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 also think it's more talked about. Women of my mother's generation wouldn't DREAM of talking about a prolapse or incontinence.

Thanks @Bowlofbabelfish - that link is fantastically useful!

Pressure and weakness related prolapsed can occur after c section. However actual rupture of the pelvic floor - where the levator Ani for example is ripped off the bone are not. Neither are tears, sphincter damage etc.

The muscle detachment from bone is not repaparable

I am astonished that mums to be aren't out there googling about their pregnancy/birth.
I googled complications so knew a good deal about them so took the tear as one of those things.Did pelvic floor exercises from my first per onward,had urgency but that decreased.
I was unprepared for lack of orgasm afterwards(someone mentioned this up thread),and there seems to be little info out there.
These threads seem to discount those of us who had OK vbs,an my complications are acceptable to me perhaps because I felt they came with the territory,but would be unacceptable and distressing to someone else.
Most posts are about traumatic births and a lot because as well since they say with the mum for years(the myth about soon forgetting when the child is here).I do feel that more debriefings are needed and and that all women should have info on this post birth regardless of how the medical side see the birth.
We also need more posts about how c sections go,not emergency ones.Not all mothers find them easy and not everyone realises that there are complications(and obviously not everyone reads that section on the consent form),and that it is major surgery and you may need more help post op at home,that you can't drive for at least 6weeks which can make life difficult and isolating for many.
Giving birth is not risk free whichever way you do it,many women in the past had the same complications but it wasn't talked about and was 'expected'.

We are TTC but I am suddenly terrified of delivering a baby vaginally. I never thought I would be, but I went in for my smear test and the nurse couldn't even do that because I was in so much pain. Obviously childbirth is different, but I don't think this bodes too well for me.

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

Not everybody believes what they read on the internet. And reading/believing what you read on the internet isn't always helpful as it can be made up statistics/risk factors, written by unqualified people, etc. It's surely down to the hcps to make women aware, it shouldn't be down to women to google and probably frighten the life out of themselves in the process. If someone asks on the internet 'how did your vaginal birth go' you're bound to get more people who've had bad experiences so it isn't easy to weigh up the birthing options accurately and really understand the risks associated.

Not every pregnant woman has access to the internet, and some women may be too anxious about it to even look so they go into it with their eyes closed and come out feeling violated and traumatised.

Accurate information should be done by a HCP using research done by the NHS so there is no chance of someone getting confused or scared unnecessarily or going for a birthing option which will cause more harm. If the statistics aren't good then so bloody what, women still need to know them! Maybe by telling women the truth and allowing them the freedom to choose their method of birth then the statistics will get better as more and more women decide what they can/and can't deal with.

@Onlyoldontheoutside women are discouraged from doing research imo, how many women don't bother with a birth plan because 'it goes out the window'- birth plans are openly mocked when really they are about knowing your options and rights in order to have more control over your experience.

I think women are kept in the dark too much and not provided with clear, unbiased informatoon. I do feel there is this narrative that c-section= Risky and dangerous with terrible, horrific recovery/vaginal birth= Safe, easy, no recovery, straight back to normal. Which obviously isn't the case a lot of the time.

They should absolutely let women know about the risks and the choices women could make to mitigate them (even if c-section). However, in my experience pregnant women are treated really poorly by NHS. My friend had horrible experience first time around, asked for a c section for a second baby, it was denied and a child was deprived of oxygen during birth...

Kescilly
Don’t worry, it’s nothing like that and the pain is incomparable. Smears hurt me too, feel like broken glass scratching me.
You (or at least I) don’t feel the pain in your vagina during childbirth as it’s overshadowed by the abdominal pain. You wouldn’t feel a splinter in your little toe at the same time as stubbing your big one ;)

Afterwards, the adrenaline and holding your baby help to make any stictches etc bearable. Good luck!

It’s not the birth specifically that’s the problem. It’s the excessive ongoing weight of a pregnancy. Perhaps women should reconsider pregnancy

The statistic upthread for an overweight 40 year old having a 40% chance of a VBAC and a 39% chance of intervention causing damage. I wish I had known the second part when I allowed myself to be talked into a VBAC. (Ok I was only 39 but still...) When it came to the birth, the promise that they would go straight to a section if there was any problems ( low threshold EMCS) evaporated.

