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.

I gave birth twice in France and whilst the maternity system is far from perfect I did get the following :
Third ultrasound as standard towards the 8th month to determine the position of the baby in preparation for birth.
Epidural on demand provided you are between 3-7cms dilated (outside that the aneasthiatist decides ), the maximum any woman has to wait is 1/2 hour.
1/2 hour pushing stage maximum. (They start offering instruments after that, forceps included).
Own room after birth or maximum twin room but they try to avoid more than one night in a twin. 3 days for a non problematic vaginal birth 4 for a ceasarian and as long as you need for any complications.
Lessons on how to look after your baby in the maternity.
The staff can take your baby if you need to sleep.
Lots of painkillers even if you say you're ok.
Upon discharge referral for pelvic floor physio. 10 sessions and more if needed for every woman as standard, ceasarians included.
This can be done with your community midwife (I chose this) or physiotherapist.
She showed me an anatomical diagram of the pelvic floor muscles and instructed me how to isolate the different areas to do the whole lot. It's not just about clenching and unclenching. For instance for your rectum you have to imagine rolling a ball up as far as pos. I had a homework sheet and I've been told to do the exercises for the rest of my life.
After baby number 2 I had my 6 week check up with the consultant who had delivered the baby. He only checked me as my baby had a separate appointment with a pediatrician - this is standard.
He referred me for 6 adominal physio sessions when I half joked that my only problem was my wobbly belly.
I was taken seriously by the physio who taught me how to improve my stomach muscles to hold everything in. We practised picking up a 'baby' / ball without damaging my lower back.
I can go back to the gyneco whenever I want if I have any problems.
The 6 week check up you can choose who it's with.
You can see a therapist in the hospital if you have any mental health issues following the birth or if you simply just want to talk about the birth (I didn't).

I had two fairly straightforward births on the normal social security system. So my experience was standard.

Any chance of a copy of those exercises SittingAround1 please?

Would also love a copy of the exercises please. I am fluent in French so would be more than happy to translate them for others.

I was never given any written instructions. Each exercise has it's own name for instance 'the drawbridge' which was listed on the homework sheet next to boxes to tick off when you'd done them lying, sitting and standing. I'll try to find the sheet and will type out each one as best I can. It'll have to be later once the children are asleep. Saturday night pelvic floor night!

Folks if you want exercises try the Dr Bri 5 week programme on the Fem Fusion you tube channel. You can find it by googling My Prolapse Journey which is the name of the initial video in the series.

Really please MN are doing a campaign on this.

What I think needs to be done is:

Proper data collection of outcomes for mothers as a result of all labours so proper risks can be calculated to inform women's choices in terms of interventions, instrumental delivery, natural birth, c section etc.

Maternal checks at 6 weeks, 6 months and 12 months

An expectation that women should by and large be able to return to a similar state than before they got pregnant. Not identical but similar. Things like incontinence and painful sex should not be considered something women should just have to put up with.

Any continuing problems should be treated seriously and rectified as far as possible. Things like a 5 finger gap in abdominal muscles three years after giving birth and regularly being mistaken for being pregnant should not be deemed bloody cosmetic (as happened to a friend of mine).

And finally and MOST IMPORTANTLY an NHS properly funded to accomplish all this!

Uretha : you need to make a whoosh movement from the outside up as far in as possible. 5 times quickly and then more slowly. Try to not tense any other muscles ie. in your vagina - difficult and don't worry if the movement is very subtle.

Rectum ; imagine rolling a ball from the outside in. You need to try to move it as far up as possible. Not using any other muscles

Vagina : there are loads of different ones each time generally imagining your vagina is a cave:
drawbridge - imagine there is a drawbridge at the entrance to your 'cave'. You need to try to close it from the top and then bottom. Then both together.

Imagine a wave has entered your 'cave' you need to roll it from the front to as far back as possible Try to keep the wave rolling at the back for as long as possible (very difficult).

Imagine the wave is now going from side to side first left to right then right to left. It's good to picture it in your mind and then try to get the muscles to follow. Again subtle movements are enough.

Then there is the clenching the whole lot and holding it.

When bending down, picking up objects or coughing make a conscious effort to hold your pelvic floor muscles in.

Great campaign - so many older women end up with awful incontinence and sexual problems due to withholding of appropriate post natal healthcare.

Women aren't birthing machines but people who deserve the best care available.

Wow that's so different SittingAround I wish that was the NHS approach.

I think its something that should be asked about at every point of contact that you have with health professionals, including heath visitors. There is a lot of questions about your childs development but what about the mums health? There seems to be emphasis on mental health and whilst its great that it is being recognised to be an issue, the pelvic floor health is not discussed.
Another factor is the lack of access to physiotherapy. I had emergency C-sections with both pregnancies and was offered no physiotherapy despite having had twins. There is an impact on the pelvic floor with the pregnancy itself not just the delivery. The French and Swiss are all offered routine access to physiotherapy after childbirth. Why aren't we?

I really think there should be specialist hospital check ups for women who have had instrumental deliveries.

I had a forceps delivery with DS1 in 2014 after pushing for four hours. He was in a tricky position and the procedure was complicated. I tore internally all the way up to my bladder (initially suspected my bladder had been torn) as well as externally and it took almost three hours for the doctor to repair me. I had a 3 litre PPH and needed three transfusions. I had no idea you even could tear internally and therefore didn't know what to look out for with recovery. It was a year at least before I could tolerate even thinking about having sex. The pain was very bad for a few months and I still have residual soreness now, especially when I have my period. Luckily no prolapse or incontinence.

