RCOG considering informing women of the risks of vaginal births

[pinguina16]

Clare Wilson from the New Scientist broke the news last week.

www.sciencealert.com/scientists-say-it-s-time-for-doctors-to-warn-women-of-the-true-risks-of-childbirth

If they decide to properly inform women about the risks to their babies and their own bodies, I view this as a landmark. #righttoknow

Evergreen - It's reality that a disproportionate amount of women who have had problems with their vaginal births will post here. You're not going to find many of those who have perfectly fine vaginal births with no complications. The experiences here are not representative of the average woman's experience, if it were there probably wouldn't be so many of us walking the earth.

Well, reading this thread was a bad idea when I'm a due a week from now with my first baby...

Liz and Evergreen I have had three VB and have had no issues in the slightest. Tiny tear with DD1 that I didn't even notice and then nothing. Honestly, this thread isn't a complete depiction of birth.

Trying to embed the link

Click here for the article

I agree maybe more transparency is good but the situation with VB is very different than with CS. If a woman doesn't like the sound of the VB risks she can't just say she's not giving birth!
Her body will spontaneously go into labour unless somebody performs a CS for her.
CS is an opt in situation whereas VB is not really, it's the default that happens.

IMO rather than presenting the current VB risks and offering CS as an alternative, far more effort should go into reducing the VB risks by evolving procedures and really understanding the processes and approaches that result in damage-free births vs complicated births.

Also had a VB, no tearing, 4 stitches for mild labial grazing, no lasting damage. I was definitely aware of the risks of tearing, incontinence etc from a natural birth but it didn't make me want to elect for a different options. I should say generally aware - not to the level of knowing accurate statistics but I didn't know any stats on c-sections either.

Going to be a bit of a twat here (pun not intended!) But surely there is a cost / resources problem here? ELC surely costs the NHS far, far more than a vaginal birth. How would the NHS budget cope if many.more women demanded an ELC?

Ps. I had what I'd consider a damage free birth. I did actually have two stitches but there was no pain afterwards (I needed no painkillers at all post birth) and at my 6wk check up the GP could see where they had been.

Hello - I wrote the article in New Scientist in question, and as I used to be a long-time lurker (and occasional poster, under a different name) on MN, I thought I'd respond to some of these points.

The first thing is that I agree that the number of women posting on here who had bad deliveries does seem disproportionately high, as according to the Royal College of Obs & Gynae, the number of women who have a third or fourth degree tear is about 5 per cent.

Secondly, I don't think we should fear for the NHS budget if more women choose elective C-sections. While the initial costs are higher, the net cost is ultimately lower, because of having to treat incontinence and prolapse arising from bad vaginal deliveries. And sadly, the lifetime cost of looking after babies who are brain damaged at birth is one of the biggest contributors to the NHS litigation bill.

I'm certainly not advocating that all women have elective C-sections for that reason though - I just wish every woman who wanted one was able to have one.

Thanks for all the interesting points raised.

5% is high though, imho. I mean a 1:20 chance of something that can lead to lifelong incontinence... That's quite a risk, and devastating to self esteem.
I think a lot of people's anger comes from the way pregnant women are treated. I had hyperemesis and spd during pregnancy and was told by a couple of doctors to just shut up and get on with it, basically. *
Then there's stuff like the state of postnatal care - can you imagine any other major abdominal op where you get no sleep after and are reluctantly given paracetamol? It all leaves you with the impression that you, as a woman, aren't important- you're just a vessel. The guidelines over vb are long overdue- fully informed consent is a vital right.
Thanks for writing the article - this is important stuff.

• I vomited in his waste bin so at least he had a lingering odiferous reminder of his callousness...

Clare thank you for writing the article, it is such an important area that really does not get much discussion during pregnancy and tends to be glossed over or minimised.

Personally, I was so happy to get the birth I wanted- an ELCS.

Thankfully, neither myself or my baby had any complications and we were out of the hospital in less than 48 hours. I was given so little pain relief afterwards (despite repeated requests) that I doubt I busted the NHS budget in this respect.

