Appalling failure of the NHS Obstetric services to detect birth injury to mothers.

[purpledalmation]

I was listening to a webinar about birth injury, and listened to two colorectal surgeons talking about the damage done to a woman's genital/rectal areas during vaginal delivery childbirth.

I was shocked and horrified that prior to stitching up the area is not properly or routinely examined resulting in external tears being stitched, leaving internal tears to heal badly and never to return to normal because the window of opportunity is closed and scarring and abnormalities result.

This results is urinary and faecal incontinence, wind, urgency to poo, poo accidents and so on. An absolute nightmare to women and often meaning they can't return to normal working, can't have further children, experience pain during sex, pain, and embarrassment.

masic.org.uk/ This organisation is campaigning for better care.

The area is properly examined, I'm not quite sure what the surgeons are on about! A midwife/doctor isn't going to start stitching without knowing the extent of the trauma. a PR (rectal examination) is offered to ensure a tear hasn't extended into the anal sphincter

No this is incorrect. Some obviously may be but not all. I listened to testimony from a solicitor who was not properly examined, stitched inappropriately and has continued to have pain and problems years later. She could not continue with her job because of this and is now self employed.

Also on the webinar testimony from a colorectal surgeon saying just this. By the the time he sees the patients they are too damaged to repair adequately. If you don't believe this go to the MASIC website and look at testimony.

Birth trauma to women is vastly underestimated because of the shame factor. What 30 year old wants to disclose faecal incontinence to their employer?

And as for women in their 20/30s needing incontinence products...

The area absolutely is properly examined. Always.
It's an essential part of the midwife's job.

You are taking these cases and assuming this is normal practice. It is not. I’m not saying this hasn’t happened to the people reporting it, but these cases are thankfully rare. It is good practice to always perform a rectal examination before suturing

20 years ago I tore quite badly during birth.
they literally just stitched me up No one checked internally at all.
. At one stage I couldn’t wear a tampon a pad was hell and sex was so so painful
I was fobbed off at every turn - they simply didn’t believe me
eventually after a lot of me keeping on pushing for answers I had 4 operations and
Things still aren’t right
Bearable but not right

Hm. After my home birth the nhs midwife did some perineum stiches, then did an internal exam of both vagina and anus, said she “wasn’t happy” with the amount of tearing, transferred me to hospital, where after a couple of hrs wait I went into surgery and had the midwife’s stiches removed and redone with about five people focused on sewing me up properly inside and out. Was a 3rd degree tear.

Never had any problems since, so can’t complain.

I was definitely properly examined after both of my births. One with an episiotomy and
one with a tear down the episiotomy line. While there are no doubt there are cases where mistakes have happened as per the ones you looked it, it really doesn’t help women to say that bad practice is the norm if it isn’t.

I don't think cases of badly treated serious injuries are as rare as we are led to believe. Anyone who has been on mumsnet for long enough can see the OP is correct. Head to the Women's Health section to read comments by many women who had been left with avoidable, debilitating issues. It's not good enough and what I read in here certainly matches the experiences of many of my relatives, friends and acquaintances.

This is an important issue and a feminist one- thank you for sharing OP.

When I tore 20 years ago I was on no drugs, so I remember it, and no one checked me internally. I was left in stirrups for nearly an hour, bleeding, after birth before anyone actually came round to stitch me. I had to ask for someone to check my back passage a few days later as it felt horrible and she only did a visual check.

I had an episiotomy 11weeks ago and I remember the (female) doctor who performed it, also examined me post birth, in order to assess what repairs I needed. I'm no doctor, but I remember her carefully examining me first.

I'm sorry, but you cannot generalise like that!! Of course midwives and doctors inspect the area prior to suturing. What do you think we do? Stick random sutures in and hope for the best?

Of course there will be some women who are negatively impacted, and some who are left with life long complications and this is extremely sad, but you can't make a sweeping statement like that and each case would need to be investigated.

With the best will in the world, giving birth, vaginally, to a baby ranging in size anywhere from 6lbs-11lbs is going to likely change a mother's anatomy! Doctors and midwives will suture tears and episiotomy, and advise on how to look after them and keep them clean but after that, how a tear heals is mostly up to nature 🤷🏻‍♀️

20 years ago I had a whopping child, born back to back. I had an episiotomy but tore too.

