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

There does seem to be a mentality that women should suffer; The Labours of Eve. Bizarre in this supposedly secular age. It seems to be a fundamental rule of society. You come across it with periods, childbirth, menopause, and any gynae problem. It seems to be hard wired.

Totally agree. I think a lot of the time it's unconscious but I think in part it does hark back to this attitude.

2. It would cost billions to educate the public and healthcare professionals and deal with all the surgery and ongoing care needed.

I'd like to take task with this.

A couple of years ago a study was commissioned into the cost to society as a whole from failure to adequately provide Maternal Mental Health Services.

It found that when you added up all the costs: from impact on social services, to unemployment benefits / disability benefits, to lost days working etc etc it cost £8.5 billion PER YEAR to the UK.

The cost to bring maternal mental health services to the basic minimum recommended level - which would help women get back to work and stop them from falling into an ongoing cycle of problems which prevented them from being economically productive was £350 million per year.

That's a £8,500,000 000 problem, which would be massively helped by a £350,000,000 investment. (The first number is 24 times the second for anyone struggling with all the noughts).

Put simply, investing in women's mental health might potentially make our society more productive and save a great deal out of that £8.5 billion cost.

I strongly suspect that the cost of investing in the physical health of women after child birth, would be similar and not necessarily as expensive as you might think.

The issue is more that the political will to invest and value women as an asset to society isn't there.

I agree, Terry. I said earlier up thread that there is a mentality of "women's bodies just go wrong" and therefore our threshold for putting up with it should be higher. When we try and access healthcare and seek help to improve our quality of life, we are up against this type of entrenched misogyny of being "moany women":

The British Association of Urological Surgeons conference 2017

“Do you think female neuro-urology and urodynamics is just putting people off? Because I say it, it would put me off?”

“You just think of pads and tape”

“Yeah it doesn’t show the wide breadth that most of the people in this room do, including male incontinence, male LUTS [lower urinary tract symptoms], reconstruction and the fancy stuff and .. which is really the interesting and exciting ..”

(Then from 1.48:40)

“But in terms of wanting to do female reconstruction I think there’s a misconception about what it is amongst trainees. When I tell people I want to do female and reconstruction they go, “well why do you want to put up with moany women all day?”. That’s not all it is but that’s the conception.

There does seem to be a mentality that women should suffer;

Even more so in some catholic countries! I gave birth in Italy and was induced on a drip but not allowed any pain medication either before or after the birth for anything that counted as a "natural" pain as that is part and parcel of giving birth. I felt really traumatised by the whole experience (not just the lack of pain relief but the lack of control - I had so many things done TO me with no explanation) that I opted for a c-section the second time around.

Wow, hinged. Those comments are awful.

allegretto

Definitely a feminist issue.
I had a second degree tear with DS after three hours of pushing and an eventual assisted delivery. Lots of stitches including my cervix and the local anaesthetic had no effect on me due to another medical issue. I developed excess scar tissue and after an appointment with a very unsympathetic (male) gynaecologist that left me in tears, I was scheduled for a vaginal cut and restitch. I wasn’t told until just before the GA that there was a risk of ‘sexual dysfunction’ following the op.
My wound was hideously swollen and bruised, got infected and took months and months to heal. I never had sex with my then DP again as the pain on attempting penetration was unbearable. I’ve since split with him and been diagnosed with vestibulitis. I have a large bulge inside but have been assured that it’s not a prolapse (I’m not so sure) My pelvic floor is virtually nonexistent and I needed an EMS machine to reactivate it.
I feel completely ruined and have accepted that I will never have another child or another relationship. I’ve been left with other permanent physical damage as a result of pregnancy too and had I known what I was in for I would have definitely chosen to remain childless.

What shocks me about this issue is that even when it's discussed, so many women still don't do anything about it for fear of being seen as a nuisance, or fear of rejection. My lovely male GP automatically referred me for physio at 4 months post partum when I asked for BF friendly hayfever meds as sneezing left me incontinant after a 2nd degree tear - they found that I have a mild prolapse. I told my NCT group about this, and not one of them wanted to ask their own doctors for referral - one of them even said that she's really happy with wearing Tena lady as it's not that big a deal. Who wants to wear a pissy smelly rag in their pants for the next 50 Years?! Awareness is important but so is normalisation of treatment. Why can't a Health Visitor ask Mum a few questions and refer at 1 or 2.5?

Just re read hingedspeculum description of rectocele and yes, I think I have that doctor did say the back wall of my vagina was very thin and she could ‘feel poo’ plus I have to digitally manipulate about 50% of the time

This isn't a female "design flaw" - my brother suffers with pelvic/groin issues like I do. His problems have become the butt of disgusting jokes, but he never gets accused of being a whinger who needs to get over himself. I've been told that mine are "part and parcel of ageing as a woman", when I've had them since I was in my mid-20s.

This is such a shocking thread. All these millions being invested in advancing all sorts of 'cosmetic' / vanity type treatments by the NHS and yet we haven't managed to provide safe maternity care which doesn't leave women physically wrecked.

So many women suffering in silence. The vaginal mesh issue is just the tip of the iceberg isn't it?

Thank you for this thread.

Labradormama That is so awful, as are so many stories on this thread. This thread is also educational - I have already learnt so much stuff that I wish I had been told years ago!

Thing is, when you hear about how postpartum French women are treated, you can clearly see that this IS a set of problems that is normal and in my cases fixable if intervention is timely. All French women have access to state funded healthcare to help them get their pelvic floor, vagina and other organs back to health after childbirth. The French acknowledge that this is a necessary part of healthcare, so why the fuck doesn't the NHS accept it? It's not even talked about in Britain. Most women get pregnant, give birth and no one ever mentions the possible trauma they'll suffer (and which 40% of us DO suffer).

