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?

@pandarific

Thread of people’s experiences of mobile epidurals, may be helpful to you. I really don’t know why they call them “mobile” if I’m honest I think it’s quite misleading x

www.mumsnet.com/Talk/pregnancy/545723-walking-mobile-epidural-anyone-have-any-experience-with-this

@catchingbabies thank you, very good to know.

Quite often panda, by the time you get to an epidural you no longer want to be mobile 😬. That’s not necessarily a bad thing- both of my epidurals allowed me to sleep and rest after long of hours of labouring. This gave me the energy I needed to push the baby out and I think I would have struggled without them. I wasn’t mobile with them but I could feel the contractions at the very top of my bump which allowed me to effectively time my puShing. I pushed for 45 min first baby and then 15 min second baby which is pretty normal. Both times with an epidural in place. I love them

Should say that I don’t think my epidurals had any affect on my prolapse issues after birth- that was down to big headed babies, constipation and genetics.

@CatchingBabies interesting that you mention the 2 hrs of pushing for first babies, I have recently come across someone else saying the same and was shocked as I did hours and hours more.

The baby stopped descending and I was told ‘it’s probably going to be a section now, but if you push it down you might get away with just forceps’. I ended up delivering without intervention but it took hours and hours. No one mentioned that I should weigh up continuing after 2 hours. The baby wasn’t in distress so I kept going. No one had mentioned length of time pushing to me, and even after looking it up later I didn’t find much info so I doubt I would have been better informed if I’d only tried harder.

I told the midwives it felt like something internal had come out. I was told it was normal. A few weeks after I was crying going to the loo. The gp said hemhorides

rrgh! GP said hemorrhoids are normal.

My second birth was fast, painful and traumatic. I had arrived and they told me there was no way I was in proper labour, I was. Then I delivered without pain relief. After birth I said I was in real pain and no one took it seriously. Just make sure to eat plenty of fruit! Back in A&E a few hours after I went home and the doctor just shook her head and apologised that a prolapse had been ignored, misdiagnosed and worsened without a single person examining me.

With hindsight I probably still wouldn’t choose a section the first time as I didn’t want the long recovery period, but I was never warned about heavy lifting, just told to do pelvic floor exercises. I’m now going to be assessed by a surgeon but I think the aftercare I got was awful.

Isn't it documented that most doctors and midwifes have c-sections? I assume there is a good reason for that.

Women are older, fatter and have higher expectations of birth. It's not always a magical experience, it does hurt and you need to be prepared. Women simply aren't prepared these days.

I do think in 50 year's time sections will be par the course in the western world.

@Kolo

I am sorry that you had such a bad experience- I can only speak for the places I have worked, but women with large babies or risk of large babies (e.g. pre-existing or gestational diabetes) are definitely counselled on risks of vaginal birth vs section. All women in our area see an obstetrician at least once during their pregnancy- obviously more frequently than that if they have a medium or high risk pregnancy. A woman known to be large for dates would definitely fall under the latter. Though I have to say we have found that significant minority of women don't really want to come up to the hospital to see us- they'd prefer just to see their midwife in the community.

As I say, we have significantly beefed up our post-natal care services with specialist physiotherapy services. Women who have had a large tear or other issue deemed to be high risk are automatically referred for postnatal care in addition to midwifery/obsetetric care. Other women can be referred at request before discharge/by their midwife or GP at a later date. I was surprised at how hard we have had to work to get uptake improved (to the point the pilot was in danger of being pulled early at one stage). I think this is partly cultural- it's not something routinely done before, women can get quite embarrassed talking about it and so on. Unlike in countries where it is done as part of routine care.

and the doctor just shook her head and apologised that a prolapse had been ignored,

^^

Oh well, never mind eh. Keep calm and carry on love.

This is the attitude towards women! If it was men giving birth it'd be a different tale. .

Most midwives have vaginal births or certainly aim to.

I have heard the thing about doctors opting for sections but ime that’s not true. If it is remember that doctors generally see vaginal Births when they’re going wrong. They miss all the trouble free ones as they’re not needed so might have a distorted view on vaginal Births?

@halfwitpicker I explained that badly. The doctor was horrified at what had happened. I remember her shaking her head and being very quiet and saying how sorry she was that it had happened. She was the first one to take me seriously.

It was a real problem getting people to understand that I had been in labour, and coped with the pain, given birth quickly with no pain relief and coped with the pain, but here I was saying this is the worst pain I’ve ever experienced and all I got was ‘yes it’s normal’. Noone examined me because I didn’t tear so it was all ‘how lucky, do your pelvic floor. My gp had given me a phone appointment only.

I’d previously thought I’d like 3 children, but I decided while in hospital this time that I was stopping at 2. The community midwives I saw at home all asked me when I was having number 3, and when I said I found this one too traumatic to consider it etc they just said ‘you’ll change your mind’.

I had this exact conversation the other day - midwives are quick to tell you of the risks of c section, not a word on vaginal birth risks.

I had a difficult birth with my son (I was 25 and not overweight for the record). I had to have an epesiotomy, had a third degree tear and forceps delivery. I also bled quite severely. I never had it explained to me how badly I had torn or how best to look after my stitches. It was over a week before my midwife mentioned I had a third degree tear. I did my best to keep my stitches clean but had to have 3 courses of antibiotics due to infections and the pain was just horrendous. I didn’t know I had an infection for over a week as the midwife didn’t offer to check my stitches and all I knew was that I was in pain which I thought was to be expected. It was just awful.

