It can ruin sex lives, stop women from engaging in physical activities, and can even prevent some types of paid work. Although common, many women are so embarrassed by it that even their partners and closest friends are unaware of the problem.
It's the injury that can result from a traumatic vaginal birth.
New research presented last week at the International Continence Society in Montreal about the psychological consequences of traumatic vaginal birth suggests that between 20 and 30 per cent of first-time mothers having a vaginal birth will suffer severe and often permanent damage to their pelvic floor and anal sphincter muscles. There can also be major psychological consequences of traumatic vaginal birth.
Conditions range from life-long urinary and faecal incontinence, painful sex, genital prolapse, body image problems and emotional trauma.
One of the authors of the research, Hans Peter Dietz, a Professor of Obstetrics & Gynaecology at the University of Sydney's Medical School, says that damage from vaginal birth is much more widespread than generally assumed.
"Only about 25 per cent of women get a non-traumatic normal vaginal delivery that did not do serious damage to their pelvic floor or their anal sphincter," says Professor Dietz. "And this is on first time mothers. If we did this kind of analysis on women who try for a VBAC (vaginal birth after caesarean) it would probably be as few as 10 to 15 per cent."
First time mother and registered nurse Anne sustained such severe damage from her vaginal birth that five years later she suffers frequent passing of urine, prolapses and a dragging feeling in her pelvis.
"I can no longer run long distances and I'm unable to participate in races like the City to Surf, which I did pre-baby. I continue to struggle interpersonally. I'm now single and the thought of having to tell a prospective partner of my condition is difficult," she says.
Midwife and co-author of the new research into psychological consequences of traumatic vaginal birth Elizabeth Skinner spent two years gathering and analysing the experiences of women who have suffered traumatic vaginal births.
"Women who have sustained vaginal birth trauma often have avulsion of the levator ani muscle. This is a disconnection of that muscle from the pelvic bone resulting in prolapsed organs. Women just put up with this 'hidden injury' as they are too embarrassed to discuss symptoms with clinicians who frequently do not believe them," Skinner says.
Skinner identified symptoms of post partum post-traumatic stress disorder in 67.5 per cent of her interviewees. This included poor baby bonding, flashbacks during sex, dissociation, avoidance, and anxiety.
Skinner says that the lack of information given to women about the risk of vaginal births, and the pressure they face to reject medical intervention, is a feminist issue.
"Previously feminists fought to return control to women giving birth. This is still true but the new 21st Century feminist issue is ensuring that women are correctly assessed for their risk of complications and given full and frank information to prevent such injuries," says Skinner.
"Idealised images of the birth process without accurate education and consent can cause poor long-term clinical and mental outcomes."
But this is not just a matter of medical staff being more forthcoming about the risks of vaginal births. It's also about a lack of choice and women not having autonomy over their bodies.
In many public hospitals women are not given the option of a caesarean delivery. NSW Health, for example, has targets to reduce the number of caesarean births.
A spokesperson from the Royal Women's Hospital in Melbourne says that they do not perform caesarean births unless there is a medical reason.
The policy to reduce caesarean births has lead to an increase in the use of forceps during vaginal deliveries and a tolerance for longer periods of pushing during the second stage of labour, both of which increase the risks to the mother and baby.
"The forceps rate has doubled in NSW over the last 10 years, at some hospitals quadrupled," says the University of Sydney's Professor Dietz. "That means much, much more damage is done than ten years ago - in some instances twice as much. This is largely a result of the attempt to reduce the caesarean births rate."
Elizabeth Skinner and Professor Dietz are not against vaginal births; in most cases, a vaginal birth is the best option. They also note that a caesarean section is major abdominal surgery and carries its own risks.
However women who have big babies, are short in stature, have Asian heritage, and have a family history of difficult births should be informed of their greater risk of trauma if they have a vaginal birth. And all women should be given the choice to make an informed decision for themselves.
"We need to build bridges between midwives and doctors so we can all work together better for the best interests of the patient," says Skinner. "At present we have a very short-term view. We make sure the baby is alive and then we leave, with little consideration for the long-term physical and emotional wellbeing of the mother."
This article first appeared on Daily Life.