Below you will find statistics (as of April 2020) for the most common issues women in the UK experience after childbirth. The purpose of this article is to raise awareness and encourage you to seek help if needed.
These conditions are common and are either preventable or treatable. If you experience any of them, do not put up with them, reach out for help.
• Pelvic floor and abdominal muscles are the two areas most affected by pregnancy and birth. The pelvic floor is in charge of pee, poo and sex. The pelvic floor and abdominals together create a pressure cylinder for core strength, needed for posture, movement and fitness. These eight short videos explain perinatal pelvic health.
• A common misconception is that the pelvic floor is weakened by pregnancy and needs to be strengthened. Actually, the pelvic floor can be both weakened and tensed by pregnancy, even if you have a C-section delivery. A tense pelvic floor is like a cramped muscle and is hard to strengthen. Good pelvic floor function is about the range - the ability to engage and also to fully *relax* the muscle. The pelvic floor is further affected by vaginal birth, tear, episiotomy and instrumental delivery.
• Abdominals are affected by pregnancy and also by tummy separation (diastasis recti) and C-section.
• Statistics shows that:
• Statistics are likely an underestimate as these are ‘taboo’ areas where women do not disclose symptoms, either because they are normalised or through embarrassment/shame, or due to lack of awareness.
• Risks of leaving these conditions untreated: incontinence and prolapse will only get worse, persistent reduced sensitivity/pain during sex, back pain, injury/worsening of symptoms when returning to exercise.
• In turn, these can adversely impact all aspects of a woman’s life: mood, self-esteem, mental health, relationships and intimacy, careers (e.g. severe incontinence affects the woman's ability to work/commute to work), ability to keep active for health and play with your kids, parenting.
• The big misconception is that C-section avoids these risks. Both vaginal delivery and C-section affect pelvic floor and abdominals, in different measure, and both require postnatal purposeful rehabilitation. A good practice is for all women to see a women's health physio at least once after 8-weeks postbirth, and its never too late.
• The best person trained to address pelvic floor and tummy separation issues is a women's health physiotherapist. There are specialist physios both working with the NHS and privately. Ask your GP for a referral or visit the Squeezy App directory and find a physio near you. Most health insurances cover specialist physio appointments.
• Make sure your PT, yoga class teacher, etc has special training in women's postnatal health and so understand which exercises help you and which ones can worsen your health.
• 90% of women tear in childbirth and between 1-10% of women experience severe perineal tears (called 3rd/4th-degree tears or OASI, obstetric and sphincter injuries) in childbirth, although health professionals feel this figure has been underestimated. 3rd/4th-degree tears are a common cause of faecal incontinence. Visit the MASIC Foundation website for more information on prevention and treatment.
• Obesity and incontinence are linked – 10% loss of body mass can reduce symptoms by 50%. Research suggests mothers are heavier and older – both of which can increase the risk of incontinence and prolapse.
• Multiple Cochrane reviews show that conservative treatment with specialist physiotherapy is effective for urinary incontinence, many causes of faecal incontinence and vaginal prolapse.
• Around one in four women experience mental health challenges in pregnancy and during the 24 months after giving birth (e.g. depression, PTSD and birth trauma, anxiety, OCD, psychosis).
• Dads have mental health challenges too.
• Due to the Coronavirus outbreak, mental health issues skyrocketed.
• If you notice symptoms that cause a significant amount of distress or impairment, or if you are unsure, check-in with your GP for treatment options.
• Websites like these can give you more information and connect you with clinicians specialising in perinatal mental health in your area (many of these organisations also run free helplines):
https://www.mind.org.uk/ (The MIND charity, has a special page on maternal/parental mental health)
https://pandasfoundation.org.uk/ (PND Awareness and Support)
https://www.birthtraumaassociation.org.uk/ (Birth Trauma Association, specialise in PTSD)
https://www.makebirthbetter.org/birth-trauma-support-for-parents (Make Birth Better CIC focuses on birth trauma and PTSD)
https://www.anxietyuk.org.uk/ (National charity helping people with anxiety)
https://maternalocd.org/ (Maternal OCD charity)
https://apni.org/ (Association for Post Natal Illness)
https://www.bacp.co.uk/ (British Association for Counselling and Psychotherapy)
• If you are experiencing thoughts about death, suicide, or harming yourself or somebody else, don’t keep it inside. Go to A&E or call 999. We have good treatments for mental health challenges, and you do not have to suffer alone.
