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.

Devise a screening tool to be applied prenatally to determine the likelihood of damage to a women’s pelvic floor.

Every women should be informed of the exact risks of having a vaginal delivery, including the possibility of levator avulsion.

More NEEDS to be done to be able to piece women back together. Stem cell research needs to be fast tracked so we have safe, strong, and effective alternatives to mesh.

I have not been able to return to work due to my birth injuries (from my beautiful, drug free waterbirth), or I guess I could, but I quite like my pelvic organs inside my body and don’t want them trying to make more of an escape than they already are. Some sort of disability acknowledgment from the government would be good, because it’s put our family under financial pressure.

The risks of a back to back labour versus a c section were not explained to me at all. It was identified during labour that he was back to back but nothing was said to me about the increased risk of intervention, prolapse etc.

Even an ACCURATE leaflet to take away with you would be better than we currently get sleepy! As it is, far too many NHS trusts are busy trying to avoid applying NICE guidance on ELCS and I don't think any at all routinely advise patients of it.

I'm.an older mother.I had a tear which took ages to heal,Hadn't healed internally at 12 week check,stopped hurting at about 18.I had transitory urinary urgency but that resolved.
What I wasn't prepared for was lack of sensation.I cannot have an orgasm.Tried everything,was told not to worry it would resolve.14 years on,nothing.This is gutting and frustrating not one drs feel they can do much about.

I totally agree with prenatal screening to be used to inform birth decisions.

There are psychological issues to be considered here as well as physical.

As a start for the list of factors that should be considered:

Pain tolerance (can easily be tested and has a huge impact on whether a planned CS would be likely to be beneficial).

Baby position

Physiology of the mother (it really does make a difference if you are small or narrow hipped etc.)

Previous birth experiences

other psychological factors (some people know they cope reasonably well with sudden change, panic, lack of control etc. - others could have predicted they would react particularly badly to being in horrible pain and having their wishes ignored...)

Y y to all the above

Me too osopolar

only it’s totally unacceptable

Agree with @sunshinestorm

A key improvement would be to have standard checks done at 6 weeks post partum. Apparently there is no standard so each GP just does whatever they feel like (or don't feel like)?

I presumed there would be a list of things the GP was supposed to check at 6 weeks. Nope! I was just asked "how are you, are there any issues you want to discuss?" I asked about my tummy and she had a quick feel and diagnosed diastasis (separated abdominal muscles). I asked how to treat it and was told to "look up exercises on Google". I wasn't even provided with a leaflet never mind a physio referral. When I asked if I should make an appointment a few months later for her to check if the diastasis had resolved she looked at me like I was crazy and said no... so how am I supposed to know if the exercises I've looked up on Google have worked or not?

My forceps birth happened 5 years ago. I suffered a third degree anal tear, deep vaginal tear and PPH. I was in immediate shock after it happened as I had no idea you could be left like that after having a baby. The consent form I had to sign prior to them stitching me up was enough to make me have a nervous breakdown- outlining the fact that I may be left with bowel and bladder incontinence, painful sex and sexual dysfunction. Hard to get your head around this in any way shape or form when you’ve just delivered your baby.
5 years on I have spent thousands of pounds on private consultations, as NHS help on these matters is scarce and patronising. I was told repeatedly that my symptoms were all in my head by GPs, health visitor and mental health professionals.
Over the 5 years my symptoms have worsened, prolapses have developed, and I am being treated for pudendal nerve damage because of severe pelvic and perineal pain and dysfunction.
My relationship with my son suffered greatly as I was a single mum trying to cope with all this alone. Even my own family believed it was all in my head. I had no support and lost custody of my son in 2016.

What would improve things? I echo many of the suggestions of previous posters. I never want another woman to go through what I have been through.

Pre-birth:

1. Screening for potential pelvic floor/anal sphincter damage, taking into account size of mother/weight/frame, ethnicity, and family history.

1. Antenatal information informing pregnant women of potential risks of birth injury. Advising them of steps to take to prevent serious tears. Offering choice of elective c section if requested. NO QUESTIONS ASKED. Women in the UK are being guilt-tripped into natural births to meet C Section quotas.

1. Mental health and emotional needs should be given equal weight when considering birth plan. Mental state prior to giving birth, being listened to and given choices impacts strongly on birth outcomes.

During birth:

1. If second stage is failing to progress GO STRAIGHT TO C SECTION. Why use forceps when we have a safer, viable alternative?

1. Blanket ban on forceps, particularly mid-forceps deliveries. They are medieval instruments that should be going no where near a woman’s reproductive organs in the 21st century.

Post-birth:

1. Educate health and social care professionals. There is a shocking lack of awareness about birth injuries among GPs, midwives, health visitors, social workers.

1. Set up birth injury ‘centres’ regionally offering access to surgeons who can offer revision surgery, women’s health physios, counselling and advice.

