When you give birth, all that stands between a smooth delivery and a complicated experience is your gynae’s skill.

Obstetrician-gynaecologist Dr Peter Chew explains that the following steps taken by your doctor can reduce your risk of injuries:
- vaginal delivery;
- Careful monitoring of your and your foetus’s health during labour; and
- Ensuring that the correct instruments are used during assisted delivery.

Dr Chew says mothers also tend to be at a higher risk of suffering from birth injuries than their newborns. The good news is the rate of birthing injuries for women is low in Singapore, since we have plenty of trained healthcare workers.

SmartParents expert and Gleneagles Hospital consultant ob-gyn, Dr Christopher Chong, notes that surgery is usually unavoidable in the treatment of birthing injuries. So, new mothers should stay alert, spot the signs of possible complications and get it promptly treated to avoid potentially life-threatening consequences. Dr Chong and Dr Chew give you the lowdown on common birthing injuries you may encounter…

1. Vaginal tears
WHAT Tears can occur in and around the vaginal area due to the stresses caused by pushing a baby out of your womb. These painful splits, cracks or breaks in the skin can occur on the inner or outer labia, around the clitoris and clitoral hood, or on the perineum — the area between the vagina and anus. Dr Chong explains that as Asian women tend to have a shorter perineum, they are more susceptible to suffering tears. You may feel pain or a stinging sensation whenever you pee because these cuts can also occur on the inside. Dr Chew says that even your anal sphincter or episiotomy wounds may sometimes be torn, which causes faecal incontinence.
LIKELY TO HAPPEN DURING Vaginal and forceps birth.
SOLUTION Minor tears and cuts can be left to heal on their own, along with practising good hygiene. Dr Chong stresses, “Difficult repairs may need to be done in the operating theatre instead of the labour ward for better visualisation, pain relief and better outcomes.” Dr Chew adds that trained medical staff will need to attend to the cuts in your episiotomy wounds and anal sphincter immediately.

2. Vulvar haematoma
WHAT Caused by the improper healing or repair of an episiotomy wound. Dr Chew explains that when blood from a ruptured deep vein collects in a closed space around the vulva, it can cause pain. As the excess blood isn’t drained properly, your vulva will swell, which produces excruciating pain.
LIKELY TO HAPPEN AFTER Vaginal births.
SOLUTION Incisions will have to be made to remove any possible blood clots or allow the collected blood to drain. Antibiotics may also be prescribed to help you avoid infection.

As Asian women tend to have a shorter perineum, they are more susceptible to suffering tears.

3. Uterine rupture
WHAT This birth injury is potentially life-threatening and relates to mothers attempting a vaginal birth after C-section (VBAC). The strong uterine contractions during childbirth can tear your weak or unhealthy C-section scar. A uterine rupture is potentially fatal for your little one. The good news is that the risk of uterine rupture is low — occurring only in 0.5 per cent of spontaneous labour.
LIKELY TO HAPPEN DURING VBAC births.
SOLUTION Your ob-gyn will advise you to get an immediate emergency C-section. However, this procedure may not save your foetus’s life. You may also have to undergo an emergency hysterectomy to stop the bleeding.

4. Haemorrhage
WHAT Massive bleeding as a result of burst blood vessels in the womb.
LIKELY TO HAPPEN DURING C-sections.
SOLUTION You’ll need to have surgery. If you have blood-clotting disorders, a haemorrhage can be potentially life-threatening. Your doctor may carry out an emergency hysterectomy.

Five more birthing injuries to wise up to… Next!

5. Fistula
WHAT A blockage of the small glands in your anus that becomes an abscess, which can turn into a fistula if left untreated. Dr Chong shares, “This can lead to faeces coming out of the vagina because of the connection between the rectum or anus and the vagina.”
LIKELY TO HAPPEN AFTER Vaginal births.
SOLUTION It’s crucial to seek medical help early, so that wound can be sutured.

6. Prolapsed uterus
WHAT A complicated labour can cause your uterus to descend into your vaginal canal. Under normal circumstances, your uterus is usually kept in place and supported by various muscles, tissues and ligaments.
LIKELY TO HAPPEN AFTER Vaginal births.
SOLUTION Avoid any heavy lifting. Also, losing excess weight can take some stress off your pelvic muscles. Practising pelvic-strengthening exercises like Kegels helps, too. Surgery will needed in difficult and complex cases.

7. Surgical adhesion
WHAT Post C-section surgery, the scar tissue from the inside of your abdomen or pelvis can cause the organs to stick together — known as surgical adhesions. A common sign of a surgical adhesion is when you feel pelvic or abdominal pain after giving birth. This is a painful condition because it limits the movement of your internal organs.
LIKELY TO HAPPEN AFTER C-sections.
SOLUTION You’ll need surgery to separate and remove these adhesions ― even then, these can still recur.

Some mothers may be put off having sex because of the pain they experience after sustaining physical injuries during the birthing process.

8. Urinary and faecal incontinence
WHAT Deep tears to the vaginal walls may cause the tissues between the rectum or the bladder and vagina to be infected, which results in incontinence.
LIKELY TO HAPPEN AFTER Vaginal forceps births.
SOLUTION Take note of any pain when you pee as it’s a sign of vaginal tearing, which can lead to urinary incontinence. Doing Kegel exercises can help you strengthen your pelvic-floor muscles and boost control of your bladder. Dr Chong notes, “Failing which, a catheter to drain the bladder, then let it heal is all that’s needed.” Also, make sure you move your bowels at the same time every day to prevent accidents!

9. Sexual dysfunction
WHAT Some mothers may be put off having sex because of the pain they experience after sustaining physical injuries during the birthing process. Because of weakened pelvic muscles and a loose vagina, intercourse may become less enjoyable for you and your spouse Dr Chew explains.
SOLUTION Find other ways to jazz up your post-baby sex such as with lubricants, role-play fun, accessorising and bondage. If the fear of sex is due to the post-traumatic stress you suffered during childbirth, get help from a psychologist or psychiatrist.

Photos: iStock

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