image copyrightSerenity Strull/BBC
WARNING: This article contains descriptions of medical experiences that may be upsetting or disturbing to some readers.
In 2024, I was hospitalized again. I suffered for about 36 hours from extreme pain that even morphine did not respond to. It was only discovered after surgeons made an incision in the abdomen that part of the intestines had protruded through a gap in the abdominal wall. This caused a perforation in the intestines and pus filled the entire abdomen, leading to a dangerous infection.
As I waited for surgery, I texted my husband all my bank account information in case I ended up living. It was so painful that it was blinding. Even though I couldn't eat anything for two days, I still felt nauseous.
The surgery lasted 5 hours. When I woke up in the intensive care unit around midnight with a dazed mind, I saw a 15cm incision from my navel to my pelvis and a large tube inserted into my abdomen. How did we get to this point? What does this have to do with childbirth?
It is widely known that childbirth can be dangerous. But relatively little is known about the problem, which can affect women not only immediately after birth but also decades later. Although the case I experienced was rare, it is surprisingly common for postpartum complications to appear later in life.
Worldwide, it is estimated that approximately 40 million women experience post-natal complications that last for months to years every year. In addition to urinary and fecal incontinence and chronic pain, it can also cause life-threatening intestinal diseases or leave scars that can prevent future pregnancies.
As in my experience, some problems are not discovered until years later or can persist for a lifetime. I met with several affected women and experts to understand the long-term physical and psychological damage that childbirth leaves behind. In this process, we confirmed the reality that women felt that medical staff did not listen to their pain, or worse, that there was no way to receive treatment.
I didn't want to bring up my experience again in this article for fear of appearing weak. However, she changed her mind in the hope that by making the aftereffects of childbirth public and raising awareness of the risks of childbirth and support measures, other women will gain the courage to demand their own rights.
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Medical intervention to save lives, with lifelong aftereffects
This is an old story that has been with human history. Childbirth is risky and can lead to complications and worst outcomes for both mother and child. Fortunately, maternal deaths are gradually decreasing in many parts of the world. Between 2000 and 2023, the ratio of maternal deaths compared to the number of live births worldwide decreased by 40%.
However, as the focus is on reducing maternal mortality, the long-term effects of labor and delivery are being neglected, according to a large-scale global research review published in 2024 by an international team of researchers.
Joshua Vogel of the Burnett Institute in Australia, the report's lead author, pointed out that it is worrisome that many women are unable to seek support in time because the boundary between the normal recovery process and abnormal symptoms requiring medical treatment is unclear. “I was shocked by the incredible variety of these complications,” he said.
adhesion
Four days after giving birth to my daughter, I was rushed to the hospital for another emergency surgery. The surgical suture site burst, causing serious complications in the intestines. This was an extremely rare case, so shocking that it was classified as a so-called “Never Event” in the medical community. But I was so happy that my newborn daughter was healthy that I tried to forget about it and was just thankful that we were both safe.
Seven years have passed since then, including another pregnancy. Everything seemed to be back to normal. Then one Wednesday afternoon, the abdominal pain that started suddenly got worse. I was working from home at the time, so I turned off the camera and attended the video conference while lying in bed, hoping that the pain would subside quickly. At around 4:30 p.m., I sent a text message to my husband saying, “My condition is really bad. I can almost see my stomach moving.” Until then, I thought I simply had severe enteritis. Looking back, at that time I was already unable to make rational decisions.
Perhaps it was because I was in such a state that I was able to somehow muster up the energy to pick up the children from school and even load the child's bicycle into the car. But the pain only got worse. In the end, I contacted my sister, whose husband is a doctor. My sister-in-law diagnosed that 'adhesions', scar tissue created from a cesarean section, may have caused the intestinal obstruction. When I started vomiting, my sister-in-law told me to call an ambulance. However, there was no ambulance available, so I took a taxi and headed to the hospital even though I was barely able to stand.
I was diagnosed with intestinal obstruction at the hospital. The medical errors that led to the first and second caesarean sections had left significant scar tissue inside the abdomen, blocking blood flow to the intestines.
