NATURAL FEMALE POSTURE – A RADICAL PARADIGM SHIFT

Submitted by Christine on May 31, 2008 - 11:41am

Pelvic organ prolapse is a condition where the pelvic organs – bladder, uterus, and rectum – press against the vaginal walls and in some cases cause the vagina to bulge outside the body. Often resulting in lower back pain and pelvic pressure, prolapse can also cause significant emotional distress. Prolapse is considered by obstetrics and gynecology to be a progressive disorder and has been treated with radical pelvic reconstructive surgery for over a hundred years. Yet, these benign conditions are not cured by surgery but merely traded for more serious problems such as bowel and bladder dysfunction, chronic pain, and sexual disability.

Traditionally considered an “old ladies” disease, prolapse is occurring at an alarming rate in younger women, particularly postpartum populations. To realize why we must first understand the pelvic organ support system.

When a newborn baby girl comes into the world her spine is completely straight, just like an amphibian spine. However, when she begins to stand, walk and run powerful bursts of energy are sent through her torso in a very specific way. With each in-breath her abdominal and pelvic organs are moved down and forward by the strong respiratory diaphragm underneath her lungs.

Over the course of seventeen or eighteen years her bladder and uterus become pinned into position directly behind her lower abdominal wall and are kept there by the prominent curvature in her lumbar spine. With each inspiration the lumbar vertebrae are drawn forward by their connections to the respiratory diaphragm. You can feel this yourself by lying flat on a firm surface and placing your hand underneath your lower back. Take deep breaths and feel your lumbar spine pull forward with each inspiration.

The mark of a young woman is her shapely figure, particularly the prominent curvature at her lower back. There is no reason women should ever lose this natural shape, yet most of us do by age thirty or so because virtually nothing in our culture is supportive of natural female posture – from our clothing, to the furniture and cars we sit in, to the ways in which we give birth. Even the information we receive from our exercise instructors and physical therapists is based on inaccurate anatomy that has been misrepresented by medical science for nearly 500 years.

Most of us understand the human pelvis to be positioned like a bowl inside the standing body, when in fact it is oriented just like those of four-legged animals. The five fused vertebrae forming the sacrum at the base of our spine are completely horizontal and together with the hip bones cause the pelvis to be positioned like a bowl tipped on its edge.

This almost 90-degree correction has profound implications for women because it means there is no “pelvic floor”, but rather a wall of muscle at our backside just like in cats and dogs and horses. Our true pelvic floor consists of wide, flat pubic bones that come together like the straps of a saddle underneath us. Over this bony floor our pelvic organs are suspended from the horizontal sacrum and held into position by the forces of intraabdominal pressure. It is a profound truth that we are horizontal creatures from the hips down and vertical from the waist up, a structural framework made possible by a very pronounced lumbar curvature.

Every time a yoga, Pilates, or ballet teacher tells you to pull your belly in and tuck your tailbone under you are working against an essential shape that nature is trying to maintain with every breath. Every time a physical therapist tells you to perform Kegel exercises while pulling navel to spine you are actually destabilizing your pelvic organ support system rather than improving prolapse or incontinence. Core strength is great, but it is time we understand that women have a completely different core than men – a difference not appreciated by any of our conventional systems of exercise or physical therapy.

During the last weeks of pregnancy the fetal head moves into the pelvic interior, which the sacrum accommodates by rocking up and tucking the tailbone under. The spine stays in this position until the birth process when the opposite occurs: the sacrum moves down and the tailbone lifts up as the baby passes through. Rarely does a woman stand up after giving birth to discover prolapse, rather symptoms usually develop a few weeks after delivery. The most likely explanation for this phenomenon is that the hormonally relaxed postpartum pelvis has not been adequately returned to its innate position of stability due to excessive time spent in soft beds and upholstered furniture. The breath, gravity, and natural shape of the spine cannot work to create pelvic organ support when slouching back into soft furniture, therefore the risk of developing prolapse increases.

Postpartum prolapse is easily prevented and best treated by alternating rest with gentle return to natural sitting and standing postures accompanied by abdominal breathing.

Comments

alemama

May 31, 2008 - 6:30pm

I know it. I just think there is more to it than that.
Christine what do you think about women who have baby after baby year after year?
or the contribution of rips and cuts or excessive pushing. Or even the effect of poor nutrition on healing.
I think in a situation where a woman has a gentle birth with no interventions and little to no tearing plus has great nutrition, good bathroom habits, doesn't go on to have another baby one year later- then simply returning to natural sitting and standing postures and breathing would be enough.
I have heard you say before that women do not prolapse right after birth but later and I have often wondered if many women have prolapse but do not know about it until their 6 week postpartum check up. I know for me I experienced symptoms of prolapse very soon after the birth that I just dismissed as related to the generous tear I had. I had no clue what a prolapse was and actually the midwife I saw didn't even know the name of it. It was only by grace that I found your site and began my path to healing.

Christine

June 1, 2008 - 12:33am

You’re not remotely a pain, Alemama. It is only through serious discussion and debate that we come to truth.

All the factors you bring up are certainly important and no doubt contribute to prolapse rates. I also think the opposite is amazing…the woman who gives birth on her back, has big episiotomies, resumes her role as caretaker shortly thereafter and yet does not develop prolapse! Actually – that was me…with my first I was outside playing Frisbee with my husband a week later. The female pelvic design is remarkably strong and stable.

But what about all these mommies – let’s just take our population – who come here two, six, and eight weeks postpartum? Rarely do we hear from someone right after giving birth, which makes sense because the bladder and rectum have been held way to the front and back, respectively, by the big baby-plug in the middle. The fascia has remodeled into this shape and is holding steady, but the natural planes of the pelvic interior must be returned to keep things naturally positioned indefinitely. Many, many of us at this point understand at a visceral level that only one thing can accomplish this – nutation of the bony pelvis. Nutation cannot occur with a flexed spine.

It was the time frame that provided my greatest insight into the process of postpartum prolapse. None of the other factors you mention could fully account for this temporal lapse before symptoms develop – not excessive pushing, nerve damage from tearing, or inadequate connective tissue. If these factors were primary, more immediate symptoms would be expected more often.

There is no doubt that many women are set up for prolapse by the circumstances of their birth and general health.

