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.

@stairway
Legimumclip, this is a post about terrible vaginal birth injuries and not receiving the right care before and after, it is not about birth in general. Im not sure how posting a positive csection experience is helpful when it’s obvious you can’t get these types of birth injuries if you only had csections. I’m not sure how useful this would be to first time mums either. Although anyone has the right to request a csection it’s never guaranteed. The NHS discourages it, probably because of money and resource issues they can barely cope with the level of csections at the moment.

That’s told me then - I’ll get my coat 🙂
I don’t want to derail the thread so bowing out.

Women who had c-sections can still end up with many of the injuries described - pelvic floor problems, bladder issues, bowel issues, nerve damage etc so I don’t think it’s very helpful to try and exclude those women from the thread. Also many women who have ‘electives’ do so after a first birth that caused them physical trauma.

I’m not trying to disclude anyone from this thread ComDummings, I’ve had csections myself. There is nothing wrong with discussing csections as well on this thread. I just think that because this thread is about awful birth and birth injuries if you are really want to talk about your wonderful birth you need to be sensitive to other people’s feelings that’s all. I have no issue with discussing csections as an alternative birth within the NHS but sensitivity is the key. MrsKrystalstubbs that is what I was trying to get across thank you. I’m bowing out now, but I hope proper funding and choice within maternity services is extended to all. I also hope that the original poster does eventually receive support for her post birth injuries.

For various reasons, I never had children and am now too old. But I've read this thread with heavy, heavy sadness for what you've all been through and continue to struggle with. I just wanted to express my compassion for your suffering.

I had a secretarial job once where I asked what job my predecessor left for. She died in childbirth.

There is so much change needed in this area, it's hard to know where to start. Valuing women as more than just cattle would be nice.

There is still a sense of "don't frighten the first time mums".

We can't make an informed choice if we don't know that forceps can damage pelvic floors, that birth injuries can lead to stomas and life changing management.

Why are we minimising the risk of birth? We need to be much more honest, pregnancy is not an easy ride for many women and labour can be life threatening for mother and baby.

Perhaps if pregnant women got recognised for the amazing feat their body is doing then we'd respect women more. Perhaps surrogacy wouldn't be seen as a kind thing to do, but more like it is - asking someone to risk her life and wellbeing for your desire to have a family.

Many women never recover from having a baby. Just look at the state of women in areas where there is no midwifery care to see the devastation of deaths and fistula.

UK women used to sew a christening robe and a shroud for themselves during their confinement for a reason.

We should talk more about the injuries. Women are adults and I loathe the patronising assumptions that we'll all opt for a c/section if we hare the truth of everything.

As someone who doesn't yet have children, this thread has made me all the more resolute that if I ever do I will only agree to having a child if I can have an elective caesarean in a private hospital. Ideally under general anesthesia.

I don't agree with you there @Lockheart but I do believe that women need to be far more assertive and insist on having an experienced midwife oversee their births and that there needs to be far greater checking of clinical practices throughout labour.

I fail to understand how in the 21st century every woman is not scanned to check the position of the baby and status of the cord, ie wrapped round the baby's neck. The twit of a midwife at my first birth did not know the baby was posterior and did not twig the baby's heart may have been disappearing as he was being strangled by the cord. Neither were rocket science and both were entirely avoidable.

And let's not broach the heavy handed unempathic comments from too many midwives too often. None seem able to understand that the majority of babies are still planned and wanted and that the woman carrying them may have half a brain.

@vivariumvivariumsvivaria this is so true and yet when you speak to a consultant about a c-section you’re given the most terrifying risks ever. Every single eventuality is laid out to you, even if it’s very rare. They’re happy to do this because it’s a procedure you’re having done and you can opt out but you don’t get any details of risks or chances of them happening when signing up to give birth vaginally. Hence why there’s never a fair comparison between the two when you weigh up the risks

this is a post about terrible vaginal birth injuries and not receiving the right care before and after, it is not about birth in general
But poor maternity care is a systemic problem within the NHS. Lack of care for vaginal birth injuries is part of the lack of good maternity care in general. I don’t think you can specifically improve care for one type of injury - it requires an improvement in maternity care across the board.

