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?

@SensoryOverlord It's not that straightforward, every birth is different. Vaginal births can become very complicated and some vaginal births cost more than planned c-sections in the short and longterm. For some women the risks of them ending up with an emergency section or complicated vaginal delivery means that opting for a planned CS is less risky and less costly.

I told my HV that this issue needs to be addressed at antenatal classes. I had no idea how bad it could be and some advice on how to manage and care for myself after would have been a great help.

I don't think women should get a full breakdown of the risks of each and free choice at all.

As stated above, the extra cost due to CS is eighty seven quid.

Of course people should be given risks - that’s the cornerstone of informed consent. It’s enshrined in law and those laws were drawn up after horrific human rights abuses such as the Nazi death camp experiments, and the Tunguskee syphilis trials in the USA. Informed consent is a critical part of human healthcare safety.

Without informed consent, any medic can do anything, for commercial gain, or personal curiosity. Please, have a read up on some of the stuff that triggered the drawing up of the Helsinki protocols for research - be warned, you’ll need a strong stomach.

I think there is a lack of public understanding about how complex and difficult obstetric decisions are. These decisions and the balance of risks can be extremely challenging for experienced professionals, not just new parents. Obstetricians do use evidence based guidelines in so far as they are able. They regularly attend meetings to discuss difficult cases and mull over ways in which care could be optimised for the next similar case. They regularly attend meetings to review new evidence.

I'm only saying this not because all obstetricians (or midwives) are flawless and perfect, but just because sometimes I think there is an unfair level of cynicism directed at them. I'm not an obstetrician or a midwife just for the record!

Unfortunately in childbirth the stakes are high and all approaches carry significant risks.

I think the main problem in the UK is resources - antenatal and postnatal care. In an ideal world all women would receive specialist ante- and post-natal physiotherapy for example. All women would be reviewed at length by an antenatal MDT including midwives, physio, obstetrics, neonates, dietician even - to tailor an optimised, personalised perinatal care plan. There would be a far greater number of specialist clinics tailored to individual circumstances. Educational classes would be thorough, evidence based, widely available and free. There aren't the staff or resources to do this at the moment. High risk pregnancies are thus prioritised.

Even beyond the health are system, large-scale societal changes in the rights and benefits that parents can access would make a substantial distance to perinatal mental health (a massive cause of maternal morbidity and mortality). Could go on and on.

For some women the risks of them ending up with an emergency section or complicated vaginal delivery means that opting for a planned CS is less risky and less costly

And in those cases, a medical professional should lay CS on the table as an option. It's completely 'free' choice I disagree with.

And as for the 'only £87 more' - my crude maths and googling tells me that if the current rate of C Sections were to double from 1 in 5 to 2 in 5 births due to free choice being taken up - that's over £12m extra per year. Hardly negligible imo.

In other areas of medicine we expect to be more informed of risks when undergoing procedures or treatment. Why should maternity care and childbirth be different? Our bodies, our lives and choice matters.

I think consent is lagging behind in pregnancy and childbirth. One fact that shocked me is that as recently as the 90s (possibly even more recent) anaesthetised women were used for students to practice VEs on without their KNOWLEDGE or CONSENT. Women who were anaesthetised from undergoing an unrelated gynaecological procedure would have a group of students line up and each have a turn practicing a vaginal examination. There are probably still practicing doctors who learnt it this way. Just goes to show there are some really deep set problems with misogyny and consent in obstetrics/gynaecological care.

@Sensoryoverlord that would be including emergency c-sections though (which I believe the majority of c-sections are?) and if women have the choice then they are choosing planned c-sections.

The £87 takes into account that a lot of women who choose a planned c-sections save the NHS money because it prevented them having an emergency section (or a complicated vaginal birth)

And as for the 'only £87 more'

That’s a figure from NICE, not one I drew up on the back of an envelope.

12m , If that figure is even correct, is nothing. It’s a drop in the ocean compared to lawsuits for brain injured children alone. It’s basically 5 or six payouts for serious damage during birth. It might even save the NHS litigation fund a few bob.

The problem in UK is lack of care during and after pregnancy. I attended NCT antenatal classes and as foreigner was the only woman who regularly seen ob-gyn and had vaginal examination... I'm in my thirties same as other ladies who attended the class.

I'm now 35 weeks pregnant and high risk due to my previous higher blood pressure and thyroid problem. I was seen by consultant but the only physical exam i had was measuring my bump and listening to baby's heartbeat. What about checking cervix? checking for signs of infections?
I had to actively fight to see endocrinologist when obgyn decided to reduce my thyroid medication based on lab results alone and ignoring the fact that the results were consistent with the one before pregnancy.

