When you give birth by cesarean, doctors are required by law to inform you about the risks—just like they do with any surgery. But when it comes to the risks of vaginal birth, what you’ll hear from your doctor is really up in the air. Some doctors tell patients nothing at all. And many doctors are not even trained to learn about pelvic floor disorders.

All of this is stunning, because birth injuries, from minor to severe, occur in more than half of vaginal births.

Today, we’re dedicating our entire episode to an interview with Kiera Butler (left), senior editor of Mother Jones, who wrote an article for the magazine about how birth injuries impact women’s lives in profound ways, why we’re seeing an uptick in traumatic births, and most importantly, what you can do to get help if you’ve suffered an injury.

This topic hits particularly close to home because my own birth injury is what led me to start this podcast in the first place. Hear the episode where I process what happened to me—and how that led me to confront Ina May Gaskin, figurehead of the natural birth movement. (Btw, Ina May is in the process of revising her book Ina May’s Guide to Childbirth thanks to the hundreds of comments you left on that post!)

Prolapse is one example of a severe birth injury, in which the uterus or bladder sags

First steps for treating birth injuries
After researching this article and speaking with dozens of doctors, Kiera recommends two first steps in getting treated for pelvic floor injuries:

If you’re in severe pain or discomfort, see a urogynecologist. The American Urogynecologic Society is a great resource to learn more about pelvic floor disorders and to find providers.

Often your issue can be resolved without surgery. So be sure you also consult a pelvic floor physical therapist. Find one through The American Physical Therapy Association.

Pelvic floor PT is a cornerstone of French postpartum care (which sometimes includes dildo video games!).

We also have an episode all about pelvic floor PT here.

Resources for specific postpartum issues
The Association for Pelvic Organ Prolapse Support is a good place to start if you are suffering from prolapse.

The National Association for Continence has some good info on incontinence.

If you’re looking for mental health resources, PATTch is a collective of birth and mental health experts dedicated to the prevention and treatment of traumatic childbirth.

Resources for delivery by cesarean
C-sections save the lives of mothers and babies every day. But just like vaginal births, they carry risks.

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal medicine published these guidelines for safe c-sections.

The International Cesarean Awareness Network (ICAN) is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).

This is all meant to inform, not frighten!
Information is power. We can’t predict what will happen when we go into labor, but we can make educated decisions about our bodies and our babies. We hope that the above information is stuff you can keep in your back pocket in the event that you need to use it.

For more real-talk about pregnancy and childbirth, we recommend Childbirth Connection.

What do you wish YOU had known before giving birth?
How could your health care providers inform you better? What’s helped? More resources welcome!

Kiera headshot: Tristan Spinski

Our sponsors for this episode are Squarespace (LONGSHORT), Thirdlove, Yogi Teas, 1-800 Flowers (click Radio Icon enter code LONGSHORT) and Tweed Wolf. Use the promo codes at checkout for a special discount.

176 thoughts on “EPISODE #110: Risky Birth-ness

  1. Hi Hilliary,
    I am a mom of two girls, one c-section due to a breech baby and a vbac. I have been a long time listener but lately have been shutting off your podcasts part way through. I love the honesty of your content and have been moved to tears in the past by the openness with which your guests speak and the light that sheds into topics that effect me and the ones I love. Lately Your podcasts always seem to have you processing your birth and looking for someone to blame. I lost some respect for you when you cornered your midwife on your podcast and poor and amazing Ina Mae Gaskin. You read her book and blamed her for you feeling guilt at not having the inspired birth she wants women to know is possible for some… Not me, though my births, though way off my natural med free plan were magical, each in their own way… Despite really hard c-section recovery and an almost c-section again… This podcast used to feel like it was for the women who needed to process their births and this was a positive place of honesty but the past few episodes have seemed like you trying to get someone to tell you that you would have had no problem if you had only had a c-section.
    You did not deserve the pain from your birth and your body is amazing and even though it didn’t make it through birth without injury, it is amazing! I love that you channeled your story and disappointment and pain into this podcast to create a place for women to meet and talk openly but I am worried that you need more than this since it seems to be a point of perseveration for you and I worry that your own negative feelings about your birth story are scaring and bringing others down.
    Please talk to someone who can help and maybe think about how this podcast could return to being about helping other women feel supported and not about your same issues every time.

    I really respect you and understand that birth and recovery is a serious and powerful and meaningful and difficult and sometimes impossible thing and want you to know that this was a place of healing for me and I hope we can get back there!
    Thanks for reading this Hilliary,

    1. I completely second Emily’s feelings. I, too, have been feeling this way about the Longest Shortest Time for a long time now. I absolutely love some of the more recent episodes that keep me coming back for more (episode 109 was amazing!), but I also get frustrated by these recurring undertones of in the delivery-related episodes.

