"You won't even tell your close friends": Why do the sequelae of childbirth still linger after many years?

Author, Melissa Hogenboom

Role, senior health correspondent, BBC Future

Published 2 minutes ago

Reading time: 6 minutes

Note: This article deals with some traumatic medical experiences that may be disturbing to some readers.

In 2024, I was admitted to the hospital again. For the past 36 hours or so, I have been in excruciating pain that not even morphine can relieve. After the surgeon operated on me and opened my abdomen, they discovered that part of my intestines had penetrated a tear in the abdominal wall, causing intestinal perforation and pus flowing into the entire abdominal cavity, causing severe infection and a dangerous situation.

While I was waiting for the surgery, I sent all my bank account information to my husband, just in case I didn’t survive the ordeal. The pain made it almost impossible to think. I haven't eaten in two days, but I still get nauseated from time to time.

The operation lasted five hours. I woke up around midnight to find myself lying groggy in the intensive care unit. There was a wound about 15 centimeters long on the abdomen extending from the navel to the pelvis, and a large drainage tube was inserted into the abdominal cavity. How did I end up in this situation? What does this have to do with childbirth?

It’s well known that childbirth can be dangerous, but what’s less talked about is that the physical problems caused by childbirth may not pass away in the immediate postpartum period, but can affect women for decades. While the particular situation I experienced is uncommon, it is worryingly common for birth complications to surface years later.

It is estimated that around 40 million women worldwide are affected by childbirth complications each year, with symptoms that can last for months or even years. Problems include incontinence, long-term pain, and even scar tissue growth, leading to potentially life-threatening bowel problems or affecting fertility later in life.

Some problems, like mine, may appear years later and persist. I interviewed multiple women and experts to get a full picture of the long-term physical and mental toll that childbirth can take. I have heard from many women who feel that their concerns are not being taken seriously and, worse still, that they are not getting the treatment they need.

I didn’t plan to revisit my experience in this column because I hate being vulnerable. But I hope that by talking about these complications, I will raise awareness of the risks of childbirth and let women know how to seek support, so that other women will be better equipped to get the care they deserve.

Life-saving treatment leaves lifelong impact

Childbirth has long-standing risks that can lead to complications and even death for mother and baby. Fortunately, maternal deaths have declined in many parts of the world. Between 2000 and 2023, the global maternal mortality ratio per live birth fell by 40%.

However, according to a large-scale global research report published by a group of international researchers in 2024, in the past, all sectors of society focused on reducing maternal deaths, but the delivery process and the long-term impact of childbirth on women often did not receive enough attention.

Joshua Vogel, a perinatal epidemiologist at Australia's Burnet Institute and lead author of the study, said it was worrying that many women didn't know how to get support for themselves, especially when they didn't necessarily know which symptoms were normal and which needed to be checked.

"The sheer variety of these complications just boggles my mind," he said.

Abdominal adhesions

My problems started with an emergency C-section.

Four days after my daughter was born, I was readmitted to the hospital for another emergency surgery. My surgical sutures burst completely and I also suffered serious complications in my intestines. This experience traumatized me so much that it was so rare that it was classified as a "never event" in medical malpractice. But at the time, I was thankful that my newborn daughter was safe, so I put the incident behind me and focused on the fact that both of us, mother and daughter, were safe and sound, and considered myself lucky.

Seven years passed, during which time I became pregnant and gave birth once more, and everything seemed to be back to normal. Until one Wednesday afternoon, I suddenly had abdominal pain that gradually became worse. I was working at the time and remember lying in bed on a video conference, turning off the camera, hoping the pain would subside soon. At 16:30, I sent a message to my husband and said, "It really hurts. I can see my stomach moving."

At that time I still thought I just had severe gastroenteritis. Looking back now, I realize that my thinking at that time was no longer rational.

Perhaps because of this, I could still manage to pick up my children from school and even move my children's bicycles into the carriage. But the pain kept getting worse. Finally, the husband contacted his sister, a doctor. The problem, she said, may be the intestinal blockage caused by adhesions — known as scar tissue — that develop after a C-section. When I started vomiting, she told me to call an ambulance immediately. But there was no ambulance at the time, so I had to take a taxi to the hospital. By then I could barely stand.

