Thirty weeks pregnant, still leaking from the last one, and my mum had a prolapse. Can I be seen BEFORE the birth?

Some of you will remember me from the thread about being told leaking was just what happens after babies. I got the referral in July. I did not mention at the time that I was pregnant again, because I was barely past twelve weeks and had not told my own sister, but I am thirty weeks now and the referral has produced precisely nothing. No letter, no date, and when I rang last week the person on the phone could not tell me whether being pregnant moved me up, down or sideways.

Two things have happened since that have got me properly worried rather than just cross. First, the leaking is worse, which I gather is not unusual at thirty weeks with a toddler who treats me as climbing equipment, but it is worse. Second, my mum told me at the weekend, in passing, as if it were nothing, that she had a prolapse repair in her fifties and "they said it was probably the babies". Nobody in my family has ever mentioned this before. I have been googling for three days and I now know far too much and understand none of it.

What I actually want to know is whether there is any point trying to be seen before the baby comes, or whether everyone will just tell me to wait until afterwards and see what state I am in. Part of me thinks there is nothing they can do while I am pregnant. Part of me thinks that is exactly what I was told last time and look how that went. And does the mum thing change anything or is it just one more thing to lie awake about?

Ring the maternity unit, not the GP. Different door. Mine had a physio attached and the GP had no idea.

Seconding the different door thing, and adding one from my own five months of getting it wrong: ask which LIST you are on. I was on the general physio one for months and nobody had noticed. When I rang and asked the actual question it got moved and the date changed by months.

Also, and I say this gently because I was the one googling at 2am in March, the internet is going to hand you a hundred scary things about your mum and none of them are about you. The board here was the first place that gave me a page with actual numbers on it and I slept after that. Not because the numbers were good, because they were real.

I was not seen in either pregnancy and I wish somebody had told me it was even a thing. Both my babies are grown now and my course happened in my forties. You are asking the question at thirty weeks, which is a great deal earlier than I managed.

Nadia, yes, there is a point, and being pregnant is the one time the route may actually be more open to you rather than less. I want to take your three questions in order because they have different answers and the googling has probably blurred them together.

First, whether anyone will see you before the birth. The guideline does not say wait. NICE NG210 recommendation 1.6.14 says to offer at least three months of supervised pelvic floor muscle training to women with stress or mixed urinary incontinence, and it says "including pregnant women" in so many words. You are already leaking, so that is the recommendation that applies to you, and it is an offer rather than a consider. What I would be careful about is the prevention numbers you will have seen on your travels: the strong finding in this field is that women who start training in pregnancy before they are leaking are about 29% less likely to report incontinence at three to six months after the birth, 179 per 1,000 against 251 per 1,000, from 5 trials and 673 women, at high certainty. That finding is for women who were dry when they started. For women already leaking in pregnancy the same review found no clear effect at any time point, at very low certainty. So the guideline offer stands, but the prevention numbers are not yours, and I would rather you heard that here than from a leaflet that blurs the two. Antenatal pelvic floor training separates them properly.

Second, whether being pregnant changes the queue. In England it very often does, and this is the part nobody told you. Pelvic health self referral, where it exists at all, is usually restricted to pregnancy and the first year after birth, because that is where the investment went: NHS England's perinatal pelvic health services programme had a universal coverage deadline of March 2024, and as at 16 May 2024, 20 of 42 integrated care boards had a service in operation. No access or waiting data is published for those services, so I cannot tell you how long, but Bex is right that the door is the maternity side, not the GP, and it is worth asking your midwife directly whether there is a perinatal pelvic health service in your area and whether you can refer yourself into it. Outside England the shape is different but the question is the same: in Ireland the public guidance lists both a referral route and a self referral route with availability varying by area, in the US the route usually runs through a doctor because the payer requires it, in Australia the subsidised route is a generic allied health item capped at five services a calendar year shared across all allied health, and in Canada it is a coverage question before it is a referral question. Getting referred to pelvic health physiotherapy has all five, and Trampolineban's point about asking which list you are on is the single most useful phone call on this whole board.

Third, your mum. Here is what this site can and cannot say. The one place the guideline mentions family is NG210 recommendation 1.3.12, which says to consider a three month supervised programme from week 20 of pregnancy for pregnant women who have a first degree relative with pelvic floor dysfunction. That is you, twice over now, and it is a concrete sentence you can say on the phone. What I will not give you is a number for how much a mother's prolapse raises a daughter's chance of one, because this site does not hold a figure it can tie to a source, and the ones you have been reading at 2am were almost certainly not sourced either. Your mum's history is a reason to ask sooner, not a forecast.

From my own history, for whatever it is worth: I was not seen in either pregnancy, the leaking started about six months after my second, and it then took three years and three clinicians before anyone measured anything. You are thirty weeks and asking. That is a different position from mine and a better one.

What I cannot tell you is what is going on with your pelvic floor now, whether your leaking is the same problem as last year or a different one made worse by the pregnancy, or what the right programme is at thirty weeks with a toddler on your hip. Those are assessment questions, and the assessment is the thing to chase. If anything changes suddenly, any of the red flags on the standing block on every page here are a same day conversation with the maternity unit and not a forum question.

Update, and a quick one because I am tired and enormous.

Asked the midwife on Monday. There IS a perinatal service, she referred me herself on the spot, and I have an appointment on the 6th of October, which after six months of the other route feels faintly ridiculous. Nobody on the phone in July knew it existed. I also said the sentence about a first degree relative and week 20 and she wrote it down without arguing, which is not something I have experienced before in this whole saga.

Mum is, for the record, mildly offended that her prolapse is now a forum topic. I have told her it is anonymous and she has stopped speaking to me about it, which is a result of sorts.