It is five and a half years since my daughter was born. Unlike some women who had traumatic first births, I went on to have two more children. From a medical perspective, all three births were considered to be successful vaginal deliveries. I am fortunate that I went on to have the two sons that I birthed with minimal intervention. However I seem unable to put the events of my daughter’s birth behind me. I have continued to seek out other women’s birth stories. I hoped that by absorbing them I would improve the sense of perspective I had on my own first experience.
Like many other expectant mothers I had aspired to the empowerment of natural childbirth. I had learned about the dangers and disappointment that tracked the spiralling cycle of medical intervention. I learned about breathing through the pain. I practiced the various positions I later used to maintain my active involvement in the birth. My husband was a committed and supportive birth partner. I felt ready.
Unfortunately, my first labour was long. Twenty two hours of contractions began in the evening and was followed by a three hour long third stage. I had tried getting into the birthing pool but it only slowed things down. I repeatedly told the midwives that I was worried about being unable to urinate. Nobody seemed to be concerned. I remember the obstetrician coming in to the room after two hours of pushing and warning the midwives that intervention would be required after three. When she returned the whirlwind began.
I was exhausted and failing. I was told that forceps were required. This did not align with my birth plan which requested ventouse over forceps. My mother had suffered pelvic organ prolapse following forceps delivery and I wanted to avoid the same fate. But I was told there were no other options. I could barely speak. They said we had run out of time. I do not remember consenting. There was no mention of the high risk factors associated with obstetric forceps in women of my age (then 32). I still had a full bladder, which I think may have been a risk factor for obstructing the delivery. I had received no pain relief.
I was positioned on my back with my legs in stirrups. I felt the separated halves of the cold metal forceps being inserted. This hurt but was bearable. Then as they were connected the feel of forceful grinding metal inside my pelvis made me freeze with fear. I was told to relax and wait for the next contraction. When it came, I dutifully gave everything I had left to that last push. But I had no idea what was in store. On top of the overwhelming wave of the contraction, I felt the metal inside me being rotated. It tore through me with a level of pain that I cannot describe. A guttural scream came out of me. No one in the room seemed to realise that this was not the proud cry of a natural birthing mother but rather a despairing plea for mercy from unfathomable pain. Months later I found out that the forceps had ripped my pelvic floor muscles away from their attachment to my pelvic bones on both sides of my body. This was termed a bilateral levator avulsion. The forceps also crashed into my tailbone (coccyx) and snapped it off. It is still dangling freely inside my pelvis.
My daughter was delivered. Everyone seemed to disappear to focus on the baby. She was briefly returned to me for my skin to skin moment then whisked away again to review some breathing issues that later turned out to be minor. The doctors returned to me because I was haemorrhaging. The process was completed with me being taken into surgery because the placenta hadn’t delivered. I opted for the general anaesthetic to make it end.
While recovering in hospital for five days, no one assessed the damage done by the forceps. I was told I had been unlucky and had some bad bruising. I was given ice packs and opiate pain relief. There was no mention of the possible complications to my health or recovery that are so common after a forceps delivery. I was lead to believe that I had achieved a relatively successful normal birth and that my body just needed time to recover. It was only when I swapped birth stories within my mother’s group that I realised my recovery was far from normal.
It had taken weeks before I could be upright for more than a few minutes. When my recovery eventually stabilised my body still did not feel right. Specialist ultrasound later revealed that I had sustained permanent damage. Because my pelvic floor muscles were no longer attached, they were unable to hold my pelvic organs in place. I had a three compartment prolapse and rectocele. I had difficulty with bowel movements. I was one of the lucky ones because I had no significant incontinence, but every time I went to the toilet I thought about the moment the forceps were rotated inside me. There was a constant dragging feeling in my pelvis. I could not run or do high impact exercise because it made the dragging feel worse, like it was damaging me further. I felt like I had been crippled. I did extensive pelvic floor exercises and physio but because the muscles were detached, there was almost no perceivable improvement. My experience gave rise to questions that I still have no answers to. Given the significant impact on my quality of life why had no one discussed the risks with me before the procedure? Why were there no checks on the damage after it? Why was I sent home unprepared for the fear and confusion that plagued me as my expectations of a full recovery failed to materialise?
Five and a half years later, I have finally had an operation to improve my pelvic floor. I found access to a leading specialist who uses ultrasound to accurately assess the anatomical issues involved in prolapse. I was advised that the specificities of my condition meant the standard treatment of and anterior and posterior repair would have an 80 to 90% chance of failure within 10 years. I decided to be part of a clinical trial to test a permacol sling (not a mesh) that would support my pelvic floor muscles and hopefully provide a long term improvement. In addition to the sling, I had an anterior repair, a posterior repair and a hysteropexy (raising the uterus with stitches to the sacrospinous ligament). The surgery lasted five and a half hours and is expected to take six weeks to recover from.
I consider myself very fortunate for a number of reasons. My children were all safely delivered and healthy. I found an experienced specialist surgeon able to comprehensively assess my condition and recommend appropriate options. The repair surgery was a success.
However, what lingers is my difficulty in putting this all behind me. I am not usually the type to dwell on events from my past. However, for the last five years I have had periodic flashbacks. I see the gynaecologist’s face. I hear her instructions. I feel powerless and overwhelmed. I feel the grind of metal as the forceps were joined. And I relive the gut wrenching pain as they were rotated. I have woken in tears in the middle of the night. I have driven myself into hysteria because the memories will not leave my head as I try to go to sleep. I have avoided writing this down or even talking about it partly because I wanted to move on and partly because it was so distressing to go over. I thought that focusing on my work, my children, my marriage and my future would distract me for long enough that distance would allow me to get over this. Yet I am finding that my slow recovery from the extensive repair surgery serves as a damning confirmation of the magnitude of the original damage. And I am haunted again. I hope that writing these words will bring me some peace.ABTA, Australasian Birth Trauma Association, bilateral levator avulsion, birth, Birth Trauma, forceps, hysteropexy, pelvic floor, permacol sling