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?

Accidental post early!...I think so women are traumatised afterwards because, in part, due to the loss of control and the fact they had no input on decisions made about them.
I really think non-bias discussion of the risks of high forceps v EMCS should be a standard part of antenatal education since there is such a unique set of risks with both, and it's a fairly standard complication of birth.
But unfortunately there is that attitude of 'the doctor will decide what is best' and 'as long as the baby is okay you can't complain'

If the £87 figure is correct then this makes the following the the Daily Mail (sorry) horribly misleading:

^Lawrence Impey, a consultant in Obstetrics and Fetal Medicine at Oxford’s John Radcliffe Hospital, says: ‘Should women have the right to choose a Caesarean section birth? It’s the six-million-dollar question.

‘The problem is that Caesarean sections take resources and they take money. And the NHS is short of money. Putting it very bluntly — if you’re spending money on somebody’s Caesarean section, you’re spending less money on somebody else. And I think that’s one of the things that needs to be taken into account.^

No wonder people believe that c sections are an expensive luxury for an already over stretched NHS when they read things like this. Very misleading if the actual long terms costs are actually very similar!

By the way for anyone that's interested that extract is from an article in today's DM covering women opting for csecs after traumatic first births. Might be of interest to some of you if you can stand reading the DM (sorry can't link).

Great, a man using misleading facts to argue that women shouldn't have a say on what happens to their bodies.

I know things can be taken out of context but so often in these type of articles the quoted obstetricians seem to be against women having a say in decision-making.

Also when you look at things such as VBACs... a couple of decades ago so many women were told they HAD to have repeat c-sections and would not be supported in a vbac/told unbalanced info on VBAC dangers. As attitudes have shifted towards vbac you now have lots of hospitals who tell women they must have a VBAC and that an ELCS is not option and won't be offered. So often there is a 180 degree turn but the remaining theme is that women don't actually have a choice.

Also even if it is 6 million. Which I doubt, but let’s take it as read.

That’s 6 million for the whole of the UK I presume, for reducing maternal trauma in second deliveries. That is an absolute fucking bargain. A payout for a brain damaged child can be a couple of million. (and yes, I know the litigation funds are ring fenced.)

So often there is a 180 degree turn but the remaining theme is that women don't actually have a choice.

Yup. And that’s the crux of it. Women should have the choice. Of course there will be times when a woman wants a homeborth but it’s too risky and she will be counselled to have a hospital birth, or similar. But overall, if there’s no compelling medical reason, a woman should be able to aim for the birth she wants. She should be aware that the birth one aims for is not always the birth one gets, but that element of at least starting out where you want to be and being aware of various ‘what if’ pathways with a clear idea of what you want to happen if they occur, is vital.

Obviously it varies from area to area, but I asked one of the midwifes how much pushback I was likely to get on my request for a second ELCS (I was feeling really anxious about them turning it down) and her response was basically that whilst she thought it would be ok, they are "trying to encourage women to have VBAC instead of second ELCS because it's cheaper." So at least in my area, cost is being factored in to decision making at the caregiver level

I do wonder whether it's intentional that certain things are left out of antenatal education. As the midwife on this thread mentioned a few posts back most women who consent to high rotational forceps probably haven't been informed of the risks vs EMCS and are just happy to submit to whatever the dr is recommending in the moment. Surely this is exactly how they want it to be for ease and inconvenience? I do wonder if a lot of HCPs simply wouldn't want to work in an environment where the power dynamics between women and staff are more balanced and women are informed/educated and involved in the decision-making.

*convenience not inconvenience

So often there is a 180 degree turn but the remaining theme is that women don't actually have a choice.

I absolutely agree with this. I also think the push for more 'natural' demedicalised births reflects this too. Feminists campaigned for women to have more agency in labour and birth, and there was a movement away from twilight sleep etc. Except now women are now pressured to have 'natural' deliveries regardless of what they actually want.

Somehow, somehow, we have to move away from this idea that anyone apart from the woman herself has the right to decide what's in her best interests.

Sorry - on the app and holding didn't work. The first paragraph is a quite from @RubyEliza

Argh! Bolding.

