Rates of instrumental delivery / emergency section in second or subsequent births

[lucasnorth]

Can anyone help me here?

I can't find anywhere with stats (preferably UK). Have asked my midwife and she didn't know and wouldn't hazard an estimate.

Situation is that I had an instrumental delivery last time. Now 34 weeks with DD2, need to decide between VB and elective section. One thing that really worries me is that I might try for a VB and end up either with another instrumental delivery (my nightmare scenario), or with an emergency section (not quite a nightmare, but obviously would much rather an elective).

Midwife is saying that rates of instrumental / em cs are MUCH lower with second and subsequent births than with first babies. But I need to know approximately HOW low.

Are there any active midwives out there who would give me a VERY VERY ROUGH estimate from their experience? Or anyone who can find any info on the net?

Thanks

I would say (as an 'active' midwife! ) that if you go in to labour spontaneously and don't have an epidural your chance of a normal delivery is probably 95 +%. But that is a guess based on my own experience. You would certainly be expected to have a normal birth. If you have a large baby, are induced, have an epidural or the baby is not in the right position then your chances of another instrumental are higher.

I always think it is such a shame when someone has an el cs after an instrumental birth as it is so likely that she would have had a normal birth otherwise.

Also taking into account what happened to you last time, was the baby large, did you have an epi, was there fetal distress?

Best of luck in your decision making, write yourself a strong birthplan that conveys your concerns to the midwife who is looking after you.

i think the website birthchoiceuk.com or something like that gives stats for all uk hospitals of c.s rates and instrumental births

definitely agree a spontaneous start to labour is the best start ,and a non augmented mobile active labour helps a great deal in avoiding intervention

and definitely a spontaneous start to labour for a best chance of success for VBAC.

No stats here, sorry, but some personal experience. I was in the same situation with you - first birth was a nightmare that ended up in an instrumental that was handled very badly and I had a huge episiotomy. I found it very difficult to choose between an elective section or a natural vaginal birth. My gynae told me that it is quite common for a second vaginal birth to stretch out and ease stiff and tender internal scarring - but if I had an elective I would be certain to have another big scar on my body. I booked into a midwife led birthing centre and spoke to the senior midwife who wrote out and signed a birth plan in my notes - saying that I would only have an instrumental delivery if the baby was in immediate and serious danger. DH was also primed that if anything went wrong with the delivery (failure to progress at any stage, baby starting to look in distress etc.) that our position was to go straight to a section.

I ended up having a natural vaginal birth. It wasn't as easy or fast as I had hoped, and I think that I probably have a pelvis that makes it harder for me to deliver than the average woman. But I had a supportive midwife and was in an environment where I knew that they would do everything they could to allow me to deliver naturally. Not only did the delivery sort out my episiotomy scar, but it also banished all the emotional scars of my first delivery (for me and for DH).

We were aware that our strategy was higher risk than an elective section, but it was also higher reward, and we knew that we had done everything possible to minimise the risks. I suppose that the problem is that in any situation, even if the risk is 1%, if you're in that 1% then it's 100% for you.

Good luck with the decision, and the birth.

Thanks all. Sorry for delay in replying - DD has decided she doesn't like going to bed...

Loopymumsy - I will ask her again more forcefully Also thanks for pointing out the induction point. The starting point of roughly one in 10 ending up with intervention is scary to me, but taking into account that many of these will be first births AND that many will be induction related I guess that takes the odds down quite a lot.

maxbear - sorry, not sure what I meant by 'active'. Not a lot of inactive midwives around . To go through the factors you list - this baby is not large (as far as I know!), I am NOT going to be induced (would go c/s if I got that far), and I'll not be having an epidural. Baby is currently lying oblique but mw is confident (!) that she will turn. If not then I'll be having a section. So no high risk factors this time - but also last time round - I was just unlucky. Especially as no one thought to offer me any pain relief before the instrumental delivery - hence my concerns about freaking out this time round. If anyone comes near me with a ventouse or forceps I think I'm likely to lamp them, or run away. Or both. I accidentally looked at a picture in an antenatal book and even that freaked me out. But roughly 95% + sounds good. Thank you

Lulumama - thanks for the link but as far as I can see the stats on that site are overall for the hospital. What I really want is stats for multip non-induced births. But thanks anyway. Spontaneous, non-augmented, mobile active labour didn't work out for me last time which is why I'm digging into things so much this time round.

