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MNHQ here: the impact of birth on women's bodies, wellbeing and sex lives(278 Posts)
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Today we're launching the next phase in our campaign for Better Postnatal Care, highlighting the impact of birth on women when it comes to things like prolapses, genital and/or anal wounds, and continence.
Figures we're releasing today reveal how many mothers are struggling with physical symptoms associated with prolapses or wounds, painful sex, and problems with continence, months or years after their babies were born.
You can read more detail about our survey here, and The Pool has this morning published a piece based on our stats if you fancy having a read.
The Chief Medical Officer’s Report of 2014 found that ten years after giving birth, around 20% of mothers will experience urinary incontinence and around 3% will experience faecal incontinence as a result of their pregnancy and birth experiences. And according to the NHS, up to half of women who’ve given birth will experience some degree of pelvic organ prolapse. You can read more about the current picture in the NHS here.
What do you think we need to be calling for to tackle this issue head-on? Do we need the collection of long-term data? Do we need to bring back the six-week check for mothers (which has become postcode-dependent now that it's no longer included in GPs' contracts)? And what can be done to encourage mothers to overcome taboos, shame and embarrassment associated with these symptoms and proactively seek help, and ask for second opinions where necessary?
We've made some suggestions here, but we'd love to know what you think. NHS England is actively looking at how to improve postnatal care at the moment, and so many healthcare workers we've spoken to are aware of the problems and looking for solutions - it feels like the right time to come up with concrete proposals.
So, as ever, do please let us know what you think!
If you'd like to join our mailing list of campaign supporters so that we can keep you up to date with the nuts and bolts of the campaign, please email us on email@example.com with 'Campaign Champions' in the subject line.
PS We very much welcome thoughts from everyone on this bit of the campaign, but for those wondering where experiences of CS come into all this - we will be doing a piece of work on that next.
Are these things more common now? Mine are adults and I haven't suffered anything detrimental after giving birth twice. Nor have any of my friends who had children around the same time. My mother has never had any problems and has home births as did her friends and family.
My own observation of women I know giving birth in the last decade is that they have much longer time spent in labour. Is this what is causing the health problems?
Decasanova - I know lots of women who have had complications from birth. The push for "natural birth" and it's long term health benefits of increased breast feeding rates, bonding, improved mobility in the short term etc has come at a detriment to women's vaginas. Now that more risk is known about health of Mum and baby during pregnancy (eg diabetes, pre-eclampsia etc) there are more induced labours which are more likely to lead to an instrumental delivery.
Both my babies showed signs of worsening health in the last few days thanks to some sharp observance by the NHS but I was induced twice for a "natural" labour and ended up with a dreadful forceps delivery the first time leading to absolutely appalling defects.
There is no weight to the complications on a vagina when discussing whether or not to plan a c-section or book in for an induction. It's not considered a medical complication to be horrified at how scarred you are, lack of sensitivity, mild prolapse etc are all considered "normal" and something that women should put up with. How many times I have mentioned my problems to other women briefly only for them to joke that they daren't get on a trampoline. It's just to be expected that women who've had children piss their knickers every now and then.
They have only just created a machine to test women's sensitivity after child birth, quite frankly no one cared whether women had any sexual sensation before now. I've been one of the very few participants in a medical trial regarding the machine. It was designed by men with no women consulting on it's design - even if I hadn't been told by the doctor conducting the trial, you could tell.
Can only echo the above. 2 short labours for me and no problems nearly 2 decades later.
Are there more instrumental labours? Fewer active, “natural” births? One Born looks like torture with the lying flat, drips, shouted at to push and so on.
I put in my birth plan that I would not consent to a forceps delivery and to go straight to a C section. (One birth centre and one home birth so no intervention).
The thing is Frith, that once the baby is in the birth canal and ready to be delivered and it's not working - as far as I understand it is very difficult to have a c-section and not something they advise doing.
And it didn't matter how distressed I was once I was in active labour and requesting a c-section, my concerns were dismissed and I had to progress as they wished. Not as I wished.
A really timely and important campaign! While women are being silenced for speaking out about womens rights and the word 'woman' is slowly being appropriated by non-women, we have a situation where post-birth suffering is going unnoticed and uncared-about by most of society.
It IS taboo to talk about incontinence, prolapse and sex pain. But it was also taboo to talk about menstruation until quite recently so perhaps we can turn the tide. The statistics on post-birth injury and trauma are horrific. I consider myself "lucky" to only have stress incontinence after two induced (one assisted) and somewhat traumatic deliveries. And thats not good enough.
Excellent campaign and its needed. I had several problems including a deep tear and minor prolapse, and was just left to deal with them.
Years later my GP flagged the scar as a potentially cancerous lump because it wasn't on my medical records.
