MNHQ here: the impact of birth on women's bodies, wellbeing and sex lives

[RowanMumsnet]

Morning all

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 protected] with 'Campaign Champions' in the subject line.

Thanks
MNHQ xx

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.

Mumsnet HQ

From Neef’s post:

Mumsnet should try and get 10,000 signatures on this so we can raise it in parliament.

I would sign. Where can I sign?

I am 51 and had three 9lb babies under 4 .

First baby major episiotomy, other two I was also cut . So I have been cut left , right and centre .

Well the years passed with ok in the vaginal area , sex etc .....WELL all I can say is when perimenopause/ menopause hits Mother Nature is cruel , my episiotomies 31 years later are causing me just misery , as the lack of oestrogen makes them go like tissue paper and some ladies hair bend over , ten on a chair and they can split.

I need HRT , local oestrogen and I have had laser treatment just to be able to wear pants / sit down , all from those births 30 odd years ago.

I have so far never leaked P, I see a women’s health physio as I am trying to have as good a condition pelvic floor as possible , and I masseage the scars every pm .

The internet is litters with ladies who with menopause get what I have it’s called vaginal atrophy, and there scars from yesterday year are making there lives a misery , no sex as some of them the scars just split open, not completely bit the outer area.

We also get on with getting on far to quickly after childbirth, almost a badge of honour to see who can get back into there skinny jeans and be put shopping ASAP , this is incredibly bad for the pelvic floor , in the immediate and future.

The French have far less problems than we do , due to at least 6 weeks of women’s health physio after each baby.

Sorry re some mistakes hope it’s readable .

MNHQ I would love to see you ask Jenny Burrell of Burrell education to speak on this. She also has a women's health physio expert on her team called Michelle Lyons who really knows her stuff. The statistics are about 1 in 3 women will have some kind of pelvic floor dysfunction in their lifetime. I work with postnatal mums in fitness and I recommend that they see a women's health physio postnatally especially if any red flags appear on my health screening form.

Right! Thank you so much for all your thoughts. Here's our summary and thoughts about action points - let us know what you think.

PETITION
We've had this petition shared with us, which asks for every woman to have a women's health physio after birth. It's already over one-third of the way to the 10k signatures needed for a response. Shall we focus on pushing this one? (It's a specific ask - but these can be the most effective, when it comes to petitions.)

TOPICS
How about a 'Birth injury and postnatal recovery' topic?

INFORMATION
Ask: GPs to be informed (by midwives/hospitals) about birth mode and injuries to the mother
Action: this is something that's been discussed in the NHS working group on postnatal care that we're involved in. Hopefully there will be a recommendation on this in the final report - we'll keep tabs on this and let you know.

Ask: Midwives to know risk factors and warning signs of PTSD and factor them in to postnatal mental health checks
Action: We can talk to the RCM about this and see what advice midwives are currently given

Ask: Accurate information given to women, antenatally, about the risks and long-term effects associated with instrumental births (as well as c-sections)
Action: We will try to talk to NHS Choices (a huge source of info) about their content on this, and also talk to the RCM about the info given to midwives. Obviously, as we've been saying, there maybe a vicious circle here in that good-quality data about the long-term effects of instrumental births seems to be hard to come by.

ENCOURAGE WOMEN TO COME FORWARDS AND PRESS FOR TREATMENT
Women who are experiencing postnatal pain, incontinence or prolapse should feel more confident about pressing for the interventions they need
Ask: More antenatal info/postnatal info about red flags and where to go if a problem. More explicit info about urinary incontinence (including catheter use), faecal incontinence, that POP is a risk associated with pregnancy not just age, and how to care for tears of all degrees.
Action: NHS Choices; RCM; possibly a content page on Mumsnet with users' advice on how to assert your need for intervention

Ask: Explore an online assessment with NHS branding that women could use as an initial self-assessment and print out when approaching GPs.
Action: Find other examples of similar tools (please send us links if you have them!) and we will try to find out how they come about and who needs to write them and sign them off.

