Childbirth risks: best overview I've found

[thomasstockmann]

I've found this overview of the risks involved in giving birth. The document comes from the Childbirth connection organisation in the US (they look like a more powerful equivalent of NCT here-any American mums to confirm/shed light?)
www.pqcnc.org/documents/sivbdoc/sivbeb/8ChildbirthConnectionVaginalBirthandCesareanBirthRiskComparison.pdf
In my view, a must read before writing a birth plan. If anyone knows of other gems like this one (reliable info put together in a concise way), could you share please?

"If you really want to understand it, you do need to do a lot of background reading and have the ability to understand research, methodology and statistics."
I can't do that so what do you suggest?

You either trust the doctors who treat you and learn this stuff on your behalf or you do take the responsibility yourself.

There isn't really a lot else you can do really. I appreciate its not ideal, but its the same for every area of health. Its not something that has absolute right or wrong type solutions. Just massive areas of grey.

I would read the overview along with other evidence and make my own decision.

The best thing about the overview lies in highlighting the risks of assisted vaginal birth in a comprehensive manner. I suspect that is principally what is pissing off many posters on this thread.

But there's limited value in highlighting the risks of assisted delivery in such a stark manner. Nobody goes into labour thinking "yeah my ideal scenario is forceps". For various reasons that would out me I had a higher than average understanding of the risks of assisted delivery, but when it came to it, I wanted my baby out alive.

If the aim is to reduce assisted deliveries and the associated birth trauma, let's talk about better ante natal care, better management of complex labours, data collection to establish the level of birth trauma at individual hospitals and thereby identify poor perfomers......I think it is a far more complex issue than giving expectant mothers a handout like this.

The fact of the matter is that once a woman agrees to have a vaginal birth she could end up with an uncertain outcome of smooth birth, assisted birth or emcs. The consequences of assisted birth and emcs were enough for me to opt for elcs, however small the risk. The senior midwives who counseled me on the risks of a cs funnily enough did not have the stats for the percentage of vaginal births ending up with third/fourth degree tears. The hospital lost my notes for my first birth which started out as an induction but ended up in emcs.

Therefore, in a perfect world, we would have all the information we need to make an informed choice. In reality, we are railroaded into the default of vaginal birth and not properly informed of the risks and consequences of vaginal birth.

The overview is helpful to women who do not have enough information on assisted delivery. It is mad to think women would be delving into "better ante natal care, better management of complex labours, data collection to establish the level of birth trauma at individual hospitals and thereby identify poor perfomers". How is that helpful for an individual who has to make a choice in the here and now?

blueshoes, I agree to a point.

I think its very difficult to make an informed choice when the number of third / fourth degree tears are not recorded. Complications in general are not being properly recorded which is a flaw in care in its own right. How can you aim to reduce the number of tears when you are not recording how many you have in the first place? So yes I do think its relevant to talk about better labour management as much as method of birth.

A couple of years ago, whilst I was looking at data, I came across information for episiotomies at different hospitals. I forget the exact figures, but most hospitals were something like 15%. I then came across one which was well over 40%. So they were still routinely doing them and it was clear in the data there must be a policy issue going on. I was horrified. And it showed up again on the place of birth study. There are significantly less episiotomies carried out on low risk women who give birth at home compared to a consultant led unit. Why?

The problem with that, is women given a general overview would never see something like that in data as it would be averaged out. So even if you did make an informed decision, you could be being incredibly mislead, by the risk appearing either significantly smaller or greater than it really is.

No railroading needed.

Its not just restricted to VBs though. The same principles apply to CS and interventions in general. If you look at overviews, the rate of intervention for women in their mid twenties is hugely overstated, but hugely understated for women over 35. Its enough of a difference to influence decisions which might not be in the best interests of the woman concerned.

Which is really why I stress the need that if you really want to be informed, you need to be able to 'read' the data available out there and be able to ask questions about what you are being told. In reality you need to be able to ask questions about the overview itself as the choices you make do seem to have a significant role in your outcome. Unfortunately its not just luck which is impacting on women's experiences.

This is why I think its massively important to encourage women to not just take the face value of an overview. Both on a personal level and on a wider political level. We shouldn't always rely on the information we are given in an overview as unfortunately it often is represented in a certain way to influence you because of political considerations in healthcare. (Which is why I would encourage everyone to read Margaret McCartney's book which covers some of this in much more depth as its rampant throughout the NHS).

Blueshoes you are quoting me out of context. Of course the bigger picture is not helpful to women who need to make a decision now, but for reasons that RedToothBrush has very clearly articulated and I won't repeat, neither is this document.