Thanks for raising this issue, and I’m so sorry for the torrid time you had. I agree that there is a massive cultural and attitude shift needed towards pregnancy, childbirth and postnatal care.
I do feel a lot of the problem stems from the weirdly macho attitude, imbued with mysticism, that seems to surround these issues. All this awful “Nature knows best” stuff (which extends beyond pregnancy and childbirth, but that’s another story), conveniently forgetting that nature is frequently an arsehole - and that one in eight women and one in five babies died in childbirth (or before their 1st birthday for the babies) before modern care. Don’t get me started on multi-page laminated plans that focus on “the experience” rather than the health and well-being of the mother and baby.
Unfortunately, I think this idealised attitude towards “natural” childbirth is sometimes now being duplicated with elective c-sections being portrayed as a panacea, when they too can have their own raft of serious short and long term consequences. Women need information, education and real, practical support, not strong opinions and dogmatism.
I worked in quite a lot of maternity units, on the neonatal side rather than obstretric, and the staff were mostly lovely, with some shocking exceptions, but usually overwhelmed and understaffed, especially postnatally. The push towards “normalising and de-medicalising childbirth”, with the pressure for 6 hour discharges, can also minimalise the upheaval, and sometimes trauma, that many women will have just been through.
I had a rather unpleasant experience with my own elective section for twins, despite almost all the staff being kind, pleasant and apparently very competent. I am amazed, looking back on it, that what was actually rather good care is so totally inadequate for the underlying situation.
I had a difficult-ish twin pregnancy. I had mild gestational diabetes which hadn’t read that it was not supposed to cause hypos unless I was taking insulin! Whilst I waited for the emergency that bumped me off my 11 o clock theatre slot until 5pm, I was nil my mouth, and my blood sugars dropped to 1.1. A drip was set up, but I was still woozy going in. I appear to have a very low tolerance to opioids - my blood pressure dropped very low after the delivery, and turning my head was enough to make me faint. It also meant my uterus continued to bleed heavily. I was taken to HDU to sort it out. I remember feeling dreadfully thirsty, and asking if the midwife would pass me the glass of water on the bedside table. I am very shortsighted and didn’t have my glasses on, so it was a surprise to me when she apologised and said she couldn’t immediately, because she had a fist up my chuff to put pressure on the uterine bleed!
I then developed gut stasis - not uncommon after an anaesthetic - and because I already had a large midline abdominal wall hernia, my abdomen bloated to the size it was before my 8lb and 7lb twins were delivered, stretching the wound. It settled on its own within a day, but it left me further unable to eat until it did.
I was given tramadol, and my blood pressure plummeted again and I was back to fainting every time I sat up, so I was restricted to paracetamol and ibuprofen. Even with most of the staff being lovely, there was still some insensitivity. The lady in my bay had also had a section, and was tolerating her delicious morphine and tramadol. She was really cheerful, said she was feeling great, and was up and about really quickly. The midwife said to her “you’re doing amazingly well, look at you, up and about a couple of hours after a section. SOME ladies lie around for ages afterwards!” Being massively sleep deprived and irrational already, I can remember weeping that I must be one of these weak women she was referring to, and tried to get up. I fainted again and got told off!
Then there was the babies. My DH was supportive, but wasn’t allowed in the ward after 6pm - part of this “women’s business, men keep out” attitude again. My babies were determinedly nocturnal, and I remember staggering around the corridor with them, one after the other, trying to settle them, every night after this major surgery. This was in Australia, and I was used to the NHS, so assumed I had to do everything on my own. I still remember the older, firm midwife saying to me “how much sleep have you had in the last 48 hours?”. I whimpered “about 20 minutes”, and she immediately grabbed the baby off me and said “get to bed - you’ve just had major surgery! I’ll take the bubs for a while and give them a cup feed - we can worry about breastfeeding after you’ve had some food and sleep!” She bought me a sandwich and a cup of tea and I could have kissed her.
(Incidentally, their attitude towards breastfeeding was really enthusiastic yet so much more practical, pragmatic and supportive and so much less dogmatic than the “breast feed at all costs and we must pretend it’s never difficult yet still express for an hour every two hours and if you give formula you might as well just give up” approach we get battered with here.)
Despite lovely strict midwives, I was still left for 5 days in hospital doing almost all the overnight care myself, then discharged home to continue caring for my two new babies mostly by myself.
In view of the abdominal hernia and the stretched scar preventing me being able to sit up or roll over without extraordinary contortions, the severe yet not quite transfusion level blood loss, the constipation from the iron supplements, the extreme pain caused by the slightest bit of straining, the thrush infected eczema from the urinary catheter, the joys of mixed feeding, the development of De Quervains tendonitis which caused grape sized swellings of my thumb tendons and left me unable to properly support the babies’ heads, a pathological terror of cot death and two refluxy babies who hated all forms of feeding and liked to tag team each other with their screaming, I was in a sorry state!
I spent most of the first year afterwards overwhelmed and didn’t have the cognitive bandwidth to come up with strategies to organise myself or think rationally, so I constantly felt ashamed at my inadequacy. I have massive gaps in my memory, so feel like I missed so much of their babyhood. I do remember crying when told I’d missed my 7 week old son’s ultrasound appointment because I was 13 minutes late, feeling like a failure because my attempts to be early, and then just on time, fell through because of he typical two tiny babies reasons and arriving to find no car parking spaces, the first time I’d driven post op, not feeling able to manage the tram then train with the double buggy. Blank faced “well, you were late.” (DH back at work in v demanding job, but overruled me and took day off for repeat appointment - I felt even more ashamed).
I started back a work when they were 11 months old with a wrecked core, less secure pelvic floor and ongoing sleep issues on top of the hangover from this gruelling time. Occasional bitchy comments at work about “seeming slow today” or “come on! You should be more fluent!” This continued a theme which had started in pregnancy with a few isolated feedback comments about “less focussed than last time she was here and coasting” because I trying to work through hyperemesis (and doing rather well on the whole, I might add).
I chucked in the job I’d worked 20 years to achieve, which was no bad thing as I realised I was having PTSD symptoms when I went as a patient to the worst of the workplaces! I eventually twigged that I had moderate depression, and was started on counselling and sertralline when the twins were 8. I feel great now, and so glad I finally took action, but think I lost many years of joy and had much sadness and anxiety stemming from this rocky beginning and the lack of time to ever recover and catch a breath.
When both my in laws had elective abdominal surgery, for separate reasons, they had loads of advice on rest and recovery, were advised to make sure they had support, no lifting anything heavy for 6 weeks, etc. I went into a more brutal surgery, after several months of illness and several weeks of poor sleep, and was just expected to get on with it. All over the world, women are having major surgery and major injuries or sickening traumas, and they are then expected to leap into action doing an enormously difficult new job - caring for a new person. It should change.

