5 things… that may enhance your recovery and help connect with your c-section scar

A note from Anna: It has been wonderful to see people sharing more on social media about their c-section scars and recovery!  It is a privilege to invite Hannah Poulton, an experienced physiotherapist and scar specialist to share her tips on recovery. Her knowledge is fuelled by a passion that mums would be equipped and encouraged with the helpful and holistic information they need most.

Hello all. My name is Hannah Poulton and I’m a Senior Physiotherapist, Scar Specialist, Acupuncturist and Women’s Health Practitioner. I own HLP Therapy and have over 2 decades of experience within Physiotherapy. 

My passion has always been to see individuals recover well, not just from the physical effects of an accident, surgery or trauma, but to acknowledge and heal from the emotional aspects too.

That is why I built HLP Therapy. A beautiful place where I can combine a multitude of skills to listen and treat every individual in a truly holistic and tailored way. I’ve always had an interest and bias towards women’s health and especially postnatal care. I believe the postnatal care for mums in the UK is sub-standard, and more needs to be done to care for mums after they have given birth and especially if they have suffered a traumatic birth or c-section birth. After the difficult birth of my two children, (one vaginal, one c-section birth) I explored further into c-sections and c-section recovery. My professional education and personal experience, allows me to understand and empathise with postnatal mums, which only seeks to enhance the treatment I provide.

My main speciality is c section recovery and all that includes. The next few tips may enhance your recovery and help connect with your c section scar.

  1. Be gentle on yourself: After your c section you are told very little about how to recover well. You are given this 6 week “time frame” in which you should recover in. But for some this is only the start of their recovery journey. Of course, your scar will do it’s best healing within this time period, but a scar takes up to 2 years to reach maturity (which means it’s constantly changing within this time). There seems to be such pressure and a rush to heal, but my best piece of advice to start with is “be kind to yourself.” Allow yourself time to reflect on your birth, time to heal well, don’t overload yourself with “a never ending list of tasks to complete.” You have been through major abdominal surgery and this needs to be recognised and acknowledged. Give yourself permission to say “no” to other peoples demands and ideas on your recovery. This is your journey in your time and your way. Don’t compare your recovery to others. It won’t help you on a physical or emotional level.
  2. Looking after your scar: In the early stages there are some simple ways in which you can look after your scar: pat dry your scar, don’t rub with a towel after a shower. Instead, use a muslin cloth to gently dry over your scar. Allow the scar to breathe. This means wearing loose cotton fibre clothing and allowing the air to get to the scar as much as possible. This could mean laying on the bed or sofa with your baby next to you and having no clothing over your scar. 10 mins a day is all you need. Your scar may feel numb. This is because nerves have been disrupted during your c section birth. Gentle sweeping hands over your tummy in the first few weeks, pat drying your scar and looking at your scar (even if it’s in the mirror) will all start to help you “engage “with your scar. There is also no rush to do these things. If you can’t bear to touch your scar in the early stages, then this is perfectly normal. Take your time. There is no rush.
  3. Six weeks after your c section (only if you are ready) you can start self-scar massage. Have a look at my videos on Instagram and YouTube on the best ways to massage your scar. Get a good scar cream (check out my online shop for the ones i recommend). Start light. Use “feather light” sweeping motions with your hands over your tummy and scar. If you can’t touch your scar at this point, then that’s ok. Take your time. Gently work on your tummy, bringing the tissues into the middle (where your belly button is). Do this after a warm shower or warm bath, so you are relaxed and comfortable. If touching your scar and skin is something you are not comfortable with, try using either really thick cream on your fingers (to act as a barrier between your fingers and scar) or use a soft towel or cloth to sweep over your tummy and scar. Use self-scar massage for 5-10mins a day when you are relaxed. Take this time out for you.
  4. To aid in scar recovery and also your overall postnatal recovery, it’s important to feed yourself well. Now I know chocolate and coffee are important (!!), but perhaps try some of these foods too. Strawberries, oranges, nuts, pulses and seeds. Oats and yoghurt, protein shakes, oily fish and leafy greens. You will need to put back in and feed your body with the good stuff in order to accelerate your recovery. Protein is really important for healing and also keeps you filled up! So make sure you are getting plenty of this in your diet. As we are over 60% water it’s important that we replenish this daily. Make a flask of water in the morning and carry this around with you and keep sipping throughout the morning. Refill at lunchtime and repeat. Keep reminding yourself to drink and flush your body with clear water. This also aids in scar recovery as the tissues under the skin are well hydrated and heal so much quicker.
  5. When you feel ready you may want to start moving your body. You may want to join a class (always look for “postnatal trained” instructors) who really understand what postnatal c section mums need. You may want to see a specialist physiotherapist before you return to exercise. My advice is start off slowly and build up. You’ve been through pregnancy, abdominal surgery and birth and probably sleep deprived too. So start off with gentle breath work, coupled with pelvic floor work. You may also want to try some basis exercise such as: knee slides, bridge, cat and cow, childs pose, wall planks and side clams. Listen to your body: it will tell you what you can do. There is no rush and no race.

I really hope you have enjoyed reading this blog. For more information on my c section recovery kits and to see the courses I am currently running for new c-section mums and professionals in c section recovery, check out HLP Therapy and look under “Positive-C-Section. ”

Keep going mama…you’re doing a great job! ✨

5 things…about why noise in motherhood can feel stressful

A note from Anna: My friend and Ear Surgeon Joe dropped me a message one day after reading something I’d written on how the noise I’m so often surrounded by as a parent drives me a bit wild! Sometimes even the happy, playful squeals of my kids can evoke a reaction in me that feels like stress or rage! He offered to give us a bit of insight (or, earsight, chuckle), into why this happens, and what we can do to help ourselves in those moments. 

