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.

[Gotofriggingsleep]

Excellent campaign, I hope that it is listened to. I had a retained placenta after my first birth six years ago. I am sure that the extremely rough manual removal has led to the prolapsed bowel, cervix and bladder that I am now living with.

I had a birth debrief while experiencing severe PND and PTSD but it did feel a bit as if she felt like things could have been worse and that I was making a fuss. I did go on to have a second child in 2016 but when I broached the subject of an elective c section the Consultant was very dismissive. Thankfully the birth was straightforward and the care during labour was great, afterwards not so much.

On the whole I have encountered an air of 'it's normal, what do you expect after having a baby' but thankfully I finally got a referral to a Urogynaecologist who agreed that living life like an incontinent mouse wasn't acceptable. I have had a TVT fitted which (fingers crossed) seems to have sorted my stress incontinence but I feel like I have a time bomb inside me - nobody can say if/when I will need surgery for the prolapses.

Both my babies were under 7lb so I guess I have been unlucky but I do wish that there was more help and support available to women affected physically and/or mentally by childbirth.

[Astrabees]

Deeply unfashionable as this may now be I had a profound belief that provided my body was allowed to get on with giving birth without intervention there was the best chance of a good outcome for me and my babies. I had a deep trust in Yheudi Gordon and Faith Haddad who were my obstetricians for the first birth and a tear was much better than any other course of action. I had a home birth second time around and actually wrote it into my birth plan that without consent any interventions would be viewed as assault and that I would involve lawyers (I was one then) and the police. I had two big babies, DS2 nearly 10lb and with shoulder dystocia that needed a bit of manual intervention. I made a full recovery within 6 weeks each time and have never had incontinence. I do think you need to be armed and ready for some of the totally unacceptable medical practices that are carried out against people's wishes.

[danigrace]

Fantastic campaign and great recommendations.

I'm so shocked to hear the 6-8 week check being for women as well as babies is now a postcode lottery!! That should absolutely be standard.

And it seems it would make complete sense to put all the most common problems (learned from research) on a standardised checklist a mother can tick yes or no to, so that there is much less embarrassment in raising the issue and it's clearer to the mother it's not "just her", this could also be quite time saving for doctors.
As this is all becoming more apparent it would be good to enquire after the mother's postnatal health at each of the babies' checks including the 9 month - 1 year check

[Putbiglighton]

I have joined Mumsnet just to comment on this. I am 51 and had my first baby 26 years ago. A back to back labour with a prolonged second stage that ended in a forceps delivery and a badly stitched episiotomy. I went on to have two more babies but I have never forgotten the pain of those stitches and how I sat on my hospital bed, crying, holding my new born daughter. This birth, and two subsequent births left me with a vaginal vault prolapse which doctor's just shrugged off as being something you had to put up with. As I have recently hit the menopause, it feels worse, and I'm having some incontinence. I recently saw an excellent (female) doctor specialising in women's health and gynaecology, and she has arranged for me to see a physio and generally been very helpful. I am looking at surgery though, if I ever want to have a decent sex life again. I feel old, embarressed and sad. This is an excellent campaign. I feel very strongly that there should be more honesty and openeness about this issue, let's keep women informed and supported. This needs to be "normalized" until it's as accepted as talking about menstruation.

[Thishatisnotmine]

Agree about the post natal check up, it simply isn't enough. I didn't attend one with dd2 as I kept forgetting but that is my own fault.
Dd1 was born with ventouse and an episiostomy then I had to have the placenta manually removed and stiched up in theatre. I haemoraged but was not aware of this until oregnant with dd2. I had mild incontinence that went very quickly and my stiches healed really well. It was only when dd1 was about 3 months old when we started having sex again that I found out it hurt. I was fortunate to have a really good GP who referred me for an ultra sound (they found something which I had removed that was likely to be a bit of scarring left from the placenta removal). But the pain it seemed was because of scar tissue in my vagina. I had a very quick, easy birth with dd2 but have more scarring inside. I had absolutely no idea that this could happen, it seems that I just have to put up with sex hurting sometimes. I pee a little bit when I am walking and sneezing etc but like everyone else I view it as 'normal'.

It does seem that women just sort of float around after birth, with no one quite sure what to do with them. We are just making a fuss going to doctors to complain about problems which women have silently put up with for millions of years and get patted on the head with a "it's what happens after you have a baby". But it shouldn't be like this.

[SheilaHammond]

Three babies (all teens now), all vaginal deliveries, one was ventouse, all 7lbs plus.

Had an episiotomy with first, painful sex and a 'lop-sided' feeling ever since (21 years!). Contstant UTIs since and now take low dose anitbiotics every day. Now have a prolapse and rectocele, some incontinence. Have no muscle tone in rectum due to cut.

Been seen by a uro/gynae consultant but 'not bad enough' for surgery. And warned that surgery is no cure, might get worse etc. Also had a course of gynae physio which was Ok but set the bar pretty low for counts as an improvement (any improvement in continence). Apparently is normal and fine to have to manually evacuate when you need a poo.

