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.

Grumpy my last baby was back to back and huge. I was almost 2 weeks overdue, had been having contractions for a week but waters hadn't gone (they didn't until he crowned). Community midwife advised me to go into hospital to 'get my waters broken', but when I got there was refused. When I asked why nothing could be done, the midwife said that she would like me to have a 'lovely, natural birth with no interventions', she 'would really like that'. So that was what I had- and no pain relief either (not for lack of begging asking). It wasn't very 'lovely', though!
The fact I had no intervention or injuries, after reading this thread, and also registering the exchanged glances of panic between the midwives and doctors whilst I was trying to push, must be down to sheer luck.
Being so fortunate, I do feel like a bit of a charlatan posting on this thread but out of everything I've experienced giving birth three times, I always remember that one midwife telling me how she would like me to labour and the way she said it.

I really think midwives get paid a bonus if their mothers to be have a vaginal delivery.
It would be great for them to give us their honest opinion about this, their "targets" and why they never mention the injuries, psychological wounds, or any true post natal care.
By the way I'm going to a pelvic floor physiotherapist that is helping me so much I wish I had known of this before.

I feel ruined by my emergency forceps delivery six years ago. My downstairs looks and feels awful. I work long shifts on my feet and get awful sore and achy pain around my episiotomy scar. Sex is often painful too. I just feel so angry over it all, I wish I had known the reality and risks of assisted delivery. I've been left mentally and physically damaged for the rest of my life.

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.

This! Women who are pregnant/giving birth are so often treated with no respect or dignity and not taken seriously that it really is like people forget this!

Name changed for this, topic which is very close to my heart. Over 10 lb baby, almost 2 weeks late, 30 hours labour, forceps, episiotomy which became infected. Various other post natal complications I was continually fobbed off about, requiring me to try to find the right professionals with my own money.

Which leads me to now, more than 2 years on - bladder and bowel prolapse (‘only’ moderate thanks to extensive pelvic floor physio & lifestyle modification), incontinence, scar tissue problems making it impossible to have sex without pain. Oh, and a PTSD diagnosis due to all of this.

And actually, when I am open with other mums, quite a few share similar stories and are suffering with at least one of these issues. They just don’t talk about it.

Things that would have helped:

• proper 6 week check where they actually bloody look at your vagina, check the healing properly etc
• French system of pelvic floor rehab for all mums - this would save the nhs millions by preventing a percentage of prolapses & therefore prolapse repair surgery required!!
• better antenatal education for pregnant women of the risks of these injuries, what symptoms to look out for, etc. This also helps with the shock and utter embarrassment when this happens to you
• better education of doctors and midwives about how to check for infection, poor healing and prolapse (one GP told me, without examining me, that I couldn’t have had a prolapse.... even though my birth had all the risk factors))
• pathways for painful sex - not just telling women to grin and bear it. Various things can be tried from oestrogen cream, lidocaine, steroid or Botox injections, laser treatment, manually scar tissue manipulation etc before revision surgery is considered but the NHS never mentioned most of these treatments to me.

I had wanted to have two children but all of this has had such an effect of my health, mental health, and marriage I think we will be stopping at one :(

Oh - and proper studies and classifications of risk and cost of various deliveries. There is this perception that c sections are very risky, painful and expensive. But that is only because the possible lifetime complications of vaginal birth (particularly assisted delivery) and cost to rectify those complications isn’t tracked accurately and costed for in terms of what an assisted delivery ‘costs’ the nhs, vs what a c section costs.

Haven't read the entire thread, but inductions?

Something like two thirds result in an instrumental delivery or section. This is is on top of the trauma of the induction itself. I was literally screaming for pain relief by the time they let me off the ward and into the delivery suite where gas and air was available. Still have flashbacks and can't stand the thought of sex nearly two years later. My emergency section was a relief!

Why do they do 'inductions'? They don't work for most women and are horribly traumatic.

Are we saying that isn't possible? We are supposed to be a rich, developed nation.

