Were you counseled about the long term risks of vaginal birth?

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Yesterday I came across a heartbreaking comment from a woman suffering from the long term risks of vaginal birth:

This may sound dramatic, and may offend some, but speaking from the lived experience of life after forceps birth injury some days I feel I would rather have died, or my baby died, than the everyday reality of these injuries.

She continued:

I feel obstetricians need to know the lived reality when forceps go wrong. First do no harm. I cannot understand how and why my body was harmed in this way as part of my medical ‘care’. I feel they should be banned then alternatives would have to be found.

She must be miserable to feel this way and her injuries did not have to occur or at least did not have to be this severe. Had she been counseled about the risks and offered a choice between forceps and C-section, she might have chosen C-section and avoided this outcome.

Incontinence and sexual dysfunction are severe consequences that threaten quality of life for many woman. We would never recommend prostate cancer treatment to a man without warning of risks to future continence & sexual function. Yet women are routinely counseled about childbirth without mention of future continence and sexual function and they aren’t counseled about the further increase in risk posed by forceps. That’s unethical!

I created the following survey to find just how many or how few women are counseled about the long term risks to continence and sexual function as a result of vaginal birth. I would be grateful for your parcipation. I will share the results when the survey is ended.

If the survey doesn’t display properly in your browser, you can take it here.

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  • Desiree Scorcia

    Neither of my OBs discussed the risks of vaginal birth or section with me. I read much more in birth literature about the risks of c section, but my reading skewed heavily NCB. I didn’t know about vaginal birth risks until after my first (emergency section) when i made mom friends and learned about leaking . Now, i feel like i hit the lottery in needing a section. It allowed me to choose ERCS for my second, and i experienced no sideaffects. It shouldn’t take this kind of good luck to get the best birth experience…

  • storkdoc

    Gosh, I think if we had to do informed consent for pregnancy, labor and delivery, the human race would quickly go extinct. That being said I do discuss risks of forceps/vacuum vs section. I have alway preferred the vacuum because in my anecdotal experience, there is significantly less harm to the mom.

    • Sarah

      Maybe if the informed consent was necessary before conception we’d go extinct…

  • Ravens Starr

    Read a sad story today by a woman in a non-childbirth related forum today. She is pregnant after having her baby die during labor, and is obviously terrified it will happen again. She didn’t give a lot of details (and I didn’t press, as she is distraught), but she said her baby’s heart “just suddenly stopped for no reason” during labor. She blames herself. Having read this blog for many years now I have to wonder what they told her, why they didn’t see signs of trouble coming, and why an emergency c section wasn’t performed.

    • Anna

      I have heard a couple of stories like this and yeah Im not gonna push for details but one I have heard the whole story of the midwife ignored a poor ctg and said “if the Drs sees that he’ll give you a c-section”. A couple of hours later OB was called, crash section was done, baby was severely brain damaged and died. Midwife quit so no repercussions for her. Just suddenly died is a typical homebirth reason but the monitoring is inadequate. Shouldnt happen in hospital but it can.

  • MelJoRo

    I think you need another option to be last question, I DID chose a CS, despite the lack of counseling about the risk and of a vagina birth. To be fair, I brought up my desire for a MRCS pretty early, so my OB obviously knew that the risks of a vaginal delivery were on my mind.

  • Jessica

    I have a connective tissue disorder so I had quite a few discussions with my OB on the topic of complications both from vaginal delivery and from surgery (in my case, the risks from surgery were substantially higher but I had special monitoring for vaginal delivery due to elevated risk of postpartum hemorrhage). I can’t recall which of us initiated the conversation but I came in with a lot of information about my own condition. She was very engaged and spent a lot of time going through the pros and cons and how to minimize risks.

