August 5, 2025
The Ripple Effect of Birth Trauma: Podcast Episode #302
The Unspoken Ripple Effect of Birth Trauma with Sarahjane, CEO of Fit Fanny Adams. Sarahjane is a recognized leader in women’s health, specializing in restoring the pelvic floor at any stage of life.
Hello, hello! This is Kristin with Ask the Doulas, and I am thrilled to chat with Sarahjane Watson today. Sarah is the founder of Fit Fanny Adams, and she has the passion to break the stigma and shame surrounding pelvic pain and dysfunction and help women restore their pelvic floor confidence, strength, and comfort. As the founder of Fit Fanny Adams, Sarahjane is an expert in restoring the pelvic floor and core and focuses on everything from preconception to pregnancy and even into the postmenopausal stage.
Sarahjane is recognized as a leader within the widely forgotten area of women’s health. Her approach reaches beyond pelvic floor exercises to rebuild a deep connection of the core, breath, posture, and connectedness to self.
Welcome, Sarahjane!
Thank you for having me, Kristin! It’s lovely to be here.
I am really excited to dive into the topic of the unspoken ripple effect of birth trauma and how that affects the pelvic floor. So let’s get into it with your experience focusing on all stages of women’s health and life! I would love to start with a bit about your personal experience and how it led you in all the areas of physical therapy to focus on pelvic floor.
Oh, thank you! As everyone does in this field, I think, my own little journey – actually, I’m very privileged and very fortunate that my birth story was generally wholly positive. But rewinding, I trained as a physiotherapist just in the late 90s, turn of the millennia. And really interestingly, pelvic floor wasn’t even incorporated in the degree. We didn’t cover it in our entire three years. With women’s health as an area to specialize in – it wasn’t really talked about unless it was something that you happened to get a placement on, a training placement on. There was no requirement, but some people – it was always deemed they were unfortunate enough to get a women’s health placement.
So even as a physiotherapist, my insight into women’s health physio was very, very limited. But really interestingly, I sort of came away from traditional practice, and it was only after I had my son – he just turned 12 – and I had a beautiful pregnancy, had a water birth. And I had a slight tear, but nothing really significant. And I was really, really interested in how I did everything according to the book. Rest for six weeks, have a six-week check, and then you can start exercising in your pre-pregnancy state. And even at my level of knowledge and fitness and the state that I went into my pregnancy with, I couldn’t believe when I popped on my trainers after my six week check, which realistically in the UK is more about baby than it is about mum – I just really felt like my pelvic floor and the whole of my insides was just suddenly incredibly vulnerable.
And nothing had prepared me for it. Genuinely, nothing had prepared me for it. And I thought, how is it that somebody who’s been educated in the human body to the level that I have been still has this mystery around pelvic floor? So from there, I then had the opportunity to really change my entire career. So I really invested in such deep research, such deep education around core, pelvic floor, pre and post natal, and the intricacies and complexities of the pelvic floor. And I’ve been really privileged to be working with many women in so many different areas, from pregnancy pre- to post-natal, and just really supporting them and getting them better prepared for labor, or certainly to really make those great first steps in postpartum recovery rather than coming back at 45, 55 and saying, I really should have dealt with my pelvic floor years ago.
It is certainly something that you don’t fully understand until you are in that healing phase, and even with the background in education that you have, until you’ve experienced it yourself and understand how to best support your body, other than, again, like you said, that six-week checkup of, “You’re fine to exercise again.” But really, we’re often not, and we have to fully understand how to heal.
That word, heal. It’s the shift at the moment I really feel. It’s all around. It’s very compartmentalized. You’ve had baby, now focus on baby, and now it’s all about getting to your pre-pregnancy state. And it’s about exercise rather than – exactly what you said, that magical word, healing. And restoring and actually giving our bodies credit for the amazing, amazing thing they’ve just done, to grow and birth another human being or beings. It’s not about suddenly saying, off you go back on the treadmill now, or off you go for your run. Everything’s going to be fine. We really need to lean into that whole transition.
