MASIC Blog – BirthFacts
This month we welcome BirthFacts to the blog. BirthFacts aims to provide evidence-based information about the risks of different modes of birth to support informed choice.
‘Over the last year, I have been researching and building a website https://birthfacts.org/the-facts-for-womens-health/ which outlines the risks of different modes of birth for women and babies. BirthFacts in large part relies on evidence reviews by the National Institute of Clinical Excellence (NICE), which is the body that determines standards of care in the NHS.
Different modes of birth have different risks and benefits. For example, compared to caesarean, planned vaginal births have a lower risk of peripartum hysterectomy, placenta accreta and other problems. However, caesarean reduces the risk of anal sphincter injury, pelvic organ prolapse and other problems. BirthFacts puts numbers on all of the relevant risks. The website does not make any judgements about what mode of birth women ought to choose. The sole goal is to provide information for women to allow them to make an informed choice. To many, this principle – informed consent – may seem innocuous, and, indeed, it should be.
In Britain, women have a right by law to give informed consent to their mode of birth. Unfortunately, today very few women do this. Few women are provided with any relevant information, and even when they are it is not comprehensive or evidence-based.
A survey by Birthrights https://www.birthrights.org.uk/and Mumsnet https://www.mumsnet.com/ found that only 74% of respondents say they were given the opportunity to discuss the benefits of a vaginal delivery, and only 42% said they were given the opportunity to discuss the benefits of a caesarean section. The MASIC survey of 703 women who had experienced instrumental delivery found that 78% of respondents felt they did not have enough information to make an informed decision about having an instrumental birth and the type of instrument used: https://masic.org.uk/wp-content/uploads/2023/11/Instrumental-Delivery-Survey-Report.pdf
To give one example, in Britain, tens of thousands of women who give birth every year will go on to suffer a pelvic organ prolapse. Almost none of these women will have been informed even about the existence of this injury, let alone how different modes of birth affect the risk. For instance, in the Mumsnet and Birthrights survey, one woman commented:
“After three days of labour, I was told to choose between an emergency forceps delivery or C-section. I knew the risks of a C-section so I opted for forceps. I ended up with a severe prolapsed bladder which is making my life a misery. I had no idea this was one of the risks of forceps and that it apparently happens to lots of women.”
Women are also not informed about how different modes of birth affect other injuries that will eventually affect hundreds of thousands of mothers who give birth each year, including anal sphincter injuries, levator avulsion, urinary incontinence and faecal incontinence. In any other area of medicine, if you were having an operation and were not told that there was a sizeable chance of a lifelong debilitating injury, then everyone would recognise that your rights had been violated. Unfortunately, this is not so when it comes to giving birth.
This is the reason I made BirthFacts. Although I am proud of BirthFacts, the fact that I felt the need to make it to fill the gap left by the NHS should be alarming to everyone involved in maternity care. This is not because doctors and midwives are failing to follow NHS advice and best practice. There is no NHS advice and there is no best practice. There is no scheduled appointment at which doctors or midwives are supposed to inform women of the risks they face. Doctors and midwives are not given any comprehensive evidence-based information to share with patients, and there are no usable NHS resources for expectant mothers.
Today, the provision of information about the risks of modes of birth can best be described as ‘anything goes’. The void left by the NHS is filled in an ad hoc way by antenatal classes that are completely unregulated. If you search on the NHS website for antenatal classes, you will be provided with a range of organisations in your area, including, for example, NCT classes or hypnobirthing. However, these organisations are not required to provide accurate information, and indeed they do not do this.
Thankfully, this situation is easy to fix. The content on BirthFacts takes around 20 minutes to read (for comparison, an NCT course is 17 hours long). The material on BirthFacts could easily be made into an NHS information leaflet or app, and women and their partners could be provided with this information at a scheduled number of appointments during pregnancy. Crucially, information needs to be provided in the antenatal phase, not during labour. Women cannot provide informed consent when they are exhausted, in extreme pain, or under varying amounts of pain relief. There is ample time for women to be provided with all of the relevant information prior to labour.
The status quo on informed consent in maternity care is poor, but it can be solved easily and cheaply.’
