Image source: Serenity Strull/BBC
From urinary and fecal incontinence to chronic pain, millions of women continue to suffer from childbirth complications even decades later.
Warning: This report contains details of traumatic medical experiences that some readers may find disturbing.
It's 2024, and I'm in the hospital again, suffering for about 36 hours from pain that not even morphine can relieve.
As surgeons would discover when they opened my abdomen, parts of my intestine had pushed through a gap in the abdominal wall, perforating the intestine and accumulating pus inside the abdominal cavity, causing a serious infection.
While I was waiting for the operation, I sent my husband a text message with all the details of my bank accounts, in case I would not survive. The pain was unbearable, and I was suffering from repeated attempts to vomit, even though I had not eaten for two days.
The surgery took five hours, and when I woke up in the middle of the night, I was still sedated in the intensive care unit, with a 15cm incision running from my navel to my pelvis, and a large tube to drain fluids from my abdomen.
How did you get to this state? What does all of this have to do with childbirth?
It is known that childbirth can involve risks, but what does not receive as much attention are the physical problems that can continue beyond the first years of childbirth, and affect women even decades later.
Although my particular case is rare, birth-related complications that appear later in life are alarmingly common.
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It is estimated that about 40 million women around the world are affected annually by complications that last for months or years, and these complications range from urinary and fecal incontinence and chronic pain, all the way to the formation of scar tissue that may cause life-threatening intestinal problems, or affect the ability to reproduce in the future.
Some of these problems, as happened to me, do not appear until years later, and may continue indefinitely.
I spoke to a number of women and experts to get a more comprehensive picture of the ongoing physical and psychological damage that childbirth can cause, and heard the experiences of women who often felt unheard, or worse, that treatment was not available to them.
I wasn't going to revisit my personal experience in this article, because I don't like feeling vulnerable, but I hope that talking about these complications, and raising awareness of the risks of childbirth and access to support, will help other women gain more confidence and be able to demand the care they need.
Life-saving interventions with lifelong effects
It's a story as old as time. Childbirth is risky and can lead to complications, or worse, for mother and child. Fortunately, maternal deaths are becoming less common in many parts of the world. Between 2000 and 2023, the rate of maternal deaths compared to the number of live births has fallen by 40 percent globally.
But the focus on reducing maternal mortality has led to a lack of adequate attention to the long-term effects of labor and delivery, according to a large global review conducted by a team of international researchers in 2024.
Joshua Vogel, a specialist in perinatal epidemiology at the Burnett Institute in Australia, and the lead researcher on the review, says it is worrying that many women are unable to claim support for themselves, especially since the distinction between normal symptoms and those that require investigation may not be clear.
“I was astounded by the sheer variety of these complications beyond comprehension,” he adds.
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In my case, the problems started with an emergency caesarean section, and four days after my daughter was born, I went back to the hospital for another emergency surgery. The sutures had completely ripped open, and I had serious bowel complications.
It was a traumatic experience, and was classified as what is medically known as an “accident that should not have happened” and could have been avoided.
But I was happy that my newborn daughter was okay, so I put the experience behind me and focused on how lucky we were to have survived together.
Seven years passed, during which time I had another pregnancy, and everything seemed to be back to normal, and then, one Wednesday afternoon, I felt sudden abdominal pain that was gradually getting worse.
I was working, and I remember participating in a video meeting while lying in bed, with the camera off, hoping that the pain would go away soon. By 4:30 p.m., I sent my husband a text saying, “It's so bad, I can see my stomach moving.”
However, I still thought I had a severe gastrointestinal infection, but now in retrospect I realize that I was no longer thinking rationally, which is probably why I somehow managed to muster what energy I had left to go to school, pick up my kids, and even hoist one of them's bike into the car.
But the pain got worse.
Finally, my husband called his sister, who is a doctor, and she said that the cause might be adhesions, that is, scar tissue that formed as a result of the cesarean section, and caused an intestinal obstruction.
When I started vomiting, she asked me to call an ambulance, but there was no ambulance available, so I took a taxi, even though I could barely stand.
At the hospital, doctors confirmed the presence of an intestinal obstruction, after the first caesarean section, and then the medical error that required the second surgery, led to the formation of dense scar tissue inside my abdomen, which began to impede blood flow to my intestines.
In some cases, a bowel obstruction goes away on its own, so I spent 36 hours in intense pain waiting to find out if I would need surgery.
On the second day, my temperature rose sharply, and blood tests showed an increase in the level of C-reactive protein, which is an indicator of inflammation, from 1 to 311, although the normal level is less than 5.
It was decided to perform the operation as quickly as possible, even though the phrase “as quickly” in a crowded hospital meant waiting another five hours of pain.
