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.

[JessTessMess]

maggie how awful. This is an excellent campaign, and I would fully support a 6 month check as even wtb subsequent dc 6 weeks you are still coming round from the shock and not sure what’s long term damage

[Zippea]

It’s not just physical issues though is it?
I have horrific scarring from my ‘normal’ vaginal delivery. A delivery I was pushed into because the dr didn’t want to do a cs. I had failed ventouse followed by forceps and ended up in surgery for many hours trying to stop the bleeding. The recovery was dreadful but I was expected to get on with it because I’d had a ‘normal’ delivery. I’ve had 16 operations to correct the damage and am now disabled.
My youngest was conceived on the one time we attempted sex because I was interested to see if I could fit dh’s penis in (I’m a romantic, me). She was born via cs and whilst I had another bleed I lost significantly less than my first delivery.
I had no voice - no one heard me. When I couldn’t bf a mw spent a whole day with me trying to get an exhausted unhappy baby to feed. When i reported post birth complications I was ignored. I only got to see a consultant because a locum happened to visit the surgery and referred me. This was 2 years after the birth injuries were sustained a d I ended up with ptsd.

I think I read somewhere that in France post natal women were given six weeks Physio etc as part of their overall care and experiences I have had would have been picked up a lot earlier.

Good luck with the campaign

[FairyFantastic]

I'm due in 4 weeks and despite family history telling me I should have a c-section I am being told I am having a natural birth, c-section has not been mentioned. I feel that at 36 weeks it is too late to request an elective c-section, and honestly I don't think I'll get one. And whilst I would love to experience natural birth, it terrifies me, and always has.

I am watching this thread with interest as until very recently I was unaware of the extent of damage labour could do. I have demanded no forceps, and this thread is reassuring me of my choice. This should not be a taboo subject. I know a lot of people here may feel embarrassed to share their stories, but THANK YOU for doing so. Yes, I am terrified, but I am also reassured that there are others out there (sadly) who I may be able to reach out to if anything goes wrong. You are all so much braver than I am/will be. Best of luck to you all, I hope we can change the system and everyone get the aftercare needed!

[SophoclesTheFox]

This is an excellent campaign. Such awful stories - I am so sorry that so many of you are suffering.

[Fauxgina]

Message me @Maggiemax if you would like details of a private Facebook support group with lots of practical advice and suggestions for local hospitals and departments to push for a referral to. It's a UK/US support group.

Is there any way you could afford a private consultation? (About £250) I have a couple of excellent suggestions if you can get to the North West

I think you need to be referred to a colerectal surgeon and also a clinic for your bladder. The start of all that is probably would come from your GP referring you ideally to a urogynecologist, if not a gynecologist.

[JohnnyMcGrathSaysFuckOff]

Maggie I am only 6w postpartum with my own prolapse/ issues but I have referred myself to a women's health physio who uses a biofeedback machine which is intended to help people who have incomplete control/ sensation there. Is that a possibility for you?

I just googled women's health physio and pelvic floor physio and found several local practitioners. I basically picked the one who looked like she had the most experience and offered the most comprehensive package. An initial consultation is £60 and then similar for follw up appts. I suspect I will have a lot of those

[Fauxgina]

@FairyFantastic - in the 3 years from giving birth from the first time to the second they'd totally overhauled their processes. Midwives are constantly reviewing practices and it is improving every day. In spite of a dreadful time I look back on the first 24 hours after labour as one of the best of my life. I was tired but content with a beautiful baby in my arms. Please don't fear it

[2rebecca]

I think that as midwives now do most antenatal care and also do most birth related suturing it makes sense for them to complete the process by doing the 6 week check as well. I think post birth physio is important and am glad I saw a physio whilst still on the ward to discuss pelvic floor exercises and exercises to bring the 2 sides of my abdo muscles back together.

[Maggiemax]

Oh lord.... I don’t know how to message you 🙈

There are pros and cons to not using any social media.... but one of the cons is I have no idea how to navigate forums like this one🙈

[JohnnyMcGrathSaysFuckOff]

Oh also google FemFusion YouTube channel. Loads of stuff on there about childbirth injuries. In particular a woman called "Dr Bri" who is very Californian iykwim but seems to know her stuff. She advocates starting by stretching the PF not contracting.

And have you contacted the Birth Trauma Association?

Well done for not letting the abuse you suffered in birth affect your relationship with your son. You sound like a fab mum.

[LineyDancer]

I'm more than happy to recommend my gynae surgeon who specialises in complex (and minimally invasive) gynaecological surgery including colorectal. He has an NHS as well as private practice. He's excellent, and I was lucky that our paths crossed after a few years of crap experiences. Please PM if I can help.

