Pregnancy, birth and your pelvic floor

Trigger warning: birth trauma

Pregnancy and birth can be a beautiful time, but the experience is not the same for everyone. For some women, the journey involves difficulty conceiving, complications during pregnancy, a birth that didn't go as hoped, or any number of other challenges along the way.

This chapter of life can leave a lasting impact – emotional as well as physical – and birth injuries can affect all areas of a woman's life.

Birth trauma and injury don't just come in the form of physical injury. According to the Australasian Birth Trauma Association over 33% of women in Australia experience birth trauma – it doesn't have to be a dramatic or life-threatening experience to cause lasting psychological harm. The support you receive from medical staff and your birth support person plays a significant role in how safe you feel, and that sense of safety shapes how you experience and recover from the birth.

Modern maternity care can feel very focused on the baby, leaving mothers feeling like their own wellbeing doesn't matter. But you do matter – you have to prioritise yourself too. You can't pour from an empty cup and you can't care for others if you're not caring for yourself.

Most common causes of birth injury

We spoke to Professor of Midwifery and Associate Dean of Research at Western Sydney University, Dr Hannah Dahlen AM, about preventing birth injuries and the associated pelvic health, bladder control and bowel control problems that can come afterwards.

“Pregnancy, childbirth and menopause can all impact your pelvic floor and cause incontinence symptoms”, Professor Dahlen tells Bridge.

“Injuries from childbirth can include tears to the anus/rectum, perineum, or vagina. Your risk of injury will depend on multiple factors such as genetic differences (it runs in families), the weight of the baby, if forceps or a vacuum are used, and the length of time pushing. However the greatest risk to women during birth is fragmented maternity care. Relationship-based care has been shown by research to be very protective against birth trauma, however this continuing care where you see the same midwife for appointments that will go on to deliver your baby is only offered to 14% of patients in the Australian public health system."

How do these injuries cause incontinence?

Damage to the muscles that make up your pelvic floor when your vagina, anus or rectum get cut (episiotomy) or tear during birth can cause problems with the muscles function and their ability to squeeze and release at the right time for you to hold, store and release your poo and wee when you want to.

Problems caused by pelvic floor injuries can range from small leaks of wee or poo when you cough or jump (stress incontinence) to fully losing control of your bladder or bowel. You can also have a prolapse which is where part of your internal organs bulge or protrude into your rectum or vagina because the muscles, ligaments or connective tissue have been damaged and can't support the pelvic organs properly.

Bladder and bowel control symptoms can have a big impact on women’s quality of life, especially when trying to adjust to caring for a newborn and the extra responsibilities and tasks that come with raising children.

After the birth

A top tip for birth support people: write down everything health professionals tell you, even if it doesn't seem important at the time. You will both be overwhelmed, and you won't remember as much as you think.

Keep a watch for symptoms or changes in your body in the first few months after birth and don’t be embarrassed to tell your doctor about any incontinence symptoms. There are often ways to treat, cure, or better manage your leaking. All women should go for an internal pelvic floor assessment with a women’s health physio, even if they don’t experience symptoms, to check everything is healing and functioning correctly.

“Many people suffer in silence and think complications with your bladder and bowel are a normal part of being a woman,” says Professor Dahlen.

“But it is not normal if it doesn’t heal and resolve with time. If you are more than three months postpartum and experiencing pain, discomfort or changes in bladder or bowel control ensure you get a referral to a specialist and keep pushing for answers and treatment.

"Within the next 10 y ears I would really like to see pre- and postnatal checks with a pelvic floor physio included as a standard part of every woman's maternal care. I would also love to see changes in the healthcare system where healthcare providers don’t minimise women’s experiences."

Tell someone if you have changes to your pelvis, bladder or bowels after childbirth.

Whatever the pain, discomfort, leaking, or loss of control you are experiencing, it is important you confide in friends, family, and your health professional. It can be very lonely managing it alone, and in sharing your experience you will often find that more people than you think have been through or are going through something similar.

Prof Dahlen's top 7 tips to avoid birth injury

1. Seek a continuing care model where you see the same midwife for appointments that will deliver your baby.
2. See a pelvic floor physiotherapist for an assessment of your pelvic floor function from 20 weeks.
3. Go to all appointments and scans so you have information about your baby's size and position.
4. Maintain whole-body fitness with regular exercise as well as pelvic floor muscle training (this includes contraction and relaxation) during pregnancy.
5. From 34 weeks start regular perineal self massage to prepare the area to stretch during birth. Your midwife or pelvic health physio can provide guidance.
6. Have a birth plan and know your options for different scenarios. Talk to your birth partner in advance so you are both clear on the plan.
7. During vaginal birth, ask your midwife, doctor or support person to try to slow down delivery of the baby's head and shoulders and apply a warm compress on the perinium to reduce pain and also significantly reduce the chance of 3rd and 4th degree tears.

Check out the Australian birth story podcast to hear lived experiences of Australian women during conception, pregnancy and birth.

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