The Head Game - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump: busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about - incontinence prolapse, pelvic pain. Problems that affect millions of women, one-in-three! I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child five years ago. And if you had told me then that I'd be speaking about this stuff out loud, I would have told you to give your head a wobble.

Helen

Hi, welcome to episode four. I don't quite know where to start with this because I find talking about my own thoughts and feelings around it almost as hard as talking about my vagina.

It's quite complicated, isn't it? It's hard to quite know what's what. But I mean everybody has their highs and lows in life. It's fair to say that the prolapse situation has at times been a low light for me. Other issues come and go, don't they? But this stuff is a bit of a constant presence, both physically and mentally, to different degrees, for different people.

Sometimes I wonder if for me it's more of a head game than anything else. That emotional toll of what feels like a broken body and losing your sense of who you are. If you can't dance around the kitchen like you used to, or chase your kids around on the beach, how can you feel healthy or strong if you don't trust your own body? How can you feel attractive when you're afraid to break a sweat and when your bits are in bits? These are some of the thoughts that have tripped me up in recent years, even though I know my symptoms are probably at the better end of the spectrum.

But I can honestly say I'm not in that place right now. I do dance around the kitchen. I recently chased my kids on the golden sands of a Spanish beach and it was so exhilarating, it was utterly freeing. And I'm finding sensible ways to get physically strong again and just move more. Gently. Gently. Baby steps. But it's happening.

And I've said it before, but sharing experiences with other women has really helped. I don't even know why that is exactly. It helps to take away a bit of the shame, maybe. You definitely feel less alone with it all, which...we all like to feel that. Everyone's situation is different. But I know that for many women, things can get pretty dark. And there's no doubt in my head that prolapse, incontinence, pelvic pain, they can all have a massive impact on your mental health.

I went down to that there, London, before lockdown, and I met up with a few people that you'll hear from in the coming weeks. One of them was Dr Rebecca Moore, who's a consultant perinatal psychiatrist and co-founder of Make Birth Better, which campaigns to raise awareness of birth trauma. So we met at her very chic clinic. It was all white walls and exposed brickwork and comfy sofas and plants. It was very cool. I could have happily told her my life story there and then...

Helen

Although I guess I'm going to spend a lot of the podcast in general talking about the physical impact and the symptoms that you can get from incontinence, prolapse, these kind of things, every woman I meet talks about the emotional toll and the mental impact of just feeling broken and losing the sense of who you thought you were, and who you feel like you'll never be again. Is that something that you hear a lot of?

Rebecca

Yeah, absolutely. I think it's not well discussed and, for every woman that I've ever sat with in that scenario, absolutely life changing in many, many ways. It's really difficult to talk about, I think, for people, because I think they often feel they can't share it with other mums or with friends or family. It can feel very shaming. And I think you're trying to negotiate not only being a new mum, but also this life changing sort of physical impact for you, and your whole sort of sense of self changes.

And most people that I sit with have got any one of a huge variety of mental health symptoms going on. Not necessarily a diagnosis, but they're struggling to make sense of what happened. They feel low, they feel anxious, they feel guilty, they feel angry, they feel distressed in lots of different ways. So I think it's really often missed and that we don't give women time and space to talk about how it feels to have these injuries, which I just think is crazy. Because if you're a 29 year old, 39 year old, whatever age you are a woman, and suddenly you're left with a prolapse or incontinence, and yet you're not expected to sort of talk about that, or voice that, it just is such a lonely, difficult place to be for so many women. So I'm always really passionate about, you know, allowing women to share all those kind of emotions, that it's okay to feel all of those things, and also that you can heal with the right support.

Helen

A couple of things you said there that I found really interesting. You referred to it as 'injuries', which gives me goosebumps a little bit, actually, because I think...even though it is a physical...I've never really thought about it as an injury before. I did have a third degree tear and I think a lot of people end up with pelvic floor problems after they have a difficult birth, but it's not necessarily that, that's the case. But yeah, so the idea that it's an injury, it almost validates it a little bit.

