Injured during childbirth

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1:08Hello, I'm James Reynolds. Welcome to the documentary from the BBC World Service. In BBC Conversations, we bring people together to share their experiences. And this time, we take on a sensitive and rarely talked about subject, childbirth injuries. Before we get into our conversations, I should warn you that we're going to be discussing the physical impact of childbirth. That, of course, means that we will have to include some detailed biological descriptions. Research suggests that one in three women experience health problems after giving birth, and some 90 % have some degree of physical tissue tearing during vaginal childbirth.

1:50While many of these injuries do heal quickly, millions of women around the world sustain trauma that can have an impact on their long-term physical, psychological and social well-being. Later, we'll bring together health professionals, including a surgeon in the Democratic Republic of Congo. But we'll hear firstly from three women here in the UK who each suffered life-changing injuries when giving birth. Let's meet Jill, Karen and Geeta. She was injured 17 years ago when having her first child. During the delivery, unfortunately, there was fetal distress and I had a traumatic forceps delivery, which left me with what's known as a 3C perineal tear.

2:33It's also known as an obstetric anal sphincter injury. And I suffered my first episode of bowel incontinence the very next day. From then till now, I've been incontinent and suffer from pain due to nerve damage. and it really just had a huge ripple effect on my entire life. I found it difficult to leave the house. I lost my self-esteem and confidence and it was very isolating. I also lost my career as a lawyer that I'd worked so hard to achieve. So, yeah, it did have a huge impact. Just to echo what Geeta was saying, my story was quite similar. My pregnancy was unremarkable. I went into labour with my first child and, unfortunately, again, it was fetal distress.

3:15I had a very urgent forceps delivery. Mine had actually resulted in a rectal and vagina tear. So I actually started passing feces through my vagina, which was very distressing. That happened a few days after birth. But I'd been examined, told I was fine, was sent home. I then got readmitted. I was extremely unwell, had a really, really nasty infection and was admitted and had to be taken to a different hospital to be repaired. I had my new baby. Bichu was breastfeeding exclusively. It was awfully traumatic for me and my husband. I still remember me going off in an ambulance with her and my husband had to follow in the car.

3:52It was horrendous. And I was taken to theatre and I was told, when you wake up, you'll have a stoma. So they gave me a stoma bag and a leaflet and said, this is what you're going to have to get used to. This is going to be your new life. I didn't have a stoma. I was able to remain functional, but I still have issues to this day. This was 15 years ago that happened. I still have issues with incontinence, with pain and the psychological impact. So for me, I'm very, very happy when people have new babies, but I can't sit there and listen to birth stories. It's a real trigger for me. So there are lots of things that still impact my life.

4:26Yeah, it's been quite a lonely, isolating and taboo experience. It's really hard if you have a sore knee. You can bring that up at dinner. People will talk about your knee pain, but it's really hard to bring this up sometimes. and it's traumatic for the family around me as well so it's really hard sometimes to know when and how to bring this kind of thing up but I'm really really happy that the BBC is starting to talk about this people are bringing it out of that taboo bracket and it's coming out into conversation I really hope somebody's listening to this and feels empowered to reach out you know I've been listening to Geeta and to Karen and all of it resonates very similar sort of situation easy pregnancy gave birth to a premature baby he was six weeks early resulted in a forceps delivery which resulted in a fourth degree tear and a recto vaginal fistula so a fistula is an abnormal connection in the body mine was between the rectum and the vagina just like karen has described and just like karen i also ended up with a permanent colostomy which is a type of stoma and a stoma is a bowel diversion surgery.

5:31Just like Geeta and like Karen, I was left with extremely severe mental health problems, including PTSD. And just like Geeta, I lost my job. So I was actually a frontline police officer and I lost my job as a result of all my injuries and my mental health problems. I remember saying to some friends, you know, I've had some difficulties after the birth and there was sort of like whispers. Oh yes, I did hear that so-and-so's mum had a bit of a problem, but I'm not really sure what happened. and, you know, there was nobody to talk to about it and it's very isolating and it's very lonely. You really have to struggle not to feel ashamed that your body has failed you because you're led to believe as a woman that this is sort of what we're here to do, is to get pregnant and give birth to babies easily and without any problems afterwards.

