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.

[RowanMumsnet]

@brummiesue The point about the prolonged second stage has come up a few times on the thread already - thank you - this might be one for us to talk to the RCM and the Royal College of Obs and Gynae about.

A quick search brings up the RCM's guidelines on second stage and - (a theme developing here) - the sentence 'Limited quality of evidence makes it difficult to assess the significance of a prolonged
second stage'. There's more commentary on the risks and benefits on p3 of the document.

[Insertquirkyname]

Is it possible that in this compensation culture that if the nhs were to recognise and promote that certain conditions aren’t normal post childbirth they feel it would invite legal action? Do they view normalisation of these conditions as an invitation for scrutiny of care?
I didn’t seek compensation, I sought change in procedure and a cure. I got neither.

I also don’t feel that a 6 week check allows you time to work out what is normal and what isn’t. I would say around 6 months after is more appropriate unless you have an infection. This appointment letter could list possible conditions the patient is encouraged to discuss such as prolapse, incontinence and pain during sex etc.

[Osopolar]

I agree that only a check at 6 weeks isnt always helpful. At that point I was completely overwhelmed and too tired to string a sentence together. I hadn't yet attempted sex so wasn't aware that I had pain when attempting sex, I found that out later. Also my GP was only interested in DS at the check.

[Sleeplikeasloth]

I think keep the 6 week check, but also offer a 6 month check.

[Astrabees]

I did notice that the anti natural birth brigade were quick on the bandwagon to suggest that natural labour without intervention might be a cause, which has probably prompted the posters recounting natural births with no injuries. My own experience of a 21 hour labour with a very long second stage was one I was very grateful for, I was told it might not have been "permitted" in an NHS hospital - since when is anything "not permitted?"

[christinarossetti]

Excellent campaign. It was only when I had babies and started listening to others' birth experiences that I found that severe tearing, anal or rectal tearing, broken coxyx, bladder, uterus or bowel prolapse, incontinence, damaged pelvic floor etc etc actually seem to be the norm, not the exception.

I don't know what the answer is, but the culture of silence surrounding these health problems, and their being dismissed or minimised by the medical profession are key factors in this situation continuing and individual women suffering in isolation.

[Weareboatsremember]

A proper 6 week check that actually looked at the mother would be a good place to start. When I had dd nearly 5 years ago, the 6 week check was with a nurse who checked the baby over, ticked the box to say that I was still breastfeeding and then sent us on our way. I’d had emcs and no one asked about me past the 5 day midwife sign off.

[RowanMumsnet]

@Astrabees

I did notice that the anti natural birth brigade were quick on the bandwagon to suggest that natural labour without intervention might be a cause, which has probably prompted the posters recounting natural births with no injuries. My own experience of a 21 hour labour with a very long second stage was one I was very grateful for, I was told it might not have been "permitted" in an NHS hospital - since when is anything "not permitted?"

Thank you Astrabees. The bit about being 'permitted' might refer to the guidelines posted below - the consensus seems to be that women should not be left in second stage labour for longer than two hours unless they are making progress. (Going back 15 years I seem to remember that my second stage in my son's birth was longer than two hours too!)

Spontaneous vaginal delivery vs instrumental births vs CS is such an emotional topic and understandably so - which brings us back to the issue of data and research that would enable women, birth partners and healthcare practitioners to make decisions based on harder information than seems to be currently available. I know some MNers who are also midwives have very well-informed professional viewpoints on this and I've read posts outlining why instrumental births can absolutely be the best outcomes in certain situations.

We would REALLY like this thread to not descend into a bunfight though so can we steer clear of accusations of 'brigades' and 'bandwagons'?

[PositiveVibe]

@RowanMumsnet
I'm sorry I don't know of other online assessments that lead to a referral.

What I know is that when I was referred to a pelvic floor clinic, a colorectal department and now an orthopedic physiotherapist, they all started with an in-depth interview of my symptoms. Pelvic floor clinic and colorectal both gave me a questionnaire to fill in and because I always ask lots of questions, I asked why the questionnaire (aside from the obvious "to get your history") and the answer was that because of the nature of the problems, patients are more likely to be honest if left to fill in a questionnaire on their own than answer face-to-face questions.

