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?

This is one of the reasons why I chose / have chosen ELCS (currently pregnant with DC2 and 2nd ELCS booked). Your chances of having a tear with long term consequences are significant and there's no equivalent risk with a c-section.

OP - thank you for speaking about your experience. I hope things get better for you.

There was a recent Scottish case involving a woman who delivered a large baby vaginally and won compensation on the basis that she was not properly warned of the consequences of attempting a vaginal birth.

Before you have a CS your doctors have to tell you about all the possible risks to you and your baby. This isn't done for VB - why? Presumably because of the desire to keep the CS rate down. We have to educate ourselves on the risks. It's odd. I think so many more women would choose ELCS if they were fully aware of the risks of VB.

Your chances of having a tear with long term consequences are significant and there's no equivalent risk with a c-section.

No, I agree. Though, of course, there are different risks. A friend of a friend had a perforated bowel

I agree with you - we should educate women about risks of vaginal birth. Both options have risks, so women should be allowed to make an informed choice about the risks in their situation and the risks they are able to live with. For example, the profile of an ELCS will be very different for a woman who wants one child to one who would like four.

What has your GP said OP? Have you been examined recently? Perhaps you need reconstructive surgery.

there's no equivalent risk with a c-section.

this is just not true - there are long term risks to elcs, just as there are to vb.

if there is going to be a change in the way we deal with post birth trauma, we need to accept that there are risks to all types of birth

hazey - it depends how you are using 'equivalent'. I assumed the OP was using it as meaning similar. If you are using to mean 'of similar magnitude' then obviously yes there are. If you mean 'of the same type' - well perineal and anal tearing is obviously unlikely.

Sorry - I didn't explain my comment because it seemed too long-winded. Here goes:

On my reading of the risks of VB and CS (NICE/NHS publications), there's no complication arising from c-sections that has the potential to give rise to long-term issues (incontinence, sexual dysfunction etc.) that is as common as tearing is in vaginal births. The risks are either more serious but more remote (e.g. hysterectomy due to post-partum hemorrhage) or more common but less likely to have long-term consequences (e.g. increased likelihood of NICU admission). Tearing and long-term issues arising from it is/are common.

As has (I think) been mentioned up-thread, the fact that these issues take time to emerge / solidify / clarify means they aren't often thought of directly in the context of birth or given the prominence they should be. Prolapses, continence issues etc. seem to almost be viewed as normal for women.

I remember reading an article by a urological surgeon at some point where the chap said that the fact of his having spent most of his career carrying out reconstructive work on women who have given birth vaginally had turned him into an advocate of caesarean birth. Obviously he was seeing the worst of what could happen but seeing the devastating impact that these issues can have on a woman's every day life clearly had an effect on him.

Yes, I guess anal and perineal tearing isn't going to be a problem with csections!

However there can be longterm bowel and urinary problems related to sections. I am waiting for a gastroenterology appointment at the moment, and have been on forums where a lot of women are suffering horrendous diarrhoea, IBS, severe pelvic and bowel pain and pain having sex since having a section, strugglng to be taken seriously.

The rates of surgical complications in csections are around 12% (one or more of the following bowel and bladder lacerations, or long term damage to the urinary tract or cervix) and I think the rate of 3rd and 4th degree tears (in first births) is around 6%.

This is why I say that all types of birth can have consequences that don't get taken seriously by hcps, and get swept under the carpet.

hazeyjane
There is a very marked distinction between the rates of complications arising from EMCS vs ELCS, especially regarding things like perforated bowels, simply because of the nature of emergency surgery performed in a hurry.

When you look at the ELCS rates, there are no complications that are remotely comparable with VB complications, yet when you are having to sit there with a consultant fighting to get a ELCS, all the stats they throw at you to put you off include complications from EMCS. And as so many have mentioned, you are NEVER sat down and warned about the risks of life-changing complications arising from a VB even though they are statistically more likely.
There is even an unpleasant contingent on MN threads who will trot out the old 'CS cost the NHS more, so you are selfish not having a VB' even though countless studies have shown that when you look at the cost of both over a number of years, they are nearly identical because of the costs associated with repairing women after traumatic VBs.

All of you who have had awful times, I'm so sorry.

Please don't feel that you are alone though. If you can do, do join the Birth Trauma Association Facebook page which is a great resource. I've found it very helpful.

I'm currently 31 weeks along and have a 3.7 DD and her birth was very traumatic. I've just finished an NHS CBT course of sessions which weren't particularly helpful and I'm left a bit in limbo regarding what to do at the moment as I have to tell the consultant in five weeks time if I want a planned CS or go for VBAC.

So, I'm going to see a perinatal psychologist tomorrow which is eye-wateringly expensive but I really need to figure out what I want to do fast!

Hysterectomy and bladder lacerations are the same in electives and emergency sections, other surgical complications are a lot higher in Emergency sections - 4.8% in electives. Bowel problems (that aren't caused by lacerations) are the same as it is from adhesions and the removal of the baby. Lung issues in newborns are higher in electives than emergency sections and pelvic pain higher in electives (although there is no idea why!)

