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?

I had forceps in theatre for fetal distress, they were going to revert to a c-section if 3 'goes' didn't get baby out... does this mean I had a high rotational forceps delivery?

If high rotational forceps are only used when baby is in a safe place for a section then why is it hardly ever presented as a choice for women? Why isn't something like that where there is a very clear choice of two options with different risks included in antenatal education?

In all honesty as much as I don’t like it, no women are not always accurately counselled or informed regarding forceps. I’ve heard them described as ‘spoons’ on baby’s head which isn’t accurate and a caesarean is only really given as an option if the woman declines forceps. Not at women are told that a forceps delivery involves an episiotomy also, there isn’t room for the baby and the forceps so the cut is needed to prevent 3rd and 4th degree tears.

High forceps are often used instead of a caesarean a) because it’s quicker and depending on the reason for the forceps being needed seconds could count. b) because assuming no complications it’s a quicker recovery for Mum and c) it means mum has a high chance of a normal vaginal delivery next time and doesn’t limit the number of children she has like a caesarean can do.

At the point a delivery is going to instrumental it’s no longer a midwife decision and while we may not always agree it’s no longer our remit. Although saying that I have previously put a stop to an instrumental delivery. The doctor tried ventouse and that failed (you only get 3 tries) and then tried forceps and on the 3rd try was pulling so hard the woman was sliding off the bed, which is WAY too much force. I did step in and say stop at that point and she went for a Caesarean section but the doctor at that point can overrule the midwife so if they had said no there isn’t a lot I can do.

Remember however these decisisons have to made fast usually. There isn’t time to discuss the options and have a discussion with a woman who is in pain, may have had medication that alters her thinking and is scared and doesn’t know what to do for the best. If it’s life saving then it has to be quick and doctors try to decide quickly what they think is in the best interests of the woman. They are human and sometimes they get it wrong as I’m sure we all do.

Elaine If you went to theatre for forceps the head was likely still quite high. A low forceps delivery can be done in the room, a high forceps known as “trial of forceps” is done in theatre as if it fails you can convert to Caesarean quickly. Wether or not you had rotational forceps depends on baby’s position and if they needed rotating first. Rotational forceps don’t deliver the baby they just turn it and then the use a second pair to deliver. This isn’t commonly done unless a woman declines a caesarean however. The most common are the low forceps and the mid-cavity.

Also quickly commenting on the horrific case linked. The woman remember was premature. A pre-term fetus can deliver through an undilated cervix, also the lower segment of the uterus (the part they cut in a caesarean) doesnt develop until 28 weeks gestation making a caesarean very risky before that for both the woman and the baby. I imagine the doctor did not want to take the risk of delivering the baby by caesarean (who had already died according the news reports) and risking taking away her fertility and chance of another child and so made a quick decisison to try for a vaginal. It was wrong but that’s the thing with decisisons such as this it may work for most people but not all and you never know who it will and won’t work for, but you try and do what has the most chance of success. I am sure that doctor will be haunted by this.

I actually asked the midwife at my nhs antenatal classes to explain why forceps are used instead of c-section and what the differences are to each and do some people opt for emc over forceps.
I was told that you can't opt for emc over forceps as forceps are used once the baby is too low for emc and there wouldn't be a choice.
I only found out the difference between high forceps and 'normal' forceps after giving birth (research online). She basically lied to me.
She quickly changed the subject onto lovely natural birthing.

Thanks catching babies, I know that most doctors will be trying not their best. But sometimes a culture is just so ingrained no one questions it and these practices go on and then suddenly in the future there may be a different way of thinking and they will look back and think the thing s that happened where barbaric.

Also I find this bit about forceps being preferable as it doesn’t limit women’s childbearing like a cs can difficult to accept. As this seems to be assumption that is just made for women.
No one asks when you are pregnant, what are your priorities, do anticipate you want a large family or would you be likely to stop at one or two children (like most people). Do you want you pelvic floor prioritiesed, is not pissing yourself when you exercise crucial to your sense of health and well-being.

Furthermore the reduction of women’s experience in birth and mode of delivery, being based upon how many children they can produce in future, it screams absolute mysogonism.

Knowledgeable people, what do you think of the Odon device's potential as an alternative for forceps?

Just carrying a baby though has an impact on your pelvic floor, and then having all those muscles which support the pelvic organs cut during a c/section also has an impact so c/section isn't the magic solution. It will be interesting to see in years time what damage women who have had multiple c/sections will have internally from the adhesions caused by surgery.

