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?

@EvilEdna1 what are your thoughts on high forceps vs c-section? They still use them at my local trust and the Ante-natal teacher I had was very against them.

In my honest opinion, it should be taught alongside sex education in general in schools.
Instead of focusing it just on pregnancy and STD prevention, they should teach you what pregnancy and childbirth actually does to the body.
I left school thinking that pregnancy is uncomfortable, but that the "worst" that happened was during you might be sick in the first few months, you pee a lot, you'll ache, and struggle to get comfy. As for the actual birth part obviously it will hurt, and you would end up with a bit of a tummy you might struggle to get rid of, some stretch marks, and your boobs could sag, and your vagina might not be as "tight".

I had NO idea about hyperemesis, gestational diabetes, sciatica, pre eclampsia, placental abruption and other placental issues like where it attaches over the cervix not to the womb and can cause severe life threatening issues. Also didn't know about tearing, possible prolapses, or the fact that almost 50% of women suffer some degree of urine incontinence as an immediate after effect of birth, with some of those suffering for the rest of their lives, and even those that don't are at much higher risk of developing it in future.There's also the risks of fecal incontinence, separated stomach muscles, and probably plenty more than i have forgotten to mention or don't even know about.
These are issues that need to be common knowledge not just for women, but also men. How many women had no idea they may suffer from these post birth issues, and are embarrassed and ashamed and feel they have to hide it from their partners if they are one of the ones who suffer these issues.

Some women (myself included, thankfully i found out about the real after effects of birth before i even got pregnant) may actually factor these potential post birth issues into their decision on having children and decide not to have a child.
Men need to know the realities of how their partners body may change and things like incontinence, since it's taboo and im sure some men are immature and would be horrified/disgusted and thats just not fair.

Also the more talked about it is, the more likely women will see their doctors and not suffer in silence. I have a major phobia of ever becoming incontinent and have spoken to so many doctors, and the sad fact is it takes on average 5 years for a woman to seek help with incontinence, usually because the frequency or severity is increasing.

with my 1st i had stiches, the 2nd was 11 days late got stuck. I had a c/section and a dislocated coccyx oh boy did that fucking hurt for nearly a yr

The only guidance I got was from my yoga teacher

Yes, same here - she really saved me in the end as I was in a lot of pain but had been dismissed by midwife/GP.

Agree, there is a whole lot of things they don't tell us about! But the prolapse/incontinence issue continues to be wrongly assumed as a vaginal birth issue...yes, a very difficult labour can add to this but in general, a good obstetrician will tell you most of the pelvic floor damage comes from the 9 months of lugging the bub around and also that most damage occurs with second and subsequent babies - we tend to "bounce back" from number 1. So I hate the idea of women opting for a c section to avoid these issues...opt to avoid a second baby instead!

I would have rather not known the risks if im honest. Once your pregnant it’s got to come out so what’s the point in going over hundreds of what ifs for 9 months

My only hope was that neither of us died, I had no expectations other than that. Childbirth and pregnancy is a choice after all.

I would have preferred more information. My NHS antenatal classes was one two hour session, with over an hour of it about breastfeeding. The only condition discussed was placenta previa. It was also held at the midwife led unit with birthing pool and twinkly fairy lights. Unfortunately I ended up with a back to back baby, placental abruption and an EMCS at a different hospital and my son couldn't breastfeed. I wasn't prepared for any of this, the friends I have with babies understandably didn't share their negative experiences until I had a baby, and I think I would have coped better had I known how frequently complications, birth injuries, EMCS, breastfeeding issues etc happen. It led to a complete feeling of failure as I went from being pragmatic to believing the 'it'll be wonderful, you're in control' hype during the pregnancy.

My only hope was that neither of us died, I had no expectations other than that. Childbirth and pregnancy is a choice after all.

Some people might choose not to have a baby if they're fully aware of the risks or they may choose c-section.

@Ponderland
I have heard that their use is becoming more common after a period where they became very unpopular with obstetricians because of the known risks. I can only speculate that it's an attempt to perform less caesareans which strikes me as ironic given the current NHS obsession with induction which in my experience is is a big factor in increased chance of emergency caesarean.