I know that there are long term devastating effects of vaginal births (I have had both and have issues that arise from both) - In all the literature that I read and all the women I talked to pre birth Of dd1 I was told about tearing, incontinence etc (my mum had a 3rd degree tear with me and believe me, has told me all about it!) - but despite knowing all of those things I still chose a vaginal birth.

I am not trying to argue that any method of birth is better than another, honestly, and I think everyone needs to be informed about the possible outcomes in all types of birth - but I think the one thing that does need to be addressed is the crap long term care for problems that arise from childbirth (caesarean and vaginal) from the midwives and hv that see you immediately after the birth, to the gp and gynaecologist who fobs you off years later.

With the lung issues in ELCS, I wonder if they can control for the fact that those babies will generally be born 'early' (within term, but possibly 2, 3, 4 weeks before they would have come naturally)? Presumably that would be more of an issue with electives than emergencies.

Yy to the long term care. I asked my gp to take a look when I was 5 months post partum as I was concerned. I had pain when standing that had not gone away. She said all was fine, but it was clear she had no idea what she was looking for. I then had a smear test and the nurse was an ex midwife. She knew what she was talking about. . It was she who explained to me that I had a prolapsed bladder and that there are surgical options for repair.

I pushed for a referral to a urogynaecologist. He refused to see me until I had done physio. When I finally did see him he was a complete arse in his manner. Made me feel humiliated (unnecessarily) during the examination because I weed on his hands when he told me to bear down (i had a full bladder as per instruction and I warned him i would leak. He said go ahead anyway. Then when I did he sent me off gruffly to empty my bladder before continuing the examination, like I'd done something wrong.

He was dismissive, uninterested during our chat. Made it quite plain that I need to go back to physio. Told me I have a weak pelvic floor (no shit, Sherlock. But why after doing 100 pfe per day for three months - though I had just recovered from a three week cough).

I had to push him to tell me whether I had a prolapse (bladder and urethra I could see for myself) because he just was not interested. He just leaned back in his office chair, turned away from me as he said: it's your pelvic floor. Come back in three months.

I was so put off that I cancelled the follow up appointment. Now I don't know what to do.

I had a horrible experience giving birth... Third degree tear, episiotomy, forceps delivery and now prolapse both front and back passage. I had a catheter for a month and to this day I struggle to void.

I'm absolutely traumatised and cry every day. I did ask for a c section which was denied by my horrible doctor, a bloody woman who had no bed manor at all.

My labor wasn't progressing g and my son was in breach... She just simply said to me several times I did not want a c section.

Forceps was brutal, I almost fell down the bed as they were pulling my son.

I don't know if I will ever have sex again.

I can see inside my vagina two bulges and I can tell try cut my labia, which no longer cover my opening. Tbh I look disgusting and feel horrible and terrified to never be fixed.

Everyday my mind goes back to the day I gave birth and wonder what could I have done to prevent so much damage. Why a c section was denied to me. So many whys

I know I'm only 3 months post partum but I just don't expect things to improve.

I do feel this has ruined my life.

With the risks of prolapse and severe tears I do believe c section is much better... I'm ruined for life... This could've been avoided with a c section

Thanks roly and penguina for your thoughtful answers.

The impression I'm getting from things like this is that truly informed consent is not as common as it should be. I also have a bit of a language barrier where I live so talking about all this before and being kept informed throughout is going to be my biggest hurdle I think.

holy crap my mouth is hanging open reading this. i'd expect these kinds of stories from a developing country, not the UK :(

are you allowed to sue? cos some of these stories come under medical malpractice imo. And not getting a c-section for a breach birth? wtaf?

It's me again (recovery from surgery so a bit of time on hands).

lastuseraccount123 Sadly this is the reality of all urogynaecology and colorectal services. The situation in the developing world is much worse (sorry for stating the obvious), with for example women who somehow survive serious birth injuries (their infant rarely survives) and then spend the rest of their lives indoors because they are completely incontinent. They are also often stigmatised and rejected by their community. These women have not had forceps used on them (neither did they get all the antenatal checks and scans we get to detect problems early, nor do they have access to trained midwives) and this is why I personnally would like a better education about birth and the pelvic floor.

To me, opposing c-section v forceps is not the answer. Just like opposing midwives v doctors, natural v artificial, feminism v well, there's no word for "masculinism" (clearly males' ideologies are dominant so they don't need such a concept), etc is not necessarily helpful. They can be interesting debates but they don't usually make things move forward very much.

I would like:
Acknowledgement of all types of obstetric injuries and better education about them
A lot more sympathy for women who suffer these injuries
Much better postpartum care (and more sympathy again)
Truly informed choices
Informed consent actually being sought
More money (money always helps)
More research into all things related to pelvic floor dysfunction
The inherent risks of childbirth gain more publicity

And on a very personal level, I would like:
my sex life back
be able to jump and run like I used to
have a pain-free coccyx
not be incontinent when my menopause arrives

natty ((((hugs))))

What's your Gp like? Can you go back and talk through that awful appt? Do you have any scope to see a private physio with specific expertise in women's health? They will then send a report to your gp...

