The terrible consequences of a difficult birth

An Australian study has made some troubling findings about the problems that can arise from a difficult vaginal birth.

In an earlier post, I quoted Professor Hans Dietz, who believes that the “increasing push towards natural birth is having the unintended consequence that more women are having longer, more difficult labour”.

Dietz and his colleague Elizabeth Skinner have published qualitative research on the psychological consequences of a traumatic vaginal birth. They spoke to 40 first-time mothers who had suffered physical damage to their pelvic floor or anal sphincter muscles while giving birth.

From the interviews with the women, they identified certain key themes, including conflicting advice from clinicians before, during and after birth; nil postnatal assessment of injuries; dismissive reactions from clinicians to the women’s injuries; and experience of PTSD symptoms.

The authors write: “Major somatic [physical] maternal trauma after vaginal birth is one of the main causes of pelvic floor dysfunction, and it also seems to be associated with significant psychological morbidity up to and including postpartum post-traumatic stress disorder”.

For those of us who have heard many women’s stories of traumatic deliveries, this is all too familiar. It’s particularly concerning that women often receive conflicting advice from midwives and obstetricians; along with my colleagues at the Birth Trauma Association, I firmly believe that midwives and obstetricians should share some of their training, so that they can agree on best practice when it comes to supporting a woman during birth and assessing risk. Poor working relationships between midwives and obstetricians was one of the problems that led to the deaths of one mother and 11 babies, according to the Morecambe Bay investigation report.

But we have also heard, many times, stories from women who have said that their doctors don’t take their injuries seriously enough, and we are only too aware that a traumatic birth experience that results in physical damage can cause PTSD – something that clinicians are still unaware of. The consequences for women can be both profound and long-lasting. The research authors say: “Mothers after traumatic birth are likely to have a reduced quality of life due to both psychological and somatic morbidity.”

And it’s impossible to disagree with their conclusion: “There is a great need to learn how to better help women who have sustained these injuries by acknowledging their concerns and providing diagnostic and therapeutic services. This is unlikely to occur unless health practitioners learn how to diagnose maternal birth trauma properly and account for women’s perceptions and needs following traumatic vaginal childbirth.”

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