Childbirth injury risks

[BackInTime]

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?

@Kolo yes I got a section in the end. There was no way they were putting forceps near me. If she just needed a bit of help fair enough but she was high up in the canal so it would have been very traumatic for us both. I was off my head on the gas and air and pain. But there was no way I wasn't getting a section at that point. I just point blank refused.

You were very lucky you demanded the section. The head size causes more damage than the weight of the baby.

@Elainethepain yes I know what the birth plan is supposed to be for, but they don't read them so it's pointless... they will even chat to you about how no one ever looks at them. Half the time the info is not needed and the other half well things change rapidly and decisions are made as you go along.

I had my twins via c section but I had to really push for it as they were adamant I should deliver naturally. I have severe back issues and knew that a natural birth could be very dangerous. I did a vast amount of research in relation to labour and found masses of information about birth injury that just isn’t out there in the public domain. It terrified me and so I went back to my consultant and presented all my research and she eventually agreed.

Interestingly enough, about three weeks before I was due I was have a pedicure and the woman sat next to me happened to be a consultant at my local hospital. We were chatting about childbirth and she said that most female doctors will have an elective section because they know the damage natural birth can do. I was gobsmacked that she admitted that.

There needs to be way more information and understanding around the risks associated with birth. I have probably terrified most of my friends by being brutally honest but otherwise no one says anything.

I had also recovered from the c-section within a week, my friends that had natural deliveries were still in a lot of pain after three weeks, unable to sit down properly, most fotnjnfections etc. It’s putting me off having more children!

I think it’s up to the adult women to inform herself too though, I was 20 when I gave birth, but during pregnancy I had all my research done (I had my daughter during my biology degree) I had research papers lined up incase they wanted to induce me I went over due etc, I had discussed the different type of forceps with my midwife (I brought it up myself) thankfully my birth was straight forward - all I did to prepare for this was to lie on my left side a lot so not to have a back to back baby, not sure if it helped or not 🤷🏻‍♀️ However due to all the other mums I’ve met, the vast majorinn were not treated well in labour, there wishes were not expected etc, so I won’t be having another until I can afford a private midwife to accompany me to hospital to advocate on my behalf. Due to the fact that I know multiple women with injuries related to forceps! But bottom line I do think that women should research for themselves, there are plenty of medical papers online for people to read and they are not hard to understand.

Sorry for all my typos I didn’t proof read

notsureabc would you advise patients use Dr Google for every medical procedure or just childbirth? Would you say someone needing treatment for their brain, heart or a broken limb should look into treatment options, pain relief options, risk factors, pros and cons and then fight to be heard rather than HCPs having a duty to inform women of all these things and then gain consent?

Whilst you found papers easy to read, for a lot of reasons very many women won't. And having read those papers, even with a degree or two in biology and biomedical subjects, trying to get a consultant to listen to and take their evidence-based revision seriously is an uphill battle. I and many others would argue it is the HCPs job to make women aware. The RCOG agrees with this but hasn't yet taken steps to ensure it is implemented: www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/

@IAmADancer

I experienced similar regarding a consultant telling me that his wife and most of his colleagues/their wives had opted for ELCS. Interestingly he said that midwives did the opposite. Perhaps it isn't that surprising when you consider their roles in relation to childbirth and the fact that midwives would have no involvement in trying to fix many of the issues women face post birth.

I also find it interesting how some posters seem to have referred to the whole "women's bodies are design for childbirth" argument. Obviously lots of people have pointed out that evolution is not equivalent to design and the whole process is dangerously imperfect, however I wonder if we are becoming as a species less good at childbirth due to medical intervention. Surely evolution as imperfect as it is would weed out those women with attributes that were not conducive to VB (e.g. narrow pelvises etc)? It would follow that we are allowing these unfavourable attributes to pass genetically through the generations by saving those mothers and their babies from dying on the delivery room. Obviously I'm not saying that we don't intervene to save lives but I think we need to understand how this intervention is impacting how future generation's chances of having a relatively uncomplicated VB.