Of course it’s possible. We don’t do it because society is still deeply misogynistic, women’s health is seen as irrelevant, or a bit disgusting, and women are ALWAYS bottom of the pile for societal regard. In many ways we havenet moved on from the biblical idea of women bringing forth in pain. It’s like a punishment. Women are vessels - for sex, for creation of children. The idea that we should be cared for and treated with dignity is actively resisted and society is going backwards on this - things are getting worse.

It doesn’t happen because people actively don’t want it to happen. That’s why.

I think the use of forceps needs to be questioned, forceps delivery is brought up again and again by women suffering from birth injuries. I live abroad and forceps are considered more or less obsolete - suction is the only intervention that is used here.
Why are forceps still so commonly used in the UK?

Just for some extra thoughts - I am a urologist, though not a reconstructive/ pelvic floor specialist. Undoubtedly birth is not good for your pelvic floor, and some really terrible things described here - not necessarily something that could have been done differently during the birth, but totally mismanaged and ignored afterwards that I think is the huger problem. From experience C-sections are not always the risk free alternative suggested. I have been involved where the lady's bladder has been injured, and even suspicion that the ureters may have been injured during a number of c-sections. My birth plan was - "both of us to get out alive" - that was it. (We did!)

I honestly think it’s about the woman and her ‘obstetric team* yes ha ha knowing the actual position of the baby just before birth and if back to back offer a c section because it’s really difficult to birth a back to back baby without intervention.

Also 24/7 anaesthetist attached to the midwifery unit purely there to provide epidurals for women who want them. Not to provide any other services in theatre unless there’s a major incident declared.

I had 6 kids and asked for one every time and never got one 6 times

I think pain in labour isn’t taken anywhere near as seriously as it should be. Or the mental trauma of birth too.

But getting out alive isn’t necessarily living is it? Some of the women on this thread are alive but not living proper healthy lives either mentally or physically.

We deserve better

Swann - My prolapses were diagnosed when I had just found out I was pregnant with ds2 (had a drs appt booked for the prolapse already and then found out I was pregnant the day before!). So I was put under consultant-led care for that, but they then told me that the damage is done by the extra weight in one area in pregnancy, not necessarily by childbirth, so a cs wouldn't necessarily stop things getting worse (though they were happy for me to choose one if I wanted one - i was on mn at the time and had the nice guidelines to hand ).
I was then referred back to MWled care and had ds2 vaginally.

Problems with referral then from a gynae registrar, then a long waiting list, then complications from surgery that I cba to go into right now.

I'm 18 months post-repair now and things still aren't right. There should definitely be more info before pregnancy. I'd argue that prolapse issues from childbirth should be taught at sex ed, tbh.

Oh re my deliveries - ds1 was 40+2 and a quick labour (4 hours start to finish), he got distressed when I was told I was nowhere near ready to deliver and to stop pushing by a midwife. Born 30 mins after I was told to stop pushing, by ventouse.

Prolapse then appeared before ds2.

Ds2 born 18m after ds1, 40+16. Induced with pessary and waters broken once in labour, another quick labour (3h), this time no assistance.

It's relevant that I have EDS, though that wasn't diagnosed til a long time after my prolapses appeared.

From experience C-sections are not always the risk free alternative suggested. I have been involved where the lady's bladder has been injured, and even suspicion that the ureters may have been injured during a number of c-sections. My birth plan was - "both of us to get out alive" - that was it. (We did!)

Yes C-sections do come with their own risks but women need to be given non-bias information on what those risks are and how likely they are vs other options. Emergency c-sections are also much riskier and the only way to guarantee not having one of those is to have a planned section.
Women should be free to decide which risks are more acceptable to them and make an informed choice.

The risks with induction are quite frightening. I was looking at my local hospitals stats and well over 40% of first time mums getting induced end up with an emergency section. However, if a first-time mother was choosing between an induction or a planned c-section would she be openly told this? Or just given c-section risks in relation to going for a planned one, whilst the induction would be spoken about in terms of a straightforward, natural birth.

I think the goal of birth is 'healthy baby, healthy mother'... if a woman is mentally traumatised or has long-term physical issues then that goal has not been met.

I don't know that c- sections are the answer. After a terrible birth with ds1 I was offered one for ds2. I weighed up the pros and cons and decided against it.

