A Mumsnet campaign on informed birth choices?

[ReluctantCamper]

these is a thread running at the moment that is both heartbreaking and infuriating.

it is very clear from the thread that many women have been seriously damaged by forceps deliveries, and no-one is very interested.

why does nobody talk about the risks?

I have probably missed out quite a lot, but I think a summary of the general consensus is that:

• we should be clearer about the risks of assisted deliveries. the outcomes should be measured in the medium to long term. At your 6 week check plenty of people aren't continent and hardly anyone is havering a satisfying sex life. However if that is still the situation after 1 year, there is clearly a problem

• women with serious tears should be stitched up by a surgeon. So much depends on their body being repaired properly. This isn't just some cosmetic repair job

The women in the thread put forward better arguments than I can, and I really urge you to read it. This is somewhere the power of Mumsnet could make a huge difference. Think of the future mums who could be spared the heart breaking trauma described in some of the posts. Please Mumsnet, think about taking this on.

Third and Fouth degree tears are repaired by a surgeon - these are nhs guidelines The tear will be repaired in the operating theatre by an
experienced doctor from this patient information leaflet from the nhs.

I think if mn were to get behind something like this, it should be focused on better, short and long term care following a traumatic birth (whatever the type of birth)

Please read the thread MNHQ. It is horrendous that women are going through this.

I think there is a massive disconnect in the NHS between birth method and later care for prolapse issues. This is partly due to the separation of clinicians dealing with the two patient populations. I still feel agrieved that MW say, "you'll be fine" when they sign you off days after birth and never see older women with prolapse and continence issues. There is also the 'pregnancy not birth causes prolapse issues' argument which I find implausible, I had a fantastic pelvic floor the day before I gave birth and a prolapse that is barely touched by physio subsequently.

I wonder if the cost differentials with VBs and particularly instrumental VBs being cheaper than a CS still stand up if the lifetime cost of corrective surgery is included.

If I had twigged that the instrumental rate at my hospital (about 25% irrc) was really more like 40% of first timers and much lower for subsequent births, combined with extra risk from being induced, I might well have enquired about a CS instead.

So, yes, a campaign would be good. I'd also like the NCT to be a bit clearer on this as I came out of my first birth totally unprepared for the injuries I had.

Exactly pico. Since giving birth, I've seen the gp re my tear numerous times, had three physiotherapists, two colorectal surgeons (one of whom I now see for 6 monthly check-ups), had various scans (including an MRI), counselling to get over the trauma...

I'm fine now but I'll probably need surgery in the future.

If this was in any way a cost saving exercise, they've completely shot themselves in the foot!

Mentioned this on the thread but one of the biggest starting points for informed choice is actually having data to be informed with.

All the stats for CS and instruments are widely available. However there is no data for 3rd or 4th degree tears which is something women are hugely concerned about. In the drive to reduce CS this kind of information is important as there is no point in reducing CS if this is at the expense of severe tears. And because the data is not freely available no one is looking at accountability, risk factors or long term costs.

If you try and get information on this the best answer you'll find is an estimate rather than figures. That's dreadful for enabling women to make an informed choice.

Its all very well saying we need this campaign on choice but this may in fact drive CS up which might not be in the best interests of women either if the reasons behind why women suffer tears are more down to policy and poor management of labour rather than women just being unlucky due to physical factors.

You need the data first to be recorded and analysed before you can make an informed choice. You can't run before you can walk.

I know there has been campaigns for 'normalising' birth by other institutions and groups, which have been about looking to reduce medical intervention in order to reduce harm to women, however these have somewhat demonised C-sections in the process which is unhelpful.

C-Sections are not good nor bad. They are something that should be used appropriately. And I say this as someone who had an ELCS by choice for anxiety. I recognise that what I chose isn't right for everyone and it should not be a choice between major surgery where the risks are more predictable and taking a gamble that not only on nature favouring you, but staff being able to manage labour under more pressurised circumstances than a scheduled operation. And I believe that at present that is the choice that really faces women, rather than one that is based on evidence based medicine.

So Step One, which would fit nicely with there being a major review of maternity services is to exam women's concerns and what information they need to address these concerns and how hospitals can be held more accountable.

Step Two is then about how you provide women with information to make informed decisions and how you get hospitals to support and provide care based on these choices.

We are a long way off Step Two and we'd be unwise to try and go for the original aims of the OP without taking Step One because this could potentially be harmful in its own right.

Women should be made aware of the risks associated with instrumental deliveries. A clear link between instruments, severe tears, anal incontinence and higher risk of prolapse should be explained.

Generally I think a better education about childbirth and the pelvic floor is needed. Understanding that the weakening of muscles and ligaments following pregnancy and childbirth (and breastfeeding) is part of childbirth. The risk of pelvic organ prolapse gets higher with each birth and there's also a higher risk with age and instruments. Making it clear to women that if they feel something is about to drop out (like a heavy tampon falling) from their vagina, they should see their GP because it is likely to be a prolapse. Explaining that prolapse might also mean a loss in mobility (no running, no high impact sport).

Postnatal depression used to be taboo and is now part of every pregnancy book and antenatal class. I wish the same shift happens regarding anal incontinence for example. It is at present omitted from antenatal literature (if it is covered, it usually is on a back page in a small paragraph in small letters). Who's at risk? Why it happens? What treatments are available? How can women access the treatment they need? What is rehabilitation like?

This information is important because it might influence women's choices. Some women might forgo childbirth all together. Some women might change what pain relief they use in labour. Some women might decide to have less children. Some women might decide that these issues won't really bother them and prefer having larger families. Etc

A few links
www.bladderandbowelfoundation.org/bowel/bowel-problems/faecal-incontinence/

www.bladderandbowelfoundation.org/bowel/bowel-problems/faecal-incontinence/faecal-incontinence-treatments/

www.bladderandbowelfoundation.org/bladder/bladder-conditions-and-symptoms/prolapse/

I forgot to send the link to the latest Supreme Cout ruling about informed consent.
This applies to all the UK and for informed consent generally. The case in question happens to be an obstetric case which makes it even more relevant for this campaign.

www.supremecourt.uk/decided-cases/docs/uksc_2013_0136_judgment.pdf

This is how the NHS has "translated" the ruling
www.uhs.nhs.uk/HealthProfessionals/Clinical-law-updates/Disclosureforconsent.aspx

Hello hello

Thanks very much for flagging this.

As luck would have it, Mumsnet is on the panel of the National Maternity Review, and we've got a particular remit to think about informed choice and what exactly this means - so hopefully this is an opportunity to think about issues like this.

We'll have a good read of the links here, but do please also come over to this thread and let us have your views.

You can also email us on [email protected] if you'd rather say something privately.

Thanks
MNHQ