Kezia gave birth to her first baby 14 weeks ago, during the Covid-19 pandemic. She had a traumatic birth with a long wait after induction and a forceps delivery with an episiotomy a cut in the area between the vagina and anus, called the perineum, during childbirth). In the days and weeks afterwards, she experienced discomfort, felt like “there’s a huge kind of empty cavernous space where things can fall out of and you can’t close”, and struggled to “connect my brain to my pelvic floor”. A week after giving birth, Kezia mentioned her concerns at a GP appointment that she might have uterine prolapse (when the uterus slips down into or out of the vagina). The GP said it wasn’t anything they would act on at that time, but “as the weeks went forward and I was expecting to kind of be able to do more and be more healed, I found that maybe I could even do less”. She returned to her GP but felt “very unsupported” by the response, and so chose to self-refer herself to an NHS physiotherapist.
Whilst waiting for an NHS appointment, Kezia also saw a private pelvic floor specialist. After an examination, she was told that her uterus had not prolapsed but that she had a relatively mild bowel prolapse and that she had pelvic floor hypertension. The physiotherapist helped Kezia re-learn to “relax” her pelvic floor muscles, and her body as a whole, and she now feels more confident returning to exercise. She describes her pelvic floor problems, and the mental health impact, as an “invisible injury”. Kezia has now also been referred to a vaginal pessary clinic but feels this isn’t the right treatment option for her yet “emotionally”, and she is focused for now on the ongoing physiotherapy rehabilitation.
The emotional and mental health impact on Kezia has been significant. The initial absence of information about her symptoms contributed to a cycle of fear and tension, as she had worried about “making something worse or for injuring myself further”. Initially she questioned whether she could be the type of mum to her baby that she had hoped to be. Kezia thought that she might not feel comfortable having sex again but is now working on reassuring herself and her body with touch exercises. Kezia and her husband had previously planned to have a second baby, and this decision is pending as Kezia is unsure if she wants to physically and emotionally proceed with this – both in terms of anxiety during the pregnancy and the possibility of another birth injury.
Kezia feels very let down by the NHS in relation to different aspects of her care, including her labour and birth, suspected prolapse, pelvic floor injury, and post-partum mental health. She plans to put in a formal complaint. Kezia says she often looks like she’s coping well, even when she is really struggling, and that a lack of continuity of care from healthcare professionals meant that they didn’t spot when she needed more support. Kezia says she is fortunate – she has a supportive partner and a childcare bubble, is confident advocating for herself, could afford private physiotherapy, and accessed counselling through her work – but knows that other women are not in the same position.
Kezia feels that healthcare professionals tend to overlook the mother after giving birth: “the baby was out, happy and safe and healthy, and I was left injured and broken and not well and nobody really minded, and nobody would provide the support that I required”. She thinks information about prolapse and pelvic floor injury is sometimes withheld from expectant mothers, both by healthcare professionals and in wider society. Kezia feels strongly that being informed is important so that women can mentally prepare themselves for this possibility. She says that pelvic floor injuries “may be normal in terms of frequency” but shouldn’t be ignored or accepted as inevitable: “it could be much better”.
Kezia felt mental health support was not forthcoming on the NHS, so she opted to access it via a work scheme.
Kezia felt mental health support was not forthcoming on the NHS, so she opted to access it via a work scheme.
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And with the mental health offerings, I found it quite frustrating. I have, in my work had a like employee assistance programme which means that I had, have been able to have like six sessions of talking therapy which I’ve used for this and for like to process the birth, birth trauma and the kind of trauma of having an injury following birth. And I feel a bit aggrieved at the NHS because I know they ask the right questions, and they talk a lot about how they ask the right questions and how the support services are there if you need them. But, firstly, I kind of lost trust in the system following the birth so I didn’t necessarily trust those services that they would provide, and secondly, I just felt like I shouldn’t have to ask for them. I felt like it’s on my notes, it’s on my notes that during pregnancy or like it’s a pre-existing condition for me that I have mild anxiety, that’s on my notes. It’s on my notes that I found my birth traumatic, I told you. And it’s on my notes that I reported these symptoms which are like in line with having a prolapse. All of those three factors together should mean that you prescribe me with some well-being support and some mental health support.
You know, like I’ve told the nurse practitioner that I’m crying every day. Like you should just say, “You don’t have to do this, it is your choice but my medical recommendation is you take us up on this offer of talking to someone or going to, you know, speak to this person about what we can do for you, for your emotional and mental wellbeing,” and that, because that was, it was always just, “Are you okay? Are you coping?” I was like, “Well yeah I am,” like I’ve got myself the support that I need. I have a very supportive partner. I have got access like the lucky with the childcare support bubble, I’ve been able to see my parents and talk to my friends, and I’ve been very open with talking about it. Like I’m not at risk of anything really serious but I’m still struggling but I can’t be struggling because I’ve got this tiny baby to look after so, if you ask me if I’m okay, like I’ll tell you, “No but yes,” I’m fundamentally I am okay but it still doesn’t mean that I don’t need support, and so I found that quite frustrating.
