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?

Also in an emergency section, the mothers body releases hormones, and prepares the baby with contractions - the actual labour process assists the baby - even if it ends up with a caesarean.

hazeyjane

Where are your statistics from? This sounds so much higher than any of the NHS guidance I've read:

"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)."

These are the risks of c-sections (in % and in order of likelihood) given in the Royal College of Obstetricians and Gynaecologists Consent Advice No. 7 (the form used to obtain consent to an NHS section):

Very common
25% - Increased risk of repeat C-section when vaginal delivery attempted in subsequent pregnancy

Common
9% - Persistent discomfort in first few months
6% - Infection
5% - Readmission to hospital
1% to 2% - Fetal lacerations

Uncommon
0.9% - Admission to intensive care unit
0.7% to 0.8% - Emergency hysterectomy
0.5% - Need for further surgery at later date
0.5% - Haemorrhage
0.4% to 0.8% - Increased risk of placenta praevia / accreta in subsequent pregnancies
0.2% to 0.7% - Increased risk of uterine rupture in subsequent pregnancies
0.1% to 0.4% - Increased risk of antepartum stillbirth in subsequent pregnancies

Rare
0.1% - Bladder injury
0.04% to 0.16% - Thromboembolic disease
0.03% - Ureteric injury

Very Rare
0.008% - Death

I've put the relevant bits in bold - 0.1% and 0.03%. Injury to bowel and cervix isn't listed as a significant risk.

I dislike quoting or discussing statistics but I don't want someone to take it as read from your post that more than one in 10 women walk away from a CS with bowel/bladder lacerations or long term damage to their urinary tract or cervix.

Further to foodporn's post above, I saw my consultant earlier this week to sign form for elcs and go through risks etc and he told me there was a 1 in 1000 risk of the bladder or bowel being nicked during surgery, so a lot less than 12% risk. The more common complications he told me were thrombosis, bleeding and infection.

I think hazeyjane is right to point out that there are risks with any type of birth - very true. It's up to the individual women what risks she feels more comfortable with, or at least I think it should be. And if you are within the percentage that suffers from whatever issue/injury then the statistic is unfortunately 100% for you...

Sorry and best wishes for a decent recovery for everyone suffering from birth trauma/injuries.

After just saying that I hate quoting statistics: 6 in 100 women suffer a third or fourth degree tear with their first vaginal birth and 20-40% of all those who have one are still suffering symptoms a year after birth.

Royal College of Obstetricians & Gynaecologists Information Leaflet

This wasn't mentioned to me in any of the 5 appointments I've had with NHS obstetricians / consultant midwives (over 2 births) where the focus has been on convincing me that a VB is a better option than a CS (and yet I've been told of the increased risk of bladder injury in CS every time despite the risks of that being 0.1% against the risks of 3rd/4th degree tear in VB being 6%).

Why are the risks of VB so understated?

hazeyjane
I have to disagree that on MN, a CS is pushed as the easy option.
I think it is quite the opposite, and any VB vs CS threads always contain misinformation and exaggerated stories on recovering from a CS - you can't drive at all for 6 weeks (not true for most), it is major surgery that cuts through muscle (not true), you can't hold or carry your baby (not true), it is very difficult to BF (not true for most), the list goes on...

What I've never seen is someone pointing out that all of those apply to women after a traumatic VB...

Thanks FoodPorn for sharing the new RCOG leaflet on 3d and 4th degree tears.
It's been edited in June and clearly it gives slightly more information than before.
There is also the beginning of an acknowledgement that caring for a newborn after such injuries can be hard.

Very enlightening thread.

I agree with RedToothBrush that the main thing stopping women getting the care they should is the lack of accurate recording of the outcomes from assisted births.

If this was a male health issue, this wide-spread, it would never be allow
allowed to continue so dismissively.

Rolypolier thank you and I am sorry for the shit time you have had too, and everybody else going though this.

You should go back to your GP and request an appointment with a different urogynae or even better if you could afford one private appt with a urogynae they should be much more helpful. Once you know what is wrong and the next steps you can go back to the Nhs and see that consultant on Nhs (or at least I believe you can). Also if you haven't already see a woman's health physio who actually checks your muscle tone and if you are doing pelvic floors properly you should. Don't assume you are doing them correctly. There's lots of things I didn't know until I saw mine including the fact that my split stomach muscles make the prolapses worse since it's all connected so she is also helping me to sort my jelly belly! Don't be fobbed off any longer, it will only get worse with age and better to sort it while you are young.

