Your health and wellbeing in the short & long-term

An episiotomy is a cut made in the vaginal tissues during childbirth to make more space and speed up the birth.

Around 15 in 100 women have an episiotomy, most often during a forceps or ventouse-assisted birth [hyperlink]. But sometimes during a spontaneous vaginal birth.

An episiotomy is usually repaired using dissolvable stitches after the birth. The area around the episiotomy may be swollen and sore to touch. You will be offered regular pain relief medication to manage this. The recovery from an episiotomy is usually straightforward, but occasionally can become infected or take a longer time to heal.

Where has this information come from?

Add

Forceps or ventouse (suction cup) are used to shorten labour to help a woman or baby. They help women to give birth vaginally. Around 30 in 100 women having their first baby give birth this way.

Instead of using forceps or ventouse, you may choose to wait for birth to happen on its own or have a caesarean section. Both options may have important risks, depending on the situation, which would be explained by your doctor.

Pain relief should be offered for forceps or ventouse birth. This could involve an epidural, spinal or local anaesthetic and will be agreed with you first.

Sometimes a doctor is not sure if your baby can be born safely with forceps or ventouse. They might offer a 'trial' of forceps or ventouse in an operating theatre in case a caesarean section is needed.

Where has this information come from?

This information has come from clinical experts and the Royal College of Obstetricians and Gynaecologists 'Patient information' on 'Assisted vaginal birth (ventouse or forceps) published in April 2020 and available at: Assisted vaginal birth (ventouse or forceps) | RCOG

Forceps-assisted birth

Forceps look like metal spoons which fit on each side of baby's head. With your permission, they may be used to help pull your baby out of your vagina while you are pushing.

Forceps have some risks. These are more common if you have a high body weight, your baby is big or in the back-to-back position, or it is not very low in your pelvis.

Your baby is likely to have marks on the side of their face where the forceps pressed on their skin. These marks usually disappear within a few hours.

Around 1 in 1000 [check] babies will sustain a nerve injury to the side of the face - most of these recover in days or weeks.

Around 1 in 1000 babies experience a skull fracture (broken bone) - most do not affect babies in the long-term, but some require care in the neonatal unit and some may damage the brain.

Around 1 in 1000 babies will experience some bleeding on the brain which sometimes causes brain damage. [icon arrays]

A shoulder dystocia [hyperlink] affects 30 in 1000 babies during a forceps-assisted birth.

An episiotomy [hyperlinked] is almost always performed during a forceps-assisted birth as it can reduce the chance of a tear to the anal sphincter (the muscle around your anus which holds in poo and gas) [hyperlink to obstetric anal sphincter definition].

A significant tear in the vagina or vulva will affect 2 in 10 women who have a forceps-assisted birth and may require repair in an operating theatre. Around 1 in 10 women who have a forceps-assisted birth will experience a tear to the anal sphincter [hyperlinked + icon array].

Where has this information come from?

This information has come from experts and the Royal College of Obstetricians and Gynaecologists consent advice: untitled (rcog.org.uk) .

Information on using episiotomy came from a research study at this link: Mediolateral/lateral episiotomy with operative vaginal delivery and the risk reduction of obstetric anal sphincter injury (OASI): A systematic review and meta-analysis | International Urogynecology Journal (springer.com) .

Information on shoulder dystocia at forceps-assisted births came from this research study: Incidence trends of shoulder dystocia and associated risk factors: A nationwide analysis in the United States - Youssefzadeh - 2023 - International Journal of Gynecology & Obstetrics - Wiley Online Library

Further 'Patient information' on 'Assisted vaginal birth (ventouse or forceps)' published in April 2020 is available at: Assisted vaginal birth (ventouse or forceps) | RCOG

This type of birth uses suction to apply a device to your baby's head which, with your permission, is used to pull your baby out of your vagina while you are pushing. Your baby will have a swelling on its head showing where the device was applied. This usually disappears within a few hours.

Ventouse-assisted birth has some risks. Up to 1 in 10 babies will have a bruise in the area of the swelling which resolves in hours or days. Around 1 in 10 will develop jaundice after the birth. Around 1 in 10 babies will have a cut on their face or scalp which usually heals within days. Around 25 in 100 babies will have some bleeding around the eye which usually resolves quickly. [icon arrays]

An episiotomy [hyperlinked] is often used during a ventouse-assisted birth to reduce risk of a tear to the anal sphincter [pop-up definition]. A significant tear in the vagina or vulva will affect 2 in 10 women and may require repair in an operating theatre.

Around 3 in 100 women will experience a tear to the anal sphincter [hyperlinked] with ventouse birth.

