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

This is from the Cochrane review I've linked to below (the body of evidence NHS basis treatment protocols and health policies on)

"Furthermore new, unexpected long-term risks of caesarean section continue to be reported; these include abnormal placentation (Serena 2005), ectopic pregnancy, haemorrhage and hysterectomy following uterine evacuation, latex allergy, implantation endometriosis, adenomyosis and increased hospital readmission (Bewley 2002). Caesarean section has also been associated with emotional difficulties (Clement 2001) including postpartum depression and negative feelings about the experience of childbirth, but not specifically among women undergoing caesarean delivery by choice (Minkoff 2003). Suggested increased risks for the baby of delivery by caesarean section include, increased admission to neonatal units/separation of the mother and neonate (Treffers 1993), iatrogenic prematurity (Wagner 2000), laceration (Smith 1997), increased neonatal respiratory problems (Madar 1999), increased special educational needs in later life linked to the timing of the caesarean section (Kapellou 2011; MacKay 2010) and stillbirth in the next pregnancy (Smith 2003). A recent literature review suggests that vaginal births involve important physiological changes that are absent or modified in babies born by caesarean section (Hyde 2011). Authors suggest that vaginal birth is an important life programming event for the infant, and that the differences in physiology that arise between vaginal and caesarean births have implications for the infant, with caesarean section increasing the risk of compromised health in both the short and the long term (Hyde 2011)."

No doubt women reading can decide for themselves whether they like Dr Amy or One World Birth better, although if that's the most disturbing thing you've ever seen online you can't have been following Jan Tritten's actions around Christy Collins' last kill.

On the subject of microbiome, OP may benefit from having it spelled out that while we know there are differences in gut flora depending on mode of birth and feeding, the latter not seeming to be relevant in this instance as OP hasn't mentioned feeding intentions, we don't actually know whether this actually makes any difference, positive or negative. We do know, of course, that gut flora is a rather changeable thing, that it has evolved throughout human history, and it will also change once baby goes on solids. You clearly take the view that it would be better to stick to what we know in the absence of proof that altering it isn't going to be harmful, if you like, since clearly the existing research hasn't established matters either way- this is why authors were calling for further work to be done in the area. OP may or may not prefer to base her decision on known risk factors. That's her call.

I would also politely request that you refrain from using 'insane' pejoratively.

Wow hadn't expected this! I've not had chance to watch or read all. But I will try but not sure it'll answer my concerns.

Beloved I'm obviously fully aware no one can guarantee either but with the risks to baby being higher with assisted delivery id prefer a section. You say very few women has assisted delivery if delivered a baby before I must be one of those unfortunate ones having had two so if I was a betting women id bet on having another as both times I've clearly been unable to deliver a baby on my own naturally.

"You clearly take the view that it would be better to stick to what we know in the absence of proof that altering it isn't going to be harmful"

No - it's not about 'sticking to what we know', no one is suggesting that. It's just that discussions about vb/cs and 'safety' surely ought to encompass more than just immediate outcomes, if longer term outcomes are regularly discussed outside of this forum in relation to this issue. I'd also say that bland assurances that 'you won't regret it' when it comes to any birth choices aren't appropriate in light of what we don't know.

"I would also politely request that you refrain from using 'insane' pejoratively."

Sorry, I'll be clearer. I think Amy Tuteur is both unpleasant and mentally ill. She could of course be unpleasant and not mentally ill, or mentally ill and not unpleasant. However, in her case she's both.

Not mad on Jan Tritten either. Oddly, I think she and Amy Tuteur are cut from the same cloth.

Nutella, I'm not sure the consultant will agree that an assisted delivery is more of a risk to your baby than a planned c/s, or that you are necessarily at high risk of a repeat of one.

If you're going to make a case for a elcs to the consultant I think you'll probably have to argue on the grounds that this is for your benefit - that you aren't prepared to risk another assisted delivery as the last two experiences were traumatic and have left you with lasting physical pain.