But there is also no doubt that postpartum prolapse is by-and-large a beyond-birth process. Really, it is the very same process through which all prolapsed women become symptomatic – the only difference is the time frame of the collapse of the support system.

Christine

P.S. This blog was actually an article I wrote (with illustrations) at the request of a well-known, progressive birth magazine. Not only was it rejected, but they absolutely refused to allow me to re-write it or give me credible reason for their decision. Sometimes it's very hard to be the lone voice, but I will keep at it for as long as it takes.

Mae

June 1, 2008 - 7:36am

Hi Christine,

I know that a number of factors can contribute to POP, but I was wondering how much of a factor you think having large babies plays in prolapse. I gave birth to two very large babies, almost 10 and almost 9 pounds respectively, and I was not a large person. It was not popular to have large babies at the time (the early 70's), but my doctor was "old school" and I trusted him. However, I am now the only one I know (other than my new friends at WW, of course) who has POP! I really wonder about the connection.

My POP didn't become obvious until I was 58, post menopausal and it follwed a D&C for heavy bleeding. I suspect that I had mild prolapse for some time though, although no one ever told me...so much for check ups every year, because I had been unable to wear a tampon for many years. I wish I could remember when that started, but I am not sure. I mentioned it to the doctor, but he just dismissed it and I, foolishly, didn't push the issue.

Just wondering about your thoughts on this.

Warmest regards,

Mae

louiseds

June 1, 2008 - 1:30am

Christine, I did gymnastics as an eight year old and ballet as a nine year old. I remember adult people commenting on my curved back (ie lumbar curve and tall posture) at a gym class. Not sure if they were worried or admiring it. The ballet was supposed to something that would help me with my gym in some way, not sure how. I suspect this was the beginning of posture engineering on my body. I remember learning to hold my tummy in as some point, probably at about twelve, when my hips would have started changing shape. I have always had a round belly, and was very self-conscious about it right through high school, as I was a swimmer and a gymnast, and this was pre-lycra. I remember thinking I was fat at age 11, after being very slim as a younger child. I remember being annoyed at age 14 that my bermuda shorts were now too small for my thighs, and I could never hold my little round belly in far enough to give it a flat appearance.

I have always, to my knowledge had a retroverted uterus. I am wondering now if my butt tucking and tummy tucking, learnt before I had finished growing, and while my body was changing from a girl to a woman, had the effect of flipping my uterus back because there was not room for it up front. If this did happen, surely its fascial supports would have changed their form to accommodate it, ie they would end up a different shape and orientation by the time I finished growing. This may explain why my uterus has always returned to retroverted position after each of my three pregnancies. The parts of the endopelvic fascia surrounding my vagina and bladder may have also ended up in an altered orientation, holding them over my pelvic floor before I had finished growing, and setting me up for prolapse once I had an episiotomy.

I am wondering if some of the weird pelvic pains that women experience when starting WW posture may be the fascia being stretched in places, and remodelled back to how they should have been in the first place? After all, the same pair of straight tubular pantihose worn by two different women will end up a completely different shape from each other once they are removed at the end of the day.

I wonder if fascia perhaps does not repair itself, but can re-mould itself around after a period of months or years, back to its original shape if the organs are put back and kept in the positions they are meant to be in (even if the tears remain)? I first started thinking about this possibility when I researched tightlacing and corseting, and discovered the radical remoulding of the organs (and presumably their fascia) that happens in response to training into tightlacing, which is very gradual, and not supposed to be painful. This is done by adult women. It does not have to be done while the woman's body is still growing.

This may explain why I am still experiencing improvement in symptoms after nearly three years. (I just realised I was lying before, when I said four years!) My fascia may be still remodelling themselves back to WW shape.

What do you think?

alemama

June 1, 2008 - 7:40am

It still doesn't feel right to me. but I am thinking about it. I will reread and think some more.
Hey and next time you get a request to write an article......use me. I think most birth mags etc. like the personal touch. I know they probably axed it out of fear- but maybe next time if you have a face (or two) they may decide to include it.

Really this is one of the best kept secrets of pregnancy and childbirth-what a crazy thing it would be to open it up and expose it in a contemporary popular culture magazine. Controversial.

Christine

June 1, 2008 - 10:12am

Thank you, Louise, for stating (beautifully) what I believe to be the obvious. I believe I, too, am still remodeling.

Mae…how in the world could your average-big baby (a big baby is 12 lbs) have been the primary cause of a prolapse developed almost 40 years later?! We are ALL designed (barring structural deformity) for birthing large babies – the greatest midwives in the world have stated time and again that the pelvis and vagina open as much as needed to accommodate a big baby. I believe absolutely that the above theory applies to big baby deliveries as well. Big babies are not a primary risk factor. And really try to picture it – think of an eight pounder heading down the birth canal pushing everything outward on its way. Now think of a ten pounder and try to think what might be so radically different that it would be a significant factor in the development of prolapse. The big baby is actually pushing your bladder and rectum even further out of the way and your spongy pelvis and accordion vagina open as necessary to accommodate this. The whole vault came down slowly over time because the forces of breath, gravity, and the shape of your spine were not in alignment.

Alemama…we’re not going to let you off the hook so easily. Try to get in touch with what is not making sense and let’s talk about it. You have always had a hard time with this theory because as an exercise physiologist you believe you were already in the right shape (I think that’s what you’ve suggested in the past) and so somehow it doesn’t apply to you. But it is my guess that in order to earn that degree you have had to conform to the male physical body, male exercise, and male theories of anatomy and physiology. I bet you’ve always had a darling figure, but am I correct in also assuming that it was more on the athletic, boyish side before babies?

Thanks so much to all of you for your replies!

