Pelvic floor recovery and what is right for you and your body – Episode 2 with Megan Vickers

In the second episode of my interview with Megan Vickers, a leading expert on postpartum pelvic floor recovery, we discuss the significance of support systems that understand your needs, as well as the importance of the pelvic floor and doing what is right for you and your body.

Episode 1
Episode 3

MARTINA: So when we’re talking about relationships, those that are around us, with people that are around us, obviously everyone is super concerned about how we restart? And how can we, and when is the right time to have sex again with your partner?

MEGAN: Yeah, and the big thing with that is, I often hear “Oh, my poor partner, you know, he must be chomping at the bit. My poor partner has been so patient” and I just always feel like what about you? Do you not have sexual desires? Do you not feel that you want to get back to that intimacy?

MARTINA: Sexual desire? What is that? Haha. 

MEGAN: The best person to find out if you have sexual desires, if you want to be intimate again, when you’re ready again, is you not your partner. So self exploration, self treatment, being aware of our postnatal body is the first step to regaining our sex life, it’s so often missed, you don’t see the midwife they check your scars have healed, boom, you can have sex now, hang on a minute, there’s a whole lot in the middle there that needed to happen. And often I’ll see women who are afraid to look and maybe haven’t even seen how their bodies look before they had a baby. So the comparisons are really tricky and can be quite frightening. And an understanding that there has been trauma there, if there’s been a cut or a tear, and that will leave a scar. But that scar is now a part of the body doesn’t mean that you’re any less pleasurable or pleasure seeking or can give pleasure, it doesn’t relate to that. It’s just scar tissue. And it’s a new part of that being that we need to nourish in here. I’m sure we all had a scar on our face, we would massage it, we’d inspect it daily, and we buy all the best creams. You can hide that and pretend that it’s all fine. But what’s that gonna do to your intimate relationships if you’re scared to show that and you can’t look at that part of your body. So trusting yourself and actually relearning yourself and sometimes you need to handhold to do that. And midwives, doctors, physios can help teach you what’s normal, how it feels, and then you teach yourself what feels nice. So, I use bullet vibrators all the time for scar healing. So I don’t know if you had a scar, but I had a scar on my first and then I had an abdominal scar when I had a tummy operation. And I just couldn’t touch it to begin with and the best thing to use is little vibrator. So bullet vibrators are perfect because they’re tiny, and you just put them on the skin. And if you were to put that bullet vibrator underwater, you’d see all these ripples. And imagine those ripples going through your layers of scar tissue just helps to move them. But it also desensitises things so when you touch it and it’s painful, if you touch it with vibration, you confuse the nerves. The same nerves that pick up pain will pick up vibrations. So everybody needs a vibrator and you explore the vaginal entrance, you explore inner thigh navels sensation, clitoral sensation stimulation, like now you relate right? Finding, “okay, that actually felt quite nice” you know, you’ve not had a pleasure sensation, I can guess there for a good while. So actually getting those sensations back is what’s going to get your want back. If it’s all scary and painful and a foreign area, it’s not going to come. And then if there’s any trauma, then you know about it. If you can’t feel envy, things don’t feel okay, if it does feel so painful. You’re not going to this big event, having sex with your partner for the first time, a really long time, there’s a lot of pressure on that, you’re not going into that blind, you are more aware of how that experience will be.

MARTINA: Wonderful. I mean, I think now everybody will be Googling. I guess we should thank you for telling us this. We are again connecting even the sexual part of our relationship. This is what is expected of me, my poor partner and so on. And then it should really all start with us. But it’s so hard to make ourselves important in this entire process. First, it’s about the baby, then it’s about how do I make sure that my husband still finds me desirable? How do I make sure that I can deliver what is expected of me as a partner and so on. But this is great advice. And it’s such a practical one. I think that also it’s beautiful that it actually does help you heal and rediscover yourself in this way. 