Exactly. And I love that focus on 30 days, 40 days in many cultures, of rest and healing and recovery and nourishing ourselves, not only with the foods and what we are drinking, but also emotionally. There’s so much to it, and with our topic on the ripple effect of birth trauma and, of course that pressure to fit into your jeans, to look like you did pre-baby – it’s really more than that. And I would love to go through what you consider trauma, because as a birth doula and childbirth educator, my clients may have different ideas of what could be traumatic to them. It could be even a fast birth, or obviously, tearing as you mentioned, or forceps delivery or vacuum. There’s so many different ways, but as an expert, I would like to hear your thoughts on what might be considered trauma.
That sounds absolutely true, and I think something – certainly over here in the UK – we focus on physical trauma. And one thing that I really experienced is – and I was really humbled by it – is the age of women who would come to me, perhaps post-menopausal, maybe in their 60s, who have struggled with their pelvic floor and who would literally be maybe very jokey about it initially. “Oh, my child had a huge head,” or something. Actually, maybe within a few minutes of really giving them the time and the space that they probably never had, they would really be in pieces around the trauma that they’d been through and the fear. And I started to really understand that – and this was before I was much more familiar with trauma as I am now – this presence of trauma is so not about the grade of your tear. And people can tear and have no real birth trauma. Or people can have no tearing, no physical trauma, but be really, really suffering, from potentially PTSD, fear of having future births, huge issues around pelvic pain, pelvic tightness. But they feel almost that they didn’t warrant it because, oh, I didn’t have a third-degree tear. I didn’t have a fourth-degree tear, so I can’t really complain.
There’s a lovely piece of research that I found. It has a lovely quote about traumatic birth and what traumatic birth is. I’ll just read it to you.
A traumatic birth is when the individual – so mother, father, or other witness – believes that the mother or the baby’s life was in danger or there was a serious threat to the mother or the baby’s physical or emotional integrity.
And that’s from Simpkin. Now, that for me, is really all-encompassing and shows that birth trauma isn’t just for the mother. Partners and witnesses at births can be equally traumatized. But really interestingly, it’s this perception of physical or actual pain or trauma or to life, and to me, I think when I really simplify it, when we don’t feel safe and in control, trauma and fear can then come in the room, and that can really, really skew how we remember something. And I talk a lot when I’m debriefing and talking to women about their births, that it’s often around that lack of control. All of a sudden, everything was going absolutely brilliantly, and then one word was said and it might have triggered them, or all of a sudden, someone came in the room and I had no control. They told me that this was happening. And then bang, it went from a really beautiful, empowered birth to something that is really traumatic for them.
And I think that we don’t acknowledge that enough as a medical process. Certainly over here, it’s really hearing that it isn’t about the level of physical trauma. I’m often really surprised by some people who’ve had horrific physical trauma and their body has responded well, but their mind has also responded well because they did still stay in control.
Right. If they’re making informed decisions every step of the way, they’re going to have less regret or PTSD or fears for future births, if they felt like birth wasn’t happening to them.
Absolutely.
They were talking and discussing potential interventions, and they weren’t wheeled into the operating room quickly without being able to process what was about to happen.
And informed consent – and certainly, informed consent is something that we really talk about a lot over here – is just beyond informed consent around internal examinations or whatever it might be. Actually, informed consent is, is someone actually consenting to an emergency C-section here? Is someone consenting to an assisted delivery? And it’s really interesting that people often feel, well, I didn’t have a choice. You absolutely did have a choice, but potentially, you weren’t made to be aware that you had a choice.
Exactly. And part of it is like with preparation or hiring a doula, taking a childbirth class, and understanding the options versus just going along with whatever’s suggested. And if there isn’t that space, even if it’s one minute to process and ask a question, that in my experience has helped so much.
Absolutely, and I think sometimes now we sort of think that because women have been birthing for so long, that our bodies will just know what to do. And I was really shocked my first birth, as are so many, by the intensity. And the intensity sort of took me from left field, and it was everything for me to stay in control. And the benefit of hind sight with future births is you know the intensity, so it’s something that you are aware that actually my body can manage this level of intensity. I’m so much more strong and resilient than I think.