As for finances, yes there are initially more costs involved with a CS- theatre time, anaesthetic etc and typically a longer stay in hospital.

But, anecdotally, I have friends who were still being followed up by gynae several months after their vaginal births, who were still suffering from pain, incontinence, low mood etc

In my experience, I had no complications from the CS and never needed any follow up at all. You could argue, some of my friends cost the NHS much more than my ELCS over the long term.

I will admit that my main motivation for an ELCS was that I had done an O&G placement while in training (I am a doctor) and I could not forget all that I had seen- from labour ward seeing all kinds of births to gynae clinic where women came with post-natal issues, some ongoing for years.

For me, I could not put those experiences aside, and in the end I didn't have to fight too hard to get an ELCS for maternal request.

I guess my point is, there should be more honest & upfront information about the risks of VB, then women can make more informed decisions.
Not to choose an ELCS, but to maybe consider what sort of pain relief will have the lowest risk of intervention etc

Ante and postnatal care is a huge feminist issue. More information would be really good - including before TTC!

to posters who have suffered birth injuries, and to those who are pregnant and worrying.

When I was pregnant and reading much literature on natural birthing methods, DH came across some research that interviewed obgyn about birthing methods for themselves and partners. Overwhelming 95% would select a C section. I have not been able to find the article, but echo what is said above. The push for natural birth and lack of transparency about the relative risks needs addressing urgently.

I'd want to know what the risks of a home vaginal birth are vs hospital. Is the NCT right that if you are at home and relaxed the risk of tears is diminished? Do water births reduce the chance of complications?

ELCS are pretty standard across hospitals (I think?), VBs are NOT by any stretch of the imagination, so just presenting planned ELCS vs VB is bound to give a skewed picture that ELCS is safer I'd have thought.

Anecdotally, the women I know who have had complications birthed in hospital not at home, mostly laid down, not in water etc.

About time.

Clare, thank you for that article. It is much needed to clear the air.

When I was having counselling on risks for my elcs, I told the senior midwife that it is not the risk of an elcs per se, but the risk of an elcs as compared with a botched vb or a vb that became an emergency cs. Sad to say, whilst armed with stats for cs, she was clueless about the stats for vbs with interventions and could only go on anecdotal evidence. BTW, she said that in her experience, only 2-3% of vbs result in 3rd to 4th degree tears. I told her the stat (in my case) is not what percentage of vbs send in 3rd to 4th degree tears but how many of first birth vbs end in 3rd to 4th degree tears. Basically I got no answers.

But I got the elcs I wanted. Which went like a dream.

i dont understand this paternalistic attitude that we shouldn't tell women the truth about birth. The fact that it's a natural process doesn't mean we can't be honest about it. Is there any other event that can result in injuries that we are not honest with men or women about? It's like 'women are too delicate and we better not scare them or they might opt for a c section (God forbid!) and really they don't need to know any of this as we know what's best for them and what their choice should be anyway.'. I had a complicated birth wth DC1 and I really appreciated the one person who had been honest with me about how brutal birth can be. It was done in a way that didn't scare me (very factual account of her experience) and helped prepare me a little for the reality of it. I think many of us first time mums were a bit traumatised by the birth as we really weren't prepared for the reality especially those who needed some help getting baby here safely. Being honest is just being fair to first time mums.

I couldn't agree more that most health care professionals do not discuss these risks openly. The only people we hear about it from is usually other mums. I actually had an NCT teacher who advised us not to listen to other women's "horror stories".