Then I wouldn’t have had to to have a massive argument with the doctor and in the end refuse consent for high, Rotational forceps, after 80 hours in back to back labour. As a result the obstetrician was forced to do another EMCS but the experience was horrendous and I didn’t bond with DS for 6 months.

I’m still glad that I refused to let her try the forceps, although she made me feel awful about it at the time and afterwards. But many of the midwives I saw afterwards said that I had probably made the right decision.

It's also subjective. If I ask for advice regarding my situation, I get a blanket 'c section is much more risky, vaginal birth everytime, do you know the terrible risks of surgery'
Then as baby is currently transverse, well if he stays transverse you'll need a c sections, me well what about the risks, 'oh it's a very safe procedure and we can tie your tubes at the same time' !!!
Just so frustrating.

The risk of high forceps, as discussed with the consultant midwife, was the main reason I decided against a VBAC for my second child. DC1 was an elective section for breech and I elected for DCs 2 and 3, have never regretted it.

I remember being quite taken aback after DC1 when friends who'd had vaginal deliveries at around the same time were discussing 'normal' birth-related problems months after I'd recovered fully.

@Newmanwannabe well perhaps women should be given the information earlier than the 1-2 hour ante-natal class during pregnancy, as like you say it's too late to then. Maybe it should be discussed in high school to an extent and then properly covered at 18+ in colleges/university.

I dunno. Both ways are as bad as the other if you ask me.

I had a lovely, semi relaxed c section. Hated the recovery tho and my ability to actual look after my baby was diminished for first few weeks. My friend had an EMCS 2 months later and sweet Jesus I was horrified by what they did to her. Made me feel very bad about complaining about my lovely neat scar - not all c secs are same.

I doubt VB is easy but I’m trying for a VBAC in the next two weeks. I’ve weighed up and done my research, and I’ve a very good OB (as I’m abroad) and the ability to get proper physiotherapist after (altho I hope I don’t need it ).

At some point we need to accept that in life we can not control everything. That there are risks in even walking around outside. That it’s not the role for teachers and HCP to make sure everyone is 100% informed, they are just human too, there is too much pressure of responsibility and litigation placed on them, and all it’s going to do instead of provide education and advice is increase the amount of disclaimers and waiver, confusing everyone all the more. Sometimes shit happens.

I agree that we need better post birth care. I've just recently had my postpartum check up and it was awful. The whole thing was less then 10mins and were only concerned with getting me back on contraception! No questions into how I was feeling mentally or physically, just was I planning another baby.
I am going to contact them to arrange some physio and push for it.

@lou0309 in our area you only get one if you request it now! The baby is automatically booked an 8 week check but the mother's postpartum check has been ditched and you have to ask for it if you want it... which means many don't.

I think the information is out there and easy to find, but it is not given out by midwives.

I read a lot of articles and stories on here about women being mangled physically and mentally by vb so I booked a cs. It was a wonderful experience and I recovered easily. Not everyone would make the same decision and why should they - we are all different.

I would like to thank everyone who has shared their birth stories here. You have all helped me and probably many others. That includes posters who shared positive and negative cs stories as these also helped. As OP says, it's about having the information that's so important.

I had a "choice" of birth method with DS2 and chose a VBAC. My first experience had been a long, poorly supported back to back labour followed by EMCS after he became distressed during the two hours of pushing. I ended up in HDU with symptoms of pre-eclampsia. I was still just about under 30, and of a low risk and healthy background. I have suspected that the unidentified SPD that had me near housebound in the final month did not help (Just pregnancy aches and pains according to my GP ).

The first month of recovery was slow. It was 3 weeks before I could carry DS on the stairs as I had to use both hands for support.

It's pretty clear that a CS is major surgery and not to be done for fun. My experience of coming so close to a VB and a slow recovery contributed a lot to chosing VBAC for my second birth...

It was a much better birth experience mentally. I got into a more active position on the birthing ball and looped hypnobirthing tracks on the MP3. Mentally it was healing from the shock and trauma of DS1's birth, but being a VBAC I ended up rushed to theatre because they were struggling to monitor him. EMCS was initially mentioned, but it ended up being a high forceps with 3rd degree tear.

