'I haven’t recovered – I’m not sure I will': Women affected by birth trauma recall experiences

We asked readers to tell us about their experience of birth trauma. Many reported persistent physical and emotional issues. In response, a leading academic says we must address the postnatal health of women

Picture: iStock

Most births do not lead to long-term health issues. Obstetricians and midwives do an extraordinary job, often under difficult circumstances.

Yet, according to a European research group, 20% of mothers report their birth experience as traumatic.

In July, Feelgood ran a feature on birth trauma. We invited readers to share their own difficult birth experiences. Their accounts of extreme physical trauma, of long-lasting impacts on their bodies, of trying to get help and not being listened to, of persistent mental trauma that had wide-ranging implications for their lives, are harrowing.

The women responded from Cork, Kerry, Limerick, Wexford, Meath, Louth, Kildare, Dublin, Monaghan and Donegal. They detailed traumatic experiences that happened as recently as last year, and as long ago as 1993.

One woman, who 15 years ago suffered a broken coccyx as a “result of a 72-hour induced dry labour”, said the “piercing pain” she endured long after was “a constant reminder of birth assault”.

Assault is what many of the women describe.

“I had a very fast, uncontrolled delivery which tore through my pelvic floor, destroyed it.”

“I had to get perineal reconstructive surgery after the doctor stitched me up incorrectly.”

“Days later after experiencing a lot of back pain, scans revealed [that] during the birth they had stitched through my ureter. I had to have a nephrostomy bag [allowing urine to drain from the kidneys] which I was left with for months.”

“Six months [later], when getting a smear, I found out I had a prolapsed uterus.”

“Painful sex from tears is ongoing at eight months postpartum.”

“Post-breaking of waters, labour rapidly accelerated – my baby was born within an hour, six hours after my first twinge at home (which as a first-time mother, is extremely quick. My body was not ready. I was forced to push on my back and tore horrifically. I suffered postpartum haemorrhage.”

A Kerry woman, induced at 39 weeks with her first baby, who had a “very fast labour with very strong contractions due to the drip” and who was “urged to push my baby out very quickly”, tore high up in her vagina. The midwife requested the obstetrician repair the tear – it had gone through to her rectum.

This happened in 1993. She describes for years afterwards suffering recurring thrush that didn’t respond to treatment, as well as vaginal infection and cystitis. That she wanted to share her experience, almost 30 years on, shows how birth trauma can linger.

Suffering ignored by medics

Another aspect of this woman’s experience – which echoes through many of the accounts – is medics’ unwillingness to take on board the very real trauma endured. “I eventually persuaded [my] reluctant GP to refer me to a gynaecologist. The GP [thought] I was much too young for surgery [for prolapse] and should wait until my late 40s and menopausal. I insisted on referral – at that stage, I couldn’t go for a walk with my children or dog, without having a toilet nearby.”

When we asked what follow-up treatment women got, many said ‘none’ or ‘absolutely nothing’. In some cases, women’s descriptions to medics of their suffering seem to have been ignored. The woman with the broken coccyx says her “public health nurse left me sitting on a hard bench seat for nearly an hour.”

The Meath woman, who needed perineal reconstructive surgery after being left with a bulge in her cervix that prevented sex with her husband, confided her difficulty to her GP. “Her answer was ‘oh, tell your husband to get a blow-up doll’.”

While some births need serious medical intervention, it seems mums weren’t aware this might happen. A Limerick mother says: “Even with the epidural, I felt the rectal exam immediately after birth. I was never informed this could happen.”

The first-time mum with the prolapsed uterus (“a big bulge in between my legs) assumed “it was all part of the healing”. Another woman commented: “I had no clue there was a real possibility of life-changing injuries due to induction... Most of this I learned afterwards from Google.”

When asked what aided recovery, women mentioned medical procedures that alleviated some physical trauma – “JJ stents inserted to heal my ureter”; “private surgery for bladder repair”.

For the mental/emotional fallout, women cited “support of family and friends”, “my ever so patient husband”, “medical professionals who listened”.

