Impact of birth injuries/prolapse etc

[QuentinSummers]

Just read this article in the Guardian and am shocked by just how prevalent prolapse are. This is a feminist issue surely?
Timely for me because I have some kind of issue and don't want to go to the doctor
amp.theguardian.com/us-news/commentisfree/2017/dec/28/vaginal-health-post-partum-maternity-rectocele

It varies. The pain of kidney stones can vary and so can the pain of labour.

I've had both. I would say that the pain of the kidney stone was similar to the pain I had at the end of the first stage of labour when there was no break in the contractions and I could no longer cope with it by breathing through. This lasted about 10 minutes. From what I can remember, the pain was like a burning pain in the centre of my pelvis that radiated out to my hip bones as the contraction ended, like a smoke ring (I remember thinking of it like that at the time). I dealt with it by breathing through then relaxing as it got to my hipbones, and relaxing through the short break. When it got continuous I found it difficult to cope. I also wanted to throw up with each contraction. I had no pain relief because it was a short labour and the midwife was telling me the contractions would settle.

With my kidney stone, I had 6 1/2 hours of pain that started as discomfort and rapidly increased. It felt like being run through with a red hot poker, and I had no 'waves' like kidney stones are said have - it was continuous. I could not settle and had to keep moving to get comfortable, only to find I it made it worse - this seems to be characteristic of renal colic. By the time the OOH doctor arrived to give me something more effective than the diclofenac the GP had given me, I had given up and resorted to writhing and groaning a bit . I also was very sick. I sort of hoped I would pass out but it never happened.

If I had had 6 hours of the labour pain, or back to back pain like a lot of women get, no doubt I would have been the same if not worse.

I would say my kidney stone was at the bad end of the scale (I should have been in hospital, especially with the vomiting) and they are worst first time. My labour was relatively easy on the grand scale, although I was left with some bad tears and PPH.

It is all relative, and different things anyway.

Your step day is obviously a bit jealous with all his competitive pain thing. He could try liver cancer, pancreatic cancer, or pancreatitis with multiple organ failure, if he wants something better I have seen relatives go through all of these and not complain, but what they went through is unimaginable.

I have been reading this thread over the past few weeks, and it is similar to many others I have seen over the years. The fact that so many women suffer pelvic floor injuries without ever being informed of the possibility is unacceptable. Fortunately, increasing social media (and the law) is changing things:
caesareanbirth.org/2017/10/17/womens-voices-are-exposing-truth-about-pelvic-organ-prolapse/

In addition to other work, the organisation Caesarean Birth has been trying to ensure short- and long-term pelvic floor damage is recognised as a maternity health outcome and cost, and also included in antenatal conversations about different birth plan risks and benefits. NHS focus, particularly during years of normal birth policy, has been to reduce caesarean rates (usually starting with elective, even if this results in more emergency), which has resulted in avoidable injuries and even deaths.

My organisation also supports women who are having their caesarean requests refused (these can be first-time mothers or mothers who have experienced pelvic floor trauma in a previous birth) where NICE guidance is not being followed.

I just wanted to say thank you to all the brave women who are speaking out about this issue, and to emphasise that while planned caesareans are not risk free (no birth plan is), this is where maternal choice must come in. A planned caesarean birth significantly reduces the risk of serious pelvic floor damage and instrumental delivery. Therefore, if this is something a woman wants to avoid, her maternal request should be supported; in fact this is why it's often referred to in research as a prophylactic caesarean birth.

There is a widely held concern that if women are informed about pelvic floor damage risks, and if stories like those here become more widely known, 'too many' women might choose a caesarean birth. This concern has contributed to the antenatal silence around planned vaginal birth risks, and this again, is unacceptable.

I had an elective section for my last birth to avoid more perineal damage and that was not a walk in the park either

Rather than it become an ELCS vs VB debate I would like to see more research in the healthiest way for women to manage pregnancy and birth.

For example forceps could be redesigned

There could be better positions to Labour in and maybe midwifery techniques to help

In pregnancy there might be better ways to sit/stand. More research into perineal massage as that might help

Risk of tearing/damage in homebirth/waterbirth vs hospital birth

Birth is such a poorly researched process, I'm sure there are things we could do to reduce the risk. Look at what we have been able to do to reduce incidence of heart attack, treat cancer etc.

My main problem is it's so common and yet that research to try to improve things for us isn't happening.

One of the main reasons women ask for an elcs isn't anything to do with damage. It about how they have been treated in the past in a vulnerable situation. Whether it be staff not keeping them informed or disrespecting them. Or a past trauma.