MrsTittleMouse - congratulations Really glad it worked out for you. Unfortunately I'm GBS+ so have been strongly advised to labour in hospital (also no mw units near me!) If I do work up the courage to try a VB then I'll definitely have a similar birth plan to yours - definitely no instruments unless absolute emergency. It's a good point about a VB being high reward (if it goes well). The other thing for me is that the thought of 6 weeks not bein able to pick up my toddler is rather daunting.

Anyway, will definitely get back onto my midwife and ask her for those stats. Thank you all for your advice

sorry to not be more help

is there another reason for why your birth last time ended in c.section>? was your baby not in a great position? what happened>

i had an induced first birth with epidural that ended in c.s and a spontaenous second birth withouyt that ended in a normal VB.

i did put a lot of effort into planning and preparing and ensureing my birth partners were able to support me too

No problem Lulumama; I'm being very picky

First time round was ventouse & forceps, not caesarean. I wasn't induced and didn't have an epidural; the only reason was that DD's head was turned sideways as she entered the birth canal, and she got stuck. 3 hrs fully dilated with no progress at all.

She wasn't in distress, there was no rush, but for no apparent reason everyone in the room just forgot to discuss/provide an epidural or spinal block (other than the G&A I was already on, and a local for the episiotomy). The pain was just indescribably worse than the labour up to that point.

What with that, and the fact that the original midwife failed the whole way through to notice that DD's head was turned (it was discovered on a shift change, I found out when going through it this time round), I just have very very little faith that things will go right this time. I know that's illogical, that I was unlucky, that most of the time the doctors and midwives are 100% great, but it's an emotional thing really. I really want to, but at the moment I can't bring myself to trust that a natural birth will be handled well. Quite why I 'feel' that a section would go any better is a mystery to me, but I do, and it's a really strong gut feeling that that's what I should go for.

You said birth partnerS - who did you have with you? And ensuring that they could support you, was that lots of discussion beforehand of what you wanted, or something else as well?

I can't answer your question directly,but I can say that a second delivery can heal the pain of a first in ways you can't imagine now (and I ended up with another section after a failed vbac second time around).I would also strongly suggest you think about a doula-mine was wonderful and really helped.

sounds quite, quite awful and i can understand why you would be considering a section, it is so important to have faith in your care givers.

it might be worth looking at for a doula to support you before , during and after the birth.

and to ensure that you feel supported and that if you have concerns again, that she can speak up and be your advocate.

i would also be discussing oyur last birth with someone at the hospital, to put your fears of something being missed again, at rest. you can put in your birth plan about your fears and that would be perfectly reasonable.

you can also request a section if it looks as though an instrumental delivery would be necessary

you could also have an epidural , as a just in case measure, although that in itself can increase the need for an assisted delivery

i had my husbadn and best friend and my mum, who all knew how importnat a VB was to me, and knew how to support me.

if you have a gut feeling a section is better for you, then you might want to listen to that gut feeling

you might feel better ahving that control about it, but there are of course pros and cons to a section, it is not neccesarily an easier option in some ways, although you won't have the worry of a instrumental delviery

To chime in again - I was amazed at how much more certain (and probably annoying) that we were about what we wanted during the second labour. I was very well informed before my first labour, and DH went to all the antenatal classes and really entered into the spirit - but we were in reality completely unprepared for how it would feel. The lists of women who were much more confident and assertive second time around and had much better experiences as a result would fill books over and over again.

