“It’s about having someone to help you understand that these issues are real”

Discussing the stress of *experience* as it relates to pain and pelvic health with Carine Carmy, CEO and co-founder of Origin

adapted from art by: Olga Ubirailo for iStock

Ah, data. The world revolves around data. Data is evidence. Evidence is proof. Proof of a problem and proof of a solution. 

But what if the problem AND solution exist in a space that has been historically under-funded, under-researched and under-appreciated? What if the data aren’t available yet? 

This is the state of women’s health. And this is (one of the reasons) why everything – healthcare, innovation, policy – lags when it comes to women’s health. 

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In case you missed it...

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On the innovation side, I don’t know a single entrepreneur in the women’s health space who hasn’t been told at some point that their audience is too “niche”. This even happens when their audience category is WOMEN. Generally, women. All women. I wish I were exaggerating that point. I am not. 

I deeply respect what

Carine Carmy

and her team at Origin are building for that reason. They are taking a category in women’s health – pelvic health – and tackling the beast that is demonstrating both need AND solution, while changing the narrative and bringing broader awareness to the issue. Also, they are scaling a whole damn company (17 clinics and growing!) to fill these critical gaps in women’s healthcare. 

I spoke with Carine about her journey to motherhood and founding Origin and got her expert thoughts on the stress related to pain and pelvic health and postpartum transitions.

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MOLLY 

I would love to start with your thoughts on stress and mind-body connection and, as much as you're open to sharing, your personal journey to and through motherhood.

CARINE

I was always someone who internalized stress physically, which I don't think I had the language to understand early on. I had an ulcer when I was 15, which is crazy. A stomach ulcer! And then I ended up getting diagnosed with ulcerative colitis, when I was 16 or 17. I also had really bad jaw pain. So there was always this physical manifestation of what was probably going on in my life while at the same time, I thought, “Everything's fine.” 

Once I realized this connection, my doctors would tell me at the time, “Don't be stressed. It's going to upset your stomach,” when actually it is the pain that can create the stress.

It’s important to reshape that narrative. I also think that [recognizing this connection] puts an undue pressure on people to feel that ‘if only they can control their mind, then their bodies will be fine’. That’s an unfair expectation of people. 

I also have my own history with painful sex and pelvic pain, which is what led me to founding Origin. 

I think all of that history, while not front-and center, played into [my pregnancy story]. I was technically a high risk pregnancy because of my IBD and I had the benefit of my pelvic health knowledge to guide me in pregnancy. 

When it comes to the stressors I experienced in pregnancy, they were less physical at first and more emotional. Take the choices around testing [during pregnancy]. It is very liberating but also very stressful. You're presented with so many choices – “do I do amniocentesis?” “do I do all these other tests?”. It is an amazing thing [to have access to information] for the modern American woman, but it's also a lot of decision fatigue. And it's your body, so your partner is giving you more autonomy in those decisions. But then you have the “Well, if I make the wrong decision, is it going to be my fault?” weighing on you. It’s that cycle of thinking where, especially if you have a history of anxiety, which I do, everything becomes much more loaded.

MOLLY 

One of the things that's on the map but I’m still trying to wrap my head around is the social narrative and identity piece. I feel like the good mother / bad mother / guilty mother / shamed mother feelings are embedded in the social narrative stressor node, but it also might deserve their own category?   

CARINE

The narrative stress for me really kicked in in the immediate postpartum period. The feeling of good mother / bad mother and what the hell am I doing? I didn't have a lot of babies in my life. I didn't even know how to change a diaper, which I didn't know I didn't know! 

“it's also a lot of decision fatigue [in pregnancy]. And it's your body, so your partner is giving you more autonomy in those decisions. But then you have the ‘well, if I make the wrong decision, is it going to be my fault?’ weighing on you.”

We got out of the hospital, and I was very confronted by the identity shift. In my work, I was someone on their A game, in control, who knows what they’re doing. I was in a flow. And then, [leaving the hospital] I shifted into a world where I felt completely inadequate.

MOLLY

Same! We brought our first baby home and we were like, “how much do we feed this thing?” We didn't know what to do at all! 

CARINE

Terrifying!

I gave birth at Cedars Sinai, which is a great hospital, and I had a good experience. But one thing that stood out to me was the room difference for Labor & Delivery, versus postpartum. You go from being in these really luxurious, large spaces where you're delivering and then, you then get moved to a tiny room where my husband couldn't even lay in his chair back all the way. 

