealing with the prolapse has been dealing with the "what if". We really should not even go there, we cannot change the past and nor do we need to blame ourselves for what has happened.

Once pop has occurred our midwives and docs should be prepared to truly educate us and give us some practicle tools to work with, I sure wish my midwife would have.

So true Kathy!!!

Agree 100 percent Kathy!

Wow, great post, alemama. I totally agree that one basic requirement during our childbearing years is being able to move well in our bodies and have some stamina and endurance. Many simply don't and this is not a good start to motherhood, physically or otherwise! Birth is not a passive event, nor is it a spectator sport, and your body needs to be ready to birth. Pure and simple. I also don't think we know diddly about long term effects of maternal nutrition on the fetal patterns later in life (metabolism, glucose regulation, etc) but that is another story entirely.
And YES when the hell did we lose familiarity with our own vaginas? I tell most women I work with that I generally keep my hands out of their bits, so it would be really great if they got to know themselves before birthing, and if they want some help to do so then I am there to help navigate the geography :) The only thing more harmful than women losing this connection is when we not only give it over to someone else, but to someone who has authority but no true wisdom (which seems to be a fairly common finding in modern medicine's relationship with the pelvic floor).
Alemama, I do have a handout about poop :) There are no pictures (wasn't sure how far to push it with the very diverse population group I work with) but the descriptions and explanations on diet are really helpful.
AnneH, so sorry to hear about your episiotomy. Sounds a bit counterintuitive to me that a birth going really fast would be grounds for an epis...unless there seemed to be signs that your tissues were about to blow (called 'buttonholing' but still a dubious reason to cut, at best). But I digress. And I hear you on going underground for the safety of your body. I hear you for sure.
Cynical, you say "I always felt that had I had better support during the birthing process (ok, my fault, I didn't like the midwife and wouldn't really let her near me, but to be fair, with the system as it was in the UK, I had never met her before and didn't like her attitude - she prob didn't like mine either!!!), I would not have the issues I now have with my POPs." Can you explain a little more what you mean? What sort of support/info/direction do you think might have helped? And thank you for the insight about heavy lifting, though other than using proper posture I am unsure what else to offer mamas with toddlers in arms.
Madsmaom, there is a big difference between pushing your baby out (most likely the most intense bearing down ever down) and the fetal ejection reflex (your body involuntarily throwing down, like throwing up in reverse). Most births are a combo of the two, when left relatively undisturbed, but it doesn't sound like you got the chance to see what your pushing experience would have been if left to your own devices. And the only thing you need a midwife to guide you towards is right back to listening to your own body, with maybe some words of encouragement along the way :)
bad_mirror, you say some good words. It is reassuring (hmmm, not really the right word) to hear that POP can occur even in the cruisiest of births, and I think you are right, a lifetime of factors come together and may eventuate in POP after birth, even after a gentle one in a pool in your lounge room. Here is my concern though: I have been attending briths for many, many years now, and have not see many major problems. Some, but not many at all. I am now realising that this is because as a care provider I have not known what to ask, how to ask it, or when to ask. The reality of POP is NOT taught in school and don't believe anyone who tells you otherwise. This is what you are all teaching me now.
Kathy, you sum it up, I think "Once pop has occurred our midwives and docs should be prepared to truly educate us and give us some practicle tools to work with, I sure wish my midwife would have." I truly wonder how much anyone knows. Sounds to me like we have hoardes of women who know they DO have a problem, who go into a care providers office, lay down and assume the position only to be told that a) nothing is wrong b) give it a little time and it will heal or c) have surgery to remove your innards. Is it just me or is something terrible wrong with this piocture? And the common thread is that a woman has the capacity to know her own body better than anyone else ever will, no matter what credentials, etc. This is where the hope lays.

Hey again Aza - to answer your question on what type of support I feel may have helped me - I don't think I pushed at the right time, I think it's possible that had I waited a bit longer, I wouldn't have torn at all, but I started pushing when the first midwife (the one I liked), told me she was going off shift so I was like 'righto, let's get this done before that grumpy one starts ordering me about!!!'. Maybe some counter pressure on perenium (sp?) may have helped, but mostly it was just having trust in the midwife - which is almost impossible if you don't get to meet them before you go into labour. As I gave birth at night, my husband was sent home almost immediately afterwards, so with adrenaline pumping through my system and a painkiller, I spent a good hour or so walking around the post-natal ward, trying to get my crying baby to sleep - this was about 2 hours after the birth. A nurse finally noticed me an suggested it was quite a good idea for me not to be walking about so soon after the labour. So, yes, a bit more TLC directly afterwards wouldn't have gone amiss!

Luckily, the system in my area of London has since changed, so this time, I will know my team of midwives and can hopefully gain a common understanding before the birth. Although, disappointingly, when I mentioned the prolapse to my midwife, the first thing she said was 'we can arrange for you to see a consultant about that!'. My reaction was NOOOO - anyone, but the consultant! That's the quickest way for me to lose any confidence about getting through this on my own and reasonably intact!

