Why is it not common knowledge what happens to you??

[rubyred84]

Firstly, a little disclaimer, I have tokophobia, so am coming at this from a point of bias anyway.

But I just think it's so awful that no one prepares women for the true possible after effects of childbirth. Prolapse, continence issues etc. Even tears. 90% of women tear in some way. I don't think that most first time pregnant ladies know this....i think it's seen as unlucky to tear, when it's actually the norm! And 45% assisted births. It just feels like a massive conspiracy, the ability to have the natural, no damage, no intervention, birth. Its actually much harder to achieve than we are led to believe. Only once your "in the club" do you realise from talking to other women/reading on sites like this, that birth injuries to mothers are pretty normal. And when you speak to doctors about issues afterwards, they look at you as if to say "didnt you know this could happen? Its pretty normal" But the risks of vaginal birth are never discussed before you have a baby.

You can probably tell I'm anxious, but I just feel like I've peeked behind the curtain so to speak, and it all feels so dishonest.

This is quite an old article but was one I came across a while ago when trying to find out data as to how common birth injuries are. I still haven't been able to find any reliable data - this article gives some reasons as to why - I.e there is no central database and also many women live with injuries out of embarrassment. I'm currently tossing up whether to get an ELCS or not (I'm private so have a choice). And it is a really hard decision to make because of the total lack of data out there. I agree these things need to be spoken about more generally but also there should be more recording of injuries and what goes on so women are informed.

www.theguardian.com/lifeandstyle/2010/dec/10/torn-apart-by-childbirth

Hi Swan8,
The Royal College of Obstetricians and Gynaecologists puts the figure for 3d and 4th degree tears at 3% overall. 6% for first time mums.

www.rcog.org.uk/en/patients/patient-leaflets/third--or-fourth-degree-tear-during-childbirth/

Of this does not take into account the individual profile of a woman. Giving birth for the first time after age 35 increases the risk.

You can look up maternity indicators by RCOG again to find out what rate of severe tears hospitals have. This can widely vary. Up to 10% in some hospitals.

I don't fully buy into the 'our bodies are designed for it, so we'll be fine' line. It very much depends on your definition of 'fine'. You'll probably be alive at the end of it, if you live in a developed country, yes. But fine?? Hmmm

From the perspective of continuing the species, the process works well enough. It generally ensures that offspring are born live, but nature couldn't give a shit about what happens to the mother. Even if she dies, her genes have been passed on, so job done.

Human evolution it at its limit when it comes to childbirth. Human infants are born pretty helpless compared to other primates because if their head were any larger, they wouldn't fit through the pelvis during birth. Adult female pelvises are narrow as humans evolved to walk upright and narrow pelvises are a necessity for this (men have even narrower pelvises as they don't need to give birth).

So I personally take no comfort in the
fluffy idea that we're 'designed' for it so everything will turn out rosey.

I agree OP. However I am one of those people who doesn't actively share my birth story with first time pregnant women because it was a total horror show and I don't want to scare them to death! When I was pregnant, rightly or wrongly, I really didn't want to hear other people horror stories. I did NCT which gave me the idea that birth, whilst painful, was manageable and best left to nature. Couldn't have been further from my experience but I suppose the plus side was I was never worried about labour or birth and I didn't panic when my waters broke. I thought 'It's ok, I've got this. Let's go'.

I didn't 'have it' at all in the end as I had PROM at term and no contractions which led to a horrendous drip induction, several forceps attempts, severe shoulder dystocia, and my baby being basically dragged out by hand. I then had a bad PPH and surgery for a retained placenta. More cuts, tears and stitches than I can count and I had actual big bruise handprints on my belly where the doctor was shoving baby down and out while someone else pulled. If I had to describe my birth in one word, it'd be violent. It took me a good twelve weeks to physically recover, longer mentally. I felt for a long time that I must have 'done it wrong' for it all to go so tits up. That was partly due to my unrealistic expectations set by NCT and only choosing to listen to nice stories so I do get where you're coming from.

