Forceps and Third Degree Tear has ruined my life - why does nobody talk about the risks?

[neef]

I am starting this thread because I cannot believe that no other first time mum has experienced what I am going through, and I cannot believe that the medical profession lets women suffer these injuries in the 21st century. Why isn't Mumsnet all over this?
I am two years on from childbirth and I have lost all sensation in my perineum and outside of vagina. I am suffering prolapses and bowel leakage despite doing millions of pelvic floor exercises and spending hundreds of pounds on women's health physio. I have severe pelvic pain after exercising or even just standing for any period of time. My life will never be the same again.
If I knew of these risks beforehand I would never have consented to vaginal birth and would have insisted on ELCS.
What can we do to stop this and anyone else out there suffering with me?

I had an emergency section and would never have an elective section. My section left me with permanent nerve damage and look many months to stop aching.

Whichever way you give birth, there is a risk.

"Took"

What were the circumstances leading up to your forceps delivery? Were you offered a section? Did you ask for one? Have you been given any answers? What do you want a MN campaign to focus on - more women should be informed of risks of forceps and allowed to choose a ELCS?

Viva you totally should! I'd be fascinated to see the results of a study like that and I think we could learn a lot from it. I agree that the identification and suturing of perineal trauma is a minefield and the worst aspect is that we never receive any feedback that can help us to improve our practice, unlike other aspects of the job. I suspect you are right that lower grade registrars go through the exact same thing regarding third degree tears so I don't think this is a problem restricted to midwives.

Oh and in answer to a post earlier on, hospitals do have to collate stats about 3rd degree and 4th degree tears. That info is collected.....I'm not 100% sure who by and it looks like it's not as publically accessible as lscs rates, iol rates.

In fact the rcog has just said that hospitals now have to not only collect stats on 3rd and 4th degree tears but also to differentiate between tears from instrumental births and unassisted births.

I posted on page 1 and have found the whole thread v interesting and shocking indeed!

My birth plan said I absolutely did not want forceps and would want to skip straight to a section, but as it happened my birth plan never saw the light of day and I went from 2cm-delivery in 40 mins, so no time for epidural/section. And they couldn't find DS' heartbeat. So forceps definitely served their purpose in my case but even I feel pretty uninformed about what actually went on down there. Eg tried to have sex last night for the first time and it literally felt like my vag had been sewn up inside and was tearing again, (so stopped of course) and although I'm sure that's obviously not the case my mind was racing with what state I could be in down there as I've no idea what they did do! I did ask if I'd had internal stitches but no-one knew

Like me, I only knew I had a tear (as well as episiotomy) and internal stitches because I saw them myself. I even asked her what stitches I had, but gave no explanation. And of course I have no real idea about what even went down in the labour room. I got left alone alot then suddenly they started to panic at the last minute and I don't even know why. They walked off as soon as they had the chance.

forceps, episiotomy and third degree tear here. I have a fair amount of scarring which lead to some bowel incontinence in the early days. I still get a bit of pain during sex but this was improving ( until i got pregnant again and it seems to be more painful again).
My aftercare was crap I saw Dr at about 8 weeks who asked me how it was and did a quick (not v thorough exam). At that point I hadn't even looked down there and had not attempted sex. Should be followed up much later. Luckily referred myself to a postnatal physio who was great and did ultrasound on me few times which I think helped. I am OK but do worry for the future especially post menopausal.
I didn't think to ask for an emergency section when forceps were mentioned I wish I knew that was a possibility now. Will def be getting a planned section for this one.

The Dr who sutured my episiotomy (in 1986) was a junior registrar I believe (he looked about 12) .I would think it was proably quite a minor cut ..I have my notes somewhere and will look .You are all aware that you can get copies of the notes from your delivery? (I have all my hospital records I think it was £32)
I suspect that as with a lot of things it's a question of practice-the more you do the better you get at it .My midwife daughter (first job) attended a day of training on suturing last week .She(unusually) did three while training but says it would be rare for her to it do it now .
In practice I think even if you pay for a consultant to deliver your baby it will be a midwife who supports you through labour .And I know which I'd prefer

Bue a study would be interesting. But for me it is simply logical that an Ob/Gyn Consultant is the best person to stitch a wound when they are also the people involved in assessing and treating later problems. As someone has already said, midwives may stitch wounds without ever seeing the end result down the road...at least the consulants in their general role in Women's Health have some idea of where problems can arise, and have some sense of issues to avoid during that initial repair.