Some 7 years later went on to have DD. After a fast birth, she shot out, and unbeknownst to anyone, I tore BEHIND my episiotomy scar.

I was left in extreme agony (worse than labour) for multiple hours, while I bled internally. Apparently they thought I had 'after pains'...

I was eventually almost unconscious when they examined me, to discover a life threatening perineal hematoma. After extensive survey where I almost died from blood loss, I am left with huge amount of scarring. Thankfully it healed ok, but there is still numbness and occasional discomfort.

I post for 2 reasons - 1, because it's an often unmentioned possibility after having an episiotomy. More awareness needs making around it.
And 2, it was due to negligence and not listening that it occurred in the first place. Women need to be believed and listened to. We know our bodies better than anyone else and this is such a huge area where changes need to be made.

I've seen the very best and the worst of women's care in this country. It needs to be better.

I've had two vaginal deliveries.

One, I was checked after - the nurse wrapped her hand in gauze then gently inserted it into me to check for bleeding. Whilst I was in the delivery suite. I was also asked again by visiting midwife at home, if I felt everything was healing ok (no tears, no grazes)

The second time, there was no examination at all. No questions no checks.

Recently, I've been diagnosed with a moderate frontal prolapse and a minor rectal prolapse. The moderate I am being treated for.

The first thing the specialist said? It should have been picked up after birth/any subsequent examination (e.g. smears etc). Instead it appears, no one could be bothered. And as a young woman (then, I'm now just a woman) I was a)under the assumption what I was experiencing was normal, and b)too embarrassed to check.

In fact, it had to get to the point of it directly impacting my life, ability to do my job and even walk, for me to seek help. And after that, it took 6 months of being told I had a UTI, despite no symptoms beyond needing to pee frequently.

So, yes, I do think the care after delivery is appalling. And I do think women get screwed.

The woman having to manually disimpact on a daily basis.

www.mumsnet.com/talk/am_i_being_unreasonable/4549623-post-birth-trauma-severe-damage-to-rectal-area

I was absolutely not checked after either of my births.

First one, I got lucky.

Second one, I was left torn internally and was in agony for years.

Midwives just kept looking at external stitches, said they were healing nicely, and that if I didn’t feel right, I should “give it time”.

That was 16 years ago 🤷‍♀️

Exactly, its far more common that people think. The most shocking thing that came out of the webinar was that women didn't speak up because of shame. To me that is just horrifying.

Maybe you should look at the numbers of women suing the NHS for these birth injuries, instead of making sweeping statements that everyone is properly checked? Clearly not everyone is.

@brewtastic @Sep200024 @JustFrustrated @Heatherjayne1972 @Habber I'm really sorry this happened to you.

For people saying this is scare mongering I suggest you actually look at the MASIC site. These are not isolated incidents occuring many years ago, these are still happening. Suggestions on how to better prepare women for the second stage of labour and full checks by a doctor would be a start.

and if one woman reads this and kicks up a fuss if things don't feel right, then I'm happy with that.

I had an episiotomy and forceps for my first baby. I tore very badly and I was told that the doctor performing it had gone through an artery. I lost 3 litres of blood and needed a blood transfusion.

I remember laying on the bed having my blood transfusion the following day and team of doctors came to assess my injuries. I can't believe they could see the extent to be honest as I was so swollen and had something called packing. It was horrible. I was in pain for a couple of months after.

I also tore whilst having my second, needed stitches but fortunately healed much better.

Maybe the doctors who did my episiotomy and forceps were at fault, maybe they were too quick but maybe they had to be as ds was in distress. I chose not to take it any further. Not sure if this was right or not.

What was the podcast OP?

This is why I posted.

I'd never heard of a tear behind a scar before. It nearly cost me my life and had a huge impact on the bonding with my DC, as it was such a traumatic event.

I can believe that.

After my extremely fast ( c 20min) delivery of twins, they checked and stitched.

But.

They didn't tell me there was another tear they'd decided not to stitch and because I was allowed to stay in hospital with DTs as they were in NICU that ironically meant there was no aftercare at all, not even the normal stuff most women get.

Because that's delivered by community MWs who obviously come to your house, not the hospital. And bc I had been medically discharged after the birth, no one in hospital would look.

I ended up getting an infection and later went to a private women's physio. 5y later and things don't feel "right" and I am too scared to run, but not in pain and can lift weights, so not complaining.