The truth about childbirth injuries


Cosmopolitan Magazine recently published an amazing piece on childbirth injuries, Millions of Women Are Injured During Childbirth. Why aren’t doctors diagnosing them?

Why do childbirth injuries occur?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Childbirth injuries are common, lead to life long disability and distress and are a subject of deep embarrassment for many women.[/pullquote]

The single greatest cause is a mismatch between the size of the baby and the size of the passage it must negotiate during birth. There are two different points at which the mismatch can cause problems. The first is during passage of the head through the maternal bony pelvis. The second point is when the head exists the vaginal opening.

Most people imagine that the pelvis is like a hoop that the baby’s head must pass through, and indeed doctors often talk about it that way. However, the reality is far more complicated. The pelvis is a bony passage with an inlet and an outlet having different dimensions and a multiple bony protuberances jutting out at various places and at multiple angles. The baby’s head does not pass through like a ball going through a hoop. The baby’s head must negotiate the bony tube that is the pelvis, twisting this way and that to make it through.


You can see what I mean in the illustration above (from Shoulder Dystocia There are bony protuberances that jut into the pelvis from either side (the ischial spines) and the bottom of the sacrum and the coccyx, located in the back of the pelvis, jut forward. How does the baby negotiate these obstacles? During labor, the dimension of the baby’s head occupies the largest dimension of the mother’s pelvis. But because of the multiple obstacles, the largest part of the mother’s pelvis is different from top to middle to bottom. Therefore, the baby is forced to twist and turn its head in order to fit.

What happens when the baby’s head doesn’t fit? The bones of the mother’s pelvis may break or split to accommodate the baby. That’s why a woman might end up with a fractured coccyx or a separated public symphysis, both extremely painful.

If the bones don’t break or split (and sometimes even if they do), the tissues of the vagina can be squeezed so hard between the baby’s head and the mother’s pelvis that the blood flow to the area is actually stopped. If that goes on for more than a few minutes, the tissue of the mother’s vagina will begin to die resulting in a hole (fistula) in the vagina. If the hole is toward the front of the vagina it will open into the bladder and if it is toward the back it will open into the rectum; there can be holes in the front and the back simultaneously.

In either case, waste products leak into the vagina and dribble out of it rendering the woman incontinent and reeking of urine and/or stool for the rest of her life. Fortunately, easy access to C-sections means that it is rare for women to push for multiple hours with no progress and obstetric fistula is therefore uncommon in industrialized countries today.

What happens when the baby’s head is too big to fit through the vaginal opening? The vagina tears to accommodate it. If the vaginal tear is small, it will heal by itself. If the vaginal tear extends into surrounding structures it will not heal unless it is sutured properly.

Perineal tears are classified by severity from first to fourth degree. First degree tears are small do not need to be stitched. Second degree tears extend into the tissue immediately surrounding the vagina; they ought to be stitched but the results are not catastrophic if they are not stitched.

Third and fourth degree tears are more serious. The illustration of the fourth degree tear below make it easy to see why they MUST be stitched or the woman will be left with bowel incontinence. Third and fourth degree tears can only be diagnosed by someone with considerable obstetric experience and they will NOT heal by themselves. They must be repaired by someone with extensive experience in repairing them.


Why aren’t childbirth injuries diagnosed? I offered my take in the piece:

We have a new cultural view of childbirth that tremendously minimizes how physically and emotionally difficult it is.

Indeed, until relatively recently, childbirth was recognized not merely as deadly, but also as disfiguring and disabling. A historian Judith Walzer Leavitt wrote in Under the Shadow of Maternity: American Women’s Responses to Death and Debility Fears in Nineteenth-Century Childbirth:

In the past, the shadow of maternity extended beyond the possibility and fear of death. Women knew that if procreation did not kill them or their babies, it could maim them for life. Postpartum gynecological problems – some great enough to force women to bed for the rest of their lives, others causing milder disabilities – hounded the women who did not succumb to their labor and delivery. For some women, the fears of future debility were more disturbing than fears of death. Vesicovaginal and rectovaginal fistulas .., which brought incontinence and constant irritation to sufferers; unsutured perineal tears of lesser degree, which may have caused significant daily discomforts; major infections; and general weakness and failure to return to prepregnant physical vigor threatened young women in the prime of life.

What changed between then and now? Quite a few things:

The widespread medicalization of childbirth dramatically reduced the death rates for both babies and women. In the past 100 years, modern obstetrics dropped the neonatal mortality rate 90% and the maternal mortality rate nearly 99%. Childbirth began to be seen as safe.

The medicalization of childbirth dramatically reduced the risk of the most debilitating childbirth injuries. The most devastating injuries, obstetric fistulas, have been rendered exceedingly rare by the easy availability of C-sections, and the more common injuries are easily prevented by the simple expedient of suturing vaginal tears.

Midwives and the natural childbirth industry romanticized childbirth in order to claw back market share. Midwives and other natural childbirth advocates resented what they derided as the “technocratic” model of birth, which they contrasted with the midwifery model which places a premium on avoiding the childbirth interventions that they coincidentally cannot provide.

We’ve ended up with a situation where physicians ignore postpartum pain, incontinence and sexual dysfunction because they are pre-occupied with preventing deaths, and midwives and natural childbirth advocates pretend childbirth injuries don’t exist because those injuries belie their reflexive worship of birth without interventions.

The truth about childbirth injuries is that they are common, can be prevented to a certain extent with the liberal use of obstetric interventions, can lead to life long disability and distress and are a subject of deep embarrassment for many women.

169 Responses to “The truth about childbirth injuries”

  1. guest
    August 19, 2016 at 2:00 pm #

    It is a shame that you never mention this↓

  2. nopedout
    July 25, 2016 at 11:46 pm #

    “Reflexive worship of..”

    You know absolutely nothing.

    • moto_librarian
      July 26, 2016 at 10:18 am #

      As opposed to what? What is your expertise?

    • guest
      July 29, 2016 at 10:38 am #

      You forgot “, Jon Snow.”

  3. Stephanie Rotherham
    July 21, 2016 at 5:15 pm #

    Welp, that picture put me off my supper.

  4. Jennifer
    July 21, 2016 at 11:49 am #

    I can’t believe in that entire Cosmo article they didn’t mention the natural childbirth industry even once.

    • Guest
      July 21, 2016 at 1:36 pm #

      It’s kind of clever, in a way. I wonder if that was an editorial decision; if they bring up that birth injury is very real, but don’t bring up the groups that gloss over it, they won’t attract as many combative yahoos in the comment section. I could easily be giving to much credit though.

    • Amy
      July 22, 2016 at 9:27 am #

      Yep. I have zero doubt that natural childbirth tactics that I used to avoid pitocin actually are the cause of my difficult labor, forceps delivery and 4th degree tear. If I had just layed in bed for a few hours instead of walking and bouncing endlessly I wonder how much better I’d be able to control my bowels, and how much less pain I would have been years after delivery…

  5. Margo
    July 20, 2016 at 11:51 pm #

    Just one of my other pet rant topics, “intact perineum” …..midwives do set a lot of store on these, like its a badge of honour… is not….some folk are luckier than others is all it is….skin type, baby size, baby position, birth position we are told, all play their part in whether you remain intact or not. For years we advocated perineal massage, if you massaged your perineum you wouldn’t tear…well, that might work for some, not for others…I have seen mums with no preparation push out large babies with no problems and mums with all sorts of birth plans covering massage, hot flannels, cold flannels, birth positions, pushing not pushing who have had small babies that have created havoc on their way out. We need to be more upfront re birthing, it hurts, in all sorts of ways, physically, mentally, emotionally and women need to know this….then women can start tomake informed choices around birth……Rant over.

    • Sue
      July 21, 2016 at 12:13 am #

      Good points.

      This idea of “intact perineum” probably reflects a poor understanding of the anatomy internal to the perineum. This is where the surgical skills of obstetricians helps them understand the detailed 3D structure.

    • Irène Delse
      July 21, 2016 at 9:22 am #

      A week or two ago, an article made the rounds: “Doctors should warn women about the real risks of childbirth” about precisely that issue.
      Dr. Jen Gunther, a gynaecologist blogger I follow on Twitter and usually appreciate, didn’t seem to get the point, though. She commented: “But normal vaginal birth carries the least risks!”
      Yeah, and some of those risks may not be acceptable to some women. How about giving them accurate info and letting them exercise their autonomy?

      • C.
        July 21, 2016 at 1:44 pm #

        But it DOESN’T carry the least risks… does it? It carries the least life-threatening risks, maybe (the risk of a serious infection is a lot lower with vaginal birth) but the risk of an adverse event occurring at all is higher than with a c-section birth, isn’t it?

        • Amy Tuteur, MD
          July 21, 2016 at 4:34 pm #

          Planned C-section carries the least risk for the baby.