I have two prolapses as a result of a back to back labour with over three hours spent in the actively pushing phase ending in an episiotomy. Thankfully I was referred automatically to a pelvic floor physio due to the time I spent pushing so am not incontinent but the prolapses remain. I didn't think much of it until a family member who is a mw was horrified I spent that long pushing as her hospital don't allow women to push for more than two hours without help. I do think that contributed to my prolapses.
I had 2 natural births, both with episiotomies and forceps-with my first an unfortunate incident by the midwife resulted in my newly sewn up bits being caught in the bed (the bottom part of the bed comes away during delivery and as she put it back caught me resulting in haematomas on my perenium which required over night stays with a new born to treat) and 8 years of pain followed- I had 3 vaginal repairs, Botox, nerve blocks, neuromodulation - eventually found out my pudendal nerve was damaged.
Now most of my repair had to be claimed on my private medical insurance. Most of the treatment I had to repair was not available on the nhs such as the injections and Botox- I was fobbed off from the nhs.
What would have made the difference to me?
Not being rushed through labour to free up the bed.
Not being stitched at the end of the bed rather than in a theatre.
A midwife trained to use the the bed.
Post delivery pelvic physiotherapist.
A gynaecologist that had the time and resources to investigate my pain.
Proper pelvic floor ex classes not just leaflets. You need someone to show you HOW to lift not just tell.
Ready availability of physio.
GPs trained how to examine for prolapse. Mine says I don't have one. Well there is something bloody well coming out of my vadge when I go for a walk. But she examined me lying down so guess what, no she can't see it. Therefore no physio referral and having to fund that privately. Luckily I can, just.
Oh and btw I had 2 easy births. Home birth with no pain relief 3 y ago, induced labour lasting 17 minutes 6w ago, no pain relief again. No interventions beyond a sweep and manually breaking waters.
Sorry i don’t think I answered the original question! How to encourage women to talk about it- the overwhelming response I got from professionals downplayed the impact it was having on me. I was told “it will never be like it was before kids (I know but I was 23 and couldn’t wear jeans let alone have sex!), I was told the pain was in my head and also that sex would be painful for a while but I had to “use it or lose it”.the nhs did not seem to recognise that it was a problem that needed fixing rather than one to be endured.
The nhs needs to realise that sex pain post childbirth impacts relationships, does need fixing and provides somewhere for people to self refer to specialists in post birth trauma. A one stop shop!
I'll be following this with interest, thanks MN!
I think antenatal education needs a lot of improvement about what to expect postnatally in terms of our bodies and gynae health etc. I'm due very soon, and no-one has ever mentioned (although I've an otherwise great GP and MW), nor have I seen any leaflets, aside from the very generic pelvic floor ones I got due to PGP. Luckily as a former staff nurse and HV I'm not totally in the dark, but obviously it's all so different with your own labour looming.
Data collection has to be the starting point- only then will an accurate picture of service need really be known. Hopefully this might lead to improvements in care.
More accurate information would help I think.
Pelvic organ prolapse is a risk of pregnancy, not an elderly problem.
Mild urinary incontinence is not the only problem women encounter. Some need a catheter for a while to be able to void, some are completely incontinent for a few days or weeks. 10% suffer from bowel incontinence (information about that problem is completely absent).
Also, there should be more awareness about serious birth injuries (3rd, 4th degree tears and fistula). At present no one talks about these and the general attitude seems to be that women should get on with it when in fact they have sustained serious injuries, sometimes life changing and instead of being allowed to rest and being nursed, these women do an incredible job of looking after their newborn. Information needs to get out and attitudes need to change. I don't know how well these injuries are recorded but I suspect women leave hospital having been ticked as healthy when they might not be. So data yes.
Pressure to EXCLUSIVELY breastfeed should stop. Whether baby is healthy should inform what type of feeding is needed. If it means giving a couple of bottles of formula, so be it.
I think really there need to be pelvic floor ultrasounds as routine at 6 weeks postpartum. At the moment any help is reliant on getting a GP (who is not a women's health specialist in most cases) to diagnose before anything is done, which means most women (if anything like my experience) are just sent away being told it's normal to have poor sensation/incontinence/unable to use pelvic floor muscles/anorgasmia. In part I think because women's sex lives are seen as unimportant, but whatever the reason, it's practically impossible to access postnatal care that is routine in other parts of Europe.
I have (recent) post natal experience. I had an episiotomy and ventouse and I have no idea how injured I was.
The midwives only cared about checking my stitches in the first few days - and even then they missed the fact they’d opened and got an infection. I had to push for a swab for, then they didn’t follow up and it was only because I asked what the results were that they looked it up and turned out I needed antibiotics.
I had a six week check but my GP didn’t even look “down there”.
Because my infection was missed and my stitches came apart I saw a consultant gynaecologist who said I had “a mild prolapse” and that I’d “probably need a repair once your family is complete”.
I have no idea what has happened to my vagina. I have no idea what I’m supposed to do next (everyone seems to have shrugged as though this is all par for the course)?
