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MNHQ

MNHQ here: the impact of birth on women's bodies, wellbeing and sex lives

12 replies

RowanMumsnet · 03/04/2018 10:16

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.

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MNHQ

RowanMumsnet · 03/04/2018 14:59

Thanks so much for all the comments so far. A few thoughts below - just want to flag that we at MNHQ aren't experts - our information comes from reading MN threads, working with various NHS working groups, and conversations with healthcare practitioners who are experts in this area. So please do chip in if you have specialist knowledge and/or personal experience.

@decasanova There is a train of thought that births are getting more 'difficult' because of maternal demographics: women in labour are more likely to be older, and to be overweight, both of which can increase the likelihood of complex births. Organisations such as the RCM are keen to say that pointing this out isn't about shaming mothers - but it does mean that midwives are being expected to handle increasingly complex births while operating in a very resource-constrained environment.

@fauxgina We went on a hunt for research into whether instrumental births had better or worse long-term impacts on women's health (compared with non-instrumental vaginal deliveries, or CS) and with the exception of a few small studies there seems to be almost nothing on this in the scientific literature. For example, this Cochrane review concluded 'We identified no studies meeting our inclusion criteria.' This is one of the reasons we think data collection might be really important. Here's a list of NHS England's national data sets.

Some interesting research we've been made aware of:

The Cochrane Incontinence project is looking at maternal incontinence and pelvic organ prolapse (POP), among other things;
Professor Cathryn Glazener at the Health Services Research Unit at the University of Aberdeen specialises in incontinence, and in previous research has investigated the causes of perineal pain;
studies have investigated difficult or painful sex after birth obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2000.tb11689.x;

RCOG and RCM's OASI (obstetric anal sphincter injury) project is investigating the rise in OASI cases in the UK over the past ten years, and has found that guarding the perineum during delivery seems to significantly reduce third-degree tears.

To everyone who's spoken about postnatal physio: there's a trial underway right now into the effectiveness of this and we've been invited to a stakeholder day at The Shard in London in June - they'd like a couple of MNers to come along (you don't have to have personal experience of physio) to contribute. If you fancy coming along do drop us an email on [email protected] and we'll give you the details. (There are travelling expenses, and babes in arms are welcome - but no facilities for older children.) [EDITED BY MNHQ to correct 'April' to 'June']

And to those who've talked about more information antenatally - yes, this is another thing a few clinicians have raised with us: the importance of women understanding what a 'red flag' looks like, postnatally, and knowing where to get help. This would mean more information antenatally, and also postnatally.

@insertquirkyname Oh my goodness - your account of being sewn to the bed (if I read that right?) is horrific!

Flowers to all of you who have shared your experiences here, thank you

MNHQ

RowanMumsnet · 03/04/2018 15:22

@adulthumanfemale That echoes so much of what we've been told - if women are rebuffed the first time they seek help they are understandably very reluctant to ask again. One of the most shocking quotes on Mumsnet about it was from a woman who was told 'if your husband can still penetrate you, you'll be fine'. (Would it be overstepping the mark to urge you to go and see the GP and ask for a referral to a specialist?)

One idea we had was for a mass self-referral - for all MNers affected by this to make appointments with their GP and report back to us on what happens next.

@PositiveVibe an online assessment sounds really interesting - do you know of any examples of these being used for other conditions, and whether they're thought to be effective in terms of getting people the treatment they need?

@insertquirkyname nyaaaaaaargh!

MNHQ

RowanMumsnet · 03/04/2018 15:33

@brummiesue The point about the prolonged second stage has come up a few times on the thread already - thank you - this might be one for us to talk to the RCM and the Royal College of Obs and Gynae about.

A quick search brings up the RCM's guidelines on second stage and - (a theme developing here) - the sentence 'Limited quality of evidence makes it difficult to assess the significance of a prolonged
second stage'. There's more commentary on the risks and benefits on p3 of the document.

MNHQ

RowanMumsnet · 03/04/2018 16:13

@Astrabees

I did notice that the anti natural birth brigade were quick on the bandwagon to suggest that natural labour without intervention might be a cause, which has probably prompted the posters recounting natural births with no injuries. My own experience of a 21 hour labour with a very long second stage was one I was very grateful for, I was told it might not have been "permitted" in an NHS hospital - since when is anything "not permitted?"

Thank you Astrabees. The bit about being 'permitted' might refer to the guidelines posted below - the consensus seems to be that women should not be left in second stage labour for longer than two hours unless they are making progress. (Going back 15 years I seem to remember that my second stage in my son's birth was longer than two hours too!)

