In 2020. What does it mean to be female? To be a woman?
Our mother’s and grandmothers have bravely fought for our position in society. Whether it be to be educated, to vote, to work. The battle to stop abuse is still very much being fought as is the battle to be paid equally to our male colleagues. I am a grateful recipient of this monumental bravery and effort by the women who have come before me.
But I’ve noticed a problem.
We have been trying to value ourselves by emulating traditional male roles in society. And in doing so, have we devalued the traditional role of female’s? To grow life, birth life, sustain life, create strong homes for mental and physical foundations, to provide food and clean clothes, to create a community, a social network, to catch everyone when they fall, to pick up the pieces and rebuild. To provide constant love, support. To create and sustain a home.
I love that we have a choice. I have personally, as have almost all of my peers had the opportunity to choose our life. What I, and most of my friends have chosen though, is to (try) to do it all. Which has, inevitably left us feeling incredibly tired and guilty. Tired because it’s impossible, and guilty because it’s impossible to do everything well.
I wonder if instead of fiercely trying to prove our worth and value by taking on roles traditionally held by men - we instead had been able to shift community thinking to simply value the traditional role of women. To consider that in fact the main job in the household, and in life, is being done at home. That the support person is actually the person leaving the house to be paid.
I think we had/have to get attention by proving we have the brainpower, the ability, the guts to do anything a man can. We had to stamp our feet, wave our bra’s, go to war (sometimes literally), so we can now say - “Hey! We’re not second rate citizens because we are awesome at bringing life to the world and nurturing that life. Yes it’s an unpaid and therefore undervalued position in society, but we’re doing it not because we can’t do anything else but because it is The Most Important Job in The World!”
I guess I’m saying, maybe feminism needs to keep going, maybe the real goal of feminism is to come full circle. Not to try and be men, but to recognise that we are different - and that means we have to grow and birth and feed the next generation. Maybe the goal of feminism needs to be: To uphold the role of a woman as giver of life, nurturer of life and (if she chooses) home-maker and caregiver. That way, women really do have freedom. The freedom to choose, and be respected and valued for either choice.
And if the role of caregiver and homemaker is seen as The Most Important Job in the World, then maybe more men would try to do it, just like we’ve been desperately trying to do jobs outside the home. And maybe. . . that’s what equality looks like.
Come to get out
Come to get fit
Come to have company
Come to not sit
Come with your baby
Come with your mum
Come with your sister
Come to have fun
Come to be present
Come to work out
Come with hair done
Come with it out
Come when you’re psyched
Come when you’re mad
Come when you’re tired
Come when you’re sad
Come when you’re young
Come when you’re old
Come when you’re pregnant
Come to be bold
Come for a sweat
Come for a smile
Come for a sob
Come for awhile
Come as you are
It’s your time
By Kym x
Breastfeeding. We’ve done it since the dawn of time. And yet, before having a baby, we rarely stop to consider that it might be harder than it sounds! By the time we give birth we’ve heard from many well-meaning family members and health professionals that ‘breast is best’ and that ‘it is the biological norm’. So then, if we do encounter breastfeeding problems (like mastitis), it is easy to feel confused, guilty, overwhelmed or wonder ‘what is wrong with me?’
Please know that if you have/had mastitis you are not alone! In fact, mastitis affects up to 20% of breastfeeding women and occurs most commonly within the first six weeks after having a baby, but can occur at any time (Amir & Academy of Breastfeeding Medicine Protocol, 2014). Women who have had mastitis once are more likely to get it again, unless they receive the right help to correct the underlying causes. Unfortunately, women are often bombarded with conflicting information on how to best treat mastitis. And sadly, as a result women often feel that ceasing to breastfeed is the only realistic option they have.
As a physiotherapist working in the field of women’s health on both a maternity ward and in a private practice, I treat many women with mastitis. It is a miserable, horrible and overwhelming time for new mothers. And it is so important that you get the right information as soon as possible.
Here is some handy evidence-based info to get you started!
What is Mastitis?
Mastitis is inflammation of the breast (Amir & Academy of Breastfeeding Medicine Protocol, 2014). Milk ducts within the breast are designed for transporting breast milk, not for storing breast milk. Milk ducts are very easily squashed, so sometimes milk can cease to flow properly through the milk ducts due to factors like engorgement, blocked ducts etc. This results in milk products seeping from the milk ducts into the surrounding breast tissue. This causes a dramatic inflammatory response in the breast.