My point on the wider picture is that if OP is trying to help other women, it is a much more complex issue than simply posting some flawed information on a website.

Vert, all information on a website is flawed by definition simply because it cannot live up to the high standards that you and red espouse.

Let not perfection be the enemy of the good.

If we take red's stance to the logical conclusion, women would not even have access to any information, however flawed, to make a decision because nothing would ever be good or comprehensive or tailored enough to that woman's needs. As I said before, we do not live in a world of perfect information, even when dealing with medical professionals, as I had described of my experience below and I like to think I am generally a pretty clued up person. Even if she had perfect information, expecting the ordinary person to be able to absorb all that and come to an informed decision is frankly idealistic. It is an emotional as much as if not even more than a rational decision.

I maintain the overview is helpful, because it is simple and cuts to the chase. It should be read combined with other anecdotal and 'flawed' information available to an individual person to make her decision. I am not for censorship.

The best thing about the overview lies in highlighting the risks of assisted vaginal birth in a comprehensive manner. I suspect that is principally what is pissing off many posters on this thread.

blueshoes you are right that the document pissed me off, but it's not for the reason you think. I had a bad tear with my first and I'm considering an ELCS for my second, for reasons similar to yours.

The document pisses me off because (the way I read it) it presents VB as "the best option", and assisted deliveries/CSs as "bad". As if forceps/EMCSs weren't a frequent and inevitable outcome of VBs! All it does is make women feel bad for failing to have the perfect natural VB that they decided beforehand was the "best option". It's not under anyone's control.

I do agree that the one case in which it can be helpful, is in helping women decide whether or not they want an ELCS, given that the risks of assisted delivery are not advertised properly. But that's not the majority of cases, and the specific level of risk is highly personal to every case anyway.

(Of course if the document was serious about helping women make an informed choice about ELCS, it would give separate stats for EMCS and ELCS. The fact that it doesn't makes me think that's not what they're after here. What they want is to show that anything other than a natural VB is ~bad~ for you and your baby.)

I am not saying that at all. I think that unless you put information like that into some sort of context then its pretty meaningless. You need to ALWAYS put on something like that, caveats that state risk is individual and not evenly distributed and you should always discuss that with your doctor if it is aimed at the general public.

Secondly, anything that presents risk to the public as an overview, needs to be done in a way that isn't so basic it treats women as stupid and one dimensional. Its about promoting this idea that risk is a tapestry of overlapping factors, not solid numbers. It is a guessing game that is so complex, that you can't break it down into some sort of formula. You can only count up your risk factors and decide which risks you find the most acceptable. Women CAN grasp the fact that if they are a certain age their risks and priorities are different. They CAN grasp the fact that if they have underlying health issues their risks are different. An ante-natal class can teach you your rights in childbirth. You can teach you that these risks are there and what you should be wary about reading on the internet and what the biggest flaws in information are.

That document is particular bad though as, as well as being based on the American care system, it makes the fatal error of lumping CS together, presenting assisted deliveries as a choice and holding up an unassisted VB as an ideal. (It also contains some dubious information which was disregarded by NICE but I won't go into that here). Unless you put things into the context of either planning an ELCS or planning a VB much of the data is frankly worthless.

I'm not advocating censorship, merely saying that that document is not helpful (reds last paragraph above sums up why). There will be pregnant women who find this thread while considering their choices and it's right that posters have pointed out its many limitations.

I agree with you that these things are as much an emotional decision as a rational one, that's why each woman needs to have an informed discussion of her own risk profile with her medical team. IME the NHS often doesn't have the time, skills or inclination to do that, and that is the real issue.

RedToothBrush Is this the sort of redressing of statistics you are talking about?
This is from Bumpology by Linda Geddes.

"Finally, some words about risks and statistics. Often newspapers will quote research that found an x percent increased risk of something (generally nasty) happening. What they're generally referring to is the relative risk, which tends to paint a far scarier picture than the figure we really care about - the absolute risk. For example, you may be told that women who request epidural pain relief during labour are 42% more likely to need additional help delivering their babies (through the use of forceps or a vacuum device called ventouse). However the risk of needing an instrumental delivery among the general population is pretty low (around 12%), so what you're actually talking about is an increase of 42% of that 12%, i.e. only a 5% increased risk. Another way to look at it is that for every 20 women who request epidural pain relief, there will be one extra instrumental delivery."

If I understand well, you would also take into account the mother's age and number of pregnancy i.e. this extra instrumental delivery might be higher if it is your first birth and if you are over 35?

I've also found this research paper which you may prefer to the American overview. To me the general conclusions you can draw are fairly similar.

Baby distracted me. Here's the link
www.sciencedirect.com/science/article/pii/S0301211506005756