Jul 7, 2016

Interview Transcript

Dr. Jones: As human beings have evolved, our big brains evolved to be bigger than our pelvis has evolved to be bigger. So births have become a little harder with a few more long-term consequences for women. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Healthcare and this is the scope of the problem of getting the baby out.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: It has clearly been an advantage for humans to have a big brain. So with the big brain comes a big head. Today in The Scope studio I'll be talking to an expert on the pelvic floor, Dr. Ingrid Nygaard. She is a professor at the University of Utah and a urogynecologist, a gynecologist who specializes in pelvic floor problems. So what is the pelvic floor really? Not something you scrub with Ajax or something but give it to us.

Dr. Nygaard: No, definitely not. It's one of those important structures that we appreciate only really when it's not functioning as well as we wish it would. The pelvic floor is made up of the muscles, ligaments, connective tissues and nerves that support our internal organs, like the bladder, the uterus, the vagina, rectum. The pelvic floor muscles run from your pubic bone at the front to the base of your spine at the back. They're shaped like a sling and they hold your pelvic organs in place.

Dr. Jones: So it's kind of like a sling or a hammock but you don't want it too sling-y. You don't want it too hammock-y. You want it to be strong. So all these muscles and connective tissues keep our insides in. What happens when a baby comes out that way?

Dr. Nygaard: Well, as you can probably imagine, to allow the baby to pass through, the structures in the pelvic floor all have to stretch quite a bit. Luckily our body starts preparing for this long before labor even starts. But the pelvic floor muscles sometimes weaken after childbirth and then they weaken further as we get older.

Dr. Jones: Well, women give birth vaginally all over the world but why do some women have problems after vaginal birth and some don't?

Dr. Nygaard: Well, we know that weakened or dysfunctional pelvic floor muscles can cause problems down the road, like bothersome leakage of urine or pelvic organ prolapse where one or more of the pelvic organs bulges into the vagina. But for most women these conditions don't happen until they're middle aged or older. We don't know very much about how young women experience changes in their pelvic floor function after childbirth. It's probably fair to say that most women notice some minor changes after giving birth but the fact that most women who deliver vaginally don't have long lasting problems speaks, I think, to how amazing our bodies really are.

Dr. Jones: So as young women they may have the original insult or the original maybe even damage but that really doesn't show up until ageing and gravity and time adds its little mix to the potion. Is that how it goes?

Dr. Nygaard: Right exactly.

Dr. Jones: Right. So if women have a problem after vaginal birth, could it get better on? And so you're suggesting that these they don't notice it or maybe it gets better on its own?

Dr. Nygaard: No, absolutely it could get better on its own. A lot of processes go on in our bodies that encourage healing and recovery after childbirth. Over the first couple of months for example, the uterus goes back down to normal size and the pelvic floor muscles start regaining their strength, and this means that symptoms that some women notice after childbirth often go away within a few months. If it doesn't get better, is there anything we can do to help? Well, we're lucky that time alone helps many women recover well after childbirth but we don't know very much about other factors that might help women recover well after vaginal delivery. But one thing women can do to help get the pelvic floor back in shape after delivery is pelvic muscle exercises. Some people call those Kegel exercises. I encourage women who notice some urinary leakage for example, to do these. It's a good idea to have someone give you some guidance to make sure you do these correctly and effectively, and a great resource for this is a women's health physical therapist and you can also ask your doctor or nurse for tips.

Dr. Jones: Oh and they're really easy to do. I just did them. I can do them while I'm even talking on The Scope radio right now and I don't have to hold my breath and my face isn't getting red.

Dr. Nygaard: It's not getting red.

Dr. Jones: But someone in the studio is kind of laughing. Oh, okay, well let's talk about does childbirth cause any problems over the long-term? We talked about that a little bit.

Dr. Nygaard: Well, over the course of her lifetime about one in five women undergoes treatment, often surgery, for pelvic floor disorders. Childbirth is one thing that can contribute to this but there are many other factors too from ageing to nerve problems like strokes to obesity and genetics plays a role as well.

Dr. Jones: I read somewhere that female paratroopers had a little more prolapse but that's just an aside. So what kind of research are you involved with regarding these problems in childbirth?

Dr. Nygaard: That's amazing to consider the fact that even though nearly four million women deliver baby in the US every year, most of them vaginally, there really hasn't been much research about how to maximize recovery after childbirth in terms of pelvic floor health. So we are conducting a study called the MAPH study, which is short for Motherhood And Pelvic Health, and the goal of the study is to find out what we can recommend to help women recover well after vaginal delivery. We're specifically looking at how things like physical activity, intra-abdominal pressure and muscular strength influence pelvic floor support and symptoms during that first postpartum year. We see this research as an important step in crafting prenatal and postnatal regimens that will promote better pelvic floor health. We're planning to enroll about 1,500 women across the Salt Lake Valley. Our participants are all first time new moms and we're so grateful to them for lending us their time and involvement to help us learn about pelvic floor health after childbirth.

Dr. Jones: So for those of you who are still having babies or about to have your first, the good news is that it goes mostly just fine and for you ladies who have some long-term consequences of getting those babies out, there's hope and there's help, and thanks for joining us on The Scope.

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