6:15But like Geeta and Karen have touched on, you know, there's been so much work done by so many people in different organisations over the last 10, 15 years that it isn't becoming the taboo that it was and women are seeking more help because it's something that just happens to you and it's not our fault and it is very common unfortunately but um you can recover i'm a great believer in people being able to turn their life around tell us then jill how your life is right now so my life right now is it is great you know i'm very privileged i'm very fortunate that i literally just have a stoma i did manage to turn my life around physically and mentally in 2023 i became the first person in the world to swim the english channel solo with a stoma i beat the men can i just say that it's very important to get that in

7:06and i've set up a charity actually called chameleon buddies which supports women in the uk but predominantly in kenya to adapt to living with a childbirth injury or a stoma what we're all about is peer support which i think as we're talking about now it's really really important to have a sense of community. Last year a group of 17 women climbed Kilimanjaro, the vast majority of us with childbirth injury or trauma or stomas, to raise money for the charity and that was giving people an opportunity to turn their negative situation and their trauma into something positive which was really empowering.

7:43Going back to Gita, our first guest, how did you deal with the fact that you were suffering from extreme injuries at the same time you had a little baby to look after? So it was very difficult. It was very difficult. You know, you're constantly rushing to the bathroom, you're having accidents, and actually things got so bad, I needed to move in with my parents, which wasn't the part of my plan at all for that extra support. But my mum, who was luckily a doctor, she was able to then advocate for me to get the care that I needed. As both Karen and Jill have said, it is very isolating when your friends are going to baby groups and doing all normal activities you know my life revolved around hospital appointments for both myself and my daughter Maya because unfortunately she was injured as well and Karen how then did you deal with the fact that you were injured you had a small baby and no doubt every time you went online there were pictures of perfect lives out there which must be very hard to look at it was really challenging and for me there was actually a moment where I actually looked online I thought surely there must be other women out here that have had this so I searched for rectovaginal fistula and birth injury and I was actually redirected to a site that supported women in sub-saharan Africa with this and the first line said this has been eradicated in the western world due to our high levels of medical care and it was quite a shock for me I thought wow there's no literally nobody out there so I did find it really hard I did pull back from all of those baby groups I didn't make social links it took me about two or three years actually to be able to confront that trauma and actually talk about it but then actually build a different life that didn't revolve around those baby groups where people still talked about their birth stories which I didn't want to do it was really really hard but I have to say for me my husband has been incredible he's been an amazing source of support and understanding and I think if you have one or two really strong relationships in your life or and sometimes they come from areas you're not really expecting them come from just lean into those people and speak to them speak to somebody about what's going on it's amazing it can be an amazing support i mean the women that we're dealing with and the young girls that we're dealing with who are also a lot of them undergoing fgm and early marriage which complicates pregnancies even further they're completely ostracized from their communities their husbands will leave them some of them have their children taken off them because they've got a bowel injury of some description as a result of having a baby this means that the young girls can't go to school, they lose out on education, the older ones can't go to work.

10:13I mean, it's really, really catastrophic the impact that childbirth injuries have on women in countries like Kenya. And that's why it's really important that we give them the opportunities to level out that inequality and give them access to proper medical supplies and peer support. When we bring them all together for the first time in our support groups, they cannot believe that anyone else has been through the same thing as them which i think resonates with all three of us here in this conversation but even more so for that kind of community and i would just also just to add is that you know women really should not suffer in silence having bowel incontinence after a child birth is not normal so if any woman in the uk or internationally is suffering please do go and and seek support i want to keep the attention of course on you and the focus on you as women and the injuries you've suffered.

11:05But I think it is also, for our audience, important perhaps to ask another question, which is, can men understand this? Do men really get what you've been through? For me, I think the answer is yes, through literally witnessing and experiencing the trauma that they see their partners experience. They also see what their friends that have had babies are going through, and that experience is really shattered for them. For me, my husband's paternity leave, which was two weeks long was taking me in and out of hospital and so he had no he had very limited special time with that new baby it was all about me and he's never ever complained but that must be quite traumatic for him to see so for me in my experience I would say yes but please can can people listen to our experiences be you male or female just please listen because I've also had experiences from women when I've told them what's happened and I've been I've literally been either sensationalized and people have said oh I can't believe that that's that's that's awful what about this and sort of they're using my story as something exciting to tell somebody else or they just don't believe me so I think whoever you are please listen to us and these women and learn from what we have to say would be my message and the thing I would say to learn from all of us is that you know education is really empowering we do not need to be protected from information about childbirth we need to be given information about childbirth we need to be told our personalized risks because then we actually can advocate for ourselves join childbirth you know sometimes there's nothing you can do about it things do go wrong sometimes but at least if you've got that education piece of knowledge you're not left vulnerable and it's that vulnerability that causes the trauma and your respective kids are now all growing up what if anything do you plan to tell them about the injuries that you sustained giving birth to those children?