Personally I would chose an emergency c-section if the baby was still high in the birth canal.

When I was pregnant I feel like everyone told me all about the risks Everyone likes to tell you their bad birth stories when you're pregnant. As a result I was completely terrified and even though DD's birth was probably what people would describe as a "traumatic" birth I was relieved afterwards as it wasn't actually as bad as I was expecting!

Also I feel that Mumsnet is very pro caesarean section. On threads like this a majority of posters seem to imply or openly state that ELCS is the better option.

So I wouldn't really agree that people don't know about the risks of a vaginal birth. In my circles the "natural birth" stuff they apparently push in NCT classes (I didn't do NCT so I don't know if that's accurate or not) is only talked about with a wry smile and a bit of an eye roll.

blueyacht me too!

Older mum - life changing injuries which nobody called injuries. Until one day I saw a consultant who referred to them as injuries. He said obstetrics people do whatever they need to do and leave colo-rectal people like him to deal with the injuries. I could have hugged him.
While I was still in hospital after the birth the doctor had to speak to a stab wound specialist in A&E to "understand better what she'd done". Oh yeah and I wasn't a very good mother because I was struggling to bf through all this.

elcs actually can be safer.

It depends on your risk profile. An overweight 40 year old who has had one c section already has about a 40% chance of a ‘successful’ VBAC. But 39% of those ‘successful’ births will require instrumental delivery and almost all of those cause damage. So your chances of an uncomplicated vaginal birth are fairly low. If you’ve already had a vaginal birth and have no other complications then your chances of a successful vbac are about 80% - big difference.

There actually isn’t much in it for a regular vbac. There’s a higher chance of future complications with increasing numbers of c sections (placental accretion etc) but a lower rate of still birth and perinatal death/hypoxia for the baby. Effectively the c section shifts the risks into the mother but it’s safer for the baby. RCOG green top guideline 45 goes through the risks of each type of delivery in detail and includes a factor to rate the strength of each bit of data (ie how solid that data is.)

Women are being failed horribly by the system - they’re told misleading and biased facts, they’re not fully informed of the risks of vb. I’m currently fighting for a second c section and I’m furious at the biased data I’ve been given. I use stats a lot in my work (I’m a scientist) and the waycthe consultant framed the risks I found shocking. Which I told her ...

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.

C-section's should not be a matter of routine choice, the female body is designed to give birth vaginally for good reason. Not to mention if everyone started demanding sections the NHS could not cope.

Better education on birth injuries by all means but I don't actually think that would put many people off. Also agree with PP who said that prolapse and incontinence are not caused so much by birth necessarily but the 9 months carrying and many other factors. There are women with 4/5/6 children with no issues and women with no children have repairs and bladder tapes in their 40s and 50s. These problems are not necessarily even caused by pregnancy/birth

Obviously there are women who need sections for their own health or that of the baby, just saying they're not the 'easy' choice and shouldn't be given without good reason

I completely agree. I had a terribly traumatic birth with my DD (my first) and the obstetrician who delivered her came to see me the next day and said 'next baby, have an ELCS!'. Following a three day induction I had three different sets of forceps (2 rotational 1 the other type), an episiotomy, severe shoulder dystocia, second degree years, a retained placenta and a PPH so bad I needed a transfusion. I had a birth debrief afterwards and was sent a report, in which it states that vaginal births are not considered safe for me in future pregnancies. I've been left with forceps damage, apparently what they'd expect to see from around four births, not one.

I was never told any risks pre-birth. I did NCT who made out I'd be able to breathe my baby out in a lovely pool as long as I stayed calm enough. I wasn't so naive that I thought that was true but I certainly wasn't expecting what I got.

I'm now having my second baby. I've got a copy of my birth report in my notes, since booking in I've had it noted that I'm having an ELCS and I saw a consultant at 12 weeks who has signed off on it, just couldn't book it as it was too early. But, before they actually book it and give me a date I was told I've still got to go and see a consultant midwife at the 'Method of Birth' clinic to talk through the risks of an ELCS. Even though it's done and dusted, even thought I've done my own research, and even though two consultants now have agreed - and one in writing - that it's the safest way for me and the baby.