I'm hoping that getting it all fixed will go some of the way to mentally healing.

SpareChange. Agree totally. Chose to have both mine by ELCS recovered well and really enjoyed getting back out running at 5 weeks and skiing at 9 weeks. Never could understand the appeal of a VB.

sparechange, I'd actually agree with hazeyjane about how ELCS are seen as a magic solution and seem to be pictured as the 'easy' solution on MN without full consideration being given to the risks. Rarely are the knock on changes in risk for subsequent pregnancies discussed (and sadly the NICE guidelines on CS fall down massively on this omission and the fact that their statistics are based only on first time mothers).

And you then see threads like this one where its completely understandable why women affected would want a CS or want to avoid ending up with similar problems.

The trouble is, that the key question isn't being asked; was the labour of posters like the OP properly managed and were her injuries the result of poor practice?

If the answer is yes, then the solution is to improve practice to reduce risks not to merely swap risks for another type of risk.

If the answer is no, its just one of those things then we should be given much more information and allowed to choose between the types of risk.

I do worry when I see threads asking about ELCS for mental health reasons because it does depend on exactly the reason for the problem. Some women would benefit from other options and more support in labour rather than ELCS, but again other options and possible solutions are not discussed. Once again if you aren't given the information you can't make informed decisions.

And as Hazeyjane states trauma is not restricted to those have a vb or an EMCS.

If you do want to think about the information that is out there, then the NICE guidelines do point out that in terms of risk, there is no significant difference for a planned vb (which includes instrumental births and EMCS) and a planned ELCS for the mother. But there is an increased risk to the baby for a planned ELCS for admission to SCBU.

And if you do think about that, either NICE are understating something (which is possible) or the stats are not being properly compiled (which is also possible) or women are simply suffering in silence or are being fobed off by doctors (which does seem to be a reoccurring theme) but if there are so many women with serious complications from a planned VB and there is no significant increased risk from having a planned VB versus a planned ELCS that does beg an important question. Where are all the women with severe injuries from an ELCS?

Maybe there is another difference here. That injuries from surgery are more easily identified, taken seriously and steps taken to try and help the problem than those women who suffer from injuries resulting from a vb or instrumental birth?

I'm not saying that's true. I don't know. But I do think it needs to be reflected on, rather than just thinking ELCSs are the solution. Reading threads on MN I do get a feeling that aftercare for birth injuries is an entire subject in its own right, and one I don't feel I know enough about to pass too much comment.

I do wholeheartedly believe that ELCS are right for some women - I was one of them. But it has to be about what is appropriate and finding the right solutions for each woman and the right solutions for maternity care in general.

An interesting article: www.newscientist.com/article/dn27929-stop-glossing-over-the-risks-of-natural-birth-to-cut-caesareans/

red
I wonder if there is a bit of confirmation bias that we've taken different conclusions from the threads!

One other thing to throw into the mix, along the lines of the questions you posed...

One group of women who don't seem to have such an uphill struggle to get an ELCS are those with so-called 'precious baby syndrome' (not my term, to be clear) - women who have had a previous still birth, neo natal death, massive ivf journey or similar (I fall under this category as well).

I'm not sure what it says about either the real or perceived risks to the baby, or that the mother has been through enough pain without the additional pain of labour, or something else altogether, but it is a very real thing in lots of hospitals. My assumption is it is because there is a perception that an ELCS is safer for a baby, or has more predictable risks.
I know women who have been through a real struggle, and had a consultant see their notes and then automatically assume they'd want a c-section

spare, I would imagine there is a few things at play with regard to precious baby syndrome. I wouldn't necessarily believe that its purely about risks being less for an ELCS and women in this group getting some kind of special treatment. I am more inclined to believe its less sinister than that kind of conspiracy suggests.

Firstly, if you've had lots of previous losses there may be greater concern about mental well being. You are more likely to get additional support and have more contact with midwives, than a first time mother who is low risk and has no previous maternal history.

Then there is the fact that you are immediately more likely to have contact with consultants rather than midwives, and there is a split about perceptions between the two groups and what they themselves do or advise their partners to do (which may be distorted by their jobs rather than simply a reflection of reality).

