Guest post: "Women are expected to go home with life-changing injuries after giving birth and just get on with it"

[JuliaMumsnet]

For Birth Trauma Awareness Week, Jen Hall from the MASIC foundation, which supports women who have suffered serious injuries during childbirth, writes about her experience of childbirth and the MASIC's Foundation latest findings:

"When I gave birth back in 2013 I had no idea what lay ahead of me. I’m not talking about the sleepless nights, breastfeeding battles, or any of the other aspects of new motherhood that are widely talked about. What I had to cope with alongside new motherhood is something that is rarely spoken about - yet is a major trauma for the thousands of women affected each year.

Severe birth injuries, or third- and fourth-degree tears, are injuries that extend from the vagina into the anal sphincter and are a leading cause of bowel incontinence in women - alongside pelvic floor dysfunction, pelvic organ prolapse, nerve damage and impaired sexual function.

My birth injury was caused by being left to push for three hours, causing a traction injury to the pudendal nerve, followed by two failed attempts with the ventouse and a brutal forceps delivery where my baby’s head and body were delivered in one contraction. Long term it has left me with many of the symptoms listed above. I’m a shell of the person I was, my confidence has been deeply affected, and I no longer feel like a woman who has control of her body.

My experience of motherhood was deeply affected by the injuries I sustained. I didn’t walk into hospital at 33 years of age to have my baby and expect to come out unable to run for the rest of my life or to carry out the most basic of bodily functions.

At The MASIC Foundation we carried out a survey at the beginning of the year to try and assess exactly what impact sustaining a severe birth injury can have on your experience of motherhood. We knew women would find this difficult to talk about, so the survey was completely anonymous. The survey ran for a month across our social media channels, and we received responses from 325 women who self-identified as having suffered severe perineal trauma when giving birth.

• 85% of women who sustained severe maternal perineal trauma said it impacted on their relationship with their child.
• 49% of women said they doubted their ability to mother because of the injury.
• 46% said the injury affected their relationship with their partner and wider family.
• 34% felt their relationship with their child was affected because they associated their child as the cause of their injury.
• 31% said they wondered whether their child would be better off without them.
• 24% of women affected regretted having a child because of the injuries they are left with.

The results we have gathered are shocking and heart-breaking, and show in stark reality the impact these injuries are having on mums and babies each year. These injuries can lead to feelings that no woman expects to feel or wants her experience of motherhood to be. The results are hard to comprehend. But if you have suffered a severe birth injury, I’d wager you can relate to some of these feelings.

I felt that I was a failure after my birth, that there was something wrong with my birthing body that had led to this. I spiralled into a deep depression, unable to comprehend that a) having a baby could leave you like this, and nobody tells you and b) women are expected to go home with life-changing injuries and just get on with it because they are mothers now.

And these feelings led to a complete rejection of motherhood in the early days. If my body could be treated so casually as collateral damage, then why did either of us matter anymore? What good would I be to my son if I couldn’t ever lift him, play or run around with him? I fixated on the time before my pregnancy and birth, before everything ‘went wrong’. I’d unwittingly given permission for an assault on my body that had profound implications for my future.

If I tried to speak out about how I was feeling to the health visitor or to my GP I felt like I was being judged on my ability to parent. I was told my injury was ‘all in my head’ on numerous occasions and another health professional suggested that maybe it was because ‘deep down I didn’t want my baby.’ The ignorance and judgement I faced only worked to compound my isolation and distress and I feared I was a bad mother because of the things I was being told every single day.

The feminist inside me was raging.

My feelings are echoed in accounts we have heard as a charity, from other women who experienced severe injury during childbirth:

“My confidence, my me-ness, the essence of who I am, has been destroyed, my relationships with my child and my partner have suffered.”

“With my son, I love him dearly, he is the best thing in my life, but his birth caused the injury and it is difficult to square the two,”

“Every year I dread his birthday and the reminders of my traumatic experience. It is not fair on him or on me – his birthdays are not a happy occasion, but every year I have to pretend it is.”

“I am ashamed to say that at times I wished I had never become a mother and I grieved for the life I had before, I paid such a high price to have a baby.”

I know these feelings are controversial to express. But I feel they are important if we are ever going to get the NHS and policy makers to sit up and take notice of women whose bodies and lives have been deeply affected by childbirth injury and trauma. As long as women are expected to endure poor treatment while giving birth, these injuries will continue. Motherhood should not become an identity that disregards womanhood, and women should not feel afraid to speak out about the physical, emotional and psychological effects of birth injury."

Read the MASIC Foundation's full survey findings here.

Follow MASIC on Instagram: @masicfoundation
Facebook: @MASICFOUNDATION
Twitter: @masic_uk
If you're looking for support or to talk to someone about your experience, please call the MASIC 24h freephone Birth Injury Support Helpline 0808 1640 8333.

