One in four women who experience a severe injury during birth regret having their child. It’s taboo to admit, but with more than 600,000 women giving birth in England and Wales alone each year, we need to talk about this.
A new survey of mothers affected by birth injuries lays bare the physical and psychological impact on women, which can last years into their child’s life.
The overwhelming majority (85%) of mothers who suffered severe injuries say their experience damaged their relationship with their child, with 14% saying this harm was permanent. One in three (34%) said they saw their child as the cause of the injury while, heartbreakingly, three in 10 (31%) thought their child would be better off without them.
The research, from birth injury charity The MASIC Foundation, surveyed 325 women who self-identified as having suffered severe perineal trauma when giving birth. The sample size may be small, but the research adds to growing concern about women’s health outcomes after giving birth in the UK.
While it’s important to acknowledge that millions of women around the world give birth each year without problems, it’s equally important to say this isn’t always the case – and women are increasingly talking about their negative experiences and demanding better care.
HuffPost UK has previously reported on the gaps in NHS postpartum care that widened during the pandemic. In a separate survey of mums, the majority (91%) said they were not given enough advice during pregnancy about postpartum recovery.
We also know that Black women are five times more likely to die during childbirth than white women. A controversial proposal to tackle this – inducing labour at 39 weeks for pregnant black, Asian and minority ethnic women as a matter of course – has been called “racist” by some doctors and midwives.
In the latest research, 78% of women surveyed said they have traumatic memories of birth and 52% said they face embarrassment due to symptoms of their injury.
This rings true for Catherine*, who had a prolonged labour following induction with her son, which then required an episiotomy and ventouse (vacuum delivery).
She had a third-degree tear (defined as a tear that extends into the anal sphincter), but it was initially misdiagnosed as a second-degree tear, meaning she wasn’t offered the correct treatment. Her undiagnosed injury left her in too much pain to sit down or attend mother and baby groups, leaving her “essentially house-bound” for her maternity leave. After a year – and hitting a brick wall with the NHS – she accessed help at a private clinic.
The damage has been permanent, though, and she’s still prone to toilet urgency and accidents. Catherine now carries pads, wipes, Imodium and spare underwear everywhere she goes. She quit a job she loved as she was struggling to manage her condition, and has been diagnosed with PTSD.
“My confidence, my me-ness, the essence of who I am, has been destroyed.”
“My confidence, my me-ness, the essence of who I am, has been destroyed,” says the 44-year-old, from Bristol. “My relationships with my child and my partner have suffered.”
Catherine has struggled to talk to friends about her experience – or even watch programmes when childbirth is mentioned – and has counselling each year in the run-up to her son’s birthday.
“With my son, I love him dearly, he is the best thing in my life, but his birth caused the injury and it is difficult to square the two,” she says.
“Every year I dread his birthday and the reminders of my traumatic experience. It is not fair on him or on me – his birthdays are not a happy occasion, but every year I have to pretend it is.”
While her partner has been understanding, Catherine says “he also carries his own guilt about what happened”. Their physical relationship has also been impacted hugely. “I feel like a shell of my former self at times,” she adds.
Like Catherine, 69% of mothers surveyed said the impact of a birth injury was both physical and emotional. Almost half (45%) said they have had postnatal depression as a result and 29% said it has affected their ability to breastfeed their baby, with 18% stopping earlier than planned.
Elizabeth*, who now has a 10-year-old daughter, describes the period after birth as the “worst time of [her] entire life” and is still impacted by her birth injury a decade later.
Aged 30, she had a fourth-degree tear (a tear that extends further into the lining of the anus). Six days after delivery, she passed faeces vaginally and was in extreme pain. She was then readmitted to hospital and found to have a recto-vaginal fistula, causing an infection in her vagina and bowel.
“I am ashamed to say that at times I wished I had never become a mother and I grieved for the life I had before.”
Although she’s had further treatment, she still experiences rectal incontinence, which has affected her ability to socialise and work. “I often avoid eating out as this stimulates my bowel,” says the now 40-year-old, from Hampshire. “I always need to know where the toilets are.”
Her birth injury meant Elizabeth was forced to give up her beloved hobbies of horse riding and swimming. For a long time, she was in too much pain to even walk her dog. “I am ashamed to say that at times I wished I had never become a mother and I grieved for the life I had before,” she says. “I paid such a high price to have a baby.”
Jen Hall, a MASIC spokesperson, is sadly unsurprised by Catherine and Elizabeth’s stories, after having a “brutal forceps delivery” that left her with physical and psychological damage herself.
“Nobody warns you that having a child can leave you with life-changing injuries and no woman should have to go through this without support and proper medical care,” she says.
Most of these injuries are “entirely preventable”, she adds – the result of something going wrong during birth or a failure to identify risk factors beforehand, according to MASIC. The charity is calling on the government and the NHS to roll out a programme of training for medical professionals.
The Obstetric Anal Sphincter Injury (OASI) care bundle – a package of training which has been praised by the Royal College of Midwives – has been trialled in 16 maternity units across the NHS and is being extended to a further 20, but this still leaves three in four (76%) maternity units yet to be reached.
The charity is calling for it to be rolled out nationwide. They’ve also set out a seven-point plan for better care, calling for:
Improved identification, diagnosis and treatment of birth injuries in the NHS.
An education programme for obstetricians and midwives so that severe injuries are recognised at birth and treated in line with best evidence.
A primary care education programme so that all women are asked at contacts following birth about signs and symptoms of OASI/incontinence, with appropriate referral pathways for those with symptoms in line with the NHS long-term plan.
Information about the risks of OASI given to all women antenatally.
Women’s concerns to be listened to and not dismissed as “normal” postnatal experiences.
Specialised psychological treatment and support for women after OASI injury and an end to the stigma and taboo of talking about these injuries.
Dedicated OASI clinics nationwide.
HuffPost UK contacted NHS England and the Department for Health and Social Care for a response. An NHS spokesperson said: “NHS England set out an action plan in December 2020 requiring every maternity and neonatal service to ensure staff are fully trained in preventing and addressing serious harm such as perineal trauma as a minimum requirement, and announced an additional £26.5m to support this training and ensure staff can be released to do it earlier this year in response to the Ockenden report,
“The NHS is also rolling out Perinatal Pelvic Health Services as part of the Long Term Plan and announced 14 pilot clinics in June with the aim of improving the prevention, identification and treatment of pelvic floor dysfunction, and in addition, maternal mental health services will combine midwifery support, reproductive health and psychological therapy for new mums who are experiencing moderate to severe or complex mental health difficulties.”
Without change, women like Catherine do not feel like they can have a second child. “I feel like I was someone the birth just happened to,” she says. “At the time I was happy to place my faith in the medical professionals dealing with me; I had no reason not to. Whilst birth is normal, natural and inevitable, and women’s bodies are designed to do it, unfortunately as we all know it isn’t always that simple. The people who were meant to help me through it let me down.”
• Surnames have been omitted to offer anonymity to interviewees.
Useful websites and helplines
Mind, open Monday to Friday, 9am-6pm on 0300 123 3393.
Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill).