Sexual and Reproductive Healthcare

Paper: Parents’ experiences of an instrumental vaginal birth findings from a regional survey in Sweden
Paper authors: Ingegerd Hildingsson, Annika Karlström and Astrid Nystedt
Paper ref: (2013) Vol 4, issue 1

Instrumental vaginal birth (IVB) refers to the mode of delivery whereby assistance is required in the form of either forceps or vacuum extraction. This paper reports the findings of both the mother’s and father’s experience of such births, using both qualitative and quantitative measures. Unlike in elective caesarean sections, preferences of the obstetrician outweigh those of the mother/parents in circumstances that necessitate instrumental delivery. Instrumental vaginal births are usually performed as a result of foetal distress or prolonged labour with weak contractions, leading to the mother becoming exhausted.

The aim of this study was to compare birth outcome and parents’ feelings in cases of instrumental vaginal birth or a spontaneous vaginal birth. A regional survey in northern Sweden was conducted of 936 mothers and 827 fathers recruited mid-pregnancy and followed up two months after the birth. Data was collected via questionnaires and was used together with socio-demographic background data of both the mother and father. This covered the mother’s age, parity, civil status, education, tobacco habits and country of birth.

Everything from perceived pregnancy and birth complications, onset of labour, mode of delivery, length and experience of labour, pain relief and overall satisfaction was assessed.

In total 684 (73.1 percent) had a normal vaginal birth and 84 (nine percent) an instrumental vaginal birth, with the rest having either elective or emergency caesarean section (not included in the results). One clear variable in those who had an IVB was parity, with 81 percent being primiparous and 19 percent being multiparous.

Results showed several adverse outcomes associated in women who had an instrumental vaginal birth. Firstly there were more women diagnosed with prolonged labour using the ICD-10 criteria. This correlated to an increase in reports of complications during pregnancy, increased use of epidurals (50 percent compared to 24 percent in normal vaginal birth) greater exposure to augmentation with oxytocin and most significantly women who had a IVB were more than twice as likely to report complications during birth.

Fathers in labour have been described to fit three roles: ‘the coach’, ‘the teammate’ and ‘the witness’.  Expectedly, fathers whose babies were born via vacuum extraction agreed with the statement ‘I almost panicked as I didn’t know what was happening’. In addition, women agreed with the statement that they were frightened that the baby would be damaged during birth. However results found no difference in the overall satisfaction of intrapartum care between mothers and fathers in the two groups.

The way in which the study was conducted made it liable to certain limitations. Most noticeably, the results can only be generalised to parents living in a similar geographical area and of similar economic status. In addition the exclusion of non-Swedish speaking parents and its observational design make it conducive to bias.

The significance the paper highlights is that instrumental vaginal birth affected both the birth outcome and the parents’ feelings and emotions. Moreover, it led to a negative birth experience and interestingly to doubts about future reproduction. These results were strengthened by the large sample size, and the inclusion of both genders.

Owing to this study it should serve to remind us in the UK of the clinical importance of a good consultation pre- and post-birth. It is important to make couples aware of what can happen during birth, as well as explain afterwards what the couple experienced.

Stimulating purposeful reflection will not only serve to reduce negative feelings it would also be important to reduce future reproductive problems.

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