Her Discussions by Dr Faye - What Every Woman Should Know Before Giving Birth | C-Sections, Epidurals & Birth Plans

Episode Date: October 5, 2026

What aren’t women being told about pregnancy and birth?From birth plans and epidurals to C-sections and postpartum mental health, there are so many decisions women may have to make, often without really knowing what their options are until they’re already in the middle of it.Today I’m talking about exactly that with Dr Kenga Sivarajah, a consultant obstetrician specialising in high-risk pregnancy and perinatal mental health, who has led labour ward care at King’s College Hospital since 2018.You’ll also learn:💉 Why you don’t get a medal for giving birth without an epidural🧠 7 postpartum mental health warning signs you shouldn’t ignore🌸 Does perineal massage actually reduce your risk of tearing?📝 3 questions to ask yourself before making a birth plan🤰 Does pregnancy really have to ‘destroy’ your body?Set your reminder for MONDAY, 7AM 🔔Resources & links mentioned:Dr Kenga’s website: https://mskengasivarajah.co.uk/Episode mentioned at 58:53: https://www.youtube.com/watch?v=E7ArQVZIC_A&t=2s🔔 Join the HERd* broadcast channel here: https://www.instagram.com/channel/AbY4liwxlLnewx4H/?igsh=MWhuaXFweGtucTB3cA==📱 Find us on socials:Instagram & Tiktok - @drfayebatePodcast Instagram & Tiktok: @herdiscussionspod📩 Want to reach out?Email: [e-mail]🛑 Disclaimers:Opinions are my own. This content is for educational / entertainment purposes and not medical or financial advice.

You're not going to get a medal if you don't have enough drawer. Literally no one's going to be there, giving you like a prize. Women go through a Nerf. Why should they not have anything that makes it a little bit easier for them? Don't walk into pregnancy thinking that everything will always be okay. It's about being well-informed, not just Googling on the internet. So today I'm asking Dr. Kengas of Orajar, a pregnancy and birth doctor who leads the labour ward at King's College Hospital. What maternity care really looks like right now and what women should know before they ever have to navigate it.

themselves. Does pregnancy have to destroy your body? Bounce back culture. Your body's taken nine months to get that way. It will probably take nine months to go back. Elective C-section. I'm going to be really controversial and actually say we're going to talk about some extremely controversial and important issues from NHS maternity care and perinatal mental health. But first, what I love to do with all the is find out how you ended up where you are, because so many of our audience are ambitious women. How are you drawn to the work that you do, caring for women in the most intense and vulnerable moments of their life?

So originally, I mean, I'm not going to lie about this, my parents kind of forced me into doing medicine. I don't think it was my kind of initial plan. But then as I went to university, I did actually really kind of enjoy learning about kind of like medical problems, like health disease. But what I found was when I was a house officer that I didn't want to kind of go towards the like kind of care of the elderly. You know, I found it really depressing that lives ended and I wanted something more positive. So that's where obstetrics came in.

And obviously not every day a moment is positive, but there are many positive moments. you genuinely do make quite a big difference, I think, in women's lives. So, yeah, that's how I ended up doing this. And then I ended up doing some of the kind of maternal medicine and mental health stuff, just purely because I was always interested in medicine, and that's, you know, what I would have originally done. But as I said, I wanted a more kind of positive experience. So I tried to combine the two together.

It's really funny you say that your parents forced you into it, because one of my favorite podcast episodes was with Dr. Nagat, who she's a GP and she does a lot of stuff on BBC. And when I asked her the same question, she said, oh, I went to medical school so that I didn't have to get married for five years. My parents weren't trying to get me married for five years. And I think because a lot of the time, people don't always give the most honest answers to that. So I really appreciate you being honest and saying,

more came from your parents, but then your love came afterwards. But Obes and Gine is one of those specialties with the highest dropout rates known to be quite brutal. When it goes wrong, it goes very wrong. And I remember one of my friends, when we were in medical school, she was doing her Obs and Guine rotation. And she texts me saying, oh, where are you? Like, can we, I need to go for lunch or like I've just had an awful morning. And me and my friend, I thought, oh, she's hungry.

She's a bit moody. She's probably come on her period or something like that. then she came down and she said, oh, like a baby just died during one of the deliveries and that was extremely traumatic for everyone involved. How do you navigate that? How do you show up and do the best job that you can do when sometimes the challenges are so, so devastating? So I think I've shaped my practice to be very safe. I would say that that is one of my kind of main aims. I do a lot of kind of expert witness work and I'm labour would lead at Kings and I spend a lot of time looking at how we make our unit as safe as possible, how we make our juniors as safe as possible

how we're functioning as a team. What do we think the pitfalls are with maternity care and where things get missed? You can't control everything. That's one of the things I've learned in obstetrics, that things will happen, that like disasters will happen, that you have no control over. And those are devastating times for us all, I think, do we take time to come back from that? Yes, absolutely. Do we sometimes feel traumatise we do? I also know that my team, definitely my juniors need someone to talk to or look up to that that will kind of move on from that and think, okay, there is the next day and the next day after that where I still have to come to work. If our mental health is kind of, you know, disrupted, then we do take some time out. But, yeah, I've made it my average.

absolute practice to make sure that things don't go wrong. We've had, you know, maternal deaths where we haven't been able to control what's going on. Those are things where someone's had an amniotic fluid embolism or something where, you know, whatever we do. And I would say Kings definitely has all the resources in the world to help someone in that situation. You know, in those kind of of cases where someone is trying to die, you know, they will pull out all the stops. Every single person who can help you will arrive within two or three minutes to the scene. We've lived with that, we get flashback sometimes, but we also have to move on.

