Tessa Spring

It’s a Monday morning in January and I’m back in Kingston Hospital for a procedure under general anaesthetic. It’s the first significant hospital visit since I was in the postnatal ward with our newborn daughter, Maeve, just over four years ago.

It feels like a full stop to a long pregnancy-related chapter. I’m 40 now and ready to move forward again but in a way that won’t cost me later in life.

Four years ago was the breaking point, when my spine fractured due to a condition called Pregnancy Associated Osteoporosis (PAO).

Our bones are interesting because they’re not static but living tissue, constantly being broken down and rebuilt through small, ongoing exchanges. Certain cells remove old bone and others form new bone in its place. In the spine, hips and pelvis, the skeleton is rich in spongy, trabecular bone. This tissue renews more quickly than dense outer bone and, over many years, much of it is gradually replaced.

In Pregnancy Associated Osteoporosis, these same regions are the most vulnerable. The pace of loss can briefly exceed the body’s ability to rebuild, leaving bones fragile at precisely the moment they’re asked to carry and feed new life. I can still vividly recall those first few months with Maeve while living with undiagnosed PAO.

It was Friday afternoon in the postnatal ward, after giving birth to her the evening before. I couldn’t sit up and hold Maeve due to a sharp pain in my coccyx and a deep ache in the bra-strap area of my spine. I also had pain in my left hand and foot. My partner Alex would pass Maeve to me so I could try and breastfeed lying down but it was difficult to do this often enough. I was worried she was hungry and that we were missing out on important bonding time.

When I eventually did speak to a doctor on the Sunday evening about the debilitating pain I was experiencing, I was told emphatically: “We don’t do postpartum scans.”

We were discharged at 5pm the next day and I visited the GP just days later. He referred me to the physio who thought I seemed okay. About three months later I felt a pop in my back when lowering Maeve into her cot. I tried to stretch out the discomfort but then experienced a sharp stabbing pain. My back muscles went into spasm and my rib cage shook rapidly back and forth.

I increasingly lacked energy, often watching the day pass from the sofa while Maeve slept on me. Lifting an ever heavier Maeve became a daily challenge. After a few more fruitless visits to the GP, I used my work health insurance to insist on a scan of my back. The results showed I had a compression fracture in my spine. It sounds odd but I was almost relieved to hear that.

After not being listened to on so many occasions, the diagnosis validated both the pain and mental health challenges I’d experienced since having Maeve, as well as the lack of dignity I’d felt in hospital.

It’s unusual for someone in their mid-thirties to fracture their spine, so I was sent for a bone density scan. It showed severe bone loss for my age. In July 2022, eight months after giving birth at age 36, I was officially diagnosed with Pregnancy Associated Osteoporosis. It was the first time either the rheumatologist or I had heard of the condition.

It’s not known what causes PAO. It’s likely to be a mix of factors for different women, with pregnancy and breastfeeding acting as the trigger. Potential risk factors include low body weight, certain autoimmune conditions, vitamin D deficiency, eating disorders, chronic stress, hypermobility, and some anti-blood clotting medications when used over a prolonged period.

Because most women diagnosed with PAO seem otherwise healthy beforehand, the diagnosis comes as a profound shock.

Before this happened, I’d assumed my bones were solid and dependable. I didn’t think of them as responsive or vulnerable. They felt fixed, something I could rely on without question. It hadn’t occurred to me that they respond to hormones, diet, stress and the way I move through my days.

Bones hold many aspects of our lives, from inherited genes to illness and patterns of living. Over time, these become written in bone.

Learning about bone remodelling altered how I understood the fracture. It no longer felt like a random event. It suggested that the internal balance within my body had shifted under strain.

When I look back at the years before pregnancy, I can see a pattern of pushing through and assuming that resilience meant continuing regardless. None of this explains the condition, yet it forms part of the broader context in which my body was operating.

Bones respond to how we live, as well as what we carry. They adapt to load over time, strengthening where they’re repeatedly used and thinning where they’re not. From that understanding I’ve tried to rebuild more carefully, by changing my habits and also working to influence systemic healthcare change.

It was through speaking to other mums about PAO for various journalism articles that I realised many of our stories sounded the same. We were just as traumatised by not being believed or properly investigated as we were by the condition itself, and by the difficulties many of us faced in accessing appropriate treatment and care.

This often unfolded at the most vulnerable moment of our lives, as we navigated the hormones of new motherhood while caring for a newborn. Many of us worried not just about our bodies but about our babies, our relationship with them and their future. Would they grow up feeling close to us, or carrying a sense of our fragility, when even holding them could be painful?

The expectations placed on new mothers rarely adjust to account for physical recovery. I found myself trying to meet those expectations while in pain and increasingly doubting my own judgement.

Over the past four years, motherhood, illness and grief have all led me to consider how I live. They’ve made me realise I don’t want to repeat the patterns of the past, and instead want to be more present and grounded, both for myself and our daughter.

I’ve come to see rebuilding as an incremental process rather than a single turning point. Bone density improves gradually and in response to consistent signals such as adequate nutrition, weight bearing movement and appropriate hormone support. Regaining confidence follows a similar pattern. It develops through repetition and a willingness to alter habits that once seemed fixed.

I now take HRT to protect my bones and am more aware of how to support my health, even through big transitions. I’ve also chosen to write about PAO, both to process what happened and what I’ve learned, and in the hope that other women are believed sooner and that bone health is taken seriously.

You can find out more about PAO on the charity website: PAO UK