It’s a pleasure to contribute to Anna’s page. We met 10 years ago through our friend Kathryn, before Instagram was much of a thing! It’s been wonderful to see what a source of inspiration and support she has become to so many young parents and we have her books on our shelf! I am an ear & hearing specialist doctor and surgeon for adults and children, working in central London. I see a whole range of conditions, some of which need procedures and surgery but also many which benefit from parallel therapy. I’m also a Dad of (soon to be 2!) and share plenty of insights from my working and parenting life at @earsurgeonjoe

The benign sound of my kids slurping or breathing heavily makes me wince and want to leave the room. I keep being triggered by harmless pen-tapping and chewing and I don’t know why…. Should I be a better parent than this? Is there something wrong with my ears?

When a sound triggers an excessive emotional reaction, it may not be a problem with your ear or the sound itself, but rather a disordering of the way the sound processing parts of your brain are communicating with each other.

Although many people who suffer with this phenomenon subsequently develop feelings of frustration, resentment and guilt, it’s helpful for us to understand that experiencing extraordinary sensitivity to sound is part of a spectrum of legitimate recognised conditions.

Misophonia is where certain sounds trigger an emotional or physiological response that is out of keeping with what might be considered reasonable. Sounds can appear quiet to others but induce anger, rage, panic, fear or avoidance in you. Oral sounds seem to be common triggers – swallowing, chewing & breathing, as are repetitive sounds – keyboard tapping, windscreen wipers & fidgeting fingers.

Hyperacusis is an increased sensitivity to sound and a lower tolerance for environmental noise, that results in physical discomfort. Again, these are sounds that are otherwise easily tolerated by others, and discomfort if frequent, can lead on to wincing, distortion and subsequent distress. Sounds can be perceived louder than they are to others.

Think of Misophonia as more of an emotional triggering and Hyperacusis more of a physical triggering.

Phonophobia by contrast is a greater than usual aversion to loud sounds. This can induce fear and avoidance of devices that emit loud sounds such as fire alarms, whistles and speakers. Anticipating a loud sound, such as when you see a balloon being slowly over-inflated, can induce real fight-or-flight symptoms. Headache and migraine overlay are common associations.

Take a look at this diagram of the auditory pathway. Hearing, listening and understanding are three different things that happen in different parts of our neuroanatomy. The auditory cortex (responsible for processing sound into something understandable), the brainstem (the brain’s ‘headquarters’ responsible for breathing, blood pressure, heart rate and sleep) and the limbic system (responsible for regulation of emotions) are all inter-linked, and constantly firing back and forth between each other. This complex interplay leaves many different places in the pathway for things to malfunction.

Research into the cause and treatments of misophonia and hyperacusis is still evolving, and despite our recognition of these conditions there’s still much that needs to be discovered about the neurobiological mechanisms. Until then, we need to focus on the broad principles of managing neuropsychological conditions, including breaking cycles and improving brain health.

The same advice you will usually hear about sleep, exercise and nutrition is all beneficial here. Any young parent knows those are not always simple to put into practice. Anna already has a wealth of information on managing anxiety and improving the health of your mind – all of that is relevant here and I won’t repeat the same content. But instead, I am going to highlight 5 things pertinent to my field which are helpful to know and that I often cover with people coming to see me.


  1. Think about your daily cognitive reserve and how to preserve it. Your brain spends all day processing the inputs of all your senses – vision, hearing, smell, taste & touch. When one of those senses is working at half-capacity, for example if you have a hearing loss or visual impairment, then your central processing has to work twice as hard to fill in the gaps whilst still filtering what’s important to you.Imagine a day without your contact lenses – you can strain for a while but you’ll soon feel knackered. The same is true of hearing and auditory processing. If you have undiagnosed hearing loss, there are things that can be done (procedures, surgery, hearing devices) to reduce your listening effort and reduce your cognitive load. Reducing background noise and enabling audiovisual cues such as lip reading (made difficult by the world of masks) and captions can have the same beneficial effect. Unfortunately there remains a societal stigma around making your hearing problems visible to the world, that doesn’t exist in the same way for people who wear glasses for their vision. Chipping away at that stigma is one of my career missions!When your cognitive reserve is low, your emotional reaction is further heightened. That emotional reaction may be anxiety, anger, rage. So what you tend to do is…avoid. Avoidance then leads to anticipatory fear, and a perpetual cycle which makes triggering sounds even more triggering. This further increases your cognitive load and down the line, you’re unable to function at the same pace you once could. Instead we need to remember that the sounds aren’t the problem. Break the cycle of sound avoidance. Shift the focus to increasing your cognitive reserve. Stop that cup from draining before the day is done. A study in 2013 in Sweden examined 140 men & 208 women and found that women with high levels of emotional exhaustion became more sensitive to sound after an acute stress task.
  1. Don’t feel shame or stay silent if you’re experiencing misophonia. Share it with a health professional or at least someone you trust that cares about you, before it ends up making you isolated. Hearing health and its emotional sequelae are just as important as any other aspect of your mental health. It deserves validation and care. Cognitive behavioural therapy is a strategy to help sufferers regain control. By examining why and how you experience symptoms opens opportunity to change that pattern and reduce impact. Counselling, sound therapy and mindfulness are all avenues to explore.
  1. If you have specifically one-sided symptoms or if you have other concurrent ear and neuro symptoms including tinnitus, hearing loss, facial weakness or numbness or the sensation of hearing footsteps or your eyes rolling – then see an otologist (an ENT doctor specialising in ears, which is where I come in). There are some things that need ruling out depending on your examination findings and hearing test. Noise-induced inner ear disease, Lyme disease, Ménière’s disease, superior semicircular canal dehiscence syndrome, perilymph fistula, facial nerve palsy and certain medications and psychoactive drugs can all be an underlying cause of hyperacusis.
  1. Take advice before using any device you see advertised online designed to tamper with your ears. Ear wax is a topic millions of people are fascinated with and people are out there to take advantage of this. As an ear surgeon I perform delicate procedures in the ear that involve being a millimetre away from causing permanent harm. It really alarms me how much unregulated tech is allowed to be sold online without any evidence base. A healthy ear is meant to produce wax and should self-clean without you needing to do anything. Wax isn’t dirty – it’s your ear’s way of protecting itself from infection. It only needs to be removed if there’s pain, hearing loss or a diagnosis needs to be made – otherwise you can leave it alone. DIY wax removal cameras might look appealing but aren’t good enough to safely be able to remove deeper impacted wax – the stuff that actually does need removing. Microsuction by a professional is the only safe and effective way you should have your wax removed. Oh, and ear candling is a complete social media illusion – avoid!
  1. Finally be aware that sudden hearing loss is an emergency that has a time-critical window for assessment and delivery of steroid rescue treatment if the inner ear is involved. Not everyone knows this! Many people still miss the boat for treatment, through lack of awareness or putting it down to a cold or wax, which sometimes can be quite devastating.

