According to Australian private health insurer Medibank Private, 3 out of 4 women who have given birth in the last 5 years have suffered a birth injury.
The survey of 1025 women found almost half of the women report experiencing perineal tears following birth.
Other consequences of vaginal birth included haemorrhoids (390 women) and urinary incontinence (318 women).
The survey reports fistula (a hole between the vagina and rectum or bladder) occurred in 4% of women, yet a search for current figures on fistula shows it occurs very rarely in Australia and is usually the result of obstructed labour.
The Medical Director of Medibank, Dr Kevin Cheng says the high level of perineal tears is alarming, in light of the impact the injury can have on women’s daily lives.
What is interesting about the Medibank Private survey is what it doesn’t say.
Evidence shows perineal tears of varying degrees occur in around 90% of all women during birth. Around 99% of those tears are minor. Given these statistics, the information from the Medibank Private survey is in line with what would be expected – perineal tears occur in most women during birth and most tears are minor.
Urinary incontinence is one of the more common problems experienced by women, affecting about 30% in the first year after having a baby. However, the birth itself isn’t the only thing which can cause weakness on the pelvic floor, but the weight of the pregnancy to begin with.
In Australia, more severe tears occur in around 1.7% of births, with rates differing slightly between states.
Internationally the rates range between 1 to 10%. The more severe a tear is, the longer it can take to heal, and the more likely it is to cause complications in the long term.
Severe perineal tears can affect the function of pelvic floor muscles following birth. With rest, treatment and time, many women can regain pelvic floor function and improve their symptoms. In certain cases, surgery may be required.
Who’s To Blame For These Birth Injuries?
What the Medibank survey doesn’t address is where the surveyed women gave birth and the type of care provider they had during pregnancy and birth.
Did they survey their own customers who chose private healthcare? Or was it a fair survey of all birth choices, including public, private and homebirthing women? Who knows.
Yet, this lack of information hasn’t stopped obstetrician and former Australian Medical Association president Gino Pecoraro suggesting midwives are somehow responsible for the number of women experiencing birth injuries.
Quoted in The Mercury, Dr Pecoraro says he isn’t surprised by the findings of the Medibank survey and goes on to say, “No midwife can practise obstetrics without an obstetrician. It is a symbiotic relationship that we need and we can work very, very well together.
“But the professional group that knows the most about looking after women who are pregnant and having babies is the obstetrician and there certainly seems to be a move away from that.”
Whether Dr Pescaro believes midwifery care is responsible for the increasing rates of perineal trauma or not, the facts speak for themselves:
- The incidence of perineal trauma varies between studies, but is more likely to occur in hospital settings compared to planned home births.
- Research has consistently shown forceps use to be associated with severe perineal tears.
- It is noted in research from 2006 the incidence of severe perineal tears is increased in areas where episiotomies are performed.
- Research published in 2012 shows rates of obstetric intervention (forceps, vacuum, episiotomy, epidurals) among low-risk women were higher in private hospitals, . These interventions are all indicated in higher incidences of severe perineal tears.
Most women give birth in hospital settings where practices increasing the risk of severe perineal injury are more likely to occur.
What’s The Point Of This Survey?
If we’re to take anything from the Medibank survey, it would be concern at the amount of women who delay seeking support and treatment for their injuries.
The survey shows 20% of women delayed seeking any treatment until their symptoms increased/persisted and just over 20% of women hadn’t sought any treatment five years after gibing birth.
Why are women so reluctant to seek help when they are experiencing pain or disfunction following birth? Many women report feeling embarrassed or are shocked by their injury and reluctant to discuss it with anyone. Others report being told by their doctor it is normal and will get better over time.
Women experiencing even minor issues following childbirth deserve support and care. Today’s culture promotes the idea women should give birth and get back to normal as quickly as possibly, ignoring the urgent need for resting and recuperating after pregnancy and birth.
There is a significant lack of post-natal support for women in the time following the 6 week post birth check up. Women who go on to experience pelvic floor problems long term may not be aware of their options for treatment and support, such as a pelvic floor health specialist.
How Do We Avoid Birth Injury?
The first and most important thing you can do is reframe the idea that perineal injury is automatically a negative and devastating consequence of vaginal birth.
It’s important to be prepared and informed about what increases the risks of perineal injury during birth and get proactive during pregnancy (and earlier!) to reduce your risk of long term pelvic floor dysfunction.
Understanding how your body works during labour and why tearing happens can help you overcome any fears – read here for 9 tips to help avoid tears.
Factors which increase the risk of perineal damage and are more likely to occur as a result of quality of care:
- Birthing on back
- Forced or coached pushing
- Use of epidural
- Forceps or vacuum assisted birth
There are a number of factors which can cause perineal injury during birth that are unrelated to care:
- Prolonged second stage of labour
- Large baby
- Position of baby
- First baby
Women who do experience perineal injury should seek support from a specialist physiotherapist who can assist with healing and regaining pelvic floor function. Beginning from the early days after giving birth, you can improve your post birth healing journey with some gentle physiotherapy.
While we know perineal injury occurs in 90% of vaginal births, the outcomes are in almost all situations positive and avoid long-term complications. The Medibank survey highlights the need for being prepared to reduce the incidence of severe injury and how commonly minor perineal tearing occurs. Most importantly it highlights how important it is for women to be aware of the ways to decrease their risk for perineal injury and to access the right support for ongoing treatment if need be.