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.

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

  1. Thank you! Thank you! Thank you so much for sharing this perspective on the c-section vs. vaginal birth debate. I really appreciate that this podcast shares all viewpoints and multiple perspectives on the same issues. I feel that I’ve learned so much and am now better prepared for pregnancy/parenthood/etc. as a result of the education I’ve received by this show.

    The vaginal birth vs. c-section debate has been something that I’ve been particularly stressed about (and I’m not even pregnant yet) because, like Kiera, I was told by a doctor that I may have trouble with vaginal delivery due my mild scoliosis. I still consider that information to be only an opinion and want to give my ob/gyn the change to weigh-in on the matter, of course, but will now ensure that I advocate for myself if I feel the need to when the time comes. As a medical professional, I appreciate the statistical approach taken by Kiera in her article and as well as the fact that she’s bringing attention to a little-discussed issue for women. Thank you!

  2. Thank you so much for this podcast! In case you haven’t heard of it I would like to recommend a book called “Reving Your Sex Life After Childbirth” by Kathe Wallace. It helped me so much. I thought for my vagina was just never going to be the same again, that sex would never be pleasurable, that there just wasn’t anything I could about the occasional incontinence. Thank god I was wrong. I’d also suggest interviewing Kathe about her book and the work she does. she’s an expert in her field and she really cares about women. It would be a great follow up to this podcast. Thank you for your show, I just started listening and I love it.

    1. Thank you so much for this suggestion! I’m still a ways away from parenthood (grad student), but I have great trepidation regarding the loss of my sex life after kids. I’ll bookmark this for my future!

  3. Dear Hillary,

    I am a big fan of your podcast, but I was really horrified by this episode. Like other commenters here, I felt as though your guest took what could be an important message–that injuries during vaginal delivery are underdiagnosed and undertreated among women in the U.S.–and turned it into an “us vs. them” debate about the “best” way to have a baby. How terrible!

    This could have been a moment to advocate for vulnerable women whose medical needs are not being met by the current standards of post-natal medical care. Instead, it became a (very one-sided) debate about the natural birth movement. What a waste of an opportunity. If you’re going to do an episode about the impacts of various medical interventions during labor on outcomes for mothers and their babies, please do it in an informed way, with guests who actually know the literature on both sides of this issue. Instead, your guest was a non-professional who clearly had an emotional ax to grind about this topic.

    In general, I’ve found your podcast to be a very fair place where people with lots of different opinions can weigh in. But in my opinion, this episode fell short of that standard. Thank you again for your hard work on the podcast.

    Nora Becker

    1. Thank you Nora, I do agree. It touched a nerve since I just recently had a baby vaginally because I wasn’t informed of what the healing process could be like, so I do think the medical profession could do better for women who give birth vaginally, but the way the information was presented made it sound like I made a mistake in not wanting a C section. It was a very lopsided presentation.

  4. Thank you for this thoughtful and much needed episode! I have delivered with and without epidurals, experienced a 4th degree tear, and received excellent care from both OBs, midwives, and pelvic floor PTs. I loathe the current trend that paints natural vaginal delivery as the only way to go. Thank you for working to normalize and advance conversation about vaginal delivery risks and the good care women can but too often don’t receive.

  5. Thank you. I gave birth on the east coast near NYC and was forced, despite asking for a c-section to push for over 6 hours, with a break where I was “sleeping”. In that the hospital was brand new I suspected that they were avoiding c-sections because one of the first stats requested by mothers in the area was the ratio of births to c-sections. After the birth I was released before pooping and was in immense pain and had to return for manual disimpaction while trying to breast feed. All the other mothers I knew in the area spouted off about the natural way and what our bodies were meant to do. I hated that I was expected to give birth naturally as a pinnacle of my achievements as a person. Family is about love not achievement. Also, it bothers me that the medical establishment seems to want to control our way of giving birth either for natural or c-section, we should be able to choose without stigma. This is a voice to a problem that is out there and no one talks about it. As far as postpartum treatment I completely agree that mothers need more, both in terms of the pelvis and depression and so many other things. A baby needs a well-functioning mother and family to thrive, not just a clean bill of health.

