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

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.

That doesn't follow. I'm not sure whether you mean evolution would've dealt with the problems or women would choose to avoid pregnancy and birth if problems were common, but neither of those things is the case.

Many of the complications listed don't have any evolutionary relevance, particularly since some are commonest after menopause. And a key point of this thread is that women aren't aware of the potential VB risks. So even that small minority of women throughout human history who've been able to choose not to get pregnant, haven't necessarily had access to the information that would've allowed them an informed choice to avoid pregnancy due to risk of incontinence.

I do think evolution will have dealt with some of the 'problems'. From a very crude perspective, without modern medicine some women would not be in a position to give birth vaginally to one let alone multiple children. The threads which discuss 'would you be alive if you had been born 100 years earlier' or similar are filled with birthing complications.

It's evolution, in the form of big heads and walking upright, that causes a lot of difficulties. Big head, little path.

Most women are absolutely fine. That's why (with contraception ) we aren't all only children. But yes I think a lot of things are glossed over.

I was told 'you've had three children, what do you expect '. What I would like is honest information. Yes, mild incontinence is nothing compared to some things. I don't regret 3 vaginally births at all. It matters though and I don't see why it should be dismissed, treated as inevitable and untreated.

It sort of depends what you mean by deal with some of the problems. There's no reason why it would've done with incontinence or prolapses, particularly given that affected women often see no/fewer effects post menopause. And your only children line, well the thing with that is that evolution cares how many children you have, not how many you lose. So for example it's no biggie from an evolutionary perspective if your first birth doesn't result in a live child, but your proven pelvis then helps you subsequently. 'Most women are absolutely fine' is a pretty big and broad claim. I mean. who's defining fine? There's certainly plenty of room for a lot of suffering without it getting to the level of something evolution would deal with.

Couldn't agree more with your last paragraph though.

I think they should be honest about the likelihood of VBAC the first time round being really long and horribly painful. No one ever mentioned that fucking hideous drip to me either in any of my antenatal classes. I think they described it as 'making the contractions more energetic' before they administered it. Fucking hell what a fucking joke. No pain relief whatsoever and contractions that had me writhing in the fiercest pain I have ever experienced in my life. I wouldn't wish that on my worst enemy. Second VBAC was fine though, nice and fast.

I think other women tend to keep shtum to expectant first time mothers as they don't want to burst their bubble and scare them. It definitely feels like a conspiracy and it's only when you come out the other side blinking into the daylight that you realise what a naive fool you were gaily clutching your whale music cd and birth plan.

My understanding of caesarians is they can impact on successful breast feeding. Not sure if anyone can confirm or deny that?

God, I miss my old vagina

Ha ha me too!

SleepFree - I had a c section and I'm exclusively breastfeeding my DD, who is 10 weeks. Milk came in on day 3. Anecdotal I know, but the midwife told me that new research suggests that c sections don't have an impact on your ability to breastfeed.

I totally agree with you, OP.

It is a disgrace that pregnant women are told nothing about the risks of vaginal birth. They should be discussed just as much as (if not more than) the risks of ElCS, especially where it is a 1st time mum-to-be over 35 expecting a baby over 9 lbs.

During and after DD's horrendous birth, I was told by many doctors and health professionals that "Of course it would likely be a difficult birth with at least some damage. Baby is big, mum's 1st birth and she is no spring chicken" etc. Well, nobody had told me . I suffered non-stop for weeks like a tortured animal and DD ended up with a deformed head.

In contrast, I got my ElCS for the 2nd birth & it was easy, relaxed, and recovery was a breeze. Breastfeeding was no problem. Bonding was no issue. Baby was totally fine and didn't cry 24/7 for 6 months like the 1st one, likely because her skull plates had crossed over one another.

God, I agree with this.

I have prolapse after a badly managed first birth which resulted in a third degree tear.

I'm pissed off as had I known that care at my local hospital was inadequate, which I directly blame for my problems, I would have pushed for a csection.

I had a section with my third and it was bloody dream boat compared to labour.

I think vaginal births are of course the preference if you have decent pre and post natal care. But who gets that?

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

Sparechange - What about those people that research the likelihood of 4th degree tears, double incontinence , major blood loss, baby in NICU etc. The people that are happy that the risks are so low that they believe the natural MLU/water birth they have set their heart on will actually happen? Who then spend the next year rebuilding themselves when the unimaginable does happen.

I find your comments over simplistic and offensive. I realise that I am fortunately in the minority but just because you go into a situation informed does not necessarily make you any more prepared or able to cope when it does.

I fully support informing women about the risks involved, but I think more effort should be placed in helping women deal with the aftermath of either type of birth by investing in better post natal care for women who have suffered from traumatic births.

SleepFreeZone

2 c-sections here and neither impacted on breastfeeding (e.g. milk came in quickly).

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.

Just noticed this point now. Clara, while I agree strongly with your premise and respect the work you're doing, you're off on this point. Bad delivery doesn't mean third or fourth degree tear. That's not the way you assess it and there can be lots of problems later on from tear free deliveries. My bloody awful VB resulted in only the teeniest of second degree tears, only just worth bothering to stitch. Clearly someone with a fourth degree tear in particular has had an awful time and an awful outcome, but the absence of severe tears doesn't make something not a bad delivery.