• The NHS Long-Term Plan (January 2019) sets goals for the next ten years to:
focus on prevention,
improve access to postnatal physiotherapy to support women who need it to recover from birth (I'm honoured to have been one of 12 speakers at the Governmental roundtable calling for specialist physiotherapy for all women after childbirth), and
improve access to and the quality of perinatal mental health care for mothers, their partners and children,
however, for women giving birth today, this is not yet the reality.
• The NHS are doing their best and some NHS GPs and specialists are more in the know than others. If you feel your GP or other healthcare providers are not helpful or refuse referral, bring the NHS Long-Term Plan or relevant NICE Guidelines to your appointment and politely but firmly ask for more support/referral.
• If you have private health insurance, use it. Most insurances cover physiotherapy and women's health physiotherapy. And many GPs are keen to help you get the best care and best use of the NHS/private care combo.
What you can do
• Do not put up with any of these conditions. Aim for prevention and early treatment. It's never to late to reach out for help.
• Close the knowledge gap. Use reliable resources to research your condition. Start with the ones referred to in this article.
• Reach out for help. Talk to your NHS GP and use your private healthcare insurance. Most insurances cover specialist physios and mental health specialist appointments.
• Consider coaching. Your health and lifestyle have a direct effect on your experience of life and your work, whether you are aware of it or not.
If you have a health challenge, some conditions require medical attention, drugs, surgery, but most recovery processes occur post-medical treatment and require a mindset change. Coaching is not an alternative to treatment. But coaching is very effective in behavioural change, it supports recovery between treatments and helps you build the recovery process. Trained in recovery and wellness coaching, I will be happy to discuss how coaching can help - you can book a call with me here. I collaborate with a network of carefully vetted practitioners that can help address areas beyond my expertise like psychotherapists, women's health specialists, nutritionists, etc.
If you don't have a health challenge, hooray! Think of how your daily habits affect the goals you are trying to achieve: Are you getting enough sleep? How sharp is your thinking? What are your energy levels like? Your mood? How are your resilience levels? How are you in conflict situations? Woman's health changes significantly through life stages - pregnancy, fertility, breastfeeding, sleep-deprivation, tiredness, periods, peri-menopause and menopause, cancer - all of these have a significant effect on women's personal and professional performance and experience of life, of balance and fulfilment. With all my clients, we explore health and lifestyle as a tool for personal mastery.
A lawyer-turned-coach, Anya Smirnova has been delivering executive coaching and health coaching since 2015. She loves supporting women to realise their full potential, particularly at times of transition in career/life when choices feel like “either/or” and the temptation is high to trade in dreams and ambitions for the security of the well-known. Her mission is to support more women to have senior positions while being fullfilled in their lives and careers.
 The NHS Long-Term Plan, January 2019. Available from: https://www.longtermplan.nhs.uk/.  The NHS Long-Term Plan, January 2019.  The BJOG release, 21 January 2015, published by the RCOG. Available from: https://www.rcog.org.uk/en/news/bjog-release-link-found-between-pain-during-or-after-sexual-intercourse-and-mode-of-delivery/.  The NHS Long-Term Plan, January 2019.  The RCOG online information for patients. Available from: https://www.rcog.org.uk/en/patients/tears/tears-childbirth/.  The Masic Foundation Manual, February 2017. Available from: http://masic.org.uk/wp-content/uploads/2017/02/information-document-masic1.pdf.  The NHS Long-Term Plan, January 2019.  The Make Birth Better Report, April 2020. Available from: https://www.makebirthbetter.org/thinktraumanow