#51 Postpartum Incontinence: Author Luce Brett's Journey Through the Wet Knickered Wilderness to Dry Land

September 23, 2020

“She asks about my recent experience giving birth and I recite the highlights, like a poem learned for school; I can drill down to the key information that medical types want: first baby, first pregnancy, to term, live birth, ‘spontaneous vaginal delivery’, no previous incontinence. Next, she asks for a list of things that make me leak – my first incontinence homework. I begin: ‘Walking, running, stretching, coughing, sneezing, lifting up a baby, farting, shouting, crying, standing up, long strides, buses, exercise, stairs ...’”

This is the beginning of Luce Brett’s book PMSL or How I literally Pissed Myself Laughing and Survived the Last Taboo to Tell the Tale. Today, we interview Luce on her postpartum incontinence journey--a life chapter shrouded in embarrassment, sadness, itchy wetness and bewilderment during a time she had expected to feel elated, joyful, and deeply in love with motherhood and her baby.

With 1 in 3 women experiencing bladder weakness and urinary leakage, this topic is as important as it is taboo. Luce’s story is both funny and factual, raw and heartfelt and something all women can benefit from hearing--if not for themselves then for someone they love.  

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View Episode Transcript

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

She asks about my recent experience giving birth and I recite the highlights like a poem learned from school, I can drill down to the key information that medical types want. First baby first pregnancy to term live birth, spontaneous vaginal delivery, no previous incontinence. Next she asks for a list of things that make me leak. My first incontinence homework I begin walking, running, stretching, coughing, sneezing, lifting up a baby farting, shouting, crying standing up long strides buses, exercises, stairs, and the list goes on. This is the beginning of loose Brett's book pm SL or how I literally pissed myself and survived the last taboo to tell the tale. Today we interview loose on her postpartum incontinence journey, a life chapter shrouded in embarrassment, sadness, itchy wetness, and bewilderment. during a time she had expected to feel elated, joyful, and deeply in love with motherhood and her baby. With one in three women experiencing bladder weakness and urinary leakage. This topic is as important as it is taboo. Lucy's story is both funny and factual, raw and heartfelt. And something all women can benefit from hearing, if not for themselves than for someone they love.

Thanks for having me. I'm really thrilled to be on the on the pod. I think what was interesting for me about my first birth, it was quite a difficult labor and quite traumatic, although on paper, it probably wasn't. So it was described as normal, and spontaneous vaginal delivery and all those sorts of things. But if I thought back to it, after it happened, I couldn't really remember much about the birth outside sort of quite grisly snapshots and these sort of brief moments of, for example, feeling alone or feeling afraid. But what I could remember most viscerally vividly was what happened just after I give gave birth when I have my first shower, and I remember thinking, wise, they put a mirror in the shower, because that's the coolest thing I've ever I've ever thought of. And there was this sort of like monument to brokenness with blood and stretch marks and the deflated belly, which I didn't know that you still had a tummy and all those things and most fresh stitches. And I was also standing in a puddle of wee. And that image kind of stuck with me for a long time because it sort of became the emblem if you like, of how I thought about my birth. So I had this normal delivery that was quite unpleasant for me because there weren't many people around. People weren't calling me by my name, it went on for a long time, and I talked quite badly. And then I had this changed version of myself, and I didn't know what to do with her. I didn't know who she was anymore because it just looked exactly like me but not like me at all. And that's partly to do with things like birth trauma and postnatal depression. But it's also does connect with why I ended up you know, 10 years later writing a book about post birth incontinence because I think it's kind of the, the taboo start with our lack of knowledge, lack of awareness, lack of proper talking about what childbirth is really like for many women. And the fact that birth stories are condensed or made personally or entertaining that you know, I could tell my birth story now to you as a hilarious joke. And you know, I could say, normally, people buy me a drink before they touch me there or whatever. But in reality, especially if something hadn't had that nice birth, my story wasn't represented it wasn't in the books people didn't talk about what happens when you look at your baby and then throw up because you've just given birth and all those sorts of things. So I think Yeah, might was my first birth didn't end brilliantly in that sense of my sense of myself and did brilliantly with my brilliant baby. But yeah, it kick started this kind of Odyssey and I call it like an incontinence Odyssey because it was largely down to the damage from that birth that's started me on this medical chain which took me to all These places that I didn't even know existed. And if I think back to her standing before the mirror, I can barely remember any her before that. And there was all of that me was this young 30 year old who had read loads of books could tell you exactly how big the baby was compared to like, fruit and vegetables, hat could spell uterus, and had learnt all about dilation had gone to breastfeeding workshops when I was pregnant, and all those things that I had never really been prepared for the brutal reality of what childbirth would or could be like, or what impact it might have.

