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.

OP, again - I'm really sorry to hear about the problems you are having and I hope you recover ok.

You and your baby can be pretty badly damaged through a c section too. My dd and I are both lucky to be here and I am physically damaged for the rest of my life following a cs.

But them's the breaks. Having a baby is a risky business.

I also think that saying epidurals increase the risk of interventions is a tad misleading. A lot of women who have epidurals are those whose labours aren't proceeding particularly happily (eg back to back baby etc) and probably would be at greater risk of interventions anyway. I haven't seen any research that confirms it is the epidural per se that leads to the interventions.

I think the OP is trying to highlight the fact that many first time mothers aren't properly informed about the real risks of epidurals. They are sold as a valid/safe birthing option (it certainly was to me) but are actually often the cause of brutal instrumental deliveries that leave the mother with severe pelvic floor injuries. Unless you have been through the trauma of a bad tear you will not be aware of the life changing symptoms that occur as a result, which include bowel incontinence, bladder injury, painful sex, painful scars and a severely limited lifestyle. You will not be aware of these issues because health professionals don't like to admit it happens, the symptoms are extremely difficult to talk about, and there is no real cure once the damage has been done. If I can prevent one new mum from going through the hell I'm going through by posting my experiences on here then great, because the health professionals don't seem to be doing this. Thanks for starting the discussion OP, and please don't be turned away from the conversation because of a few negative comments from mums who have had caesareans and have no experience of this kind of injury.

You're right neef, but all those things can happen through a c-section too. Several of the things on your list happened to me because of a botched cs. Sadly, however you deliver, there is always a risk that you may sustain injuries.

Sorry to hear about your bad c-section experience rally, nobody should have to put up with symptoms like that if it was a 'botched' operation. There is a risk of sustaining injury when giving birth but, from my experience, my life-changing injuries could have been avoided if I'd been more informed about the risks of epidurals. My baby was small (6,9), and in the right position for delivery, the only reason so much assistance was needed was because my epidural had numbed me so much I couldn't feel anything in order to push him out.

I'm sorry to hear about your experiences too neef. I guess I just feel like the risks of cs aren't ever really mentioned either. No one seems to believe that it could lead to serious injuries of bladder, bowel etc. The risks may be lower statistically, but they're still risks and the injuries can be just as severe and devastating. I know that from first-hand experience.

But ultimately I fully support any efforts to make sure women are better informed about the risks and benefits of all the options open to them.

I just honestly don't know what you're trying to achieve with this thread

Medical professionals and midwives train and train and have experience day in day out of handling all sorts of birth situations. I think making women think they have a say in how their birth goes just makes a lot of women feel guilty, like they have failed if they want an epidural or end up having a c section. I knew epidurals can slow down labour and make other interventions more likely - every woman I have ever spoken to on here or in real life knows this. But epidurals are valuable nonetheless. And I don't appreciate being lumped as uncaring because I had a c section! I suffered enough with that! Until a way is invented to painlessly airlift babies from women, birth will involve pain and possible damage. Trying to take control of the situation is an understandable way of trying to cope with the often traumatic aftermath, but it's the job of doctors, surgeons, midwives, anaesthetists and so many others to help dleiver the baby as safely as possible. If you were unlucky, don't blame yourself and don't make other women feel like they would be failures for experiencing similar. There are plenty of threads on here discussing birth injuries without the blame / responsibility way you are trying to make it. IMO the NCT should lay off its focus on birth choices blahdy blah and explain to women about birth injuries. But really, if you're going to be injured it will happen whether you do all the bloody hypnobirthing in the world.

I mean language like 'all the options available to them' - please let professionals do their job. I could have overridden the pros and said I wanted a natural breech birth (and the NCT tried to persuade me it was a good idea) but I trust the professionals and they said it was by far the safer option for me and baby.

The culture of 'options' must cheese off maternity staff no end. 'Oh you'd rather not have forceps? Ok we'll pop them back in the drawer then, what would you prefer?'

ThisBitchIsResting, I'm personally pretty glad we have options when it comes to interventions (within the limitations of safety for mother and baby). If I hadn't refused Kielland's rotational forceps and insisted on a c section at that point in labour, they would have tried to turn a stuck 11 lbs 9 ozs baby with a head that measured off the centile chart. Every time I think about it I break out in a cold sweat wondering what state we would both be in had they tried it.

