In this podcast, experienced urogynaecologist Dr Deepa Gopinath will be discussing the topic of childbirth trauma, including what childbirth trauma is, how a patient would typically present, physical injuries of childbirth, the tools available in assessment and more.
This is the first podcast in a two-part series on childbirth trauma. Tune into our second podcast on this topic, discussing the specific treatment options & the role of health professionals.
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMd studio Dr Deepa Gopinath
Deepa Gopinath is a urogynaecologist with dual subspecialist qualifications from Australian and United Kingdom. She is the lead clinician for Urogynaecology at the Nepean Hospital in Western Sydney and treats women with pelvic floor problems. She has several special interests, including recurrent prolapse and incontinence, but is passionate about the pelvic floor problems in women at the end of the spectrum from post-partum to frail elderly. She is actively involved in creating multidisciplinary team models, improving access to health information to the women and shared decision making. She has also published and presented widely.
Today, we’ll be discussing the topic of childbirth trauma. Tune into our second podcast on this topic, discussing the specific treatment options & the role of health professionals.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.
Dr Gopinath, thanks for talking with us on PodMD today.
Deepa : Thank you for having me.
The topic of today’s discussion is childbirth trauma. Deepa, Can you describe for our listeners what childbirth trauma is?
Deepa: For most women, giving birth is a positive experience. For some it may be a mixed or negative experience. Child birth trauma is a broad and complex concept that often describes a series of related experiences and negative psychological responses to childbirth. There may be physical trauma to the mum or the baby, but this is often not necessary.
It is thought that at least a third of the births can be traumatic and this can result in long lasting negative impacts not only in the woman’s life, but also their partners, children, friends, and family. Consequences of traumatic birth include mental health problems, compromised maternal- infant relationships, poor marital relationships and concomitant depression in the partners and present a challenge to future reproductive decisions. Traumatic birth and its negative sequelae have only begun to be properly recognised in the last 15 years
How would a patient with childbirth trauma typically present?
Deepa: As you can see, childbirth trauma is a very broad concept. The injury sustained may be physical or psychological and one can lead to the other. Physical injury is often due to the damage to muscle and connective tissue supports of the pelvic organs. The muscles can be over stretched or even ripped from its attachments which reduces the overall stength. This may present immediately or delayed after months or years. However, if the injury is severe, the onset may be a lot quicker. Examples of physical injury would include urinary and fecal incontinence, pelvic organ prolapse, dyspareunia or painful sex or pain over the tear or episiotomy.
Psychological trauma is often presents as depression and even post-traumatic stress disorder. Women may feel with a low mood, extreme sadness, frequent spells of crying, lack of interests, negative thoughts, feeling of being overwhelmed by daily tasks, mood swings, feeling disconnected from partner or baby, problems with appetite and poor sleeping. As you can imagine, a physical injury can cause psychological trauma, hence its important to investigate to find the cause of the depression when a woman presents to your clinic and find out if there is birth trauma
Let us talk more about the physical injuries. Are some women more at risk of these than the other?
Deepa: Yes, Women are twice as more likely to have physical injury with vaginal birth compared to a caesarean. Research shows that only a 1/3rd of women who attempt a normal birth achieve atraumatic birth and avoid serious pelvic floor trauma. However, having a caesarean gave only partial protection from pelvic floor problems as it also depends on other factors like your family history, body mass index, lifestyle choices etc.
Mums are now a lot more older well into their thirties when they are having their first baby. Having a bigger baby over 4 kg, assisted vaginal birth especially with forceps, having baby in the back-to-back or occipitoposterior position etc are all risk factors. One of the major barriers of prevention is the difficulty to identify every woman who may be at risk of a severe physical injury.
Going into the details, how does physical injury manifest in the affected woman?
Deepa: These vary depending upon the type of injury. If the supportive connective tissue and the muscle of the pelvic floor is damaged, this can result in leakage of urine, prolapse of the vagina where the bowel and bladder may herniate into the vagina and present as a vaginal lump. This can then cause difficulty with bladder and or bowel emptying. This can cause anxiety, altered body image and affect sexual relationships. If the injury is in the anal sphincter complex, this can result in leakage of wind and stool from the back passage. They may present with painful sex which may be due to painful scarring in the perineum or discomfort in the vagina.
Are there any tools that help in assessing these risks during pregnancy and perhaps help the woman and partner to be better prepared?
Deepa: Though the ideal goal would be to identify all women at risk and recommend vaginal birth to those women who are unlikely to sustain serious physical injury, this is far from realistic. However, there is a tool that help in identifying women who may be more at risk of developing pelvic organ prolapse and urinary incontinence. This was developed from the information available from two prospective longitudinal studies (PROLONG and SWEPOP) where women giving birth vaginally and by caesarean after their first birth were followed up for 20 years. This risk prediction model is called URCHOICE and is available easily on line just on google search. Given that a caesarean section is not completely protective, the idea is to get a individual risk and then have an informed discussion with the woman and partner about mode of birth.
There are preventative strategies during pregnancy and labour that can also be implemented to minimise damage and its important that these are discussed with woman and her partner at 32-36w gestation. This includes perineal massage and pelvic floor exercises, optimising body weight. There are also specific care bundles developed and practiced in Australia to prevent perineal trauma and anal sphincter injuries.
Thanks again for your time Deepa, that gives us a great summary on what Childbirth Trauma actually is. In our next episode, we’ll discuss specific treatment options & the role of health professionals. We’ll include the link to URCHOICE in our show notes.
Deepa: Thank you