The recovery was very different. I retained my strength, but chuffing Nora it hurt. I was sitting on frozen sweetcorn for a month! I also didn't dare go more than a few minutes from a toilet or shower in that first month. It also buggered up the SPD to the extend that some days I was crawling up the stairs because I couldn't move my hip. 3 months later I was still in constant pain and functional mobility impaired.

It felt very much like a choice of ELCS where recovery would not be quick and back to normal in days, or a gamble on VBAC where recovery could be quick or incur complications... I drew a short straw!

I was well read from books/ internet. HCPs often felt time limited and impersonal. Community MW and mental health MW were good.

Issues like the SPD were easily dismissed or poorly managed.

I suspect that there is a lot unknown simply because it is unreported and not on the radar. For example the SPD statistics seem to be way off the experiences of so many women I've met and vastly under reported. How does that affect birth outcomes and injuries? We're sold the tale that active pregnancies and labour facilitate birth, and by the later stages of labour, I simply didn't have the physical strength to do anything other than lie passively on my back despite instinctively feeling it was wrong. Even if it didn't change the outcome of the birth, it was a major factor in my birth trauma.

Outcomes can't be predicted, but there do seem to be significant blindspots in complications of pregnancy and birth, frequent poor management of them and rushed impersonal care to feed agendas.

I think being open and honest is important. I don't see it as scaremongering. My birth experiences were not ideal but they were the ones that I had.

I've had two very large babies naturally, I'm tall and slim, no diabetes. The second was over 12lbs and I fractured my coccyx during the delivery. Over 2 years down the line I still have pain and don't expect it to get any better.

I did know the risks as had previously had a large baby. The problem wasn't the not knowing but the fact my pleas to have a early induction, telling them the baby was huge fell on deaf ears. I got smiles and pats on the back and was allowed to go two weeks overdue. 'You've had one big baby you can have another!'. A scan at 34 weeks put the baby at 8lbs.
3 midwifes had to deliver my baby, one told me I should have been on a hospital ward and not in a birthing centre.
All is fine and my baby was healthy but I'm pretty sure had my concerns been listened too and they induced me early I wouldn't have the injury I have now.

I'd like a third child but it's not going to happen because I don't think my body could take anymore damage!

Totally agree. My DS teenager so I had a book rather than looking on internet so much. There was only a tiny bit at the back on complications and things that could go wrong. I honestly had no idea my nether regions would be such a total and utter car crash. The whole birth was horrendous but that's a whole new thread I also wasn't prepared for the weeks, leading into years of pain and discomfort. As soon as the baby is born that is the focus, not a word about the mother. Felt totally unprepared and I'd go so far as to say traumatised and decided never to repeat the experience.

Thanks very much @DuggeeHugs
I’ll have a look into that ; I’m trying to find out other statistics specific to my hospital too so hopefully the consultant will agree 🤞🏻

The information is out there but it’s NOT easy to come up with a personalised risk. I’m a scientist, i understand statistics and I’ve still spent hours pondering over study designs or whether what this or thatvpaper actually means.

What’s needed is agreed upon data that are collected and followed through nationally. I would also like to see this data stratified by rough age bands/number of previous births/weight.

• by institution: percentage of women who have emcs with no prior trial of labour (TOL) percentage who have emcs after TOL, elcs rate, vbac rate. And then in each of those categories I would want to see: percentage of first, second, third and fourth degree tears. Episiotomy rate. Forceps rate, ventouse rate. Prolapse rate. %of women with birth injury at birth. % with clinically significant issues 3,6,12 months and ongoing to long term.

I’d also like to see the following be discussed with women:

What will happen if labour does not progress?
Do you use forceps? What’s the injury rate? Do you use high rotational forceps?
Is position of baby at presentation assessed? How does this affect care? Are women informed of the hugely increased risk of instrumental delivery with OP presentation?
What’s the threshold for switching to emcs if labour does not progress?
What will happen if you’re overdue? Will you be induced? If so by what method? What foetal monitoring is then used?

Women are not given anywhere near enough info to understand what’s happening. Birth remains the physically most risky thing a women will do in an average life. Informed consent is key and it’s still not really being enforced