When considering natural birth your choice of position may influence damage to your pelvic floor region. I have come across some articles suggesting this kneeling squat. Like in the picture attached below and above.
With my birth I was squatting in an upright position with my back supported against my husband (a hypnobirthing birth position). Some articles suggested that this isn't such a great position as too much pressure is put on your pelvic floor muscles although the pelvis is widened in this position.
As time goes by and I speak to other women about my pelvic organ prolapse and I am astounded to keep finding more and more women who had the same thing happened to them....even my own mother in law! I am still speechless that people will not talk easily about this and that so few people are aware that a women's organs can fall out of her body. Every single person I have spoken to who has POP all had vaginal deliveries although I am aware of it also happening with ladies having c-sections (I have not come across any).
I so desperately wish I had the information that I have now about the true statistics of the risk of serious pelvic floor damage when having a natural birth and especially a VBAC and the likely hood of it happening (between 25 - 33% estimated). Studies show that the risk of POP with a VBAC is even significantly higher. I wish I wasn't so easily persuaded by beautiful pictures of the "moment of birth" with a vaginal delivery and reading beautiful birth stories that reads like a "love story". Ever since I have spoken to more medical professionals who work with pelvic floor damage confirm that natural birth does indeed carry a risk of serious damage which has life altering effects and many female doctors told me that they themselves would never choose a natural birth because they have seen the devastation a natural birth gone wrong (and the percentage of women who falls into this group) causes.
I am all for choice. If women can make an informed choice about their birth option the risk of post-partum emotional trauma is less. If I only knew what my chances were of developing POP was this high I would have seriously considered the VBAC I had. And if I stubbornly went ahead with the VBAC, at least I was informed of the risk that I was taking.
My reason for posting this is not to frighten "new moms to be" but to make them aware of some of risks that accompany vaginal births because information about POP is not easily available and won't be openly shared especially among extremely pro-natural caregivers.
Here is an article describing so much of what I have been through and still battling with daily:
It ruins sex-lives and destroys marriages, stops women from engaging in physical activities and even prevents some types of paid work. Although common, many women are so embarrassed by it that even their partners and closest friends are unaware of the problem.
It's the injury that can result from a vaginal birth.
New research presented last week at the International Continence Society in Montreal about the psychological consequences of traumatic vaginal birth suggests that between 20 and 30 per cent of first-time mothers having a vaginal birth will suffer severe and often permanent damage to their pelvic floor and anal sphincter muscles. There can also be major psychological consequences of traumatic vaginal birth.
Conditions range from life-long urinary and faecal incontinence, painful sex, genital prolapse, body image problems and emotional trauma.
One of the authors of the research, Professor of Obstetrics & Gynaecology, at the University of Sydney's Medical School Hans Peter Dietz says that damage from vaginal birth is much more widespread than generally assumed.
"Only about 25 per cent of women get a non-traumatic normal vaginal delivery that did not do serious damage to their pelvic floor or their anal sphincter', says Professor Dietz. 'And this is on first time mothers. If we did this kind of analysis on women who try for a VBAC (vaginal birth after Caesarean) it would probably be as few as 10 to 15 per cent."
First time mother and registered nurse Anne sustained such severe damage from her vaginal birth that five years later she suffers frequent passing of urine, prolapses and a dragging feeling in her pelvis.
"I can no longer run long distances and I'm unable to participate in races like the City to Surf, which I did pre-baby. I continue to struggle interpersonally. I'm now single and the thought of having to tell a prospective partner of my condition is difficult," she says.
Midwife and co-author of the new research into psychological consequences of traumatic vaginal birth Elizabeth Skinner spent two years gathering and analysing the experiences of women who have suffered traumatic vaginal births.
"Women who have sustained vaginal birth trauma often have avulsion of the levator ani muscle. This is a disconnection of that muscle from the pelvic bone resulting in prolapsed organs. Women just put up with this "hidden injury" as they are too embarrassed to discuss symptoms with clinicians who frequently do not believe them," Skinner says.
Skinner identified symptoms of post partum post-traumatic stress disorder in 67.5 per cent of her interviewees. This included poor baby bonding, flashbacks during sex, dissociation, avoidance, and anxiety.
Skinner says that the lack of information given to women about the risk of vaginal births, and the pressure they face to reject medical intervention, is a feminist issue.
"Previously feminists fought to return control to women giving birth. This is still true but the new 21st Century feminist issue is ensuring that women are correctly assessed for their risk of complications and given full and frank information to prevent such injuries," says Skinner.
"Would women proceed with a vaginal delivery if they were appropriately counselled about the risk of urinary and faecal incontinence and/or compromised sex lives? Idealised images of the birth process without accurate education and consent can cause poor long-term clinical and mental outcomes."
But this is not just a matter of medical staff being more forthcoming about the risks of vaginal births. It's also about a lack of choice and women not having autonomy over their bodies.