A lot of care in NHS is focused what is cheapest, not what is best for the patient. And on targets... That's why they pushing for vaginal birth, to hit targets....

@Elainethepain during my failed induction a doctor performed a VE to check dilation. The pain was so awful I begged him to stop - I was crying and trying to retreat up the bed. He refused to stop. The midwife just stood and watched. The whole thing probably lasted about two minutes but it was unbearable and I spent the next two hours sobbing in the car park. Only the thought of my baby kept me there.

The midwife later said "I thought it was ok because if he'd stopped and started again it would have hurt more". She couldn't have cared less about my distress or my consent being withdrawn.

I'm more than willing to believe those medical students are still out there.

Women's consent and right to make decisions about their body were non-existent in my experience.

@DuggeeHugs in any other context that would be seen as serious sexual assault... and it IS assault. Absolutely disgraceful women are subjected to that kind of treatment in this day and age.

@Elainethepain I didn't realise that until 13 months later when I broke down at my smear test. At the time I was 4 days into a failed induction; exhausted, in pain and with no clue that I should still have a right to all the usual courtesies granted patients in other medical situations. I was a naive first timer and am still angry when I think about that examination.

Something needs to be done about how women are viewed throughout pregnancy, childbirth and beyond. At the moment they are treated like objects to get babies out of and expected to have ridiculously low thresholds for staff behaviour. Completely unacceptable.

And women now get sent home within a few hours of birth or 24 hours after a Caesarian. With very little after care. Major abdominal surgery and home the next day with only parcetamol. Wouldn’t happen to a man!

@Polarbearflavour

To be fair more often it is the woman or her family that are desperate to leave and putting on pressure to leave as soon as possible - usually to be with older children. Better, more flexible and more affordable childcare resources for parents would be a help. I have known of many women to stay on the postnatal ward for days for reassurance only or support with breastfeeding, if that is their wish.

@Duggeehugs

That's appalling, I'm so sorry. I can't speak for everyone but I can say that as a medical student consent was emphasised, I never did and as a doctor would never ever examine someone unconscious for my benefit (rather than for example, their medical need) without their permission. And when I was on a gynae placement, that did indeed mean going around the pre-ops to ask and documenting their consent in the medical record. A medical student who didn't do so would risk expulsion. There was a small group of students at my university expelled (rightly) for performing unnecessary venepuncture on patients without consent. Everyone who knew about it was (rightly) appalled and that kind of thing was certainly not normal.

There must be an evolutionary arguement in that -
100 years ago babies and mums who needed c sections would probably have died. Now they can be done as an emergency. No problem. They will section you in an emergency if mum or baby is going to die (provided they can’t rip baby out. With forceps, it’s apparently a lot cheaper).

However now all of the females born to these caesarean mums are having their own babies and perhaps they have some of the generic reasons that their mum had for needing a caesarean.
But this is never even accounted for. I cant ever recall being asked how “do you know how your mum was in labour /delivering with you?”

My aunt had emergency cs. My neice asked on these grounds is it not more likely she would need an cs, and as she didn’t want it to be an emergency could she request it. This was a few years back but the midwife apparently laughed and said no way! She didn’t even get as far as an obstetrician. There was no discussion either about why or why not this would be an option. Just plain no.
Guess how she ended up giving birth..... emergency cs

*my cousin not neice

My mum had an emergency section the first time. She was told to have a VBAc the following 3 births. (She wouldn’t have ever thought of demanding a c section which you probably couldn’t do.)

She had 3 appalling forceps births and me and all my sisters have had EMCS/ subsequent ELCS for each birth.

I do think there has to be something genetic. My consultant believed in our case it’s related to pelvis shape/ position, which can be hereditary .

Sreberko - what would an obstetrician be checking the cervix for? There is zero evidence this serves any purpose in a routine antenatal appointment. The reason obstetricians see women in other countries is that there is financial benefit for them. Like in the USA which has appaling morbidity rates for women giving birth and postnatally, especially for non-white women. Maternity services need more resources but that is better focussed on more midwives and one to one midwife care which is known to improve outcomes....and better postnatal care so those with truama after birth, both physical and emotional, are not dismissed and fobbed off but helped with compassion.

I feel that maybe women are encouraged to do too much too soon after childbirth. Instead of staying in bed for six weeks or whatever with sisters etc around to look after stuff, we're back on our feet. I was pretty ok after the birth but did too much too soon and now have a mild prolapse. I was told not to lift anything heavy after the birth but thought this was for the episiotomy stitches and when they were gone I did the damage. I think that there could have definitely been more info about this.

In my area, we do have a perineal clinic for women who have had very bad tearing. I used to teach maternity practicum and I've helped to handle discharge teaching for women with very bad tears. They got an automatic referral.