1. Train women’s health physios on treating birth injuries specifically- too often it is lumped together with normal physio treatment after a straight forward delivery.

1. Recognise birth injuries as a disability. Acknowledge their relation to birth trauma and PTSD.

Generally:

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

1. Much wider media coverage is needed. Mumsnet could be instrumental in forging those media and new media connections. Why haven’t birth injuries been covered properly on Woman’s Hour for instance?

Sorry for the really long post, needed to get so much off my chest. Well done Mumsnet for starting this campaign. So badly needed.

Thing is - what does it say when one of the biggest (perhaps THE biggest) parenting UK sites has all manner of chat sub-forums about parenting and childbirth and rearing.. yet for all the posts here and the wonderful campaign started... there ISN'T a birth injuries or post-natal care sub-forum that i can find.

Does either one exist?
Have I missed them?

I'm not talking about wrapping them up and hiding either one in among other related topics, I mean, specifically discussing birth injuries and post-natal care of the mother?

Why not?

There's clearly a huge underlying problem with knowledge, advance real patient choice.. and it seems like a huge gap. Even though MN are the ones who are doing such a wonderful job of spearheading the campaign.

A few pages back a poster specifically had asked their ob/gyn for a better understanding of the risks associated with various medical options (not just VB vs. ELCS) and there was virtually no information about it because the data isn't collected.
Other posters have also raised the point about quality of life, follow up GP appointments, repair surgeries, privately paid for physio etc are not factored into the cost of ELCS so skew the data - and it seems like there's a MASSIVE gap there. I'm hoping MN picks up the £££s aspect in their campaign because it's one of the first poorly-informed points raised in any discussion where (shock horror) a woman might want to make an informed decision about what the best option is for her.

I like the idea of the post-partum checklist idea. Easy to implement, can be based on other country practices (e.g. France's better checks which focus on the woman, not just the baby), etc.

also - i can't find a petition link on the campaign. again, have i missed it or is it not done yet? or is it not going to be? i can't figure out if i'm missing something obvious!

lou tbh I have been shut down mentioning birth injuries because 'its wrong to stress out and scare pregnant women'.

I don't know if that's why there isn't a sub forum or not, but it is certainly a prevalent attitude.

My story isnt half as bad as some on here. I've had 2 vaginal births...
1st was a 2nd degree tear and the 2nd was a 3rd degree tear.
Both babies pretty much popped out after about 5/6 pushes.
In fact the midwife only just caught ds1!
First tear was stiched up by the midwife with no pain relief. Wasnt too bad but I could feel it. Very odd sensation!!
She did a good job and despite some discomfort no issues.
The 3rd degree tear was another matter!
I was anaemic throughout the pg and lost a lot of blood at delivery.
A registrar sewed me back up and did a really bad job - but I did have a painkilling injection this time!
It just never healed. The anaemia didnt help. I ended up with granulation.
I had to ask the Dr to check my wound at my 6 week check...all she wanted to discuss was contraception!!
I have sensation loss and pelvic floor weakness. I pee myself quite often!
It's just never been the same...
But I got off lightly compared to many 😔
I agree mn needs a birth injuries topic.

neef ‘s post is the best post on this so far. Summarises very consciely just how much could actually be done.

I also second lou ‘s suggestion for a specific topic here on MN

Astrabees I’m sure it wasn’t your intention but your post comes across as judgemental. I also had the unwaivering belief in my body. I said from the start of pregnancy I wanted a home birth, was cared for throughout by the home birth midwifery team, did hypnobirthing, practised active birth positions & squatting, crawling to get baby in the right position, the whole lot.

In the end I still ended up with a stuck baby and a labour that was mismanaged leading to extended second stage, induction, forceps, episiotomy, and post part I’m hemmorage. Looking back on it now, there were signs that something was amiss with my birth from the start (referred into hospital due to lack of foetal movement once in labour, extremely strong contractions measured by the machine, despite staying only 3cm dilated, failure to progress even after having my membranes ruptured, I could go on).

What I am saying is, sometimes an unwaivering belief in your body isn’t enough, and those sort of comments just make people like me who ‘couldn’t do it on our own’ and have ended up permanently mentally and physically damaged as result, feel like crap.

One of the main statistics you get when looking up info on maternity units is the rate of C-sections and for hospitals it's seen as 'the lower the better'... it's concerning when you think how every vaginal birth that has resulted in a third degree test or other permanent birth injury to the mother actually contributes to a 'positive' statistic for a hospital. Also denying women choice and autonomy by refusing maternal request sections.

I think overall women are very much discouraged from researching and educating themselves about birth and about their rights and options.

Birth plans are sneered at and mocked. The general attitude is 'Ha don't bother with one of them it goes straight out the window!' when they're really about women considering the different eventualities and educating themselves so they can make decisions that are actually informed.