In many public hospitals women are not given the option of a caesarean delivery. NSW Health, for example, has targets to reduce the number of caesarean births.
A spokesperson from the Royal Women's Hospital in Melbourne says that they do not perform caesarean births unless there is a medical reason.
The policy to reduce caesarean births has lead to an increase in the use of forceps during vaginal deliveries and a tolerance for longer periods of pushing during the second stage of labour, both of which increase the risks to the mother and baby.
"The forceps rate has doubled in NSW over the last 10 years. At some hospitals quadrupled," says the University of Sydney's Professor Dietz. 'That means much, much more damage is done than ten years ago — in some instances twice as much. This is largely a result of the attempt to reduce the caesarean births rate."
Elizabeth Skinner and Professor Dietz are not against vaginal births; in some cases a vaginal birth is the best option. They also note that a caesarean section is major abdominal surgery and carries its own risks.
However women who have big babies, are short in stature, have Asian heritage, and have a family history of difficult births should be informed of their greater risk of trauma if they have a vaginal birth. And all women should be given the choice to make an informed decision for themselves.
"We need to build bridges between midwives and doctors so we can all work together better for the best interests of the patient,' says Skinner. 'At present we have a very short-term view. We make sure the baby is alive and then we leave, with little consideration for the long-term physical and emotional wellbeing of the mother."
Thank you so much for sharing your birth and post partum experiences with regards to healing. I think it is really important that we share those details too as it helps to prepare a mom mentally for what lies ahead (the good and the bad).
Marijke, I agree that talking about POP can create a lot of fear. I guess it is very similar to any other serious medical condition that can happen in life. We can choose to educate people about good health practices and how to prevent certain conditions like cancer by recommending to use sunscreen for example and to look out for warning signs of cancer. In the same way I think we need to educate women more about the importance of taking care of their pelvic floors as statistics indicate that around 50% of all women will have to face POP someday, yet very few women even know about this.
My wish is that pregnant ladies or new moms who read this will not go into a flat panic but empower themselves by knowing the risk factors and should they have risk factors to use the information to make an informed decision about their birth choice. If I had known about so many important ways to prevent this my life could have been different today, but there is very little information about this around as it is seen as a taboo subject. My wish is that moms who has already given birth and notice a change in continence or bowel/bladder movements, cervix position will empower themselves and get evaluated and perhaps get a physio referral if needed.
When I was pregnant with my first child and had to make a decision about which birthing method I wanted to use, a very good friend of ours told me a story of a very close family member who suffered prolapse (He didn't use the word prolapse but I know now what he described is exactly POP) and that they will be choosing a c-section after they have seen the devastation and permanent damage that was caused by their family member's natural births. Somehow I just brushed these comments aside and argued with him that I don't believe what he was saying and if it is true this must have been a total freak accident. If POP was a total freak accident I wouldn't have posted here about it. As far as I know there is no serious long lasting complication of around 25 - 30% chance with a c-section? There are pretty serious complications with a c-section but the odds of those happening are pretty small (that results in permanent lasting damage at least). This is just my train of thought and wouldn't want to impose it on anyone else.
Anyway I am not saying that one birthing method is better than the other. For me the bottom line is that women can make an informed decision to what feels right for them. Some people are so terrified of a c-section that they are totally okay with taking the risks of what a normal delivery may bring.
This article by Dr. Amy Tuteur (who chose to deliver her own 4 children with vaginal births, all breastfed) I feel highlights an important fact about natural childbirth that I feel is not openly talked about:
Jana, I think it is really great that you are willing to share all the details about your pregnancies and recovery. I think it is wonderful that Moomie is such a place where we can read about each others real life stories. Your advice that your body has run a marathon is so true and that the rest is crucial!
PS: I can also add a hemorrhoid to the list just like you ladies.
Thank you for your well wishes Marijke and Jana. xx
Ps. I have to add. I am selfish after birth. I do a lot of lying in bed. Sleeping when baby sleeps. Eating what i feel my body needs - lots of protein and healthy fats and liquids. I don't go out of the house at all for at least two weeks and I also don't allow visitors. Your body has run a marathon and need to recuperate. That is really important.
I saw in earlier posts you said no one seems to be talking about the post labour body and what labour does to your body. F
I can just relate my own three births quickly and tell you about the post-partum healing: *not for sensitive readers. Haha!
State of body and weight, age:
Fell pregnant at 25, 48 kg, very small frame. Gave birth weighing 73 kg. (I put this in so you can see the weight that was added to my joints and body).
Exercise and state of mind:
I jogged until 8 weeks, then did absolutely nothing further. Ate what I wanted and did some kegels before birth. Believed there was nothing to birth, everyone does it, did not consider a c-section for one second, even though lots of people told me I was insane. Changed drs at 36 weeks pregnant, because I thought my gynae would force a c-section.