Yanbu. I had an elcs but then against almost everyone I know has a CS.
The only 3 people I know who had a VD had horrific experiences to share and would never do it again. The recovery might be a bit longer with a CS but I would take a few weeks over all the issues listed above with a VD.

The other thing I wanted to add is about the repairs of tears post birth.

Really anything more than a small tear ought to be done by a surgeon or someone with proper training.

With a deeper tear the layers of muscle in the perinium need to be reconnected otherwise these muscles which stabilise the pelvic floor will not function correctly.

By the time I got to a surgeon after DC3 my perineum was nothing but a layer of skin. I was chuffed to discover that this particular muscle could be repaired. However when he came to operate he said he had done what he could but much of the muscle had withered away suggesting it had been disconnected a long time previously. So it hadn’t been correctly reconnected after the birth of DC1.

But this isn’t treated as a delicate, careful operation is it? It’s more like never mind it’s only a second degree tear let’s pop a few stitches in.

As to the people who say people suffering from childbirth injuries should have done more research it seems a bit mean.

I asked actual qualified doctors the right questions and got misleading answers about vaginal birth not really making prolapses worse and it being possible to repair everything afterwards.

I reckon I was clearly silly not to do a course on anatomy and the examine myself to check which muscles were damaged before weighing up the risks......

TheUnmentionable Reading your posts makes me want to cry..I'm so sorry you are suffering due to incompetent and uncaring doctors..It's awful :(

Cslightly off topic but all the posts saying "women used to die in childbirth" are pissing me off. Women STILL DIE in childbirth in their hundreds of thousands all over the world every year.

Surely evolution as imperfect as it is would weed out those women with attributes that were not conducive to VB (e.g. narrow pelvises etc)?

No, because there are two opposing selection pressures. There’s a pressure to narrow the pelvis because that’s more efficient for walking and running and there’s a pressure to widen it because a baby’s head needs to get through. So there’s constant pressure both ways. Evolution works only in the now - there’s variation in a population and each generation gets acted on by the factors that apply to it, without reference to past or future.

It’s not a case of ‘weed out all the faulty women and you’ll be grand’ or we would all have had pelvises millennia ago that babies just dropped out of.

Oh and saying women should do theor own research is so unrealistic it's stupid. Dors that include sixteen year olds? And non-English-speakers? And women with visual impairment or dyslexia or anything else that might make reading scientific english online a challenge?

Surely evolution as imperfect as it is would weed out those women with attributes that were not conducive to VB (e.g. narrow pelvises etc)?

Agree completely- it’s complex enough when you actually have the background to read the primary papers and evaluate them. Women need accurate, accessible, easy to read info.

Knowledge is power. I would welcome accurate, un-sugarcoated information about risks / possible problems and injuries in childbirth Same as with breastfeeding information / propaganda.

All the information all the way through antenatal classes (I did NHS ones) for both birth and breastfeeding was all about the ideal to aspire to - the message is it’s natural, the body is designed to do this, bla bla bla. I get they don’t want to terrify women. I get that going into birth and breastfeeding with a positive attitude is really helpful. But credit us with a little bit of common sense and grit - we can handle being told about these risks!

@notsureabc lying on you left side doesn't not guarantee you a baby that's not back to back... I've had 2 back to back babies. It's like a breech baby, at the end of the day how you sleep is not going to ensure you avoid these things. You baby may never have been back to back.

@magpiefeather agreed. Most women go into it with no real idea at all. I know I was clueless with my first.

I had third degree tear, retained placenta and prolapse after a no drugs, natural water birth. It pisses me off when some natural birth advocate imply you did something wrong as the mum if this happens to you. I had a massive baby who had their hand by the side of their face. An episiotomy was done without any pain relief or warning. They literally just sliced me. I was then transferred to another hospital who treated me as if I had brought it on myself despite following everyone’s advice that I was having a safe birth at a midwife unit. I got virtually no aftercare and they were understaffed so forgot to give any pain relief at all for 24 hours, by which point after three days being awake, I had basically lost it. I was left with PTSD.