Jen will be coming back onto the thread on Tuesday (time tbc) to answer your questions.

Thank you for this. Very important work. I note that in your report you have a list of things that need to change. However they are all reactive and actions that are recommended after injury has already been sustained and identified.

Do you think part of the solution is raising awareness with women before they give birth? An honest one, by GP’s, midwives etc that if negligent practice happens or things go wrong there will be no care and no treatment? So that women are fully appraised of the risk they are undergoing, by putting themselves in the hands of woefully inadequate services both during and after birth?

I was too exhausted, injured and overwhelmed with the care of a poorly newborn to fight for my own care after I gave birth. I remember being shocked at the complete lack of treatment for my injuries. Until 6 months later when I had to have another operation to repair the damage so I could walk properly again.

So many women like me realize only too late that they should have demanded better care, honesty about the true scale and impact of birth injury and that professionals should have been held to account.

I want to see:

Obstetrics and midwifery better resourced and with far more training emphasising listening, empathy, and recognising sexist attitudes even within oneself

The "downstream" costs of obstetric injuries incl psychologic birth trauma to be passed back to the original obstetric unit.- if their performance was measured, or even if funding depended, on things like instances of perineal tearing, % of women expressing unhappiness with staff attitudes etc or % women with 3rd degree tears, that would sharpen the focus a bit

Resource proper pelvic floor training info. This is not that difficult. The NHS used to have an app called Squeezy. I know about it not from NHS but from MN. Create a series of short informational videos for women ttc - pregnant - and postpartum and promote heavily via social media. You could do that for under £100k easily.

Also, come up with better tools for women. I don't believe Kegels do that much. You wouldn't strengthen your bicep by just doing arm curls - you'd use weights. Why not make PF trainers available on prescription much more widely? It would save £££ on surgery down the line plus MH treatment, and also support women staying fit which has other health benefits.

But mostly, we need to challenge the misogyny which is deeply ingrained in the NHS, and which doesn't understand middle aged women as real people with lives, who want to run or have sex, they're just "Mum" and pretty irrelevant.

Thank you for sharing. This is so important to talk about. I'm so sad for everyone here with these awful experiences. I had birth trauma which is relatively mild compared to some of the stuff I've read but it totally ruined my mental health and destroyed my life. I had pnd and ptsd with horrendous flashbacks. It took 2 years of therapy to sort me out...and that was private because God forbid you even try and bother to get any psychological help on the NHS. Maternity services in this country are not fit for purpose. The way we are infantilised, dismissed and treated like cattle to be managed and kicked out of the ward ASAP is completely normalised. It still makes me angry 7 years later.

MrsKrystalStubbs I'm sorry, really upsetting to read about your experience and that of other women. The natural birth at all costs ideology is harming women when there is an alternative. I would never suggest that elective section is the right choice for all women, but it seems that women are discouraged and put under huge pressure to have natural births. Do you think now, retrospectively that you were given the right advice? because an episiotomy or tear and the use of forceps can cause very very heavy blood loss. I would have guessed (im not in medicine) that this type of trauma would cause more not less blood loss than a carefully managed section.

@Evianlife

Even those of us who have a csections are chucked out after 24 hours after major abdominal surgery and expected to just get on with it.

That's true, in my case also, being chucked out after major abdominal surgery with then no support with lifting the baby or anything at home because, y'know, who cares, just get on with it....which is really terrible but, unbelievably, a fairy tale compared to what so many women have posted about on this thread, and left me feeling lucky I had a c section (not elective but carried out extremely well, and I had no injuries aside from the c section itself jusf some muscular back issues that resolved after a few months).

I'm just utterly disgusted and upset for every single poster for the way you've all been treated, by the hospitals, doctors, midwives, HVs, partners, wider family and anyone else who treated you in a way that was less than you deserved. It's heartbreaking. My blood boils reading this thread!!

Appalling isn’t it? Women deserve better. I would wholeheartedly support a campaign to improve the standard of care.

Thanks for your post. The aftercare following my obstetric anal sphincter injury was appalling. I was incontinent whilst in hospital after and asked the midwife for some incontinence pants as I was leaking shit and she offered me a maternity pad. I was upset and said that would not be enough, I needed a nappy and she told me that's not usual following a third degree tear and there was nothing else she could offer me. It was the middle of the night so I fashioned myself a makeshift nappy from a maternity bed pad.

Wholeheartedly support any campaign to improve maternity services in the UK.

Someone once told me that in France childbirth/ maternity care are all about the mother but in the UK it’s all about the baby. It is unsurprising that PND is so high here, the way our injuries are minimised and how we are not listened to.

I was shocked by the lack of basic kindness and assistance from maternity staff, my midwife was a complete bitch.
My son is an only child, no way was I going to go through labour again.

