NHS Choices page on assisted deliveries updated

[pinguina16]

The NHS Choices website has updated its page on assisted deliveries.

If you'd rather not know the risks involved, don't click on the link. If you'd rather know, in case you're in difficulty and are offered a choice between instruments or a c-section, have a look. You don't always get a choice but it can happen.

www.nhs.uk/conditions/pregnancy-and-baby/pages/ventouse-forceps-delivery.aspx

Page for c-section
www.nhs.uk/conditions/caesarean-section/pages/introduction.aspx

Thanks for posting. 13-27% risk of faecal incontinence with an assisted birth???! Is that right? I thought it was lower. They usually keep quiet about that, don't they?

Also surprised to see only one in eight births involve forceps or ventouse. Of my friends who've given birth it's been a lot higher than that.

Any idea of the 1 in 8 includes or excludes women who have an elcs? I.e. It could be more like 1 in 5 "natural" deliveries.

I'm a bit confused by that bit about incontinence.

If you read it, it says the risks are higher after instrumental delivery. But the paragraph with the 13-27% figure doesn't refer to instrumental - it just says 'incontinence after childbirth'. So is that figure all births, or instrumental ones?

Also, what do they mean? A lot of people I know have had post-birth incontinence which has lasted a day or two, or a week or so. Sometimes that's just trauma to the muscles and bruising. I don't really see that 1/4 of all women, or 1/4 women having an instrumental birth has long term anal incontinence, that seems very high.

Overall, a pretty confusing paragraph I think. It wouldn't have passed my boss when I used to draft, put it that way!!

Penguin it is confusing. I think the 13-27% figure relates to 3rd and 4th degree tears, as that's what the preceding paragraph refers to.

The way I interpret it is... the topic of the whole page is assisted delivery, and we're looking underneath the main heading of "What are the risks of a ventouse or forceps birth?". The 2 particular paragraphs with that statistic are under the sub-heading "Anal Incontinence" (as one of the risks of assisted delivery) and the text refers directly to 3rd and 4th tears.

But in short.... AAAAAAARGH!

I'm very glad it's been updated but I still wish they were in more detail. Before I had my daughter, the one thing I didn't want was a foreceps delivery to the extent I had in my birth plan that I'd rather have a c section. Low and behold, I needed foreceps and they weren't nearly as bad as I'd anticipated they would be. More information needs to given on assisted deliveries, foreceps in particular, as the concept is terrifying!

I also think that this 13-27% may refer only to the women who fall within the category of having a 3rd or 4th degree tear (so 4% of ventouse and 8-12% of forceps deliveries). If that makes sense?

It is confusing ... I had a humdinger of a tear but from a fast natural birth. So that is definitely possible. Thankfully no fecal issues for me.
So is it "all births" or instrumental?

It needs to be clear as the nhs shouldn't give ftm the idea that natural births can't rip you up. I know some women who were shocked and traumatised that they made the "natural" choice and still got damaged. I think anti intervention threads can unwittingly give this impression.

I agree the stats ought to be clearer. It is an improvement from the old version which mentioned next to no risk.

My understanding is that faecal incontinence can happen even without a third or fourth degree tear (big baby??? forceps on their own??? back to back presentation???). I've no medical training, I'm just regular Jane so if anyone knows more, it would be helpful.

I think it is possible the 13-27% relate to all vaginal births. Any midwife/obstetrician who can infirm/confirm?

Personally there's a figure I don't seem to be able to find. It is the rate of assisted deliveries for first time mums. Does anyone have a figure?

There was a study in 2014 reported in a RCOG Press Release and repeated verbatim at the BJOG website.

The study used a cohort of 639,402 first-time mothers who had a vaginal delivery of a single baby between April 2004 and March 2011 and a second birth before April 2012

Results show that the prevalence of third or fourth degree tearing at first birth for the cohort was 3.8%

Furthermore, the report found that among women who had a vaginal delivery at second birth, the rate of a severe tear was 7.2% in women with a tear at first birth, compared to 1.3% in women without

I have been told that severe tearing can occur regardless of instrumental intervention or not (i.e. the baby comes out so fast nothing can prevent it). It's just that instrumental intervention increases that chance.

I don't have a figure. But I did just find that around 65% of instrumental deliveries were in ftm's.

I suspect that that is partly because some people who have difficult first births will have electives the next time, and partly because a lot of people who have a difficult first will have easier second/subsequent (I fell into the latter camp).

I would be massively surprised if 1/4 women having a vaginal birth had anal incontinence of any duration. That just doesn't seem correct to me.

Zoo speed can affect it. I worked very hard to maximise oxytocin and minimise adrenaline because that's what nct, hypno and nhs advocated ... upon reading Birth Skills I saw what I thought was twaddle about how it wouldn't be there if it wasn't useful.
I doubt my birth prep actually did this but in the end my body "dumped" oxytocin like "a badly dosed induction" (overheard) and dd shot out after 4 or 5 hours, could not control pushing, tore from fanjo to arse hole frankly.

