Pelvic floor injury after birth · Part 1 of 5
Prolapse After a Forceps Birth: When It Isn't Just "Normal"
In this article
If you've felt heaviness, bulging or leaking since a forceps birth, and you've been told it's just what happens after a baby, this is for you. I'll explain what prolapse is, why forceps births are so closely linked to it, and the deeper muscle injury that often sits underneath. I'll also cover what you were entitled to be told, and how to start getting real answers.
This series: pelvic floor injury after birth
- Prolapse after a forceps birth: when it isn't just "normal" (you are here)
- Levator avulsion: the injury no one told you about
- "Why didn't anyone tell me forceps could do this?"
- "It's normal after a baby": when pelvic floor symptoms are dismissed
- Living with a pelvic floor injury, and what a claim can cover
Something doesn't feel right.
Maybe it started as a feeling of heaviness at the end of the day.
A dragging sensation, like something was falling. Or a lump you felt in the shower and didn't want to look at.
Maybe you leak when you cough, or laugh, or pick up your toddler. Maybe sex feels completely different now, or hurts. Maybe you've given up running, or the gym, or anything that makes it worse.
And maybe, when you mentioned it, you were told some version of the same thing:
That's just what happens after you have a baby.
I want to gently push back on that. Some changes after birth are common. But common is not the same as normal, and it's certainly not the same as nothing anyone could have done.
If you had a forceps birth, there's a specific question worth asking. You deserve someone who will take it seriously.
What prolapse actually is
Pelvic organ prolapse
When the muscles and tissues supporting the bladder, uterus or bowel are weakened or damaged, one or more of those organs can drop down into the vagina.
In plain terms: the "floor" holding your pelvic organs up isn't doing its job anymore, so things are sitting lower than they should. Pregnancy, Birth and Baby has an overview of prolapse after birth.
Queensland Health lists the common signs of prolapse. They include a heavy or dragging feeling in the vagina, a sense of something coming down, a lump you can see or feel, problems emptying your bladder or bowel, recurring urinary infections, and pain or reduced sensation during sex.
Jean Hailes notes that prolapse more often appears later in life, around and after menopause, and that childbirth is one of its main risk factors. Their guide to prolapse explains this in more detail. That's partly why it can feel so jarring to be dealing with this in your thirties, with a baby on your hip.
Why forceps matter so much
This is the part I most want you to understand.
Prolapse after birth is often a symptom of an injury to the pelvic floor muscle itself. One of the most significant of these injuries is called a levator avulsion. It happens when part of the main pelvic floor muscle tears away from where it attaches to the bone.
Research led from Western Sydney University has found that forceps are strongly associated with this injury. In one study of first-time mothers, avulsion occurred in 13% of vaginal births and none of the caesareans, and forceps significantly increased the risk. Professor Hans Peter Dietz, one of the leading researchers in this field, has written that avulsion is linked to prolapse, and that forceps delivery is a modifiable risk factor.
A modifiable risk factor
A risk that can be changed by the choices made in your care, unlike risks such as your age or your baby's size.
In plain terms: whether forceps were used, and why, was a decision someone made. And decisions can be questioned.
RANZCOG, the college that sets standards for obstetricians, lists damage to the pelvic floor among the maternal complications of instrumental birth. It also notes that forceps carry a higher risk of severe tearing and changes to continence than vacuum.
If you also had a severe tear into the back passage, you may find my article on third and fourth degree tears helpful too. Those injuries often travel together.
If this is landing for you, and you're starting to wonder whether your symptoms trace back to the birth itself, I'm happy to listen. No pressure, and no need to have it all worked out.
What you were entitled to know
Here's a question I'd invite you to sit with. Before your baby was born, did anyone tell you that forceps could cause lasting damage to your pelvic floor?
For many women, the honest answer is no. Amy Dawes, who co-founded the Australasian Birth Trauma Association, has described being told the risks of a caesarean but never the risks of forceps. She only learned the extent of her injury more than a year later.
Material risk
Since the High Court's decision in Rogers v Whitaker, doctors in Australia must tell you about the material risks of a treatment. These are the risks a reasonable person in your position would want to know.
In plain terms: if a risk would have mattered to you, you had a right to hear about it before the decision was made.
I explore this in much more depth in "Why didn't anyone tell me forceps could do this?". Consent was one of the biggest themes in the NSW Parliament's 2024 Birth Trauma report. In its response, the NSW Government committed to strengthening consent processes in maternity care.
Where to from here
Get properly assessed.
A diagnosis matters, both for your health and for understanding what happened. The Australian Physiotherapy Association's position statement on physical birth trauma notes that injuries like levator avulsion can be detected with 3D/4D pelvic floor ultrasound. It recommends referral to a urogynaecologist where needed. A pelvic health physiotherapist is often a good first step.
Know that there are treatment options.
The Australian Commission on Safety and Quality in Health Care's guide to treatment options for prolapse covers pelvic floor exercises, pessaries and surgery. I talk more about living with these injuries in the final part of this series.
Notice if you've been brushed off.
If you've raised symptoms more than once and been told it's normal, that delay may matter, medically and legally. I've written about that in "It's normal after a baby".
You don't have to carry this alone.
The National Continence Helpline, run through Pelvic Floor First, is free on 1800 33 00 66. Birth Trauma Australia offers peer support from women who truly get it.
Frequently asked questions
Is prolapse after a forceps birth always someone's fault?
No. Prolapse can happen after births where everything was done well. The questions are whether forceps were needed, whether you were told the risks, whether they were used properly, and whether your injury was picked up and treated when it should have been.
My birth was years ago. Is it too late?
Not necessarily. In NSW, time limits often run from when you knew, or should have known, about your injury and its cause, rather than from the birth itself. The rules are strict and technical, though, so please get advice soon.
I'm embarrassed to talk about this.
So many women are. You can share as much or as little as you're comfortable with, at your own pace.
Do I need a diagnosis before I get in touch?
No. Many women contact a lawyer before they've ever had a scan. Part of the process can be getting the right assessment.
A closing thought
You've probably spent a long time adjusting your life around this quietly: the outfits, the exercise you've stopped, the way you plan a day around bathrooms.
You're allowed to stop adjusting long enough to ask why.
So here's a question to take with you: if you knew for certain this wasn't "just normal", what would you want to do next?
This article is general information only. It is not legal or medical advice, and reading it does not create a lawyer–client relationship. Every situation is different. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