@JuliaMumsnet could you maybe move this to child birth or post natal health? It's not the thing most pregnant ladies want to see when they're already worried about the unknowns of labour 😩

@Slayduggee

What I found most shocking was the both from HCP and my husband after I was discharged from hospital. My mothers generation stayed in hospital for 7-10 days to rest and recover from the birth.

A day after giving birth I was told by a HCP normally I would have been discharged by now (1 day post birth) and the only reason I was here was because newborn required some medical treatment for three days. I could barely shuffle a few yards. I had a forceps delivery where I tore and had an episiotomy and a haemorrhage. After I was discharged I was taking the maximum dose of paracetamol and ibuprofen at least 6 weeks afterwards. When I told the midwife how much pain I was in she just shrugged her shoulders. As long as baby was fine I was irrelevant

I had this after my 2nd son, I was in labour 18 hours that resulted in a forcep delivery, I gave birth at 1am and 10am the same morning I was discharged, I felt like I was about to give birth again once I was home, and basically a huge blood clot slithered out of me, the doctor was called and he said it was to be expected after such a large baby (10.5 pounds). I had a blinding headache which i could barely move (apparently caused by the epidural) and my doctor told me unsympathetically, "if you were my wife, I would tell you to get on with it"

I am surprised I went on to have a 3rd child.

