Birth injuries without instrumental assistance

[worrywilma]

Hi, just trying to gauge the risk of birth injuries from an unassisted vaginal delivery.

I'm terrified of having a prolapse or being doubly incontinent so will be considering asking for an ELCS when the time comes.

I know an uneventful vaginal birth is preferable, but how likely is that to happen? Im desperate to avoid forceps and for first births, they seem to be a regular occurrence causing massive problems later in life.

How has your vaginal delivery affected you?

Tia x

I had forceps and episiotomy for my first birth. Pelvic floor has been totally fine, I can laugh and cough without incident, and I can’t tell where the episiotomy was now! Instrument deliveries aren’t all doom and gloom… :)

My first birth was a forceps delivery too and everything is fine and dandy down there. Running, sneezing, you name it! Recovery was fine too I have nothing to compare it to but I don't think it was any different to recovery from an unassisted birth. Just out of interest what are the massive problems you're referring to that they can cause later in life?

@mintgreensoftlilac thanks for sharing your experience.

I've read quite a lot of threads on here from women who are incontinent, affecting both bladder and rectum., 4th degree tearing and prolapse due to the vaginal walls being quite badly damaged due to the force.

Fully open to hearing all experiences to try and make an informed decision!

You have been reading far too many horror stories. People on here are hardly going to talk about nice, smooth easy births are they?

A CS is major surgery. Look it up if you are getting your info from the internet. And right after it - you will have a tiny baby to care for. With all the bending, lifting and carrying that that entails…

You want actual stats, not anecdotes on here

I have prolapses and I had only C-Sections, with no labour beforehand.

It can be genetic I think.

That said, I'd probably still opt for C Sections as I suppose it could be worse.

My forceps episiotomy took 9 years to heal.

I couldn’t climb stairs without being in agony.

DD is an only child as a result. :(

The only consolation is that they probably would have damaged her pulling her back up the birth canal had I had a c-section (although they had prepped me for one).

I advise you to read up on brachial plexus injury make sure that you are aware of what it is and how it can be prevented. Midwives are supposed to be trained in manoeuvres to prevent this but sadly it still happens and the baby can be injured to various degrees

I've had two deliveries (including 6 weeks ago), no interventions or birth injuries. I was out of hospital same day and feeling well that evening. C section is a major surgery and can have complications too. Is there a reason you think you'll end up with intervention?

2 births, 10lb babies, no instruments, small tear each time, healed well, no lasting effects.

I was really scared each time but it was totally fine.

3 births and nothing. Obviously my fanjo looks different. But was never really staring hard down there 😆 Had to be catherised for my first as baby was on my v full bladder or something. Maybe my bladder was in the way? Can't quite remember. No effects from that

Second and third uneventful and quick, 9 and 10lb. Gas and air and second degree stitches that have healed perfect many years later. No instruments needed luckily but I think overall I would prefer an instrumental delivery to a section

No bladder issues. Had a weak pelvic floor immediately following no3. Paid for a personal trainer to do some diastasis recti healing and pelvic floor/core strengthening exercises

According to the latest maternity audit data (2018/19 - so admittedly old!) 23% of first time mothers had an instrumental delivery, of which 6.9% suffered a third or fourth degree tear.

44.3% of all first time mothers had an episiotomy.

4.5% of first time mothers who had an unassisted vaginal birth (ie no instruments) suffered a third /fourth degree tear.

25.9% of first time mothers had a vaginal birth without intervention, meaning they were not induced, did not have an instrumental birth, and did not have a c-section. However some of these had episiotomies and some of these needed drugs to speed up their labour.

48% of first time mothers had a spontaneous vaginal birth, meaning they avoided instrumental deliveries and c-sections. A significant number of these women were induced and/or had episiotomies.

NHS digital publishes more recent statistics, but they don’t break them down into first time mothers vs others. These show that the rate of c-sections (for all women) has increased to 45% of all births, up from under 30% only 5 or 6 years ‘ ago.

Many women who had instrumental births, episiotomies or emergency c-sections had good experiences of their births. Some women who had spontaneous births without intervention found them traumatic.