Sometimes you will have difficulty passing urine after this type of birth

Where has this information come from?

Add The information on what to expect has come from clinical experts. Information on risk of obstetric anal sphincter injury came from the Royal College of Obstetricians and Gynaecologists 'Patient information' on 'Assisted vaginal birth (ventouse or forceps) published in April 2020 and available at: Assisted vaginal birth (ventouse or forceps) | RCOG

The information on episiotomy leading to a reduced chance of anal sphincter tear came from this research study: Lateral episiotomy or no episiotomy in vacuum assisted delivery in nulliparous women (EVA): multicentre, open label, randomised controlled trial | The BMJ

Around 20 in 100 women give birth by unplanned caesarean section (where their baby is born through an operation on their tummy), usually during labour.

In a first pregnancy around 30 in 100 women give birth by unplanned caesarean section, while 70 in 100 give birth vaginally.

After a previous vaginal birth (even if it was assisted with forceps or ventouse) 8 in 100 women have an unplanned caesarean birth while 90 in 100 give birth vaginally without assistance.

During a first birth, most women will have either grazing (where the vaginal surface is scratched) or a deeper tear that may require stitches. These stitches are usually inserted by a midwife.

About 6 in 1000 women who plan a vaginal birth will have a tear to the anal sphincter (the muscle around the anus which holds in poo and gas). These are also known as third- or fourth-degree vaginal tears. No women should have such a tear after planned caesarean birth.

[Pictogram]

Anal sphincter tears require a repair in an operating theatre. Sometimes these tears can lead to faecal incontinence [hyperlink].

Where has this information come from?

A national guideline on caesarean birth included this information which was found in a review of published studies updated in 2022.

It is considered normal to lose up to 500ml (around 1 pint) of blood during childbirth. Major bleeding means that you lose more than 1500ml of blood or more than 15% of your blood volume. Sometimes you will require a blood transfusion due to bleeding.

Your chance of bleeding will be higher if you have: a higher body mass index, Asian ethnicity, a multiple pregnancy (e.g. twins), excess amniotic fluid, clotting disorder, a low lying placenta, anaemia, had a previous postpartum haemorrhage or had more than 5 previous births.

Your care team should assess your chance of bleeding and prepare in advance to manage this if it happens.

Almost 1 in 100 women require a blood transfusion after giving birth. There is no significant difference in the chance of requiring a blood transfusion after a planned caesarean birth compared to a plan for vaginal birth.

Where has this information come from?

A national guideline on caesarean birth included the information on there being no difference in chance of excess bleeding in a review of published studies updated in 2022.

The information on chance of requiring a blood transfusion is based on a research study from Canada available at: Birth outcomes following cesarean delivery on maternal request: a population-based cohort study - PubMed (nih.gov) .

The chance of requiring a hysterectomy is around 16 per 10,000 women after planned caesarean birth and 8 per 10,000 women after a plan for vaginal birth.

[trial a pictogram of 1.6 coloured dots in 1000, 0.8 coloured dot in 1000? - explore options]

'Where has this information come from?

A national guideline on caesarean birth included this information which was found in a review of published studies updated in 2022.

The risk of a spinal anaethetic will usually be discussed with you before the day of the caesarean birth. These risks include: itching (1 in 3 women), not working well enough so needs to be replaced (1-2 in 20), a drop in blood pressure which is quickly treated (1 in 5), conversion to general anaesthetic as not working well enough (1 in 50), severe headache (1 in every 100), permanent nerve damage (1 in 13,000 to 24,000), temporary nerve damage (1 in 1000), paralysis (1 in 250,000 women), abscess in the spine ( 1 in 50,000 women), memingitis (1 in 100,000 women), blood clot in the spine (1 in 170,000).

Where has this information come from?

Risks of epidurals, spinals and general anaesthetics - Labour Pains

The average pain score (on a scale of 1 to 10) during birth is 8 for planned vaginal birth, 1 for planned caesarean birth.

The average pain score 3 days after planned vaginal birth is 4, while after planned caesarean birth is 5.

The average pain score (on a scale of 1 to 10) 4 months after planned vaginal birth is 0, and after planned caesarean birth is 0.

Where has this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Where has this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Around 2 in every 1000 women giving birth will spend time in an intensive care unit. Around 3 in 1000 women do so after planned caesarean birth and around 1 in 1000 do so after a plan for vaginal birth.

Where has this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Different types of infection can happen after vaginal or caesarean birth. Around 164 women in every 1000 develop an infection after planned caesarean birth, and 102 in every 1000 do so after a plan for vaginal birth.