And I agree @RubyEliza that I strongly suspect that hcps don't particularly want well-informed patients capable of fully engaging with decision making.

Treating postnatal incontinence is a public health priority enshrined in French law. I've found a report that says treating incontinence and its consequences in later life costs 2 to 2.5 % of the total health budget, 3.5 billion euros a year. There are huge savings to be made. It really is a matter of political will.

@Yarnswift

I do think that women are talking about issues like prolapse more and more

I’m fighting for a repeat cs at the moment and I think I have found data that shows this. It’s in Swedish, and it’s the latest from socialstyresten ‘Komplikationer efter
förlossning: Riskfaktorer för bristningar, samt direkta och långsiktiga komplikationer’

There’s a table on risk of anal sphincter injuries that shows that they are more common in women with higher education. Now after we’d had a chuckle about rarified arses, DH and I discussed that, because we are both scientists, and we know that when you get a result like that, it’s generally necausevthe higher the education level, the less crap women put up with, the more likely they are to complain etc.
And that means if you think about it that all the other rates are probably under reported.

Anyway, tucked right at the end in appendix three of that report is a table that shows thirty year outcomes. The highest incidence of complications is for women who have had BOTH vaginal and cs births.

Incidentally, when he was reading this and helping me translate, DHs main observation was that ‘why on earth isn’t there more data on this?’ To which the reply was ‘because it’s womens health love, no one gives a fuck.’

Hello!

Just happened to spot this thread on Active (and must admit I haven't read the entire thing yet) but wanted to highlight that filling this data gap is something we're campaigning for as part of our Better Postnatal Care campaign. There's a full update on where we are with that here - we'd love you all to support and follow along if this is something you're interested in. (If you want to be added to our email list for updates about the campaign - with an absolute No Spam Guarantee - drop us an email on [email protected]).

Our developing thoughts on this are that it could be tacked by something called PROMs (patient-recorded outcome measures - will be familiar to those of you who work in healthcare), which would involve women who've given birth being asked a standardised set of questions about their pelvic/anal/vaginal wellbeing at regular intervals when they see their GPs. This info could be anonymised and collected centrally (along with info about their birth modes) and could build up over the years into a useful data set that could help HCPs to give pregnant women better info about risk.

Would love feedback on the idea!

Thanks - off to read the whole thread

MNHQ

I think that would be great - it’s clear from the Swedish data that these things are underreported. I think there’s a definite attitude of that just how it is. actually asking the question of women will make them realise it isn't inevitable and that it is an issue. I’d be all for this.

Brilliant campaign MNHQ, really hope you get somewhere with it.

@Yarnswift

I think that would be great - it’s clear from the Swedish data that these things are underreported. I think there’s a definite attitude of that just how it is. actually asking the question of women will make them realise it isn't inevitable and that it is an issue. I’d be all for this.

Brilliant campaign MNHQ, really hope you get somewhere with it.

Thank you! Good luck with your efforts for the birth you want - Birthrights might be able to help if you haven't found them already

@tiddlyipom

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.

Ah thank you @tiddlyipom

I should say, the call for universal offer of postnatal physio is v much part of the campaign too - and lots and lots of other organisations and some MPs are very much on board with this one

If it helps Rowan the figures I quote come from here static.cnsf.asso.fr/wp-content/uploads/2018/05/R%C3%A9%C3%A9ducation-pelvi-p%C3%A9rin%C3%A9ale-2014.pdf If anyone at MNHQ reads French there's a brilliant questionnaire at the back. It bears repeating, ALL new mums in France get this automatically.

The report also states that 25 to 45 percent of women suffer urine incontinence and over 20 percent of women anal incontinence.

Can anyone tweet MD in Private Eye? I bet he'd be all over this.

I

@bowlofbabelfish I assume your trials are not emergency situations where though where if you take the time to throughly explain all the options and all the risks and benefits the baby has died by the time a decision is made? That’s the difference. You cannot consent in advance it has to be at the time.

@carlitamurray32 I said a caesarean isn’t that much more expensive than an instrumental delivery. We were discussing high forceps vs caesarean, bearing in mind high forceps are done in theatre. Someone said they believe high forceps are used because they are cheaper. I said there is not much cost difference between the two. It’s more expensive than a vaginal delivery yes.

