Photo credit, Serenity Strull/BBC
Warning: This article contains details of traumatic medical experiences that some readers may find disturbing.
It's 2024 and I'm in the hospital, once again. I have been suffering for about 36 hours from pain that even morphine cannot relieve. As the surgeons will find when they cut me open, parts of my intestine have protruded into a breach in my stomach wall. This caused a perforation, leaving pus all over my abdomen, leading to a dangerous infection.
While waiting for the surgery, I texted my husband all my bank details, in case I didn't make it. The pain is blinding. I'm gagging intermittently, even though I haven't eaten anything in two days.
The operation lasts five hours. I wake up at midnight, still dizzy, in the intensive care unit, with a six-inch (15 cm) incision running from my belly button to my pelvis and a large drainage tube in my abdomen. How did I get here? And what does this have to do with childbirth?
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While we know that childbirth can be dangerous, we talk less about the physical problems that can last beyond the first few years and affect women even decades later. Although my particular situation is rare, childbirth-related complications that appear later in life are alarmingly common.
It is estimated that globally, around 40 million women per year are affected by complications that last for months or even years. These can range from urinary and fecal incontinence to chronic pain and even scar tissue formation which can lead to life-threatening bowel problems or harm future fertility.
Some of these problems, like mine, don't appear until years later and can persist indefinitely. I spoke with several women, as well as with experts, to get a clear idea of the lasting physical and psychological after-effects that childbirth can cause. I've heard from women that they often feel like they're not being listened to, or worse yet, not having access to treatment.
I didn't intend to reflect on my own experiences for this column, because I hate feeling vulnerable. But by talking about complications and increasing public awareness of the risks of childbirth and how to get help, I hope other women will feel more empowered to advocate for themselves.
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It's a story as old as time. Childbirth is risky and can cause complications or worse for both mother and child. Fortunately, maternal deaths have become rarer in many parts of the world. Between 2000 and 2023, the rate of maternal mortality relative to live births fell by 40% globally.
Yet the focus on reducing maternal mortality has often led to neglect of the long-term effects of labor and delivery, according to a large global study carried out in 2024 by a team of international researchers.
Joshua Vogel, a perinatal epidemiologist at the Burnet Institute in Australia and lead author of the study, said it was worrying how many women are unable to seek help for themselves, especially since it can be difficult to distinguish what is normal from what should be monitored. “I was amazed by the bewildering diversity of these complications,” he said.
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In my case, it all started with an emergency C-section.
Four days after my daughter was born, I was back in the hospital to have another emergency surgery. My stitches had completely come undone and I had developed a serious complication in my intestines. It was a traumatic experience, described as a medical “never event” because it was so rare. But I was delighted that my little girl, just born, was doing well; So I put that episode behind me and focused on how lucky we were both to be healthy.
Seven years passed, punctuated by another pregnancy, and everything seemed to be back to normal. Then, one Wednesday afternoon, I felt sudden abdominal pain that gradually got worse. I was at work and I remember being on a video call while lying on my bed, camera off, hoping it would go by quickly. At 4:30 p.m., I texted my husband: “It’s really bad, I can see my stomach moving.” I still just thought I had bad gastro. But looking back, I realize that I was no longer thinking rationally.
Maybe that's why I somehow managed to find the energy to pick the kids up from school, even going so far as to lift my child's bike and put it in my car. But the pain only got worse. Eventually, my husband contacted his sister, who is a doctor. She said it could be adhesions – scar tissue – from my C-section, causing an obstruction in my intestines. When I started vomiting, she advised me to call an ambulance. Since none were available, I took a taxi, even though at that point I could barely stand.
At the hospital, an intestinal obstruction was confirmed. The initial C-section, followed by the medical error that led to my second surgery, had left significant scar tissue inside my abdomen, which was now restricting blood flow to my intestines.
