Informed Consent After Birth

You can do everything “right” and still feel blindsided after birth. That’s the heart of today’s conversation: why so many moms reach the postpartum months and think, I wish I would have known, and how that gap in education can quietly break trust in the healthcare system.

We talk about informed consent in pregnancy and postpartum through a pelvic health lens, including what changes are expected after vaginal delivery, what can shift with pushing, and why interventions like tearing, episiotomy, vacuum, or forceps may affect pelvic floor recovery. We also name the uncomfortable truth that many people are led to believe their body will return to exact pre-pregnancy function, when reality is more nuanced. This is not about doom or blame. It’s about realistic expectations, better preparation, and clear options, including what pelvic floor physical therapy can support during postpartum recovery and return to exercise.

A big thread is communication: how do clinicians discuss risk, pelvic organ prolapse, and symptom monitoring without accidentally creating fear, pain sensitization, or kinesiophobia? I share a personal story about blood pressure anxiety and “white coat hypertension” to show how the way we talk about health can shape how the body responds. We also zoom out to the bigger system, including how new pelvic floor research takes time to reach everyday care, and why proactive preconception education could change everything for active moms and athletes.

If this resonates, subscribe for more evidence-informed conversations on exercise during pregnancy, postpartum rehab, and pelvic health, then share this with a friend who deserved clearer answers. After you listen, leave a review and tell us: what did you wish someone had explained before birth?

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Transcript

Welcome And Medical Disclaimer

SPEAKER_00 0:07

Hello everyone and welcome to the Farma Moments podcast. My name is Christina Fleming. I'm a public former physical therapist, researcher, and exercise and pregnancy and a mom of two who have competed in constant high-listing or weaklisting, pregnant post-part, or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise. Whether you're a recreational exerciser or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey. We're going to talk about fertility, pregnancy, and post-partism topics that are relevant to the active individual. While I am a public floor physical therapist, I am not your public floor physical therapist, and know that this podcast does not substitute medical advice. Alright, come along for this journey with us while we navigate motherhood together. And I can't wait to get to it. Hello

The Post That Sparked Debate

SPEAKER_00 1:08

everyone, and welcome to the Marvell Mamas podcast. Christina Brevitt here. And today I wanted to talk about a post that I had put up on my personal social media talking about informed consent and discussions around the awareness of the way that your body was going to change in pregnancy and postpartum, whether you had a vaginal delivery or a cesarean. This is a very charged topic. And so I am going to do my best to do this justice. But I do want to disclose at the very beginning that communication is hard. Scientific communication is hard. Catering a conversation to a very sometimes triggering conversation is not perfect. And I am not perfect. Therefore, I'm going to try and do my best to portray these sensitive topics well and hopefully correctly and to not make anyone feel dismissed, unheard, or to minimize your experiences in any way. And so I just really hope that I do an okay job here. If I am not perfect, I apologize. I this is an area that I am actively investigating and very interested in exploring, both from a research perspective and from a clinician perspective. But I'm going to try and do my best. Now, one of the things that I had posted, I said, knowing what you know now, right? Postpartum, your recovery, kind of transitioning into motherhood, all of these things, would you have done anything differently? Or is there something you wish you would have known? And it was very interesting because there was a huge swing of responses from fairly benign, like I kind of wish I would have done more of this, to very heated discussions around the way that our healthcare system is set up and feeling deceived by providers. Um, there was one um clinician in particular who focuses a lot on um very complex, persistent uh prolapse conversations that had many of her members, like she asked her members to respond. And so there was a lot of emotional, charging, like emotionally charged conversations and sometimes disagreements. Um, and it was just kind of interesting