I get the general impression that if a normal physiological birth can't be achieved then a lot of women would much rather have a c-section than forceps. @Catchingbabies I get that women are in pain/scared/on meds but I really think that kind scenario should be discussed with them during pregnancy and it noted if a woman is strongly against forceps, then have this taken into account if a decision between forceps or section needs to be made during labour.

Forceps are discussed in pregnancy, along with caesarean and ventousse. The possible situations are talked about in antenatal classes. We don’t ask women what they prefer as most forceps deliveries are low and a caesarean isn’t possible then. But when writing a birth plan later a woman is welcome to state she doesn’t consent. Even discussed earlier the consent needs to be at the time so that the reason why in that situation can be explained, at that point most women just want the baby out and so consent to the quickest and safest method.

Forceps and ventouse were not covered in my (utterly useless) antenatal classes. Neither were c sections. I asked if all this would be covered and got a very sniffy reply along the lines of ‘women who fail at labour might need that.’ By that time I’d already been booked in for a (needed, placenta and vasa previa) section and I had several questions - they refused to answer them.

Women MUST be told this stuff. I really think that one of the reason PND rates are so high is that women are genuinely shocked when they hit the reality of birth.

To me it’s much better to have a positive but realistic outlook. It will be painful - here are techniques for breathing, movement, and pain relief options. It can go wrong, and here’s what the main things are and how we deal with them.

It’s possible to be positive and realistic.

My friend gave birth a little while back. Was very into hypnobirthing and very positive. She knew the baby was OP but wasn’t offered any options - it was only when she had to have forceps and an episiotomy and ended up with with a broken coccyx that the MW told her ‘yeah we thought that’d happen.’ Women need to be told that last a certain point a section isn’t faesible - she had no idea of that. And she’s really angry that they thought she’d need serious intervention but didn’t tell her before it was too late. That is really poor care. She’s also not been able to have a six week check, and had to insist on an x day for the coccyx. She thinks she has a prolapse too and has been told that yeah that's just howbit is.

That is a dreadful standard of care.

It sounds like some antenatal classes are more comprehensive catchingbabies, but I remember saying to DH after ours that instrumental delivery was basically skipped over- there was literally a one sentence "if baby gets stuck then we can use forceps to help get them out" but that was it. No discussion or info. We spent blooming ages being shown a scalp monitor though...

I don’t agree that it is necessarily older mothers! I am early 20s and suffered a severe prolapse following the birth of my baby this year - and I am annoyed that I wasn’t aware of this before my baby was born, not that it would have prevented it but at least I would have been aware. I am now looking at a lifetime of problems and surgery..

@CatchingBabies But reading the list of risks associated with forceps for mother and baby, none of that was outlined to me in the same way that c-section risks were. I also wasn't made aware that a normal scenario which I could face would involve a choice between a section and high forceps. For me, the risks of the section may be so much more acceptable than the risks of forceps.

If some country have BANNED high forceps then the least the U.K. can do is make sure women are know exactly what they are consenting to and that all women are aware they have the choice not to have forceps (without being misled or scared in the moment)

The antenatal classes were shockingly biased towards vaginal births virtually at all costs. Csections were only touched upon in an "option of last resort" type way and I recall one of the midwives saying "but we don't want to dwell on nasty things like that as you ladies will hopefully all have uncomplicated deliveries" Needless to say I was not very popular when I told the class that I had been booked for an ELCS as after undertaking thorough research, looking into the hospital's stats etc and reading NICE guidelines I felt that this was the safest mode of delivery.

Currently there is no completely safe mode of delivery and to be honest I think very few women come out of pregnancy and birth completely unscathed. There will always be the lucky few who have bodies that ping back to normal with no lasting damage and have uncomplicated deliveries that have no real impact on the woman's mental and physical health. For most women though it's a case of weighing up risks and taking a gamble hoping that you avoid the worst of what can happen. I think this is why women having access to unbiased information and consequently having choice over delivery method is so important. Things can and do wrong with all options but if you make an informed choice then I do honestly think it's easier to accept the more adverse outcomes that may come as a result of your decision.

I would go as far as to say the current system is devised to prevent women exercising choice and is keen to keep women uninformed about what can go wrong. Information provided to expectant mothers is patchy and completely biased towards VB birth and the whole infrastructure to support pregnant women is designed to make VB the default and to make deviance from it extremely difficult. All expectant mothers wanting a VB should at the very least be encouraged to read about the different forms of intervention that could be necessary, the likelihood of intervention being required (usually quite high) and the pros and cons of each. They then should be encouraged to think about scenarios that they definitely wouldn't consent to eg using rotational forceps instead of going straight to EMCS. I also think that expectant mothers should be better informed about induction and it's chance of increasing the need for intervention and whether a C-section would be preferable.

