(Trigger warning: This article discusses birth trauma.)
Childbirth injuries – it’s an unglamorous possible outcome that few people want to talk about, even in antenatal or new parenting classes. But whether we want to discuss it or not, pelvic injuries during childbirth are very common. Studies show that women having their first baby have a 75 per cent chance of having some trauma to this area. And pelvic injuries can result in some rather uncomfortable symptoms: incontinence related to passing urine or stools, prolapse (common types include a dropped bladder or uterus, or bulging rectum), or pain, including pain during sexual intercourse. With scant information available, many women who experience injuries associated with childbirth are left feeling confused or ashamed and will tolerate highly inconvenient, even distressing symptoms rather than seek medical help.
To shed light on this uncomfortable but important matter, I spoke to two Inner West Mums who experienced such injuries: Rachael, who suffered a uterine and bladder prolapse following a long and difficult labour, and Caz, whose bowel ruptured after her son’s caesarean section delivery, a rare complication that left her fighting for life. I hope that in sharing their experiences we can begin to discuss women’s health issues openly and encourage those suffering in silence to seek professional help. Both Rachael’s and Caz’s experiences are indeed at the severe end of the scale. But regardless of the severity of one’s injury, it’s essential to know that there are numerous options available to alleviate symptoms.
In a follow-up piece, I seek the expert knowledge of Inner West Mum Erin Nesbitt-Hawes, an obstetrician and gynaecologist with Alana Healthcare for Women, which provides obstetrics, gynaecology and allied services for women’s health issues, for greater insight into this subject. ‘There are lots of ways to get help should you suffer any of these symptoms after having a baby,’ says Erin. ‘Please don’t be too embarrassed to seek help.’
‘My son took a long time to arrive,’ says Inner West Mum Rachael. Sixty hours, in fact. After an exhausting two days of labour, the baby was found to be in a posterior position. Rachael required an epidural, episiotomy and forceps delivery. A postpartum haemorrhage came next. ‘My son’s birth was drawn out and pretty traumatic for all concerned.’
Rachael faced numerous challenges following the birth. She explains: ‘For several months, I felt like I’d been run over by a bus. My breastmilk supply was low, so I was breast and top-up bottle feeding; my iron was low from the haemorrhage, leaving me feeling very tired; I had an anal fissure, which made doing number twos excruciating, and I was still healing from the perineal stitches.’ She also returned to work part-time just four months after the birth. There was so much to contend with that a common symptom of prolapse that Rachael was experiencing – regular urine leakage when she stood up from the toilet – seemed like the least of her problems, she says. ‘I didn’t think too much about it until I noticed my cervix outside my vagina one day, when our son was about two years old. That was a scary discovery!’
Rachael went to her GP who gave her a referral for a pelvic ultrasound. The ultrasound confirmed there was indeed a stage 1 prolapse. Rachael began to see a pelvic floor physiotherapist who suggested exercises to strengthen her pelvic floor. Unfortunately the exercises didn’t prompt much improvement. ‘I decided to look at what was available online. I found a great DVD by a US-based physio called Hab-it (www.hab-it.com), which aims to strengthen muscles in the whole region from the pelvic floor up to abdomen and down to the knees. I tried to do the 20-minute routine in the privacy of my bedroom three times a week. Those exercises kept me stable. I also saw a gynaecological surgeon, who offered a pessary and suggested that I might consider surgery after I’d finished having kids.’
The birth of Rachael’s second baby, another boy, was mercifully easier and didn’t seem to cause more damage. But by the time he was four, she noticed her cervix was protruding further at certain times in her menstrual cycle, and the prolapse was becoming hard to live with. Rachael returned to her GP, who recommended having surgery before she hit menopause, as oestrogen aids recovery.
This time Rachael went to a new gynaecological surgeon. He said Rachael had likely experienced a vaginal tear during childbirth that had never been diagnosed, and that it had weakened the pelvic floor muscles over time. Her uterus was also enlarged, and her cervix unusually long, which contributed to the feelings of heaviness and dragging. ‘Hearing him tell me that was the first time I realised that this problem was not my fault. I wasn’t suffering because of something I didn’t do, or should have done; it was just the way my body responded to having my first baby.’