As for aftercare in regards to the tear, there was nothing except a letter asking me to go to the hospital about 6 weeks after birth. I had no idea why I was being summoned. When I got there the dr put her finger up my bum, told me to squeeze and then said it all felt fine and sent me on my way.

I am now pregnant again and have been told I would have to go to a hospital this time (as opposed to a birth centre) and will quite likely need a c section to avoid any further potential issue with incontinance. In all honestly I feel relieved and from everything I have read a planned section should be much quicker to recover from than my first horrific experience.

Just to wade in but please educate (even a little bit ) on the more abnormal things that can go wrong with pregnancy.

I was a perfectly healthy 29 year old.

First pregnancy.

Woke up in the middle of the night with chronic chest pain at 23 weeks pregnant.

I knew it was heartburn within an hour & asked my DH to take me to hospital.

After a week in hospital I was told I had gall stones.

That night I had blood dripping from my nose & gums.

I was weeing blood.

I literally crawled on my hands & knees to the nurse station for pain killers.

HELLP syndrome as all pregnancy syndromes has to recognised.

Unfortunately for my little Poppy it was all too late.

Sorry if I’ve derailed the thread

My point was - please, please educate more. Even my consultant told me I was dying (in those words) from a blood disorder rather than knowing what was going on

@pandarific I had a mobile epidural. It basically just meant I didn’t need a catheter as I could get to and from the toilet with a Zimmer frame. I had been quite active on the birth ball until I had the epidural but the nurses advised I use it as an opportunity to sleep. I’m glad I did as my labour was 32 hours.

halfwitpicker
Women are older, fatter and have higher expectations of birth. It's not always a magical experience, it does hurt and you need to be prepared. Women simply aren't prepared these days.

I think there is sadly some truth in this. For those posters saying they are not told about risks in birth, I don’t agree. I think the nhs does plenty within the time and resources it has, via ante-natal appointments and classes to inform women, but it’s best to put the effort in to learn stuff too in your own time. When I was pregnant I spent 9 months reading every pregnancy and childbirth book I could get my hands on. I knew tonnes by time of delivery. I’m not saying it made it easy (I actually thought I was dying birthing DC1) but at least I knew I’d educated myself on the matter. It’s absolutely awful for women who experience bad vaginal deliveries (I count myself in this group!) but overall the outcomes are safer for the population overall, than having a sky high c-section rate.

I was very well educated in terms of the birth iam. I did nct classes, read the books etc. But in terms of what happened afterwards? Nothing. Do you remember prolapse or incontinence being mentioned at NCT classes? I don’t!
I dutifully did my pelvic floor exercises, tried to have an active birth, water pool etc, etc. It did nothing. What i needed was a decent standard of postnatal care. Someone, just once, to ask if I had any problems with passing urine or stools, or to examine me and check how I had healed. I had one gp examine me after my first birth and they didn’t even spot the prolapse I could actually feel when I pushed my pram.

This is not just about pre-natal education, it’s about making sure that women are adequately cared for at the most vulnerable time in their lives. This is just not happening right now in most of the country.

I didn’t have high expectations of birth, I just didn’t expect my rectum to fall out of my vagina Is that really too much to ask?

The NHS gave me loads of information, and I sought out further sources. I was well prepared. I never found anything warning about pushing too long apart from the possibility that the baby may become distressed.

Even if I had tonnes of information about the dangers, by the time I’d pushed for more than 2 hours I’d been in labour for nearly 24 hours, and had woken up when it started the previous night after just a couple of hours sleep. I really wasn’t aware of how long it had been going on for, and I don’t remember anyone asking me if I wanted to keep going, only encouraging me to continue.

I actually think I probably would have decided to continue pushing even with all the information I have now. It’s the aftercare that I think really let me down. It was just ‘no tear? You’re lucky. Do your pelvic floor’ and everything else was about the baby. I was already 100% focused on the baby, I needed a hcp who was there for me. Everyone kept saying how lucky I was to have an easy birth. But I had really done myself some damage.

It was like because I’d had a natural birth everything was fine because everything is fine after a natural birth.

They never tell you either that with vaginal births your bladder is not the same either even if you do pelvic floor exercises. One sneeze or cough away from pissing yourself.

Defo with big babies though there is a risk the baby getting stuck.

I thought this was very apt for this thread

@benandhollysmum

Most bladder weakness is caused by the pregnancy itself and not the method of birth. Severe tears can make it worse however.

It's possible that the current generation of mothers is suffering a greater number of complications in childbirth than previous ones.

I might have known it would be women's fault for being fat and old .

There are greater risk factors, but women have always had childbirth injuries whether they are 17 or 47, no matter how fit and healthy they are, or how straightforward the pregnancy. Ever since we started to walk upright on two legs. The OP is spot on.

I wasn't old or fat, I was 29 when I had DD1, had a BMI of 20 and was very fit. I had a straightforward pregnancy and birth, did pelvic floor exercises, but still had tearing and stress incontinence for months afterwards.

I don’t have any expectations about candles and whale music and breathing the baby out. Birth is inherently risky. I understand that. I have no ‘daft’ expectations.

I DO expect modern medicine and practice to help me get this baby out in the safest possible way for both of us. I’m well read, I’m a scientist, I understand and can critically appraise the evidence I’m reading. I’m polite to HCPs.

I’m still being treated like a silly schoolgirl. It’s disgraceful and it gives me zero trust that when it comes to the birth I will be treated well.