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 3 DC- all without anything but gas and air. No intervention, no injuries- tiny tear with DS 1 which wasn't even stitched. I can't say I was pleased to not have an epidural but that's what happened.I'd have an epidural if you can. I was 35 when I had DS1. They left it too late at the hospital to give me an epidural. With DD there was no one available to do it- they were so busy that day and with DS2 he arrived really quickly.

@remaininghopeful23 Thankyou.I have two now grown up children, both born by very emergency c section. Not going into details but similar experiences to you both times.This was 55 and 52 years ago now

I said no forceps in my birth plan and my consultant said that it would be highly unlikely they wouldn't need to be used so recommended a section.

2 sections later and I'm pleased with my decision. I don't feel the need to experience vaginal birth and felt comforted knowing the likely damage verses a vaginal which is anything from a graze to 4th degree tear.

Look at your hospital’s statistics.

With mine, 10% of vaginal births need instruments. And one in three vaginal births ends up being an emergency CS.

I have large babies, largest was 10lb 5. My first I had episiotomy and forceps and long labour. Recovery was ok, just struggled with breastfeeding as hurt my coxyx. Second was induced and ended with an emergency section, third was a scheduled section. Pelvic floor and continence all fine. I did prefer the sections, found them easier to recover from as long as I got plenty of sleep after (lol). Hope all goes well.

You’ve been in a rabbit hole of reading about bad birth stories. Stop !!!!!

I really wouldn’t go for an elective personally

I was worried about instrumental delivery too, and had a lot of risk factors for it (drip induction, epidural, position wise I was almost on my back) but I had a quick pushing phase and born vaginally no issues. They weren't going to stitch as I had internal grazes only but I bleed a lot so that's the only reason they did stitch. Recovery very smooth, no pain and continence absolutely fine. It is hard the not knowing but I do feel you'll read more negative stories as people are less likely to post positive ones

Two deliveries, both vaginal with no instrumental intervention. Both fairly quick (less than 8 hours start to finish) and no stitches needed for either.
My NCT group never wanted to hear my boring story!

I had forceps with my first, it was an awful drawn out recovery (infection, burst stitches) but its healed fine. No incontince at all, not even sneezing or coughing. My pelvic floor is a bit weaker since having my second child but only the odd fart if im lifting heavy weights in the gym🙈

I had an episiotomy/forceps delivery with second degree tear (9lb baby) and that was actually fine and healed well with no pelvic floor issues- still not sure if I have a second, if I’d try vaginal birth again or elective C-section.
Personally I just had the worst haemorrhoids for over a year post baby and I wish someone had told me about that!

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.

I think this is the most important thing.

You cant know whether you are going to be the person it goes perfectly for (C or Vaginal). Or someone unlucky.

Theres an incredible amount of unknowns about both options but 9/10 things go reasonably well.

I remember after my elective C the largest psychological factor was the fact I had chosen to do this to myself. An assault on my body in a way. I had forceps in plan C. I felt like I had been hit by a bus and had a recovery to match that. I had a few complications and thank god they were short term (worst one was nerve damage). But the thought I had willingly signed up to that would have been difficult to process if damage had been permanent.

Im not sure that’s worse or better than those who have control taken away in emergencies. Those people can be quite traumatised. And that’s for C as well as Vaginal.

You need to do what you’re comfortable with. If that’s a C do it. In all likelihood things will be fine. But it is good to prep yourself that there’s always unknowns. And this is why I am pro choice. Pregnancy and childbirth is not without risk whichever way you do it.

With all this in mind I will opt for a plan C again. But under no disillusion it’s a risk free or easy option.

Goodluck OP 😊

@Forevertiredmam how did you get them to go after a year?! Maybe there is hope for me after all 😂

OP I was exactly like you and loved the idea of a nice water birth but very afraid of the complications to mother and baby if things went tits up with vaginal birth.

I was very much considering a straight ELCS, but researched a lot and found the ARRIVE study and Melbourne Uni research on elective inductions at 39 weeks in healthy first time mothers reducing risk of tearing by 37%, so I opted for an elective induction at 39 weeks after lots of reassurance from the hospital that at any point during the induction I could opt for a c section, which I did end up doing in the end.

However, I really enjoyed my induction experience and I am glad I got to experience contractions and gave vaginal birth a chance (baby’s position meant labour didn’t progress and I wasn’t keen to carry on past three days).

The consultant (NHS) was super supportive of my decision and DH and I were prepped and in theatre within the hour. The c section was wild and trippy and amazing too!

However c section recovery is no joke! You need someone or two someones to do everything for you for at least two weeks. Like making all meals, propping up pillows and getting you water and lip balm in bed while all you do is hold and try to feed baby (which is definitely harder when recovering from c section as it’s really sore to cradle baby when you have a healing abdomen wound).