It's bloody ridiculous. I told the community midwife I'm not going, and contacted the obstetrician who delivered my daughter directly. She's booked me in to see her at 28 weeks, and sent me a lovely email saying not to worry about it, she remembers my birth (it must have been bad she's got 25 years experience!) and that she'll book me a date when she sees me.

ust saying they're not the 'easy' choice and shouldn't be given without good reason

I disagree. If a woman is fully informed on the risks and benefits why shouldn’t she have control over what happens to her body?

Cost is not the answer - NICE is currently looking at the lifetime costing of birth methods. If ALL those women requesting had easy VBs after then the cost would be lower. But depending on their risk profile up to 60% of them need a c section anyway and an emergency one costs more. Then factor in the cost of therapy, surgical repair of tears, surgical repair of prolapses, lost work time and lifetime effects and the cost benefit disappears (and may even go the other way.)
Right now, those costs are not monitored because they’re kicked down he road to general surgery budgets.

All women, of fully informed, should be able to have a c section on request.

Back in 2016 the RCOG were wanting to see all women warned of the risks of VB in the same way they are of CS risks: www.google.co.uk/amp/s/www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/amp/

In part this is a duty of care issue as so many women go in ignorant of the risks/they are brushed off with platitudes about millions of women doing it before or that's what your body is designed for.

In terms of cost, NICE have calculated that a CS costs just £87 more than a VB delivery, which doesn't support the 'it's too expensive' argument at all.

In no other area of medicine can women expect to be ignored, patronised and not given full risk disclosure in the way they are about birth choices. This needs to change.

the female body is designed to give birth vaginally for good reason

We are not designed to do anything. That is not how evolution works.

If we are going down the natural fallacy route though, here are some other perfectly natural things:

Asbestos
Arsenic
Cyanide
Dysentery
Dying of cancer.

All natural.

C-section's should not be a matter of routine choice, the female body is designed to give birth vaginally for good reason.

They absolutely should be an option given to every woman. According to the paperwork provided to me by my Trust they reduce the risk of stillbirth by half. That should be a choice all women are allowed.

I'm so pleased you've posted this op!!

Currently shitting myself facing the decision of another vaginal delivery after having a 3b tear and a PPH with my first baby, vs the option of ELCS.

I saw a midwife at the listening clinic the other day to go through my previous birth, didn't even have my notes and it was 30 minutes of a sales pitch on fancy episiotomy scissors so they can divert the cut away from my scar tissue and didn't mention anything about sections. Told me that I can have surgery to correct damage afterwards, but brushed past it when I mentioned nerve damage causing fecal incontinence.

I haven't slept since and feel like I'm facing such a huge decision on my own! No endo-rectal scan offered, no one has ever checked me down there to see how I've healed. Sex has been painful since giving birth and I have urgency issues with bowel movements.

I'm terrified

Forgot to add, she also ignored the fact that my DH is 6ft6 with huge shoulders. Dc1 is also huge and she's convinced that this baby will be smaller like me, because I've got size 5 feet

Unfortunately antenatal education is very lacking which does have an impact. As a midwife, I see more and more people suffering from traumatic births, induction rates are incredibly high and in most cases are unnecessary.

C-section's should not be a matter of routine choice, the female body is designed to give birth vaginally for good reaso

Of course we should be given a choice once women have been given proper information on the risks and statistics of different birth methods.
We weren't 'designed' to give birth vaginally, we have evolved to. Evolution isn't perfect and doesn't care about birth injuries or a few women / babies dying.
In fact if we were to let natural selection work then women whose bodies aren't perfect for giving birth would die in child birth like they used to 🤷🏼‍♀️

A friend was pregnant with her first baby and was been told that the baby was on the large side. She was very slim, fit and healthy so no issues with obesity or gestational diabetes. Her obstetrician only gave her negatives about a CS and she went into a vaginal delivery with a birth plan, a birthing ball and a tens machine. Needless to say the birth didn’t follow the plan and there were huge complications which have had long term consequences for her including PND.