Inflammation is essentially your immune system’s response to a stimulus that your body has flagged as a potential threat to your health and wellbeing. Your body sends all kinds of immune cells (think of these as ‘soldier cells’) to the affected area to help fight the other cells that your body thinks are the bad guys. In the case of mastitis, the foreign milk products escaping into the breast tissue are registered as foreign and a potential threat, so your body creates an inflammatory response to fight them. This is why you may feel sick, may have a fever, pain, breast swelling and redness. Taking over-the-counter anti-inflammatory medication (such as Voltaren or Neurofen) is generally safe whilst breastfeeding and can effectively help reduce the inflammation. If you are able to catch mastitis early enough, and manage the inflammation well, usually mastitis can be effectively treated without requiring antibiotics. That’s great news!
(A note on infective mastitis: In some cases mastitis can be infective, but not in all. The only way of knowing whether it is infective or not, is if a milk culture is taken. As this is a time consuming process your doctor will normally decide whether or not to give you antibiotics based only on your clinical presentation. And whilst antibiotics will treat an underlying infection, they do not treat the inflammation associated with mastitis, nor do they correct the underlying factors that may have contributed to the development of mastitis. Therefore, it is important to address these other issues as well as taking antibiotics.)
Common symptoms of mastitis:
Common causes of mastitis:
Here are 5 important things you can do at the first sign of mastitis:
In summary, don’t suffer in silence! Pay attention to your breasts. Trust your intuition and listen to your body. If something doesn’t feel right seek help as soon as possible. There is plenty of help for mastitis and breastfeeding problems out there.
By Christel Weston.
Amir, L. H., & Academy of Breastfeeding Medicine Protocol, C. (2014). ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeed Med, 9(5), 239-243. doi:10.1089/bfm.2014.9984
Cooper, B. B., & Kowalsky, D. (2015). Physical Therapy Intervention for Treatment of Blocked Milk Ducts in Lactating Women. Journal of Womenʼs Health Physical Therapy, 39(3), 115-126. doi:10.1097/jwh.0000000000000037
Witt, A. M., Marinelli, K. A., Gill, S. L., Bolman, M., Kredit, S., & Vanic, A. (2015). Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. Journal of Human Lactation, 32(1), 123-131. doi:10.1177/0890334415619439
It was a funny realisation in the years following my youngest’s birth. I didn’t know if I wanted another baby. I had never thought about this decision much before. I truly thought I would either have an insatiable desire for another child, a feeling I wasn’t complete, or, the exact opposite. I finite feeling of completion, a resolute understanding that we’d made our family and weren’t going back for more.
What I didn’t expect was the uncertainty. Of all the feelings, that was the worst. How could I not know? Should I read into that that if I wasn’t sure, then the answer surely should be ‘no’? I mean, having a child is a huge decision and if you’re unsure, well that’s enough to say you shouldn’t, yeah?
But then, if you’re not sure that you’re done, well, that clearly means, you will regret not having had another child? A wise woman once said to me…”You’ll never regret having the child once they’re here, but you may regret not having them in years to come”.
But then I had two kids….and I felt many times over that I may regret the choice of going once again through that sleeplessness, those tantrums and looking squarely down the barrel of possible divorce a few times in the process.
My youngest has just turned 6, and when she turned 2, then 3, then 4, the conversation came up. Birthdays tend to focus this point for us. After long frank chats together, several weeks of independent contemplation, and lots of looking at other people’s babies and re-thinking the good and the bad. Each time, we came to a ‘no’. Then when she turned 5, then 6. We stopped bringing it up.
We occasionally drew up a list of pro’s and con’s. A ridiculous thing to do when making this decision, I would not recommend it. The list of con’s was stacked with immediate practicalities, financial decisions, holiday options. Then a few more touchy topics like ‘would we survive another dose of PND’, or what if our third has a disability and changes our lives as we know them much more completely then we are expecting? On the pro’s, it was one line:
‘I want one’.
How much weight do you give that statement? Well, I guess it depends.
And right there, in that awkward place of unknowing, risking, dreaming, dreading, is where we are left. In many ways, choosing to stop having babies is often a bigger decision then having them at all. Sure, there’s an argument that once you’ve got one, how many more you have doesn’t change your life as dramatically as the first. Which is probably true. But when do you stop? 1? 2? 3? More?
Some women describe certainty, and I envy them. But many other’s, I found, are like me. We talk a lot about this place we’ve found ourselves in. Refreshingly, everyone’s ‘it depends’ actually depend on the same few topics.