MEGAN: And I think there can be a huge role in the partner at this point. You know, they should be buying me the vibrator. They should be saying “I’m gonna take the baby out, so you can’t hear us. So you’re not distracted, so you feel totally safe. Here’s some really nice oil that I found. Here’s a vibrator. Let me know how it goes” It would make me so excited to know that that was happening and they need to give us space to do those things. And my husband for sure is such a fixer. “All right, that’s not working. Right. How do I fix it for you?”

MARTINA: This autopilot.

MEGAN: Autopilot, yeah. But if you give any woman the space and the time and the tools to help herself, she can do it on her own, she doesn’t need you to fix her. And my husband actually has learned. Exactly what I need is to create those environments for me, in your support team isn’t there to take the baby from us, the support team is there to look after the mum. “Okay, right, you need to do your rehab. So I’ve laid out the mat, I’ve put some water there, I’ve set up the TV and the balls there. Do I need to take the baby out or leave the baby with you whilst you do it? It’s all ready to go.” And that’s going to make us do our rehab. Hey, rather than “I’d like to have a shower,” I’d like to do that. Then I’d like to do this. Having a team around us to understand what we really need. And we can be vocal about it. You know, “What I really need you to do for me is to sit in the bathroom and hold the baby whilst I have a shower because I don’t want her out of my sight. But I also want to have a shower. That’s what I need.”

MARTINA: That is so empowering. Because I think we feel so guilty about leaving, you feel guilty about taking a shower, you feel guilty for even thinking about working out, so knowing that you are worth it and that you need to have that space and then asking for it from your partner, you will then exude confidence. And you have it sorted out, you know in these practical ways. 

MEGAN: Yeah, absolutely. And even hearing myself say that out loud. I’d love to say that I had done that myself. But I obviously didn’t. I almost want a third baby, so that I can do it this way that I have figured out; that’s really why I wrote the book, there’s all these things that I kind of have learned, and I’ve put in there my vulnerabilities because it is an all part of motherhood, I think. And we learned from our own journeys and people’s journeys around us aren’t always relevant until they’re relevant. So we’ll hear these stories, but actually, we don’t absorb what we need from them until we’re really in need. 

MARTINA: 100%. 

MEGAN: And I think if we talk to ourselves, like you would a friend or you know, sitting here and having this conversation, you know, I want to listen to me, I want to know exactly what I want. You know, instead of being embarrassed or defensive, I’m sure our husbands will be really grateful, our partners would all be grateful if we know, if they’re told exactly what we want.

MARTINA: I will share something intimate. To conclude this question my family always openly spoke about sex, and how important sex is in any relationship and how when things are wrong or going wrong, or things are hard. It’s always that connective tissue between the two people. So I grew up with a very open mind about this. And of course, transitioning into motherhood is difficult and, physically, it’s so difficult, and as you wrote in your work “magnificent and brutal”. But my husband proudly says, how much it has brought us closer and, physically, how much more we can enjoy each other and absorb each other’s energies. And that is thanks to this process. So there can be beautiful things that can come out of it.

MEGAN: Yeah, and it’s exploring your postnatal body together and all those things. And when I talked to clients about this, and I say, talk to a partner about a different sex life now, you know, it’s probably not going to be what it was before. You’ve been present differently. You could bring in the vibrator and show him which bits feel nice, which don’t feel nice. Think about your position. What is your position? Because it’s your body. And it can just be a different sex life or maybe better than it was before.

MARTINA: Can you tell us what is (because I know that so many women actually have no idea) what is the pelvic floor?