Sometimes the blockages clear up on their own; so I spent 36 endless hours waiting to find out if I was going to have to have surgery. On the second day, my temperature skyrocketed and my blood tests revealed that the level of C-reactive protein, a marker of inflammation, had reached a dangerously high level, rising from 1 to 311 (a normal level is less than 5). The decision was made to operate on me as soon as possible (even though, in a busy hospital, that “as soon as” took another five long hours…).
After the procedure, the surgeon explained to me how well the operation had gone, even though it had turned out to be more complex than they had imagined. They resected 60 cm (23.5 inches) of the part of my intestine that had been deprived of blood and oxygen, but the procedure had saved my life. Once again, over time, I recovered well and the stoic in me said, “It could have been worse.”
But the medical complications were not over.
Photo credit, Serenity Strull/BBC
Major abdominal surgery
Globally, the use of cesarean section is increasing and accounts for approximately 21% of all births. In some countries, this figure reaches 58% (Dominican Republic). In the United States, it exceeds 32%. C-sections can be vital in protecting the health of mother and child, but they come with an increased risk of complications, says Soo Downe, professor of midwifery at the University of Lancashire.
When complications arise, they are not always immediately apparent. A US study that followed 43,646 mothers for 50 years found that those who gave birth by cesarean section had a 16% higher risk of death during this period compared to those who gave birth vaginally. They also had a higher risk of death from cardiovascular disease, diabetes, respiratory disease, infections and kidney disease.
Stefanie Hinkle, a perinatal epidemiologist at the University of Pennsylvania in the United States and co-author of the study, explains that the reasons for this phenomenon are not yet clearly established. Women who had a C-section were more likely to be older, had a higher BMI, smoked, or had diabetes or other pre-existing conditions, but this link persisted even after researchers took these factors into account.
One hypothesis is that cesarean section is an indicator of poorer general health. “Another explanation is that the surgical procedure itself affects long-term health, for example through complications such as infections, blood clots or cardiovascular events, or through the formation of scar tissue and complications in subsequent pregnancies,” says Hinkle.
It is clear that cesarean sections come with many long-term risks. They can lead to an increased risk of ectopic pregnancy, which is a pregnancy where the fertilized egg develops outside the uterus. Scars left by C-sections can increase the risk of placenta accreta, a condition in which the placenta anchors too deeply into the uterine wall.
Like many women I know, I haven't really taken these risks seriously because C-sections have become so common that it's easy to forget that it's a major abdominal surgery.
Lack of follow-up
In a cruel irony, the surgery I needed after the first bowel obstruction created even more scar tissue inside my abdomen. Therefore, four months later, the same problem recurred and I found myself back in the operating room to undergo another emergency procedure. Luckily there was no infection or perforation this time as the team operated on me the same day. I was told it could happen again tomorrow, decades later, or never, as I am now at permanent risk of recurrence.
Anyone undergoing abdominal surgery can develop scar tissue, as shown in my case. A 2017 Swedish study of women found that 37% of women who had ever had a C-section had abdominal adhesions, compared to 10% of women who had never had one.
Because adhesions can stick internal organs together, they can lead to abdominal pain and intestinal obstructions, as well as a slight increase in the risk of maternal and infant mortality in future pregnancies, which is higher in emergency deliveries. Adhesions can also surgically complicate subsequent cesarean sections, increasing the risk of bladder and bowel lacerations. The fact that the number of C-sections is increasing means more women could be at risk of complications, Downe says.
Vaginal births can cause lasting physical aftereffects
Vaginal deliveries can also cause many complications.
Heather Barnes, now around 75 years old, suffered a fourth-degree tear during the birth of her daughter more than 40 years ago. This means that the anal sphincter, the muscle that holds in gas and stool, is torn, as is the lining of the anus or rectum.
Barnes still suffers from chronic pain and complications today. Forceps, curved metal instruments resembling large pliers, were used to help extract her daughter, who was trapped. This caused him to have fecal incontinence, perineal pain and pudendal nerve damage. “I suffer every day. I never really get a break,” she explains.