@moregingerbreadplease I've had mine since 25 and so lived with it 17 years now. I know and have known many young women with problems. I think people tend to associate bladder problems with older women.
Regarding use of forceps etc, I've no idea where this information comes from, I've never had anyone discuss any problems with delivery at any point.
I was at a birth where the baby was an unknown breech. The birth was halted and an emergency c section deemed necessary but the consent was horrendous. They were terrifying. Which having said the operation was necessary I was confused as to why they made it seem so dangerous. They did not outline why continuing with a vaginal birth would be too risky to continue but then made the c section sound like a really dangerous option. It was very scary!

Forceps are discussed in pregnancy, along with caesarean and ventousse.

Not in my experience. I wasnt offered antenatal classes. My midwife told me it would be a waste of time because it is mostly about active labour and as I had a twin pregnancy I wouldn't be allowed to have an active labour. Even the three different consultants i saw refused to go into details with me about any of the above. Everything i knew about the risks and benefits of the above interventions before going into labour, id learnt from dr Google.

Good thread; this needs to be talked about more openly.

In some ways I felt lucky that I had a couple of female friends who didn't hold back about telling me how they got tears and got cut when they had their babies, because if they hadn't, it wouldn't have occurred to me that I would have to be cut/get a tear.

As it turned out, I got a second degree tear and a following infection and I was in quite a lot of pain. Coupled with the baby blues for the first few weeks (which no one tells you about how fucked you're going to feel), I felt really low for the first two months after giving birth.

I didn't get PND, it was just the baby blues and the tear/infection that got me down, but I never expected to feel that low after having my baby. I'm normally a happy positive person so the injuries sustained during the birth really threw me, and whilst I'm physically recovered, I'm not 100% sure I've emotionally recovered despite being 10+ months post partum.

From my own experience, people don't honestly tell you what injuries you can sustain or how low you can feel with the baby blues due to giving birth, and it's because they don't want to scare you. When my close girlfriends start having children I will make sure they know about the possible injuries they can sustain (without scaring them too much!) so they can mentally prepare for it if it does happen. I wish someone had been more candid with me.

If more people knew the truth about risks of birth injuries and long term/permanent incontinence etc, i expect more women would elect for a Caesarean and the NHS doesn't want that.

I think the overwhelming message with antenatal education is that both is unpredictable and you should expect to put yourself fully in the hands of the doctors and midwives. They will know what is best to do and you should go along with whatever they say without question. They don't want women to have a say and choice in what happens unfortunately.

@CatchingBabies also if high forceps are 'quicker and safer' than a c-section then why are they banned in some countries?

never expected to feel that low after having my baby.

Same. And for me it was very up and down - okay one minute, the next in floods of tears. I was not prepared for that at all.

If more people knew the truth about risks of birth injuries and long term/permanent incontinence etc, i expect more women would elect for a Caesarean and the NHS doesn't want that.

This is it, in a nutshell.

Elaine I don’t know forceps are banned in some countries, I asked earlier what they do instead but no one answered. Some countries as we’ve discussed on this thread do a vaginal examination at EVERY SINGLE antenatal appointment for some unknown reason. Some countries don’t induce until 3 weeks overdue rather than 2. They all do it differently and who knows who has it right.

What’s very clear on this thread is that care needs standardising, it’s wrong that some women get less antenatal education than others, it’s wrong that some areas don’t do physio referrals for perineal trauma. It’s wrong that some women feel they are abandoned postnatally. I am lucky enough to work in a small hospital where we don’t have the same pressures as the busy ones and that means we have more time for patient care. Our maternity unit has recently had a patient survey where 90% of women reported being happy with the care they received during pregnancy, birth and postnatally. That shouldn’t be down to luck of where you live however, that should be an absolute given that you get the same standard of care as everyone else.

It's the aftercare that is so shit in this country. As well as the perinatal care. Antenatal care is a bit shit too.

Women MUST be told this stuff. I really think that one of the reason PND rates are so high is that women are genuinely shocked when they hit the reality of birth

^
This

So sad to hear so many stories of horrendous injuries and worse. These experiences need to be shared not to scare anyone but so others are more prepared for various situations and so that they can make better decisions for their own health and well-being.

@CatchingBabies I think it's high forceps that are banned, in which case they will perform a CS.