P4P MB The Physical Effects of Birth Trauma
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[00:00:00] This episode is a collaboration between Melissa Dessaulles of Mommy, Berries Physiotherapy and The Pelvic Floor Project.
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[00:00:56] Melissa Dessaulles: When I work with postpartum clients, I want them to tell me about their [00:01:00] birth, not only so I can decipher whether they've had a vaginal or C-section birth, but also what happened physically. Did you tear? If so, do you know where and what degree? Did you have an episiotomy? How long did you push? Was your C-section planned or was it nothing like you had planned? Not only does it give me a description of what the tissues have gone through, but your story, how you tell it, what I see in your face, what I hear in your voice and observe in your body language tells me so much about how your nervous system is processing it all.
[00:01:33] Birth trauma is a very subjective experience and not only is it felt emotionally and mentally, but your physical symptoms will be related to what your body and mind is processing as well. Here to discuss it all with me is Kate Borsato, a perinatal mental health therapist and educator for moms. Her own experience with pregnancy and childbirth directed her to this important area of practice, and she's passionate [00:02:00] about helping other women through her virtual clinic across Canada. I trust you'll find our discussion helpful as we dive into the reasons why some births may be experienced as traumatic. What feelings may persist after ways to move through the trauma, and how our approaches as physical and mental healthcare providers have differences but should feel related. Most importantly, there's nothing wrong with you. You did nothing wrong, and you are not alone. Let's talk about it.
[00:02:35] Kate, thank you so much for being here today. I. I actually think it's important. I recorded an episode, that talked about the physical effects of different perinatal mood disorders like anxiety and depression. And I wanted to make sure to point out that I think sometimes people listen to some of these episodes and think, why is a pelvic floor physio. Talking about mental health, but I think we're quick to [00:03:00] compartmentalize mental health and physical health and we both see all the time that they go hand in hand. And so I, I reached out to you, Kate, because I was talking with some of the local midwives and doulas, and your name came up as a resource that they like to lean on. And so thank you so much for saying yes to this when I emailed you.
[00:03:23] Kate Borsato: Oh thank you for having me here. I love any opportunity to connect and yeah, to learn more about what you're doing, and I'm honored to be here and I'm flattered that my name came up, so thank you.
[00:03:33] Melissa Dessaulles: That's great. Yeah. Will you start by telling the listeners a little bit about yourself? Who are you? Mm-hmm. Talk to us a little bit about your group.
[00:03:41] Kate Borsato: Sure. So my name is Kate Borsato. Positionally, if you wanna think about where I am. I'm on the far west coast of Canada, so I live on Vancouver Island. I have two little girls, gosh, actually they're not so little anymore. They're six and seven. And so my background is in mental health and so many professionals who support folks in the [00:04:00] perinatal period, I started as a bit of a generalist and then I became a mom myself, and I realized, first of all, how shockingly difficult this whole transition was. And then really realized how few resources there were for perinatal mental health as a focus, right? I think that's what we really need as parents is to know that we can go to a pro, a professional who who specializes in the thing that you need them to specialize in. And so you know about eight or so years ago, that's when I, I I dove into perinatal mental health. So I started working with clients online. I've always done virtual video-based therapy and my practice grew and I just started bringing on more and more people. So now we work across Canada and support moms and partners with their mental health.
[00:04:46] Melissa Dessaulles: That's great and yeah, I wonder if I really quickly preface this before I kind of dive into some of the questions that I have for you, because I actually have a pretty extensive intake form when people come to see me. I ask them a lot of [00:05:00] questions before they even come in and I want to know, things about how they perceive stress and what kinds of things are going on in their life and just general questions about their nervous system and how they're coping and how they're sleeping. And I've been noticing more and more women come in and I always ask them, and I'm gonna put air quotes around this, "was your birth traumatic" because everybody has a different account of their birth and everyone perceives things differently. And I'm noticing more and more women answer. Yes. And I was, as I practice in this area more and more, I really start to think are people having more birth traumas or are just more women coming to see pelvic health physios, therefore, more of this comes up and it really piqued my interest when there was a a screening of a documentary called Birth Time and I went to right around Christmas time and it was three women that were, had made it their mission to find out why there was an increasing num or of women [00:06:00] experiencing physical and emotional birth trauma. And one, one of my main takeaways from that was just that women feel less and less part of the process. And so both of those kind of made me think, I've gotta talk to someone about this. And so that's why I wanted to have you here specifically to talk about birth trauma. And I wonder if you'll start by just defining that term, like what does that even mean?
