Birth injuries for mums from a physical perspective
It can be all too easy for new mums to downplay what they have been through in childbirth. Many mums recover very quickly from the birth and find that they are soon physically well. However, some mums can suffer serious injuries that can be hard to talk about and seek help for.
Pregnancy and childbirth is a huge physical and psychological process. It is one of the biggest, life changing events any woman will go through. Women can suffer life changing injuries during childbirth, such as urinary incontinence, vaginal tears that can lead to pain, surgical repair and in extreme cases, bowel incontinence.
It can be easy for everyone to forget about what a mum has been through once the new baby has arrived. A lot of the focus of care after a birth is on the health of the baby which is of course extremely important, but it is also important not to forget to make sure that mum is okay too.
Many women are too embarrassed to talk about any injuries they might have and are not seeking help or support for themselves. We are here to say you are not alone and that it is so important to access any help or support you may need after giving birth, particularly if you have been left with a physical injury. Many birth injuries are treatable, but your recovery will depend on the treatment you are given and the timing of this treatment.
Some urinary incontinence during pregnancy and immediately after the birth of a baby is considered normal. This is usually caused by the additional weight of the baby and by your pelvic floor muscles relaxing before the birth to allow the baby room to be born. The pelvic floor is made up of layers of muscles below the bladder and womb that acts as a barrier from the back bone to the pubic bone. Once you have given birth, any urinary incontinence is usually caused by the muscles weakening and stretching during birth. Assisted delivery using forceps or ventous can also damage the pelvic floor muscles.
Women who have had an epidural can also have some urinary incontinence because the catheter that will be inserted can make it harder to control your bladder. This should resolve a few days after you have given birth.
Urinary incontinence during pregnancy and after birth is very common and nothing to be ashamed of. It is important that mums are not made to feel embarrassed to speak about this issue with friends, family, their midwife or their GP.
Urinary incontinence can be reduced and treated with pelvic floor exercises during pregnancy and after childbirth. Often, it is a temporary condition, but if it is more severe there are surgical options to tighten or support the bladder.
Many women experience vaginal tears during childbirth, particularly women who are giving birth for the first time. Most women will have discussed the risk of a tear to the perineum (the skin between the vagina and anus) during childbirth with their midwife before they give birth.
Tears can happen naturally, or sometimes the doctor or midwife might recommend that a cut is made instead of allowing a tear to occur. This cut is called an episiotomy. Either way, the vaginal opening is enlarged to allow more room for the baby to be born.
There are four different categories of vaginal tears, depending on the thickness of the tear:
- First degree tears are usually small, skin deep tears that heal naturally and fairly quickly. They often do not require stitches.
- Second degree tears are deeper tears that affect the muscles of the perineum. These tears usually need stitches in order to heal.
- Third degree tears are deeper still and involve the muscle surrounding the anus. These tears require stitches or surgical repair.
- Fourth degree tears are the most severe. They involve the lining of the anus or rectum and will require stitches and a surgical repair.
It is vital that the extent of any tear is correctly identified and properly repaired when it happens. There are guidelines in place for midwives and doctors to follow when tears happen.
Many women can recover well from severe tears if they are recognised and treated correctly straight away. They can go on to have straightforward vaginal births again in the future.
Complications following a mother’s birth injury
Unfortunately, in some cases the extent of a tear is missed by the midwife or doctor involved, or a repair may not be carried out correctly.
This can lead to many problems, including infection and pain, bowel incontinence, uncontrollable wind, a hold (fistula) developing between the vagina and anus and anxiety, fear and psychological damage.
Treatment can be extensive. Antibiotics are often given to treat infection. Surgery can be required to clean and repair any tear. If bowel incontinence means that the tear cannot heal by itself, the doctors may suggest a stoma is formed to allow the tear time to heal. A stoma is a surgically created opening on the surface of your abdomen to divert your intestine and the flow of faeces out into a bag.
Managing a stoma is a huge adjustment, let alone trying to manage a new born baby on top. This can be an extremely difficult time for new mums, both physically and emotionally. In these circumstances, mums can miss out of the first few weeks of caring for, breast feeding and bonding with their baby.
Support following a birth injury
Managing a newborn baby and a birth injury can be very difficult. You may have worries about the future, your recovery, your job, future pregnancies and the potential effect of any birth injury on your relationship with your partner.
If you think that your tear was not correctly identified or treated you may be able to bring a medical negligence claim against the hospital or doctor who treated you. The aim in a medical negligence claim is to secure you the financial compensation you need to ensure that you have access to medical and rehabilitation services now and in the future. By doing so, this can help maximise your recovery and allow you to focus on your baby and getting back to normal.
It is so important to know that you are not the only person out there going through this and that there are people, charities and support groups that can help. Women should not be ashamed or embarrassed of any birth injury they might have and I would encourage mums to speak openly with friends, family, their medical team and charities – all of which can provide invaluable support.
The Bladder and Bowel Community is a charity giving free confidential advice, support and information for anyone affected by bowel or bladder conditions. MASIC (Mothers with Anal Sphincter Injuries in Childbirth) also provides advice and support to mums who have suffered injuries following serious tears in childbirth.
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