So you did all the right things, preparing yourself throughout pregnancy and studying up and getting all the knowledge that you needed to have what you, you know, believed would be a easy, normal birth. And it didn't turn out that way. And what you have been dealing with since then, is an issue of what you called post birth incontinence. Can you tell us a little bit about how many women experienced this because it's a very sort of taboo topic, and people don't really like to talk about it. And you've done a marvelous job of bringing it into light through your very, very funny and very well written book.

And the statistics are incredible and quite shocking. So around one in three women who's had a baby were so and I mean, that's just way the figures around bowel incontinence are massive, too, I think it'd be you test around one in 10, was sitting under the carpet completely, and don't talk about them because they're embarrassing. And we also write it off as something that happens to old women or old people. So we end up in this funny situation with incontinence where we don't actually talk about the reality at all. And I think it can therefore be unnervingly shocking for young mums, particularly if they emerge from childbirth and bear leaking, when even with what happened to me, I only have what you would call a second degree tear. But I was leaking quite badly right from the start. So when I went home, and during the first few weeks where I was quite unwell, because I have several postpartum hemorrhage is after my first birth. I kept saying to people, I think I'm waiting, I think I'm leaking. And they were saying, Well, everybody leaks a bit, don't worry about it. That's quite normal. And so that's the kind of people trying to be kind. So it's not about nobody stood up badly at that point in my story, but they were minimizing it. And it was only sort of two or three months later, when I finally was in front of the consultant who was trying to sort of sign me off after all these hemorrhages. And he was like, so she was sitting looking at me and she's like, What do you mean, everything makes you wait, and nothing makes you really, what do you mean? And when I explained it, and I gave her a list of things that made me meet her in like, standing up or carrying my baby or walking up the stairs or running or pushing a pram, and those sorts of things. She was like, okay, that is a step beyond what most people are managing. And so that was the first time I had a referral for physio, but I think we tell women to sort of get on with it. And we sort of there's also this sort of veneer around women, isn't it, we should just kind of not make a sauce, because we've had a baby, you can't complain. If your child Bethany, she really depressed if you're both alive at the end of it. And I think well, you're kind of getting used to having your boobs out. And everybody's been looking at you when you were in labor and all that sort of stuff. So I was very intimate with my women, friends who I've met who had babies at the same time, but incontinence is a step quite far, isn't it for a new friendship. You know, all it's really brought us together at that point was that we all lived in the same postal code area as the UK and wanted to have a baby, and we're pregnant at the same time. And then we did make friends. But it's a very hard thing to say to someone who you've not met recently, you know, you've only just met, you know, how much are you weeing? Like, is it just a little bit when you sneeze? Or do you sit through your jeans? You can't do that? Because we haven't normalized the conversation, which means that I think I found unusual. I was quite badly incontinent after one baby at the age of 30. But I'm not sure I am. I sport I certainly am not alone in having found incontinence complicated and difficult. The only thing that's unusual about me is that I've got help quickly in the UK often takes women up to seven years to get help if they need urine. It can take people decades, since I wrote a book about it since the NFL came out. And I have to be careful claimed at prime when I'm talking about it, like one of the first times I spoke about the book on a webcast. Somebody was talking and she said that she had bought my book and she was going to go back to her GP who've been initially a bit dismissive about her being incontinent and she said 40 years ago, so she had been incontinent for 40 years, Wow.

It's not uncommon to see throughout this industry, in the postpartum phase where women aren't, they simply aren't taken seriously. So many times women just don't speak up, they're not willing to talk about it. And then when you find that courageous few who do speak up, sometimes they're telling an obstetrician, they aren't feeling right, emotionally, they're anxious, they're not sleeping, they're think they're depressed. And almost every time we've heard about this, the response from the obstetrician is the baby blues, you'll get over it, then she walks out thinking, there's something wrong with me. And, you know, we had we had a woman in our last postpartum support group who shared with everyone she had an anal fissure. Every time she had a bowel movement, she bled and reopened up and I thought, God bless you for sharing this with people because suddenly everyone had their own version of their own struggles and story to share. And we're given this impression, not only before we get pregnant, but even during pregnancy, we that we have to not only feel well and feel grateful, but we have to look beautiful. How can anyone handle that postpartum phase with all of this lack of talking, lack of sharing and pressure to look a certain way?

