Using forceps or a vacuum to vaginally deliver babies is resulting in more injuries to both mothers and infants in Canada, according to a large new study.
The study published in the Canadian Medical Association Journal on Monday looked at nearly two million single-child hospital births in four provinces between April, 2004 and March, 2015.
The data shows the number of operative vaginal deliveries, where a vacuum or forceps are used, is declining, while the risk of injury from such procedures is on the rise.
“We found increases of seven per cent of the rate of obstetric trauma among first-time mothers following forceps deliveries,” the study’s lead author Giulia Muraca, a postdoctoral fellow at the University of British Columbia’s department of obstetrics and gynecology, told CTV News. “Any time we are seeing an increase in a complication we should be concerned.”
In Canada, operative vaginal deliveries fell from 16.8 per cent of all vaginal deliveries in 1995 to 13.2 per cent in 2014, whereas caesarean delivery rates increased from 17.6 per cent to 27.3 per cent of all deliveries over the same time period, according to figures included in the study.
The spike in C-section births has previously led to recommendations to increase the number of operative vaginal deliveries. But the injuries that can result from forcep or vacuum deliveries highlight the need to improve the training and skills of doctors who perform them, researchers say. They also note that the potential risks of both C-sections and operative vaginal deliveries need to be carefully weighed in each case.
The rate of obstetric trauma during operative vaginal deliveries jumped from 16.6 per cent in 2004 to 19.4 per cent in 2014 for first-time mothers, according to the study. The largest uptick in injuries occurred when forceps were used, a rise from 19.4 per cent among first-time mothers in 2004 to 26.5 per cent in 2014.
The injuries range from minor cuts to serious tears and lacerations that impact the mother’s ability to control the bowels and bladder.
“These perineal lacerations or tears that we are seeing, those accounted for 87 per cent of the cases of obstetric trauma among women who had forceps or vacuum deliveries in our study. Those aren’t anything to scoff at,” said Muraca, who holds a PhD in population and public health from UBC. “These cause long-term quality of life implications such as having severe perineal pain or sexual dysfunction or abscess formation. Perhaps the most disabling complication from these lacerations is an inability to control your bowels or your bladder.”
The study also noted an increase in trauma to babies during operative vaginal deliveries.
Laura Ralph said she delivered her son with the help of forceps two years ago because his heart rate would drop every time she pushed. She said the procedure likely weakened the tissue that holds her pelvic organs in place. She’s OK now, but she wishes she had chosen a caesarean.
“In my case, the front vaginal wall got weakened, so now the bladder is kind of drooping into the vagina,” she said. “It was scary to think (about) what was my life was going to be. I couldn’t walk for long periods of time. I couldn’t lift up my son without a dragging, heavy sensation.”
Muraca and her fellow researchers are examining what’s behind the rise in injuries related to the use of forceps and vacuums. One possibility is that today’s obstetricians aren’t as practiced when it comes to these procedures.
“It could be because operator skill is declining. It could be that obstetricians aren’t skilled as they used to be in performing these forceps and vacuum deliveries,” Muraca said.
Dr. Janet Lyons, the high-risk obstetrics medical lead at the BC Women's Hospital & Health Centre, said the risks are rare, and women should not be afraid of natural deliveries.
“Women who have an operative vaginal delivery in general are really quite pleased short and long term,” she said.
The report suggests policy-makers be cautious when recommending surgical vaginal delivery without improved training and oversight. At the same time, the authors warn against completely abandoning such procedures.
“For those who are considering child-bearing, or who are perhaps conceiving a birth plan, please consider and enquire about all the risk and benefits of all modes of delivery,” Muraca said. “If you do have to make these decisions in labour, then you can do so competently.”
With a report from CTV News medical affairs specialist Avis Favaro and producer Elizabeth St. Philip