These stories are dreadful.
My mother was always bitter and upset that she had to wait two years after the birth of my brother to get her prolapse seen to. This was in 1959.
Things haven’t improved much, it seems.

This is me. 8 years later I'm still suffering with awful chronic pain and never had the two children I'd planned. I was told by a female consultant that sometimes women are left with pain and that I just had to get on with it.

I don't know anyone who had a fairytale birth. We all have lasting physical damage. Some of us need to manually evacuate the bowel via the vagina and think that's normal.

It is unsurprising that PND is so high here, the way our injuries are minimised and how we are not listened to
Exactly. I felt that I was disfigured and struggling but my concerns were minimised and ignored. It’s no wonder I developed PND and still struggle with mental health and cry about my injuries 3 years later. I’ve considered suicide because I don’t want to live like this, but I couldn’t do that to my child.

It's been 11 months since giving birth, the 8 day long induction plus 23.5 hour labour left me traumatised mentally and physically. Lots of mistakes were made by the nhs and the only reason I haven't made an official complaint is the fact that my daughter was miraculously born healthy. That's been the only thing that has helped me get through these last 11 months. People I know keep asking me when will I have a second baby and don't believe me when I say I won't, as I'd never want to go through that experience again and risk nearly dying again it wouldn't be fair on my daughter.

I am one of the lucky who suffered no lasting injury and my heart goes out to those who did. But I had a terrible 36 hour labour, back to back baby, no one listened and was treated with contempt and unkindness by the midwives. Ended with a failed epidural and emergency section under general anaesthetic. I couldn't believe that within 3 hours I was expected to get up and walk to the next room to get my own breakfast. Staff - and my own family - told me I had a healthy baby so nothing to complain about.
The whole experience left me severely traumatised and we only have one child as a result. I feared I would die and have never in my life been treated with such a lack of empathy and care

It’s insane. The contrast really hit home when my partner had keyhole laparoscopic surgery and was looked after for ages in hospital and told to rest up for a month. Keyhole. Laparoscopic. Surgery. God it makes me so angry.

Yes, I can absolutely relate. Was so traumatised by my first (hospital) birth that I suffered panic disorder during my second pregnancy at the thought of having to go through it again had to have a home birth.

I was only young when I had my first child and was completely traumatised by the labour. 19hrs on a visiting ward (no delivery rooms free) having contractions every 2 minutes in front of people visiting their relatives. Another 2 hours of contractions and 2 hours of pushing, a rushed epidural, forceps, episiotomy and an IV drip afterwards. Could barely walk for weeks and still have painful scar tissue 20 yrs later. Like a pp said my overwhelming feeling after the birth was complete shock that I was still alive. I genuinely thought I was going to die.

And all anyone says is “well that’s why it’s called labour, it’s not supposed to be easy.” As if that makes it okay and somehow the trauma is irrational.

And yes lack of care- I had to change my own sheets because they were soaked in blood, took my 10 minutes to shuffle to the cupboard to get them and could barely stand up let alone walk. It took me so long to get from my bed to the breakfast room that the other ladies cheered for me when I got there. Which was lovely but also sad to look back on. A few hours later and I was discharged and home, stitched up and barely able to walk, with my new baby.

@FortunesFave

I have had two elective sections and would advise my daughters to do the same. I know that there are risks attached with sections but just look at what happens to MOST women having babies naturally.

I'd rather take the risk of organised, calm surgery than the bloodbath that is natural birth.

I've always said that if men had babies, c sections would be the default.

There are many downsides to csections. Surgery isn't always calm and organised and even if it started out like that things can change quickly. Describing vaginal births as "bloodbaths" is very unhelpful.

I agree with the PP who said that midwives don’t always seem to like involving the (often male) doctors. My daughter was showing signs of distress when I arrived at the local cottage hospital, so I had to stay on monitoring. I stayed there for 26 hours being monitored, still showing signs of distress before they decided to send me to the nearest ‘proper’ hospital, and even then I was told to make my own way there. I was monitored there for a further two hours being made to feel like I was making a fuss over nothing before suddenly it was an emergency - even then, when the doctor was finally called and told the midwife to prepare me for theatre, she dithered around until he came back and shouts at her that I had to go NOW! My daughter was born blue following a failed ventouse and two sets of forceps and had to be resuscitated; fortunately she was fine within minutes (although black and blue from the forceps), but my pelvic floor has never recovered from the forceps. I had two planned sections with my subsequent children.

This is disgusting. I've had 3 children. Could write a very long piece about my injuries and post-natal care, but I'll try and keep it short.

After suffering a 3rd degree tear with my 1st, I was left to have to climb on a chair to get into bed as the bed was so high I couldn't get in it. Changing my own sheets after 3 days of lying in my own blood. That was 28 years ago. I was young and just left to get on with it.