A C section does by its nature carry higher risks for mothers and babies. Babies don't get the mucous squeezed out of them, and there is now evidence to suggest they may be more prone to infections because they do not get the exposure to the mother's vaginal bacteria during birth. One study found a higher risk of death for babies born via section, even adjusting for the fact that some sections are done due to problems. The mother also faces risks of pneumonia, hemorrhage, paralytic ileus (bowel stops working due to its being manipulated during surgery), bladder infections (due to the required urinary catheter), bowel obstructions due to scar tissue, and they can have an increased risk for problems with subsequent pregnancies (placenta previa, placenta accreta, possible rupture of the uterus). It can also limit the number of babies you can have, depending on how many C sections you have.

Agnurse, I have read that maternal morbidity is higher for for cs, but for babies is is lower. I would gladly take that risk. So some of the research must be conflicting.
So babies by cs have more chance of infection, maybe, but eliminated chance of other risks for example shoulder dystocia.
Also paralytic ileus, how high is the chance that this could happen? % wise.
Is this any worse than faceal incontinence from a serious tear?
Unless you’ve experienced a bad tear yourself, people don’t understand what it’s like.
I take your point there are risks to sections, but shouldn’t women male up their own mind? To have both lots of risks presented to them. Alongside the fact that a cs may limit the size of their family.
But instead they are being railroaded down the vb route.

I hope I see the day women are supported to make their owm decisions about birth and like any other area of healthcare can make a choice.
I think it will be a huge step forward for women’s rights in the uk, when obstetricians, (lots of them men) stop dictating to women about their own bodies.

I think @merryoldgoat has got it in one.
There have always been these issues but everyone seems so obsessed with having the perfect, natural birth. Women judge other women on their birth and anything other than a couple of pushes and it's either seen as a failure or told you are showing off/exaggerating. I was told by someone who had never had a baby, that hypnobirthing would have helped my delivery. My baby got stuck and was in the wrong position to come out. But we seem to be perpetuating this view that get yourself a doula and a hypnobirthing class and it's going to go great. And I suppose it does go great, except for when it really doesn't

I absolutely agree OP. I think there is a scandalous lack of information and education given to women about the hazards of childbirth. Just because it is a natural process that are bodies are designed to do does not mean that it carries significant risks, years ago those risks included death, now thankfully due to medical advances death in childbirth is rare, but serious significant and long term damage to the woman's pelvic organs and muscles is all too common.

I had absolutely no idea of the inherent risks of natural childbirth and delivering large babies.

My first birth I had an episiotomy, no biggie I thought, rather that than a tear. Except the episiotomy was stitched up too tight and I had to go back and have further surgery a few months later under GA to have it corrected.

Second birth I delivered a 10lb6oz girl, all fine until I had a massive haemorrhage some hours after birth and almost died on the operating table as they shovelled units of blood in to me as fast as possible.

3rd baby - when I tentatively asked if maybe I should have a CS this time due to the horrible experience last time around I was dismissed and told not to worry, there was no way that would happen again. This time baby was 10lb8oz and I had a 4th degree tear which did not heal properly and which now has left me with permanent bowel Incontinence which has had quite some impact on my life.

Babies 4&5 were by elective section and were entirely straightforward and trauma free.

I am angry at the way I was not given proper info (and my own anecdotal experience would suggest this is the norm) legally speaking if one is not given full info of possible risks in a natural childbirth before undergoing it then the hospital is deemed to not have acquired informed consent by the mother and is open to a lawsuit if anything goes wrong.

This as you can tell is a bit of a pet subject of mine, as a mum of two daughters I will make sure they are fully informed. The stakes are too high and it's not good enough that women are left incontinent from menopause onwards.

I don't see this fixation for natural birth. Most women say they would like a straightforward birth but are keeping a very open mind towards epidural and think they are the bee's knees....and they can be....but seriously increase the chances of having instrumental birth and that increases the chances of more serious birth injury. They also nearly all want to avoid induction but once told they should accept by their midwife a huge percentage are induced. Anecdotally I have noticed lots of them then have instrumental births and emergency caesareans. If the NHS was invested in reducing birth injuries they might well start tackling the induction and instrumental birth rate rather than worrying about the relatively small % of women who want a planned caesarean due to a bad birth last time or tokophobia.

I do agree that hospitals are very keen to point out all the risks in having a CS, but less forthcoming to mention tears, incontinence and Post partum haemorrhage as a result of natural birth. I'm sure this has something to do with wanting to keep the costs down, after all CS is much for expensive for the hospital. But I wonder what is the long term costs both in terms of medico legal defence costs and cost to NHS of women with chronic and permanent continence problems...