Talking openly was a big healer, particularly with women who’d endured similar trauma: “Speaking to my sister-in-law who had her baby nine weeks after me – a few years later, we opened up to each other about the trauma of birth. We both cried so hard. It was the first time I didn’t feel so alone.”

But other women said: “I haven’t recovered – I’m not sure I will”, and “I just had to get on with it”.

For some, the trauma had profound consequences for their plans for future children. “No more children. One and done,” stated one woman. Another wrote poignantly: “I loved my little man so much. All my energy and effort went into being the best mama I could be. I never did have a second child as a result of how long it took me to recover from, what I’d been brought up to believe was a beautiful experience. I adore my son with every fibre, I’m grateful he came out perfect, but would I go through it all again? No.”

Postnatal care should be free

Deirdre Daly, assistant professor in midwifery at TCD School of Nursing and Midwifery, has read the women’s accounts. “I am deeply saddened. To read one alone is shocking; when you read so many together, it’s difficult to absorb.”

Referring to one woman’s inability to drive past the maternity hospital for more than 10 years post-birth, Daly says she finds this level of trauma is shocking.

“Another said she sought clarification from the hospital and was told she was ‘clinically well-managed and should be grateful’, that they had a ‘hard time believing’ her. Even reading that I felt how re-traumatising it must have been for her.”

Daly leads the MAMMI (Maternal Health and Maternal Morbidity in Ireland) study, which examines prevalence and risk factors for a range of health issues in more than 3,000 first-time mothers in Ireland. She questions why women who’ve suffered birth trauma are referred to private practitioners. “So if they don’t have the money to pay for that, they’re not going to get help? No woman should have any degree of trauma or suffering as a legacy of becoming a mother. And if they do, the help and care for that should be free.”

There’s a sense, says Daly, that these women have been abandoned. “They certainly feel abandoned.”

Is she surprised by the women’s experience? “Sadly, no – not after doing the MAMMI study.”

MAMMI revealed – among other consequences of birth trauma – that 51% of women had urinary incontinence three months after their first child’s birth, while just over 41% continued to suffer a year postpartum.

“What bothers me is the level, depth and persistence of a lot of this trauma for the women who responded to the Irish Examiner article,” says Daly.

One of these respondents described being “at peak fitness” when she got pregnant with her first child. She’d attended prenatal classes, yet felt “totally unprepared for the brutalism of birth”. Recalling how labour was slow, she says: “I hardly slept in the 30 hours it took to finally deliver my baby.

“The obstetrician was patient, encouraging but needed to do an internal intervention halfway through. I was shocked by the pain – and frightened. Was the slow delivery damaging the baby? I needed an episiotomy. Breathing techniques I’d practised during the preceding weeks were forgotten.”

Afterwards, she felt angry: “Why didn’t anyone tell me giving birth could be so bloody, drawn-out, and painful?”

Women suffering alone

Daly says there’s a sensitive way to convey difficult realities and agrees there’s a culture of silence around what can go wrong during birth. “There’s no publicly available data about women’s health postpartum. Many respondents said they weren’t told about these health issues. One said she wasn’t asked about her incontinence or painful sex. Therefore women think it’s only them – that they alone are suffering this – and they don’t talk about it.”

At the very least, she says, women should be given information about what is and isn’t normal after birth, and about when and where to go for help. “Post-natal care is structured in such a way that it’s all about the baby and not about the mother. That needs to change. The service needs to be woman-focused and woman-centred.”

Daly sees the National Maternity Strategy 2016-2026 signalling great hope for women, once it’s fully funded. “There are pockets of exemplary care and change happening – continuity of care that’s completely centred on the woman and is easy for her to access. Many hospitals have expanded services – for example, postpartum visits are being delivered to women by competent midwives.”

A maternity service needs to give women time, she says. “What matters to women is a service that listens to them – listens to understand them, not to defend a particular hospital. Women want a service that’s about them, that enables them to become empowered.”

The MAMMI study has developed a suite of resources pertaining to women’s health after motherhood, including a four-week course on how to address common physical and mental health challenges after birth.

• exa.mn/futurelearn-health-after-motherhood
• aimsireland.ie