Two straightforward vaginal births, some tearing and stitches in and outside. Ostensibly healed well. I'm in good health generally, not overweight and don't have any conditions or take any medication. I do however piss myself if I cough when I'm tired, or if it's a big cough. I wouldn't have thought it worth going to the doctor for although it is rubbish and rubbish that we put up with even small consequences like that, just as "one of those things".
My sex life has been OK with new partners although I believe the trauma of giving birth put me off having it with my husband from that day forward. It was offputting that anyone would think I wanted to be roughly irrigated (for want of a better place) in a place which had been torn and injured and bruised, although that might say more about him than sex in general. We're separated now. I think even a straightforward birth is traumatic and I've pondered if "baby blues"/PND is a form of PTSD.
Thanks so much for all the comments so far. A few thoughts below - just want to flag that we at MNHQ aren't experts - our information comes from reading MN threads, working with various NHS working groups, and conversations with healthcare practitioners who are experts in this area. So please do chip in if you have specialist knowledge and/or personal experience.
@decasanova There is a train of thought that births are getting more 'difficult' because of maternal demographics: women in labour are more likely to be older, and to be overweight, both of which can increase the likelihood of complex births. Organisations such as the RCM are keen to say that pointing this out isn't about shaming mothers - but it does mean that midwives are being expected to handle increasingly complex births while operating in a very resource-constrained environment.
@fauxgina We went on a hunt for research into whether instrumental births had better or worse long-term impacts on women's health (compared with non-instrumental vaginal deliveries, or CS) and with the exception of a few small studies there seems to be almost nothing on this in the scientific literature. For example, this Cochrane review concluded 'We identified no studies meeting our inclusion criteria.' This is one of the reasons we think data collection might be really important. Here's a list of NHS England's national data sets.
Some interesting research we've been made aware of:
The Cochrane Incontinence project is looking at maternal incontinence and pelvic organ prolapse (POP), among other things;
Professor Cathryn Glazener at the Health Services Research Unit at the University of Aberdeen specialises in incontinence, and in previous research has investigated the causes of perineal pain;
studies have investigated difficult or painful sex after birth obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2000.tb11689.x;
RCOG and RCM's OASI (obstetric anal sphincter injury) project is investigating the rise in OASI cases in the UK over the past ten years, and has found that guarding the perineum during delivery seems to significantly reduce third-degree tears.
To everyone who's spoken about postnatal physio: there's a trial underway right now into the effectiveness of this and we've been invited to a stakeholder day at The Shard in London in June - they'd like a couple of MNers to come along (you don't have to have personal experience of physio) to contribute. If you fancy coming along do drop us an email on firstname.lastname@example.org and we'll give you the details. (There are travelling expenses, and babes in arms are welcome - but no facilities for older children.) [EDITED BY MNHQ to correct 'April' to 'June']
And to those who've talked about more information antenatally - yes, this is another thing a few clinicians have raised with us: the importance of women understanding what a 'red flag' looks like, postnatally, and knowing where to get help. This would mean more information antenatally, and also postnatally.
@insertquirkyname Oh my goodness - your account of being sewn to the bed (if I read that right?) is horrific!
to all of you who have shared your experiences here, thank you
I asked for advice about a suspected prolapse during a smear test last year, only to be asked whether my husband had noticed anything. When I replied that we weren't having sex at the time (because of my discomfort, the nurse made a sort of wide-eyed chicken bum face and said: "Oooo, bet he can't be very happy about that!" I nearly cried with frustration. And didn't ask her what she thought I should do next. Haven't been to see anyone about it either, although symptoms have improved a bit.
Could there be an online assessment?
I know a physical examination as well as a questionnaire is optimal care but an online questionnaire would detect a lot of issues.
Like others have GP don't necessarily seem to know what questions to ask.
@rowanmumsnet not stitched to the bed- sorry- I was stitched in the delivery suite rather than in a theatre- I Had hundreds of stitches as was cut right up to cervix then tore through perenium- it was a bed where the bottom part came away and there was a tray for all the janky stuff to fall into - as they put the base of that back on they clamped it shut with my bits in there rather than lifting me up the bed!
I don't think women coming on here saying 'well I have had 10 kids and I'm ok.. ..' is particularly helpful. These issues need to be almost 'normalised' so women don't feel scared or embarrassed to share with friends or their GP. Thinking no-one else is in the same boat makes it worse. I had a back to back labour and was left in second stage labour for 4hrs. I then had forceps. It was horrific and I was left with a prolapse which affected my physical and mental health terribly. I have had more children but only because they agreed to a c-section. Ironically the only thing which has helped is having the 'vaginal rejuvination' laser treatment which has cleared my symptoms and changed my sex life. What's the answer? Who knows, I don't think instrumental deliveries should go ahead after a prolonged 2nd stage, it's a hard one unfortunately.
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