Instrumental deliveries: never mentioned risks

[tstockmann]

Risks of faecal incontinence and pelvic organ prolapse both straight after birth and later on in life are common after ventouse and forceps.

You're probably going to check your pregnancy book and find nothing on this. I suggest checking the following pages:
forcepsthefollowonblog.wordpress.com/2014/10/28/what-i-wish-id-known-before-giving-birth/

www.patient.co.uk/doctor/faecal-incontinence (Scroll down to Aetiology-childbirth)

www.patient.co.uk/doctor/delay-in-second-stage-of-labour-and-use-of-forceps (Scroll down to Outcome)

www.patient.co.uk/health/genitourinary-prolapse-leaflet (Scroll down to What causes genitourinary prolapse? Childbirth)

The NHS Choices website does not mention any risks at the moment. This is wrong. They have assured me the page will be updated in February 2015.

I had a forceps delivery and the obstetrician managed to tear my cervix with the forceps. I bled all over the delivery room and the NINE people present. It was up the walls and on the floor! I had a blood transfusion and didn't even leave the delivery room until about 5pm the following day (delivered at 9pm).

However, the baby had to come out somehow.

Oh gosh yes, the things you dont find out until after its done. Had to have an operation after the birth to repair the damage and never been completely the same since!

Things they don't tell you or, as far as the first article is concerned, a piece of sloppy journalism.

Other than posting a scaremongering set of links, what do you actually suggest? Forceps/ventouse are used to get a baby out when there is concern about the baby. They are not used just for a laugh!

I had keloid forceps (no time for any pain relief of any kind) and my recovery afterwards was horrific - as was the experience itself. I'd do it all again in a heartbeat though because it saved my sons life.

Not sure what the point of your post is to be honest - no one chooses intervention as a fun alternative to doing it naturally do they? It's medical need, with all the complications and side affects that that entails.

I am not scaremongering. I am giving information I only learnt about after giving birth. Epidurals (they often slow down labour) and being older (your uterus might not contract as well) put you at higher risk of an assisted delivery and therefore at higher risk of serious pelvic floor dysfunction.
I am merely passing on information which I personally would have liked to have known before writing my birth plan.
I obviously know forceps saved both my baby's life and my own. It doesn't in my view take away the horror I've had to go through and the forthcoming problems in 10/15 years time.

To DinoSnores My suggestion is more honesty from midwives.
Promoting natural birth is one thing (it is what I would choose now and advise other women to try). Telling women the risks they might face when using epidurals for example is another. I was not informed of any risks and I don't believe this is right.

I wish I had known stuff like this before, I had a natural delivery and 2nd degree test but the recovery was worse than the birth they definitely don't tell you half the stuff until you are through it

This is really strange, any book on delivery I read when pg told of all this and that was over 20 years ago.
I must admit to reading every book the library had and buying a few as no internet for advice and support then.
I often think that the idea of information being so easily accessible with latest technology is a myth.

Sorry, must admit to not relying on hc professionals to inform me though. I believed it was my responsibility to be informed.

Interesting posts.

Mmolly2013 I just want to clarify: I don't mean natural births are easy, all I mean is that trying for a natural drug free birth lowers risks of severe perineal damage. I am sorry you had a bad time.

theposterformallyknownas I agree it is my own body and therefore my own responsibility to inform myself.
I really tried: I spoke to a lot of friends who had given birth (who also shared their own friends' stories), I went to antenatal classes, I bought some books (clearly the wrong ones) and searched the Internet.
Unfortunately severe tears are too often presented as rare (in truth, up to 9% according to the RCOG, so not common but not rare). The other aspect that is not explained in my view is that forceps are used when there already is damage to the perineum (full dilation for a long time and possibly 1 or 2 failed ventouse attempts). If you add the episiotomy and the overstretch from the forceps themselves, the damage is tremendous. So a severe tear (3d or 4th degree) in isolation is serious but with forceps we're talking of a severe tear + an episiotomy + a distended perineum + possible damage from a ventouse.

Thanks for this thread OP, you raise a good point.

I had an ELCS for my 2nd DC following a ventouse/forceps delivery for my first.

Quite a few people (acquaintances, not medics) tried to lecture me on the risks of c-section (and I'm not denying there are risks) but just went blank when I raised the risks of instrumental birth.

Having already had a DC damaged by a forceps delivery, and long term damage to me it really irked me the way people go on as though opting for c-s necessarily means you have a more risky delivery.

For me, I chose one set of risks over another, and it was informed by my own circumstances (e.g. was not a repeat CS and first CS' are known to be safer than repeat CS).

I wouldn't expect a MW to keep me informed or to tell me about risk.

So a severe tear (3d or 4th degree) in isolation is serious but with forceps we're talking of a severe tear + an episiotomy + a distended perineum + possible damage from a ventouse.

Not necessarily - I had a second degree tear with forceps, and no episiotomy; so it's a possibility, but not a certainty.