[LineyDancer]

Maggie, tap the three little dots on the bottom right of the message. You get a menu including a private message option.

[endofthelinefinally]

I had a bad tear with first baby due to precipitate labour.
I was sutured by a junior doctor. It took ages and she used 4 or 5 prepacked needles and sutures.
It healed slowly and badly.
When I had second baby I tore along the scar, but the consultant came and stitched me up, making a really good repair that healed quickly with minimal scarring.
A couple of years later I had to have surgery on haemorrhoids that had developed during pregnancy . This was done by a junior doctor. (A theme developing here). They made a terrible mess of it and I had to go back for further surgery 2 weeks later. The consultant had a go this time but with limited success. Too much damage done.
25 years later I still have a rectocele, chronic pain and bleeding. I am far too scared to seek any help.
I know juniors need to learn, but more care needs to be taken so that they are adequately taught and supervised.

[Anatidae]

A very timely campaign.

I would be calling for;

Better and longer term data collection - over decades. Including instrumental delivery rates by area and hospital, birth injury data broken down by type and truly long term follow up. Problems can manifest decades down the line

Antenatal classes to be more realistic, with realistic information on birth difficulties, basically what can go wrong, what’s fine in each situation and crucially, the potential consequences of that - the latter is generally glossed over

Stopping using c section rates as an indicator of quality - an elcs is a preferable outcome to an unwilling vb in my book and definitely s preferable outcome to a vb with serious complications.

Better care for women in labour - too many are belittled, their wishes ignored, and consent not sought for sweeps/other invasive checks. Ongoing consent is so key.

Better postpartum checks - the French model is worth looking at and comparing (proper checks, pelvic physio etc.)

Better access to post birth excercise like the above pelvic physio - it is disgraceful that this isn’t standard.

Redefining what a successful birth is. Right now it seems to be ‘baby ok regardless of mother’s health.’ That’s got to change (linked to c section rates etc - fuck having a ‘successful’ vb counted as a good outcome if that’s at the expense of faecal incontinence.

Basically data collection to drive a change in attitude.

[April229]

I wouldn’t like to see hospitals embracing the NICE guidelines. There is no point in saying woman can choose how they give birth if you are to fight and fight to have a c section if that’s what you want.

I would like to see more balanced information- endless leaflets about c sections risks, not a single bullet point about the long term risks of vaginal births.

[HelenaDove]

Im childfree by choice so not affected but i have seen posts about these issues on different health related threads and the misogyny from some members of the health profession that some women have experienced and the refusal to acknowledge really boils my piss.

i do have an overactive bladder which ive had since my early 20s and i did get told that needing a pee every 20 mins is normal And i find smear tests INCREDIBLY PAINFUL but thats as close as ive come to this.

Maggie and others affected bloody appalling.

[Elderberry9361]

Perinatal PTSD is very common and goes right under the radar from a health visitor/GP perspective. We have to get more information transferring from maternity services and an automatic referral to get counselling and help. I had undiagnosed Perinatal PTSD after having a failed ventouse and rape by giant forceps delivery that created both physical and emotional trauma. Our nervous systems are incredibly damaged by a traumatic delivery. Ours was a near miss and I had an NDE and was so dissociative I didn't recall it fully until 17 years later as up until then I hadnt felt safe in my own body. We can, with the right in person help, rewire our nervous systems. However, this has to be earlier than in my situation as Mum's nervous system directly impacts on baby. This affects our baby's nervous system too. How anxious we are gets transmitted skin to skin or through interactions, feeding, whatever, so it is vitally important that we address care of the Mother (and the vicariously traumatised partner) and the baby as having paramount importance. This is affecting the mental health of our children as they need a resilient, healthy nervous system to navigate this all too complex life we have created in a culture with systems that are totally broken. We need community. We need to start to help each other and gather together. To listen and be heard. I will get off my soapbox now. Phew.

[DrunkOnCalpol]

When talking to medical professionals about my birth several of them said 'the only thing that matters is the baby is here safe'. Literally telling me to my face that my health and wellbeing is of absolutely no concern to them now I'm a mum. Doctors I know refused forceps for themselves or their partners and insisted on a c section instead as they know the damage it does, but they're happy to do it to others.

[HelenaDove]

" Doctors I know refused forceps for themselves or their partner"


Because i bet those doctors didnt want their own sex lives affected.

