Jen:
Amy, welcome to the Mumsafe Movement Podcast. I'm very excited that you're here.
Amy:
Thanks for having me, Jen. I'm pretty bloody excited to be here too.
Jen:
So let's get straight stuck into the way that we always start the podcast, which is a word to describe how you're showing up. And if it's been a shit show of the morning, that is fine. A win and something that you're working on.
Amy:
I actually would say this morning, I've had some really, really good conversations even prior to our chat. And so the word I'm feeling at the moment is excited. And I'm excited to have this chat with you because I do think it's really important. The win at the moment is we're just coming into Birth Trauma Awareness
Jen:
Mmm.
Amy:
Week and we're already getting some good media. And I think there'll be a feature on the project on Sunday. So that's huge for us. And then working on... We'll talk more I think about this but my understanding is there's not a single profession that works with birthing parents that has any kind of specialist training in relation to birth related trauma and so we are going to fill in that gap of needs and we're currently working on a project to develop professional training for professionals.
Jen:
Fantastic, what kind of professionals were that before?
Amy:
For anybody that works with birthing parents, so we're keeping the content broad.
Jen:
Mm-hmm.
Amy:
Primarily, I would say midwives, that's the biggest area of interest that when we've been taking people, they're registering their interest, predominantly we're seeing midwives, but we're also seeing mental health clinicians. We're seeing, you know, sonographers, doctors, anyone really needs to know and understand the impact. of birth-related trauma and how prevalent it is and what can be done to prevent it and what we can do to better support people that are impacted by it as well.
Jen:
Fantastic. And we're definitely going to cover a lot of those.
Amy:
Yep.
Jen:
There are a lot of my questions, but we might just put a note in there that we will put the link. Can we put the link to express interest in the show
Amy:
Oh
Jen:
notes?
Amy:
yes, yeah
Jen:
Because
Amy:
absolutely.
Jen:
I think exercise professionals are going to be on that list as
Amy:
Yeah,
Jen:
well.
Amy:
yeah.
Jen:
So Amy, so we can get some context. Can you tell us who is the Australasian Birth Trauma Association? What do you do?
Amy:
Yeah, what do we do? So we are a small charity with big ambitions for safer births and better healing. So we are a peer-led community dedicated to the prevention, treatment and support for the people that are impacted by birth-related trauma.
Jen:
and you're based in the Sunshine Coast.
Amy:
Yeah, I'm based in the Sunshine Coast, but we are a national organization.
Jen:
Okay, and how many, I know we were just talking ahead of time that you have a team of volunteers working with you, although they
Amy:
Mm.
Jen:
all have full-time jobs and all the rest as well. What's the size of the team and what kind of workload does that leave you with? Yeah.
Amy:
Okay, so it was funny because at the start of 2022, we were a core team of four, I call them my core team, they're like my wing women. And at the end of 2022, I was like, yes, we're ending the year with 16 volunteers. And those are volunteers that help in general day to day, the running of the organization. So we have, you know, somebody that supports us with finance, somebody that supports us with analytics. website support because we're primarily an information-based organization. Then we have advocacy, we have peer support workers that provide that direct support to people that are experiencing birth-related trauma. And then of course we've got our board and advisory panel as well. So at any one time we have about 25 volunteers within the organization. But if we translate that into time spent in the operations side of the business, it's actually quite a few hours. So
Jen:
Hmm.
Amy:
we worked it out recently and we have two full-time members of staff and I'm one of them basically and so it can be a bit of a challenge because there's such a need for what we do like prior to us existing and forming and we launched in 2017. Nobody was really talking about birth-related trauma and that's both psychological and physical. So There wasn't really a dedicated place for people to seek support and even still to this day, how you get support and access the support is quite luck of the draw.
Jen:
Yeah, and give us a little bit of it. I want to have this conversation because
Amy:
Mm.
Jen:
I think that people from the outside looking into businesses, charities often don't realize that they're a one woman show like
Amy:
Mm.
Jen:
or a very, very small team because we do such a great job of going, Hey, look at my shiny website and all of those things. So
Amy:
Mm.
Jen:
where does your like financial support come from?
Amy:
I just have to make a side note about the shiny website because one of my volunteers that she she's actually a mum of four Works in the not-for-profit space and then volunteers
Jen:
Wow.
Amy:
for us and she's a comms expert, right? and she joined us in January 2018 and And she just made our stuff look absolutely outstanding And I even just think where she leveled up what we were putting out looked like we're like a really well-operated organization, but we literally survive. I think what's the Australian expression, the smell of an oily rag. When
Jen:
Mm-hmm.
Amy:
somebody told me that expression, I was just like, yep, that's us. So we basically survive off donations and fundraisers from the community. I did say for a period of time that I'm kind of the queen at getting those small sort of $10,000 grants here and there. And that ensures that all the peer support that we provide to the community is free. But yeah, it's very difficult to get funding for operations. So yeah, it's just, it's an ongoing challenge. And yeah, that's a battle. So when you said about the word, it was like, oh, I'm excited, but also very tired.
Jen:
Hmm. If there was someone listening now, Amy, you never know who
Amy:
Mm.
Jen:
could be listening like what? What would your ideal ask be?
Amy:
help us reach more people and help us do what we really could be doing and so what I mean by that is very early on because I wanted to just start connecting with people quickly for me based on my own experience and how when I first discovered my birth-related trauma which is physical I thought I was the only one and part of feeling like you're the only one when you're experiencing it is incredibly isolating, I felt a lot of shame around my experience and interestingly, Panda have released a study a couple of months ago about shame being a contributor to perinatal suicidality, which is a big topic that I'm going
Jen:
Huge.
Amy:
left to field here, right? But it's important to talk about this because I am contacted every day. or very often by women that say that we have saved their lives because we have given them information and resources where they thought, well, I must be the only one because no one was talking about it. So what we do as an organization is we amplify the voices of our community. And not only do we amplify their voices and share stories with the hope to make change, but the other thing is, is because we hear these stories, it informs all of the work that we put out, the resources that we create, the support services that we create. but we could be doing so much more. As I previously mentioned, we are currently developing our training for people working with birthing families. And that training is consumer led, but delivered by experts. When I peel off layers and contributing factors to birth related trauma, there's just another one there. And it's so big, but there is... it can be prevented, not always. And it's really important to acknowledge that it's not always preventable, but there is so much more that
Jen:
Mm.
