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?

www.nejm.org/doi/full/10.1056/NEJMoa021788

The risk of urinary incontinence is higher among women who have had cesarean sections than among nulliparous women and is even higher among women who have had vaginal deliveries. However, these findings should not be used to justify an increase in the use of cesarean sections.

Childbearing is an established risk factor for urinary incontinence among young and middle-aged women.1-4 It has been suggested that vaginal delivery is the main contributing factor, possibly because of damage to important muscle tissue or nerves. However, pregnancy itself may cause mechanical changes, hormonal changes, or both that can lead to urinary incontinence

It’s also not an equally loaded risk. The risk of accreta on a second c section is vastly less than the risk of a tear involving the anal sphincter for example.

If a woman wants several children, then the risks of multiple sections do become more relevant. If a woman wants one or two, they are very small.

This is what I mean by saying that women need to be counselled on their individual risk profile. My consultant spent a good ten minutes ofbthe appointment banging on about emergency hysterectomies when actually for me, with my individual risk profile, this is not one of the major risks.

Not a single benefit of section OR a single risk of VBAC was covered. NONE. I asked for their rate of instrumental delivery and 2-3-4 tear rate and was told ‘oh very very rare’ when I pressed for a number she said ‘one or two percent.’ I’m afraid I do not believe that any institution has a complication rate of VBAC that low. I requested to see the actual numbers and she got very annoyed.

I suffered terribly with tokophobia while pregnant with my twins and was having treatment for it, but I wanted an elcs. The consultants were so dismissive and patronising and kept reiterating the risk of c section, so I went away and did my research. Found out that for DCDA twins, c sections provided better outcomes for all than vaginal delivery. They weren’t happy with me for looking this up and presenting it to them, but they had no comeback and booked the section (although I ended up needing an emcs sooner anyway).

The first couple of days were tough, then a reasonably unpleasant week, then I was fine. I have friends who are still suffering 5-10+ years down the line from birth injuries.

I do agree that the French system of physio would make a big difference (although the only reason their system works that way is to protect men’s sex lives, to be honest).

@Yarnswift - I'm really interested and impressed by your knowledge of the risks of repeat cs v vbac. As someone who will probably have to make similar arguments in the not too distant future, I'd be so grateful if you could point me in the direction of some of your sources. I feel a bit overwhelmed by the research to be honest!

@EvilEdna1
You should do an 'ask me anything' thread! It'd be so interesting!

www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/

This is the main guideline. It provides a very balanced examination of risk and also assesses the strength of each piece of evidence

Good luck - I hope you get the birth that is best for you.

I tore my urethra during birth. It was really painful but my stitches are starting to heal now. I didn't know that could happen before birth and it is quite hard to find information about it now so not sure what the long term consequences will be.
I had a very fast natural birth and was told I wasn't in labour until my baby head crowned.
I wasn't expecting to have an easy birth but it would be good to have more information about the risks and how to recover. I have just been told to do pelvic floors and I can't do them properly.

I had absolutely mangled nether regions after DD1's birth - massive massive tearing, and also permanent damage from my legs and pelvis being mishandled under a spinal block (I'd had severe PGP all pregnancy). I still struggle to walk any distance 6 1/2 years down the line and can't sleep well for the discomfort. Add in massive massive PTSD from how terribly I was treated from the birth and I was an absolute mess when I got pregnant with DD2 afterwards.

Community midwife (who had been livid at the way I'd been treated and mess I was left in) did a referral for me to see the specialist birth trauma midwife at the hospital. Her first words to me were a snarled "if you've come asking for a c-section you ain't getting one". Basically our NHS trust appears to devote a salaried post to snarling at pregnant women, telling them they're silly and to go away.

I'm currently in a quandary. I feel they don't give you genuine advice. I do have an obstetrician. But I believe they just treat you as a statistic. I've had vaginal deliveries. The first 3 were straightforward between 6hrs (longest) and 40 mins (third) and recovery was good, no tears. One push with each. So yes I can see why straightforward vaginal delivery is advised as best for recovery. Although the third left me with anterior prolapse. My last 2 births however were traumatic for different reasons. They were very fast, and whilst that sounds perfect, I mean no pushing, very fast labour and baby literally exploding out. This actually causes me physically so many problems and took months to recover from. Bowels and urinary were completely messed up, very painful and distressing. So I'm unexpectedly heavily pregnant and wanted advice on delivery. Actual advice. Obviously the very fast births impacted on my prolapse, and whilst they say it won't make any difference, pregnancy does the damage etc, this is rubbish. From my personal experience, the delivery does of course effect an existing prolapse but there's no prediction to what degree. My concern is, currently not pregnant, my prolapse is manageable. It's front wall not back wall and my womb remains high. It could be surgically repaired but did to my age and children this would be very difficult and likely need repeating. A close relative has had the repair twice and it's not been successful due to scar tissue and complications so it's not a surgery I want to rush into.
So I want straightforward advice from someone about my risks of another vaginal delivery versus c-section, can I get it??? I just get text book answers which are essentially just have a vaginal birth and deal with the mess after.
It annoys me as I'm genuinely really stressed and worried and can't face the recovery of a similar vaginal birth with my demanding family and not able to leave the house for 3-5 months confidently due to waiting/hoping for recovery in that area.
It's so hard to get someone to listen to you and treat you like s person.

