Writing about pregnancy loss, fertility – and women’s healthcare more generally – can sometimes feel like an unrelenting carousel of bad news, absence, lack of thought, lack of resources… So something I’m going to try out here at Life, Almost is a series of occasional features putting good news in the spotlight: The people trying to fix things.
For the first post of this kind, I interviewed physiotherapist Jenni Calcraft, of the PABL project – a specialist service helping women with their physical recovery after baby loss.
‘What we're actually doing is reconnecting emotionally with the body’
‘It’s been a steep learning curve for me, running these sessions,’ says Jenni Calcraft, a qualified physiotherapist and Pilates teacher, and founder of the PABL project (PABL stands for Postpartum After Baby Loss).
‘After the classes, I often ask if there was anything that people found difficult and sometimes there's a particular exercise or position, such as lying on your tummy, that has been emotionally triggering, accentuating someone’s sense of loss.’
In the case of lying on the stomach, she explains, that’s because it could be the first time someone’s done that since early pregnancy – or even before.
Since 2022, Jenni has been running physio-led Pilates classes for women who’ve experienced stillbirth or early infant loss, at the Alder Centre in Liverpool (which offers bereavement care for parents).
The classes, which run in six-week blocks, are small – with no more than six women in a class – and cover different aspects of postnatal recovery, such as strengthening the pelvic floor and core muscles, breathing and posture, c-section scar management and checking for separated abdominal muscles (diastasis recti).
Having had a close friend lose her baby at full-term, and seeing how the physical changes and care needs of women are often under-appreciated and uncatered for when a baby dies, Jenni says she ‘jumped at the chance’ when asked if she wanted to teach postpartum classes at the centre.
‘Postpartum is postpartum,’ she says. ‘And I feel like all women should have access to support for their physical well-being and recovery.’
Yet, she adds, ‘there is a real disparity in the availability and the ability to access that between those who are fortunate enough to bring their baby home and those whose baby has died.’
The classes at the Alder Centre – which are free – are designed to help bereaved mothers feel as safe and supported as possible, with counselling staff on hand. Now, after many enquiries from women who don’t live near enough to attend in person, Jenni is launching online classes, too. Beginning next month, she says these are suitable for anyone who has experienced a stillbirth, early infant loss, late miscarriage or termination for medical reasons within the last 12 months. (You must be at least six weeks post vaginal delivery and at least 10 weeks on from a c-section and been told that you are safe to exercise).
Postnatal recovery after baby loss is a healthcare gap within a healthcare gap.
As healthcare professionals, journalists and campaigners have highlighted many times, postnatal care can be minimal – and often inadequate. In the UK, it’s not routine to be assessed by a specialist physio after birth or to automatically be offered specific support – unlike the much written-about French system, la rééducation périnéale, in which all mothers are referred for six weeks of government-funded pelvic floor rehab to help strengthen the muscles, with the intention of preventing incontinence and preserving sexual function.
‘Within the whole population, pelvic floor issues – for example – are just accepted as normal,’ Jenni tells me. ‘But, actually, although it is common, it is not normal to have any form of pelvic floor dysfunction [such as leaking urine] after three months postpartum. And it can lead to issues later on’. (This could be in the form of worsening incontinence or pelvic organ prolapse, particularly after menopause and its accompanying drop in oestrogen).
In general, whether for urinary incontinence, ab separation, pelvic pain, or wanting to return to exercise after pregnancy and birth, women often find they have to source – and pay for – support themselves. But even this option ‘is often very inaccessible for anyone who’s experienced a loss,’ says Jenni. ‘There are so many barriers.’
‘Firstly, we are relying on women to be self-aware enough to come forward,’ she continues. ‘It's a bit of an epidemic, even within the general population, but I think after you've had a loss you're less likely to be proactive about addressing any specific issues – because, understandably, it's not the main thing that's on your mind when you’re grieving.’
Unfortunately, after baby loss, women may not be signposted by healthcare professionals either. Although there are some excellent guidelines for supporting bereaved parents, currently, Jenni tells me, ‘there's nothing in there about pelvic floor function. And there's nothing about returning to exercise.’
‘So there's an issue right at the point at which guidelines have been written and that is something that I would really love to have the opportunity to influence,’ she adds. (She’s recently joined the All Party Parliamentary Group on Baby Loss, to inform her work with bereaved parents, but also to advocate for the physical recovery needs of those who are postpartum after loss).