Kezia’s osteopath (an allied health professional focused on joints and bones) first suggested she might have a prolapse when she saw him for back problems and described some other symptoms. [Spoken by an actor]
Kezia’s osteopath (an allied health professional focused on joints and bones) first suggested she might have a prolapse when she saw him for back problems and described some other symptoms. [Spoken by an actor]
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And, you know, I sort of I said, “I can’t control-, I don’t feel like I can close my anal sphincter. I don’t feel like I know where anything is down there anymore,” and I was obviously very worried about that. And I hadn’t really suffered from urinary incontinence at all, but I had had an episode where I very, very urgently needed to move my bowels, and I did manage to make it to the toilet, but I sort of ran downstairs, you know, it was a, it was a close call and that obviously was quite worrying. Anyway, so I explained all this to the osteopath and he said, “Oh it sounds like this might be prolapse,” which I’d never really heard of. And he sort of said, you know, “Perhaps your uterus is kind of fallen down a bit,” and he, from the outside did quite a lot of lifting stuff up and stretching muscles out, and after he’d done that I sort of went to the toilet and I was able actually to kind of locate my pelvic floor a little bit more and also had a bit of sense of relief from the heavy feeling of heaviness.
Kezia worries that her prolapse symptoms will come back if she has another baby.
Kezia worries that her prolapse symptoms will come back if she has another baby.
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But I don’t know, like obviously it’s early days anyway but I can also imagine that it’s not necessarily a good idea in terms of I wouldn’t want to go through the whole pregnancy just being worried that the prolapse might kind of-, particularly if I’ve been able to rehabilitate. Like, say if it’s this time next year, I’ve rehabilitated it really well, like it’s still a bit there but I’m really fundamentally asymptomatic, I think I might be then quite anxious during a pregnancy that my symptoms would return, or I’d make things worse. So, I might not feel comfortable kind of opening myself up to that risk and of course the risk of further birth injury but I might, so I don’t know. I might have the opinion of ‘actually no, I’ve really got to know myself in a kind of pelvic floor capacity. I know how to use it much more effectively, I know that I need to relax it. I know that I need to engage it here. Or I know that I can keep strong during my pregnancy’, and maybe I’ll just have a scheduled c-section and then do all of the same thing again but with my abs rather than my pelvic floor [laughs].
So yes. I definitely had some dark teary moments where just the thought of not being able to carry another child played very heavily on my mind and I’m not really quite there anymore, but it’s still not necessarily something that I would open myself up to.
Kezia thinks that taboo about talking about bodily fluids contributes to the isolation of having urogynaecological conditions.
Kezia thinks that taboo about talking about bodily fluids contributes to the isolation of having urogynaecological conditions.
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Like any sort of incontinence, you know, harks back to being a child and I’m sure everyone’s got a story of when, you know, they wet themselves as a child and that was really embarrassing for them or like in some way a bit traumatic, and to think that you’ve sort of regressed to being there makes it hard to talk about. And people don’t really talk about poos and wees that much just in general. There’s an idea, you know, in the culture, like ‘Oh like it’s disgusting if a woman does a poo.’ Like women don’t fart, and if you do then you’re not sexy, so you don’t necessarily talk about those things. I mean I have always farted in front of my partner so probably that’s okay for me, but I know that lots of women will still go to the toilet to do a fart and if that is where you are then it’s very unlikely you’re going to openly say, “Oh by the way, actually I did a fart and then a little bit of poo came out,” because, you know, that would be horrifying for you. And yeah so I suppose people don’t wanna, people think that other people don’t wanna hear it and lots of people also don’t wanna hear it. And they just-, like the injury the core is, your core is literally the kind of innermost, not innermost but like a real fundamental kind of internal part of how you function mechanically but also I think emotionally. And if you don’t feel like you’re functioning in your innermost self, that’s very hard to talk about. In the same way that any kind of mental health problem or physical disability would be very difficult to talk about in a room full of strangers or outside of your immediate support circle or people that you feel comfortable talking with. Because you don’t just go out in life opening yourself up to the world and all of your vulnerabilities. It’s not really how we’re designed to do, so I think that yeah, it’s hard for women to talk about it.
Kezia, who has prolapse, has found support in online communities for pelvic health. She appreciates that the information is more “easily accessible”.
Kezia, who has prolapse, has found support in online communities for pelvic health. She appreciates that the information is more “easily accessible”.
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And then I found myself now in a sort of little niche in social media of kind of women’s pelvic health and birth-, the birth community and little private Facebook groups about prolapse and that kind of thing which is actually really nice but they’re not , you know, you sort of, I got, I found them because someone told me that someone that they knew who was a yoga teacher suffered from this and then I reached out to her on Instagram and then she told me about it, like it’s quite a protracted route to finding those sorts of support networks and getting interested in it [laughs].
And also so much of what you read is like ‘Oh well, don’t Google because it doesn’t help and it just adds to the worry and the fear’ and you’re like ‘Well where else am I gonna find information? If the NHS hasn’t provided me with the right information and Google’s like by degrees reassuring and terrifying, like where else can I go?’ and you end, and you do you end up finding the bits that you need but it’s more through word of mouth than through kind of easily accessible research for just any, any old person to access
Kezia would like others with a prolapse to see a pelvic health specialist as soon as possible.
Kezia would like others with a prolapse to see a pelvic health specialist as soon as possible.
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I found it difficult when people just said like things would get better because I was like ‘You don’t know that’ [laughs]. So really, I think I would just say it’s really hard and you’re not, it’s not all in your head, like you are suffering from an injury, it’s not your fault. Injuries require resources to heal effectively. So, I would just really strongly urge you to try and get those resources in place, starting with going to see a pelvic health specialist so that they can assess you individually and give you recommendations that are tailored to you. And yeah, that’s my main bit of advice and whether that’s fighting for it through the NHS or if you’re lucky enough to go private, but make sure that you do seek that support. And in the meantime, just, you can just, you’ll be able to keep going, and you’re really strong and yeah that’s all. It’s hard.
