Amy Dawes is the founder of The Australasian Birth Trauma Association. After experiencing a traumatic forceps delivery with her first child she has become a passionate campaigner for informed consent in childbirth. Here is her story:
For me, as I approach the 8th year since I experienced significant physical trauma from the forceps delivery of my first child, I am not only saddened but shocked that women are still considered ‘collateral’ when it comes to the birth experience.
My life has been completely altered, I live with prolapse and faecal incontinence, my children have witnessed their mother unable to make it to the toilet too many times. My relationship is slowly eroding due to lack of physical intimacy.
My mental health has suffered to such an extent that I have wondered if my kids would be better off without me. They are young now, but every day I carry the burden of wondering whether my mental health has impacted their emotional wellbeing.
Financially, the cost of bringing new life into the world has been staggering, hundreds and thousands of dollars spent on specialist care, colorectal surgeons, women’s health physiotherapy, couples counselling, psychologist/psychiatrist appointments, specialist exercise physiology, expensive underwear for incontinence, numerous devices to try and manage my symptoms and ultimately a lifetime of treatment.
A normal vaginal birth can lead to a lifetime of serious, embarrassing and life altering problems. Incontinence, among other issues, is an entirely natural consequence of an entirely natural vaginal birth. A normal vaginal birth 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.
All over the world we hear about the shocking rates of caesarean section, in both developed and developing countries. Many birth workers quote the WHO’s suggested rate of caesarean sections. Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15%. Yet, there is no empirical evidence for this optimum percentage.
Despite this, increased caesarean rates are considered poor outcomes by many in the birthing community. So poor in fact, that many hospitals have targets set in place to reduce these rates. But at what cost? Where does that place a women who is planning her birth? Is she a statistic? Do we keep her uninformed so that we can make a decision based on what we think is best?
Many of the interventions used in childbirth pose a significant risk to the health of mother and the baby. It is crucial to recognise that if a mother during labour consents to a procedure or an intervention, that she fully understands the risks associated with it. Given the pain levels involved in labour (and the need at times to act quickly) it should be considered crucial to have these discussions about the risks associated with the different procedures and interventions, long before she is in the delivery suite.
It’s so sad that we don’t treat women like adults and give them autonomy over their bodies. I believe that many well-meaning health professionals don’t want to ‘scare’ women – how about they start giving us a choice?
The focus of maternity policy should be on facilitating positive physical AND psychological birth outcomes for all mothers and babies, regardless of delivery method, and a good starting point is listening to what each pregnant woman wants and values in her birth plan.
If it’s a vaginal birth, then provide her with the best support and health professionals to optimise her chances of achieving this, advise her on how to prepare for labour, and be honest with her about the likelihood of risk (for example, is she 35+, is she overweight or obese? Is her baby large?).
It’s important to recognise that one woman’s satisfaction might be improved by helping her avoid an unwanted caesarean, whereas another woman’s experience might be improved by planning one from the outset.
A supportive decision-making approach, rather than a prescriptive and authoritarian one, is more beneficial for all birthing families and there should not be a ‘one-size-fits-all’ approach to birth. We must strive for informed choice because ultimately, knowledge is power.
Women are sent blindly into birth, ignoring staggering statistics and left flailing on the other side, grasping for resources and information in the early days postpartum when we should be focused on our baby and managing our emotional and physical wellbeing.
When we shield people from knowledge that unfavourable outcomes may occur, we are communicating to birthing families that wants and needs of individuals are of less value than what you perceive is to be best. Almost daily we hear stories of women telling their doctors they have issues with their pelvic floor and doctors shrugging them off, dismissing her new reality as normal. Has it become so normal for you to see this damage, so normal, that you can’t even begin to imagine what it feels like to live in a broken body?
When we fail to mention the common outcomes of a physiological birth, such as tearing or pelvic organ prolapse, we aren’t preserving the magic of pregnancy and birth; we’re preserving the status quo of failing to treat those that are bringing new life into the world as whole people.
When we neglect to inform, in turn we neglect to support. Whilst we cannot ever prevent all birth trauma occurring, we can, however, prevent more women and families from saying, I wish someone had told me.