So it felt a little on the nose – “oh, this is exactly the treatment of the American mother – when you’re pregnant, you’re a queen, and when you’re postpartum… good luck to you!”

The birth itself was interesting. I didn't have a lot of pain. And I was terrified of pain. I was terrified of tearing because of my history with painful sex. I ended up getting an epidural at eight or nine centimeters because I didn’t want to feel pushing. But then I had the experience of the numbness and not being ready for that – the lack of control – it felt a little bit destabilizing. 

MOLLY

If you don't mind me asking more about it, when you were getting closer to birth and then when labor started, did the history of painful sex and the history of pain, in general, come up? Meaning, did it come up conversationally or psychologically in the moment, or in terms of your concerns/fears/worries when it came to preparing for birth?

CARINE

I was really worried before I walked in the door, but then once I was there, it released. Like “I’m okay. I'm here now. There will be an epidural.”

I was also very lucky that my contractions didn't really hurt, which is bizarre. My doula was very confused. Everyone was wondering what was actually going on. I took myself to the hospital.  I feel woozy pain. And then they realized I was in labor. There was a moment of not actually feeling the sensation. I don't know if that's a thing or if it's because I’m used to being in pain. 

MOLLY

That's exactly where my brain went – maybe you just have a different way of interpreting pain? Like you have your own lifelong coping strategy for how to interpret pain, internally. I don't know. That's really interesting. I wonder if there's research…

CARINE

I also had a very helpful conversation with one of our PTs - Liz Miracle - before I went into labor and delivery. I had said “I’m freaking out, what do I do?” And she said, “You know, we've built a business to heal people. Even if you have a tear. That's the whole point.” 

This idea that there's nothing you can't heal from. It was a really helpful totem pole for me. I did tear, and it was fine.

MOLLY

I love the idea of having someone along the journey that can convey the message of there's nothing you can't heal from.  That message just feels like a balm on… 

CARINE

Yeah, a balm on your nervous system!

MOLLY

Yes! 

As you mentioned, having a baby brings on that identity shift, bringing home requires a whole new skill set of skills that seems completely foreign. And, then on top of it all, there is also a whole new relationship between you and your body that is also unsupported or under-supported for so many women. 

Did you feel like you were specifically prepared for the body shift? 

CARINE

For me, I was obviously lucky given my role and what I’ve been exposed to. I felt very strong going into labor and delivery. 

I did get a lot of mixed messages, postpartum, from my doctors when it came to physical activity. The “don't walk too much” that left me wondering “wait, I can't walk? What is too much?”  Back to the identity piece, being physically active is also very important to me. So when I was able to do those two things again - workout and work – is when my anxiety levels really went down.

There's so much orientation towards the negative from the medical system. The doctor's job is to prevent harm, it's not to make you feel good. It's this “let's make sure you get to baseline but not, above that.”  

There is definitely an over orientation towards negative messaging. Anything we can do [to counterbalance and] orient towards the positive or hopeful or would be beneficial. 

MOLLY

The orientation towards the negative is so interesting when you think about it from the perspective of stress. A do no harm approach that does not weigh the risk of adding on layers of stress that could have health impacts down the line.

Especially when considering the messaging. We don’t have the big picture to show how negative-oriented language in the postpartum window has an impact on a longer timeline.

I also wonder about the impacts of fear-based marketing aimed at this time of life. When I was about to have my second daughter, I remember getting served ads that were basically saying “buy this sock monitor thing or your baby will die in their sleep and it will be all your fault” (I mean, the wording was a little different but you get the point). 

Going back to those early days, how much do you think the anxiety at the time related to a seed that was planted in your head even before your baby arrived?

CARINE

A lot of it. 

You're already in a hyper-vigilant state. So even if someone says something small or you hear one story, the way that it's messaged makes you hold on to it. Your number one job and instinct is to keep this baby alive. It’s terrifying. 

The lens through which I saw everything in the early days was at a “red alarm” level.

MOLLY

Do you think that's a part of American culture? How everything is like a little bit of a red alarm. Or does this come back to the good mother narrative and concern about feeling judged rather than deciding what is the right thing to do for our baby?

CARINE

I don't know if it’s Western culture or just hormones. Again, you're hyper-vigilant. It’s essentially your body telling you ”what else matters?”  But there's definitely the narrative piece swirling around that too. 

