How much should women be told about complications in labour or birth?

[Flomaba]

Hello I am a midwife who does ante-natal classes and am studying medical law. I would really appreciate any feedback on whether or not women think we should tell them all of the risks all of the time, some risks all of the time, or any other variations so that women can choose whether or not to take that risk. Many thanks and best wishes.

I think it depends on the woman to be honest! For me, we talked about the most common risks eg needing episiotomy, assisted delivery, PPH etc at antenatal classes, but I wouldn't have wanted to go into all sorts of 'what if' type scenarios as I was using hypnobirthing and wouldn't have wanted things like that playing on my mind (I'm a born worrier). Other friends looked into loads of things, our antenatal teacher pointed us in the direction of some useful websites if we wanted to learn more and I think that was the perfect balanced way to do it :)

Unless you mean during labour, when I decided I wanted to know the ins, out and whys for everything the MW told me!!!

I would say tell them about the risks, but back it up with statistics so women don't get unnecessarily panicked about really rare complications. Eg. x% of women will have y problem, and this is how we deal with it... You need to make it sound like you as a healthcare team are capable of dealing with complications so women feel secure and that they can trust you to keep them safe should they encounter any difficulties.

Anything that can reduce risks should be told to them - Count the kicks, getting on all fours to improve foetal position etc.

The only thing I'm not sure about is whether you should give detailed stats about stillbirth and neonatal deaths. I went into labour with DC1 thinking it was a 'few in a million' chance, so was not really scared or worried about the possibility. When I since learned it's actually around 8/1000, it was in the back of my mind throughout DC2's birth, which made me feel more vulnerable.

When I was pregnant I was happy to learn about all the risks. It made me feel more in control. When it all went tits up and I had an EMCS I knew what was happening so kept pretty calm.

I wish I had known that the natural drug free water birth I thought I was having actually only happens to a very small % of mums. My local hospital says 4% of births are like this for them. I found this out retrospectively. Knowing that would have made me feel better about my actual birth.

Same for BF. I would like to have been made aware of the initiation vs success rates as again I was in the dark about the potential complications/difficulties.

I think you need to know. I went to parentcraft classes and asked what happens if the baby gets stuck. I was told it cannot happen. I asked the consultant, told her he felt too big and I was worried. She asked me what size my feet were and said I'd be fine. I asked several people and they all dismissed me, told me such a thing doesn't happen and not to worry.

One shoulder dystocia which they screwed up later and I have a son with erbs palsy.

We need to know.

They should be told about complications after birth too - things like jaundice, pph, pnd, infected episiotomies, mastitis, strep b etc. Too often antenatal class information stops at the birth, with the exception of breastfeeding. And when postnatal classes don't start until the baby is 6 weeks old, that leaves a gap in knowledge.

Good point Hecate - shoulder dystocia is an example of something either not mentioned or glossed over as something extremely rare in antenatal classes. As we both know, it's actually quite common, and has little to do with maternal foot size .

Also give statistics. At my Ante-natal class, we were just given information with no factual back up, just frightening what if scenarios.
Eg: A women put off induction for 24hrs so she could go to her fathers birthday party & the baby died in the womb.
This was one story we were told. It would have been nice to have been given actual facts rather than worrying stories!

Well this is how not to do it.

The parting message at my NHS ante-class was

"to remember that not every women would come home with a live baby"

People need to be made aware of the risks. However, they don't generally listen.

I nearly died in childbirth 4 weeks ago. I had toyed with the idea of having a home birth. Had I done so, I would have died, without a doubt. I just hadn't appreciated the risks and the fact that things can go wrong, even with a 'perfect' obstetric history.

Hi, I am a critical care nurse. I see the worst ever scenarios in my working life.

It is horrendous, no two ways about it, it is just horrific the things that can and do go wrong.

I never discuss what i see with pregnant friends/family.

It is just too bad to describe or even talk about sometimes.

I am currently pregnant, i am very very aware obviously and i am anxious and scared because of what i know and have experienced.
I wish that all those years of experiences could be erased from my brain, i can only imagine that this is how it would affect allot of people if they knew.

I believe that things like pre eclampsia, GDM, placenta previa, possibility of bleeding/infection/IUD should be highlighted, but anything more horrific should not be "kept" from women, maybe leaflet form "what could go wrong" may be helpful...BUT not forced on women like for eg in the Bounty pack. But available maybe in waiting rooms.

Depends on the individual i suppose.

nananaps, can I ask you a really nosy question? Given your experience, will you be opting for a caesarian? (I am assuming that is the safest way to give birth, although I might be wrong).

