Making birth-related decisions is hard at the best of times. After birth trauma, these decisions become more difficult.
A few things to consider:
Sometimes, women describe their birth experience as satisfactory, but once they are out of the haze of early motherhood, women may realise that something is wrong. It might be the sensation of vaginal heaviness, the awareness that something is sitting lower vaginally, a feeling of vaginal laxity, or inability to engage the pelvic floor normally.
Sometimes, women can experience urinary incontinence (the involuntary leakage of urine), or pain with intercourse. This is usually the time that women will seek support from their GP, pelvic floor physiotherapist or sometimes, gynaecologist. Before you contemplate future delivery methods, a good first step is to fully understand the nature of your birth injury.
Your pelvic floor physiotherapist, gynaecologist and obstetrician should also be able to direct you to information specific to you, so that you can make informed decisions. Luckily, we have some evidence that the first birth results in the greatest stress on the pelvic floor and surrounding structures, which means that a second vaginal birth doesn’t necessarily put you at greater risk of problems into the future; a birth injury does not mean that you can’t have another vaginal birth. You can read the abstract of this paper here, or alternatively, you can speak with your doctor or physiotherapist about this research.
The most important thing is that you get information that is specific to you. No matter what your choice is regarding future birth pathways, that’s ok. The health professionals taking care of you want you to have an opportunity to make informed decisions. It’s your body, and your choice.
2) Did you have a difficult and/or traumatic birth experience, but as far as you know, have not sustained a physical birth injury?
Some women describe their birth as difficult or traumatic, but things ‘down there’ feel normal. That’s OK as well.
Psychological trauma is not better or worse than physical trauma; it’s different, and it brings it’s own challenges. If you are experiencing intrusive thoughts, nightmares and/or flashbacks relating to your birth experience, it’s really important to get professional support. Psychologists are well trained to provide both assessment and intervention for birth-related trauma. Once you understand the nature of your condition, and have received some support, you will be in a better position to make a decision about subsequent birth pathways.
Again, a traumatic birth experience does not mean that you can’t have another vaginal birth, although it might mean that you don’t want to, and that’s ok as well. These decisions are really tricky and it’s really important that you make the most of the professional support that is available to you.
3) Did you have a difficult and/or traumatic birth experience, AND, sustain a physical birth injury like levator avulsion or pelvic organ prolapse?
If you have experienced both psychological trauma and physical trauma, it’s really important that you seek the support of your whole team of professionals, including your doctors, pelvic floor physiotherapist, and psychologist. Once you have received customised information, then you can make an informed decision. Everyone in your therapy team wants you to make a decision that is both well-informed and consistent with your own preferences and goals.
But I really want an elective caesarean section… I don’t want to have a vaginal birth. That’s OK as well. But before you make that decision, let’s be certain that it’s a well informed decision. Perhaps some of the factors that resulted in a traumatic delivery won’t be present in your next delivery? Perhaps you will have a really good birth experience the second time around? These are not statements designed to influence you or to manipulate you. It’s more about taking the time to understand your motivations, preferences and also contemplate the various risks of both birth pathways.
One of the reasons why birth-related decisions can be difficult is that all birth pathways carry risks. Your team of health professionals are there to provide you with balanced information. We are working on a visual aid that nicely summaries the risks of vaginal birth and the risks of cesarean delivery, but in the meantime, your team of health professionals is the first port of call.
About the Author:
Sally Ely is a masters-educated physiotherapist with extensive training and experience in the management of pelvic floor dysfunction and chronic pain. Sally has a graduate certificate in Health Policy and is a PhD candidate at the University of Sydney. Owing to her strong interest in birth trauma and informed decision making, Sally decided to undertake research which explores themes such as risk communication, antenatal education and informed consent in vaginal birth.