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.

BrokenFannyNameChange - I think you misunderstand me, I had very little faith the first time round, which is why I spent all my savings on a private hospital and the best consultants who supported natural birth to give me confidence, I had an innate feeling that this was possible but felt that I needed a team I could trust around me. It seems to me that the spiralling of interventions that are sometimes not even subject to proper consent is part of the cause, this ignoring of the mother's feelings and well being in all respects. I do however struggle to understand why mothers accept being told what to do , particularly over inductions when some of the things that happen are actually assaults. I know it makes you very unpopular in hospital but they do need to know that you are the customer. I would have thought that more people would complain via PALS or direct to CQC about the awful things that are happening.

StopPOP, you have been absolutely wonderful in getting this going. Thank you.
I know that ‘rage + this is so vital’ type of writer’s block.

There was an article (think it was daily fail but still) where women were sharing their stories of poor consent during childbirth. One woman kept drifting off between her contractions and woke up at one point to the male doctor starting to perform a VE to assess dialation! I don't even think this kind of thing is rare.

The article had input from a male obstetrician/gynaecologist who basically said women are in a lot of pain and there isn't enough time between contractions to properly discuss options and gain consent. Then added that women nowadays read inaccurate information on the internet and think they're experts when they know nothing.
I just think that is a bit of a cop out and leads to an attitude of not bothering with consent at all. There ARE ways that consent can be achieved and ways in which this can be improved.
As for the internet... maybe some doctors don't like how it empowers women. Unlike previous generations we have a wealth of valid and reliable information at our fingertips that we can use to question decisions.

I was 52hrs from start of induction contractions to finally giving birth (it was an additional 7hrs of pessaries before contractions were in full flow so I don't count that). My induction was very mismanaged and far too long. Afterwards I had a massive bleed and my stitches had to be done twice.

Three years on I have poor bladder control and a torn pelvic nerve. We have been unable to conceive again and when I had surgery on Wednesday they found endometriosis was to blame and this COULD have been from the trauma but obviously no one knows why endometriosis forms. Needless to say I conceived very easily first time and since his birth not a chance. The scars from my episiotomy are very thick and left me with continued pins and needles in the area to this day.

I've had three children.
First was an emergency section, due to a placental abruption, no problems after that one.
Second was a vaginal delivery with gas and air.It was an "easy" birth but I did get a third degree tear.For a few weeks after, I was peeing myself quite a lot but it gradually stopped.
The last one,12 years ago, was the one which gave me problems.
I was 5 weeks early, went to the hospital in agony, contractions had come on so suddenly and were three minutes apart from the get go.
After examining me, the midwife told me I was not in labour, not dilated at all.
I remember thinking that something must have burst inside me, the pain was so intense, then within 10 minutes of being examined, excruciating pain and the baby shot out,blue.
I have never seen anyone looked as shocked as that midwife. ...
My problems started a little bit after then, peeing when laughing/coughing/sneezing.
It was manageable, although sex was and remains unconfortable, sometimes painful, with all the extra uterus hanging down my vagina.
I did my pelvic floor exercises religiously but it is only after seeing a women's health physio in the last six months that I realized I'd been doing them wrong.
For thirty years.....
Just to add, none of my babies were big.Two were prem.
I am a lot luckier than most on the thread, for although all my deliveries were in the UK, I live in Australia now and so, when I mentioned to my GP that I was leaking urine (well, actually gushing at the end) I got a referral immediately to a gynecologist who specializes in pelvic floor repair.
I have recently had a full POP repair, all three in one, bladder,bowel and uterus, so I'm no longer leaking or wetting myself and planning trips around where the nearest toilet is, wearing long length clothes in case I piss myself, worrying about smelling.
It was so demoralizing.
So, what could be improved?
Every woman should be offered physio to ensure they are doing their pelvic floor exercises properly.
A full physical exam in the months after the birth.
Education about post birth injuries as part of ante natal care.
My ante natal care was OK but I was not warned about birth injuries, what causes them, what happens or should happen if you have a birth injury.
Post natal care was,looking back, all baby focused.My stitches were not checked, for example, when I said they still hurt after a few weeks, I was told to have a salt bath.

