In a previous blog, we focused on the issue of birth trauma, its potential causes and the many life-altering injuries that infants and labouring parents have been known to sustain during the birth process. The use of certain medical devices, including forceps and vacuum pumps, in the course of vaginal deliveries is associated with a substantial number of obstetrical injuries each year, including cerebral palsy.

In cases where the delivery of a baby is stalled, progressing too slowly for the baby’s or parent’s safety, or where the baby’s birth position is not ideal, forceps or vacuums may be used to assist in moving the birth process along. Although both devices are safe and effective in most circumstances, both have unfortunately been associated with an elevated risk of obstetrical injuries, in addition to the birth trauma that the baby might experience. 

In 2017, it was reported that Albertans are more than twice as likely to suffer an obstetrical injury in the course of delivery than the international average of other developed countries. The following year, the Canadian Medical Association Journal raised the alarm about an increase in forceps delivery-related obstetrical trauma over a ten-year period. Most recently, this new study indicates that the rates of obstetrical trauma caused by forceps and vacuums in single-infant deliveries are higher than previously thought, particularly in Alberta, British Columbia and Ontario.

Prevalence And Types Of Obstetrical Injuries

The Canadian Medical Association Journal study results yielded some concerning findings for expectant Canadian parents: 

  • Of the successful forceps deliveries, more than a quarter involved maternal trauma, and around 13 per cent of the successful vacuum deliveries also involved maternal trauma.
  • This includes injuries to the anal sphincter, cervical tears, vaginal lacerations, damage to the urethra or bladder, perineal tears or other pelvic trauma.
  • The most common maternal trauma was obstetric anal sphincter injury, which was doubled in those who had a forceps delivery compared to those who had a vacuum-assisted delivery, the study found.

For some, such injuries may be transitory, short-term and soon forgotten in the busy days following the welcoming of a new person into the world. For others, though, obstetrical injuries can result in lasting physical, psychological and emotional harm for the delivering parent that may also impact other close family members.

Operative Vaginal Delivery Versus Cesarean Delivery

Operative vaginal delivery (OVD) is the term used to describe the delivery of a child that involves the use of forceps, a vacuum, or some other medical device. Contrasted with a cesarean section, in which an infant is delivered via incisions to the abdomen and uterus, OVD is considered by some practitioners a safer alternative. However, as the Canadian Medical Association Journal reports, “no randomized controlled trials have compared outcomes following operative vaginal delivery and cesarean delivery.” Given this lack of clinical proof that cesarean deliveries have worse outcomes than operative vaginal delivery, some context is important in determining how and why birth and obstetrical trauma from operative vaginal delivery is on the rise in Canada. 

Concerns with cesarean births in North America prompted a re-examination by the medical community of the true need for these procedures in all cases. As recently as 2016, the Journal of Obstetrics and Gynaecology Canada reported that, of all singleton (one child) deliveries in Canada, more than 26 per cent occurred by cesarean section, while less than 11 per cent were OVDs. Trends indicated that cesarean deliveries continued to rise, while rates of OVDs continued to decline. 

The new research suggests that efforts to reduce the number of cesarean deliveries may have yielded negative net benefits. There is a suggestion that a lack of training and regular practice in the proper use of medical devices (such as forceps and vacuums in the course of births) may have contributed to the increase in the number of obstetrical and birth injuries. It makes sense, given that cesarean deliveries occur at a rate twice that of OVDs. The study’s authors note that levels of training play a significant role in OVD injury rates:

The risk associated with OVD is heavily dependent on the health provider’s expertise. The declining use of OVD (in favour of cesarean delivery) has reduced opportunities for acquiring proficiency in performing these deliveries, especially with forceps. As a result, OVD is under scrutiny in the face of reports of rising rates of maternal and neonatal trauma with OVD and of concerns regarding the relative safety of forceps versus vacuum.

The Burden On Our Medical System 

This most recent study indicates that one per cent of operative vaginal delivery result in some type of obstetrical injury. This is not an insignificant figure for expectant parents weighing their options in making a birth plan. There can be long-term consequences of any obstetrical injury, regardless of how it occurs operative vaginal delivery, cesarean birth, or unassisted vaginal delivery). 

In Canada, obstetrics is considered the highest-risk medical practice, based on the professional insurance rates that practitioners in this field pay in relation to their counterparts with other medical specialties. It is impossible to know with certainty how many complaints relating to obstetrical trauma are filed each year with the various provincial colleges, as governing bodies do not release this information. Cases that settle are almost always confidential. However, what has been recognized for years is that any factor that causes birth and obstetrical trauma rates to rise in Canada puts the entire health care system at risk. According to Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada, as quoted by the Toronto Star in 2015:

“We need a system that starts from a position of compassion rather than finger-pointing. There are all sorts of efforts going on now to reduce risk and improve safety. Birth will never be without risk though. It’s the most dangerous thing we do as women.”

The rising cost of settlements in delivery cases — in terms of damages, legal fees and lifelong care — is posing an increasing burden on healthcare systems everywhere, she says.

“The cost of dealing with these outcomes is threatening the entire health system in many jurisdictions.”

Compassionate and Experienced Calgary Birth Injury Lawyers

Cuming & Gillespie LLP Lawyers remain committed to providing clients with the highest level of professional services to ensure that when obstetrical and birth trauma occurs, you will receive the compensation you deserve. If you know or suspect that you have suffered an obstetrical injury, let us advise you on your legal options. Call us today at 403-571-0555 or use our online contact form to schedule a meeting.