Rebecca

Yeah. And I think it's a wound in all different ways. It's a physical injury and it's a real wound to your sense of self. And I believe that it needs the utmost respect and proper treatment. So many women that I sit with have just been told that That's just what happens. You've just had a baby. Or it's been sort of silenced or missed, or they've just been told to go away and come back if it doesn't get better...and it's just not good enough. We wouldn't accept it with any other injury that we had. So I think we just need to be a lot more open about talking about these things, because they're happening for so many women.

And I think the more we talk about them, the less shame there is about it. We say, look, hang on, this is not okay, but it is something that lots of women experience. So this is what you should be demanding for your care and your treatment. It's not good enough just to be told to go away.

Helen

And I think that point as well about people finding it difficult to talk about and the stigma and the embarrassment and the shame and all of those things magnify the mental impact of it as well, because it's good to talk, isn't it? We know that. And if you can't, or you don't feel like it's almost a legitimate enough problem, if you're just told, this is childbirth, get on with it, then it is sort of going to fester, isn't it?

Rebecca

Yeah. And I think if you are suddenly incontinent or you can't control passing wind or you've got really terrible pain when you have sex, these are deeply personal and intimate things, and as a new mum, most of us won't necessarily have the luxury of having old friends around who have just given birth. So you might be trying to build friendships at the same time with people that you've perhaps done one antenatal class with. And if they're all sitting there having had an uncomplicated birth, it's very difficult and very courageous to be able to share what's happened for you. So I find most people just tend to not share and then, as you said, that is a place for sort of shame and to just fester away, really.

Helen

And when you see people, is it usually quite soon after or can it be years after?

Rebecca

I think it's really variable, so I think often for some people, it takes time to kind of process what's happened. And you're perhaps so in the early midst of just physically coping with this, that the thought of doing anything else is too much. So it can be years later for people, or you do get people perhaps where they're...I often get referrals from physiotherapists, who are really wonderful and doing this very expert piece of work with someone around their pelvic health, and clearly are realising that this is, you know, someone who's also really struggling. And so I will often get a lot of referrals in from physiotherapists.

Helen

I hear that a lot. And it was probably my experience as well that when you find a physiotherapist that you connect with, and maybe they've got more than the six minute appointment that your GP has. They become a bit of a counsellor as well.

Rebecca

Physios are absolutely amazing. And the ones working in women's health, I cannot praise them more highly. If it was up to me, I would have every woman see a pelvic physiotherapist as routine care, because it makes such a huge difference.

Helen

Definitely. One of the things I was going to ask you about is...giving birth, looking after a newborn, it's a crazy time, hormones are all over the place, we know about the baby blues...how do you know where the normal stuff ends and something more serious is going on in terms of mental health?

Rebecca

Yeah. So again, I think it is really difficult, it's difficult to tease out what's due to being exhausted, what's due to perhaps being lonely and not seeing anybody all day. And really it comes down to how often things are happening and the impact they're having. So we've all had a terrible day as a new mum where everything goes wrong, you cry all day or you feel angry and you smash everything and you know, it just...we've all, every single one of us have had that day as a new mum. But if that is happening every day for most of the day, for weeks and months, then it's starting to become something different. And that might be your mood is really low or you feel really anxious all the time, you can't get out the house, you can't sleep at all, even if baby's asleep, we feel angry all the time or you're kind of intrusively, worrying and thinking. So if that's happening most days, all the time for you, then I think that is something different to us all having bad days.

Helen

Obviously the things that we're talking about, incontinence, pelvic pain, prolapse, they can be improved over time, but in many cases it will be something that you have to sort of live with rather than something that can be cured. How do you manage your mental health over the long term, I suppose? Is it a case of you sort of start talking about it and then...I don't know, how do you...?

