Delays in childbirth injury diagnosis are impacting women's mental health, survey finds

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9 hours ago

Warning: This story contains discussion of suicide.
A long bike ride to the park is Kristy Keefe's idea of a perfect day with her sons.
She relishes every precious moment, having missed out on too many years ago when a traumatic birth led to a mental health collapse.
"I have pictures and I am like I don't remember that," she says. "Because I was there, but I wasn't there."
Kristy says she has blocked out some memories after hitting "rock bottom" when her second child was unexpectedly born in the hallway of her home six years ago.
The trauma of her son Riley's birth, coupled with a fourth-degree vaginal tear, triggered feelings of dread and isolation.
"I was really anxious. I really didn't want to be in the house because that's where it happened," she says.
"I didn't want to be left alone with my baby by myself," Kristy remembers, saying she was having intrusive thoughts about something awful happening to her child.
"I just felt really vulnerable and unsafe. It went to rock bottom."
For women's health leaders like obstetrician Nisha Khot, Kristy's story cuts deep.
"It's just a sign that we have failed women," Dr Khot says.
Perinatal Anxiety and Depression Australia says one in three women experience a traumatic birth, with injuries including pelvic floor damage, perineal tears, episiotomy, incontinence, pelvic organ prolapse, as well as psychological distress.
Understanding the impact of those birth injuries was the focus of a new survey from advocacy group Birth Trauma Australia (BTA).
Nearly 400 women from around the country were asked questions about their birth experience, injuries sustained, diagnosis of the injuries, pain issues, incontinence and mental health.
BTA chief executive Amy Dawes says the longer birth injuries take to diagnose, the more catastrophic the consequences.
"We found that women that had struggled to get a diagnosis, they were 2.4 times more likely to experience suicidal thoughts," Ms Dawes says.
"It's a taboo within a taboo. I have … heard firsthand accounts of women sharing their experiences of being in a really dark place following their birth trauma and struggling to get care, being dismissed."
The new research also found almost all (98 per cent) of those who experienced birth-related trauma reported ongoing physical injury or pain that was not managed.
It found that distressing or emergency procedures (69.6 per cent) and poor management of pain or physical injuries (53.8 per cent) are the most significant contributors to birth trauma and can lead to significant mental health impacts.
Improving the mental wellbeing of women after a traumatic birth is a top priority for Dr Khot, president-elect of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
"If you have physical trauma and you're struggling with your body functions, then that is going to affect you psychologically as well, so it's not as if they're two separate entities," she says.
Dr Khot says, while shocking, the survey results do not surprise her.
"You just had your first baby and suddenly you find that you are incontinent," she says.
"That has such huge implications for you to be able to just lead a normal life … go out with family, look after your baby, hold your baby, just lift your baby.
"You can't do any of these things because of your incontinence. That is bound to have a huge impact on your mental wellbeing. How could it not?"
It has been more than a year since a landmark inquiry in New South Wales heard traumatic birth experiences can have tragic consequences, including suicide and suicidal ideation.
The inquiry found a number of women suffered preventable birth trauma in NSW and urgent efforts must be made to address it.
BTA says there is now more investment and education of healthcare workers in the space, but more is needed.
Misdiagnosis and delays in diagnosing birth-related injuries were also examined during the inquiry.
BTA survey participant and mother-of-two Kristy says she struggled to get professional support in the public system for her incontinence, which compounded her psychological distress.
She says it was disappointing to be out of pocket, but feels the private gynaecology, psychology and physiotherapy expertise she received was crucial to her mental and physical recovery.
"I feel that if I didn't go and get that help and paid all that money … that maybe I wouldn't be here today."
Ms Dawes says Kristy's experience is common.
"Everyday women and birthing people across Australia are falling through the gaps in care," she says
"They're sustaining severe, sometimes preventable, injuries and they fall through the gaps in a fragmented healthcare system."
RANZCOG, BTA and the Australian College of Midwives are developing a federal government-funded birth trauma education pilot project, which will guide clinicians in prevention and rehabilitation of birth-related trauma.
BTA is also advocating for mandatory postnatal screening and more funding for psychological support and physiotherapy.
In its most recent budget, the New South Wales government allocated an extra $83 million for maternity care, family care centres and maternal vaccination.
Victoria is spending an extra $21 million on its perinatal mental healthcare program.
The Queensland government launched an $11 million women's wellbeing line this year and is also funding 30 new mother and baby beds for in-patient treatment of severe perinatal mental health disorders.
In Western Australia, the NSW inquiry has prompted the development of a birth trauma policy for its public hospitals.
Incoming RANZCOG president Nisha Khot says she will be urging her obstetrician colleagues to prioritise the issue.
"We should not forget that the reason we do what we do is because we want to support women. We want women to have good experiences and good outcomes," she says.