Amy:
we could do to help parents as they transition into parenthood and go through the process of a most vulnerable period of their life. But yeah, we do what we do with such limited resourcing. We could do so much more if we had some of that core
Jen:
Yeah.
Amy:
permanent staff
Jen:
You've got
Amy:
or
Jen:
what?
Amy:
paid staff, yeah.
Jen:
Yeah, and you've got one regular donator, is that right? That's
Amy:
Yeah,
Jen:
right.
Amy:
yeah. So very early on, I was lucky, complete luck. I was in a Facebook support, support group, a kind of a support group
Jen:
Yeah.
Amy:
for mums is support, right?
Jen:
It's so support.
Amy:
Yeah, yeah, yeah. And, and I would talk about what we were doing. And then I just had another mum say, Oh, I'd love to meet you for a coffee. Coffee, I think we can help. And she, she worked at a law firm. but they also ran another not-for-profit called the Brain Injury Foundation. And I guess they could see synergy in our work and they basically said, if we could fund any role, what role would you like to be funded? And because we're voluntary led and we provide peer support, I thought we're gonna have lots of volunteers. So let's pay for a volunteer manager. And so they started supporting us way back in 2018. And that is the one funder that has just consistently supported us through this time. On top of that, we started an annual fundraiser in 2020. Originally it was called the Walk and Support, and then we've just rebranded and we're calling that the Big Step Challenge now, which is stepping forward for safer births and better healing. And that's a big sort of event in our calendar, but there are so many amazing charities doing amazing events that there's a lot of noise out there. So we need to look at other ways that we can hopefully... get the support that we desperately need.
Jen:
Are you allowed to share who your key supporter is? Are you allowed to share there?
Amy:
Yeah, yeah, I
Jen:
Yeah.
Amy:
mean, McKinness Wilson law firm. Yeah, yeah, they've been there. Yeah.
Jen:
from the start. I guess the conversation I wanna have right now is like, yeah, we are all we're having, but the exposure is if you are someone listening and you
Amy:
Hmm.
Jen:
are in a position, whether you are employed by a law firm, whether your husband is or your partner is, like this is a conversation that you can get in contact with Amy and have around the potential to offer either one-off or ongoing support
Amy:
Yeah
Jen:
to
Amy:
amazing.
Jen:
help women with birth trauma. So.
Amy:
Yeah
Jen:
Anyway, let's just
Amy:
and
Jen:
put that out there.
Amy:
yeah
Jen:
Ha ha
Amy:
I know
Jen:
ha.
Amy:
I really appreciate that and I think you know it's interesting that you said to help women as well because if we because what we haven't sort of said is I guess
Jen:
We're
Amy:
like
Jen:
gonna
Amy:
let's
Jen:
get there, right?
Amy:
yeah
Jen:
Ha
Amy:
we're
Jen:
ha ha!
Amy:
okay we're gonna get there but it's huge but let's okay
Jen:
Yeah,
Amy:
let's
Jen:
yeah, I digress, but I was like, that is such an important conversation because people just don't realize how many hours you're working on such little, and nine times out of 10, not getting paid for that. So, and
Amy:
Mm-hmm.
Jen:
it's not a sob story, and it's, you know, you're a woman on a mission to get really cool stuff done in the world,
Amy:
Hmm.
Jen:
and if people can help, and this resonates with them, well, why wouldn't they? So,
Amy:
Yeah, but even if
Jen:
yeah.
Amy:
it's pro bono support as well, or expertise support, like we can always do with more hands on deck. Like one of the biggest gaps in this space, and maybe why we've struggled to get big funding, is there's such a lack of research in this space. And I've learned so much, it's been such an incredibly steep learning curve for me. And I have so many hypotheses. I'm like, do I need to start doing research? But it'd be, you
Jen:
I
Amy:
know,
Jen:
hear you, I have those thoughts all the time.
Amy:
yeah. Yeah, right. Women's health is so under-researched and, you know, there's things like that where I see maybe that's a direction that we need
Jen:
Yeah,
Amy:
to move in as well. Yeah.
Jen:
yep. Okay, so let's flip all the way around. Like you, you
Amy:
Yeah.
Jen:
started this charity in 2017. I remember, I was thinking I was sitting in my car when we first connected and had this huge conversation. And we've like floated around each other and, and intended to do and then done and then not done and all these things. And we're excited to be supporting the Big Step Challenge. And again, we'll get to that later on. But why did you even start the charity in the first place? Like tell us, you know, the five to seven minute snapshot of your journey.
Amy:
Yeah, the biggest thing was, you know, I was pregnant with my first child way back in 2013. And like so many mums, I thought that if I do all the right things, I'll get the birth that I wanted, which was a drug free water birth. At the time, I when I found out I was pregnant, I was training to do a fitness comp intending to stand on the stage like an umpa-lumpa. And, and so I was the fittest I've ever been. I continued training throughout the pregnancy, although back in 2013, no one knew what kind of training I could do. Like I can't, it's just wild when you think it's only like less than 10 years ago and how far we've grown, but that's probably later in the conversation. But yeah, so I did pregnancy yoga, started meditating because I'm a massive stress head. And then I did a private birthing course and I thought I'll just breathe the baby out. And...
Jen:
Didn't we all?
Amy:
Yeah, yeah, so she didn't get the memo and long story short, I ended up having a forceps delivery and sustained a third degree tear. Significant bleed, very scary experience, but when I was in recovery, everybody kept telling me, well, you got the birth that you wanted. And I, you know, first time mum, you don't know what's normal and what's not. And even though I couldn't get out of bed for the first time, I was still in the hospital. five days and I was sort of wheeled outside in a wheelchair on day six to get some fresh air. I didn't know that I wasn't okay and I just thought things would improve. Initially I suffered with fecal incontinence but was very fortunate to be suggested that I should go and see a women's health physio. I'd never heard of them before. Somebody suggested that to me. So she kind of helped rehabilitate me. And I just thought things would get better, but I had to take it easy moving back into exercise because that was the biggest question. Like, when can I exercise like I used to? And then I was 16 months postpartum and I did my first run, ironically, a mindful triathlon. So, you know, a 5K run, 90 minutes yoga and a 15 minute meditation. And then I felt this like heavy dragging sensation in my vagina, which I now know to be a prolapse. I literally can't walk past the toilet in South Bank and not think of that horrible day
Jen:
Mmm.