And agree with others, where is the MN subforum for this?

is there a specifc place on MN that we can request 2 new sub-forums to tackle birth injuries and post-natal care please?
or should i just report the thread?

just report your post saying you'd like a response...

Fuck me, this thread puts me right off having kids. Even on OBEM it's shocking, the amount of women asking for epidurals and the midwives fobbing them off and saying "you don't need one, you can do it without it". What a crock of shit - why not be honest and say "we don't have enough funding/spare doctors for one". That's the most likely truth.

The NHS doesn't have enough money to treat most things - I saw several doctors for IBS for example and got brushed off each time.

If I give birth I am quite tempted to go to another country where epidurals and decent aftercare are the norm.

The NHS doesn't have enough money to treat most things

I agree - the thing is by underfunding maternity care it creates huge issues down the line. Depression, anxiety, physio and prolapse repair cost far more than decent care at source would. That’s before you even start on lost productivity at work, long term disability etc. Putting money into good maternity care is like putting money into early intervention/poverty reduction - it pays huge dividends but years down the line so politicians just kick the can down the road.
And it’s just women, so no one cares really

There are so many great examples of the lack of joined up thinking in the NHS.

I think my favourite is the slightly more expensive urine test kits that return a 'clean' sample massively more often. They cost a tiny but more than the standard pot, but save hugely down stream (excuse the pun) on not having to retest, wasted time processing duff samples, diseases that get harder and more expensive to treat because they were missed etc. etc.

But they were never brought in, because they cost more at the point of use....which hits the budget of Person A...and all the follow on costs are Not the Problem of Person A.

Its transparently obvious that treating women poorly during labour is costing the NHS massively further down the line....but this doesn't hit the budget of the obstetrics unit...so they can't justify the price hike it would cost them.

The NHS is underfunded, but at least some of the things people have proposed are potentially cost neutral at worst. ELCS on request for example- see NICE. The problem however is a refusal to make a long term assessment. The costs for prolapses and repairs don't show straight away and don't come out of obstetric budgets.

Yeah, this is a huge issue - costing isn’t done in the lifetime costs of the patient it’s done by discipline. Preventative care is something that gets chipped from budgets early on in any cost cutting excercise.

If costing models were changed so that ALL lifetime costs of an action or inaction had to be included then the pressure would be back on to supply the preventative/better care upfront.

That goes for pretty much everything from nuclear power stations to ELCS. Not including downstream costs (long term waste storage, prolapse repair) is frankly, a bit stupid.

Hello

Just a quick Friday afternoon post to say thank you SO much to everyone. It's been an incredibly busy week here - we've had lots of interest in this from the media which is great - apologies for not being as present on the thread as we'd have liked to be.

We will sit down and have a very thorough read of this discussion next week and come up with a summary of suggestions made (including a new forum!) and post that here - and then we'll start to think about a plan of action.

If you've emailed us, we'll endeavour to get back to you ASAP!

Hope everyone has good weekends (and do please keep adding your thoughts)

Thanks
MNHQ

I just wanted to say thanks for sharing these stories... I had a really difficult birth and recovery and have felt so awful about it because all I hear from people is that it's over quickly and it really isn't that bad and you recover in a week or two. There's an expectation I should be back to normal but nearly 5 months on I'm still in pain from my c section and can't walk/drive far, lift things, or wear normal clothes!

I feel awful because I feel so judged for not being able to bounce back.

I was in labour for over a day before the emc and it was awful. I was on 3 contractions every 10 minutes from the get go and they were SUPER painful, far worse than the kidney stones I had despite what everyone says about that. I get the impression it's supposed to not be that bad and I'm a failure that it wasn't easy for me and dd didn't just pop right out. People I know didn't find it that bad, and definitely didn't have it that bad for over a day!

