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We need better care to relieve birth trauma



Content warning: This article contains descriptions of childbirth, obstetric violence and references to birth trauma.

Having recently given birth to my third child, I know all about the anxieties that accompany pregnancy and labour. Like any prospective parent, my strongest wish as my due date neared was for the safe delivery of my baby. In Australia, a country with one of the lowest infant mortality rates in the world, it was a wish that, fortunately, would more than likely be fulfilled.

Pregnant woman touching stomach while sitting on bed in hospital (Credit: Cavan Images)But that wasn't my only priority for childbirth — I was concerned about my own health and how my body would recover from a third pregnancy and birth. Unfortunately, maternal outcomes are not as rosy in Australia, which has a high rate of intervention during childbirth. In 2017, caesareans and instrument-assisted deliveries accounted for 35 per cent and 11 per cent of births respectively. More worryingly, one in three women reports experiencing birth trauma.

In our foetal-centric antenatal model, the health and wellbeing of the person giving birth are secondary considerations, stemming in part from a belief that suffering is a defining characteristic of childbirth. But what if a 'safe delivery' meant not just a healthy baby, but a healthy mother too?

At a recent COAG meeting, Federal Health Minister Greg Hunt introduced a national strategy to improve maternity services across Australia. The plan includes a shift to a midwife-led continuity of care model where the same health professionals provide care through pregnancy, labour, birth and the postnatal period. It's a model that a Deakin University study found reduced both the overall C-section rate and the number of episiotomies performed during childbirth.

The drive to reduce the caesarean rate, however, often means the risks of vaginal birth are downplayed. Stefan Hansson, Professor in Obstetrics and Gynaecology at Lund University, wrote at the Conversation that he 'worried' that C-sections were 'marketed' as a safe way to avoid pelvic floor problems:

'Women are well aware of the discomfort and embarrassment associated with urinary incontinence and have an understandable fear of sexual dysfunction. But despite the reported findings that suggest decreased risk with a caesarean delivery, these problems are manageable, treatable and, importantly, not life-threatening.'

But the injuries that some suffer after vaginal deliveries — particularly instrument-assisted deliveries — are so severe they can hardly be described as manageable or treatable. Amy, a woman who shared her story at the Australasian Birth Trauma Association website, recounts how a traumatic forceps delivery left her with a catheter for four months after the birth of her baby, permanent bladder damage and triple pelvic organ prolapse. She also developed pubic symphysis pain, which left her almost unable to walk.


"Not surprisingly, Amy spent more than 12 months seeing a psychologist for PTSD and postnatal anxiety caused by the birth."


While her injuries were not life-threatening, they were extremely debilitating. She describes how the combination of the catheters and pain from an episiotomy meant she didn't leave her house for three months. She has had three surgeries — one for painful hyper-granulation at the episiotomy site and two nerve blocks for pudendal nerve pain — and undergone months of treatment from a women's health physiotherapist. Not surprisingly, she spent more than 12 months seeing a psychologist for PTSD and postnatal anxiety caused by the birth.

Amy's experience, while extreme, highlights many of the weaknesses in the current obstetric model and shows how much harm is possible when maternal health is treated as an afterthought during childbirth. Her labour was induced when she was 11 days overdue, a now routine practice that increases the risk of shoulder dystocia, instrument delivery and perineal trauma. She had never met the midwives and doctors who managed her labour and was excluded from decision-making throughout the process. She describes feeling highly stressed, which can slow active labour. One in two forceps deliveries results in pelvic trauma, yet she was not warned of these risks and did not provide consent for their use.

Other practices that can adversely affect maternal health are unnecessary vaginal exams and CTG (foetal heart rate monitoring) during labour, which can lead to a cascade of intervention resulting in instrument-assisted deliveries or C-sections — exactly what happened during my eldest daughter's birth.

A foetal heart rate monitor strapped to my abdomen was unable to get a good read on the baby's heart rate. There was no sign that she was in distress, but the doctor told me that I was not allowed to take off the monitor until she could sign off on the baby's heart rate. An unwieldy cord meant that I was stuck on the bed, left to endure contractions lying down — the worst position for a person in labour. An epidural, episiotomy and forceps delivery followed.

The continuity of care model aims to reduce these sorts of unnecessary interventions that expose labouring people to the risk of injury. Of course, the health of the baby during childbirth is paramount, but that doesn't mean the person giving birth should put aside their own welfare and sustain unnecessary injuries during the process. To reduce the incidence of trauma and injury suffered by the person giving birth, the health system needs to make maternal outcomes a priority in obstetric care.



Nicola HeathNicola Heath is a freelance journalist who writes about the workplace, social affairs, sustainability, and the arts and entertainment. She tweets at @nicoheath.

Main image credit: Cavan Images

Topic tags: Nicola Heath, childbirth, PTSD, post natal depression



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Existing comments

What modern medicine currently offers is generally speaking the best for both mother and baby and a far cry from the situation as recent as the 1950s in this country when there were few specialist obstetricians and the vast majority of deliveries were done by midwife nurses. In Africa where there has been little specialist obstetrics the terrible rate of damage to the genital tract and lower urinary tract is well known and related to the unavailability of CS and forceps assisted delivery. Medicine's obligation is not to offer "priorities" when it comes to human lives but to offer equal priority to mother and baby and to use whatever means achieves that equity. And this is not misogyny - its science and good medicine! Yes, it takes a few weeks to get over a CS but the baby is fine from the outset without any birth trauma. All in all that is far better in the long run than having a damaged baby and a mother with a damaged genito-urinary tract. Best not to have the amateurs influencing treatment options, just as it is not wise to have the lunatics running the asylum even if they are the ones "having the baby "so to speak.

john frawley | 07 November 2019  

I am a grandmother now but the one thing I would change about my life is having my daughter delivered by c-section and not forceps. It is 38 years since she was born and I am still under the care of a urogyno and a colorectal surgeon for ongoing problems. I have had three major surgeries so far, and still live in daily discomfort. Not life-threatening problems, yes, but there are many things that are hard to live with even if they do not kill you. Severe pelvic floor damage that forceps deliveries can cause is one of them.

radar7 | 05 July 2020  

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