This is the third instalment in my Diastasis Recti blog series, and follows my second pregnancy through until 12 months post-partum.
To be 100% crystal clear, I am not writing this for sympathy or whatever emotion it may appear to foster, I am writing this in the hope that if somebody out there is going through similar post-partum issues to what I went through, they can follow my journey and get a sense for how things turned out for me (which will be my final instalment – Part IV).
...and so...
Pregnancy and Delivery
My second pregnancy was a rollercoaster from the get-go. Due to the remaining divarication from my first pregnancy I started showing at week 6 and expanded rapidly. During weeks 7 and 8 I experienced intermittent bleeding, but was thankfully given the all clear after a scan. However, at week 13 things took a turn for the worse. I woke up one morning with intense abdominal pain. Such pains were nothing new to me, so I tried to ignore them. As the day wore on, the pain increased and by the afternoon I was doubled up on the floor, shaking in agony. We sought medical advice and were directed to our closest hospital Emergency Department. My husband dropped me off at the hospital and then went home to put the twins to bed. It was now evening and the hospital was busy. After a decent wait I was triaged by a Doctor who asked me about my symptoms, the pregnancy and general health, before asking me to go back to the waiting area. By now, sitting in a chair was too painful so I resorted to kneeling on the floor, whilst resting my head and shoulders on the chair. After an hour, a Nurse walked through reception and came to me. I explained to her, as I had during triage, that I was 13 weeks pregnant and suffering abdominal pains. Soon after I was seen by the doctor again, who prescribed me diamorphine for the pain and sent me back to the waiting area. I remember being concerned about taking such a strong drug, but I was physically exhausted and quite certain I was having a miscarriage!
I remained in the waiting area, kneeling on the floor and lying on the chairs until 7am the following morning, more than 10 hours after I arrived. I overheard the incoming Matron (Senior Nurse) being briefed about me. “You mean a lady who is 13 weeks pregnant with a suspected miscarriage has just spent all night in the waiting area?” I heard her bark. Needless to say, things happened pretty quickly thereafter. I received scans and blood tests to check for a miscarriage, gall stones, perforated bowel and appendicitis; everything came back clear. The whole team was perplexed, and to add a new twist, the pain was starting to subside without further medication.
The Consultant theorised that due to me having a rear-tilted uterus, it would need to push forwards in order to give the baby space to grow, which is perfectly normal for somebody with a tilted uterus at this stage of a pregnancy. When this occurs, the abdomen wall provides interim resistance whilst everything settles down however, in my case, there was no abdominal wall, so my muscles went into intense spasm to protect the uterus.
This was the first real sign as to how my existing condition was going to impact my second pregnancy!
My bump continued to grow at an alarming rate, and I continued on with the usual pelvic pain, back ache and core issues that had been ongoing since my first pregnancy. Alongside, the physical pains I was also suffering from significant levels of fatigue triggered by the most basic of tasks, something I had not experienced before. The simple act of walking upstairs would leave me exhausted, and required me to sit down and rest. This was accompanied by a lack of mental clarity, an almost ‘fuzziness’ or ‘cloudiness’ of my thought process. I put this down to hormones and ‘baby-brain’, and just tried to carry on.
During a routine midwife check-up at 30 weeks I raised the fatigue issues and my concerns regarding the remaining 10 weeks. I tried to explain that it felt like my body and mind were shutting down and that the only time I felt at ease was if I laid down and gave in to the lethargy. The midwife was largely unsympathetic and made comment to the fact that ‘pregnancy is always harder when you already have children’. She conducted no further investigations or tests, and said the baby would come when it was good-and-ready. She made me feel like I was weak and pathetic for even having the audacity to raise my concerns and voice my feelings out loud.
When I was around 39 weeks pregnant I saw a Reflexologist so she could assess how ‘ripe’ my cervix was and try to stimulate activity. At the end of the session she asked me if I’d felt particularly tired through the pregnancy, sluggish and generally out-of-sorts. I was quick to confirm ‘yes’. “Hmmm,” she said, “it looks to me, based on your feet, that your thyroid gland isn’t working properly, if at all. If you don’t feel better after having the baby, I would suggest seeing your Doctor to get some blood tests done.” I thought to myself how odd the observation was, especially since she made it based on my feet – to this day I have no idea how!
Eventually, 10 days after my due date, I went into labour. After a long and painful start, the consultant confirmed that my baby was ‘back-to-back’ and that I should prepare myself for the possibility of an emergency caesarean-section. The final stages of the delivery were tense, the baby became stuck and distressed, which led to us rushing to emergency theatre, where the surgeon made a cut and assisted with ventouse (kiwi) VBAC delivery as a last resort before C-section. Roughly thirty-six hours after my labour began, we were finally blessed with a beautiful, healthy girl.