Then if you have had previous experience with such services, you'll know how to navigate the system better and know how to communicate with HCPs. I don't think this should really be underestimated, and I think doctors are possibly aware of this too, which means you can't be as easily just fobbed off.

And finally such women are more likely to be older and more likely to have fewer pregnancies so the risks are slightly different to the general population anyway (I believe the rate of CS in over 35s is closer to 33% than the more general 25% you'll see quoted which relates to all women) plus the risks associated with subsequent pregnancies may be irrelevant.

In short, women in this group are going through the system via an alternative route and have particular characteristics and demographics which are not reflected in the population as a whole, so I think its unwise to look at them as a particular case study too much.

There's an "article" on Babycentre about recovery after forceps and a severe tear that I'm not happy about . I sent an email asking them to be more nuanced about the recovery but with no success.

I thought some of you might want to "campaign" and want to send them an email too.

This is the page in question.
www.babycentre.co.uk/x2434/i-had-a-severe-tear-after-a-forceps-birth-will-the-damage-last

You can email the Editors using this link.
www.babycentre.co.uk/e536987/contact-us

Of course this matters to me personally but as the National Maternity Survey for 2014 shows that Babycentre is the second most used site by expectant women during pregnancy to inform themselves (after the NHS Choices website), I think it matters generally too.

National Maternity Survey 2014
See page 34 (actual page 24 in doc)
www.npeu.ox.ac.uk/downloads/files/reports/Safely%20delivered%20NMS%202014.pdf

Thanks for your help

Bloody hell that article looks like it was written by Disney!

I LOL'd at the "if you're worrying about anything, like having another baby then ask at the 6 week check". After forceps I was still walking down the street unsure whether I was about to involuntarily shit myself at the 6 week stage, not to mention the broken down episiotomy that was still partially opened and bleeding.

Recovery from an instrumental delivery is totally underplayed by almost every service/place of support I can think of.

Needless to say after being fed the fairytale first time round I did my own research and had an ELCS second time. The recovery was a breeze in comparison.

I hope you don't mind me resurrecting this thread but I am another person ruined by forceps.

I had my baby boy five weeks ago which left me with a deep vaginal tear/laceration, lost 1.6l of blood, three transfusions and then completely and utterly incontinent. Two days after my catheter was taken out I couldn't hold my urine at all, not one little bit. They were completely confused by me and didn't know what to do, my own consultant told me that she'd never seen a case like this before. Not remotely reassuring!

I now am managing the situation by going to the toilet on the clock and ensuring that my bladder never gets full, if it does I leak uncontrollably.

On top of all of this it seems I have a rectocele prolapse. I've been doing my pelvic floors religiously but the bulge is freaking me out. I feel like a freakshow. I've been horribly constipated and in an attempt to get things going I took too many laxatives yesterday and had the opposite problem, with pressing on the bulge giving me another bout of diarrhoea.

I feel absolutely butchered and don't know how I can ever have sex again.

I've been over it all in my head so many times and nothing makes me feel any better about it all. My baby's head was measuring in the 95th percentile throughout my pregnancy and despite paying serious money to go private my consultant never discussed the option of a c-section with me. She offered an induction, I went with that but ended up going into labour spontaneously while waiting for ARM.

I'm so annoyed with myself that I never brought it up or pressed it, despite me thinking at length that I needed a section. Even random people were telling me I huge and that I'd need a section. To give you an idea of how petite I am - my wedding ring fits on the finger of my 7 year old niece. My consultant will not concede that my baby's head was too big and for that reason he couldn't rotate in the birth canal. I'm convinced that this is the cause for him going into transverse arrest.

I am breastfeeding exclusively and have been told by the physio that they won't diagnose a prolapse until I'm 6 weeks postpartum or until I'm finished breastfeeding. I'm hoping and praying that this bulge goes down with time but what I read on the internet about rectocele prolapses is not at all reassuring.

I agree with everyone who believes forceps should be banned. As a result of being dragged down the table (3 times) I've been left incontinent, with a prolapse, constipated, pain/discomfort on walking and excruciating coccyx pain on sitting. Not to mention the emotional trauma of it all.

And I paid serious money for all of this! So much for f*ing private. And I think my consultant is proud of her low c-section rates. The lowest in the hospital apparently. I wanted to punch her with my catheter bag when she told me that.

twixes :( sending hugs and good thoughts.

I was terrified of forceps and luckily avoided it. My heart goes out to all the ladies posting here!