12:58Well, I would like to answer that, if that's OK, because since my son was born, I've been open completely. He's known literally from the age that he could understand words that this is what's happened to his mum and why it's happened. Because I think in the darkness where secrets are, that's where problems arise and that's where stigma comes from and lack of understanding and lack of education. I agree. So I think if we can't be honest with our own children and our own families, we can't expect people to be honest with the general public and with each other. So my mantra in life is no secrets, no shame.

13:32And that's certainly how my son's been brought up. And it's normalized the whole thing. You know, he doesn't feel any guilt over this because it's not his fault. But it's important. It's part of his life story. So, yeah, there's no secrets in my house. and with my daughter Maya she's actually got a physical injury from it on her face so there was no hiding the story from her and actually she's become part of my journey she's very proud of the work that I do you know to help advocate for other women I'm very honest with my children and they know all about my story so yeah I would echo what the other two ladies have said absolutely just keen to hear as we end in a couple of minutes time how you all are right now and what a good day looks like even with the injuries you sustained what what enjoyment feels like in in your own lives uh gita firstly i feel like i'm very lucky because first of all i started volunteering with the masic foundation and then a few years ago i was fully supported back to my law firm so but now i actually am in a different role i i purely work in advocating and supporting other women in patient safety and maternity safety so i feel very lucky now to be doing work that I'm doing.

14:42A good day is not having an accident, but that generally doesn't happen. But yeah, things have moved on. For me, I work, I work, I'm a physiotherapist by background. So I do a bit of clinical work, but also I've got a research and education role as well. A good day for me looks like getting up, having minimal pain, because I still struggle with quite a lot of pain. not having a bowel accident. But what's quite interesting is I look all right. Nobody really realises anything going on, but there's a huge scaffold of strategies sitting behind me that cover pain control, the right amount of exercise, and making sure I open my bowel before I leave the house.

15:24So the other day when I was going out early, I had to wake up an extra hour and a quarter earlier to make sure my bowel was empty. I have to eat the same things. I have to have a very rigid routine. So for me, a good day is doing all of that and not having an accident and my pain being about a two or three out of ten. For me, definitely. For example, yesterday I was at work and I got a photograph sent to me by the team in Kenya of a five-year-old holding up her little stoma bag, really pleased that she'd got one. That, for me, is a really good day because it makes me realise I'm part of a community of women empowering each other and that something positive has come out of my experience.

15:57And that is what I hold on to every single day. And that's what we're doing here today. Jill, Karen and Geeta, our thanks so much to them for sharing their personal experiences so openly. And in case you were wondering about all the background sounds you heard during that conversation, it took place during our daily programme, Outside Source, which we host live from the BBC's busy newsroom here in central London. I'm James Reynolds. You're listening to the documentary from the BBC World Service.

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19:10In our first conversation, Jill spoke about the connection she has with women in Kenya who've been through a similar trauma. That is where we want to start our second conversation by speaking to Dr. Vindya Pantidana. She works in Kenya. She's also treated women in India and in Tanzania. We'll also hear from Lucien Wasingya Kassadeka, a surgeon in the Democratic Republic of Congo who operates on women with birth injuries. And we'll hear from Emily Pullen, a midwife working for the National Health Service here in the UK. We begin with Dr. in Kenya. Compared to what you see in UK, childbirth injuries are much more common in this part of the world.

19:53Some which you cannot prevent with very good practice, but majority can be prevented if the women are well educated and then they were prepared. If you look at Asia, you do not get a lot of perineal birth injuries because they monitor labour and they give epithetomy. But here I have seen nobody gives an epithetomy and then you support only the perineum in the end of the day. You'll get teared so bad. We're trying really hard in the NHS to educate women because I think that's one of the most important things that women know, that this is a common thing that can happen during childbirth. Women, we know, want to know as much information as they can and what they can do even in their pregnancy to start preparing the perineum ready to kind of deliver their little one.