We are given vague and bias information at antenatal appointments. Leaflets often don't talk about the risks of forceps or birth injuries at all.

You only have to look at online forums to see how many women genuinely don't seem to realise their rights in pregnancy and birth as well. I have seen so many threads where women are saying they 'have to' be induced at 40 weeks/have an ecv/have a sweep/have VEs during labour and are genuinely surprised when they are told they can decline any intervention or procedure if they feel it's not going to be beneficial. I think it's particularly sad when women say they 'didn't realise' you were 'allowed' to decline VEs... in what other context would it be okay for someone to do something so invasive without your permission?!

So yeah off track a bit but I think women need to be as informed as possible and be more involved with decisions.

I think sunshinestorm has a really good point. Compared to my mum, who had me in the 80's, I know so much about pregnancy and labour. But I still knew so little about prolapse, stitches healing, what I can decline or agree to. I was so upset that I was booked in for an induction with dd2 (didn't need one in the end though) and was angry for not telling the hospital mw that I did not want one automatically the day after 42 weeks. But I should instead have been angry that I was not asked if I wanted an induction or had the options explained. Why are we not informed about all these things?

When giving birth to dd1 the consultant said he was going to have to make a cut and I said no. Except I didn't mean no, I was just sad and tired, but a great nurse there stopped him saying "no, she hasn't consented". She also told someone who was cleaning me to count the clean swabs being used and then count the used ones to check there were none missing inside me. If only everyone paid that much attention to basic tasks.

Neefs post is excellent. All those things should be part of a 'birth package'.

I agree with so much of what has been written above. On the point about lack of information about birth injuries, I had an EMCS with DC1 and was given a choice between ELCS and VBAC for no.2. I did some extensive online research about respective pros and cons but nowhere did I find any real information about risk of birth injuries from vaginal birth (lots about risks of c sections though!) I ended up speaking to 10 close friends and finding out how vaginal birth had affected them and statistics from my (admittedly) small sample were quite shocking. When I tried to discuss this with doctors and midwives however I was fobbed off with talk of how my friends were just unlucky, with an inference that they were not representative. In retrospect I think they were representative and the lack of honesty and transparency makes me very angry to think about.

(I ended up deciding VBAC (in all honesty probably because of the pressure from NCT classes and others to experience a 'natural' birth), and ended up with bad third degree tear and forceps. I'm lucky that I only have v minor urinary incontinence problems although sex is still uncomfortable almost a year on and id happily never do it again for that reason.

I think all of the suggestions above are great and Well done Mumsnet for starting the campaign.

Lou excellent points

I insisted on a csection as I have always had ridiculous anxiety over giving birth and everyone I know has ended in an emergency csection. My nephew had come out blue during an emergency csection a couple of years prior and I wasn't willing to take that chance. I had to fight tooth and nail for it, seeing multiple midwives, eventually the head midwife. Most of them insisting the statistics I had researched about 'natural birth' were just not true, it was a lovely, beautiful experience.

My hospital mail was sent to my neighbour during my whole pregnancy so I didnt even get to see the antenatal shrink they had proposed. As i got my appointments by text I had never even noticed. I also had hyperemesis and my community midwife tried to get me to visit her families acupuncture business, without actually telling me it was her families (ethical? Not really)

I eventually got my csection, but not before the first midwife I saw decided to send social services to my house as punishment for going against their bullshit ideology. SS was very confused by the referral.

Having a child should not be about how much fucking suffering the woman goes through. Get the baby out safely and efficiently, with the least amount of damage to both.

As a result, I would be out of this country like a shot if I ever fell pregnant again. I am traumatised from the midwives and their abusive treatment. The doctors? Complete professionals from the consultants to the surgeons. Will take a lot for me to let a midwife near me ever again.

I certainly would not trust my child's life in their hands.

And I'm sure there must be good midwives, I just met very very few of them. Met a lot of spiteful, bitter women who shouldn't be anywhere near women and babies and abuse their position to treat women like dirt. Specifically the hospital midwives.

Oh and because I had such a pleasant birth experience (csection) with amazing doctors I am still breastfeeding a year later. I put this down to the lack of trauma.

The hospital did try to get my baby on to formula (as in, you are not leaving until you bottle feed) but I fought tooth and nail to feed and it paid off. There is a serious push from formula companies in the hospitals too. The way women and babies are treated in this country is shocking.

Hi there. I gave birth four times with no harmful effects at all. Eldest is 27 youngest 21. All 'natural' vaginal, one with an epidural. Lovely midwives

Very pleased for you Hoochy. Wish it was the same for all of us that have suffered terribly.

I know I need to contribute to this thread (having promoted so hard!!. I've name changed from Shakey15000) but despite having written about my ills hundreds of times, I'm finding it hard to form a coherent contribution due to intense anger and a feeling of getting it right because of its immense importance.

All the suggestions have been great and it's staggering that we have to even formulate this.