  • Emma

    I had to have ultrasounds throughout my pregnancy, and when my baby was showing close to 9 lbs at 38 weeks, even then, c-section was never mentioned as an option.
    I ended up in labour for 2 days, pushing for 2 hours, 4th degree tear, and baby in NICU for meconium aspiration. Commence the hell of raising a newborn when you can’t even get up, move, walk, because of the pain. 2 months later I was back in surgery for a fistula and infected sutures. That surgery resulted in a painful abcess a month later. I was not pain-free until 1.5 years after the birth of my son, and I was in so much pain that I couldn’t care for him properly for the first 6 months of his life.
    So yes, I would have chosen a c-section, hands down, over the hell that was recovering from a 4th degree tear and all the very common complications that come along with it.

    • Anna

      Im so sorry that happened. Its all too common a story unfortunately.

    • seenthelight

      You poor dear. Internet hugs. This shouldn’t happen in modern societies.

  • rational thinker

    With my first the doctor told me c section recovery was horrible compared to vaginal birth.Then I got 4rth degree tears.

  • Daleth

    Not only was I not counseled about those risks, my MFM’s repeatedly dismissed my concerns when I asked about the risks. I was pregnant with mono-di twins and even though *that alone* is a medical indication for c-section, AND one of them was breech at nearly every ultrasound, AND we all agreed that they needed to come early (the standard of care for mono-di twins is to deliver in week 36-37), they still spent months refusing to schedule a c-section and trying to convince me to attempt an induced vaginal birth.

    Even when I came in with a printed-out stack of medical studies to show them why I preferred to deliver by c-section, they still tried to scare me into attempting vaginal birth. Even though mono-di twins are so high risk that if you do attempt VB, you have to labor in the OR because the risk of needing a c-section for one or both babies is so high! And even after my CS was finally scheduled, the week before it the head of MFM tried once again to convince me to attempt VB, just because it so happened that at that day’s ultrasound, Baby B was uncharacteristically not breech.

    Since I had a team of MFM’s looking after me, I just kept insisting and finally got one doctor who acknowledged that many of his colleagues pushed a little too hard (no pun intended) for patients to attempt VB. (Note, since I’m talking about MFM’s, not regular OB’s, every single one of those patients was by definition high risk.) He agreed with me that women should be counseled on the risks of VB.

    As for the other docs, their attitude was basically, “You should attempt VB and if anything goes wrong, you’ll all end up fine.” Which I’m sure we would have, since this was a gigantic university maternity hospital with every possible specialist on hand 24/7. But my point was that I didn’t want to spend however many hours in labor, in pain, hoping we would all be ok; I didn’t want a crisis to erupt and have to spend any time freaking out and praying for my babies (even if they did end up being fine). I just wanted to go in and have my babies in half an hour with as little stress, pain and risk as possible.

    And if it was that hard for me to get a c-section — a high-risk twin mom who also happens to be a lawyer, very accustomed to standing up for myself — imagine what it would be like for a singleton mom who wanted a maternal request CS.

    • MelJoRo

      That is astonishing, and quite terrifying. God forbid baby B hadn’t distress and you had to suffer through a breech extraction or an emergency surgery, even if the end result was ok. Also, it seems crazy to push for a VB with moms of multiples…like how many women with a set of multiples are going to have more than 2 more pregancies (with the risks of repeat CS jumping up astonishly after 3)??

      • Daleth

        I know, seriously. And guess what I found out after they were born? At my hospital, the placentas of twins are always examined to check if they’re identical (one placenta = definitely identical; two placentas that fused could mean ID or fraternal, but usually fraternal). The whole shebang, placenta and umbilical cords, is delivered to the pathologist. And the pathologist’s report for my boys mentions that their umbilical cords were, respectively, only 9″ and 10″ long. Normally they’re about 22″ long.

        Why does that matter? Picture a baby trying to exit the womb: the placenta has to remain attached in order for the baby to have an oxygen supply while it’s coming out. If the cord is too short, it will pull the placenta off the uterine wall during delivery, cutting off the baby’s oxygen supply. That risk is especially high if the placenta is anterior — as mine was — because that’s basically as far as the placenta can be from the exit.

