Geeta’s Story
Women’s Stories is a collection of REAL women talking about their journey with MASIC.
There can be many adverse outcomes during childbirth but Obstetric Anal Sphincter Injury is somewhat unique, in that it can affect up to 6% of women after a first delivery, patients at risk can often be clearly identified, and specific best practices can be put in place to potentially avoid injury.
The biggest risk factor for OASI (as we have heard) are first time mothers having a vaginal delivery. There is certainly a lot of information to take in as a first time mother regarding ante-natal care, how to care for your baby, breastfeeding, sleep routines. It can be overwhelming. However a lot of this steep learning curve, and mass of information that is imparted, is actually, in my opinion better placed once the baby has arrived. Had I and the scores of OASI mums I have met, had the benefit of hindsight our main focus would have been on obtaining information regarding having a healthy and safe delivery. Because if that doesn’t happen, nothing else matters. In order to have that healthy and safe delivery, mothers need information. It in parts saddens, frustrates and at times enrages me that pregnant women are still seen as a particular, or sensitive section of the population, that need to be shielded from informed discussions, about a life changing event that will happen to them.
Education is everything. It gives women power, especially first time mothers, to be aware and make pertinent choices. It is always difficult to talk about things in theory, but I would say to anyone who is not convinced, that educating and empowering women antenatally is absolutely essential, to please talk to some of the women who have had OASI injuries. I can guarantee you not one of them would say they would have preferred to have been shielded from learning about the risks of an obstetric anal sphincter injury. In fact, I did just that.
Thanks to Professor Keighley and the ground-breaking charity MASIC, I am connected to many women like myself whose lives have been devastated by an OASI injury. I put this very question to them, would being informed about an OASI injury have scared you? These are some of their responses;
“Informed choice is the key thing here. I had no idea OASI was even a thing, and for that I feel hoodwinked and deprived of vital decision making for my body I would have understood what was happening to my body and why afterwards I had a growth scan that showed my baby was big but was pressured into a vaginal delivery.”
“Had I known the risks I could have made an informed choice and life would be so very different now. The link between instrumental deliveries and continence issues have to be made clear, it’s about women making educated decisions based on facts and statistics when not under pressure”
“An honest and frank discussion of the facts of OASI needs to be had, way before your birth I wanted a home birth and wasn’t aware of OASI risks at all”
Every one of them felt very strongly they should have been informed about the risks of OASI. The information that needs to be given can and should of course be addressed in a sensitive and factual manner. But that is easily done, as it has been done with planned medical and surgical procedures for decades. A simple and frank discussion of what the potential risks are; for first time mothers having a vaginal delivery, for assisted deliveries particularly forceps, for bigger babies and when there is malposition of the baby. And that correctly performed episiotomies and ‘hands on’ deliveries can help reduce OASI.
My own case ticked nearly every box. I was a first-time mum having a vaginal delivery. Due to a prolonged difficult labour there was an assisted delivery, ventouse was applied several times and failed, which then progressed to forceps. My daughter was also malpositioned. Following a very traumatic delivery she sustained facial injuries and I suffered a 3 C tear which was then poorly repaired. I experienced my first episode of facecal incontinence the very next day.
From that day onwards I continue to be incontinent of faceces and flatus, to have marked faecal urgency and passive faeccal incontinence. Neither I, my GP or the team I was initially referred to had any idea of the gravity, permanent nature and significance of my injuries. The physical and psychological consequences over the last 11 years has been devastating. I have lost my career I worked so hard to achieve, my dignity, everything that defined me as me. Had I been made aware of the risks of OASI during my ante-natal hospital and NCT classes I would have been alert to the fact that when an assisted delivery was indicated or ventouse failed I was at increased risk of injury, I could have discussed options that may have prevented my permanent and debilitating injuries.
The question I was asked to address is how much do we inform beforehand without scaring. Pregnant women do not need to be protected. They need to be given a clear set of facts; that there is a potential risk of an OASI in specific circumstances. What myself and so many women who have had OASI have been through has been far more scary then imaginable. Being educated and informed of risks is absolutely essential. What is scary, is that some people, still, in this day think it isn’t.
