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 was simply questioning how you had arrived at the conclusion that VB and ELCS are - on balance, and disregarding individual differences - equally safe.

I will repeat what I said. I suggest you read it carefully as I think I have made the point clearly enough already:

with all the information we have currently there is very little difference in the overall risks between a planned vb or a planned ELCS. What is far more important and relevant is looking at your own individual circumstances and risk factors and indeed considering your ability to cope with certain scenarios.

I think the absolute risk is still small. It is an increased risk, but the size of that risk is relative and that's the important bit. The risk of dying in the UK, whether it be through a planned vb (which includes EMCS) or a planned CS is very small, full stop.

At which point did I say that it was equally safe?

The NICE guidelines themselves say that the difference is small enough to justify allowing women the choice, which is the same as me.

I had a forceps delivery 6 months ago now & it left me totally traumatised. I had to have nearly 40 stitches. Sex is very painful now & I will never be the same again. Directly after the birth my bladder stopped working & I had to be catheterised for nearly 4 days before it worked again. I was in tears every day & convinced I'd end up incontinent. (I didn't, thankfully.) I am a young, healthy woman & had no idea that this would be my labour story.

I had an epidural but the reason was that no one tells you about the level of pain you go through in labour - I found it horrendous. The whole experience was extremely traumatic so any thread that brings awareness to these possibilities is positive as far as I'm concerned. At least I'll be going into it with my eyes open the next time. I do not want this experience to put me off having children but I've realised it is far more common than I imagined. Half of my NCT group gent through a forceps delivery too.

I think there should be more honesty about the personal risk of things such as induction, I was recently offered an induction for a large baby (10+ pounds) no risks were explained to me but I knew from my own research that the emcs in an induced labour with a large baby is 50%, I asked the dr about these statistics and she agreed they were correct. I have no idea why they offer an induction which is just as likely to end in a emcs as a vb (I have no idea what % of those vb would be involving forceps/vontuse/episiotomy but I'm sure the chance of a vb without instrumental health is less than 50%) I declined an induction and planned a c-section, we made a plan that if I went into labour in the couple of days before the elcs I would labour naturally as long as I didn't need any pictocin, pain relief (besides gas and air) and I was progressing normally, in my opinion a section was safer compared to any diversion from a straight forward birth.

If I has listened to medical professionals without researching birth options myself I would have most probably ended up with an induced birth and I would have possibly needed an epidural. I don't believe I would have been able to birth an 11 pound baby if I didn't have full control over movement. This seems so logical to me, but it seemingly is not the way my dr thought!

I think the risk of instrumental birth in the context of induction is something that more information should be provided to mothers on - as Stripy suggests.

I had a ventoused delivery and an episiotomy and was healed fully in two weeks with no side affects with incontinence etc. They told me the risks as they prepared to do either but is there much choice in that situation? He had to come out RIGHT THEN. I was terrified because all instrumental deliveries are painted as terrifying and damaging but it was very straightforward and as the doctor said as I wailed and screamed at the thought of it 'this is totally normal, we do it every day'. There are risks to every aspect of childbirth, instrumental as much as CS or the tears of natural birth.

Happy for you that it all worked out well Redling, but I'm not sure what your point is? The fact that some instrumental deliveries are necessary, and heal very well, is no reason to not inform women about the possible risks. They certainly make sure we're 100% aware of all the risks and then some for C-sections, so why not do the same thing for forceps and ventouse?

Chacah, I don't think that last comment was fair.

I for one was interested to read Redling's post about her forceps delivery. I am truly sorry to hear about your experience and all of the bad experiences that pps and the OP have had as well. Clearly, there are a lot of people out there who have had extremely difficult recoveries following instrumental delivery. It is good though to have a balanced range of views. I have found that people can be less likely to share positive stories than negative ones and I for one am very aware of the risks associated with instrumental delivery despite being a FTM. I have actually heard a lot less about the risks involved with CS. Perhaps I am in the minority there, but I don't accept the argument that instrumental deliveries are "played down" while c-sec risks are "exaggerated".

From other posters on this thread I am glad to see that I am not the only person who finds the OP's tone regarding instrumental deliveries a little unhelpful. IMO, if we want to be truly informed, we should not be focussing solely on negative outcomes. I am repeating myself here but, IMO each case is totally different and I am never likely to agree with anyone who slams one birth method over another, unless they are a trusted and well qualified HCP.

Decaff I completely agree that it is good to have a balanced range of views, but in my view it's not what happening right now, and women are generally under-informed about the risks of instrumental deliveries.