After arriving at the hospital, the doctor confirmed that I had an intestinal obstruction. The initial C-section, combined with the medical errors that occurred during the second surgery, left me with a large amount of scar tissue in my abdominal cavity that is now compressing my intestines and blocking blood flow.

Sometimes intestinal blockages resolve on their own, so I waited in excruciating pain for 36 hours to see if I needed surgery. The next day, I started to have a high fever, and a blood test showed that the level of C-reactive protein (C-reactive protein), an indicator of inflammation, rose sharply from 1 to 311, which is much higher than the normal level of 5 or less. The doctor decided to schedule surgery as soon as possible, but in a busy hospital, "as soon as possible" still meant I had to endure another five hours of pain.

After the surgery, the surgeon told me that it went well but was more complicated than they had originally anticipated. They removed a 60 centimeter section of my intestine that had become necrotic due to lack of blood and oxygen supply. This surgery saved my life. Once again, as time passed and my body gradually recovered, I, who was always used to being stoic, thought to myself: "Things could have been worse."

But the medical complications didn't end there.

major abdominal surgery

The proportion of caesarean sections continues to rise globally and currently accounts for approximately 21% of all births. In some countries, the proportion is even higher, such as the Dominican Republic at 58% and the United States at over 32%. Prof Soo Downe, professor of midwifery at the University of Lancashire, said caesarean sections may be vital for the health of mother and baby, but they also increase the risk of complications.

Complications may not appear immediately. A US study that tracked 43,646 mothers for 50 years found that women who had a caesarean section had a 16% higher risk of death during that period than women who gave birth naturally. They are also at higher risk of death from cardiovascular disease, diabetes, respiratory disease, infection and kidney disease.

Stefanie Hinkle, a perinatal epidemiologist at the University of Pennsylvania and study co-author, said researchers still don't know the cause. Women who had had a C-section were more likely to be older, have a higher body mass index (BMI), smoke, or have diabetes and other pre-existing conditions; but the association remained even when the researchers took these factors into account.

One possibility, Hinkle said, is that C-sections themselves reflect poorer overall women's health. "Another possibility is that the surgery itself could have long-term health consequences, such as infection, blood clots or cardiovascular problems, or complications from scar tissue and subsequent pregnancies."

Clearly, there are multiple long-term risks associated with a caesarean section. This type of surgery may increase the risk of ectopic pregnancy, in which a fertilized egg implants and develops in a location other than the uterus. Scarring from a C-section may also increase the risk of placenta accreta, in which the placenta attaches too deeply to the uterine wall.

Like many women I know, I did not consider these risks too seriously at first because caesarean sections have become so common that it is easy to forget that this is actually a major abdominal surgery.

Lack of follow-up

Ironically, the surgery I underwent after my first bowel obstruction caused more scar tissue in my abdominal cavity. So four months later the same problem reoccurred and I was back in the operating room for emergency surgery. Fortunately, this time the medical team performed the surgery on me on the same day and there was no infection or perforation.

The doctor told me it could happen again tomorrow, it could happen decades later, or it could never happen again. In other words, I will be at risk of another bowel obstruction for the rest of my life.

Anyone who has had abdominal surgery can develop scar tissue, as my experience illustrates. A 2017 Swedish study found that 37% of women who had had a caesarean section developed abdominal adhesions, compared with only 10% of women who had never had a caesarean section.

Abdominal adhesions may cause organs in the body to stick to each other, causing abdominal pain and intestinal obstruction. It may also slightly increase the risk of mother and baby death in future pregnancies, and the risk associated with emergency delivery is higher. Adhesions can also complicate subsequent caesarean operations and increase the risk of bladder and bowel tears.

Dawn pointed out that the increasing number of C-section births means more women may be facing these complications.

Natural childbirth can also cause long-term physical damage

Natural childbirth can also cause many complications.

