Despite the billions upon billions of births over the millennia, experts say many mothers still suffer in obscurity in the 21st century because scant attention has been paid historically to the lasting physical effects from giving birth.
“It’s amazing how little we actually know about what’s normal recovery,” says Dr. Dee Fenner, the Harold A. Furlong professor of women’s health and the director of gynecology at the University of Michigan. “When is it comfortable for women to resume all normal activities, including sexual activity? There’s actually a paucity of data on that.”
Fenner runs the university’s Healthy Healing After Delivery Program, which touts itself as a first-of-its-kind program featuring an interdisciplinary team of health experts who treat post-partum specific ailments — from serious lacerations resulting from childbirth to urinary and fecal incontinence, as well as addressing related issues like painful sexual intercourse.
[See: 10 Ways to Make Your Childbirth Easier.]
Experts say many women don’t know where to turn and quietly endure childbirth injuries for months or even years. A University of Michigan study published last August in the American Journal of Obstetrics & Gynecology found, using MRIs to evaluate women who had higher risk births — such as having larger babies or longer labor — that nearly one-third had fractures in their pubic bones, based on seven weeks’ post-partum scans. Another 41 percent suffered tears to their levator ani muscle, which forms the majority of the pelvic floor and is situated on either side of the pelvis.
Hour-for-hour, women suffer a significantly higher rate of injuries in childbirth than from playing the most dangerous — or injury-plagued — women’s college sports, points out Dr. John DeLancey, a co-author of the research published in AJOG and Norman F. Miller professor of gynecology at the University of Michigan Medical School. “It’s an incredible amount of work that a woman has to do to push a baby’s head out,” DeLancey says, requiring much stretching of muscles and pressure on the surrounding bones.
Where upwards of half of women have a small skin tear, he says that maybe 10 to 15 percent of all women who give birth suffer a more severe tear to the levator ani or a bone fracture. These are typically internal fractures, he says; they can’t be seen with the naked eye and are routinely missed at the standard six-week check-up following a delivery. “It does explain, for the many women who’ve had a hard time delivering, why they have so much pain in that area,” DeLancey says. “We really haven’t had an explanation for them before.”
A physical exam is typically performed during the six-week check-up, and patients are encouraged to discuss lingering symptoms like bleeding. But experts say more complex pain complaints often aren’t fully addressed or understood because of the relatively limited time patients spend with their doctors after giving birth and because the science is still emerging on childbirth injuries. Pelvic floor injuries can precipitate additional problems down the road, too, like pelvic organ prolapse, when an organ like the bladder drops — or prolapses — and presses against the walls of the vagina, which can be uncomfortable, cause incontinence and make sex painful.
But the risk for short- and long-term complications from vaginal delivery doesn’t mean all women should plan to have a C-section as a preventive measure, Fenner says. Though the procedure may be safer for certain higher risk births, it carries its own risks and doesn’t preclude the possibility of long post-partum recovery. Nor, as doctors seek to keep mom and baby safe during delivery, is it possible to prevent all injuries. For example, where forceps may be needed to safely pull a baby out of the birth canal, it can also increase the risk of injury to the woman, like a pelvic bone fracture.
A popular mistaken belief is that once the baby is born, no pregnancy hurdles remain — that “the body will return, relatively quickly, to the status prior to pregnancy,” says Dr. Angela Vinturache, a consultant OB-GYN and co-author of a University of Calgary study published last year in the open access journal PLOS One, which surveyed women about symptoms that persisted a year after having a baby. “We found that 77 percent of women experience back pain, almost 50 percent experience urinary incontinence and 40 percent experience both.”
Vinturache says 70 percent of women who experienced back pain said the pain had an impact on their daily activity, with 10 percent acknowledging a severe impairment. “From the women who experienced urinary incontinence one year after childbirth, almost 20 percent reported moderately to severe impairment in their ability to perform daily tasks,” she says — including caring for a child. “We also found that obesity in pregnancy is an important risk factor for both back pain and urinary incontinence.”
[See: How to Cope With Gestational Diabetes.]
Vinturache notes there’s wide variation in the reported occurrence of these symptoms in previous research, from 18 to 60 percent for urinary incontinence and between 4 percent to nearly 90 percent for back pain, depending on a range of factors including the time since delivery. She found it significant in researching women with low-risk pregnancies that so many still had symptoms one year after giving birth that impaired normal functioning.
As research focuses more attention on childbirth injuries and symptoms, experts say talking about injuries and physical complications from birth should be a priority for doctors, patients and their partners.
“Women should seek information and advice about pregnancy, the birthing process and the recovery period,” Vinturache says, adding that prenatal education, antepartum pelvic floor exercises and weight management are only a few of the preventive measures women could undertake while preparing for childbirth. In addition to staying active while pregnant and doing exercises to strengthen pelvic floor muscles, like Kegels, before delivery, physical therapy may be helpful for some women to address persistent post-partum pelvic pain. But it’s important to work with qualified health professionals, such as doctors and physical therapists at centers specializing in pelvic pain treatment, to assess the appropriate approach and ensure exercises are done properly. (Kegels, for example, are often done incorrectly.)
[See: 10 Things No One Tells You About Breast-feeding.]
Doctors say partners should be patient and flexible in providing support and seek to be more informed about recovery given how it varies for every woman and pregnancy. Though experts say many women are able to resume sexual activity in six weeks, full recovery often takes much longer. “Doctors should also be aware of the high incidence and persistence of such symptoms many months or years after birth, and be prepared to counsel and offer support and interventions to their patients,” Vinturache says.
“Women and their partners should first acknowledge the problem exists and has an impact on their lives,” she continues. “They should be aware that help does exist and [of the] need to ask for it.”
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How Can Women Suffering Silently From Childbirth Injuries Find Healing? originally appeared on usnews.com
