IT’S a subject that is rarely spoken about, but one which adversely affects thousands of women every year.
Cork barrister, Doireann O’Mahony, is keen to open up a conversation about faecal incontinence, arising from tears while giving birth.
She recently organised Exit Wounds, an educational event in Dublin where more than €8,000 was raised for the hardship funds of Nurture Health, an organisation which works on a sponsorship basis around the country, including Cork. It provides affordable counselling and support services — with a ‘no wait list’ policy — to those affected by birth-related trauma, whether concerning conception, pregnancy, childbirth or other related difficulties.
Doireann studied law in University College Cork before joining the Bar in 2012 and has been practicing since, specialising in the area of medical negligence.
It is through her work that she has met women with postpartum health issues, many of whom have largely been keeping quiet about injuries sustained during the delivery of their babies through the birth canal and the resultant faecal incontinence. Why the silence?
“Women can feel totally isolated, like they’re the only person in the world with it. They feel deeply ashamed so they hide the problem, they won’t even talk to their GP. They see it as a personal failure. It has diminished them in their own eyes, so therefore they think it must have diminished them in the eyes of others too.
“They might even believe that their incontinence is a normal consequence of childbirth. It’s only when they finally talk to a solicitor that they express what has happened to them.”
Doireann brings up statistics that illustrate the scale of the problem.
“The Royal College of Obstetricians and Gynaecologists’ (RCOG) figures show that fourth-degree tears — the most severe type, which involve the perineal muscle, anal sphincter and/or rectum being damaged — increased three-fold in the ten years to 2012.
As many as 10% of mothers in the UK who give birth through the birth canal will develop some form of anal incontinence, a devastating life-long injury.”
In Irish terms, she estimates that there are 6,000 women per year suffering the same fate, many of whom are afraid to leave the house.
As she explained in her Exit Wounds address: “The impact of such an injury on a young woman is catastrophic. Her entire life is controlled by faecal incontinence. She may experience unconscious soiling, finding after the event that an accident had happened.
“More commonly, she may find that she has no control over wind and such a degree of urgency that she has only minutes (in some cases only a few seconds) to reach a bathroom before a major disaster.”
Doireann paints a picture of lives completely altered by these injuries, the majority of which follow vaginal delivery with forceps.
“For professional women, it’s often the end of their career; she’s not able to continue. Relationships break down; husbands leave wives eventually. There’s a huge psychiatric fall-out. There are so many devastating aspects.”
So why is this happening?
“Babies are getting bigger across the board and mothers of bigger babies should be informed of the risks and have the option of elective surgery.
“Also, junior doctors are not getting as much training as they would have before, especially in instrumental delivery with a forceps. The skills for delivering by forceps are being lost. It’s a very highly skilled thing to do. Before, they’d have been in all the time, seeing senior doctors doing it and doing it themselves under supervision,” she maintains.
Lessons can surely be learned from other countries such as Denmark, where there hasn’t been a single forceps delivery in 14 years; instead a suction cup called a ventouse is often used.
Doireann believes attitudes in society must also change.
“There’s a huge pressure on women to go down the route of natural childbirth, with no pain relief and a whale song in the background playing. Meanwhile, there’s a stigma around Caesarean births, with the phrase ‘too posh to push’. That’s rubbish. It’s almost a martyrdom thing, like women should be able to have a long labour and do it without any pain relief. In reality, childbirth is not without risks but no-one ever mentions the risk of vaginal delivery.
“For me, the major thing is information so people can make an informed choice. It’s very sad to hear people say, ‘If I had known; if I’d been told, I’d have had a caesarean in a heartbeat’. It’s devastating to hear someone say that.”
Is there any hope of recovery for these women?
“There are different cases. Sometimes doctors fail to recognise the injury, sometimes they do spot it and repair it but sometimes the repair is substandard. They can do corrective surgeries but the outcomes really are very poor. The best thing is to prevent these injuries in the first place.”
She concludes: “The assumption that a vaginal delivery is always to be preferred must surely now be abandoned. There should be a patient-centred approach in which the mother feels entitled to make the doctor take into account her own values. There can then be an assessment of the comparative merits of giving birth vaginally and by Caesarean section.”
Nurture Health has an accredited counsellor, Helen Anglim, in Cork city who is fully trained in the area of pregnancy and maternal mental health.
The organisation is also in the process of securing an additional counsellor in West Cork.
To find out more, phone its headquarters on 085 8619585, email firstname.lastname@example.org or see https://nurturehealth.ie