Christine

granolamom

June 1, 2008 - 12:21pm

that's the question that I'm stuck with. a baby, 8 lb, 10 lb whatever, coming through like a train or getting stuck and taking lots of time, can do all sorts of things to the vaginal walls. at least that's what I read in the STWW book. and it makes sense to me. so after a baby, are the vaginal walls 'supposed' to go back to the way they were? or is some of the 'looseness' normal?
I know that the tone of the vaginal wall does not prevent/contribute to a prolapse, just wondering.
but either way, really, if you're standing with your pelvic organs over bone, keeping them that way with the forces generated by breathing, nothings gonna fall out. even if you've got the mother-of-episiotomies. at least in theory.

then again, normal is irrelevant, because we are all as different as we are the same. a neuromuscular disease, or a surgical history or anything along those lines will mean that your body doesn't necessarily behave the way it 'ought' to.
I agree that fascia most likely changes due to use, but what about those of us with connective tissue disorders? could be the fascia doesn't respond the way it theoretically should. maybe that's one reason that some of us can birth babies year after year without prolapse, or reverse a prolapse within a few months, and some of us will never really be able to achieve a reversal.

and maybe the 'risk factor' question (be it large babies, episiotomy, chronic constipation, etc) is only important when superimposed upon a system that's already unstable.

and one more thought...Christine, don't take the rejection of the article personally. I agree with alemama, alot of mag's like the first person type stories. you know, 'this terrible thing happened to me, I triumphed, and in the process became a better person and it can happen to you too' type of thing.
don't get me wrong, I think you're article is WONDERFUL and so important, but mag's have to sell to their audiences.

babygotback

June 1, 2008 - 11:05pm

thank you for clarifying, christine, that a big baby is more like 10+ range. I have a hard time with that notion since I have a lot of faith in the human woman body for natural birth. It is misinformation perpetuated that gives women fear regarding the ability of their bodies to birth normally the size of baby their body makes. The idea of the lovely female body unable to open properly is unfortunate, though vacuum extraction, mandated pushing technique, upper adominal manual pressure and other obstetrics methods leave me suspicious. Perhaps those are some of the reasons behind the fears and critisisms of the female ability to birth without damage. Have you ever taken a mirror and seen yourself pass a BM? If you have healthy bulk in your diet, your BM can be wide, your skin around the anus stretches easily. We just don't notice it because no one is there measuring the centimeter capcity of our anus or telling us the right moment to push! There is no need for us to imagine after a large BM that our anatomy will necessarily be negatively altered.

I like what Christine had to say about how things change over time with the various factors of spinal alignment, posture, etc. I gotta wonder about the women whose diets are not providing nutrients the body uses to repair, about women who jump into pregnancy before the previous birth is far enough distant for a full recovery (some midwives have said 2 years is a good amount of time for the body to be in prepregnancy health. Hopefully the woman is nursing, giving her the advantage of increased calcium absorbtion, etc.)

Interestingly, the women in my country walk around with large burdens on their heads, they work hard, they also spend hours a day sitting and visiting neighbors. I have yet to see a woman with her backend tucked in!!! I have been so impressed with this. It even would seem that they deliberately poke it out more when they have a large basket of something some vegetable or a big bucket of water on their head as they hike up a hill to their house. It makes me wonder at the idea of of not lifting weight excessively and wonder if we just need to put stuff on our heads more often! Ha! These ladies have great posture. (Though I have not yet asked about anyones underside-hee hee. I'll post an update when I get the courage to take a poll!)

I have to say that women DO complain of early postpartum discomfort down there, heavy vagina feeling, tugging downward, feelings of escaping weight, etc. I bet there is some amount of prolapse for women initially that we write off as just 'recovering from birth'. The ladies who take it easy or lay much of the time in the early days probably experience less of this heavy feeling. It is likely normal to have a time where the vagina is still soft and feels saggy a bit from the incredibly hormones. I said once before that it takes 6 weeks to obtain the balance of hormones to get the breastmilk balance acheived. After a miscarriage, some women find that a pregnancy test shows positive still. A granny midwife friend has the experience that she sees women show this result up to six weeks postpartum/postmiscarriage. It is difficult to say how much a role hormones and other changes will have on a woman postpartum. I know birth is normal and a woman can be healthy after without damage from the birth, but I will say that just as some suggest a woman's body over time will change and some prolapse can be considered normal, that a woman after birth might as well expect a time of soft and heavy tissue, as we similarly expect the breasts to become full for the first 6-12 months. What is sad is that this expectation is not shared by medical folks, who, instead, either don't acknowledge it or want to intervene with surgery. I'd suggest a good rule is to have women know that they would wisely consider 1-2 years postpartum as a time of regaining prepregnancy vitality, that in that time, they would wisely not lift too much, do jarring exersize, focus on posture and healing foods, etc. What do I know...these are just some thoughts, as a mother of 4 and dwelling in childbirth teaching and assisting for 8 years now. I believe in the strength of woman's body and that variation can be a matter of time and not necessarily be unhealthy.

"This may explain why I am still experiencing improvement in symptoms after nearly three years. (I just realised I was lying before, when I said four years!) My fascia may be still remodelling themselves back to WW shape."

Louise, thank you for sharing this! What a hope and insight!

The connective tissue disorder idea is an interesting one. I wonder, too, about some of these factors. The pop that some experience at birth is pretty intriguing. I want to do some research on that. I am familiar with the water breaking pop, but it is sad to think of internal protective wall tissue tearing in this way. :( I believe in the ideal with women and birth (obviously ;)), but I do know that variations occur. Anyone used comfrey internally or other herbal poulices to help knit tissues together. I know some natural healer folks who use comfrey and either tobacco or tea leaves to "knit" together breaks in muscles. Anyone have personal experience?

Oh, man, I have to break the train of thought to say that my baby just came off the breast from nursing, blew 3-4 kisses at my breast and got back on. Is that not sweet?

I guess I want to ask some questions/share some thoughts about the article. By the way, COOL on YOU for sending off that for publication. Too bad they didn't even help you know why or how to adjust it, if possible, to fit their interest, of course without altering valid info. Have you tried The Compleat Mother? They'd print it, I am sure! If even only your first paragraph were put in print to a wide audience, that would be so great!!

Without references on the third and part of fourth paragraphs, it is hard to just take this information. Not to be critical, but it would help if info were shared as to how you come up with the ideas presented here and in other parts where authoritative information is shared.

I can't see, even though I read your book, that the sacrum is really "completely horizontal". Maybe I am not picturing this right, I'd guess a good natural posture has the sacrum at like a 45-60 degree angle. When my three year-old is desperate to use the bathroom, I see a good 40 degree angle, hehe, but I just can't imagine that language in real life. I like the image of the pelvis having a wall of supportive musclature, rather than the pelvic floor--this gives me a visualization for keeping my posture. Imagining the pubic bone underneath me as the lowest point helps, now I have this tipped bowl image to add to it. Thanks!