        So you tell me how things would’ve gone if I’d delivered vaginally. If Baby A had pulled the placenta off on his way out, depriving himself of oxygen while he was still only halfway out, and leaving Baby B inside with no oxygen, and causing me to hemorrhage because the womb can’t contract (and thus can’t stop bleeding) when one and a half babies are still inside it. How would that have gone for us, do you think?

        Instead, because I’m a determined person who knows how to stand up for herself (did I mention I’m a lawyer), I got a C-section and my boys came out with Apgar scores of 9 and 10. To put it mildly, that’s not what would’ve happened if I’d let my doctors pressure me into attempting a VB.

        • demodocus

          That is f’ing terrifying to imagine.

          • Daleth

            Yep.

    • Jennifer Farra

      Wow. I was a first -time, low-risk mom and at about 25 weeks I just told my OB that I would prefer a section and she was totally on-board. This was in 2005. I feel so fortunate to have gotten my MRCS in before there was so much backlash and quotas and policy changes.

      • Daleth

        I’m so glad it was easy for you. It should be for everyone. It really seems to depend on the OB — that’s why on chatboards you’ll see women asking, “Can anyone recommend an MRCS-friendly OB in such-and-such city?” It’s insane, it’s like we’re discussing contraband or underground, non-FDA-approved meds.

  • Cartman36

    I wish that falling to discuss the risks and benefits of ALL options with women was not just limited to childbirth. I became pregnant with baby # 3 nine months after a tubal ligation. I was totally unaware at the time that I had the tubal ligation, that there were different methods for tubal ligation and that each type had a different levels of effectiveness. I ABSOLUTELY feel that my providers were more concerned with making sure that I knew it was permanent (hahaha) than they were with helping me to determine the best option for me. If I had known that a bilateral salpingectomy was the most effective sterilization procedure there is with as close to zero risk of spontaneous pregnancy as possible, I would have insisted on that versus the tubal ligation from the onset.

  • MaineJen

    My mother in law recently confided in me, in a just-between-you-and-me voice, about the indignities of caring for her uterine prolapse. !!! This woman is over 80 years old…her last vaginal delivery was in 1973. I’d call that a significant long term risk.

  • Griffin

    I used to post here as Oscar so some of you will know this story. 18 years ago I was pregnant with my first in the Netherlands. I had heard from a Brazilian friend several years previously that women in Brazil often get elective cesareans to “spare their nether parts”. That’s the first I ever heard about the harms vaginal birth can cause.

    So when I got pregnant, being a scientist, I started reading about the risks and benefits of elective CS as opposed to a trial of labor. After a few months of research, I wanted to discuss my findings with care providers. Well, forget it. When I mentioned elective cesarean to the midwife, she said I would NEVER get one in the Netherlands. I then forced an ob to meet me (midwife-led care means you’ll never see an ob generally – this was also a country that did NOT do routine ultrasounds) and he got this cold face when I tried to discuss elective cesarean and ushered me out abruptly. I ended up going across the border for an elective cesarean with a sympathetic ob and midwife pair who pretended I was travelling through, started labor, and had to get a CS.

    So, yeah, I can totally guarantee that at that time in the Netherlands at least, the possibility of physically ruinous vaginal birth was NEVER discussed with women. Later several women told me, after I told them I had had an elective CS, how their vaginal birth had ruined them and, in one case, caused extreme Erb Palsy in the child. All of them were traumatized and said that had they known about elective CS and the risks of vaginal birth, they would have chosen the former in a heartbeat.

    It makes me really angry to think of the suffering that is routinely handed out to women under the guise of “it mostly goes well” and “we don’t want to worry anyone”. Such paternalistic irresponsible garbage.

  • rational thinker

    I think one of reasons a lot of obstetricians dont tell women about maternal request sections is because of all the pressure in the media and online and everywhere really about the us section rate being too high and stupid documentaries like business of being born.A lot of the time from natural childbirth industry I see it a lot on the news too.People just see these things and assume cause its on the news or a stupid documentary that it must be true.So that may be why c sections became so demonized.People just believe what they say on tv or online no one checks anymore to see if something is true.Facebook is probably the worst example.So if an ob says c sections are the safest delivery method in most cases for mother and baby it is going against popular belief.Even with a college degree,doctorate, you cant beat popular belief.

