#and i do have an appointment with the student health physio the week after next. you don’t need to care about this i’m just talking

[mybumpbirthandbeyond]

Motivation

I understand from the beginning this blog has been about me – mainly my pregnancy, my birth and my ‘recovery.’ I have said before, but I continue to be overwhelmed at the reaction and response to what I have written, from people I haven’t spoken to in years, to possibly people I haven’t even met. With that in mind I now feel I might need to do a wee introduction to myself.

I live in Scotland with my husband, our son and our two Springer Spaniels. I am now living in the town I was born in. I went to primary school here and went to secondary school not too far away. My mum taught at my primary school, and my dad taught at my secondary school. (Yeah, I didn’t have many boyfriends at school – especially as my dad was head of PE and one of the rugby coaches!!). I think it’s important to speak about a major thing that happened in my life, because it might explain my mindset. When I was 14, my dad was killed crossing the road in Spain when he was on a golf holiday. It is the worst thing that has ever happened to me and my family, and that hasn’t changed. It’s been 18 years, but it you never get used to that – you learn to live with it. Every single happy occasion is tinged with sadness knowing he is missing it all. That will continue for the rest of my life. It’s become even more apparent now I have my son – he would have loved being a grandparent and would have been the best Grandpa ever. Cailean is Gaelic for Colin – we named him for my dad. We pronounce it differently to the Scottish Gaelic pronunciation, but I suspect it’s similar to the Irish. I’m okay with that. 😊 I mention all of this, because no matter how tough this journey gets, I’ve been through worse things, and I know there are always going to people in a worse position than me.

I studied Law with Spanish at the University of Glasgow. I lived for a year in Granada in the south of Spain studying Law IN Spanish as part of my degree. I became a lawyer in Glasgow, having trained in civil and criminal court practice. As a newly qualified, I then focused solely on crime. It’s less like Suits or Legally Blonde, more like: this cell smells of pee, the client stinks of alcohol, and I’m at a police station until 5am and I have to leave for court at 7am miles away. The gown was pretty cool though – makes you feel quite powerful, like a superhero – defender of the neds and the smelly. I do sometimes miss it – the challenge of being constantly intellectually challenged and thinking on your feet (literally on your feet in the courtroom) by some of the brightest legal minds in the country. The buzz of winning my first trial and being able to learn at the feet of the masters in High Court cases when instructing Counsel. I always thought I’d end up wearing the wig myself, but sadly legal aid is a shitshow and crime really doesn’t pay – what they don’t tell you is, it doesn’t pay the lawyers either!

Fun fact – the Spanish always comes in handy on holiday, and actually we were already booked to go to Mallorca when the doctor told us we were pregnant. Bit shit I couldn’t have a cocktail on holiday, but there you go! I had bought new clothes for it and by the end of the 10 days – yes 10 DAYS - only weeks pregnant, I couldn’t fit some of them! Start of the story of my life…We were in the hotel restaurant and they had homemade ice cream. Anyone who has been pregnant knows whippy or soft ice cream is a no-no. Anything has to be from pasteurised milk. It was roasting, the ice cream looked amazing – what can I say. I used my language skills to explain to the waitress I was pregnant, and was the ice cream made from pasteurised milk? She congratulated me and had to go and check with the chef but thankfully it was. So the first person in the world we told we were pregnant, was the waitress. It was in Spanish so I didn’t really feel it counted, but it makes me laugh even now. Even more so when ‘pregnant,’ in Spanish is a word that looks like it could mean ‘embarrassed.’ You can imagine when I was Uni student you didn’t want to be making that mistake in conversation!!!

Hope that gives a bit of an insight, but back to the rehab. In my last blog I mentioned the decision I made to definitely have surgery and hitting the reset button multiple times in preparation. I was due to appear at Grainne’s conference in Glasgow. It was so oversubscribed, that Lyndsey ended up sorting another date here at my local hospital for anyone who couldn’t make it to the Glasgow date. That was due to happen the end of March. The week of the conference I was due to see Lyndsey, having not seen her since the end of February. I’d still been working hard in between times and progressing where I could but it always helps to have a goal and something to aim for.