While, as Jenni says, ‘it’s not appropriate’ for physical recovery to be the main focus of someone’s care after the loss of a baby, support with any physical consequences of pregnancy and birth is still highly relevant. As well as preventing future health issues, women who experience a loss may (although not always) go on to have another pregnancy in relatively quick succession. Ensuring that someone is physically able to return to exercise can also help them cope with their grief.
One issue is that, after the death of a baby, once women have been discharged they lose contact with postpartum healthcare. ‘Or the contacts they do have tend to be focused on the emotional side – and that’s very appropriate and needed – but it means there’s less opportunity to ask about physical issues,’ Jenni explains. ‘It’s not asked about in the same way that it would be after a pregnancy where the baby has lived.’
Even if someone does decide they need more support with their physical recovery after loss, the question is: where do they go?
‘The women I've worked with often say they didn't know where they could go for support,’ says Jenni, who is working on creating a directory of PABL practitioners (pelvic health physiotherapists with a special interest in working with those who have experienced a loss) so local support is easier to find.
‘Because if you look online, all the content is incredibly triggering, isn't it? I've had women say that they didn't even want to look, because of all the potential triggers.
‘Or they try to make do with postnatal YouTube videos – only with the sound off, as the instructors tend to say things like “don't lift anything heavier than your baby”, which they find too upsetting. But that means they don’t get the proper instruction, in terms of how to do the movements.
‘It’s hard to access the information in the same way,’ she says. ‘You're probably not going to go to something called a “Mummy MOT”, because, obviously – although you are a mum – it’s triggering going without your baby.’
The same is true of postnatal exercise classes. Even basic resources given out by physiotherapists – such as instructions on how to perform pelvic floor exercises correctly or c-section scar massage – can be worded in ways that are upsetting, presuming someone has a living baby at home. This is something Jenni realised once she began running the Alder Centre classes, prompting her to write more appropriate materials to give to the women attending (these are also available for free here on the PABL website).
Accordingly, the ‘absolute priority’ of the PABL project classes is participants’ emotional wellbeing. ‘It's a really safe space,’ Jenni explains. ‘We provide a lot of time: we have tea and coffee afterwards. There’s always cake. There’s also a lovely breakout area, with sofas, and separate counselling rooms.
‘There are clinical psychologists on site as well. We've never needed to use them, but it means there are layers of emotional support around what we're doing.’
She adds: ‘I also think the fact that these are group classes has been really powerful. It can be quite bittersweet, that peer support – being in a room with other women who have also had a loss – but it can also be incredibly helpful.’
Something Jenni hadn’t expected when she began running the sessions is that, along with gains in physical strength, ‘we’re seeing a really significant change in emotional strength as well’.
She says: ‘I've spoken to the psychologists about this – because this is new for me – but it seems to help women reconnect emotionally with the body. Which is really important after a loss. After a loss, the body is a source of trauma: and trauma is held in your body.
‘We've had women who, at their first class, can't even touch their tummy – or they don't want to engage with their pelvic floor because it's so traumatic to focus on that part of their body.
‘As a teacher, you don’t want to avoid triggers – you want to give people a safe opportunity to experience it and sit with those emotions and work through them when they’re ready. So at the start of the block of classes, we talk about possible triggers. And how we accept and acknowledge that this is an emotional process.
‘For some women, by the end of the block of classes, they're going to Pilates classes at their local gym with a friend – something they previously wouldn't have felt able to do that because they were so emotionally triggered by their own body.’
As well as helping women reconnect with their body, classes like the PABL project can also help women who are keen to return to exercise – perhaps as a way of piecing together some parts of their old identity – to do so in a safe way. Because there can be a temptation, Jenni says, to rush this process. Something that is perhaps inevitable when the world around you doesn’t recognise your maternity, your birth, or your baby, in quite the same way.
Yet as Jenni puts it: ‘Your body is still postpartum. And it really deserves the same love and support in recovering physically as any other postpartum body.’
For more information go to thepablproject.com If you are interested in joining the online classes, you can find more information here – or email hello@thepablproject.com to register.
What a phenomenal and much needed project for bereaved parents. After the stillbirth of my daughter at 32 weeks, I did not have the confidence or desire to join the 'regular' postpartum classes and be questioned why I was not bringing a baby with me. So I joined a delightful group of pensioners. I gained strength and rehabbed my broken body with them, and only the teacher knew my story (perfect for me at the time). I wish I had this option of finding support in other bereaved mothers, though. A fabulous and thoughtful care option - with the ability to expand to pregnancy after loss classes too, I imagine.
Kelly - bereaved mother and PhD researcher
@birthingafterloss
This is so brilliant and so needed - thanks for sharing