We expect childbirth to be hard, of course. The pain is accepted almost dismissively. As women, we talk openly about bleeding, sore breasts and the risk of postpartum depression.
But given time, we expect that the swelling will reduce, muscles will strengthen, tearing will heal and tears will dry. No one expects that childbirth will leave them with lifelong physical injuries.
Sadly, this is the case for Newcastle mum April Hagan. In December 2015, April was two weeks overdue to give birth to her first baby. Following an excruciating balloon catheter induction (to manually force open her cervix), April endured a long and agonising labour that failed to progress. Eventually, April was informed that forceps were going to be used to deliver her baby.
And so it was that April begun her journey into motherhood with vaginal tearing and blood loss so severe that she required emergency surgery to attempt to repair the extensive damage. Her body had literally been torn apart.
The true extent of the damage to April’s body would not be revealed for almost 12 months postpartum. She has been diagnosed with bilateral avulsion (pelvic floor muscle torn from the bone) and subsequent prolapses. Her bowel, uterus and bladder protrude painfully into her vagina. This permanent diagnosis has had a devastating impact on her quality of life.
“There is no break from the discomfort and pain” April said. Everyday activities like bending, running and jumping are no longer possible. She is not even able to lift up her own son. When he cries, reaching out his small arms for her to hold him, she is forced to tell him no.
April’s physical birth trauma is certainly not an isolated incident. Research indicates that 20 percent of first-time mums sustain major irreversible birth trauma to the pelvic floor muscles.
The results of pelvic floor injury include urinary and fecal incontinence, genital and anal prolapse, painful or impossible intercourse and psychological trauma. A Swedish study found that 40 percent of women who delivered vaginally had some form of urinary incontinence 20 years after giving birth (compared 29 percent of women who had a C-section).
Issues like incontinence and the implications of these injuries are so rarely discussed openly. This means that survivors of physical birth trauma are left feeling embarrassed and isolated. These issues are only discussed, in whispers, amongst affected mothers. Organisations like the Australasian Birth Trauma Association and Support Group provide much needed support and information to affected mothers.
Another implication of the taboo nature of pelvic floor trauma is the financial impacts of these injuries on the public health system. Because the effects of pelvic floor injury often present years after childbirth, the costs of treating these injuries is often overlooked.
The hard truth is that the public health cost of the ongoing management and treatment of pelvic floor injuries is astronomical. Costly surgical and medical management, inpatient and ambulatory care, plus the indirect costs of loss of productivity, all adds up. This is particularly significant in relation to the ongoing debate about reducing the caesarean rate.
For April, despite being two weeks overdue with a very large baby, a cesarean was never discussed nor offered. “I completely trusted my treating health professionals to guide me through the best and safest birthing option”, stated April.
One can’t help but wonder why the significant risk of prolapse was not discussed with April as part of informed consent. And why, at no point prior to induction or during her long and laboured birth, was she not offered any alternatives to a ‘natural’ birth.
Embarrassed and ashamed, the women who have experienced pelvic floor trauma hide their physical and emotional scars from the world. They carry their heavy burdens silently.
But the scars of childbirth should not be a secret. Together, we need to break the silent taboo surrounding physical birth trauma. Awareness needs to be raised about the high prevalence, severity and impact on quality of life that these injuries have on women. We may not be able to completely eliminate the risk of pelvic floor trauma in childbirth but we should, at least, be fully informed on the mitigating risk factors. We need to enter motherhood with our eyes open, empowered with the knowledge to make the right decisions about our own births, bodies and babies.
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