Joe Manjaly FRCS (ORL-HNS)
Consultant Otologist, Auditory Implant & ENT Surgeon
The Royal National ENT & University College London Hospitals

Ear & Hearing Specialist Doctor & Surgeon
One Welbeck ENT, London


5 Things…to reassure new mums about difficult thoughts

Naomi Law is a Psychology researcher and mum of 2 boys. She is passionate about women knowing they are not alone, and aren’t failing, when they struggle with difficult thoughts about motherhood. After publishing peer reviewed research about negative thoughts in new mums, she wanted to share her affirming and shame-reducing insights with us!

What is ‘normal’ for new mums to think and feel?

There is a popular ideal of motherhood which appears in thousands of subtle ways in the images and advice targeted at new mums. It’s an ideal that says becoming a mother is effortlessly natural, fulfilling and joyful.

This may be your experience of motherhood, but what if it’s not? If your life doesn’t match the ideal? Are you failing?

All mothers — especially those in the early months — need regular reminders that this motherhood ideal is just that: it’s an ideal, not a reality.

Together with two co-authors, I recently published a scientific study exploring some of the realities of new motherhood.

Our research involved nearly 400 new mums, all with babies under 1 year old. By filling in questionnaires, they told us how often they had experienced negative thoughts about motherhood, as well as any feelings of guilt and shame.

Our study found that it is very common for new mothers to have negative thoughts about motherhood, including about their baby. The findings also suggested that women struggle to share these thoughts and that the more negative thoughts they experience, the more guilt and shame they feel.

The good news, though, is that understanding that these thoughts are common — and not a sign of failure — may reduce mums’ feelings of guilt and shame and improve their mental well-being.

If you’re a new mum and you’re having negative thoughts, we want you to know you’re not alone.

Here are 5 reassuring tips from our research:

  1. It’s very common for new mums to have negative thoughts about motherhoodAs much as anything is ‘normal’ about having a new baby, we can say that having difficult thoughts about motherhood is ‘normal’, because it is so common.These are just some of the thoughts we asked about in our study:
  • The majority (about 60%) of the mums taking part said they thought being with their baby was boring, at least sometimes.
  • Over one-third said that they sometimes thought they were trapped or that there was something wrong with them.
  • Nearly two-thirds said they thought they were a ‘bad mother’ at least some of the time
  • One in five mothers reported thinking they shouldn’t have considered having a baby.Overall, more than 90% of the mums in the study said they experienced negative thoughts about motherhood at least some of the time.
  1. Other new mothers may be having similar negative thoughts as you, even if they don’t say it out loudIt can be hard to share negative thoughts about motherhood.We gave the mothers in our study a list of negative thoughts and asked them how easy they would find it to share each one. Many said it would be ‘difficult’ or ‘extremely difficult’ to tell someone else.It may feel hard to say when you’re having negative thoughts about becoming a mother because everyone else looks like they’re ‘fine’ or ‘coping’. But given that we know negative thoughts are extremely common, what may actually be happening is that someone who seems to be ‘fine’ on the outside is experiencing their difficult thoughts in silence.If you are having distressing thoughts about motherhood, you are not the only one.It may help to share some of these thoughts with someone you trust. Sharing difficult thoughts can ‘normalise’ them and it may help them lose some of their power.
  2. Having negative thoughts does not mean that there is something wrong with youBecause we tend to talk about early motherhood as a time of joy and fulfilment, it can feel like you’re ‘getting it wrong’ if you don’t always feel joyful.One of my co-authors for this study, Dr Pauline Hall, is a clinical psychologist working with new mums. She regularly sees how women can become caught in a vicious cycle of negative thoughts.When an intrusive thought about motherhood appears, the temptation can be to interpret it negatively (e.g. “there must be something wrong with me for having that thought”). This can make you feel distressed, guilty or ashamed, which leads to more negative thoughts, and the whole cycle begins again.Pauline’s reminder is that “A thought is just a thought”. Instead of engaging with it, or ruminating on it, you can try to ‘let the thought go’. You will likely find it becomes less powerful.