LaVolcan You're absolutely right. Forceps don't necessarily mean an episiotomy and/or a severe tear. Sorry about the confusion, I was trying to give an example of why the damage is in my view always worse with forceps. For example the colorectal surgeon who now follows me confirmed that you can suffer faecal incontinence following a forceps delivery without any tear. It is because of the increased damage made to the pudendal nerve.

I'm glad some of you find the thread useful. I had never heard of the new mother who could not walk further than half a mile for 3 months until it happened to me. Overall it is only a small percentage of women who experience that level of injury during birth but I wish I had known more about this before.

OP is absolutely right to flag this issue. I am so angry that I was not informed about the real risks of epidurals and the subsequent increase in interventions as a result. An epidural was actually recommended to me by a healthcare professional to prevent a 'traumatic birth'. In a actual fact my epidural slowed labour down and prevented me from feeling any urge to push - resulting in an episiotomy, 2 failed ventouse attempts, forceps and a 3b tear. I am still suffering everyday as a result of these injuries nearly two years down the line. It has ruined my life and I am staggered to think that there will continue to be more women subjected to this misery unless something changes.

Firstly, thanks for highlighting the risks associated with epidurals OP and neef - I am so sorry to hear about your experiences and I wish you a good recovery. I will certainly think v carefully if an epidural looks to be on the cards for me and after reading your post neef, I think I will mention in my birth plan that I would not like anyone to offer me an epi.

Re the OP - thanks for mentioning possible problems following instrumental deliveries. However, it seems to me that instrumental deliveries can be life saving procedures. I know that if I had the option to have a forceps / ventouse delivery vs risking life threatening injury to my baby or me, I would pick forceps every time despite the risks, (which btw I was aware of before coming across your post, although maybe not in such detail).

The OP reads to me as if mums should be warned off assisted deliveries full stop and does not mention epidurals at all, which I don't really find particularly helpful TBH. Unless every woman in the country is to have an ELCS I don't see that the use of ventouse / forceps in some cases can realistically be avoided..? Maybe someone can tell me differently.

DecaffTastesWeird I fully accept your criticisms. I did not mean to come across as anti ventouse/forceps. They saved my baby's life and my own.

I simply want women to have better information about childbirth generally. I did not have access to this information. Unless you know what you are looking for, in my view this information is not readily available. My pre-birth self lived in a world where faecal incontinence following childbirth did not exist and prolapse only happened when you get old.
All healthcare professionals (GP, midwives, women's health physios, gyneacologists and colorectal surgeon) I have met since giving birth have all agreed on one thing: "we do not talk about these problems".

I think the risks associated with instrumental deliveries are well known, particularly in this day and age when people are not just dependent on one Mirriam Stoppard etc book for their pregnancy information but have access to huge amounts of online data too, some of it from very reputable sources and therefore reliable. You say you didn't have access to the information but since you obviously have access to the internet I find that unlikely.
Modern medicine can't guarantee you a delivery which doesn't leave either you or your baby with problems. As you say yourself, without the forceps you both have died. You seem to say that if you had been better informed you would made different choices but given that on your own hypothesis the alternative was maternal and infant death, I assume you are now glad you proceeded as you did, given that it saved your life and that of your child.
I would concentrate on what you got out of your delivery - e.g. your child, and try and think about it more positively. Most of us have some problem or another after having our kids - its a small price to pay for having them though.

Sorry if I've missed it, but what's the alternative if you don't want an instrumental delivery but the baby needs to get out asap? If they say "we need use forceps" and you say no, is a c-section always an option at that point?

Damn good thread OP. These and others are the reasons why I had an elective c section. I think if the information was more readily available many women would chose the same to spare themselves the nightmare of pelvic floor injury.

I had a c section with my first child as he was breech- for me him being breech was amazing as it meant I didn't have to go through 'natural' childbirth and all the associated (and likely) interventions.

I'm currently 34 weeks with dc and have just had my maternal request c section approved but not without a lot of pushing on my part. I realise there are risks with abdominal surgery but, similarly, I am an intelligent woman able to think and choose for myself and I feel there shouldn't have been so much pressure for a vbac.

My worst nightmare would have been an instrumental vaginal delivery followed by an emergency section.

The conversation seems to be turning to victim blaming so I shall leave it there and return to what I effectively have: a beautiful baby and a prolapsed bladder and uterus and a damaged anal sphincter. Tara!

What are you looking to achieve from this thread, OP?

You are angry and upset about your experience - but what could have been done differently? How would you advise women to avoid similar? As previous posters have said, no one wants forceps or ventouse to be used but sometimes they are the best case scenario. Do you think your care was clinically negligent? You mention your epidural and age - do you think women over a certain age shouldn't have epidurals?

I had a c section due to breech and was quite relieved not to go through natural birth!

Victim blaming?

At the point that intervention is needed they will do anything to get the baby out. A live baby with a degree of damage is preferable to a dead baby and slightly less damage, surely? I mean, given the choice you'd avoid it all, but child birth is a risky process.

There are risks in every option. C section is not a 'safe' option. It is major surgery with all the risks associated with major surgery.