Birth related injuries to mothers can be absolutely devastating, and can have long-term effects. They can affect personal relationships, careers and mental health.
Some childbirth injuries are unavoidable, and they can be a natural part of having a baby. Childbirth injuries can have an impact on the psychological and/or physical well-being of a woman. Injury can occur during any pregnancy, even if the mother has no risk factors and the pregnancy is deemed to be normal. Sadly, some injuries are caused, or made worse, when midwives and doctors make mistakes during a mother’s pregnancy, labour or delivery. Here we look at the types and causes of birth injuries to mothers and their implications.
Common types & causes of birth injuries to mothers:
- Vaginal tears during birth
- Post-natal depression (PND) and Post-natal Traumatic Stress Disorder (PTSD)
- Post-partum Haemorrhage (PPH)
- A ruptured uterus
- A prolapsed uterus
About 9 in 10 women suffer perineal tears when the perineum (the skin between the vagina and anus) stretches as the baby is born. Most perineal tears are quite minor and should heal naturally within a short time after the baby is born. However, more serious tears can also extend to the vulva (external genitals) and muscles in the anus (back passage). These require repair, take longer to heal and may have long-term effects.
Types of tears during childbirth
First degree tears are skin-deep and only affect the outermost layer of skin around the vagina and perineum. You may need a few stitches, but normally they heal quickly. First degree tears have the best chance of quick recovery with minimal pain. Normally, there is no long term damage. Your midwife will decide in consultation with you, whether it is necessary to stitch your first degree tear or not.
Second degree tears are deeper tears, involving the muscles of the vagina and the skin around the anus. Stitches are normally required to help the tear to come together and heal. Dissolvable stitches are usually used, so that the mother doesn’t need to have them removed. Second degree tears can be quite painful and recovery normally takes a few weeks. Your midwife will examine the tear from time to time to ensure that it is healing well. You should report any signs of unusual discomfort or signs of infection to your midwife.
Third and fourth degree perineal tears are the most serious form of tears during childbirth. These types of tears are typically deeper and more serious. Third degree tears damage the anal sphincter (the muscle which controls the anus). Fourth degree tears also involve the lining/muscles of the anus. Third and fourth degree tears are unpredictable. The Royal College of Obstetricians and Gynaecologists (RCOG) lists the following as risk factors:
- the mother’s first vaginal delivery
- the second stage of labour is particularly long
- shoulder dystocia during delivery
- the baby is large (over 8 pounds 13 ounces)
- labour is induced
- an assisted delivery (for example, if forceps or ventouse are used).
If you are concerned about suffering a serious tear during birth, you can talk to your or midwife or doctor about it during your antenatal care. They may be able to recommend measures to help reduce the risk of a serious tear, such as perineal massage. Perineal massage helps the perineum to be more elastic and can help reduce the risk of it tearing as your baby is born. Another option is an episiotomy, a procedure designed to reduce the risk of a serious tear.
What is an episiotomy?
An episiotomy is a surgical incision made by a doctor or midwife during childbirth. It is a deliberate cut designed to expedite delivery and help reduce the risk of uncontrolled tearing of the perineum. This incision makes the opening of the vagina wider, so there’s more room for the baby to pass through.
There are two types of episiotomy you might hear about:
midline episiotomy - a cut from the vagina directly towards the anus (rarely done)
mediolateral episiotomy - a cut from the vagina, but angled off to one side of the perineum. Mediolateral episiotomies are more common in the UK.
Midwives and doctors should only recommend an episiotomy if there is a medical need, or the mother specifically requests one. It may be the best course of action if your baby is in distress and needs to be born quickly, if they are in a difficult position or if you are having an instrumental delivery using forceps or ventouse.
Some women may prefer an episiotomy over a spontaneous (natural) tear. Spontaneous tears can cause serious, lasting damage to the muscles around the vagina and anus but are said to heal better. Studies show that episiotomies reduce the risk of suffering a serious tear. Your doctor should explain the risks and benefits of an episiotomy to you before performing one.
Failure to identify and repair tears following childbirth
If you suffer a perineal tear, your caregivers should identify the tear at delivery and manage it appropriately. You can also find more information and support regarding perineal tears from the charity MASIC (Mothers with Anal Sphincter Injuries from Childbirth).
Following delivery and for the rest of your postnatal care, your midwife will ask you about the condition of your perineum and where necessary examine the perineum. Care of your perineum forms part of your post-natal midwifery follow up. Serious tears and episiotomies can, unfortunately, cause a great deal of suffering if they are unnoticed and not repaired at the time of delivery or if they’re repaired poorly. For example, they can cause complications such as:
- incontinence – lack of control to pass faeces (stool) and/or wind
- rectovaginal fistula – a serious tear can cause a hole in the wall between your vagina and your anus, which can cause faeces to pass through into the vagina
- pain and soreness – the tear may make it difficult for you to sit for a long time, or be very active
- stinging pain when passing urine
- pain during sexual intercourse.