However saying all that, my DD and I are very lucky in the fact that we are both fine, both recovered perfectly eventually. I have to have an ELCS next time, which is no bother to me, I'd rather that. And it clearly wasn't SO awful that I'd never think of it again because we're trying for number 2 in the new year.

Plus, not everyone has a horrible time. I've a friend who's currently having her fourth, and her babies pop out easily in a matter of a few short hours with barely a graze, and they have all been big babies. She's always induced at around 38 weeks because of GD and has never experienced the drip in the way I did. We're all different, for every horror story there will be one of a mum serenely breathing her baby out.

I think it's up to the woman to inform herself about the risks and realities, there is no excuse when we have the internet and NHS and other websites with facts and figures. I had prepared myself for a much worse experience than I had. I was very lucky that I had a relatively easy labour and birth, 17 hours start to finish, only needed gas and air in the final few hours and had no tearing, no intervention. But I had been slathering my bits with almond oil for weeks and doing perineal massage as I had read that it can improve your chance of not tearing. I was also allowed to give birth kneeling up, lying down during the pushing stage increases the risks of interventions and tearing, again I had read up on this as I wanted to be as informed as possible about the life changing experience I was about to go through. I also kept very active during labour, walking and bouncing on a Pilates ball, until the pushing stage when I got up on the bed. I think the information is out there but it doesn't occur to some people to find it, or they are discouraged from informing themselves because of 'horror stories'. Obviously a lot of the time there are uncontrollable factors that will make it a lot more difficult, but it is within reach of most to put into place some preventative measures.

silkpyjamasallday
Professionals tell us of an increased risk of a child having Down syndrome for mothers over the age of 35 or an increased risk of autism in children born to fathers over the age of 45. I'm not sure why it stops being their job telling us women over the age of 35 giving birth for the first time or women who are obese have an increased risk of severe obstetric injuries.
There needs to be general awareness about these injuries (not least so women who suffer from them get the compassion they deserve) and at the moment there isn't. I think it's starting to change because there have been a few articles about birth injuries in the press recently. Also the Montgomery v Lanarkshire court case is forcing the NHS to look at issues around consent and is therefore bringing those types of risks to the fore.

I was totally mortified when pushing out my first that I pooed. I felt as if I'd committed some terrible act and would be looked down on/revolted the midwife. Turns out it's very common. I was never told that !

Also may I add- I feel nobody talks about their 'downstairs' afterwards. I'm TTC but I would like a heads up on how it's going to be, is it going to be much different during intercourse with my partner? If it's so damaged and different I'd have an ELCS. I'm also fearful of V birth. I'm terrified it will ruin intimacy between me and my partner. I wish there was more information out there on exactly what it's like afterwards so I could make an informed decision to weather I wanted to risk it.

@Batterseapark thanks very much for that - I will take a look at that website now. It isn't just the tearing that worries me - it's also the other things that may not be picked up straight away and reported - e.g. urinary incontinence, faecal incontinence. Maybe I have a skewed impression of how often these things occur from reading posts on Mumsnet, but it does seem a lot of posters have suffered pretty awful and sometimes life altering injuries. I'm one of those over 35 first time mums too!

I feel exactly the same. I think a lot of the information available to mums to be is presented in a very fluffy don't worry it will all be alright way and tries to stay away from the bad things that can happen so as not to worry you. I don't find this reassuring at all.

The whole your body was designed for this is the biggest load of crap. Intelligent design is not a scientific theory and anyone who believes in it should not be allowed to have anything to do with delivering people's babies. In nature a lot of mothers and babies do die.

My grandma was a midwife in the era of call the midwife and she said what it was really like would not make for Sunday evening viewing. Yes more people had a natural home birth and it was common to have a breech baby vaginally. At the same time mothers and babies were more likely to die. A lot of people struggled without pain relief as it was rarely offered. Women with chronic health conditions were told not to have children because they would die.

