On the day she was due to deliver, 26-year old D’Lissa Parkes lost over two litres of blood during a C-section and died after giving birth to her daughter, who now requires full time-care due severe brain damage from the lack of oxygen in the womb.

She had suffered from constipation, with a colonoscopy earlier in her pregnancy revealing an obstruction in her colon, to which no intervention was performed. Instead, doctors decided to perform a manual version, when they realised that the baby had not turned in the womb, leaving her with a ‘diamond-shaped’ bump.

According to the coroner, Parkes had a “megacolon diagnosed which, due to failures in accessing medical records and scans, was not known to the maternity staff.”

“This possibly could have contributed minimally to her pulmonary embolism, but the principal risk factor was pregnancy.”

“D’Lissa was so excited to become a mum … [but she] will never get to meet her greatest achievement,” said D’Lissa’s mother, Sylvia Parkes.

“She’s been robbed of motherhood.”

Told by doctors that it “was all in [her] head”

According to the World Health Organisation (WHO), approximately 830 women die each day from preventable causes related to pregnancy and childbirth. According to the Registry of Birth & Deaths, ICA Singapore, maternal mortality in the country is 8.6 in every 100,000 births, and is less common in a vaginal delivery than after a caesarean delivery.

In addition to risks of mortality, however, expectant mothers face risks of other harms – both physically and mentally, during and after pregnancy.

A study in the British Journal of Gynaecology (BJOG) suggested that 85% of all women have some form of tear during their first vaginal delivery. Tears can cause long-term complications can include urinary and anal incontinence and painful sex, but beyond that, women suffer in silence; unsure whether symptoms are normal and embarrassed to ask for help or, or have their symptoms brushed off by doctors.

During childbirth, Debbie suffered a fourth-degree perineal tear, resulting in damage to her anus and the muscle that controls it. Although surgically repaired, she needed to be fitted with a colostomy bag, which impacted her way of life.

"Everything changes. I have to consider it everywhere I go. If I leave the house, I take spare clothes, I have to scan places for the nearest toilet,” Debbie said, adding that the effects of the tear were not solely physical.

Debbie also suffers from depression and her relationship with her partner broke down a year after her delivery.

Another woman, Jenny, opened up to share her ordeal with a third-degree tear during childbirth, leaving her without sensation in her bladder, in addition to chronic pain-causing nerve damage.

Unfortunately, when she shared about her pain to her doctor, she was told that it was to be expected, and that it was “all in her head.”

"Where am I going to get help for this because nobody believes me?" she said.

Both women are victims of the physical and psychological injuries they received through childbirth, which has been exacerbated by poor diagnosis, improper care and an unwillingness, thus far, to speak about the issue.

Skilled care during and after pregnancy needed for better outcomes

According to National University Hospital women’s centre, perineal tears are a real concern even in Singapore, with at least 4% of women experiencing third or fourth degree tears, and an estimated 95% of Singaporeans have episiotomies, as the perineum is shorter in Asian women.

In some cases, episiotomy causes pain during sex in the months after delivery and increases the risk of fecal incontinence.

Healthcare professionals are looking at ways to reduce risks of perineal tears during vaginal births.

In a collaborative project between the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, a new technique has been developed to reduce the risk of a serious tear, by preventing the weakest point of the perineum from being damaged in delivery.

According to specialist perineal midwife Adelaid Aduboffour, “If 10 women are going to have baby and eight of them or nine of them are likely to have a trauma, then we need mandatory training across the board,”

“If we don’t get this right it means it’s affecting women’s general way of life, affecting their relationships,” she stressed. MIMS

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