Ok thisbitch, maybe my choice of language wasn't well thought through. I actually think NCT et all have a lot to answer for in selling the 'birth experience' and making women think that if things go wrong, it's because of a medicalised approach.

What I support is better education about the fact that childbirth is a risky business and that no matter how you give birth, you may sustain a life-changing injury.

Thanks rallytog, I think we agree

I thought Kiellands forceps weren't used any more in the UK?

It seems they're not uncommon in Scotland.

I think there is a discontinuity of care between obstetricians and particularly MW delivering babies and gynaecologists patching women up, sometimes many years later due to birth injury. The MWs who saw me after I'd had DD were blasé about my significant injuries and said I'd be fine to have another VB. What those MW don't see are the women who are so injured or traumatised that they choose never to have another child. They sign you off their lists after a couple of weeks and you are effectively a success story to them.

I'd really like to see 'lifetime cost' measured when considering different types of birth as there is generally a "VB costs £x and CS costs £y" description which doesn't take into account later care costs.

I think my mistake was agreeing to be induced. DD was definitely over cooked, but when gentle induction stuff failed, it didn't occur to me to say "what are the typical outcomes of a full on induction? Would a CS be a sensible option?"

I had a third degree tear 6 months ago and I still cry nearly every day. I asked for a CS and was persuaded that I would be so much better not to by the MW and consultant and I regret not having one every single day. I've still not recovered and at the moment don't think I ever will mentally at least.

I think it's really important that women are well informed about recovery from birth injuries at some point PP. I too was really distressed that three days after my delivery the visiting MW was chirping on about how I could easily have a natural delivery second time around.

I know that some women recover fine from injuries but others don't and like some of the OPs have said, it's not talked about and should be.

Somebody nailed it above when they said that birth is a risky business. It is, and I think that advances in medicine which have given us a low maternal and infant mortality rate have made us forget that it's one of the riskiest things you can do as a woman. However, I'm not sure what frightening NCT classes with tales of prolapses would achieve. A figure of 9% for serious birth injuries was quoted earlier: if that's correct then that's still over 90% of women who will be fine. I think it is quite widely known that epidurals can slow down labour and can prevent you getting into optimal positions for labour, but in my case (back to back labour with a massive head) I was glad to have one and would do so again even though it ended with forceps and a 3c tear.

What I do think is scandalous is the patchy nature of aftercare for women with birth injuries. I'm lucky that my local hospital has an excellent integrated gynae/colorectal clinic which proactively follows women up. I've been on threads on here where posters report little or no follow up, for example no endoanal scanning in subsequent pregnancies to assess the level of damage and inform birth choices. I was also lucky that my request for a CS in my next pregnancy was taken seriously and agreed without hassle: for many women this is not the case.

I suppose what I'm saying is that birth is risky whatever choices you make re drugs etc, and birth injuries are going to happen. It's how women are cared for afterwards that's the important thing.

P.s Blondiemama I agree that this should be talked about more, it is difficult to argue for better care when people still allude to ops done for "women's problems". People also forget that immediately after these injuries happen, omen also have a newborn baby to look after and caring for themselves can take a back seat. This is another reason why proactive follow up is essential.

(I hope you feel better soon -what happened is not your fault)

I had to sign a consent form for an instrumental delivery before transfer to theatre which mentioned all of the worst case scenarios like that, though I wasn't really in my right mind when I signed it. But then, I probably wouldn't have survived the delivery otherwise because things went pretty badly wrong.

Yes it's good to know the risks but that would mean information given on every possible type of delivery and every possible type if outcome

At the time of delivery every woman is going to say get the baby out by any means possible rather than worry about a prolapse.

I think a better way would be to give out the info after the woman has given birth, so if it was forceps, a leaflet on what might happen afterwards.

If I knew beforehand, I think I would have been anxious the whole way through wondering what type of delivery I was going to have and then worried I would suffer the consequences afterwards iyswim

A lot of is being said here is really contradictory. On one hand criticising the NCT for 'selling the birth experience' and on the other hand blaming epidurals for birth injuries. The NCT is then criticised often for being critical of epidurals...can't win!
Tearing and birth injury are mentioned in NCT classes but in gentle ways. Scaring pregnant women.into being fearful of birth will lead to more epidurals not fewer.

