Are assisted deliveries more risky for baby than a c section?

[nutelladipper]

Just that really...
I'm meeting with a consultant on Friday to discuss birth options. I've had two assisted delivery one ventouse one forceps. Forceps was due to mild shoulder dystocia.

I'd prefer a c section after two fairly traumatic births. Risk of another shoulder dystocia and general fear of more bad tears/scars and more damage to my already painful and damaged coccyx.

I'm trying to prepare for meeting my doing lots of reading but most compare a c section to a natural simple delivery. Given the odds I suspect is have another assisted so wanted to know about the risks to baby?

I know I can obviously ask consultant but trying to prepare!

Thanks

Did you have an epidural for both births and were you supine when you gave birth?

Both these things make a forceps/ventouse birth more likely and increase the chance of a shoulder dystocia.

When you say 'forceps were due to a mild shoulder dystocia' I wonder if you've got things the wrong way around - assisted delivery is a risk factor for shoulder dystocia, not a way of resolving it. Shoulder dystocia can never be resolved by twisting or pulling on the baby's head, as it's a problem with the shoulders - that they haven't fully rotated and therefore are impacted on the anterior pubic arch. It's usually resolved by pushing the mother's legs back against her chest (McRoberts manouvre) while applying pressure over the baby's shoulder to dislodge it. Pulling on the baby's head is absolutely contra-indicated. here

My SIL asked for a caesarean after problems with her coccyx the first time (much physio), and they said yes.

I requested an ELCS for my dds birth in 2012 following from the assisted delivery of dd1 in 2009. I'd had an assisted delivery with ventouse and incurred damage to my tailbone (which I still have pain with, 6y on despite having physio 4m after her birth).

I got the ELCS but had to fight for it. The consultant did not recognise my coccyx pain as a genuine medical reason. It was granted as a plain old 'maternal request'.

FWIW, the CS happily madr no difference to my tailbone issues

I think the risks for the baby generally go:

Least risky

1. Natural unassisted vaginal delivery
2. ELCS
3. Assisted vaginal delivery
4. EMCS

Hi beloved. I'm not sure what Supine is sorry? But no I didn't have an epidural for either.

That may well be right, i can't remember what happened I just remember forceps and episiotomies! I wasn't aware of should dystocia until afterwards.

Either way they were two births I'd really rather not repeat?

Thank you

Supine just means lying flat.

Very unlucky to have no epidural but a forceps with a second birth - that's very rare.

I've also had a shoulder dystocia and I understand what you mean about not wanting to repeat the experience...

Instrumental deliveries are more common in women who've had epidurals, but that doesn't mean the epidural makes the instrumental birth more likely. There is correlation, doesn't mean there's causation. It's also possible that this is because women who feel the need for an epidural are experiencing issues that make instrumental more likely, such as difficult positioning of baby, lengthy labour, exhaustion etc.

Like you OP I've experienced the joys of unepiduralled ventouse and can see why you'd rather not repeat it! Actually if I had to do that or my recent EMCS again, it'd be the latter every time. Good luck finding a suitable way forward.

motolov I don't agree with your assessment of risk. I would have thought ELCS and assisted delivery is similar. One is a major abdominal delivery and another is performed in emergencies. Without statistics we can argue all day long about how many have complications following ventouse and we will go no where.

FWIW I had ventouse with DD1, no tear, episiotomy and just stitches. Then normal unassisted delivery with DD2 with episiotomy and minor tear. Again just stitches. Both recovery are the same. Ie bounce out of bed, walking, feeding and no pain down under immediately.

Terrors, that wasn't my personal assessment of risk. I read it in a reputable article some years ago now, but cant remember where, otherwise I'd provide a link.

Remember that was in response to the risks to the baby: the abdominal surgery itself is a risk to the mother. The risks of ELCS to the baby - if delivered over 38w - are negligible.

But in summary an elective c section is safer than assisted.

First was ventouse, episiotomy & 2nd degree tear.
Second was forceps, episiotomy, deep 2nd degree tear. Shoulder dystocia and cord around neck. Ages to heal. Couldn't drive for a few weeks and sitting due to coccyx pain was hard. Still have pain now. Tears are also still sore.

X

I had this conversation with my consultant. She advised that an ELCS was less risky for the baby than an assisted delivery, with EMCS being the most risky. That chimed with the reading I'd done before our meeting. As I have a relatively high risk of needing an EMCS or assisted delivery I have decided to go for ELCS. Yes, it will be major surgery for me, with all that recovery from abdominal surgery entails, but the baby is my main concern. And, let's face it, recovery from a 3rd or 4th degree tear is no walk in the park either.

I hope you get the birth you want this time, Nutella.

Thanks Flumpty. That's really useful.

The consultant I'm meeting is one I've not met previously and I just hope she's not one that won't allow an actual two way conversation (like my last!).

What ready had you done?

"But in summary an elective c section is safer than assisted"

Really not so - not for mother.

Would point out that according to the birthplace study 95.9% of healthy mums having a second/third/fourth baby at home had a completely normal delivery. The forceps rate for this group was 0.4%. Unplanned c-section 0.5%.

Thanks to all for answering my confusion.