[00:06:23] Kate Borsato: Okay. Yeah. Gosh, first of all, I wanna say very clearly and underline this, that birth trauma is a subjective experience. It's a subjective term, meaning that there is no black and white answer. There's no checklist that you could go through that would tell you yes or no. This was traumatic. And so for those of you listening, if you feel like what you went through was deeply distressing, deeply disturbing, difficult, maybe changed you, someone will say I'll I felt different after that, it's possible that it was traumatic. And so I know that there's been so many experiences where people have told you, oh, [00:07:00] that wasn't so bad. Or um, so-and-so had it worse, or, that wasn't traumatic looking at your records or your notes And nobody can tell you whether it was or wasn't. So that's what the subjective piece means.
[00:07:12] So when we zoom out and just look at the word trauma, trauma happens when we experience something that is deeply distressing, disturbing and we're not able to cope with it very well. And so that's where the subjective piece comes in. Two people might experience the same thing, the same car accident, the same injury, right? But it might be traumatic for one person and not for the other. And that really depends on how you are able to process and cope with it. And it's not so much like a one person's better than the other. It's based on so much of our past, what we learn, how we've coped with things before, the support that we have. What our nervous system does, so there's so many factors. I don't want anybody to feel like they weren't good at birth if they experienced trauma. We look at things like [00:08:00] prolonged and intense pain that doesn't let up. That can be a traumatic experience, right? As humans we're built to deal with and process pain in shorter bursts, but prolonged pain where you feel like there's no way out, or that there's no end in sight, or that just keeps going and you can't do anything about it. That could be trauma that could be, that could cause trauma, it could be traumatic. We also know that when we are faced with a situation where we are scared about our own safety, our own lives, or your baby's life if you're facing that fear, regardless of what happens. So even if everyone's okay, if you're facing that possibility and that fear, that can be traumatic. When you think about childbirth it's like ripe for an opportunity to experience trauma.
[00:08:46] Melissa Dessaulles: Absolutely. And I think this is where I want to mention when women postpartum come to see me as a physio, generally they're coming with symptoms that involve, persistent pain that, I'm still having [00:09:00] pain in my perineum or around where I had my C-section, or I'm not able to do certain activities. I'm not enjoying sex. It actually hurts to have sex. I'm having difficulty getting back to exercise, and I think whenever we kind of, I break down some of the issues with the tissues, it always comes down to, let me show you what these muscles look like. Let me help you understand how they behave, but also let me help you understand how they're related to the nervous system. Because if you still have, certain stresses or certain beliefs or certain memories, of your birth and how is that affecting your tissues? They'll never just be, oh, this muscle has a problem in isolation. There's always a bigger picture. And so just wanting to tie together that, some of these lasting feelings or lasting memories will show up in your tissues, which is making you go in to see the physical care practitioner.
[00:09:54] Kate Borsato: Wow. It's. It's amazing when we acknowledge that, right? Like back to what you said at the beginning, how all of these [00:10:00] things overlap and how the pain and the memory and the difficulty can literally live in a certain area or tissues. One thing I didn't mention that I wanna make sure we do before we move forward is that the relational pieces that happen during birth can be really important to tune into as well. So physically things might be going as you had hoped, and they might all be going smoothly, right? But let's imagine you didn't have the emotional support that you wish you had, or your partner wasn't quite there for you the way you wish they were, or a provider, a midwife, doctor, nurse, somebody made a comment that hurt you or didn't treat you that well, or talked about your body as if you're an object instead of a human being. Right? There's so many different ways or examples of this, but there is a relational piece that can actually be part of this picture as well, that can be part of trauma.
[00:10:52] And of course the elephant in the room and we would be negligent to not talk about this, is the sexual piece as well. That so many women, so [00:11:00] many birthing women, birthing people have sexual trauma in their history, whether that's childhood trauma or adult trauma or anything in between. And again, this idea that, that area, those tissues carry this trauma. And now again, you might be in a vulnerable, painful position where if you're not being cared for and held properly, that can be very traumatic.
[00:11:23] Melissa Dessaulles: Absolutely. Absolutely. And I think that, I think it's important, I always try to help people understand that the, again, the reasons you're coming in to see me, these physical issues, this isn't necessarily your body failing you. This is your body thinking it's protecting you. It's working so hard to protect you. And we just need to work on ways that it's going to understand that you don't need it to do that anymore. Or, and that I always want them to understand that I don't want you to think that, oh my gosh, I've got all these mental health things to work through now, all these emotional things, and I've got all these physical things that they should always feel like they're blending together, right?[00:12:00] And it should feel like you're working on a common, a common issue.
[00:12:04] Kate Borsato: And one thing that comes to me right now is, with this idea of working on these pieces together. So what can be really corrective for folks that come to see you? If you're aware of all of these emotional pieces, if you're creating safety, if you're educating, if you're getting consent, if you're teaching them about their bodies, there's all these opportunities to help them heal that trauma through the care that you are providing, which is really beautiful. You know that, but just to echo that.
