*Guest blog* A tale of two babies: my postnatal body and me

I’m very happy to be able to share Beth’s story with you, in her words. Her delivery and 4th trimester issues are common, as was her need for greater support at that time. The fact that we were able to provide the help she needed at that vital time makes me very proud. It’s a testament to everything I’ve worked toward as a Pelvic Health Physio, and demonstrates how I believe we can provide truly holistic and individualised care that changes lives. I’m so proud of how far she has come on her rehab journey, it’s not been easy. I’ll let Beth tell you…

I’ve had writers block for a couple of weeks since confirming that I would write a blog to share my story.

Where to begin?

How much to share?

Does writing it down make everything a bit too real?

You see, I’m still on my journey to recovery so I can’t tell a story of ‘happily ever after’ just yet. However, what I can tell you is a story of hope and amazing progress all through the wonders of physiotherapy and the incredible care I have received from Jilly.

I had always wanted babies and was incredibly lucky to have met my Mr Right, got married and successfully conceived by the age of 25. Having always been sporty and being the owner of a solid set of hips I was pretty confident in my ability to birth our daughter and have my youthful body snap back into shape.

When I went into labour with our daughter I was so excited that she would be with us soon. It was a really difficult and slow early labour due to her being back to back but once in established labour everything progressed well. As such, I was completely devastated and traumatised when, on her way out, she got her head stuck at the wrong angle in my birth canal and went into foetal distress. Within just moments I went from having two calm midwives in the room telling me they could see her head to being faced with a full surgical team rushing me off to theatre, the consultant visibly panicking. Within the next few minutes I had a spinal injection to numb my lower body and was given an episiotomy to aid a forceps delivery.

“You have three pushes or we’ll have to do a c-section!”

Like hell were they going to slice my bits, shove those over-sized salad servers into me and THEN do a major abdominal operation! I used all my remaining strength to push and after a two day labour our beautiful daughter was born healthy and well.

As soon as I regained feeling in my lower body I became very aware that I couldn’t stop myself passing wind and felt like my pelvic floor had completely abandoned me! I’d previously had women’s health physio in my early twenties due to an over-toned pelvic floor (not as great as it sounds) so asked to be referred for some help and was added to the lengthy NHS waiting list. On leaving hospital I was given no advice about post-natal rehabilitation and assumed that my body would just ‘do it’s thing’.

Four weeks after our daughter was born I braved looking ‘down there’ and was faced with an open episiotomy. I rushed off to see my GP and was referred back to the hospital where I was informed it would have to heal via granulation. A couple of weeks later I was checking how it was healing and noticed a bulge where I was not used to seeing one, lying across the opening of my vagina. Feeling completely sick I realised that at the age of 26 I had a prolapse. Already struggling to deal with a traumatic birth, a poorly reflux baby, an open episiotomy and a pelvic floor that ached more that I ever imagined anything could ache this was the straw that broke the camel’s back for me. Back I went to the doctors in floods of tears where I was told…

“Oh, it’s a very mild bladder prolapse and doesn’t come anywhere near the entrance. You shouldn’t be able to see it. It will go away by itself within a few weeks. They’re incredibly common.”

I felt like the doctor had missed the memo that to me, seeing any part of my insides approaching my outside was not ok and didn’t understand why she thought it was mild when I could clearly see it right there! I became incredibly nervous about doing any sort of exercise and held on until my NHS physio appointment terrified that I’d end up carrying my bladder into the appointment in a bag-for-life!

Unfortunately, my NHS physio was not the salvation I had been waiting for. I was examined by two different people to be told by one that I didn’t have a prolapse and the other that it was just a very mild bladder prolapse that I shouldn’t be able to see or feel. I was getting so frustrated that a GP and two physios had told me that I shouldn’t be able to see it when there was clearly something there! No matter how many times I explained I was told the same thing and sent on my not-so-merry way with pelvic floor exercises to strengthen my weak pelvic floor. I was also told not to do anything that would put pressure on it. This included being told not to do any sort of high impact exercise, weight training, sit ups and even walking unless I was on a flat gradient! Having always been incredibly active I felt like I was suddenly disabled and became very anxious and depressed.  I obsessively googled prolapse information and each time became more and more upset with the state of my body. I felt completely embarrassed and ashamed of my vagina and wouldn’t let my husband anywhere near me for months. When we did eventually try to have sex it was so horrendously painful that I couldn’t do it. My GP told me that although I felt pain from my episiotomy scar there wasn’t anything wrong and it would improve over time. Completely miserable at 10 months post partum I convinced her to refer me to a gynaecologist so I could discuss my prolapse and scar tissue. I was added to a six month waiting list.