The physical issues I have been left with from my first birth (prolapse front and back, torn ligaments and scarring) were caused by the forceps, by massively made worse by terrible aftercare.

Being treated with more dignity and respect during labour would be incredibly helpful (I remember begging the midwife to tell me what was happening during delivery and she was astonishingly reluctant to do so)

Follow up care that focused on the mother along with the baby would be hugely helpful too - a stitches check as standard at 6 or 12 weeks (or 6 months!?) would surely identify some of the issues raised here. I had an infection post birth for 6 weeks which could have been picked up sooner had my health been explored as well as just baby's.

A referral to a specialist physio post birth like the French system would be wonderful.

Exactly a planned c section should be offered to
A woman if her baby is in an awkward position. Mothers should be consulted and advised before labour starts. All this pushing for pain free natural birth really pisses me off! Labour is how the woman doing it should be all about not some fashionable feelings of midwives or doctors so called birth gurus.

while I wouldn't call what happened to me horrifying like some of the things detailed here (and i'm very lucky)

My issue was my daughter got stuck (shoulder dystocia) and they had to do a 'crash episiotomy' that wasn't in any way neat or well planned. They stitched me up, but being asthmatic, I caught a cough in hospital (As you do) and I split my stitches.

The nurses refused to stitch me back up, instead insisted it was probably an infection (not my cough) which was disproved with a swab, but by the time the results came back they informed me I couldn't be re-stitched and would have to be left to heal 'from the bottom up now...' which basically meant for the next 4 months while this GAPING WOUND next to my vag healed, I had to wash every time I went to the bathroom, could barely sit down, was on infection watch and have been left with a massive scar that 9 years on still gives me trouble.

CS is not risk free and I doubt many people think it is. One would be doing very well to have spent any time in NHS antenatal and obstetric care at all and not come away with abundant information about the risks of CS. ELCS involves its own set of risks, which may or may not be more acceptable to the individual woman than the different but also significant risks of attempting vaginal birth.

However, if a woman wants to reduce her risk of prolapse, actually the best evidence we have is that ELCS is the answer to that. Pregnancy itself is a risk factor, but prolapse is more likely when a woman delivers vaginally. Improvements posters suggest such as dignity during labour are of absolutely vital importance in general, but not necessarily in reducing the risk of prolapse.

We should of course be clear that a woman may prefer not to have an ELCS for many different reasons and the increased risk of prolapse isn't the only consideration. Informed consent is what is necessary. We should also demand proper physio care for women who have delivered vaginally too.

In many countries they look at foetal position before the baby is born. A friend of mine ended up with an horrific birth (forceps, everything) and was then told after that they were AWARE that her baby was in a position in which forceps or a c section would be all but guaranteed. Yet she was encouraged to go for a VB and didn’t even get an epidural.
Why the fuck wasn’t she told that beforehand if they knew?? It’s not informed consent if the information is withheld!

Indeed it is not hypermice.

And yes, women who for example have babies who are back to back at the start of labour should be given accurate information about the greater risk of complication and need for intervention, and offered the option of ELCS accordingly if this is more acceptable to them.

Paul, DD was back to back, which is why they think we suffered the shoulder dystocia.

Wouldn't surprise me kritical. I have had a back to back birth too, luckily not as bad as yours but not much fun! Had I known then what I know now I would have demanded ELCS.

While I said that a c section wasn't the right option for me I agree that more information beforehand would be very beneficial - however midwifed need more time to be able to accommodate this.

My first midwife was very casual on time and my appointments lasted half to 3/4 of an hour. It wasn't until I had a different midwife with my second I discovered they only had 10 minutes per appointment!

Paul

Yes just to be informed would be nice. My GP told me my first baby was back to back and said ‘I hope you will be ok’

I was 20 and clueless ending up with a long pointless labour, crash team being called in, emergence episiotomy snd forceps. I was traumatised. Awful episiotomy scar and dodgy sex for months. If only I had been told I would have opted for a c section. Calm and planned.

I had s further 5 children but the first birth still upsets me and ds 1 is 27.. it’s not good enough.