I mean, yeah, it's really funny. I, there's like, one or two photographs when my son was first born, the first one, and my husband really excitedly put a photo up. And the photograph, people emailed me afterwards to say that there was part of my thigh covered in blood in the photograph. So this sort of perfect picture of mum and baby that you get on social media, when someone's given birth have this kind of bloody thigh on the side. And we removed it, but it's funny. It's quite sad. Actually. That's the reality. And I think people don't talk about right

keep it keep it clean, keep it pretty, keep it censored. Don't show it's real.

And, and, you know, that's, that's really unrealistic expectations for you as a foster mom, doesn't it? Because you then think what, like, hang on, like, I'm bloodshot here, what's going on? I also think it's really interesting what you're saying about and people in your groups, because I found that the minute I started talking about incontinence, people kept coming up to me and telling me their stories. And I always want to be really clear, like it's a huge privilege, actually, that women have come and told me these stories, and I realized during the story I'm the first person they have ever told, I think you don't have to be me. You don't have to tell jokes. You don't have to write a book with the word pest on the cover and a big yellow wager compel everyone, but you should know because I get that but you are not alone. And you are not alone. In physiological terms. They are not the only women. Lots of women suffer from it. As we all grow older in the perimenopause and menopause, more and more women becoming confident. A, it can be significantly helped, if not cured, almost all your encroachments not all of it. Sometimes people will have a spinal issue or ever, but almost always, it can be helped or cured. As to you don't have to tell anyone except for who might be able to help you. I'm not saying that we have to walk around saying our most shameful secrets in public. I'm saying that it's okay. If it feels awful. And she can get some help because you're not going to be the first woman. He said mistakes. The second thing he put up there, and that I do hear a lot of swelling about people being dismissed. And I don't quite know what the answer is to that globally about women talking about childbirth injuries, postpartum mental health, and being completely diminished about it. And I, I think that that some of us do need to shout quite loudly.

You give permission to other people when you do that.

Yeah, I think you really do. And I think people need that. It's like an invitation. And, and we sort of know that. But I think especially with incontinence because one of the other things we've been fortunate because people don't talk about it is that, for example, I had a doctor being very shocked when I explained to him that because my level of urine Risa with incontinence was so much dream or bad. I quite often had spare clothes in my handbag, I had to change my place of work more than once I quick tip like washing a pair of knickers now, you know, you need to be wearing black tights or leggings or black trousers, all that sort of stuff, changes what shoes you can wear, because you're more likely to leak if you run in certain shoes because of or I was in it. And I found I was modifying my whole life. Lots of women are and sometimes in ways that are really significant, really bad, like they're not exercising. And so they're putting on weight. I definitely did that. Because I didn't want to go running. I didn't want to risk weighing myself and then when later on so I had some surgery and I had some physiotherapy to get therapy first. And nobody talks about like, what effort it is to get out of the house and do your job and get home and collect tickets from play school or whatever and and Both seem like weird stories, but they're not. Loads of people are doing that all the time, especially women.

I'm very curious what your experience was like with the various care providers. How many people did you have to go to before you finally felt that you were heard and understood and actually successfully treated?

So it was it was quite an interesting one. So I, I've had a lot of repair. I've had a couple of people be a bit dismissive. And I've had a couple of people try to be D stigmatizing people saying, don't be embarrassed, and it's like, I am embarrassed, I'm about to deprecate. It's like saying, calm down, calm down, like doesn't work.

Well read and things like and don't worry, I've seen it all before. And I think well, you haven't seen mine.