  1. New mums can have upsetting or distressing thoughts even when they’re not depressed

    In our society, there’s a tendency to approach new mums as if their mental wellbeing falls into two camps: some mothers are diagnosed with depression, anxiety or another mental illness (which hopefully helps them access the support they need), whilst everyone else is considered to be ‘fine’. Our study helps to show that the reality is more complex than this simple division.The mums in our study were not, to the best of our knowledge, experiencing postnatal depression, but negative thoughts about being a mother were still common. The more negative thoughts mothers reported, the higher their levels of distress, guilt and shame.As a new parent, your thoughts and emotions may be complex, and you may need reassurance, regardless of whether or not you are experiencing mental illness.
  1. But…if you are finding your negative thoughts are distressing, there are people who can help

    Having said that it is very common to have negative thoughts about motherhood, we also know that having repeated, uncontrollable, negative thoughts is one of the symptoms of depression.Whilst having some negative thoughts is absolutely normal, these thoughts lie on a spectrum, with some new mums experiencing more than others.If you find that your negative thoughts are distressing, are interfering with your ability to function or happen over a prolonged period of time, then we would encourage you to talk to someone who can help.Approximately 10 percent of mothers experience postnatal depression, and this figure may be even higher since the start of the COVID pandemic.You don’t need to continue to suffer from the impact of negative thoughts. Many effective treatments are available, which don’t necessarily include medication.There are suggestions below of where to find help.

Sources of support for negative or distressing thoughts about motherhood:

  • Talk to someone you know and trust
  • Contact a professional such as your GP or health visitor
  • The Maternal Mental Health Alliance has a list of charities and support organisations, including helplines https://maternalmentalhealthalliance.org/resources/mums-and-families/
  • The book ‘Good Moms Have Scary Thoughts’ by Karen Kleiman is full of reassuring words, guidance and simple exercises to help you feel less alone.

If you’re interested, you can read the full report of our research here: rdcu.be/cl9nh

We are holding a free webinar supporting new mums with negative thoughts. The session will include open, reassuring discussion and practical tips about handling difficult thoughts when they arise. There will also be a chance to discuss what could be done better to support new parents with negative thoughts. If you’d like to join the seminar, there are details here. Hope to see you there!

Date: Wednesday 24th November, 10am.



5 tips to take you from exhausted to energised

By Wilma Macdonald @_maverickmotherhood.

“You’re a mum now, that’s just the way it is. We’re all tired.”

A note from Anna: I kind of knew it before, cognitively, but this past year it has truly sunk in that I need energy for far more than running after the kids. I need energy to laugh, to rationalise anxious thoughts, to think straight, to enjoy life. This is why I’m so excited to share Wilma’s words with you. Wilma is a nutritionist passionate about equipping fellow mothers with the energy needed to thrive in motherhood, rather than just dragging ourselves through in survival. She shares her five top tips to take you from exhausted to energised.

How many times have you heard that phrase when you’ve shared the fact that you’re so tired you can’t feel your face anymore.

Pre-pandemic, a lot of us were coasting close to our life limits. Now over, what feels like, 3000 lockdown days later, you’re feeling flat, lethargic and rundown, you’re last on the priority list (below the laundry basket) and feel like you’re holding on by your chipped fingernails most of the time.

But it doesn’t have to be this way, I promise.

I know — from real won-in-the-trenches experience — that when you feel frazzled and exhausted, the joy of motherhood is harder to find.

And you deserve joy.

I’m going to share 5 tips that’ll help take you from exhausted to energised that include pleasure and don’t eliminate fun and joy

  1. Get your iron levels tested.

1.2 billion non pregnant women, 1.5 billion pregnant women. That’s how many, worldwide, the World Health Organisation say are affected by iron deficiency.

Studies have also shown that low iron levels may be one of the key contributing factors in fatigue in women. 1, 2

Your body stores iron but growing a human, birthing them, bleeding for 6 weeks afterwards and monthly menstruation depletes them. If you’re not filling these stores back up, your body will start giving you feedback.

If you’re knackered, cold all the time, struggling to concentrate and your hair is looking frazzled, ask your GP to check your iron levels – they won’t dismiss you or think you’re over reacting.

Food sources of iron to add to your plate are red meat, chicken, spinach, tofu, seeds. Vitamin C helps absorption while dairy and tannins inhibit it, so best have some red pepper instead of a cup of milky tea with your steak.

Always get professional advice on supplements as some have a tendency to bung you up. You don’t want to have to make a choice between being tired or being constipated.

  1. Now’s the time for nourishment not deprivation

If your car runs out of fuel, you take it to the petrol station and fill its tank up because it can’t run on fumes. Neither can you, no matter how hard you try.

One of the only ways to get more energy is through the calories you eat. Not just any calories, these are keeping you fuller for longer, nutrient dense, va va voom inducing calories.

Carbohydrates are usually the first to go, they’re the tantruming toddlers of the food world – misunderstood. They are your body’s and brain’s preferred energy source.

Refined carbs – white bread, pasta, croissants — are considered a dieting disaster as they release glucose (aka sugar) quickly, whereas unrefined carbs – sweet potato, apples, bananas, lentils — release the sugar slowly.

The carb encrusted key to your energy upgrade is to include a variety of carbs eaten alongside protein and fat. This is what’ll keep you off the energy rollercoaster that crashes mid-afternoon.

  1. Get to know the 3P’s of your bodily fluids

Did you keep a pee and poop diary for your tiny ones? It’s time to do the same for yourself.

The fluids that come out of your body are a detox pathway that give you a lot of information about your health.

