Childbirth injury risks

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A discussion among friends about our childbirth experiences has made me think that not enough information is given to women about the possibility of injuries and long term problems as a result of a vaginal delivery. Almost all of us have ongoing incontinence, some had bad tears and one has had a prolapse needing surgery. These things are impacting women’s lives years after giving birth. It seems to be a hidden problem with many women suffering in silence.

AIBU to think that women need to be more informed about risks of a vaginal delivery especially in situations where there’s a high risk of injury like with a big baby?

It's possible that the current generation of mothers is suffering a greater number of complications in childbirth than previous ones. Present day mothers tend to be quite a bit older, which is known to be problematic, and there are also far more seriously obese mothers than before, with more gestational diabetes - again, this leads to more complications, from bigger babies to poorer wound healing and more infections.
Previous generations of slimmer, more active women in their early 20's probably had more straightforward deliveries, and didn't need warned about risks that were fairly rare.
And there is always a reluctance to put the fear of God into women at antenatal classes by cataloguing all the disasters that might befall them.

The only way of avoiding the risks of vaginal delivery is to have a Caesarian instead. Which is major surgery, and simply substitutes a different set of risks. Women should discuss with their obstetrician which would be the safest option in their own particular circumstances, bearing in mind that a section can be technically difficult and risky in morbid obesity for example.

Do you mean so that they can then make an informed choice between a natural birth versus a cesarian?

I totally agree. It’s a difficult balance to get right as you don’t want to spread fear but there should be open conversations about the ‘risks’ of natural childbirth in the same way we articulate the risks of sections.
It won’t sit well with some who think that you can simply avoid injury through hypnosis and pelvic floor exercises. These things are valuable but they can’t fully mitigate against tears and injury.

There so much pressure put on us to have a perfect birth and it seems to me that tears etc are seen as a bit of a failure and blamed on the woman because she didn’t prepare properly. So woman do suffer in silence.

The risks of ALL types of childbirth need to be explained and explored and if things go wrong we need to know the signs and symptoms and have the confidence to get help.

Women should discuss with their obstetrician which would be the safest option in their own particular circumstances, bearing in mind that a section can be technically difficult and risky in morbid obesity for example.

Women in the U.K. don't meet with an obstetrician when pregnant (routinely anyway)

Op I agree that it's something people don't talk about. I can no longer orgasm since having my son, I didn't even know that could happen! It also still feels uncomfortable having sex almost 2 years after my delivery (tear, episiotomy, rotational forceps)

I was 28 (almost 29), no GD and not obese

Women in France have far less complications (especially far into the future with incontinence) and have physio sessions before and after birth (six weeks after) to support the proper core development and muscle lacing.

I think we need a similar model here

YANBU.

The risks of a c section are more well known imo and yes that’s because it is higher risk, being major surgery but also the nhs wants to keep costs down.

I pushed for 5 hours with DS1 and required an episiotomy due to the resulting feral distress. My stitches broke down and took months to heal, I was in pain and on antibiotics for a long time. I know friends who had c sections who recovered quicker (realise this isn’t the case for everyone). I also found the postnatal care utterly dire- i had no follow up on this, and very little support or advice. It definitely contributed to my PND.

Childbirth has always been dangerous with the possibility of leaving you injured or damaged.

It’s just these days there are a subset of women chasing some magical experience and a whole load of midwives and birth practioners encouraging unrealistic thinking.

If the narrative changed I think it would help a whole load of women.

I totally accept that there are women for whom childbirth and pregnancy are easy and straightforward and I’m genuinely pleased for them. But the majority need some assistance (from very minor to c-section) and I think it’s irresponsible to not be given a realistic picture.

Not that I’m bitter.

Uhh, fetal distress not feral!!!

I was also 27, easy low risk pregnancy, not overweight. In fact my pregnancy with DS2 was high risk and that was a much easier delivery, and recovery.

I agree OP. I had a hugely traumatic delivery with dc1- epsiotomy 4th degree tear, now have prolapse. Dc2 c section was a walk in the park in terms of recovery.

Main thing is though we need far far better postnatal care, automatic referrals to women's physios for women with any injury/other risk factor.

The risks of a c section are more well known imo and yes that’s because it is higher risk, being major surgery but also the nhs wants to keep costs down

I agee Cadbury but it would be interesting to know how much the follow up operations and treatments to repair these injuries cost the NHS.

Actually with vaginal deliveries it’s the opposite. Underweight and Obese women tend to have fewer birth injuries because they have access to expert high risk care that normal and over weight women don’t.