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I had this incredible incontinence nurse who was just brilliant, and she knew how to do things like this, I would ask her something and then cry. And she would say like, I don't know the answer to that, but I'm going to go and find out. And she knew when to look at me and when to like, look away, she knew when to leave me on my own. She was absolutely fantastic. And I think I wouldn't have survived it without her. And I but I also my surgeon was great. In fact, his reaction was really fascinated me. And he was incredulous that I had lived the life first five or six years and leaking urine as badly as I was leaking it, because he showed me You did a test where he literally filled my bladder, and then they make you do things to see when it leaks. And it's sort of a horrific piece in the book because I write it very much from my point of view. I just didn't know what the hell was going on. And I kind of went for this test, the sound is quite interesting, and ended up sort of tied to a bad standing up waiting in front of about 12 people, including all the students is when I didn't know and all this sort of stuff. It was really scary, but also sort of in its own way, sort of oddly hilarious as well. I mean, how weird is that? And it's gonna be through some details like this lovely continence nurse, they all just take your socks off, darling, because it's so nice. Like, why do I have a god I have to be standing up and wearing leather my feet. So yeah. But by doing that, and putting my bladder on a large screen in the corner, he could see how much it was leaking. And he was like, incredulous that anyone would walk around putting up with this stuff. The original title of PML was shame broken families and everyday to do. What's interesting about incontinence is that it's really common. And these stories are common, that just filing. And I really thought with that consultant, just as I've bought some of their health care providers, you I've had lovely letters and things from doctors and nurses. And some of the doctors especially obstetricians actually have said, I can't believe your birth is like that. That was really awful. And with them, I thought I bet you see 10 women a week, you had a birth that was like mine or worse. Yeah. So silence base and no one talks about it. And like you said, the word permission, I think is really important because, but right or wrong. That's the truth. women feel they need permission permission to complain. I mean, men, by and large, don't feel like they need permission to complain. Women do permission to make the first because I always think why is that negative? It's okay to make that. But why is attention seeking? If you are poorly then you need attention paying to you attention seeking is the appropriate response. we characterize that as an awful way that women behave only attention seeker. And I can't bear it and especially women who are pregnant so they're very vulnerable at that point physically. And when you've just had a baby or women with postnatal depression, it's like so so give them a break. Like, nobody is making a fuss if they've got postnatal depression and they want some help. That's not making a fuss that presenting with an injury that is as fine as obvious as a broken leg. But unfortunately, one that we don't we don't talk about with any kind of kindness.

We I've heard stories of women who tell their own mothers or their own partners that they think they have postpartum depression, but they don't use that language. So they're saying, I just feel so overwhelmed. I feel like I can't get a break. And on rare occasion, we hear where that trusted person says to them, I don't understand you wanted to have a baby, that point you made earlier about women just expect to deal with this kind of stuff. We expect to deal with periods and postpartum bleeding. And you know, sort of mess as you said, messy stuff.

We we spend our life with messiness, like that is the female condition as far as I can tell. And then there's the the risk of sounding like, completely pretentious, there is this kind of awful way that that we are forced to feel like any kind of strength we have is things like multitasking. No, that's not multitasking is a result of living too much to do. It that's got nothing to do with a status not an inherent strength for me.

It's the only way to function.

No, yes, it's a functional, functional part of being a contemporary woman quite often, and it drives me mad. I also just think that thing you said, Oh, you know, well, you wanted to have a baby, didn't you? I mean, seriously, like, that is such a patient blaming victim. I mean, it's like, really, I wanted to have a baby. And I set the end of the book, like I talked about what I've learned, and I tried to be on the whole, I want to be optimistic, I want to try and make things better. But I don't think we should make people who've been sick, or who've had terrible birth, or who have ended up incontinent or whatever, they're awful, have cancer or whatever. I don't think we should make them reassure us all, that the world is a good place by saying what they learned from it, and that they've got something great from it. Because I could have learned every single lesson I learned by not horrible things happen by nice things happening to me. We do a lot of that. And and the extension of that, is that like you asked for a baby, you wanted this perfect life. No, I just wanted something normal.

I had that thought all the time, like everyone before me in history has been through this. Why is this so hard for me, who is to say wasn't hard for all of them? Or that society hasn't changed in a way that's made it harder for us today when we're so isolated?

Yeah. And I think that I also, I often think about that. And I think it's like when people say to me, women give birth and fields, and I remember one saying because I was so depressed, I didn't care anymore. So Aren't they the ones that don't?

