When Amy Mageropoulos was pregnant with her first son Bobby, she dreamt about the time they'd spend together when he was born.
"I had these visions of taking the baby for a walk in the pram and getting some fresh air," she said.
But the reality of new motherhood was far from what she had imagined.
A long and difficult labour left the Sydney mum with a string of debilitating injuries, and largely couch-bound for the first three months of Bobby's life.
"I had what is called an assisted vaginal delivery," she said.
"They tried the vacuum six times, and then that failed, so [I had a] massive episiotomy and then a forceps delivery.
"In terms of pain, I've never experienced anything like it … it was excruciating."
After the birth, Amy was left with ongoing pain and needed to use a catheter to empty her bladder.
"I felt very trapped because physically, I couldn't do much," she said.
"He was the perfect baby and I didn't really get to enjoy him because of everything else that was happening."
Amy's year of maternity leave ultimately became a year of recovery.
She was diagnosed with triple pelvic organ prolapse, chronic pelvic pain, post-natal anxiety, and post-traumatic stress disorder.
These days, her physical injuries — which are largely invisible — mean that even the most everyday tasks have to be meticulously planned.
"My life is not spontaneous by any means anymore," she said.
"Everything is planned around my bowel habits and pain thresholds."
The pervasive impacts of trauma
Amy's experience is a familiar one to Australasian Birth Trauma Association (ABTA) founder Amy Dawes, who had her own traumatic birth experience in 2013.
Ms Dawes said the impacts of birth-related trauma were far reaching, but often "not talked about".
"Birth-related trauma can occur through pregnancy, through labour and the birth process, or it can be [from a] lack of postnatal care," she said.
Despite improvements in awareness, Ms Dawes said the topic was still taboo, and that when people did seek help, they were sometimes dismissed or ignored.
"Women quite often go to seek support for what they're experiencing postnatally but they're told it's normal, or 'what do you expect, you just had a baby?'"
This week the ABTA released a report on the impact of physical birth injuries, based on the findings of a survey of 800 women across Australia, New Zealand, and the UK.
Almost half of the women surveyed — all of whom had experienced physical birth trauma — reported ongoing pain; 44 per cent said they suffered urinary incontinence; roughly one in five said they experienced faecal incontinence.
"It's a small sample, but I think it's reflective of a bigger picture," Ms Dawes said.
For most women, the impacts of their birth injuries weren't just physical. According to the report:
- More than half said their birth trauma had stopped them bonding with their baby
- 85 per cent said it affected their mental health
- 65 per cent said it affected their relationship with their partner
- 84 per cent said it affected their sex life
- 74 per cent said it affected their ability to exercise or play sport
Women's health physiotherapist Lyz Evans said the day-to-day impacts of birth trauma were "absolutely huge".
"For many women, it seeps into every single crevice of their life."
Getting help for physical injuries
In Australia, it's estimated about 3 in 4 women suffer some degree of perineal tear during birth. Most of the time, these tears "heal well", Ms Evans said.
But in some cases, deep or undiagnosed tears, as well as nerve and bladder damage, and pelvic injuries "more hidden from view" can lead to debilitating symptoms, such as incontinence, prolapse, and painful sex.
Research undertaken by Ms Evans on women with third and fourth-degree tears found more than half were still experiencing symptoms four years later.
"[These are] symptoms the average individual would deem unacceptable. I think that's staggering.
"[Historically], there's very much been this whole sense of, 'you have a baby, you just put up with it' … I think we've got to the point where women are not going to accept that anymore."
But treatment for birth-related trauma can be difficult to come by.
Ms Evans said many people weren't aware treatment was available, and in some cases couldn't access it because of "huge geographical barriers".
The cost of specialist appointments can also be prohibitive.
"There are some hospitals where [women] can see a pelvic health physio in the public system, but … they're few and far between," Ms Evans said.
The ABTA survey found one in five women had their condition diagnosed by a women's health physiotherapist. But more than half of women receiving physiotherapy treatment were paying for it out of pocket, Ms Dawes said.
"For many women, that is just not an option, and that really needs to change because these injuries don't just go away."
The survey also found almost a third of women waited more than two months for a diagnosis, with one in 10 women waiting more than a year.