I hope that articles like the one in the Guardian can start a conversation about this at a national level. Wouldn't it be great if in future British women could have access to the sort of support postpartum that French women are able to take for granted?

*many, not my

It’s so shocking to read these stories.

I’m from the Birth Trauma Association – we’re a small charity that supports women who have had traumatic births and campaigns to improve maternity care. Most of our members have symptoms of postnatal PTSD, but there are also a number who have physical damage of the kind some of you have experienced.

It was good to read the Guardian article, but people might also be interested in this article on birth injuries from the Mail (I realize a lot of people aren’t fans of the Mail, but this is worth a read). In particular, it highlights the work of Professor Peter Dietz, an obstetrician based in Australia, who has been using 3D ultrasound imaging to diagnose a particular kind of damage in childbirth, namely levator ani avulsion, where the pelvic floor muscle completely detaches from the pubic bone. It’s a common outcome of forceps births, but unfortunately in the UK it’s very unlikely to be diagnosed, with the result that women are simply expected to put up with the prolapse and incontinence that can arise as a consequence.

It is important to warn women of the potential risks of childbirth. As Professor Dietz says in the article: “Given that patients are warned of risks as low as one in 1,000 before routine varicose vein surgery, it is incongruous not to warn a woman having her first child at 38 that she has a 15 per cent chance of an anal sphincter tear.”

I prolapsed into my knickers (post c-section) after trying to pick up a new car seat in a shop. I had no idea if it was usual and to be expected, or if I had been disembowelled and was about to pass out and die. I eventually worked out what it probably was and that it could probably be safely pushed back in enough to get my trousers back on and get help, from remembering a scene with a sheep in a James Herriot book I had read 15 years previously.
I don't think that is an acceptable state of affairs.

People get very defensive about birth and gynae injuries. There's the "don't scare the pregnant women" stuff that Miaow has already mentioned, and outside of specific feminist or birth trauma groups, you are quite likely to get a response along the lines of "well I had a forceps birth and I'm FINE. My baby was more important to me than my principles, stop talking for all pregnant women, stop whinging blah blah blah."

I'm not sure why people do it, there's possibly some guilt in there.

The other thing that gets this kind of response is finding smear tests traumatic. It used to happen a lot with debates about pain relief during birth, but I haven't seen so much of that lately. The move to de-medicalise some elements of birth started out as a feminist idea, but it now gets used as a big stick to beat mothers with. Same with breastfeeding. One friend of mine had a DS who would not feed and was becoming ill as a result. A breastfeeding peer counsellor who became involved relentlessly bullied her about not latching on properly and insisted on feeding practically all the time, when her DS had a tongue tie and some other issues with his mouth. It was nothing to do with latching or frequency, he was unable to feed properly without some assistance first.

I've found that you will occasionally come across this attitude of almost perverse jealously - "If I've suffered, then so should you. Why should you be ok, when I'm not?" when it comes to pain relief in childbirth or birth injuries.

Its almost a direct reversal of an "I'm alright Jack" attitude.

I personally, don't get why anyone would want to inflict the misery they suffered on others, but it pops up with a surprising regularity.

I have often wondered if its a coping strategy, for some who have been badly scarred mentally and physically. If there is no alternative and its something 'we just have to put up with', then they can almost rationalise and accept what happened to them more easily. The 'we' is really an 'I' that is projected onto others.

It of course, holds us back from progress in women's health care, but overall I genuinely don't know that I see as much demand from women to improve women's care as you might expect.

In the UK we have considerably lower standards and expectations in this area generally than some of our European neighbours (though some are worse and it can be patchy), which is quite shocking imo. We definitely are not leading on this.

Women can push back on this. There have been some really big shifts in attitudes towards maternal mental health (though a long long way to go too sadly) in the last decade. There are some aspects of it, which 10 years ago, were still much more taboo and women were afraid to speak about on MN which has changed quite significantly.

This is a feminist issue for sure, as women's physical health has had a back seat for centuries. It is time we lobbied to be informed of consequences of types of birth so we can go on make informed decision about pre- and post natal care.
We buy into this neo-liberal belief of "getting back to work" immediately after childbirth as a show of equality and strength. But our bodies need at least 6 full months to heal from after birthing.
I was a proponent of Active Birth, consulted Dr Michelle Oden, had no tears or cuts and yet 25 years later have a prolapse. If I had been informed about potential prolapse in later years, I may not have got back to weights, jogging etc so soon after childbirth.
So my thoughts to all young women is to be gentle with your bodies after child birth, don't rush to exercise rigorously, learn how to lift and eat healthily.

Hi Kim

Keep up the good work!

I'm joining this thread for the first time - I follow the British Trauma Association on Twitter and it is amazing to see how many women feel the same as we do. I too read the Guardian article and have been galvanised into doing something about this issue. Women are not properly consented about what is likely to happen to them during birth and this is so wrong.

RedToothBrush

You missunderstood me. My point was made sarcasticly. Obviously the investment would be worth it from our point of view but even though that study was carried out years ago and the conclusion obvious in terms of cost benefit, nothing has happened because the CCG’s /Trusts / whoever's in charge these days dont want to fund it.

I work in this area and see it all the time. A case is made where making a simple change would improve health outcomes drastically and it’s refused on dubious grounds (say cost). You ask if they know how much the cost would be and they havent a clue. Something else is going on (vested interests imo). Too many people on too many committees have too many fingers in the pie to change things. Its all about the financial structures and who benefits.

TheSmallClangerWhistlesAgain

That ‘design flaw’ comment was made to me by my colorectal surgeon. Interesting that your brother suffers too. I wonder how many men this affects? Anyone know? I know men suffer with hernias a lot.