Severe tearing in childbirth – not just a physical problem

NB I’ve edited this post in response to a comment.

A traumatic vaginal birth involving severe tearing can cause mental health problems, including post-traumatic stress disorder (PTSD), according to a new study from Hans Peter Dietz and Liz Skinner.

About 90% of women experience tearing during childbirth, but most are first or second degree tears, which are relatively mild and heal quickly. Approximately six percent of women have third or fourth degree tears that can damage the anal sphincter.

Dietz and Skinner have done a lot of work in this area, which I’ve written about before. They both feel that the problems of a difficult vaginal birth tend to be overlooked in the drive to reduce caesarean sections, which are usually perceived as more risky for both mother and baby.

The study identified 40 first-time mothers with major pelvic floor trauma and interviewed them one-to-four years after they gave birth. Just over half (22) of the women had “major obstetric anal sphincter tears.”

Of the 40 women, 35 had “Multiple symptoms of pelvic floor dysfunction” causing lifestyle alteration. These symptoms included “urinary or fecal incontinence, prolapse, chronic pain, dyspareunia [painful intercourse]”.

It’s hardly surprising, then, that 27 experienced PTSD symptoms, including “poor baby bonding, flashbacks during sex, dissociation, avoidance, anxiety”.

Probably the most worrying themes to emerge from the study were the lack of awareness or communication from health professionals:

  • 36 women said there was no information provided by clinicians on potential postnatal pelvic floor morbidities
  • 36 said that there was no postnatal assessment of their injuries
  • 26 said that they experienced “dismissive reactions from poorly informed clinicians to maternal injuries. One woman said: “The midwife said that this was OK… but I knew that it was not normal… The doctors really did not understand the situation… I was in shock – devastated and unable to get any health professional to understand.”

Although the study was carried out in Australia, I’d be surprised if a UK study didn’t find something similar. I’ve now heard numerous stories about obstetric tears not being treated properly or women having their concerns dismissed as unimportant. One of the problems is that midwives often don’t see the consequences of tearing in childbirth – women are only under midwife care for 10 days after birth, so if a tear has failed to heal properly weeks, months or even, shockingly, years after birth, they’ll be dealt with by another group of health professionals entirely. So midwives may well assume, wrongly, that a tear during childbirth has healed without problems. And that may lead to an unjustified confidence that obstetric tearing isn’t a significant problem.

As I’ve already reported, the RCOG is now campaigning for better understanding of obstetric tearing in childbirth, and better care for the women who experience it. But we still have a long way to go – and In the meantime, a lot of women are suffering in silence.

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2 thoughts on “Severe tearing in childbirth – not just a physical problem

  1. Hi Kim and colleagues, I was pleased to read this blog but am concerned that the title is misleading. The study seems to be about ‘major pelvic floor trauma’, but the title says ‘tearing’. I think it might be helpful if there was some introductory discussion about different degrees of tear. Some can be very serious, overs not (levels 4< 3, 2 and 1). Mary

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  2. Thanks, Mary, it’s lovely to hear from you. That’s a good point – lots of women have first and second degree tears that heal very easily and it’s important to make that distinction. Because of the OASI project, I’ve heard a lot of stories recently from women who have had very severe, life-changing tears, and that’s obviously what the writers are talking about here. I’ll amend the post to take note of that.

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