Would You Want to Know if You Were at Risk of Pelvic Problems After Birth or is Ignorance Bliss?

“Why didn’t anyone tell me this could happen?!” – the distressing question almost every woman who has given birth cries out during a women’s health consultation. I feel that strong tug of my heartstrings and her pain threatens to break down the walls I have to consciously work hard to keep up so that I can maintain some level of professionalism. Being an empath, and a highly sensitive person, it’s a constant battle, and I struggle to swallow my tears and maintain my composure.

She’s had ongoing problems since birth which only seem to be getting worse with time, and nobody has given her the answers she’s been looking for. It could be months after birth, but most often it’s been years – too many years. People have told her it’s “normal” after childbirth for her body to feel this way but her intuition tells her otherwise. This is the first time she has ever heard of pelvic organ prolapse or pelvic floor trauma. Today, finally, she is given clear answers.

The wonderful thing is she not only has answers but also a clear management plan that will help her heal from her pelvic issues. By seeking help from a physiotherapist who works exclusively in women’s health and pelvic health, she has begun her journey down the road of recovery. She can breathe a sigh of relief because there is light at the end of the tunnel, at last.

But, as they say, the damage is done. And now it’s about “damage control”. Coming back to her initial question “Why didn’t anyone tell me this could happen?!” – I really struggle to answer this – but the simplest answer is “We’re afraid”. We are afraid to inform women about the risks of a vaginal birth because we’re afraid we’re going to make her afraid. And nobody wants a pregnant woman to be anxious or scared, especially during this crucial time where her body works to grow new life.

“We are afraid to inform women about the risks of a vaginal birth because we’re afraid we’re going to make her afraid”.

One of the biggest concerns medical and health professionals have is whether to inform women of their individual risks of pelvic floor dysfunction associated with childbirth. Some women have publicly expressed their concern after suffering pelvic floor trauma such as Amy Dawes, and some have even taken legal action, such as Nadine Montgomery. As a physiotherapist who is passionate about education and empowerment in women’s health and pelvic health, I do feel a strong sense of obligation to educate the women who interact with me. But I am faced with this dilemma – to inform or not to inform?


Women are quick to question after the fact, but do they really want to know before they give birth? Personally, from the interactions I have had with hundreds to thousands of women over the years, the impression I get is yes, women want to know. Women are inherently strong – both in body and in mind, and are able to take in information that may seem adverse, and use it to their advantage.

I’m not sure why we think that providing education about risks will reduce every woman to an anxious bumbling mess – give women some credit. As a woman who is currently pregnant, I find it deeply disempowering, quite offensive and a remnant of patriarchal culture. That someone can make the decision for me – that, according to them, it is in my best interests not to be informed. I am not afraid and it has nothing to do with being a women’s health professional and being educated in the area – if I was in any other profession I would want to know – in fact I know that I would feel liberated by the information.

I also understand and acknowledge that some women do not want to know. All women are different and unique – some women, like myself, are planners and like to be “in control” and any semblance of loss of control can be quite disarming. Other women prefer to take life as it comes and don’t feel the need to worry about things until they happen. It is inherently a personality thing, so whichever way a woman chooses should be up to her. Personally, I have already spent the better part of my life struggling with pelvic health issues and I always found it incredibly difficult managing the feelings that my body was warring against me. So for me knowing my risk factors will help me to prepare for the possibility and I can at least retain some control.

We assume that women will be strong enough to handle living with the pelvic problems after birth – when the truth is, now she has no other choice. She must be strong because it’s already happened, and she didn’t have any control or say in the matter. But we won’t tell her before she gives birth – even though she may want to know, if for no other reason than to prepare for life after birth, or to take measures to prevent the pelvic problem from occurring in the first place. We continue to be reactive rather than proactive.

“But I find myself wondering, what is “normal birth”?”

There is also a belief that educating women about their risks will lead to a rise in c-section rates. And when policymakers are working “Towards Normal Birth”, there is a fear that educating women about their risks will work against this directive. But I find myself wondering, what is “normal birth”? And why not “Towards Safer Birth” which I feel is something we can all unite in working towards together?

“The reality is we have a significant amount of research and evidence into risk factors that can predict if a woman is at risk of obstetric perineal injury or of pelvic floor tearing or pelvic organ prolapse”

Does “normal birth” mean “natural birth” or vaginal birth regardless of the possible birth-related complications? Is it still “normal birth” when a woman is rushed to surgery for an emergency anal sphincter repair because her pelvic floor just couldn’t handle the forces. The reality is we have a significant amount of research and evidence into risk factors that can predict if a woman is at risk of obstetric perineal injury or of pelvic floor tearing or pelvic organ prolapse, yet we shy away from sharing it. What are we really afraid of, I wonder?

The truth is by educating women, we can prevent birth-related complications or at the very least allow women opportunity to prepare for it. I honestly don’t believe educating women will lead to a rise in “unnecessary major abdominal surgery” as it is often phrased. Most women want to give birth vaginally and will take the necessary steps to prepare their bodies so that they are able to. If a woman does decide to opt for a c-section based on being made aware of her individual risks being high and she’s not willing to suffer from long-term pelvic problems, why should anyone take away her right to choose a safer birth for an ultimately healthier life, physically and psychologically for her?
So my question to you is, would you want to know if you were at risk of having pelvic problems after a vaginal birth? Or would that knowledge make you afraid?

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1 Comment

  1. Mary Teague on July 23, 2017 at 2:51 am

    Hi Heba,
    I would love to know the results of this poll. I am a physio working in the maternity unit of a private hospital in Adelaide. I have often wondered how much I say in the antenatal classes in relation to risk factors…….my gut feel is that the majority of women do want to know !!

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