In the age of information, including the internet, an individual can research any topic. Since each person has limited knowledge, discerning fact from fiction is often a challenge. In regards to postpartum rehabilitation, most women seek their own fitness plan to snap back from magazines and the internet.
Women are seldom advised by their own exercise program, often to their detriment. For example, performing sit ups can cause separation of the abdominal muscles due to increased intra-abdominal pressure from holding their breath and stretched connective tissue from pregnancy, weight gain and hormone change. Below is a recent post that discusses pelvic floor rehabilitation which is routinely done in France, la rééducation périnéale.
The French Government Wants To Tone My Vagina
Inside my amazing and embarrassing postnatal “perineal re-education” class, paid for by la France.
Last week I began re-educating my vagina.
Let me explain: I live in France.
Shortly after my husband and I moved to Paris, I became pregnant, which was a relief, because I would get fat for a legitimate biological reason, not just because of all thepain au chocolat. When I gave birth to our daughter last November, my husband and I spent five government-sponsored days in the maternity ward at Clinique Leonardo Da Vinci, where we learned that French hospital meals come with a cheese course and that as part of my postpartum treatment I would be prescribed 10 to 20 sessions of la rééducation périnéale. This is a kind of physical therapy designed to retrain the muscles of the pelvic floor, including the vagina, and is one of the cornerstones of French postnatal care. Two months after our daughter was born, I summoned the courage to teach my vagina some new tricks.
Hmm, this is becoming the kind of story that uses the word vagina a lot. I know anatomical terminology can make people a little squeamish—as one of my guy friends pleaded when I was six months pregnant, “Could you please stop saying the word uterus?” But not to worry! I’ve Googled common euphemisms for vagina, and I’ll incorporate the gentler ones as we go along.
As you can imagine if you’ve ever watched a Gallic romantic comedy, the French are a little more blasé about the female body than Americans are. I realized this the first time I went to the gynecologist here. “Take off your pants and underwear,” he said in a bored voice, barely looking up from his computer. Wait, he’s not leaving the room? I thought. There’s no little paper gown? But then I realized just how stupid that little paper gown is, after all. Yes, just take off your pants and underwear. We’re all big kids here and we’ve seen it all before; no need to get into a lather about some exposed lady parts.
By the end of my pregnancy, my body had changed so much that I lost my American self-consciousness and really got into the swing of it. “Should I take off my pants and underwear now?” I’d ask, even though it might just be an appointment for fetal monitoring. Everything looked so different, I wasn’t even sure it was my body anymore—not the middle part at least. That belly and those boobs definitely didn’t belong to me, so who cares who saw them?
But then came the aftermath of the birth. The middle part of my body had bounced back, with even better, bigger boobs! (They tended to leak sometimes, but whatever.) But what was going on down there, in my, uh, private area? What had once been like an old friend, comfortable and familiar, was now a stranger, or at least that relative you only see once a year on holidays. Our easy banter had suddenly been replaced by strained and awkward interaction.
La rééducation is the French solution to this and has been paid for by French Social Security since 1985. France is one of the only countries that sponsors such a program, and the idea behind it is—well, there’s not just one idea, but many. It being France, everyone wants you to be able to have sex with your husband again as soon as possible. (You’ve gotta get that area back in shape before he gets fed up with your recovery and finds a mistress!) On the other hand, the government also wants to make sure you can easily and safely have another child; thanks in part to official encouragement, the French birthrate is now the second-highest in EU, at 2.1. And on a third hand, well, what the heck is going on down there, anyway? Will I really pee a little when I sneeze for the rest of my life?
The first order of business in these workout sessions for your yoni is a long interview with your kinésthérapeute. You’re asked about the current state of the muscles down there, if you had a complicated delivery, if you’re experiencing incontinence, and some mysterious questions about organ descent, which the French are extremely paranoid about. Then, you guessed it—it’s “take off your pants and underwear” time. Because these sessions usually begin during a woman’s maternity leave, most offices allow you to bring your baby with you. So now you’re half naked while a strange woman probes your hoo-hoo, and your little one looks on from the stroller, adding a whole new level of weirdness.
