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?

@lilifer did you ask for the c-sections or were they advised, I'm being told that a c-section won't help the urinary/bowel situation and vaginal won't make it worse.

@statisticallychallenged maybe it's down to SPD being different for everyone. I had it terribly with ds and had to wear a body tubigrip and could barely move for months, but it was not an issue at delivery.

@boredandtired It does vary hugely and I know for a lot of women it doesn't cause delivery problems - I think what frustrated me was that they refused to consider me as an individual and just quoted this as if it was an absolute fact. The way SPD presented in me was with massively limited lateral movement, to a ridiculous extent. There was no way I could have birthed a baby without exceeding my pain free gap, it would have been physically impossible.

Funnily enough this time round when I've explained the state I was in last time nobody seems to be arguing either about the next c-section or about the last one being warranted, so it's possible that the approach here has changed a bit. I really hope so.

Basically if you're having your first baby there via induction you're more likely to have an emergency c-section than an uncomplicated VB.

Anecdotal evidence of anyone I know who has been induced has ended up with an emergency section or an incredibly difficult birth.

BoredAndTired - the urinary/bowel situation can only be made worse by vaginal birth as there could be further damage to muscles and ligaments.

I was told after DC 2 that I had a small prolapse but that it would not be worth repairing until after my family was complete.

I then remember asking a doctor if vaginal birth could make the prolapse worse and he said some times these things are a bit better after birth and some times a bit worse.

Bollocks. It’s only ever going to get worse as the muscles supporting your organs potentially rip and get more damaged. They aren’t going to spontaneously fix themselves during the birth are they?

After DC 3 I was left with massive prolapses. Also my muscle was entirely ripped off the bone (someone mentioned this up thread) and the muscles inside my bum were damaged.

The prolapses have been repaired privately but the other damage can never be fixed.

I am angry because I feel I was misled that a) damage from births was easily fixable and b) that more births were unlikely to make much difference

In reality a) lots of birth damage cannot be surgically repaired and b) if you are prone to bad tears then repeated births will make everything much worse.

I don’t post much but suddenly feel I ought to so that other people won’t be misled in this way.

"@DuchyDuke" that link is so helpful. Although it is quite expensive it would be worth it if I had some improvement.

A lot of people have mentioned that it should be up to individuals to research their own birth risks. I did research quite obsessively and made a birth plan that was based on this when i went in to labour it ( and me) was completely ignored.

that is v interesting because I was induced with my first birth and yes it was just a cascade of horrendous intervention
Id have much rather just had a planned c section.
Why do they continue to pressure women into inductions instead of just offering a section if it has such an impact regularly?

@Theunmentionable thank you, that's essentially how I see it too. I'm lucky I've not torn vaginally but I did have terrible muscular bowel problems (and a tear) which were excruciatingly painful and distressing. I feel like it's so hard to get people to speak to you as a person and not a statistic, it seems I'm lucky, but it doesn't feel very lucky. They definitely try to tell you there's no evidence birth will make it worse and that damage would be done in pregnancy anyway, but this is such a load of rubbish! I'm not saying pregnancy can't cause issues, but it feels like this is a way of shutting women up so they don't question it, have a vaginal birth and then deal with the consequences.

Well I can see that pregnancy could put strain on your muscles which could lead to prolapse but if they are intact then you can strengthen them through exercises etc.

Once your muscles have been damaged there is only so much you can do. You can do literally thousands of hours of pelvic floor exercises (I have) and you won’t reattach your pubic muscle to the bone or fix your internal sphincter which isn’t under voluntary control in any case.

Most doctors seem to know very little about this stuff apart from the uro-gynaecologists or colorectal surgeons.

I wouldn’t be at all surprised if my pubic muscle hadn’t already partially detached after birth number 2 but I wasn’t properly examined until I felt like my insides were falling out after birth number 3 and made use of my private health insurance to go and see a consultant and a women’s health physiotherapist.

How I wish I had done my research better.....