We have a job to do, and that was the responsibility that we took when we became, you know, obstetricians. A lot of our audience don't have children yet, and more and more you turn on the news and, you know, the Occadine report or different maternal health scandals across the country, when you see those, it can become quite anxiety-inducing the thought of having children. What would you say to those listeners who feel anxious about being pregnant or going through labour? I would still say that, you know, the vast majority of units are doing their best

to make sure that there is safe maternity care. We have kind of improved things massively at Kings from the time that I've been there. We have looked at every bit of our practice, i. I sit on the kind of serious incidents panel and we do not get nearly as many serious instances as they used to be in the past. We have done so much to try and reduce that to a very minimum.

But do you get unexpected outcomes? Yes. Don't walk into pregnancy thinking that everything will always be okay. Sometimes things do navigate off that path. But I think it's about being well informed and having actually read evidence-based information, not just Googling on the internet, speak to people in the actual business.

And if you don't feel that you're getting the answers or being listened to, then you can ask for other opinions. But I think, yeah, it is incredibly difficult to navigate, especially if you know nothing about maternity care. Like lots of my friends and family don't. And I'm always amazed that they don't. But then I also think to myself, I don't know anything about accountancy.

I have to find the right accountant to give me the right advice. And I think that's a lot about, you know, obstetrics as well. Find the right obstetrician to find the right midwife. And then you will be guided in the kind of correct way. I'm the only doctor in my friendship group. And I think, but in my friendship group from my school friends. And then obviously, then you go through a gathering with your friends from medical school and everyone's a doctor. and actually the conversations and the experiences that these two groups of people have couldn't be further apart in healthcare.

It really is the power of having access to that knowledge. And in the NHS at the moment where it's overstretched and definitely geographical differences up and down the country, depending on the hospital you're at, how much resources there is available can really impact how much knowledge you have access to. And I do find, yeah, my friends, they come to me for a lot of questions, not just on knowledge, but more to navigate the system, to navigate the NHS to get the best out of their healthcare experience. I always think, God, if you weren't friends with me, then it would be Dr. Google. And what you see can be really, really scary. So I want to talk about the Nottingham maternity reviews. It looked at 2,500 cases between 2012 and 2025 involving mothers and babies dying,

being seriously injured or babies being still born and found deep-rooted failures for many years. How would you help prospective mothers understand the state of current NHS maternity care without becoming terrified of giving birth? I think there is inequality and I think you're right. So I think if you look across the country, there are units that are practicing very old-fashioned obstetrics where some of the consultants and the midwives have not moved on into 2006 and they need to look at what the current practices and understand why that guidance has changed from 20 years ago and the issue is in these units is that when you're a consultant in a

unit your practice often filters down to the juniors that you work with and you often and then end up hiring juniors that ultimately get on and agree with you. And so that becomes a culture within certain units where they practice differently from maybe what the national guidance has moved to. So I would say there is a lot of information in the Royal College of Obstetricians and in the kind of nice guidelines about what current practice should be. you know, for things like, for example, reduced fetal movements, latent phase of labour often, I think, came up in the Nottingham review

about how long you should be in latent phase, how, you know, when you should go in and be invited in to be reviewed in a maternity unit if you are in early labour. And for those who aren't medical, do you mind explaining what late in? Late in phase is like the very early stage of labour. And there was, I think one particular case, which was one of their standout cases, was a woman who'd been in early labour for many days and actually was very distressed

and, you know, they declined to invite her in for review. When you are in that kind of early stage of labour for that long, first of all, you're exhausted, but also the baby can get distressed. There can be other issues going on that you need to then check the woman and the baby. Women do need to know these guidelines exist, first of all, and that there's very clear evidence. And this is where you access, them. But if you're not being told that by your midwife or the obstetricians that you see because

they think or believe in something else, then obviously you can be misled. So I do think there needs to be more work on kind of creating maybe more kind of national videos or information on very common problems. Now, I don't think that the NHS is going to be able to fix and cater for every, you know, one of the issues is that people have gone to get care out of guidance or they've got, you know, their own birth plans that are very bespoke. And I think that's where, you know, their struggle is. The NHS is good in many ways if you're having an issue, an actual, you know, medical issue. It will help.

I don't think it's there to help, you know, lots of kind of nuanced birth plans because they don't have the resources for that. They just simply don't. And especially when you go out of London in some hospitals that have much less staffing, they definitely don't have the resources for that. Because your area of specific passion and expertise is in perinatal mental health. And I'm really interested later on to discuss how a birth experience then feeds into mental health outcomes of women. I find myself torn in a lot of conversations with my friends,

because you sit on one side of understanding the struggles of working in the NHS, you know, having lived experience of busy shifts where you don't always have the emotional bandwidth or just time to give to patients because you're overrun. But then on the other hand, I sit and I speak to my friends who aren't doctors and they tell me their experiences have been dismissed by doctors. And I've struggled to navigate that personally, seeing both sides. And it will be interesting to come on a bit later on and speak. about how these soft skills of doctors, how that impacts the mental health outcomes of women

later on because it's really those soft skills that really do often get lost in the moments of high intensity when just making sure that someone survives is it becomes priority. But before we come on to birth decisions and mental health before and after birth, we have a section of the podcast called buy or bye bye. So I'm going to show you a something and I would love to know whether you would buy this thing or say bye-bye to it. And there's only one rule. We absolutely love nuance and balance because there's not nearly enough of it on social media. So feel free to make your answers as long and balanced as you would like. So bounce back culture. Bye bye. Bye-bye. Why should you? I mean, your body's taken nine months to get that way. It will probably take nine months to go back.

