Beth

Age at interview: 30

Brief Outline:

Beth has a pelvic organ prolapse following a forceps delivery. This has had a big impact, both physically and emotionally. Beth does not feel that she has received the support that she needed from healthcare and has had to be very proactive in order to find things that have helped her.

Background:

Beth is a teacher and is currently on maternity leave. She lives with her husband and baby. She describes herself as White British.

Condition: pelvic organ prolapse

More about me...

Beth had a “traumatic” forceps delivery in 2020. As the pain and swelling around the scar from an episiotomy (a cut in the area between the vagina and anus, called the perineum, during childbirth) subsided, she still felt that something “wasn’t quite right”, and it felt like her “organs are going to fall out”. After searching online, she wondered whether this was a pelvic organ prolapse. She consulted her doctor who said that this was “normal” after childbirth and advised her to do pelvic floor exercises. Beth felt “very lost” and “dismissed”. She went down a “bit of an internet spiral” to try and find out what to do next. She started to wonder whether her pelvic floor muscles had been damaged during labour and went to a private urogynaecologist who she describes as “quite dismissive”. Beth decided to pay to see a women’s health physiotherapist who was “holistic” and “compassionate”, and who “took the time” to examine and listen to her. The physio diagnosed a levator ani avulsion (where a muscle becomes detached from the pubic bone).

Beth’s prolapse has had a “dramatic effect” on her life. Although she thought that having a baby would be “joyous”, she found herself feeling “deep sadness”. Beth describes “a grieving process” for the “kind of mum I thought I was going to be”. She feels that the emotional impact was also tied up with memories of a traumatic birth. She has “shied away from conversations about childbirth” and tends to avoid some people and situations. For a long time, Beth was scared to pick up her daughter or put her in the car. She stopped doing things that she “used to find a lot of joy in”, and has felt like a “stranger” in her body. Although her husband has supported her “100%”, Beth feels that her experience “took a real toll” on her husband, and it has also had an impact on their intimacy.

Beth has had to be “relentless” in the “quest for good care” and this has taken a lot out of her. Although she had had some support from her GP and health visitor, Beth does not feel that anyone has been “looking out” for her. She feels let down because she was not consulted, or fully informed, about the forceps delivery and episiotomy: “they just kind of did it to me”. Beth would like health professionals to think of her “as a person”, to listen, and to take the condition seriously. Things are gradually improving for Beth, and she has started to do a bit of exercise again. She had found online counselling useful in tackling the emotional impact, and online Pilates exercises have helped her to “regain some confidence in moving my body”. Beth feels very fortunate to have the means to pay for this.

Beth finds it “bizarre” that so many people have prolapses, but no one talks about them: “there is this huge thing probably going on under the surface”. Beth describes how it can feel “a bit shameful” because “it’s my vagina and it’s my sexual function, you know, bladder function” which people don’t want to talk about. She has found a private Facebook group that has provided support and knowledge, and this has made her realise that she is not alone. She would like others to know that these symptoms “aren’t necessarily normal after childbirth and that you don’t have to live with them”. She would also like teenagers to understand about the importance of pelvic floor health.

Since giving birth, Beth has become aware of different and changing sensations in terms of prolapse.

After giving birth I initially just had lots of pain and swelling around the episiotomy scar which I think kind of meant that I wasn’t feeling other things in the area. And so, I think maybe that’s why it wasn’t until about three weeks post-partum that I started to feel these other sensations. The main sensation I had was it felt like there was a tampon that had kind of slipped down from my vagina and there was something still there like there was something poking out. And for probably about a week and a half, because I was still wearing maternity pads, I just thought that they bunched up and were just, you know, and I was constantly sort of like pulling them out and thinking they were kind of stuck. And so that was the main feeling. And then, my, but then after I would say that sensation took a while as to go. That was like a few months of like pelvic floor exercises. But then the sensation changed and it kind of felt like just being open and slightly unsupported and it didn't ever feel like my vagina sort of came back together properly is the only way I can describe it. It just felt like it was kind of a bit open all the time. But then now it makes sense with the diagnosis of the avulsion because there just isn’t that muscle that supports the pelvic floor in the same way and bringing it closer together. So, I think that is just that is a symptom of the, of the partial avulsion*.
 