On my first baby, I had an induction which resulted in a section as she got stuck and was too high in the birth canal to perform an instrumental delivery. Thank God. The section was grand... I healed fine and was back on my feet very quickly. But my eyes had been opened to what could have happened... I was I heading for a forceps and an extensive episiotomy. On my second, I was happy to try for a VBAC and went the 14 days over, waiting for labour to begin, which it eventually did a few hours before I was being brought in to have my waters broken. Again thank God. I was not looking forward to that. After labouring for a day, I was fully dilated and the same thing happened again. My dd got stuck high up in the birth canal and I just refused to let an instrumental delivery be performed. I was high from the gas and air and in absolutely agony. I wanted to die. But I knew I'd be screwed if I had the forceps. I was thrilled afterwards as her head was on the 95th percentile, so I would have been damaged hugely. I was so naive on baby number 1. Baby number 2 I realized that you have to be on the ball and know how to protect yourself.

As I said earlier women are definitely discouraged from doing any of their own research. They're told that the information provided to them at midwife and antenatal appointments or NCT classes is all they will need to be prepared. Women are often told by consultants to not Google and birth plans are openly mocked and labelled as 'pointless as they go straight out the window'. I honestly think a lot of HCPs don't want women doing their own research and being armed with facts and a clear idea of what they do and don't want. I remember reading an online newspaper article (possibly Daily Mail) about consent in childbirth and a lot of women were sharing their negative experiences including one woman who woke up to the doctor giving her a VE, a male consultant obstetrician was asked for input in the article and he basically said that consent is too difficult to obtain in labour as women are in too much pain and that pregnant women use Google then think they're experts when really the doctor knows best.

A lot of women just aren't aware that their basic human rights still apply in pregnancy/birth as well and I don't think this is accidental .. you see so many threads on here with women stating they 'have to' have a sweep/induction/ECV to turn baby and so on. A lot of HCPs use language such as 'allowed to' and you 'have to/will need' about completely optional things and fail to discuss alternatives.

I did research quite obsessively and made a birth plan that was based on this when i went in to labour it ( and me) was completely ignored.

What is the point of a birth plan and why do midwives go along with the farce of making one? Is it just to make women feel like they have some control of a situation where actually they have no control. It is really difficult not to scoff at a wide eyed first time mum talking about her very detailed and researched birth plan.

@elainethepain that’s a truly shocking statistic. Seems so ridiculous that inductions continue to be handled this way.

Does anyone know the actual risk of going overdue? I was 15 days overdue, and had pressure from about day 10 to have an induction. The pressure got more and more to the point I lost all confidence and felt like I was being completely irresponsible in carrying on waiting.

I've never made a birth plan or been encouraged to do so? They are pointless as you have no idea how you will feel or how your birth will go. A 2 hour labour comparedwith a 36 hour labour would not have the same birth plan.
The only things worth writing down are who you want with you or not, and things like whether you want the jab or not, which they ask you anyway.

Kolo the risks after 14 days do start to rise but not hugely... I think they recommend monitoring every two days. Now saying that, I'm Irish and no way would I have been able to go a day over 14 days. I was pressured from 10 days but once I went for monitoring, they were happy for me to go to 14 days

In fact a birth plan gives the woman a false idea she has a say in her labour, when the reality is after several hours you may well beg for drugs despite your birth plan saying drug free...
My first I had a bitch of a midwife who said 'I've no idea why you're making such a fuss now you'll be here all day' at 9am, 5 hours after labour started. So at that point I gave up, thought I would die, and had asked for drugs. I had pethidine at 9.30am and he was born 23 mins later....

This is a hospital setting ... Maybe a home birth with a midwife sought privately might be a different situation. Although insurance concerns might factor into that

@Boredandtired they're not about a set 'plan' of labour and birth just about thinking of different eventualities and preferences. E.g. Baby goes into distress and they want to do trial of forceps before c-section.. do you actually want the trial of forceps or do you want to go straight to a c-section?
I didn't do a birth plan and proper research and subsequently felt violated, I didn't really know what was happening and they made all the decisions for me and my body