Expected Body Changes After Birth

SPEAKER_00 4:01

overall. One of the things that I have talked about a lot on this podcast, and the reason honestly why this podcast exists is because I believe that many individuals don't really have an idea about how their body is going to change, or there is not an understanding of how your body changes in pregnancy and postpartum, the risks for things like pelvic flora dysfunction in the postpartum period, the variability in injury expectation and experience for many women in the postpartum period and in their recovery. And one of the things that one of the big themes that came up, I think, in all of these conversations around what would you do differently was I wish I would have known. Or I would have made different decisions. Would information have been presented to me differently? Or I even asked my healthcare provider, saying this was my goal postpartum, and they belittled the impact of this delivery for me, and it permanently changed my life. And I think that piece, first and foremost, as kind of the first thing that we talk about, is incredibly important. I have talked on this podcast and done full podcast episodes on expected changes and recovery arcs with both vaginal and cesarean delivery, with the asterisk sign of that there is a lot of variability in what happens during labor and delivery. And many times it is quite uncertain how your recovery is gonna go. And there are kind of specific factors to you that are going to change your recovery experience, right? For example, we do know that during pregnancy, your urethra, the hose that attaches your bladder to the outside of your body, increases in the amount of movement that it has. And if you have a vaginal delivery, some of those changes are permanent. That is an expected change. If you have a vaginal delivery or you have done any type of pushing, then vaginal wall range of motion changes are expected. Your opening of your vagina increases throughout pregnancy and then gets stretched during labor and delivery. And you will see some recovery, but we do not see recovery to a hundred percent of what you were pre-conception. And with tearing, and if an epesiotomy or instrument like forceps or vacuum delivery occur in your instance, then the risk to the pelvic floor is higher, where you can have tears in those muscles and more difficulty with your recovery. Your recovery can take a little bit longer because there is more structural damage there, for example, with vaginal delivery. Now, I will admit, and this is something that I have tried to change, at least for people who are seeing me, many women aren't told that. They do know, right, and intuitively, that baby stretches through those muscles of the pelvic floor and there is a recovery process. But I feel like the individuals who have the more extreme, I don't want to say extreme, but more traumatic, more high on the intervention, like vacuum, forceps, psiotomy, and higher degrees of perennial tearing, they are often not told that this could be their recovery until they are being educated on what their recovery is going to look like after it has already happened. And there

Fear, Language, And Prolapse Talk

SPEAKER_00 8:11

was a large cohort of people who are in that bucket who have those changes in their vaginal walls that came with a lot of symptoms of heaviness. And that's those symptoms created a lot of bother to that human, which was affecting their quality of life, their body image, and their mental health in their postpartum recovery. And there was a very big theme of, you know, they they tell us that there's a stretch to the pelvic floor, but they don't tell us like what those worst case scenarios can be and what that might look like from a recovery perspective. And if I would have known, I would have opted for an elective cesarean. Right. And then there was C-section moms who had a really hard time recovering, being like, I wouldn't have chosen a C-section and I was kind of forced into a C-section. And so there was a lot of discussion back and forth about what's the better option or what's the worst option. And I think what it comes down to though is that many women felt like they did not get the education that was important to them in the time where they could have made a decision. And subsequently, that decision was stripped away from them. And then three, um, there was a smaller minority, but people who felt misled that they specifically asked their physician and the physician downplayed the vaginal recovery piece and really pushed away from the cesarean delivery when they were kind of speaking to what their desires and things were for their recovery. And, you know, and some people were talking about how some of that is really guided or dictated by the number of c-sections in a hospital being really um seen as a negative health outcome, you know, where individuals will sometimes opt away from a hospital that has a high C-section rate where this is, you know, published, this is published information that the public can take a look at. And so I think this kind of creates this really interesting conversation around how do we have informed conversations? When is the appropriate time for us to have those conversations? And how do we talk about the breadth of experience that individuals can have in a way that doesn't create pain sensitization, et cetera, that can that can also occur, or kinesiophobia or fear around exercise, labor, and delivery, et cetera. And when I said, you know, we we have this sensitization that occurs, um, I was met with a lot of pushback because people were saying that, you know, I was not allowing moms to make their own decisions, et cetera. And I didn't mean it that way. Um, and this is where I feel like I have a hard time communicating because I don't feel like um that maybe I'm saying this in a right way, or people are feeling dismissive when I am saying this. But one of the things that has helped my clients tremendously is understanding what your body is going to feel like in the postpartum period as an expected management and saying that in a way of like, hey, these are the structural changes that in pregnancy that we will expect postpartum. And then, you know, if there are more severe symptoms or things like that, or something goes awry in your delivery, then, you know, that might change our timelines a little bit. Um, I have been playing around a lot with that delivery so that we are not sensitizing the pelvis as well. Because, like, for example, I had a person who was in my DMs who was saying to me, my pelvic physio said that my bicep curl workout at two weeks postpartum was what caused my grade one prolapse. And now, you know, she's thinking about not having more kids, et cetera. Um, where she was in a very kind of normal postpartum recovery trajectory. And that communication of those changes um led to a heightened awareness where she was really in a uh quote unquote normal recovery window. And would her recovery have been different if the way that that was communicated was different? And so the response from um Kim, who runs Wild Mattressines, matres, um, who is wonderful, one of the things that she said, which I think is a very important point, was you know, we talk about not wanting to create fear, but we don't talk about how to have these conversations in a way that doesn't instill fear. And I think that is such an important point and something that I uh one, I still struggle with. Like I want to have these conversations in a way that is helpful, informed, transparent, right? And acknowledges the vast range that pregnancy and postpartum can go. I want my obstetrical colleagues to have the same thing. But I think it also has to be acknowledged, and she is right, that our system is not created in a way, and there is a not a lot of attention paid in many settings to the way that health information is communicated. And the what is communicated is often the check