I had a trip to Belfast at the start of March. Some of you will have seen my posts about that – yet more queries about if I was pregnant, yet more jeans that didn’t fit. This story was getting old. Happily, there was a tiny gym in my lovely hotel and after work the two days, I hit that. I was feeling pretty good but as I mentioned I had motivation – when you know you’re going to be tested in a room full of some of the best pelvic health physios in the country, you don’t want to look weak and useless. If I’m going to be tested on my ability to perform a crunch with a double leg lift (thanks Antony!) then you better believe I’m going to work my butt off to give a good account of myself. Not only that, but Antony was due over to Scotland in May to run a course for fitness pros and physiotherapists (thank you Rosie!). We had agreed I would donate my body to the cause and we would finally get the chance to meet in person. Powerful thing motivation.

Then it just disappeared. Coronavirus hit and my appointment and the conference were postponed (understandably). Lyndsey kindly called me, which was unexpected, to tell me she was being redeployed to a ward and did I still have contact with Grainne and Antony in case I needed anything? That’s the incredible thing about these people – they’re not just amazing at their jobs, they are amazing people. That is why I am so lucky. That is why I knew I would cope – even if it was a bit rubbish knowing I will go months without physical feedback and what felt like nothing to work for. Wrong.

I’ve mentioned perhaps only a few times (!) how lucky I am and how much respect and admiration and just pure gratitude I have for those on my team. I’ve not even seen Grainne and Antony in person, but I undoubtedly count them as part of my team. How could I not? They have helped me progress in a way I never thought was possible. They have advised me in ways Lyndsey admitted she couldn’t, because if it isn’t for the likes of Grainne and Antony, that information just does not exist, or certainly not enough of it does. I am more informed now than I ever have been. That is down to them and everything I have been advised. I owe it to all of them, to work at this and continue to work at this regardless. I owe it to myself, but a bigger driver is not letting them down. That is almost more important to me than doing this for me is.

I was unwell for the first few weeks of lockdown. It was suspected kidney stones, possible kidney infection, after I discovered blood in my urine. Pretty scary especially when you’re in a lot of pain. When the X ray and urine came back negative and the antibiotics didn’t work (yep a trip to the GP and hospital during a pandemic) – the doctor was perplexed so made an urgent referral to Urology. They then made an urgent referral to Radiology for me to have a CT scan. Radiology apparently decided it was routine, not urgent, so I had to chase around three different departments. With it being ‘routine’ – they weren’t doing routine appointments during the pandemic so I wouldn’t be seen. Urology decided to get it upgraded as urgent as I still had blood in my urine. Finally, they agreed and two weeks later (this has now been going on over a month) I have now had my CT scan. I’m waiting to hear from Urology.

In that time, I felt pretty demotivated – I was in pain so rehab felt out of the question. The pain was mostly in my side, but also my lower back and lower abdomen. Not really helpful to then engage in exercises testing your core. Time started to tick by, but I was exhausted and just not really in the mood. Then a lightbulb just flickered on and stayed on. How could I possibly explain the next time I spoke with one of my physios I just haven’t bothered? I wouldn’t be able to look them in the eye and I would be ashamed. The pain was still there, albeit duller than it had been, so I pushed through. This is the resilience I was referring to in my previous post. I needed to forget about my kidneys and just get on with it. That’s what childbirth is about after all – you may be in pain or discomfort, but you just get on with it because there’s no choice. So do what you have to, but just do it.

I started posting about it again on social media. I had been relatively quiet, but I thought I needed to get accountable. I knew there was a chance they were watching (I wasn’t wrong). I addressed the things I would like to do and how I was managing that without direct feedback from my physios – I bought an abdominal slant bench with the idea I could try to get to full sit-ups. Lyndsey had discovered a 30 degree angle was probably ideal until I could overcome the initial angle from flat to 30 degrees – after that I was fine. Then I had a message from Grainne who had seen my story on Instagram. She told me to just do it. Forget the bench just do it. It seemed like a piece of simple advice, but she’ll never know how much that impacted my mindset (unless she reads this of course!). It lit a spark of less thinking, more doing. So I did exactly that, and before I knew it I had reached 15 full sit-ups. My feet were locked and that is still the case now, but I never needed them to be before everything. I’m aiming to get to a point where they aren’t locked. That’s the point - I have goals back, it’s just I’m setting them and not my physios.

