Catherine had a "perfect" natural birth. But it made her first months of motherhood hell.

Natural. Drug-free. In the water. And only 12 hours long. Catherine Harry had what many would consider to be a “perfect” birth. But it made her first months of motherhood hell.

“Medical professionals would say it was textbook. I breathed my baby out into the water calmly, with no drugs… And I still ended up like this.” By “this”, Ms Harry is referring to the emotional and physical trauma she was left to nurse, with lifelong consequences.

Ms Harry’s memories of her labour are that it was easy and straightforward. She did feel a “ripping” sensation right as her daughter was crowning, but when her doctors later checked her, they told her she had only a mild prolapse and first degree perineal tear – nothing to worry about.

“Early on I thought something was not quite right, but people kept saying I was completely normal. I couldn’t walk, I couldn’t sit down because I was in so much pain,” she told Mamamia.

“Three days postpartum I pushed to get to breastfeeding class. Some women had given birth 24 hours ago and were sitting on wooden chairs with their legs crossed. I needed a cushion, and even that was painful. I lost the end of the class because I had to leave, I was in that much pain.”

Ms Harry couldn't escape the memory of a distinct feeling of tearing. Eventually, when her daughter Michelle was four-months-old, she sought advice from a different specialist. She was told she likely had a levator avulsion, which meant her pelvic floor muscles had been pulled off the bone, leaving her pelvic organs exposed and putting her at high risk of severe prolapse.

According to the Australian Birth Trauma Association's research, 10-20 per cent of first-time mothers (between 15,000 and 30,000 women in Australia per year) may suffer major irreversible physical birth trauma in the form of pelvic floor muscle and/or anal sphincter tears. Additionally, up to 20 per cent of all women who deliver a baby vaginally will end up with surgery for pelvic organ prolapse, anal or urinary incontinence.

It would be another five months before Ms Harry had the official diagnosis of a levator avulsion. And those five months were emotionally tumultuous.

'I was just reliving that moment over and over again.'

The ripping sensation haunted Ms Harry. She began suffering from nightly, overwhelming nightmares and intense panic attacks every couple of days.

"I was just reliving that moment of feeling all my muscles give out over and over and over again," she said. "At the height of it, I was having panic attacks where I'd have to call my husband and get him to come home from work, I just couldn't do anything."

She couldn't pick up her six kilogram baby or cut pumpkin without feeling like her organs were going to pour out of her. Her whole body was exhausted. And worst of all, she mentally couldn't dissociate her daughter from her physical injuries.

"I couldn't separate the fact my daughter was here and she had caused my injuries."

Ms Harry would at times feel like she couldn't have Michelle near her, that she didn't want to be a mum anymore, and that she wished someone would take her away.

"It was distressing for my family to hear. At one point I was really bad and my sister offered to take her for a few weeks," she said.

"I ended up in the emergency room twice and the only reason I didn't get admitted to the mental health ward was because I was breastfeeding (something Ms Harry said she felt she dearly needed to connect with her daughter) and they didn't have the facilities to have my daughter with me."

All the while, Ms Harry knew isolating herself from her baby made no logical sense. It wouldn't cure her.

As well as the mental difficulties was the physical pain and discomfort - something Ms Harry said was "constant".

"Getting out for brunch on the weekend should be no effort, and I'd get literally 20 metres down the road and burst into tears. I felt too uncomfortable and had to lie down."

"It's still really upsetting to me remembering that time, particularly the aversions I had towards my daughter. My overriding feeling is I was really sick. I was really mentally unwell. And I'm so grateful I have such an amazing, supportive family and husband. I don't know if I would have made it out otherwise."

Ms Harry said with the prevalence of birth trauma, she was speaking out because she believed expectant mums needed to be given "more realistic" prenatal advice when deciding between vaginal birth, c-section and whether they'd accept the use of forceps or vacuum.

She said she'd never heard of levator avulsion, and had only ever heard prolapse discussed in the context of menopause, not four weeks postpartum at 30 years old.

"I had a debrief with my hospital afterwards and asked why they didn't tell women about muscle avulsion. They don't want to scare women, but they're withholding such a basic thing women should know about. We're not delicate little creatures," Ms Harry said.

"Medical professionals need to strike the right balance of not scaring women but also giving them information to make choices about their healthcare."

'Women need to be treated like adults.'

University of Sydney obstetrician and gynaecologist Professor Hans Peter Dietz, who is an expert in pelvic floor trauma, said the number of women diagnosed with anal and pelvic floor injuries was steadily rising in the western world, with the great majority occurring after a first baby born vaginally.

