Forceps and incontinence


Jill Raleigh Fischer, a nurse, wrote about her experience with forceps and incontinence on The Skeptical OB Facebook page in response to my piece Incontinence: the traumatic result of vaginal birth that dare not speak its name. Jill gave me permission to share it on the blog. She was motivated to share her experience after reading a DONA international article “ACOG to OBs: Consider Operative Vaginal Delivery to Reduce Cesareans,” and notes that operative vaginal delivery has the highest risk of pelvic floor damage and subsequent incontinence.

I am a sample of one and my forceps baby is almost 41 years old… born in the heyday of forceps deliveries. Do I want any and all measures to be used to save the life of a mother and her baby ~ absolutely. Do I think “operative vaginal delivery” should be used to reduce cesareans ~ hell no!

That said, my son’s mid-forceps delivery was performed by a perfectly competent obstetrician in a perfectly fine hospital. No one has been sued.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Try asking some women how forceps delivery worked out for them.[/pullquote]

I went into labor at 40 weeks gestation with a SROM (spontaneous rupture of membranes) and progressed normally for a first labor. That is until the second stage of labor (pushing). After three hours of trying very hard to push an occiput posterior baby out, a forceps delivery was recommended. A spinal anesthetic was administered and forceps applied.

My entire body moved down the table with the pulling and tugging applied to my son’s tiny head and body. With gratitude from all that is within me, he arrived healthy and whole and suffered no more than a bruise to his beautiful face. He had no lingering problems from his traumatic entry into the world.

However, forceps delivery is an incredibly invasive procedure and can and does result in trauma to babies and to their mothers’ bodies. This consequence appears to be grossly under reported or even recognized. The above New Yorker article cites the historical lack of use of evidence based practices in obstetrics. Perhaps that has changed, but no one has asked how I have fared since my forceps encounter.

My first experience was intense perineal pain. Sitting for a month plus was very difficult. On the plus side, I was able to have 3 more children with natural, vaginal deliveries. Would I have traded being able to have fewer children had I undergone a cesarean section the first time and having 4 with the pelvic difficulties I have had? That is a loaded question I can’t answer since I adore all of my children.

I had complete urinary incontinence immediately following my son’s forceps delivery. I was horribly embarrassed. This improved but persisted as a problem. By the time my youngest child was 4 (and the first one was 10) I was experiencing pelvic prolapse. I underwent a hysterectomy and bladder suspension. 4 years after that I underwent an A & P repair. The damaged tissues between the vagina and the urinary tract and between the vagina and the end of the digestive system needed to be repaired to improve function of both systems and decrease urinary incontinence.

With the passage of time, aging and gravity, inherited quality of tissue, and the emerging thought that these procedures are not what should be done, I found myself needing a pelvic reconstruction at age 55. Seems old ~ so what? It’s not old when it is you this is happening to. Again, I was fortunate to work with an exceptional surgeon and had insurance to assist me in obtaining good care. But, there is no putting it back the way it was no matter what kind of deliveries you had. With my history, I had even less chance than that.

Still, the evidence seems to suggest that the kind of damage I have suffered is less common following cesarean section deliveries. Did anyone ask how it went for me? Did they ask anyone? Any real studies done that support using operative vaginal deliveries in lieu of cesarean section deliveries?

I am not writing about a few tugs on a vacuum, though this should be done with the utmost thought, skill, and care. I am writing about a violent procedure and to say that there is no reason any woman should again endure a forceps delivery merely done to avoid a c-section. It may look cost effective and that it reduces pain and suffering. I am telling you that from my experience, it costs plenty of money, plenty of suffering and it costs women world wide their dignity.

So, try asking some women how forceps delivery worked out for them. And, women… fight to retain control of your bodies, your healthcare and your birth process!