[00:12:29] Melissa Dessaulles: Absolutely. I like to talk about it like green input and red input and that certain things are gonna make you feel red and I always want to be green we'll, we will be making sure that things that we work on are green for you so that you can help to move past some of these things that you're working on. Kate, can I ask you then is birth trauma. And PTSD synonymous because you'll hear people use those terms interchangeably. And I wonder if you can speak to that a little bit? [00:13:00]
[00:13:01] Kate Borsato: Yeah, sure. So they're, I do not see them as synonymous. So you can go through something traumatic but not develop PTSD, Post-Traumatic Stress Disorder. So PTSD is a clinical term. It's a diagnosis. It's, it represents a whole group of symptoms that a person would need to have over a set period of time. So these types of things would be, you know, intense um, it's like flashbacks. It would be a lot of anxiety and hypervigilance. Maybe things like avoidance. So maybe a person would not be able to look at photos of their newborn or talk about the birth at all, or even driving by the hospital might create a very fearful reaction in their body. So things like this, and anybody who wants to know more about that, there's tons of information online. Just Google symptoms of PTSD. So that's a very specific sort of cluster of symptoms, but not everybody who goes through something traumatic, birth trauma, will go on to develop all of that. So some [00:14:00] people are able to process the trauma afterwards to talk about it to, and it doesn't have to be with a therapist. It could be, but it could also be with a midwife. It could be with a physiotherapist, just a loving person who's able to hold space for you. So one of the most helpful things, we'll probably talk about this a bit later, but is telling your stories, going through the story, talking about it. Crying about it if you need to, letting some of the emotion out instead of shoving it down and just getting on onward and upward, like mothers are really pressured to do.
[00:14:29] So no. So for those of you listening, if you're like, oh God I did have a traumatic birth, now what does this mean? It just means that you're a human being and you went through something really hard and it's gonna be okay. You can absolutely move through it. I think it can be really powerful to assign the word trauma to your experience. So again, going back to what you said at the beginning, is birth trauma increasing or what's actually happening here? I think one factor is that people are becoming more aware of their experiences, more aware of the the feelings that are coming up. They're more likely to [00:15:00] apply the words to their experiences. Whereas, if you talk to, and this is maybe just my experience, but when I talk to my mom's generation, a lot of the women will say, oh, that happened to me too. But we just didn't call it that. They just powered through, and I think our generation we're more likely to say, wait a second, what the hell like that was, that was hard, what a, I need help here! So I think there's also like a generational piece there. Does that make sense?
[00:15:23] Melissa Dessaulles: Absolutely. I wonder, it always makes me think, not only when I'm talking to some of my clients, but in my experience, I would describe my second birth, especially as quote, unquote "traumatic" in the events that played out. Lots of different things happened. I had to be induced, which I didn't want to happen. I wasn't dead set on having an epidural, but I ended up having one. Positioning wise, I just wasn't happy in the end with how it, how everything played out. I had to have an episiotomy. I had to go for an emergency procedure. But to be perfectly honest, I don't look back on that day as traumatic at all. I actually only have fond [00:16:00] memories. I think my husband had more trauma than I did because I think hormonally, and plus I think that I was in a I wasn't in a, I wasn't in a place to notice what was going on with myself, to be honest, whereas he was lucid and watching it all. And I wonder if you could speak a little bit too. I really do think that he had but postpartum, we always talked to the mom, how are you? And how's the baby? I don't think the partners often acknowledged as much. And I wonder, will you speak to that a little bit? How often are you finding that the partners are dealing with the trauma?
[00:16:33] Kate Borsato: I honestly, I don't see it a lot because I think that people are not, again, focusing on dads, I don't think there's a lot of space in for dads or partners right now, even though they're struggling. We know that. We actually know that one in one in 10 dads develop postpartum depression. It's a thing, right? This is a very real thing. But I love that moms are getting so much more support now. We haven't created space yet for the partners to come in so that, that needs to come. So [00:17:00] in my practice, I don't see partners coming. I don't see clients talking too much about their partners, which is fine, they don't need to be But what I do know is that witnessing something like that, when we witness scary situations, when we witness, our love, our partner, and our child going through something so difficult and you, and when you feel helpless, that is a very difficult thing to go through. So I can't even imagine what that's like for partners to sit back and and support, but not really feel like they can do anything. So I guess the answer is no, I don't see a lot of it, but I know it's out there and I know partners are struggling as well. And so they would need to look out for the same types of symptoms. So again, it's that like avoidance, that hypervigilance. We know that trauma is very highly linked with perinatal anxiety and depression as well. So it's just something to note, right? Just if this conversation resonates with you, just be curious, like, how is this showing up in our life now? How might this still be here? Maybe it's not, right? Just like what [00:18:00] you said, Melissa, you went through some pretty intense experiences, but you wouldn't deem it as traumatic. And again, it's subjective. That's your call to make.
