“We make sure the baby is alive and then we leave”

“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 wellbeing of the mother.”

Anecdotally most women will know at least one friend who has required reconstructive surgery following their vaginal birth. In my case I have two friends who waited years before they had the courage to see their doctor in order to have serious issues fixed.

Why is it we don’t talk about it? Why do we seem to think that physical trauma is just all part and parcel of birth to be endured in secret?

Skinner is a co-author of a new piece of research looking into the psychological consequences of tramatic vaginal birth.

The women Skinner (an experienced midwife) interviewed were all low risk first time mothers. From a population of 850 births evaluated, 70 were identified as having major pelvic floor trauma (1 in 12) and 40 agreed to participate in the study. Of these 40 some had given birth without intervention (14), some with ventouse assistance-vacuum (8) and some with forceps (18). Of these women 100% suffered ‘levator avulsion’ (where part or all of the pelvic floor muscles are pulled off the pubic bone on one or both sides – resulting in urinary incontinence and/or urterine and/or bladder prolapse) and 55% suffered major obsetric anal sphincter tears.

Co author University of Sydney’s Professor Dietz says “Only about 25 per cent of women get a non-traumatic normal vaginal delivery that did not do serious damage to their pelvic floor or their anal sphincter” and continues “The forceps rate has doubled in NSW over the last 10 years. At some hospitals quadrupled”.

Dietz suggests that in trying to reduce the caesarean rate, other forms of intervention are once again on the increase.

Once again the lack of balanced information is making it very difficult for women to make an informed choice about their mode of birth.

The following findings from the study make very depressing reading…

  • Inadequate antenatal education (reported by 72.5% of respondants)
  • No information from clinicians regarding the possibility of postnatal pelvic floor issues (reported by 90%)
  • Conflicting advice before, during and after birth (reported by 87.5%)
  • Partners traumatised by events (reported by 52.5%)
  • Long term sexual dysfunction / relationship issues (reported by 67.5%)
  • An absence of postnatal assessment of injuries (reported by 90%)
  • Multiple symptoms of pelvic floor dysfunction causing lifestyle alteration (reported by 87.5%)
  • Putting up with the symptoms quietly (reported by 90%)
  • Symptoms of PTSD (Post Traumatic Stress Disporder) (reported by 67.5%)
  • ‘Dismissive reactions from clinicians’ (reported by 65%)

Skinner and Dietz believe that physical and psychological birth trauma is a major public health issue with “forceps being the main risk factor. Only a small proportion of anal sphincter trauma us optimally repaired, and major levator trauma is rarely diagnosed and never repaired”.

If postnatally your pelvic floor exercises do not appear to be improving symptoms it may be you have suffered ‘levator avulsion’. A simple explanation of this tramua can be found here. Go to your GP and request further investigation and support – there are options.

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