The decision is very black or white. Obviously. There’s no half in this decision whatsoever. So even if you don’t know, you have to sit on one side of the fence. I’ve chosen my side, and I’ve made a happy peace with it. But in many ways, it has been the biggest decision of my life. And I was so surprised I didn’t know. Because I thought I would.
Becoming a Mum, it's a rollercoaster. I didn't get it right, not every time. But I picked up a few good tips and here's the shortlist
1. When feeding, prepare your area before you snuggle in, it helps to have:
3. Wear long sleeve pyjama’s to bed even in summer, getting up to kids at night is tough, but so much worse when you know you’re going to be cold.
4. Always carry wipes. That is all.
5. Embrace the big scarf or the shawl. Not only a neat fashion accessory that can be a handy cover for those little vomit stains on your top, it’s so easy to wrap about you and bubs for some privacy during a breastfeed and double’s up as an extra blanket when you live in Melbourne and get four seasons in a day!
6. Make your goal for the first few months to ‘achieve nothing’. You and I know that in fact your achieving so many tiny miracles and laying down the foundations of a healthy, happy, balanced human. But in terms of your old life, this may feel like you’re making very little progress. Go with this new rhythm. Embrace it if you can.
7. When you get out of bed to feed your baby at night, cover your sleep area with the doona otherwise it will be cold when you return to your bed and you will lose precious minutes of rest while you try to get cosy again.
8. Find a village. Family, friends, mother’s groups, play groups, facebook mum tribes. You need people with babies and kids around the same age as yours. No one else has the stamina to discuss poo’s, sleep routines, details about your nipples and breasts, food refusal, teething, leaps and thunderclouds except those who are also in that moment. You need them. You may need to find them. Go forth.
9. Learn how to do a pelvic floor muscle contraction correctly and do your exercises. You wouldn’t stretch your hamstring 3 times it’s length and do no rehab for it. The benefits of a healthy pelvic floor are far reaching and have a huge impact on your quality of life.
10. Take a photo every day of your baby. A video if you can too. You simply cannot appreciate all the little expressions, dimples, giggles, even the tantrums and the mess. Sometimes taking a photo at the worst times helps you to realise that this too shall pass. It all passes, the good, the great and the terrible. And believe it or not, you’ll want to remember and smile, laugh or cry about it all.
Image By Mark Freeth. https://www.flickr.com/photos/freetheimage/14427500673
A Poem about vaginismus...
The Vagina’s are angry
Angry about respect
They’re closing in protest.
The vagina’s are angry
They don’t want to be plucked, shaved, or zapped
They don’t want to be douched, or scrubbed
They don’t want to be powdered and dried,
You don’t know it yet
But they’re closing in protest.
The vagina’s are angry
They don’t respond to threat’s
They don’t respond to pressure
You’re vagina hasn’t told you yet
But it’s closing in protest.
The vagina’s are angry
They’ve taken a stand
They’re screaming inside
And are not taking appointments
The vagina’s are angry
You may not have got the memo
Vagina’s are independent and strong
Communication is key, it’s a two way street
They’re closing in protest.
The vagina’s are angry
They want to feel safe.
They need to feel nourished
They respond to respect
They respond to appreciation
They respond, yes they respond.
The vagina’s are angry
But they don’t want to be
They are ready, willing and able
But they’ve been hurt and need care.
The vagina’s are angry
Let them breath, let them speak
Let them stand as they are
Let them not be conformed
The walls will come down
The screams will subside
They ask for respect
We all owe them that.
So this was exciting! But also probably the most nerve wracking thing I've done since jumping out of a plane!
Penny Johnston, has a program called Babytalk that is part of the ABC radio network. She invited me in to talk about getting back into exercise after having a baby. We discuss what happens physiologically to your body when you are pregnant and whilst you are recovering postpartum, and some of the challenges new mum's face getting back to exercise. Click the link below to have a listen!
I have a bone to pick with expectations.
I first learnt about them on a student exchange trip to France at the age of 17. It was meant to be “amazing”, a “once in a lifetime experience”. Instead it was lonely and difficult. I found myself in a world where I could not express myself and as a result became an outsider, that awkward person that hangs on to groups of people without contributing. I became depressed and felt guilty for squandering this “amazing” experience with my own genuine feelings.
I was so disappointed and let down by my experience and felt the blame lay squarely on my unrealistic expectations. This spurred a realisation for me.
Expectations can ruin an experience.
Not once in the lead-up to my 2 months abroad did anyone say to me: “you’ll feel really lost”. Instead it was “you’ll find yourself”. Well, I found more of my physical self as I made a daily trip to the patisserie to fill my emotional void with sugar coated almond croissants. But unfortunately, I had never felt more insignificant.