Heather Barnes, now in her 70s, suffered a fourth-degree perineal tear when she gave birth to her daughter more than 40 years ago. This means the anal sphincter, which controls gas and bowel movements, is torn and the lining of the anus or rectum is damaged.

The most common long-term complications include:

Dyspareunia or pain (35%)

Lower back pain (32%)

Urinary incontinence (8% to 31%)

Anxiety (9% to 24%)

Fecal incontinence (19%)

Depression (11% to 17%)

Tokophobia (6% to 15%)

Perineal pain (11%)

Secondary infertility (11%)

Other less common problems include pelvic organ prolapse, post-traumatic stress disorder, thyroid dysfunction, nerve damage, peripartum cardiomyopathy, and obstetric fistulas.

Barnes still suffers from chronic pain and complications. When she gave birth, her daughter was stuck in the birth canal, and the doctor used forceps to help remove the baby. A forceps is a curved metal tool shaped like a pair of large forceps. The delivery left her with fecal incontinence, perineal pain, and damage to her pudendal nerve.

"I'm in pain every day, and I really don't have a day off," she said.

Barnes' experience is by no means an isolated case. Decades after childbirth, incontinence remains common, especially among women who have given birth naturally. One study followed women 20 to 26 years after giving birth and found that 61% had urinary incontinence, 22% had fecal incontinence, and 17% had symptoms of pelvic organ prolapse.

Suzanne Hagen, professor of health services research at Glasgow Caledonian University in the UK and lead author of the study, said the statistics did not reflect the serious impact the problem was having on women's lives, including their relationships and their ability to work.

Take Barnes, for example. The trauma left by her childbirth experience was so deep that she was afraid to have another child and could not return to work.

She told me, “Knowing that I could become incontinent at any time was so stressful.” There was no one she could talk to about her incontinence or pain. "You wouldn't even tell your best friend."

It is estimated that as many as 90% of women will experience at least some degree of tearing, bruising, or need an episiotomy during natural childbirth. An episiotomy involves making an incision between the vagina and anus to widen the opening of the birth canal, making it easier for the baby's head to be delivered.

The proportion of lacerations in cases requiring the use of instruments such as forceps or fetal vacuum suction device to assist delivery is significantly higher. A fetal head suction device is a device that uses suction to absorb the baby's head and assist in delivering the baby. More severe lacerations increase the risk of urinary or fecal incontinence, pain during intercourse, and the need for repair surgery.

South Asian women are at higher risk for vaginal lacerations. Kajal Da Silva, a mother of one, didn’t know this until she suffered a Grade 4 laceration herself.

Today, six years after she was injured during childbirth, DaSilva said, "My whole life still seems to revolve around this injury."

"I couldn't even make any plans because I had to think about what I was going to eat, what I was eating, what I was going to do the next day, and how to plan my trip to make sure there were restrooms along the way."

She still has chronic pelvic pain, is unable to sit or stand for long periods of time, and has no plans to have any more children. "I can never mentally allow myself to even think about having another child."

chronic pain

Whether giving birth naturally or by caesarean section, women often still suffer from pain years after giving birth. One cause may be damage to the pudendal nerve. This nerve travels through the pelvic cavity and is responsible for controlling movement and sensation in this area, including the reproductive organs, anus, and urethra.

Women's pain is not always taken seriously by medical staff, a problem that has been documented time and time again. For example, a 2024 report on childbirth trauma in the United Kingdom mentioned an incident in which an obstetrician reportedly told a midwife, "There are no nerves in the vagina," while suturing the wound of a patient who was not receiving adequate pain relief.

Barnes said she first learned about pudendal nerve pain from reading in the newspaper. "No one believed I was actually in pain."

mental health

Some of the long-term consequences of childbirth are not physical injuries but psychological trauma. The link between the two has been confirmed. In fact, negative birth experiences are seen as a significant risk factor for developing mental health problems after birth, as well as for persistent fear of childbirth.

Dimple Mistry, a mother of two, still has triggers that bring back traumatic memories of a fourth-degree laceration six years ago. At that time, her wound sutures tore open and became infected, so doctors performed an ostomy surgery on her, which is to create an outlet in the abdomen through which feces and gas can be discharged from the body.

