Severe Pelvic Floor Damage and Incontinence After Childbirth: When It May Be Medical Negligence and How Women Can Recover
Severe pelvic floor damage after childbirth can lead to incontinence, prolapse, and chronic pain — injuries that often go under-recognised or dismissed. This article explains how such injuries occur, when they may indicate substandard obstetric care, what medical negligence looks like, and how women can seek help, recovery, and legal advice. Written by a lawyer specialising in medical negligence and women’s health in NSW.
Understanding Pelvic Floor Damage After Childbirth
The pelvic floor is a group of muscles and connective tissues that support the bladder, uterus, and bowel. During pregnancy and childbirth, these muscles stretch to allow for delivery. While minor trauma is common, some women experience severe, long-term injury that causes urinary or faecal incontinence, pelvic organ prolapse, pain, and sexual dysfunction.
These injuries can have profound physical, emotional, and social consequences. Many women describe feeling “broken” or “dismissed” after being told their symptoms are normal post-birth changes. In reality, severe pelvic floor damage is not inevitable, and in many cases, it is preventable with timely and appropriate medical management.
How Pelvic Floor Injuries Happen
Severe pelvic floor damage typically occurs when the tissues, muscles, or nerves supporting the pelvic organs are overstretched, torn, or not repaired correctly.
Common causes include:
Prolonged or obstructed labour placing pressure on the pelvic tissues.
Instrumental deliveries (forceps or vacuum) causing trauma to the pelvic muscles.
Improper repair of severe perineal tears, especially third- or fourth-degree tears involving the anal sphincter.
Failure to recognise and manage levator ani avulsion, where the key pelvic muscle detaches from the pubic bone.
Delivery of large babies (macrosomia) without adequate assessment of risks.
Multiple vaginal deliveries without appropriate postnatal recovery or physiotherapy advice.
In some cases, nerve damage—such as pudendal nerve injury—can also lead to long-term pelvic floor dysfunction and incontinence.
Key medical references:
RANZCOG Clinical Guideline: Management of Perineal Tears, 2022
NSW Health Maternity Policy Directive: Recognition and Repair of Obstetric Perineal Trauma, 2023
Royal College of Obstetricians and Gynaecologists (RCOG) Green-Top Guideline No. 29: Third- and Fourth-Degree Perineal Tears, 2019
When Pelvic Floor Damage May Indicate Medical Negligence
Not all pelvic floor injuries result from negligence — childbirth carries inherent risks. However, negligence may exist if the standard of care fell below what a competent practitioner would have provided in similar circumstances.
Examples include:
Failure to monitor the progress of labour and identify obstructed labour early.
Delay in offering or performing a caesarean section when risk factors for trauma were clear.
Incorrect use of forceps or vacuum devices.
Failure to recognise and properly repair a severe perineal tear.
Inadequate postnatal follow-up, especially where symptoms of incontinence or prolapse were ignored.
Dismissal of patient concerns about pelvic pain, leakage, or pressure after delivery.
In these situations, a patient may be entitled to compensation if it can be shown that the injury would likely have been avoided had proper care been given.
Legal findings in Australian medical negligence cases frequently turn on expert evidence about what reasonable care required and whether failure to act caused the injury.
How a Woman Can Recognise a Possible Claim
Women may consider seeking legal advice where:
They developed urinary or faecal incontinence soon after birth, but their symptoms were not investigated or referred to a specialist.
They were told their pain or leakage was “normal”, despite severe symptoms.
A significant tear was missed or not repaired correctly.
They later required reconstructive surgery for prolapse, incontinence, or muscle avulsion.
They were not warned of risks associated with instrumental delivery or vaginal birth after caesarean (VBAC).
In NSW, potential claims are assessed under the Civil Liability Act 2002 (NSW). A medical negligence lawyer can help review medical records, obtain expert opinions, and advise whether the injury was preventable.
Systemic Implications for Patient Safety
Severe pelvic floor injuries raise broader issues about training, supervision, and transparency in maternity care.
From a systemic viewpoint, these cases highlight:
Inconsistent assessment of perineal trauma immediately after birth.
Limited training in recognising levator ani avulsion and sphincter injury.
Under-resourced maternity units leading to rushed examinations or inadequate follow-up.
Social stigma around incontinence that prevents women from reporting symptoms.
A lack of trauma-informed care for women experiencing distress after birth injury.
Addressing these gaps is critical for patient safety and public trust in maternity services.
Policy references:
Australian Commission on Safety and Quality in Health Care: Maternity Care Safety Review (2024)
RANZCOG: Birth Trauma and Consent Education Framework, 2023
Recovery, Validation, and Legal Support
Recovery after severe pelvic floor injury involves more than physical healing. It often requires a multidisciplinary approach including pelvic physiotherapy, urogynecological assessment, and psychological support.
Validation begins when women understand that their suffering is real and not their fault. Many feel dismissed when told “this happens to everyone” — but severe damage, incontinence, or prolapse are not normal outcomes.
A legal review can provide clarity about what went wrong, promote accountability, and help fund treatment costs and future care.
Women can also access:
Pelvic health physiotherapists for muscle rehabilitation.
Specialist surgeons for repair or prolapse correction.
Counselling or trauma therapy for psychological recovery.
Peer support groups, such as the Australasian Birth Trauma Association (ABTA).
Conclusion
Severe pelvic floor damage and incontinence after childbirth represent a hidden epidemic of preventable harm. While not all injuries are due to negligence, many could have been avoided through timely intervention, accurate diagnosis, and appropriate repair.
By recognising these injuries as serious medical conditions—not just “part of motherhood”—the legal system and health sector can work together to improve care, accountability, and healing for affected women.