Also think that you should be taken seriously if you want an ELCS after sustaining birth trauma. I requested and was granted an ELCS for DC2 but the doctors were at pains to reassure me that it probably wouldn't happen again etc with little or no acknowledgement of the long term effects on mental and physical health of it happening the first time.

For those wondering if labour length and interventions are a cause to longer term problems, I had a short (2hr) natural birth with no interventions yet ended up with two mild prolapses.

In terms of what could be done to help prevent this issue, greater highlighting of the risks regarding post labour complications when discussing birthing methods by midwives etc, plus an automatic referral to a women's health physio as soon as pregnant and for this care to continue automatically after the woman's 6 week post natal GP check. The physio could initially check pelvic floor exercises are being done correctly (as they sometimes aren't) to help strengthen the pelvic floor before labour, and then afterwards to help correct any prolapses or incontinence problems (and they can even give suggestions for other issues eg discomfort during sex).

I think the 6 week check should be performed by a dr who specialises in women’s health. I’m not convinced GPs are understanding te gravity of some of these injuries or are checking properly. In other countries such as France all women see a women’s health specialist post birth.

I had a prolapse following back to back labour, prolonged second stage, shoulder dystocia, instrumental delivery then fiendish constipation. 4.5yrs later my symptoms are nearly resolved after having a course of 3 Nu V 'vaginal rejuvenation' treatments. It has worked for me, gotten rid of the awful bubbly feeling I had for years.
I had private and NHS physio, bio feedback, pelvic floor trainers...all useless and was preparing myself for an op to sort it out. Have a look at it and consider. It did wonders for me and now I can go a day without even feeling or thinking about my vagina which is something I hadn't been able to do since my first little boy was born.

Brummie for info sake, do you mind detailing what that involves?

Some of these stories are awful

I felt my antenatal care was excellent - i was considered high risk so had multiple consultant appts and extra scans etc. with both pregnancies. With dc1 I ended up being induced at term but then having an emcs after labour failed to progress at 9cm. Dc2 i opted for an elcs. Luckily no physical problems in either case but i felt post natal care was quite poor. Never given any advice on pelvic floor, or separated abdominal muscles. I had pain having sex (so it was impossible) up to 12 months after dc2, and as I'd had a section the gp just said it must be psychosexual without even examining me (no idea what caused it but luckily now cleared up). Also given less than 24 hrs in hospital after my second section - literally as soon as i could walk/ hobble they were prepping my d/c home. Hospital was so noisy and uncomfortable i agreed to go but didn't really feel well enough. I felt you could tell how overstretched they were.

I had 3 treatments (max no) about 6 weeks apart. They use a laser to burn the inside of your vagina (rotates around a speculum like cage). It regenerates the vaginal tissue and regrows collagen which plumps everything up. I had problems with ait bubbles and 'looseness' during sex and this has saved me needing surgery. Apparently it can help with incontinence as well, it takes about 10 mins and is a litylr uncomfortable and costs about £500 a go but worth every penny in my opinion.

Crikey!!! Lasers, burning.... mind you, if it does the trick....!

Thanks for responding. So it's not for actual prolapse, more just 'looseness'?

It sounds awful but your vagina is pretty tough It can be used for prolapse as well, obviously if your organs have dropped and protruding then no but just general symptoms it should help. Have a google, it has saved small part of my mental health and sex life x

brummie thats great that its worked but a lot of women wont be able to afford £500 Treatments like this should be available on the NHS. You can bet if men were affected they would be.

Air bubbles are dangerous surely.

Personally I had easy births and labour. One was 4hrs 5mins from first contraction to born. I only woke up cause the dog had an accident in the hallway haha. I sincerely hope that women who do suffer during and after labour/birth start getting the help and support they need I think people assume women should be tough and handle it in their stride but honestly help where's needed. I think the 6 week check or some sort of thorough gp/nurse/medical check for the mother should be considered and maybe even be offered as a home visit so it's a place they're comfortable to talk in if they're not comfortable going to the doctor about an incontinence problem etc. Hope his gets sorted it's a shame it has to be a campaign worthy issue. Good luck to the campaign going forward all the best to the women who need it. Xoxox

Helena, treatments like that are a long way from being available on the NHS, it's classed as cosmetic and I doubt that will change any time soon. Air bubbles are one of the most common signs of a mild prolapse or vaginal laxidity, they are not dangerous in the slightest.

Thing is... Most of the posters Sharing their injuries on here (many avoidable, but others just bad luck or unusual events) sound like they're being treated as successful clinical outcomes from a healthcare perspective... Yes?

So that means not only is there a lack of data on clinical outcomes and risks in one way.... There's also a massive amount of inaccurate or downright misleading data for other care options too.

Where is the funding going to come from to address that? Not the cash strapped NHS. Possibly academia/research?

Also:
To the posters saying stuff like "I'm 30 years old, double incontinence, prolapse, can't have sex, I had access to standard medical NHS services throughout, I shouldn't be living like this is normal".. what has happened when you Frame it that way to post care medical staff? Like your GP?
Is there any acknowledgement that this isn't normal or is it just that the checks are so useless (like some are suggesting), only focus on baby, or... Well, it sounds like a care pathway for mums simply doesn't exist in the UK?!?!?

sound like they're being treated as successful clinical outcomes

From a "did the birth go well" short term angle I mean

I think it starts with the dreadful postnatal care on wards. It's such a dreadful experience that many women leave when they probably aren't well enough.

If money was invested in proper postnatal care with privacy, support from midwifes and access to food and water women might not be so desperate to get out the door. Maybe this would help with mental health and breast feeding rates as well.

I believe all wards should be restructured to have private room postnatal and far more staff employed.