A Blood Pressure Story About Anxiety

SPEAKER_00 13:41

mark on the list and how that is communicated, the skills required in healthcare communication is not heavily prioritized. And when that is the case, right, we can have these instances where failure to communicate leaves this experience of deceit or lying through a mission that, you know, in hindsight for many people feels very um, very damaging. And so I think this is a really important component. And, you know, Kim is in the mental health side of things, and she is now doing her postdoc in maternal mental health outcomes and its relation to pelvic flora and birth-related injury. And it's that connection, that multidisciplinary team that I think is also highlighted because her skill set is in communicating these things well and understanding that communication, the impact of that lack of communication on health outcomes. Um, but that isn't something that's prioritized in pelvic health therapy, for example. That's not something I think that is prioritizing, and you all can correct me if I'm wrong in midwifery or in obstetrics. Like I remember with my delivery, my first delivery, I was always on the fence with my blood pressure. And I truly believe that being as active as I was really helped me not flip into pre-E. But I was always kind of on the fence. And, you know, have not having hypertension at all with my second pregnancy and knowing and feeling the difference in my own body, I think I always was a little bit on the high blood pressure side. Every time I went into my obstetrician, I felt like there was a microscope on me. And they were like, Are you gonna, do I need to pull you? Like, you know, there was this hypervigilance, which on one side I really appreciate, right? Because I know the outcomes, like the negative health outcomes of gestational hyperatension and pre-eclampsia. But on the second time, it really scared me and it stressed me out and it made my blood pressure worse because I would come in. And now I legitimately have white coat hypertension. And so I feel myself stressing out and I feel my blood pressure rising. And I remember with Quinn, COVID was almost a good thing because I did a lot of um self-monitoring of my blood pressure at home. And so if I was a little bit high in the clinic, I would show my journals and diaries to my providers because I just knew in my soul that I was not hypertensive. It was absolutely situation dependent. And I ended up, you know, having no problems with him with my blood pressure in my subsequent pregnancy. And so that is a scenario, right? Not an extreme scenario by any means, but one where the way and method in which people are communicating in an attempt to be diligent created fear and discomfort and stress and anxiety for me that it has long-lasting consequences, right? So um it's really hard, right?

Why Preconception Education Matters

SPEAKER_00 16:41

It's really hard. There is this kind of discussion around where education happens and who that responsibility falls on, right? Because when you are already pregnant, right, um there's this emotionally charged piece on the side of the person who is having these conversations. But really, a lot of this conversation or like, you know, how your body is going to change ideally starts in the preconception window. When you are already pregnant and you're making the decision between a vaginal delivery with a potential pelvic floor injury or a major abdominal surgery that does have its own set of complications, um there, you know, there's a lot of discussion, I think, um that needs to be had about where sources of information are. Many people end up going to social media, which, you know, there are pros and cons to that. But many individuals, they don't really think about it. They think about wanting to have a baby. And the rest of it is reactionary or secondary to the I want to get pregnant conversation. And so, you know, there are people talking about the system, which I think is important. Like we have a reactionary system, we don't have a proactive system. And, you know, some people were saying that the failure to disclose had paternalistic undertones and is is rooted in the patriarchy. I I don't I don't know, and I don't really have the education or experience to dive into that arena and realm. I do know that we are learning a lot more about the significance of pelvic floor-related injury in the last 10 years, um, where we now have better imaging on MRI. We have a lot more longitudinal pre-post preconception in pregnancy postpartum. We are in the last five years, we have gotten a lot more information around changes in vaginal wall range of motion and pelvic floor defect in subsequent pregnancies and second and third pregnancies. The bulk of our literature had been in the first pregnancy. And now we're looking at interpregnancy windows in pelvic floor recovery when you have a shorter interpregnancy window versus a longer interpregnancy window. And so some of this, I do believe, and I do not mean to say or dismiss people's thoughts or emotions about this, but some of it is just that we are learning so much more about the pelvic floor part of recovery. And it was just never prioritized because maternal and fetal safety was such a huge priority for so long that keeping mom and baby alive was was really a big goal in midwife free and obstetrical care for so long. Um and as we are starting to learn more, as we are having more women advocating for themselves, there's been a change in our literature. And, you know, what we say is like a long time, like this research has been for a long time here for a long time. You know, when some of our KT gaps, our knowledge translation gaps are in the 15 to 16 years, um, getting that information to providers when it is not commonly known in academic circles is a very tangible barrier and something that I feel very passionate about trying to fix as somebody who is in the research space and in the provider space. And so this acknowledgement around I wish I would have known, I think there is an education opportunity for our OB providers and our pelvic floor physical therapists, anybody who's working with individuals in the pregnant and postpartum space or exercise professionals. And I think the understanding of these conversations is important to drive changes in education. Well, there whether this is like a delayed conversation or not, it is kind of interesting, right? And we we do want to make sure that these voices are being heard, that we are, you know, using evidence-informed care frameworks and understanding where the gaps are in our birth space education and trying to fill them so that moms feel like they are able to make informed consent decisions. But, you know, um, some of my research is looking at pelvic floor dysfunction in exercise and pregnancy. And so I have a lot of awareness of the literature around pelvic floor dysfunction in the birth and obstetrical spaces. And the density of that research is very minor, and a majority of it has been in the last eight years. And

