Birth Injuries to the Mother

Introduction

Being pregnant and giving birth to a child are the most precious moments in life. Proper care and attention should be given to the new mother and child to make it more a good experience to remember. During childbirth, some birth injuries can happen to the mother and newborn due to various reasons. Some birth injuries are common and part of natural childbirth and resolve on their own.

What Is a Birth Injury?

The physical injuries happening to a mother or the baby during childbirth is called birth injury. The birth injuries to a newborn are often called neonatal birth trauma. The common birth injuries to newborn includes head injuries, bruises, and broken bone.

In mothers, some birth injuries are considered normal as a part of the delivery of a baby. The common birth injuries are tearing in the vaginal area and damage to the pelvic floor. The normal birth injuries that occur in a normal delivery get recovered easily. In some cases, birth injuries can occur due to mistakes by midwives or doctors. These can hurt their physical and mental well-being. The risk factors that can lead to birth injuries are

• Position of the baby (not in a head-down position).

• First vaginal delivery.

• Shoulder dystocia (one or both shoulders of the baby got stuck during delivery).

• Large baby.

• Prolonged or very quick labor.

• Vacuum or forceps delivery.

• The small or unusual shape of the pelvis.

• Complications during labor.

What Are the Common Birth Injuries to Mothers?

Vaginal Tear

A vaginal tear during birth is a common birth injury that occurs when the baby's head comes out through the birth canal. Normally the muscles of the vagina stretch around, helping the large head of the baby to come out. If the baby's head is too large for the vagina to stretch, it can cause vaginal tears. Also called a perineal laceration or perineal tear.

A vaginal tear that involves the skin around the vagina only is normal in childbirth and heals within a few weeks. If the tears are more severe, they extend up to the external genitalia and the muscles of the anus. This requires a long time for healing and has long-term effects.

Types of Tears During Childbirth.

1. First-Degree Tear: This affects the outermost layer of skin around the vagina and perineum. These are normal, heal quickly, and might need some sutures. There is no serious complication, and recovers with minimal pain.
2. Second-Degree Tear: These are deeper tears extending to the skin around the anus. Second-degree tears are quite painful and require more time to heal than first-degree tears. Requires sutures; absorbable sutures preferred. If any discomfort or unusual pain is experienced, talk to the doctor. Avoid all chances for infection.
3. Third and Fourth-Degree Perineal Tear: These types are serious vaginal tears that are deeper. It can damage the muscle that controls the anus and the muscles surrounding the anus.

Vaginal tears can be prevented by a procedure called episiotomy. A surgical incision made by a doctor during childbirth. The incision is made between the vagina and the perineum (anus). This makes the vaginal opening wider, allowing the baby to come out easily. It also reduces the risk of vaginal tears.

Postpartum Hemorrhage:

After normal childbirth, women experience blood loss which lasts about 2 to 6 weeks after the childbirth. Heavy bleeding in the initial days gradually becomes lighter as days pass.

Abnormal heavy bleeding is dangerous and termed postpartum hemorrhage (PPH). Two types of bleeding are there.

1. Primary or Immediate PPH - within 24 hours of childbirth and heavy bleeding.

2. Secondary or Delayed PPH - heavy bleeding after 24 hours and lasts up to six weeks after childbirth.

Primary PPH occurs in about 5 in 100 pregnancies, and around 2 liters of blood is lost.

Secondary PPH occurs in about less than 2 percent of pregnancies. It is seen in women suffering from an infection following childbirth. All possible steps have to be taken to reduce the risk of hemorrhage. Postpartum hemorrhage should be considered an emergency event and treated quickly.

Ruptured Uterus:

A ruptured uterus occurs when the uterine wall gets torn and breaks open. Commonly seen in women who had a previous cesarean section and are trying for vaginal delivery in the next childbirth.

The uterus is a muscular organ that supports the growing fetus. Following a cesarean section, scar tissue is formed along the prior cesarean section incision. During labor, the pressure builds up and causes the uterine tear. This occurs at the site of a previous cesarean delivery scar. Uterine rupture is an emergency, leaving a hole in the uterus and severe blood loss. The supportive organ is ruptured and life-threatening for the fetus. It can result in reduced heartbeat of the baby and oxygen level is reduced. The baby will be at risk of brain damage. Signs of uterine rupture includes:

• Severe abdominal pain.

• Vagjnal bleeding.

• Fetal distress (non-reassuring fetal status).

• Low blood pressure of pregnant women.

• Contractions are not stopping.

• Labor slows down.

The first line of treatment is emergency cesarean section and uterine repair. If uterine repair is not possible, a hysterectomy (surgical removal of the uterus) is done. Followed by blood transfusion and antibiotics to reduce infections.

Uterine Prolapse:

It occurs when the pelvic floor muscles and tissues around the uterus become weak. The ligaments are weakened and cannot provide support for the uterus to hold the baby. The uterine prolapse is seen in women who have multiple vaginal deliveries. It is most likely seen in prolonged hours of labor or the baby is large. The uterus moves from the normal position and moves down into the birth canal. It affects the quality of life. The symptoms are

• Painful sex.

• Urinary incontinence.

• Heaviness in the vagina.

Uterine prolapse can be managed through pelvic floor exercises. In serious cases, a surgical repair or hysterectomy is done.

Postnatal Depression (PND) and Postnatal Post Traumatic Stress Disorder (PTSD):

Also called birth trauma occurs due to a bad experience during childbirth. PND and PTSD are not physical injuries but need to be addressed with importance. It can affect the mental health and well-being of the new mother. These cannot be generalized and are more personal, and women react differently to the situation. The symptoms are,

• Feeling isolated.

• Difficulty bonding with the newborn.

• Guilty feeling.

• Avoiding hospital visits and meeting doctors.

• Reluctant to speak to others.

New mothers may face many difficulties and need the proper support and care. Husbands and other family members can help the new mothers to overcome such difficult situations.

How to Prevent Birth Injuries to the Mother?

Some birth injuries are common and cannot be prevented, but can help to reduce the associated risk.

• Pregnancy-safe exercises.

• Strengthening pelvic muscles by doing pelvic floor exercises.

• Avoid constipation; this can weaken the pelvic muscles.

• In high-risk pregnancies giving birth by cesarean helps in preventing birth injuries.

Conclusion

Birth injuries to the new mother happen during childbirth; some are minor and heal on their own. Serious birth injuries need medical treatment at the earliest to avoid harm to the baby and mother. The new mother needs care and support from the health care providers and family for an easy recovery.