I remember being shamed by one of my fellow consultants who said, me that I looked thinner in my scrubs and normal clothes when I was four months postpartum, arrived back to work and, you know, then went on a kind of major like intermittent fast. I mean, maybe that was good for me at the time, but I went on a major intermittent fasting diet and felt ashamed that I was fat. Well, actually, I was four months pregnant and I was back at work full time, mate, so, you know, he could jog on. Why should women bounce back? They should just take the time. They've just gone through a pregnancy and a birth. and they're navigating having a newborn.

So it's a huge impact on your life. Just take your time. That's awful, coming back to work in that being an experience, both plans. So I'm 50-50 with these. I think it's sensible to have a good birth plan that encompasses some of the essentials that you need to understand. So birth plans are a good way of talking about what might happen, what you might want in terms of

you know, your like birth in what mode of delivery, what some of those risks and benefits are, and then afterwards. But I think, as I said, very nuanced, detailed birth plans, in my experience, often do not end up happening because their obstetrics is, you know, doesn't always follow the rules. And I think have a, have a plan, but don't be restricted by that. And definitely don't always think that every bit of your plan will be carried out or happen. And that's not because staff don't want to do that for you. It's just that that is the nature of what we do. So things can change from literally sometimes one minute to another and we have no control over that. Yeah, I think in the best way possible, keep it, keep it open. I watched an influencer birth experience YouTube video recently

and it was probably one of the most responsible birth experience videos I've ever seen. It was brilliant. It was by Steph Ellswood, and she was speaking about, she had quite a traumatic birth experience. It didn't stick to her birth plan whatsoever. And at the end, she completely reframed it. The umbilical cord was short, so she had to have an instrumental delivery. She didn't want that. But at the end, they told her, you know, this was the way that we had to bring your baby

into the world safely, you know? And she completely reframed it at the end by saying, yes, it wasn't the birth that I wanted. Her baby was delivered safely and she was safe. I thought it was really responsible because it encompassed that what we want is important, but the realities of what can happen should also be, you know, understood. I mean, I do NHS and private obstetrics, and I often see with some of my private patients, that there is like a tunnel vision about what they want. And they're also all these, like, women who are very high achieving,

and they've always achieved what they wanted in life. and this is the first time in their life they haven't achieved what they wanted to achieve and it's really hard for them I think especially it's the first in many many ways that you're going to lose control having a child going through birth is losing control of what you achieve and what you want to achieve and what you think the outcomes are going to be

because that's the first time in your life where you can't control everything but you can I think like you know you've just mentioned and Steph look back and go, actually, that's the birth that allowed me to have a safe delivery. And I think that is an amazing way of looking at it. You've really said some of a very important point about high achiever, ambitious women, because our audience, I know a lot of our audience are very high achiever.

Taipei girlies who, you know, wants to do their best they can in everything in life and actually being faced with something you don't have as much control over can be really scary. are there any tips and advice you have for those women when it comes to pregnancy or birth plan, whatever? Go through the different outcomes with your midwife or obstetrician. For example, I always say to people, if you want a vaginal birth, except that instrumental delivery is part of that plan,

because, you know, sometimes you may end up having that done. You know, if you really feel like against that, then have a C-section instead, because actually if there's one part of that that you don't want to do, then, you know, opt for a different mode of delivery. It might not be what your first choice would have been. But actually, if that really does make you feel upset or distress,

then choose something else. I think don't go into it thinking it's not going to happen to you. I think actually these outcomes could happen. And, you know, what would I really not want? What would be my optimal? But what would be actually something that I would accept and be okay with as well? And I think, obviously, we always want women to have a, great experience in their birth. That is what we want. But sometimes the safety element will trump

that unfortunately. You mentioned an interesting word a little bit earlier on. You said achieve. When you were speaking about a lot of women, they see their birth plan and their birth plan doesn't go as plan. And that, if you're a high achiever woman, that is something you haven't achieved. I wonder how much damage that narrative does where certain ways of giving birth are often seen as superior to other ways of giving birth. I mean, I always say to people, you're not going to get a medal if you don't have an epidural, like, literally no one's going to be there giving you, like, a prize. Of course you should have an epidural if you need one. You know, you can actually have birth in a nice, pleasant way without pain, and you can still push the baby out at the end. So,

I think there's all these kind of myths that people hear that actually aren't true. You don't need to be uncomfortable for the whole thing and tired and frazzled by the end of it. I know, you know, this is my, personal opinion, I think, God, women go through enough, you know, why, why should they not have anything that makes it a little bit easier for them, but, you know, hypno-birthing? Again, partial. I get many people who say that they're going to hypno-birth through the entire birth. Unless birth is very quick, I'm yet to have someone who's used it the whole way through. Obviously, you do get some births that go very quickly, and that is possibility. But if you're having a birth more than, you know, a few hours, it is very difficult to act.

I think no one anticipates what that pain is exactly like. I guess it's tired and exhaustion. But I think, yeah, for the early stages and, you know, for the first part, then absolutely. If your labour's quick, then yes. Elective C-section. Yeah, I'm going to be really controversial and actually say for, you know, lots of women, I think it's absolutely the right choice. I really do think that if you're very anxious, have, you know, issues with your mental

health, then having a long protracted labour is perhaps not the right mode of delivery for you. I think sometimes a nice elective section where you go in, you know the date, you know the time, you put on your own music. You know, yes, there is recovery afterwards. Yes, it's a moderate-sized operation. But done in the right way, you'll be fine. And I think two weeks of moderate pain and actually most women are out there walking around doing normal things again. So I actually think that I'm a big supporter for, you know,