@liadan so did you have an emergency section for the 2nd? Sounds similar to me. I KNEW my baby was huge. There’s a history of big babies in my family. My midwife always claimed I measured fine, but I knew I was massive, and I had a GTT anyway, which was negative. I asked and asked for a growth scan before the birth, but was told it was a waste of time. I ended up being induced, and having 3 days of labour, I’m sure someone said during that time that the babies head was so big he couldn’t even get down enough to press on my cervix to fully dilate me (though who knows what was real or imagined by that point). Anyway, he was deleivered by emergency section after 3 days and weighed almost 12lb. My 2nd I insisted on having an elective unless they gave me a growth scan before the birth. They refused to do that so I carried on insisting on a section, and was given one. They measured his head at birth (it wasn’t something that was done with my first) and he was way above the scale. To the point where they were worried about encephalitis. I had to go to clinic to get his head measured all the time until he was 6months old. Turns out he’s fine, just with a big head, and he was 11lb born at term. I’m 5’5 and I would have been torn in half delivering my boys vaginally, I reckon!

The argument of the increased cost of ELCS is a complete red herring. Assuming a woman can even get any help for post birth injuries, the cost of treating isn't going to come out of the labour ward budget so of course a vaginal birth will look more cost effective. Plenty of women assume their injuries are normal or are fobbed off so don't get any help, thus skewing the results too.

@sreberko Repeated vaginal examinations can stimulate the cervix to dilate and cause premature labour, it’s why speculum are used to look at the cervix rather than feel it if people are labouring early. Such dangerous practice to routinely check the cervix! Plus it increases the risk of infection every time you do it, that’s just baffling! I bet you won’t find one piece of research based evidence backing that up!

If anyone would like to see the evidence on post term induction and a research paper explaining why the original study showing the increase in the Stillbirth rate is flawed feel free to PM me your email address and I’ll send it. It’s saved on my computer but the links don’t work unless you have a log in so need to copy into a document.

I really think our high induction rate is the main contributor to our high instrumental and EMCS rate.

God reading this thread makes me remamber my own trauma :(. Had a birth plan but it went to hell. I was in labour for over 50hrs, send back home 3 times and told to take paracetamol and have a bath..I was having regular contractions for hours and my waters broke and they STILL send me back as I was only 2cm..for over 30 fucking hours!

When I EVENTUALLY got admitted, got induced and my body went crazy with blood pressure getting so high I was at risk of a stroke. At that point I haven't slept for 2 nights and just wanted it all to end..I REFUSED all medication, screamed at the doctor that I should be giving birth already, that something is WRONG and I want her to check..she did..and said my baby is looking straight at her and it explains why I'm contracting but not dilating..God WHY it took so long to get that info I don't know..
The whole thing ended up with forceps, after epidural and also full spinal as epidural only partially worked. Baby was posterior with a hand glued to head too..Why I didn't get a c-section I will never know..

As things stand we were lucky..my baby was battered from forceps but not damaged..I was traumatized but not damaged permanently..

My post natal care was absymal though. I was never even examined even though it was forceps delivery..

Some of these stories are horrendous, I’m so sorry those that have gone through such a traumatic experience. I hope you all raised complaints about the appalling care you received but sadly I assume most didn’t as I know there is an attitude that you should be glad you have a live baby and shut up about what you went through to get there. I promise you not all midwives are like that, I would honestly leave if I ever thought I’d put someone through any of these situations. Whilst I disagree that caserean sections are the answer I can see why some of you feel that way having had such awful vaginal births, a lot of your stories seem to be a result of poor practice and / or not being listened to however that may have made the outcome very different if the care provided was better. It’s shameful that these things are still happening.

So sorry to have not RTFT, but this is one of my pet soapbox topics.

After suffering a third degree tear during an otherwise textbook birth, and receiving such horrific aftercare I developed PND / anxiety / PTSD (possibly even a nervous breakdown) I was adamant that my second - and last - baby would be a section. Although I got one agreed without too much of a fight, I was amazed by how much the risks of a section were laid out, whereas the risks of another vaginal birth, particularly another tear, were glossed over.

The damage done to women's bodies during childbirth is considered just collateral damage - unavoidable, unimportant, secondary to the health of the baby.

The rampant misogyny within obs & gynae is a scandal. From childbirth to vaginal mesh, women are expected to suffer and keep quiet.