Spontaneous vaginal delivery vs instrumental births vs CS is such an emotional topic and understandably so - which brings us back to the issue of data and research that would enable women, birth partners and healthcare practitioners to make decisions based on harder information than seems to be currently available. I know some MNers who are also midwives have very well-informed professional viewpoints on this and I've read posts outlining why instrumental births can absolutely be the best outcomes in certain situations.

We would REALLY like this thread to not descend into a bunfight though so can we steer clear of accusations of 'brigades' and 'bandwagons'?

MNHQ

RowanMumsnet · 03/04/2018 16:21

[quote PositiveVibe]@RowanMumsnet
I'm sorry I don't know of other online assessments that lead to a referral.

What I know is that when I was referred to a pelvic floor clinic, a colorectal department and now an orthopedic physiotherapist, they all started with an in-depth interview of my symptoms. Pelvic floor clinic and colorectal both gave me a questionnaire to fill in and because I always ask lots of questions, I asked why the questionnaire (aside from the obvious "to get your history") and the answer was that because of the nature of the problems, patients are more likely to be honest if left to fill in a questionnaire on their own than answer face-to-face questions.

A questionnaire on its own wouldn't be the optimal diagnostic tool but a physiotherapist can already tell a great deal by reading it.[/quote]

That sounds really interesting and intuitively 'right', thank you

MNHQ

RowanMumsnet · 03/04/2018 16:24

Also noted the points about relative value of 6w check versus 6m check. As we understand it, the problem at the moment is that the maternal check was not included in the renegotiated GP contract (the 6w baby check is included), so it's now a local decision whether they include this option in their package of care.

MNHQ

RowanMumsnet · 03/04/2018 16:38

@Astrabees

It seems to me that this thread is very much being steered a particular way. Anyone with an personal experience is being told not to be anecdotal and anyone who works in the field is being encouraged to contribute! Such a grim picture being painted here, which of course is the reality for some, but not for substantial proportions of people. Having seen Fauxgina's unchallenged post early in the thread I don't have much hope for it.

We are really sorry it feels that way. All perspectives are welcome!

MNHQ

RowanMumsnet · 03/04/2018 17:33

@Astrabees

Unless I have a fundamental misunderstanding of the survey the 1224 women who participated presumably chose to do so, rather than being a random group chosen to provide answers. I suppose this must make it more likely that they would have some issues they would want to bring to our attention. Presumably if you had no problems and experienced great care then you would be less likely to take the survey?

You're quite right that the survey was self-selecting and that such surveys aren't perfect. However, weird as it definitely is, we haven't been able to find a better data set than ours - by which we mean one that covers lots of women, is relatively recent, gives a good detailed picture of women's experiences, and is statistically rigorous. That's why we think better data collection and analysis could be a really important part of the picture.

The stats about prevalence when it comes to incontinence and pelvic organ prolapse don't come from our survey - they come from the NHS or professional medical bodies.

MNHQ

RowanMumsnet · 06/04/2018 14:33

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

MNHQ

RowanMumsnet · 10/04/2018 13:03

Right! Thank you so much for all your thoughts. Here's our summary and thoughts about action points - let us know what you think.

PETITION
We've had this petition shared with us, which asks for every woman to have a women's health physio after birth. It's already over one-third of the way to the 10k signatures needed for a response. Shall we focus on pushing this one? (It's a specific ask - but these can be the most effective, when it comes to petitions.)

TOPICS
How about a 'Birth injury and postnatal recovery' topic?

INFORMATION
Ask: GPs to be informed (by midwives/hospitals) about birth mode and injuries to the mother
Action: this is something that's been discussed in the NHS working group on postnatal care that we're involved in. Hopefully there will be a recommendation on this in the final report - we'll keep tabs on this and let you know.

Ask: Midwives to know risk factors and warning signs of PTSD and factor them in to postnatal mental health checks
Action: We can talk to the RCM about this and see what advice midwives are currently given

Ask: Accurate information given to women, antenatally, about the risks and long-term effects associated with instrumental births (as well as c-sections)
Action: We will try to talk to NHS Choices (a huge source of info) about their content on this, and also talk to the RCM about the info given to midwives. Obviously, as we've been saying, there maybe a vicious circle here in that good-quality data about the long-term effects of instrumental births seems to be hard to come by.