POSTNATAL PHYSIO
Ask: GPs to have more training in post-birth symptoms and warning signs, and be readier to refer to specialists
Action: RCGPs

Ask: Postnatal women to be offered physio as a matter of course
Action: Petition

Ask: self-referral route to specialist centres
Action: not sure - will talk to NHS England and RCGPs about this one!

Possible action: What do MNers think about the 'mass report' exercise, in which women who are affected go to their GP - perhaps in a designated week or month - and report back to us on the responses they get? Would be great to have a bit more info on what happens to women when they initially approach GPs. (We could set up a survey mechanism so that women could give us more info about their symptoms and the GPs' responses without having to share that with all and sundry.)

DATA COLLECTION
Ask: NHS England includes maternity and postnatal data as a brand new national data set
Action: we will explore this with NHS England and with the National Maternity Review team

Ask: A new 'priority setting partnership' for maternity and postnatal care issues under the James Lind Alliance rules. These PSPs can incentivise researchers to fill holes in current research.
Action: We will have an initial conversation with the James Lind Alliance to see what the process is.

POSTNATAL MATERNAL CHECKS
Ask: six week, six month (with ultrasound?) and one-year contact points with postnatal women to specifically ask about risk factors and symptoms, and signpost/refer on to specialist support where necessary. Must proactively ask about vaginal, perineal and anal health, and include examinations if the woman wants one. The appointment letter should make it clear what the appointment is about and give pointers to women about symptoms they might want to discuss (this could be where the online self-assessment tool is flagged.)
Action: RCGPs

RISKS AND OUTCOMES IN LABOUR
We will talk to the RCGP about things like prolonged second stages in labour, elective CS and informed consent; we'll also see if we can bring in Birthrights on this as this is very much their area.

Let us know your thoughts - apologies to anyone whose points aren't explicitly addressed here: we've tried to identify the most common themes.

I am well up for the mass report ! I have my 8w check on Thurs so can get cracking right away. Would it be an idea for tidiness sake to create a separate thread just for that?

Thank you RowanMN. I've signed the petition btw.

I haven't read the whole thread as some of it is a bit triggery for me so sorry if this has been covered, but re the petition and proposed requests for additional services - this needs to be costed properly, to prove it will save money in the long run. You could approach The King's Fund or Dr Foster to do some work on this. National policy change won't happen without some evidence of savings in the current climate.

Although, thank goodness, I have not suffered as ladies here are bravely discussing, I did have a horrid experience 40 yrs ago with the birth of my first son. I'd been in hospital for a week already with v high bp - they tried to induce me and, getting nowhere, huge baby, etc - a c section was decided on and an anaesthetist was sent for.
I waited for ages, alone in a corridor, frightened I was going to fall off the trolley. Eventually, the team, with anaesthetist, appeared - he was not a happy man; had obviously been dragged away from his dinner, the golf course, whatever. He asked if this was my first pregnancy? 'First and last,' I quipped, trying to be brave, not 23 and terrified!
'Its no laughing matter', said he and just shoved the mask over my face. I can still remember the nurses' horrified faces and the feeling of falling into the abyss ( I still have nightmares now about never waking up again)
The nursing staff were very apologetic for his behaviour, but I fought for an epidural for my next even bigger baby's cs. They didnt want to do it, but no way was I going to have a general anaesthetic again.

Data collection and risks and outcomes in labour are the elements of Rowan’s post that I think are crucial. For me the key to this whole issue is prevention, not cure.

If more long term data was collected following birth interventions such as episiotomy, instruments, tearing, I feel sure there would be overwhelming evidence against them showing that c sections are far preferable. I can’t believe a long term impact study for forceps use has never been done .

Looking at the issue of informed consent is also key to prevention. A woman given the information about risks and outcomes of mode of delivery is able to make the right choice for her body and future life. We do not currently consent in any meaningful way to violent birthing interventions, such as forceps use, and it is therefore questionable whether some of the practices leading to birth injury are legal in the first place.

i have signed in support.

Forget the six week check - how about enforcing that all women who give birth are examined? I wasn’t after ds2 - waste of time as he was small at 1.4kg according to midwife. A point repeated by my gp when I tried to explain the embarrassing problems I was experiencing. I was finally repaired when I experienced an ectopic - in the words of the surgeon I was a mess to that extent that I had to repaired before he could deal with ectopic.