    • Anna

      I agree. Every second day theres an article out on how terrible c-sections are, usually based on some rubbish study. Now this article written by someone clearly not medically minded let alone trained suggesting all kinds of dangerous crap and its being shared by groups who think thebsuggestions should all be implemented. OBs would be damned if they do and damned if they dont. Women and baies will pay.

    • seenthelight
  • rational thinker

    After 24 hours of labor with my first and two hours of that pushing my ob was getting mad I think because it almost 11pm and he told me a few days before not to call him at 2 am. I thought he was joking. i went into labor at 11 pm I called him at 12 and was in the er at 4am ob got there at 6am.He just had a bad bedside manor altogether then after pushing for 2 hrs he yelled at me and said”you should have just asked me for a c section”. That was funny cause two weeks before I did ask and he said no.So in the end I had 4rth degree tears and had to sit on a inner tube for 2 weeks. I don’t like to have sex and whenever I sneeze I piss myself.But I did get A beautiful baby boy, At the time that was all I cared about.I did not realize how it would be after I healed up.Looking back I was almost two weeks overdue he was 8lbs 11oz and his head was 14cm and his shoulders also 14 cm. I think he got too big in the time he was overdue, I had an ultrasound 3 days before he was born and I remember it hurt like hell I don’t think they were pushing on my belly too hard I think it was cause he was too big. I did not get any stretchmarks until the last week they started showing up a little 5 days before he was born. I had a girl 2 years later with a new ob and i was induced after 5 days late I had another vaginal delivery I didnt tear at all labor was 3hrs and I only pushed twice and got right out of bed an hour later. She was 6lbs 13oz. If I do have another I will be demanding a section if they think the baby will be over 7 and a half pounds.

    • space_upstairs

      Man, I’m glad my OB induces at 40 weeks after seeing that. Hopefully my baby won’t already be oversized then…but lower chance of that with no diabetes.

  • Stephanie

    With the birth of my first child, not only was I not counselled to the risks of vaginal birth, I was told that it the pain was no more severe than period cramping, and that I would bounce right back. I sat on a donut for 4 weeks, with a 2nd degree tear that would not heal. I also developed stress incontinence.
    When I became pregnant with my second, I told my NEW OB about the hell that my earlier delivery was, and how I was terrified of giving birth vaginally again. I asked if a cesarian was a possibility, and told no but not to worry, as tearing was unlikely with later children. I remember hoping that the baby would be breech so I could get one. When they discovered the baby had a true knot in her cord, I again asked for a section, but was told that the delivery could be managed without one. I was given an early and high epidural in case an emergency section was required, and they ended up using forceps when the knot pulled tight. Again, I was on the donut, this time with a 3rd degree tear. The sutures became infected and required surgical repairs.
    My incontinence increased, and I was in depends at the ripe old age of 25. Sexual activity became painful. I refused to have more children until I heard maternal request sections were possible.
    I became pregnant with my 3rd, and was able to obtain a maternal request section. Before approving my request, I was counselled to the risks of bleeding, infection, difficult recovery, and scarring. I laughed at the OB, as I had all of the above and more with my vaginal deliveries. I was also informed I wouldn’t have been approved if I hadn’t had prior vaginal deliveries.
    This delivery took significantly less time, was significantly less painful, with a much easier recovery and it was the only delivery where my baby didn’t need to be resuscitated.
    Had I known maternal request cesarians were available, I would have never consented to a vaginal delivery.

    • My period cramping varies, but it can leave me curled up on my bed in great pain that does not respond to OTC painkillers, only getting up to stagger to the bathroom to throw up, for up to eight hours, with pretty severe cramping that I can control to a degree with OTC painkillers after that. I do NOT enjoy those particular periods, and I wouldn’t handwave that away as “no big deal” either. Granted, that’s worse than most women deal with, but “no worse than period pain” is not a good indicator because it varies so much between people.

