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?

I don’t know that they’re bigger on average? My DH was 10lb, so was his brother and father (who is 77) my gran was a twin and they were both close to 10lbs (born in 1930)

That said, there is a book called the gentle birth method which follows a number of regimes, in part, to ensure your baby isn’t big (it doesn’t try and keep it small- just avoid big) it’s written by an obstetrician and whilst it’s fairly woo, I remember telling friends about it and they were aghast that anyone would be stupid enough to follow it. We all continued with our NHS lassiz faire attitude (although I have to say no big babies, although none of us are overweight)

In my post birth review the consultant said it’s likely I have an issue with my pelvis- too narrow or similar- as there is such a prevelant family history of difficulties. Obviously that makes problems more likely and I’m ensure risks only increase with bigger babies

Owlinatree- my reservation with an ELCS is that I had a complication caused by the operation (PPH) which caused me lots of issues. So both sides seem to come with injuries

I did lots of reading and decided the best thing for me to do to avoid injuries was not to have an epidural and to stay active during the birth. And do yoga before birth, that helped a lot

My friend did all that, she was so convinced she would have an easy birth S she was fit, active, big time into her yoga of various different kinds and mind of matter hypnotism stuff.

Ended up nearly loosing the baby and then she had feelings afterwards “but I did everything right, why did this happen to me, why did my body fail?” And plunged into PND.

She’d probably have felt a lot better if she hadn’t been peddled the myth that you can have a magical birth experience with the right preparation.

Can anyone point me in the direction of finding the costs for each type of birth and risks?
I have an appt with a consultant next week to request a csection and trying to get prepared with all the information I can get!
Thanks!

Yoga and moving around isn’t very useful if your baby has got itself into a poor position, or has the cord wrapped round it’s neck

The absolute best thing we could do for women is to remind them that they only control 50% (as an absolute maximum) of their birth experience, and they have no idea what the baby, controlling the other 50%, is up to.

Many women find their baby controls the birth 90, 95%, and their input is really very little.
People have to bear that in mind when putting their trust in reading/ yoga/ birth classes. Things can help (active during labour, staying fit, yoga, hypnobirthing) but they will NOT dictate your birth experience.

I hate rubbish like Babdoc's post.

Oh yes in some mythical past women were slim and healthy and didn't piss about having careers before babies.

When was this, exactly? Are you aware how many people suffered disease and malnourishment before the mid-C20th, not ideal for birthing babies? Are you really suggesting that across the sweep of human history, women today are uniquely unhealthy?

And even if that were true, who cares? Practise medicine to address the needs of the patients you have, not the ones you want.

Any woman should be able to choose a csec if she wants one for any reason. It's awful the way women are treated like idiots because they're pregnant. I was under the care of a consultant for a twin pregnancy. Id done my research and was sure i wanted an ELCS as twin 2 was breech. I set out my reasons and discussed it with the consultant. I said very clearly i didn't want to try a vaginal birth due to the risk of instruments and injury.

Regardless of this, she wrote on my notes "vaginal birth if twin 1 is head down". Ended up in a traumatic birth in which i very nearly lost them both. If id pushed for elcs it wouldn't have happened.

I was also told by other women that csec would be taking the easy option and that's not "doing it properly".

Not RTFT.

A friend has a 5cm diastasis recti, that puts her a constant risk of bowel herniation, and worst case scenario, the intestines could get strangulated and if not immediately treated this could be fatal. She is currently looking into her surgical options, both NHS and private.

This is a direct result of having pregnancies in quick succession.

At no point when the midwife and health visitor have been 'pushing' contraceptive advice has anyone ever explained to me the risks associated by having pregnancies in quick succession.

Its not as simple as saying C sections as a default way to deliver / completely on demand are the answer. I know 3 women personally who have had immense complications from pregnancy after a c section, where the placenta adhered to the scar tissue. One woman had a vertical c section where they found her placental tissue was only buried too deeply within her womb lining and her uterus was saved. This is placenta accreta. The other two had placenta percreta, where the placenta grows through the uterus on to nearby organs. The risk of this directly increases with repeated c sections (one woman was on her 3rd child, one on her 5th). Both had c sections with full trauma team on standby. My friend on her 5th child had an emergency hysterectomy, but bled out, received 21 units of blood, had 4 heart attacks but survived, with ongoing health issues from the placental tissue in her intestines and bladder. My friend's friend, having her 3rd child, did not survive.

The increased risk of accreta, increta and percreta in successive c sections is poorly publicised, but if you are proposing having several children just assuming that c section is safer than vaginal delivery is naive.

I have had two babies in two years... I had an episiotomy with ds1 and gave birth lying flat on my back feeling sick from the diamorphine. Stitches were sore but soon healed.

Ds2 I had in the pool, a much quicker and easier Labour and my body just took over. I had him sitting up in the pool, and whilst i did tear I healed without any pain

I have had no problem with incontinence and aside from a bit of scar tissue all is fine "down there".

I think the increase in birth injuries may also be linked to an increase in inductions/sweeps instead of allowing bodies to go into Labour naturally.

Ds1 I had a sweep the day after my due date so whilst Labour started shortly afterwards it was very long and I was exhausted by the time it came to pushing, hence the episiotomy.

Ds2 I went into labour naturally he night before my due date and he was in my arms within 2 hours of getting in the birthing pool.

I think also people discuss things more now and recognise that they shouldnt have to suffer as a by-product of giving birth.

The risks should be discussed. I've had friends who have had inductions because "baby was measuring big" at 37 weeks and then had tiny 6 pound babies by emcs after days of failed induction because the baby was simply not ready to be born.