Amy:
of when that actually happened. So I booked an appointment with a physio, went to see a physio, she palpated, you know, like did an internal palpation and she identified or diagnosed me with having a bilateral levator evulsion which is quite significant pelvic floor muscle damage. And I went into that appointment, a 35 year old woman, and I walked out of that appointment I thought I was like an 85 year old woman. I was told that I would need a device to support my organs inside of my body. I was told I shouldn't lift up my daughter. And like I said, she was only 16 months old. Of course I dutifully like stopped. And I was told I can exercise like I used to. So unsurprisingly, hearing all of those things, my quality of life and my life as I imagined felt completely ripped away. And my mental health just took a... a downfall and I became very mentally unwell.
Jen:
Mm.
Amy:
But I got good psychological support and as I began to kind of get to a place of feeling better, I started to research and started to talk to people and then I discovered how prevalent birth injuries are and particularly prolapse which isn't necessarily a birth injury can obviously occur outside of childbirth but childbirth I think is one of the biggest contributing factors. And I just thought, well, why aren't we talking about it? And so thus my career of talking about my vagina for a living was born. And it was through the research that I stumbled across the work of my co-founder, Dr. Liz Skinner, who was doing groundbreaking research at the time. Cause as I've already said, there's very little research in this space. And her research was about the psychological consequences of physical trauma. And I just reached out to her and I was like, what can I do to help? And she said, I wish there was a birth trauma association in Australia. And I said, let me make that happen. And I basically have not stopped since.
Jen:
Hmm.
Amy:
And I tried to just summarize that really quickly. I know I spoke really fast, but it's a lot.
Jen:
It is a lot and the first thing I would like to backtrack on is a bilateral avulsion
Amy:
Mm.
Jen:
because there will be people listening that don't understand what that is.
Amy:
Mm-hmm.
Jen:
Would you like to explain?
Amy:
Yeah, I guess I want to preface this and I'm sure you would have already said this, but Content warning because it can be difficult and quite confronting to hear of these kind of injuries, especially when we don't it's not publicly acknowledged at this time
Jen:
I think also while you're saying that Amy is, and I have this awareness all the time because I do teach people about the consequent or the potential consequences of birth.
Amy:
Mm.
Jen:
None of this information is designed to scare anybody. It's
Amy:
Mm.
Jen:
designed actually to empower you through education.
Amy:
Mm.
Jen:
So, and also there should never be, or we hope there is never a level of shame when somebody, especially trainers, because trainers are gonna be listening to this of going. Oh, what if I've done things with my client that could have caused, you know, not going to cause an avulsion, but, you know, contributed towards prolapse or what we can pelvic floor or things like that. And it's really important that we all just pause and go. We do the best we can with the information that we have at that time. It's nobody's fault as to what we don't know. But the reason we're having these conversations is to raise awareness and empower people to understand what may have already happened to them or to be able to support other people in their journey. So.
Amy:
Hmm.
Jen:
Yeah, yeah.
Amy:
I think that's really powerful. I mean, it is just the saying is knowledge is power. And for me, I guess I trained as a personal trainer. And when I found out how crucial the pelvic floor is to function, I was like, hang on a minute, why did we not talk about that at all in my education in becoming
Jen:
Because
Amy:
a personal trainer?
Jen:
men don't have the same problem, Amy.
Amy:
Exactly, because we're because women are a special interest group. They're only 50% of the population, but don't worry about that yeah, so I do think it's knowledge is power and Yeah, so in terms of an avulsion and what it means firstly, it sounds utterly terrifying when you've had your pelvic floor ripped off the bone Really like a common injury for people that have had a forceps delivery. That's my
Jen:
Mm-hmm.
Amy:
understanding but it can occur in a uncomplicated vaginal delivery and also with a vacuum delivery as well. So it's really important to be informed that these injuries can occur. And like you say, it's not about scaring people, but it's actually empowering because there's plenty of people that would know that these things can happen, still want to go through a vaginal birth process, but when maybe they end up with this result. Are they going to be as mentally unwell as someone that is just completely blindsided by their injuries? Like, of course not. So in terms of what, what it does mean is that basically, and obviously not physio or a medical professional in any way, shape or form, but we have our pelvic floor and that pelvic floor holds in our organs, our bladder, uterus, bowel. Um, yeah. And so when you have a baby through the birth canal, it has to stretch to three times its size. There is no other muscle on the body that does that. And it is crazy because I love your content, Jen. And you were talking about we rehab an ACL, but it's okay, you've been through it. You've actually brought new life into the world, but don't worry about that. Let's
Jen:
Mm-hmm.
Amy:
just pretend that after six weeks, it's magically okay. Like it's just wild. And so you can end up with, you know, dysfunction was the pelvic floor without having a tear. In my case, it's come off both sides of the muscle. And at this stage, there is no surgery that can reattach muscle to bone in
Jen:
Thank
Amy:
the
Jen:
you.
Amy:
pelvic floor, pelvic floor. And so you can see why it felt like a bit of a life sentence. Subsequently, I have opted for conservative management and I lift weights twice, three times a week. I hike for hours and have no symptoms. I actually live a really active lifestyle now because at some, I actually, one of the women health and fitness summits that I attended, I heard two physios say, you should never say to a woman, you can't do this. You say to women, what do you want to do? and how can we get you doing those things again? And it was just a like, bing, light bulb moment. It stopped me being scared of exercise and taught me how to exercise effectively. And it's something that I've heard you say, Jen, is about rehabbing from the inside out. Just don't think we talk about that enough.
Jen:
Mm.
Amy:
And so that's why I'm such a fan of your work as well.
Jen:
Thank you. What does conservative management look like for you?
Amy:
Yeah, so initially I had two physios. So I have one physio, women's health, both pelvic health physios, one that fits pessaries. And so I did basically for six years just wear a pessary every day. And a pessary is a device that you insert inside the vagina and it basically supports your organs. And that can be really confronting, right? Because
Jen:
Mm-hmm.