Louise - to your point about the customer/ salesperson relationship, I agree, but I think the relationship is slightly different in places like the UK where healthcare is free. Here. the feeling I get (when not using my private healthcare - which doesn't cover maternity) is that 'you're lucky to get an appointment, as there are people much worse off than you, so stop being difficult and be happy with what we offer!". My husband always finds it amusing when I start arguing with the doctors, or just openly say, 'thanks but no thanks' to their suggestions of surgery. Who knows, maybe I'll end up coming back to them with my tail between my legs - but not yet!!!!! I am to this day in disbelief about the witch of a urogyn, who, at 4 months PP had a quick look at my bits and before I had even got my clothes back on said, 'yes you do have a prolapse - you'll need a vaginal hysterectomy'. When I mentioned that I was not ready for such a drastic step, she said 'well, you'll still have your ovaries', and gave me the kind of smile the villain in a James Bond movie tends to favour. It makes my skin crawl. Just so amazingly callous. I really cannot think of a better word for her than a butcher! She clearly had no appreciation for the devastating effect that flippant sort of approach would have on a 31 year old new mum. I felt so patronised and weak. And then I turned militant!!!!!

Phew, I enjoyed that rant!!!

Hi Cynical

I think the only way to be able to handle thoughtless comments is to make sure that you are very well prepared, almost to the point where you can second guess them. Go into consultations when you have done enough research yourself to be able to treat the consultation as a reality check, rather than as your only source of information. Use them as a support, rather than as a solution. That way you are in a position to have a discussion, rather than just listening to bad news (which might turn out to be not that bad, with a bit of discussion).

This is why web forums are so useful. We are peers. We can disagree. We can bring different perspectives. I don't think consultations should be very different. Any professional can give better value for money if they know that the client at least understands the language they are talking.



I can not believe I forgot to mention this! I was told by my midwife- "Oh, I believe you have a cele of some sort- look it up on the internet". I can not describe to you the sense of devastation-I felt when I started reading- it was suffocating. And then I found this site- and over the days I read and read and it helped me. Then I got the book and that empowered me. And then I watched the dvd and finally started to emotionally feel well. All the information I have shared with my sisters and friends has come from my personal experience with prolapse and the wisdom shared here and in print materials by Christine and other women. I actually loaned out my book so much I needed another one. A midwifery student friend of mine used the book as a reference for a paper and presentation she did for school.
Any good midwife will have a lending library full of great books to inform and empower women about birth, postpartum and parenting-your library would be incomplete without this book.
Also I believe there is a pamphlet here that you can download and share with your clients that will have the website and other information.


The pamphlets are accessed via the Homepage, Resources link, under Brochure. There is also a downloadable bookmark under the Links section of Resources. It is a single bookmark on an A4 sheet, marked ready for commercial printing, so you can save the file and take it to a printer. If you are handy with a publishing program you can select the graphics and paste them into an A4 page, I think it is five to a page, then print them and just cut them up. I try and keep a ziplock bag with a few bookmarks and brochures in my handbag. They would make great info pack ingredients.


Cynical, is there any way you could hire an independent midwife for your next birth(s)? Or at least with your team this time be really blunt and honest about your experience and keep them on their toes:)
Thanks for the link; I have actual already printed out one of the other brochures since it has a good pic of the posture so I can give women an idea of what i am talking about. Years of gyrating around peoples lounge rooms trying to demonstrate has taught me that visual aids are incredibly helpful!

I've got one more thing too . . . I wish that "professionals" would stop saying that a retroverted uterus is a "variation of normal," when really, it's the first cue that you may be prone to POP! If I had found WW and started working on my posture some 15 years ago after my first pelvic exam when I was told I had a "slightly retroverted uterus," I seriously doubt I'd have pp POP now. So much evidence here on this site (and with my own body!) that retroversion can be corrected to a degree with posture . . . .

I had my two babies in two different countries, both had "free" health care. The first one was in Australia,admittedly I was only in labor a short while so they were not ready for me, the baby was quite blue with the cord round his neck, they rushed him away, I was left for the next hour, freezing cold possibly going into shock, no covers, the doctor then returned to sew me up with no freezing, not once mentioning the baby, in between stitches I managed to ask him how was my son, he muttered "keep still he's o.k." Needless to say I had quite a few complications pp. The next baby was born in England, not quite so dramatic but I found the nurse to be extremely rude, there was absolutely no compassion, I felt I may have interrupted her coffee break. I never had a baby in Canada, but the "free health care" there was no better than the other two places, Since being in the States (3 years) I must say I find it quite refreshing the difference in attitudes in the medical profession. That is my rant for the day. I hope it helped someone. Chester

I know this conversation is several years old, but being pregnant with my 3rd child I am left with so many questions. My first child was born in a hospital with no pain meds and my doctor held her chin down through my rectum because during the pushing stage, she was sliding backwards significantly. During my second birth, also a natural one, I hit the pushing stage and the urge was so strong that I held nothing back and she was out in one push. This second birth was in a semi-squat position with me feet on paddles at the end of the bed and my hands on a squat bar.
My bladder prolapsed a week later. I am not sure how much of my birth with the second baby had to do with my prolapse, since I know that poor posture among other things definitely influenced it. But there is so much conflicting information over what would be the best position, if any position, on a prolapse. Whether childbirth really affects Pop, or if it has to do with how you handle your body PP. Anything you could offer, I am trying to master the WW posture, and struggling with it. But still very early in the process.

Christine does address some of these issues in her book. I couldn't remember if you had it or not. - Surviving

No, I do not have it. We've hit some really hard financial times and I am having to save up for things and space them out. Do you suggest the fundamentals video? Or the book? I was kind of thinking that if I can scrape together the 25 for the fundamentals digital download, that'd be my next buy

The book is an important resource for your self-study and it would be a shame not to get it when it's 30% off. Basics is great, but that is more of a starter program. - Surviving

So which book then? Is it the Saving the whole woman?

The Saving the Whole Woman book and First Aid for Prolapse dvd are the very beginning, and contain all the background material, practical advice for daily living, and exercises. They are both a great start into this work.