I don't find it helpful that a lot of the information is geared towards low risk women. Yes if you are low risk you are likely to have an easier time and a lot more options but not everyone falls into that category. It is harder to find good information about higher risk birth.

When I had my first, I wanted a lovely natural birth and felt my body was designed for this, I was low risk. Midwife happily went along with my ideas, didn't suggest anything else.

Then I went into labour, 46 hours of painful contractions, got to 6cm and a consultant realised my son was breech and I was rushed off for a scan to confirm and then a c section which ended up being given under GA as he was distressed.

Nobody had ever spoken to me about c sections or suggested I read up about them. I didn't even know if you still bled after a c section. I felt like I had failed because my body was made to give birth and I hadn't managed it.

Perhaps because it took a couple years to decide yes, we were going to TTC and then another 3 years to get a BFP I'm really surprised by people saying they 'didn't know' and 'no one told them'. Who, exactly, is supposed to tell you and when? And how low risk should they go?
If it's 1 in 10,000 that you'll have a particular problem, you'll only wish you'd been warned if it happens to you. We didn't tell anyone we were TTC so it would have been wildly inappropriate for anyone apart from the doctors we were seeing to start giving advice plus dealing with infertility I was really not into hearing about how haaaaaaaard it is having the 2 kids you always wanted slightly closer together than you meant to. (I mean, I'm sure it is - just tell someone else about your BF/potty training/sleep woes)

And once you're actually pregnant, there's no point in scaring people, really. Most people I spoke to (friends, cousins, aunts...) shared as much as they thought I was ready to hear and I think I still ignored most of it as 'oh, that won't happen to me' or 'oh, things are different now' (and, to be fair, a lot of it didn't and some of it wouldn't have helped to expect it).

Also, there's loads of information available online now, particularly individual stories, bloggers, forums... the official line isn't the only one now so as long as you take a couple steps away from the Bounty magazine, you can get as much information as you want at whatever stage you decide to start learning. I'd got a pretty clear idea that getting a baby out might be even less amusing than getting it in had been. Likewise, that they might not sleep, that BF hurts, that making up bottles in the night is a pain... but equally, that many, many people do it and most people are OK, some are great, some suffer a lot and it's a lottery.

@Phryne
One issue is going to antenatal classes (well to try and get some information) and being told about postpartum psychosis (which is right because it's a psychiatric emergency) which represents about 0.2% of mums and never being told about bowel incontinence which concerns probably around 10% of mums (figure from patient.co.uk). We're not talking 1 in 10,000 here.
There is a blind spot to do with women's health issues.
For me the issue is as much about women being aware so they can make individual birth choices as it is about raising awareness of how physically traumatic (labour being painful is covered but not the aftermath of some births) giving birth can be so women who go through these experiences are not ignored or told it is all "normal". If it is "normal", why is it not explained upfront?

No, @sausagepastpot, you have not attended NCT classes as a translator, and if you don't know why then you should not be doing it.

Sorry for the derail, but it really gets my goat when people who are supposed to be professionals don't know the first thing about their job.

I never realised tears were that common- I was very lucky that I didn’t tear, or need any assistance. I was 21 when I had my son. I also only needed gas and air.

I had a healthy happy baby. No tears. No assisted delivery. I was up and in a shower alone within an hour of having my son and was happy to walk to the postnatal ward from the labour ward but wasn’t permitted to.

So although it may feel as some people sugar coat it- for me it was actually a pleasant(but painful) experience, and was probably MUCH easier than a c section although I understand not everyone has the same experience.

I agree OP. I had my first over 8 years ago and the trauma and damage still haunt me today. I had absolutely no idea how horrific it was going to be. I had done NCT, read Ina-May Gaskin and Ju Ju Sundin and was all geared up for life-affirming proof my body was made to do this. Ha ha ha [hollow laugh]

I had my second by ELCS because by then I'd worked out that CS is not the worst outcome and avoiding one shouldn't be the primary consideration if you are going to have a baby with your mental and physical well-being still intact.