It's miserable. I just put up with it now.

[rowdywoman1]

Fantastic MNHQ. This is so needed. There have been some shocking threads on here recently and anything that can happen to get women listened to and treated properly is long overdue.

[carrie74]

I'm so glad you're doing this MNHQ, a great campaign. I've been incredibly lucky after 2 babies to not notice any after effects, but the occasional comment from (close) friends, and reading some of the 'normal' stories from posters here is an abomination. I truly believe there would be much greater research and care if this was happening to men, and that makes me furious. Thank you for doing this.

[capercaillie]

I was referred for pelvic floor physio after my first birth as it was a long second stage and I’d had some bladder distension. The physio was brilliant - a class on pelvic floor health and then an individual session with a physio. I had a small prolapse that has mostly gone although I wouldn’t say that everything returned to as it was before. Would like to see that sort of physio available to all women.

[Morphene]

I think the most important contributing factor in women not coming forward for these issues to be addressed is the de-humanising experience they have just been through.

My own birth injuries were actually caused in the main by a failure of self care in the weeks after giving birth. I was so utterly lost as a person having had an utterly degrading experience that I didn't attempt to deal with an increasingly damaging constipation issue. I have been left with damage in the form of anal prolapse that affects me every day. It was all completely unnecessary and would not have happened if I had been treated like a human being during labour.

So if you want women to report and get treatment for birth injury you will probably need to prevent them being given the impression they are worthless during childbirth.

Any sort of check in the hospital that made me feel like my pain and fear were of interest might have helped. An appointment in the diary for me (as opposed to the baby) might have helped, no matter when it was for. A single health professional asking how I was as opposed to the baby would have helped.

I was asked for my credit card details more frequently than I was asked how I was feeling or dealing with my traumatic birth experience.

[JohnnyMcGrathSaysFuckOff]

Tbf many of the abhorrent attitudes from HCP discussed here are also displayed by us - MN posters.

How many threads on home birth or refusing interventions say things like oh you should just be glad to give birth with medical equipment available, or oh your baby is what matters? I have seen any number of threads go like that (see also smear test threads).

It is pure misogyny but lots of ordinary women internalise it, too - not just 'the establishment'.

[LineyDancer]

That's a fair point, Johnny

[blinkineckmum]

Great campaign. My aftercare has been brilliant but after 3 births, 2 of them back-to-back, I feel embarrassed talking about my recovery with other women. Many are squeamish and unsympathetic.

[Mydoghatesthebath]

Great campaign mumsnet.

I have 6 children first and fourth were back to back labour and ended in hours of pain, forceps and episiotomies. Needless to say not nice.

Other 4 anterior presented and 2 no worse then a period pain while other 3 were usual pain but straightforward.

I think tutu key is knowing the babies position. And midwives do!!!! That’s what gets me.

Having a back to back baby is virtually impossible to deliver without intervention and women should be told this and offered choices.

In my view equality will come when any woman can request c sections and/or epidurals on demand and no crap about there’s no anaesthetist available one should be available 24/7 for labouring women.

[Arthien]

This needs to be "normalized" until it's as accepted as talking about menstruation.

But menstruation isn't really normalised it is? If I need to change a pad or tampon at work, I have to sneak it into the toilets up my sleeve, or in my pocket, or take my handbag which means everyone in my office will 'know'. A massive proportion of working aged women have (or have had) periods, yet somehow we still have to keep up this weird facade that (like pooing) women don't have periods, or if we accept that they do, it's just 'women's troubles' and that's that. It hasn't been that long since Bodyform switched from using blue liquid in their adverts!

If society can't accept periods (including the blood and cramps that come with them) as something that many women have to deal with, then it's no wonder that the more intimate or gory realities of birth and post-natal health are hush hushed and women are left feeling like they're on their own if they have birth injuries or long term effects.

for everyone who has posted their story. Let's hope this campaign gets people talking about what 'the miracle of birth' can really be like and what can be done to improve things.

[Mydoghatesthebath]

I actually hope my dds don’t have babies. I want more for them than this.

[AuntyElle]

I’m so glad MN are launching this campaign. Many of the posts here are heart-breaking and it is so wrong that better care and acknowledgement is not provided.

[ProseccoPlz]

I had horrendous after-care following the birth of my first and only child who is now 4.5.

We live in Scotland. I had a normal, healthy pregnancy and endured a 23 hour labour. Labour went well, it became stressful when it was time to push. Baby was becoming stressed so we had the resuscitation team in on standby. They used forceps and I have a tear plus episiotomy and a load of stitches.

Post-natal care by the midwife was awful. I was in severe pain but the midwife kept reassuring me this was normal and didn't take my concerns seriously. I was in agony, I couldn't go to the toilet and I couldn't stand for any length of time, let alone walk.

I experienced a loss of bladder control and complete urine incontinence for a week after birth. Gradually this subsided.