Maybe take a look at the birth trauma Facebook page mentioned upthread?

Hang in there. I was in a nightmare situation after my dds birth and it did improve. It took time but it improved. Where in UK are you? I got referred to St Marks in North London who were v good. Thinking of you.

pinguina I agree.

Birth injuries are so hidden. Who am I going to talk to about my incontinence? Women in developing countries have it much worse. Their injuries are more likely and more severe. Ironically their rarity can be s problem here in a way.

After I had ds1 I was left completely incontinent. Totally and utterly unable to hold even a drop of urine. I tried to explain to the midwives on post natal that i need another inco pad for the bed. No, a proper one, not that 3mm thin thing. They did not understand how incontinent I was. Until I showed one. I stood up and the entire contents of my bladder gushed out. A pint, despite the catheter. In fact, catheters fell out or leaked. I had six catheters put in and eventually said 'no more. Just give me nappies'. I was severely rationed in nappies. Far fewer than I needed, but the midwives had difficulty scrounging them from other depts.

Consultants came to see me, mystified. There was concern I had a fistula, so my bladder leaking into the vagina. X Ray scan ruled this out but I had no sensation of fullness, of voiding, nothing.

Turns out their best guess was nerve shock from the prolonged labour on my back with a poorly positioned baby. They're were visibly relieved to find out it was not a fistula. Only two surgeons in the entire country deal with those.

They had no idea whether this was permanent. I was sent home with a shrug.

It took a few months but slowly I did get a return of function. I could eventually choose to wee, meaning my bladder was holding. It's three years on and im stress incontinent and occasionally leak urine without warning or sensation. A steady trickle. I can't feel when my bladder is full. I go by the clock. I'm pregnant now and fear for my pelvic floor.

Another one ruined by forceps. DS was stuck so I was taken to theatre for keillands forceps to rotate him. He came out battered with marks on his face and didn't wake or feed for the whole day, nobody checked on him all day but that's another story.

I had episiotomy and only second degree tear, none the less it was agony for months, I couldn't move let alone walk for the first week. No after care, refused pain relief as staff too busy chatting despite me begging and crying in pain.

Multiple visits to various gps who refused to look and gave more prescriptions for antibiotics. Eventually paid private after calling maternity unit and being told you've had a baby what do you expect.

Encouraged to have second delivery naturally as everything vaguely healed by that time although nobody actually wanted to check.

After birth of second dc finally diagnosed with severe prolapse of bladder and bowl, mild uterine prolapse and perineum non existent. Various problems on a daily basis that I won't go into. I will be having surgery but am told I'm so young this will probably need to be repeated and each time it gets harder to repair.

On top of that I have coccyx pain everyday sitting and lying down which I don't think I will ever be free from.

Plus there was the suicidal PND which I was too ashamed to get help for.

And I was the one who turned my nose up at women who wanted c section over natural birth and at the time was so relieved to have avoided a c section. Now I know which option I would want for my daughter.

I also saw a specialist midwife when pregnant with dc2. She was more than awful and told me not to think she was my fairy godmother and after two sessions never got in touch again despite me clearly being a wreck.

I could go on and on but basically my experiences of birth on the NHS have been dire and I wouldn't wish them on my worst enemy.

I am a very strong character but truly worry for women coping after these brutal births who don't have so much strength.

I think this trauma and the physical damage will be with me forever. So much for my natural birth.

addictedtohotbaths I'm so sorry for what happened to you. That sounds awful and then to have had such shoddy aftercare is unforgivable.

Like you, my birth left me hardly able to walk. I thought it was normal at the time.

Three years on and approaching birth of my third baby and I realise I'm still not over it. It all come flooding back. The anger, mostly. I hate the 'well what do you expect' attitude. Having said that, my current mw and the previous obstetric consultant I spoke to before the birth of ds2 were not dismissive. They were lovely, actually. Good people are out there.

I think the psychological trauma could be addressed better.

to everyone on this thread who is still suffering from birth aftermath.

With regards to the lung issue and elcs, ds's paed said that the combination of ds's lungs not being quite ready (depsite the fact he was born at 39 weeks), and not being prepared by being squeezed through the birth canal exacerbated his breathing difficulties. It is complicated with ds, because it turned out that he is disabled and so it is difficult to tell what problems are caused by his disabilities or by his birth. But the paed in NICU said that they did see a higher level of babies born by elcs with breathing difficulties.

I know that everyone is told of the risks of Elective Cesarean before they have one, but I often see it presented on Mumsnet almost as a 'trouble free' option. It makes me anxious when I see these threads, because I know that before electing for a cesarean I sucked up all these positive stories, and thought any risks must be exaggerated (not even taking into account that an elcs could leave someone mentally traumatised as well).

So sad to hear these stories. My thoughts go out to you all.

Hazey. Sorry to hear of your son's other health problems. The lung thing makes sense. All sections would miss out on the squeezing, but ELCS babies would be more likely to be 'early' in terms of the readiness of lung development. That logically sounds like it could explain the difference.