  6. Wow, Hillary–THANK YOU for this episode! All of this has been on my mind since I gave birth to my first child in September. I gave birth at a very highly esteemed hospital affiliated with an Ivy League school in the Boston area. At a Q&A session we attended, someone asked about Episootomies. Their answer was that simply they didn’t do them. I honestly had never even HEARD of them so I thought nothing of it. And honestly, postpartum recovery for vaginal births was barely discussed at any point. I kind of just assumed I’d be sore for a few weeks and that was that.

    Like Claire in the MJ article, I delivered a large baby (9lbs) at 42 weeks. I was told after that I tore twice AND had an episiotomy. I couldn’t sit down – or even drive- for 10 weeks. I had multiple internal hemmorhoids. I’m incontinent and sex is nearly impossible. I have constant pain in three of my vertebra. I was told by a NP later that my recovery was “worse than a Cersarian”.

    All that being said, my birth experience was great. The pain management was excellent and my son came out without a dent, so to speak. I learned later that the doctor who delivered him
    was fired for doing too many episiotomies shortly after I delivered. I don’t fault her for doing it because she brought my son into the world very effectively, but I do wish they had fully informed me of how intense my recovery might be. I felt totally bewildered for months.

  7. I also was disappointed with this episode because the discussion I’m sure made any woman thinking about having a baby or currently pregnant terrified. I was also angered that once again, women are being told that one way to give birth is right and the other way is wrong (just like we are made to feel about breastfeeding/formula feeding). Women should be supportive of each other no matter how they give birth because it is a common experience many of us share and we are all stronger because of it no matter if it happened through c-section, with an epidural, or unmedicated. I had two positive birth experiences (yes,it wasn’t easy and there were difficult parts) and healed well after both births. I do pee a little in my underwear if I hold it too long and pass gas accidentally but there are women out there that have not been traumatized by giving birth. So for all the pregnant women, don’t fear because things can go well.

  8. This episode was fascinating, but also scary. As a first time mother due in 3 months, I was left with the impression that there’s nothing I can do — that no matter how we get this baby out, I am greatly risking my health and well-being; that there are no ‘good’ choices.

    I found it difficult to reconcile much of the information provided with so much of what I’ve been reading and hearing from my doctor., and left me confused. For instance, kegel exercises are ineffective pre-birth? Assuming it is true, which exercises ARE effective in reducing the risk of pelvic floor injuries? Or can nothing be done?

    I was left feeling a bit helpless at the end of the episode and after reading the article. There was nothing actionable here; the message seemed largely to be that there is no way to prepare ourselves for birth and no matter what we do, there’s a good chance we will end up incontinent, uncomfortable, and unhappy with our choices.

  9. Dear Hillary,

    Thank you for this episode! I’m a big fan of this show. I’m a mid-20s woman, pretty far removed from parenting at this point…but I like to get ideas about motherhood and all of its facets. I’m a tall person with small hips, and have been told that I’d probably need to have C-sections. Honestly, though the recovery and risks aren’t “cakewalks”, they sound better than the complications of vaginal delivery. I found myself mentally squirming in my seat at work hearing about tears, incontinence, and prolapse. Mentally squirming and cringing.

    Despite my slight angst, I found Kiera’s approach and the overall conversation to be very honest. I share her ideology about the sexism and lack of awareness re: OB-GYN issues, and pressures of the “natural vs. medicated/natural vs. caesarean” debates. I’ll be darned if anyone tries to *tell me* what’s best for me (outside trusted doctors) regarding my birth plan!

    Thanks again, and as always, for an informative podcast! Crossing my legs in fear for now, but am always grateful for the insights.

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