Emotional distress during birth
While the latest ABTA report focuses on physical birth injuries, birth-related trauma can also be psychological.
It may be triggered by unexpected complications or emergencies, unwanted intervention, or inadequate pain relief, among other things.
Hannah Dahlen, a professor of midwifery at Western Sydney University, said emotional distress during birth often comes about when women feel fearful, helpless or unheard.
"It could be your baby being resuscitated in front of your eyes and … there's nothing you can do," she said.
"But often it's about disrespect. It's about lack of consent. It's about coercion."
Professor Dahlen said one of the biggest risk factors for birth trauma was "lack of respectful, relationship-based" care.
"Sometimes we forget that the woman is there … and how we care for her, how we treat her and how her birth is, will actually form how she feels about herself as a mother," she said.
"It's really important that we try to prevent trauma by putting in place trusting, respectful relationships, so when a birth is not straightforward and we do need to step in, we are absolutely making sure women are emotionally and physically OK."
'You become quite depressed and hopeless'
In 2020, West Australian mum Belinda Isbister suffered a moderate prolapse following the birth of her son, which meant she struggled to walk for months afterwards.
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Before falling pregnant, Belinda had been a competitive equestrian athlete, but after her birth, she struggled to return to the sport she loves.
"There were a lot of tears, a lot of anguish and anxiety," she said.
"I love sport and I loved my riding — it was a huge part of my life and the idea of not being able to do that was quite distressing."
Some of the most debilitating symptoms Belinda experienced were the psychological ones.
"It was really tough, the first six months in particular, and as a mental health nurse, I felt quite ashamed that I was experiencing poor mental health myself," she said.
"You become quite depressed and hopeless about your situation. You don't know what the future holds for you."
Belinda sought treatment for PTSD, but still struggles with anxiety. Her husband, Rhys Yuill, also sought mental health support to address some of the trauma he experienced.
"Nothing can prepare you for it," Rhys said of seeing his wife deal with birth injuries.
"You don't want to watch the love of your life go through absolute hell … and you don't know where to turn.
"[In] my family, we're brought up to be doers and fixers. I couldn't do anything to help, couldn't do anything to fix it."
Belinda said all new parents should have access to subsidised psychological support and women's health physiotherapy.
"I think any woman, whether there's complications or not, should be able to access some really good postpartum care to ensure that they're returning to exercise in a safe way," she said.
"And that they give their bodies the best chance to recover from what is a major life event."
Addressing and preventing birth trauma
Ms Dawes from the ABTA agreed that government-funded physiotherapy and mental health support should be expanded, and said routine postpartum health checks should also be extended beyond six weeks.
The ABTA report also called for women to be offered "unbiased information on a comprehensive range of birthing practices and potential birth complications" to ensure they are fully informed of the risks of birth — including those associated with vaginal delivery.
Professor Dahlen agreed that care providers "need to be honest with women about risks", but said it was also important to give women strategies and adequate support to help them cope with birth.
She added that "continuity of care" models — where a woman sees the same care provider over the course of her pregnancy, birth and postpartum period — can ensure mothers have a better experience, even after a previous traumatic birth.
"They're more likely to be listened to, they're more likely to have the things that are really important to them … actually valued and respected," Professor Dahlen said.
But an "awful lot" was required to increase that model of care, she said.
"Currently, in Australia, only about 15 per cent of women have access to continuity of care with a midwife, despite the fact that the World Health Organization recommends it."
'I wish I had asked more questions'
In the years since the birth of Amy Mageropoulos's first son Bobby, her life has been full of specialist appointments, physical and psychological therapy, and multiple surgeries.
At 37, she's recently had a hysterectomy, which has offered her some relief.
"But I still have a lot of issues with pain … I'm also faecally incontinent, so I don't have a lot of control over my bowels."
Amy said she kept her injuries "hidden" for a long time, and only began telling people about them in the last year.
"You don't want to scare women [who] haven't had children," she said.
"But I feel like sometimes [not saying anything] can cause more harm than good, because although it won't happen to every mum, it can happen — so it needs to be spoken about."
She said when it came to preparing for birth, information and education were "key".
"You're not a burden — if something doesn't feel quite right or you don't understand, just ask.
"I wish I had asked more questions."