MEGAN: If we put it simply, it’s the floor of our pelvis. Your pelvis is a bony ring, all of our movements pass through here. As we twist our body, lift a leg, raise our arms, all movement passes through the pelvis, which makes the pelvic floor super important. If we think of the pelvic floor, it’s often described as a hammock. You imagine that hammock running between two trees right? The bony pelvis are the trees, and if the bony pelvis is moving too much, those trees are swaying in the breeze, they are crooked, if they aren’t strong or supportive then the hammock is going to swing. And so it starts the pelvic floor as a unit as its strong, strong unit starts up the bony pelvis. It’s how we hold ourselves to our pelvis. If there’s any pain through there, all those things come into account. And then the pelvic floor is a hammock that’s slung between them, so that’s the fabric of the hammock, and we want a good strong hammock that’s all the fibres knitted together no tears or frayed edges, you want layers of fabric, layers of muscle. And with that, we can support all of the organs, we can be this strong core strength that we really need. And that’s what’s going to tolerate all the movements that pass through here. So it has a front, it has a back, it has the sides left and right, and it has multiple layers. If we think about the pelvic floor in layers, there are squeezy parts, but they are the entrance muscles, and they’re called sphincters, they sit like circular muscles at the entrance to each of our passageways. If we need to wee or we might break wind, they’re the ones that we squeeze automatically. But if we’re just doing that, we’re using 1/3 of our muscle, there’s a whole load more muscle within the pelvis that we’re not accessing if we just squeeze. So deeper to those further inside, there’s a long muscle which runs from your tailbone to the pubic bone. And when that muscle contracts, it kinks the pipes like a hose pipe. So the pipes run down and it kinks them so no wind can come down, no urine can come down and create stiffnesses of the vaginal wall. When we do a powerful contraction, we come into that second stage, we get a squeeze, kink, we want to feel something going on a bit further in. 

MARTINA: Yeah, so all the way? 

MEGAN: Yeah, absolutely. But then there’s another muscle. So this other muscle, it’s called levatae anal, so literally Latin for elevate your anus. So it’s the lift part of it. Let’s say you have a pinch, a kink, and then a sheath-like lift in the base of your spine, and it makes you lift up. I mean, that’s why it makes up our core strength, because it holds us there. You’re going to struggle to create a lift from here, you need to kind of put your pelvis in a good position to find all three components. 

MARTINA: It is so hard because it’s not something that teachers tell you at school while you’re doing this. Yeah, it’s not something we studied in biology, yet it is so important, it’s really the base of stability of the woman’s body. 

MEGAN: It’s your core strength and then when we think about that, and how impactful that is, then why we’re just dedicating this time when we’re feeding our baby a couple of times a day or when we’re sat at traffic lights, or when we’re preparing food is that enough to restore your core strength, you know, these squeezes that we’re told to do whilst you’re doing something else and maintaining a conversation? If I’ve had a birth injury and a cut and trauma to the extent I’ve had on top of pelvic pain in my pregnancy, is that going to be enough to restore that strength in my pelvic floor? The answer is, it’s probably not. But then you know, as a new mom or any mom, or any person, really most of us tend to live time-poor. So we don’t have all that time every day to kind of roll out a mat and focus on ourselves three times a day. So when I talk about pelvic floor exercises, it’s once a day for me when you’re building strength, you take it to the gym that day, it’s in a theoretical gym – it is just your lounge or your bedroom or whatever. And you work that muscle to fatigue at that point. You see what it can do and you time it out. You don’t squeeze it ad hoc through the day, you give it time commitment but then just do it once. 

MARTINA: What is the time period?

MEGAN: It really is how long is a piece of string. So for a new mum, for example, you’re going to struggle to work on endurance holes because there’s gonna be inflammation and swelling and that connection with the muscle might not be there. So you work on just sending that connection down to those three muscle layers and then you release them. You work on the back passage in that way, the vagina and the front passage, the urethra where the wee comes from, and then you go again. You work on them, okay, I can feel it. And as soon as you start to not feel it so well, not manage to get to the top level, struggle to isolate, struggle to breathe, then you’re probably getting tired, that’s when you stop. Whether you are just starting or a year down the line. We hear the gold standard is 10 seconds. 10 times 10 fast ones. Well, I’m sure what we both do in a day is completely different. Why do we need the same pelvic floor exercises? They should be tailored to us rather than follow this, so it’s good to have a goal and a kind of outline, but it’s it we need to tailor it to ourselves really.

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