There are several studies that have started to suggest that stress or anxiety before giving birth increases the risk of damage and medical intervention.

Why is that? Is there something going on in the way we manage birth that is adding to problems?

Plenty on place of birth to make you wonder that goes beyond how high risk a pregnancy is.

If this is true then the risks associated with a planned vb v a planned elcs could be being heavily influenced by poor practice in vbs.

Thats an argument to do research into the glaring disparities and inconsistent care that we are aware of.

Its not as simple as presenting the risks of vb v elcs as if they are set in stone. There are dangers in doing so.

I very much admire what you do and your principle Pauline and always have done, but its not as straight forward as you present either.

Just found this on Facebook and thought it was pertinent. After giving birth to her first child, not even Serena Williams could get HCPs to listen to her:
mobile.nytimes.com/2018/01/11/sports/tennis/serena-williams-baby-vogue.html

Took a screenshot of the first comment because, well, it's perfect.

Following with interest. My heart goes out to all of you who are suffering.
I'm also quite frightened as after a 36 hour labour 3 months ago I'm clearly at risk of prolapse in future. Also had horrible problems with a tear but won't go into that.

Does anyone know of info about how to avoid prolapse later on?

The whole woman link upthread is useful. But in general there isn't much advice apart from "do your kegels" which I always feel guilty about.

In my mind kegels are like tooth brushing, if you get a cavity it's your own fault for not brushing.

But that article and this thread shows that's utter bollocks.

Are you ok from the tear? It can take ages to feel better and is yet another thing no-one talks about...

Hmm ok well I have done the kegels daily since TTC and I wonder if having strong pelvic floor contributed to tear. I had a 2nd degree bilateral tear ( going up each side of the vaginal wall) but it didn't heal and I couldn't walk far which was devastating to me and has contributed to PND. After seeing 3 different GPs, finally diagnosed with infection at 10 weeks and now at 13 weeks it is finally starting to heal. Previous 2 GPs were dismissive "these things can take months to heal", "why don't you swim instead of walk"? Umm because this isn't Venice, I can't swim to get around! ( Don't have a car).

I did perineal massage daily from 28 weeks. I wonder what difference it made- maybe lessened the tearing, maybe moved the tear from the perineum, but being inside the vagina it was harder to spot the infection- if midwives had picked it up I could be in a whole different place now. They never once looked inside so the value of their examinations was questionable.

Many women do choose a caesarean in order to reduce the risk of pelvic floor damage:
www.researchgate.net/publication/272450469_Why_do_some_women_prefer_birth_by_caesarean_An_internet_survey

Importantly, many women who experience pelvic floor damage say they had no idea what could happen and that had they known, they would have chosen a caesarean. This is not only indicative of poor antenatal communication, but further evidence that the two issues - pelvic floor damage and maternal request caesareans - are and always will be inextricably linked.

Absolutely, there are other improvements in maternity care that could help minimise pelvic floor injury risk, and research (and action) on these is to be encouraged.

But in the meantime, and while it is not the preference of all women, a prophylactic planned caesarean is an important and valid one, and one that needs to be better recognised and supported 6 years post-NICE CG132.

Lastly, for many women who choose a caesarean, no matter what new research or developments are achieved to improve vaginal birth outcomes, they will still not be willing to take this risk.

I think fully informing women, listening to them, and respecting their choices, needs to be the way forward for both PVD and PCD.

As has already been noted caesarian birth is so expensive so it would be a major problem if lots of women started choosing it which they might well if they knew more the risks of vaginal birth.

Definitely a feminist issue. My body is wrecked from dds traumatic delivery. I'm pre menopause but can't run or jump.

In my info gathering I've been totally shocked how common this is and how debilitating. Bad prolapse = little exercise = weight gain, depression, poor cardiac health and more.

In France mothers get decent post birth physio and prolapse rates are lower.

It should not be an accepted result of pregnancy.

Imagine if a man walked into a GPs and said my penis is falling off. I think more action would be taken

My forceps delivery and 4th degree tear should have meant anal sphincter and pelvic floor physio was an automatic referral. Women are simply not valued and it gives me the rage

Sorry I've not had time to read the entire thread. I had my DS 7mths ago and had 2 mild prolapses. My GP said she'd refer me to women's health physio (back in October) but as I'd not heard anything by December I went private and saw the lady I'd have seen at the NHS trust. She told me that GPS can't refer to physio for this issue and could only refer to the continence team (I don't have continence issues). It's shocking that the NHS is so short of funds that they cant cover the cost of physio to help us repair/strengthen our pelvic floor after giving birth. I agree that it does seem like once the birth is over women are just expected to deal with it and carry on as normal whilst hiding any problems.

