Pelvic floor injury after birth · Part 3 of 5
"Why Didn't Anyone Tell Me Forceps Could Do This?" Consent, Choice and Pelvic Floor Injury
In this article
So many women with pelvic floor injuries say the same thing: nobody told me this could happen. This article is about that feeling and what sits underneath it. I'll cover your legal right to be told about risks, what consent should look like in labour, and how a court actually looks at these claims. Informed consent is something I care deeply about, and I'll be honest about both its power and its limits.
This series: pelvic floor injury after birth
- Prolapse after a forceps birth: when it isn't just "normal"
- Levator avulsion: the injury no one told you about
- "Why didn't anyone tell me forceps could do this?" (you are here)
- "It's normal after a baby": when pelvic floor symptoms are dismissed
- Living with a pelvic floor injury, and what a claim can cover
Nobody told me.
You did the classes. You read the books. Maybe you even wrote a birth plan.
You heard plenty about the risks of a caesarean: the surgery, the recovery, the scar.
But forceps? If they came up at all, it was as a quick way to "help the baby out". Nobody mentioned the muscle that holds your bladder, uterus and bowel in place. Nobody mentioned that it could tear away from the bone. Or that you might be dealing with prolapse, leaking or pain for years.
And now that you know, you keep returning to one thought:
If someone had told me, I might have chosen differently.
That thought matters. It matters emotionally, and it can matter legally.
You're also in good company. Amy Dawes, co-founder of the Australasian Birth Trauma Association, has spoken about being told the risks of caesarean surgery, but never the risks of forceps.
Your right to know
Material risk
In Australia, the High Court decided in Rogers v Whitaker that doctors must warn patients of material risks. A risk is material if a reasonable person in your position would likely attach significance to it. It's also material if the doctor knew, or should have known, that you in particular would.
In plain terms: it isn't up to the doctor alone to decide what you'd care about. If it would matter to someone in your shoes, you should be told.
Is pelvic floor damage a risk a woman would care about? I think most would say yes.
RANZCOG, the college that sets standards for obstetricians, lists damage to the pelvic floor and anal sphincter among the maternal complications of instrumental birth. Its own patient leaflet on assisted birth mentions pelvic floor injury as a possible risk for mothers. Research has found forceps are strongly associated with levator trauma. And Professor Hans Peter Dietz has noted that an elective caesarean would prevent levator avulsion, though it carries its own disadvantages.
Put simply, the risk is known, it's significant, and there are alternatives. Those are the ingredients of a material risk.
What consent should look like in labour
I'll be honest about the hard part. Labour isn't a calm consulting room. When a baby needs to be born quickly, there may only be minutes.
But that's exactly why consent conversations are meant to start well before labour. RANZCOG's statement says women should be informed during antenatal care about instrumental birth and when it might be needed. Consent at the time should be obtained and documented. The national standard on severe tears also sets out what should happen to reduce your risk during pregnancy, labour and birth.
An obstetrician writing in O&G Magazine in 2024 made the same point. Informed consent in the birth space depends on antenatal education, clear communication and good documentation, especially when decisions become time-critical. The Australian Physiotherapy Association's position statement on physical birth trauma also says antenatal physiotherapy can help women make informed decisions about how they give birth.
So it's worth asking yourself some gentle questions about your own care. Did anyone talk to you about forceps during pregnancy? When forceps were suggested in labour, were you told why, and what the alternatives were? Were you asked, or just told? And is there anything in your notes about that conversation?
If this is landing for you, and you're realising a conversation that should have happened never did, I'd really like to hear your story. There's no obligation.
How these claims are actually decided
I want to be straight with you here. I think it's more respectful than false hope.
A "failure to warn" claim has two parts.
Breach
Were you given the information about material risks that you should have been given?
In plain terms: did they tell you what you needed to know?
Causation
If you had been properly warned, would you have made a different choice? And would that choice have avoided your injury?
In plain terms: would knowing have changed what happened to you?
That second question is where these claims are won or lost. In NSW, a court can't simply accept your statement today about what you would have done back then. It looks at the surrounding evidence. That might include what you said in pregnancy about your birth preferences, any anxieties you raised, what was in your birth plan, and what alternatives were genuinely available at the time.
That can feel unfair. But it's also why the details you remember, and anything you wrote down or said in pregnancy, can be so important. Please don't throw anything away.
Failure to warn is also often only one part of the picture. Many claims look at the whole birth: whether forceps were needed at all, how they were used, and whether your injury was identified and treated when it should have been.
Things are starting to change
The NSW Parliament's 2024 Birth Trauma report heard a great deal about consent. In its response, the NSW Government supported 42 of the inquiry's 43 recommendations. It committed to strengthening consent processes and improving how information is given to women. Lawyers at Carroll & O'Dea have set out the government's response on consent training and birthing intervention policies.
That's encouraging for future mothers. But if the conversation didn't happen for you, you're still entitled to ask why.
Apart from a claim, you can raise concerns with the Health Care Complaints Commission, or about an individual practitioner with Ahpra.
Frequently asked questions
I signed a consent form. Does that mean I can't make a claim?
Not necessarily. A signature doesn't prove you were properly informed. What matters is what you were actually told, and whether it covered the risks that mattered.
It was an emergency. Doesn't that change things?
It can. In a true emergency, there's less time for discussion. But that's why antenatal conversations matter, and it's also why the decision to use forceps itself can be examined.
I can't remember exactly what was said.
That's very common. The medical records, your partner's memory, and anything you wrote at the time can all help fill the gaps.
I also had a severe tear. Does that change anything?
Possibly. Forceps carry a higher risk of severe tearing too. My article on third and fourth degree tears explains more.
A closing thought
Consent isn't a form. It's a conversation that respects you as the person whose body is on the line.
If that conversation never happened, you didn't fail to ask the right questions. Someone else failed to give you the information you needed.
So here's something to sit with: if you'd been given the full picture, what would you have wanted to say?
When you're ready, Part 2 explains the injury itself, and Part 5 covers what a claim can cover.
This article is general information only. It is not legal or medical advice, and reading it does not create a lawyer–client relationship. Every situation is different. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