In comparing the anatomy of women to men has me thinking, can't they also get prolapse. Sure, their bowels are not going to fall out of an opening they don't have, and they obviously have fewer organs to consider, but continence and vitalitiy functions (aka healthy sexual function) depend on the structural integrity as well. It was funny one day in a childbirth class when we were talking about kegels. A woman piped up and announced on behalf of her red-faced husband that he was practicing kegels with her after reading about how they helped men as well, and by golly, he sure can keep an erection now since starting the kegels! (Alrighty then, moving right along...haha) I guess I just wonder when so many comparisons are made to female and male pelvic strength. I have no idea what elements of WW would help a man, but I am sure there are some elements that overlap--though I am not sure how attractive (or necessary) the WW posture would be on a man- uh...no.

"During the last weeks of pregnancy the fetal head moves into the pelvic interior, which the sacrum accommodates by rocking up and tucking the tailbone under. The spine stays in this position until the birth process when the opposite occurs: the sacrum moves down and the tailbone lifts up as the baby passes through. " I just don't think this is true. (not confrontational, but in a spirit of understanding) A woman's spine exaggerates the bow forward toward the end of pregnancy, and is encouraged in my childbirth classes. Sometimes I describe the belly button being like a flashlight, that during pregnancy, you don't want that light to shine above the level of your belly button on a wall, but it needs to be pointing downward, which helps keep good pregnancy alignement (and the baby in better positioning.) Thoughts?

The final sentance would be cool to expand. It would be cool to see a bit more on the 5 or so elements of WW lifestyle: the diet summed up, the posture, the breath, etc. Heck, that paragraph would be handy posted on my wall somewhere I regularly pass by as a reminder.

Anyway, thanks for the article. I hope it gets published somewhere. The information and experience you share Christine (and all you WW!!!) is so important to disemminate. You know I'll be sharing along the way with my four daughters (and their poor friends who will flock over the years.)
Thanks for the pondering.

louiseds

June 3, 2008 - 2:28am

Hi Babygotback

A couple of points.

First, the bit about what the posture does during late pregnancy and birth. I hope Christine will pick this up. It is documented on pp70-71 of Saving the Whole Woman, 2nd edition. It is really about the last couple of weeks of pregnancy, not the main part, where WW posture will make the flashlight stay low. Christine's descriptions of what happens to the woman's body are really good, and Nikelle's illustrations are so clear and simple. I have not seen illustrations before that illustrate the subtlety and the significance of the minor changes in the woman's pregnant body at the very end.

The second point is about the angle of the sacrum. How do you measure the angle of a three dimensional, wedge shaped (from the side view) bone? The top surface looks probably close to 70 degrees from horizontal on the outside because the spinal processes of the lumbar vertebrae stick out and cover the top of the sacrum, making it look more vertical than it is. Looking at Nikelle's illustration on p70 the top surface of the sacrum looks like about 25 degrees from horizontal but the underside is indeed horizontal before it curves downwards at the coccyx end. Even a line drawn perpendicular to the top of the sacrum through its core would be only about 15 degrees. I guess there would also be the normal variation that you see in all humans, and some would be less, and some more. You are probably both correct in what you measure.

If you haven't already read it, I think this book would be essential reading for anybody involved in assisting women in labour and birth. As an expectant mother 26 years ago I read about the way the coccyx lifts when the mother is vertical and closes down when she is lying down or half-propped, during labour, and how the baby's head needs to turn through 90 degrees to negotiate the passage easily. It has only been since reading Christine's book that I have fully understood the rest of this process.

The way the two ilia rotate at different angles at the sacroiliac joint allows the pelvic diaphragm to increase in area in one plane and decrease in area in another plane to allow the baby's head to pass, and kind of spiral out, just like water spirals out of a bottle more easily than it comes out straight down.

As the coccyx moves up, the ischial spines also move apart, again because of the weird uneven rotation on the two sacroiliac joints.

And the way that the pelvic floor slackens when the coccyx is closer to the pubic bone, but is more open when the coccyx is further from the pubic bone.It is truly an awesome piece of machinery.

It is a pity most plastic, model pelvises used by childbirth educators do not enable these joint movements to be simulated, because they lack the stretchy ligaments that are the key to birth. If women knew how their pelvis moved during birth, and how this birth canal changed during the labour to enable the baby to come out, I am sure there would be more vaginal births. Ignorance is indeed a powerful tool in discouraging women from doing what their bodies were designed to do. And if the educators cannot show it, how can the women learn it???

Please tell me what you think about these thoughts, as I know you work in this field, and I do not. I think this is what Christine means. The discussion is always open.

Cheers

Louise

babygotback

June 3, 2008 - 8:08am

Well, I am ready to invite you over as a special speaker in my classes.:)

The light clicked on when you pointed out that the sacrum is not a flat row of fused vertebrae, but rather a three dimensional structure. I get it now!! Thanks. That brings clarity to the info I read in the article.

Where does the information come from about tail tucking under in the last weeks of pregnancy? (Besides that Christine said it--not to invalidate, but more than one reference is helpful.) I am very interested to understand more about it.

I do understand about how the bones and ligaments move to accomodate the passage of the baby. I also think it is fascinating. It goes to show how important being upright, aware, and active in birth is.

I have read the book, though it has been a while, and I agree that this stuff is great info and also would like to see more of it shared in birth classes and by resource professionals for pregnancy and birth.

Thanks for taking the time!

louiseds

June 3, 2008 - 9:26am

Hi Babygotback

It is not in the first edition. It is in the second edition. There is a reference list at the back with all the references for each chapter listed under each chapter heading.
I think the reference you may be looking for it is Vleeming A et al. Movement, Stability & Low Back Pain - The Essential Role of the Pelvis, F.A Davis Co. 1996. There are fifteen references for this chapter alone. Some of the others might be helpful too.