Seven weeks ago, Rachael had a partial hysterectomy (a procedure which removes the uterus but leaves the ovaries). However, the surgical route is not a decision to be taken lightly, she warns. ‘The operation took a greater toll on me than I expected,’ she says. ‘In the weeks after surgery, I was in constant low-level pain, and had to go back to hospital when I had another haemorrhage. It can take up to six months to fully heal. Over that time, I have to be careful with lifting, bending, stretching, and carrying things, which can be difficult to manage with small children, and life in general.’
Looking back, Rachael says she was naive about the potential damage that could be inflicted by childbirth. ‘After the operation I started reading Naomi Wolf’s book Vagina, and wish I’d read it sooner, to have more info about what’s essentially been a taboo subject.
‘I think women generally find it difficult to speak about issues relating to prolapse and vaginal injuries, even among friends and at mothers’ group. It’s still a very “private” area, which means that many women suffer in silence. I had a member of my family tell me she’d had a prolapse for more than 45 years and never told anyone, apart from her GP. She also had surgery recently, and is feeling a million times better.’
In sharing her story here, Rachael hopes that women experiencing similar problems will feel comfortable about seeking help. ‘Birth and motherhood are challenging enough without having ongoing issues that compromise your comfort, your ability to exercise and play with your kids, and your sex life. Help is available, but you need to be proactive in seeking it out, and also to push through your discomfort around discussing it. There’s absolutely nothing to be ashamed of!’
When Caz gave birth by emergency C-section under general anaesthetic following a very long labour, she had no idea that her ordeal had only just begun. A day or so after her son’s arrival, her abdomen began to swell and harden. The hospital staff explained it was the massive dilation of the colon, called Ogilvie’s syndrome, a rare complication of obstetric surgery, and that she must have nil by mouth to allow her bowel to recover.
But it did not recover. Twelve days after giving birth, Caz was back in hospital, unconscious. ‘My cecum, the balloon between the small and large bowel, had ruptured and I was going into septic shock,’ she says. She was gravely ill.
Surgery was performed immediately, removing the cecum, 10 centimetres of small bowel and 20 centimetres of large bowel, and washing out the entire abdominal cavity which was septic. Caz was given an ileostomy, similar to a colostomy – where the cut ends of the bowel are connected to a hole in the abdomen, diverting the stool to be collected in a bag. ‘After the operation I was in ICU for a week with a 40 per cent chance of survival. I had two more operations to follow and received the highest dose and strength of antibiotics a person can have. There was fluid on my lungs, abscesses in my tummy and a dose of shingles. I spent a total of five weeks in hospital, two of them in ICU.’
Caz was so unwell, she didn’t see her newborn baby again until he was seven weeks old. She remains eternally thankful that her mother-in-law helped care for her son during that time. Caz was devastated that she had been unable to breastfeed her son. But the emotional scars would run much deeper. ‘The guilt I feel that I almost died and left my son without a mother or my husband without a wife threatens to cripple me sometimes. I just have to take a deep breath and remind myself that I am here and draw on that strength I was capable of while I was in hospital.’
Fortunately, down the track, the ileostomy was reversed and Caz has regained normal bowel function. ‘I have not experienced further bowel issues and am not on any medication. I rejoice in this fact every single day!’ However, Caz’s birth complications took one further blow: she experienced fertility problems due to the physical trauma and the numerous surgical operations she underwent. Caz suffered both a miscarriage and an ectopic pregnancy resulting in the removal of her fallopian tubes. ‘I always wanted a bigger family,’ she says. ‘We considered IVF but have taken the hard decision that the pregnancy and delivery is too risky for my health … and life!’
Caz wants there to be greater awareness of injuries associated with childbirth. She says: ‘Everyone assumes it’s just vaginal problems that can occur. Bowel injuries are quite common too and it’s sad that these issues aren’t talked about. I wish they were out in the open. Childbirth injuries can be lonely and affect every part of your life.’
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