Rebecca

Well, I think it has to be a sort of bespoke treatment for each woman. So first of all, you've got to really hear her story from start to finish. And often nobody would have done that, so that might take 2 hours. And you hear it all, the good, the bad, the angry, you have to sit and hear that and really validate that for somebody. And then it's about really mapping out a plan for each woman. So yeah, you have to be realistic that I can't necessarily take away all of those physical symptoms, but there are so many things that you can do that will help you going forward.

So it might be that you have therapy so you have a space to process it and learn how to cope and learn some practical skills around just managing those feelings day to day. It might be that you want to take medication. If you've got a really severe depression, say, that's really impacting on you, then it might be that medication might help as well. It might be about working clearly with a physio as well. There might be dietary things you do, there might be supplements you take, there might be meditation, there's a whole host of different things. And I think what I feel is that we need to offer women all these choices. So it's not good enough to just say, here's a prescription, or go and self refer yourself for therapy and wait for seven months. You need to map out, look, there are all these individual things that actually, if you add them all in, can really ease things, not cure, always, but make things seem better. And I suppose the other thing is sort of really involving the partner as well, because I think often they get really missed out of this equation.

Helen

Really good point.

Rebecca

And there are invariably difficulties with sex, with intimacy, with relationships. There is a sort of another layer of stress and understandable worry. So we've got to get better at thinking about the whole family and how they need support, rather, and of course, mum, but the whole family matters as well.

Helen

And how good do you think we are in the UK at the moment? We know the NHS is just massively stretched, isn't it?

Rebecca

I think there are pockets of places that are absolutely astonishing, but most women, I think, would tell a story of not that good or patchy. So one bit might work really well, but not all. I think the difficulty for me is that I feel women are often left to kind of source and create their own treatment plan when they are struggling and tired and exhausted and low. And of course, then it's really hard to do that. So we should be leading that, we should be supporting women, not asking them to do that themselves. So I think a common story I hear is women being on waiting lists for a very long period of time, or not really fitting the remit for services and feeling it wasn't quite the treatment they wanted. Or women have ended up paying for things privately, which is hugely expensive, and not everybody can do that. So very variable, I think.

And I think it's really confusing for women, because sometimes they might be referred for physio, sometimes they see a urogynaecologist, it's not a sort of a uniform response. And even when women talk about having had an expert gynaecology review, I find that what each person has been told is very variable. So it just seems very chaotic I think for a lot of people.

Helen

It does sort of feel like an area of health where, as a member of the public, I had no understanding. I had never even heard of a prolapse before it happened to me. I already had a child by that point, by Caesarean section and the pelvic floor? I just barely knew what that was. It sort of feels like the whole of society almost needs to get better at this understanding, this stuff.

Rebecca

And I think that's where we at Make Birth Better would say this is about antenatal education. So actually, time and time again people say to me exactly that. I didn't know what a prolapse was, I didn't know how common it was, I didn't know the risks associated with a vaginal birth or a Caesarean birth or a forceps delivery. And why aren't we giving women this knowledge, this power? Because we should be. These are common things. You should not be having this happen without anybody discussing it. I had one woman who said to me, I did so much research, antenataly, because I wanted to feel really empowered and really in control. And I read all kinds of different sources of material and not once did I read about a prolapse.

And it's perfectly possible to discuss these things with women antenately without women being frightened. We are capable of knowing about these things, and actually knowing about it beforehand is often really, really helpful. And it might mean that you opt for a different choice of birth in the moment, but if you don't know, you're not making an informed choice.

Helen

And equally, it might mean that you care for yourself in a different manner immediately after. Because that's the other story that you hear of people who have damage for whatever reason to the pelvic floor and then come out and go and try and run a marathon or strain on the loo or pick a child or whatever it is. Yeah, I feel like it's not going to fix the problem entirely. But if you're better informed, it's got the help, isn't it?