Birth and recovery:
3.4 kg baby @ 38 weeks pregnant. Normal delivery, vacuum assist, in labour for 10 hours, lying on back when giving birth, no epidural. Had to be cut. Seconds after giving birth, I was fine! Went home the next morning. Got a lot of stitches but in all honesty NEVER had any problems with it. No soreness, nothing. Breastfed easily and was in love with my baby.
Sex and vag life afterwards:
Had sex for first time about three months after birth, was super scared and got some or other vaginal trauma. My vag would "tense" and tighten when having sex, making it super uncomfortable and sore. It came right by itself after a few months. Never had any leakage problems and after pregnancy, no constipation, nothing.
State of body, weight, age:
Fell pregnant at 27, 56kg, still small frame. Gave birth at 75 kg.
Exercise and state of mind:
I was jogging when I fell pregnant. Did a 10km after giving birth to my first. I started swimming at 6 months pregnant – 20 lenghts a day – until the day I gave birth. Did lots of stretch exercises. Was determined to give birth naturally again, did hypnobirth and practiced a lot. Did a lot of birth preparation, even did a meditation course.
Birth and recovery:
3.2 kg @ 37 weeks (Sion had a two complete knots in his cord). Was in labour the whole night but not really hectic. From 6am I was in active labour, gave birth at 9am. No intervention, apart from being cut. Most beautiful birth to date. Still on back. Afterwards hectic “after birth contractions”. Had a heomorroid, very very sore. No leakage or anything vag-like. Stitches were not sore, went away by themselves. I was very emotional after Sion’s birth for about two weeks. (Had a lot to do with the horror of hospitals and how they treated my baby after birth).
Sex and vag life afterwards:
Had sex about four months afterwards, it was fine. None of the issues after Nienke. Just had sex very little, there was no time with two small kids.
3. State of body, weight, age:
Fell pregnant at 30, weight 57kg, weight at birth approximately 85 kg.
Exercise and state of mind:
Jogged when I fell pregnant up until 12 weeks, then walked with Sion in the pram every day until about 30 weeks. Did lots of stretching again. Bit of swimming but was very lazy in the end. Was determinded not to give birth in a hospital ever again. Found a midwife in Bloemfontein and drove 1.5 hours to see her. Did a LOT of birth preparation. Lots of meditation, unborn child work. Visualization etc. Squatted on the toilet my entire pregnancy, mostly in preparation of birth and constipation. Haha!
Birth and recovery:
Home birth at my midwife’s house at 40 weeks, Neva weighed 3.8. Squat position when she came out. Birth started in the evening, stopped during the night, at 9am I got a stretch and sweep, 3pm I went to midwife’s home, Neva was born under water at 5pm. I tore and had to have stitches. Had hectic after birth contractions when Neva breastfed. Heamorroids, very very sore. (Panamor suppository!) Again no leakage or any other problems. Very emotional again for two weeks.
Sex and vag life afterwards:
Had sex I cannot remember when after. Think two to three months? Got easier with the more kids I had. Wasn’t uncomfortable at all. Vag was fine and I inspected a lot since my friend had a prolapse.
Vag condition now and sex life now:
My vag is in great condition. Looks completely normal from the front but if you look and inspect inside its way more lumpy and not smooth at all. My sex life is AMAZING, serious the best it has ever been. No problems with self-lubrication, internal, external orgasms, no problems at all. No leakage ever – and I jump on the trampoline! I also jog 6km a day and recently did my first 21km. I can honestly say my body is better than ever, fitter, stronger. My vag is lumpy inside but working great. No constipation (I don’t squat anymore though. Hahah)
Just wanted to share my experience. I truly believe natural child birth is amazing, transforming, spiritual, beautiful and so great for your baby. However, each person’s experience and life outlook differs and that is fine. What is evident is that I did a LOT LOT LOT of preparation, physically and mentally before birth – especially the last two. I believe in listening to your body ALWAYS. There is a lot of strain on your joints and muscles by carrying such a heavy load.
I am really sorry you are going through this Gloei. Hugs.
I suffer from cronic constipation but I don't know when, someone told me never to strain. I thought I was regular when going into labour (second vbac), I had gone the day before, but I was constipated and yes, did a poo during birth (that dreaded thing many stress about!) and got a hemorrhoid to show for it. Day 4 after birth (second vbac, 3rd child) saw me crying like a baby - I thought I tore and had a stitch there but it was a hemorrhoid and I was scared to poop.
But I had never had issues with leaking pee, not before or during pregnancy. I have been told to do kegals before even getting pregnant, because I thought that's just what women had to do, like while standing in line at the store.
I had never heard of pop either.
And 'luckily?' everything has gone back the way it should.
I am so sorry that you have had to go through this. *Hugs*
*edited to add*
I like this article, not all doom and gloom www.todaysparent.com/pregnancy/the-truth-about-pelvic-prolapse/ As I feel, although necessary to talk about, this thread made me afraid and had I read it before having children or before considering a vbac it would have left me crying in the corner (as my first thoughts after reading the whole thread was 'that's it, not having another!')