A mother has called for a ban on the use of forceps during childbirth, or for women to be better informed about their dangers well before they give birth.
When Amy Dawes, from Brisbane, went into labour with her first child in December 2013, she was determined to have a natural birth.
"I did all the right things [like] eating well, continuing exercise, pregnancy yoga and meditation, and after doing a calm birth course, I was ready to breathe her out," Ms Dawes says.
But things didn't go as planned, and forceps were used to help Ms Dawes' baby girl make her entrance in the world. Ms Dawes says she wasn't informed of the dangers of using forceps, and it was a dramatic birth that resulted in extensive injuries for Ms Dawes.
"My pelvic floor muscle was torn off the bone and my perineum [was] cut then torn, leaving me with a third-degree tear," she says.
Ms Dawes spent weeks in bed recovering from the traumatic birth, but her injuries resulted in a prolapsed bladder and ongoing problems including fecal incontinence that still requires meticulous management today.
"My postpartum physiotherapist likened my injuries to that of being in a car crash," she said.
"Pelvic floor dysfunction has serious power over everyday life, affecting all areas of your world and the people around you. Whilst I still think vaginal births can be a positive experience for some women, my wish is for women to have an opportunity to be provided informed about the risks involved with childbirth, especially interventions such as forceps, so decisions don't need to be made in emergency situations."
Her experience prompted Amy to launch the Australasian Birth Trauma Association, and she says she's been contacted by hundreds of women who have suffered life-altering injuries, but who also often say their suffering is dismissed by health practitioners.
"Many have struggled to bond with their babies, some can't care for the babies and need help from their partners or family (especially hard if you don't have family around to support). I also know women who've had to leave their jobs because they are physically unable to return to work."
"These injuries have huge impact on the individual and all the people around them, the sad reality is, many women suffer in silence because it's extremely difficult to talk about."
Professor Steve Robson, President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), says forceps-assisted births account for around 6 per cent of births in Australia.
"Forceps are used when the baby is not delivering naturally and birth is delayed, or sometimes when there is urgent foetal distress. So forceps are obviously much safer than leaving a distressed baby undelivered," he said.
Professor Robson says forceps are less likely to fail than vacuum-cup (ventouse) deliveries and are also less likely to cause major injury to the baby, but they are more likely to injure the pelvic floor of the mother.
Professor Hans Peter Dietz, of Sydney Medical School, told the ABC that he regularly sees the aftermath of traumatic births while conducting surgical trials on women with damage to their pelvic floor and anal sphincter.
"Many obstetricians are simply not aware of how much damage is done by forceps," he said. "Forceps are a great instrument to use for the obstetrician but it's very much at the cost of the woman and sometimes the baby."
Still, Professor Robson of RANSCOG says there is no reason to ban forceps. "The idea is to ensure that every person performing a forceps delivery is highly trained, and that their use is only in situations when they are clearly required," he said. "An unassisted vaginal birth is obviously what we should aim for where safe is possible, but where help is needed, forceps are sometimes the only safe method of delivering a baby."
Ms Dawes says she'd like to see women being informed in an "honest, unbiased" way about each mode of delivery well before their due date, "so women can prepare for all contingencies, and make informed decisions about how and where to deliver."
She says she'd also like "for women's informed choices in childbirth to be respected, and for informed consent for high-risk interventions to be obtained in the antenatal period as standard protocol."