The hospital ignored me and refused to give me painkillers until I got to the delivery ward - then the midwife put me on a monitor and was shocked about how strong the contractions were that early in labour. She immediately got me on an epidural. (The delivery ward was absolutely fantastic at least, even if labour and the before and after care were terrible.)

Im sorry so many people have had awful experiences but thank you for telling me that I'm not alone and this is normal. Especially that it is normal to feel like you can't face it again, that that isn't you being a failure. People really don't talk about this or admit that it was bad, and I feel terrible to still be in pain and to be upset about my experience.

I had irregular contractions throughout my 81 hour labour. At about 67 hours, the midwife decided to use an induction drip and as I had been in labour so long and knackered we went for an epidural. The contractions were still irregular and when I got full dilated at 79 hours, I pushed for 90 mins to no avail. It turned out DD was lying diagonally and never would have come out naturally. I was terrified of an instrumental delivery as I did not want the possible associated issues of incontinence. However, I was too upset to articulate this (even though it was in my birth plan) and agreed to a trial by forceps which did work. What no one told me (inc DH) til afterwards was that DD was in distress. If I had known that I would not have consented to a trial as that came with higher risks. I also had pre-eclampsia which was not diagnosed until I was in labour as my blood and urine tests were ignored by my GP despite the midwife being concerned.

However, fortunately, DD was fine (albeit tiny).

I was left with a bladder and bowel prolapse, a tear as the forceps were used without episiotomy. I was not examined at my 6 week check although the locum ancient GP rubbed his hands together and asked sleazily if I wanted my breasts checked (err no). At 7 weeks I realised I was prolapsed when going to the loo got very difficult and it felt like I was posing round a U bend. I was devastated and did not let DH near me until 6 months post part. It really affected my wellbeing. I went straight to my GP when I realised I had the prolapses and got referred to a gynaecologist straight away by 10 weeks post partum.

He said I was absolutely fine, it was not that bad and to keep breastfeeding to 'lift' my uterus.

When I went back to work one year PP I saw my GP again and asked for a referral and saw someone different. I stressed the impact on my life and work and she referred me to a urogynae who took me seriously and 18 months pp I got a double repair which was done very well and I recovered quickly. 5.5 years on, its great although I wouldn't have had anything done if I had not been emphatic that I would not have any more children.

What surprised me was how the student nurses on the ward thought that post birth injury was incredibly rare. The whole ward was filled with women of various ages having prolapses repaired! The nubile student nurses had the attitude that it only happened to women who failed to do pelvic floor exercises and were lazy. I was slim, a non-smoker and low risk, yet I still got bad prolapses.

If you had an abdominal hernia sit ups would not be suggested to 'knit' the muscles back together so I am baffled when doctors suggest pelvic floor exercises will help when prolapses are basically hernias. My urogynae said that no amount of kegals would have helped!

Prolapses affect toileting but also sex. I wouldn't want sex in an upright position, and would want to check beforehand that there was nothing making the bulge worse (poo) as it could be easily felt which was a horrible thought. Why its considered something to put up with I have no idea. My aunt had prolapses after her first in 1972 and had 2 more children and was left with terrible problems that were not repaired until about 2006. The attitude that there's no point fixing them until your older as the likelihood of them recurring is high is ridiculous. Besides, the likelihood of rectocele reoccurrence is actually low if the non-mesh method to repair is used.