Cheers

Louise

alemama

June 1, 2008 - 12:50pm

for photos- you will soon see the Alemama montage. And to a degree you are correct in assuming that I was taught the male model of physiology. In fact I did not have one class pertaining to women- for that matter they did not offer one. However most weight lifting positions I used had the butt go out for major lifting. Even in high school we had to stick our butts way back look our eyes up to the ceiling and lift our chests. and in my college weight training classes they used this same form for heavy lifting. Dead lifts, Squats, clean and jerk, any over head press- they all used this form- Now I will say that I was taught the plank as an ab exercise but mostly the focus was on sit ups and crunches- In my anatomy classes I learned all the parts of the body but just that: the names- attachments and insertions but not the practical application- my education was significantly lacking in that department- pass the test- no one ever mentioned nutation ect. and I certainly never saw a model with a horizontal pelvis- which is a real shame. I am so glad for my new education- and the knowledge I have of the female body. I think as a woman in the field most of the male instructors just left me alone- I had a testing and prescription class that had a female instructor but it was more of the VO2 max stuff where you use machines to measure lung capacity, body fat, the response of the heart (EEG/EKG), blood pressure....stuff like that- and memorizing protocals for things like the rockport step test. So I don't know- I don't think I was really educated much one way or the other about the female body.

I am still thinking about this. I know for me and many women they have no freeking clue about their vaginas- what they look like, how they feel, etc. I can remember being asked after having my first baby if I had looked at my vagina and thinking no why would I do that? I just trusted everything was fine- as I had never looked before having a baby...I really regret that now. so with out knowing much about your own vagina combined with being totally obsessed with my new baby I can not imagine even thinking about the sensations of my vagina- it is hard to remember back to a time that I was not hyperfocused on the condition of my vagina- but as a new mom I just wasn't and if the midwife didn't tell me about it then I didn't know about it. And at one day or even two weeks postpartum I chalked all soreness up to the fact that I passed a big ol baby through my tiny vagina. I think most women don't really have a clue and that is why most report later rather than sooner-it takes a while to realize there is a problem and in most cases women get told about it. oh ya and most doctors don't even notice postpartum prolapse. I know I had my rectocele after baby #2 but never in all my postnatal visits or my prenatal visits for baby #3 did anyone ever say one word. They just don't see it. I don't think they are even looking for it.

and now my brilliant thoughts on big ol babies. FAT SQUISHES. Most big babies are about the same size in structure as their smaller peers- they are just fatter. Now I say most- there are few babies- I know of one- that are born big- huge shoulders with collar bones that break on the way out and giant way out of the norm heads- but most babies just squeeze right out even the 10 and 12 pounders. Also those bigger babies are often longer putting weight on in the legs from that extra inch or two of length and once you pass the shoulders the rest of the body just flows out- long legs and all. I felt the birth of my biggest baby was also the easiest. Gravity.

Christine

June 1, 2008 - 12:59pm

Thanks so much, granolamom…your points are very valid.

But here’s the deal…many of us agree that there is only one way back from prolapse (well, two with Alemama’s Naugli). If there is a way back, there must certainly have been a way forward – those two must be the same, right? Yes, vaginal wall stretching, big babies, and weak connective tissue may well exacerbate the situation but any or all might also never be noticed in a woman who re-naturalizes her pelvic organ support system after birth. My first baby was almost nine pounds and I had a large episiotomy – did my very active lifestyle postpartum prevent prolapse at that time? Another baby and episiotomy and throughout my twenties and thirties my vagina felt no different whatsoever. By age thirty, however, I was beginning to have problems with SUI.

As far as the article, I think whacking medicine, midwifery, yoga, Pilates, ballet, and physical therapy in one swoop was too much for even the most progressive of publications.
We will be heard – it’s only a matter of time.

Christine

Alemama - just read your response. Remind us again how bad your tear was. There is no doubt that serious tearing (God bless Mommynow!) can result in instant prolapse of the back, and soon after the front, vaginal walls. I think at some point we will have to conclude that there are many paths back (in time) but only one (two! :) forward.

Christine

June 1, 2008 - 2:26pm

Yeah, Alemama…squishy babies are the other side of the made-to-be-vaginally-born equation.

I am reminded of my horrendous battle with mice when we lived in the country. Twice we paid an outfit to come to our house and mouse-proof the entire thing – garage and all. Through that experience I learned that mice (1) have no bone – they are all cartilage and (2) can squeeze through any opening ½ inch or larger! They simply extrude themselves like taffy! Neonatal bones do this same sort of thing - plus, the fetal scalp folds in on itself like a vegetable steamer. C.

sarahlove

June 1, 2008 - 2:51pm

Hi ladies, I notice you're all big names here, so I hope it's OK for a little person to add on. :0)

What I was wanting to add is that I've always had "lazy posture" by which I mean not following the rules they teach you-tucked bum, shoulders back, chest lifted, tum pulled in. So, in all actuality, my organs have been held in the ww posture at least in the hip area. That said, I have been known to slouch which probably smushes everything further down than it should be. My feet also tend to duck outwards just a bit rather than pointing straight forward.

As to births, I had a 9 and a 9.8 babe. With the second i felt two very distinct pops as she pushed out, one when my water broke, and the other which I can only describe as similar to when you bite into a cooked sausage and break the tension of the tight skin and the juices come flowin out....mmm. So, I really feel that my proplapse had something to do with that second odd pop. It's just sort of an intuitive knowing...the feeling was of something pulled taut, sort of bursting, or busting, or releasing. Something other than the babe i mean. The suasage descrpition best describes the sensation.

The other factor that I feel, since reading here, did not help, was my main relaxation spot for pp healing, besides bed, was my soft glider rocker with ottoman. Usually with both kids (50lbs together) on my lap snuggling. Talk about creating an unhelpful c shape-then weighting it down for good measure.

I'm certainly not knowledgeable on this subject to argue any points, but this was my experience. I am a slouchaholic on soft furniture, to be sure. So I feel the c shape made things much worse, but that big baby and the 2nd weird pop keep me wondering.

louiseds

June 2, 2008 - 5:15am

Hi Sarahlove

You are more than welcome to join in these blog discussions. Just cos I have been around for years doesn't make me or anyone else a big person, nor you a little person. We are all women sorting out the same stuff. You have much to contribute as grist for the mill as we all discover more about how our bodies work.