for the right cases. Yeah, absolutely. Remembering there's not a league table of delivery, it's what's the delivery that works best for that individual. Yeah. Why do you think so many obstetricians still are against the idea of elective C-sections? I think because of, you know, our worries about things like adherent placentas in the future, that people have multiple cesarean sections, there's risk of the scar opening in future. You know, if you choose to have a vaginal delivery in the future, there's, you know, risk of surgery in terms of, like, damaging other organs with multiple sections. So, yes, the first vaginal delivery can be difficult, but subsequent vaginal deliveries are usually, you know, easier. But I do think that we are looking at a

different subset of women nowadays. They're not having as many children. A lot of people are only having two or three children. For many women with their mental health, that vaginal delivery is not the right option. Also, you're asking women to come and have vaginal delivery and take a chance when there's all this press about maternity care being difficult. And I think that terrifies some women at the moment. So this is another way. But we are struggling to house the number of elective section requests that we have and that's obviously something that we need to look into in how probably the mode of delivery pattern is changing across the UK and what we can do to kind of facilitate that. Induction at 39 weeks? Absolutely. And do you want to elaborate on that? Lodes of good evidence

from the US, there was a arrived trial. So as an obstetrician, I think you do have an insight into like babies behave from 39 to 40 weeks and then when they go very post. dates. So in the third trimester babies often put on a lot of weight. They're putting on weight every week and you often see when people have gone to 42 weeks, the babies much, much bigger. Had they been born maybe two or three weeks earlier, it would have been much easier vaginal delivery. They also tend to pass maconium, which is, you know, their poo about kind of, you know, when they go post dates, which isn't a risk in its own, but then when you put it with a long labour or baby gets upset, you know, they can accidentally swallow it.

which can lead to issues. Plus, you know, babies at their peak neurodevelopment around 39 to 40 weeks. That's when they're meant to come out. So, yeah, I'm a big believer in induction, but induction done in the right way. So not a long protracted induction, but something that will actually get people into labour

within kind of 12-ish hours. And then they'll be delivering in the next 12 hours after that. So I think it needs to be done in the right way. Yeah. Have you listened to the podcast about free births? I think the Guardian did a investigative. I was part of that interview. Were you? Oh my gosh.

I listened to that recently. And there was a couple of them where they were going past dates and there was one really sad one where the mother, it looked like the discharge was suggestive of like McCona even had been passed. What would you say to those women who were losing their faith in medical institutions and turning towards something like free birth in? Yeah. And I understand that.

I do understand. Like there are many units where the induction is, so slow. I mean, my sister-in-law recently gave birth somewhere else in the UK and she was there for five days before they even broke her waters. I think as maternity units need to look on how to get women induced, you know, inefficient way that is actually going to get them into labour, not just sitting around the birthing unit for five days, kind of going crazy. I'm saying that because I think in Kings, we have looked at different ways. We've now got to much better, like, optimal routes in how we induced people. There's a lot of re-education that we've done. We've introduced some new medication,

not even new. I mean, other people have been using it. So I feel like we're getting there. You know, if I say actually, I think it's great to be induced from 39 to 40 weeks. I've actually got to have a way of making it happen rather than just inviting someone and then they're going to sit there for a week doing nothing. So yeah, we are trying. I hope other maternity units are following suit. Effie duerals. Yes, absolutely. So we We have now introduced a kind of lighter epidural that women are much more mobile with, and they are able to actually walk around a little bit more, be on the birthing ball. And there's a little bit of feeling, I think, when they're pushing,

that there is a contraction going on, which gives them a bit more of a sense of where to push and when to push. So, yes, there is no reason to be in pain through the whole thing. If you're going to have an induction, absolutely. pick an epidural, go to sleep, rest. Yeah. Perineal massage. Yes. Really useful. You know, it kind of softens perineum a little bit. Otherwise, that tissue can be very tight,

especially if you've not had a baby before and just allows it to stretch more when, you know, the head is delivering. And then lots of perineal support, proper perineal support when the head is delivering, will reduce your risk of tearing. Brilliant. Before we come onto mental health, I just wanted to go a little bit more into both, decisions and the rising free birthing, which we mentioned in, not just free birthing,

quite extreme forms of freebirthing. How did that make you feel being involved in that? I mean, I was just truly shocked. I would describe it as a cult. I think the reason why those women have gone to the extremes is because they have believed that the leaders of those organizations are giving them, you know, factual advice and they aren't. So I actually watched, I think it was a 25-minute video of, like, a baby who was having a shoulder distosia that was filmed that was basically kind of dying in front of us where the father was trying to deliver the baby. It was just horrific.

And for those who aren't medical, would you mind? Yeah, so it's when the anterior shoulder gets stuck under the mum's pubicis symphasis and the head delivers out, but the anterior shoulder gets stuck. So the baby then is deprived of oxygen because the body is not released. so the baby's unable to breathe. I mean, this would be like a complete medical emergency in a hospital, like you'd get a whole team that would arrive, that would help you with maneuvers to deliver the baby.

