POTENTIAL BIRTH INJURIES TO MUM

January 15, 2020 /

Written by Caroline Meyer

Birth can be quite a scary process especially for first time mums. Some injuries can occur during the birth process that are natural and usually unavoidable although there are some that happen which can be avoided. Injuries in childbirth can be traumatic and can have a long term physical and psychological impact. During delivery of larger babies vacuums and forceps may be used which can cause trauma to the mum and baby. Being forewarned is being forearmed. Here are a few of the injuries that occur more commonly during childbirth, the risks, complications and treatment of the injuries.  

RISKS OF BIRTH INJURY AND TRAUMA 

  • Difficult delivery or labour  
  • Large babies weighing in over 4kg 
  • Early babies born before 37 weeks 
  • Prolonged labour 
  • Babies lying in abnormal positions (breech, buttocks-first, shoulder dystocia etc.) 
  • First vaginal delivery 
  • Induced labour 
  • Assisted birth (forceps, vacuum etc.) 

COMMON INJURIES TO MOMS 

  • Vaginal or perineal tears during birth 
  • Ruptured uterus 
  • Prolapsed uterus 
  • Post-partum Haemorrhage 
  • Post Natal depression 

Many women suffer tears during a vaginal birth (up to 90%), most of which are perineal tears which affect the skin between the anus and vagina. These are generally small tears which heal quickly. Occasionally the tears can be more serious and can tear into the anal muscles and the vulva. These injuries can take a long time to heal. There may also be long-term effects as a result of these tears. These tears have to be monitored carefully to avoid infection and can be quite painful. If you have a lot of discomfort, it is best to get the tear checked out to make sure you are healing properly. Extreme tears can damage the sphincter and even the muscles and lining of the anus. These types of tears are handled on an individual basis as they are unpredictable and may need various interventions to heal. 

If you have concerns about tears during birth, especially if you are aware that you are carrying a larger than normal baby, you can speak to your medical professional during antenatal visits. You may be advised to try perineal massage to help the skin stretch without tearing during birth. You may also be offered the option of an episiotomy during birth. This is an incision made during the birth to reduce the uncontrolled tearing of the perineum. This cut helps the vagina open wider for baby to pass through with less risk of tearing deeper into the muscles.  The most common episiotomy is a cut from the vagina at an angle to the side of the perineum. A midline episiotomy is another option which is a straight cut from the vagina towards the anus. This is rarely done. An episiotomy is generally down at the request of the mother or if the medical professional needs to help birth a baby which is in distress and other delivery interventions are not helping. Most women prefer an episiotomy to a spontaneous tear as it is more controlled and reduces the risk of a serious tear. It does however take longer to heal than a natural tear. 

Complications of episiotomies include: scarring and pain during intercourse, incontinence (flatulence and stool control), pain when passing urine, pain when sitting or when active, and rectovaginal fistula (tear in the wall between the anus and vagina which can cause faeces to enter the vagina). These may require further interventions and possibly a secondary repair, requiring longer healing periods. 

POST-NATAL DEPRESSION AND POST-TRAUMATIC STRESS DISORDER  

Injuries and traumas during childbirth or just a bad experience during or after the birth itself can have an impact on the mental well-being of new moms. The drop-in hormones after birth can also induce PND. Some of the more common signs include: feeling isolated or a sense of guilt, feeling depressed or a sense of failure, difficulty bonding with baby, avoiding anything birth related, severe fatigue and possible withdrawal. There are many other potential signs and symptoms that will require medical intervention in order to recover from it. It is important to consult your doctor to get treatment if you are feeling this way. 

POST-PARTUM HAEMORRHAGE  

It is normal for there to be some blood loss after having your baby. This bleeding can last for 2 to 6 weeks after the baby is born. It is usually fairly heavy for the first few days after birth and gets lighter until it eventually stops all together. Some women experience abnormal amounts of bleeding. This can be quite dangerous for the new mom. Heavy bleeding for the first 24 hours after birth is known as immediate PPH or primary PPH. Heavy bleeding that continues after the first 24 hours and up to 6 weeks is referred to as delayed or secondary PPH.  Primary PPH happens in around 5% of pregnancies and can result in the loss of around 500mls of blood. It can however be more severe and result in the loss of 2L or more of blood.  Secondary PPH happens in around 2% of births and is usually as a result of an infection after delivery of the baby. PPH can be life threatening and steps are usually taken to reduce the bleeding as quickly as possible. If you experience heavy bleeding, ensure that you get medical attention immediately. 

RUPTURED UTERUS  

A ruptured uterus is when the womb tears during pregnancy. This is more common in women that have undergone previous caesareans and usually occurs at the site of the scar. This needs to be treated immediately as it can be life threatening to mum and baby. The treatment usually involves an urgent caesarean and repair of the uterus where possible. In cases where repair is not possible, a hysterectomy is usually done. The surgery often requires a transfusion and antibiotics for the mum as there is often a lot of blood lost. A ruptured uterus makes future pregnancy risks and all future pregnancies will require a C-section. 

PROLAPSED UTERUS 

Childbirth can result in some of the pelvic organs bulging into the vaginal canal. In up to 50% of vaginal births there may be some prolapse.  This is generally not life threatening but can affect quality of life. Symptoms of prolapse include pain during sex, urinary incontinence, heavy feeling in the perineal or vaginal area. In mild cases of prolapse pelvic exercises, weight loss and treating constipation can assist in improving the situation. A severe prolapse may require surgical repair to the pelvic floor muscles or a hysterectomy (removal of the uterus) preventing further births. 

REDUCING THE RISKS OF BIRTH INJURY 

While it may not be possible to prevent birth injury, you can reduce the risks by being in the best possible health. Do pregnancy safe exercises especially pelvic floor exercises. Avoid constipation as straining during elimination can weaken your pelvic muscles. Discuss a caesarean with your doctor if you are carrying a large baby (although this comes with its own risks). Perineum massage can also help stretch the skin to avoid tears.