Yum! Image by Faruk Ates
Looking back, I still think it was a valuable experience, but it should have been just that…an experience, not “the time of my life”. I think that actually goes for most major events in life.
I had a similar experience following the birth of my first child, Lily. The most common question I was asked during my pregnancy was: “Are you excited?” After hearing this for the 20th time, my response was reactionary and immediate, I would break out the big smile, nod profusely and explain I couldn’t wait. And it was the truth.
But the effect of this question was like hypnosis for me. It solidified my subconscious thinking that parenthood was meant to be, and going to be ‘exciting’. Even if I may have read a chapter on settling, or listened to the antenatal session on juggling time in the post-natal period, these concepts were abstract and hard to tangibly imagine. The overwhelming emphasis from my world was that this was going to be the most exciting and rewarding journey of my life.
Then, diagnosed with post-natal depression when Lily was 6 months old, I was perplexed. This was meant to be exciting and rewarding. Why was I finding it so difficult? How is it, that millions of women have done this mothering caper the world over, and I feel it is beating me? I was young, healthy, fit, and educated. I had read the books and attended the classes. At my kinder graduation aged 5, my teacher proudly announced I wanted to be a mum when I grew up. BRING IT ON!!
The reality…you all know it, turn on the broken record. Tired beyond all scope of possible imaginings, feelings of defeatism as a tiny person up-ends your life and makes you feel inadequate, body changing issues, a feeling of distance with your partner, watching your friends go overseas and earn money and attend trendy wine tasting events.
I was expecting this:
But I was experiencing this:
I thought there was something wrong with me. Now I know, there wasn’t. My expectations were just so far from reality that I had lost before I had even begun.
I tried to keep up the performance of being on top of everything and “happy”. It was EXHAUSTING. But why did I do it? I’m still not entirely sure. Maybe because I didn’t want to let down everyone who was telling me how happy I should be. Maybe because people don’t want to visit you when your a vomit-stained, un-washed, teary mess who keeps falling asleep. Maybe because I thought I’d fool myself if I kept on the hamster wheel.
Did it work? Yeah, maybe. Sort of. Not really.
What did work? Talking. Well for me anyway. Mothers’ group was brilliant. 8 other mum’s right there in the trenches with me, sleep deprived, angry at our husbands, feeling like slaves to our 6 months olds. It was gold. We used to open a bottle of wine at 12.30PM and get it all off our chests. Then I had to talk to a psychologist for a bit as well. Similar issues, less wine and more expensive; but also very helpful.
Should 1 in 7 mums experience post-natal depression? It seems wrong to me. So, I find myself asking, what are we doing as a culture, as a society that makes this feeling of defeatism and sadness so profoundly common in new mums?
Unrealistic expectations are playing their part.
Unrealistic expectations of happiness, of fulfilment, of love, of connection with your partner, of physical recovery. And unrealistic expectations and understanding of the enormity and loneliness of the mother workload.
So, as a community can we moderate this expectation? I think we can. It’s not about bringing all pregnant women down and telling them depressing stories about motherhood. But let’s just say it how it is. There are high’s and there are low’s. Let’s ask open ended questions to pregnant or new mums such as “How are you feeling about becoming a mum?” to allow them to express themselves, rather than ramming pre-packaged emotions into their psyche.
None of this is to say it’s not worth it. And for goodness sake, share your lovely stories about your children too. But don’t sugar coat parenthood. Don’t watch too many nappy ads that make being a mother look like running through an immaculate house in white pants while your perfectly clean child giggles constantly. Sure, there is the odd moment like that (FYI: you’re mad if you wear white anything as a mum, and my house has never been immaculate since becoming a parent) but the bare bottomed giggles and the cuddles do happen, and are awesome!
As a community and society, let’s help to put expecting parents in a frame of mind that acknowledges the road into parenthood not as “the time of your life” but for what it is, an experience.
Do you wee more than every 2 hours? Do you wake up overnight to wee? Do you make sure you go to the toilet before you leave the house? Do you rush to the toilet as soon as you get in the door?
If you answered yes to any of the above questions, you are not using your bladder correctly, and you could be setting yourself up for conditions such as:
The bladder’s job is to fill, store and then empty urine. The bladder is a muscle, called the detrusor muscle. Which means it’s really good at stretching, then forcefully contracting and rebounding to it’s normal shape. And it does this over and over and over, every day of our lives. Within the wall of the bladder, there are baroreceptors, or ‘pressure receptors’ that feedback information to our brain about how the bladder is filling. Once these messages get loud enough, they come to our conscious attention, and we get the urge to go to the toilet. Once on the toilet, our brain sends a message to the bladder to contract, and the bladder muscle squeezes all our urine out.
