Rosie

Age at interview: 34

Brief Outline:

Rosie experienced severe pain and urinary incontinence after an episiotomy (a cut in the area between the vagina and anus, called the perineum, during childbirth). Following a successful course of physiotherapy she no longer has pain, and her incontinence is improving.

Background:

Rosie is the head of a primary school. She lives with her husband and young child and is pregnant with her second child. She describes her ethnicity as White British.

Condition: urinary incontinence

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Rosie described a “traumatic” childbirth which left her with severe pain from an episiotomy (a cut in the area between the vagina and anus, called the perineum, during childbirth). Several weeks later, Rosie was still finding it difficult to do even the most “mundane” activities like filling the dishwasher or walking to answer the front door. Rosie was deeply concerned about resuming a “healthy sex life” that would not be “agony”. She contacted the GP, asked to be examined, and was referred to a gynaecologist. From here, Rosie saw a women’s health physiotherapist who assessed her and provided a series of different sized dilators to “desensitise the opening of the vagina”.  She was also prescribed oestrogen cream to make the episiotomy scar “stretchier”.

Rosie told the physiotherapist that she was experiencing urinary leakage when she coughed or sneezed, and that, although this was “not bad compared to other women”’, it was far from ideal in her job as a school teacher. The incontinence was also having an impact on her getting back to the gym, which was something that she really enjoyed. Over the following weeks, the physiotherapist supervised progressive pelvic floor exercises and gave advice to “retrain the brain” to allow her bladder to fill and empty completely. Rosie’s treatment has been very successful: her pain had gone, and she is now expecting another baby.

Rosie feels that incontinence is a “taboo subject”. It has really surprised her that although people told her “every detail” about their labour, nobody had talked about “bladder and bowels and bodily fluids”. She feels that there are several reasons why women might not seek help after childbirth: first, “the main focus is on the baby”; second, there is a sense that pelvic dysfunction is “normal” after childbirth; third, that nobody wants to put additional pressure on health services; finally, women feel pressure to “be out and about” with a “beautiful little baby” and don’t want to admit to needing help. Rosie would like health professionals to be aware that “it takes quite a lot for some people to get to where they are” and not to “assume that people know things, because they really don’t”. Rosie feels that she did have to be a bit “pushy” to get an examination and to access care. She worries that it would be a real challenge for some women who are suffering emotionally to be “proactive or pushy”. Rosie is also concerned that women, like her, don’t know that this sort of effective care is available.

Rosie described the healthcare that she received as “absolutely incredible”. She stressed the importance of the “personal touch” so that people don’t feel like they are “on a conveyor belt of patients”. She feels that her health care providers took a really “holistic approach to the care”: they “listened”, “understood”, and “took her seriously”. She acknowledged that health professionals work in “difficult circumstances” and wanted to say, “thank you because it is appreciated and it makes a massive difference”. Rosie would like other women to know that “it’s not abnormal”, “whatever you’re experiencing someone else will have”. She would advise other women to “do your pelvic floor exercises”.

Rosie is still aware of her urinary incontinence and chooses particular clothes for exercise, but things have improved overall and it has less impact on her.

I’m now in a place that I wouldn’t, you know, to begin with I was kind of like, ‘Oh gosh, like do I, do I-?’ stupid things like if I went for a run, I’d make sure I had black leggings on, you know, like little things like that or if I was going to the gym, I’d make sure I had a long top on in case, you know, there was, you know, in case I did leak or anything and I guess that’s, I do still think about it but not as much if that makes sense. And I guess I’m kind of more aware of, I guess I’m more aware of what I can and can’t do and ways to prevent leakage if it does happen but, as I say, I know that it’s definitely not where it needs to be still. So I’m still kind of working on, on those exercises and making sure that I’m kind of consistent with them. I guess, I mean obviously I’m not in any pain or anything like that anymore so that’s had a huge impact because life has gone back to, you know, how it was before and I think the kind of, the confidence, I think to begin with when you’re not sure, you know, if you cough and what’s gonna happen, you kind of are very aware of where you are and who you’re with and, you know, are you gonna be able to go to a toilet, you know, like that kind of thing. Whereas, I don’t even think about that at all anymore so I guess that’s had a huge impact but I’m also aware that my issues were nowhere near as bad as some peoples are so I guess in a way I was quite lucky with that as well.