Because intestinal obstruction sometimes resolves on its own, I endured extreme pain for 36 hours while waiting to see whether surgery would be possible. On the second day, my body temperature soared sharply. Blood test results showed that the level of C-reactive protein (CRP), an inflammatory indicator, was significantly outside the normal range (less than 5) and rose to 311. The medical team decided to operate as soon as possible. However, given the busy hospital conditions, “as soon as possible” meant waiting another five painful hours.
After the surgery, the surgeon said that although the surgery was more complicated than expected, it was successful. A 60cm section of the intestines that had been cut off from blood and oxygen supply was removed, but thanks to this, his life was saved. As time passed, I recovered smoothly, and because of my naturally calm personality, I thought, “It could have been worse.”
But the medical complications did not end there.
major abdominal surgery
Worldwide, cesarean sections are on the rise, accounting for approximately 21% of all births. In some countries, this figure reaches 58% (Dominican Republic), and in the United States, the proportion of cesarean sections exceeds 32%. Sue Down, professor of obstetrics and gynecology at the University of Lancashire, said caesarean sections can be essential to protect the health of both mother and child, but they can also result in an increased risk of complications.
Even if complications occur, the symptoms may not appear right away. According to an American study that followed 43,646 mothers for 50 years, mothers who had a cesarean section had a 16% higher risk of death during that period than mothers who gave birth naturally. They also had a greater risk of dying from cardiovascular disease, diabetes, respiratory disease, infections, and kidney disease.
Professor Stephanie Hinkle of the University of Pennsylvania, a co-author of the study, said the cause was not yet clear. Women who had a cesarean section were more likely to be older, have a higher body mass index (BMI), smoke or have diabetes and other underlying health conditions. However, even after the researchers adjusted for these factors, the correlation between cesarean section and risk of death remained.
One hypothesis that could explain this is that the caesarean section itself may be an indicator of poorer overall health of the mother. Professor Hinkle explained, “Another hypothesis is that the surgery itself has long-term adverse health effects, such as complications such as infection, blood clots, cardiovascular disease, scar tissue, and complications in subsequent pregnancies.”
In reality, the long-term risks associated with cesarean section surgery vary widely. Cesarean section surgery can increase the risk of ectopic pregnancy, in which a fertilized egg implants and grows outside the uterus. Additionally, scars resulting from surgery increase the risk of placental adhesions, in which the placenta adheres too deeply to the uterine wall.
Many women around me, including myself, do not think deeply about the risks of cesarean section surgery because it is so common, and we often forget that it is a major abdominal surgery.
Lack of follow-up care
Cruelly, the surgery I had after my first bowel obstruction left more scar tissue inside my abdomen. Because of this, the same problem recurred four months later, and I had to undergo emergency surgery again. Fortunately, this time, the medical staff performed open surgery on the same day, so it did not lead to infection or intestinal perforation. However, the medical staff left a comment saying that it may recur tomorrow, it may appear decades later, or it may never recur again.
As my case shows, anyone who undergoes abdominal surgery can develop scar tissue. According to a 2017 study of Swedish women, abdominal adhesions occurred in 37% of women who had previously had a cesarean section. On the other hand, the rate of abdominal adhesions in women who had never had a cesarean section was only 10%.
Adhesions can cause internal organs to stick together, causing abdominal pain and intestinal obstruction. This slightly increases the risk of death for the mother and infant in future pregnancies, especially in emergency delivery cases. Additionally, adhesions make subsequent cesarean sections surgically more complicated and increase the risk of rupture of the bladder or intestines. Professor Down warned that the rise in caesarean sections was putting more women at risk of complications.
Natural childbirth can also leave permanent damage to the body.
Numerous complications can occur even during natural childbirth.
Heather Barnes, now in her mid-70s, suffered a fourth-degree perineal tear when giving birth to her daughter about 40 years ago. This means serious damage that ruptures not only the anal sphincter but also the lining of the anus or rectum.
Barnes lives with chronic pain and complications to this day. When the baby got stuck in the birth canal and did not come out at the time of birth, forceps, a metal instrument bent like large tweezers, were used. During this process, Barnes suffered damage to the pudendal nerve, resulting in fecal incontinence and perineal pain. He said, “I am in pain every single day.”
