Opinion
Why We Need to Talk About the Risks of Childbirth By: Jocelyn Fitzgerald, MD, URPS Whether we want to admit it or not. pregnancy is likely the most physically demanding and dangerous thing that most women will ever do. Research across medical disciplines demonstrate that pregnancy is not a “health neutral” event and has known long-term maternal risks1. As a Urogynecology and Reconstructive Pelvic Surgeon, I see women whose ages span decades. 25% of women in the US has a pelvic floor disorder2 such as vaginal prolapse or urinary/fecal incontinence, and vaginal delivery is the most significant modifiable risk factor for these conditions3. Their presentation to my clinic is frequently delayed due to lack of awareness among patients and providers alike that pelvic floor disorders exist and that they are treatable with specialist care. Many of my patients are extremely frustrated when they learn how common pelvic floor disorders are and that it took so long to get treatment; they prevailingly want to know why “nobody ever told me that this could happen”. There seems to be a slowly changing paternalistic attitude in OB/Gyn of “prolapse is rare so I won’t mention it” or “she’s already pregnant, so why tell the patient about prolapse and worry her?” that has gotten many of my patients to this point. Pelvic floor trauma is not rare; 20% of women in the US will have prolapse surgery in her lifetime. Women just don’t talk about their symptoms out of fear that they are uniquely broken; and they haven’t been educated on the resources for conditions like incontinence and prolapse. In general; little attention is paid to women’s health
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beyond pregnancy. There is also a pervasive idea that if you are the kind of doctor who openly discusses the maternal risks of childbirth in prenatal counseling that you are “fearmongering”; or being “anti-natalist”. (Which is a stunning accusation to direct at an Ob/Gyn or Urogynecologist, who literally makes their living secondary to women giving birth, but I digress.) Is clearly presenting historically omitted or downplayed information about how pregnancy realistically affects a woman's body really fearmongering? What are we afraid women will do with this information? I think we need to reckon with the idea that we are uncomfortable with the thought that not every woman would choose motherhood if presented with the facts. But, it is none of our business what reproductive choices women make with the information that they have. If all it takes to have a woman forego pregnancy and birth is to counsel her about the increased rate of anal incontinence with forcep deliveries4,
or the long term ramifications of preeclampsia on her heart attack or stroke risk5, or the 15% of women who experience postpartum psychiatric disorders6 then we have likely done that patient a valuable service in helping her make an informed decision about one of life’s most serious choices: whether or not to become a parent. Meanwhile, for women who strongly desire childbearing, more information on the physical, mental, and emotional effects of pregnancy is not going to deter them from parenthood, but rather benefit them from a preparation standpoint. How can we inform women where to find treatment for postpartum disorders if we don’t also educate and talk openly about the risks of those very disorders? By withholding information about maternal risks of pregnancy, we not only delay care for postpartum pathology and prolong women’s suffering, but we increase isolation and anxiety on the back end. The idea that describing the risks of birth trauma will lead to unnecessary
Image found in Reference 3
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