[quote Girlmama3]@JuliaMumsnet could you maybe move this to child birth or post natal health? It's not the thing most pregnant ladies want to see when they're already worried about the unknowns of labour 😩[/quote]
Please don’t move it. Far too many women are poorly informed and prepared for childbirth, as the thread demonstrates.

I chose an elective c section as a first time mum and I was judged for it by a lot of people. But it was definitely the right choice for me.

I think post birth urinary stress incontinence is, sadly, pretty usual. At least people talk about it now and there is specialist physio available to help. Years ago you suffered alone- I used to think if was just me and felt too embarrassed to talk to my doctor about it. I do think that women’s gynae and obstetric issues are not taken seriously enough. You only have to look at some of the treatments that have been inflicted on women.

@Mintypolo so bizarre that anyone judges anyone for how their baby comes out their body. Literally couldn’t have less to do with other people! I’m having one and hiding it from a lot of people for this reason. I’ll tell them after but just didn’t want to have to justify myself to people before it when I’m already anxious about it

This thread has made me cry. It doesn’t take much. I was made to have a vaginal birth after a third degree tear with my first pregnancy.
I had a fourth degree tear with my second child.
No one listened to me.
I nearly died of blood loss and spent 4 hours being “repaired” while awake feeling violated and like a slab of meat.
It’s ruined my life.
If I could rewind and have a section I would.
They sent me home a day and a half later with paracetamol and I fainted with the pain of trying to sit down.
My life will never be the same again.

Women deserve choice.
This should not be shrugged off as normal.

I read this thread with trepidation; the subject of care around childbirth is a difficult and I'm sorry for pps that have suffered (and are still suffering)
It deeply saddens me as a mum and as a midwife. I had my own traumatic first birth with a five hour second stage with over two hours of pushing and subsequently developed a prolapse and PND. I loved my baby but many times I thought ' why have I done this to myself?' The community midwife wasn't that interested- quick check and gone. The health visitor was brilliant and kept me functioning.
I think I've said on other threads that this is partly what kindled my interest in midwifery. There was no way I'd let my patients suffer!!!! In reality, my training did give me some flashbacks to my own experience and led to counselling which really helped. I never hesitated to ask a doctor to look at my patients: I didn't strive for vaginal birth at all costs; I was happy if mum and baby were happy (and dads)
And honestly this is what most midwives I know also want; but with understaffed obstetric units the reality is different. There is so much pressure in maternity care and you might be surprised at how many of us shed tears and have sleepless nights.
I guess what I'm trying to say is most of us really do care about women and try hard to be 'with woman'. I have taken babies to watch while mum sleeps, I've sat with babies while mum has a long bath. We regard this job as a privilege to be with women at the most vulnerable time of their lives but the job itself has changed so much.
I hope you will take this in the spirit that it's intended- its not meant to be 'me, me me' but I do understand, really.

[quote sarah13xx]@vivariumvivariumsvivaria this is so true and yet when you speak to a consultant about a c-section you’re given the most terrifying risks ever. Every single eventuality is laid out to you, even if it’s very rare. They’re happy to do this because it’s a procedure you’re having done and you can opt out but you don’t get any details of risks or chances of them happening when signing up to give birth vaginally. Hence why there’s never a fair comparison between the two when you weigh up the risks[/quote]
The NICE guidance on CS that I read 13 years ago before requesting a post-EMCS elective CS with DS2 had a table summarising the comparative risks of various complications for vaginal vs CS delivery. I don’t think it separated out the risks of an assisted delivery (eg forceps) vs unassisted though. I found it helpful.