Ms. Barnes' case is far from isolated. Urinary and fecal incontinence are extremely common in the decades after childbirth, especially among women who have given birth vaginally. A study of women 20 to 26 years after giving birth found that 61% had urinary incontinence, 22% had fecal incontinence, and 17% had symptoms of pelvic organ prolapse.
Suzanne Hagen, professor of health services research at Glasgow Caledonian University in the United Kingdom and lead author of the study, says what these statistics don't reveal is the devastating effects of these problems on these women's lives, on their relationships and on their ability to work.
Ms. Barnes, for example, felt too traumatized to have another child and was unable to return to work. “The stress of knowing at any moment that I could have an accident is simply unbearable,” she told me. At the time, no one talked about incontinence or pain. “We didn’t even talk to her best friend about it,” she adds.
It is estimated that up to 90% of women will experience at least one tear, abrasion or episiotomy – an incision made between the vagina and anus to widen the opening to allow the baby's head through – during a vaginal birth. Deliveries requiring the use of instruments such as forceps or ventouse – a device attached to the baby's head by suction – are associated with significantly higher tear rates. Deeper tears come with an increased risk of urinary or fecal incontinence, pain during sexual intercourse, or the need for reconstructive surgery.
Women of South Asian descent are at higher risk of vaginal tears. A fact that mother-of-one Kajal Da Silva was unaware of until she suffered a fourth-degree tear.
“It's like your whole life still revolves around this injury,” says Da Silva, six years after suffering the injury during childbirth. “I couldn't make plans without thinking about what I'm going to eat, what I'm eating, what I'm doing the next day, or planning my route to make sure there's a toilet along the way. »
Kajal Da Silva still suffers from chronic pelvic pain, cannot sit or stand for long periods of time and has no plans to have more children. “There is no way I would allow myself, mentally, to even consider having another child,” she says.
Chronic pain
Whether the delivery took place vaginally or by cesarean section, pain is common in the years following birth. It may be due to damage to the pudendal nerve, which runs through the pelvis and controls movements and sensations in this region, particularly in the genitals, anus and urethra.
It is widely established that women's pain is not always taken seriously by health professionals. A 2024 British report on childbirth injuries, for example, mentions an incident in which an obstetrician allegedly told a midwife that "women don't have nerves in the vagina" while stitching up a patient who had not received adequate pain medication.
Barnes says she only found out about pudendal nerve pain through the press. “No one believed I was really in pain,” she said.
Mental health
Some lasting consequences of childbirth are not physical, but psychological. We know that these two aspects are linked. Indeed, a negative experience of childbirth is recognized as a major risk factor for developing mental health disorders after birth, as well as a persistent fear of childbirth.
Dimple Mistry, a mother of two, still suffers from flashbacks and triggers that take her back to the trauma of her fourth-degree tear six years ago. She had to have a stoma – an opening in the abdomen that allows stool and gas to pass through – after her stitches came undone and led to an infection.
“I was passing stools through my vagina, and I knew something was wrong,” Ms. Mistry said.
Following these experiences, when she was pregnant with her second child, she explains that one of her greatest fears was going into the hospital and dying during childbirth – and this fear had a profound impact on her.
Ms Mistry's stoma was reversed, but she now suffers from bowel emergencies, chronic abdominal pain and pelvic pain due to adhesions at the surgical site. “I think basically my intestine is stuck to the wall of my stomach. As a result, when food passes, it cannot circulate freely,” she explains, which leads to persistent abdominal pain.
“It’s as if the baby is the candy and the mother is the wrapper. Once the candy is taken out of its wrapper, we throw it away” – Alison Stuebe
And while there is now greater awareness of postnatal mental health in the year following birth, it is often overlooked that many women continue to suffer from mental health problems many years later.
An analysis found that approximately 4.5% of women continued to experience depressive symptoms throughout the three-year follow-up period. It is estimated that approximately 10-15% of new mothers experience depression, which is the most common postpartum mental health disorder. Other disorders include anxiety, post-traumatic stress disorder (PTSD), and postpartum psychosis.