Sounds simple right?
And it can be. But the bladder muscle, like every muscle in our body, contracts best within a certain range of motion. Or, in the case of the bladder, within a certain volume of urine. So, why do we care if our bladder is, or isn’t contracting at it’s best?
If the bladder is not filled enough, then the detrusor muscle is unable to generate sufficient force to expel all the urine, and we can experience; poor urine flow, increased post-void residual (the amount of urine left in the bladder after emptying), urinary frequency, and increased risk of urinary tract infections.
Additionally, over time, if the bladder is never allowed to fill up and stretch, the detrusor muscle becomes stiff and can become unable to hold decent urine volumes. This can progress to symptoms such as urinary urgency, urinary frequency, nocturia (waking more than once per night to urinate), and urinary urge incontinence.
Now, don’t get too carried away on the big wee’s, bigger is not always better. If you repeatedly over-stretch your bladder muscle, you end up with lazy pressure receptors that forget to send your brain the message that your bladder is filling. Also, your bladder ends up looking like a deflated balloon and this also can result in poor urine flow, poor emptying and urinary urgency.
So, hopefully now you are asking “What is this magic volume that I need to be wee-ing at every toilet stop?” Drum roll please…..Optimal bladder habits are as follows:
250-500mls per wee
5-6 wee’s per day
0-1 wee per night.
So, how do you find out if this is what you are doing? Grab yourself a measuring device (preferably a dedicated one you have purchased for the task, and not the kitchen measuring cup), measure and write down your wee’s for at least a 24hour period. If you fall within the above range, give yourself a pat on the back (or bladder) and move on. If not, make the time to speak to a continence professional such as a urologist, continence physiotherapist or continence nurse and find out what is causing your less than optimal bladder habits, and how to fix them. Unfortunately, we know that poor bladder habits or urinary symptoms such as urgency, frequency and incontinence get worse over time unless they are treated. So seek treatment sooner rather than later.
She came from my being.
Started as a seed, always there. Never apart.
Her number was chosen, she won and thrived;
My bread was her bread, my lungs, her air.
She was me. There was no divide.
My rhythm was her lullaby.
We became an alien, a two headed, strong willed force of nature.
She came with a purpose, perfect from the start.
She breathed her own oxygen and her blood pumped red.
I didn’t think twice when they cut her physical bond to me. It didn’t even bleed a tear.
We smiled. Why didn’t I mourn that more?
She did not recognise herself, rather knew herself only in relation to me.
Without my body, my scent, my sounds; she was lost.
My milk sustained and nourished her. She grew fat on it.
She was physically, completely a product of my body.
I was her world. It came with responsibilities;
some of which were terrifically, physically, emotionally challenging.
Others that were utter gluttony in their delight.
And all she wanted was me, we were so wrapped in each other,
We may as well have been one and the same. And we were.
She took food from a spoon and I mourned a little loss,
Gone was the monopoly I had on her creation.
She carried on the job of children; to grow and learn and become.
Become a personality, an individual, an identity, a person.
She found her voice, a beautiful husky utterance that I recognised as my own.
We watched her stumble out her first steps and babble out her first words.
Steps became skips and words became songs.
She was blooming. And so was our love.
And all this time, she had been observing,
Drinking in language, gestures, concepts.
Lapping up information and gathering opinions.
Lots of them mine, but then, a word I do not say, or a gesture that is foreign.
There is a dart of panic. A loss of control. An extension of the cord
Now she is at school. Now the tables have turned.
I am here for food, for clothes, for transport, for sleep.
But there are many hours and many teachers and many friends, shaping my baby.
This walking, talking, running, jumping, skipping, thinking, writing, reading; baby of my body.
Then there are the moments before dawn, a little tip toe down the hall
There is a soft little voice and hand and she is curled in my body once again.
Later, she will make her breakfast, dress herself, and run with friends
But in this moment, rarer by the day, she has come home to rest.
She is beautiful and she is mine.
But when did she become apart from me?
I will never know. And I will not hold her back.
Though she may travel far and wide,
She is my baby of my body, and always she will be.
Hi! Welcome to The Blog!
Please be aware, Womankind Physiotherapy's blog is not intended to replace information and advice from your health care provider. For specific concerns regarding your health you must seek individualised care by your preferred provider.