Amy:
you don't know that you can have a baby and then suddenly you need a device to hold your organs inside your body. Like it's just, again, it's a bit mind-boggling that we don't talk about this. And so I also had a physio that was more sports focused but still a pelvic health physio and she sort of taught, you know, got me learning about engaging the body. I mean also at the grand age of 35 or 36 learning how to have an effective bowel motion and you know all of these little tips how to engage because I mean again before you have a baby Your pelvic floor is a, it just does its thing.
Jen:
works.
Amy:
You don't need to think about it, it just works. And then post having a baby, you have to learn how to re-engage it again until it becomes like,
Jen:
automatic.
Amy:
it just automatic. Thank
Jen:
Yeah.
Amy:
you, can't find the words. Why are we not talking about this? It's just so, it could change someone's life. And that, you know, as you know, that's why we advocate so heavily for women to have access to pelvic health physiotherapy free. in the postnatal period because regardless of birth you would benefit from having at least one session.
Jen:
Yeah, and if we take that step forward further is what about the women that could have a pelvic health physiotherapist appointment in pregnancy that could potentially make all the difference in their birthing experience because what I'm hearing from you is that you were in the fittest stage of your life which means you are exercising a lot which means you are doing a lot of this like so tightening, tightening up and the key thing that we forget when we teach all women to do or all pregnant women to do pelvic floor exercises hey, how about you learn how to relax that muscle as well? And there is no research behind this, but I stand by it until there's research to suggest otherwise, that if that pelvic
Amy:
Mm.
Jen:
floor cannot relax in pregnancy, her baby is not coming out easily.
Amy:
Oh, well, you know, we talked about research. I think that this is an area and it's very difficult because you wouldn't get ethics. So one of the campaigns that we did back in again in 2020 is we want we called for Medicare subsidized access to pelvic health physiotherapy in the perinatal period so pregnancy and beyond. So at least one session and natally and up to five sessions postnatally. It's really difficult to do in pregnancy. So it's almost it's a conversation you want to have prior to having a baby. The other thing is, is I do think pelvic health physios have a place to be as commonly associated with birth as midwives and doctors,
Jen:
Yes.
Amy:
because they can talk about what the body does. And what you said about, like most professionals will say, do your pelvic floor exercises. That's great. Most people don't do them correctly. We know that statistically. The other thing is, is... if you've already got a tight pelvic floor because you do so much exercise and then you do more exercise, well then how are we gonna relax to allow that baby
Jen:
Mmm.
Amy:
out? And it cannot be a coincidence that we have so many sporting women in our cohort. And last year we released our birth injuries report, which was again, the first report of its kind. We had over 400 Australians talk about the impact that their birth injuries had on their lives. one of the things was the ability to exercise and it came through again and again. I was a professional runner, I was a professional horse rider, I was you know it cannot be a coincidence and no one's really looking into it so
Jen:
Where
Amy:
yeah.
Jen:
did you get to with the lobbying for the pelvic floor support or the women's health physio support? Where is that? What's the status of that campaign?
Amy:
We basically had a meeting with the Department of Health at the end of last year and she came with all the things that Medicare do subsidize and it's kind of that's where it is. We are working with the Australian Physiotherapy
Jen:
Hmm.
Amy:
Association to kind of get some stats. Because the complicated thing is, again, when you're under resourced is we need to demonstrate what cost that is going to save in a woman's lifecycle. We know that it is. Incontinence is the number one thing that puts elderly into a care home.
Jen:
Mm-hmm.
Amy:
Right? Okay, so what continence is, you can get support for that. It's important to know that, right? But lots of people suffer in silence. The impact of prolapse, you know, I think the perception is that it just happens, or for a long time, it just happens to old people. And even the the obstetrician that delivered my first daughter, when I told him my physio had recommended a pessary, he said they're just for old women that don't have sex. And yet my pessary literally changed my life. I was able to lift her, I was able to feel not as panicky if I did some exercise. It changed my life. And even the other day, I was speaking at a conference for sonographers and I had to look at all the different pro lapses on the screen, right? And it's confronting. Google's not your friend. If you ever get a prolapse diagnosis, Google is not your friend. And, you know, I'm looking at these quite significant prolapses on the screen and I'm just like, how have we normalized this
Jen:
Mm.
Amy:
for so long? Because the impact psychologically of not having your organs sit where they're supposed to is huge. So... What does that ripple out into? That ripples out into how we parent. It ripples out into our relationships, how our ability to return to work or continue raising families. Like it's just, it's so far reaching, but we don't have the data. So we are working with the APA
Jen:
Yeah,
Amy:
and yeah.
Jen:
it makes me think about further linking to the mental health aspect. I was at in a conference yesterday and it was talking about depression is going to cost us $6 billion globally by 2030. And it's like if there's research in that, how can we then link the what we've what we know about mental health associated with birth trauma to the costs that it's, you know, the global But if this many people didn't have birth trauma or pelvic floor related stuff going on that was impacting their mental health, well then can we put it into monetary terms that way? I don't know.
Amy:
Yeah, well,
Jen:
It's such a massive conversation.
Amy:
it is and it is that great need for funding. So I have connected in with a fabulous organization called the Houston Institute. One of the researchers there is looking to do stem cell therapy into prolapse
Jen:
Oh wow.
Amy:
repair. And, you know, we are talking about a possible collaboration in the future. So there's conversations that are happening. The other thing is what was so exciting is an incredible not-for-profit called the Lip Timber Foundation. They released a survey about two weeks ago and in that survey, because they've been focused on mental health, but in that survey they decided to broaden the scope of what of the questions they asked. So it's women's mental health and they asked about sort of more broader women's health problems. One in two women that have experienced birth injuries are living with severe mental health conditions,
Jen:
One in two.
Amy:
one in two. And that's the first organisation that I have seen that has talked about birth injuries publicly and supported what we've been saying. For years,
Jen:
Yep.
Amy:
in our birth injuries report, 89% of the 801 respondents said that their birth injuries had impacted their mental health.
Jen:
Wow.
Amy:
Like we have to talk about this and there has to be more research.
Jen:
Yeah, so let's circle around a little bit Amy. We've talked about your experience with birth trauma, which you premised at the front was a physical example of birth trauma. Can you share with us some other, so we've talked about an evulsion, we've touched on prolapse, what other kind of physical birth trauma can a woman have experienced and or recognize that she's experienced if she doesn't recognize it already?