So I believe training is the answer along with god like attitudes from midwives and doctors.

I have signed!

MNHQ - the self report questionnaire. There is one I have seen which measures stress, anxiety and depression (the DASS or the DAS-21). Something like this could be developed asking about continence symptoms, prolapse symptoms, pelvic pain, and potentially even trauma symptoms (especially the less obvious symtoms, such as avoidance behaviours).

If there were to be 6 week and 6 month checks (I agree both are needed because sometimes symptoms don’t appear as early as 6 weeks on), this questionnaire could be given at the start of the appointment which would make potential treatment required quite clear to the GP

www.psytoolkit.org/survey-library/depression-anxiety-stress-dass.html#_introduction

Ask: Accurate information given to women, antenatally, about the risks and long-term effects associated with instrumental births (as well as c-sections)

What about the NCT? They are a huge source of antenatal information for women.

What about the NCT? They are a huge source of antenatal information for women.

Too biased towards natural birth I think. They should definitely have the information but they shouldn’t be the sole source of it. This has to come from the state healthcare system and not be confined to private

Whilst I found the NCT great for making mum friends I found they really pushed drug free natural non-intervention based labour. They didn't cover any of the post natal problems other than PND. Whilst it is an important issue they really dismissed the risk of prolapses, tears and incontinence (I specifically raised these fears and they completely dismissed them as very rare occurrences despite the majority of women suffering tears of some degree).

I agree about NCT. I think they actually had a negative impact on the mental health of some of the women in my group who had difficulties during the birth or breastfeeding. In the ‘preparation’ the difficulties were smoothed over or ignored. Potential short and long term physical issues ignored entirely (tears, prolapse, incontinence). It was portrayed as ‘every woman can do this without any major issues’ so many of us then struggled with the reality of tears, continence issues, csections, inability to breastfeed. I personally felt like no one had been honest with me about the whole thing and if they had i would have been more prepared.

How about a push for maternity medical staff to really listen and respond proactively to women when they tell them if they think something is wrong or they are in too much pain.
I've read so many posts on various threads of women not being believed and also have heard anecdotes from friends.

The worst was a friend who felt there was something really wrong after giving birth (this was in France, they are far from perfect despite excellent post natal care). She told the midwives but was told 'no you're fine, don't worry we're sending you up to your room'. She got there and they made her get into bed by herself, as soon as she stood up she had a major haemorrhage, collapsed and her heart stopped. They had to rescitate her room's on the floor, rush her down to theatre and give her blood transfusions. It was awful.

From last week's SNL

I had a Women's Health physiotherapist come along and talk to mums which was very beneficial. Most of them booked an appointment with her and if there are any red flags women should be referred though they won't get the same standard of treatment on the NHS as going privately sadly. I think all mums should get this postnatally and in France I believe they do see a WHP after birth.

www.facebook.com/search/top/?q=michelle%20lyons%20celebrate%20muliebrity

this is one of the exceptional women's health specialists I follow and Burrell Education.

'I think it starts with the dreadful postnatal care on wards. It's such a dreadful experience that many women leave when they probably aren't well enough.

If money was invested in proper postnatal care with privacy, support from midwifes and access to food and water women might not be so desperate to get out the door. Maybe this would help with mental health and breast feeding rates as well.

I believe all wards should be restructured to have private room postnatal and far more staff employed.'

Those wards are awful! Yet, when the new hospital in Glasgow opened up, guess which unit was still a ward rather than all private rooms?

Agree that there should be better post natal checks. No further support or advice was available for my recovery after the 6 week check. I felt like I was "signed off" despite not being fully recovered. How can they know if I ever recover when they don't see me or examine me again? I suggested coming back in 6 months time for a check to see if I was fully healed and the GP's response was "Well I suppose you can make an appointment if you want to, but it isn''t necessary". So basically they don't care to check if I've recovered or not?

Also agree it would be good to have a forum for birth injuries and advice on recovery as no support appears to be forthcoming from the NHS.

Oh my god Fauxgina the SNL clip is genius. I’m going to post to my birth injury twitter account post-haste