Alexia’s Interview: A Focus Piece on the Mental Health Consequences of OASI

This winter Alexia Koster will break her silence on the agonizing aftermath of her son's delivery at the second annual SOLACE Summit. Fifteen months ago, Alexia excitedly prepared for the birth of her first child, as so many women do, only to leave the hospital severely injured and with little to no support or resources to guide her through recovery. Her story is marked by a 4th degree tear, hemorrhage, two incidents of wound dehiscence, three surgical repairs, mental health disorder, and one inpatient psychiatric hospitalization. It is also marked by a will to be heard. Through Alexia's journey she has repeatedly had to advocate for herself to receive the attention and assistance that she not only required, but deserved. Today her advocacy continues as she turns her focus towards improving postpartum care for other mothers.

In a recent interview with Alexia, she detailed her fight to heal physically and mentally from her traumatic birth. Her story reveals the inadequacy of both postpartum wound care and mental health screenings. It also underscores the fight that many women find themselves in to reclaim their body and mind in postpartum. While her desperate pleas for help were continually met with a lack of urgency and concern, she refused to be silenced. Relying on faith and an uncanny sense of humor, she is here today to share a message of awareness and hope.

Alexia's experience highlights the mental health dimensions of obstetric anal sphincter injuries (OASI). The torch she carries signifies a vast gap in maternal health, with a call for higher standards of provider education, practical tools for recovery, and reducing stigma. Her concerns correspond with the focus of this year's summit, Hidden Wounds: Breaking the Silence on Maternal Mental Health, which is centered on the intersection of OASI and maternal mental health. The event will align with OASI Awareness Week and takes place on February 4th, 2026. This conference is open to women with lived experience, their families, and professionals across disciplines (providers, therapists, and advocates) who want to deepen their understanding of OASI and mental health impacts, as well as students in any health professions, public health, or advocacy field!

Can you walk us through the support you received in regards to mental health following delivery?

I was sent home with Wellbutrin, an anti-depressant. It didn't help. My postpartum depression wasn't gradual. It felt like the very second my OB told me I had a 4th degree tear it was like a switch flipped in my mind and every happy feeling I had turned negative in an instant. At my six-week checkup my doctor saw how distraught I was – hadn't showered, puffy eyes, anxious. She referred me to a counselor who I met with once a week over the phone. Weeks later I moved to Washington state and needed a mental health referral to continue working with a therapist. I was able to get one, but no one returned my calls. At this point I was 11 weeks postpartum and only four weeks post-op from my third surgical repair. Six weeks went by with no help in sight. My son's gastroesophageal reflux disease (GERD) had me on edge. I was constantly worried about my tear and incontinence. I worried I would never feel normal again. I felt ugly and disgusting – completely broken. I felt like life wasn't worth living anymore, but at the time I thought if I take my life, then my husband will find me – I'd rather be hit by a bus, which is called passive suicide. The reality is – no one listened to me. I felt no one was going to hear me until I was dead.

At what point did you take matters into your own hands?

A friend of mine had committed suicide recently and I saw firsthand how grief stricken her family was. I knew I needed to get help – if not for me, for her. The day I admitted myself, my son was upset, which triggered his GERD and blue spells (an episode where reflux can initiate a temporary nerve reflex that causes the baby to hold their breath and turn blue or pale). I was panicking and trying to get him to calm down. I placed him in his Pack n' Play and went into another room. I hit the wall with my fist, which was completely out of character. I lost touch with reality in that moment – I didn't even know where I was. My husband found me crying in the corner. I drove myself to the hospital and said that I was going to harm myself. Even though I didn't truly want to end my life, it was my final attempt to get help. At that time, I was admitted for three days. The daytime nurse did my daily assessments. I didn't find her relatable, since she had never had a baby before and didn't understand what I was going through. I was set up with a counselor to see within the first few days after discharge. After the initial evaluation, he was booked out, but pushed everything aside to schedule weekly in-person appointments with me. He was very helpful. I saw him for six months and he was the most amazing counselor I've ever had. He was fantastic.

What impact did SOLACE have on your journey?

After delivery I isolated myself so much so that I did not want communication with anyone. When I found SOLACE I began reading every birth story on their website. It made me feel less alone. Reading stories about how others healed made me feel better. In the beginning it felt like it was just me – like I was the only person on this planet going through this.

What are some of the gaps in maternal care that you became aware of during your experience?

Before becoming a Licensed Practical Nurse (LPN), I was an EMT for nearly six years. I was never trained in postpartum recovery from vaginal birth. I was simply told most women heal in six weeks. I was never even taught about the type of tear that I had in my delivery. The only information I was given on pelvic floor issues was that they typically only occurred in old age. My old instructor actually reached back out to me with questions on tearing and healing after the fact.

I also later learned that none of the nurses who cared for me after my son was born had experience taking care of a 4th degree tear. Even the OB-GYN who discharged me allegedly disclosed to a friend that he had never seen a 4th degree tear in his career. I felt like an alien.

Then, when I began experiencing wound dehiscence, everyone wanted to see the wound breakdown. Since I was at a teaching hospital, they allowed a resident radiologist to perform a rectal CT scan on me with no pain medication at my four-week assessment. Apparently, this was way too soon to do one and my tissues had not yet fully healed. It was excruciatingly painful.

All of this made me contemplate not going back into healthcare.

However, my final surgeon, Dr. Thomas Clark Powell, MD, MPH at the University of Alabama at Birmingham Hospital was amazing. He was referred to me by my OB-GYN. He was understanding and made me feel like this wasn't some foreign thing that couldn't be fixed. After surgery he called once a month for three months. He is also who directed me to the SOLACE Foundation and other support groups online.

What would you do differently if you chose to return to healthcare?

Listen to patients. Take them more seriously. I would pay a lot more attention to my patients when they tell me something is wrong with their body. I always did at first, but after you do it for so long you question more. I would investigate into their complaint a lot more.

What are some of the insensitive comments that physicians and nurses made to you after the fact?

• "Things like this happen."
• "Not a big baby, but a big baby for you."
• "Could've been worse, you could've had a c-section."
• "At least you didn't have a c-section."
• "You could always have another vaginal birth, don't let a doctor discourage you."

What are your intentions in sharing your story publicly?

I remember how alone I felt in the beginning and I don't want anyone else to feel that way.

My message to healthcare providers is that you have to listen to your patients. I feel like they took my history of anxiety and ran with it. Everything was blamed on my anxiety. Even if you think your patient is just depressed or anxious, take it seriously because you never know. It's normal to be anxious in postpartum after a severe tear. No one asked any questions outside of that.

If you had the opportunity, what would you go back and tell yourself prior to this experience?

No matter what happens, it's going to be okay. You may be miserable now, but if I could go back and be okay and my son be okay – I would do it all over again to ensure his safety.

This experience has made me appreciate God and has helped me grow in my faith. I became a lot closer to God in those moments. Many times, I would cry and pray in the shower. I am just grateful my son and I are okay. No regrets... Actually, I do have a regret. I was so focused on my tear and so worried about the future that I did not get to fully enjoy my baby... I didn't even realize what I was missing until around five months postpartum. I feel guilty that I spent more time scrolling on the support pages than with my son.