Amy:
Yeah, so I could probably refer again to the birth injuries report that, so we asked people what their injuries were. So the first most prominent one was third and fourth degree tears. I think when we go into childbirth generally we know that we don't want to tear, we don't know what that actually means for quality of life. Now a third and fourth degree tear will have a catastrophic impact on your quality of life. Unless picked up and actually I think the outcomes can be really good if it's picked up at the time of birth Problem is it's not always correctly diagnosed and we see that a lot A third and fourth three tier is of the anal sphincter
Jen:
Mm-hmm.
Amy:
and that can mean that you will end up with fecal incontinence Um, you're not able to hold apart, which is really awful if you're, you know in the shops um Uh, and so then after that it was prolapse And then after that, it was nerve injury. So, you know, we've got ponderoneuralgia. Again, it's a condition that doesn't get much acknowledgement and has such an impact on people's quality of life. The other thing that came through a lot was infected stitches.
Jen:
Mm-hmm.
Amy:
And that could have been infected stitches of, you know, perineum tears or caesarean wounds. Then you've got sort of... varying other injuries which could be again pelvic floor muscle damage, you know, lesser degree tears. So we've got first and second degree tears which are much more common. I think it's about 80% of women will tear to some degree in the first birth, if it's a vaginal birth. So those are kind of the main ones.
Jen:
And I just heard you say birth trauma associated with C-section. I think sometimes we think that birth trauma is more vaginal delivery focus. Can you?
Amy:
Oh, well, I have to disagree.
Jen:
Hahahaha
Amy:
I mean, actually, I think I think, you know,
Jen:
I
Amy:
there
Jen:
think that,
Amy:
is.
Jen:
yeah.
Amy:
Yeah, I think there's a misconception out there,
Jen:
Yes.
Amy:
right? The ABTA focuses on physical trauma. But I'll tell you why. A, my experience. And so obviously, I talk quite vocally about it and my cats come to say hello.
Jen:
Man!
Amy:
I talk a lot about my experience. And obviously, if that gets into the media, then people find us that way. Now birth related trauma. we say birth related is a trauma, whether physical or psychological, that occurs at any time in the journey to parenthood. So that could be reproductive trauma. We obviously support lots of people that have trouble conceiving, go through multiple rounds of IVF. Anybody listening that's been through that journey, my understanding is there's very little psychological support for that process. And yet it's a, you know, it's a heart wrenching process. You know, we've got pregnancy trauma. So that's people that have conditions throughout pregnancy, such as hyperamesis, which is severe morning sickness that can completely impact quality of life from gestational diabetes, can't say that very well, to sort of lesser known conditions like preeclampsia or placenta accreta or previa, or any kind of just unknown condition that completely blindsides you. And then you've got the labor and birth experience and what occurs during that time. And it's not always about the birth experience, which could be intervention such as emergency caesareans or instrumental deliveries. But it's often how we're treated in that moment. That can be a big, big catalyst to trauma. You know, feeling like you're a spectator in your birth experience, feeling like you're coerced into making decisions or or not feeling fully informed about interventions that you were encouraged to have through to really poor communication from care providers. And then you've got postnatal experience as well, which could be birth injuries, it could be having the baby to go into special care. That's a huge trigger because when you have a baby, nothing really prepares you for leaving without. the baby and of course that is vitally important to acknowledge those that have experienced loss and then as well as that birth injuries. Often what we see Jen in our cohort is what I'm now referring to as a cascade of vulnerabilities and so we see people that have maybe gone through challenges conceiving then they have a difficult pregnancy but they can't complain because they wanted this baby so much. And then they might have a traumatic birth experience. And then when they get to the other side, well, at least you have a healthy baby. And so even in 2023, that healthy baby narrative is still the prevailing narrative and probably is still a barrier to people seeking support.
Jen:
I think that's a messed up narrative on a daily basis isn't it? It's like mum's
Amy:
20.
Jen:
life is... life can be so tricky as a new mum regardless of your experience yet to be pretty much
Amy:
Yeah, that was a big theme that came through in our birth injuries report. In fact, what we called medical gas lighting,
Jen:
Mmm.
Amy:
it sort of came through again and again. And this isn't just around the birth experience. This is something that happens to women all through their life cycles. You know, we're just told, oh, you're pregnant, just think happy thoughts, and you'll get the outcome that you want. Oh, you you're experiencing incontinence, or that just happens, you know, it's normal to not be able to jump on a trampoline or cough without. keeping your legs together. But there were very significant experiences where people are very, they're suffering ongoing symptoms of ongoing pain or painful sex or whatever the symptoms were, but it just came through that people's, when they're brave enough to seek support, they still are told it's normal and normalizing these kind of experiences.
Jen:
That helpful.
Amy:
Mm.
Jen:
Talk to me a little bit about the psychological birth trauma. So I know that you've just listed off a lot of, you know, what's the key difference to someone that's experienced and maybe you have listed it off already talking about, you know, coercion and not having an active role in your birth process, but how would you explain that more to us?
Amy:
Yeah, so I guess the impacts of psychological trauma is, I think any trauma, right?
Jen:
Mm.
Amy:
If how you're feeling about your birth or pregnancy or journey to parenthood, if you're not feeling okay with that, then that's valid. Like some people can find the word trauma too big. And again, it's like, well, I didn't end up with a life altering injury or my baby's okay. So, I shouldn't be traumatized. And I think it's so important to acknowledge that birth as a possible traumatic event is really confronting because we associate trauma, say, with war veterans or paramedics and birth is typically perceived as a happy event in our life. And, you know, looking after babies is all peaches until you've had a baby. And so it's, so in terms of, if we talk about the psychological impacts rather than the causation first is, yeah, so, it, you know, there's sort of four key things that indicate trauma. And so to meet a full diagnostic criteria for say, post traumatic stress disorder, you would have to meet all four of these criteria. But often, people may have just one or two of these symptoms, and still would benefit from a specific trauma treatment, as opposed to more traditional therapies that you would use for say, depression or anxiety. Now those four key things are, now I've got to remember, you've got, so avoidance, avoiding talking about the birth experience, this big one for parents, dads or non-birthing parents, you know, avoiding the hospital, avoiding any reminders of the birth for me. When I saw those mummies at the park, like doing the group exercises, I'd get really triggered because I'm like, I'm never going to do that. And then you've got big mood changes. So that can be symptoms of depression and anxiety. They can coexist with PTSD or symptoms of PTSD and more commonly recognized as I said before. But other mood changes could be like intense anger. And that could be anger directed at the partner because they didn't go through what you went through. And anger towards the health professionals as well or guilt or shame. Those are big ones for our cohort as well. The other aspects that we see are things such as, you know, developing unhealthy coping mechanisms, because traditionally we don't seek support for trauma until much further down the track. And so we just try and manage it ourselves until we're not able
Jen:
Hmm.