I've just been looking at patient.info and found this depressing little piece of information (no one told me about this!!):

"How many women are affected by genitourinary prolapse?

It is difficult to estimate how many women are affected by genitourinary (GU) prolapse because many women do not visit their doctor for help. It is thought that around half of all women who have had children have some degree of GU prolapse but that most do not seek medical advice".

patient.info/health/genitourinary-prolapse-leaflet

I don't think knowing all the bad points would help first time mothers at all. I went into the birth of my first child very naive and sure that nothing bad would happen to me. Well it was extremely fucking painful but I didn't tear and my son was fine so I suppose I got away lightly. My second birth was quick and luckily once again I didn't tear.

I'm trying to think whether anything else could have helped me prepare for my first labour and I honestly think the answer is no. I had copious antenatal classes plus a doula and still I was very very shocked.

I was an avid watcher of 'Embarrassing Bodies' so I knew the risks, I'm pretty sure I now have a prolapse and coupled with awful haemorrhoids, I don't think my husband is going to be allowed anywhere near me for a long time to come.

I do though have two happy healthy children, yes my vagina is fucked but my baby is alive.

Also, post-partum care in the UK can be lacking. I live in Switzerland and on my 6-week post-birth check-up with my obstetrician (not midwife), she checked the strength of my pelvic floor muscles. I had a long labour & assisted delivery and the result was a very much weakened pelvic floor. I was sent for 12 weeks of physio to repair this and even afterward was recommended to use a pelvic floor muscle stimulator to get the muscle tone back. This prevents both urinary & faecal incontinence and prolapse and makes sex feel better and more ‘normal’ again.

I have recommended my friends in the UK to purchase one of these devices for use after their births as I found it so helpful myself.

I totally agree. None of my friends ever talked about their birth experiences.

I told everyone about mine.

I had a c section because I didn’t want to risk any of those things.

One if the babies in my nct group died when he was mess then s week old. When his parents asked the course leader a few weeks later, why age hadn’t said that this could happen she said “We used to, but nobody ever thinks anything bad wil happen to them”. Not just neonatal death, but traumatic births and physical damage.

Quite honestly, before I had dc, I wasn’t interested in anyone’s birth stories, stitches etc.Even if i’d listened, I either wouldn’t have cared/remebered or thought it could happen to me..

It would be interesting to compare the experiences of women who gave birth in their 20s with that of older 1st time mothers.Between the ages of 25 and30 I had 4 large babies. I had some stitches with the 1st two, but have suffered no lasting effects. All pregnancies and and births were straightforward. I had the last two at home (policy not choice), and needed no pain relief though gas and air was available. Don't remember any horror stories being told to me, and I read all that was available about pregnancy and birth. This was in the 1960s, so pre internet, and no classes in the areas where we lived. Caesarians were extremely rare, and even then there were few maternal deaths.
Nowadays women tend to be older 1st time mothers, and also there is the obesity problem.

I read a lot about childbirth (mainly on MN) prior to having dc1. I was definitely prepared for tears etc as I’d heard they were really common. I had also heard about the worst sorts of injuries and knew they were a risk. I think the only reason I didn’t request a c-section was because my mum had three really straightforward births and I thought that was a good sign. In the end I had quite a complicated birth, BUT dc1 and I came out of it unscathed. I only had 1st degree injuries despite assisted birth and shoulder dystocia and a quick recovery in terms of vaginal injuries. We had other complications after birth, but they weren’t injury related.

I did NCT and found the info quite a mixed bag tbh. Some was really useful and some was not great - all the lighting candles and massage etc... probably great in a textbook birth, but not mine. I remember meeting the NCT teacher 3 weeks postpartum and I think I just glared at her as I was cross about her romantic, effusive descriptions of childbirth . I wished we’d had someone a little less positive tbh, strange as that sounds.