You know, usually we have about four or five minutes to deliver. This was, I think it was like, it was something crazy, like 20, 22 minutes or something. I mean, that was one of the things I watched. There was lots of kind of advice about that urinary tract infections don't exist. Baby can be blue and that's normal after birth. There's a whole load of, misinformation. And I think that I agree. I think either the women have had traumatic events in the

past that have led them to end up going down that route. But I think it's also in the US where there's a lot of issues with insurance. And I didn't realize, but in some states they ban, for example, vaginal birth after cesarean section because people can't get insured for it. So then women have chosen to go down this more extreme pathway. We do. get occasional free birthers, but it is less in the UK, I think. Free birthing, or in this context that the series goes into it, was no medical interventions at all, including no scans. In this certain group of free birth in, this free birth society that's discussed, they don't advocate for any medical investigations or interventions

whatsoever. No ultrasounds to check the dates or to check for any issues, no blood tests before giving birth anything. And then no interventions during delivery. And there was a really, really horrible part in this series where they talk about how the women who lead it, who don't have any medical background, they aren't midwives and they aren't obstetricians. They say that instances where labour goes wrong is very, very, very rare. And they say they'd never heard of it or seen it happening and that I just thought that was you're giving these women. But one of them has had a stillbirth herself

so I mean they should be kind of in prison for you know what they've done sorry but they should it's completely illegal they have created this kind of all around themselves that they I don't know I don't know what training that they say that they've had

none of them are medical or have had medical training they've obviously scouted out some very vulnerable women and then made, I think, a lot of money telling them misinformation that is going to affect these women's lives. I think they're both millionaires now

from this. And I think where there's so many things that can go wrong in the best circumstances where you have the best care, as you said, you can have the best care, be at a brilliant hospital with brilliant staff, brilliant access to technology and interventions and medications, and still things go wrong, trying to go through birth and pregnancy and delivery at home

with none of those available. Some of the stories that you hear from these women who've lost babies who had stillbirths, it's, oh, it really is awful, it's awful to hear. I wonder if all the women that go to them, what has happened to trigger, you know, that pathway and what their pathway in the US maybe is like, in terms of if women do feel traumatised,

like what is the pathway they have for them to decompress afterwards and to break it down? Because lots of people do feel traumatised by certain things. In one part, we're medical. So for us, there is, obviously we have certain things

that are traumatic or we think are traumatic. But I think women and patients have a different set of issues that they might find traumatic where the medical staff do not think anything has happened. happened. And so I think it's trying to kind of marry that together and sometimes have a debrief

afterwards or explanation afterwards that could then de-escalate that. If a woman is allowed to then you know, ponder and like, you know, kind of think on that afterwards, it can consume them. Yeah, yeah. I would love to now talk about your area of passion, so perinatal mental health. for those listening, could you explain what perinatal mental health is? Because I think there's a lot of misconceptions or even like stereotypes that come along with those terms. So perinatal mental health basically encompasses, I guess, from a context in where we work, it basically encompasses people with a serious mental health issue usually. So something like bipolar or schizophrenia, obsessive-compulsive disorder,

which is not always thought of as a serious mental health issue. issue but definitely escalates in pregnancy. And then some people with more like severe anxiety and depression who come into a setting where they get looked after by a perinatal psychiatrist, often a care coordinator, a psychiatric nurse, and then an obstetrician. And at Kings, we have like a kind of joint system where they get looked after by all of those people, a whole team. There is inequality in perinatal mental health care across the country. And then some women will develop perinatal mental health issues during the pregnancy or after birth. Typically, that can look like quite severe depression or anxiety. There is a subset, very small subset of women

who become psychotic after birth. We call that postpartum psychosis. Sometimes it's linked to having a pre-existing mental health condition. Sometimes it is not. It can just be de novo. We look after a whole different, you know, kind of different levels of women. I would say that women with milder issues probably don't come to us, but some women in that kind of moderate category may end up coming over. There are different resources. We've done a lot of work on trying to make sure

that all of all women will have access to some kind of mental health care and pregnancy. It sounds like I'm doing a lot of NHS bashing. In this episode, I don't want anything I'm saying to be misconstrued as NHS bashing, just more bringing awareness to certain issues that people might see on social media or on the news. And I want to talk about a video that I watched maybe two or three months ago,

and it was a woman. She presented to her A&E with what sounded like postpartum psychosis. And she was with her partner. And a partner kind of said, like, she's not herself. And then she was sent away. And then I can't quite remember the details. I think she may have presented a second time, turned away again. And then she ran out into the road, I believe, was hit by a lorry.

but she was telling this story from her hospital bed and, you know, trying to bring awareness to her situation. And she did say, you know, the care that she got when she was in hospital from the NHS was absolutely incredible. Do you have any advice for women or partners or relatives of women who are struggling with their mental health around perinatal mental health on advocating for them if it isn't,

those concerns aren't taken seriously? because they can have devastating consequences. So it is really difficult, and we've looked at these pathways. So I think if you have a serious mental health condition and you get pregnant, you actually get looked after very well because people know about it. They know what to do. You get a birth plan.

You get pre-birth care plan. You get put on the right medication usually. You get more continuity in terms of your midwifery care. I think the difficulties still lie in the diagnosis of postpartum psychosis it's because it comes on very suddenly. I think partners are not always aware of what's going on because sometimes they might think, oh, she's just tired or she's just stressed.

Obviously, they did the right thing. They went to A&E. They should then see a psych liaison, consultant or trainee, and then that should get passed on to perinatal mental health urgently. The problem with perinator mental health as it stands is that they don't do outvowers on calls. So you're not going to see, a perinatal mental health psychiatrist if you went to A&E at 3 o'clock in the morning on a Saturday.

