Conditions that threaten women’s lives in childbirth & pregnancy

Hysterectomy

For some women, the obstetric emergency they experience during childbirth results in doctors needing to perform a hysterectomy (removal of the womb). In many cases this is because doctors are unable to stop the bleeding (haemorrhage). In others it is because the womb is the site of infection (e.g. septicaemia/blood poisoning) and antibiotics are not being effective. In this summary we discuss the experiences of women who had a hysterectomy during childbirth.
 
Why a hysterectomy was needed?
Some women are aware before the operation that a hysterectomy is going to be performed, and why. Anna had septicaemia and doctors had explained to her that if the antibiotics they were giving her did not work, they were going to have to move to “plan B”. She was grateful that she was given some time to prepare herself and her family.
However, often the nature of the emergency means that hysterectomies are performed to save a woman’s life, without the woman having time to prepare herself. She may not fully take in the full impact of what is happening until hours or days later. Alison T was very ill with amniotic fluid embolism (AFE), a very rare complication of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the womb and triggers an allergic reaction, and did not realise a hysterectomy had been performed for several days' “it was the least of everybody’s worries at the time”. But she went back to see the consultants a few months later who explained the operation to her. Anna and Karen were told by doctors during the emergency that a hysterectomy was likely. Alison haemorrhaged (heavy uncontrolled bleeding) after the birth of her son, and woke up in intensive care to be told she had had a hysterectomy. Doctors came to explain to her afterwards why it had been necessary.
Physical recovery
Women had varying experiences of their recovery from the hysterectomy. It was a major operation, and they were advised not to lift or drive for 6-8 weeks after their operation. Mandy and Sarah said it was important to rest and give your body time to recover, to ask questions and see your GP if you have concerns.
 
Pain control after a hysterectomy is managed with strong painkillers and women generally do not have long term pain. However, Alison continued to have an odd twinge where the drainage tube had been taken out. Sarah experienced tingly pain for a while. Lisa experienced “inexplicable shooting pains” and has often felt as if something was splitting on her insides. She has been to the doctor frequently for reassurance.
Fitness levels varied after their hysterectomy. It is normal for women to feel more tired than usual and this was influenced by how long they had stayed in hospital for and the nature of their obstetric emergency. Sarah, who was in ICU for 2 days and then had another operation found it took her a long time to get her strength back. Karen, who also had an under active thyroid, described the two years since her operation as a “rollercoaster.” “I’ve gone from being a very fit person to being not as fit… and I find that very frustrating.”
 
Alison felt fitter and healthier than before she got pregnant. She said, “I think I definitely had a sense of wanting to get my body strong and healthy because I feel…that my body let me down.” Ten months after her hysterectomy she was able to run a half marathon.
 
Occasionally women can have longer term problems following their emergency. Sarah had bladder and bowel problems. Alison T still has regular bleeding, as the doctors did not remove all of the womb.
Ongoing health issues
Several women were worried that their hysterectomy would trigger an early menopause. Alison was told that there was less chance of a menopause being triggered because doctors had not removed her ovaries. She was relieved to hear that after ten weeks she was not showing any signs. However, Anna was only twenty one when she had her hysterectomy and has been put on hormone replacement therapy and told to look out for hot flushes. Cara was very worried about the menopause kicking in as she knew from an early stage that she wanted to try for a baby through surrogacy.
Impact: sex life
For some women, having had a hysterectomy had a big impact on their sex lives. Lisa felt that it had made sex rather boring. She felt it had lost its purpose. “Because suddenly you sort of think, there’s no function, because my down below bits don’t work like they used to so it’s very numb.”
However not all women felt like that. Cara felt that her hysterectomy did not have a lasting impact on her sex life. “I’ve gone on to have a really, really healthy relationship with my new partner and I don’t feel any less a woman.” Anna described how she has rediscovered her sex life in the year since her operation. Although she does not feel as confident in her body sometimes, in some ways things have changed for the better.
Impact: am I still a woman?
Several women talked about feeling less of a woman as a result of their hysterectomy. Rachel went back to work after 4 months, “I was really battered. I mean my body changed and I lost my uterus and my ability to have children…” Sarah felt that “nothing was the same” afterwards. She also mourned the loss of her periods. “Not having periods is bizarre, it is just the weirdest thing ever. And [for my girls to] have no concept of periods because there is not period paraphernalia in our house.” Lisa felt, “I’m the one that’s been left with no womb. I’m the one feeling like half a woman. I don’t feel as feminine as I used to. I don’t feel as confident as I used to. Nowhere near.”
 
Cara said that she didn’t feel less of a woman following her hysterectomy. For her the hardest issue was not being able to complete her family.
 
Impact: fertility
The impact of a hysterectomy on their fertility affects women very differently. For older women who felt they had completed their family, it did not have a big effect. Karen was in her early 40s and she joked with the doctors that it would save her husband having a vasectomy. Alison T, also in her early 40s with 5 children, was “not bothered in the slightest. I wasn’t upset about that.”
 
Mandy had a hysterectomy after her first child was born. Although she would probably liked to have more children, she felt that she had come to terms with only having one. In some ways, she felt thankful for the hysterectomy because it taken away the anxiety of falling pregnant again and facing another life-threatening emergency in childbirth.
However, loss of fertility may be devastating. Lisa felt she could get over the horror of the rest of her experience, but would be living forever with the loss of her fertility.
Sarah suggested that having had a hysterectomy is a “taboo sort of subject”. When people stop her in the street with her three daughters and ask if she is going to have any more, she feels she can never answer honestly. The absolute lack of hope was very difficult. “Because when you’ve had a hysterectomy, there’s no way… you even just fantasise about being pregnant… [no] sliver of hope.”
Anna has two sons, and was just 21 when she had her hysterectomy. Although doctors left her ovaries, they have failed so she has no hope of more children. “That was so hard. That was my last little chance gone and that broke my heart.” Cara felt great pain at not being able to have more children. This affected her relationship with her sister as she had her own children.
The agony of losing their fertility had started to heal for some women. When interviewed 14 months after her experience, Anna said not being able to have another child, “broke her heart” but she is starting to accept it and she can cope. She commented, “It’s easy to sink, you have to be quite tough on yourself.” Five years on, Sarah said that not being able to have another child has been traumatic. She advises others to “allow yourself to go through the process until you are at a place where you are happy, and it does take a long time.”

Last reviewed April 2016.

Feedback

Please use the form below to tell us what you think of the site. We’d love to hear about how we’ve helped you, how we could improve or if you have found something that’s broken on the site.

Make a Donation to healthtalk.org





Find out more about how you can help us.

Send to a friend

Simply fill out this form and we'll send them an email