“You're already in a hyper vigilant state. Your number one job and instinct is to keep this baby alive. It’s terrifying.” 

For me, the narrative piece also played into how I was thinking about work, postpartum. The team was fine without me but in the early days, the baby was sleeping (a lot!) and it was almost easier for me to work in the first month than in month five when it's much more hands on and she's not sleeping at night. In the first month, I would be checking Slack here and there and not wanting to tell people because I didn’t want it to come across that “oh, she's addicted to work.” In reality, when it was more related to the fact that staying somewhat tethered to my work identity helped me avoid a full on spiral into postpartum anxiety. Over time, as I started to really own my new identity as a mother, I needed work less. I started to ground and integrate. 

MOLLY

I love how identity keeps coming up. It adds such a personalized edge to the equation. And how the example from your experience –  the identity shift from a worker → mother – can be jarring and a stressor for certain people. 

“[continuing to work in early postpartum] was more related to the fact that staying somewhat tethered to my work identity helped me avoid a full on spiral into postpartum anxiety.”

This brings to mind the question about how we could approach the transition in a more personalized way. The one-size-fits-all approach in this transition window might not work for everybody. Maybe a two week rest and recovery period with a longer tailed mental transition back into work would be healthier for some. 

I feel this way about paid leave policies sometimes. If you have a policy where everyone gets four months completely off with the expectation to fire back up 100% after that, it might actually be more jarring than having less time up front and a longer, slower “fire back up” window. How do we get more creative with it? 

CARINE

I ended up really redesigning my map. If you have a choice in how you approach it, if you’re a founder or your own business owner, there isn’t really a playbook. 

Identity is formed by the things you do every day – the repeated actions and rhythms of your life. All the things I did before that had accumulated into my perception of self, were no longer things I could do postpartum – I couldn’t walk, I wasn’t working. Even the way that people interacted with me, socially, fundamentally changed.  That was the jarring part.

MOLLY

I would love your thoughts on the current version of the stressor map. 

Mapping the web of stressors related to modern American motherhood

Specifically, what might be missing that we need to identify and talk about more as a stressor? Or are there additional connections between stressors that are specific to the experience of being a woman and/or in a cycling/birthing body? 

CARINE

I’m not seeing PAIN in here, which I think is interesting.

MOLLY

Good call! Would you see pain as a layer within a stressor node or would it be its own thing?

CARINE

Its own thing. I think it would be one of the horizontal ones. It could be a function of your pregnancy or postpartum experience – like pelvic pain, back pain, sciatica. Imagine your pregnancy experience when you have back pain versus when you don’t, the level of incremental stress that that causes. I think that could be an interesting one to consider.

MOLLY

How does pain tie into the other stressors? 

CARINE

If you have a health problem at all, that's a stressor. 

Pain [as a stressor] could be related to the woman's health journey – it could be a chronic pain like ulcerative colitis or TMJ or back pain – especially if it is unexplained. 

MOLLY

Is the “unexplained” also where medical gaslighting comes in? Or where does that show up?

CARINE

Well, that’s part of the experience, right? If you're in pain or being gaslit, it makes that layer far more exacerbated as a stressor. 

Whereas, if someone's like, “this is my experience. I have chronic pelvic pain.” and the response is acknowledgement that “okay, this pain is real”, you don’t feel crazy. The stress level around the pain experience is different as a result of that. 

MOLLY

I feel like another thing that plays a part at multiple layers, across different stressor nodes, is access to (or lack of access to) either information or medical professionals who are specialized in the thing you need help with. Maybe that also connects to the mental load or isolation part of your prenatal care journey. But I'm guessing that also plays into pain?

CARINE

Yes. The “is there a provider who can help me?” question is one of the biggest issues in women's health, broadly, not just in pregnancy. If it's endometriosis, for example, it could take 10 years to get a diagnosis.

So, access to the information that is real or access to the provider who is specialized or access to someone who's in network. These are all related stressors.

MOLLY

Which is why what you are doing with Origin is so important! 

Origin is obviously a healthcare company when considering the work you do in the women’s and pelvic health space, but I was also thinking about the role it plays in long term health – how it decreases stress load and potentially affects stress-related illness – especially during the sensitive window of postpartum. For example, the service brings in the stress buffers of human-to-human contact, social support, education, and feeling heard.  

