Fault Lines

“Consent is by the second,” the physical therapist, Ashley, says to me, as she prepares to evaluate my pelvic floor. We are in a small frigid room on the 12th floor of a hospital. I am reclined on a bed, a gown covering my lower half. “You can tell me you are uncomfortable at any time.”

I am a 38-year-old woman who has birthed three children. This is the first time these words have been spoken to me in a doctor’s office. Today is also the first time I have been educated about the shape, structure, and purpose of my pelvic floor, assisted by a handy model that Ashley manipulates as she explains it to me. My pelvic floor is a bowl of muscle upon which my organs rest. It is in charge of supporting my organs, keeping them in place. It is also responsible for opening and closing to allow me to do things like use the bathroom or have sex. I am here because after three vaginal births, I often pee a little when I sneeze, laugh, exercise, or dance with abandon. I am here because it recently occurred to me that it doesn’t have to be this way.

Ashley touches the walls of my pelvic floor, asking for my consent every few seconds. Then she has me do a kegel, cough, sneeze, and laugh. When she removes her finger she has a diagnosis.

“You have a birth injury that I can feel. Some scarring. Did anyone ever mention that to you?”

“No,” I say, and I am mortified to feel tears rising in me.

Tears come without warning when I let myself recall childbearing too clearly: the ache of each child’s delivery extending through my first year as their mother. My childbearing traumas are small, well within the chasm of what we deem normal: a small tear followed by a bad infection with my first; a successful induction due to the onset of a liver condition called cholestasis with the second; and a scheduled induction at the height of Covid with my third. All three of my babies were full-term and healthy. They breastfed easily and gained weight in the first week of their lives. I healed faster after each birth, back on my feet within hours after the third.

It was unremarkable.

And yet, when someone asks me about having babies, I hear myself saying it is hard, so hard, so much harder than everyone says: the violent contraction of yourself, the reluctant expansion of your life. A hairline fracture in my heart aches whenever I remember it—the way the pain of labor continues, a throbbing that evolves over time, bleeds into the year that follows giving birth. It is so common: the relentless wear on a mother’s physical, mental, and emotional health. And yet, it is extraordinary: the unique, relentless loneliness that accompanies the all-consuming labor of maintaining life.

“Sometimes, after giving birth, the muscles in your pelvic floor just go dead, or sometimes they kind of freak out and tense up. It can cause all sorts of symptoms,” Ashley explains. I picture the questionnaire I was asked to complete when checking in for the appointment, the long litany of horrors I was asked about: bladder and bowel pain, incontinence, strange bulges, and leaks. I felt relieved, as I checked only two of the 50 boxes, that I had dodged most of the bullets that lead a person to pelvic floor physical therapy.

And yet, when she says I have a birth injury I want to burst with gratitude for this simple validation: I have been injured. I have suffered harm. I am not the same as I was.

I know this, of course. I’ve spent a decade as a mom, submerged in the mess of clichés about raising children: I experience the highest of highs and the lowest of lows, day after day after day. I am no longer the girl I was when I decided to have kids, and more and more I accept I will never again be that girl. Often, I really like the mother version of myself.

But the beginning is so difficult, so extreme, that it in many ways defies description. The beginning injured me in a way that is invisible and quiet and painful—and wholly inarticulable. When I try to talk about it, I receive understanding looks from other women and empathetic dismissal from doctors. It is hard, but it is normal, they say, the word normal a cage in which my distinctive experience dies.

Ashley tells me I need to do Kegel exercises to strengthen my pelvic floor. “Your abs and your glutes want to help, but they can’t. You have to isolate the pelvic floor muscles. Inhale deeply, and when you exhale, lift the floor of the bowl as high as you can and try to hold it. Lift.”

My heart goes out to my little pelvic floor, which has not yet bounced back from childbirth. It has been stubborn, confused, and neglected. I empathize. I am grateful to my glutes and abs, so eager to help. They want to pitch in, to compensate for what has been lost.

Ashley hands me a daunting list of exercises, targeting my many neglected muscles. I consider walking away, canceling my next appointment, letting things continue as they are. After all, my symptoms aren’t so bad when you look at the spectrum of possibilities.

But I know my broken foundation, the bowl holding my vital parts, is what needs to be fixed. I know tears won’t stop rising up, trying to deliver a message I have swallowed for years, unless I keep the helpers at bay and focus my attention and time on the scar tissue—the confused, panicky parts of myself that have forgotten how to do their job.

As I walk to my car, the words echo in my mind: you have a birth injury. An injury I have been carrying for years, that reveals itself only quietly, in specific moments of uncontrolled humanity: a cough, a sneeze, an urge to dance with joy. I turn on my car and inhale. When I exhale, I lift.