[quote Girlmama3]@JuliaMumsnet could you maybe move this to child birth or post natal health? It's not the thing most pregnant ladies want to see when they're already worried about the unknowns of labour 😩[/quote]
That’s right, sweep it under the carpet. If I had known of the risks of a forceps birth I wouldn’t have agreed and 15 years later wouldn’t be suffering regular pain and discomfort from damage. My DD wouldn’t have a scar on her face

There needs to be a modernised science and medicine based approach to maternity care, pre and post birth.....40 years ago women were kept in hospital, given their meals in bed and a milky drink at night, the staff took care of the babies. When I had my first in 1997 I was shocked that I had to go down the corridor and get my own breakfast, and wheel my baby down with me because as a new mum I didn't want to leave my baby alone. A few years later and it was becoming the norm to send women home a few hours later, didn't matter how hard the birth was or how much pain anyone was in. Apart from citing shortage of beds, there really needs to be more 1-2-1 aftercare, with longer stays in hospital. Doesn't help seeing celebs on TV prancing around, barely showing signs of having been pregnant, to be expected to do the same. Collectively we need to shout louder and demand better. It's disgusting and horrendous reading and relating to the horror stories on here. Who can we send our grievances to that will make any sort of impact.

@Organisedchaosalways:-

Director of midwives
Director of Womens' and Children's Services
Trust CEO
Sir Simon Stephens and soon his successor
Your MP
The Health Secretary, Sajid Javid

I think some of the problem for a very long time has been the influence of the NCT on local maternity services. Whilst they have done many good things they have a particular mantra around natural childbirth which is not always very helpful for many women but has helped shape a very midwife led service. At its best that is never an issue but the issue is it's rarely at its best and very often committee's are spun a sanitised version of what actually happens and the lack of care and respect labouring and nearly labouring women actually receive.

The threads on here about poor standards on post natal wards are testament to poor service but this is undone by the pile on if anyone complains, because it's free and the public should be grateful for suboptimal care (across the board). The public (the NHS most important stakeholder) needs to stop being grateful and start being entitled.

[quote MrsKrystalStubbs]@FortunesFave what an insensitive response to this thread. Most women who suffer birth injuries (me included) have no idea about what can happen to them. And aren’t offered a CS on the NHS which is why these problems occur.[/quote]
This is why I'm telling anyone and everyone about my fight for a maternal request c-section. You can indeed get them on the NHS - it's a shame nowhere does them privately outside of London as I'm miles away. If people ask why, I give them the pro and cons to both vaginal and c-section, ensuring to highlight that the vaginal birth data tends to reflect uncomplicated vaginal births and the c-section stats include emergency sections that started out as vaginal births (how ironic). I explain why, for me, c-section is the right choice but thst I recognise that there are many women who have fine vaginal births. For me, I want to play it safe and not gamble on whether my body can get through it without a ton of intervention.

@MiniTheMinx

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.

I totally agree with this post. I will gently challenge your use of 'natural' to describe all (or in my opinion any) vaginal births though. I think the term 'natural' is an important part of maintaining vaginal as the default birth that every woman should strive for because, after all, anything else deviates from what nature intended by that definition. Instead, vaginal is a more accurate description.

Personally, I object to 'natural' being used for any birth that is overseen by a medical professional. My rationale is that natural processes such as breathing, eating, drinking, pooping, etc. do not meed to be monitored by medical professionals. Unless a woman is giving birth alone or with non-medically trained family, a birth is medicalised to a greater or lesser degree and quite the opposite of natural.

@Lockheart why would you go only for a private hospital? I've done loads of research and found out that NHS would be best option for c section, this is due to the fact that they do loads of them hence have most experience.

From my 1st midwife appointment I was repeating that I'd like to have c section and did not really engaged in any other conversation about any other birth option. I was made feel
as if I am mental for wanting c section although I am very petite and my mum who has similar build to me had life changing injuries as a result of a vaginal labour.