[00:18:09] Melissa Dessaulles: Yeah, absolutely. I'm curious to know, and I think that I've had relationships with counselors in the past, so I didn't feel the need at that time to reach out to someone I knew that was there. I didn't have a negative stigma associated with it or anything. But I wonder, like in the event that, so I don't know that I was flagged for needing to talk to someone, but obviously there are certain births that I'm sure care providers flag as this would be someone that would be that would, it would be valuable to refer them on to someone. And I wonder I respect that every country and probably every province is different, but are there certain measures or certain steps that are taken when a care provider deems that maybe that birthing person would benefit from having some help. Am I clear on my question?
[00:18:58] Kate Borsato: You are clear, and I wish I had [00:19:00] a really awesome, clear answer, but from what I know, there's not a very straightforward system. So it really depends on who's catching you, who's there to notice and to ask the questions, and then to follow up on the answers that you give them. We know that the idea of screening, first of all, for perinatal mental health, this is a must, we need to screen for all postpartum women we're supposed to be screening. When I say screening, I mean like the actual formal measures for perinatal anxiety and depression. Providers know that they need to be screening, but what often happens is they will screen, they might have a positive screen. But then they don't know what to do about it. There aren't clear resources. There's just not like a very clear path through for folks. I think providers often have their own referral network that they might refer to a therapist like me or their own team. But sometimes it takes some advocacy from the families part, like asking midwives, asking physios who can I see? Who do you know? We don't really have that built into the system very well. And [00:20:00] it would really depend on the province that you're in too. So I know in, in British Columbia, we have the reproductive mental health out of BC Women's Hospital. But again there's a limit to the number of folks that they can support. You also have to have a referral into that program. So most, most therapists you wouldn't need a referral to. So people, if you ever wanted to see somebody on my team, you can just self-refer and book in. But in terms of that, like initial flagging, there is not a system that I'm aware of at this time.
[00:20:29] Melissa Dessaulles: I've, like you touched on before, I think there's lots of different ways to move past something that we perceive as traumatic. Like for example, whether it's just be talking to your friends or talking to your family I'm definitely a talker and I think that's where I get a lot of my release. But I think some people, I, I, I know some people would prefer to journal or to keep a diary or what, whatever, or to share publicly. Some people find a lot of release in that method. And I wonder if [00:21:00] you could talk a little bit about some of the benefits of, because I absolutely want to talk about your services and what kind of things that you do to help these clients, but I wonder if maybe even before that, are there things that women can do that they can ask their care provider? Can they ask them to talk through with them what happened during my birth? Or what are some of the things that went on? Because I do notice that there's a sense of maybe more stress or may be trauma around the unknown. Like the number of women that come in and I'll ask them, if they had tearing, do you know the extent to your tearing? Or do you know some of these things that happened in your birth? And a lot of women say, I don't know. I don't know a lot of the things that happened and I don't know why they happened. So is that something that you often suggest that people do, early on is ask their care provider to talk through with them some of the decisions that were made or some of the things that happened. Would you?
[00:21:57] Kate Borsato: Absolutely. Yeah. [00:22:00] Absolutely. And it really depends on what the source of the pain is, whether we're calling it trauma or not, but what is the, what happened and then trying to help people figure out what do they need from there. But if there are questions about why things happened, or sometimes folks will have that feeling that things were done to me and I don't understand, or I don't, it, it wasn't right. You have the right to access your records at any hospital or birthing center or home birth. So those are your records. And so if there are gaps or any confusion, then absolutely request those just to fill in, because that sense of not knowing what happened to me is very powerless, very, is a very helpless feeling. And so the, yeah, the more you can fill in those pieces, you can ask your partner to narrate what they saw. That can be really helpful as well because for birthing folks, you're also losing sense of time. Things can feel confusing and and it's really helpful to hear things told back to [00:23:00] you.
[00:23:00] I often think about, being younger years and going out with friends and having sleepovers and, even if we were getting into like wild things in the evening or going out and partying or something, it's like talking it through the next day, did you see so-and-so talking to and this person, it's talking through. That's what we do as people. We talk things through and it helps make sense of what happened. It helps put everything into place. And usually when I give that example, moms are like, yeah, I totally do that. So you could do that with your provider, with your partner, with the hospital notes. One thing I'll add to that too, in terms, cuz you're asking like, what can people do to help move them through some of this? Sometimes when people feel like maybe something happened that shouldn't have happened, they might benefit from, bringing that up, calling it out, filing a complaint, writing a letter, even if it's not a formal complaint, it's like you might need to tell somebody what happened was not okay. You might, if you don't want to do that, it like many people might feel I don't really wanna even go there and bring this up with that person. [00:24:00] Sometimes it's helpful to write a letter that you'll never send, so you're writing it with the intention of never sending the thing and you can get as angry, you can use whatever language you want. It's like calling it out, what happened? Sometimes people burn the letter, flush it, destroy it somehow. Maybe they keep it for later. But again, it's this act of getting the language out, getting into that ad self-advocacy energy, like this was or wasn't, okay, this is what should have happened. You, when you said that, this is how it made me feel. So it's getting into that more, that powerful place rather than the victim place that really hurts and doesn't help our healing. Does that make sense, Melissa?
