Birth injuries broadly fall into 2 categories: perineal tears and organ prolapse. However other types of injuries can be sustained following childbirth; for example as a result of infection, a reaction to or issue with the siting of an epidural, or a problem with a caesarean section wound.
Tearing is estimated to affect 90% of people who birth vaginally, according to the RCOG - Royal College of Obstetricians and Gynaecologists. The majority of these are 1st or 2nd degree tears that affect the vaginal mucosa and/or perineal skin, and normally require suturing. A estimated 11% of birthing people suffer from 3rd or 4th degree tears (Dudding et al, 2008), which extend towards the rectum, and in the case of 4th degree tears; into the rectum. This is also known as an Obstetric Anal Sphincter Injury (OASI), and requires surgical repair.
Pelvic organ prolapse (POP) occurs when the supportive pelvic floor network of muscles is damaged, causing organs to protrude into the vagina or anus. This includes the bladder and urethra (the tube carrying urine), uterus, small bowel, rectum and vagina. The most common condition is a cystocele; a prolapse of the bladder into the vagina.
POP is a common condition affecting 40% of women over 50 years in age, and can also be experienced immediately postpartum. It is difficult to determine the incidence of POP in birthing people following delivery, as it can take time for the condition to become apparent and diagnosed. A number of studies have found that there is a link between vaginal delivery and pelvic organ prolapse later in life. In addition, the incidence of POP increases as menopause approaches as there are hormonal changes that affect muscle tone. Unfortunately many people who experience OASI also have problems with POP.
Because birth injuries are of a personal and intimate nature; embarrassment and shame are commonly experienced by people suffering from this type of injury, and this may prevent them from seeking the support they need. A loss of confidence can result, and there can be a lot of anxiety surrounding the challenges of day-to-day living with the injury e.g. fear of accidents and lack of control over the body, and anxiety about the injury worsening over time. It can impact the relationship that the person has both with themselves and with a partner. There can be a mis-trust of the body, and a loss of identity. They may feel resentment about the events that caused the injury.
In terms of physical impacts long-term; tears that are left untreated can cause issues with painful sex or even prevent penetration, and 4th degree tears can result in prolapse. Living with a prolapse can affect urinary, faecal and reproductive function. In some cases people suffering from incontinence may have to give up work and/or may have less freedom to travel away from the home. Bathroom modifications are sometimes required, and living with any degree of spontaneity becomes very difficult.
A practitioner in emotional health and wellbeing can provide a compassionate listening space for a person suffering from a birth injury to be heard. They can use a solution-focused approach to understand how the person is impacted day-to-day, how they would like to feel instead, and what their goals are for the future. The practitioner can then use visualisation and relaxation techniques tailored to the unique needs of each client. These may include a visualisation supporting physical comfort (for example in the perineal area), a visualisation to help with motivation for exercise or diet changes, support for coping with anxiety and low mood, support with regaining intimacy in their relationship, the promotion of healing and advocacy for healthcare access. A typical session will last 60 minutes, and a minimum of 3 sessions is recommended.
The visualisation and relaxation techniques are recorded and shared with the client for continued practice outside of the sessions.
If you feel this all sounds familiar and wonder if you would benefit from the help that I offer, do please send a message to firstname.lastname@example.org to arrange a no-obligation introductory call. At the time of writing (January/February 2022) I am offering 3 FREE sessions of support as part of a case study for my Certificate in Perinatal Emotional Health and Wellbeing with the Traumatic Birth Recovery College in the UK.
Dudding, T. C., Vaizey, C. J., & Kamm, M. A. 2008. Obstetric Anal Sphincter Injury, Incidence, Risk Factors and Management. Annals of Surgery 247: 224-237.