I think badgering mothers to be over 35 across the board (whether they are healthy or not) to have inductions leads to more epidurals and then the fear from some midwives that if you move its difficult to monitor the babies heartbeat. If your wired up to a machine to monitor the baby and you have a midwife moaning and arguing with you everytime you crouch or get on your knees or stand its a problem. Mine was worried incase i fell and because the monitor did not work as well in some positions yet great if your lying down. If a woman can give birth in a coma naturally with contractions alone why do we have to push so aggressively on our backs and be moaned at for trying to use gravity? I thought that having a walking epidural meant I could move freely and use gravity. I did all my reseach not to tear but i was fighting my midwife all the way until she threatened to get someone with forceps and she did. I knew she was close and i could have got her out gently but for fear of forceps i gave two or three big pushes on my back and baby popped out easily while i tore. I have problems to this day and i know that it was the aggressive pushing. How about the hospitals sort out monitors that stick properly so the woman who are advised for induction can move more freely. More women are having children later in life today so thats more women having inductions and epidurals (as contractions are stronger. )

Haven't read full thread but I do think awareness that pregnancy can trigger autoimmune problems should be wider known. I (myself included) have had serious auto immune problems (MS) triggered by pregnancy.

Sorry fat fingers..

*I (myself included) have known a lot of people that have had serious auto immune problems

This is a transphobic thread. Men give birth too.

Wow do men have vaginas and wombs?

Wow.

Things I think would help;

*more women speaking up about post birth vaginas
*collection of accurate statistics on rate of birth injuries and a measurement of the impact of these ion women's wellbeing
*more information available to women about post birth injuries etc, based on said statistics
*post part Check ups at 6 weeks,12 weeks and 6months for mums with a specific focus on pelvic floor issues, injuries etc
*access to women's health physiotherapists, on maternity wards and quick referrals via GP or their involvement in post natal check ups
*a thorough look into how much £ is spent treating pelvic floor issues as a result of birth in order to see true cost impact

I genuinely think one of the biggest problems is that no one talks about it for fear of judgement or feeling like a failure or that you should just put up with it, everyone else does when in fact most people are suffering in silence! Other than midwife checking your stitches in the days after birth you don't get asked about your vaginal health. You often don't realise something is wrong until a bit further down the receiver line so it should be something that's brought into follow on care.

I personally feel the aftercare I had was not good enough. The maternity ward felt like a conveyor belt and health visitors have has v little Input.

We all know from other taboo issues such as sexual abuse, domestic violence etc that it is very hard for people to come forward and tell someone, but many say they would have said much sooner had someone asked them!

We need to be asked and we need to be listened to!

www.the-pool.com/health/wombs-etc/2018/14/Jennifer-Rigby-on-post-birth-vaginas

Definitely 6 week check as standard and pay for more post natal support eg more health visitors in the early months. These used to visit and support the mother and the baby.

First birth, 48h+ of labour, epidural almost two days in which stalled everything, syntocin drip to get it going again, another stalling in the second stage, ARM, eventual episiotomy and ventouse, PPH.
Second birth, arrived at hospital with what I thought were mild contractions and turned out to be 9cm, ARM revealed meconium in waters, baby born 30 min after arrival at hospital by ventouse after fetal distress, no pain relief, second degree tear, stitches.
Third birth, induction, frustratingly slow 5-6 hours followed by 2cm to birth within 20 minutes, baby born in caul, no pain relief, doctor in shock, small tear.

At least births 1 and 2 had the potential to be hideously traumatic experiences, but I am fine and was healed within days each time, I believe because I was taken care and attention over and given a real sense of a choice - obviously not in the second ventouse, but with dc1 when I had started to panic the MW told me we could go to a CS if I really felt I wanted it but I'd said from the outset I didn't want one and we were going to try and manage without. So lovely and encouraging. I remember the stitches taking forever each time (and being pretty unpleasant at that) but I felt proper care was being taken. I was checked thoroughly in hospital (and told off for being out of bed a day after dc1), by MW at home and had a proper 6 week check by a gynaecologist. I also had the option to attend a group physio course after the 6-week check. The only long-term consequences of the births have been a bit of increased fartiness, and a twinge in my scar now and again.

I'm not in the UK. I suspect, reading many of these stories, things might have been a very different story if I had been. It is possible to do things differently. Women should not have to put up with the things so many of you have put up with.