The Birth Debrief, with Illiyin Morrison - 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. And if you had told me back then that I would be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hello. How are you bits? I hope you're doing well. Did you hear last week's episode yet? There have been some lovely responses about 'Erica's Story'. She speaks so brilliantly about bowel incontinence and her struggle to get support after a birth injury, but it's such a positive and hopeful episode as well. Women have told me how they needed to hear it, how they feel seen by it, or less alone. I personally love this idea that came out, that even when things are hard, we can at least take ownership of our own story. There is a power in that. So if you missed it, listen back. It's a good one.

Why Mums Don't Jump is sponsored by iMEDicare - Pelvic Health Naturally. IMEDicare provides devices or products for pelvic health that are safe and easy to use, helping you to manage your symptoms while you're on the way to recovery. Products like Lumana activewear - fitness leggings and running shorts that have absorbent underwear built-in, for protection from leaks. Whether that's wee or sweat or period blood or discharge. And the leggings have a phone pocket, which is music to my ears. You can find Lumana via the affiliate shop on the Why Mums Don't Jump website, where you'll also find a discount code. Thanks to the team at iMEDicare.

This week then - it turns out when you open up conversations about pelvic floor issues, like we do on this podcast, you can't escape the fact that a lot of women don't get the birth they wanted or signed up for. Severe tears, instrumental births...are something we hear a lot about. Obviously not the only reason women end up with pelvic floor issues, but a major factor.

And if you're injured or are left feeling traumatised, distressed or anxious by a difficult birth, or by any other challenges in the perinatal period, for that matter, it can have a lasting impact. If that's you, you might be offered something called a birth debrief, which is a service provided by some NHS hospitals where you can talk through your experience, usually with a midwife. You can go through your maternity notes and you can ask questions.

Alternatively, you can find an independent practitioner, someone like Illiyin Morrison. Illiyin is a birth trauma specialist midwife who offers a birth debriefing service. She's a mother of two. You might know her from Instagram as @mixing.up.motherhood. And she's an author. Her book, the Birth Debrief, came out last year. It's beautifully written, very relatable and something to consider if you need to reflect on your pregnancy, birth and everything that happened after. We sat down to chat about picking up the pieces after a traumatic birth, about birth debriefs and when they might be useful.

Side note: as ever, I am not a medical expert, so keep in mind that this is not intended as medical advice. That said, let's get into it. Illiyin told me how she used to work as a midwife in an NHS hospital in London. But her own birth experience led her to give up clinical work and become a birth debrief facilitator.

Illiyin

I kind of stumbled upon it, having had a really difficult birth with my daughter. I then went back to work and found that I couldn't be there and really was just very triggered by lots of different things and realised that actually, in many ways, there are parts of the system and the ways in which we work within the system that were causing the harm that I suffered. And I didn't want to be complicit in it. And so I quit my job. Sort of like the day that I came to that realisation, I quit my job ,with no idea what I was going to do.

But a few months in, my husband got locked down in Spain. The pandemic started and he was locked down for four months. So I was stuck at home. But luckily enough, my parents were there, I was staying with them and my sister. We had a great time. Our daughter was 16 months old. I mean, there was just nothing to do. So it was like she was having ice lollies for breakfast, there was just no stress. And I was like, well, I might as well just start blogging what life is like, you know, with a toddler. And so I started Mixing Up Motherhood and within a very short amount of time, it sort of blew up. I don't really know. There are lots of different things I was sharing about my traumatic birth, the steps that I'd taken to overcome it, and I was sharing a lot about sort of racial inequality and childbirth and things like that.

And I think it was just...it's all timing, isn't it? A lot of the time, how things land. It's timing. And because I was sharing a lot about my own traumatic experience, I had a lot of people that were then saying, like, they would DM me their traumatic experiences, and I was like, okay, I'm gonna see if I can offer this as some type of service, like, remotely. And I started it, so I was like, you know, birth debriefs, come speak to me and we'll kind of work it through. But within about six weeks, I had a six week waiting list. So it was like timing and tapping into a bit of a niche, which made me. I was impartial, qualified, experienced, but also, I can listen to people. I didn't find it difficult to listen and to actually hear. That is a skill that has really taken me time to refine, because I think culturally, we like to fix things for people, particularly if they've had any difficulty. And we like to try and find silver linings. And sometimes when you've had a difficult perinatal experience, there's no silver lining. And when someone tries to offer you a silver lining, it's like, what? You know, I don't need you to do that. I just need you to hear me. And by you doing that, you are somewhat diminishing my experience. And so, actually, let's not. So, yeah, I've been doing this for nearly four years now, and, you know, I don't know, hundreds and hundreds of hours of debriefs, and, you know, I've written a book in between and have a podcast and also all sorts of things. Life is life in that time. But, yeah, I stumbled upon it, and here we are.

