Birth is a completely unique process for each woman who goes through it.
Whilst everyone hopes for a smooth, trouble-free labour, it's no secret that complications can and do occur, and when they do, you rely on those tasked with your care - doctors, midwives and doulas, or other professionals - to look after you as well as they would look after your baby.
Unfortunately, for some new mothers, that care never comes, and labour becomes an incredibly traumatic experience, leading to suffering, both at the time and for many years afterwards.
This was the case for Joanne Page, a mum-of-two from Kent who endured horrific injuries during the arrival of her first son, Elliot, and is still dealing with the outcome 22 years later.
Here, she tells her birth story, and explains why she wishes she'd spoken out sooner.
'I'm going to have to cut you,' the doctor said. My baby was stuck, she explained, and he needed to come out now.
I said it was fine, and at the time, I truly believed it was. I'd had an epidural, so I couldn't feel anything anyway, and all that I cared about in that moment was making sure that my child came into the world as quickly and safely as possible.
He was my first child, you see, and the first grandchild for both sets of grandparents too. I had the perfect marriage, the perfect house, and now we were eagerly awaiting the arrival of our perfect little boy to complete the equation.
I'd had a good pregnancy, issues with pre-eclampsia in my third trimester aside, and my labour, at a week overdue, had been smooth at first too. Now things had taken a turn for the worse, and it was touch and go whether I'd even get to meet my little one at all. So here I found myself, legs up in stirrups, with the doctor using forceps to tug so hard on his head that I feared that it would pop off altogether.
'No baby can survive this,' I remember thinking to myself as she pulled, climbing back up the bed just for her to drag my body back down again. But mercifully, he did survive, and I was so thankful to see a healthy, albeit slightly bruised, baby boy come out into her arms.
As Elliot, as we'd chosen to call him, was whisked away by the midwives, the doctor told me that although she had cut me, I'd also torn my anal sphincter muscle quite severely, and I'd need stitching up. Normally this is a procedure that would be done in a theatre, but it was already busy, so because I was already numb she could do it for me where I was.
I agreed - I had no reason not to - and she then asked my mother in law if she would help her by putting her finger up my back passage so that she could work around it to get a tight stitching. I know it sounds strange, but neither of us questioned it - when a doctor asks you to do something, you trust them and you do as you're told. The procedure took about an hour and a half, but once it was done, it was okay, and I was even able to go back to the ward.
Two days passed, and I hadn't been for a wee. At first I put it down to swelling and all of the other side effects that come with pushing out a child, yet looking back, it was my first indication that something might not be quite right. Other parts of my body were swelling too - my ankles looked like they belonged to an elephant.
A midwife examined me and said that the forceps had damaged my urethra tube, to the point where no wee could get out because it was so swollen, so they had to catheterise me. This was traumatic, but no way near as traumatic as what was to follow.
My wound started to smell - so badly that I had to be moved to a separate room - and it was then that the staff discovered that I was ravaged with an infection so strong it had dissolved all of my stitches. Listening to their diagnosis, I started to realise that something truly terrible had happened to me.
'Can you stitch it back up?' I asked naively, but they just replied, no, sorry, we can't. It's like material that's been stitched together and then ripped; you can't then bunch it up and stitch it back up, because it would be too tight. I would have to wait 18 months for the tissue to granulate naturally.
I was exhausted by the infection, full of antibiotics, still catheterised and hooked up to a drip, and they'd essentially told me that I'd have to spend the next 18 months weeing and pooing out of the same hole, and caring for my wound whilst also caring for a newborn baby. It was devastating.
As it happened, I couldn't face caring for Elliot at all. He was looked after by the midwife because I didn't even want to look at him. Doctors advised me not to breastfeed - after all, I could hardly keep myself going, let alone myself and a baby. The chance to build a connection was taken away from me because I had to spend so much time looking after myself.
I was having to measure how much fluid I was drinking, to then measure how much was coming out in the catheter, and I had to be on laxatives, because I couldn't risk having constipation. I needed to shower my wound and dry it with a hairdryer at least eight times a day. The doctor would come around and flush my wound with saline on a daily basis, but when I later checked my notes, she'd written that she'd only done it once. Clearly she knew how wrong things had gone.
After five days, Elliot and I were allowed to go home, but ultimately, it made very little difference. My schedule still revolved around showering, drying myself with a hairdryer, wearing massive sanitary towels. I also had to have salt baths, four times a day, to keep things sterile.