I was an elc. People did try and make me feel bad but I had researched the risks and benefits of vb, elc and emcs to a high degree. I knew the benefits and risks of each so well - still do. I sat silently and made no comment as I'd made it my business to know what I was choosing. But it made me so mad that women weren't made aware of the risks and benefits of all choices. That women would be pushed to accept risks they didn't even know about. Surely medicine should have moved on but it hasn't. It also shocked me how judgment women were. I will never forget a family member telling me I hadn't given birth properly. But I didn't care!

I have had both my children by ELCS by choice. I researched it thoroughly whilst pregnant and decided that I would rather take the known risks of ELCS over the lottery of a natural labour and birth (plus I'm a wimp and didn't want any pain).

People do really need to be more open about these things but unfortunately it doesn't seem to be the done thing to do any thing other than "natural"

sorry you are suffering.

after I had my first vaginal delivery (nearly 9 pound baby, large head., long labour episiotomy, high forceps delivery, primary post partum hemorage, bi-manual massage, transfusion, second transfusion, retained products) I said to my Ob "what would you do differently in my next delivery?"

and she said "well we'd scan you and induce you early if the baby was big". Like god forbid I'd have an ELCS - better to have my baby be premature.

I was induced on the first labour and I think it was no coincidence that things went so wrong. My next baby was 10 pounds. I would have died in labour if c sections weren't around.

I said goodbye and never saw her again.

I do not think ELCS should be the norm for giving birth. I saw women giving birth and then running around on the beach or where ever 3 days later - that doesn't happen with c-sections and I wished I was them. But by god an elective c-section is better than a bloodbath botched vaginal delivery - I've had both and I know which one I recovered from faster.

Just wanted to thank ReluctantCamper who put this thread on the MN's campaigns' board.
We've been noticed! (www.mumsnet.com/Talk/mumsnet_campaigns/2421902-A-Mumsnet-campaign-on-informed-birth-choices)

Copy of what MNHQ said:
"Hello hello

Thanks very much for flagging this.

As luck would have it, Mumsnet is on the panel of the National Maternity Review, and we've got a particular remit to think about informed choice and what exactly this means - so hopefully this is an opportunity to think about issues like this.

We'll have a good read of the links here, but do please also come over to this thread and let us have your views.

You can also email us on [email protected] if you'd rather say something privately.

Thanks
MNHQ"

If the hyperlink does not work, here's where you can go to give your views.
www.mumsnet.com/Talk/site_stuff/2422177-Step-this-way-to-help-shape-the-future-of-maternity-services-in-England?pg=1

This is a very interesting, and very sad thread. My heart goes out to you all.

Can I ask a question? How feasible is it to say in your birth plan that you do not consent to forceps and would prefer to go to cs rather than have them? Is there a point where the baby is too far descended to do the cs and thus forceps/ventouse are inevitable?

That's what they said to me in my debrief. DS was too far down, they wouldn't have been able to get him out fast enough by csection.

But there was a good bit before where the midwife said to the doctor, the baby's heart rate is low, something is wrong, we need to act now. Something to that effect! The doctor said no, let's carry on... Maybe that was the point we should have gone for csection rather than the episiotomy, forceps, 4th degree tear and very ill baby that followed.

I think other countries have banned forceps. It would be interesting to know what they would do in that situation.

A couple of posters have talked about the risks of VBs being minimised, and I completely agree.

Hidden away on the NCT website is the stat that around 4% of women will have a 4th degree tear from a VB, yet not one single book tells you that. None of them say that you have a 1 in 5 chance of rectal incontinence.

Yet read the chapters on C-section risks. The Sheila kitzinger in particularly listed all the risks with alarmist language. She talks about the risks of secondary infertility from CS, hemorrhaging and blood clots.
All of these have a less than 1% likelihood, but are highlighted as reasons to avoid having a CS, when you are 4 times more likely to end up with serious complications from a VB.