Bear in mind that most of the above statistics are for first time mothers. Subsequent births are much easier, and rarely lead to eg needing instruments.

I’m struggling to find the data on prolapse. I think its 50% of women who have had vaginal births end up with some degree of prolapse, but often this doesn’t materialise until much later in life (post menopause). This is versus around 25% of women who only had c-sections.

True.
My son has erbs palsy because of this.

This. If you have a vaginal birth there is a 50% chance you will have a prolapse after and this chance increases by 10% with each vaginal birth thereafter. The reality is the majority of women who've had a vaginal birth have unsymptomatic prolapses. Fortunately, they don't ever feel them or don't until after the menopause due to the hormone changes. Studies show that only 3-20% (different results for different studies) of women with prolapses have any symptoms.

Unfortunately, NHS pelvic floor physiotherapists generally don't tell women they have prolapses if they don't have symptoms which does seem wrong. The diagnosis does have mental health ramifications, but if more women were aware of it and that they actually have one, it would massively reduce the stigma which surrounds the diagnosis.

Thanks for your replies.

It's the unknown that I'm scared of. I won't know if I'm going to have life long problems until after the fact with a vaginal birth. But after a section, I kind of feel like I know what could be coming. If that makes sense?

I had no instruments and tore into my back passage. I had no idea it was even possible before it happened to me.

For what’s it’s worth a consultant told me women can still end up with problems after a C-section. It’s not a fool proof way to protect your pelvic floor.

Look into birth positions that could reduce the risk of tearing.

Based on the statistics I posted above, I chose an ELCS, and will be having a second in just a few weeks. The first went really well and recovery was, in fact, much easier than I was expecting. People rightly say that women can still end up up with problems post CS, but statistically it is less likely, and you are more likely to have a predictable recovery timeline that makes everything easier to plan for.

It is worth considering a few other factors. The older you are, the more difficult a vaginal birth will be (your skin is less stretchy and other reasons). By the time you are 40, you are statistically more likely to have a CS than a vaginal birth. If you are overweight, otherwise in poor health, or an older first time mother, you will likely have a harder recovery, whether you have a vaginal birth or CS.

Finally, there’s a lot to be said for following your gut instinct. I knew that if things went wrong for me in an ELCS, I had still chosen the option that I was most comfortable with, and I would have just had bad luck. That would have been a lot easier to come to terms with than if I had allowed people to talk me into a vaginal birth that subsequently went wrong - I would have been very angry and upset at those people, and angry and upset with myself for listening to them.

It’s not just the delivery that causes damage to your pelvic floor, it’s the weight of the pregnancy. I know women my age (mid 50’s) who’ve never had children but have done urinary incontinence. It’s age and perimenopause.

i had a ventouse delivery with my first and two unassisted deliveries. Pelvic floor wise, not sure there was much difference.

I had no instruments and only 2nd degree tears both times but still got continence issues from the 2nd birth. Will always regret not insisting on a c-section. That birth was traumatic, and I haemorrhaged badly

I was terrified of giving birth, I ended up having two (induced) vaginal births. One stitch the first time, no stitches the second time. No long term affects or prolapse (that I am aware of). I’d try and avoid reading too many horror stories. There are plenty of horror stories about c-sections as well.

I refused an induction and had a natural labour.

Didn't even have a tear.

Prolapse is often caused by the later stages of pregnancy. That's a lot of pressure. So that means women who have c sections still have a prolapse.

First baby at 37, 2 day labour but had her vaginially, no instruments (was discussed but refused unless baby was in distress), had a PPH but would have had it either way.
2nd baby at 42 3 hour labour, vaginal birth, few stitches (nails caught me on way out) healed from both fine, 8 years later no pelvic floor/bladder issues but I did do my exercises post and pre birth and still do until now.
Also had a vaginal hysterectomy 4 months back and still no issues. Choice is totally personal but I wouldn't entertain a CS unless medically necessary. I've had multiple surgeries since (unrelated) and the scar would have prevented some of them being done keyhole.
I think people are prone to sharing bad experiences over food so you don't hear many saying my birth was fine.