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The NHS Forth Valley Maternity Statistics have finally arrived.
What many want to know is, what are the chances I will give birth naturally, without induction or surgical assistance. The answer to this question... 38%. Or 4 in 10.
It is OK to feel disappointed by this -if you read on you will learn how I arrived at this figure.
It should also be said, that numbers don't tell you about is individual cases. There will be so many incredible birth stories wrapped up in these numbers. Those for whom an elective c-section was absolutely the right choice. Equally an induction. Those who dreamed of a home birth and achieved that, and those that didn't. Every number tells a different story, and statistics group women who may not be the same or have arrived at birth following the same journey. Numbers don't carry any emotion, but birth does, so I have tried not to judge but just to explain the results.
Lastly, the numbers are open to interpretation - so this is simply mine. Taking into account what is happening in Scotland, and what I am hearing about from the women that I work with and encounter through this job.
Question 1: How many live babies were born in 2023?
Answer: 2725.
This is exactly 100 less than 2022.
Question 2: Of that number, how many were boys/girls?
Answer: Male 1400 , Female 1325
There were also more males born in 2022. This is fitting with national statistics and biologists will tell you more males are necessary as they have a lower life expectancy what with wars etc. I have definitely found a lot more mums pregnant with boys on my course than girls, I'm surprised it's not higher!
Question 3: Of that number could you tell me about place of birth? How many were born in theatre/ delivery suits/ AMU/ home, BBA (e.g. en route, car park etc)
Answer: BBA - 19 Home - 21 Hospital 2685 (Labour Ward/Theatre- 2674, Triage - 3, Antenatal Ward - 8)
This is super frustrating as they lumped hospital births together and completely ignored the AMU! So we don't know what the breakdown was between labour ward, theatre and AMU. (AMU is the Alongside Midwifery Unit where they have birth pools.)
BBA means Born Before Arrival - this is all those women who were en route when baby made an early appearance.
The GOOD news here is home births! This figure has DOUBLED since 2022! This is brilliant!
21 women embraced birthing their babies safely in the comfort of their own homes. However, whilst it is a move in the right direction for Forth Valley... a quick google of the stats on home birth for Fife or Tayside both show they had 8 in the month of November 2023 alone! Forth Valley still does not have a dedicated Home Birth team - and this is something that would really increase these figures.
Question 4: How many vaginal births?
Answer: 1519
Taking that starting figure of 2725 - only 55% of women experienced a vaginal birth. It is unclear from figures of those 55% how many were induced, had an assisted birth or experienced a perineal injury during birth, but somewhere in that number is also the women who had a completely natural unassisted delivery.
Question 5: How many water births?
Answer: 86
Just 3% of women had a water birth. If we discount elective c-sections, this figure rises to 5%. This may be at home or in the AMU hospital birth pools. It also does not mean others did not use the water or birth pool for comfort but got out to birth their baby on land, but it is still quite a disappointing figure. Perhaps I should have asked how many indicated a water birth on their birth plan? This might have told a bigger story of those that wanted this, versus those that got.
Question 6: How many inductions of labour?
Answer: 1255
If we again take the elective c-section figures out the equation, that is 1255 out of 2296 births that were induced - or 55%! If we pop those elective c-section figures back in that number comes down to 46%.
That number is STAGGERING! It is RIDICULOUS! And I have a lot to say about it.
Firstly, there are absolutely some circumstances where an induction is the right choice for you and your baby. Inductions do have a role to play and I appreciate that. My first born was induced.
However.... if you do a very quick google of Scotland's Induction Rate, you will get an average figure from Public Health Scotland that states the Scottish Rate of Induction is 35%. Forth Valley is well above this! Also bare in mind, that average will have many health boards sitting below 35%. NHS Lothian is the lowest of the mainland health boards (more on that below).
Public Health Scotland puts Forth Valley as the forth HIGHEST for 2022-2023. You can read more about their report by clicking the link above. It also gives the wider Scottish picture. That more pregnant women are being classed 'high risk' because of gestational diabetes and high BMI. I struggle to believe that in the last 10 years, women have all of a sudden got bigger and diabetes has shot up. What I think is that they are now measuring this more, testing for this more, diagnosing this more and this is leading to the high induction rate.
Is this increase in inductions saving babies lives? No. Short answer. Still birth figures have not significantly changed in the last 40 years, yet interventions to prevent this have massively increased! What is more, induction carries its own risk.
So it seems a bit backwards that you can be 'high risk' so an induction is offered, which is in itself risky.
FACT: An induced labour is far more painful than a natural spontaneous labour. This is because you do not have any of your birthing hormones to support with pain relief, and the contractions can come thick and fast - putting your uterus at risk of hyper-stimulation and causing stress to the baby.
FACT: An induced labour can lead to a cascade of interventions which each carry their own risk. Such as increased likelihood of having your birth assisted by forceps or ventouse or an emergency c-section.
NHS Lothian quote these statistics on their page - and bare in mind that they have the LOWEST induction rate on the mainland!
In NHS Lothian, following an induction there are around:
50% vaginal births (1 in 2)
30% unplanned caesarean births (1 in 3)
20% assisted birth – ventouse or forceps (1 in 5)
So think about this as you read the next statistics. There is no evidence that one choice led to another, but you can make an educated guess.
