What is birth injury?

Birth injuries are physical injuries experienced during childbirth, and can affect either the mother or the baby. In newborn babies, a birth injury (often called 'neonatal birth trauma') can include many things, from bruising to a broken bone.

In mothers, birth injuries range from tearing in the vaginal area to damage to the pelvic floor.

Birth injuries in mothers typically fall into 2 main categories:

Injuries to the perineal area

• Perineal tears and episiotomy — around 3 in 4 women who give birth vaginally experience 'perineal trauma' (a tear or surgical cut to the area between the vagina and anus).
• Nerve damage — occasionally, nerves in the perineal area can get damaged during childbirth, which can lead to a painful condition called pudendal neuralgia.
• Haemorrhoids (piles) — these are swollen veins around the anus that you might feel as lumps. While they can be painful or itchy, they are usually not serious.

Injuries to the pelvic floor

• Muscle damage — the 'pelvic floor' is a group of muscles inside the pelvis that helps hold the uterus, bladder and bowel in place. In up to half of all women who give birth vaginally, there are permanent changes to the pelvic floor due to over-stretching or tearing (avulsion).
• Pelvic organ prolapse — if the pelvic muscles are damaged or weakened, the organs inside the pelvis can drop down towards the vagina, causing bladder and bowel problems.

While these birth injuries are physical, many mothers can experience emotional or psychological distress — before, during or after the birth. This is known as birth trauma. There are ways to decrease your risk of birth trauma, and both treatment and support are available.

What causes birth injury?

If you suffer a birth injury, the cause was most likely something out of your control.

Some of the main risk factors for birth injury include:

• the position of the baby, such as in a breech birth
• having a large baby (over 4kg)
• having a very quick or very long labour
• labour complications
• assisted delivery using forceps or ventouse (vacuum)
• having a small or unusually shaped pelvis

Can birth injury be prevented?

Although it's often not possible to prevent birth injury, there are some things you can do during pregnancy to reduce your risk:

• Exercise regularly (make sure you do pregnancy safe exercise).
• Strengthen your pelvic muscles with daily pelvic floor exercises.
• Avoid getting constipated or straining on the toilet, as this can weaken your pelvic muscles.
• Giving birth by caesarean could prevent some birth injuries, but this is major surgery so carries health risks of its own.

How is birth injury treated?

Some birth injuries are minor and may heal on their own — for example, a minor perineal tear or graze. Other injuries need treatment at the time, such as a deeper tear that needs stitches. You may also need some pain relief.

If you had a more serious birth injury, such as a significant tear or damage to the muscles of the pelvic floor, treatment may include physiotherapy and exercises to strengthen your pelvic floor muscles. Some women may need to use pessaries in their vagina or surgery to repair a prolapse.

Sometimes, signs of pelvic floor damage or prolapse are not detected and treated until much later.

If you have had a birth injury, you may be at more risk of it happening again with your next baby. Your doctor will talk to you about whether you should consider a planned caesarean section next time.

If you experience any ongoing symptoms, such as pelvic pain or bladder and bowel problems, you should see your doctor.

Resources and support

• Talk to your doctor, midwife or obstetrician.
• You can call Pregnancy, Birth and Baby on 1800 882 436 to speak with a maternal child health nurse (7 days a week, 7am to midnight AET).
• The Continence Foundation of Australia offers information and support to people with bowel and bladder problems. You can call the helpline on 1800 33 00 66 between 8am and 8pm (AEST), Monday to Friday.
• Visit the Australasian Birth Trauma Association website for information and support, including peer-to-peer support.
• Visit the PANDA (Perinatal Anxiety & Depression Australia) website for information and support after a traumatic birth. You can call the PANDA national helpline on 1300 726 306 ((Mon to Fri, 9am to 7.30pm AEST).