          The studies that look at C-section risks for mothers considered death, hysterectomy, infection, blood transfusion, and other immediate risks. They don’t consider the risks of incontinence, pain and sexual dysfunction that are far more common than the immediate risks.

          • C.
            July 21, 2016 at 5:45 pm #

            That’s pretty much what I figured.

          • Daleth
            July 22, 2016 at 1:25 pm #

            Planned c-section also carries the least risk for the mother, according to that huge UK study (all births over a three-year period, so over 2 million births). They compared women who got planned pre-labor c-sections to women who attempted vaginal birth and found that women in the first group were almost 20% LESS LIKELY TO DIE than women in the second group.


            Why? Because it’s women who attempt vaginal birth who end up needing crash c-sections at 3AM with general anesthesia and an exhausted medical team. And of course, even an apparently successful vaginal birth can kill you, especially since women who birth that way are hardly monitored at all compared to women who deliver by c-section, so they can quietly bleed to death in their home or midwife-led birthing center.

    • Erin
      July 21, 2016 at 9:54 am #

      Yes. When I was talking to a Midwifery manager about my debrief I asked why we were told so many “lies” (apparently all women can breastfeed and all you need to birth any baby is a positive attitude) at our ante-natal classes, why we couldn’t discuss c-sections and forceps, why we weren’t allowed to talk about the damage that vaginal births can do. Her answer went something like this:

      Really bad tears etc only happen to a tiny percentage of women and most women don’t find their emergency sections traumatic so it’s not a problem.

      I pointed out that it was only luck in my case that I could give anything like informed consent…because I’d had time to self diagnose a stuck baby over the 81 hours between my waters breaking of their own accord and a Doctor sticking a consent form in my drugged up, exhausted seeing snakes face. However apparently that’s not an issue.

      Interestingly enough I’d say that in the two birth trauma groups I’ve been apart of, the traumas are pretty much divided 50/50 by women who suffered horrible injuries from their deliveries and those who struggled with their emergency sections because primarily our system sells it as abnormal and a form of failure. Telling women in such a vulnerable hormonal state that they’ve effectively failed at being a Mother before their child even takes it’s first breath should never allowed.

      It’s even the Doctors to a degree though. I had to really fight for a General Anesthetic for baby 2 but most of the arguments weren’t based around the actual risks but stuff like “Healing birth”, “Skin to Skin”, “Breastfeeding”, “You can’t be traumatized if you’re holding baby” and “More healing birth”. The final straw came when they tried to show me a video of a “gentle c-section” and I pretty much sprinted from the room returning to point out, if I could watch videos of it, I probably wouldn’t be asking for a GA.

      And the really rubbish thing, I can’t even guarantee that when I reach 9 months, they won’t try and change the rules again.

      • guest
        July 21, 2016 at 11:16 am #

        You know, if I broke my arm in a traumatic way, I doubt ANYONE would suggest that I deal with the trauma by having a “healing bone fracture.”

        • Erin
          July 21, 2016 at 6:31 pm #

          Ah but childbirth is some amazing mystical thing which cures everything…

          It would probably cure that traumatically broken arm.

          I don’t think a lot of the staff I’ve encountered in my attempts to make baby 2 a better experience for me than baby 1 actually believe that I would find being awake for another section triggering. They think I’m just afraid or being awkward or in the case of a rather astute Anesthetist “punishing” myself.

      • Madtowngirl
        July 22, 2016 at 12:54 pm #

        I wish I could upvote this comment 100 times. “Telling women in such a vulnerable hormonal state that they’ve effectively failed at being a Mother before their child even takes it’s first breath should never allowed.” A-fucking-men!!!

        *”You can’t be traumatized if you’re holding baby”* – I guess that’s why I didn’t get PPD and PTSD-like symptoms when trying to breastfeed my baby…..oh wait.

  6. Margo
    July 20, 2016 at 11:38 pm #

    I am not suggesting this is what has happened to you, but sometimes women have intact perineums but internal tears that are not picked up on. Any woman who has on going pain, weeks, months post vaginal birth should be offered an internal scan to assess for damage. Too often, ‘intact perineum’ or ‘no tear’ is thought to mean no damage and that is simply not necessarily the case, the damage can be deep and not easily seen. Never put up with pain without further investigation.

    • Daleth
      July 22, 2016 at 1:25 pm #

      Yep. Women in that situation need a pelvic MRI and a urogynecologist to evaluate it.

  7. StephanieA
    July 20, 2016 at 10:38 pm #

    I know I’ve mentioned it before, but my second delivery was rough. I had SPD during pregnancy and delivery made it worse. My son’s head was big and he was OP. I didn’t tear but I wouldn’t be surprised at all if I had some kind of tailbone injury. I literally could not walk upright for a few weeks and couldn’t have a bowel movement without suppositories for months. My doctor said he definitely damaged my pelvic floor muscles and prescribed kegels. Things have gotten better, but we’re considering a third baby and I’m scared to have another vaginal birth.

    • Sue
      July 21, 2016 at 12:15 am #

      That sounds terrible – and stands in contrast to the recovery of many women from cesarean surgery – so-called “major” abdominal surgery – which leaves the sitting-down bits alone.

  8. crazy grad mama
    July 20, 2016 at 10:25 pm #

    OT: I need someplace to dramatically roll my eyes at the ironically-named “A Normal Parent’s Guide To Homeschooling.” It hits all the AP classics: evil OB, natural birth, co-sleeping, extended BFing (yes, apparently this is all relevant to homeschooling).

    • Who?
      July 20, 2016 at 11:05 pm #

      ‘Normal’ is right up there on my list of words I despise. Along with ‘should’.

      And that’s without even starting on the nonsense within.

      • MI Dawn
        July 21, 2016 at 9:09 am #

        Yeah. It’s like “Family”. You just KNOW that most groups who have Family in their name only recognize 1 type: White, middle-to-upper class with SAHM.

        • Who?
          July 21, 2016 at 6:24 pm #

          Yes. We’re having a lot of talk hear about the importance of the values and opinions of the ‘mainstream’. Who all, as far as I can make out, match the description you have given.

    • The Computer Ate My Nym
      July 21, 2016 at 9:11 am #

      Now I want to write a book called “A completely abnormal parent’s guide to schooling their kid(s) however works best for them and their kid(s).”

      • guest
        July 21, 2016 at 11:18 am #

        I would buy that.

      • crazy grad mama
        July 21, 2016 at 11:24 am #

        And now I’m imagining a full line of Completely Abnormal Parent’s Guides. Would 100% buy.

        • The Computer Ate My Nym
          July 22, 2016 at 2:43 am #

          “The Completely Abnormal Parent’s Guide to Pregnancy and Childbirth: Don’t expect it to be all rainbows all the time.”

          “The Completely Abnormal Parent’s Guide to Feeding Your Baby: You don’t live in the paleolithic era and don’t have to pretend you do.”

          “The Completely Abnormal Parent’s Guide to Toddler Tantrums: This too shall pass. Probably like a kidney stone.”

          • KeeperOfTheBooks
            July 22, 2016 at 9:56 am #

            I’d take signed copies of every book! Multiple copies, at that–one for me, one for every new mommy as a shower gift.

          • Daleth
            July 22, 2016 at 1:27 pm #

            “The Completely Abnormal Parent’s Guide to Pregnancy and Childbirth: Don’t expect it to be all rainbows all the time.”

            I think this might be catchier: “The Completely Abnormal Parent’s Guide to Pregnancy and Childbirth: The Regular Farts Vastly Outnumber the Rainbow Unicorn Farts.”

  9. Monkey Professor for a Head
    July 20, 2016 at 7:59 pm #

    When I was a med student doing a GP rotation, I remember seeing an elderly woman who had had a colostomy to treat faecal incontinence caused by childbirth. Apparently it was a big improvement.

    It’s sad that something which can have such a huge impact on quality of life is swept under the carpet. Maybe because it’s embarrassing, maybe because it’s not life threatening. Maybe because a woman’s dignity is just not given as much importance as it should be by society.

    • Azuran
      July 20, 2016 at 9:36 pm #

      Maybe it because for the longest time it was just the way life. Back when there was no contraception, no c-section and women’s value was based on giving children to their husband, childbirth injury was just a part of life that no one could no anything about.
      But now that we have access to all those ways to prevent or treat those injury, we should talk about them.

      • Who?
        July 20, 2016 at 11:07 pm #

        Exactly. They had zero choice, except to whinge and complain, or be stoic.

    • Sue
      July 21, 2016 at 12:17 am #

      And prolapse too.

      Another good use for the surgical skills of OBGYNs

    • Irène Delse
      July 21, 2016 at 9:31 am #

      It makes me rethink one literary trope that can be found in some very old stories (at least from the Renaissance era), that of the “dirty old woman” or “stinking old woman”. I thought it was some of the usual misogyny of the times, especially where it concerns women who were not marriage material.

      But the more I read this blog, the more I wonder: maybe it was taken for granted that many women would be incontinent after years of childbearing, and so would be shunned by society. What a world.