That then gave me the freedom to test my boundaries – press-ups were on my knees and had been for a while. What if I did them full on my feet how I used to? Started with 4, then 8 on my knees. Next night, 6 on my feet, 6 on my knees. Next night, 8 on my feet, 4 on my knees. Then it was 8 on my feet, but 8 on my knees. Now, it’s more like 16 on my feet, and 14 on my knees – I’ve just done it over two reps. I started doing more upper body work with the dumbbells I already had. Then I started doing my planks on my feet – I last only a few seconds but this is usually after my press-ups and sit-ups so I’m letting that go at the moment. I don’t use the bench now: until the other night – I tried a few reverse crunches. My back wasn’t a fan, so will have to leave that on the shelf for just now and come back to it. Instead I’ve been trying to build more strength in the crunch with the double leg lift – I’ll explain why in a couple of paragraphs.

In between I got a very welcome email from Grainne – given how everything was going, she wanted to do another consult. Not just that, but somehow in the midst all of the chaos, she had put together an online version of the course that was due to take place in person and I was very kindly being given access as the live case study. Told you – amazing person! The course was really interesting, and amazing to work through - no surprises here. It was fantastic to get the opportunity to read more about what I was going through and the more clinical side. Of course, there are bits there are lost on me, but I like to learn so that’s not a problem. She is going to continuously add to the section on me because there will be further updates, but it’s crazy to listen back to the consults we had when we first started.

Our next consult was even better than I thought it was going to be, because both Antony and Lyndsey were also able to join. Lyndsey had started this whole journey of mine and was the reason I even know about Grainne and Antony – I was delighted she would get to speak to them ‘face to face’ as it were, for the first time. With my back giving me a bit of bother, I altered what exercises I was doing in the lead up to the call. I absolutely knew Antony was going to ask me to do the crunch with the double leg lift and I really wanted to not want to collapse in a heap like I did last time. I had to prove the work I had put in and that I was getting stronger. I actually practised some but had to stop, so was slightly dreading that part, but it’s amazing what strength you find when you need it. It was more or less the first thing I was asked to do, aside from stand there so they could see what the appearance was like. There was a comment or two that it looked good, but I didn’t really pay attention too much. Funny how I did a few days later…

I was honest about my lack of motivation, but Antony said it was a good thing – athletes need days off and come back feeling refreshed, why wouldn’t i? That’s what I love about Antony – he challenges your beliefs and pushes you to be better. He has such a knack for stating something so simply that it really strikes a chord and resonates.

The double leg lift and crunch went well enough, but the repetition tired me out. Not sure if I’ll ever get over that the way things are, but it definitely went better than last time. Antony admitted it was the hardest thing he would ask me to do and he always starts there. Good thing I love a challenge! One of the biggest takeaways I had from this were two-fold: I hold my breath when it gets hard. When I’m pushed to my physical limit, I hold my breath. Antony asked me to sing a note as I did a sit-up. I tried so hard not to laugh as it seemed so ridiculous. They must have all thought I sounded like the cat’s chorus!! (I promise I can actually sing better than in that video if anyone ever sees it). In my defence, it’s the same part of the sit-up that previously stopped me from doing one at all – that’s where I lose it. I now have a decent marker for progress though – when I can hold that note, I’ll have gotten stronger and sit-ups will be easier.

Secondly, when we were wrapping up at the end, Lyndsey said how much she appreciated being on the call. She said something she had never said to me– she knew she couldn’t help me get to where I wanted to be which is why she told me to listen to that podcast all those months ago. That was huge. You worry people are offended when you seek a second opinion, yet here was Lyndsey saying she was grateful they were able to help when she thought she couldn’t. See what I mean? Incredible people – I can’t say it enough.