But you might do if you went at 3 o'clock in the afternoon on a Monday. And I still think we need to tackle that inequality and that issue. The issue is we don't have enough parentatal mental health psychiatrists or trainees to cover those hours. What should happen is that if they are worried enough, then they should be admitted and then kept on, you know, the obstetric ward until someone can come and see them. Obstetric ward is much nicer environment for them. And we then, there should be an emergency pathway that the team can initiate. So we would then get a registered mental nurse to come and look after them and make sure that they were okay and until a perinatal psychiatrist could come. And what advice would you give for women about their mental health

before getting pregnant? So I think if you, obviously if you think you've got a severe mental health conditional it you know you fall into one of those categories where you've got bipolar or schizophrenia or obsessive compulsive disorder then get some preconception counseling you know actually go and seek out advice from a psychiatrist about what medication you should be on what medication you could you may have to stop or change don't just stop your medication suddenly most medication is actually completely fine we often see people have stopped their medication suddenly and then they deteriorate in pregnancy, try and seek out advice, try and understand what happens with your condition in pregnancy. There are preconception like services available within the NHS, and I would try and, you know,

seek that out first. If you do feel actually you're, you're more prone to getting anxious or depressed, then there are talking therapies available in all of the boroughs. You can go down that path. So I think it's a little bit about preparing yourself and what support you're going to get, what support you're going to have during the pregnancy. And I was reading some interesting research recently about how there's a relatively clear link between those who struggle with PMDD, those who struggle with postpartum depression, and those who may struggle with perimenopausal depression. First question I had is, do you think that there's value potentially in the future of screening women with, say, saying, do you struggle, have you ever struggled with PMDD? It's almost screen for who might be at risk of perinatal depression.

So that's my first question. Then my second question would be, what advice would you give, say, women maybe who if they struggle with PMDD and then they get pregnant? Yeah. So I think, you know, you do often see that. and you see these women who are just actually really unwell during the pregnancy and then they completely recover when they give birth, they're a different person. I would say the biggest struggle with that subset of women is that they have not been optimized on any medication and they don't want to take medication because they're so anxious and depressed,

they often feel that the medication is going to do something to the baby and then that sets them off in a cycle. So I think getting them in early and before they get pregnant and talking about the safety of the medication and already having them on, you know, an SRI or something would be really helpful. There was an article that came out recently that caused a lot of stir. And it was, I think it was the times they did an article about paternal postpartum depression. And the comments were just filled with women extremely frustrated. It was a lot of women saying, you know, women go through birth, they go through pregnancy. Can we keep postpartum depression as a term used exclusively?

for women to acknowledge that experience that they have. And can we have a different term to refer to what men go through? I was torn on it because I completely recognise that and where women's health has been overlooked for very long and women feel that their experience has been ignored for a very long time. To have it almost meshed with a male experience feels like another injustice in itself. But then on the other hand, I felt as though, it doesn't need to be this gender war.

How can we find a way of acknowledging men's mental health as well in the struggles that men may have? I think it is actually important to address men's mental health afterwards and I think as a unit, there's no point fixing one person and then not fixing another. If you're going to be a happy family unit, then often partners mental health feeds off each other. I think purely addressing the women in that

and not addressing the male is the wrong thing to do. And you do see lots of partners who do have mental health issues or, you know, definitely struggle after the birth of the first child. I don't think they're quite the same, probably the same, like, cause. But, yeah, I think that we shouldn't try and kind of eliminate men out of this equation. They are an important part of the family you know. What is it that makes you so passionate about perinatal mental health? You know, I've realised my own mum has got bipolar and that has affected our family unit greatly.

So she is very, you know, very much when she's well, she's like the kind of beacon of our family, like organises things, is doing everything, looking after the grandchildren. We all love her. But when she's not well, our family kind of like breaks down slightly where we don't really do anything together. In lots of ways you don't want to see. your mum in that state because you want to remember her, you know, in the good times. I think that it made me realise how important a woman is to the family unit. I mean, we just talked about men, but I really think that a woman being well, you know,

makes the family unit, you know, kind of stronger and it actually affects children's mental health, children's upbringing. So I do realize that it is everywhere. It's not just the women with serious mental health issues. I think almost everyone has an element of some depression and anxiety at some point in their pregnancy. And we have to work on it to make it better. And I think having a woman that's well and happy post-birth

makes a huge difference to her family. A lot of the anxieties that women have about taking medication in pregnancy, and maybe a perceived risk that could have on the child, it doesn't always encompass how that child will be affected if the mother's mental health is unwell. And actually the risk benefit way up of that where if the mother is not well, if the mother's mental health is not well,

what damage can that do and a lot more damage than taking medications that are known to be safe? Yeah, I mean, you get these frustrating conversations where you're starting to talk about autism, I mean, it's annoying that that, those studies are really, some of them are quite deeply flawed because there's so many confounding factors in women who have depression and anxiety, who are on antidepressants, a lot of them have smoked or, you know, drunk alcohol or whatever.

And you're then trying to say, actually, you're trying and then say that antidepressants call autism. I mean, they don't because there's 20% of our pregnant population are probably on antidepressant. Really? It's very common. And it's just frustrating because in pregnancy you cannot, sometimes you can't get therapy that quickly

or you can't use therapy to make yourself better. And we know that actually the antidepressant would help greatly. And then you watch these women where they're just, they're not optimal. You know, they're really, really struggling. They then really struggle postpartum with a baby. And you wonder what their bond is like. and they've not taken the antidepressant just because they're worried about autism

and they're affecting a whole host of other things. So it is incredibly frustrating to watch. And I think there's a lot of misinformation out there. And again, that education just needs to be a lot better. We know that women who are autistic are often misdiagnosed with depression or anxiety. And there's a genetic component to neurodivergence. And I wonder how many children of mothers who are being treated for depression and they are autistic, how many of those mothers,

were autistic in the first place, you know? There's just so many confounding factors. Exactly. And you actually, actually, what they don't realize is that they are well themselves, then you will have, you know, a happy, well-adjusted baby. Like, that's just going to follow suit. And how much neurodivergence is there in the population?