      • The Computer Ate My Nym
        July 22, 2016 at 2:50 am #

        I never thought of it before, but I wonder if that problem didn’t fuel the misogyny: it’s not hard to feel superior to someone who stinks constantly, especially if you don’t inquire too carefully into whose fault it is. And it’s an easy excuse to exclude women from positions of responsibility if they literally stink constantly from incontinence–such a thing would truly be a distraction during, for example, business negotiations or diplomatic discussions.

        • Daleth
          July 22, 2016 at 1:31 pm #

          Yeah, and honestly, when every childbirth made 1 in every 100 men an instant widower and left easily 1 in 10 of them with a severely incontinent (and thus depressed) wife for whom sex was now painful, I can actually kind of understand why you might instinctively want to devalue women (to lessen the pain of losing them) and why you might want a mistress.

          The medicalization of childbirth SOLVED THOSE PROBLEMS for millions of people. It’s easily one of the most feminist things ever to have happened.

  10. AA
    July 20, 2016 at 7:30 pm #

    The largest physician group in my system has recently opened a Female Pelvic Medicine clinic and its chair has particular clinical interest in accidental bowel leakage. I hope more women will be able to get treatment for these issues, I know that many women are embarassed to tell their doctors about bowel issues.

    • Pinky
      July 20, 2016 at 7:41 pm #

      This is great news. Let’s hope they look at why the damage is happening as well aS helping women to deal with it.

      • yentavegan
        July 20, 2016 at 9:44 pm #

        Why damage is happening? Because Mother Nature could not care less about any individual mother’s birth experience. C/sections save lives and the quality of those lives.

      • MI Dawn
        July 21, 2016 at 9:08 am #

        It happens because Mother Nature is a bitch. She doesn’t care if a woman lives or dies.

        I had 2 very small babies (6-12 and 5-13). I still have urinary incontinence unless I pay very close attention to my body signals, and I’ll leak even then sometimes. Neither baby was 1)operative – no forceps or vacuum), 2)forced pushing or 3)term. BOTH, however, were OP who only rotated to OT. I have a weird pelvis.

        My MD did the episiotomy I begged for (he was trying to stretch the skin rather than do one). Looking back, for many reasons, I would have preferred a C/section.

        • guest
          July 21, 2016 at 11:20 am #

          I had a c-section after eight hours of labor (including early labor), a 5 pounder and a 4 pounder. Sometimes when I cough *really* hard I can still feel my bladder starting to give way. From what I’ve heard, even carrying a pregnancy with no labor can cause this.

    • Megan
      July 21, 2016 at 9:41 am #

      I wish I had access to a clinic like this to refer patients. The resources for specialized treatment for pelvic floor injuries are lacking in many communities, especially rural ones.

    • Amy M
      July 21, 2016 at 12:33 pm #

      When I gave birth, there was a resident present for much of the labor and delivery. I was talking with her a bit, and she told me her goal was to go into pelvic medicine, so I was especially thankful to have her around at that point! She did a bit of perineal massage, so at least at that time, that must have been considered in the “worth trying, can’t hurt” category. I was lucky, I only sustained a minor tear, which was stitched. I don’t know what happened with that doctor, I hope she went on to specialize in pelvic medicine like she wanted.

  11. Pinky
    July 20, 2016 at 6:54 pm #

    Once again Amy you fail to tell the whole story. You mention nothing about the flexibility of the pelvis and how it can enlarge during labour. Nor do you mention anything about foetal skull moulding. You mention nothing about the harm Valsalva pushing does to vaginal wall and pelvic floor, or anything about the importance of the mother’s position when giving birth. Cherry picking and scare-mongering as per usual.

    • Deborah
      July 20, 2016 at 8:22 pm #

      I think Amy’s article was specifically discussing childbirth injuries which occur when these things have not been enough to prevent the damage.
      She has written another post similar to this one where moulding of the fetal skull is discussed.
      Type “fetal bones” into search and you will find it.

    • Amy
      July 20, 2016 at 9:20 pm #

      If any of these injuries happen to you, they happen 100%. At that point do you think a woman who’s suffered a fistula cares that in most cases the pelvis is flexible enough to prevent them?

      If you want to talk cherry picking and scare mongering, go after the ICAN ladies. They routinely treat things like getting an IV in labor or being offered an epidural as catastrophic downsides of hospital birth.

    • Sue
      July 21, 2016 at 12:23 am #

      But you’re wrong, “Pinky” – Dr Amy has been through this evidence many times before – including the evidence showing that the birth position stuff is a myth.

      Stretching and moulding are understood – the article doesn’t say that every baby gets stuck, does it?

      What is your explanation for shoulder dystocia or other mechanical obstruction of labor? What is the incidence, and how is it affected by “birth position”? With supporting evidence, pls.

    • moto_librarian
      July 21, 2016 at 10:57 am #

      Just stop. I did not Valsalva push during my first delivery. In fact, I could not stop my body from pushing. My contractions did not space out very much during the second stage, and I was rapidly growing exhausted. I did not have pain medication, pushed in every position imaginable, and had perineal support from my CNM. It did not prevent me from having a cervical laceration and a 2nd degree tear. In fact, the cervical laceration may well have been prevented had I had an epidural. I delivered a 6 lb., 4 oz., baby after SROM and no augmentation of labor. I now have a rectocele and nerve damage that causes me to have urgency and occasional leakage from my bowels. NO ONE WARNED ME ABOUT THIS. NO ONE. Natural childbirth advocates love to talk about informed consent regarding c-sections, but they have no problem with glossing over the very real risks of vaginal birth. So now instead of recovering from a c-section when I actually had time off for maternity leave, I will have to take of 8 weeks of work to heal from rectocele repair. If I’m lucky, an interstim device will fix the urgency and leakage problems, but I’ll have to trial it first. Let me tell you what a delight it is to worry about crapping my pants when I take the kids swimming or go on a romantic date with my husband. Splinting every time I need to have a bowel movement is equally charming. Maybe if you and your buddies would quit cherry picking your own data, we could actually give women autonomy over their bodies.

      • MaineJen
        July 21, 2016 at 11:26 am #

        I had involuntary pushing during my first labor too. YOu literally can’t stop or control it. My epidural took the sensation of pressure away. I still had a 2nd degree tear but it could have been a lot worse. Your labor sounds like it was horrible!

        • moto_librarian
          July 21, 2016 at 1:12 pm #

          It had really been manageable up until the point that I hit transition. The nausea and contraction pain hit me like a ton of bricks at that point, but our son was born less than 12 hours after SROM. I totally expected pushing to “feel good.” Imagine my shock and horror when it proved to be excruciatingly painful.

          • guest
            July 21, 2016 at 1:18 pm #

            I remember thinking during the pushing stage “This feels 100 times worse than contractions, not better!” It was the beginning of the end of woo for me. I felt duped!

          • moto_librarian
            July 21, 2016 at 1:58 pm #

            Oh yes. I still remember waking up during the night after delivery (once I was capable of rational thought again after sedation for surgery) and feeling absolutely betrayed by my childbirth teacher. I was furious.

          • Charybdis
            July 21, 2016 at 5:14 pm #

            Umm….why would you expect pushing to feel good? (Serious question. I had a planned CS and in no way ever thought that pushing would be anything but painful)

          • Kelly
            July 21, 2016 at 7:00 pm #

            It felt better for me to push. It does not happen like that for all people though.

          • Monkey Professor for a Head
            July 21, 2016 at 7:35 pm #

            Pushing felt good for me, but that was only because I had an epidural which didn’t quite cover my abdomen but covered my perineum wonderfully. Pushing took away the abdominal pain, and I was able to push efficiently with no pain at all – it was great. It would have probably sucked without the epidural though.

          • moto_librarian
            July 21, 2016 at 9:29 pm #

            In retrospect, it does sound ridiculous. Yet over and over again, our teacher told us that if we could get through the awful bit of transition, that pushing would feel good by comparison. I guess I didn’t think it would be pleasurable, but I did think it would feel better than just feeling contractions.

          • AA
            July 21, 2016 at 9:57 pm #

            Several references to pushing being more comfortable than transition at this NCB website:

      • guest
        July 21, 2016 at 11:32 am #

        I also had uncontrollable pushing. The nurses tried telling me to stop and take breaks, but my body wouldn’t let me. Got that baby out in 30 minutes as a primip, but had 2nd degree tear and was terrified the entire time about the damage I was doing to myself. I felt like I was being torn in two. Luckily I healed ok and haven’t had long term pelvic floor issues (yet), but if the baby had been just a hair bigger, who knows? From the outside my birth was a shining example of a textbook vaginal birth, but I honestly don’t know if I want to risk it again.

      • demodocus
        July 22, 2016 at 1:16 pm #

        What is valsalva?

        • MI Dawn
          July 22, 2016 at 1:52 pm #

          Holding your breath and bearing down (think having a hard bowel movement).