[00:24:38] Melissa Dessaulles: Absolutely. And I think that the, this is like a na, a natural place to move to. So let's say that, I'm a mom that, comes out of my birth feeling, "Yeah, something's missing or something doesn't feel right and I can acknowledge that I had a hard time with my birth and that's maybe stopping me from moving forward," or "I'm having a hard time bonding with my baby" or, anything that just [00:25:00] doesn't feel right. And I, I talk through it with my partner or I talk through it with my friends or my family. I asked my care provider to help talk through, to fill in some of those gaps that I don't remember. But maybe, and then how to reach out, whether we ask for a referral from a friend or an Allied Healthcare member or whatever, to find someone like yourself. Maybe if I know everybody's so different, but I wonder if you could help listeners understand maybe some of the things that you help them work through or some of the other strategies. You have mentioned some of them, but I wonder if there's anything that we haven't included yet. So people can understand like, what would I really get out of booking an appointment with someone like Kate or someone from her team? Like what will that do for me?
[00:25:45] Kate Borsato: I think there's kind of two pieces that, that I would say are most helpful. One, one would be raising your awareness of what exactly is troubling me? What is the piece? And usually I'll invite moms to share like, what happened? Tell me about birth, what was that like? And we'll [00:26:00] slow right down. And it's so slow that it's a way that we don't normally speak to people. People wanna know, get through, get to the point. People generally don't wanna hear the hard stuff, but in counseling it's no, we can hear it all. And so I will go through very slowly and pinpoint exactly what was the moment that felt the most difficult. And often it's a moment that is surprising to clients, right? It's not necessarily the tearing or the injury, right? It might be that moment that they didn't ask whether I was ready for the epidural or that moment when they took the baby away and no one told me what was happening. I didn't know. And so for 30 seconds I thought I lost the baby, for example. So it's like that's a huge piece is slowing it right down and noticing where is the pain, where's the distress? And usually we'll feel it in our body as well. So this is that connection. And so this is what I will do is guide clients to really tune in, as you're telling the story, [00:27:00] so you're storytelling, you're in your head and you're checking in with your body, head, body, head, body, and your body tells you when the distressing part comes up, you'll feel it.
[00:27:09] And so what I will do with clients is slow them down right in that moment. And we'll sit in that for a minute. And when you do that's when you process the pain. If you can feel it, if you can slow down and say, oh my gosh, yes, that was hard. That wasn't okay. And there's some other things that we can do with those layers, depending on what comes up. So that's a big piece, is slowing everything down, building awareness about what went wrong and helping you move through that. The other piece that we do a lot in therapy is building skills around soothing your nervous system in general. So we know that anxiety is so high these days, gosh, in general, but especially in the perinatal period, and especially if you've gone through any kind of trauma. So what that means your nervous system, your system that is responsible for basically perceiving threat and safety and risk outside of you. It's on high alert. It's like [00:28:00] hypervigilant mama bear, just firing and stressed and on it, right? And that is functional when you need to be protective, but it's not super functional when you're always up there. And so I teach clients how to, first of all, notice when you're up there. And how to bring your whole nervous system down. This is like a thread through most of therapy because when our nervous system is down and regulated, then we can be the moms we wanna be. We can parent the way we wanna be, we can connect with our partners in an intimate way. Like without that ability to regulate, we miss out on a lot of the good stuff in life. So that's a really tangible piece that we would do in our work together.
[00:28:39] Melissa Dessaulles: I love the part that you, the first part that you brought up because I think that, we've mentioned a couple times how valuable it is to talk to our friends and family, but how often women will say to me, I, I feel bad sharing that cause I don't wanna scare anybody, right? Nobody you, when you have a moment to talk to someone you also don't wanna be that Negative Nancy that's oh, this is [00:29:00] hard for me. You want to bring your best. Everybody naturally wants to bring their best foot forward and create positivity in the world. So how often we say fine, it was great, had a little problem but it's mostly just, we always talk about the baby and rarely do we feel comfortable talking about, quote unquote, negative things, right? Yeah. And so I think that's important for people, nor on the flip side, people that would describe their birth as magical. Don't wanna share that either. I find that a lot of them are just like, I don't wanna brag cuz I've heard that so many people have a hard time in their birth that I don't want to share that I felt it was really magical and that's where I think people like you are so valuable because you're a neutral party that like someone can just share everything honestly and not feel that they need to say something.
