What Went Wrong The First Time?

Survey respondents will know that in addition to asking about what type of tear they experienced and whether they chose an ELCS next time, I also asked 12 extra questions about their birth experiences.

I wanted to find out if there was a clear pattern that linked my survey respondents’ tears to a certain birth experience e.g. inductions or big babies.

Here’s what the results showed….

(1) Instrumental Deliveries

*3rd degree tear but don’t know which category

Woman who had 3c and 4th degree tears had a mostly higher than average rate of instrumental deliveries. Sufferers of 4th degree tears had a particularly high rate of forceps deliveries compared with the national average.

These findings back up the literature which states instrumental deliveries carry a higher rate of 3rd and 4th degree tears due to reduced time for the perineum to stretch.

(2) Induced Labour

*3rd degree tear but don’t know which category

Woman who had severe tears had a higher than average rate of induced labour. Sufferers of 4th degree tears had a particularly high rate of induction with a drip containing the artificial hormone, syntocinon, compared with the national average.

(3) Birth Weight

*3rd degree tear but don’t know which category

A fascinating result. The more severe tears i.e. 3c and 4th were NOT correlated with bigger babies. The less severe tears i.e. 3a and 3b occurred with baby weights closer to the national average.

(4) Episiotomy

*3rd degree tear but don’t know which category

This result must be interpreted carefully. The increased rate of episiotomies associated with more severe tears is most likely linked to instrumental deliveries. Please read this.

(5) Baby Position and Shoulder Dystocia

No clear pattern. Several women did not know the answer and I don’t know the national averages so it is hard to compare.

(6) Use of Epidural and Length of 2nd Stage

No clear pattern and I don’t know the national averages so it is hard to compare.

(7) Position of Mother During Delivery

No clear pattern. Most women were on their backs (70%).

(8) Instruction on When to Push

No clear pattern. Most women were given guidance of some kind either continuously or intermittently (80%).

(9) Mother and Medical Staff Activity During Delivery of Head 

No clear pattern. The only results to note were that all women who suffered a 4th degree tear were either pushing gently or strongly (none were panting), and had staff controlling delivery of the head. No woman reported that she alone was controlling delivery of the head.

 

References

National averages were obtained from the following report:

Patterns of Maternity Care in English NHS Hospitals. 2011-12. Royal College of Obstetricians and Gynaecologists.

At time of writings the 2012/13 data was due for publish in summer 2014.

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