Barnes' experience is by no means unusual. Urinary and fecal incontinence are very common complications that appear decades after childbirth, especially in women who gave birth naturally. According to a study that followed women 20 to 26 years after giving birth, 61% of respondents experienced urinary incontinence and 22% experienced fecal incontinence. Additionally, 17% reported experiencing symptoms of pelvic organ prolapse.
Professor Susan Hagan of Glasgow Caledonian University, UK, lead author of the study, pointed out the seriousness of the problem hidden behind these statistics. It is pointed out that these complications have a destructive effect on women's lives, interpersonal relationships, and social activities.
For example, Barnes was so traumatized at the time that she could not bring herself to have a second child or return to work. He confessed to reporters, “The stress of living with the constant awareness that I could make a mistake at any time is truly terrible.” At the time, there was an atmosphere where no one would disclose their urinary incontinence or pain to others. “I couldn’t even tell my best friend about my situation,” Barnes said.
It is estimated that up to 90% of women who give birth vaginally have an episiotomy or at least some lacerations or abrasions. A perineal incision is a procedure that involves making an incision between the vagina and anus to widen the opening through which the baby's head comes out. In particular, the incidence of lacerations is significantly higher in deliveries using medical devices such as forceps or suction delivery devices that are attached to the baby's head using suction power. The deeper the laceration, the greater the risk of urinary and fecal incontinence, dyspareunia, and the need for reconstructive surgery.
South Asian women are at higher risk for vaginal lacerations. Casal da Silva, a mother of one, had no idea about this until she suffered a fourth-degree laceration.
Six years after suffering a birth injury, da Silva says, "Life still seems to revolve around it. I can't make any plans without calculating what I'm going to eat, what I ate, what I'm going to do the next day, and making sure there's a bathroom along my route."
Da Silva still suffers from chronic pelvic pain, which prevents him from sitting or standing for long periods of time. I have no plans to have another child. “I just can’t mentally handle the thought of having another child,” he said.
chronic pain
Whether it is a natural birth or a cesarean section, it is not uncommon for pain to continue for several years after giving birth. This can occur when the pudendal nerve, which passes through the pelvis and controls movement and sensation in the genitals, anus, and urethra, is damaged.
It is well-documented that medical staff do not always take women's pain seriously. For example, a British report on birth trauma published in 2024 records a case in which an obstetrician-gynecologist told a midwife, “There are no nerves in a woman’s vagina,” while suturing the perineum of a mother who had not received adequate pain relief.
Barnes only learned about pudendal neuralgia from a newspaper article. He confessed, “No one believed that I was really suffering.”
mental health
Some of the long-lasting effects of childbirth are psychological rather than physical. However, these two are closely related to each other. In fact, negative experiences related to childbirth are considered a major risk factor for not only persistent fear of childbirth but also postpartum mental health problems.
Dimple Mistry, a mother of two, still suffers from trauma that reminds her of the fourth-degree perineal laceration she suffered six years ago. He had to have a colostomy (ostomy) installed in his abdomen to expel feces and gas after his stitches burst and became infected.
“I knew something was wrong when I saw stool coming out of my vagina,” Mistry said.
Because of this experience, Mistry's greatest fear when she was pregnant with her second child was that she would walk into the hospital on her own and die during childbirth. This fear greatly affected his daily life.
Mistry later underwent stoma restoration surgery, but is currently suffering from a feeling of urgency to defecate, chronic abdominal pain, and pelvic pain due to adhesions at the surgical site. He explained, “Basically, it seems like the intestines are stuck to the abdominal wall,” and “when food passes through the intestines, it cannot move freely, so you suffer from constant abdominal pain.”
Although awareness of postpartum mental health in the first year after giving birth is greater than in the past, it is relatively unknown that many women still suffer from mental health problems years later.
One analysis found that about 4.5% of women continued to experience depressive symptoms throughout the three-year follow-up period. It is estimated that approximately 10-15% of new mothers suffer from depression, the most common postpartum mental health condition. In addition, anxiety disorder, post-traumatic stress disorder (PTSD), and postpartum psychosis may occur after childbirth.
Neya Joshi, also a mother of two, suffered from PTSD due to the treatment she received in the postnatal ward following an emergency caesarean section in 2020. At the time, he felt neglected and without any support.