I was unable to go to the toilet to empty my bowels without feeling as though I was going to pass out. The pain was horrendous. I couldn't leave the house out of fear of needing to go and if I did the only thing to soothe the pain was to jump in a hot bath straight after. I felt like I was going to pass out every time.

I eventually spoke to the doctor when my child was around 6 weeks. Their advice? "Have you tried emptying your bowels standing up in the shower as it's a different position?". What kind of advice is this to give to a first time mum? They offered no support or help and I felt desperately alone.

I was admitted to hospital on one occasion because I couldn't go to the toilet to empty my bowels which resulted in being unable to empty my bladder. I was given a catheter and enema's to try and resolve the problem. I was also examined and again no cause found for the pain.

Several appointments later, I was finally referred to gynae who administered Botox to relax the muscles in my back passage and they searched the area with cameras. The Botox helped but it didn't relieve the problem.

After 12 days of being unable to empty my bowel, I was sent back to hospital by my GP. They put me to sleep again to discover I had a fistula and they performed surgery. This is a tunnel from the back passage to begins. No wonder I had been in agony trying to empty my bowels! This immediately resolved the pain but sadly for me this was a whole year later after giving birth. A whole year of not being taken seriously, a whole year of suffering and now I still have issues. I attend physio for incontinence issues and I have a prolapse of the bowel, bladder and uterus. I am going in circles with physio. I have been going for a year with no real progress.

I am thirty-one years old and this is not how I should be. I cannot do physical exercise like I used to, I am ashamed to have sex with my partner and most of all I have been put off ever trying for another child because of the experiences I had.

This has made me feel so depressed, it impacted on my experience of being a mum to a beautiful newborn and I will never forget the treatment I experienced from the midwife in those first few days!

[JohnnyMcGrathSaysFuckOff]

I need to stop posting on this thread but it makes me so fucking angry.

We are providing the state with future citizens, we are making the next generation of humans. I mean, humanity wouldn't exist without women doing this.

But we are subject to bullshit quotas and targets (keep CS rates down) and outdated ideas (giving birth on back, under bright lights) using instruments like forceps that are basically eighteenth-century technology.

Are we saying this is the best we can do? I don't believe it.

I dream of an integrated women's healthcare pathway with excellent, unbiased antenatal classes available to all. Birthing suites staffed by female clinicians and MWs providing woman centred care, acknowledging the trauma that many patients will have been through from rape and SA. A place where consent is paramount and birth is not seen as an undignified ordeal but a moment where thr female body does something miraculous, whether unassisted or not. A place where women are supported and celebrated. I imagine sympathetic breast and bottle feeding support and every woman having self referral access to a physio. I imagine postnatal community care with supportive groups of new mums and postnatal exercise classes. A system where experienced mums help newer ones and HCPs work with mothers, recognising their importance, not belittling them.

Are we saying that isn't possible? We are supposed to be a rich, developed nation. It should be possible. How can we get there?

[AuntyElle]

Hear, hear, JohnnyMcGrathSays!!
ProseccoPlz, words fail me, I’m so sorry

[GrumpyPantz]

Prior to giving birth I knew nothing about birth injuries and had no idea of what was normal or what to expect. Better information and more open discussion is needed. This doesn't happen because nobody wants to "scare" women by talking about it.

I also think the fetishisation of natural birth is leading to unnecessary injuries. My baby was huge and positioned back-to-back, the surgeon who saved my life told me afterwards that I should have had induction or ELCS a month earlier and should not have been left to go overdue with such an enormous baby. All because midwives were determined for me to go into natural labour.

[Mydoghatesthebath]

prosecco your post made my cry

johnny too bloody right

[Mydoghatesthebath]

Grumpy said it in my op and agree scans and midwives can tell the babies position and a back to back big baby is virtually impossible to birth without forceps or other intervention.

[jedenfalls]

Jesus H this is outrageous.

Im one of the lucky ones, very serious complications meant I had an emcs, so I ‚‘only‘ have painful surgical adhesions to deal with. And a little bit of minor inocntinence.

I cannot believe this has had so little research (well, actually I can. Depressingly)

[Carouselfish]

Straightforward birth, 2nd degree tear, but pushing process pretty fast and 3 years on, bowel movements require 'putting myself back together' afterwards and I'm terrified of ever having sex again.
Went to the doctor who said are you doing pelvic floors. Rolled her eyes when I said not as regularly as I should. Rolled her eyes about examining me. Ignored my trauma at idea of anything going inside my vagina and roughly penetrated without lube, with spectrum leaving me bruised for 3 days. She'd had four children and thought I was just making a fuss. Said I'd never get an elective csection, despite it meaning I will not have another child as I know any pushing will permanently destroy me down there as an older mother. She said I could get referred to a pelvic floor specialist but told me I 'wouldn't like it'. I do pelvic floors more frequently now but have had panic attacks in the doctors since and won't attend alone. Trying to gather courage to go private about it all.
Doctors shouldn't base their treatment of women on their own experience. They shouldn't dismiss the psychological aspect of post natal care.