I was thinking about your 'lazy posture', and tried to do it while looking in a mirror. Yes, you can do it without tucking your butt (tucking wouldn't be lazy enough!), but when I straightened my mid and upper back, and tucked my chin to give my breasts more prominence, my shoulders moved back relative to my breasts and my whole upper body moved forward relative to my pelvis. So did my hands. My breasts also ended up higher. This means that my whole centre of gravity must have shifted forwards. I also noticed that my tailbone lifted. I also noticed that I became significantly taller. As my breasts rose my rectus abdominus muscles would become more stretched and firmer. I think this is what Christine means when she talks about 'winding up the pelvis' into stability.

When you say that your feet 'duck out', this might be just the way you are put together, but it also happens when your pelvis is tilted backwards, which closes your pelvic diaphragm and your pelvic floor becomes more flaccid. I would think it would be quite difficult to walk in lazy posture with your feet facing forwards? Straighten up the upper back and feet effortlessly face further forwards. Can you take yourself back into 'lazy posture' then straighten up, and reproduce the changes I just wrote? What happens?

The tummy tucking and butt tucking I was talking about seems to be encouraged by posture and fitness police to keep the spine straight and tall, and lessen the lumbar curve. Every professional I see tells me that too much lumbar curve puts strain on the lower back. I don't think it is the lumbar curve per se that is the problem. I think it is the thoracic and cervical curves that makes the lumbar curve tighter. Flatten out the thoracic and cervical curves and it creates a large radius lumbar curve that goes further up the spine, and *less* lower back strain, because the vertebrae are more like a straight line. The upper and lower surface of each disc are more parallel.

How can this possibly cause lower back strain???

Christine, your comments on this?

Your pops are a mystery, except that it has been explained to me that pops and cracks anywhere in the body, eg cracking your knuckles, or cracking your knees when standing up, are signs that pressure is being redistributed within the area. They are actually air bubbles coming out of solution, caused by changes in pressure, just like taking the lid off a softdrink, or the bubbles that form on a propellor on a ship. It makes sense to me that redistribution of pressure is happening big time in the birth canal as the vagina goes from being long and thin to short and fat, and as the uterus contracts from the top. There will also be pressure redistributions when the baby's head turns, allowing it to move further down, and the pelvis nutates to allow the tail bone to lift, and the ischial spines to separate and birth the baby's head. Does this resonate with your experience?

BTW, there are also pressure redistributions when a woman goes into WW posture, and bones, muscles and organs shift around in response to gravity acting on them in a different direction, cos they have all rotated forwards. It may all be normal biomechanical reactions. It just sounds horrible.

Re your soft glider rocker holding your body in a c-shape, I would think that really doesn't cause a problem, as long as the intraabdominal forces from breathing and wriggling around can be resolved in a direction away from your vagina. When you rock back with your babies you would be almost lying down, wouldn't you? So gravity will be able to resolve sideways, back into your spine and forwards (upwards through your belly) as well as towards your vagina, so the vagina is only getting a fraction of it. What can you feel in your vagina and vulva in this position with a heap of little kids on top of you? The problem with a c-shape comes when the woman is vertical (particularly with tummy and butt tucked) and gravity can only resolve down the plughole, cos the abdomen is braced in all directions by abs and flanks of steel!

Christine, your comments on this?

Cheers

Louise

Christine

June 1, 2008 - 3:51pm

Hi Sarahlove – thanks so much for your thoughts and experience. As I said in a previous post, I’ve deeply contemplated that “pop.” There have been others as well – several while lifting. The endopelvic fascia thickens around the base of the bladder to become the pubourethral ligaments, which connect onto the back of the pubic bones. This area is both suspended by the urogenital portion of these ligaments and supported by the vagina’s connective tissue attachments to the pelvic wall (arcus tendineus).

The pubic bones are built to be quite mobile and to move in concert with the rest of the pelvis. Orthopedists say the fronts of the pubic bones compress together when the tailbone is lifted while the backs move apart. The opposite occurs when the tailbone is tucked under – the fronts of the pbs decompress while the backs compress.

If I had to take a wild guess I would say the connective supports to the pubic bones have a narrow range of stress/tension capacity beyond which when overly stressed in an open position may result in giving way of the ligament. I do not believe, however, that this tissue ever tears completely free, but rather is greatly stretched. Pelvic surgeons believe the problem is at the front/sides of the vagina where they attach to the pelvic side walls (paravaginal defect).

It would be nice to know for sure the most vulnerable areas during the birth process – but in the final analysis it probably doesn’t matter one iota to our recovery.

:) Christine

granolamom

June 1, 2008 - 4:44pm

I like that one, christine.

"It would be nice to know for sure the most vulnerable areas during the birth process – but in the final analysis it probably doesn’t matter one iota to our recovery"

could be that there are many roads leading to a prolapse, but the same road to recovery anyway.

sarahlove

June 3, 2008 - 2:46am

Thanks Louise, you're posture description really is helpful. My book hasn't arrived yet, so I'm appreciating all the details on posture I can gather.

The 2nd pop was the mystery, the first was my water breaking. When I really go back into the feeling of the 2nd pop, it's almost as though her head was against an elastic band that finally *popped* out of her way, then she came out. At the time, I said that I didn't think I had fully dilated...it's so hard to explain because it was a totally internal feeling, and fast also. Maybe that "elastic band" feeling was the muscular hammock that holds up the bladder, stretching to it's limit and popping back...? hence the prolapse? Who knows, as has been said, however it happened, it happened. Now it's about healing!

As to the glider, no I am not horizontal in that chair. I am sitting, back against the chair, feet up on the ottoman. The problem was that I was sitting in lazy posture. Making a C of my low back to lap, then placing kids on top of that, basically pushing all my organs back and down. Now I can sit in the chair in ww posture and it doesn't feel problematic.
Even with the kids.