So many of us go into pregnancy now thinking that childbirth will be this beautiful, birth pool experience and that we will feel empowered and safe, etc. I blame the whole ‘write your birth plan here’ section in the hospital notes and the preoccupation with hypno birthing and competition for the most ‘earthy’ and goddess type labour. Some people do have this, of course, and great for them.
We seem to have forgotten that it used to be such common place for women to die in childbirth-it IS dangerous, it’s just that we have the medical capabilities to deal with it, most of the time. It’s bloody, painful, risky and gory and we seem to have forgotten than this is the norm.

Just incase anyone is reading this who is pregnant with their first and now terrified, I actually don’t know anyone who have had serious problems after childbirth and only one who has mild bladder incontinence.
I had a c section and a very successful vbac. The risks were there, and I was very aware of them, but my beautiful kids make the chance worth taking

boredandtired
Wow, I’ve never heard of anyone delivering a baby in one push, let alone no pushes!

Perhaps that’s why people are unable to advise? In your position, I’d probably be pushing for a c section. Good luck

Rainbow that’s awful.
Did you get your cs in the end.
You should have complained about that midwife.

This case makes interesting reading, but depressingly I don't think anything has changed:

"The Montgomery v Lanarkshire case of March 2015 drew fresh attention to informed consent. Nadine Montgomery, a woman with diabetes and of small stature, delivered her son vaginally; he experienced complications owing to shoulder dystocia, resulting in hypoxic insult with consequent cerebral palsy. Her obstetrician had not disclosed the increased risk of this complication in vaginal delivery, despite Montgomery asking if the baby’s size was a potential problem. Montgomery sued for negligence, arguing that, if she had known of the increased risk, she would have requested a caesarean section. The Supreme Court of the UK announced judgment in her favour in March 2015. The ruling overturned a previous decision by the House of Lords,2 which had been law since at least the mid 1980s.3 It established that, rather than being a matter for clinical judgment to be assessed by professional medical opinion, a patient should be told whatever they want to know, not what the doctor thinks they should be told."

Going for a pee after giving birth was a shock screamed the place down jug of water helped. Shouldn't have pushed soo hard don't push unless your told to!

@ansumpasty thank you! I didn't realise it was unusual. My second stage for each has been under 2 minutes so I considered myself 'lucky' but the last 2 were literally expulsions more than anything else which is actually fairly terrifying! This is a contraceptive baby so not a risk I anticipated again and if I did have a c section I could have a sterilisation which would be a relief but obviously this alone is not a good enough reason to have surgery. I just wish I could feel properly informed.

Rainbow that’s awful. Did you get your cs in the end.

(Sorry - felt like namechange time) Ironically I didn't want a CS... I wanted assurance that my care wouldn't be transferred back to the shithole hospital I'd had DD1 at if they were busy at the unit I'd booked into for DD2's birth!

@Dreamingofkfc I’m obviously generalising and a clinical judgement would need to be made. But still know of lots of labour stories where women were left labouring in huge amounts of pain for well over 12 hours. Often needing instrumental delivery - so left exhausted, torn genitals and with their newborn. Just grim

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 went into labour naturally with DS1 and pushed for 5 hours which ended in fetal distress, episiotomy, broken down stitches and took months to heal.
I was induced with DS2 due to OC. My waters broke at 6.30pm and he arrived at 7.17pm. A quick albeit painful, easy labour, first degree tear and felt normal again within 2 weeks.

I'd choose to be induced again!

Sorry but this is misinformation. It's perfectly possible to have prolapses with a c-section; they are often a result of the pregnancy itself rather than delivery specifically.

Also, although having a c-section slightly reduces the risk of incontinence, it is still there.

C-sections increase the risk of other complications in the mother (and potential for breathing difficulties for baby).

I certainly think that more information ought to be given to women on the risks of forceps delivery to the mother, though.

Vaginal childbirth without intervention is pretty wonderful, though, and I would definitely say it was preferable to a c-section in terms of the experience, risks, and recovery time afterwards.

@Msmotherofdragons I would disagree with this. My prolapse was from the birth of my third child. Subsequent pregnancies have not made it any worse but deliveries had, unless you have experienced it (which many professionals have not) I don't know where they get this from. I've not had a single person I know diagnosed with prolapse during pregnancy and to my knowledge unless you see a physio during pregnancy, I'm not sure who's checking (I've never had an obstetrician check for prolapse during pregnancy) so every single person I know with varying degrees of prolapse has had it caused by child birth or lifting.
They tell you this as there is no clear evidence before delivery of your risk of it happening so the advice is to have vaginal delivery.

And I'm not 'pro c section' btw. I've had very positive vaginal births as well. But the misinformation dished out about prolapses is really unfair.
There is far less risk of prolapse with c section.

@Boredandtired, totally agree with you that obviously women who have vaginal deliveries do develop prolapses.

But it also happens to women who have c-sections, as does incontinence, so it is misleading to suggest that vaginal childbirth is the only risk factor here.

It's not my personal experience but I do have a couple of close friends who have been diagnosed with prolapse following c-sections, so I know it's possible -- it's mentioned in research papers too.

I'm not saying there's no risk of course, and there are considerable other risks with surgery I am only discussing prolapse in this respect, and I probably do know a disproportionate amount of people with prolapse due to having one for years now and various physio/clinics at hospital etc, I will have come across many women with them.
It just a personal issue for me, because I know I could live long term as I am now, without repair surgery but if a further vaginas delivery causes more damage like the last birth, I may then have to have surgery to have reasonable quality of life.
But I am very anxious of elective c section and potential risks.
Obviously if I'd stuck at 2 kids, I'd have no experience of prolapse related to childbirth and if I'd stuck at 3 it would not have been life impacting, so again I guess my personal experience affects my viewpoint and knowledge.

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