My quality of life hit rock bottom, and I barely left the house. I had a baby that I'd feed and change, ready to go out, but then I'd need to go to the toilet because I was on so many laxatives, then I needed to shower after each bowel motion, and by the time I'd done all of that he would need feeding again. It was a constant thing; every hour of every day was reduced to just going to the toilet and keeping the wound clean.
The granulation was a slow process, but when we reached the 18 month point, I hoped things might improve. Then I was told that my wound had healed, but not properly, so I was left with an extra hole in my back passage. Not only did I have to dig faeces from the hole, to stop sores, many of my previous issues actually weren't fixed at all.
I didn't tell anyone what had happened to me, not even my own mum, who hadn't been with me in the delivery room at the time. I was too embarrassed. I also didn't want to go and have anything done because I knew I'd have to have further surgery, and the whole situation had left me terrified of going into a hospital under any circumstances. My coping mechanism was to push everything to one side and pretend it had never happened. Deep down though, I was destroyed. I couldn't talk about birth with my friends, I couldn't even watch it on TV. I just told people that I had a bad time, but never gave details. I was just so ashamed.
It also had a massive impact on my other half - he was distressed by what he saw when I was in labour, then distressed again by what I was having to go through afterwards. I'd walked in that hospital one person and walked back out another. I had all of these things wrong, I couldn't cope with him and looking after a baby, and sex was out of the question. Inevitably, our marriage broke down.
All everyone says to you when you become a mum is 'your baby is alive and you've got a healthy baby'. Yes you have, and yes that's amazing, don't get me wrong, but if they knew what you had to go to through when you have a birth injury, they'd understand that it's not all that matters.
Eventually we managed to rebuild our relationship, and five years later, despite my ongoing battle with the outcome of my first birth, decided to have another baby. Looking back, I don't know how I did it, but I was an only child, and I was adamant that I didn't want my son to face the same fate.
Elliot meeting his little brother Hugo
Carrying Hugo, my second son, was drastically different to what I'd gone through with Elliot. I had to carefully monitor my weight, to ensure I didn't gain too much, and a C-section was booked for my 37th week of pregnancy because I can never give birth naturally again. When he arrived, of course we were thrilled and loved him deeply, but I also had an incredible sense of guilt, because I hadn't wanted anything to do with his big brother at the same time in his life.
My condition has held me back a lot as a parent, particularly when the boys were younger. Even when we did manage to make it out as a family, all of sudden we'd have to pile into the car and race to the toilet.
'Mummy's got something wrong with her tummy,' I'd say gently if they asked, but I was always conscious of telling them the whole truth, particularly when it came to Elliot. How do you explain to a child that in the magical moment when you became his mum, it caused injuries so extreme that your whole life had been turned upside down?
Over the years, my doctor and I have tried various options to help me process what I've endured - I've had cognitive behavioural therapy, I've been on tablets, I've been referred to a mental health team - but I don't feel that I'm a depressed person. I have post-traumatic stress from everything I went through, and am still going through now.
If I was an alcoholic, soldier, an anorexic, there would be a dedicated team who could help me, but the truth is that there is nowhere to turn for birth trauma. If I'd been raped, I'd be referred to a specialist, but in my eyes, it's comparable to a rape - you're being violated, down in that area, and that is never going to be the same again.
My family are amazing, and all support me where they can - the boys know just by the look on my face that I need to get to a toilet, and will always find one for me in a hurry! But it wasn't until about three years ago that I decided enough was enough, and that I wasn't going to suffer in silence any more.
I told my mother, who was heartbroken that I hadn't opened up to her sooner. I've taken steps to get the surgery that I still need - despite my anxieties around hospitals, I know that it's time for me to help myself now, and this is the only thing that can make the difference that I'm hoping for. I've even reached out to a charity called MASIC, and am going to attend their next seminar and share my story to medical professionals so that they'll better understand the needs of women in my position.
I've also discovered online birth trauma groups, which made me realise how many of us out there have been through the same thing, but are too afraid to speak out. I've spoken to 30-year-old women with colostomy bags, just because they've given birth. Others, like me, gave birth years ago, but are still feeling the affects of their birth trauma every single day.
It's like you've been robbed of a part of your life, but I've decided that that doctor's mistake is not going to rule mine any more. This isn't my fault, someone did this to me and I'm determined to raise awareness of the trauma that thousands of women go through every year.
And if I stop even one mum-to-be from going through the experience I did, it'll be worth every twinge of embarrassment and every moment of fear, because no woman should ever have their lives ruined just because they had a baby.