It makes me very angry that the correct information is withheld, hidden or manipulated in order to push an anti-CS agenda.

I completely agree about the risks of vb being completely unspoken. I had my first baby almost a year ago - I was induced and he was a big baby with 98th percentile head. I was pushing for 3 hours and ended up with a large episiotomy and huge tear - they were stitching me back together for an hour and a half.

I left the hospital virtually unable to walk - I felt my insides were falling out! Stitches got infected then came away - I spent about 6 weeks on antibiotics and it was 2 mths before the tear and episiotomy had healed.

But I now have a prolapse and because the stitched disappeared before it had healed - virtually no perinium with a large gap in my pelvic floor muscles - I've just got scar tissue where the muscle should be. Walking and standing is hugely uncomfortable - I'm looking to get surgery soon - fortunately I have bupa cover as nhs have been completely useless.

What annoys me is that my tear was only described as 2nd deg and no forceps were used - so as far as the hospital is concerned it was a successful vb - yet still all this damage. I still can't believe it when I see mothers walking down the street with tiny newborns - I just can't believe they can walk so easily.

I hugely regret not asking for a cs.

I've seen 3 consultants privately - they all say that there is some advice about using fast dissolving sutures for birth tears as less painful - but whilst this is ok for more superficial tears it isn't ok for deep muscle tears. Apparently they're being used in the wrong circumstances - if they'd used the right stitching I'd at least have a perinium and not now need surgery for that.

spare change that is absolutely shocking about the stats.

I had never heard of a 4th degree tear before I had mine, but I'd been soundly put off by the risks of a cesarean.

Skiptonlass
"Can I ask a question? How feasible is it to say in your birth plan that you do not consent to forceps and would prefer to go to cs rather than have them?"
There is no arm writing this in your birth plan. As other posters' experiences show, it doesn't mean your plan will be followed but you can try.
It might be that you'll need to start arguing well before they mention the word "forceps" (probably as soon as your labour is not progressing anymore).

"Is there a point where the baby is too far descended to do the cs and thus forceps/ventouse are inevitable?"
In my case, the short answer is "I don't know". Neither my baby nor I were in distress.
I had an epidural (I lacked the support I would have needed-hubby did what he could but sadly was not up to the job (no hard feelings against him as he was just out of his depth) and triage midwife was not kind (more hard feelings there as she was trained and supposed to be there for me)). All well until fully dilated. Then baby was stuck. At that point (because of my lack of awareness about instrumental deliveries), I was not worried about what next. I naively thought they might use a ventouse and that would be it.

I was left one hour to see if baby would come out (I checked afterwards and that is the recommended procedure for someone with an epidural, they also turned me on my left side). Nothing. Obs was called in. Her words: "Your baby is almost there and in an optimal position, we'll use a ventouse and get him out." Ventouse failed.

Second obs comes in. Tries the ventouse again. Fails. At that point, 2 things were said:"I'm sorry, we sometimes don't know why ventouse fails" and "we're now going to move to forceps". Then "people invade the room" (2 obs, 2 midwives, 1 paediatrician, 1 somebody to hold the lights and probably more I can't remember). Then they explain they have to perform an episiotomy so they can use forceps and then they ask me to work with them and with the contractions to push. One series of 3 pushes and baby is out. And I start bleeding, a lot. Too much for delivery room so wheeled off to theatre to deliver placenta manually, stitch me back together and transfuse me.

I debated whether to write all my birth down (it is I'm sure unremarkable for a forceps delivery) and decided that it might be useful. As you can see, there was no discussion about risks. I was unaware of the risks of forceps (and use of instruments in succession or effect of prolonged second stage on pelvic floor for that matter) and because my baby's heart rate was fine, I was not worried.
All I'm trying to say is if there is no clear cut emergency, you might want to try discussing procedures before they actually happen. Easier said than done. A well briefed birth partner might be useful.
3 basic questions might have helped us:
What is happening?
What does that mean?
What options are there?

If other posters were successful in articulating their choices when things were not going well, I personnally would be interested to learn how things unfolded (what was said and when).