[Elderberry9361]

We need more trauma informed practices in maternity services. When I had my son, which was a near miss delivery, the room was so full of other people's trauma and fear that it was, in a way, inevitable that what happened happened. I want to encourage each family, particularly mum, to share any adverse experiences, particularly those in childhood, as these affect the state of her nervous system and this can cross the umbilical barrier and will ultimately affect how calm or otherwise her baby is. Someone who has been abused or neglected, for example, is much more likely to have a traumatic birth. We need more information and support for people planning to have a baby that helps them to rewire their nervous system so that they are able to module and self regulate. Trauma informed practice across all services, all maternity, GP, CCG, complementary therapies and particularly creating the opportunity for women to have sensitive, compassionate sexological support to understand about female genitals and arousal pre and post birth. This needs to be a mainstream offering.

[April229]

Erm that first bit was would not wouldn’t.

[pickledmommy]

I was induced and ended up having a 9lb 10oz boy via forceps delivery. I've since suffered with the healing of my scar and from incontinence.

The midwives in the hospital and the ones doing the home visits were very dismissive of the pain from my tears and it was clear that I was just supposed to get on with it. I had to make several GP appointments to have the scar checked and they were infuriated that the midwives had signed me off from their care.

My birth plan stated that I preferred any other option over a forceps delivery but I was over ruled by the dr who told me that this was his job and I should trust that he knew what was best for me.

Overall I believe that due to the size of my baby, which had been noted at every scan as being top centile, I struggled to get him out and laboured for too long being told to push despite not feeling like I needed to push. In retrospect I don't believe I was capable of birthing him naturally but it was the only option I was ever presented with and even when I begged for a section I was ignored and spoken to like my concerns were not valid.

More research is needed into the scale of interventions involved in induced deliveries and more choices given particularly where a baby is estimated in the high centiles.

I'm now 13 Months post birth and my incontinence is not improved one bit. I've just had a referral to a specialist via the NHS and he was excellent and has given me some great advice and referred me in to an incontinence team so I'm hopeful I can improve. But why could I not have seen him sooner or been given this advice straight after birth? The quality of care from midwives is so focused on breast feeding to the detriment of anything else it just feels as though the mother is not important at all.

[agbnb]

This is commendable work, MN!

Not enough attention is paid to this nor is it well understood. The quality of medical care afterwards (or to educate and instill knowledge about risks, prevention measures before injuries if any) is haphazard at best.

It's as if women's quality of life doesn't matter. Because we should all just be grateful and we idyealise a romantic idea which isn't anywhere close to the average experience.

If dads had to accept a fraction of the physical trauma (and lack of medical care) around these issues, it would be a national outcry!

I'm hoping you get good media coverage with this, and it starts to become less taboo in our culture as a result.

[MrsRonBurgundy]

I’m currently pregnant and am having an elective c section due to my concerns around birth injuries. I’m well aware that I will have a potentially worse initial recovery, and that there are variables with a section, but for me there are fewer variables with a planned section and a more controlled process is something I need to be able to cope.
I didn’t have to fight too hard once I was able to demonstrate an understanding of the risks. I did have a discussion with the consultant around the following though:

• all the c section risk statistics published were the emergency and planned stats combined. There were no stats available to me on risk of injury to me or my baby with a planned section. I asked consultant to provide these to me but he couldn’t, all he could say was a planned section was “considerably safer” than an emergency.
• I struggled to find comprehensive and factual information about birth injuries, severity and likelihood anywhere. Again when I asked the consultant about this, all he was really able to provide me with were the c section risks.

I think all of the information and risks about every type of birth should be easily and readily available for women either considering getting pregnant or who are already pregnant to allow us to make our choices in an informed manner. I have no experience of the aftercare side of birth yet but from friends experiences, I understand it’s not much. Which seems crazy given what our bodies go through. Some of these stories on this thread make me so sad and angry that women have been left to suffer with nowhere to turn. to you all that have had negative experiences

[WantingMuchMore]

I think delivery room practices changed considerably in the 17 years between my first and last birth and whilst I can only speak from my own experiences, it wasnt for the better. I was induced with my last - against my express wish - and denied an epidural on five ocassions of asking both before and during the drip being administered. Despite telling the midwife something wasnt right, having experienced 3 prior births with no intervention (not even pain relief) I was ignored, over ruled and treated with absolute distain. My child and I were exceptionally lucky to both make it out of that room alive after 37hrs of absolute hell. Ive been left with not only the physical difficulties but enormous emotional side effects that have effectively paralysed any libido I might have had left and created an intense fear of pregnancy. I think more needs to be done to consider PTSD and other non physical impacts following traumatic birth experiences. The lack of decent aftercare on a physical level, magnifies the emotional effects which are in my experience utterly dismissed by health care professionals.