 

Though she has since had good experiences of urogynaecological services, Rosie was initially put off by embarrassment, knowing health services are busy and feeling that her symptoms were not as “horrific” as others’ health problems.

I guess two reasons I think probably for quite a lot of women there’s that kind of embarrassment factor and I think, I think that’s probably the prime, prime reason and I guess secondly maybe the not sure where, like where to go or not wanting especially in the last couple of years not wanting to put additional pressure on health services and like I have to say if that had been my only symptom, I probably wouldn’t have gone back to the doctor but because I was in so much pain, I kind of, and this was the secondary part of that but I think and just the not knowing that the services are there and are available and actually the service, in my experience, the service that’s been provided has been incredible and I wouldn’t have known about it at all, and I guess also when you hear about some women’s experiences and how horrific things can be post giving birth, I guess, you know, having a bit of incontinence is like the least of some people’s worries so I guess, you know, when you’ve got people with kind of prolapsed vaginas and all and all sorts you kind of think ‘Oh well, you know, if I’m just wetting myself a little bit, you know, why, why would I worry about that,’ kind of thing maybe.

 

Although she had had to wait a long time, Rosie was pleased with how her appointment went with a specialist and the follow-up.

But once I got the referral yeah went up to the hospital and really quiet, like I was like, ‘why has it taken this long because there is no-one here at all?’ So again, middle of Covid so I was sat in a waiting room and then, yeah consultant came out, consultant and two nurses were in the room at the time. She was amazing, obviously knew exactly what she was talking about, really reassuring kind of brought in personal elements as well, like you know, she obviously had her own children in the last few years and kind of mentioned them and the experiences that she’d gone through which again is, you know, is reassuring that people are not just at work, you know, bringing that kind of personal element to it as well. I mean she may have been making it all up for all I know but it helped [laughs]. And really kind of gentle, listened, understood, did a referral which again, you know, when you because by then you feel a bit stupid because it’s a lot better than it was when you did the referral so especially at the minute, you don’t want to be wasting people’s time and I kind of was very open about that. I said, you know, “It is better, it’s still definitely not how it should be but-,” and she was really reassuring of that as well. Like, “No, you know, absolutely you should be here, you know, that’s fine.” Apologetic about the fact that it’d taken a little while and then also just the fact that there was a kind of next step I think is quite, just shows that you’re being taken seriously if that makes sense that, you know, they’re going to do something and you’re like, ‘Oh okay I haven’t made all this up’ [laughs]. And then, yeah, the physio appointment actually came through quite quickly after that so that was helpful because you’re kind of then like in the system. I feel like once you’re in the system it’s fine, it’s just getting into it.
 

 

Rosie found it strange that people will talk about their labour, but no-one talks about bladders, bowels and bodily fluids after childbirth because it is “taboo”.

Everyone is more than happy to tell you all about labour and pregnancy and, you know, how horrific it is and everything and you hear every detail of everyone’s labour but nobody talks about the after bit at all and it really, I just found it really strange actually, you know, being quite an open person, I’m really happy to talk about things. I found it really odd that I know everything about everyone’s labour and then it’s only when you mention something about the af-, you know, post labour and people are like, ‘Oh yeah that happened to me’ and I’m like why don’t people talk about that part of it as well? It just, I just find it really interesting that that’s the kind of, you know, you think people just walk out of hospital and everything’s fine which is, you know, my experience so not the case. But that seems to be a kind of un-talked about taboo subject which yeah, seems odd.