[00:29:46] Kate Borsato: Or that they're being ungrateful. Yes. I know. In this world there's so much sensitivity, which is lovely toward one another. And especially toward folks struggling with fertility. For a mom, for somebody struggling to become pregnant, to [00:30:00] hear somebody complain about anything that has to do with pregnancy, birth, postpartum is like a punch in the stomach, right? It's really hard to hear that, and I think most people are quite aware of that and trying not to share anything negative. And I think too, there's this black and white tendency that we all have that if I say birth was hard, that means I'm saying something bad about my baby. Or if you said I hated that experience, that means I hate my baby. It's like, no. Of course you hate an experience where you felt terrified and in the most pain you've ever been in. Does that not make a lot of sense? And that has nothing to do with how you feel about your baby, right? So we can have all these feelings at the same time. You can be disappointed in some parts and so relieved and happy with other parts. You can love certain things about your provider and wish some things were different. You could be grateful for how your body grew, your baby, and also disappointed in how your body responded during labor, like you can hold them all and, and I think in therapy we really teach that one feeling is not wiping out the rest.
[00:30:58] Melissa Dessaulles: It was interesting. I was just [00:31:00] chatting with a friend that just had her second C-section and she said given this was my second C-section, I was a bit more prepared for what that was gonna look like and what that was gonna feel like. And I feel like I can bond with my baby better this time than I did last time because I wasn't prepared for a C-section and I felt I failed. And I thought that was so interesting that. Sa, not same birth, cuz obviously they're both going to be a little bit different, but just a mindset. She said it was my mindset and that I really did feel that I didn't have the right birth the first time. And just her being able to acknowledge through time and I actually don't know if she's sought help from someone to help her process all of those emotions, but just to show how different your whole experience can be given mindset and given experience.
[00:31:44] Kate Borsato: And how harmful it is when we judge ourselves. Oh, really? Like we have these expectations and this might again be something that's different now than it was in the past, a generation ago, is the expectations that we have of ourselves [00:32:00] and like this pressure to be good at birthing instead of just going into labor and birthing and doing what needs to be done. Right now, there's this, hierarchy of natural, unnatural, medicated, unmedicated, blah, blah, blah, blah, blah. There's just so much information that folks have. And I was no different like with my first child seven years ago. I wasn't in this field, so I didn't have this awareness, and I was used to just being like, good and working hard. And I thought, someone's gonna have a hypnobirthing experience and a meditative calm, maybe even an orgasmic one. I'm gonna do that. And I approached it with that's gonna be me. Like I'm gonna do that. And my world was rocked because it was so far from that I felt, I felt embarrassed. I felt like I failed. I felt like I wasn't good at it. And there's this quote around trauma being also about our shattered expectations. If my expectation going in was that like, yeah, who knows how this is gonna go, I'm just gonna roll with it. Like surfing over a wave. Who knows? [00:33:00] I probably wouldn't have experienced it in such a painful way, but my expectation was that I was gonna be this birthing goddess, just like breathing through it and, I was nothing close to that. And it was all okay, but it was the expectations that kind of set me up. And I know folks will resonate with that in, in some way or another.
[00:33:20] Melissa Dessaulles: It was so that's so timely that you bring that up. There was just a couple days ago some research put out by, she's a PhD student, PhD student in clinical psychology. Her name's Kimberly Johnson. And she experienced her own kind of trauma, physical trauma after her birth and really opened her eyes to, I wasn't told about any of this, like I didn't anticipate any of this. And so she, that, her her study looked at kind of birth related physical pelvic floor trauma and associated symptoms, right? And said they were associated with higher rate of mood and anxiety disorders in the fourth trimester. So [00:34:00] that, pelvic floor trauma is linked to perinatal mood disorders. They hypothesize that the lack of information going into birth would cause greater distress following the birth. And sure enough, they found that kind of ed education, basically eyes wide open, going into it with eyes wide open and understanding these are some of the things you might experience after that are normal. Expect that they could happen. But that, so that education not only reduced, the pelvic floor trauma, but helped in, in basically decreasing the distress if it does happen. So that's a big study. That's a huge, that's a big deal for people to understand, like you said, just having. But on the same time, at the same time, I think we struggle as healthcare providers to scare people. Do you know what I mean? The last thing you wanna be is like, oh, you're so excited, but let me tell you about what might happen. I think that it's hard [00:35:00] as a healthcare provider too, knowing, we see this on the other end that, that the women that go in with their eyes wide open often do better, but we also don't want to overwhelm. So I think it's right. Like it really is difficult, isn't it?
