What France Prescribes and Japan Does Not

A woman gives birth in France and, some weeks later, receives a prescription for pelvic-floor rehabilitation: a course of sessions with a physiotherapist or midwife, reimbursed, offered as a matter of routine to essentially everyone. It is so ordinary there that women discuss it the way they discuss a dental cleaning.

A woman gives birth in Japan and receives a one-month check, at which the baby is examined thoroughly and she is asked how she is. After that, for most women, there is nothing. The difference between those two countries is not biological, and it is not that one of them cares more. It is that one health system classified the pelvic floor as a muscle group that has just undergone a traumatic event, and the other classified what follows as a fact of life.

Describe it in the language used for any other injury and the neglect becomes obvious. A sheet of muscle has been stretched to several times its resting length over hours. It may have torn, or been cut. Connective tissue and fascia through the abdomen have been progressively loaded for months and then abruptly unloaded. Nerves have been compressed. The rib cage, the diaphragm and the breathing pattern have all been displaced and have not automatically returned.

Any of that happening to a shoulder would produce a referral, a plan and a course of treatment. Happening here, it produces the sentence everyone has heard: it is normal after a baby. Leaking when she sneezes is common; common is not the same word as normal, and it is certainly not the same word as untreatable. Pelvic floor muscle training has some of the strongest trial evidence in conservative medicine for exactly this, and the evidence has been strong for decades.

Pain with sex after childbirth is extremely common and very often persistent, and it is one of the most consistently misattributed symptoms in the whole field. It gets explained as tiredness, as low mood, as the relationship having changed, as her not being interested any more.

A large share of it is mechanical. Scar tissue that has healed short and tight. Muscles that have learned to guard and will not release on request. Tissue changes driven by the hormonal state of breastfeeding, which produces dryness that has nothing whatever to do with desire and which responds to the same simple measures dryness always responds to. These are things a pelvic health physiotherapist and a 婦人科 treat as routine.

The cost of getting this wrong is not only physical, and this is the part that deserves to be said slowly. Picture two people lying in the dark, a few feet apart, not speaking. She is thinking: something is wrong with me, and if I say it out loud it becomes real, and he will think I am broken. He is thinking: she does not want me any more, and I am not allowed to ask twice. Both of them are wrong. The actual answer is a band of scar tissue that healed a centimetre too tight, and it is treatable in six weeks by somebody whose entire job this is. They will not find that out, because the one sentence that would unlock it is the one sentence neither of them can say. Marriages have ended in that silence — not over anything either person did, but over a mechanical fact nobody was ever given the words for.

The gap is real but it is not total, and the most useful thing on this page is a service a great many women do not know exists in their own city. 産後ケア事業 is now a duty of municipalities under the amended 母子保健法. It comes in three formats — a short stay, a day visit, and a visit to the home — and it is subsidised, often heavily. It exists to give a new mother rest, feeding support, and someone to ask.

It is chronically under-used, and the reason is almost never cost. It is that using it feels like admitting to not managing. Which is the same 我慢 mechanism arriving at the single worst possible moment — a woman at eight weeks, not sleeping, declining a subsidised service designed precisely for her, in order to avoid appearing to need it.

Two other things worth knowing. 産後うつ affects roughly one in ten new mothers, is a medical condition rather than a failure of feeling, and has treatment that works — the one-month check now routinely screens for it, and an honest answer there is worth more than a composed one. And if no local pelvic physiotherapy is available, asking the 婦人科 directly about 骨盤底筋 and about scar tissue by name will get further than describing a general sense of not being right.

There is a second thing happening alongside the tissue, and it is not medical. For a year or more the body has been handled constantly and almost never on its own account: examined, measured, fed from, climbed on, woken. It has been useful without interruption. A great many women describe emerging from that stretch feeling not injured but vacated — as though the body were equipment they administer rather than somewhere they live.

The repair for that is not more effort. It is contact that asks for nothing — touch with no feeding, no examining and no outcome attached, in which the only question being answered is what she notices. That capacity comes back reliably and faster than most women expect, but it does not come back by being waited for, and it does not come back during a task.

Moonlight does not treat pelvic floors, scar tissue, incontinence or postnatal depression, and would be doing real harm by implying otherwise. Those belong to a 婦人科, to pelvic health physiotherapy, and to a municipal 産後ケア service. Saying which door a thing belongs behind is not this house deflecting. It is the part of the work that protects you.

What is inside this house’s boundary is the last section and only that: unhurried attention to a body that has spent a long time being useful, with nothing asked of it. Not before the medical questions are answered — alongside them, or after, and never instead.

A French woman and a Japanese woman go through the same enormous event, and one of them is handed a rehabilitation plan and the other is handed a leaflet about the baby. Everything downstream of that — whether she leaks at forty, whether sex hurts at thirty-five, whether she spends a decade quietly believing her body simply stopped working properly — follows from a decision taken by a health system, in a meeting, years before she was in the room. Your body did not fail. It was not offered the aftercare that the same body would have been given three thousand miles away, and then it was asked to be grateful. That is worth knowing on its own, because it takes a verdict about you and turns it back into a gap in provision — and a gap in provision is something any woman can walk around, the moment somebody finally tells her it is there.