Helen

And, I mean, birth debrief might not be a phrase that everyone is familiar with. I certainly wasn't when I became a mother in the first place. Certainly. So tell us like...what do you mean when you say birth debrief and when might you need one?

Illiyin

Yeah. So some people might know them as birth reflections or birth afterthoughts, and they are often offered through the hospital trust that you are with or that you birthed with. And it's an opportunity within the hospital setting to go through your clinical notes with a midwife or sort of a senior midwife, and to kind of get an understanding of what happened. Now before, when I started doing them, I'm not going to claim that I was the only one. But there weren't many people doing them privately. And so basically what I was trying to do differently was to create the impartiality that then means that people understand that my loyalty is actually to them and their story. I have no kind of vested interest in the Trust. I'm not defensive. And that's often the problem with listening services, is that there's defensive practise, but there's also an element of a lack of trust, because they're like, well, you work here. This is, you know, the things that I'm coming to tell you you may be doing yourself, and I could be speaking about the Trust that you love and that you feel is being attacked. And so maybe that isn't the safe space I need it to be.

But also, when you've had a difficult experience sometimes in a hospital, being asked to go back into that hospital in itself can be massive. But also what I found was there was a space for PTSD and for sort of like severe trauma, based on the person who was offering its understanding of trauma. So, for example, what I mean by that is like, if you've had a postpartum haemorrhage of two litres, as a practitioner, we might say, oh my gosh, that was so traumatic. Do you need a birth reflection? If you've lost 500 mls? They might be like, nah, but she's okay now. The person who's lost two litres could be absolutely fine, could have felt perfectly safe and well. And the person who's lost 500 could be dealing with symptoms of PTSD and struggling to understand how and what has happened to them. And so this meant that there wasn't really a space for those people who had what perhaps professionals would deem clinically normal, meaning that they were often left to kind of navigate all of these feelings on their own and not really knowing what to call them and where to put them.

Helen

Yeah.

Illiyin

And so what I was trying to give importance to, and continue to give importance to, is the fact that trauma is an internal response to an external event, meaning that we can't actually define it for anyone. That is in the...it's in the vocabulary of the beholder. And so when you start to give people the permission to say, I feel this, rather than saying to them, that was this, then you open up a whole wealth of ...kind of conversation, but you also open a space for people who perhaps have felt very much unseen. And so that is what I was doing, or I do. But also what we do find is that for a traumatic birth, there could be a listening service or mental health referral and things like that. But we aren't necessarily looking across the whole perinatal space from preconception well into postpartum. And we know that that whole perinatal period can be really layered and really complex for lots of different reasons. Mentally, physically, emotionally. People need support across the board.

And what we're also missing is how everything is connected. So we treat things as isolated events. Oh, how was the birth? And it's like, we can only talk about the birth, but can we talk about how something that happened in pregnancy might impact the birth and might also impact postpartum and how actually, we need to kind of really hold space for the whole experience. And so that's when I started offering sessions for people who had perhaps had IVF or who'd had multiple miscarriages or who'd had hyperemesis in their pregnancies or previous prolapses and things like that. Because actually what was really coming up was, oh, well, everyone's asked me about the birth, and the birth was fine, but actually, I'm really struggling with feelings of ingratitude because I desperately wanted this baby and I had all this IVF for this baby, but actually, I'm hating it. I hate being a mother, and I don't know how to deal with those feelings. And it's like, well, let's talk about it. Let's break it down.

And so I absolutely adore what I do. I think it is. It's so...what I found is it's so needed because people don't have it. They don't have somewhere where they can just say, start to finish, let's talk about it, and then let's pluck out the bits that make sense. And similarly to what I do in my book, it's all about sort of reflecting, redefining, and sort of re-informing what happened. So it's not a silver lining. It's just about understanding.

Helen

Yeah. Oh, you made me feel a bit emotional going through some of that, because I think you're absolutely right. And I think trauma is a big...it feels like...it can feel like a really big word, can't it? And sometimes allowing yourself to...what's the word? Like, sort of feel like you can label yourself with this big word of 'trauma'. It's hard to feel like you can qualify, like you don't, you know, like, oh, it wasn't that bad. The baby's all right, everything's okay. So I think hearing that from you, that it can be all of these things and you don't have had to have had a near death experience for it to be real and for it to really affect you. So how would someone know if their trauma warranted a birth debrief? Like, how would they know if this is something that might help them? When are you struggling sufficiently to need to get to this help?