[add pictogram for overall infection only]

Specifically, 17 in 1000 women develop infection inside the womb after planned caesarean birth and 14 in every 1000 have this after a plan for vaginal birth.

A wound infection affects 16 women in every 1000 after planned caesarean birth and 5 in every 1000 after a plan for vaginal birth.

A urinary tract infection affects 9 in every 1000 women after planned caesarean birth and 6 in every 1000 after a plan for vaginal birth.

Mastitis affects around 46 in every 1000 women after planned caesarean birth and 21 in every 1000 after a plan for vaginal birth.

There seems to be no difference in risk of septicaemia (infection in the bloodstream) between women after planned caesarean birth compared to a plan for vaginal birth.

Where has this information come from?

This information has come from a research study set in Sweden, available at: Planned cesarean section vs planned vaginal delivery among women without formal medical indication for planned cesarean section: A retrospective cohort study of maternal short-term complications - PubMed (nih.gov)

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Where has this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Around 1 in every 1000 women develop a blood clot which blocks a blood vessel after giving birth. There is no significant difference in the chance of this happening after planned caesarean or a plan for vaginal birth.

Where has this information come from?

Around 25 in every 100,000 women die after planned caesarean birth compared to around 4 in 100,000 after planned vaginal birth.

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Around 9 in 100 women experience depression (significant low mood) in the year after giving birth. There is no clear difference in the chance of this happening after a planned caesarean section compared to a plan for vaginal birth.

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Placeholder Text

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

This is when the placenta (the organ that gives the growing baby oxygen and nutrients) grows too deeply into the womb in a future pregnancy. This means that a caesarean birth is usually needed and there is often a lot of bleeding after the birth, so a hysterectomy (removal of the womb) is commonly carried out. For every 10,000 women having a caesarean birth, an extra 6 cases of placenta accreta occur in a future pregnancy compared to 10,000 women having a vaginal birth.

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

This is where the wall of the womb tears open, usually where a previous caesarean scar is. It usually occurs during labour. This can endanger the lives of the mother and baby, or cause brain damage to the baby due to a lack of oxygen. For every 10,000 women who have a caesarean birth, an extra 98 women will have a rupture of the caesarean scar in a future pregnancy compared to 10,000 women having vaginal birth.

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Stillbirth at term (from 37 weeks gestation) affects around 3 in 1000 pregnancies. It is UNCLEAR whether the chance of this happening is increased after a previous caesarean birth compared to a previous vaginal birth.

Where did this information come from?

The rate of stillbirth was taken from the Office of National Statistics 2022 report [hyperlink]. A national guideline on caesarean birth included this information which was found in a review of published studies updated in 2022.

More complicated surgery with each caesarean birth

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Placeholder Text

Some women will experience some differences in sexual activity after childbirth compared to before.

Around 42 in 100 women will experience one or more sexual problems after a planned caesarean birth and around 37 in 100 will do so after planned vaginal birth.

Around 23 in 100 women experience reduced desire after planned caesarean birth compared to 22 in 100 after planned vaginal birth.

Around 14 in 100 women experience difficulty in obtaining orgasm after planned caesarean birth while 13 in 100 do so after planned vaginal birth.

Around 8 in 100 women experience (deep pain during sex after planned caesarean birth while 6 in 100 do so after planned vaginal birth. (6 in 100 respectively).

Insufficient lubrication (11 in 100), pain during sex (15 in 100), pain on entry during sex (8 in 100) appear more common than after planned vaginal birth (7 in100, 9 in 100, 3 in 100 respectively).

Where did this information come from?

This information came from a research study from Denmark, available here: Mode of birth and long-term sexual health: a follow-up study of mothers in the Danish National Birth Cohort - PubMed (nih.gov)

Leakage of urine 1 year after birth

Where you lose bladder control and leak urine.

Between 7 and 20 in every 100 women who have a planned caesarean will experience this compared to 20-49 in every 100 women who have a vaginal birth.

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Leakage of faeces (poo) 1 year after birth

Where you lose control of your bowel and leak faeces/poo or flatus/gas.

8 in every 100 women who have a planned caesarean will experience this compared to 11 in 100 women who plan a vaginal birth.

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Around 14 in 100 women experience prolapse of the organs (bladder, bowel and/or womb) in the pelvis, meaning that they push down through the vaginal walls causing a feeling of pressure in the vagina. This affects around XX in 100 women after a planned caesarean birth and XX in 100 women after a planned vaginal birth.

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text

Where did this information come from?

Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text Example text example text example text