The proven link between epidurals and instrumental birth is not one.of causation but correlation anyway.

You make a good point coldhands - after care for injuries is shocking.

I knew the risks of a emcs delivery and happily consented beforehand (as the alternative was dead me and dead baby), but no one ever sat down with me afterwards and said right, this is the injury you've got, this is how it's likely to impact your life going forwards, and here are your options for dealing with it. And it sounds like that is a fairly common experience.

This discussion is interesting.

I'm in N Ireland and there is definitely a lot of 'attitude' towards women who choose anything other than natural childbirth.

I had a section with my first and have chosen to have a repeat section (albeit with having to be very unwavering in my decision during antenatal appointments). People are generally quite that I'm daring to 'risk surgery' and I've even had someone say that I was 'too posh to push'.

I was honestly totally terrified of the possibility of a vaginal birth injury and would rather have 100 stitches in my stomach than the unknown of a vaginal delivery and the use of instruments vaginally.

I really resent the fight that women have to have to have a surgical delivery if they choose that and feel that, in balance, the benefits outweigh the risks. I appreciate it's easier when a woman knows that she wants just one or two children. People say that if people want a section birth they should have to pay for it, well I don't agree, I couldn't have afforded it. I don't feel that in the great scheme of problems facing the NHS that c section births are the big draining cost.

Starting a thread about such a controversial topic and then going off in a strop as soon as someone says something you don't like isn't very constructive!

Dotty good on you for exercising your right to an ECS. You were right to be terrified of the possibility of vaginal birth injury - it is a horrendous thing to cope with. The other posters on here who are saying that it is only 9% of deliveries that end in major injury to the mother so why scare the remaining 91% have clearly never been exposed to the realities of such injuries - if they had they would want to do everything they could to help prevent even a small percentage of new mothers having to go through that hell.
Why should there be such a disparity in birthing experiences if bad ones could (sometimes) be prevented by women being better informed/cared for and their bodies and future health put before short term cost saving measures?

I was well informed before DD was born (many different books on childbirth, NCT course, etc) and I didn't know abut the risks of instrumental deliveries. The extent of my knowledge was "well, if the baby gets stuck they might try to get it out with forceps, which might bruise the baby and if you believe those people who were suing in the americas they might pull the baby's head off". The NCT class never mentioned the possibility of severe damage, and the books glossed over the possibility too.

It's true that these things do happen, but intentionally keeping women in the dark because "we don't talk about these things" until the last second when they are high on pain/fear/drugs and you are making them sign a form to protect yourself from liability is not appropriate. I'd rather have been told/aware of what could go wrong, so I could get my thoughts in order about it all before I hit transition.

As mentioned in an earlier post I'm one of the 9% so I am aware of the life changing nature of these injuries, but I also think it's important to recognise that my experience is not typical. As Quitelikely and MabelSideSwipe said earlier, any information given to pregnant women about the risks of epidurals and instrumental delivery would have to be given very carefully as fear can also slow down labour.

I also agree with ThisBitchisResting about the myth of choice. Without outing myself too much, as well as injuries from having DC1 I also have a life long injury caused by forceps used at my own birth(big heads run in the family). Before I had DC1 I was therefore well aware of the risks of instrumental delivery, and wrote on my birth plan that forceps were to be used only after discussion of the risks and benefits of other options (all the stuff they tell you on the NCT course basically). But when it came to it, my baby was stuck half way down the birth canal with the cord round his neck and a heart rate that was getting slower and slower. I was absolutely terrified and just wanted him out.

Now, there were certainly elements of my labour that could have been managed better (the point at which his heart rate was lost and the monitor was clipped to his head should have been the time to discuss options for delivery), and I don't disagree that everything possible should be done to reduce birth injuries to the lowest level possible, including informing women about all their options and the risks associated with them. Perhaps hospitals should have to publish the number of 2nd degree tears and above in the same way that they have to record CSections, maybe that would encourage better management of labours. But ultimately I go back to my earlier point that childbirth is an inherently risky business. You can do all the hypnobirthing you want and something still might go wrong; as rallytog1 has shown, you can get birth injuries from a C section; there's no way that's completely risk free. I hate it that for whatever reason, these threads always turn up so many women who in some way blame themselves for asking for an epidural/not reading up enough/not challenging the professionals, when really they did their best in what is often a very frightening experience.