I guess we must have very different experiences - before I gave birth, I had never heard a single negative story about instrumental delivery, while I had heard a lot about the risks of C-sections. (but then I didn't go on Mumsnet.) After I gave birth and something not-so-great happened to me, they started pouring in - I found out that my mother, my aunt, my grandmother, several in my NCT group had traumatic instrumental births with difficult recoveries. It would have been good to know that beforehand, not just to find out after the fact that it wasn't just me after all.

The way I see it, it's a little bit like having a thread about the statistical risks of cycling in town, and reading a testimony from someone who just cycled to Tesco stating it all went just fine. That's great and reassuring, but not exactly the point, iyswim?

I am never likely to agree with anyone who slams one birth method over another

and sorry, in case I wasn't clear: in my view it's not about being "for" or "against" instrumental deliveries, if only because in many cases there's no other choice!

it's merely about informing women about the potential risks, so they can come in fully prepared for all eventualities. In the exact same way we do it for C-sections.

chachah my point in posting was that i did t want anyone reading this thread to feel terror at the thought of a birth needing instrumental help, which I did because having read the childbirth threads on here there are actually so many about complications following interventions. And I was read a disclaimer which I had to sign as the doctors prepared to intervene, and they asked me whether I wanted ventouse or C section and I chose ventouse, as I was actually born that way as well and in the heat of the moment I thought it had gone fine for mum and me. In the end I think I chose right, as I probably would have had a longer recovery from c section. In your case and in others where there have been post birth complications maybe a c section would have been better. But you don't know at that point, so informing people of the various risks (which happens in my experience) doesn't make a lot of difference. Really I find the childbirth threads very down on instrumental births so I don't understand your point that people aren't aware of potential risks. I am so sorry that you have had a difficult time but I just didn't want everyone readings this thread to think that it's a given that instrumental intervention causes problems when it's very commen and often straightforward. I was terrified and I didn't need to be.

I wasn't posting to go 'lah lah lah it was fine for me shame not for you! either. I was trying to illustrate that in general it's a very straightforward and common method of birth. You can hear about a bad experience and a good one, and so knowing the risks involved... still you really don't have much to go on to make a choice. Birth is difficult however it happens. My SiL had a natural birth a few weeks before me and has had to have surgery weeks after to repair the tear damage. you just don't know what's going to happen, no matter how informed you are beforehand.

Redling, thanks for your kind response, but again I can only say that we have very different experiences of the general level of awareness. I don't think the Mumsnet threads are representative of that, because the people who read them are either the people who had bad experiences themselves, or the people who are already looking for information on the topic.

It was a constant theme around me when I talked to other women in similar situations that they were so shocked that something like that could happen to them, they'd had no idea. And of course everyone around you assumes that since you haven't had a c-section, you must be fine to run around after a few weeks.

It's like most medical risks: by definition it is just a risk, usually a relatively small one, and no one is saying it is the experience of the majority.

The reason these risks need to be publicised more is not necessarily so that women can make different choices, sometimes there is no other option. It's simply that they are aware of the possibility, aware that it is common enough that it doesn't just happen to other people. Because it makes a world a difference to how you will deal with it, should you be one of the unlucky ones.

It seems that we are really talking about forceps/ventouse vs EMCS because they are the unplanned events.

I had forceps, I wasn't given any choice or of saying no even, although there certainly would have been time to tell me the pros and cons of each option. I honestly don't know what choice I would have made but as it happens my recovery from forceps was straightforward.

I don't know how much information you should be given before hand either - a balance needs to be struck between saying that things may go wrong, but normally they don't. I can remember at the ante-natal classes thinking that they were rather dwelling on what could go wrong and not much about how to make it go right - like staying upright, like making sure you don't go and tire yourself out in early labour.....

In my case, I have always felt that the acceleration I was subjected to was unnecessary, and was protocol driven, rather than driven by my health or the baby's health, which led to further intervention needing the forceps. This is where I would like to see more information presented. How many women really need induction/acceleration, which once they have it seems so often to end up in intervention? I don't know the answer, but I sigh when I hear yet another person say that they had to be induced, which led to EMCS/ventouse/forceps, and I wonder if they would have had a perfectly straightforward delivery if they had been left alone and the baby had been left to come in its own time.?

I think if women were more aware of the risks of instrumental delivery it might make it easier to decide not to use epidurals or other pain relief that means you end up on your back in bed. If with each contraction the woman can think yes this fucking hurts but it's reducing the risks associated with instrumental delivery so I'm going to choose to deal with this pain now to try to reduce the risk of ongoing pain.

I knew all about the risks, I did not have an epidural, I needed assisted delivery, but was unable to have an immediate surgical intervention due to anaesthetist being busy.

Shit happens quickly sometimes....

Forceps or possible stillbirth is a choice I had to make - knowing the risks of forceps did not help me in the slightest.

Turned out just fine.