If you’re fighting in that first birth, the intensity of blimey, this is big – then actually, if you’ve got someone else in the room who’s starting to take that control away, you can start to appreciate how easy it is for those women to suddenly feel out of control and completely overwhelmed. And it’s a very careful line and a very fine line with educating women as to the intensity of the situation, but also that actually that intensity is something that their body is really, really capable of. There’s lots of processes within this amazing childbirth process that with the education and support and insight beforehand, you can really be better equipped than just walk in saying, well, women have done this for ages; my body knows what to do. Because actually, as a community population, we often don’t share our birth stories, our positive birth stories, and help the next generation into supporting them through birth. We just say, oh, the hospital will take care of you and the midwifery team will take care of you. To some degree, it’s true, but it’s not that insight that comes through with it.
Exactly. I 100% agree that it’s important to share experiences and stories. I feel like women will share their trauma or a movie type of situation that’s out of control versus a beautiful birth story or one that they were able to make informed decisions, even if it didn’t turn out the way they wanted to in their preparation.
Absolutely. I’m a huge advocate of, as part of the birth prep for my pregnant clients, getting them to have a phrase. I’d love to talk to you about your birth after I’ve had my birth, but at the moment, I’m just trying to just separate myself from as many stories as possible so I can have an unbiased experience. Because people think that there’s a right to share their birth story on you, so we’re getting people going into the labor room thinking it’s like in the movies with screaming and shouting and this and that and the other, and horrific stories, and I think that’s the thing where we should really be better supporting women and preparing them through education, through understanding. Pelvic floors are designed to open. They are fundamentally designed to open and birth a baby when we’re relaxed and we feel safe. But when we don’t feel safe, the body will do what it does best, and it will keep that baby in there until we feel safe. So actually, staying in control and feeling safe and getting your birth partner or your birthing team to keep that feeling of safety is absolutely critical to allowing your pelvic floor to open. And I think that sometimes you’re really focusing on, oh my goodness, you must do your Kegels. You must strengthen, strengthen, strengthen if you’re going to have a baby. Yet we don’t say, actually, the biggest priority for you is to understand how to soften and open your pelvic floor when things get really intense. So I’ve got a pregnancy program where we might be doing a series of squats and deep squats and core engaging with the breath and the pelvic floor, and then at the end, we’ll stay in a hold of a deep squat and actually soften and open the pelvic floor, no bearing down, but just starting to understand the real difference between, ah, I can still open these muscles even though my body is feeling tired and intense and my thighs might be screaming at me and there might be lots of other busyness going on in my head, but I’ve still got a real deep connection with softening and opening the area that will allow a baby to come into the world.
Yes, that’s so important! So as far as after the birth and that recovery time, what are your suggestions for ways to begin the healing phase and how can our listeners find a pelvic floor physical therapist in their area? I know obviously it’s a little bit different in the UK compared to the US, but I’d love to hear more about your thoughts on that recovery initially.
So I would always advise people to do their prep before, working with a pelvic floor specialist, so that they do understand how to soften and open the vagina, how to work with the breath, and the link between the breath and the pelvic floor, so they have a super weapon going into labor and really feeling, yeah, I can really feel this connection, because it is so, so transformative for you to be consciously aware, this is where now I need to soften and open rather than necessarily pushing against tight muscles. So I would really encourage that preparation in advance.
The other thing I often encourage is, in the UK, we’re encouraged to write a birth plan, which I wholly advocate for. But I also get my clients to write a postpartum plan, to have it on the fridge, to share it with whoever’s in the house, and remind themselves of how much rest they need to have. I will be having my nap, and this is what I need you to do to make the nap happen. There’s food in the freezer; remember to get it out and use it rather than just suddenly thinking I’m going to cook from fresh. Have a plan, and reinforce those areas that they know will be most challenging for them. For me, it was always rest and sitting, doing less, because I’d just get up and do. But actually, resting, elevating my feet, getting my weight off my pelvic floor, to allow it to heal in a gravity-neutral position – it’s so critical in those early days. Really critical in those early days. Write that note and pop it on the floor, saying, “Mom and baby sleeping,” at all times, unless you’re ready to open the door to somebody. It’s really, really important. And, I think, really taking those early days, those early days of just starting to mentally connect with your pelvic floor, is really, really underestimated. And don’t panic if things don’t feel the same, but to really just kind of say, okay, how can I really let the breath go down into the pelvis and feel that lovely connection back with the breath and the space and the pelvis, and then playing with just becoming aware of where the vaginal entrance is, what a vagina lift feels like. Can you find the clitoris? What about the anal sphincter? And being really aware, that might take time to come back, especially if there has been physical trauma. To really support that tissue healing, to really then take that. If you think of that bell curve, if you’ve had physical trauma, and potentially more emotional trauma as well, you really need to lean into that and to maximize that and to say, actually, I need to take more time to do that than I would if I had a nontraumatic birth, and to give yourself grace, to really heal.