"I was passing stool from my vagina and I knew something was wrong," Mistry said.

She explained that this experience made one of her biggest fears when she was pregnant with her second child the possibility of dying during childbirth after walking into the hospital. This fear had a great impact on her.

Mistry's stoma has since healed, but she still suffers from urgent bowel movements, chronic abdominal pain and pelvic pain due to adhesions at the surgical site. "I think my intestines are basically stuck to the abdominal wall. So when food passes through my intestines, my intestines can't move freely." This caused her constant abdominal pain.

Although society now has more awareness of mental health problems in the first year after childbirth, fewer people know that many women still suffer from mental health problems many years later.

One analysis found that about 4.5% of women had persistent symptoms of depression during the three-year follow-up period. It is estimated that about 10 to 15% of new mothers suffer from depression, which is the most common postpartum mental health problem. Other problems include anxiety disorders, post-traumatic stress disorder, and postpartum psychosis.

Neya Joshi, who also has two children, developed post-traumatic stress disorder while receiving care in the postpartum ward after undergoing an emergency caesarean section in 2020. She felt abandoned and unsupported.

"I was physically unable to take care of myself, let alone a newborn baby, but I still had to handle everything on my own," Josh said.

With the support of a perinatal psychologist, she recovered one year postpartum. However, she later developed premenstrual dysphoric disorder (PMDD), in which she would experience intense depression and hopelessness one to two weeks before her menstrual period. Research has found that the two conditions are often linked.

Josh said after the birth of her second child, her mental health symptoms became more severe and affected her daily life.

"I often feel tired, extremely irritable, depressed, anxious, insomniac, and have nightmares. It's really not easy to live such a half-dead life while raising two young children."

Like other women I interviewed, Josh had struggled to get a correct diagnosis and appropriate support. She then trained as a postnatal doula and became determined to help other women suffering from postpartum problems.

Get support for yourself

Obviously, there are no quick and easy solutions to many postpartum complications, but knowing what support is available to you can be an important first step.

A team of British researchers published a report in 2019 exploring women's experiences of receiving care after pelvic organ prolapse. Studies have found that many women delay seeking medical attention, in part because they feel embarrassed or feel their symptoms are not being taken seriously. One woman suffered from the disease for 30 years and did not seek medical attention until her symptoms worsened.

In addition, society also has many misunderstandings about the postpartum recovery period. "One of the important factors is that people generally expect that some discomfort or impairment in physical function after childbirth is normal," Vogel said.

He explained that women often anticipate complications and think: "This is what my body is like now...I will leak urine when I cough, or I will never be able to run again."

Among the women I interviewed, DaSilva said physical therapy helped relieve some of her symptoms, but she had to pay for the treatment out of pocket. Being able to track the progress of her physical recovery will also help improve her mental health.

"When you see with your own eyes that your body is really getting better, things start to change." She has also received a lot of help from mutual aid groups, one of which she now personally leads. “You can meet other women who live in the same area and have gone through the same trauma, so you no longer feel alone.”

Barnes also mentioned that gaining recognition and having someone believe in her experience was important in helping her cope with her injury, especially since her pain had been ignored for years. "Years ago, a doctor told me that I was a rather stupid, neurotic woman. I will never forget that."

Her advice to other women is to never stop trying to get your voice heard. "These injuries are like a cruel thief that steals your life. Don't let it take over your entire life."

As for myself, I didn’t know what abdominal adhesions were at first. No one ever told me that having had surgery would put me at higher risk.

Despite everything I've been through, I still consider myself lucky. I have been able to recover smoothly from each complication and do not have ongoing pain issues in my daily life. I also know firsthand how important it is to get yourself the medical help you need.

On a daily basis, I rarely revisit those traumas or associated risks. But occasionally when I have a stomachache, I still think about the possibility of being admitted to the hospital next time, and how I should express my situation so that the medical staff can deal with it as quickly as possible.

As multiple experts have told me, knowledge itself is power. So, I hope that by sharing these experiences and information, other women will know what symptoms to look out for and when to seek support.