Women Need Better Options for Postpartum Complications
Surgeons have been performing surgeries to improve the symptoms of pelvic floor disorders — common postpartum complications — for decades. But little research has tracked the long-term results of these surgeries, until a recent Duke University study followed women for five years after two common prolapse surgeries. They found failure rates for both procedures were equally high — over 60% patients experienced surgical regression with new or worsened symptoms.
Yet, at the same time, more than half still reported their quality of life, five years on, was much better than before surgery.
“This was surprising to us,” said lead author J. Eric Jelovsek, M.D., director of Data Science for Women’s Health in Obstetrics and Gynecology at Duke. “That failure rate was higher than we expected. But that does not necessarily align with how patients feel, and we don’t know why that is.”
Pelvic floor disorders are common complications after childbirth; by some US-based estimates, 58% of women who deliver vaginally and 43% of women who deliver via C-section have some kind of postpartum pelvic floor dysfunction, which often worsens over time. In other words, weakened connective tissue and ligaments in the pelvis, following the strain of childbirth, can lead to varying degrees of pain, fecal and urinary incontinence, painful intercourse, and/or eventual pelvic floor prolapse, wherein internal organs like the uterus or bladder descend into the vagina.
“We may be at the point where we need to think of treating prolapse as treating a chronic disease that’s likely to return over time,” Jelovsek said. “It’s like getting a hip or knee replaced. Will your quality of life improve? Yes. Is it worth it? Absolutely, but down the road this will likely be something we’ll have to revisit.”
Or perhaps a better solution is to invest in efforts to prevent, and diagnose and treat postpartum complications early. Pelvic floor disorders and other common postpartum complications are seldom discussed in the lead-up to childbirth, or in its aftermath, when medical attention shifts to the baby over the recovering mother. This leads many — doctors and new mothers — to view postpartum complications as an inevitable result of pregnancy that time may or may not cure.
Take, for example, the condition of “baby belly,” which affects roughly 60% of pregnant women after birth. Long mistaken for an inevitable pooch of motherhood — baby weight that just won’t go away — diastasis recti is actually a gap between abdominal muscles that allows internal organs like the stomach or intestines to poke through. It’s seldom diagnosed, and medical and fitness advice to ‘fix’ the problem often makes it worse; commonly recommended tummy-flattening exercises like crunches and bridge poses can put more pressure on the gap and cause the muscles to separate further.
Kegel exercises and core strengthening exercises during pregnancy and after childbirth can go a long way to both preventing and treating these conditions, but discussion of such solutions is still an uncommon part of obstetric care, which typically stops with childbirth. This is despite growing recognition of the ‘fourth trimester,’ a term that describes the period of post-birth recovery for mothers, during which initial signs of these complications often start to manifest.
When postpartum complications are diagnosed, women tend to be referred to specialists who may overlook the larger picture. “As Kari Bø, pelvic floor expert at the Norwegian School of Sports Science, explains, ‘Gynecologists, urologists and colorectal surgeons concentrate on their areas of interest and tend to ignore the pelvic floor common to them all,'” writes Allison Yarrow at Vox.
The result is, many women live for months and years with steady or worsening symptoms, a ‘new normal’ that gets chalked up to the price of motherhood.
It’s difficult to disagree with Jelovsek’s call for more research to understand the disparity in satisfaction and outcome following surgery to repair pelvic floor prolapse. Indeed, more research might solve part of this problem; a quick search on PubMed, an aggregator of medical research, reveals only 120 studies looking into diastasis recti, for example.
But the other part may be as simple as happiness that a malingering physical problem was finally diagnosed and treated, even if that treatment didn’t last. After all, when these conditions are seen as inevitable, any respite can seem like a gift.