Research Gaps And System Barriers

SPEAKER_00 21:11

so I do want to acknowledge that yes, we have a systems-related problem. Yes, we do have a failure to communicate or informed consent piece. Um, and we need to have a lot more obstetricians who are having conversations about, hey, this is how your body is changing. Because I do not think that that is prioritized as much because so much of our pregnancy care is making sure that mom and baby are not in a complication transition, right? That has been the central focus. And there is a call from outside the in the clinical postpartum space to make sure that that education is provided. And so an awareness for obstetrical providers is needed. And then the emphasis then is going to be on how health and science information is communicated. And I think that is something that is a huge need in all of healthcare. Right. We call it in my geriatric space pre-traumatic stress disorder, where oftentimes the oh my gosh, oh my gosh, don't fall or don't hurt yourself in the older adult space actually creates a lot of fear and anxiety. And fear of falling is it's in and of itself its own risk factor. And so there is something to be said about the intense pre-education and what that does to a person's sense of self and sense of safety. And so while I agree on some areas, I disagree on others that I think it is really important that how this is communicated is really well thought out in order to have an informed consent conversation that that uses maybe neutral language. I don't know if that's the answer. And this is where I feel like I'm in muddy water and I and I want to be so careful with how I'm expressing myself, but that I think it is important, right? And then the acknowledgement of who that education comes from. Because, and I say this with all respect, like I know more about pelvic floor dysfunction and rehab from pelvic floor dysfunction than most obstetrical providers, right? And and again, I don't say this with negativity. I say this as somebody who just rehabs the pelvic flora out all the time. And where, you know, our OB teams can help with, you know, um, they're looking at fetal monitoring, all this kind of stuff, all those things I know nothing about. And that is not my expertise. I'm not going there. Um, when it comes into the muscoskeletal domain, right, like I don't know how much of a priority that education is. I'm not sure, right? Especially like the OB versus urology type of domain. And so understanding what the level of education is on the sense of the provider, um, and then working to fill in those gaps, I think is another important piece. And so I've been talking for 22 minutes about this. Um, and I I don't want to be going around in circles and I don't want to be trying to say the same thing over and over and over again in an attempt to not um step on anybody's toes or make people feel like I'm being dismissive of their complaints because I really am not trying to do that. Um, but it is interesting because I tried to open up this conversation and when I started to respond, I felt like people started to attack me on it. And it was just to try and put a different perspective or like ask further clarifying questions. And um, I think that speaks to the emotional nature of motherhood and that motherhood transition, um, where a sense of um unmet expectation or the I wish I would have known isms or the hindsight being 2020 um can really create a lot of conflict and uncertainty in our moms, especially when they went in with one belief system and that belief system was challenged. Um I think that there is a lot of people who are really not told or they are made to believe that with appropriate rehab and recovery, that their body is going to feel the exact same pre

Resetting Expectations And Closing Thoughts

SPEAKER_00 25:11

or post-baby as it did pre-baby, that with the right things and making the right decisions, that your body is going to feel exactly the way that it did preconception. And that's just simply not true. And I think that's where if I had to break it down to one theme, that mismatch of expectations and that feeling of a gap in knowledge that was only filled in when it was already present versus, you know, having the education that there were some preventative pieces or that there was a lot that could be said that could prevent or or change what that recovery arc looked like. When that gap existed, a lot of emotional sensitization, like mental health concern really popped into that comment section. And so I will continue to try and show up as best as I can. I really do want to have a reflective practice and, you know, sometimes check my bias and where my bias is and make sure that I am portraying information in a way that does due diligence to the wide breadth of experiences of mom and pregnancy and postpartum. Um, and I'm gonna continue trying to fill that gap. You know, one of the things that I say, and I say it lightheartedly is like, you know, we expect our bellies to change in pregnancy and we expect our boobs to change with nursing, but we expect our vagina to go back to factory settings after pregnancy. And some of that is just simply not true. And I think that awareness and knowing of that awareness um it is really pivotal and really important. All right, let me know what your thoughts are. Cannot wait to have more of these discussions. I I hope I did my due diligence in how I was discussing this. I do want to be sensitive. This is a very sensitive topic, and I am very aware of that. Thank you all so much for sharing your experiences on that post. I think it was so important, and I cannot wait to chat more.

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Bye.