Postpartum Health Concerns
During the pregnancy I started to experience incontinence issues. I think that this was largely due to my lack of abdominal support – the pelvic floor just eventually gave up trying to hold the huge load of my second pregnancy. After the birth, the incontinence didn’t go away, in fact it got worse. Like many new mothers, I worked on kegel exercises to try and rebuild some strength in my pelvic floor. I know this is a really common issue; I have many friends who have also experienced it, but for me it just seemed like yet another part of my anatomy failing. So, I had a little pity party! 😉
As soon as the delivery was over, I began strapping myself back into the elasticated bandages and supports in a desperate attempt to aid those initial few days of recovery. Over the coming weeks I returned to exercise, following the same routine and strategy that I used after the twin pregnancy. Slowly but surely, I started to recover to a similar physical ability to which I had at the start of the second pregnancy. Within six months I was able to attend aerobic and boxercise classes. On the whole, these seemed fine although jumping and lunging were absolutely out…those exercise lead to pelvic and groin strains, or incontinence accidents!At this stage, my husband and I truly believed that I would never be able to return to running again. Every time I tried to run I would get hurt; it was a very sobering realisation.
Once I stopped breastfeeding, I noticed the level of physical and mental fatigue increased, similar to the pregnancy. By now I found holding a conversation difficult and spent a lot of time sitting down. I knew something wasn’t right so I visited the Doctor who carried out a blood test and confirmed that I had an underactive thyroid (hypothyroidism), just as the Reflexologist had indicated. He suspected that it was triggered by the pregnancy but would probably remain a chronic lifelong condition. I was so angry that this had been missed during my pregnancy, and more to the point, that I had been made to feel so pathetic for suggesting that anything was wrong. It took a number of months for the medication to normalise my thyroid levels, but when it did, the results were incredible - I had my mind and energy back!
In the meantime, my physical condition remained the same. My divarication had settled back to an approximate 8-inch separation, with my bowel exposed beneath the skin. I was locked into the same perpetual daily cycle of wearing all the supportive garments, including the abdominal splint and pelvic belt. Picking up the twins was increasingly difficult and I still had to approach simple daily activities, such as getting out of the car, like someone three-times my age.
I tried to keep smiling and pretended that I was coping fine, but inside, and behind closed doors, both my husband and I were struggling. To me, admitting that I was facing a daily physical battle, would effectively mean I was admitting to being a bad Mother; keeping up the façade was grinding me down!
Seeking Solutions
Late one evening, my husband came into our bedroom and exclaimed, “I’ve just watched a lady on ‘Embarrassing Bodies’ be treated for the same condition as you. You need to watch it!” For the record, ‘Embarrassing Bodies’ is a British TV program in which patients divulge their awkward and, at times, humiliating health issues on National TV. Probably not the most romantic thing he has ever said to me, but he’s said worse! The next morning, I watched the episode and understood why he was so animated. The lady they featured had suffered from a similar case of diastasis recti that had failed to respond to the normal methods of rehabilitation. Whilst her divarication was less than mine, our similarities were notable. The episode followed her from diagnosis, through surgical intervention and rehabilitation. At last, hope!
I immediately booked an appointment with my Doctor. We discussed my case and the steps that had been taken to rehabilitate through exercise, supported by Physiotherapists, Osteopaths, Chiropractors, and Fitness Instructors. I raised the option of surgery and he agreed that it sounded like a rational and reasonable approach, but informed me that it was not a core procedure conducted by the UK National Health Service and would therefore require funding approval. He referred me to a Surgeon and submitted the funding application.
The appointment with the Surgeon was a disaster. Despite me having witnessed a similar case on TV, he told me that no procedure would be successful for my condition. He also commented that I was probably just overweight (I was low-mid normal on the BMI scale), and that I needed to stop feeling sorry for myself and start doing 50 sit-ups a day. I was speechless! (It is well-known by anybody who has any current knowledge of Diastasis Recti that sit ups are a big no-no as they strain the area; this is the same for any exercise that causes ‘coning’ or ‘doming’ of the abdominal muscles.) Once I had gathered my thoughts, I tried to discuss some of the information that I had gained from other Health Professionals, but he simply escorted me out of his office and told me to seek help elsewhere. I was utterly mortified. I left the appointment and cried. Perhaps there wasn'tany operation that could fix me; perhaps I just had to finally accept my pain and limitations!
Ever the optimist, my Husband was quick to respond, “okay, so we’ll contact the Doctor from the TV show and see what he says”. So that’s what we did, that very same day.
The Surgical Consultant was one of the most pleasant and approachable medical professionals I have ever encountered. From our initial consultation, he made me feel relaxed and able to ask questions. He explained that I was a good candidate for the operation and that he had full confidence that once my abdominal muscles had been reunited, I would see a significant improvement in my mobility, alongside a substantial reduction in abdominal pain. He only had one concern; due to the limited fat around my abdomen, closing the incision would be tricky and presented an increased risk to the aesthetics. “Aesthetics?” I responded, whilst trying not to laugh, “honestly, I have little concern regarding my image, just please get my body working again”.
So, 12 months after the birth of my third and final child, I booked into theatre, ready to be sewn back together again …
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