20:47There's other practices that we can do to even hold the perineum when the baby's head is crowning, even consider doing an episiotomy. So that's like a controlled cut away from the back passage if we're worried about a tear extending to that area. But we know that sometimes, no matter the best clinical practice, sometimes these obstetric injuries do happen. So sometimes that's one of those things, no matter what we've kind of done to prevent it. Child birth injuries here in Congo, they are most common because we have poor access to safe delivery. Many women, they end up delivering at home or in the roads.

21:29And in unstable areas where there is war, like in the eastern part, some they run to the bush and they deliver in the bush so that we got quite a big number of childbirth injuries. Women, they end up leaking urine or stool. The community does not understand this problem as a disease. They think this is a punishment from God. And this woman should go through this. And they will be stigmatized, isolated, and they will be rejected by their communities. And they will be accused as witch, that they are doing witchcraft. That is a big challenge here in Congo. And for us, we keep treating these women and we help them free of charge because obstetric fistula can be prevented and can be treated even free of charge.

22:20Doctor, how do you help women to overcome that stigma?

22:50Obstructed labour, the baby, most of the time, the baby will die. And at the end, they will be stigmatised. They will be accused that they're the one who killed the baby. And here in the UK, Emily Pullen, you've heard Dr. Wasingia Kasideka speak about stigma in the DRC. What do you see here? I believe this is probably a hidden injury that a lot of women will suffer and perhaps not tell anyone about from, you know, generations before us. women went through childbirth and they leaked urine after or they couldn't go running anymore, go out on trampolines or run for the bus or whatever it might be.

23:30So I think the generations before us kind of normalized that after having a baby, that's just what your life might look like now. There's definitely a bit of a turn now. Women are kind of saying, no, I don't want to have to live my life like that, having to wear incontinence pads and not being able to live the life that they did before childbirth. So I wouldn't necessarily say it was a stigma as such, but perhaps women just haven't spoken about it. Women's health in general, pelvic health, it's not a priority in this country, sadly still. And Dr. Pantirana in Kenya, what kind of information is available to women where you are?

24:09We see patients of poor, rich, middle class. The thing is, whichever the information a woman who gets pregnant is minimal. They are not prepared. So they do not know even simple things like to do pelvic floor muscle exercises, wear a belt when you are carrying maybe twins. It will support your back. basic information. Dr. Lusin Wasingia-Kasideka in the Democratic Republic of Congo, how much information, how much education is there where you are for women? Most of the time, the women always hide in the community. They just think that child birth injuries, they have to go through that because they have delivered.

24:59Even some midwives, they will tell them, you are no longer single girls, you are now a woman. You have to go through that. And they will hide the disease. So that we are trying to work hard to do awareness, to increase awareness. We do like TV talks and radio talks to try to explain to the women about the child birth injuries. We are getting up to 5 ,000 and 7 ,000 new cases. And most of those cases, they remain untreated in the community. So we also talk in public gatherings, even the Sunday church, the mosque, because many people do not even talk about these things. You find these most affected ones, they hide themselves.

25:51So we destigmatize the community through community involvement. You go to the counties, give talks and give the word. If anybody after giving childbirth has urine leaking or stool leaking, you come, we treat you. That sounds really interesting. It's funny to hear in different countries what the challenges are. you know yours might be in the Congo you know access to health care and diagnosis and a lot of kind of cultural beliefs whereas here in the UK a lot of women you know deliver in a hospital setting yet still we are also experiencing some of these challenges in terms of making sure women are diagnosed with these tears at the right time and they're repaired correctly and again education whilst perhaps it's not stigmatized as much as it is in the Congo for say there's definitely work that we could do perhaps.

26:48I need to start a media campaign perhaps. Emily in the UK, Vindia in Kenya and Lucien in the DRC, health professionals helping to prevent and to treat birth injuries. I'm James Reynolds. You've been listening to the documentary from the BBC World Service.

27:17the end feels like all you can manage. The stress, the responsibilities, the uncertainty, it all starts to stack up. And when you're overwhelmed, taking that first step to reach out for help can seem impossible. You might wonder, where do I start? Will I be understood? And will it even make a difference? At Rogers Behavioral Health, we understand that moment, and we'll meet you there, exactly where you are. Because together, we can help you make sense of your challenges and find the support that fits you and your life because our treatment is personalized, not one size fits all. And if you're facing anxiety, OCD, an eating disorder, depression, or challenges with substance use, we've got you covered there too with compassion and care that makes each step feel easier than the last.

28:02At Rogers Behavioral Health, One step can change everything. Visit rogersbh.org or call 800-767-4411 to start with a free screening.