Now, it may seem rather counter-intuitive but it was at this point I decided that if I was going to go through all this again I just needed to just crack on. Both myself and my husband knew we wanted one more child and there was only one way it was going to happen! I was absolutely terrified about having to give birth again and what would happen to my body but I couldn’t wait with such a huge shadow hanging over me – it was easier to face my fear. Two weeks before my daughter’s first birthday we found out I was pregnant.

I spent my second pregnancy flipping between excitement that we were having another baby (we found out it was a boy) and absolute terror about the birth and impact on my body. I obsessively checked my prolapse on a daily basis to monitor what was happening with it. Some days it was there, others it wasn’t. Unfortunately, when my gynaecology appointment finally came around it wasn’t obvious and I was told there was nothing wrong with me. I was also told there was nothing that could be done about my painful scar tissue whilst I was pregnant. Great!

Having had a difficult first birth I was seen by a consultant a few weeks before my due date. She couldn’t even finish introducing herself before I broke down in her office. She calmed me down and explained that second babies come out much easier – I would probably just have to breathe him out.

My due date came and went. Twelve days overdue I was admitted to hospital to be induced and became very anxious. Induction meant medical intervention and I desperately wanted to avoid all of that this time. I really wanted a water birth. Luckily the hospital was too busy to induce me when I arrived so I was given a sweep and sent away. Four hours later my waters broke and I was in established labour. I was managing well at first but as the pain increased I started to panic and requested an epidural. This meant giving up on the idea of a water birth in the maternity led unit and going back to the labour ward. From this point on everything started to go wrong. The phlebotomist (blood person) couldn’t access a vein for blood tests, the gas and air was making me violently sick, it took three midwives multiple attempts to get a clip on my baby’s head and the anaesthetist couldn’t find the right place in my spine to administer an epidural. To make matters even worse, the midwife I had was absolutely horrible. I started to realise something was really wrong when my contractions changed from the ‘normal labour’ ones to the ‘it’s time to push’ ones. My midwife was asking me to push but I just didn’t feel my baby was coming. As the pain intensified I kept shouting that there was something wrong and being told there wasn’t. However, within moments, a consultant appeared in the room and declared that my baby was showing signs of distress. On doing a scan she confirmed that his head wasn’t even engaged and explained that the only option was an emergency c-section. I felt like I had jumped into one of my nightmares but from somewhere I found a sense of calm and confidence and off to theatre we went. The surgical team were absolutely amazing and before too long our beautiful baby boy arrived healthy and well. Our family was complete.

I was later told that the c-section hadn’t been straight forward.  My womb had torn down the middle as they pulled him out, they had come close to damaging my bladder so had spent lots of time checking it and pumping it full of dye to ensure it wasn’t leaking and I had lost three times more blood than ‘normal’.

I found my c-section recovery really difficult and incredibly slow. Although I kept being told by doctors that it was slow because it had been a complicated operation, I couldn’t help but compare myself to friends who seemed to be recovering so much quicker. As time went on I also became very aware that my stomach was not contracting back as it had done the first time. It was stretched and hanging down like an apron, covering my pubic area entirely. My community midwife took one look at it and told me I had severe abdominal separation and would likely need an abdominoplasty (operation to pull the muscles together and do a tummy tuck). I went to see my GP who confirmed I had incredibly thin and separated abdominal muscles. She said I had been referred to NHS women’s health physio so to wait for my appointment.