    • Heidi
      July 21, 2016 at 12:43 pm #

      Well, as a lady who wasn’t pregnant all that long ago, the information you’re going on about is abundant. I attended a birth class, all that was covered. I could google it, I could ask my OB/GYNs about it, they would explain it. What no class mentioned was the whole truth about tears. They mentioned an episiotomy and pretty much how outdated that was and maybe a quick gloss over of tears. Like you’ll get sewn up and it’s no big deal. They didn’t go over rectoceles, cystoceles, fistulas, being so swollen you couldn’t pee, having the worst pain in your life afterwards (I found it worse than labor and since I went from 4cm to 9cm in probably an hour I had a lot of issues getting the epidural to actually work. I was in labor pain longer than I wasn’t.), the very real possibility sex would not be six weeks after birth, prolapses, future pelvic issues, etc. Now I don’t wish they would have said, you’ll probably be incontinent, your vagina will be prolapsed, you’ll want to kill yourself because of the pain, and the narcotics will make feeding your baby a huge safety issue at night but I had ZERO idea what to expect. My issues were actually the result of a successful vaginal birth but I assumed I was wrecked forever down there because no one gave me the truth! I’d still have another vaginal birth, but now I know what to expect and won’t necessarily spend my nights crying. We should know the WHOLE truth so if something bad does happen, we’ll have a clue and can hopefully get treatment.

    • TheArtistFormerlyKnownAsYoya
      July 21, 2016 at 1:43 pm #

      Perhaps because this is an article about damage sustained during childbirth, not an article about the amazing things a woman and baby’s bodies can do to facilitate childbirth?

    • MB
      July 21, 2016 at 1:59 pm #

      I was taught as a child that if someone doesn’t tell the whole truth, that is a lie. My midwives LIED to me by withholding information. It’s been a year now. Sex is still painful. This is horribly embarrassing, causes me extreme emotional stress. Had I been told the truth about vaginal birth, I would’ve gone RUNNING to a c-section. I even begged for it during my 28 hour birth and 6 hours of pushing (4 hours of which were unproductive). Oh, but it’s just sex for what, the rest of my life? Who cares, right? In fact, if asked, my midwives would probably tell me to buck up and feel lucky. In some places they cut off your clitoris, I should be THANKFUL to still have mine, right?

      This is a terrible fact, but it’s still only the tip of the iceberg when it comes to the medical care that was provided to me by my midwives. It was subpar, which is unacceptable in 2016. I pay my bills, I have insurance! When they get my order wrong at Denny’s, I get it taken off my bill. That is my recourse. Where is my recourse for my untreated, unmonitored gestational diabetes? Where is the recourse for having an infant born with hypoglycemia and put on a glucose drip for the first three days of his life? Guess what? I don’t get any. I don’t get those three days back, I don’t get my sex life back, shit, I don’t even get 10% taken off the bill.

      What a sham it all was.

      • moto_librarian
        July 21, 2016 at 2:00 pm #

        I am so, so sorry. You have every right to be outraged.

      • lawyer jane
        July 21, 2016 at 5:17 pm #

        Whoa, were they CNMs that did not diagnose your GD?

        • MB
          July 22, 2016 at 8:45 am #

          Yes, CNM. My blood/glucose numbers were way off for the first glucose test of the pregnancy, so she ordered the second test, as she is obligated to do. In the more advanced test, your base blood/glucose level is tested and then you are administered more glucose over the course of three hours and your blood/glucose level is taken after each hour (you probably know this already). As a note, I was specifically told I did not have to fast for the more advanced test, I called twice to confirm that. Of the three numbers that were taken, the first two were right on the threshold of what they considered to be normal/abnormal, and the third was way off. She referred to this as “borderline” gestational diabetes. Had it been diagnosed as regular GD, I do believe the hospital she worked through required her to refer me to a high risk OB.

          She brushed it off and said, well, it’s up to you, if you want I can order you a kit so you can test your sugars at home, or we can just test your sugar levels as you come in for your next visits. She seemed very cavalier about it, so I assumed that it was totally fine and did not request the kit. She never took my blood/glucose levels after that in any of the following check-ups. I watched what I ate in a general sense – i tried to stay off the ice cream and eat my veggies. Anyway, long story short, at 38 weeks my water broke. I had a 9 lb baby after 28 hours of hard labor who was hypoglycemic and had to be in the special care unit away from me for 3 days on an IV administering glucose. I really blamed myself for not eating right for a really long time. But now, I just think it was the condition not being managed by what was supposed to be my health care prof.

          • guest
            July 22, 2016 at 1:06 pm #

            Please, please, please file a complaint about your midwives. Ignoring GD can be deadly. If your water hadn’t broken at 38 weeks, your baby would have faced a much higher stillbirth risk than average, with nobody doing the monitoring necessary or counseling you to have a 39 week induction. This is really upsetting, subpar care that will end up killing a baby if it hasn’t already.

          • Daleth
            July 22, 2016 at 1:34 pm #

            Seconding this. Subpar medical care like that should be punished and, for the sake of future patients, corrected.

          • MI Dawn
            July 22, 2016 at 1:56 pm #

            I’m thirding the “report this care” as a former CNM. If your sugars were off, you SHOULD have at least been referred to an OB for co-management. We did have GD patients, but they were followed very closely and the OBs saw them also. And if there was any hint of macrosomia, the OB was on call for the delivery in case of problems.

          • MB
            July 24, 2016 at 8:38 pm #

            Hi Dawn – how is the best way to go about this? I’m in Michigan, if it matters.

          • MI Dawn
            August 5, 2016 at 8:17 am #

            Hi, MB. Sorry I missed this comment! I don’t know exactly how in Michigan (I’m in NJ and the laws and regulatory boards may be different) but you should be able to find who licenses midwives in Michigan, and there should be a site to complain about them.

            The site “Safer Midwifery for Michigan” (Dr Amy has it in her blogroll) has good links that can help, too.

      • Who?
        July 21, 2016 at 6:32 pm #

        I am so sorry.

    • Who?
      July 21, 2016 at 6:30 pm #

      Lucky you came along, Pinky, to tell everyone how if they have birth injuries it is, partly at least, their own fault.

    • Kelly
      July 21, 2016 at 7:01 pm #

      Too bad my pelvis has stayed flexible after birth and sometimes I am in pain because of it.

    • corblimeybot
      July 22, 2016 at 12:02 pm #

      LOLOLOL my pelvis was permanently damaged by a birth that produced a small 2nd degree tear that healed really well, and by less than ten minutes of non-valsalva pushing.

    • Azuran
      July 24, 2016 at 10:35 pm #

      But those things do not prevent birth injuries in 100% of the births (as the dozen of personal anecdotes in the comment show) You are the one who is trying to lie about the real risk.

  12. attitude devant
    July 20, 2016 at 4:14 pm #

    Indulge me. I always love historical examples of ob/gyn issues. Louis XIV had a wife (two different ones, if you include Madame de Maintenon), a formally recognized mistress (I count three, all at different times, the last also being Madame de Maintenon), and numerous dalliances. Ergo, he had lots of children. One of his mistresses became pregnant in due course, delivered, and thereby encountered such a heinous perineal injury that she retired from Court. Apparently it was that awful. The wags at Versailles laughed that she was “wounded in the King’s service, and therefore rendered unfit for service.” Not a very nice time to be a woman.

    (Don’t even ask me about Marie Antoinette’s menstrual cycles or we could be here all day.)

    • fiftyfifty1
      July 20, 2016 at 4:42 pm #

      Now you have me interested. What went on with Marie Antoinette’s menstrual cycles?

      • attitude devant
        July 20, 2016 at 6:09 pm #

        They were always very irregular, which may have had something to do with her not getting pregnant for several years after marriage, but not everything because contemporary accounts report that her brother had to travel all the way from Vienna to explain to her husband how to do the deed, and the matter was even more complicated by the anomalous penis her husband reportedly had…). Anyway, by the time she was incarcerated she had developed full-on menometrorrhagia and was always, always bleeding. Her jailer’s wife reported helping her wring out soaking menstrual cloths and she was very pale, thought to be anemic. The cause of this is unclear. She might have had anovulatory bleeding, or myomata, or any number of things, but she was quite weak at her own trial.

        Anovulatory bleeding has a biblical story attached to it too. Remember the ‘unclean’ woman who reaches out to touch the hem of Jesus’ robe? She was bleeding continually or near enough to it that she couldn’t be ritually purified (under Jewish law) to be able to live with her family or cook for them. Although I’m not religious I always thrill to the audacity of that poor outcast lady, daring to reach out and touch a holy man, seeking healing for herself. Took chutzpah, no?

        • Amazed
          July 20, 2016 at 6:35 pm #

          “Reportedly had” might actually turn out to be a very good description. AFAIK, nowhere in Louis’ diary was it mentioned that he missed a day of hunting around the time of the supposed surgery.