This is such important news - thank you for sharing it. I've always known that I would have an ELCS (and have done a lot of research on both for years) and it's partly through that research and partly from the complications my mum told me about from my own birth that I've always known it's the choice I want (I would have died or been brain damaged if she had given birth naturally due to a very soft skull - luckily no matter what they tried she just never had contractions so went in for c-section)

We are currently TTC #1 and I was so concerned that I wouldn't be allowed an ELCS I went to talk to my GP about it already - she was very understanding and while couldn't guarantee anything, made a note in my notes regarding my wishes for when the time comes. It's still a worry though as I really fear I'll be forced into something I really don't want.

bella
I think there are two types of people - those who worry when they don't know the risks, and those who worry more when they know the risks

I wanted to know everything and be able to make choices based on the knowledge. I want to be prepare for the best and worst outcomes and know what I could expect in each case. Many of my friends were the same.

But I also had friends who wanted to bury their heads in the sand and skim read over anything that said it would be worse than period pains, and end with euphoria and unicorn farts. The more they heard about the bad things, the more they panic

Equally, I wanted to know about MC stats and know what happens. But others wanted to be all 'lalala it won't happen to me'

Is it because some women are too delicate to handle anything other than a sugarcoated version of life? Dunno, but the NCT teachers are playing to the crowds with dumb comments like 'ignore anyone who tells you horror stories'

Clare thank you for the article. It was published the day before my first consultant appointment at 17 weeks, which was perfect timing because I was intending to use that appointment to request ELCS. I mentioned your article and the consultant said she would read it.

The appointment went like a dream. My reasons for requesting ELCS related to a previous surgery that had left me with some continence issues - as a consequence I told the consultant that I was not willing to take a 5% risk of making them worse and that even a 1% risk was too high. The ELCS was agreed on the spot - no arguing, no counselling, just "planned CS 39 weeks" written in my notes. The relief was immense.

Posting here because I know many MN'ers struggle to get ELCS agreed - which is entirely wrong imo - and I wanted to post a positive story. Obviously no birth is without risk, but my anxiety over the birth has lifted since the appointment.

What a great article clarewilson. It is such good news that the RCOG are looking to make this change but how shameful that it took the tragic case referred to to bring us to this point. I've talked about this on MN before (I've had two maternal request c-sections) but it is mind-blowing that women are not currently informed of the risks associated with vaginal birth and yet are showered in information regarding the risks of c-sections if they request one. The circumstances of that case are just horrifying. How could that woman not have been advised of the awful risk she was taking in attempting a VB in those circumstances?

We're in a situation at the moment where women will be desperate to avoid a c-section because of the risks they've been told it carries and have no idea that a vaginal birth will almost certainly carry a greater risk of their baby dying or being left permanently disabled.

My father has cerebral palsy caused by oxygen starvation at birth. I am so glad that I informed myself of the risks involved in vaginal birth and c-section birth. The medical professionals I dealt with in requesting a c-section... my consultant would barely acknowledge that there were risks associated with VB. It was up to me to bring those up in the meeting. He was just there to tell me how awful c-sections are.

I suspect that whatever the risks many women will want to at least try to experience vaginal delivery. Not taking away anything from those who can't or don't want to. Another factor is that surgery is surgery and means at least weeks of recovery, inability to drive etc so I think it's fair for the RCOG to post a list of risks for each method for women to make informed choices. For the record, I had four spontaneous vaginal deliveries, all now grown up. I had no problems until recently when I have some prolapsing which may require one surgery but not four! Apparently prolapses often occur post menopause as before the hormones keep things less saggy. No regrets here, for me the births were positive experiences.

I'm currently pregnant with my second, and attended a hospital ante-natal class run by a midwife. It was 95% first time Mum's.

From my small group of friends (anecdotal experience - not scientific!) very few had the birth experience they were hoping for. Between us we had PPH, constant monitoring of baby, tears, episiotomiy, csection after failure to progress, induction etc. There were a couple who had no problems, including one home birth, and we're all now fit and well.

However, NONE of this was mentioned during the antenatal class. It was all about the pool, some diamorphin if you need it, and we'll have you home after a few hours .

Of course there's no point in scaring mums-to-be, but this is basic medical information! I felt things were glossed over, and the Mum's were given an unrealistic expectation. Being set up to "fail" when they are unlikely to achieve this "ideal" birth scenario.