After the operation, the surgeon told me that it went well, although it was more complicated than the medical team expected, and the surgeons removed 60 centimeters of my intestine, after depriving those parts of blood and oxygen, but the operation saved my life.
As time went by, I recovered well again, and I said to myself, with my usual sternness: “It could have been worse.”
But the medical complications did not end there.
Major abdominal surgery
Caesarean section rates are high around the world, accounting for about 21 percent of all births. In some countries, the rate reaches 58 percent, as in the Dominican Republic, while it exceeds 32 percent in the United States.
A caesarean section may be necessary to protect the health of the mother and baby, but it may carry a higher risk of complications, according to Sue Down, a professor of midwifery at the University of Lancashire, and when it does occur, it does not necessarily appear immediately.
An American study that followed 43,646 mothers over 50 years found that women who underwent cesarean sections were 16 percent more likely to die during the follow-up period than those who gave birth naturally.
The study also observed an increase in the risk of death resulting from cardiovascular disease, diabetes, respiratory disease, infection, and kidney disease.
Stephanie Hinkle, a specialist in perinatal epidemiology at the University of Pennsylvania and co-author of the study, says that the reasons for this association are not yet clear.
Women who underwent C-sections were, on average, older, higher in body mass index, and more likely to smoke or have diabetes or other pre-existing health conditions, but the relationship remained even after the researchers took these factors into account.
One possible explanation, Hinkle explains, is that a cesarean section may be an indicator of poorer overall health.
"Another possibility is that the surgery itself affects long-term health, for example through complications such as infection, blood clots or cardiovascular problems, or through scar tissue and complications in subsequent pregnancies," she adds.
It is clear that there are many long-term risks associated with a caesarean section, as it may increase the risk of ectopic pregnancy, a condition in which the fertilized egg grows outside the uterus.
The resulting scars may also increase the risk of placenta accreta, a condition in which the placenta attaches abnormally deep into the uterine wall.
I, and many women I know, haven't thought much about these risks, because C-sections have become so common and familiar that it's easy to forget that it's major abdominal surgery.
Lack of medical follow-up
In a cruel irony, the surgical treatment I needed after my first bowel obstruction led to more scar tissue forming inside my abdomen.
That's why, four months later, the same problem happened again, and I went back to the operating room for another emergency surgery.
Fortunately, this time there was no infection or perforation of the intestine, because the medical team performed the surgery on the same day.
I was told that the problem might happen again the next day, or after several decades, or it might never happen again, and I was now at risk of it happening again for the rest of my life.
As my case shows, anyone who undergoes abdominal surgery can develop scar tissue.
A 2017 study of women in Sweden found that 37 percent of women who had previously undergone a cesarean section had intra-abdominal adhesions, compared to 10 percent among women who had never had a cesarean section before.
Because these adhesions may connect internal organs together, they may cause abdominal pain and intestinal obstruction, as well as a slight increase in the risk of death for the mother or infant in subsequent pregnancies, which are higher risks when the birth is an emergency.
Adhesions can also make subsequent caesarean sections more surgically complex, increasing the risk of bladder and bowel ruptures.
Dawn says the rise in caesarean section rates means more women may be at risk of these complications.
Natural childbirth may cause permanent physical damage
Numerous complications can also arise from vaginal birth, as Heather Barnes, now in her mid-70s, suffered a fourth-degree tear while giving birth to her daughter more than 40 years ago.
This means a tear in the anal sphincter, which is responsible for controlling the passage of gas and stool, as well as a tear in the lining of the anus or rectum.
The most common long-term complications:
Other less common conditions include pelvic organ prolapse, post-traumatic stress disorder, thyroid disorders, nerve injuries, cardiomyopathy associated with pregnancy and childbirth, and obstetric fistula.
To this day, Barnes still suffers from chronic pain and complications resulting from the use of obstetric forceps, a curved metal instrument used to help extract her daughter after her exit became difficult during birth, causing her to suffer from fecal incontinence, pain in the perineal area, and damage to the pudendal nerve.
"I'm in pain every day, and I don't get a single day of rest," she says.
Barnes' experience is not an exceptional case.
Urinary and fecal incontinence are very common problems decades after childbirth, especially in women who gave birth vaginally.
One study, which looked at women between 20 and 26 years after giving birth, found that 61 percent of them suffered from urinary incontinence, 22 percent from fecal incontinence, while 17 percent had symptoms of pelvic organ prolapse.
What these statistics don't show is the devastating impact these problems have on women's lives, their relationships and their ability to work, says Susan Hagen, professor of health services research at Glasgow Caledonian University in the United Kingdom, and the study's lead researcher.