When I said I had nothing to work for I was wrong. I’m not just working for myself – I’m working for my team. As little information as there is out there about Diastasis Recti, these people are trying to change that. The least I can do to thank them for everything they are doing for me, and so many other women out there, is to work my ass off to show their research, their advice, their practises work. That they are right, and I am proof of that. If you’ve seen my recent post, you’ll know what I mean. In under 6 months my body shape has changed massively – even to the point that I am actually noticing now. I would never have agreed before about that. I refused to believe or listen when people told me ‘your tummy is coming down.’ Oh yeah? Well how come the gap is no smaller and the measurements say it isn’t? I haven’t had those measurements taken since February. If I was gambler, I’d bet at least the circumference has come down since then.

I’m now back to doing more of the type of exercises I’ve always done at the gym. That’s liberating in itself, but I also have freedom to decide where this goes. I probably always had that freedom, but the reality is I was holding myself back – I was constantly checking in to make sure it was okay. That’s nobody’s fault – its partly the way people are trained to treat women with diastasis recti, but it’s partly down to my attitude of not wanting to do wrong; not wanting to disappoint. That’s innate in me and always has been.

There’s very little that is off the table now. I jokingly said I’d like to get to pull-ups. Well the response was a resounding, unanimous ‘DO IT’. I’m going to be grateful for the rest of my life to these people and I can’t even begin to thank them enough. They haven’t just given me all the advice, support and help when I needed it most – they’ve given me motivation, a positive mindset, and the freedom to choose the direction that this goes. They have backed me all the way and continue to do so. There is still such a long way to go, but what will be a very difficult and no doubt painful journey, is made a hell of lot easier with them on my team. I’ll need this when the days get tough and there will be many of those ahead. This is my motivation when I hit the reset button.

[mybumpbirthandbeyond]

The Catalyst - Part 2

I’ve always been a bit of an idealist and someone who stands up for myself. I’m not in any way confrontational, but when it comes to it, I’ll not be pushed about. I’ve always had strong values and beliefs, and truly believe that if someone can’t stand up for themselves, you stand up for them and advocate on their behalf. I guess that’s why I was so keen to be court lawyer. I always knew I was going to do Criminal Law - I just never expected it to be defence! You may meet those as guilty as sin, but ultimately, there are always those who truly need help and that was one of the things that always kept me going when the negatives of the job crept in.

Being the lawyer in the family, (although no longer), means I am the go-to for complaint letters. I write a mean complaint letter – articulate, but you sure as hell know I’ll not miss when I have a point to make. When it comes to my own postnatal care, I’ve mentioned how I wished I had argued more at the start and pushed to make sure I wasn’t signed off when my son could have been blinded by an e.coli infection in his eye at just one week old. I should have pushed back when I was told – ‘yeah I can feel all the way down to your bowel. Here’s a tubi grip and if needs be, get your GP to refer you to a physio at your 6 week check.’ My physio had that chat with me at the low point of my rehab. Contact patient relations – something was missed. That was the catalyst for what I very much hope will be major change.

To recap – I spoke with patient relations who put me in touch with the head of Maternity Services in Fife. I made it clear I wasn’t complaining - more investigating. This cannot happen again. She was very helpful and said she would have a clinical manager look into my notes and what process, if any, was followed. That was November. I should expect to hear something a few weeks later.

December came and I had my consult with Antony, as well as my ultrasound. I was feeling more positive and definitely felt there was progress and work to be done, but still hadn’t heard. When I finally did, they wanted me to meet face to face with Maternity Services and Physiotherapy. At last, something was happening! Finally, I would know what was missed.

The meeting took place in January. I had already seen my physio that just before Christmas. At that point she told me I should expect to hear soon – my notes had been requested by the clinical manager, and she had already been spoken to. Her interim manager had also been spoken to, and would likely be present at any meeting. The manager and a Maternity Services Manager (on behalf of the Head) were there with patient relations. My husband came with me. Initially I didn’t even think of having him there, but I was glad I did – another pair of ears, but a supporter who could relay my story from his point of view.