(If you have a strong gut feeling though, I don't see anything bad in having an elective section - it really isn't an easy decision, is it?)

sorry to butt in but just wanted say am also wondering about second birth (although not even preg ) had ventouse (broke) then forceps after induction/ epidural/ back to back 9lb 7 baby (all the reasons for instrumnetal birth suggested by maxbear!!)I asked a passing dr to use forceps on me as dI felt worried that I wasn't getting anywhere!!
Have also wondred whether I would ask for elective cs as never not ever want to be induced but would love to experience a spontaneous birth (was 42 weeks when induced)
Think as Hellymelly says a spontaneous vb would be very healing although I ended up having a blood transfusion after the internal/ mental experience was wonderful just wou;d like to avoid forceps next time!!
good luck with your decision lucasnorth Would love to know what you decide to do!

Lucasnorth, your first birth sound near-identical to mine.

The bottom line was that DS was posterior and it was not going to be an easy delivery.

I am due to give birth again mid September and had v similar worries to yours. I had a debrief of the last labour with the supervisor of midwives a couple of days ago which I found extremely helpful, it answered many questions and has left me with a very positive attitude towards my next labour.

The midwife didn't offer me any stats on a non-instrumental birth second time around but she did assure me that the likelyhood of it was greatly reduced.

I was however v relieved last time that I had managed to avoid an emergency CS which was probably my worst fear. I could accept an elective CS for medical reasons but couldn't face a long labour which ended in a CS anyway. The consultant wanted me to have an epidural fairly early on which I refused. I truly believe it would have ended in CS if I had gone for it.

For me the forceps (while deeply unpleasant) was the lesser of two evils. My DS was delivered safely albeit a little chaotically in the end and I had avoided the dreaded (for me) CS.

Good luck with your decision, keep us posted.

Don't know if this helps at all (personal experience!)

I had a nightmare first birth - managed a vaginal delivery but only just! 37 hours, augmentation, back to back labour, "stargazer" baby, ventouse with 2nd degree tear (dd1 was 9lb12oz and at that was 4 days early!!!)

But my subsequent 2 were fine! Ds was a 10 hour no bother labour, nautral delivery and I only needed a couple of stitches. 9lb3oz at 10 days early. Dd2 was induced at 37 weeks as I was very ill in the pregnancy - a 12 hour labour and natural delivery and she was tiny for me - only 7lb15oz!

So I wouldn't say that an initial instrumantal delivery was automatically followed by more. Everything is looser, for example!!!

I had a forceps birth with a 9lbs 6oz first baby, who had been posterior throughout labour. Also had an epidural.

Second birth didn't involve any instruments, despite baby being nearly 2lbs heavier.

I think you'll be hard pressed to find research that shows rates of instrumental delivery for multips, unless you have a look on MIDIRS (you have to subscribe to access the research). here

Many hospitals don't collate their birth stats to differentiate outcomes for first and second time mums. Shame really as this information would be really useful to the public.

I think it's a really tough decision to make and you can look at all the stats you want to be as informed as you want but at the end of the day that was what happened in that specific case and might not apply in the same way to you.

I had a hard delivery with ventouse 1st time round. second delivery baby was large and got stuck and I had forceps which resulted in a 3rd degree tear + associated problem of incontinence bladder and bowel.

I was told that it was far less likely that I would need assistance with ds 2 and as I had birthed a 9lb 1oz baby I would probably be fine for a 12lber! As it turned out I wasn't as ds 2 got stuck. I asked for a c-section and was told no. When I said I didn't want forceps I was asked why and I replied because of tissue damage and was told it would be fine. It wasn't. I have to have investigations again as to what the problem is (but I am crrently 33 weeks prgt with ds 3) as 18 months on things are still not right.

With this pregnacy I have asked directly for a c-section. I seem to grow large babies my body can't deliver and I do not want anymore damage to my lady bits. For me a c-section is the answer as I after my 1st birth I lost faith in my body and after my 2nd I lost faith in my caregivers. Now the most important factor for me is a safe delivery with ds 3 and myself emerging okay. There are risks but compared to possible incontinence again I don't want a natural birth.

I would say yes, look at the stats but remember you are a completely different case, each pregnancy is different and each delivery is different and your caregivers may not agree to alternative plans whilst you are actually in labour which leaves you rather at their mercy.

Good luck!