My obstetrician also gave me the ordering Molotov listed:

• Unassisted vaginal
• ELCS
• Assisted

-EMCS

I also think that some of the risks of ELCS fall to the NHS to deal with whereas some of the risks of unassisted vaginal that go to the end or that end up assisted but don't require surgery fall to the mother (ongoing bladder problems for example) and are not allocated to the intervention when calculating relative risks after the event. So they don't get "counted" in the risk metrics in the same way.

Beloved, yes, I once researched in detail the studies conducted which seemed to demonstrate a link between asthma and CS delivery. It was based on flawed data. I looked at this stuff over 3 years ago and cannot remember details to link. Apologies for this, as it would be really useful especially as it was an objective assessment.

I think you show yourself to be too personally involved/set against CS wrt your comments in other posts: especially against an individual who another pp mentioned who you labelled as a "loon".

I still think Cochrane is woo. I couldn't fathom anything that was useful to an individual needing/requesting CS.

As a worthy side, do mental health reasons mean anything to you? Just because a woman can give birth vaginally, does not mean that she should.

Thanks, prem, for supporting my first post back there.

I agree with the posts by Lady at both 15:39 15:33.

*15:43, not 33.

I think I'll be discussing risks to both me & baby which I fully understand, the reason for this post was to get a better understanding of the risks to baby - in regards to the procedure. I'm feeling a little confused by most of today's posts but will try to read again later when I've not two children demanding my attention.

X

nutella, you nees to examine the risks/benefits that are known. The long-term risks to babies born by CS are not known: you cannot logically base your decision upon what is not known.

I was born via high rotational forceps (I was almost an EMCS delivery) and suffered chronic childhood asthma. Happens to run in my family. My DM suffered pelvic floor damage as a result of that intrusive forceps delivery.

What I'm saying is that you have choices based on knowledge and data gathered so far. You nees to decide which risks/benefits appeal to you the most. Forget the guff and consult the Greentop Guidelines and NICE recommendations.

Good luck

Thanks Molotov I appreciate that.

I'm not someone who dwells on anything that isn't fact so I won't let it cloud my thoughts.

I'll do some more reading tonight.

Thanks for sharing dingalong. X

Nutella and dingalong , I am also one if the unfortunate 'few' who had a worse delivery with dc2, and was left very swollen and sore after being in labour for several hours before they decided I clearly wasn't progressing.

Dc2 was born with extensive facial/cranial bruising which led to concerns about bilirubin or jaundice (I think, I'm not a medic)

I had horrible painful tears and episiotomies both times and was nearly dragged off the table (both deliveries done in theatre) such was the force they used to extract my baby.

I defy anyone (including my NHS consultant) to tell me it is safer to my baby to try all that again. My consultant agreed with me and is willing to discuss with me again at 34 wks in case I've changed my mind.

Fwiw my trust are also now doing 'customised screening' for short arses like me but also other ethnic groups and very petite women who are (like me) married to 6ft westerners. I'm getting extra baby sizing scans at 28,32,36 wks. If baby is large they will suggest csection regardless of previous obstetric history.

I know this is a hugely hot topic but some of the links here are not very helpful and I think both options are not entered in to 'lightly' by women who have had experiences like myself, and OP.

Thanks Annie & good luck with your 34 week meeting.
Unfortunately I'm a great tall 6ft so can't argue the petite arguement haha but I'm glad to here your trust is taking proactive steps. X

I've been reading this thread open mouthed!

I can't quite understand the very 'hard sell' tactics from beloved about vaginal birth. I just don't get it...

I was told and have read the same order of risk as Molotov and Prem have said, and I agree with Prem that the complications of vaginal births for the mother are less likely to be reported and recorded. I also think that most elective csections are done because of a pre existing condition in the mother or baby, and that's not accounted for in the stats.
I personally believe that if all things were equal, healthy mothers and babies before delivery, Elcs would be shown to be at least as safe as vaginal birth.

Good luck Nutella

Thanks meeska

I think the important part of that though Meeska is "all things being equal", which does not take account of the sometimes arbitrary policies in an NHS hospital.

I know my particular circumstances aren't relevant to Nutella which is why I asked if this would be her last baby. Since it is, and given the nature of her previous births, c-section is a perfectly rational decision.