Illiyin

Yeah. So this is the thing, and this is something I really want to debunk. Like, it is nothing. Because we often see, particularly as mothers, we think that we need to have reached a certain level in order to do something for ourselves. So it's like, well, okay, my birth isn't really keeping me up at night, so actually it's okay. And it's like, ah, but we don't need to reach limits. Like, we don't. We can just be like, this is bothering me. I think about it quite a bit. You know, I'm like, I don't need you to come to me when you are in the pits of despair. I want to catch you before that, because that can come later. That can come before when you're least expecting it, and it will shock you. And what we don't want is for you to be shocked because the shock can paralyse people. And then you just go, well, this is just it, you know? But actually, when we say, actually, this is really bothering me, I'm going to just try and figure things out a bit beforehand. I'm gonna take an hour for myself, and you might find that that's sufficient. And this is what I say. Like, a debrief is like the opening. It's just the start. It's just having a space to unpack some things to then be able to go, I think I need more help with this. Or actually, no, my questions have been answered. I'm okay. I just needed to get the clarity so that it wasn't playing on my mind in this way.

And some people will come to me and they'll say, do you know what? Can we book two more sessions just to figure it all out? I'm like, perfect. And others will say, do you know what? I think I'm going book some long term therapy. Brilliant. And then there'll be some who say, I'm good. And it's like, that's it. All I want people to think when they are sort of contemplating having some type of debrief with someone like me is - I'm just cranking open the box a little bit to see what's going on. And then I get to have the agency to decide if I want more if I want less. But at least I want to do this small thing for myself. So there's no...there's no perfect time. There's no, you know, should I, shouldn't I? It's more. Do I need it? And being comfortable with saying, actually, I need this thing and I'm gonna go and get it, rather than waiting for it to be a sort of life or death thing, like, where you're like, I am on my knees.

Helen

Yeah, yeah. You don't have to wait until crisis point to see if there's something that could make you feel a bit better. And how...what does that journey look like? How would someone begin to start picking up those pieces if things just aren't feeling good?

Illiyin

Yeah. So if someone inquires and says, I'm thinking maybe I need a debrief, but I can't figure it out, and I just say to them, just stop and write down the things that are bothering you. Like, because often when we have things in our heads, we just ruminate all the time, but they don't ever come out. So it's like, okay, actually, if I can see this, like, tangibly hold these things, then I can get a deeper understanding of perhaps what my needs are, what is bothering me. And if they come and see me, we basically, I will ask them to share with me their whole story from conception through to postpartum. And then we kind of take it as, that's just my listening time. Like, I'm literally doing nothing else but listening. I won't ask questions in between, and then we'll go, okay, so now tell me how you feel. Because a lot of the time, we're asked what happened, but we aren't asked how we feel about it. And so it's like, I'm giving you the opportunity to put words to your experience. I've already got what I think, but that's irrelevant. You know, a lot of the time when we're having these conversations, there is relevance given to the opinion of the listener and less relevance given to the voice of the sharer. And it's like, this is your space. So tell me. You know?

And I think for a lot of people, that's the first time that someone has genuinely asked them in order to hear them. We often hear to respond rather than, like, you know, we listen to respond rather than listening to hear. And that's quite problematic, because that's why we end up going, but at least baby's healthy. But you're all right now, aren't you? Because we're already thinking, how can I make them feel better? How can I say the right thing? But when you listen to hear, you're going, mmm, okay. You know? And sometimes that's all that person's needed. I hear you.

Helen

And sometimes that's. That's just enough. Right? They can go away. Right? Wow. Okay. And sometimes it won't be enough, I guess. And what is the journey beyond that? I mean, is it always something that can resolve? Is it sometimes something you have to live with? Should you go and seek further help, counselling, whatever it is?

Illiyin

So for me, I actually really rebuke this idea that you can get over something or that you should get over it. I think it kind of really undermines what that was. The way that I...I sort of view any traumatic episode is it's like a bag, and you're carrying it with you. It's now, like, attached to your person, and all you're seeking to do is make the weight less heavy. So it's like, actually, I'm not giving myself this task of getting rid of the bag. I'm just saying, actually. Well, welcome. Hi, bag. Like, you're here. I carry you, but I barely notice you. And if I do, I'm not shocked by you because I already knew that you were there.

