Alberta women, and Canadian women on the whole, are more likely to experience obstetric trauma in childbirth than the international average, according to a recent report.

The Canadian Institute for Health Information (CIHI) report shows 14.5 out of every 100 Alberta women who have instrument-assisted vaginal deliveries experience serious obstetric trauma.

That's better than the Canadian average, but more than double the average of other developed countries within the Organization for Economic Co-operation and Development (OECD).

In Canada, 16.9 per 100 instrument-assisted vaginal deliveries involved third- or fourth-degree obstetric trauma, and the OECD average is 5.7.

This kind of severe tearing, caused by instruments such as forceps, can lead to long-term complications including incontinence and problems with bowel control.

Obstetricians react

"I just feel like the rates being reported in other countries are falsely low," said Dr. Venu Jain, associate professor in the department of Obstetrics and Gynaecology at the University of Alberta.

Jain, who's been practising for more than 10 years, believes there could be a number of reasons for the discrepancy between Canada and the other countries studied, including variation in reporting.

"Maybe [in other countries]  it's not being recognized or if it's being recognized, it's not being reported accurately. And even if it is being reported accurately, the surveillance systems that are looking at the incidences may not be picking them up accurately."

Canada's rate of severe obstetric trauma doesn't come as a surprise to Jain.

"I still don't feel that these rates are too high."

According to Jain, forceps are sometimes used because a baby needs to be delivered quickly for safety reasons, such as an abnormality in the baby's heart rate. But more often, he says, these instruments are used because  the baby is too big for the birth canal.

"Of course, forceps might be contributing. Sometimes we deliver the baby a bit too quickly... But if we try to deliver them a little bit more gently and in a controlled fashion, I would argue it's not the forceps that are causing these tears, but the larger babies that these forceps are allowing [to be delivered] vaginally that might be responsible for it," said Jain.

But Jain says the Canadian system isn't perfect. During his decade in practise, he's witnessed a decline in the amount of training new doctors receive when it comes to using instruments such as forceps.

"I would certainly say the amount of exposure that residents are getting doing instrumental deliveries on a consistent basis has gone down," said Jain. "There's always space for improvement and certainly trying to improve the training of physicians —   particularly training in instrumental delivery — might impact safety of delivery and perhaps might go towards reducing the incidents of these tears." 

Calls for change

The numbers are concerning for Calgary-based pelvic health physiotherapist Gayle Hulme.

"I've seen women with post traumatic stress disorder due to their obstetric trauma," said Hulme.

In addition to helping women deal with pregnancy symptoms and preparing them for childbirth, she also sees women after they give birth and often deals with patients who've experienced serious tears.

"For being a large developed country with supposedly great health care, we should do better," she said.

Hulme would like to see several treatments with a pelvic health physiotherapist incorporated into standard, publicly funded prenatal and postnatal care in Alberta to help women prepare their bodies for birth, and recover after the fact.

The statistics also worry Dana Weatherhead, president of the Association for Safe Alternatives in Childbirth (ASAC).

She wants the province to fund more midwife-led births— a move she believes would allow more women to birth at home and relieve pressure on hospitals for those who wish to deliver there.

"Now this woman can naturally progress through labour and there doesn't need to be this cascade effect and all these interventions, which lead to these third-, fourth-degree tears, potentially."

While he isn't opposed to increasing funding for midwifery care in the province, Dr. Jain, isn't convinced it would impact the rates of obstetric trauma.

"Those are not factors of the degree of busyness of the physician, but more related to their training and so on," said Jain.

No one from Alberta Health Services was available for an interview on the report.

But, in a written statement, a spokesperson said it has strict follow-up procedures after birth and that may lead to more incidents being reported. AHS also says age contributes to a woman's risk for obstetric trauma and in Calgary women tend to wait longer to have children.

EDITOR'S NOTE: The original version of this story has been changed to add the views of a doctor in the field of obstetrics, and to provide relevant context on obstetric trauma.