They can tell you if you’re dehydrated, not eaten enough, if you’re ovulating, if oestrogen levels are low, if you’re not moving enough, if you need to chew your food more, if you’re nervous/excited, if you need help breaking down fats, if you’ve had enough fibre, if you’re stressed out…

The list goes on.

The 3P’s and what to look for are:

  • Poop – Shape, consistency, frequency
  • Pee – Colour, smell, frequency
  • Period Blood – Colour, consistency, clots

The key thing is to know what’s normal for you. Get comfy checking, track them and look for patterns – for example, if you’re stressed out do you get bunged up quicker or if you eat avocadoes do things move a bit faster.

  1. Focus on quality of sleep instead of quantity

“If I go to sleep in the next 5 mins and he doesn’t wake up, then I’ll get 6 hours, 15 mins and 12 seconds sleep”.  Anyone else do that? Instead of going to sleep, we get deep into an insta scroll comparing pink tiled utility rooms and wondering if everyone is doing a garden makeover apart from you.

Sleep training it is. For you, not for tiny human.

  • Go to sleep at the same time every night, think 1030pm not midnight
  • Tryptophan converts to melatonin, your sleep hormone. Oats, nuts, seeds, milk all contain tryptophan, have a snack or milk with these if hungry before bed
  • No devices an hour before bed
  • Brain dump into a journal
  • Clear clutter from bedroom
  • No caffeine after midday
  • Have an orgasm

For tonight, let’s start with one thing, put your phone far enough away that if you wake up in the night and stretch your arms out, you can’t reach it.

  1. Keep it simple

30 different vegetables a week
An hour of exercise every day
10 minutes of mediation at 530am
2 litres of water a day
9 hours of uninterrupted sleep a night
Split your macros, count your peas, weigh your butter, lose the will

I could go on. It’s A LOT. Add some tiny humans into the mix and it’s no wonder you don’t know where to start or have the energy to find out.

Strip it back, way back……. further than that. Make it so small that you wonder if you’ve done anything.

Eat an extra portion of green vegetables
Meditate for 2 minutes
Drink one extra glass of water
Chase your toddler down the street
Go to bed 15 minutes earlier tonight
Read a page of your bonk buster before bed

Choose one of these and do it over and over again until it becomes a habit. It’s the small things we do repeatedly that build up to make a big difference

These 5 tips aren’t about supporting your health so that you can push yourself to your limits or be even more productive.

It’s about, giving yourself the same love, care and attention that you’re giving everyone else.

There’s never been a time when YOUR health needs the most love, care and attention than now.

Wilma is a nutritional therapist, mother, eBay enthusiast and founder of Maverick Motherhood where she’s on a mission to help exhausted mum’s upgrade their energy and inject vibrancy and va va voom into their lives. You can find her at maverickmotherhood.co and @_maverickmotherhood.


  1. Krayenbuehl PA, Battegay E, Breymann C, Furrer J, Schulthess G, Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration, Blood (2011) 118 (12): 3222–3227.
  2. F Verdon, B Burnand, C-L Fallab Stubi, C Bonard, M Graff, A Michaud, T Bischoff, M de Vevey, J-P Studer, L Herzig, C Chapuis, J Tissot, A Pécoud, B Favrat Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial 2003 May 24; 326(7399)

5 things about Pelvic Health

By Clare Bourne @clarebournephysio

A note from Anna: Never had I met someone so passionate about pelvic health that they carry a model pelvis in their handbag at all times. When I first met Clare, I thought ‘wow, if she is so evangelical about the pelvic floor, perhaps I need to listen up!’ Looking after your pelvic floor doesn’t stop at squeezing whilst you brush your teeth, here she is to tell you all you need to know.

We have probably all heard about our pelvic floor at some point, but was it just a leaflet handed to us with the advice to do some squeezes? For many you may not have given it another thought, but others of you might feel plagued by symptoms or changes in your body that you have never felt confident to talk about. So much of pelvic health is still taboo: incontinence, prolapse, painful sex, periods….do any of us find these things easy to open up about? I am sure the answer from most would be no.

Let’s dive into 5 things about our pelvic health to help open up this conversation and ensure those that need it get support.

1) Pelvic floor dysfunction is common in postnatal women but does not have to be forever

    • Incontinence, prolapse, painful sex…..just a few of the symptoms mums can experience and right off as, ‘well I’ve just had a baby’….often not helped when they try to reach out and are told ‘this is just what happens’ or ‘well at least you have a healthy baby.’ I want you to hear that there is help and treatment for all of the symptoms above, that doesn’t require surgery, and you CAN struggle with how your body has changed, new symptoms AND be grateful for your baby..
    • You are not alone if this is you, these symptoms are more common that you think:
    • 1 in 3 will suffer with incontinence
    • 1 in 12 with prolapse
    • 83% of women have reported to experience painful sex after birth.

2) Pelvic floor dysfunction is associated with depression 

    • As you can imagine all of the above symptoms mentioned can impact our mental health, which has been proven in research, and often these symptoms limit the exercise we feel we can do, and we know that exercise is good for our mental health. So it can really knock us from both angles, along with the loneliness and isolation that can occur as none of these topics are easy to open up about. Opening up is definitely the first step, start with a friend, your GP or find a pelvic health physiotherapist. Pelvic floor symptoms don’t need to stop you exercising, we might need to modify for a while but exercise and movement is good for our pelvic health, and we want to get you back to what you love.

