Sarah’s Story

Before having my first child

I have always been active and fit. I love to run, ski, swim, hike, play tennis and attend fitness classes. When I was pregnant, I wanted to maintain an active lifestyle but was aware that I needed to make some modifications. I joined a prenatal fitness group and exercised with other moms-to-be 2-3 times per week. I also continued to run 1-2 times per week.

About 4 months into my pregnancy, I experienced some leakage while running. I persisted for a few weeks by not drinking anything before a run but continued to leak. How bothersome! I couldn’t enjoy my run because I was thinking about how to tense up my pelvic floor while running, which of course is near-impossible.  

Birth experience

I opted to be followed by a midwife for my first pregnancy. I was healthy and had no complications, so the weeks leading up to my delivery were a combo of calm and excitement. I was really looking forward to meeting my baby.

The evening I went into labour I called my doula, Jacquie. She suggested I get into bed and sleep as much as possible so that I was rested for what was to come. I laboured at home for 10 hours, and was joined by Jacquie around 2:00am, when I couldn’t cope on my own anymore. She followed me around the house as I leaned on towel racks and between doorways, bracing myself as the contractions intensified.

At 7:00am we left for BC Women’s Hospital. I remember sitting in the back seat of our car, looking out the window in between contractions, seeing the rain bolt down. A typical Vancouver in October!

By the time I was at the hospital I was looking forward to having an epidural. The pain was getting almost unbearable for me, and I was not opposed to accepting some pain management for the level of discomfort I was in. That said, I was encouraged to get in a bath and hold out a bit longer. Not finding any relief in the water, I tried the nitrous oxide (laughing gas). I must have been experiencing too much pain to adequately inhale the agent; I experienced no benefit.

Finally, a resident arrived to give me an epidural. I was asked to sit on the edge of the bed, as still as possible, while he inserted a needle into my lower back. I was a good student and did as I was told, except when I lunged forward in response to intense contractions. Time passed. What’s taking so long? The resident was having trouble placing the needle in the correct spot. When he did start the numbing medicine, I felt relief on one side of my body but not the other. After some jiggling of the needle and increasing the dosage, I felt total relief and lay down to rest.

My parents arrived at my bed-side, and we met for about 45 minutes. Finally, I started the second stage of labour; time to push this beautiful baby out. I was all for it…only when I was told to follow my urge to push, I couldn’t feel a thing. Hmm…this is disorienting. I told them to cue me, which they did. I pushed with all my might for about 15 minutes, but then heard the staff talking about the baby’s heart rate.

An OB was called in to discuss the best way forward. She approached me and told me my options. I could go immediately for a c-section or allow her to use forceps to pull my baby out. I sensed that she wanted to go with the latter because time was of the essence. I agreed, and that’s what happened: within a few minutes, my baby boy was born. Oliver James Mattia. He was placed on my chest, and he wiggled his way up to my neck. I was hit with a most intense feeling of love and joy, and an outpour of tears. I held him for the next few hours enjoying the bond. Time passed, but I was unaware of time.  

A few hours later, I got up to pee. I took a few steps but couldn’t make it to the toilet. I peed all over the floor.  What the heck is going on? I sensed that something was gravely wrong. I spoke to my nurse but was assured that this was “normal.”  Ok, I accepted the feedback but questioned whether the nurse was right because this didn’t feel normal at all.

I stayed two nights at BC Women’s because I felt so distressed about my incontinence. I attended a physio session with a few other women who had also just delivered but none of the others appeared to be experiencing the amount of incontinence that I was. I couldn’t retain any urine.

Any time I stood up it all came out. 

Home

I stayed at home for the first week to allow my body to heal. I might have gone outside a few times, to assess my progress but I didn’t notice any improvement. I spoke with my doula about my urinary incontinence, and she advised me to contact the Dayan Clinic, for pelvic floor physiotherapy.

Physiotherapy

Desperate to learn what I could do to fix this problem, I booked an appointment immediately. I learned that there wasn’t much that I could do until about 5-6 weeks post-delivery but was given a few gentle exercises to try anyways. I didn’t experience much benefit for the initial 1-2 months, but after that I did see some improvement.

