Archives of Women's Mental Health

, Volume 21, Issue 3, pp 341–351 | Cite as

Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units

  • Elizabeth M. Skinner
  • Bryanne Barnett
  • Hans P. DietzEmail author
Original Article


Vaginal birth may result in damage to the levator ani muscle (LAM) with subsequent pelvic floor dysfunction and there may be accompanying psychological problems. This study examines associations between these somatic injuries and psychological symptoms. A qualitative study using semi-structured interviews to examine the experiences of primiparous women (n = 40) with known LAM trauma was undertaken. Participants were identified from a population of 504 women retrospectively assessed by a perinatal imaging study at two obstetric units in Sydney, Australia. LAM avulsion was diagnosed by 3D/4D translabial ultrasound 3–6 months postpartum. The template consisted of open-ended questions. Main outcome measures were quality of information provided antenatally; intrapartum events; postpartum symptoms; and coping mechanisms. Thematic analysis of maternal experiences was employed to evaluate prevalence of themes. Ten statement categories were identified: (1) limited antenatal education (29/40); (2) no information provided on potential morbidities (36/40); (3) conflicting advice (35/40); (4) traumatized partners (21/40); (5) long-term sexual dysfunction/relationship issues (27/40); (6) no postnatal assessment of injuries (36/40); (7) multiple symptoms of pelvic floor dysfunction (35/40); (8) “putting up” with injuries (36/40); (9) symptoms of post-traumatic stress disorder (PTSD) (27/40); (10) dismissive staff responses (26/40). Women who sustain LAM damage after vaginal birth have reduced quality of life due to psychological and somatic morbidities. PTSD symptoms are common. Clinicians may be unaware of the severity of this damage. Women report they feel traumatized and abandoned because such morbidities were not discussed prior to birth or postpartum.


Birth trauma Pelvic floor Avulsion Morbidities PTSD 


Authors’ contributions

Elizabeth Mary Skinner: project development, template construction, data collection, data analysis, manuscript writing

Professor Bryanne Barnett: manuscript writing

Professor Hans Peter Dietz: project development, approval of protocols, data analysis, manuscript writing

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2017

Authors and Affiliations

  • Elizabeth M. Skinner
    • 1
  • Bryanne Barnett
    • 2
    • 3
  • Hans P. Dietz
    • 1
    Email author
  1. 1.Sydney Medical School NepeanThe University of SydneyKingswoodAustralia
  2. 2.School of PsychiatryUniversity of New South Wales (UNSW)SydneyAustralia
  3. 3.Raphael CentreSt John of God Health CareBlacktownAustralia

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