3) How to approach your postnatal recovery 

A lot of women feel that the care and support they receive during pregnancy and birth is amazing, and yet as they transition into the postnatal period they feel alone and unsupported. Often this is the time when you navigate a lot of changes in your body and you move from pregnancy, where most are amazed by what their body can do, feeling empowered by it’s ability to grow your baby, to then shocked at how your body feels, it’s struggle to function as it did before and unsure of exactly how to care for it. My top advice is to take the first 6 or so weeks slow, you don’t have anything to prove. Focus on caring for yourself, rest, good nutrition, water, fresh air and sharing how you feel. Please remember caring for yourself IS caring of your baby. It is natural for us to want to be active, but slow and steady really does win the race. In the early weeks focus on pelvic floor exercises and deep breathing and know that you are building the foundations for future activity and exercise.

4) How do you do pelvic floor exercises?

I know, I know…they are boring and dull…and yet so essential! We’ve probably all heard of them, but how do we actually do them? Just squeeze and hope for the best, imagine a lift going up and down to multiple floors…. actually for most of us it is as simple as thinking about holding in wind (and let’s be honest we’ve all done that before!!) It is often more gentle and subtle that you think, so try it now, think about holding wind and letting go. You shouldn’t be using your bottom muscles or leg muscles, but just feel a tightening around the back passage and vagina that no one else can see. They are a totally stealth exercise…which makes them brilliant and yet so easy to forget. Make sure you fully let go between each squeeze but try building a few into your day. Like so many things in life they are just an investment in our health, even if they are not that fun.   

5) How to access support and help if you are struggling

Some of you might have really tried to do pelvic floor exercises and just feel you are not getting anywhere. This could be for a number of reasons but we think around 50% of women are doing them wrong, and this is where a pelvic health physiotherapist comes in. It is our job to help you to learn how to do your pelvic floor exercises correctly and support you with your symptoms. You can get referred on the NHS via your GP for symptoms of incontinence, prolapse, painful sex, diastasis recti or pelvic pain, or you can find one privately via www.thepogp.co.uk or www.squeezyapp.com.

Clare Bourne is a pelvic health physiotherapist based in London and a Mum of 2. Her passion is to openly talk about taboo topics and help to make women feel less alone on their pelvic health journey. She is soon to launch her new ‘All About Mum’ Cards which provide all essential information for a new Mum and her postnatal recovery. You can find Clare @clarebournephysio or clare-bourne.com

5 Things To… Improve Communication With Your Partner


By Catherine Topham Sly @insightandconnection

A note from Anna: Amidst the challenges of the last year, investing in our relationships with our partners may have slid down the list of priorities. In our household, we often have to remind ourselves that we are on the same team as we find ourselves bickering or feeling misunderstood. Catherine gives us some golden tips on how we can best approach these moments of tension and frustration.

We all know that communication is one of the secrets to a happy relationship. But it can be hard to know how to do it well. This is especially true when we didn’t grow up around great communicators (so that’s most of us, including me).

When you can’t get through to your partner it’s frustrating, stressful, and ultimately, miserable.

Most of the time, better communication means being a touch braver. We have to trust our partners – and ourselves – enough to take a risk and let them see a little bit more of us.

In my experience working with couples, our partners know way less about how we feel about things than we think. And stuff said in arguments usually doesn’t go in properly, because we can’t think straight when we’re angry. So if you haven’t talked about it calmly, you haven’t talked about it.

It can be scary to say how you feel, what’s worrying you, or what you need. It’s worth it though, to break those frustrating patterns of misunderstandings that only leave you feeling further apart.

1. Say how you feel (not what your partner’s doing wrong!)

Most of us here in the West were not brought up to pay much attention to our emotions. And everyone wants a partner who’s easy-going, right?

So what we tend to do is put up with things, often not fully aware we’re getting annoyed or upset. We often do this until something tips us over the edge and we blow. Sound familiar?

Then our perfectly valid complaints come out critical or blaming. And the trouble with this is that criticism just invites defensiveness.

Want to break that frustrating pattern of criticism-defence? This is how: notice and talk more about how you feel. Take the focus off what your partner has (or hasn’t) done. State the facts of the situation, as blandly as possible. Then tell them how you feel about it – using emotion words.

So instead of saying, “You never listen to me!” try, “When I’m saying something and you look at your phone, I feel rejected”.

Think they already know how you feel? Don’t be so sure. Humans are not as see-through as we think we are.

2. Share what you imagine

One of the most powerful changes you can make in your relationship is to get into the habit of saying the things you’re imagining.

Most of us do something like this. But a lot of the time they come out as accusations. So when you’re frustrated, you might say something like, “You don’t care about me at all!”

Where does this get us? More defensiveness. (Ugh.)

See if you can be brave enough to share your fears from a softer place. Try something like, “When you looked away, I imagined you weren’t interested in what I had to say… or even in me.”

Find the courage to let your partner hear about your worries. When they see your vulnerable side, they’ll feel more empathy and softness towards you. This will make them feel closer to you, and more willing to help.

3. Ask for what you need

How do you know you need to address something? An emotion tells you, whether it’s anger, frustration, sadness, or even excitement.

That’s how it works: feelings are messengers about needs.

Ask yourself, “What do I need?” whenever you feel a wave of emotion. (This will change not just your relationship with your partner but your life.)

We can’t always get all our needs met, at least at the same time. But until we acknowledge and discuss them, we’re missing opportunities to find solutions.

“I need you to give me your undivided attention for a few minutes” is a great start. “Because I need to feel like I’m important to you and you want to understand me” is even better.

It helps to follow up needs with specific requests, like “Would you be willing to…?”

If your partner isn’t used to talking like this, they might not respond how you want at first. Stay with it – a request is just the starting point of a negotiation.

4. Say ‘and’ not ‘but’

The simple habit of saying and instead of but can transform your communication. This might sound like verbal trickery. But it can actually create a genuine shift in how you and your partner look at things.