Neya Joshi, herself a mother of two, developed PTSD following her time in the maternity ward following an emergency C-section in 2020. She felt abandoned and unsupported.
“I was physically incapable of taking care of myself, let alone my newborn, and yet I was left alone to manage everything,” says Neya Joshi. With the support of a perinatal psychologist, she recovered from her PTSD a year after giving birth, but then developed premenstrual dysphoric disorder (PMDD), which causes intense feelings of depression and hopelessness a week or two before her period. Research has shown that these two disorders are often linked.
Joshi's mental health symptoms worsened after the birth of her second child, affecting her daily life. “I tend to suffer from fatigue, intense irritability, low mood, anxiety, insomnia and nightmares. Living this half-life while raising two young children has been a real challenge,” she says.
Like the other people I spoke to, Joshi also had difficulty obtaining an accurate diagnosis and receiving appropriate support. She has since trained as a postnatal doula and is determined to help others experiencing postpartum distress.
Plea for support
Obviously there is no silver bullet for many of the postpartum complications, but knowing what supports are available can be an important first step.
In a 2019 report looking at women's experiences of care after pelvic organ prolapse, a UK-based team of researchers found that many were slow to seek help. This was partly because they felt embarrassed or felt like their symptoms were not being taken seriously. One woman suffered for 30 years and only went to see her doctor when her symptoms got worse.
One of the main reasons why so many women suffer for years is that care is often focused on the baby rather than the mother, leaving women often feeling alone or lacking information and support.
Alison Stuebe, a professor of obstetrics at the University of North Carolina, wrote in a report: “It's as if the baby is the candy and the mom is the wrapper. Once the candy is taken out, we throw away the packaging. »
Part of the problem is that women are typically only offered a few check-ups after giving birth (although policies vary from country to country), says Vogel, meaning that possible lingering problems can go unnoticed. It is therefore unclear how long many women continue to suffer before seeking help, if at all. “We don't even really know what happens to each of them after giving birth,” he adds.
A recent survey revealed that women overwhelmingly felt that there was “a need for prolonged follow-up” one year after giving birth. Of course, many new parents simply don't have time to think about themselves when caring for a child.
Added to this are preconceived ideas regarding the period following childbirth. “An important element is the idea that some discomfort or impaired function is normal,” says Vogel. He says it's common for women to simply expect complications and say, "Well, that's how it is for me now...I'll pee when I cough, or I can't run..."
Among the women I spoke to, Da Silva found that physical therapy helped relieve some of her symptoms, but she had to pay for the treatment out of pocket. Being able to track the progress of his physical recovery has also had a positive effect on his mental health. “When you can see with your own eyes that things are improving, that’s when everything changes,” she explains. She also took advantage of support groups, one of which she now runs. “You can meet women from your region who have suffered the same injuries as you, and you no longer feel isolated. »
Barnes also explains how recognizing her suffering and being believed helped her cope, especially since her pain had been ignored for years. “The fact that a doctor told me years ago that I was a rather stupid and neurotic woman will stay with me forever,” she says. Her advice to other women is to never stop fighting to be heard. “These wounds are like a cruel thief stealing your life. Don’t let it take over your entire being,” she adds.
In my case, I initially didn't know what adhesions were – no one had ever told me that I was at increased risk after my previous surgeries.
Despite everything that happened, I still consider myself lucky to have recovered well from each complication and to feel no pain on a daily basis. I also learned firsthand how important it is to fight to get the medical help you need.
On a daily basis, I rarely think about the trauma or the risk. But when I have the occasional stomach ache, I find myself thinking about what another trip to the hospital would entail and what I would say to get emergency treatment.
As many experts have told me, knowledge can be a powerful tool. So I hope that by sharing these thoughts, others will know what to watch out for and when to seek help.
*Melissa Hogenboom is a senior health correspondent at the BBC and author of *Breadwinners* and *The Motherhood Complex*. Her Instagram account is @melissa_hogenboom.
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