But. I was pressured into having a c-section because my hospital had a policy of intervening if a woman is in labour for more than 24 hours. They count this from the time that she presents at hospital. I was told to come in as soon as my waters broke for unrelated reasons, so for me, the clock started earlier than it would for many women. There is a family history of long labours - my mother's third labour took 36 hours (she had a total of 4 vaginal deliveries over 10 years). Neither I, nor my baby, was in distress: the c-section was for the convenience of the hospital. It left me with adhesions to one fallopian tube, which was then twisted round and stuck to my uterus, pulling it out of alignment. It took five years of infertility (including a miscarriage which I was later told was doomed because of the misalignment of my uterus) before anybody even mentioned that my c-section might have been to blame. By then, I was 40 and my fertile years were behind me.

Now, I understand that these circumstances are extreme. I very likely have a claim for negligence against the NHS, but I am not sure what purpose that would serve other than take money out of an already cash-strapped service and deprive other patients of the care they need. But I do feel passionately that women considering a c-section for reasons other than medical necessity should be informed of the risk of secondary infertility so that if she wants to have another child, she can factor in this risk.

Beloved72 Wed 29-Apr-15 19:23:22
"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%.

However since the OP has had shoulder dystocia those stats are not relevant. She will be at much higher risk of a complicated birth than those stats suggest.

She is unlikely to be classed as low risk - which is what the birthplace study reported on - and would probably be classed as high risk if I'm not mistaken

Which puts a very different spin on that risks and where she should consider the best place for her to give is.

There are unknown factors regarding an ELCS. Yes Cochrane say things but they are also not flawed themselves. Most of those studies combine data for ELCS and EMCS and as such are perhaps do not truly reflect the risks accurately for an ELCS. Also ELCS are now recommended not to be performed before 39 weeks unless there is another clinical issue that puts the baby or mother at risk, for many of the reasons related to breathing/admission to SCBU. You'll also notice that Cochrane say
that psychological issues are NOT associated with women who have an ELCS by choice. There is tonnes of evidence that if your planned method of delivery matches with your actual method you are at much lower risk of psychological issues. Whether that be a vb or a cs - simply because you can mentally prepare.

I would caution the OP to understand what she is really reading and to understand that if she looks at any research she considers that a planned ELCS should NOT be put together with a EMCS for risk as its poor methodology in the vast majority of cases (there are some places where it is appropriate to look at but most of the time data for the two should not lumped together). Instead an EMCS is part of the risk for a planned VB and should be compared with a planned ELCS in this way.

Many risks for an ELCS are associated with repeat CS too. So how many future child the OP will have is a relevant consideration. Having had 2 child previously already the likeihood of the OP having more is perhaps limited.

I generally think Cochrane is good however in this particular case there is a massive problem with the quality of studies because of the lack of separation of planned and unplanned CS. Its a problem that is not being properly addressed in research even now.

I think the OP needs to consider the following: her psychological well being, the number of future child she intends to have, how much she is at increased risk of a complicated delivery due to her medical history.

Spouting ideology and irrelevant information is not particularly helpful. Especially when not considering the OP has specifically mentioned her psychological wellbeing and her more complex medical history.

Redtooth thank you that makes a lot of sense

(P.s. It is my last child!)

Sorry, I'll be clearer. I think Amy Tuteur is both unpleasant and mentally ill. She could of course be unpleasant and not mentally ill, or mentally ill and not unpleasant. However, in her case she's both.

Sorry but I find this a deeply sickening and inappropriate comment.

I think Amy Tuteur is incredibly wrong and biased in what she says. She is at the end of the spectrum of having an agenda and doing anything to push it.

However I do not think she is mentally ill. And as someone who has mental illness issues I find the comment sickening and stigmatising. She is someone who simply believes something to a level which is evangelical. I do not think she is particularly far removed from some natural birth advocates who say things which are utterly barmy.

I tend not to take her blog terribly seriously. And where it does have a point, it has to be taken within the context that midwifes are trained (or more to the point not trained) very differently in the US to the UK.