[00:35:13] Kate Borsato: It really, it is. And my thought was like who's gonna do that? And who has the time based on our system right now? So many folks don't even have doctors or they're on a rotating basis. There's quick, short appointments, which is understandable from the medical side of things, but like where do you get that education? But this is where the online education world can come in and I think it's amazing. But something that we'll do with clients often is talk about birth, yeah, birth planning, but also worst case scenario planning, which again, nobody wants to talk about, but I'll nudge clients who are pregnant to think of okay, so what would be worst case scenario? How do we plan for that? And how do you get something that you want out of that experience, even if it looks totally different, right?
[00:35:52] So many will say I don't wanna have a C-section. I don't wanna have blah, blah, blah, blah, blah. Okay, so if you have all of that, how can you still feel [00:36:00] connected? How can this still feel special? How can you still feel like the most powerful woman who just got through this experience, like how do we bring those things in, even if those, less than ideal situations happen. So it's actually like very empowering and important to look at things that aren't necessarily ideal. You're not gonna manifest these bad outcomes. I think that's also like a bit of a harmful belief that's out there right now is I don't wanna put any energy into the bad stuff cuz then it might happen. It's no, we don't manifest stuff that easily. Can you imagine if we could, like we'd all have everything we wanted so we don't manifest bad things. So thinking about them is not going to put that into motion. It's gonna help you feel more prepared.
[00:36:43] Melissa Dessaulles: I think a lot of cultures do that so much better than us. I think that a lot of cultures do tend to look at worst case scenarios. So that they feel prepared for it. And I don't know that our culture necessarily does that. It's we're like positive, like toxic positivity, right? Yes. That's like the, so then you fail all the time if you don't have that scenario, and I [00:37:00] think that you just brought up for me the last place I wanted to go with. So then from both of our fields of practice, how do we help people prepare for this and and I, you've brought up, and I wanna circle back to that, but you, we've both talked about how our practices blend together, and when you were talking about that, one of the things you do. For postpartum women is help them work with their nervous system. That's exactly what I would say that I do all the time too, is I wanna, I want you to, I'm gonna show you with models and show you on your body why you're experiencing some of your physical symptoms, but let me also tell you about why your brain is the higher center here and that we're gonna be working with your nervous system more than anything, and seeing like that mind body connection and how you can help play a role in your body moving past things, because it always seems to come down to that, and I am loving that, like this study I just talked about that Kimberly Johnson played [00:38:00] such a huge role in, we're already doing that as pelvic health physios. We're starting to see so many women come in during pregnancy to learn about their body and learn about their pelvic floor and learn what happens during pregnancy and birth, so that they can picture it and they can learn to work with their nervous system during pregnancy and during birth, and then know how to support it as it goes through a rough time postpartum.
[00:38:27] So I think that we're starting to learn that we can go in eyes wide open and I absolutely respect that every person's going through that differently. And I think that, I try my best to apply all of this to each individual in front of me and I think that, if I'm hearing more and more women that recognize previous birth trauma or previous sexual trauma or previous, I don't know pain issues or anything like that or beliefs about c-section being the wrong birth are starting to seek out[00:39:00] people like you during pregnancy too, because they recognize that emotionally or mentally they are having some hurdles. So are you starting to see some more people during pregnancy that are thinking a bit more proactively?
[00:39:14] Kate Borsato: Yeah, absolutely. I think there, there is a lot that we can do preventatively, but I'm also hesitant to imply that we can, hustle up front to avoid any kind of outcome. Like what I think we can do is learn as much as we can. We can develop skills, right? We can learn how to support ourselves. We can explore limiting beliefs that we have about our bodies or ourselves or things like that. But we can't necessarily avoid pain, and this isn't just with perinatal period. This is just life. This is a zooming way out high level. As humans, we are going to confront difficult experiences all the time until we are no longer here. And it's a big piece of this is learning [00:40:00] about how do you support yourself when those things happen. How do you cope? How do you learn to regulate your nervous system so that even if breastfeeding is really difficult or bottle feeding is really difficult, or even if three years later tantrums overwhelm you to the point of like intense anger. Okay. How do you roll with that? How do you get through that? So I think there is, yes, there's a lot that we can do upfront, but it's not, it doesn't mean that if anybody listening is struggling, it's because they didn't do enough upfront. It's like this is just the human experience. There's, let's not tell ourselves that we can learn and work super hard and then avoid all of these challenging outcomes. Like this is also just part of life. And so how can you support yourself along the way? The entire way, not just upfront to prevent the hard things. Does that make sense?
[00:40:53] Melissa Dessaulles: Absolutely. I think that, yeah, I think that, whenever you reach out for help is the perfect time. And I think that[00:41:00] I always think of, I always explain the same thing to my clients by you coming to our appointments before does not guarantee anything, does not help you predict the future. But perhaps it puts you in touch with someone that you know you can trust after. As someone that meets you during pregnancy, they just know Kate's there after. They know who to talk to. Kate's not a new person after, Kate's a familiar person after. But absolutely, I think you're like, you hit the nail on the head whenever you reach out for help, is the perfect time.