I am not OPTING for anything!
Because of various problems, i am being given a sheduled C section.

Dont forget that i see the worst possible end results, this isnt a weekly occurance, its probably once or twice a year...if the woman "makes it" to our dept, there are many others who do not
My view is very very biased and very skewed.

My front bum does twitch when folk tell me their birth stories, i cant help it

I one for sharing info - i think alot of women are made to feel like failiures and all that utter rubbish when things do go wrong or they are told utter rubbish about sections, that frightens them.

Our bodies create this incredible human being but because it might end up coming out the sun roof rather than VB they feel like they have to act like they have done soemthing wrong....a couple of hours of expeltion suddenly over shadows 9 months of growing the baby and a life time of looking after it.

If info is out there you can choose to read it or disregard it - but if its hidden or people are frightened to say anything for fear of being accused of " peddling thier nasty tales" or being afraid to say anything about thier birth...then that to me is subversive....

clear consise facts and a few scenarios - eg, your labour is not progressing, the heart beat has stayed down - this is what will happen.

I think women should be told what symptoms need immediate attention. In my first pregnancy I almost died - I developed fulminating pre-eclampsia (BP 240/120, pulmonary oedema, class I HELLP) at 25-26 weeks. I ended up in intensive care; baby stillborn.

I'd had mild headaches (but only intermittently) and felt like I was going down with flu, but nothing more, for about a week beforehand. However, I had realised the baby had slowed / stopped moving. I think women should be made more aware that that combination of symptoms is concerning. I was never told anyting about risks or given any information (not even the DoH pregnancy book). I thought pre-eclampsia never happened that early on in pregnancy.

I appreciate my case is rare but I very nearly died because I didn't know - I didn't deserve that. A few women do die every year because their community midwives don't like to worry them with information about these risks.

Its something I feel strongly about.

I think women should be told. especially when they specifically ask.

also agree about the warning signs, they should be mentioned more and gp's and midwifes shouldn't fob women off when they ask.

It's going to depend so much on the women - I think there are a considerable number who would worry themselves sick if they knew of all the things that feasibly could go wrong, but then there are others who would feel empowered, or in control if they had more information.

Don't do what my utter fuckwit of an antenatal MW did - say "You might need forceps but I won't show them to you because I don't want to scare anyone." I mean WTF!!!! If there's any guaranteed way to scare people it's by saying something ridiculous like that.

I think the statistics and reactions should be explained, at least for the most statistically likely complications.

It would be nice to zen through it all but women need to be treated as primary partners when it comes to their health and that means being given information so they can react if they notice something wrong. If you have a headache and puffy ankles in the last month of pregnancy but think PE is really rate you won't react the same way that you would if you'd been informed of the risks.

I am someone who wants to know everything. I am perfectly capable of realising that the worst stories don't happen often but I still want to know about them so I will recognise the signs. Even more important for me to know about things that commonly go 'wrong' and what the options would be in those scenarios. Although I do agree that fear is not helpful in childbirth, I am someone who is more frightened if I feel I don't know enough.

just a sample size of 8 vaginal births in my immediate family:

• 1 shoulder dystocia
• 1 3rd degree tear
• 1 failure to progress (ventouse)
• 1 failure to progress (fundal pressure)
• 2 retained placentas
• all but one with tears/epis

I don't think we all have 'funny anatomy' and weird babies and would have loved to hear about the possibilities before.

I know it's not strictly about during birth but one thing I wish I'd been given more of a heads up about is the fact that you feel like you've been hit by a train for some weeks afterwards! Never mind the tiredness, I wasn't prepared at all for feeling everyday like I'd just done the work out of all work outs! Plus I think how to care for tears, piles etc might be a good thing to know

I think the whole issue is really interesting, just from your thread title.

'Complications' and 'risks' implies that women shouldn't expect these things to occur unless something has gone 'wrong'. However, for example, if 37% of women experience some degree of tearing, is it 'abnormal'? Or is it 'undesirable' rather than 'abnormal'?

We all talk about induction of labour being 'likely to fail' but interestingly, the statistics show that only 0.9% of all deliveries are listed as 'failed inductions'.

I personally (nurse) wanted all the information and all the facts. I was also quite 'interventionist' in my approach. All 3 of my pregnancies were induced for medical reasons, but with 2 of the 3 I could have opted for 'watch and wait' if I had wanted. There was no way I was going to 'watch and wait' when the doctors couldn't tell me that the next time I watched I would definitely have a live baby.