The one good thing about my distress was that I was highly motivated to do my exercises every day and to attend physio with biofeedback every week. I persisted with this regimen for 12 months and am pleased to say that I was able to return to some of the activities I enjoyed. Sports with no bouncing like swimming and strength training were in, but jumping jacks and running were out. That said, I modified running so that I could still enjoy it; I only ran in the morning but made sure that I was dehydrated and using a pad. I tried using a pessary but found no benefit because it repeatedly slipped out.

For the second and third year post-delivery I continued to practice pelvic floor physio exercises, but not as often. It’s challenging to find the time to keep them up in the context of parenting a toddler, working full-time, and having a social life! It was at that stage that I started to learn about surgical repair options.

Second child

Despite this trauma – and yes, I would call it a trauma – I yearned for a second child. Unfortunately, I was experiencing secondary amenorrhea (cessation of regular menses after having periods in the past). Perhaps this was due to the stress that I had been experiencing with my urinary incontinence, or weight loss from breast feeding, as well as hormonal irregularities. I underwent IVF three times (this story is posted on Grace Fertility website), and happily became pregnant with my now second child, Clara Alexandra Mattia.

During my pregnancy, I worried about further damage to my pelvic floor and discussed this with my OB, Dr Nancy Mitenko. She explained to me that based on her review of the literature, and her personal and clinical experiences, “the first baby paves the way for the second.” She said that there was a high probability that I wouldn’t experience any further damage. What a relief!

Nevertheless, I sought out a second opinion. I consulted with Dr. Roxana Geoffrion. She recommended a c-section delivery to prevent further damage to my pelvic floor. Given that I had explored the non-surgical options to overcome my urinary incontinence and it was still significantly impacting my quality of life, she told me that I was a candidate for surgical repair. I could do this once I had completed breastfeeding.

I discussed Dr. Geoffrion’s recommendation with Dr. Mitkenko, and after much debate we booked a c-section.  However, a few weeks prior to Clara’s birth I changed my mind. I had been reflecting on what my OB had said about “the first baby paves the way for the second” and that there was a high probability that I wouldn’t experience any further damage.  I also considered the impact of having a c-section on my birth experience and the recovery period. Two things stood out: I wanted to re-experience the intense feelings of love and joy that I had when Oliver was placed on my chest immediately after delivery and I wanted to be able to function independently at home right away as opposed to healing from surgery. I decided to cancel the c-section and take a risk with vaginal delivery.

Birth experience # 2

To my delight and relief, my birth experience with Clara was smooth and totally satisfying.  I was induced three mornings in a row, and on the third morning I went into labour. I was admitted to St. Paul’s Hospital and laboured there throughout the day. Around 10:30pm I was given the option to have my water broken. I felt a bit nervous, so I called my doula who was at home with a cold. She told me to “go for it,” so I did. 

My partner decided to have a nap to prepare for my labour. Glad he was looking out for all the work he had ahead of him. Ha ha. I can’t resist the humor of this scene because a few hours later when I was leaning over the bed bracing myself with contractions, he woke up wondering, “what’s going on?”

“We’re having a baby,” I said, with a mixture of laughter and irritation.  “Geesh, what do you think???”  

Luckily, I won the jackpot and had the most talented nurse with me. With each contraction, she held my hips and rubbed my back in a way that absorbed the reverberation and pain. I gave the nitrous oxide a try and this time loved it. I felt this floaty, light sensation that numbed my pain for a few minutes at a time. Nevertheless, once my pain reached a 9/10, I did want an epidural.  I was all set up with an IV. The anesthesiologist inserted the needle without difficulty, and he followed my request to not overdo it as I wanted to remain connected to my body during the delivery. 

Clara was born at 2:15am, and I had no tears and no additional damage. An hour after having her I got up to pee and felt ecstatic - no leakage!

Conclusion

I hope my story provides you with some comfort. If you are currently experiencing urinary incontinence or planning your labour and delivery, Be Pelvic Health Aware has a list of suggestionsComing soon! that you can review with your OB or midwife to reduce the risks of incontinence.

ABOUT SARAH

Sarah is a clinical psychologist with 25 years of experience helping people adjust to living with chronic conditions. She is also a mother who has lived for many years with stress incontinence. As a psychologist, Sarah understands the impact of health issues on self-image, emotional well-being and quality of life, and as a patient she lives with these issues. These two perspectives put her in a unique position to contribute to our team’s goals to teach women about pelvic floor care in pregnancy and delivery.

Sarah is the Research User Co-Lead on the #BePelvicHealthAware team.