Particularly well done on tackling the costs argument too, though. So important to see it hammered home that ELCS IS NOT GOING TO COST THE NHS MORE ON AVERAGE. People never seem to factor in that the most expensive births are ones where VB was attempted and assistance needed. At least some women currently opting for VB and ending up with the expensive instrumental deliveries and EMCS would opt for ELCS if it were on offer to them.

I agree that the risks should be highlighted.

I had a VB 3.5 years ago and now have a bladder, uterine and rectocyle prolapse. As in cervix is hanging out of me most days, I struggle to urinate and open my bowels at times. NHS won't operate "in case I want more children" as I'm 30. I don't WANT another child! I'm happy with 1!

And this is why they don't tell women the risks- because they'll all want sections and it costs too much! Women will continue to suffer.

I've never seen any evidence that cs causes breastfeeding issues. In my NCT group the ones who had difficult births (inc emcs) all breastfed without issues. it was the 2 easy births that couldn't breastfed at all and the less complicated birth struggled with breastfeeding and gave up within a couple of weeks.

Some other really 'helpful' things I was told by 'very knowledgable' people after cs was that you can only have 2 kids once you've had cs and they must be 18 months apart. Neither is true (thought I have seen some research suggesting 18 months+ might reduce risk of scar rupture but it wasn't conclusive).

All these risks and issues people 'helpfully' told me about cs (which I had no choice about anyway!) and yet no one mentioned to me about the risk of incontinence linked to tearing or how to reduce the likelihood of tears even though I'm really into sport and incontinence would make it very hard to do the thing I love the most! People are very biased in their views!

girlwiththelionheart I don't think it's about cost (with less assisted deliveries, vbacs, emcs, treatment later on for prolapse and incontinence issues it would probably balance out if more people has elcs) . I think there is a small but powerful group of natural birth enthusiasts who are concerned about the increase cs rates and are fighting to reduce them. The WHO has given guidance encouraging countries to reduce cs rate, hospitals have to publish stats on #of cs's and they seem under pressure to keep them low regardless of what women want. Until there is the same focus on the risk of vaginal birth injuries and long-term health issues for mother or baby there will always be pressure on hospitals and hence on women to avoid c sections no matter what the cost/risk to woman and baby

Yes, there's definitely a group of zealots. Many people are still under the impression the WHO has a recommended rate of 15%, which it doesn't and hasn't for years. The WHO themselves are fond of a bit of scaremongering on the matter actually, even as they publish statements making clear they don't have a recommended rate.

There is that but the NHS wouldn't want or be able to afford to give everyone c secs.
With every other procedure you are told about possible outcomes except vaginal births. I'm sure money factors into it.

Money does factor in, but only because they're taking a very short term approach. NICE have said ELCS for those wanting it wouldn't cost the NHS more! We really need to interrogate claims that it does.

When I went in to ask for an ELCS (my DS got group B strep despite an EMCS first time around) and I was keen to avoid the possibility of the same happening again, the consultant gave me a spiel about the risks of a section, I had to sign a scary looking document accepting the risks of everything from the baby being cut to death - with the percentage risk given, and she gave me a booklet about VBAC in case I changed my mind. I said I was aware of the risks and still wanted one and she was fine, but said she had to go through it all so I was fully informed.

No one ever fully informed me of the risks of the alternative though, which I thought was interesting. NCT classes were all about trying to avoid a cascade of intervention, and promoting water births.

I've had 3 VB's and 2 CS's so I consider myself an expert .

I think any extra information is good. I found that hardly any information was forthcoming about the risks of CS or VB when I was pregnant. With my first CS (planned 2 days in advance) I got given a leaflet and that was it. All my worries were dismissed and then when complications happened I got told they were very common. I wasn't given much info about VB complications either but thankfully I didn't have any so it wasn't a problem.

There is a reluctance to associate childbirth with serious physical trauma (either to baby, mother or both).
For some healthcare professionals and antenatal class teachers it seems easier to deal with the problem by behaving like it doesn't exist in the first place.
Personally I don't think this is the right approach. As drilled during pregnancy I would have liked my choices to be informed. It wasn't the case.

I think on multiple sections, they are clear with you that with each section, certain risks increase. However, everyone seems very relaxed about my no3 section in October and the latest research that I saw seems to focus on 4 plus.

I was advised after my first section to wait 2 years before having another and my understanding is that it may reduce some risks, but know people who have had successful smaller gaps.

IMHO, I think if they fail to tell you about the risks then that's worse than knowing and making an informed decision.

alwaysinahurrynowI wonder if there's similar risks/evidence with a pregnancy after a vaginal delivery with 3rd degree tear? I'd imagine longer healing time would reduce the likelihood of repeat tear and there's definitely consequences in later life for those who have repeat severe tears but we're not made aware of this in the same way.

Sorry pride, have been away. Didn't mean to ignore.

On the evolution bit it's not just surviving children. It's the mother too. Even just 100 years ago (and still today in a lot of places) this was incredibly important for the life chances of the child.

On the fine bit post labour. It's difficult to really know, given the lack of information. I guess though fine because most women are walking, talking getting on with their lives. Any problems tend to be hidden. I completely agree that they shouldn't be.

We shouldn't have to suffer in silence and accept these things as inevitable consequences of being a mother.