This link is interesting... There has been a five fold increase in 3rd and 4th degree tears in recent years.
But the thing that stands out is that if you have a bad tear first time around, you have over 7% chance of it happening with a second birth, compared to 1% chance if you didn't tear first time.
So why time and time again do we see people saying 'you'll be fine next time' when you are actually at a massively increased risk?

www.rcog.org.uk/en/blog/perineal-tearing-is-a-national-issue-we-must-address/

To put it bluntly, because it's not the consultant's 'ass on the line' (figuratively and literally). I think they think 7.1% chance of a repeat is a 92.9% chance of not a repeat.

However it would surely be better to assess each woman's risk individually instead of statistically.

If a woman has a small perineum, a high bmi, a borderline result in her glucose tolerance test or significant weight gain our is to be induced (all risk factors for 3rd and 4th deg tears) then maybe consider discussing options for managing them. DEFINITELY invite the woman to speak to a consultant about the degree of damage she currently has.

I did not suffer another big tear second time around. Just a second degree and am glad I had a vb (took a lot of courage, mind) but I did insist on a growth scan beforehand, as my damage was caused by a 10.5lb baby with a very large head circumference. I was also adamant I would no consent to forceps and cs.should be discussed early on if labour was slow. Had the consultant write that in my notes.

skiptonlass
In answer to your question on whether it's ever too late for a cs, yes.
It all depends on where in the birth process that baby is stuck. If it's at the very top of the pelvis, then a cs is possible. If the baby has descended a little bit (but before the 'turn') they may use the very risky kiellands forceps to help turn the baby. Though these have been banned in a lot of countries and some hospital trusts. They require a lot of skill and are used rarely so obs may lack the necessary skill to use them safely. By turn I mean that at the top of the pelvis the baby must face your hip to get through. At the bottom of the pelvis it should face your bum.
If the baby is stuck after the turn they'll use other forceps such as Neville Barnes.
If the baby is already quite far down the birth canal, then ventouse will be tried. These are preferred as they aren't the fanny shredders that are forceps.

A c section attempted when the baby is far down through the pelvis, especially after the turn, is very tricky and risky. It involves pushing the baby back through the pelvis. The turn makes that difficult.

I am not a obstetrician so am happy to be corrected. This is just my lay understanding of the decisions and process.

By the time they start talking about forceps, it may be too late for a safe, standard c section and proceeding is the least risky option. for me, a heads up about this would have been appreciated.

I think a better understanding of poor presentation, posterior babies, turned heads etc would help to assess EARLY whether this baby is going to get through. Would it be so unfeasible to have an ultrasound DURING labour?

And I'd like there to be mention of possible forceps or ventouse BEFORE a cs it's off the cards. Keep the woman involved.

I was laboring for 70 hours before reaching second stage. That INCLUDES a synto drip induction. Two hours of pushing should have been a clue that I want getting that baby out by myself. Yet heart rate was fine and I was led to believe I could do it off I just persevered. I was fighting a losing battle, though.

thanks roly and pinguina as I had the same questions as skiptonlass, being a first timer.

After what I've read I really don't want forceps so am hoovering up alternate info and questions to ask (and making sure to pass them on to DH for D day )

I'm in the US and the stats from my hospital show that forceps are hardly used (I think this is the norm in a lot of places); I have my hospital tour and follow up in the next week with my Dr, so I'm going to start quizzing her about delivery. I suspect at some point here they go c section, but I'm really interested to see how, what, when and where they make this call, must be from an ultrasound or similar at the start of labour I imagine

An ultrasound during labour would have really helped us know what was going on. They didn't realise DS was presenting back to back until he popped out the wrong way round. At my debrief, they validated it by saying every consultant gets one of these births and I was it.

They should be working with women to properly and safely deliver these births, not brush it off as just bad luck. After all, I'll have issues to deal with for life now and if we do have another baby, I've already been strongly advised by 2 doctors to have an ELCS. Hardly a good outcome!

Yes and what does that 7% chance of another a bad tear mean for the woman that has already had one?

If she already has serious muscle damage it could lead to lifelong disability.

Oh and I think the actual number of serious tears is higher because so many get missed and there is no feedback loop.