ENCOURAGE WOMEN TO COME FORWARDS AND PRESS FOR TREATMENT
Women who are experiencing postnatal pain, incontinence or prolapse should feel more confident about pressing for the interventions they need
Ask: More antenatal info/postnatal info about red flags and where to go if a problem. More explicit info about urinary incontinence (including catheter use), faecal incontinence, that POP is a risk associated with pregnancy not just age, and how to care for tears of all degrees.
Action: NHS Choices; RCM; possibly a content page on Mumsnet with users' advice on how to assert your need for intervention

Ask: Explore an online assessment with NHS branding that women could use as an initial self-assessment and print out when approaching GPs.
Action: Find other examples of similar tools (please send us links if you have them!) and we will try to find out how they come about and who needs to write them and sign them off.

POSTNATAL PHYSIO
Ask: GPs to have more training in post-birth symptoms and warning signs, and be readier to refer to specialists
Action: RCGPs

Ask: Postnatal women to be offered physio as a matter of course
Action: Petition

Ask: self-referral route to specialist centres
Action: not sure - will talk to NHS England and RCGPs about this one!

Possible action: What do MNers think about the 'mass report' exercise, in which women who are affected go to their GP - perhaps in a designated week or month - and report back to us on the responses they get? Would be great to have a bit more info on what happens to women when they initially approach GPs. (We could set up a survey mechanism so that women could give us more info about their symptoms and the GPs' responses without having to share that with all and sundry.)

DATA COLLECTION
Ask: NHS England includes maternity and postnatal data as a brand new national data set
Action: we will explore this with NHS England and with the National Maternity Review team

Ask: A new 'priority setting partnership' for maternity and postnatal care issues under the James Lind Alliance rules. These PSPs can incentivise researchers to fill holes in current research.
Action: We will have an initial conversation with the James Lind Alliance to see what the process is.

POSTNATAL MATERNAL CHECKS
Ask: six week, six month (with ultrasound?) and one-year contact points with postnatal women to specifically ask about risk factors and symptoms, and signpost/refer on to specialist support where necessary. Must proactively ask about vaginal, perineal and anal health, and include examinations if the woman wants one. The appointment letter should make it clear what the appointment is about and give pointers to women about symptoms they might want to discuss (this could be where the online self-assessment tool is flagged.)
Action: RCGPs

RISKS AND OUTCOMES IN LABOUR
We will talk to the RCGP about things like prolonged second stages in labour, elective CS and informed consent; we'll also see if we can bring in Birthrights on this as this is very much their area.

Let us know your thoughts - apologies to anyone whose points aren't explicitly addressed here: we've tried to identify the most common themes.

MNHQ

RowanMumsnet · 20/04/2018 14:35

Hello

Back with some updates for you

First off thanks very much for the recent comments and input

Emma Hardy MP - great (we'd missed this) - we'll contact her and see if she wants to do any further campaigning on this

@sjpPOP we'd love to talk to you about the assessment tool if you're up for it - you can find us on [email protected]

@JohnnyMcGrath sorry you didn't get what you needed (and deserve).

@antiGrinch Self-referral is on our list! Just working out who we need to badger about it.

@TigerTown thanks v much for that link

And in terms of what we've been up to:

We've asked the RCM to feed back on some of the points touching midwives' roles, information dissemination and training. We're mindful that midwives don't exactly have the most leisurely roles as it is but on some of these points (eg giving info to women antenatally as well as postnatally) they do seem to be the obvious contact point. They're looking into it and we will report back.

We had a very interesting convo with MASIC - a charity that supports women with anal sphincter injuries incurred in childbirth - and they're doing lots of work in similar areas. We're going to see if we can work up an action plan to support some of the stuff they're already doing. Any MNers affected by anal sphincter injuries might want to take a look - they are launching support groups and have information for women.

Some MNers and I are going along to this stakeholder group focused on postnatal physio and we'll report back on that in June.

We've also been invited to a pelvic floor stakeholder day at the Royal College of Obstetrics and Gynaecology and will report back on that too.

MNHQ

RowanMumsnet · 23/04/2018 16:07

@londonloves Flowers Really hope the physio improves things for you

@gizzymum thank you! That's really useful. The stakeholder day is part of this study into implementing pelvic floor exercises into antenatal care. The organisers have been inundated with people wanting to take part I think but we will report back here after the stakeholder event

Thought you might like to have a listen to this: we went on to the Standard Issue podcast to talk about the campaign (my first podcast experience, so please be kind...)

Just a reminder also that if you want to be added to our crack squad of campaign supporters please email us on [email protected] - you get all the campaign news direct to your inbox.

Thanks

MNHQ x

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