Are women receiving the information they need to make informed decisions about vaginal birth and C-sections?
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…
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.
After reading this women’s heartbreaking Twitter comments I created a survey to ask women about whether they received counseling about the risks childbirth injuries from vaginal birth and whether they would have benefited from that information.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]When women aren’t counseled on the risks of vaginal birth they are deprived of the opportunity to make informed decisions.[/pullquote]
So far 563 women have taken the survey and they indicate overwhelmingly that they did not receive the counseling to which they are entitled.
1. The most common serious longterm complication of vaginal birth is urinary incontinence. According to the recent paper Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis nearly 15% of women will eventually suffer from some degree of urinary incontinence. This can be a life limiting condition yet women report that they were not counseled about the possibility.
Over 90% of women were not warned about this serious long term risk.
2. Pelvic organ prolapse is also a serious risk ultimately affecting 6% of women. Pelvic organ prolapse can cause a variety of unpleasant symptoms as the uterus, bladder or both protrude through the vaginal opening. It can be the cause of incontinence and can also profoundly impact sexual function. Nonetheless, even fewer women were counseled about this complication.
Over 95% of women recall no counseling about uterine prolapse.
3. Sexual dysfunction is both a short term and a long term complication after vaginal birth. Incontinence and pelvic organ prolapse can contribute to sexual dysfunction but a common complication is painful intercourse (dyspareunia). Accurate statistics are hard to come by and sexual dysfunction can be affected by factors unrelated to childbirth, but the evidence suggests that vaginal birth increases the risk.
Over 95% of women report that they were not counseled about the increased risk of sexual dysfunction after vaginal birth.
4. Not every woman feels the need to be informed of every possible risk, but in this case women overwhelmingly believe that they are entitled to know about the increased long term risk of urinary incontinence, prolapse and sexual dysfunction.
Over 98% of respondents would have preferred to know about these risks.
5. Would more comprehensive counseling change women’s decisions as to mode of birth? Here the results were mixed.
While 56% of women believed it would make them more inclined to choose maternal request C-section, 44% did not.
Why do so many clinicians — obstetricians and midwives — fail to provide women with the information they need to make informed decisions about mode of delivery?
I suspect it involves a variety of factors, but two seem to me to be most important.
First, women’s pain and anguish are often discounted. No one cares especially that women are suffering long term serious complications. It almost as if childbirth complications are viewed as women’s lot.
Second, there is a deeply entrenched belief that C-sections are “bad” and vaginal birth is “better.” C-sections are demonized in every possible way with some natural childbirth advocates going so far as to say that women who have babies by C-section haven’t really given birth.
Of course most women would prefer an uncomplicated vaginal birth to major abdominal surgery, but that’s not an accurate depiction of the choice women actually face. For many women the choice is between a vaginal birth with injuries and complications and a C-section which has its own risk of complications. Each women will weight the risks differently but when they aren’t being counseled on the risks of vaginal birth they are deprived of the opportunity to make informed decisions.
That’s paternalism and it is never appropriate no matter how much providers may believe otherwise.