Helen

Nice. Yeah.

Illiyin

You know? And so what that does is it takes the pressure off this person to be like, I should be over this by now. Why is it still bothering me? It's like, well, it's bothering you because it's a huge thing that happened in your life that deserves space. Like, it deserves space for you to acknowledge it. So saying to people, are you not over that? It's like, why would I be? You know, five years later, I think about my daughter's birth. I've had a child in between. And I'm like, it still sometimes bothers me when I see people and they have their first baby, and they're like, oh, my gosh, it was a beautiful home birthday. And I'm not.

Helen

Yep.

Illiyin

You know, it's not that I don't want that for them, but I'm like, bloody hell. I would have wanted that for my first initiation into motherhood. And so I don't feel any shame about that, because I'm like, this was a big thing that happened to me. I carry it with me. And that's okay?

Helen

Yeah. I mean, we're formed by our experiences, aren't we? That's part of...it becomes part of who we are. This is great. And again, I hadn't hadn't thought of it like that. Oh, so much good stuff. Right. But so obviously, yeah, that was the other thing. I read in your book that the National Institute for Clinical Excellence doesn't routinely recommend birth debriefs for everyone, because they're not for everyone, are they? And sometimes even perhaps, they can do more harm than good. Is it something people should approach with caution?

Illiyin

Most definitely. I think, you know, and this isn't. It's so funny, because I remember someone saying to me, are you telling people not to go to their hospitals, but to come to you? And I'm saying, no. Telling people that maybe...maybe they should just think about what's for them, because this isn't about me. This isn't about the hospital practitioners. This is about the person. And it's about really looking inwards and going, what do I want? What am I seeking? Because if I go into this hospital space and I get someone who's going to read through my notes, is that what I need? Do I need to get an understanding of what happened clinically? And these notes aren't written by me or by someone who knows me. And so are they really going to reflect what I actually went through? And perhaps if what I was going through was more of an emotional experience, will those notes have any idea about that?

And so it's like, actually, I just want you to understand what it is that you are seeking so that you go in there with absolute clarity and clear expectation.

What we have in hospital debriefs, where a lot of people struggle, is that their expectations were not met, that they thought that it was going to be something that was really going to help them to feel much better. And in actual fact, it's brought lots to the fore, and now they've just been left with it. And then what? Like, okay, so all this expectation, and often there might be a waiting list for this. So they could be waiting for this debrief for, like, four months. They're like, okay, it's gonna help. It's gonna fix everything. And it doesn't. And that's not to say that not all of them do, because some people who facilitate these things are so good. And for that person, their expectation was met, and they got what they needed. But for a lot of people, they do not get what they need, partly because of their own expectation. And I say that in the least gaslighting way, but also because perhaps that person doesn't have the skill, doesn't have the skill to hear, and they can do more harm with perhaps defensiveness, and they can do more harm with the normalisation of your lived experience, that for you was very traumatic, but for them was routine. And so when you go into this space and someone says, but everything worked out fine, that is normal practise. Well it's normal for us as practitioners, but for a person who's living that for the first time, it could be anything but normal.

So, you know, I think really it's so important when approaching something like an NHS debrief or a hospital debrief, that you speak to them first about what to expect so that you have an understanding of if you need it. You take someone with you who makes you feel safe and who makes you feel like you can use your voice. And if you falter, they just hold you up. And that you also go prepared with a list of questions, but also know that what you lived is your truth. And so even if those notes aren't reflecting what you lived, it doesn't mean that you were wrong, it just means that the notes don't say it. So, you know, it's...they can be really good, but exercise a little bit of caution and know that actually you do have the agency to say, this isn't going to be for me, this isn't the right method to help me to work through what I lived.

Helen

And so often in these conversations, it comes down to this idea that knowledge is power. I am keeping you for too long. So a couple of last questions - pivot a little bit. And I've never had a trained midwife on the podcast before, but I have had messages from midwives who have said, you know, they knew very little about pelvic floor issues before they found the podcast. One that it had changed the way she practises midwifery and how she advises new parents when, when they give birth. So do you remember, like, what level of training you had around pelvic floor dysfunction during your training or about postnatal recovery? Was there much? Was there any?

Illiyin

None

Helen

None? Right.