      As a now-pregnant woman for the first time, this episode brought up a lot for me. I found my blood boiling and my teeth gnashing involuntarily several times during this episode. I think the conversation should be more centered around informed consent from ALL angles, because informed consent is almost entirely absent from so many aspects of prenatal and postnatal care. But completely glossing over the risks of c-section (which, I’m sorry, still aren’t being talked about enough either) or ignoring the benefits of vaginal delivery does as much of a disservice to society as does ignoring the risks of vaginal delivery and its lasting impacts on women. I agree, this issue is not talked about enough. But the lens of this episode just really got under my skin.

      For anyone looking for a great discussion on informed consent and reproductive rights from a perspective that doesn’t fling its judginess at you with so much negativity, I loved the recent episode of the Birthful podcast, episode 96, “Informed Consent, with Cristin Pascucci.”

      1. Wow, what a great podcast! I’m listening to old episodes and I love the positive attitudes towards natural birth and attachment parenting. Thanks for sharing!

  2. I thought this episode would spark a lot of feelings, both positive and negative and from skimming the comments, it appears to be so.
    I am 4 weeks postpartum with my 2nd, both births started off w/o intervention (so #2 was an attempted VBAC), got an epidural and ended with a c-section (34 hrs with the first, 21 with the 2nd, both due to baby’s heart rate going/staying down – both boys are totally healthy and had great APGAR scores!). Both times I felt that I should aim for a birth with intervention only if necessary and both times, it WAS necessary. The first time, I was very disappointed that I had to have a c-section (full on sobbing in L&D) and the 2nd it was easier since I had already experienced the ups and downs of a crazy labor and delivery. And there’s the part of me that felt relieved that I never had to push a baby through my vagina and it’s all still intact. Then there is the part of me that feels guilty for feeling this way. I’m wondering if there is a way to present both the pros and cons of vaginal and c-section birth side by side so it doesn’t feel like a judgement on either experience, but a full understanding of both possible outcomes. I’m imagining a page or two chart in childbirth books or handout from the OB. As my first OB told me almost 30 hrs into labor (after I had the epidural and could have a normal conversation) – the baby has to come out one way or the other. So it’s important to understand what’s involved in both.
    I will say that with my first, there was a ton of info available about the risks and benefits of both epidurals and c-sections and very little about vaginal birth injuries – this podcast is where I learned about pelvic floor PTs and nerve damage. And I’m a “do the research” kind of gal. So while this info was presented with some personal bias, 1. it’s a podcast, not a news site 2. it’s really important info to get out there. Thank you Hillary and Kiera for giving us even more info.

  3. When I discovered I was pregnant (a total surprise) my “birth plan” was as simple as they come: I would try to last as long as I could without drugs but was very open to an epidural and I REALLY didn’t want to have a C-section.

    I was induced at 38 weeks due to a clogged ureter on my son’s kidney and was put in the hospital overnight, taking the drugs used to induce labor. The next day, after more drugs that were not really working, my OBGYN broke my water and almost immediately my contractions began. I endured about 2 hours of pain before I was begging for an epidural. I was given the epidural and was put on oxygen shortly after since my oxygen levels dropped drastically. Finally, some peace!

    About 5 hours later I was ready to start pushing! I hit almost every contraction and, with my fiancé on one leg and my mother on the other, I pushed and pushed while the nurse and my OBGYN cheered me on. About an hour and 45 minutes into the pushing, my doctor gave me a concerned look in between contractions, ” We may need to do a C-section. I am going to try and turn the baby, but he’s getting stuck in your pelvis and I can’t tell which way he’s facing to know exactly how to turn him.” I was alarmed. This was the one thing I did not want. It was literally the only wish I had for my birth plan: no C-section.

    After another hour of pushing, clamps, tongs, suction pulling, and my doctor’s finger tips trying to turn my son’s head to fit through my pelvis, we had no choice; to have a healthy momma and baby I had to go into surgery.

    I was exhausted. I was emotionally drained. I reluctantly agreed and cried all the way to the OR. My fiancé cried too because he knew how important it was for me to deliver our son vaginally and how much I DID NOT want a C-section.

    I was pumped full of even more drugs (I had gone through a few tapes of epidurals by this time) and was basically in a drug-induced coma for the 25 minute C-section delivery.

    After Lincoln was born I was stitched up and wheeled to the recovery room. I sat, whole body shaking and teeth chattering from feeling cold, nauseous and so unbelievably exhausted I could only stay awake for a few minutes at a time. For two hours I watched everyone in our families hold my son. I refused to hold Lincoln because I couldn’t feel my arms and was afraid I would drop him. But after a couple hours passed, I was able to kind of control my gagging and chattering chompers and attempted to get my kiddo to latch with no luck.