And I always say the best time for a pelvic floor to heal is the first time, to give it that early day support, to really feel nourished. Things like cold compresses in the early day, but also things like strategies for toileting and bowel movements in those early days postpartum can be for some people more traumatic than birth. And giving women strategies to use like a squatty potty to elevate their feet, to again work with this concept of softening and opening the back passage, to really allow the bowel and the peristalsis to start to happen, and to get them to understand it is really likely your bowels will be very different because that space that was just taken up with baby has now dramatically changed, and the whole of your gut will still be sort of recovering from birth, as well. So to really support your hydration, to really support your bowel movements, and to give yourself a little bit of perineal support whilst you’re having a bowel movement, if you have had physical trauma, and to understand that so many, and I cannot reiterate this enough, so many women think that they are the only person to be experiencing this hideous array of symptoms postpartum. And I think it’s really important to say that they’re never alone, and really make sure that you seek help and lean into that network of a team around you. If you’re working with a postpartum doula, a health visitor, that medical care team that you’ve got – tell them if you’ve been affected by hemorrhoids, if you’ve been affected by anal tears and fissures or vaginal tears, and really start to tell them, you know what, it is really incredibly uncomfortable and painful for me to poop. Because this will then have a knock-on effect on the overall well-being of the pelvic floor as well.
So I think it’s really, really important that you start to understand early signs and say, actually, I need some more TLC in this area, reaching out for support, and I would really encourage everybody, but specifically if you’ve had a tear or a long labor, an assisted delivery, an episiotomy, a C-section, to really reach out and get a women’s health physical therapist, a core pelvic floor specialist, to support you in that restoration process, because that pelvic floor is so critical in our pelvis position, as well as continence. So when it comes to restoring our posture, reducing back pain, supporting any abdominal separation, it all comes under the same umbrella, that sometimes when we’re talking about pelvic floor, we think we’re talking about continence. So that pelvic floor physical therapist, that specialist, will really bring the whole lot together for you and get you to understand that this is about healing; this is about restoring the body postpartum, and to give you strategies to make things like bowel movements more comfortable and help you to understand that for some people who have had a lot of trauma and are suddenly feeling that they’re a little bit more vulnerable in the back position and don’t have control of wind like they used to, that they need that support because going out will become more difficult for them because they will have less confidence. And those are the people then that are very susceptible to and vulnerable to postpartum mental health because they’re not getting out and they’re feeling that their body is letting them down. So I would really say, reach out for help in the early days and understand that this is something that every women goes through who’s having postpartum experiences and to make sure that you really get the help that your body needs and deserves because that will set you up with great pelvic health going forward.
Exactly. And I would love to touch on the client or the Ask the Doulas listener who is experiencing trauma in past deliveries but is preparing their body for the next baby, so pre-conception stage. And you talked about those exercises to do early in pregnancy and the importance of that, but how can our listeners prepare for the physical work that their body is going to do in labor and to potentially prevent future trauma, if they had tearing or any sort of issues in their last recovery? And you mentioned even that fear of having the next baby and how that creeps in if there was trauma, with an emergency Cesarean, for example.