All better now.

The page is badly written and confusing. Are they talking about permanent faecal incontinence or transient incontinence that resolves soon after birth? And what do the stats relate to? Because if they relate to all vaginal births, that is something women should be aware of when choosing a birth plan. We hear so much about the risks of caesareans, vaginal births should be no different. Access to this information is very important when weighing up the benefits and risks of the different modes of birth. It certainly puts into perspective the threads we've had on here where women with previous tears have been denied/talked out of ELCS for subsequent births. If the figures are true, I would suggest medics who have done this have put the future health and wellbeing of the mother firmly at risk.

That said, I find it difficult to believe these figures relate to ALL vaginal births -unless there is a massive taboo/conspiracy of silence that has so far gone unmentioned.

Really the NHS should be doing a much better job of providing accurate information.

Furthermore, the report found that among women who had a vaginal delivery at second birth, the rate of a severe tear was 7.2% in women with a tear at first birth, compared to 1.3% in women without

That is VERY interesting (but unsurprising). I had a third degree tear - no instrumental delivery, mind - and a consultant told me that I was at no increased risk of a tear second time around. I knew it was bullshit. I'm having an ELCS.

This is interesting. I am having an ELCS next week after a very long labour ended in EMCS with DD.

The consultant tried to convince me VBAC was a good option but although they could provide stats for risks relating to CS they could not offer correlating stats for VBAC, instrumental or even normal delivery. At that point we agreed I would have an ELCS.

So, I think it's good they are making more stats available, but I agree they need to be clearer.

seaoflove You are right, it was bullshit. zoobaby is pointing at the latest study/review on that subject.

Flumptydumpty I too would like much more information on incontinence after childbirth. My extremely limited knowledge would suggest permanent urinary incontinence would be more common than permanent anal incontinence and both uncommon/rare. Therefore I think they mean transient anal incontinence. But talking about "resolution" doesn't seem right either. I suspect some women keep experiencing uncontrolled wind or worse, urgency. There is also no mention of very long term outcomes, ie what happens after the menopause when the body ages. I'd be interested in understanding that a bit more.
If anyone knows the best place to get answers to these questions, please let us know.

Yes, seaoflove your consultant was talking bullshit.

PrincessOfChina what was your consultant trying to convince you on the basis of, then? Just his/her own feelings/preferences? The preference of the trust to get their c section rate down and get a pat on the back?

pinguina you are exactly right, we need this data so that women and HCPs can make evidence-based decisions. At the moment we're being expected to weigh up the risks with only half the data. Which is not a risk-based or evidence-based decision at all.

Urinary incontinence to some degree is sadly not rare. Including in those who have sections. Do those exercises!

My worry was worsening the damage that's already been done to the sphincter/pelvic floor. I told him this, and I had the RCOG guidelines in my bag. He said it is pregnancy that stresses the pelvic floor (won't dispute that) and the method of delivery is irrelevant. I hate it when doctors treat people like idiots.

But I digress. I've ranted on quite enough about third degree tears on MN

Just an update.
I'm awaiting clarification from NHS Choices about the % of anal incontinence following birth. Will let you know in due course.

In the meantime, this suggests that the numbers would be for all births.
www.cochrane.org/CD007471/INCONT_pelvic-floor-muscle-training-for-prevention-and-treatment-of-urinary-and-faecal-incontinence-in-pregnant-women-and-women-who-have-recently-given-birth

Thanks Pinguina, that's v interesting. Let's see what the revised NHS info will say. Hopefully it'll be clearer this time.

Going off to do pelvic floor exercises now....

Today I received the answer from NHS Choices website.
Sadly they confirmed that "13% to 27%" represents the rate of anal incontinence for ALL childbirth.

I have to say this particular topic was NOT covered AT ALL in my antenatal class/notes (urinary incontinence was). I don't know if your classes covered that topic and how it was presented but with numbers like this, I think it ought to be a compulsory topic to cover.

Having had two assisted deliveries with second degree tears and episiotomies I'm find this all very interesting.
I'm pregnant with no. 3 and I'm meeting a consultant tomorrow to discuss options as my preference is elcs. I'm just started to construct my list of questions!!

X

Pinguina, could you ask them to provide the details/citation of the research study they get that stat from? I will look it up and let you know what it really says.

Sadly they confirmed that "13% to 27%" represents the rate of anal incontinence for ALL childbirth.
Pinguina, those numbers look really odd. Also, what do they mean by it... Do they mean, caught short once when still bruised from the birth... or caught short once a day for the next year...?

Because I don't see how it can be the latter: I am 100% sure I would have heard about it from one of the many women with whom I have gassed on about childbirth over the years.

I'm baffled...

I suspect that that is partly because some people who have difficult first births will have electives the next time, and partly because a lot of people who have a difficult first will have easier second/subsequent (I fell into the latter camp).

Oh yes. Had rotational forceps used for DS1, which left me badly bruised and in pain for months afterwards. DS2 fell out when I went to the toilet