      I am sorry that you had such awful experiences, and I’m glad you got a C-section at least once when you requested it!

      • Chi

        OMG I feel you so much. I describe the first 3 days of my periods as ‘hell on earth’ because honestly the cramps are enough to make me not want to be upright in any way shape or form and I spend much of that time curled around a hot water bottle.

        Oh and I’m also at a higher risk of severe migraines due to the hormonal changes. Fun right?

        Also, describing contractions as ‘no worse than severe period cramping’ is disingenuous and minimizes what is for most women (and was for me) an excruciating experience. Cos it paints BOTH period pain AND contractions as no big deal.

        I HATE how sexist medicine can be.

  • Guest

    My OB spent more time going over what I should avoid eating during pregnancy than risks by birth mode.

    • space_upstairs

      Really? What a pain. My OB was quick with that: just avoid raw animal products and street food due to food poisoning risks. Done.

      • Guest

        Yes, mine was quick with that too, but that was my point! The two seconds my OB spent on what not to eat was longer that the nonexistent discussion on vaginal birth risks. When I did try prompting the discussion by saying I was worried about tears, her response was “it’s a space issue” (like I didn’t know that), and when I pressed about severe tears, she responded simply “they’re rare.”

        • space_upstairs

          Yeah, that’s pretty rude. I guess they assume that most people don’t want to know about vaginal birth risks and that C-sections are considered a mark of shame for both the doctor and the patient. It’s conventional wisdom that C-section recovery is slower than vaginal birth recovery on average, but apparently complicated vaginal births are worse than routine C-sections. The situation sounds remarkably similar, in fact, to breastfeeding: on average, breastfed babies do as well as or slightly better than formula-fed ones, but when breastfeeding goes south, especially with the most dogged insistence on straight-from-the-source, exclusive feeding (analogous to preferring forceps over C-section at the first sign of birth complications), the results can be brutal.

          It’s also a common belief that people wouldn’t want to know much about risks at all – that hearing about what could go wrong just makes people upset or even (The Secret-style) increases the odds of things going wrong. As a natural pessimist, though, I’d rather know what could go wrong to prepare for it, because I’m inevitably going to worry about it anyway, and it’s more painful when that worry is delayed to the last minute and not dealt with properly. Thankfully my OB was forthcoming when I was concerned about preeclampsia, and will be similarly forthcoming when it comes to the risk and risk factors for vaginal birth gone wrong (other than being overdue, which he already mentioned very early on that he works on avoiding).

  • Chi

    The only HINT I got of possible post-labour complications, was ONE birthing class where we spent 10 minutes learning how to do kegel exercises, with the message being that if you did them x times a day for x days, you’d be totally fine and dandy with no incontinence problems or anything.

    My daughter is 4.5 years old and I STILL suffer from stress incontinence. Particularly when I sneeze (and it’s spring here so allergy season so I’ve been sneezing a LOT).

    I did the damn kegels and they haven’t done a thing to help.

    • MelJoRo

      I’m so sorry! Have you considered PT? In my experience, PTs who treat women’s health issues are compassionate and good at their jobs. They have way more tools in their toolbox than legal s.

    • Ravens Starr

      Do they do anything at all? A FOAF recently posted something to fb along the lines of having a uterine prolapse and how kegels haven’t helped at all. It has started to feel like shaming – anything bad happening to you “down there”? Should have done your kegels, lady!

      • fiftyfifty1

        “Do they do anything at all?”

        Excellent question! Research has provided some answers:
        1) Kegals do NOT help at all for fecal (stool) incontinence.
        2) Kegals do NOT help at all for uterine prolapse (or bladder prolapse.)
        3) Kegals may provide some help with urinary control, although many of the studies are poorly designed.

      • Sarah

        I’ve always had the impression they’re better for just general tightening and toning up, and aren’t useful for more serious issues.

      • BeatriceC

        At the risk of TMI, I’ve done so many damned kegals that I can bring a man to orgasm with just vaginal muscle contractions. Still had to have surgery to fix incontinence.