For my second baby I wanted/needed a c section. The consultant produced a sheet with risk of death etc. I asked for the comparative sheet for vaginal birth. He asked if I was a doctor! It amazes me that they think having a basic comparison is information that most intelligent women should somehow be denied as if it’s rocket science.

I was also told that all my problems would be made worse by pregnancy and vaginal birth would make no difference. I had a straightforward c section and my symptoms didn’t get worse. I cannot see how I would be saying the same if I had gone for a VB.

I think my meeting with the supervisor of midwives to have a review 1 year later, sums it all up really. She said, birth is a natural thing so we don’t routinely offer painkillers. The fact that they are so conditioned now to see it as a natural thing that even if you have actually just come out of surgery to repair a rip in a sensitive part of your body, they still don’t think you are worthy of medication. Most people take paracetamol for a headache FFS! I was made to feel abnormal that I wasn’t walking around. I was shouted at for pulling the emergency cord after being bullied into going to the shower (with baby) the next day when I had surgery at midnight! I had fainted from the pain!

Midwifery needs a serious overhaul.

TheUnmentionable this is so true. I was told I had been given "internal and external sutures" but it wasn't explained what that meant. I had no idea that they'd sewed my pelvic floor back in place until the internal swelling and pain started to cause other issues. As it was the lack of information and aftercare caused the stitches not to hold. I'm left with lasting damage. I genuinely had no idea that an internal tear was even likely prior to it happening.

"Birth is a natural thing" - so are kidney stones, gallstones, arthritis, and 1000 other conditions that we DON'T expect people to handle with no pain relief.

@boredandtired I did say I don’t know if it helped, it was just something random I read online. But I have a friend whose baby was back to back and by using the ball/lying on her left side she managed to get him to move.

@notsureabc but they move often anyway! My little boy was transverse till 39 weeks, suddenly flipped for birth, and my back to back babies turned as they came out,, no amount of lying on my left side and rocking on all fours for weeks made any difference. These are just things we can do that are thought to encourage positioning. And to be honest absolutely irrelevant to the majority of problems being discussed. There's no evidence the ball and lying on the left side made your friends baby move, he could well have moved anyway.

@duggeehugs are research papers dr google? I never said women shouldnt be told things by hcp but I did say that it’s also your responsibility to make yourself aware. Of course the NHS should tell women the truth and when I was pregnant this infuriated me as I knew they were sugarcoating vaginal births. But also they can’t induce you without your consent, which I was not going to provide (due to educating myself on the risks for first time mums) if it came down to it, so they would’ve had to do something else.

It amazes me that they think having a basic comparison is information that most intelligent women should somehow be denied as if it’s rocket science.

There was an article about how women are denied proper information about birth and an obstetrician was saying how maternity care is the only area of medicine where patients are treated like children and it's seen as okay to withhold information, not involve women in decisions and so on (he also wanted to see a change) I do often read women writing on threads about how patronised they were, not taken seriously or listened to etc

@notsureabc how do you expect women to find these research papers without Google or similar? Most of us don't have Athens or Elsevier access. When the results come up, how are people unused to research papers meant to evaluate them, to know which are good quality and which are not, which research is on a firm footing and which is not, which has been sponsored by interested third parties and requires bias assuming? All of these are skills which people learn, such as HCPs, and therefore it should be for them to correctly lay out risks and consent for their patients. That is their job.

And as for consent. Unfortunately some HCPs don't respect consent. That has nothing to do with how educated the patient is and everything to do with the arrogant unprofessionalism of those individual HCPs. And they can induce you without your informed consent when you're scared and told they have to get your baby out soon because you're getting sick and by not telling you there is a right to say no. Again, that is a failure on the part of the HCP not the patient.