I mean, I mean that right? Is that the standard factory? And do we have to? Yes, it's difficult for women. Now, women before as well, there were loads of things. So it's like, Okay, then do you want to breastfeed my baby for me then? Right. But also, and I know that when we were talking earlier, like, perhaps I've made them sound really, really miserable. but also those births were incredible. And I remember my first son's birth as being like a miracle. And I'm not a religious woman. And I felt that it was the moment of magic when he was born. It was like a magic trick. And my money was mashed. There was blood everywhere. There was Newtonian everywhere, which is sticky man, and disgusting, when it's like sticking over your legs and all that. And at the same time, as he was coming out, it was something about the moment something about pushing him. And I think the amazing thing about childbirth is it's all these things at once. It's it's religious, it's boring, it's meaningless. It's the most meaningful thing. It's funny, it's exhausting. It doesn't make sense. It jumps to time. It's linear. It's a dream. It's all these things at once. And that's what makes it so amazing and difficult to talk about. Because that's another thing I think we do that slightly insidiously, blames women for the whole thing. So we say, Why did no one Tell me if it's everybody's fault, but we don't know exactly what childbirth like. And the reason we don't is because many of us, or many of us don't, this doesn't, we've not been there. And I think you probably have to be in a birth room to know what it's like. I mean, and things like, I didn't know this. But so when I had my first baby, they said, she wanted me to look. And I remember having the wherewithal to sort of say, like, I think the moment they're looking at that part of me and asked me now is gone, because it was already torn. By that point. I could feel her breath on my thighs. That's how close she was. And she said, Give me your hand, it will help. Like I told my hand and it did help. And like I would never have believed you. What that would do before he was before born before he existed to touch his head and he came out. And it was only about three or four years ago when he was about 10. His head didn't feel the same twice to sneak in and touch it when he was asleep. That's me describing a traumatic birth as probably one of the most emotional and meaningful things that happened to me and something that I will always be grateful for. That's, I think why I get so upset when people say that you wanted a baby, because I think I've never met someone even the worst traumatic birth even with huge hemorrhages, even women who nearly died, to don't have some gratitude for the experience to pretend that complaining or wanting help as a health thing is not that. But no, of course they're great.

And And the thing is, it doesn't, it doesn't go away. As we get past the baby stage and raise children, we still have all these challenging moments and mixed emotions of you love this little being more than anything in the world get, you want nothing more than to get rid of them sometimes in moments. And imagine if people were always every time parenting was challenging or anything, you know, we were having a difficult moment.

People said to us, well, you you wanted a child. I mean, it's it's so normal to have those mixed feelings about it.

I think also we it's interesting what you said there because I think I've seen women in their 80s and 90s describe childbirth. I didn't write about this in the book, but it's something that I find fascinating. And so I've seen women that old, ie those who gave birth 75 years ago, and they start talking and they sound exactly like I sounded, you know?

Absolutely. We relive it and we relive it.

Yeah. And and these people are talking about something like their 70s or 80s. And about that sort of moment. And yeah, yeah. And yet we sort of derived their experience. We, we don't talk enough about that either, because I don't I know lots of women who find that their children stuff that very problematic I certainly did for the first four or five years, because, you know, I was in my 30s, mid 30s, she did not expect to be reading and I thought by text, but you know, you don't expect that to be your reality. And I found it very conflicting. And I never blamed him. I never did not for any of it. It wasn't about blame. But it was true that we were united in this thing. That, for me was a very complicated, very complicated task, those two things going on all the time. And I just think that's very rarely explored. We should be talking about the stuff in all our lives. But we because we should be talking about and seeing and sharing our birth experiences with our sisters and our aunts and friends. And it shouldn't be this this thing that women only want to share the perfect moments of the birth, I felt that I had failed at giving birth and very common.

One more thing that I feel complicates things is when we're pregnant and expecting a baby, society and all the well meaning people around us, prepare us to fall in love. And we envision falling in love with the partners we fell in love with and it's like, oh my gosh, I can't wait to feel that. Hi again. And when you're holding your baby, I mean for me when I was holding my son, and the days and months that followed, my heart was so full. The thought I kept having over and over was love is not the emotion I am feeling this is not at all, like the love I have felt toward my husband or even toward my brothers or my parents. This love comes with anxiety, anguish, it's not that carefree joy that I think we expect we will feel it's so heavy. And then on top of it, everything about our lives changed with this baby. Everything that changed from our bodies, to our careers to our relationship with our partners all links back to this little person that you would lie down and die for like they can wake you up 12 times in a night and every time you pick them back up in your arms, as delirious as you are, you're like I get to hold you again. It is the most complex emotion I've ever personally experienced. And I am just convinced we haven't created the right word yet to describe what we really feel toward our babies. Love isn't an adequate description for me.

It's really interesting. So I often say that about MSL. So it's got politics in it. It's got my personal story. It's got this biggest story of all these other women and stuff. But also people ask me what it's about. Yeah, it's about the, and how we tell stories and yeah, and continents, but it's also about love. And when you're saying this word in the book, I talk about a lot about my children as well. And what that meant, like you say that there's not really the word. And then when my son was really young, he said, Do you love me? And I said yes. And he said like, do you love all of me? And I was like, Yeah, but you know you love my hands, my face and yeah. And he said, Do you love the poo and my bum? I said Yes. And maybe that's what love is. I don't know.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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