There's probably a huge amount that is underlying in many people. We're starting to uncover that now, but I guess 10 or 20 years ago, we didn't, did we? We just ignored it. Yeah, it's the classic thing. of autism didn't exist in the 50s and then like my dad can name I don't know every rock that he sees

he's like this is a this rock you know it's that you think did it not exist back then or are we only just realising it now so we've had a couple of community questions in first of all we have how do you stop feeling lost in your identity

even a year or more after giving birth so I always say to like my women I'm like have you gone to a pregnancy class have you made some they don't need to be your best friends they don't even need to be your friends for life they just you need to get out of the house after a few weeks you need to go out even if it's doing something different every day that you you might not you know love these people but you need to go and chat to them and do something else if you're just stuck at home you're going to start feeling

very isolated you're not going to feel yourself um so i say do as many kind of classes there's lots of like free classes around, go for a walk with someone, go for a coffee with someone. Along the way, you may actually make some lifelong friends, but you might not and that's okay. Take time for yourself, like don't feel like you have to be with your baby all the time. There's 24 hours in a day, even if it's just for one or two hours, sometimes give a baby to your husband, give a baby to your mother-in-law, give your baby to your mother, like do something else. Try and kind of keep on like doing the things that you would have usually done eventually. I don't think babies need you all the time.

I think that's just a myth. Whilst we're talking about the support system, the village, what are the early warning signs of perinatal mental health conditions that maybe the village could look out for? Or also new mothers themselves. So it is normal to be tearful. Like you do get the baby blues. But I think if that is kind of ongoing

or like feeling like very guilty about things that you're doing, starting to kind of obsess about certain. you know, rituals or like, for example, like lots of women do start to like get this obsession about breastfeeding and they go into a vicious cycle, feeling that your baby is like kind of foreign to you or having, you know, thoughts that the baby might be harmed or that you might harm the baby. Those, you know, are definitely kind of, you know, bad warning signs. I think not sleeping, awake, like losing your appetite, those kind of things. like really, you know, that needs, you need to seek help urgently.

And another community question, does pregnancy have to, quote, unquote, destroy your body? No. Like, I wonder how much of that relates to, like, the medical or surgical consequences, but actually how much of that question relates to the societal expectations of how women should or should not look after giving day. So, obviously, I mean, I never used to be, I never used to follow Instagram, but I now look at all these kind of influences and you're like, but what did you do in your day? Oh, right, okay, you, you woke up, you made your electrolyte drink, then you went for your like hour walk,

then you made yourself your high protein breakfast or whatever, then you went to the gym, then you made your high protein lunch, then you did some emails and then you made your high protein dinner. Well, what have you done all day? Nothing. So this is your job. My job is, to deliver babies, look after pregnant women. So my job is not about my body. It's about what other things I do. So I can try and exercise and I can try and have high protein meals, but I don't have all day to do that because I've got a lot of other things to do.

That's how I look at it. So they might have a perfect body, which in societal terms, but my body does a lot of other things. So I think stop looking at these people and thinking actually that's real life because it's not. We are doing a million things in our day. if we can try and do some exercise if we can try and eat healthy then that's fine

but we're not going to always achieve that yeah it's hard isn't it when you're you've got people who are optimising their health but they have all the time in the world to optimise their health and that's what they've made their business about is optimising their health my business is about doing something else and I'm trying to do that

but I also might not get the time every day to do that I was writing about this recently when I was talking about like a wellness influencer selling say like a supplement and saying that's the answer to what maybe an issue is. And then a doctor saying the answer is something else, but the doctor has grey hairs from all the stress. They've got sallow eye sockets, you know, grey skin. They're probably a little bit sleep deprived.

And one of them looks like the picture of health. And the other one absolutely doesn't look like the picture of health. Who are you going to believe? You're going to believe the glowy-skinned wellness influencer rather than the doctor. and I think that that is the health landscape that we live in now because the doctor is having to do a lot more stressful and tiresome work than the health influencer.

Yeah, I mean, obviously I could be better. But if I do a labour workshop from 7.15 in the morning till 9.30 a night and then it takes me, you know, 45 minutes to get home. I'm sorry, but I'm not going to then do my 30 minute, like whatever dumbbell exercises that they're telling me that I could fit into my day because it's only 30 minutes. I genuinely am not because I've been on my feet all day. And if I feel like getting six chicken nuggets from McDonald's,

then I will. Like, I mean, they haven't lived my day and I haven't lived theirs, but I'm pretty sure that if I had all day where I did nothing else, I think I would have a better body, obviously, but that's not my job. I think that's really refreshing to hear. Yeah, as I said, a lot of the audience are ambitious young women, and it can feel like the pressures are just getting more and more and more.

and to hear from someone who has a demanding job who doesn't always optimize their health completely outside of that demanding job is very refreshing to hear. So thank you very much for sharing that. I want to talk a little bit about Serena Williams because her birth story shows how quickly birth and recovery can become a little bit more complicated than people might initially expect. So she had an emergency C-section after her baby's heart rate dropped during labour.

And then the next day she felt short of breath and recognised the signs of a blood clot because she had one before. She asked for a CC scan and a blood thinner, but her concern wasn't acted on straight away with a nurse suggesting her pain medication might be making her confused. Serena kept insisting and scans later showed several small blood clots in her lungs. When we talk about birth safety, do you think maybe we focus too much on the baby arriving safely and not enough on the mother's recovery afterwards or listening to mothers? I think we've tried to do a lot of work around that and what postpartum kind of involves.