For those of you worried about being told to give up sports, it may not be the case. The physio said I was ready to start gentle jogging in short intervals to start working my way back up to running.

ariadne I can't see how vaginal birth with senior midwife, followed by 2 hours of surgery to repair 3rd degree tear, followed by physio, then by investigation into prolapse (scans etc), then by prolapse repair ops, can possibly be cheaper than a CS
Yes a vaginal birth is cheaper in that instant. But in terms of follow up impacts on women's health and total ££ spent by the NHS on that woman as a result of childbirth, it might not be.

It would be good to do a proper analysis on whether the French model works out cheaper in the long run. This thread has made me think we really need to do something about women's long term gynaecological health in antenatal classes.

QuentinSummers I totally agree- caesarian's more expensive there and then, the definite cost of X number of people's time, whereas vaginal birth is more unknown or in the future for some other budget to deal with.

As has already been noted caesarian birth is so expensive so it would be a major problem if lots of women started choosing it which they might well if they knew more the risks of vaginal birth.

Strangely enough NICE don't agree with you. Because of the associated costs of long term complications. They said this couldn't be tallied up, but that ELCS were value for money when this was taken into consideration and that ELCS should not be refused on the grounds of cost as a result.

This is NICE who have an obligation to investigate costs to the NHS and have deemed some treatments too expense for the NHS.

Also, its been pointed out there was a point at which so many women had planned ELCS it would in effect be CHEAPER for every woman to have an ELCS rather than a planned VB because it could be scheduled. There are places in the world were this is close to reality and the majority of women are having ELCS (parts of China, I believe).

You are repeated what you've been told by the media rather than what's in the NICE guidelines for cost effectiveness and efficiency. Its strange how they like to perpetuate the myth isn't it?

Hello, it's been very shocking to read a lot of your posts on this thread.

Am I right in thinking that if one has particularly bad hemorroids, it could be more likely to suffer from cystocele and rectocele prolapse issues?

I am aware and don't want to steer this conversation into a ELCS or VBAC. But I am due my second baby soon and have been suffering from hemmoroids. I am currently deciding between an ELCs or VBAC and concerned my pre existing hemmoroids could make me more likely to suffer these prolapse problems. Does anyone know?

Just to make clear I am in no way comparing hemmoroids to the awful cystocele and rectocele at all. I just wondered if there was a correlation as they are both due to muscle weakness.

Red toothbrush
I'm not repeating what the media have told me, I'm simply going on my own observation of the number of professionals in surgery and aftercare and how much that costs versus the costs of vaginal delivery. Maybe I'm wrong but I'd be amazed if Caesarian birth is cheaper than vaginal birth in itself ( not the long term costs).

Here's the link to the MN webchat on Jan23rd about prolapses if anyone wants to post a question in advance

www.mumsnet.com/Talk/mumsnet_live_events/3144287-Webchat-with-Sherrie-Palm-of-Pelvic-organ-prolapse-support-organisation-Tuesday-23-January-9-10pm

Thank you, was worried I’d missed the webchat. I really hope that after that we can look at possibility of a MN campaign on this area of women’s health.

Me too AuntElle

Lilone I can tell you anecdotally that my mum has had to have strangulated haemorrhoids operated on twice, and has pointers towards (though no official diagnosis of her own) the same genetic condition that caused my prolapses and my (and sisters) hernias.
So in that case they are linked (I get them too, but not like my poor mum!)

But they're common anyway, so it is very probably nothing to worry about.

I also thought I'd missed the webchat - in my brain we're at the end of January now

I belong to a wonderful facebook support group www.pelvicorganprolapsesupport.org I did not know a thing about prolapse until diagnosed. the group is really supportive and lots of experience with surgical and non-surgical solutions to prolapse. Women only, so we talk about everything. Sherrie Palm will be speaking on MumsNet tomorrow (Tuesday) night at 9pm.

I have had posterior Colporrhaphy which has improved my perineum and stopped the tampons falling out but has not helped with the problems with the rectum - mainly difficulty with clearing all of the contents, even when using stool softeners. I was told it did not always help when I had my op

Is there anything else for me, or will I be condemned to digitating for the rest of my life?

Thank you to Shakey. I joined the APOPS support group and have learned so much there. www.pelvicorganprolapsesupport.org it is run by the lady giving the Munsnet webchat...brilliant information. I did not want to learn all of this but it is helping me cope so much better with my bloody bottom!!