Alberta women, and Canadian women on the whole, are more likely to experience obstetrical trauma in childbirth than the international average, according to a recent report.
The Canadian Institute for Health Information 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.
Dana Weatherhead, president of the Association for Safe Alternatives in Childbirth, says the numbers are concerning, but it's difficult to compare jurisdictions because it's not clear if they have the same reporting standards.
"The other thing is that countries that I would think would have been higher due to lower caesarean rates actually have quite low tears, and so the one thing that's coming to mind is comparing the whole picture of their care model, and they actually have a different care model, meaning that they have access to midwives and a different system, so I think the numbers are quite skewed," she said.
Weatherhead says she wants to see more women given the option of home births and access to midwives in order to help them make their own decisions about the way they give birth.
She says often there's a cascade effect during childbirth, where one medical intervention leads to another and then another, and can be the result of overworked physicians and limited hospital space.
"It's a huge concern that our caesarean rate is double. It's a huge concern that 50 per cent of our women are getting epidurals," said Weatherhead.
"I'm a full supporter of intervention when needed. Those are things for high risk situations and we have a lot of low risk pregnancies and women that want limited intervention and as you can see it's happening at a very high, high rate."
She's concerned not only about the physical damage to women that is occurring, but also the emotional trauma that can come with it, particularly when women are placed in birthing positions where they're not able to provide informed consent over what's happening to their bodies.
"A lot of these women, they're so vulnerable in this delivery room that they don't even know some of these things are happening. So in their head, they're being told 'well, your baby could die, their heart rate is dropping,' and then after they realize, you know what, I could have just birthed," she said.
"It's not on a physician, it's not on a hospital, it's systemic. We need to do an overhaul on all of our systems so that women are supported and can make informed choices."
Care before and after birth
Gayle Hume sees the damage done from obstetric trauma in her practise as a pelvic health physiotherapist, but also works with women to prepare their bodies for the birthing process.
"We probably need to do a better job of creating an environment where women do know that there's lots of ways that they can have options for birth as well as how they can prepare for the birth," she said, adding she also thinks work has to be done on the emotional effects of the trauma.
Hume points to the fact there is very limited public funding for the kind of work she does and it's earmarked for more severe cases of obstetric trauma.
"The concern is, mostly just how women are managed, in my opinion. Managed before and managed after they have a baby," she said.
"And I think that's where sometimes things go a little bit sideways and I don't know in other provinces, but I do think, generally speaking, there could be a little bit better or prolonged care for women, particularly before and after childbirth."
No one from Alberta Health Services was available for interview on the report, but a spokesperson said there are strict follow-up procedures after a woman gives birth and more incidents may be reported as a result of that process.