    After attempting a few more times, we decided to call it a night and opted for the nurse to watch the baby for the next few hours so his Dad and I could sleep and try again in the morning.
    I threw up for the next 2 days from the drugs. I was unable to hold the baby for too long because I was so nauseous. I was so tired and hungry, but nothing would stay down. Luckily, he was an angle and slept pretty much non-stop during our 5-day staycation in the hospital. I never was able to get the kiddo to latch correctly.

    I was up and walking about 36 hours after my C-section, with the hopes of getting my catheter out. I tried to gingerly use my body while also pushing myself a bit more every day to be sure I would be able to care for our son after his dad’s 5 weeks of paternity leave were up. Luckily, I was able to recover pretty well, which I give credit to my active and healthy pre-baby lifestyle.

    Fast forward 3 months-I have been working out and pumping the pounds off, but I now have PAINFUL experiences with sex. My OBGYN says I have stretched my pelvic floor to its limit from the extensive pushing that lead nowhere. That coupled with my exclusive breast pumping and low-estrogen birth control (Nexplenon) I am basically a woman in menopause.

    I have been putting an expensive cream called Estriol in and around my “problem areas” on my vagina to increase “wetness” and possibly reduce the tightness of my pelvic floor with the hopes I can have enjoyable sex again in the near future. Sadly my doctor says she thinks I have an 85% chance that I will have to go to physical therapy to reduce the pain and strain. Who even knew there was PT for something like this?!

    I often wonder if this all could have been avoided if I just had of had a C-section…. I would have been able to explain to the doctors about my reactions to drugs and painkillers, I would have saved my body hours of stress, possibly had that “gold hour” with my son to help him and I learn to breastfeed, and I might have been able to save my vagina from being stretched to the limit and been able to have some sort of a sex life 8 weeks post-delivery instead of being basically sex-free more than 3 months after my baby was born. I don’t feel like I failed at childbirth, but I do wish I knew then what I know now so I would have been able to prepare myself for what was to come.

    Hindsight is always 20/20, right?

    Needless to say, if I ever have another baby, I will choose a C-section birth.

    1. You did what you had to do because your baby had to come out before your body was ready to labor . You couldn’t control that and you tried REALLY REALLY hard as did your doctor it sounds like. Post traumatic birth PTSD IS REAL. Be gentle with yourself, you have a lot of healing left to do after all of that !Get thee to a PT who does pelvic floor PT, def use the estriol , and remember it will take at least six months to heal more thoroughly ! Also, for a (hopefully) empathetic read check this out – I think she is right on -warning – frank talk in article . And though she is directing this towards women after vaginal birth, you pushed so long etc it’s almost the same, and breastfeeding women even after a more normal planned section can also experience a lot of pain sec to atrophy , I had 3 sections and still found it on point . Also, things get much better ( w baby , sleeping , etc ) after the first six months I think. First 6 months of newborn care , I’m not a fan .


  4. This episode was so great! I am not sure why a lot of commenters are angry about this episode…
    I had a natural, med-free, vaginal birth. And let me tell you… It was not ‘glamorous’ or ‘beautiful’ as everyone and the books said it would be. I wanted a vaginal birth not to feel more like a woman but because I am TERRIFIED of surgery – period. Since the beginning, I mentally prepared myself that I had no other option but to deliver naturally. I walked an hour every other day, I did prenatal yoga, I ate super healthy and stretched out my hips using yoga positions to assist me with a natural labor. And it worked! Labor was long and hard. I was in labor for three days. With 24 hours of back to back contractions. Luckily, I only pushed for 28 minutes (I believe the walking and yoga really helped me on this one). It wasn’t until right after my son was born, my midwife told me she needed to sew me since he tore me in a hook shape. Basically, instead of tearing me vertically, I was torn in a hook shape. Which meant my tear went all the way to my butt cheek. Which also meant that the anesthesia does not work in that area so I felt EVERYTHING.

    My vaginal birth was traumatic. To this day, it still gives me the chills thinking of what happened to me. My mom was there and she experienced three natural, med free births as well and she told me it broke her heart to see me in so much pain, during and after the birth. She told me she never felt so out of control that she couldn’t help her daughter.

    I really appreciated this episode because it DID NOT scare me – it empowered me. Information is power and I appreciate the nitty gritty of childbirth. I, personally, want to know everything because it gives me a sense of control of my own body.

    THANK YOU Hillary! I really enjoyed this. More people need to know about this.

  5. This was helpful, but I wish this episode spoke to VBACs. I’m currently preparing for my second child’s birth, and I’m seeking to hear perspectives of women who’ve went the VBAC route. I think this would be a great podcast in the future.