Stripy makes an excellent point. I feel exactly the same. If I had been more informed about the risks of instrumental delivery I would not have chosen to have an epidural which took all the control away from me during my labour. Had I known the risks I would have tolerated any amount of short term pain from my contractions knowing that I wasn't going to be facing long term, life changing symptoms. Pregnant women's bodies deserve to be treated with more respect.

birthtraumacanada.org
Excellent website, putting honest childbirth stories out there and questioning current obstetric practice and the issue of uninformed consent.

Ill be honest ive skim read a lot of the debating on this thread. I agree with the message that the OP was trying to convey though. I read up on the internet but clearly i wasnt looking for the right things. I attended the NHS antenatal classes and they were abysmal. I had no idea of the risks attached to the use of forceps/ventouse. If i had known then an emcs wouldnt have seemed like the riskier option. Then, if id known all of the risks with an emcs (which i dont, theres little point in knowing when it is the only option left), i dont know what i would have done.

Thinking about all this makes me think im not ready to TTC. It is such a frightening prospect tbh.

There are three aspects to to the discussion:

• the first is what I take to be OP's point, that there should be more information on all birth choices in advance. Antenatally most women have most choices open to them so they should be fully informed about the risks and benefits of all choices. At that stage choice is meaningful as someone could, for example, chose CS to avoid the possibility of forceps.

• then there is the discussion of information giving when there is no choice. In an emergency situation, where the options are forceps or death, it does seem pointless to go through the risks of forceps as they are unlikely to be worse than death. It may also be highly impractical to start giving information in the middle of an emergency.

• finally there is the question of who is affected by a risk. We can know the likelihood of a certain risk actualising I percentage terms, and in some cases we can known that certain groups are more likely to be affected by the risk (e.g. Breech position is more likely to require intervention), but that still doesn't tell us in advance what will happen to a given individual. This is the nature of risk if there wasn't uncertainty about outcomes it would not be a risky decision.

A risky decision can be justified by it's consequences, i.e. if things turn out right, it was correct to risk, if things turn out wrong it was incorrect to risk, but for me this reasoning is fallacious. It is not the outcome that justifies risk, but the reasonableness of the decision in the first place. If someone takes a risk that has a huge likelihood, let's say 99% chance, of seriously harming innocent others for a minor benefit to himself (e.g. drives very drunk through a busy high street full of people, going well over the speed limit and swerving on the pavement), but gets away with it (1% change actualises), I'd still want to say that what he did was wrong despite no harm coming from it. If the reasonableness of the decision is what matters, then choices should be fully informed to allow people to make the best choices.

Booboostoo Very well summed up. I agree with your explanation about reasonableness. MW should discuss risks pre-birth so women can make informed choices. Unfortunately I don't think it is happening now. A lot of pregnancy books don't give that information either. In my view a lot of mothers-to-be write a birth plan out of thin air.

I have now found 2 mumsnet threads for women who
1-have suffered anal sphincter injuries and fistula
www.mumsnet.com/Talk/general_health/a1597449-Calling-all-Raggedies-the-THIRD-Ragged-Bits-thread-Childbirth-injuries-sphincter-problems-fistulae-all-welcome

2-suffer from prolapse
www.mumsnet.com/Talk/general_health/a2029642-PART-9-Mar-2014-Any-old-prolapse-Uterus-womb-prolapse-rectocele-cystocele-enterocele-urethrocele-incontinence-pelvic-floor-anterior-and-posterior-repair-TVT-etc

Hope that helps.

"At that stage choice is meaningful as someone could, for example, chose CS to avoid the possibility of forceps."

Low risk women are not being given the option of an elective c/s in most NHS hospitals.

I'm not sure there are any plans afoot to change this.

In fact, the push is towards reducing the number of first c/s.

And it'd be hard to campaign for an increase in elective surgery when there are other priorities in maternity care - such as improving women's access to one to one care in labour.

The NICE guidelines offer all women the choice, you don't seem to like this but they do.

I mentioned this particular example for choosing ELCS as it was my reasoning for both pregnancies.

No one said anything about a campaign to increase any kind of birth. Again it's about giving women information, what they do with it is up to them.

Sorry Booboo but the Nice Guidance is GUIDANCE. Not 'rules'.

And hospitals are given targets for c-sections which they are struggling to achieve. Hence some hospitals (eg Chelsea and Westminster) actually including on antenatal notes that they do not provide c/s for low risk women.

I appreciate that it is possible sometimes to get around this but it's getting less and less easy.

Incidentally - I have no problems with ELCS being offered if hospitals have money for it AFTER they have plugged the holes in there antenatal provision so that all labouring women are guaranteed one to one care. I'm very much in favour of money being spent on deficiencies of provision that are currently putting women and babies at risk.