There are two methods for the re-education itself, manual and biofeedback, and most kinés use a combination of the two. The first is just what it sounds like: The therapist inserts two fingers into your wuzza and talks you through a series of exercises designed to give you better control over your muscles. Can you, for example, contract your vagina and pull her fingers in and up? You may find this cringingly embarrassing, especially when afterward she tells you, “C’est assez faible” (“It’s rather weak”) and that you’re going to need more than 10 sessions.
The biofeedback method is somewhat less embarrassing but a little more terrifying, in that it requires buying a “sonde,” or (as it says on the package) an electronic vaginal re-educator. A sonde is a little dildo with electrodes coming out of it that the kiné inserts into your shnush, then hooks up to a laptop that records the force of your internal contractions. You can watch how hard your muscles are working on the screen and even play little video games using the sonde as a joystick. I played a Pole Position game at my last session, and a friend played what I can only call Cooter Pac-Man.
I finished up my most recent session with a set of moneymaker burpees, in which I had to try to contract my muscles halfway, then fully, then halfway, then relax. And I totally sucked at this. My daughter, who is 3 months old now, is just learning hand-eye coordination, straining to close her hand around a toy in front of her. I knew just how she felt as I tried to get my bajinga to obey; up until that moment, I couldn’t remember trying to voluntarily make these muscles move. The whole thing made me laugh, one of those combination laughs of embarrassment, absurdity, and despair that I find myself emitting all the time in France. (I’m sure there’s a compound German word for it.) It was so hard, and so ridiculous—what was I doing with no pants on in this Haussmanian office building while a strange French woman kept telling me to breathe and contract, “soufflez … et contractez!” over and over again?
But you know what? Despite the occasional embarrassment, these sessions actually work. There haven’t been extensive studies done, but what studies exist show that la rééducation significantly reduces incontinence and pelvic pain at nine months after giving birth. Frankly, I’m happy there’s a medical professional paying attention to what happened down there. Rééducation périnéale gets scoffed at in American andCanadian publications as one of the most lurid examples of the indulgent French welfare state, but as far as I can tell, we do exactly nothing in the United States to help women get back into shape after giving birth.
An American woman gets her six-week postpartum checkup and, if nothing is seriously wrong, she’s cleared to have sex again and sent on her way. If she’s lucky, the doctor or midwife reminds her to do her Kegel exercises, but without much guidance. Meanwhile, at least in the experience of many of my friends, she may still be experiencing a variety of symptoms that, while not medically serious, sure are annoying, embarrassing, and strange, and not at all conducive to reinvigorating her sex life. Elective “vaginal rejuvenation” through plastic surgery is on the rise in the U.S., though this surgical reconstruction is largely aesthetic and pays little or no attention to returning sensation or control to the woman. Americans’ lack of attention to the female body after giving birth is our own version of the modesty gown or the word vajayjay; we’re covering our eyes and pretending there’s nothing there to see, until it can no longer be ignored.
La rééducation périnéale, on the other hand, may be giving me more information than I ever wanted about my Lady Jane—or, as I like to call it, my vagina. But after the initial embarrassment, I find I’m feeling better about my postbirth body. We’ll see if that lasts. The health care system here also pays for sessions of “abdominal re-education” that starts after la rééducation périnéale. These are ostensibly to help strengthen the abdominals in case of weakness or C-section, but also have the side benefit of providing “un meilleur aspect du ventre” (a better-looking stomach). Yes ladies, I get to do government-financed sit-ups to get myself back in shape for bikini season! C’est la France, bien sûr.
Every woman who has had a baby, sometime in her life, deserves a musculoskeletal assessment.
Postpartum Strong® 
I think this is important that women know there is something that can be done other than suffer in pain. Maybe with more research on this the US will follow suit.
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