I was just joking about being a little person. But you must admit, you big ladies do have a whole lot of answers!! And all of us little people are so thankful for that.... :o)) teehee!!

alemama

June 3, 2008 - 7:19am

During my second birth I had my water break twice. First was early on in labor- then the second was right before the baby came out- the first pop I felt deep and low the second pop was different but both had a gush associated with them.
Yesterday we put a rope up in the tree in the back yard for the kids to climb and swing on- and of course I had to see if I could climb it too-after all if a three year old can do it......well I started up the rope and at the second knot I had some serious pops my pelvis. I was gripping the rope with my feet and my knees were in a deep bend but going to the outsides- so my hips were externally rotated and as I pushed with my legs I had the exact same gristly feeling you describe- pops right where my ligaments from the femur meet the pubic bone.
So maybe it was the round ligaments that attach in the pelvis making the pop sound and feeling for you. Really it was exactly as you describe- just a gristly meaty pop.

Christine

June 3, 2008 - 2:56pm

Hi Babygotback…this point we are clarifying about the birthing pelvis is central to the concept of the type of postpartum recovery we are promoting here. There really are persistent “old wives’ tales” about the pregnant spine that need to be done away with so we as a species can move on toward offering women healthier births and beyond.

I have synthesized the theory from several sources as well as my own study of anatomy and observations of the pregnant and postpartum spine.

Nichols and Randall researched and wrote on the subject of maternal injury throughout the seventies and eighties. In their book, Vaginal Surgery (1989) they describe the “lightening” process:

“To understand and anticipate the vaginal injuries commonly associated with parturition, the attendants should recognize that normally, and certainly in the labor of the primapara, at full dilation of the cervix the presenting part does not at that time emerge from the cervix and, for the first time, begin to descend into and through the vagina. Rather, the fully engaged presenting part, almost completely covered by thinned, beginning to dilate cervix, has in all probability occupied the upper third to half of the vagina for two or more weeks. As a result, distention of the upper vagina with accommodation of the engaging vertex or breech has occurred very gradually, so gradually in fact that the patient may not be aware of the descent taking place until she notices a new awareness of heaviness, low backache, and at times rectal pressure, while at the same time breathing becomes somewhat easier, for ‘lightening’ has occurred.”

This process, coupled with scientific studies of the pregnant spine, allowed me to understand what was taking place.

This is from the work of Dutch researchers Snijders and Vleeming:

“Low back pain during pregnancy has often been ascribed to postural adaptation, resulting in pronounced lumbar lordosis (swayback). However, we and others have found that, in general, the curvature of the lumbar spine is less before than after childbirth…We studied a group of pregnant women and noticed flattening of the lumbar spine in normal erect standing...” Movement, Stability & Low Back Pain – the essential role of the pelvis 1999.

Heavily gravid women tell us that they cannot “do” the lower body posture – which I take to mean that they cannot further push their bellies out. This is because they are already well in the posture and trying to control their pelvis is just not possible. Therefore, it makes no sense from an anatomical viewpoint to focus on anything but the upper body posture and walking with feet pointing straight ahead.

And Louise, the reason for all the concern around back strain and hyperextension of the lumbar spine is just plain misunderstanding. Few places on the planet comprehend that we have an essentially horizontal spine with a highly stable platform from which to move that is dependent upon a fully developed lumbar curve. xC.

granolamom

June 3, 2008 - 8:47pm

can only speak from my own experience, but once I was in my 9 mo I felt unable to get into WW posture. yes, I had a very exaggerated lumbar curve, but it didn't feel right. paying closer attention, I noticed that the curve was higher up. meaning the angle at the low thoracic spine had increased, as did the upper lumbar vertebrae. but L5-S1 was almost FLAT. I wasn't trying to push my belly out, but to lift my sacrum. and it just wouldn't go.
I wondered if it was maybe due to ligament laxity? my whole pelvis feels like its spreading apart that late in pg. hard to explain.

mommynow

June 3, 2008 - 7:44pm

Okay I have always wondered this and now after reading your post I have to ask.
I had absolutely no symptoms of prolapse during my pregnancy. The minute I stood up from the birth I felt like my insides were going to fall out. I had tremendous pressure. So why is that? That is why I always thought it was the birth that caused my prolapse. It didn't take weeks to notice. I noticed right after. It took me time to find this site and that is why I wasn't here right after otherwise I would have. I told the nurses there and they just dismissed it as "oh you probably have a lot of swelling etc." nice try. People really have no clue, even if it is becoming more and more prominent.

Also I always check out other peoples' postures and I just don't understand why some people have the same posture as I did with the tailbone tucked under and slouched shoulders and do not end up with prolapse with or without birth. I have some friends from yoga class and by looking at their postures you would definitely think they would have prolapse but they don't. They have had babies as well and some hard births and they do not have prolapse. My sister grew up the same as me. Did the same things, same posture problems etc. and didn't get prolapse. What is going on? What you teach Christine totally makes sense so why all the exceptions?

granolamom

June 3, 2008 - 8:39pm

mommynow, I have all those questions too. I've been thinking of it like a table. one leg gives out and it will still stand, two legs, well it depends which two, but you might still be ok. break a third and its all over.
so maybe if you've got super strong fascia you can get by with hard births and poor posture, but maybe if you add chronic constipation to the mix you wind up with a prolapse.
my sister's got the same posture I always had but worse, she's had 8 kids in 11 years, some of them flat on her back, some with episiotomies. one was a particularly hard and 'medical' birth. and no prolapse.
but she's not low tone like me, she doesn't have my connective tissue issues, and we're very different personality-wise (I believe somehow this comes in to play too).

and then remember that most women wouldn't recognize a mild prolapse if they had one. I didn't. I remember noticing that I had a small bulge years ago, asked my mw and all she said was, hmm, just a weakness there. do more kegels. and I ignored it. never connected it to the feelings of pressure or frequent urination or any other symptoms. and then there's also those in denial and those who just plain won't tell you they have a prolapse too.

so no answers from me, just rambling thoughts...

alemama

June 3, 2008 - 8:52pm

as granolamom- I would never have known. Most of us are so far out of touch we have no clue what is going on with the parts of our bodies we can't see-
I think most women feel it is normal to pee a little when they sneeze or to have some pain with sex or to have to pee frequently or to feel some pressure at the end of the day. and truthfully most women don't even recognize symptoms- too busy to wonder about silly symptoms- you know what I mean?

