Birth trauma, consent and the burden of hidden injuries

Maternal birth trauma has featured quite heavily in the news following the NSW government’s enquiry into its causes and the injuries suffered by women.  This is an emerging area and one where women are feeling more empowered to be more involved in planning their births and seeking help for their injuries.

  • NSW Government health consent guidelines – obligate health professionals caring for pregnant women to have early discussions with the pregnant woman about interventions that might occur in labour.
  • It is important that a woman understands the nature of the injuries that she might suffer in the childbirth process so that she can give informed consent. The importance of timing in the consent process.  Those of us who have been through labour know that the pain can be overwhelming, and it is difficult to weigh potential options in the throes of labour.  A pregnant women should as per the guidelines be given the time to consider her options, this should take place during the antenatal process.
  • Language is important in the consent process – a health professional may explain to a woman that she might tear after a forceps delivery and that an episiotomy can help to avoid such a tear.  There have been cases where women have refused an episiotomy because they have not understood what it meant and have gone on to have a 3rd degree tear.  Wrapped up in this decision was also a misunderstanding of what a tear actually is. 
  • A tear sounds quite innocuous and not particularly serious.  However, it is very important that women understand that 3rd and 4th degree tears together with levator anni avulsions are very serious injuries.  It is arguable that a woman who consents to a forceps delivery while understanding that she might tear has not given informed consent unless she is also told of the consequences of such a tear – such as fecal incontinence and chronic pain.
  • Cascade of interventions – it is widely accepted that in obstetric and midwifery circles that one intervention leads to another.  This means that if a woman undergoes a type of intervention perhaps as an induction to start her labour, she is more likely to have another type of intervention, such as an epidural.  Once she’s had an epidural then she is more likely to require an instrumental delivery.  This means that when a woman is being consented for an induction, she should also be thinking about the consequences of an instrumental delivery and whether she is prepared to accept those risks.
  • The injuries following a traumatic childbirth are serious and often debilitating both from a physical and a psychiatric perspective.   The physical injuries are hidden injuries, they are not on display like a broken leg.  Women feel self-conscious talking about their incontinence (urinary or fecal) to others and so many suffer in silence.  Further the impact of psychiatric trauma can also prevent women from talking about their birth and/or their injuries as avoidance is a prominent symptom in psychiatric trauma.
  • Where women are not informed of the potential injuries they might suffer, they can be very scared when those injuries materialise.  Some women have reported attending at their local hospital’s emergency department because of a pelvic organ prolapse.
  • Injuries from birth trauma can be very debilitating but they are not obvious and a woman might feel self- conscious explaining to others about her injuries. For example a woman might find it hard to sit or stand for prolonged periods, this can affect her ability to work. A woman might find her genitals are damaged and scarred, this might affect her intimate relationship with her partner. A woman might find she has to use the toilet frequently and for a long time this will affect her ability to attend social events and might make her more reclusive and likely to stay at home.
  • Legal process – in the medico-legal setting.  We read the medical records very carefully and attempt to work out whether the injury suffered by the woman (or baby) was avoidable.  If we think there is some evidence to suggest that the injury was avoidable, we send the medical records to an obstetrician who acts as an expert witness in legal cases.  We will ask that obstetrician if the injury could have been avoided and whether certain steps should have been taken to avoid such an injury.  If the expert obstetrician agrees with our case theory, then we can start a case in the court.  Most cases do not run to a full hearing and are settled outside of court by way of mediation.  We seek compensation for the costs of past and future treatment, time off work, pain and suffering and for the costs of cleaning services.

If you have been affected, get in touch. We do not charge for our first consultation and we offer a non win no fee service. We have helped many women and their partners access compensation to help them to live their injuries.