    • Anna Lee

      I am so sorry that happened to you. Something similar happened to me; I was having lots of pelvic floor issues (scar tissue, pain, incontinence, etc). When my OB told me for the umpteenth time to do Kegels, I said “No, you are writing me a referral for a pelvic floor physical therapist.” I saw that PT for 6 months, and it really really helped me even with the stress incontinence. I hope this helps. I think pelvic floor physical therapists can really help with these post-partum problems.

      But honestly, if I had to do it all over again I would request a C section, or after 24 hours of labor just refused to continue to push until they rolled me to the OR.

    • demodocus

      Pretty much identical for me, except I sneeze to tobacco and one of the guys who is rebuilding the porch next door smokes cigars. sigh.

    • The Bofa on the Sofa

      I did the damn kegels and they haven’t done a thing to help.

      The best role for Kegel exercises is for dirty talk and foreplay. Believe me, you call a guy and he says, “What are you doing?” and you say, “Kegels,” if he knows what you are talking about, it will be, like, “Schwiing!” He’s on his way home! (because he’s imagining it in his head)

      Now, if he doesn’t know what that means, and he says, “What’s that?” and you tell him, it will be Schwing, but he’ll also turn into a drooling idiot.

      • fiftyfifty1

        Tone deaf as always.

        • Chi

          I dunno, I actually found Bofa’s comment rather amusing ^_^

          • fiftyfifty1

            When we get into a discussion of Kegals around here (e.g. in the context of reassuring a woman that we know she’s not lazy or doing it wrong when they don’t work for her incontinence or pelvic organ prolapse, that reconstructive surgery vs. pessary is what she needs to be talking to her OB/gyn about) Bofa, historically, jumps in to remind us that “Kegals” is the special code word that he and his wife use when they wanna talk sexy on the phone and that it always works to give HIM a boner, and hearing THAT will surely motivate us to try his tip with our own partners. So luckily for you, if you stick around, you’ll get to hear his amusing story many times again.

  • Anna Lee

    Personally speaking, I was not counseled about the risk of vaginal birth. I ended up needing 6 months of pelvic floor therapy, and can no longer move faster than a walk. I was not physically healthy enough to return to work until 16 months. I do wish a C section had been offered to me and that I would have been brave enough to choose it, despite the societal pressures to do otherwise.

  • Kq

    I learned about a lot of that here. Yet I don’t think it ever sunk in until aftet the kid was born…

  • space_upstairs

    My OB hasn’t brought it up (yet…I recently started the third trimester). But he brought up already at the 2 month visit the higher risks of stillbirths and complicated births that lead to C-sections in overdue pregnancies, and thus that he prefers to induce at 40 weeks. No complaints here. I can ask at the next visit about rates of vaginal births that leave the mother in diapers…he will probably share the stats like he did for pre-eclampsia when I was worried about that. (He said pre-eclampsia was 1 in 20, with severe deliver-premature-or-die cases about 1 in 100, and the main risk factor being genetics/bad luck, not so much age or lifestyle.)

  • attitude devant

    When I trained, in the late 1980s, there was some academic guy at the University of Colorado whose area of research was the lifetime costs of c/s vs vaginal delivery. This was an analysis of the cost of medical care. His data showed that c/s saved the healthcare system money in the long run by protecting against urinary and fecal incontinence as well as uterine prolapse. Vaginal birth wasn’t even close.

    • Amy Tuteur, MD

      Neel Shah recently acknowledged that C-sections actually save money in the short term by using fewer staffing resources compared to long labors.

      • fiftyfifty1

        Oh, do write a post about this!

      • Cristina

        I believe it. I was in the hospital for nearly a week (including recovery) because my doctor and the OB were so determined to wait for my induction to kick in. I also had a nurse in the room with me the entire time. Had I been sectioned, I would have been out sooner and freed up L&D resources.

      • BeatriceC

        Yup. I’m watching something like this unfold right now.