A study co-authored by Prof Dietz states permanent maternal birth trauma affects 15-40 per cent of women giving birth vaginally for the first time.

Prof Dietz said several drivers were behind the growing problem, including the age of first birth (22 per cent of new mums are age 35 or over), obesity rates (about half of birthing mothers are classified as overweight or obese), high birthweight babies (1.4 per cent of newborns), epidurals encouraging unnatural pushing (three-quarters of women use pain relief during birth), the use of forceps (eight per cent of births), and pressure to reduce Australia's c-section rate, which currently stands at 33 per cent.

He said the pelvic floor muscles, which hold in pelvic organs such as the bladder and uterus, were a system the medical world was only just beginning to get its head around thanks to advances in medical imaging.

"The structure is one we knew next to nothing about until very recently because we couldn't see it, and that's what gets damaged in childbirth primarily," Prof Dietz said.

He said while effective treatment options still needed to be developed, including potentially surgery to reattach the muscles after an avulsion, the focus should be on prevention.

Prof Dietz is calling for a move towards more individualised assessments.

Like Ms Harry, he believes pregnant women are not being adequately informed on their personal risks with vaginal birth. He also said expectant mums needed to be properly educated about the pros and cons of procedures, such as using forceps and c-sections, based on personal factors such as their age, weight and baby's size.

Prof Dietz is strongly against the use of forceps, and fears too many older women are being discouraged from having a c-section

"The likelihood of having a normal vaginal birth at age 20 without any damage is 80 per cent. At age 40, it's less than 20 per cent. We need to tell women this," he said.

He is also calling for thorough evaluations post-labour. After a first vaginal birth, he believes women should be automatically assigned a Medicare-funded physiotherapist to diagnose and treat any tears as early as possible - so that women like Ms Harry don't have to go through months of  unexplained physical pain and emotional turmoil.

He said his overarching message was that pregnant women needed to be "treated like adults".

"It it simple a matter of ethics to treat adults like adults, like you would want to be treated yourself. If we know something is risky, we must share that with the patient."

Prof Dietz said he too often heard one phrase from women: "Why didn't anybody tell me that things could be so bad?"

"Women trust us, and that trust is being betrayed... This idea that we keep everything bad from women and when it happens we say 'tough bikkies', it's disgusting, I don't know how anyone could tolerate it.".

'Messing with childbirth on a massive scale is something we must be cautious about.'

Professor Hannah Dahlen, of the Australian College of Midwives, has a different position. She said she was saddened by the level of birth trauma injuries and agreed the current model of care given to women needed improvement - but she firmly stressed more c-sections was not the answer for preventing pelvic floor damage, due to a higher risk of severe short-and long-term complications.

She said while vaginal births had a higher incidence of pelvic floor damage, this was usually down to the use of interventions such as forceps and epidurals which could be destructive to this muscle system.

She said women needed to be supported to have a good birth physically and emotionally, and be helped to achieve a birth as natural as safely possible.

Prof Dahlen believes what is required is for continuity of care to be rolled out, meaning each woman would see the same midwife from the start of pregnancy through to six weeks after birth. She said doing so would ensure women are being adequately informed about what they're in for.

"Continuity of care is the safest way to have a baby, to reduce unnecessary intervention, and to keep women feeling listened to and to advocate for them. In a continuity of care relationship, a midwife will get a woman the right services and the right support as soon as she needs it," she said.

"We can't eradicate birth trauma but we can respond appropriately when it does happen.

"To turn around and say women should have c-sections will mean we have more women dying and more significant damage. (Prof Dahlen pointed to the WHO recommendation that 10-15 per cent was the 'ideal' c-section rate.)

"Messing with childbirth on a massive scale is something we have to be very cautious about. What we want is a balance, asking ourselves when is vaginal birth the safest thing to do and when do we need to use technology to intervene."

Prof Dahlen also said more research was needed into who was more vulnerable to pelvic floor damage, what type of birthing position was safest, and how to treat pelvic floor issues after labour.

***

Things for Ms Harry started looking up about 12 months postpartum. Her painful symptoms diminished and she started to feel safe in her own body again. She does regular physio exercises, wears a pessary device, and expects to be back to normal in about five years. Most importantly, her relationship with her daughter is now exactly how she always hoped it would be.

Ms Harry is now expecting her second baby. She said she today felt far more equipped to make decisions about her upcoming labour. She just wishes she felt this way the first time around.

"It's not about c-section versus vaginal delivery... It's about women making informed choices about their healthcare for them and their families."

While she waits for a cultural change, she is urging women: "Don't stop asking questions until you get answers that make sense to you".

Do you think women need to be more informed on birth risks? Tell us in the comments section below.

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