          As to Marie Antoinette, it’s quite impressive how she’s supposed to be hiding her lover while imprisoned for a last night of hot sex (with the guards coming in to check on her every two hours or something but hey, that’s the peak of romance!). I guess the details about those pecky cycles and the long recovery after her last childbirth just weren’t interesting enough to merit a mentioning. Can you tell that Zweig was an admirer of Freud’s?

          To be fair, in Zweig’s youth many things to do with medicine were still taken exactly the wrong way. For example, a young woman here in my country chased a famous poet in the 1910s. She was clearly unstable, had gone through a personal tradegy, supposedly used what drug was in vogue at that time and to us, it would have been very obvious that she needed help. Instead, her obsession with him was taken as a sign of a passionate and sensual soul, and did I mention sensitive? She even managed to marry him which didn’t help her obsession one bit. Surprised? She ended up committing suicide early into the marriage. So I guess I shouldn’t be so hard on Zweig.

          • attitude devant
            July 20, 2016 at 8:50 pm #

            Not clear that surgery was done, so that’s neither here nor there. As for Zweig, I’ve never read him (but I have seen movies based on his books—does that count?). I think it’s hard for us at this remove to imagine the tenor of life in Vienna before the wars. It seems to have been a very different place. I’m sure they’d find me a very boring individual, since I’m not interested in cultivating any such soulfulness and artistic sensibility.

          • Amazed
            July 21, 2016 at 5:09 pm #

            Do not despair, Addi, if we happen to find our way there, we can hang out together. It’s our duty as a pair of very boring, uncultured individuals!

        • Elizabeth Neely
          July 20, 2016 at 8:02 pm #

          being Jewish I have always thought about that too, But apparently Jesus was the man with the plan….who need medical insurance???

        • July 21, 2016 at 2:36 am #

          According to what I have read, Marie Antoinette’s main problem — and why she remained a virgin for years after marriage, was her husband’s inability to have a full erection due to a severe phimosis (tight foreskin) which caused him pain. Circumcision solved the problem. Catherine the Great was in the same situation, too.

          • MaineJen
            July 21, 2016 at 9:39 am #

            Cue anti-circ parachuters in 3…2…1

          • AirPlant
            July 21, 2016 at 9:45 am #

            We really need some kind of code word. I don’t know if I can survive another thread derailed into baby penis.

          • MI Dawn
            July 21, 2016 at 9:51 am #

            Well, at least in THIS case, you can point out it was done to a consenting adult, not an infant.

        • Irène Delse
          July 21, 2016 at 9:55 am #

          The remonstrances of Joseph II (Marie-Antoinette’s brother) did help her and Louis XVI conceive, but there was no operation. There were vague rumors in the correspondence of the time, but as all physicians & surgeons who examined him attest, and as Joseph found out, Louis had no physical impediment, only timidity and a low sex-drive. Marie-Antoinette wasn’t very keen on having intercourse with her husband (that’s a euphemism!) and was very afraid of having children. So basically she tended to keep her thighs together and do everything she could in passive way to avoid it. Whether consciously or not, it’s impossible to say. But her brother did give her a very stern talking-to, reminding her that as a queen, she had one job, give children to the state.
          Btw, I don’t know Antonia Fraser, but Marie-Antoinette’s best biographer to date is French historian Simone Bertiere, who took care to research the letters of that family in the archives of Paris and Vienna. Many biographers (including Stephan Zweig) used only one set of archives, or even the published edition of the letters, which sadly have been “cleaned” of most of the references to sex, menstruation, etc. But the letters of Joseph to his brother, for instance, are as explicit as one would wish.

          • attitude devant
            July 22, 2016 at 9:29 pm #

            yes, Fraser quotes Josef’s letters extensively. I think at one point he reports that “The king of France is a great dunder-headed fool!” after having to exhort the couple to exert themselves to have a baby. I’ll look for Bertiere in translation, but Fraser is quite well researched and annotated. My favorite little tidbit was the dressing book Marie had. Her ladies would bring her a folio of swatches of material from all her dresses and she would pit a pin in the swatch from the dress she wanted to wear that day. These swatches (and the little pin-pricks) still exist. Wouldn’t you love to get your hands on them?

    • Elizabeth Neely
      July 20, 2016 at 8:00 pm #

      what book are you reading it sounds fascinating!!

      • attitude devant
        July 20, 2016 at 8:46 pm #

        The account of poor Marie Angelique, who died, is from Nancy Mitford’s excellent book on Louis XIV, and Marie Antoinette’s story is recounted in Antonia Fraser’s bio of her. Fraser posits a uterine cancer, but she should have asked any gynecologist. There are lots of perfectly benign conditions that can lead you to bleed until you are anemic.

    • Charybdis
      July 20, 2016 at 9:20 pm #

      Madame de Montespan was quite a piece of work herself, using potions and black magic to remain the favorite of the King.

      Madame Pompadour has always been my favorite mistress (maitresse-en-titre). She was a very interesting person in her own right.

      • Who?
        July 20, 2016 at 11:09 pm #

        Have you seen the Dr Who (David Tennant) with Mme Pompadour? Gorgeous actress.

  13. LibrarianSarah
    July 20, 2016 at 3:19 pm #

    I think it is a crime that we don’t cover the things that could go wrong in childbirth in sex ed. I mean I think health/sex ed so be a 4 year thing in high school and cover all these kinds of things. Too many people think childbirth is no big deal which is why we have no maternity leave and pro-lifers.

    Granted when I was 13 my grandfather (who was an OB) sat me down and explained in graphic detail every single thing that he had seen go wrong in childbirth and then told me “so don’t have sex before you are married.” When he couldn’t tell me that marriage would protect me from all that stuff happening I let him know that I wouldn’t be having sex ever which was fine with him.

    His probably wasn’t the best way to explain the bird and the bee’s but there needs to be a middle ground between that and “babies come out of vaginas or get cut out by doctors and that’s all we are going to cover about this.” People should know that giving birth is not all sunshine and rainbows and no doctors can’t fix everything. And because teenage pregnancy is unfortunately still a thing, they should learn it in school.

    • The Computer Ate My Nym
      July 21, 2016 at 9:07 am #

      I think the risks of pregnancy and delivery ought to be part of counseling prior to having an abortion. Replace the crap about fetal pain (probably doesn’t happen, definitely doesn’t happen before 25-30 weeks) and breast cancer (simply not correlated with abortion) with actual facts about the dangers of continuing a pregnancy.

      • LibrarianSarah
        July 22, 2016 at 1:15 pm #

        While with everything you said, I also think that one of the big reasons that the pro-life has gotten such as strong foothold in American political and social culture is that men and boys don’t know anything about it. Like it or not, most political and social power is still concentrated in the hands of men. And as long as pregnancy, menstruation, and the BASICS of women’s health are still pushed into the “icky women’s issues” ghetto of knowledge this type of misinformation will permeate. That’s why all this crap is required to be told to women getting an abortion because some (probably male) politician thought it was true and didn’t bother looking otherwise because that’s “icky women’s stuff.”

  14. Heidi
    July 20, 2016 at 3:00 pm #

    I feel like I probably came out of childbirth fairly unscathed compared to a lot of women, but the first few weeks postpartum, I wasn’t convinced it was all going to be okay. I didn’t experience any incontinence, although I couldn’t feel if I had to urinate or not for the first few weeks and I couldn’t pee sitting down. So I’d go to the bathroom every couple of hours to prevent any accidents, so I guess I kind of was incontinent. After a while though, the swelling went down and I could feel the need to pee and could pee sitting down. Anyway, I had a second degree tear and tore both ways. I had to take hydrocodone and a lot of ibuprofen to manage the pain for the first week or two. But you know, I was supposed to exclusively nurse every two hours hopped up on narcotics! Sex after the six week period was still very painful. It took weeks after that before it was bearable and a few more weeks until it could be somewhat enjoyable. I’m okay now though 7 months out. Now I experience random hip pain, I assume from my hips loosening while I was pregnant, but mostly things are okay. But the first three or four months was definitely not okay. I spent many nights crying, fearing the worst. No one really tells you this stuff!

  15. Kelly
    July 20, 2016 at 2:28 pm #

    I have SPD and this is the first time it is still affecting me after birth. My tailbone hurts so much on some days. I know lifting would help out a lot but I just don’t have the ability to go at this point.

    • FEDUP MD
      July 20, 2016 at 6:39 pm #

      PT was a lifesaver for me. Find someone who knows about childbirth injuries though.

      • Kelly
        July 21, 2016 at 7:08 pm #

        If it continues, I will probably try to go next year. We have to get the baby out of PT before I would be able to do my own.

  16. BeatriceC
    July 20, 2016 at 1:26 pm #

    My oldest (and only close to full term baby delivered vaginally) is 17 now and I still deal with stress incontinence, which was not a problem before I got pregnant for the first time. These are the things nobody tells you. I’m 40 years old and I can’t sneeze without peeing my pants. That stinks, both literally and figuratively.