Over the next few weeks as well as the appearance of my stomach being a problem I started to get lots of unpleasant symptoms. I had episodes of bladder pain that felt like a UTI even though I didn’t have one, my back was sore, my pelvic floor felt uncomfortable and my prolapse was as bad as it had ever been. I also had a really horrible sensation that felt like I was going to pee every time I took a step. I didn’t leak when walking but if I tried to run I would leak a bit after a couple of minutes and when I sneezed I would sometimes have an ‘oops’ moment. Having experienced stress incontinence after my daughter I assumed I had weak pelvic floor muscles and started trying to do pelvic floor exercises. However, whenever I did them my bladder symptoms got much worse.

Eventually I was seen by an NHS physio who once again told me I didn’t have a prolapse and explained that we could try some exercises for my abdominals but I would likely need surgery. It was at this point I decided enough was enough. I didn’t want any more surgery and I needed to know what this prolapse was that no-one could find! I had heard about Jilly through the mum’s grapevine in my area and booked to go and see her.

In my first appointment I completely broke down. Two years of trauma came flooding out. Jilly was absolutely amazing and for the first time, a health professional seemed to understand the true impact of my experiences on my confidence, mental health and quality of life. Jilly did an examination of my pelvic floor and abdominals and explained that surgery wouldn’t be necessary, we could get my body sorted together. I still feel emotional thinking about that moment because it was the first time since having my daughter that I didn’t feel hopeless and alone. My diagnosis: an over-toned pelvic floor which was giving me lots of unpleasant symptoms (including the painful sex) and separated abdominal muscles that needed to be pulled together, shortened and strengthened.

Jilly also established that my mystery prolapse was something called a urethrocele. The lower part of my front vaginal wall had been stretched by my first birth so my urethra wasn’t supported as well by it anymore. None of the other health professionals I had seen could feel it because it was hard to notice when examining a patient lying down. Finally being listened to by someone and having a diagnosis was like a weight being lifted off my shoulders.

In contrast, in March this year I had a follow up urogynae appointment at the hospital. When I explained I had some mild stress incontinence the consultant offered me surgery without even examining me. Thanks to Jilly I was able to confidently decline an unnecessary operation.

So, where am I now?

My son turned one just three weeks ago which feels like a significant milestone! Since I first saw Jilly last Summer I have had regular appointments. Each time she has truly listened to what is going on and tailored my treatment and home exercises accordingly. I no longer have an apron covering my pubic area – my abdominal separation has drastically improved, my abdominal muscles have shortened massively and I now just have a small bump which is barely noticeable. People no longer assume I’m pregnant and I can finally wear non-maternity clothes! My bladder irritation/pain still flares up occasionally but episodes are becoming shorter and further apart, my pelvic floor is still over-toned but I am seeing steady progress in being able to relax it, sex is now pain free, I don’t constantly feel like I could pee myself every time I take a step (this symptom hasn’t gone away completely but has improved lots) and my stress incontinence when sneezing has pretty much gone. I go to Spin classes every week, I do lots of walking and I do regular workouts at home involving lots of safe core exercises and all over body strengthening exercises. Furthermore, I have lost 1.5 stone since Jilly gave me the confidence to get back to exercise and I feel stronger than I have in nearly three years.

There is still some work to do but Jilly is confident that my stomach will continue to flatten and shrink down as my abdominals continue to shorten, strengthen and come together and she believes I will be able to run without the fear of leaking again one day soon.

As for my prolapse? It’s still there some days but I’ve stopped obsessively checking myself which I’m taking as a win! It bothers me much more mentally than it does physically and I sense that with this one, time will be the healer.

My message to you – if you have read my story and can relate but have not yet had help, please go and get it. Maybe you do need surgery, but maybe you don’t! Physio certainly isn’t the quick fix and that can be really hard initially (trust me, I want things yesterday) but at the end of it you have a strong, rehabilitated body that you understand, and that’s so worth the wait!

Many thanks to Beth for her open and very honest blog. I hope this chimes with many of you.

 

If you’re interested in talking to me (Jilly) I have a clinic in Cardiff and also see people via Skype sessions. Click here to book yourself an appointment.

If you’re a physiotherapy professional and would like to attend a live course (The Happy Bladder Course) please click here click here.

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Image courtesy of Dream Capture Photography