@MrJohnReese

In my area all pregnant women and those up to 6 weeks postnatal can self refer to women's physio. I refuse to believe we are the only area where this is possible.

Oh! @MrJohnReese if you'd be up for emailing ([email protected]) or PMing me to tell me whereabouts you are that would be really useful

@FluctuatNecMergitur

If it helps Rowan the figures I quote come from here static.cnsf.asso.fr/wp-content/uploads/2018/05/R%C3%A9%C3%A9ducation-pelvi-p%C3%A9rin%C3%A9ale-2014.pdf If anyone at MNHQ reads French there's a brilliant questionnaire at the back. It bears repeating, ALL new mums in France get this automatically.

The report also states that 25 to 45 percent of women suffer urine incontinence and over 20 percent of women anal incontinence.

Can anyone tweet MD in Private Eye? I bet he'd be all over this.

I

I'm a hopeless monoglot I'm afraid but yes, all the organisations lobbying for universal postnatal physio talk about the French experience a LOT. I haven't got to your previous post yet (still reading from the beginning) - do the French stats show long-term outcomes? I know one organisation is trying to track down outcome studies for the French postnatal programme to use in persuading the NHS of the benefits

Durr sorry Fluctuat, it's right there in your post a couple of posts back - sorry. The women at Pelvic Floor Patrol will be very grateful!

@RowanMumsnet

[quote FluctuatNecMergitur] If it helps Rowan the figures I quote come from here static.cnsf.asso.fr/wp-content/uploads/2018/05/R%C3%A9%C3%A9ducation-pelvi-p%C3%A9rin%C3%A9ale-2014.pdf If anyone at MNHQ reads French there's a brilliant questionnaire at the back. It bears repeating, ALL new mums in France get this automatically.

The report also states that 25 to 45 percent of women suffer urine incontinence and over 20 percent of women anal incontinence.

Can anyone tweet MD in Private Eye? I bet he'd be all over this.

I

I'm a hopeless monoglot I'm afraid but yes, all the organisations lobbying for universal postnatal physio talk about the French experience a LOT. I haven't got to your previous post yet (still reading from the beginning) - do the French stats show long-term outcomes? I know one organisation is trying to track down outcome studies for the French postnatal programme to use in persuading the NHS of the benefits[/quote]

assume your trials are not emergency situations where though where if you take the time to throughly explain all the options and all the risks and benefits the baby has died by the time a decision is made? That’s the difference. You cannot consent in advance it has to be at the time.

Some do involve surgery (deep brain stimulation one for example)

But what I’m saying is That the time to provide the information that allows informed consent is BEFORE onset of labour. You cannot do it in the context of an emergency medical situation because as you say time is life or death. And in that situation the patient is in pain, vulnerable and pressured.

So what needs to be done is to explain before the birth : “in roughly x% of births, we hit this situation, in that case you’ve got two options normally - one is straight to emcs and one is where we use what is called high rotational forceps (quick run through of risks of each.) now its not common to have them but it does happen. If this happens we will ask you what you want. You can also make your wishes known now and we will ask you again if the situation arises. Do you understand? Do you have any questions?”

That’s how it should be. So the woman is aware (really how many women are truly aware of high rotational forceps pre birth - I wasn’t) and then IF she is in that emergency situation she has previously been given the info. She’s aware there’s another option. She can say on her birth plan ‘no forceps, straight to emcs if possible.’

How it should NOT be is no discussion of it before, then the patient asked or told ‘we have to do x or the baby will die.’ That’s not informed consent. And high forceps - I know a few women who’ve had them with no pain relief and all those women are physically damaged, traumatised, and had no idea there was another option.

Im kind of disturbed that this proper consent process is not in place already. What is the justification for women not being told this stuff?

Birth plans are touted as being for he trivial stuff and often mocked, but really they’re for important stuff like this.

Here you go Rowan, this is another useful link you can pass on: www.hal.inserm.fr/inserm-00370068/document

Happy to lend my language skills to the cause if it helps.