Obviously I'm not saying inductions are unnecessary but I'm sure they contribute. All my friends who have been induced tell me how horrific it was!

I'm afraid I haven't rtft yet but I agree. I don't know how I went into it so blinkered. I researched a fair amount, did my perineal massage, planned to stay active and upright during labour etc. My perineum didn't tear but my labia did. I didn't even know this was physically possible! And I have a minor prolapse which is something I'd never really heard of before. I'm in no way traumatised by my minor injuries but I've felt stupid ever since for not knowing they were a possibility.

I did lots of reading and decided the best thing for me to do to avoid injuries was not to have an epidural and to stay active during the birth. And do yoga before birth, that helped a lo

Luck and genetics helped a lot you mean

it’s just these days there are a subset of women chasing some magical experience

I think this is a problem. The PP who talked about yoga and staying active is an example of this. I read up on hypnobirthing and intended to give birth in the pool with soft lighting and music playing. As it happened LO was back to back, (which I was unaware of as she was early), I laboured for 30 hours, got all the way to pushing and was then given an EMCS as baby's head was at an awkward angle. This was neither my fault nor the baby's, but there are still some who believe if I'd only done pregnancy yoga I'd have been fine.

americanpregnancy.org/pregnancy-complications/placenta-accreta/

Well I also had a back to back baby second time round and I am sure that yoga and moving did help, although I did end up delivering on my back in the end. Kneeling wasn’t doing anything sadly. Sorry but I think there’s a lot of negativity on this thread, of course you can’t guarantee anything but the only thing you CAN do to help is prepare. It’s different if you have serious health conditions of course.

I don’t really understand how yoga helped if the baby was back to back? It got itself into a poor position and the yoga was supposedly to prevent that, surely?

@oldbirdy

Nobody said c secs aren't without risk. Were those women adequately informed about the risk of multiple c secs in a short space of time? I suspect not. If they were, then presumably its a risk they were willing to take. If a woman is adequately informed why shouldnt she be able to choose a csec? The alternative is a woman being forced into a medical procedure she doesn't want.

From my experience it was impossible to get the consultant to talk about risk and benefit of c sec vs vaginal. All I've been told about any future pregnancies is that a vbac should be possible. That's it.

They didn't even take her home from the hospital.

Off topic I know, but do you mean that the hospital didn't arrange transport home for your mum? I'm not UK based so not sure if thats normal

Haven't seen if anyone has mentioned it but I think part of the problem first time round is not knowing what to ask because it is so far from anything you have experienced before and I found having heard other people's experiences really didn't make up for that.

I didn't ask questions about the birth until very later - and even then they were very specific to one unusual concern in had - so they couldnt get me into see the birth choices midwife in time (when she got in touch in was already in the labour ward!). The birth wasn't dreadful but it did require interventions and I do have some questions I will be asking if we have another DC. Because now I know what to ask when before I really didn't (despite having done lots of reading).

I did pre natal yoga from 12 weeks until right up until I gave birth basically. Sat on a birthing ball every night etc.
I'll say it again, a straight forward birth or being able to birth a b2b baby without intervention is due to luck and genetics.

I think other countries have restricted the use of forceps due to injuries and think the UK is lagging behind.

I think there needs to be some general education at school level that leaving having kids v late and being obese can increase the risks of injury

Then there needs to be more focus on it at ante natal classes. Agree there is a fine line between scaring people and being realistic. At my NCT class we got told to do perenium massage to prevent a tear. The reality is it does reduce the chance of tearing but most women will still tear anyway and that's an important point to ignore.

There should definitely be much more help for women post birth - physio etc

ithinkididmagic I had to argue for an elcs for 2nd birth (after being advised by the obs in my debrief after 1st birth). It wasn’t exactly difficult, more tiresome. I think you have a right to a elcs (many years since I researched it though, I could be wrong or guidelines changed). I basically had to just keep repeating over and over, to every person I met telling me how a Vbac is possible, that I wanted an elcs.

ready
I don't think they were informed, no.

However the short space of time isn't relevant as far as I know. The 5 c secs were over 12 or 13 years, and the severe accreta lady it was her second c section 3 years after her first child was born.

The point is, choosing a c section to avoid possible vaginal complications is not a clearly less risky proposition, unless you intend to have, and do have, just 1 child. I fully support people's right to choose a c section, but they should not do so without being informed that if they intend to have several children, they are potentially placing them self at risk of placental complications that can be life threatening. If they are fully informed and make that choice, then that is very different from not knowing and assuming they are making a safe choice to avoid prolapses, incontinence etc whilst unknowingly placing themselves at risk of such severe complications.

I absolutely agree! My airy fairy NCT teacher glossed over episiotomies and assisted deliveries in about 20 seconds... Turns out 7 out of 8 of us had tricky births, including 4 emergency sections, lots of tears, infections and 2 babies requiring a stay in NICU.

I had a terrible birth resulting in PTSD. I was riddled with infections, physical intimacy with my husband in now nonexistent (and our son is 6!), there are problems with incontinence, my pelvic floor muscles are shot to pieces... I feel utterly broken by childbirth. My son is my world but the experience was hideous. I felt out of control and terrified.

oldbirdy

Multiple sections increases the risk of accreta etc. But for a woman giving birth for the second and last time, who is 40 and has stated categorically that this is her last, to be told that she has a hugely increased risk of accreta is incorrect.

And yet this is the kind of data my consultant was using. Women need all the facts - I’m only being told half of them and I’m pretty pissed off at that

@coffee3 Try the NICE guidance as a start. The RCOG website has some useful information on risks, some of which are specific to age. This website links to the cost information but isn't without bias: cesareandebate.blogspot.com/2013/06/new-nice-quality-standard-reinforces.html?m=1