  17. Anna
    July 20, 2016 at 1:08 pm #

    People watch movies like Angelique or Gone with the Wind and think that back in the old days giving birth was this glamorous event when you lay in your luxurious bed all clothed in lace coiffed and made up, no bothersome OBs bothering around trying to check your cervix. OK, you could die but you preserved your dignity and were all lady-like and gorgeous. I imagine if Melany instead of dying giving birth “just” began wetting herself now and then. And Ashley wouldn’t want to be with her anymore cause he was all so sophisticated and aristocratic that he couldn’t bear the sight of it… Whole different story that would have been. I personally had absolutely NO IDEA that this is such a major problem when I chose to get pregnant. The mass media should highlight this more, the Cosmopolitan article is just great and the most honest piece on the topic that I have read.

    • guest
      July 20, 2016 at 1:21 pm #

      Even in Gone with the Wind, Scarlett O’Hara had one kid and was all NOPE, NOT DOING THAT EVER AGAIN.

      • swbarnes2
        July 20, 2016 at 1:36 pm #

        In the movie. In the book, I think her first marriage is when she’s a teen, and she has one child with each husband. So she’s a teenage widowed single mom during the war.

        • guest
          July 20, 2016 at 1:40 pm #

          Yeah, I only saw the movie, and I’m not even sure I saw all of it.

          • LibrarianSarah
            July 20, 2016 at 3:55 pm #

            I don’t think I ever made it through the whole thing without falling asleep. Maybe it is because I am from up north but I never got the whole “lets relive the Civil War over and over again” that seems to be popular with a large segment of America. Never mind the whole marital rape thing.

            Mammy calling people “white trash” was the only part of the movie I can say I enjoyed.

          • The Computer Ate My Nym
            July 21, 2016 at 9:59 am #

            Again, it’s been a looooonnnggg time, but I remember the book as being a little subtler than I think you’re giving it credit for. For example, I remember Scarlett at one point looks at the soldiers getting ready to go off and bravely defend the homeland (TM) and thinking “They’re a bunch of fools!” She isn’t quite able to go from this revelation to any useful understanding of how the system is manipulating her and others, but I think Mitchell may have been at least somewhat aware of it. Though I also remember it as being “wince at every third word” racist and it’s probably worse than I remember.

        • Amy M
          July 20, 2016 at 3:05 pm #

          Yep, she had one child/husband in the book, so three kids total.

      • Charybdis
        July 20, 2016 at 8:14 pm #

        I always thought that she was a “one and done” type in the kid department because of her vanity.

        Not long after Bonnie Blue’s birth, Mammy is helping Scarlett get dressed and is lacing up her corset. Scarlett says something about lacing it tighter and making her waist smaller but Mammy replies “You done had a baby, Miz Scarlett; you ain’t never gonna have a 17(?) inch waist again.” To which Miz Scarlett replies that “there will be no more babies then”.

        This was in the movie, as I watch it about once a year and haven’t read the book. Nor do I have any desire to read the actual book.

    • The Computer Ate My Nym
      July 21, 2016 at 8:53 am #

      IIRC, Scarlett in GWTW had post-partum depression after her first baby was born, at least in the book, though she is described as recovering physically “indecently” easily. Melanie did everything “right” by suffering horribly and nearly dying but being willing to do it again for her guy…At least, that’s how I remember things happening. I read it a good 30 years ago so my memory of what happened should probably not be taken as canon without verification.

  18. mythsayer
    July 20, 2016 at 12:49 pm #

    Omg….I literally started shaking reading this. This was why I requested a c-section. I would rather risk surgery than ANY of this stuff. I don’t understand how it’s even a discussion. To me, surgery is easier and cleaner and about as risky as any of the things mentioned here. And CHOOSING surgery from the outset makes it even easier. You make an appointment. No stress.

    And I totally get that this is my opinion and many people feel the opposite about surgery bs vaginal birth. But there’s no valid reason surgeries should be vilified. In he modern world, it’s a perfectly valid way to have a baby. Especially if you’re only planning to have one. Mine is six. I just turned 38. Never planned another and I won’t be having anymore (particularly because now I take methotrexate which is a literal poison and would kill or severely maim a fetus…so there’s no question that I will not be having another baby).

    Choice should be the name of the game. Always.

    • Glia
      July 20, 2016 at 1:24 pm #

      And INFORMED choice! I did not want a scheduled c section, but needed one for baby’s safety. I was disappointed because of all I’d heard about how terrible they were. Instead, I had an awesome, calm, beautiful c section and a pretty easy recovery.

      I was told a lot about the risks of a c section, but so little about the risks of a vaginal birth, let alone how nice a section could be. I feel that I went into the section pretty well-informed, because I had the time to read and learn before it happened, but if I’d gone into a vaginal birth as planned, there was some pretty important information that I wouldn’t have known.

      • Sue
        July 21, 2016 at 12:31 am #

        Ironically, you hae to be told all about the risks of surgery, because it is an “intervention”, but there is no equivalent requirement to explain all the risks of vaginal birth, including no requirement to quote one’s individual outcomes.

    • Daleth
      July 20, 2016 at 3:06 pm #

      My feeling exactly. And I went into pregnancy planning to deliver with CNMs at my hospital’s birthing center. That was before I found out what third and fourth-degree tears were, what shoulder dystocia was, what a levator ani injury was…

      When I had to fight my doctors to schedule a CS (even though I was carrying twins and one was breech most of the time), they tried to scare me off with tales of how there can be wound healing issues with c-section incisions. I said, “I would much rather deal with wound healing issues in an incision on my belly than in a tear on my vag!”

      • Elizabeth Neely
        July 20, 2016 at 8:09 pm #

        I could nor even imagine a vaginal birth, I cried and begged for a c section, and my doctor was a peach and said of course dear, whatever you want, it is your body. Wow

        • Jennifer
          July 21, 2016 at 11:56 am #

          I loved my c-sections. Both of them. The scar is so small now you can barely see it.

      • Sue
        July 21, 2016 at 12:29 am #

        “I would much rather deal with wound healing issues in an incision on my belly than in a tear on my vag!”


        Those “healing issues” with the lower abdominal wall, even if it gets infected or causes an ugly scar, are rarely associated with any long-term functional impairment.

        • Daleth
          July 29, 2016 at 10:07 am #

          Those “healing issues” with the lower abdominal wall, even if it gets
          infected or causes an ugly scar, are rarely associated with any
          long-term functional impairment.

          Bingo. I actually did end up having wound-healing issues in my incision, because I had gained so much water weight in late pregnancy (get this: a few days after birth they finally, after much begging because I was in misery, gave me diuretics and I lost 60 pounds in 10 days!). The fluid got into my incision and opened it partly up, so I needed a wound vac for I forget how long, 3-4 weeks or so.

          But the thing is, the nurse who came to my house every couple of days to change the dressing on my wound vac specialized in treating obstetric patients, and she mentioned that she had several patients with wound vacs ON THEIR GENITALS. Omfg. Imagine having to wear a wound vac for weeks between your legs. And how scary, to spend that whole time just praying that things get even close to back to normal down there.

    • angry and scared
      July 20, 2016 at 3:36 pm #

      That’s great if you can find a doctor to do the c-section. These days, many ob/gyns are as full of woo as the worst midwife.

      • attitude devant
        July 20, 2016 at 4:05 pm #

        So, ask around. I do them. And ACOG supports maternal request caesarean. Ask.

        • angry and scared
          July 20, 2016 at 11:45 pm #

          I have asked several gynecologists. I want to be certain of getting a c-section before I get pregnant. Each and every one has respond by trying to talk me into a vaginal birth and telling me that nobody in their practice/hospital does elective sections.

          What state are you in?

          • Charybdis
            July 21, 2016 at 10:52 am #

            You might try collecting a list of vaginal birth complications, everything from minor to fucking devastating and ask the doctor why they are touting vaginal birth as “safe” or “better” or “whatever”, given the fact that any number of things can go wrong. A planned CS removes all of that uncertainty. The doctors cannot guarantee you an easy vaginal birth with no injuries or long-lasting repercussions to both you and the baby. Mention you are not willing to gamble with your pelvic floor or the fact that you are reliably toilet trained, have been since toddlerhood, and are not willing to chance incontinence. Ask them straight out who DOES do elective CS and you will go see them.

            Or, just outright tell them that you hope like hell that you develop some complications (placenta previa, GD, pre-enclampsia) so that a CS becomes necessary.

          • Daleth
            July 29, 2016 at 10:14 am #

            You might try collecting a list of vaginal birth complications,
            everything from minor to fucking devastating and ask the doctor why they
            are touting vaginal birth as “safe” or “better” or “whatever”, given
            the fact that any number of things can go wrong. A planned CS removes
            all of that uncertainty.

