The Royal College of Obstetricians and Gynaecologists says that around 90% of women tear while giving birth. Even ‘minor’ injuries, like grazes, can be very ouchy indeed while they’re healing. For some women, birth injuries and perineal trauma can go on to have long-lasting effects. 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. The prevalence of medium-term and long-term symptoms associated with birth injuries is simply unknown; we’ve spoken to NHS clinicians who say it’s not uncommon for women in their sixties to present for the first time with symptoms that can be traced back to a difficult birth decades before. It is also not known whether instrumental births result in worse long-term outcomes than caesarean sections, because the long-term data necessary to find out is not routinely collected.
What care is available?
Care can often be pretty disjointed after the birth, especially if a woman goes home 'out of area' from the hospital where she gave birth. When women who've had perineal trauma are discharged from hospital, it can be a bit of a lottery as to whether they are properly followed up by their community-based midwifery services or GP. Women with more severe perineal trauma (third- and fourth-degree tears) are usually recalled for a follow-up appointment in hospital: it's women with first- or second-degree tears or other kinds of trauma who are not always recalled, and these women can find it difficult to get follow-up care if they continue to experience problems.
The six-week check for the mother, which used to be provided by GPs as standard, is now quite patchy - and again, there's no central record of how many GP surgeries continue to offer this appointment to new mothers. From conversations we've seen on Mumsnet and from conversations we've had with NHS staff, it's apparent that some women who approach GPs with symptoms of pain, incontinence, discomfort or uncomfortable sex risk being told that their symptoms are normal for women who've had babies, and that they need to just get on with it.
If a woman's first attempt to seek help results in a brush-off, she's very unlikely to try again. Some areas do have perineal care clinics, but women can't self-refer to these, highlighting the important role GPs play as ‘gatekeepers’ to NHS hospital services. But according to our survey results, a much larger number of women don't seek medical care for these symptoms in the first place - perhaps because of embarrassment, or feeling that it's ‘normal’ for things to be difficult after you’ve had a baby, or being overwhelmed by the difficulty of having intrusive medical examinations and procedures while in possession of a tiny infant.
Not sure where to go?
If you experienced tearing, injury, or perineal or vaginal trauma during birth - including an episiotomy and/or the use of instruments such as ventouse or forceps - check out NHS Choices’ advice on recovering from episiotomies and tears. If you’re in any doubt at all about whether you’re healing properly, be proactive about asking for help and advice - from your midwife if you’re still under her (or his) care, or from your GP. And if it’s been a while - even years - since the birth but you suspect something still isn’t right, please know that you’re not alone - and seek medical advice. You can ask your GP for a referral to a specialist. For accounts of when births go right, when they don't and other experiences from those who've been there, check out this recent discussion or head to our childbirth Talk topic.
Read this guest post by Jen from the MASIC Foundation, the only multi-disciplinary UK charity to support women who have suffered severe injuries during childbirth known as OASI (Obstetric Anal Sphincter Injuries). The charity is run by injured women and healthcare professionals who are committed to better detection and prevention of injury during childbirth.