It may also mean you need another procedure to correct the damage (secondary repair), causing further pain and distress.
If you suffered a third or fourth degree tear, if this was not identified and repaired at the time of delivery, and if you suffer continuing problems as a consequence, please contact our Obstetric Anal Sphincter Injury experts, Janine Collier and Gwyneth Munjoma for compensation advice.
A negative experience before, during or shortly after childbirth (‘birth trauma’) can affect mental health and wellbeing. Negative experiences during childbirth are highly personal, and everyone reacts differently. However there are some common signs and symptoms, for example:
- difficulty bonding with the baby
- a sense of ‘failure’ – that the circumstances surrounding baby’s birth were somehow their fault
- feeling isolated or guilty
- avoiding situations reminiscent of the birth (going to hospital, seeing birth depicted on television).
Many mothers suffer in silence. However, post-natal PTSD and post-natal depression needs the right treatment and support. Get further information about psychological damage after childbirth.
Women experience some blood loss after giving birth. Vaginal bleeding is normal for about 2 to 6 weeks after the baby is born. The bleeding is normally heaviest in the days immediately after delivery, becoming gradually lighter over time.
However, some women experience abnormally heavy bleeding, which can be dangerous. This is called a post-partum haemorrhage (PPH). There are two types of PPH:
- primary or immediate PPH – heavy bleeding within 24 hours of the baby’s birth
- secondary or delayed PPH – heavy bleeding after 24 hours, and up to 6 weeks after the baby’s birth.
Primary PPH happens in about 5 in 100 pregnancies. Normally, about 500ml (1 pint) of blood may be lost. However, in very rare cases, a particularly severe haemorrhage can lead to blood loss of around 2L (4 pints) or more.
Secondary PPH is rarer and affects less than 2 in 100 women. It normally happens if the mother suffers an infection following delivery. A major bleed can be life threatening. Midwives and doctors are trained to recognise situations where a mother is at high risk of suffering a PPH. They should take the necessary steps in order to reduce the chance of a haemorrhage - or prevent it altogether. And, if a haemorrhage does occur it is important to treat it quickly. Doctors and midwives are trained in controlling heavy bleeding.
A ruptured uterus is a serious complication during pregnancy. It happens when the wall of the uterus (womb) tears during pregnancy. It’s more common in women who have previously had a caesarean section, at the site of their caesarean section scar.
It is very important that doctors and midwives diagnose and treat a uterine rupture promptly. A ruptured uterus is considered a medical emergency because it can be life-threatening to both the mother and the baby and cause serious damage to the health of the mother and baby.
First line treatment is urgent caesarean section and uterine repair if possible (hysterectomy if not). Usually, the mother loses a lot of blood and needs a transfusion and antibiotics to reduce the risk of infection. It can take a little time to recover from losing so much blood and the surgery itself. Women who have more children in the future will need a caesarean section. Read more in our article on uterine rupture.
Childbirth can also cause pelvic organ prolapse. This is where one of more of the pelvic organs bulges into the vagina. It’s quite common, and the NHS states that up to half of mothers are affected by some level of prolapse.
Pelvic organ prolapse is more likely in cases where labour was particularly long or difficult, or the baby was particularly large.
A prolapse of the uterus (womb) happens when the uterus slips out of its normal position and down into the vaginal canal. Most of the time, a prolapsed uterus or other pelvic organ isn’t life-threatening. However, it can affect the mother’s quality of life and general wellbeing significantly. Possible symptoms include:
- urinary incontinence
- pain during sex
- a feeling of heaviness in the vagina and/or perineal area.
Many cases of a pelvic organ prolapse can be managed through pelvic floor exercises, treating any constipation and weight loss (if appropriate). However, if you suffer a serious prolapse it might require more invasive treatment such as a hysterectomy (removal of the womb, which means the woman cannot have any more children) or surgical repair of the pelvic floor muscles.
Medical negligence claims for maternal birth injuries
If you believe that you may have suffered a birth injury, or think that your labour and delivery may have been mismanaged or a mistake made during your care caused the problem, you might have a medical negligence claim.
Doctor or midwife negligence can cause birth injuries which affect mothers and their families for the rest of their lives. The effects of childbirth injuries are very personal and individual, but possible consequences include:
- physical symptoms which affect your quality of life, such as incontinence
- mental health problems, such as postnatal post-traumatic stress disorder or depression
- relationship breakdown
- problems bonding with your new baby
- being unable to return to work because of your symptoms
If you suffered a birth injury, are worried about the care you received, and think it might have caused a problem you may be eligible for birth injury compensation. Our maternal birth injury claims solicitors understand what you’re going through, and we can help you get answers about your care.
Find out more about childbirth injuries claims.
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