            Exactly. But I found that in arguing with my doctors about a c-section, the one thing I said that really gave them pause and helped convince them to stop stonewalling was what you wrote here:

            The doctors cannot guarantee you an easy
            vaginal birth with no injuries or long-lasting repercussions to both you
            and the baby.

            I had a whole medical team because it was a high-risk pregnancy, so several times I had basically this conversation:

            Me: I’d like to schedule a c-section because I’m not comfortable with the risks of VB.

            Doctor: Well, VB is generally safer. Why, I had a patient last week smaller than you who had triplets vaginally, no problem!

            Me: That’s great, but you can’t guarantee that that’s how it will go for me. There are women who have serious complications and there’s no way you can guarantee that I won’t be one of them.

            Doctor: (…silence…)… Well, no, we can’t guarantee. Of course we also can’t guarantee you wouldn’t have complications from a CS.

            Me: Right, of course not. But there are different possible complications from each, and I’m just not comfortable risking the complications of VB, so I want to schedule a CS.

          • Roadstergal
            July 29, 2016 at 11:46 am #

            I like this idea. Ask for, in writing, a guarantee that the VB will be easy and safe and have no short- or long-term complications. Say you’ll either sign that, or a C/S informed consent :p

      • mythsayer
        July 20, 2016 at 11:54 pm #

        That’s why I said choice SHOULD be the name of the game. It’s not, and it should be. I fully believe is have been forced into a vaginal birth if I hadn’t moved to Japan when I was 15 weeks pregnant (just turned it that way…got pregnant, then we got orders to Japan). My Japanese OB was willing to do the c-section.

        Doctors should support them and I think it’s wrong that a lot don’t. I can have a tummy tuck. Why the heck shouldn’t I be allowed to choose a c-section?

    • AnnaPDE
      July 21, 2016 at 12:38 am #

      This is exactly how I approached the whole thing, too. Luckily my OB had zero problems with this.
      Unfortunately, turns out that the painful sex thing 7 months later can still happen — if anyone has helpful ideas on that, I’m all ears!

      • Jennifer
        July 21, 2016 at 11:57 am #

        This can sometimes be caused by hormonal imbalances. I’d get your levels checked. If they’re off you can use estrogen creams or take hormones pills.

    • antigone23
      July 21, 2016 at 2:52 pm #

      If I knew the true risks of vaginal birth, I would have had an elective c-section with my first. I had one with my second and it was worlds easier. Things have gotten better than the nightmarish first year, but my daughter is almost 6 and I still have painful scar tissue in my vagina. I still have to be extremely careful during sex. I wish with all my heart I could have my old vagina back.

      • guest
        July 22, 2016 at 12:38 pm #

        I’ll second that. I would go back in a heartbeat and have a C-section. It never occurred to me that sex could be changed forever (although looking back it seems obvious it would have an effect). Mine first is 5 and I still have to be careful as well. The 2nd child completely changed it all – everything that used to feel good is horribly painful and everything that used to have no sensation now feels good. I’m a whole new person and my husband and I have had to relearn everything. It is a real blow to my self esteem and our marriage. I am very vocal about this to women close to me that are pregnant and usually get shushed by the older women. I don’t care, I wish someone had told me these things before.

    • manders
      July 22, 2016 at 3:23 am #

      I recently had an elective c-section (July 13) and I am so happy with how my recovery is going (very well) and just so relived my OB-GYN agreed with me about possibly preventing long term pelvic floor damage to preform the surgery. He told me he has seen 8 lb. babies just rip women apart. I was nervous when delivery day came but determined to have the C-section and I am so glad I did! I read a study somewhere that said mothers who have had maternal request (elective) c-sections are overall very satisfied with their choice and do not regret them. It is an elective surgery but it isn’t the same as getting breast augmentation or liposuction – it is the birth of your child and should be an available option for any women giving birth.

  19. CSN0116
    July 20, 2016 at 12:46 pm #

    I know that the literature always shows that cesareans are associated with increased maternal morbidity (compared to vaginal), but isn’t it referring to things like high BP in the immediate postpartum period and stupid shit that remedies rather quickly?

    I always hear about the “horror” of permanent numbness at the scar line, but how does that compare to a permanently numb vagina?!

    From my experiences, women feel like they have to love vaginal birth and that it’s always less damaging than a cesarean, so even if they’re suffering with post-delivery issues, they will not discuss them, not even with their doctors.

    What do I know? My vagina stayed in tact throughout my two scheduled cesareans (I never labored), but that bitch is never going back to normal after my two vaginal deliveries (2nd degree tearing with the first). I have to use larger size tampons now, and while sex is less painful (penetration), I have considerably less sensation – thank God clitoral sensation stayed in tact. My cesareans are responsible for none of that.

    • T.
      July 20, 2016 at 1:19 pm #

      Part of the problem IMHO is that se are taught not to discussione some things. Speaking about numbness in your vagina is in general less well seen as speaking of numbness anywhere else…

    • guest
      July 20, 2016 at 2:10 pm #

      I’m sure the numbness is permanent for some people, and I don’t want to discount that experience, but my numbness was gone after a year. And while it was there, I didn’t find it unpleasant or problematic in any way.

      • Taysha
        July 20, 2016 at 2:58 pm #

        6 years in I’m still numb.

        Affects me exactly nothing, tbh.

        • fiftyfifty1
          July 20, 2016 at 4:29 pm #

          It took me 8 years to be entirely free of numbness. It only affected me during the first few months. All my undies had elastic that hit exactly right over the scar, and it gave a creepy feeling when it would rub. So I wore granny undies for the first ~9 months.

      • Roadstergal
        July 20, 2016 at 3:08 pm #

        My husband had numbness along a surgical scar for over a year. My PT was very aggressive about scar work, in contrast to his, and mine was gone before 6 months. I think that’s another part of all of this that gets lost – how responsive surgical scars can be to PT. Mine mentioned at the time that she ‘does’ a lot of C/S recovery.

        • fiftyfifty1
          July 20, 2016 at 4:27 pm #

          Hmmm. I would need to see some data for this. In my clinical experience, results seem random based on the individual. Some people heal quickly, some people don’t, some produce a lot of scar tissue, some don’t. Some seem to regenerate sensation within months, some never do.

          • Roadstergal
            July 21, 2016 at 3:29 pm #

            I’d love it if there is some data! My husband and I had very similar collarbone breaks, even on the same side; we both got two surgeries, one to put in the plate and one to remove it (okay, my husband had three, because he re-broke his). For both of my recoveries, I had quick loss of numbness and the same PT; for his first two, he had long numbness and a different PT. For the third, he had shorter numbness and yet a third PT, but I did some of the things for him my own PT had done to me. But for the third, he had the ortho I had for both of mine, different from his previous orthos. So we had both surgeon and PT correlated with easier recoveries. :p

      • Erin
        July 20, 2016 at 4:42 pm #

        My dental nurse has been numb for 29 years. I have feeling back and got it back quite quickly. It came back weird though at first. You could pinch the left hand side of my stomach and it would hurt on the right for a while.

        • guest
          July 20, 2016 at 5:16 pm #

          Nerves can be weird. I cut the tip of a finger off not too long ago with a veg peeler. Bled like crazy, but no pain, because I apparently cut off just the right amount of nerve (or something – I am no doctor). Then it was numb for a while, and now parts of that finger are very painful if tapped.

        • MaineJen
          July 20, 2016 at 5:45 pm #

          My chin is like that. If I touch the left side of it, I feel it on the right. Very weird.

    • Azuran
      July 20, 2016 at 2:29 pm #

      Honestly, not including people who have pain, what is so bad about having some numbness on a line on your lower abdomen? When is physical sensation of the skin in the lower abdomen an important thing in life? NCB are making it to be such a huge thing.

      • Daleth
        July 20, 2016 at 3:03 pm #

        I know, who cares? And who cares if there’s a little pooch or overhang or whatever there? Would you really prefer numbness and a weird little pooch in your genitals?!?!?!

        • Anna
          July 21, 2016 at 4:53 am #

          I think both can be frustrating. However so many women don’t even have numbness or pooch after CS but the NCB talk about it as an inevitable outcome. Having myself experienced both throughout this year and having recovered from both I can say it did suck at times. But more like a reminder of the fact that my delivery was not what I wanted it to be. The pooch is definitely not so attractive, the numb feeling is weird but neither in itself is such big deal in fact. I now have no pooch but my scar is kind of deep into the skin. Whereas some women I know had even skin after the CS right away and some had the pooch after vaginal delivery. My grandmother still does and she had an otherwise uncomplicated vaginal birth. But she was never into physical activity and always a bit overweight.

        • Sarah
          July 21, 2016 at 4:27 pm #

          I must admit I do care about the hang. Couldn’t give less of a shit about the numbness though, and quite proud of the now sadly fading and unobtrusive scar. I felt it was my war wound!

