THE FRENCH SOLUTION
Unlike new mothers in France, Canadians don’t get access to free pelvic-floor work. So, asks Claire Gagne, what’s a gal to do?
Have you heard about the French and their vaginas?
In France, any woman who has delivered a baby gets a prescription for 10 free physical therapy sessions to “re-educate” her pelvic floor — you know, that collection of muscles, ligaments, tendons and fascia that supports your pelvic organs, helps you have enjoyable sex and stops you from peeing your pants.
Emily Mazo-Rizzi, an American who has lived in Paris for nearly 20 years, happily took advantage of this governmentfunded rehabilitation when her first baby was born in 2012. “I have no desire to be incontinent or have a prolapsed uterus or bladder,” says the Pilates instructor who just had her second child in France.
The appointments, which started around six weeks prenatal, went like this: A specially trained midwife, wearing a medical glove, stuck her finger into Mazo-Rizzi’s vagina to feel what was going on while MazoRizzi attempted to contract and squeeze different parts of her pelvic floor muscles. After every session, she was sent away with homework, which usually involved three exercises. When her newborn is six weeks old, she will begin therapy again.
“In France, most women do it,” says Caroline Mollard, a physiotherapist in Paris who specializes in pelvic floor and perineal rehabilitation. “Most of them have talked to friends who have done it, or moms or grandmas tell them to do it because they have problems controlling their urine.”
Six weeks postpartum, French women are encouraged to follow up with a physiotherapist or midwife twice a week for about a month and a half.
If 10 sessions aren’t enough to fully rehabilitate a woman’s pelvic floor, she is sent back to her gynecologist to write another prescription and the sessions continue. Once the therapy is done to the satisfaction of the therapist, she starts 10 sessions of abdominal muscle rehabilitation to fix di a stat is recti( the separation of the abdominal muscles) and regain core strength. This tummy work is also fully covered by the French health-care system.
New moms are told not to exercise until they’ve completed their pelvic floor and abdominal retraining. “They are motivated so that they can start exercising and getting back in shape,” says Mollard.
While new French moms are engaging in this intensive postpartum therapy, Canadian women are generally left with their pelvic floors hanging. Take Toronto mom Sylvia Vickers*. She had a bit of an “oops, I did it again” feeling when a wee bit of pee would leak out with a sneeze, laugh, cough or other sudden movement after her daughter, Samantha* was born in 2015.
She considers herself a pretty avid researcher, but she had never heard of pelvic floor physiotherapy until a friend tipped her off. “I did a lot of research before Samantha was born,” she says. “I was on all the mom blogs, but I never came across it.”
She started seeing a physiotherapist about four months after Samantha was born, but it was a long haul. By the time she went back to work after her maternity leave, she still wasn’t cleared by the therapist to start running or playing Ultimate Frisbee — two activities she enjoyed pre-pregnancy. When she got pregnant with her second baby, the urine leakage came back. “I’d really like to not pee my pants every day,” says Vickers.
Mary Wood, a pelvic health physiotherapist in Edmonton, isn’t surprised by the lack of awareness in North America. “We’ve seen a huge increase in women in our clinic from 10 years ago, both prenatally and postpartum, but we’re seeing a small percentage of all births,” she says. “Women usually find out about us from a friend of a friend.”
If you’re thinking about getting pregnant or are pregnant and you’ve had urine leakage, sexual pain or chronic constipation, you should see a pelvic health physiotherapist as soon as possible, says Wood. During pregnancy, you may want to see one if you have pelvic or back pain.
If you want to see a physiotherapist after delivery, it might be prudent to contact one and set up an appointment during pregnancy because many have waiting lists. Most provinces have a roster of pelvic floor physiotherapists, says Marie-Josée Lord, a Canadian pioneer in this area who trains others. Make sure you’re dealing with someone who has received specialized training. Although the specialty is gaining popularity among therapists, you might be hard-pressed to find one in smaller cities and towns across Canada.
Some provinces have programs that will pay for pelvic floor physiotherapy, but that’s only after you have a problem, such as pelvic organ prolapse. Prevention is always better, says Julia Di Paolo, a pelvic health physiotherapist in Toronto, but that means you’ll have to pay out of pocket or through extended health benefits. “My suggestion is to ask for this as a push present,” she says.
If you see a physiotherapist, she will let you know when it’s safe to start exercising again. Take note: We often start working out way too soon in this country.
“Our bodies were designed for this,” says Di Paolo, “but they weren’t designed to go back to hardcore exercises six weeks later. We need to honour that recovery time.” *Name has been changed.