Barnes, for example, was so traumatized that she was unable to think about having another child, nor was she able to return to work.
“The stress of knowing that I could have a bowel movement at any moment is absolutely terrifying,” she told me.
At that time, talking about fecal incontinence or pain wasn't common, and Barnes says, "We didn't talk about these issues even with our closest friends."
It is estimated that up to 90 percent of women experience some degree of tearing, abrasions, or episiotomy during vaginal delivery. An episiotomy is a surgical cut between the vagina and anus to widen the outlet in front of the baby's head.
Births that require the use of instruments such as forceps or a suction device, which is attached to the baby's head to help extract the baby, are associated with much higher rates of ruptures.
The deeper the tear, the greater the risk of urinary or fecal incontinence, pain during sexual intercourse, or the need for reconstructive surgery.
Women of South Asian descent face a higher risk of vaginal tears, a fact that Kajal da Silva, a mother of one, was unaware of until she suffered a fourth-degree tear.
“It's as if your whole life still revolves around the injury,” says Da Silva, six years after she was injured during childbirth.
She adds: "I can't make any plans without first thinking about what I'm going to eat, what I'm going to do the next day, and how I'm going to plan my trip to make sure there's a toilet on the way."
Da Silva still suffers from chronic pelvic pain, cannot sit or stand for long periods, and does not plan to have more children.
“I psychologically cannot even allow myself to think about having another child,” she says.
Chronic pain
Whether vaginal or caesarean delivery, pain is a common problem during the years following childbirth, and may result from damage to the pudendal nerve, which runs through the pelvis and controls movement and sensation in that area, including the genitals, anus, and urethra.
It has been proven in many studies and reports that health care workers do not always take women's pain seriously.
For example, a 2024 British report on birth-related trauma cited an incident in which an obstetrician allegedly told a midwife that “women have no nerves in the vagina,” while suturing the wound of a patient who did not receive adequate pain relief.
Barnes explains that she only learned about pudendal nerve pain through a newspaper.
“No one believed I was in pain,” she says.
Mental health
Not all of the lasting effects of childbirth are physical, some are psychological, and the two types are known to be related to each other.
The negative experience during childbirth is a major risk factor for developing mental health problems after childbirth, as is the constant fear of childbirth.
Dimple Mistry, a mother of two children, still suffers from memories and situations that bring back the trauma of her fourth-degree tear six years ago.
She underwent a surgical procedure to create a stoma, an opening in the abdomen that allows stool and gases to be diverted out of the body, after her sutures came loose and became infected.
“The stool was coming out through my vagina, and I knew something was wrong,” Mistry says.
As a result of this experience, Mistry explains that one of her biggest fears during her pregnancy with her second child was being hospitalized and dying during childbirth, a fear that had a major impact on her.
The stoma was later closed and her bowel path was restored to normal, but she now suffers from an urgent need to defecate, and chronic pain in the abdomen and pelvis due to adhesions at the surgical site.
“I think my intestines are basically stuck to my abdominal wall, so when food passes, the intestines cannot move freely,” she says, which leads to continued pain in her abdomen.
Although there is increased awareness of mental health problems during the first year after giving birth, what is not sufficiently understood is that many women continue to suffer from these problems years later.
One analysis found that about 4.5 percent of women continued to have depressive symptoms over a three-year follow-up period.
It is estimated that between 10 and 15 percent of new mothers develop depression, the most common postpartum mental health disorder.
Other disorders include anxiety, post-traumatic stress disorder, and postpartum psychosis.
Nia Joshi, also a mother of two, developed post-traumatic stress disorder as a result of the treatment she received in the postpartum ward, after undergoing an emergency caesarean section in 2020.
She felt left alone, without care or support.
“I was physically unable to take care of myself, let alone my newborn baby, yet I was left to deal with everything on my own,” Joshi says.
Thanks to the support she received from a psychologist specializing in pregnancy and childbirth, she recovered from post-traumatic stress disorder a year after giving birth.
But she later developed premenstrual dysphoric disorder, a condition that causes intense feelings of depression and hopelessness during the week or two before her period, and research has repeatedly found a link between the two conditions.
Joshi's psychological symptoms became more severe after the birth of her second child, which affected her daily life.
She says, "I usually suffer from fatigue, extreme stress, mood swings, anxiety, insomnia, and nightmares. It is difficult to live a life in which I do not feel like I am living it to the fullest, while raising two young children."
Like other women I spoke to, Joshi faced difficulties getting the right diagnosis and the right support.
She has since trained as a postnatal care assistant and is determined to help others with similar problems.