Agree that it's the post birth care that is lacking. Mind, the NHS in general needs better aftercare. I know there are cuts etc but surely it just banks spending down the line if the only thing you do for women is book them a GP appointment six weeks later, plus if they're lucky a couple of perfunctory midwife visits?

Still, as I said, that's true across the board. My old mum had major surgery a couple of years ago and she was just left to get on with her recovery on her own. Fortunately she had us but it was a horrible time for her. They didn't even take her home from the hospital. (She couldn't walk at that point.) Our health service in general is just pretty shit.

If the risks of C Section are so much greater, why is it almost the de rigour way to deliver babies in the US and Canada? The NHS has been misleading us here I believe - yes the risks of surgery are high, but I don’t think they are any higher than the risk of childbirth. Reducing sections is definitely more of a cost issue than a patient care one.

My friends all seem to think bigger babies are easier to give birth to as they "help push themselves out" really winds me up as my 10lber didn't ! hE definitely did some damage down there.

And actually I would say that all women who give birth should be referred to women's physio. The only guidance I got was from my yoga teacher!

YY, agree entirely. The current practice of bigging up the risks of c sections, while remaining tight-lipped about the risks of vaginal delivery is a disgrace. It effectively means a large proportion of women do not give informed consent to their treatment in childbirth.

Also agree that the piss-poor provision of post-natal services, such as access to specialised physio, needs a radical overhaul.

Can't help thinking there's some institutionalised misogyny underlying this.

There also seems to be such negative comments about c sections not just about risks but about how the baby will be colicky or not as calm . So we are convinced that vaginal is the way to go because it’s best for baby but Mum should be considered too.

There’s lots of negativity around the recovery time after sections but not about the recovery time due to birth injuries - one of friends was in agony and couldn’t sit down unless it was on a rubber ring and another was doubly incontinent.

No, I don't. I think what's important is that the information and support is given afterwards. There was enough info out there to frighten the shite out of me before each of my children, I didn't need any more as it just creates fear which then can affect outcomes so it's a vicious cycle really.

I had a 3rd degree cat C tear and then 2 second degree tears with my children. The 3rd degree tear was horrific, and it wasn't until I Googled it that I understood what had happened, but I'd really rather have not been told before. It was bad enough when my friend described her episiotomy in detail.

The only way of avoiding the risks of vaginal delivery is to have a Caesarian instead

There is another way - don't have a baby. I did my research and vowed I'd never put myself through it.

Posted too soon.

So many women who have had dreadful birth injuries, horrific post natal care and ongoing problems years after giving birth.
Post natal checks with no physical examinations for women who have had tears, episiotomies, forceps deliveries ffs.
Women should be made aware of all the things that can happen during delivery, and there needs to be much more medical help afterwards.

www.mumsnet.com/Talk/mumsnet_campaigns/3211564-MNHQ-here-the-impact-of-birth-on-womens-bodies-wellbeing-and-sex-lives

Didn't post the first post after all.....
Everyone should read and get involved in this campaign.

My mum had us all young and was always slim. She is in her 70s having surgery for birth injuries that were never properly dealt with.

I run antenatal classes and I spend loads of time on telling women and their partners what the evidence says about how to cut the risk of birth injuries. You can never eliminate the risk. The main ways to cut the risks are positioning in second stage, try not to lie down while pushing, try not to squat, try it to have an epidural as it increases the chances of an instrumental birth, partners and midwives shouldn't coach pushing in an ideal world although with an epidural sometimes it's necessary. Also to consider the risks/benefits of high forceps Vs emergency caesarean.

It's not like we don't tell women this stuff (while trying not to scare them shirtless). It doesn't make a difference in most cases as the women come up against the maternity system which often makes trying to do all this really hard.

I also cover caesareans in detail and don't dwell on the risks unless I am asked but the risks are there and research tells us overall vaginal birth is safer for low risk women. Doesn't mean it's not the right decision for some women though and I always encourage a weighing up of options in cases like early induction Vs caesarean.

Shitless rather than shirtless!

I agree too. I didn't have a vaginal birth in the end but I did NCT and NHS classes. Even with both of those classes I didn't really know much about injuries resulting from vaginal birth. But I didn't want to know either, I didn't want to think about the gory reality of it. I knew tears, stitches and incontinence were relatively common.

Information about c-sections was not given to me by the NHS or NCT either, it was spoken about a lot less than vaginal birth. I knew there was a risk of infection and no driving for 6 weeks. I did have what turned out to be excruciating trapped wind in my chest caused by the surgery, I went in to hospital for two days as they thought it could be a pulmonary embolism. I'd never heard of that before, but apparently they explained it in the risks part of the consent form two minutes before the emcs. So there was risks involved in c-sections which I didn't know about.