Severe childbirth injuries from forceps, vacuum 'unacceptably high' in Canada, research shows

Canadian mothers face a high rate of severe, long-term injuries from the use of forceps or vacuum in childbirth, and urgent action is needed to reduce it, the authors of a new analysis paper say.

Operative vaginal delivery (OVD) refers to using forceps or vacuum in the second stage of labour when the cervix is fully dilated. Health-care professionals may need to use the instruments if labour stalls or if the fetus is at risk.

In an article published Thursday by medical journal BMJ, epidemiologist Giulia Muraca, an assistant professor in obstetrics and gynecology at McMaster University, and her co-authors note that Canada has the highest rate of maternal trauma during forceps- and vacuum-assisted deliveries out of 24 high-income countries. Canada's injury rate was 16 per cent, compared to an average rate of 5 per cent for the group.

The paper says that of the more than 35,000 single infants born after OVD in Canada, one in four attempted forceps deliveries and one in eight attempted vacuum deliveries resulted in obstetric trauma — most commonly, obstetric anal sphincter injury, which involves severe tearing to the perineum. 

Up to 15 per cent of deliveries in Canada include the use of forceps or vacuum.

"These rates of injuries are absurdly, unacceptably high," Muraca said in an interview. "And there's been … no concerted effort to reduce them. Perhaps even worse, we're not even recognizing or talking about them."

WATCH | Canada has an 'absurdly high' maternal trauma rate from forceps births

When Laura Ralph of Vancouver gave birth to her son seven years ago, she recalls it was a chaotic and anxiety-provoking experience. The doctors told her the fetal heart rate was falling and they needed to use forceps to deliver him quickly.

"At one point, I was worried that my son might die and that I might die," Ralph said through tears.

Ralph needed a blood transfusion in the operating room. The forceps also contributed to pelvic prolapse, which happens when the pelvic floor muscles weaken, she said. In her case, her bladder fell into the vaginal wall.

Long after her son's birth, Ralph said, she was dealing with lingering mental health issues, as well as the long-term effects of pelvic prolapse, including not being able to exercise as strenuously as she would have liked. 

When she later became pregnant with twins, she had a planned C-section.

Ralph contributed to the BMJ paper as a patient partner because she hoped it might prevent others from experiencing what she did, she said.

More severe perineal tears can lead to pelvic pain, sexual dysfunction and fecal and anal incontinence, which "can have devastating effects on social, psychological and physical wellbeing," the paper says.