Here’s an obvious statement and I am pretty sure in any profession – including my own – we’ve always been told the merits of saying sorry when you’re wrong, and particularly in a situation that could result in legal action. It doesn’t always mean an admission of liability, but I have the feeling the NHS are so jaded from legal action that some are incapable of saying it. Sorry goes a long way. Half the time when I write a complaint, if there was an apology there wouldn’t be a complaint – admit you’ve done wrong and then make sure it never happens again. I made mistakes as a lawyer and I was dealing with someone’s liberty. I know the stakes are so much higher in the healthcare, medical etc professions, but the principle is the same.

I basically told them my story to the point I was at. I never mentioned my consults with Grainne or Antony – why should I? I did that through my own volition (thanks to my physio’s encouragement), and their kindness and generosity in hearing my story. I pay taxes and was cared for by the NHS. I was never abusive, I never took advantage. I was the model patient and more than that, I’m damn well-read on most things – I understood medical terms, I did my research and never put a foot wrong.

They were both sympathetic but it was the head of Physio (let’s call her Y) who said the words ‘I’m sorry.’ They aren’t the ones who need to apologise. The Physio department has done everything for me – how could they have done more if they didn’t know about me???

The woman from Maternity Services, let’s call her X, was that sympathetic way but more like ‘nothing we could do.’ I think that’s what pissed me off the most. It was almost like she was trying to make excuses. She told me that I wouldn’t have been seen within 8 weeks anyway, because the body takes that long to more or less go back to normal after giving birth – in terms of uterus etc. I already knew that (I did my research) but if I had been referred earlier, it wouldn’t have taken almost 4 MONTHS for my first appointment!!! Who knows what progress could have been made in that time. Are there referral processes in place? Her answer was any midwife can refer a patient to a pelvic health physio antenatally or postnatally at any point. So basically, I didn’t have to wait until my 6 week check with my GP and that midwife could have referred me. Or as I was told, I should have been examined on the ward and referred during my two night stay. ‘The uterus is still very much an abdominal organ at the point after giving birth, so it would have been impossible to tell about the diastasis.’ Really?! Then how was it that the community midwife felt my bowel two days later? I’m not suggesting it would have happened straight after giving birth, but if there is a referral process on the ward, why does it exist if these diagnoses can’t be made at that point? (My physio has since said what she said was rubbish!)

I pointed out I was examined by a student midwife before being discharged. Nothing against those learning – I’ve been there myself and we all have to start somewhere, but would it not make more sense to have someone supervising the student who isn’t even finished her degree at that stage?

Was anything in my notes then after it was discovered when I got home? ‘No.’

Just let that sink in – NO. A midwife examines your stomach and sinks her hand all the way down to your bowel. Is that normal? No. Is that a good sign? No. Is it significant? Yes. But let’s not bother writing that in the notes…REALLY?!?!?!? It takes a lot to render me speechless, but I’m quickly finding out that’s becoming all too common on my postpartum journey. If I didn’t write something material in a client’s file, it could mean something major missed and we lost in court – may have even led to the person being refused bail and put in jail. I could easily get disciplined at the very least, if not sacked. If someone medical leaves something out in someone’s notes, surely that’s on the same, if not a worse level of incompetence??!?!?!

Y was very kind – she was trying very hard to find a polite way of saying ‘you’re an extreme case.’ I think the words she used were – ‘cases like yours are uncommon.’ I acknowledged that I’ve learnt that very quickly and I’m not offended. She pointed out that she was so sorry because I am the type of person they need to see – not those with 1 or 2 finger/non-existent gaps. They explained there was meant to be a process but what made me realise how important this meeting was, was when Y asked me what did I want to happen. What had to change?

My physio had already told me they were going to put posters up on the labour wards about diastasis. I guess next time I’m there I’ll know they’re because of me. Posters aren’t really going to cut it though – there needs to be drastic change. How often are posters up on the walls at your work and no one pays a blind bit of notice to them? My husband pointed this very thing out. I told them they need them up in antenatal clinics as well. I unleashed my pent up anger at the breastfeeding agenda. I wasn’t abusive – I was just blunt. ‘No offence, but the breastfeeding agenda the NHS has is everywhere you look. Women have absolutely no idea about Diastasis. There should be as much about this, as there is about breastfeeding.’ I stand by my point – and it’s not just because breastfeeding epically failed me either. Those of you who receive a Bump Birth Baby book at your booking appointment. Have you noticed (or maybe not) that there’s a minuscule paragraph on mastitis? I got it twice in two weeks, with an abscess requiring referral to the breast clinic. Thrush? Nothing on it at all. I got it within two weeks of giving birth. Diastasis? Not a damn thing. I appreciate you don’t want to scaremonger, but can you at least mention it and direct people to where they can get help? Is that really so much to ask? This is what I pointed out.

