BMJ  2006;333:753 (7 October), doi:10.1136/bmj.333.7571.753-a

Letter

Caesarean delivery in the second stage of labour

Consider the value of a functionally intact perineum

The first 150 words of the full text of this article appear below.

EDITOR—Spencer et al say that instrumental delivery may reduce the caesarean section rate in the second stage of labour.1 Although this may be important for the 2006 NHS budget—saving anaesthetic, operating theatre, and hospital costs in the short term—the longer term health outcomes and costs of a high forceps delivery are concerning and go unmentioned.


Figure Removed (Available Only in the Full Text)
 Credit: STEVENSON/SPL JAMES

 

Recognised third and fourth degree perineal tears occur in 0.5-6% of vaginal deliveries in the western world.2 3 A further 30-44% are estimated to be unrecognised.1 One of the most significant factors, clinically and statistically, to be associated with perineal injury is an instrumental delivery.2 3

Up to a quarter of women with a tear will experience faecal incontinence.3 Although perineal injury during childbirth may not be the sole factor for faecal incontinence, perineal damage increases its likelihood.3 The economic costs of faecal incontinence are large, lifetime cost estimates ranging from £7000 . . . [Full text of this article]

Michelle J Thornton, consultant colorectal surgeon

Wishaw General Hospital, Wishaw ML2 0DP Michelle.Thornton@lanarkshire.scot.nhs.uk


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Relevant Article

Caesarean delivery in the second stage of labour
Chris Spencer, Deirdre Murphy, and Susan Bewley
BMJ 2006 333: 613-614. [Extract] [Full Text] [PDF]

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