Physio Amanda Savage contributes to taboo-busting book on sex, pleasure and intimacy after birth

'Shock to the system'

Ms Savage uses the term ‘inhibited’ to explain what can happen to mothers’ pelvic floors. ‘You’ve literally had such a shock to the system, your brain can’t remember what to do with your muscles.

‘Mums say they feel like they have “weak” muscles. But it’s important to explore whether the muscles are truly weak; perhaps instead they are not working? “Weak” and “not working” are not quite the same thing.

‘A weak muscle would be one that has had a long period of not being used, say because you were carrying the weight of twins or it was a very big baby. You maybe didn’t pay much attention to the pelvic floor when you were pregnant and then it got a big stretch.

‘In which case it’s going to take quite a long time to come back from a place of true weakness. Just like if your leg got weak because you were in a plaster for six weeks, it’s going to take quite a while to build strength back up.’

Pudendal nerve latency

Ms Savage suggests that nerve damage can also be a factor: pudendal nerve latency. ‘Up to six months after the birth, you can find poor neural flow through the pudendal nerve that supplies the pelvic floor. This is a physiological problem. Messages are only very slowly making their way to your pelvic floor, so by the time you need the pelvic floor to have moved, it’s too late, which can cause leaks.’

But it can also be a mental health issue. ‘So many times I’ll say to a mum: “Do you think you’ve switched off below the belly button as a way of coping with what you just went through?” Many times delivery has been a traumatic experience – maybe not "officially", but on a personal emotional level. It’s a big experience, to expose all your private parts to an awful lot of people!

'Mums don’t realise how vulnerable they can feel until they’ve been through it, and they often don’t process everything until afterwards. Perhaps there were too many people invading your private space, or maybe you were sent home scared and without guidance – the last memories you have of that space [your vagina and vulva] are not happy ones, so you just would rather not think about it.'

Do you need to be vulnerable in a space with a physio, revisiting things that you haven’t yet wanted to or had time to, but need to? This could also be done with a psychologist or a counsellor, but often it is your physio who will offer that space to be vulnerable [Amanda Savage]

Physios who offer a 'space to be vulnerable'

Building a relationship is crucial, Ms Savage notes: ‘Often what I’m trying to do as a physiotherapist is work out: do you need to do classic pelvic floor strength exercises? Or do we need to spend time reconnecting with your breathing, being aware that when you breathe you can feel your pelvic floor and how to relax it?

'Or do you need to be vulnerable in a space with a physio, revisiting things that you haven’t yet wanted to or had time to, but need to? This could also be done with a psychologist or a counsellor, but often it is your physio who will offer that space to be vulnerable. Many of my patients find themselves crying, but I think we need to go through these steps in order to process our experience and help the brain allow the muscles to work again.’

Social media can mislead

Many women – and society at large – have preconceived ideas of what a body should be like after a baby, Ms Savage points out. ‘Social media can make women believe that everybody else has just “bounced back”, and they want fixing because they haven’t. They don’t realise that others might have put a lot of work in, or are very lucky genetically.

'It’s good to both let go a bit and accept that life is different, and also accept that there’s work to do,’ she adds.          

The book also covers the following topics

• sex tips for new parents: reigniting the spark with your partner
• sexual self-care: how to address the pain and sexual dysfunction that often occurs after pregnancy
• coping with post-natal depression and a changed body 

Amanda Savage is based at South Cambridge Physio: https://www.southcambridgephysio.co.uk See also: https://supportedmums.com

Get Your Mojo Back by Clio Wood will be available, price £14.99, from bookshops and through Amazon from 10 January. Watkins Publishing. ISBN: 9781786786951