Be really sure your DP is up to the task and if not, have your mum or someone else who is an absolute super star stay. You truly need so so much support.

Additionally, you have a large scar on your abdomen! It might be wonky or jagged. You might get an overhang! It HURTS!!

I just say this as I think I was so worried about tearing vaginally that I forgot about the practicalities and vanities related to a big incision on my abdomen - I cried when they took the bandages off! I think that might just have been the shock. I feel okay about it now and it’s healing nicely, but I feel like no one really talks about this aspect - maybe I’m just a horrid vain person though lol.

You may very well need osteopath scar massage to help with scar tissue and healing so it’s not like a c section means you escape needing postpartum rehab either.

Additionally, you can’t go on long walks or get back to exercise as fast as a straightforward vag birth - so the start of mat leave is potentially a bit more sedentary and possibly boring/depressing if you’re used to being quite active.

In your case, I would think about all the elements that make an uncomplicated vaginal birth more likely, like size of baby and position of baby, your own fitness and age etc and do a risk calculation based on your own factors.

Lots of the horror stories we hear may very well be related to women being very overdue, with big babies or mother’s existing health issues, rather than risks that will necessarily apply to you.

Just something to think about! And wishing you the very best of luck with whatever you decide :)

This is Australian study FYI https://www.unimelb.edu.au/newsroom/news/2023/may/mothers-choosing-to-induce-labour-at-39-weeks-have-better-health-outcomes

I was induced with my first and it ended up with forceps and episiotomy. I also had a PPH, stitches, long birth etc. I found recovery tough but I just got on with it at the time. I was just so happy to have my baby. But when I got pregnant with my second and reflected, I couldn't go through that again. As soon as I mentioned the word forceps they were booking me in for an ELCS. It made me wonder why they would put you through the chance of forceps in the first place. I found my ELCS recovery so much better! I do have urinary incontinence if I have a really bad cough or hard sneeze. It can also suddenly come on me that I'm desperate for the toilet and can't hold it. I have to go to the toilet regularly to keep this at bay.

Look into Hypnobirthing- it helped me through.

Everyone has their own preference so do what you prefer

But also please avoid the horror stories as much as possible during your pregnancy

Lots of love, you got this x

Had a small tear that needed one stitch that's all. Babies 8 11 and 9 4.

I had a c-section and lost all sensation in my bladder. I couldn't tell when I needed to urinate until i tried to stand up and couldn't as my bladder was so full now I have to go every 4 hours to prevent this.

Not trying to scare you just want you to know that c-sections are not without risk.

I had two sections and they were both great

Walking within two days, driving within two weeks

@Ellorie haha they’re such a pain aren’t they! I don’t really feel like they ever truly go but I rarely have flare ups now. I just made sure that I was consistently drinking a lot of water, whole grains/ fibre in general and strong probiotics.

Which is great. Just for contrast I was walking less than 2 hours after my second vaginal birth. Went to the GP ( for the baby check) and the shops less than 12 hours later. An uncomplicated VB is just much quicker to recover from, for me this was especially important when I had a toddler.

1st (and only) birth. Quick 3 hour induction. Just gas and air. No tear. Back to normal 48 hours after the birth (apart from tiredness). Never had incontinence. No prolapses. I was very lucky. I know that is not every ones experience, but it is possible.

You can have incontinence and prolapses from a CS (the weight of a baby on your pelvic floor).

I am a midwife and I would say when I do booking appointments for women having their subsequent babies and ask if they do pelvic floor exercises. 95% say no. Unfortunately I think the education about the importance of doing these forever and not just while pregnant/a few weeks after birth is not great but if you don't look after the muscles there, you are more likely to end up with incontinence the older you get.

I had a vaginal birth with my first baby. I did tear and needed stitches afterwards but that all healed absolutely fine. I can't even tell where the tear was.

I've got no problems with continence, can sneeze/laugh/go on a trampoline with my child absolutely fine. I too was petrified of long term problems after birth but I made sure to do my pelvic floor exercises religiously and I think this really helped.

I had forceps and an episiotomy too and it was excruciating for at least a month after birth. Couldn't sit down, could hardly walk, couldn't lie down because of sciatica. He's an only child too. Sex was really painful for at least 5 years afterwards as well, but seem to have finally got back to normal now.

I had a third degree tear (not an instrumental delivery) with my first. Absolutely no problems from the tear itself, healed well and no continence issues. The only issues I had were as a result of the spinal anaesthetic from when they were stitching. I had an elective section for my second only because she was frank breech (I had been cleared by consultant for vaginal delivery until baby turned breech) and the recovery was much longer and much harder than from the tear. It is major abdominal surgery, which comes with its own risks. There are also a number of factors which increase risk of prolapse, not just vaginal birth.