Illiyin

So I don't recall, other than in first year, and this was quite a few years ago, a bit of conversation around the pelvic floor, but more about where it is and what it does rather than the impact of pregnancy and birth on it. And then even around sort of perineal care, it was very much about the suturing and identifying the tears and the kind of basic level of hygiene and things like that, rather than actually lifelong impact of these tears and what that could look like for people. So I remember even discharging people and just being like any issues with weeing, let your midwife or your GP know. And it's like, what does any issues mean? Like, at what point?

Helen

Like, what's normal, what isn't?

Illiyin

Yeah, what's normal, what isn't? And, like, as practitioners, did we even know that? Did we know what the levels are, what we should be telling people to look out for, really? And if we're saying to them, well, you know, as long as you're not wetting yourself - I can't stand that, because I'm like, is that where the bar is? We have to be, like, wetting ourselves before we are worthy of help? What does that do to your identity? What does that do to your sense of self? What does that do to your experience of motherhood and your ability to parent confidently and competently? What do you mean, as long as you're not wetting yourself? Maybe midwifery training has changed a lot since I've studied. But looking at the people that I see who come to me for traumas around pelvic floor issues, tears and continence, we're still doing a disservice to people in terms of how much we are supporting them through navigating that. Yeah, I think we definitely could do a lot better.

Helen

Yeah, I think. I mean, there's obviously work to be done. There's so much. I mean, there's a couple of figures in your book around. What was it? So, postpartum birth injuries, physical and mental effect. One in 20 birthing parents, 6% of birthing women have birth trauma. If we look at the bigger picture, we know there's this massive shortage of midwives in the UK. Racial disparities within healthcare. I think maternal mortality for black women still, I think four times higher than for white women. Significant, too, for women of asian or mixed ethnicity. So many real serious questions about the quality and the safety of maternity services in the UK at the moment. And thankfully, like, conversations are happening, so that's. That's good. And none of it is to knock the majority of health working professionals who are doing their best in a really, really challenging situation. But I get...this is the bit where I give you a magic wand and, you know, from your experience as a midwife, as a mother, as someone who sits through these birth debriefs, is there one...I mean, there are probably many things that need to change, but what would be the first thing?

Illiyin

A lot of the language I would scrap, I would actually really say, I would give people the space to name things, whatever they want. Why are we not allowed to say it was traumatic or it wasn't traumatic or it was difficult. Why is it that we're, like, given all of these restrictions around what we name things, rather than it being like, that's the word I choose, and that just makes sense. And if you need me to explain it, I can, but that's the word I'm going to choose, you know, to really give someone the power to go, this is my word. And I know it might not be what the dictionary says, and I know it might not be what the National Institute of Clinical Excellence says it is, but it's what I'm calling it and that's enough.

Helen

Yeah. So the language around our lived experience, as we have experienced it, not as anyone else would put on us, those words, that language. Be able to say it and be able to....for someone to listen on a level. Yeah. Okay.

Illiyin

Yeah. To meet you where you are.

Helen

Yeah. That's what...see, we just..conversations like this are so important because I know there will be people listening and they'll be going in and I just. Empowerment is what we need.

Illiyin

And I think as well, just to know that there are people that exist that can do these things that can help you. You know, when you are navigating this trauma or difficulty, it's like you feel like you're on your own and you're not. You're not. There are people that are here to hear you and to support you and to guide you and to not pressure you and to not place any expectation, but just to meet you exactly where you are.

Helen

Birth trauma specialist midwife Illiyin Morrison. I will put her details in the show notes along with some other resources for charities that offer support. And I'll also link a previous episode with the perinatal psychiatrist Dr Rebecca Moore, where we talk about the mental health implications of pelvic floor dysfunction. You can find Illiyin's book, The Birth Debrief in the Why Mums Don't Jump affiliate shop on my website and I'll be back next week.

But in the meantime, you know what to do. Spread the word. Tell a friend, spam a WhatsApp group, give me a like or a share on Instagram. It all feeds the algorithms and helps other people to find us.

You've been listening to Why Mums Don't Jump with me, Helen Ledwick. You can find me on socials @whymumsdontjump or online at whymumsdontjump.com. Bye for now.

Season 5 of Why Mums Don't Jump is brought to you by iMEDicare - Pelvic Health Naturally. The team at iMEDicare are passionate about improving quality of life for patients with pelvic health problems, and they supply products that are safe and easy to use as part of your rehab journey. Products like the Efemia bladder support - a reusable vaginal pessary for stress incontinence, helping you to stay active without worrying about leaks. Made from a soft and flexible silicone, Efemia is widely available on NHS prescription as well as through the affiliate shop on the Why Mums Don't Jump website, where you'll also find a discount code. Check it out.