A questionnaire on its own wouldn't be the optimal diagnostic tool but a physiotherapist can already tell a great deal by reading it.

[RowanMumsnet]

[quote PositiveVibe]@RowanMumsnet
I'm sorry I don't know of other online assessments that lead to a referral.

What I know is that when I was referred to a pelvic floor clinic, a colorectal department and now an orthopedic physiotherapist, they all started with an in-depth interview of my symptoms. Pelvic floor clinic and colorectal both gave me a questionnaire to fill in and because I always ask lots of questions, I asked why the questionnaire (aside from the obvious "to get your history") and the answer was that because of the nature of the problems, patients are more likely to be honest if left to fill in a questionnaire on their own than answer face-to-face questions.

A questionnaire on its own wouldn't be the optimal diagnostic tool but a physiotherapist can already tell a great deal by reading it.[/quote]

That sounds really interesting and intuitively 'right', thank you

[RowanMumsnet]

Also noted the points about relative value of 6w check versus 6m check. As we understand it, the problem at the moment is that the maternal check was not included in the renegotiated GP contract (the 6w baby check is included), so it's now a local decision whether they include this option in their package of care.

[Astrabees]

It seems to me that this thread is very much being steered a particular way. Anyone with an personal experience is being told not to be anecdotal and anyone who works in the field is being encouraged to contribute! Such a grim picture being painted here, which of course is the reality for some, but not for substantial proportions of people. Having seen Fauxgina's unchallenged post early in the thread I don't have much hope for it.

[Fauxgina]

Astrabees, feel free to send me a private message with your concerns regarding my post so we can keep the conversation here constructive. I can assure you I have no bandwagon and I absolutely refute that I am against "natural labour without intervention". I mean, really.

[RowanMumsnet]

@Astrabees

It seems to me that this thread is very much being steered a particular way. Anyone with an personal experience is being told not to be anecdotal and anyone who works in the field is being encouraged to contribute! Such a grim picture being painted here, which of course is the reality for some, but not for substantial proportions of people. Having seen Fauxgina's unchallenged post early in the thread I don't have much hope for it.

We are really sorry it feels that way. All perspectives are welcome!

[Fauxgina]

Alright, I am really trying to steer clear of a bun fight but I want to say why I am so animated about the topic:

"Such a grim picture being painted here, which of course is the reality for some, but not for substantial proportions of people"

Half of all women will experience some form of pelvic organ prolapse (POP). 1 woman in 2. You can have a POP if you are childless but a contributing factor is pregnancy and childbirth. So for substantial proportions of people - post labour information on pelvic physio etc is absolutely vital to guarding the long term health of their bodies. The weight of carrying a pregnancy for 9 months is enough to stretch out ligaments etc, so a c-section itself wouldn't alleviate all risk (and obviously in and of itself carries different risks).

[Astrabees]

Unless I have a fundamental misunderstanding of the survey the 1224 women who participated presumably chose to do so, rather than being a random group chosen to provide answers. I suppose this must make it more likely that they would have some issues they would want to bring to our attention. Presumably if you had no problems and experienced great care then you would be less likely to take the survey?

[katmarie]

I agree hugely about the six week check thing. Mine was next to useless for me, the doctor barely asked about me other than to prescribe contraceptives. I had a cut and stitches, so was advised no sex until after six weeks, so I had no idea if there were any problems in that area at the six week check. The doctor told me nothing, and so even attempting sex was pretty frightening, even with my dp being very gentle and thoughtful.

I would echo others who've suggested a six month check, however I think it would be equally well done by a midwife in the home, than by a Gp, certainly in my experience midwives have had a far better understanding of the impact of giving birth on the body than any Gp I've seen.

I think we all expect pregnancy and birth to leave it's mark on our bodies but it shouldn't limit quality of life.

[RowanMumsnet]

@Astrabees

Unless I have a fundamental misunderstanding of the survey the 1224 women who participated presumably chose to do so, rather than being a random group chosen to provide answers. I suppose this must make it more likely that they would have some issues they would want to bring to our attention. Presumably if you had no problems and experienced great care then you would be less likely to take the survey?

You're quite right that the survey was self-selecting and that such surveys aren't perfect. However, weird as it definitely is, we haven't been able to find a better data set than ours - by which we mean one that covers lots of women, is relatively recent, gives a good detailed picture of women's experiences, and is statistically rigorous. That's why we think better data collection and analysis could be a really important part of the picture.