[00:41:28] Kate Borsato: I think like I'm remembering back, maybe I'll share this if we have a little bit of time. I'm remembering when I was postpartum and going to a physio, this is after my first birth and, this was before I was really waking up to the fact that I was struggling with my own mental health, like anxiety mainly is what I went through perinatal anxiety and had gone to a pelvic floor therapist. And I remember just ditching out eventually. Like I couldn't get myself to do certain, like the internal, there was an internal exam that I just [00:42:00] avoided. I totally avoided it and never went back. I don't think I ever went back, and you probably see this this this is the moment. It's not that clients will come to me first. They usually will realize there's a problem elsewhere, whether it's with their partners sexually or when they drive by the hospital, or when they try to get through a physio appointment and can't do it for some reason. So yeah, I just wanna highlight that again, this like intersection and how so many other professionals are actually the ones catching, like they're the first ones. And so that's why we really do need to be connected here. Because for me it was the, it was that office that I realized oh, I need some more support here. This isn't just about kegels or whatever.
[00:42:46] Melissa Dessaulles: Not, not at all. Exactly. Yeah. Yeah. Absolutely. I think that, yeah, I think we've talked about some good things here and I hope that people listening have not only helped to blend some different things in their head together, but also [00:43:00] for other healthcare providers to think a little bit about why when this person comes in to see me, what's the big picture here? What other things are going on and what's their story? What's their history? What are their beliefs? What kinds of things are they saying? Or maybe not saying and, helping to connect with people in your community.
[00:43:17] I wonder if you could is there anything else before I ask you to share a little bit more about your offerings, is there anything else, Kate, that you feel like I haven't touched on that's important for people to get out of this?
[00:43:27] Kate Borsato: I think what the message I wanna leave is that it's never too late to process any trauma or any difficult experience. So if you're listening in your four years postpartum, 10 years postpartum, it's not too late. You haven't done anything wrong, you haven't missed the window. So there's no rush and support is there for you when you're ready for it.
[00:43:50] Melissa Dessaulles: Awesome. I'm gonna share everything about you and how people can find you in the show notes, but will you talk a little bit about what kinds, I know you're very active on social media, [00:44:00] which is where a lot of our clients live, and I think you do a great job of speaking to people consistently, and it gives a sense that you're always there. And I wonder if you can talk a little bit about that platform and anything else that would be helpful for people to know as far as finding you goes.
[00:44:14] Kate Borsato: Sure. Thank you. Yeah, so I do try to hang out on Instagram, cause I know that's where most of us are anyway. So I try to, talk every week about anxiety and tangible tips. So I'm really personally but also professionally a bit tired of a lot of the info. There's so much information and I think we need more skills and we need more support in that way. So I teach some of these things online on Instagram. I also have a program that's going to be entirely practice based. So this will be skills around, like we've talked about, regulating your nervous system. How do you use your breath to go from overwhelm to calm? How do you know tapping? I'm gonna be teaching tapping, meditation. Also some CBT cognitive behavioral therapy skills that are very well known to [00:45:00] be very effective. So this whole group is gonna be about useful things that actually work. And it's less than $20 a month to be part of that program. So that's a good option for folks who don't want to, or who can't afford therapy. Cause that can be very expensive. So of course the therapy's the option for those listening. There's this program. There's also the free resources on Instagram. I have some self-paced anxiety courses that might be useful. So there's like a whole range of things that you can engage with in whatever way works with you.
[00:45:30] Melissa Dessaulles: That's great. And I think that if we didn't highlight it enough, I think one of the biggest reasons why I wanted to reach out to you is not only cuz you're local to bc but I know that your services are Canada-wide, I wanna say?
[00:45:40] Kate Borsato: Yes. Yeah.
[00:45:41] Melissa Dessaulles: Canada-wide. And that, that it is all online because I know that a lot of you feel stuck at home with a baby that you know these services are at your fingertips. And so I just wanted to make sure to highlight that because I think sometimes we feel it's a bit of a barrier to get out to see someone in person.
[00:45:56] Kate Borsato: Yeah, absolutely. And babies are welcome. Like [00:46:00] it's, I would never say don't have your child in session. If you're a child being with you is possibly the reason you wouldn't book in, bring your baby. Let's hang out. Like it's okay. So we're all about realistic support for you at this time.
[00:46:13] Melissa Dessaulles: Awesome. Thank you so much for sharing not only your time, but your passion and your stories.
[00:46:19] Kate Borsato: Thank you for having me. I appreciate it.
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