          • guest
            July 21, 2016 at 4:45 pm #

            My c-section incision doesn’t have any hang so far, but something about pregnancy made my very old appendectomy scar develop hanging skin over it. 🙁

      • mythsayer
        July 21, 2016 at 12:05 am #

        It’s a little annoying, I have to be honest.

        My numbness is actually from my tummy tuck and thigh lift and not from the c-section. My TT and thigh lift were both extensive. The TT scar wraps around my hips on both sides by about 3 inches and my thigh lift scars are both about 10 inches long. It’s been 5 years since I had the plastic surgery so the numbness isMOSTLY gone but there is some permanent numbness.

        Early on, it was REALLY annoying (but totally worth not having a whole pile of hanging skin on my tummy and legs…I lost 140 pounds so I had a LOT of hanging skin). It just feels strange to feel normal and then feel nothing. But the nothing still feels like something because you can still feel almost like phantom pressure. It’s not a normal numbness.

        It’s really hard to describe.

        But I can tell you that if you weren’t happy about getting an emergency c-section (or even a planned one) in the first place, and it wasn’t something you were willing to deal with for a healthy baby (or in my case, the delivery I wanted, since I scheduled my CS at my 35 week appointment and never even tried labor), I can understand why you’d be really upset about permanent numbness, even if it’s just a tiny bit.

        Yeah it’s a small thing, but you notice it everytime you put clothes on. And it’s the WORST when your partner touches you on the numb part, especially if you weren’t expecting the touch. Just really…disconcerting.

        So yeah. I’m the champion of c-sections. But I won’t lie about numbness being a comfortable feeling.

        • demodocus
          July 21, 2016 at 10:11 am #

          Congrats on losing that much weight!

          • Charybdis
            July 21, 2016 at 10:55 am #

            Second that! Good for you! You’re my hero for today!

      • Mishimoo
        July 21, 2016 at 7:20 am #

        I have some numbness in patches on my right leg, which doesn’t bother me and I rarely notice. The only feeling is a phantom burning pain when I think about it too much (burn scars). They’re not a big deal to me, but I can understand how others would be frustrated by it.

      • momofone
        July 21, 2016 at 9:06 am #

        I have no numbness (that I notice) from my c-section. The numbness from my mastectomies is more troublesome; I have phantom pain and sensations that don’t match touch (I’m sure there’s a way to put that that makes more sense, but I’m not sure how)–itches that burn if scratched, or that are only resolved if I scratch someplace else, as in itching on my chest but having to scratch my forearm to resolve it. I also have lymphedema, so I’m not sure if or how that plays into it. My c-section scar is the old-fashioned kind and I have no trouble from it.

    • Daleth
      July 20, 2016 at 2:48 pm #

      I know that the literature always shows that cesareans are associated with increased maternal morbidity (compared to vaginal), but isn’t it referring to things like high BP in the immediate postpartum period and stupid shit that remedies rather quickly?

      Yep, and here are some links about a recent UK study that looked at every birth over a 3-year period (so more than 2 million births) and found that scheduled pre-labor CS was almost 20% LESS likely to kill the mother than attempting vaginal birth:

      One thing that’s shocking to me is when research compares outcomes in moms who had CS vs moms who had VB and concludes “omg CS is associated with higher morbidity–we should definitely urge women to choose VB instead of CS!”

      The problem with that is that there’s no way to know in advance whether an attempted VB is going to work, and about 1 in 4 of them don’t–they end in emergency CS. By comparing all women with CS to all women with VB, they slant the results in favor of VB because they’re only putting the successful VB into the VB category. They put all the unsuccessful VB into the “CS” category and then somehow conclude that the women who had whatever type of morbidity had it because of the CS, when in fact it may well be because they spent 20 hours in labor before getting the CS! And it may even be because of the problem that caused them to need a CS in the first place (for instance, an exhausted uterus that can’t contract strongly enough to get the baby out also can’t contract strongly enough to stop the bleeding, so you are at high risk of postpartum hemorrhage).

      Long story short, a lot of “CS-associated morbidity” may actually be morbidity caused by the long, unsuccessful labor that preceded the CS.

      • Glia
        July 20, 2016 at 2:54 pm #

        Ah, the beauty of the “intent to treat” model! So many errors in analysis happen when it is not used.

    • Taysha
      July 20, 2016 at 2:50 pm #

      I have some numbness around the area of my scar, but it’s not horrible (I’m sure some people have some horrid complications).

      My personal take has always been a c-section is a “controlled” injury – the surgeon has complete control and knowledge of how things can turn and we have a pretty good handle on how to avoid complications and mitigate them.

      Vaginal birth has no safety net. You can’t predict complications effectively, you can’t control tearing, you play catch up to every problem.

    • StephanieA
      July 20, 2016 at 10:51 pm #

      Yep. I had a great vaginal birth the first time around, but the second one was awful. I cried the first time my husband and I had sex after that delivery- everything felt loose. It’s gotten better over time and with kegels, but it makes me angry that no one takes this seriously. Vaginal birth is not worth ruining your sex life, in my opinion.

  20. fiftyfifty1
    July 20, 2016 at 12:44 pm #

    I’m glad that Cosmo ran this piece, but am bummed that in each of the case examples there was a pat miracle cure. One woman is fixed with a week of estrogen cream. The other goes from severe urine and stool incontinence and pelvic organ prolapse to Voila! Cured! with physical therapy. The truth is that well designed research studies show that PT provides no improvement for fecal incontinence or pelvic organ prolapse. The article also makes it sound like CS has no advantage over vaginal birth for preventing pelvic problems. In reality, pre-labor CS is extremely protective for fecal incont and POP.

    • J.B.
      July 20, 2016 at 1:02 pm #

      Examples are tough, and presumably part of the reason for providing those was to suggest that yes you can treat issues. My history with physical therapy is really complicated, and I think that it does not lend itself well to insurance codes. I’ve seen three different physical therapists in my life – the first two for shoulder and back problems and the last for hip and low back pain. The second physical therapist said “why are you here?” Umm, because I hurt?

      My issues start from anatomy and were worsened by pregnancies (although not impacted much by birth.) The shoulder issues are partly related to the low back stuff but it’s only the latest PT who actually looked at that in detail. As a result I’m finally making progress!

      If you come in complaining of pain in one spot that is what insurance will pay for. There’s a lot of variability among therapists, and if they are used to seeing very injured people they may ignore “minor” stuff – until it gets worse of course!

    • Megan
      July 20, 2016 at 1:24 pm #

      Yes, I was thinking this too. In many cases, the treatment for these problems is anything but a miracle cure.

    • moto_librarian
      July 20, 2016 at 1:50 pm #

      Yeah, I wish that they would have at least mentioned that surgery is often the only effective therapy. Physiotherapy helped with the urinary incontinence, but it’s never going to fix the nerve damage or the rectocele. Problems like mine are the direct result of vaginal birth, not pregnancy.

    • lawyer jane
      July 20, 2016 at 2:17 pm #

      I agree that a review of the actual evidence would have strengthened the article. But two of the examples of “miracle cures” (PT for one and the estrogen cream for the other) are for pain — not prolapse or incontinence. Are there studies on that? I’d be a skeptic about the PT, except for having had such amazing results with it myself for back pain.

      • fiftyfifty1
        July 20, 2016 at 4:40 pm #

        “I’d be a skeptic about the PT, except for having had such amazing results with it myself for back pain.”
        I would encourage you to be a skeptic anyway despite your n=1 for an entirely different body part. Pelvic floor PT may or may not help with pain (the one woman’s example), and has mixed results with urine incontinence, but has been shown NOT to help with fecal incontinence and POP which is what the other woman claimed it did for her. And it makes sense that PT couldn’t help with fecal or POP. How could PT possibly help with what is a structural problem (severed muscles, disrupted sphincter)?

        • Meredith
          July 22, 2016 at 5:06 pm #

          Yeah, that article bothered me as well because it made physical therapy out to be almost magic. I liked going to pelvic floor physical therapy, but I think its role has been oversold in some circles. Personally, physical therapy was helpful simply so someone could check my ability to kegel, check my muscle tone and strength, and teach me how to lift things correctly, etc… What really bothers me is when physical therapists start to incorporate woo or non-evidence based modalities into their practice. The simple kegel (or pelvic floor muscle training) is fairly evidence based and personally it has been amazing in terms of managing the symptoms of my prolapse and keeping me active, which then in terms builds up overall strength and keeps my weight down, which can itself help manage the symptoms of prolapse. But I’ll still probably need surgery post menopause and I don’t see how any physical therapy would change that. Anyway, I’m guessing you are in the medical profession (?). I write a small blog about the postpartum body, specifically the pelvic floor and diastasis recti, but although I recommend pelvic floor physical therapy, I’m hoping to write a piece about its limitations as well ( Any good sources you’ve come across?

    • Daleth
      July 20, 2016 at 2:40 pm #

      Even CS during stage 1 of labor is very protective. It’s after stage 2 that you’ve already sustained a lot of the damage so there’s not much other than tearing for CS to protect you against.

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