Yes beloved I know it's more of a risk to me but I'm willing to take that risk as long as im not putting baby at risk. Thank you

Sorry, nutella, I wish I could find you a comprehensive document that spells it all out, but there doesn't appear to be one, sadly. When I was researching I had to go all over the Internet to find different pieces of data and evidence and then try and piece it all together. For example, I researched the risks to the baby of ventouse/forceps then those of ELCS. The problem is that the data is not granular enough to make a perfect, 100% informed decision based on all facts, eg ELCS figures lump in all pre-planned c-sections, including those where mum/baby was seriously ill beforehand. That is clearly going to result in a different (higher) risk profile than ELCS on maternal request, or for previous history of shoulder dystocia.

After much research and soul-searching I felt, on balance, that a c section would be the least risky option for my baby. If somebody could have guaranteed me a "normal" unassisted vaginal birth I'd have been happy, but of course nobody could.

Flumpty funnily enough what you are saying about if someone could guarantee a natural unassisted delivery you'd of have that is exactly what I said to my husband yesterday.

Yes I've had the issues with research being disjointed in terms of getting the answers I want.

Thank you

nutella I literally could have written your post.. I have already had the Consultant appt and didn't have any problems, she listened to what I had to say and agreed that we would have another appt nearer my due date which is fine by me..

They do this as standard when you are requesting a Csection from what I can work out, in case you change your mind (not bloody likely) or in case any other aspects of your pregnancy change.

In the UK (assuming you are) following the NICE guildlines you are allowed to ask for an Elective section, if your consultant is not willing to do it they are supposed to refer you to someone who will. The midwifery service is supposed to be all about 'respecting mothers choice' so don't get in too much of a flap like I did, felt like I was going for a job interview or doing a sales pitch

I have also done a bucket load of research and agree that it is virtually impossible to find stats on elective c sections ONLY (ie not including emergency,previous illness, other factors etc)

I, like you would gladly have a vaginal delivery if someone could guarantee it would be successfull and not result in a bruised battered baby and bruised stitched, ripped, ends up infected and on antibiotics vagina for me...

Is this likely to be your last baby? My c-section left me infertile, so personally it isn't something I would enter into lightly....

Annie That's good to hear.

Yes this is my last baby. Sorry that has happened to you.

X

Nutella, I had an awful instrumental 1st birth and fought quite hard for my eventual ELCS. The experience and recovery was a piece of cake in comparison to the instrumental delivery - it was really cathartic for me and DH. I too was willing to risk the harm to me so long as the risks to baby were small (DD1 was left scarred by her forceps delivery).

You won't regret this decision.

Thanks herethere. I'll let you know how it goes after my appointment on Friday. X

"Flumpty funnily enough what you are saying about if someone could guarantee a natural unassisted delivery you'd of have that is exactly what I said to my husband yesterday."

Nobody can guarantee you that OR a straightforward c-section.

Rates of emergency c-sections and assisted deliveries are very, very low for women who have given birth before - for women who go to birth centres they are less than 1%.

"You won't regret this decision"

You absolutely can't say that unless you have a crystal ball.

Would also add that the risks to the baby are not just those arising from the birth itself, but of the possible future impact on the immune system of health of mode of birth.

You can't assess the risks and benefits of c-section or vaginal birth without taking these things into account.

microbirth

Beloved, I agree with some of your counterpoints. However, the link you provided seems incredibly woo to me.

I believe the link between asthmatic children born via CS is grossly misleading: eg. it wasn't determined whether the control group came from a family with asthmatics.

Stuff like this is just scaremongering, anti-CS tripe.

"I believe the link between asthmatic children born via CS is grossly misleading: eg. it wasn't determined whether the control group came from a family with asthmatics."

I haven't had a look at the evidence the Microbirth film discusses so I can't discuss what controls are in place in relation to atopic disease, diabetes etc. Have you?

However, there is a growing body of evidence on the factors influencing intestinal flora of infants born at home or in hospital, vaginally or abdominally, babies who are fed breast milk or formula milk, which is finding startling differences between these groups. This alone would concern me, given what scientists are discovering about the influence of the human microbiome on adult health.

As for it being 'woo' - even a Cochrane summary of the risks and benefits of planned c/s for low risk mothers states: "The differences in neonatal physiology following vaginal and caesarean births are thought to have implications for the infant, with caesarean section potentially increasing the risk of compromised health in both the short and the long term. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics."

Cochrane reviews 'woo'? I don't think so.

It also points out "There is no evidence from randomised controlled trials, upon which to base any practice recommendations regarding planned caesarean section for non-medical reasons at term. In the absence of trial data, there is an urgent need for a systematic review of observational studies and a synthesis of qualitative data to better assess the short- and long-term effects of caesarean section and vaginal birth."

In other words - where departing from the physiological norm without a sound clinical rationale, it's not good enough to say 'lack of evidence of harm is proof of lack of harm'

Cochrane

here

Woo would be right. If anyone reading is going to watch that film, would be a good idea to educate yourself about the other side of the coin too. Dr Amy Tuteur has some choice words.

www.skepticalob.com/2014/01/microbirth.html

I disagree strongly with her on a number of points (personally I'm pro homebirth for those who want it and opposed to circumcision, for example) but her views on this are worth reading. Anything that's not only been endorsed by Jan Tritten but is happy publicly associating itself with her should be approached with a great deal of caution.