The trouble with the word but is that it often dismisses whatever came before it. And, on the other hand, is expansive.

If my partner says, “I’m exhausted” and I say, “But I need you to do this”, how will he feel? Like I completely invalidated his exhaustion.

If I say, “I know you’re exhausted, and we need to do get this done”, he’ll at least feel seen and understood.

That’s the point of a partnership, by the way: to make your partner feel loved, appreciated, understood, accepted, important, and close to you. The rest is just details.

5. Know when it’s better not to talk

You might think that a relationship therapist would recommend always talking about everything. Nope!

There are plenty of times when it’s better not to talk. If either of you is angry, hungry, exhausted, drunk, in a bad mood, or feeling insecure, or if the kids are in the room, wait.

Take a break whenever either of you feels overwhelmed by a conversation. If you keep getting wound up every time you come back to a topic, it can help to write to each other instead.

The thing about communication is that often less is more. If you bang on about things, your partner will stop listening. See if you can make your point in just a few sentences, and then leave it. Resist the urge to say it again a different way. Let it sink in.

Research has found that happy couples say five positive things to each other for every one negative. Try keeping track of your ratio. Increase the number of compliments and thanks your partner hears. See what changes.

Want to know the great thing about improving communication? Small changes can have a massive impact. Vulnerability is strength – watch what happens when you lean into yours.

5 things to…stop people pleasing

Stop people pleasing getting in the way of your dreams

5 Things Guest Submission by Joy Jewell @self.hood

A note from Anna: As someone who has struggled under the immense and relentless pressure of pleasing others, I am incredibly passionate about encouraging people to address this as a gift for themselves. Joy brings us some salient tips so that we can find our voice and claim our space as someone equally deserving of having our needs and feelings validated!

For generations women have been raised to give it all up for their family, to be the supportive wife and mother who puts everyone else first, saying yes to everything in a desperate plight to keep them happy. We’ve been moulded into people pleasers, dropping everything to support not just our family, but anyone around us.

Being a people pleaser is a tough gig because it’s a life of sacrifice. You can’t spend your days fulfilling the wishes and desires of others without giving up your own. In order to give someone time and energy you have to take them out of your own resources; once they are handed over they can’t be taken back.

As a result, you feel unfulfilled. You are so busy looking after everyone else’s wellbeing and supporting your loved ones in pursuing their dreams, you let your own dreams become dormant.

You tell yourself  ‘one day’.

When the kids start school or leave home, or your partner gets that promotion, or you retire… one day gets pushed back again and again.

People pleasing is a huge obstacle to personal fulfillment because it gets in the way of doing things for yourself – whether it’s spending some time alone to relax, or pursuing much bigger life goals.

Something has to give. It’s time to stop filling everyone else’s cup and start pouring into your own. Here’s how to start breaking free from people pleasing so that you can stop minimising yourself and live the life you deserve.

    1. Learn How to Say No
      Saying no lowers stress levels and frees up time, but the mere thought of it can create anxiety. Saying no does not equate to being unlikeable. It’s ok to turn things down. It doesn’t make you a bad person.If a straight ‘no’ feels uncomfortable, try these:Delay: On the verge of a panicked yes? Buy time with ‘I’ll have to get back to you’. This lets you come back with a considered ‘no’ when you’re less pressured.Gratitude: If you can’t yet separate saying no with being rude, start with gratitude. ‘Oh thank you for thinking of me, I’m afraid I’ll have to decline this time’ is to the point and kind.

      Alternative: It is possible to say no and still be helpful. Simply provide an alternative. Refer them to someone else, suggest another time in the future, or offer more hands off support.

    1. Turn ‘Should’ into ‘Could’
      We have a habit of filling our world with ‘shoulds’. ‘I should take the kids to the park, I should drink more water, I should do more exercise, I should be more productive’.Should is loaded with pressure. It’s demanding, overbearing… a burden. The ‘shoulds’ are always in the background convincing you that you aren’t doing enough. It’s exhausting.What if we replace ‘should’ with ‘could’? Suddenly, the pressure is lifted. We no longer feel like we are behind, frantically trying to catch up. ‘Could’ turns ‘should’ into an opportunity, not a demand. Where ‘should’ is asking for an end goal, ‘could’ gives you options.For a people pleaser, who often feels burdened by the things they think they have to do, this is an important and liberating shift. It allows you to pick and choose between the tasks that serve you, and those that don’t.
    1. Budget your Time and Pay Yourself First
      Picture each hour of the day as a coin. You start out with 24, just like everyone else. Several coins are spent straight away on sleep, then there are the non-negotiables like eating, cooking and basic hygiene. It’s up to you where to spend what’s left, but a people pleaser will give away their coins without hesitation, to anyone who asks for it. At the end of the day, there’s nothing left in the pot for you and you may feel taken advantage of.Time is a precious non-renewable resource, and life is short. We never know when our time is going to run out. Just like you would budget 24 coins, thinking carefully about how to spend them, get into the habit of budgeting your time too, always earmarking some for yourself every day. Pay yourself first, make it a daily priority.
    1. The 3 Ds
      People pleasers often think they need to do more, or do better. You take on all the responsibility for tasks, forcing a smile as you do so, but you are left feeling like you are drowning in your to-do list and don’t know how to come up for air.Feeling like you can’t cope is promptly followed by feelings of failure. Here’s the thing: you are allowed to ask for help, you are allowed to let things go, you are allowed to save things for another day. It doesn’t mean failing.Next time overwhelm creeps in remember the 3 Ds: delegate, delete, delay. Get all the tasks that you feel swamped by into a list and decide which can be delegated to someone else, deleted completely, or delayed to another time. Not only does this help beat overwhelm, it creates time for things which truly serve you.
    1. Celebrate your Own Achievements, Daily
      Do you need validation in order to feel good about yourself? Years of putting all your focus on other people can leave you unsure of yourself, so you look for approval from those around you.It is possible to appreciate your worth without looking to other people to reinforce it.Start celebrating your wins, especially the small ones. Going for a walk when the sofa was more inviting, making time to meditate, reading a chapter of your book, saying no instead of a knee-jerk yes… celebrating these daily achievements will help you raise your self esteem by getting you into the habit of thinking about yourself in a more positive way.