But yes, there is definitely, I think, a kind of drop off in how much like senior help that you get. Often our most junior people will be doing those ward rounds. But they have access to come to senior help. But then sometimes you wonder, do things get recognised all the time? I'm shocked by it because, you know, you think Serena Williams would have access to her own... private obstetrician or private, like many, many people with private healthcare, like, and why did she not call one of them? If a woman was like that in my care, they would just phone me and I would get a CT scan for them. Yes, the postpartum can be confusing because is

shortness, breath and tiredness just because you're postpartum or is it because you've actually got heart failure or a clot in the lung or something else? And I think we're much better at recognizing those things and getting investigations done quickly. There are still barriers in women sometimes seeking help because they're at home with a baby. They don't want to come in. They don't want to wait a long time in triage to be seen. We're trying to kind of break all that down. And having those midwifery visits at least keeps in check that if you do have something

wrong with your observations and you're going to be coming back into hospital. But yeah, I think that that pathway does need to be strengthened more. Do you have any tips for women in that position where they feel like they're not being listened to? In our unit, you could always ask to get the doctor ASAP, and they will get the doctor for you and explain what your situation is. But there's Martha's rule now where even if the doctor disagrees with you, you can get a second opinion. So that is all available. So I've worked in very well-resourced hospitals with very advanced digital systems. and every so often I think, God, I probably won't live in London my whole career.

And I think, I don't know if I can go working the NHS in Wales. I don't know if I'd survive. And yeah, so I just, I wonder, is there any advice that you give for women who elsewhere in the country and maybe aren't as lucky to have you as an opposite nutrition, have variation in resources available? Do you have any advice for them? I guess research where you are going to give birth. I mean, yeah.

A lot of women actually have research where they're going, what the resources are available to them, who are maybe, you know, in the community asked. Like, who are the, who are the obstetricians that will listen to, who the midwives? They can't take everyone. But I think it's worthwhile knowing that and understanding that. But Martha's rule has actually come into every,

it's meant to have come into every unit in the whole country. So you can ask for a second opinion. That is your right, your legal right, to ask for a second opinion if you do feel worried. you don't just have to just listen to that doctor who's seen you. If you're still worried, then you insist that you see someone else. I think most people are reasonable, and obviously some doctors are tired and stressed in triage. We accept that.

But if you go and you ask for more, you know, another opinion, I'm pretty sure that you will get your investigations. But yeah, I agree about the disparity, and I don't know if I could work anywhere except Kings of the Portland now, because I'm used to this level of, like, we saw, And it is incredibly difficult to. I mean, even thinking about writing my own notes again, actually, I'm like, no. I've never had to hunt right now.

But we used to think, we used to for the whole of our training. And yeah, it's a complete game changer. Yeah. I remember being so shocked in one of the lectures in my master's, one of the lecturers said, said after 26 weeks, he wouldn't advise women traveling to certain places. I think North Wales and parts of Cornwall parts of Scotland, she wouldn't advise any of her patients to travel to past 26 weeks.

because the access to certain resources, certain senses, it was just so far away to get to. And it made me laugh because I remember when I came down to do my first year as a doctor, there was one of the doctors I worked with. He had grown up in London his entire life and he said to me, oh, do you even have hospitals in North Wales? And it made me laugh because I said, of course we have hospitals. But then now with the experience from working in London,

I look at the hospitals we have in North Wales and there's two hospitals, maybe 40 minutes away from me but the specialisms within those hospitals is limited. If there was certain specialties, you do have to travel about four hours to get to. I think it's something worth looking at. Obviously not every unit, not all those units can take every woman that wants to book with them.

And I think that is really difficult. You know, when you look at these reports, And they keep on talking about, you know, safety cultures and maternity. But, I mean, I think if you really got to the root of the problem, it's that you need to make midwifery an attractive career, you need to make, you know, obstetrics an attractive career. Why would lots of people do obstetrics when they could do something else medical in the NHS where it pays to say exactly the same,

but not be getting up in the middle of the night in your like 50s and, you know, early 60s, to come in and sort out a crisis. So I think they need to look at all of that again. And the same that goes for the neonatologists, you know, who are also up with us at night and A&E and see actually that there's a massive difference between some of these medical jobs. There is, you know, a lot of the midwives

who are doing intrepartum, like, you know, care in birth. They're up on their feet for 12 hours and you need to make it an attractive career part of it. And yeah, that comes to money. unfortunately, which it always comes down to. But I think if you want to make maternity care great again, then those are the things you need to look at in people kind of choosing those careers. Because I have to say that not many of my trainees are picking obstetrics anymore.

A lot of them are doing gynecology because they don't want this quality of life. I've spoken about this a lot a couple of times on the podcast, but that was always my dream. That was always what I wanted to do. And then in my fourth year on my obstetrician, the obstetrician said it's the worst specialty you could. And it really just completely shattered my dreams. He said, you've still got time to go try to get a career, do a career in finance.

And at the time I was, I was so excited. I think it was like my first day of my obstetrics rotation. I was so excited. And just I've never met more a lot of quite depressed and unfulfilled consultants. And then since then I've met so many more consultants who are very passionate about what they do. And it's, but there's, I think it's, there's a reason it's got the highest burnout rate. And I often talk about this in, in the context of women's health.

When we talk about how women's health has been overlooked and all these reports about NHS maternity care, yes, we'll talk about the female patients who have been wronged, but we also need to talk about the female staff who have been wronged in, in these situations. The vast majority of NHS employees are women. When we talk about women's health, we also have to consider the, women's, the health of the women who are running the healthcare service. With all that being said, the final question that we ask all the guests is, what do you wish every woman knew by the time she was 25? That fertility has an ending and to think about their options. There's lots of options

available now, obviously. It's never like too early to just get a kind of preconception appointment, like optimise your health around pregnancy. Go into it like, like, kind of exam, like do your research, get the information, and then you'll feel much better equipped to deal with the journey. That was beautiful. And we do actually have an episode that I can put on screen now of talking all about the biological clock with Dr. Nagler, because it's a very, very important topic to be thinking about. So thank you so, so, so, so much. Thank you for having me.