Where do you see Origin’s care model playing a role on the opportunities side of the maternal stressor map?

CARINE

There's some data that shows a high correlation between depression, anxiety, incontinence, and other issues that relate to postpartum recovery, like prolapse or painful sex. So we know these issues are connected.

“The ‘is there a provider who can help me?’ question is one of the biggest issues in women's health… [limited] access to the provider who is specialized or access to someone who's in network. These are all related stressors.”

Outside of the pure physical pain recovery piece, and obviously that is a big part of it, I think there's two other critical streams with important psychological benefits. 

One is the need to know “is this normal? What's going on?” For me, there's this untethered lack of safety when the medical community does not validate what's going on for you or is not able to give you a plan to deal with whatever is going on. 

Throughout pregnancy and postpartum, having someone that you can talk to on a regular basis – help you calibrate what's happening to your body, help set expectations around that bell curve of your experience from the beginning to the peak of labor and delivery and everything afterwards – is so critical. It can’t be fulfilled by an OB and it can’t come from a fitness instructor. You need a clinician who understands the musculoskeletal system to say, “Okay, this is what's going on for you.” Not in the red alarm way, because these issues are not usually level 10 health care issues, but in a way that addresses the “this really doesn't feel right. What's going on?” type of questions.

The second comes down to the fact that most people have no idea that they have a pelvic floor. Most people walk into Labor & Delivery and that's their first experience and interaction with this like a really big part of their body and their muscles. The life-changing nature of what we're doing at Origin is also providing this deeper connection to understanding yourself and your body. That is separate from having someone to converse with and validate what’s happening. It’s about awareness almost like,”holy shit, I have an arm? No one ever told me I had an arm!” 

MOLLY

Ha! Unfortunately, that was me. I definitely did not know much about my pelvic floor before pregnancy. I’m absolutely paying for it now. 

One of the psychological benefits you mentioned that feels aligned with the goal of softening potential stress is having the “this is what this is. Here's the plan” type of response.

We know that unpredictability and lack of control relates to our physical response to stress.

A quick(ish) lesson about stress

Having someone respond to your ailment with a blase “I don’t know what is happening. I don't know when it's gonna show up again. It might show up tomorrow or never, who knows. I have no plan for you.” versus having someone say “Okay, this is what's going on. And this is how we’re going to approach it”. That’s a very different stressor. 

CARINE

I think that's exactly right. And, to your point, there's a lot of language in the physical therapy community around this work. It's called “common but not normal.” 

It’s about having someone to help you understand that these issues are real and then have the language to talk about what is happening. Maybe they can't give you predictability for what’s going to happen every day or how it's going to be over an X period of time, but there are guideposts in the same way that there are guideposts for other healthcare issues. 

[At Origin], we’ll never tell a patient “in six weeks this will never happen again” but we can say “ok, here is the recovery plan and here is what you can expect”. I think that alone offers this deep sigh of relief.

MOLLY

In your dream world. What does preparing for the postpartum period look like?

CARINE

I actually think it starts when you're pregnant. I think there should be at least one or two visits through every trimester in which you're checking back in with someone, getting that quick guidance. No one should be walking into labor and delivery without understanding how their pelvic floor muscles work or what it means to push. You have to start preparing your body to do that before you have like a 30 pound bowling ball on your hips. 

And then there's postpartum. Let's have more screening moments, whether that's with a PT or with your OB. Ideally, you’re not leaving the hospital without a rehab plan based on your labor. I know these are big aspirations, but it needs to be embedded. 

The educational model around postpartum depression has really helped. You don’t hear about it for the first time after you give birth. People now know that postpartum depression could happen. Maybe they’re advised to find a therapist ahead of delivery. At the very least, they hear the language early on so that if they start to feel those things, they can name it. With pelvic floor and full body issues, no one is getting the language early on, so when something does happen, some don’t even know they can discuss the issue with their doctor.

MOLLY

This feels tied into the stress of isolation/loneliness or the counter to that which is the stress buffering effect that is social support. Recognizing the importance of having a person for you, the birthing body, post-baby – someone who is an expert or specialized or can, at the very least, acknowledge and name what you are feeling and recovering from – seems so critical and such an obvious need. 

CARINE

Yes, it's so important to have an advocate and a support person AND experts lined up for the range of postpartum needs.

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