Absolutely, and that can be so, so early days. It might not be any intention of having another baby, but it can be – in those initial eight weeks, there is no way I can do this again. And I think that should really be addressed. And I think being really educated in the pelvic floor, in terms of it’s so much more than just squeezing and stopping the flow and really getting women to understand and take the shame out of talking about their pelvis, talking about the vagina, understanding the sort of six key muscles in that pelvic floor complex, starting off with the clitoris and that clitoris lift, the vaginal entrance, the vaginal close and opening, the vaginal lift into the vaginal canal, and then the anus, the anal sphincter, so it’s another close muscle, the sphincter, and then the lift into the back passage. And then finally, the whole of that pelvic floor hammock which stems from the base of the sacrum and the tailbone and spans as wide as the sit bones and then comes forward to the pubic bone. So there’s six key muscle movements in there for women to really start to become familiar with so that postpartum when everything’s had a mighty good stretch, or if there’s been a C-section, then the link between the abdominal incision and the pelvic floor can be quite significant as well. I know what it felt like before. I know what I’m searching for in that memory bank of muscle activation. Whereas if you’re starting suddenly on day one postpartum after having an episiotomy, let’s do my Kegels and we go to squeeze and we can’t necessarily find it, then often what happens is we’ll start to mentally squeeze the wrong area, and quite often, we squeeze higher into our abdomen. And if we don’t get the results and we don’t feel that strengthening and we don’t see the healing and the restoration we want, we think, oh, I’ve got a bad pelvic floor. We don’t realize that we’re actually squeezing the wrong bits. So working with that specialist is really critical to get you familiar. Don’t just pretend to stop the flow of urine. There’s never, ever once that I have said that as a cue to any of my clients. But to really start to feel the opening and closing of the vaginal entrance, to really start to feel the vagina lift the whole way up, especially if you’re worried about, for example, prolapse or a little bit of bulging or weakness in the vaginal wall. Work out where you feel the gaps in that lift, and that’s where we need to be focusing on the strengthening.
Excellent advice. So how can our listeners work with you, Sarahjane?
I love the world of online, so I have online programs, and I work one to one with clients all over. You can reach me on Fit Fanny Adams on social media, or sarahjane@fitfannyadams.com will get you in touch with me. But I’ll drop a link through to you for my pregnancy program, which is a six-module online, at your own pace workout and body preparation and mind preparation program taking you into the fourth trimester. I put a little promo code in there for your listeners for 10% off. If this has helped anyone, I’d love to hear that or hear what would help women more as well as we really uncover and open up this conversation.
Yes. And you also have a podcast, and I’ve had the pleasure of chatting with you on yours, so if you’d like to fill our listeners in on how they can learn more about their pelvic floor?
Yes, at the pelvic floor connection. It’s called the Pelvic Floor Connection Podcast, which is available on Apple, Spotify – all of the usual channels, except YouTube. I’m still not on YouTube. That’s a work in progress. And there’s quite a lot on birth preparation, gyno preparation, postpartum recovery. I’ve got a lovely interview with a professional climber who really shared openly her conversation around restoring after a difficult birth in a population – I always find working with athletes, who are used to their bodies responding in a certain way and used to being able to train, and suddenly trying to fit in restoration with a new baby in a body that suddenly feels very alien to you. It’s just – it’s so humbling, and I think people like Katie are just incredible at sharing their stories to help other women to understand that this is so much more than putting skinny jeans on. It’s a real embracing of this new mother body that you have been blessed to step into.
I can’t wait to listen to that episode, Sarahjane, and I will share that with my clients, as well!
Wonderful! Thank you so much for having me. It’s been lovely to guest on your podcast, Kristin.
Thank you so much! And we always ask a final question: any last words of advice for our listeners?
Oh! Preparation. Preparation, and I would say invest in understanding what and how amazing your body is, and not just that your body can birth, but really take the time to understand how it births so that you can work with the surges of the uterus, the opening of the vagina, the deep connection with your breath, to make that birth process so empowered so that if intervention and other options have to come into the mix, you can really stay in tune with the power of your body, and I think it’s a process and an awakening for me that has really not only helped me in birth, but really helped me beyond kind of understanding how strong women really are.
I agree, women are so strong, not only physically, but emotionally, and it takes both to labor and to fully recover and heal. Thanks again, Sarahjane! I loved our time together!
Thank you, Kristin!
IMPORTANT LINKS
Birth and postpartum support from Gold Coast Doulas