Josh said, "I was in a situation where I had to take care of everything on my own, even though I couldn't even take care of myself, let alone my newborn baby." Thanks to the help of a psychiatrist, she recovered from PTSD a year after giving birth, but later suffered from premenstrual dysphoric disorder (PMDD), which causes extreme depression and despair one to two weeks before her period. Studies show that these two diseases are often linked.
Josh's mental health symptoms worsened after the birth of his second child to the point where they interfered with his daily life. He said, “I often suffer from extreme fatigue, severe irritability, depression, anxiety, insomnia, and nightmares,” and “It is difficult to live an incomplete life while raising two young children.”
Like the other women I interviewed, Josie had difficulty getting an accurate diagnosis and support. This experience served as an opportunity for her to receive training as a maternal assistant to help those suffering from postpartum aftereffects.
Voices calling for expanded support
Clearly, there is no immediate or perfect solution to the many complications that occur after childbirth. But knowing what support is available can be an important first step.
In 2019, a British team of researchers who surveyed the treatment experiences of women with pelvic organ prolapse found that many women put off seeking help. This was partly due to concerns that disclosing one's symptoms would be shameful or dismissed as insignificant. Because of this, there was a woman who endured pain for 30 years and visited the hospital only after her symptoms worsened.
The main reason why so many women have suffered for so many years is the chronic lack of support. Postpartum care often focuses only on the baby, not the mother. As a result, mothers feel extremely isolated or are placed in a blind spot where they cannot get the information and support they need.
In a related report, Professor Allison Steubey of the Department of Obstetrics and Gynecology at the University of North Carolina pointed out, "It's like the baby is candy and the mother is the wrapper. Once the candy is taken out, the wrapper is thrown away."
Vogel said that although there are differences in medical policies from country to country, in most cases, only a handful of examinations are provided to mothers after giving birth, making it easy to miss long-term complications that occur after birth. Because there are no ongoing checkups, it is not even clear how long women endure pain before seeking help. He said, “We don’t even know exactly what happens to all mothers after giving birth.”
In a recent survey, an overwhelming majority of women responded that they needed follow-up even a year after giving birth. Of course, many new parents are so busy taking care of their children that they don't even have time to take care of themselves.
Additionally, misconceptions about body changes after childbirth also add to the problem. Vogel pointed out that “a big problem is the perception that a certain level of discomfort or decline in physical function is taken for granted.” Women often accept complications as fate and resign, thinking, "This is how my body is supposed to be. It's natural for me to leak urine when I cough or not be able to run."
Among the women I interviewed, da Silva said that self-funded physical therapy helped alleviate some of her symptoms. Being able to see the physical recovery process with my own eyes also had a positive impact on my mental health.
“Change begins when you can physically see that things are getting better,” da Silva said. He also found great comfort through self-help groups, and currently runs his own self-help group. “At self-help groups, I can meet women in the community who have gone through the same injuries as me, so I no longer feel isolated,” da Silva said.
Barnes also explained how important it was to gain genuine empathy and trust in a situation where her pain had been ignored for years, and how it helped her endure the long pain. He confessed, “I will never forget the memory of being told by a doctor many years ago that I was a pretty foolish and nervous woman.” That's why Barnes advises other women to never stop asking for their voices to be heard. “These injuries are like cruel thieves that steal your life,” he said. “Don’t let them consume your entire being.”
At first, I didn't even know what adhesion was. This is because no one has ever warned us that we are exposed to greater risks due to past surgeries.
Despite all the ups and downs I've gone through, I'm still lucky. Fortunately, after experiencing complications every time, I have recovered well and am living without daily pain. Through this process, I learned firsthand how important it is to speak up and demand your rights to receive the medical help you need.
In my daily life, I now rarely think of that trauma or danger. However, sometimes when abdominal pain suddenly comes on, I picture in my head how I will be taken to the hospital again, what treatment I will receive, and how I will explain it to the doctor to ensure prompt treatment.
As many experts have told me, knowledge can be a powerful weapon. I hope that through my experience and that of others, more women will be able to carefully monitor their health and seek help at the right time.