Amy:
to manage it. And we do have to get support. The other big thing is nightmares, flashbacks. reliving the birth like in a blow-by-blow it will just come to you. Often
Jen:
Wow.
Amy:
we have women that talk about being going to the dentist for the first time and then they have a flashback of being in the birth suite so that's a really big one as well.
Jen:
It's huge, isn't it? It's absolutely huge. The impact is huge.
Amy:
Yeah, and it's why this year for awareness week, the theme is specifically around PTSD in the postpartum periods, because we need to know about these signs and symptoms because people will benefit from specific trauma therapies. And also, the sooner we get support, the sooner we can start managing it and sooner we can start to hopefully bond with our babies and it doesn't ripple out into our lives. The other big thing about psychological trauma gen, and again, some of it's my hypothesis and some of it is out there, it's evidenced, but what we bring into birth suite is really important. And there is a huge gap. As consumers, we don't know why our preexisting trauma can affect our birth, and then clinicians don't necessarily know to ask the questions. we don't necessarily, there isn't an environment to ask these questions but it's really important to acknowledge and again this is a this is a really sensitive topic but many of us experience trauma in fact Headspace will say that 70% of Australians have experienced at least a traumatic event in their life. Statistically, one in three women have experienced violence, sexual violence, typically at the hands of a partner. There was a paper published, I saw yesterday, that said there has been an increase in the number of domestic violence instances in pregnant women. We are walking into the birth suite with our baggage, and that baggage and what we have experienced prior will come out in the birth experience. But nobody knows that. Like I remember my own personal experience, my midwife said to me, have you got any preexisting mental health conditions? I did, I came with baggage, right?
Jen:
Hahaha
Amy:
But I was the best that I'd ever been. I was so happy, I was pregnant, you know, like I'm like, why are you asking me this? I didn't know why. Obviously now I know. It's to make sure that I'm signposted to support services for potential post-natal depression, right? And I understand that. But the same applies for pre-existing trauma. So you will have people that have gone through horrific events, and they are maybe having ongoing psychological support. But you'll also have people that have maybe had a one-off horrific event, and they've buried it because that's what we do with our trauma, particularly sexual trauma, for example, lots of people don't, you know, the politics around that, we're not believed, women are not believed. And so you think you've buried it, and then you go into the birth experience. and maybe you are given an epidural and you're immobilized. And then what do you think happens? And this was drawn to my attention because this is, like I said, a steep learning curve for me. And it's only through storytelling that has given me the knowledge that I have. And a brave mom last year, Hannah shared her story for Awareness Week. And she talked about that exact experience. She was numbed from the waist down, no sensation. She had a flashback of abuse from her swim coach. She is at such high risk of experiencing PTSD of the birth process because she's lost that control during the birth process, but we don't talk about this enough. The other really scary statistic, and I do think it's important to know, the child mistreatment study came out, it was published a couple of weeks ago, or a month ago, and this is a horrific stat. 28.5% of Australian adults aged between 16 and 60 have experienced child sexual abuse. So we need a maternity system that provides safety, and that safety is not being given.
Jen:
and ask the questions. I'm trying to find the words, but my brain goes to, you know, women, should I have an epidural? Like, that's a question, right? A lot of women will ask for a pain relief option, and there should be a whole heap of questions. Now, listening to what you've just said around, well, if you've had this happen in your life, this is the potential experience of being completely out of control if you have an epidural,
Amy:
Mm.
Jen:
yet. I know those questions. Well, I mean, you know they're not being asked, and I can imagine that they're not being asked because, or I think they're not being asked.
Amy:
No, but that, but that isn't, but it's also acknowledging the challenge. So, um, we don't have a necessarily a psychologically safe environment for people to disclose that information,
Jen:
Mm.
Amy:
but also we're asking clinicians to ask that information and then where do they send these people for support if they need it. So that's already a barrier. So we've got lots of these barriers. And like I said, at the beginning, we don't necessarily have the answers as an organization, but what we're trying to do is say, just remember the people that you're working with. may have a trauma history. So what can you do in the moment to prevent trauma from occurring? And that's what's really powerful. Actually, there's some incredible evidence that came out in the US that showed that PTSD or trauma can be prevented from occurring in the moment where perhaps the trauma is occurring
Jen:
Mm.
Amy:
by the application of compassionate care. And that is really, really powerful. But I preface that with understanding that we've also got a workforce that's undervalued. doing incredibly long hours, you know, off the tail end of three years of a pandemic, how can they apply compassionate care when nobody's caring for them as well?
Jen:
Yeah, and I think that's really important because I have an awareness that I quite often go, well, the medical industry is not doing this. And it's like the individuals in the medical industry are doing the fucking best they can.
Amy:
Yeah, yeah. I mean, with every with every industry,
Jen:
Yeah.
Amy:
there's got this gonna be bad eggs in every profession, in whatever world we work in, right? There's obviously going to be bad eggs. But what we see in the stories that we hear is sometimes like I just, I always talk about this particular story of a mum saying that she was in the second stage of labour. And she actually said to the midwife, like, why are you being so mean to me? And that midwife said, well, because we want to go home and you're not pushing. but probably not like that either. And to me, that's not somebody that is okay.
Jen:
Mm.
Amy:
Maybe that's somebody that's just coming on the end of a 24 hour shift. What do we do to support our carers?
Jen:
Absolutely.
Amy:
And so that's, you know, it's a much bigger problem
Jen:
It's
Amy:
than,
Jen:
huge.
Amy:
yeah,
Jen:
Yeah.
Amy:
yeah.
Jen:
Okay, let's start to bring it around to or to talk to exercise professionals that might be listening.
Amy:
Mm.
Jen:
What so you know, my instinct is a very thorough pre exercise screening is going to help to pick up potential birth trauma. We're not we're not it's not within our scope of practice to diagnose anything, but we can certainly see red flags and refer on. What would you say, Amy, at that first? First consultation with a new mom that has had a baby, whether it was a recent birth or in the past,
Amy:
Mm.
