Mental health and pelvic floor dysfunction

Perinatal Mental Health Week – a week close to my heart:

12-18th November 2023 marks Perinatal Mental Health Week in Australia, a week that holds huge personal significance for me. PANDA (Perinatal Anxiety & Depression Australia) founded this week in 2005. This was a way to help both health professionals and the general community better understand what perinatal mental health involves.

The theme for PMHW 2023 is “connection through conversation”. As described by PANDA, “honest and compassionate conversations about perinatal mental health are life changing”. It can be extremely difficult to know how to ask a question of someone who is suffering or to ask for help if you’re the one facing mental illness. PANDA writes: “everyone needs help at some point in their lives, and everyone deserves compassion and support. Reaching out, truly listening and making a connection is more important than getting the words completely perfect”. 

My account of postnatal depression:

Following the birth of my first daughter, Claudia, in 2020, I was hit hard with postnatal depression. The fear around Covid-19, lockdown, isolation from my family in New Zealand, not having a physical Mother’s Group due to the pandemic, my husband working shift work, Claudia having colic, extreme sleep deprivation and physical birth trauma: it was the perfect storm. 
I felt ashamed, defeated, like I was failing as a mother – something I thought I would excel at. I sought professional help and with the assistance of my GP and Psychologist, slowly started to see the light at the end of the dark tunnel that is postnatal depression. I know, however, that mental health can and often does have its peaks and troughs. Just because you can feel like you’re back to “normal’, there is no room for complacency in the mental health space. A change in circumstances, physical or emotional stressors or the mental load of motherhood can upend someone who was otherwise feeling on top of things. 


Spreading awareness:

The ABC recently launched The Birth Project – an investigation into maternity care. According to their data, “hundreds of thousands of Australian women come away from childbirth with damage to their pelvic floor”. In addition, “as many as one in three Australian women experience traumatic birth; however, limited data means it’s hard to know exactly how common it is”. 
Having experienced my own birth trauma, I can empathise with anyone suffering these life-changing injuries. This was a significant factor in my decision to become qualified as a Pelvic Health Physiotherapist. I know first hand just how transformative Pelvic Health Physiotherapy can be in managing/minimising symptoms and regaining quality of life. A safe and supported pregnancy, holistic postpartum care and the management of birth injuries (if applicable) help to foster positive mental health in the perinatal population. 
Simply put, poorly managed pelvic dysfunction can contribute to adverse mental health in the perinatal population. Working towards better health outcomes in these patients has become something of a personal and professional mission for me.

The statistics laid bare:

1 in 5 mothers and 1 in 10 fathers experience perinatal anxiety and/or depression. Historically, parents have had to suffer in silence. Accept that anxiety and depression may be part of the package. Soldier on and pretend all is ok. We now know that not only is that ineffective but it is really damaging. 

Lessening the stigma around mental health, in particular perinatal mental health, is something that I am dedicated to. This starts with conversations, asking the vulnerable and, at times, scary questions. It also involves listening and leaning into the answers, as confronting as they may be. I must emphasise that it is crucial to know when professional intervention is required. This is usually a GP or a Psychologist. It’s one thing to have an empathetic ear and another thing entirely to know how to help a person in the throes of mental illness. 

How we are doing our part at PMPP:

While PMHW is focused on parents, mental health conversations are for everyone. In light of this, I have made some changes to our approach to mental health in PMPP Physiotherapy consultations. All of our initial consultations, regardless of whether they’re for jaw pain, a sore back or following a joint replacement, include the following questions:

  • “How is your mental/emotional health at present?”
  • “What does your support network look like? (A GP you trust, neighbours, family, friends that can help)”
  • If required: “What do you need right now” and/or “would you like me to check in with you again?”

The more comfortable we are in asking these questions, the more we work towards transparency and ease in mental health conversations. 

From one Mum to another:

I had a patient the other day, a few days out from her scheduled induction. She asked me “what should I expect in the first six weeks?” So many answers swirled through my head, where to even start?! I simply told her “the first six weeks are about discovering yourself as a mother”. I reiterated the importance of self care and used the examples that my Psychologist taught me: getting fresh air and sunlight, having a daily shower and prioritising nourishing meals. I also suggested that, best she could, she take the pressure off herself to be or do anything in that fourth trimester. The hormonal changes alone can be enough to derail even the most resilient person. Self-compassion, I explained to this expectant mother, is vital. 

PANDA – a lifeline for me and many, many others:

PANDA is “dedicated to supporting the mental health and wellbeing of expecting, new and growing families”. PANDA has a range of information, services and programs to support parents and families during pregnancy and the first year of a new baby.

Yours in health, 
Ali Minichiello
Physiotherapist/Pelvic Health

I recently featured in a podcast dedicated to open conversations around parenthood. Please note that this podcast discusses confronting mental health themes and the interviewer uses some colourful language! You can listen here: https://podcasts.apple.com/au/podcast/a-problem-shared-is-a-problem-halved-finding/id1679800062?i=1000632486222

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