    1. I just had an attempted VBAC 9 weeks ago. My OB was super supportive – I didn’t even have to ask. Unfortunately, 20 hours into labor, the baby was under too much stress so I ended up with a second c-section, but I am so glad that I tried. And my son is happy and healthy and while I had a stronger reaction to the anesthesia immediately post (really intense shaking/shivering so I couldn’t hold my son for over an hour after I was in recovery), we still got our skin to skin, he was able to nurse, my overall recovery was good and very similar to my first c-section. Def talk to your OB about a VBAC and seek out experiences from others both achieved and attempted.

  6. I LOVE this podcast. Found it a few months ago and just find all of the episodes to be incredibly thought-provoking and honest. The Scarlet A about an OBGYN that also performs abortions, how not to accidentally raise a racist… but this one in particular was huge for me this morning. I am disheartened by some of the comments to this episode as I feel it’s been the best one yet in terms of putting my own journey in perspective. I wanted a natural birth so badly with my oldest, took the hypnobirthing classes and everything, but ended up with a c-section. After 33 hours, I asked for the surgery. The nurses and my midwife (with hospital privileges) advised me against it, but I was insistent that this lack of progression could NOT go on strictly because I could not do it anymore.

    They gave in to my demands. My baby was born with a substantial cut on his nose and I found out he had turned “sunny side up” in the canal. He couldn’t get past my pelvic bone. For YEARS I felt like a complete failure for not having a natural childbirth despite having the healthy mama and healthy baby outcome we all want. I should NEVER have felt that way. Especially after hearing this episode, I realize that there’s always risk. Instead of pushing an agenda, our medical providers and the authority resources out there should strive to give mothers a complete review of all risks of both vaginal and cesarean births. They should better consider us as individuals, too. I know women who dealt with/are dealing with substantial birth injuries. I hope we all can be supportive of a woman’s right to choose the birth that makes the most sense for her.

    Just to complete my birthing history…I tried for a VBAC with my second without success and had a fairly textbook c-section with her and my bonus baby (#3) as well. I wonder if I would have even tried for the VBAC (subsequentially feeling the failure all over again) if I had the perspective this episode gave me. Thank you, Hillary.

  7. I am a huge fan of LST, but as an OBGYN, I found this episode dangerously skewed and misinformed.

    Firstly, the failure to adequately compare the risks of vaginal delivery and c-section is irresponsible. Yes, there are risks at time of surgery, but there was no mention of risk of subsequent c-sections. The scar tissue that forms makes our job much more difficult and significantly increases the risk of complications with every subsequent surgery including surgeries later in life if a woman develops cancer or another problem that needs to be managed surgically. There is increased risk of hernia and bowel obstruction later in life. Increased risk of problems with the placenta in future pregnancies such as placenta acreta which caries risk of hemorrhage and is often managed with hysterectomy at time of c-section. For obese and diabetic women there is increased risk of wound complications such as infection, access and wound separation. I am ready and willing to perform a c-section when I need to. I will even perform an elective c-section if that is how a woman would like to become a mother, but I will only do so after a very honest conversation about how many babies she would like and the short and long term risks of c-section compared to vaginal delivery.

    Second, the biggest risk factor for developing pelvic organ prolapse is being pregnant, not vaginal delivery. Sometimes women who have never been pregnant can develop prolapse simply due to the tissues weakening over time. A c-section will not necessarily prevent a woman from developing prolapse, but the scar tissue will make the surgeries later is life much much more difficult.

    Lastly, on a personal note, this episode left me feeling vilified. I care so much about my patients. I lose sleep over them, I spend extra time away from my family to make sure they are taken care of. Pregnancy, labor and delivery is unpredictable. We do our best to keep mom and baby as safe as possible while making sure mom is emotionally cared for as well. I do not have ulterior motives, I simply want what is safest for my patients.

  8. As a woman who had a medically recommended c section, and suffered only the “normal” complications – I’ve been unable to have comfortable sex with my husband for more than 2 years. I have a swath of nerve damage that means I can feel nothing across my lower abdomen except an intermittent burning. It feels like being bitten by hundreds of red ants and occurs entirely unpredictably.

    I’m now pregnant again and hoping for a vbac, but am under increased monitoring because I have an anterior placenta which raises my risk of the placenta having grown into the scar (accreta), or of not being well enough attached to support the pregnancy as it progresses (abruption and likely stillbirth)

    These are the “normal”, long term effects of a c section. These are not what you’re warned about when discussing c sections with your doctor, which are the immediate surgical complications. In fact, i was assured that I would “feel like a new woman” by about 8 weeks post surgery. My husband and I now joke that indeed, I do feel like a new woman – someone who is physically so different from who I was that she is unrecognizable.

    While I’m sorry that neither of you had the birth experience you wanted, I don’t think there is a way to give birth that is free of long-term risks and complications, and I think that your episode was misleading and ill informed about the common, long term consequences of c sections. I appreciate the comments from MW above, and think that perhaps you should have spoken to more medical professionals before publishing this episode.

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