Jen:
what are the key questions that we should be asking the moms that we're working with in order to start the conversation and then make sure that they get directed to support without diagnosing because it is very much our not space to do that, not our space.
Amy:
Yeah, I think it's really important this question because I do think that as personal trainers and how many women you work with, you might be the first person that could acknowledge that trauma. Again, that came through in our birth injuries report, not personal trainers per se, but talking about pelvic health physios were often the first health professional that has acknowledged someone's think that if you are working with a mother in that sort of early postnatal-ish period, even really up to, you know, five years,
Jen:
Mm.
Amy:
because, you know, postnatal is forever, is ask them about their birth experience. It probably is helpful as if you're going to be working with them to know whether they've had an instrumental delivery, for example. You don't need to have the answers. You don't need to diagnose exactly like you say. It's ask them and provide them a space to tell you because often people that have gone through a difficult experience they just they just want to share it and they feel they can't and I think that would just be a great a great point in which to start. Also be aware of those red flags of potential trauma as well because People don't always know that they can get support for what they're experiencing. So what do we know are the definite red flags that they might indicate in that conversation? Well, we know emergency caesareans, instrumental deliveries, those sort of postpartum hemorrhage. So those sort of common occurrences. You know, I only learned again recently that if someone's experienced a postpartum hemorrhage of significant bleed, then They are then at risk at subsequent autoimmune diseases, but no one actually says to mums, you know, you should maybe go in and check your bloods, maybe get an iron infusion. So to be across what those, what they indicate to you and what they'll tell you, and then know what that can mean. So if she's ongoing battling with tiredness, well, what does that mean? Do you wanna share a
Jen:
Mm.
Amy:
little bit about your experience? And... Yeah, it's just opening up the conversation really.
Jen:
Yeah, I absolutely agree and getting exercise professionals that are choosing to work with moms in this space to have a thorough pre exercise screening, which involves what kind of birth experience did you have? You know, was it a vaginal delivery? Was it a c-section? How long were you pushing for? Did you have any tearing? You know, did you have an episiotomy? How's it healing? Like all of those questions. And I love what you said about you don't have to have the answers because I really see our role as we gather information, we have that awareness of what may have happened to the woman in front of us. Hello pussycat! That's so cool! We have this information and then we don't necessarily even tell her anything because we're not here to tell her anything at all but to say, have you ever considered seeing a pelvic health physio?
Amy:
Hmm.
Jen:
Or how are you feeling about your birth experience? And then
Amy:
Mm.
Jen:
have you ever considered... seeing a mental health professional to talk about you? Or has anyone ever reflected your birth experience with you?
Amy:
Yeah, yeah. And I think also, I think regardless of where they are in their motherhood journey, I think, you know, I've said this for years, and I'm pretty sure you've said the same thing, which is that who's in your referral network?
Jen:
Hmm.
Amy:
And ideally, any personal trainer would have a pelvic health physio that you would work with and cross refer to. So before they start training with you, please go and see a pelvic health physio and just see where you are. Like what's the functionality of your pelvic floor? Yes, if you've experienced any tears, if you've got any ongoing symptoms from that. So that is also obviously ensures that you've got best practice, but it is also great. You expand your network, you know, maybe you know some great clinicians in the area that provide psychological support, like mental health clinicians. Like who's in your network? and make sure that you get good feedback about the individuals you refer to. Word of mouth is everything. Again, because birth trauma is now, people are talking about it a lot more. I do think that there's lots of people that say they're experts and I always think word of mouth is everything. So make sure you get feedback if you're referring.
Jen:
I thought, well, if you're referring, you need to go meet them, in my opinion, like go
Amy:
Yeah,
Jen:
experience.
Amy:
but even in meeting them, you might not necessarily get a good sense. So,
Jen:
Well, experienced
Amy:
yeah.
Jen:
at appointment with them, like inside
Amy:
Yeah.
Jen:
of Safe Return to Exercise, we say go meet that person, ask them if you can have an appointment as if you were a postpartum mom, whether
Amy:
Oh
Jen:
you choose
Amy:
wow!
Jen:
to have an internal or not, then fine.
Amy:
Love that.
Jen:
But having that, and sometimes you meet pelvic health, the personalities just don't match and that's okay
Amy:
Yeah, yeah,
Jen:
too. Like you
Amy:
yeah.
Jen:
don't have to work with that person if they're not the right person.
Amy:
Yeah,
Jen:
The other.
Amy:
always second opinion. It's okay to get a second opinion. Don't, yeah,
Jen:
Absolutely. The
Amy:
yeah.
Jen:
other thing that I heard you say was about getting information back from the physio. So it's easy for us as trainers to go, hey go see this person. It's the next level and the level of care that we want trainers that are specializing in working with mums to have is that two-way conversation. So it's not just send them and hope that the mum can then deal with the outcome because probably she can't even remember what's being said to her but then to get the information from the physio back to you so that you can create a safe and effective training program for that individual.
Amy:
Absolutely,
Jen:
So important.
Amy:
yeah,
Jen:
Yeah,
Amy:
yep, couldn't
Jen:
yeah.
Amy:
agree more.
Jen:
Let's talk, because it is Birth Trauma Awareness Week, as this
Amy:
Yeah.
Jen:
episode is dropping. It's literally just started. Tell us, we know that Birth Trauma Awareness Week is your major fundraising activity for the year. And
Amy:
Mm.
Jen:
this year you're doing... big step challenge. Tell us about that and throw some statistics in there Amy because I know that that's why you're doing the big step challenge.
Amy:
Yeah,
Jen:
And
Amy:
yeah, yeah.
Jen:
I want to, yeah.