The stats about prevalence when it comes to incontinence and pelvic organ prolapse don't come from our survey - they come from the NHS or professional medical bodies.

[Cutesbabasmummy]

I was induced at 38 weeks and had a forceps delivery. £ years on my pelvic floor muscle is still in spasm and I'm in constant pain. All the physio said was "do pelvic floor exercises!" and I'll just have to put up with it!!!

[shrunkenhead]

I can only echo that the 6 week check really needs to be as much about the mother as the baby. I really wanted to be examined as knew I want right/or If I was reassurance would've been helpful but wasn't offered an examination. It's all v well ticking all the boxes Re breastfeeding/PND/contraception advice (?! WTAF like I'd ever need that again!) but the one major part of the body that has undergone serious trauma seems bottom (no pun intended)of the list.
It's embarrassing anyway so no one is going to beg to be examined, it just should be a vital part of the 6 wk check.

[Maggiemax]

Hi Ladies, this is my first ever post on mumsnet, I’ve always heard such wonderful things from other mums and what a great source of support and advice this forum is. I don’t use social media of any sort, but saw a news headline today, on this particular topic.

It finally gave me the courage to speak about my own experience and perhaps seek advice from someone that has been through the same.

I gave birth to my darling little man, in March of 2012. He was a big baby, and Labour was intense and fairly quick, however the midwives were busy with other mums that were having difficulties and my husband and I were left alone for most of the Labour.

My contractions started to lose intensity so they said they needed to give me a drip to get them up again, they did this, and left me for a couple of hours, they had a shift change, and when the new shift came in, they discovered I wasn’t actually connected to the drip at all, I had saline in my Canular and the drug to help me, was just dangling to the floor.

Next thing I know, a doctor is called in, she tells me nothing puts my feet in stirrups and I am given and episiotomy and they tell me I am having forceps, I was given no pain relief. And until this point I had only been given gas and air.

I can only describe the feeling of have forceps forced inside you as the most awful violent violation. Solid could steel felt like it was ripping me apart. I suffered fairly heavy blood loss at this point, just under 2 litres ( I’m told this is heavy but I don’t really know)

My son is now 6 and a dream come true, I however am still suffering terribly. There has certainly been nerve damage, as it takes me a very long time to be able to pee. I sit on the toilet and try and let my body remember how to open my bladder, it can take a long time. I don’t think my bladder EVER empties fully. And of course, if I run, sneeze, jump or cough... my bladder has no issue in releasing then. I was told I need physio, for my pelvic floor, but I simply have no control over it. I cannot feel it. That in combination with every time I open my bowels, my insides fall outside is how it feels, a large grape sized portion of flesh, which I have to push back in after going to the toilet. It makes it exceptionally hard to clean myself, and I am so conscious of this. I suffer with IBS and this is made much worse by it. I have lost control of my bowels more than a few times now, as again, I just don’t have the muscle control anymore.

Doctors tell me that surgery isn’t the answer. That I should take measures like a home enema every morning etc etc. But I am 36 years old. This has caused me so much embarrassment and depression.

My husband is fantastically supportive but I am just miserable. And truthfully I just don’t know what to do.

Is this what life is going to be now? Do I have to learn to live this way? Or is there something I can do??

Sorry if I have bored you all to tears.

Thank you for listening

Maggie

[Movablefeast]

I am only talking anecdotally but in France the health care system seems much more concerned about the woman's body before and after birth and offer a lot of help and support for women to gain back their health. Has there been any investigation of other countries health care systems and what is successful?

[Movablefeast]

Maggie you definitely should not be suffering like this. I don't live in the UK so don't know how you make sure you get the care you need but I hope others on this thread will .

[LineysInTheSand]

Oh Maggie That's so bloody awful.

I've said this on another thread - I've had far, far better aftercare having just had a hysterectomy than I and other women ever got/get after c-sections and other birth experiences.

That dichotomy itself is a major issue that needs investigation. I'm not imagining it.

[Maggiemax]

Thank you.

I dread the future, as of at 36 I struggle to be I. Control of my bladder and bowels, what is going to happen as I age 😢

How can you work on muscles you have no sense of feeling in.