Rebecca

Yeah. I mean, it was really interesting. I went to the MASIC conference last year, which is for mothers with anal sphincter injuries and lots of women with third and fourth degree tears, and somebody asked them exactly that question. Would you have wanted to know about tearing and prolapse beforehand? Do you think it would have made any difference? And all of them said yes, they would have wanted to know that it still would have been important to know and could have actually been really helpful to have known that this could happen.

Helen

Yeah. And the more we talk about it, the more we break down those stigmas, the more people just understand it, it becomes part of the language. We know how to ask for help and what's going on. Maybe then there's more of a focus on it and maybe we can find better solutions for it and all of that stuff.

I guess just thinking about women who might be listening to this, who are quite new to this whole experience, what advice would you have for them? Obviously, I wish I could bring them all here and sit them on that sofa next to you. How do they get to see you? What would you say to them?

Rebecca

Yeah, I think you have to be really courageous in that first step, don't you? Because you've got to let somebody know what's happening for you and that feels really scary. And lots of women never disclose these kind of things because they're worried that they'll be judged or seen as a bad mum or that their baby will be taken away from them. And I really want to try and reassure them that that is not the case, that the focus on anybody working in the perinatal field is about supporting you to be as well as possible.

So for most women in the UK, that's going to be with your GP, because that is the point of access for NHS services, for sure. Now, I know that can be very variable for women, that some GPS are wonderful, some are not. So it's about if you have a connection with a GP, great. If there's somebody in a surgery that you think has a perinatal focus or is listed as having an expertise in postnatal care, perhaps try and see them specifically, take somebody with you to advocate for you. If you can't say it, write it down and ask for a double appointment if you can, so you've got space to try and get it out, what you want to say. And although it can be really difficult, if you don't get the response you feel you deserve, go back, see somebody else, don't accept that as good enough. And I think that is the route for most women. Sometimes it might be a very good health visitor. You can self refer for therapy in many places, but again, it's very variable. There are often long waiting list. If you have the luxury of having health insurance or being able to pay for something privately, then clearly that means you can cherry pick your person that's a real expert in your area and can often see people a lot quicker. But for most people, it's the GP and I think you just have to really think about beforehand when you go in, what you're experiencing and what you want, and do not be afraid to ask for that. Do not be afraid to say, I really think I need some physio, or this is what I would like to happen, because that's not you being awkward, that is what you deserve.

Helen

And there is hope, isn't it? I mean, you must see women come in in bits and potentially leave in a much better place.

Rebecca

Yeah, I mean, I think the thing with all of these injuries is they take time. I wish they didn't for the woman going through it, but they do take some time to heal, I think, physically and mentally. And you have to be kind to yourself during that process. And small steps are still steps, so you have to be realistic because you're also trying to be a new mum and coping with sleep deprivation, but setting small goals, you will get better, but you need to be gentle with yourself in that process. And you really need somebody who's going to walk with you through it because there really is no substitute for that. And whether that be a professional or a family member or your partner, but they can constantly be checking in with you and seeing how things are, and just to know that there are 100 different ways to heal and you're entitled to pick the ones that feel right for you.

Helen

I love the idea. A whole range of ways to feel better and you have the right to choose. Try one thing, try another. And the point about pelvic floor dysfunction being an injury, I found really empowering. It's not failing. Maybe more like an unfortunate event, a setback, but not a total loss. I don't know. Lots to think about. If any of this resonates. I have tried to pull together a few links on my website that might be useful. So cheque that out. Make Birth Better is on there. You can also follow Rebecca on Instagram @drrebeccamoore

In the next episode, I'll be speaking to the kick ass writer Luce Brett, who's about to publish a book about her experience of incontinence. So listen out for that.

This podcast is not intended as medical advice, so please seek your own professional help and get involved. Subscribe - I love it when you tell me what you think -please spread the word, tell a friend or spam or WhatsApp group, write a review on itunes. Let's end the stigma. You've been listening to Why Mums Don't Jump with me, Helen Ledwick. You can find me on Instagram @whymumsdontjump or online at whymumsdontjump.com Bye for now.