“Only about 25 percent of women get a non-traumatic normal vaginal delivery that did not do serious damage to their pelvic floor or their anal sphincter.” – Professor Hans Peter Dietz.
Walking down the hallway after having her second son, a woman tells me she could feel her insides falling out and basically and had to catch it. Suffering a recurrent prolapsed vagina and other associated issues post birth, she is now on the wait list for corrective surgery.
Flagging the issue of traumatic births isn’t just about the well-being of women postpartum, this is also about how dramatic changes in their physical and mental health adversely affect their lives. Some so profoundly ruin their sex life, marriage, physical activity and ability to return to the workforce with conditions ranging from genital prolapse, painful sex, urinary and faecal incontinence, body image issues and emotional and mental trauma.
A recent two year study into the psychological consequences of traumatic vaginal birth cites that “20-30% of women are affected after a vaginal delivery. Trauma to the levator ani and external anal sphincter muscles are major factors for urinary and faecal incontinence and pelvic organ prolapse.
Such injuries are likely to be associated with psychological trauma, partly because of overlapping risk factors, and partly due to resulting pain, sexual dysfunction, changes in body image and symptoms of pelvic floor dysfunction.
After two years of gathering and analysing women’s recounts of their traumatic vaginal birth experiences, midwife and co-author of the research Elizabeth Skinner, identifies symptoms of post partum PTSD such as poor baby bonding, flashbacks during sex, dissociation, avoidance, and anxiety, in 67.5 per cent of her interviewees.
What is even more harrowing is that over half of the women interviewed said their partners were also traumatised, 90% said they were not prepared for what actually happened and 65% said they suffered dismissive reactions from their clinicians over their maternal injuries.
“Women just put up with this “hidden injury” as they are too embarrassed to discuss symptoms with clinicians who frequently do not believe them,” says Skinner.
Lack of information
Skinner flags this as a feminist issue due to the lack of information given to women about the risk of vaginal births, and the pressure they face to reject medical intervention.
“Previously feminists fought to return control to women giving birth. This is still true but the new 21st Century feminist issue is ensuring that women are correctly assessed for their risk of complications and given full and frank information to prevent such injuries.”
“Would women proceed with a vaginal delivery if they were appropriately counselled about the risk of urinary and faecal incontinence and/or compromised sex lives? Idealised images of the birth process without accurate education and consent can cause poor long-term clinical and mental outcomes.”
This isn’t just a case of the health system educating expectant mothers on the risks of vaginal births as part of their prenatal care, it’s also about a lack of choice as in many public hospitals women are not given the option of a caesarean delivery unless there is a medical reason.
The policy to reduce caesarean births has lead to an increase in the use of forceps during vaginal deliveries and a tolerance for longer periods of pushing during the second stage of labour, both of which increase the risks to the mother and baby.
The University of Sydney’s Professor Dietz confirms, “The forceps rate has doubled in NSW over the last 10 years. At some hospitals quadrupled. That means much, much more damage is done than ten years ago — in some instances twice as much. This is largely a result of the attempt to reduce the caesarean births rate.”
While the study is not against vaginal births it does highlight the need for awareness.
“We need to build bridges between midwives and doctors so we can all work together better for the best interests of the patient,’ says Skinner. ‘At present we have a very short-term view. We make sure the baby is alive and then we leave, with little consideration for the long-term physical and emotional well being of the mother.”
Have you ever had a traumatic birth experience?