My 2nd birth was a shoulder-dystocia birth - can't fault the labour care there once the dystocia was happening - all systems go. Episiotomy was worse than 3rd degree tear for after-pain.

3rd birth was ECS due to polyhydramnious. Again pre-natal care was good. Thank goodness it was my 3rd DC and I knew 'what to do' as I was left alone, unable to stand upright, in agony, holding on to the bed, doing a shuffling side step to get to baby to pick up and feed, all the while thinking I was dying. Having to beg for painkillers. Was offered counselling afterwards due to the birth. Stupidly refused it, at the time I was just so thankful he was alive.

In light of the survey findings, is there a plan of action going forward? What can I do to help?

The contrast really hit home when my partner had keyhole laparoscopic surgery and was looked after for ages in hospital and told to rest up for a month
My neighbour had heart surgery. There were nurses visiting his home, he attended a support group, he had three months of physiotherapist visits, and the whole time he was treated with kid gloves and wrapped in cotton wool. Meanwhile a new human being came out of my body and as soon as the epidural wore off I was expected to look after my baby and return to normal life. When I asked for physiotherapy to treat my diastasis recti the GP said the NHS can’t afford to pay for physiotherapy for every woman who has a baby, you’ll have to google it and copy the exercises on YouTube.

I had a 3dt with my first, alongside multiple other complications including a pph of 3.5 litres. With my 2nd I had an ELCS. The really, really noticeable difference for me was the attitude to pain afterwards. With my tear, I could hardly walk. On the ward on day 5 I was told to walk to get my breakfast. I could barely shuffle to the loo, let alone get all the way up a corridor and stand in line waiting for the toaster and kettle to be free. I didn't have breakfast that day. I was told to take paracetamol and ibuprofen, which I did, but it was so so sore. I remember thinking I must be the world's biggest wimp because everyone having a vaginal birth is "up and about straight away" so we are told. 4 weeks pp and I still couldn't walk for 10 minutes without severe pain. I remember crying down the phone to the midwife who had me in, checked me over and established it was all healing/no infection and told me to....take paracetamol. It took months and months to recover.

My c section - sure, that was painful. I'd say really painful the day after and then sore for about a week. I was constantly told to rest, prescribed strong painkillers, given a lot more help in terms of pain management generally. Yes I was also discharged the following day, and staggered out clutching my belly (!), but armed with practical advice and adequate pain relief. I was pain free after 2 weeks and felt back to normal after about 4 weeks. It really, really winds me up when "natural" births are pushed as easy and positive and much better to recover from. It simply isn't true for some of us! And I will end by saying (because so many times when I talk of my experience I get the "well there must be a REASON you tore!" comment) - I was a healthy bmi (23), in my 20s and fit and healthy with my first. I was considered very low risk and could have had a home birth. My baby was 8lbs 7oz so not huge although, agreeably, not small either. It was "just" bad luck and when I see these stupid "breathe through it, relax, visualise a waterfall" bollocks, it makes me so angry. I did nothing wrong and it still happened to me! And no amount of fucking breathing or thinking happy thoughts would have prevented it.

As a scientist I find it baffling that the evidence base marginally favouring vaginal birth over C-section is based on short term
outcomes (e.g. maternal and child perinatal mortality) and not long term outcomes like PTSD, incontinence, prolapse and other long term adverse effects. Studies looking at this are few and generally with small samples. We need a big study on long term outcomes so mothers can make properly informed decisions.

I had an elective section for precisely this reason. I was so grateful for MN because it was only here that I read uncensored/unbiased accounts on the realities of childbirth. There were a few statistics on how many natural births end up in injury and to which degree. This is information that nobody in real life would every share.

The social sentiment that having an emergency or planned c-section should be something to feel regretful or disappointed about is FAR higher than the relief a woman should have for proactively taking a decision to avoid traumatic, possibly lifelong, disfigurements. Getting the covid vaccine is a personal choice to avoid a potentially serious health trauma. Millions of people happily take that up and are proud of it. Getting a c-section to avoid a huge risk of severe lifelong injury is often seen as cowardly or gloating. Indeed, the first poster in the thread was immediately bashed for being insensitive when she brought up her ELCS.

Society still wants to paint women as warriors who do their own research and then courageously still opt for a natural birth. They might employ a whole raft of massage techniques before the birth to minimise the risk. Some will be lucky and have a picture perfect birth. Others will not and will live to regret their decision along with the guilt that they "consented" to it by choosing the natural birth that is subconsciously pushed on us by friends, family and medical professionals.

At the end of the day, it's your private parts. To put it crudely, nobody in the world give a shit about your bowel and bladder function. Why would anyone run the risk of ruining your perfectly functioning lower regions for a soundbite of telling people you had a successful, natural birth. If the past year has taught us anything, it's not good enough to say "well it doesn't happen to some people". A high enough risk of a significant health trauma should warrant measures to avoid it.