Y then asked me if I had known about Diastasis before this happened. Everyone knows the answer to this – no. How could I? I’m a firsttime mum and not even those qualified to tell me, told me about it.

That then leads me on to the next point I hammered home. Midwives are not trained properly. They have next to no clue about this and that’s what worries me the most. I appreciate they have no control over the University course, but training on the job should be mandatory. Your muscles separating during pregnancy may be normal, but no one knows about it. This means people are returning to exercise without knowing what they can and can’t do, potentially causing further damage. If this is a result of pregnancy, why the hell don’t know they about it???

There’s a common theme here you may have noticed – Y is doing all the talking. I think X is frightened that if she says too much I’ll go into legal mode (I did drop it in). Y said she was aware they would need to collaborate more and get training organised. Apparently, they are now under the same line management and collaboration should be much easier. She said would I be happy to be contacted? I agreed and said I’d be happy for my name to be used in any case studies etc, but also happy to be used physically in any training. Practical training is surely best for any practical role.

X’s parting offering, was to suggest she get the newly allocated perinatal mental health midwife to give me a call. Probably because my husband gave a rather frank assessment on what this has done for my mental health. Parenting is hard enough without this on my plate, and the news it might never improve. I agreed she could contact me, all the while thinking, I doubt much will come of this (more on that later).

I’d like to think when I left the room, there was a sigh of relief from Maternity Services. I still made it clear how much I respected the midwives and I wasn’t there to make a complaint. However, as I said in the meeting, I’m confident enough to advocate on my own behalf, but what about those who can’t? What about those are who don’t have the support I do?

I’d also like to think they looked at each other and realised they have some serious work to do. This meeting may have been a catalyst for change, but this has to be the beginning, not ‘thank god we dodged a bullet.’

My physio told me some shocking information. She had sent someone from her department in the hospital where I gave birth on a fact-finding mission. Asking a variety of midwives on the labour and postnatal ward about their knowledge of diastasis and what they would do. Newly qualified; those at the end of their careers; those from different health boards who had transferred etc. Some knew what it was under different guises (rectus sheath, DRA, diastasis); others had no clue. Some had a vague idea of what they would do; others had no clue. One person, ONE PERSON knew what it was, and the process of how to assess and then refer. That one person was relatively newly qualified, but had trained in Edinburgh, where apparently, this is standard practice. So because I live over the bridge, a mere few miles from Edinburgh, I got the shit end of the stick when it came to care for my diastasis. How can this not be standard practice ACROSS THE NATION? Across every practice involved in the care of pregnant women and those who are in the postnatal period? Let alone across two health boards separated by a bridge over a river less than 20 miles from each other.

When I saw my own physio after the meeting it was interesting to hear what Y had relayed. She basically told my physio and her colleague they would have to put a training plan in place for midwives, and my physio would be more than likely the one to run it. She told me she would start looking at it after Grainne’s conference, with the most up to date information available. I realised in that moment that we were both on the brink of bringing about real change to antenatal and postnatal practice. I said to her – ‘you are in a position to make something happen. You could be breaking ground with this training.’ If this comes off, my suffering won’t be for nothing. I will not have been through all of this in vain. That’s what I’ve wanted since the start. If my blog helps one person to know to get seen by someone before returning to exercise; it if helps that GP be a better doctor in those 6 week checks; if it helps an aspiring midwife improve their knowledge; if it helps that new mum get through the day; and if my experience of Diastasis helps those who come after me, then none of this will have been in vain. That’s what keeps me going when I hit rock bottom. And if I can be a catalyst for change, then no one should suffer as I have suffered.