Amy:
Yeah, so the big step challenge is we're basically encouraging people to step forward for safer births and better healing and that's psychologically safer and so that's again very individual but it is really about providing choice and options and conversations and what does safer births look like for one person it could look completely different for another and then better healing. Well at the moment as it stands there is no national guideline for That is changing. And there are some guidelines being developed by the Royal College of Obstetricians, the Australian College of Midwives, Monash University, and I forget the last organization, Cochrane. And they are seeking consumer representatives. They're taking applications. for that until the 11th of August. So I'm just gonna put that in there because it's so important. There's no standard postnatal care in Australia. It's just like mind blowing, like, see ya, off you go, go raise this new life. But back to the big step challenge. So we're asking people to step forward. And for the 110,000 families that are impacted by birth related trauma every year. Now we're saying 110 steps and that could be, you do 100. and your friend does 100,000, I can't do the maths, but you catch, you get the drift. But also we're acknowledging the fact that there are some people that physically are unable to do the steps, so we're saying do something that you love, whatever that looks like, however big the step is, just step forward and help us better support the community and how we do that is obviously by dedicated peer support services. through a growing body of advocacy work and increasing awareness for both community and health professionals around the impacts of birth-related trauma.
Jen:
So Birth Trauma Awareness Week is what are the dates? And I know that if people are listening
Amy:
Yeah.
Jen:
in real time, it's now.
Amy:
Yeah, yeah.
Jen:
What are the dates from the 16th to
Amy:
Yes,
Jen:
the...
Amy:
16th to 23rd. And even if you listen, you know, because you're listening to it, after the week has started, it's not too late. And if you just think I really want to support this organization, you could jump online and support somebody else's challenge and help boost their, you know, their goal. And it's been incredible to see so many mum safe trainers get on board this year. This year, we've got the biggest number of participants than we've ever had
Jen:
Ah,
Amy:
any
Jen:
amazing.
Amy:
other year. So just get behind and support it and just know you know even if you donate no matter how small
Jen:
Yeah.
Amy:
it makes a huge difference for us and really does mean the world.
Jen:
Absolutely. There's so people know exactly what to do to jump in. So if you want to do the maths, it's 15,714 steps per day to hit that 110,000. And I have a commitment that I'm going to walk them because running them for me is easy. And I know that that's just such a privilege thing to say for so many people, especially when we're talking about birth trauma and pelvic floor and things like that. But fuck me, I get frustrated with walking.
Amy:
I love
Jen:
I'm like,
Amy:
walking!
Jen:
oh my God, I'm
Amy:
Oh,
Jen:
like,
Amy:
it's my
Jen:
I could
Amy:
happy
Jen:
run this
Amy:
place! Yeah.
Jen:
in like an hour and I'm done. Whereas walking, I can't even get 5Ks under an hour at the moment. And it's driving me nuts. So my commitment this week is
Amy:
I love
Jen:
to
Amy:
that, Jen.
Jen:
walk those goddamn steps. Any running on top will be extra and not counted in the step count. If you want to laugh along the way, I'll show you what I'm doing on Instagram. And I did set up a mom safe specific. page. So if somebody wants to join a team, jump on my team, walk with me or you're allowed to run. If you have got a team of clients that you want to set up now and rally the troops, you could all go for a walk on Saturday morning. So you've got a whole week to kind of set that up, set up your own individual team and like Amy said, if you not just want to donate, if you want to donate, it's really important that we remove this $5 isn't enough. And I'm not saying, if you've got more than $5 to donate, please do donate a larger number, but never underestimate the compounding capacity of many people doing small things.
Amy:
Oh,
Jen:
So.
Amy:
yes, yeah, absolutely.
Jen:
Yeah. What else Amy to wrap us up? What else do you want us to know, need us to know? Where
Amy:
Well,
Jen:
can people go? So
Amy:
yeah.
Jen:
if someone's listening to this and maybe they're a trainer and they've got clients and or maybe they're among themselves and they're going, oh maybe this was me or maybe they know that they've experienced birth trauma but they haven't either haven't reached out to support or haven't reached out recently. Where can they go? What can they do? Tell us about the peer support.
Amy:
Yeah, I just want to say, it's really, really important to say this now, it is never too late to start healing. And you know, one of my favorite books, this again, talking specifically around incontinence, but highly recommend it if you haven't read it, it's called PMSL, or literally how I pissed myself laughing. And she talks about suffering from severe incontinence for seven years
Jen:
Huh.
Amy:
before she actually sought support. So it's never too late. But if you want to start getting support, we have so much information on our website. We've got lots of resources available there. And then we provide dedicated peer support services across the nation. And that is, we've got a multiple touch points. So we do it through peer to peer social, which is for women and birthing people that identify as having birth related trauma. And that is a private Facebook support group is about 4,300 members, really safe space, such a diverse range of experiences. really ultimately just somewhere you can either share your story and often that's all that's needed. I just need to someone to hear me and not tell me at least. The other thing that we do is one-on-one support via written chat on the website so connecting with our mentors or our peer support workers and they have a lived experience but they are walking talking proof that things can get better and they can and you can heal whatever healing looks like to you. And then we also do small in-person support programs, which we have actually temporarily had to pause because we haven't had ongoing funding at this stage. But those are basically, I call them mother's group with information because for me, I thought I'd make my lifelong friends at my mother's group, but it turns out I needed something shoved up my bum every Thursday, which is when my mother's group met. So by the time I managed to go to the mother's group, I just felt utterly broken and like I was the only one struggling. And so just FYI, the thing's shoved up my bum is to make sure my anal sphincter.
Jen:
I was like,
Amy:
Yeah, yeah, I should probably
Jen:
yeah.
Amy:
put that in there.
Jen:
I was like, I was like.
Amy:
Yeah, yeah. But, yeah, so it's really an opportunity for people to connect with women in the community and make friends that way, but with people that get it, because that's what you want. You just want to speak to someone that gets it.
Jen:
Yeah,
Amy:
Yeah. So that's what we do.
Jen:
fantastic.
Amy:
Yeah.
Jen:
And people can find you on Instagram
Amy:
Yeah,
Jen:
and on all the social spaces as well. So,
Amy:
yes absolutely.
Jen:
fantastic.
Amy:
Jen, so good to chat!
Jen:
Thank you, Amy. This has been, we've got in lots of directions and I hope that what we have covered has helped trainers and mums alike to understand more and also know what they can do more to support in each other, the mums they work
Amy:
Mm.
Jen:
with. And also... work that you're doing as well
Amy:
Yeah,
Jen:
Amy.
Amy:
yeah,
Jen:
Thank
Amy:
thank
Jen:
you
Amy:
you
Jen:
so
Amy:
so
Jen:
much.
Amy:
much.
Jen:
See you soon.
Amy:
Cheers then, bye bye.
Jen:
Bye.