Request support
Obviously, there are no quick fixes for many postpartum complications, but knowing what supports are available can be an important first step.
In a 2019 report examining women's experiences of receiving care after pelvic organ prolapse, a team of researchers in the United Kingdom found that many delayed seeking help.
This is partly due to their feeling of embarrassment, or their feeling that their symptoms are not being taken seriously. One woman suffered for 30 years, and only consulted a doctor when her symptoms worsened.
One of the main reasons why many women continue to suffer for years is that care often focuses on the child rather than the mother, leaving women feeling alone or lacking information and support.
“It's like the baby is the candy bar, the mother is the wrapper, and as soon as we take the candy out, we throw the wrapper away,” Alison Steube, a professor of obstetrics at the University of North Carolina, wrote in a report.
Part of the problem, Vogel says, is that women usually get only a limited number of follow-up examinations after giving birth, although policies vary from country to country, meaning that any ongoing problems may go undetected.
Therefore, it is still unclear how long many women will suffer before they seek help, if they do so at all. “We don't even know for sure what happens to all women after giving birth,” he says.
ووجد استطلاع حديث أن الغالبية الساحقة من النساء شعرن بوجود "حاجة إلى مزيد من المتابعة الطبية" بعد مرور عام على الولادة.
وبالطبع، فإن كثيراً من الآباء والأمهات الجدد لا يجدون ببساطة الوقت للتفكير في أنفسهم أثناء رعاية أطفالهم، وتتفاقم هذه المشكلة بسبب التصورات الخاطئة عن الفترة التي تلي الولادة.
ويقول فوغل: "تكمن المشكلة إلى حد كبير في اعتقاد النساء أن الشعور ببعض الألم أو تراجع القدرة على أداء وظائف الجسم أمر طبيعي بعد الولادة".
ويوضح أن من الشائع أن تتوقع النساء حدوث مضاعفات، وأن يقلن لأنفسهن: "حسناً، هذه هي حياتي الآن، سيتسرب البول عندما أسعل، أو لن أكون قادرة على الركض".
ومن بين النساء اللواتي تحدثت إليهن، وجدت دا سيلفا أن العلاج الطبيعي ساعدها في تخفيف بعض أعراضها، لكنها اضطرت إلى دفع تكاليف العلاج من مالها الخاص.
كما ساعدتها القدرة على متابعة تقدم تعافيها الجسدي في تحسين صحتها النفسية، وتقول: "عندما تستطيعين أن تري بنفسك، وبصورة ملموسة، أن الأمور تتحسن، عندها يبدأ التغيير".
واستفادت أيضاً من مجموعات الدعم، وهي تدير الآن بنفسها إحدى هذه المجموعات، وتضيف: "تستطيعين مقابلة نساء في منطقتك تعرضن للإصابات نفسها، فلا تشعرين بالعزلة".
وتصف بارنز أيضاً كيف ساعدها الاعتراف بمعاناتها وتصديقها في التأقلم مع وضعها، خصوصاً بعدما جرى التقليل من شأن آلامها لسنوات.
وتقول: "لن أنسى أبداً أن طبيباً وصفني قبل سنوات بأنني امرأة ساذجة وتقلق بشكل مفرط"، وتنصح النساء الأخريات بألا يتوقفن عن المطالبة بأن يصغى إليهن.
وتضيف: "هذه الإصابات مثل لص قاسٍ يسرق حياتك، لا تسمحي لها بالاستيلاء على كيانك كله".
أما في حالتي، فلم أكن أعرف في البداية ما هي الالتصاقات، ولم يسبق أن أخبرني أحد بأنني أكثر عرضة للإصابة بها بسبب العمليات الجراحية السابقة التي خضعت لها.
ورغم كل ما حدث، ما زلت أشعر بأنني محظوظة، لأنني تعافيت جيداً بعد كل مضاعفة، ولا أعاني من الألم في حياتي اليومية.
وتعلمت أيضاً من تجربتي الشخصية مدى أهمية الدفاع عن النفس والمطالبة بالمساعدة الطبية اللازمة.
في حياتي اليومية، نادراً ما أستعيد ذكريات الصدمة أو أفكر في المخاطر، لكن عندما أشعر بألم عابر في معدتي، أجد نفسي أفكر فيما قد تنطوي عليه زيارة أخرى إلى المستشفى، وما الذي سأقوله حتى أحصل على الرعاية العاجلة.
وكما أخبرني كثير من الخبراء، فإن المعرفة يمكن أن تكون مصدر قوة، ولذلك، آمل أن تساعد مشاركة هذه المعلومات والتجارب الآخرين على معرفة العلامات التي ينبغي الانتباه إليها، ومتى يجب طلب الدعم.
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