Christine

June 3, 2008 - 9:49pm

Well, Mommynow…from the way you’ve described it in the past, your ob basically performed a posterior colporrhaphy while repairing your episiotomy/tear. I have no way of knowing how severe it really was, but when the back vaginal wall and front rectal wall are surgically fused they must function as one unit, no longer able to slide past one another to perform their various functions due to obliteration of that most specialized tissue - fascia. You felt the immediate and severe heaviness that virtually all women report after posterior repair and those symptoms have stayed with you.

I can’t account for the differences between women better than granolamom just has. Who knows?

All I am saying is that at the most fundamental level of our bones we are more alike than different. My hips may be wider than yours and my lumbar spine more extended, but our joints are all in the same place as are our organs and connective tissue.

There are basic laws of pregnancy that are common to all human females. Granolamom’s description of her spine in the last weeks of pregnancy is how All healthy spines work – her sacrum was frozen into counternutation (tailbone tucked under) because there was a large fetal head (granolababy has a big, beautifully shaped head btw) keeping it pushed out of the pelvic interior. As the head and shoulders are born into the hollow of the sacrum – which is much more roomy – the tailbone lifts up as the baby slides past.

This movement happens in every single vaginal birth and is the primary reason why birth positions should be such that full pelvic movement can take place.

:-) Christine

granolamom

June 4, 2008 - 9:49am

christine, your description of the fetal head keeping the sacrum in that position makes so much sense. I knew *something* wasn't allowing movement there.

discouraged

March 5, 2009 - 12:05pm

Christine,
I am so thankful for your new publications. The posture is explained so well using the model, and although I had your other book and have been on and off the site regularly, I finally "get it." I also like to make some of my own clothes and love the kind of top that falls loosely in front, a very feminine look with the posture. Now, if I can just retrain 64 years of bad posture that everyone told me was good!
Keep up the good work. My daughter is a PT and I am sharing the information with her. Also, I think PT clinics should ask their clients if they have ever been diagnosed with a prolapse as it should certainly affect the kind of exercises they do with women for other things like knee replacements, broken legs, etc.

meribelle

July 8, 2009 - 5:57am

All my life as a child my parents told me to stand up straight, hold my stomach in. My butt was always tucked in. I am still not totally sure of the "posture" but I know what I was doing was wrong. I am 61 and still have a lot of good years. I am beyond grateful for this site and the information provided. I just wish I had more time to do the exercises. Thanks, m.

Tasha PT

July 8, 2009 - 9:31am

Tasha Mulligan, MPT, ATC, CSCS

Although I whole heartedly agree with you that posture is a huge component of controlling/resolving pelvic organ prolapse, it is just a piece of the puzzle. I am a 35 year old mother of 3, under the age of 6, with a cystocele prolapse (grade III) that has been resolved through appropriate Kegel exercise, postural awareness, and strengthening my entire abdominal basket. I strongly believe that all three components must be addressed for complete resolution of POP. The reason for this is that although your pubic bone provides good bony support for your abdominal organs, it does not and can not completely act alone, and soft tissue, or the musculotendinous portion of our pelvic floor muscles provide the rest. It is important to recognize that performing a correct kegel exercise is a 2 step process that goes well beyone squeezing your sphincter muscles. And working all the muscles of our abdominal basket is very important as we are all aware that there is not one function of our body that is performed by only one muscle. There are always stabilizing muscles and assisting muscles for every step we take, every reach, and every twist. This is also true for our pelvic floor. I address thisa nd the other components of pelvic floor rehabilitation at www.hab-it.com. My blog discusses many other topics associated with prolapse and incontinence issues. I am excited about your site as well as other good sites that are helping to bring more information to women. Knowledge is power for women and will allow them to take control of their own bodies.

Tasha Mulligan MPT, ATC, CSCS

louiseds

July 9, 2009 - 9:16am

Hi Tasha

Welcome to Wholewoman. It is very easy to assume that our own model is correct and that the other person's is wrong. I know where I sit, after about 45 years of doing it your way. I thought I was doing OK, until POP came along. My formal diagnosis, about five years ago, was sixteen years after the birth of our third baby. The only way I could get some progress with lessening my symptoms was by taking Christine's model of pelvic anatomy on board as well. I have been doing Wholewoman techniques for about five years now and am going great. I no longer do Kegels for exercise purposes, but menopause is causing some other changes, so I may take them up again. You would have to admit though, that there is no research *at all* that proves that Kegels can cure prolapse, whether or not you include the abs. Please cite the research if you can. We would all be interested to read it.

I would not say you are absolutely wrong, because I think Kegels do have some benefit for maintaining and increasing bladder continence, and certainly benefit sexual function and enjoyment. I do agree with Christine that you are barking up the wrong tree by saying that the pelvic floor is at the bottom of the fruit basket. An examination of the positions of your own pelvic bones, when in what you call good posture, will show you that the pelvic floor is indeed diagonal, with the base of the pubic bone considerably lower than the bottom of the coccyx, and moreso if you allow the lower abdomen to relax, with the resultant forward tilt of the pelvis and sacrum, and raising of the coccyx. The pelvic structure is indeed an amazingly complex piece of engineering. Please try to understand what Christine's different approach to pelvic anatomy teaches all of us. You might learn something.

BTW, we do try not to promote commercial interests on these Forums, whether they are our own or other people's. Instead, we would prefer that you invite Members to email you privately instead of advertising upfront. I wouldn't advise women not to contact you. We are all free here to make up our own minds and use our God-given grey matter to understand better how our own bodies work. I hope you can keep your mind open to learning new ways of looking at the female body too.

Louise

sarah1354

January 10, 2010 - 7:48pm

Hi Tasha,

So could you explain a proper Kegel? How you do yours etc. I have a cyscocle leve 2.I am taking care of my posture and doing kegels during driving to work. I am going on vacation next month and will be active hiking, scuba, and riding a horse. I'm a little worried about the horse back riding. Right now my cystocle is good. Will see my Doctor in 5 months to see how things are.

Thanks,
Sarah

louiseds

January 10, 2010 - 11:10pm

Hi Sarah

As you can see, we have not heard from Tasha for a long time. She only made a few posts. You might have more luck asking her your questions by visiting her website. She does have her own Forum.

Cheers

Louise

Christine

July 8, 2009 - 11:59am

Please refer to the following thread for my response to Tasha Mulligan, PT.

http://www.wholewoman.com/drupal/node/2701