By following these five tips, you can break out of the people pleaser trap and start shining a light on the hopes and ambitions you have for your own life, gloriously guilt free.

Home Learning with ease and without pressure

More Enjoyment – Less Pressure

5 Things Guest Submission by @enchantednanny

A note from Anna: I count myself privileged to call The Enchanted Nanny a friend having handed tiny Florence over to her care almost two years ago whilst I spoke to a group of mums about post natal anxiety. Danielle has had my three captivated by her Youtube phonics, songs and story times, more than Peppa Pig ever did! Her desire is to support parents in supporting their young ones as we all feel our way through the Pandemic. So, feel the pressure lift as you read her words today.

It comes as no surprise that parents are struggling with the world’s new situation. The weight of children’s education has fallen directly onto the shoulders of those not trained to hold it.

It’s like being presented with the rough blueprints of a house, along with a pile of bricks, some tools and a loose set of instructions – and expecting to create a structurally sound home.

The impact of attempting to complete the task to perfection, while also maintaining the life you had before would cause no end of stress, anxiety, upset and eventually burn out. As well as a messy, unfinished, slightly wobbly house.

Much better in this instance, to admit that attempting the whole task blindly is simply not sensible, and that your time would be better spent laying and maintaining the house’s foundations, organising the bricks and getting ready for the construction team to hit the ground running when they take over.

Most parents are not trained to provide the intricacies of a full school day, and those that are certainly did not learn to deliver their profession from home, while balancing siblings, housework and a pandemic. It’s vitally important that parents understand that they are not expected to build the whole house – to be teacher, mum, emotional counsellor, chef. Instead, parents need to feel informed and supported, and to understand that this time is about maintaining the foundations, not attempting to build the whole house.

1- Remove the Pressure

Children are resilient. It’s their superpower. They make the best of a situation and they bounce back. Although this time seems long and detrimental, please remind yourself often that in the grand scheme of things, this is a small segment of their young lives. They haven’t stopped learning just because the learning is no longer formal and set within the walls of a school. Your children continue to learn every day, whether you are consciously teaching them or not. No one (and I have spoken to many school head teachers to verify this) is expecting you to facilitate a school setting or bridge the gap in their learning. Please remove that pressure and expectation from your already burdened shoulders. YES we want them to keep learning NO this does not mean teaching to a structured, formal and fast paced timetable at all times.

2- Find the Magic

I am not saying that this experience is easy or that every moment is magical. Most of us are not used to being with our children 24/7 and it’s not without it’s challenges. This situation does however present us with a unique opportunity to surrender our structure opening the door to new experiences and learning opportunities with our children. Being with them every day gives us time to be surprised by them, intrigued by them and to learn who they are as people. Our children are being granted the gift of experiencing us as individuals too – as we learn alongside them. They have seen us laugh, cry, they witness our struggles, our triumphs and sharing these moments with us is creating a bond between parents and children, the impact of which I think we will see when this generation are parents themselves.

3- Have a Safety Net

It’s SO important to know that you are NOT alone in any of this. There are professionals and resources out there to help you across or around every obstacle, whether it’s help with the educational stumbling blocks, mental health support, child development advice, support groups or even pages specifically designed to give you regular breaks while your children learn, sing or play.

This list is best made when you’re alone and calm. Fill it with links to ANYTHING that will get you through predicted tricky moments. This list will be your safety net. You’ll know that you can ‘break glass in emergency’ and it’s always their when you need to solve a problem and no longer have the energy.

Fill your safety net with those closest to you. I have a code word for when I am at breaking point. I send it to my Mum and she calls and supports from afar.

4- Build in a Release Valve

One little change that can have the most positive impact is understanding that you are free to set a home learning schedule that suits YOU and your household. This might mean learning Sat-Wed instead of Mon-Fri or completing the bulk of the learning early in the morning or much later in the afternoon. It’s home learning and you’re in charge!

Tension can build in even the calmest of households, so build in a release valve and know that you can use it at any time. You can guarantee that whatever your release valves are, they will still include some important learning. Ours is building a ‘spa at home’ or baking and cooking together. BOOM

an important lesson in self-care, maths and culinary skills – and a much more relaxed and happy family!

5- Carve out a Sacred Learning Space that Your Child Will Want to Spend Time in

We all work best in different environments. Some like blank, tidy spaces others prefer being surrounded by colour and white noise. Some learners are visual, some auditory and some learn best when moving around. Creating a sacred learning space for your child is vital and avoids a negative association with learning and their memory of our current situation.

Ensure they know it is theirs, that it feels personal, the lighting is good and it’s separate from the rest of their world, with all of the tools they’ll need close by.

My middle child is a visual/kinaesthetic learner, she sees, feels and moves in order to learn best. Learning prompts have been displayed on the wall along with her favourite drawing and physical resources are readily available, there’s space to move. I’ve popped some cheap and cheerful flowers on her table and we start each learning session with a cup of something warm. The sacredness of all of this has made her learning special and comfortable – for both of us.


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