Question 7: How many instrumental births and of that how many forceps/ventouse?
Answer: Forceps - 193, Ventouse - 117
We cannot know that these births were following on from an induction. It is safe and reasonable to assume that some definitely were, but that there will be some where the women went into spontaneous labour and for whatever reason required assistance to birth her baby. If we assumed all were following induction that would be 25%, however perhaps we could also suggest that 20% were following induction and 5% following spontaneous labour.
Question 8: How many c-sections? And the number of elective vs emergency?
Answer: Total c-sections - 908 elective sections - 429, emergency sections - 475 , cs grade not recorded - 4 *
Many people think I am anti-c-section as I am so in favour of a natural birth experience. It is true, I do have to admit to not being impartial and recognise my own bias. I'm not the BBC. I wanted to experience a natural birth, as a rite of passage, and I was very glad I was able to. It was so wonderful, I do probably encourage that angle. However, I can be in favour of that but also in favour of c-sections! If there is anything I am 'anti' it is women being uninformed.
There are medical reasons why an elective c-section is without a doubt the only option for some women. There are also personal, practical, emotional reasons why it is also the best choice. Absolutely no judgement here.
But I really feel for those women who had hoped and planned for a vaginal birth and then their birth journey led them to a c-section. I know for some this will have been following an induction, and traumatic and I hope you are able to get a birth debrief with your midwife or consultant so you can fully understand the circumstances around what happened.
Please know this though: You didn't fail. Birthing through your belly is birth. You made the right choices for you baby at the time. And you did not take the easy way out! You are incredibly brave - you should feel so proud!
Final note on this: The WHO World Health Organisation recommends countries not exceed 10 to 15 percent for optimal maternal and neonatal outcomes. If we take out elective c-sections, 475 out of 2725 is 17.4%. So, Newsflash - this is HIGH. No surprises there with such a high induction rate!
Question 9: How many births without intervention except augmentation? And how many without intervention at all?
Answer: NHS Forth Valley is unable to provide the information you have requested as we would require to interrogate individual records which would involve a considerable number of records. As a result we are required to respond to your request in terms of section 12 of the Freedom of Information (Scotland) Act 2002: Excessive cost.
Despite the fact they provided this information last year. Hmmm.
Question 10: How many vaginal births after c-sections?
Answer: 80
Did you know if you have had a c-section before you do not necessarily have to choose this option the second time around? These 80 women did and achieved that.
Question 11: How many episiotomy?
Answer: 145
An episiotomy is when a surgical cut is made to your perineum (the area between your vagina and anus - although not straight down, usually diagonally). It is ok to feel scared about this happening. It is often done to make additional room for the baby, or for forceps, and to prevent a tear. You would have a local anaesthetic so you would not feel it. It is repaired with stitches which dissolve around a week later. 145 out of 1511 vaginal births at Forth Valley had an episiotomy. This is 9.5% of vaginal births.
Put another way, there is a 90.5% chance this will not happen to you - and you can always decline this intervention if it is offered.
Question 12: How many 3rd/4th degree tear?
Answer: 3rd - 45/ 4th - 1
The scariest question of all. Firstly tears are graded 1, 2, 3, and 4.
1 is termed 'a graze' and may sting a bit like a graze, but does not require stitches and will heal on its own in a few days.
A grade 2 tear is a little deeper and may need a stitch or 2 which will dissolve.
Grade 1 and 2 tears are fairly common so they are not counted by hospital boards.
A grade 3 tear is extends into the perineum and also affects the sphincter muscle of the anus. 45 of 1511 experienced this - 3%. Remember this means 97% did not experience this.
A grade 4 tear also involves the bowel. Only 1 women experienced this. 1 in 1511 which is 0.06%. So looked at more positively 99.94% of women did not experience this.
These numbers are lower than the national average so this is good news!
So there you have it. Those were only the questions I asked and my interpretation of the results. What do you think? Did anything surprise you?
Did you give birth in 2023? Are you one of these statistics? If so I would love to know your birth story. You can share it with my by clicking the link below.
Finally, if you are currently pregnant and reading these statistics has filled you with dread, please know that was not my intention! It was merely to inform and shine a light on my local hospital. Birth is unpredictable, there is no guarantee of a natural vaginal birth.
Of the original 2725 babies born, 429 (16%) chose an elective c-section, 1255 (55%) chose an induced labour, and only 1041 or 38% of women, chose a spontaneous birth. But if that is you - if that is what YOU want - please know that there are things you can do to tip the odds in your favour. Of making it more likely you will get the birth experience you want.
And that is where I can help. So if that is you, please get in touch by clicking the link below.
This message says it all:
"Hi Heather, I just wanted to message you to thank you. We had such a positive birth experience and I don't think we would have had that without your classes. You gave us the confidence to follow our gut instincts and push back when required. Out birth ended up being everything we wanted it to be with the exception of not making it to the pool as quickly as she appeared so quickly!"
Would you have asked something else? Let me know in the comments below?
I hope you find this information helpful.
Heather xx