Birth injuries are physical wounds that occur during the delivery process that affect either the mother, the baby, or both. In mothers, birth injuries most commonly occur in two areas: wounds in the perineal region (the delicate tissue between the vagina and anus) and damage to the pelvic floor. Let’s take a closer look at these most common birth injuries, what to expect, and how mothers can heal.

Wounds in the Perineal Area

Episiotomies

An episiotomy is a small incision from the back of the vagina toward the anus, a procedure that widens the vaginal opening in order to assist in the delivery of the baby. In the 1920s, doctors began routinely performing episiotomies in an effort to reduce trauma and damage. Proponents of the procedure reasoned (with little evidence) that a prophylactic incision in the perineum would prevent severe tears. They also asserted that a clean cut would be simpler to mend and would heal more cleanly than a natural tear. This argument gained traction in the United States, and it gradually became common practice. In fact, by 1979, 63 percent of all deliveries included an episiotomy. 

Many doctors now believe that episiotomies can do more harm than good. The procedure doesn’t prevent severe tears, and some research argues that it may even increase the risk, particularly when used with assisted vaginal delivery tools, like forceps or vacuum extraction. There is no evidence that the procedure offers better opportunities for healing than natural tears, and it has been linked to long-lasting medical issues, such as fecal incontinence. For this reason, the American College of Obstetricians and Gynecologists (ACOG) recommends that episiotomy be done only when it is absolutely necessary. This might include situations when the fetus is stressed and needs to be delivered more quickly or to prevent larger tears that may happen during delivery.

Pudendal neuralgia

The pudendal nerve is one of the primary nerves in the pelvis. It extends from the lower back, along the pelvic floor muscles, and out to the perineum. This nerve is responsible for communicating feelings of touch and pain in the perineal area, as well as controlling the sphincters (the muscles responsible for the opening and closing of the bladder and bowel).

Nerves are typically flexible and springy, but when they experience a major trauma or lots of repetitive small trauma, they can become inflamed. If the pudendal nerve becomes injured, compressed, or irritated, you may experience pain, discomfort, and other issues. 

During a vaginal delivery, the pudendal nerve is stretched. This issue typically goes away in the weeks following childbirth. However, for some patients, especially those who have had a more challenging birth experience, the pudendal nerve is injured or becomes irritated. For some, the pain can return months or even years after the baby is delivered. 

Hemorrhoids (piles)

A hemorrhoid is a painful swelling of a vein in the rectum. When you’re pregnant, the baby puts extra pressure on this area. As a result, hemorrhoids can develop both during and after pregnancy, particularly after a vaginal delivery. Symptoms include pain, rectal itching, bleeding after having a bowel movement, or a swollen area around the anus. While they can be painful or itchy, they are usually not serious.

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Damage to the Pelvic Floor

Supportive pelvic muscles and tissues can weaken during pregnancy and are strained during childbirth. When combined with other possible perineal injuries, like tears, an episiotomy, or nerve damage, the pelvic floor may become injured. Pelvic-perineal dysfunctions are among the most common issues people experience after pregnancy. 

Prolapse, which may not appear until years after delivery, has numerous unwelcome consequences. Urinary incontinence associated with a bladder prolapse (cystocele) can be aggravating. A rectal prolapse (rectocele) can cause constipation, incomplete bowel movements or an inability to hold gas or stool, and sexual dysfunction. Vaginal delivery is associated with a high incidence of postpartum urinary issues, as well as incontinence of stool and flatulence. By one estimate, 35 percent of new mothers experience urinary incontinence following childbirth and 20 percent of first-time moms experience severe pelvic floor muscle injury after a normal pregnancy and delivery. 

Common Causes of Birth Injury in Mothers

Birth injuries to mothers are typically the result of something that was beyond their control. Some of the most common risk factors for birth injury include the following: 

• Having a small or oddly shaped pelvis
• The baby’s position during delivery (for example, a breech birth)
• Complications during labor
• An unusually long or unusually fast labor
• Birthing an exceptionally large infant
• The use of assisted vaginal delivery tools, like forceps or vacuum extraction

Preventing Birth Injuries in Mothers

Childbirth is often unpredictable, and sometimes it’s not possible to avoid maternal injury. That said, there are some things mothers can do during pregnancy to minimize their risk:

• Practice daily pelvic floor exercises to strengthen the pelvic muscles.
• Engage in regular, moderate, pregnancy-safe exercise.
• Stay hydrated and strive to keep bowel movements regular. Straining on the toilet can further weaken the pelvic muscles.

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Treatment for Birth Injuries in Mothers

Many of the injuries mothers sustain during childbirth, like a small perineal tear or graze, are relatively minor and resolve on their own with time. Other injuries, however, require immediate remediation, such as a deeper tear that requires stitches. Pain relief may also be necessary. For more severe birth injuries, like damage to the pelvic floor or significant tears, treatment may also encompass physiotherapy and exercises to reinforce your pelvic floor muscles. Some patients may require the use of a pessary, a removable device that is inserted into the vagina to provide support in the area of prolapse.

If you have experienced a birth injury, you may be at a higher risk for it recurring with a subsequent pregnancy and childbirth. Your healthcare provider may want to discuss whether you should consider an elective cesarean delivery next time. If you have any persistent symptoms, like pelvic pain or bladder and bowel problems, consult your doctor.

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