While many women worry about needing a Caesarean section for fear of the extra recovery time and increased complications, vaginal births that require the use of forceps can also bring serious long-term side-effects. And a new study reports that trauma from forceps deliveries has been on the rise in recent years.
In the past few decades, forceps deliveries have become less common while C-sections have been on the rise. But concern over the prevalence of C-sections, which bring the risk of infection, cause extra recovery time and potentially lead to issues with future pregnancies, has incited doctors to increase their use of operative vaginal deliveries, which involve forceps or a vacuum. But according to a study published in the Canadian Medical Association Journal (CMAJ), this has brought a surge of injuries to mothers. The research found that while 19.4 percent of first-time mothers who had forceps deliveries experienced obstetrical trauma in 2004, that number jumped to 26.5 percent of mothers in 2014.
Obstetrical traumas, explains Giulia Muraca, the study’s lead author, most often involve severe perineal tearing, but they can also include cervical tearing or injuries to the bladder or urethra. And the effects of these traumas are not short-lived. Muraca, who is a postdoctoral fellow in the department of obstetrics & gynaecology at the University of British Columbia, says severe perineal tearing “can lead to impaired control of the bladder and bowel function as well as pelvic organ prolapse, one of the most common reasons for gynaecologic surgery.” It can also contribute to painful sex long after birth.
The study looked at nearly two million deliveries of single babies in Alberta, Manitoba, Ontario and Saskatchewan from 2004 to 2015, and while C-section births were still more common than operative vaginal deliveries (26.6 percent versus 18.2 percent among first-time moms), researchers noted that for every one percent increase in operative vaginal deliveries, there was likely to be an additional 700 annual cases of obstetrical trauma among first-time moms.
Muraca theorizes that the rise in injuries is due to a decline in expertise. Because fewer doctors were performing operative vaginal births in the past few decades, “maybe the younger obstetricians haven’t had as much experience training using these instruments,” she says.
But that doesn’t necessarily mean we should rule out operative vaginal births as valid options. Cristopher Ng, who contributed a commentary on the study in CMAJ, writes: “We have reached a critical juncture in obstetrics: We can either accept a rapidly diminishing role for operative vaginal delivery or rise to the challenge of optimizing the training and decision-making skills of our providers of obstetric care.”
In the meantime, Muraca says that women should ask their health care providers about the benefits and risks of all modes of delivery. “All interventions carry their own risks. I think because [operative] are through the vagina they’re perceived as being more natural, but they have just as many risks—just different risks.” Once you understand the risks of each, Muraca says you should feel confident talking to your healthcare provider about your preference, should the need for an intervention arise.
And for those who’ve already experienced obstetric trauma, Muraca says don’t feel ashamed to seek help. “Your duty as a mother does not have to include a diminished physical or sexual life.”