*Note: A levator avulsion is when some muscle fibres become detached from the pubic bone, and it is a risk for prolapse.

 

Beth is avoiding seeing friends who have had recent straightforward births so that she doesn’t have to compare stories.

Loads of my friends have been having children in the last year, like so many of them at home. And you know, none of them have-, well one has has a prolapse that I know of and all of the others had fairly straightforward births, either-, well they said that they did, and you know, normal vaginal delivery with no issues or they ended up having C-sections and I have found that quite difficult, my friends have had C-Sections. Because with my delivery, my daughter’s heart rate was going up and down and it was all over the place. And they could’ve given me a C-Section, but they didn't. And I felt like the risks of forceps delivery weren’t ever discussed, no one ever mentioned the risk to my pelvic floor at any point and I didn't feel like I was consulted for it. It happened and it, they just kind of did it to me.
 
And so I found it particularly difficult with friends who have had C-Sections. I haven't-, you know, I’ve never said anything, but internally I kind of found it quite difficult to deal with. And I’ve definitely shied away from conversations about childbirth and you know, it’s all our first time being pregnant, and it’s something that lots of people want to talk about and everyone wants to ask you about and I’ve kind of got to the point where, so we have a family friend whose just had a baby and I don’t really want to go and see them just yet because I don’t want to hear about their birth experience and I don’t want them to ask me about mine.
 
So, part of me wants to wait another few months, you know, until that’s maybe perhaps not so fresh in their memory. So yes, I think it impacted in that way. And then also lots of my friends want to-, so where I’m from there’s lots of countryside and my friends have-, lots of friends have moved back there now, and they live out in the sticks and they go walking with their babies and carriers, rather than a pram. I don’t feel like I can do that because of the impact on my pelvic floor and you know, so I sort of have tried to avoid certain things because I don’t want to physically exert myself in that way, but also don’t want to explain it either.

 

Beth felt stuck and frustrated after being told that the only type of pessary she could have fitted on the NHS was a ring pessary.

I’ve got this NHS appointment for a pessary fitting, but they only fit the ring, which I’ve been told is not very good if you have an avulsion. You need to have a cube pessary or something similar to that. But they just, when I spoke to the GP they said, “Oh no, we just don’t fit those. We just don’t have them. We only offer the ring.” So then, I don’t really know where to go from that. So, I need to find—so I feel like my experience with healthcare services so far with this condition has just been-, I’ve been trying to kind of navigate my way through it and drive forward. And it’s been…yeah, quite lonely at times and been quite frustrating and it felt like no one really has your back and no one’s really looking out for you, you know, which has made something that’s been like quite traumatic and like difficult to deal with even harder. You know, harder than it needs to be, I felt.

 

Beth described feeling “lonely” and feeling like “no one really has your back” when navigating her way through urogynaecology healthcare. [Spoken by an actor]

So, I’m still trying to get an appointment with a consultant urogynaecologist who will do scanning on me. So, I have just a better idea of what’s going on, ‘cos I still feel a bit a bit lost a little. Although I’ve got a better idea, I still feel like you know, I’ve got this NHS appointment for a pessary fitting, but they only fit the ring, which I’ve been told is not very good if you have an avulsion. You need to have a cube pessary or something similar to that. But they just, when I spoke to the GP they said, “Oh no, we just don’t fit those. We just don’t have them. We only offer the ring.” So then, I don’t really know where to go from that. So, I need to find—so I feel like my experience with healthcare services so far with this condition has just been I’ve been trying to kind of navigate my way through it and drive forward [laughs]. And it’s been…yeah, quite lonely at times and been quite frustrating and if felt like no one really has your back and no one’s really looking out for you, you know, which has made something that’s been like quite traumatic and like difficult to deal with even harder. You know, harder than it needs to be, I felt.