Is it possible to totally refuse forceps?

(133 Posts)
RevoltingPeasant Tue 26-Mar-13 17:38:32

This is a musing rather than urgent Q, as not even pg yet! Am v organised grin

The Birthrights thread got me thinking: can you refuse in advance one specific procedure, or is this just really not possible?

In an ideal world I'd want a homebirth but would transfer to hospital if any probs. However, once there, would it be possible to say I simply don't want forceps under any circs, and to go straight to CS if it's tending that way?

Or will an NHS hospital not have that flexibility?

I ask because I've seen some forceps horror stories, and that + episiotomy is my real fear during birth! <wimp>

louisianablue2000 Sun 07-Apr-13 23:19:50

I worried quite a bit about tearing before DD1 but there is not a lot you can do about it unless you get an ELCS. Not sure that would heal any quicker anyway. FWIW my episiotomy took less time to heal than one of my tears.

WRT a forceps delivery, in the heat of the moment you might have no choice. DS's heartbeat started to drop 2h into labour so they decided to go for an EMCS. I was 5 cm when they checked in the delivery suite. By the time I was pushed through to theatre I was 10cm and having involuntary pushes. They abandoned the EMCS and I was told 'you push and I'll pull' (notes said 'mother agreed to forceps'). Luckily he came so quickly they didn't have time to prep me for forceps. But the point is you might well be in a situation where you have no time to make calm decisions and a birth plan would be ignored, and trust me, you'll just want the baby safe at that point.

Try not to worry about worse case scenarios, we always hear the horror stories but you have no idea if they will happen to you and the worst ones are rare.

PeaceAndHope Sun 07-Apr-13 22:56:54

Yes. If a medical treatment is forced on you then that it considered assault.

I wouldn't worry so much about harming the baby- when a forceps delivery is suggested, a c-section is typically also an option. They are likely to prep you and take you to theatre anyway in case forceps don't work. You have every right to tell them not to bother with a trial of forceps and waste time and go straight to a c-section instead.

To the people saying why wouldn't someone consent to forceps. Because they cause facial nerve palsy, erb's palsy, nerve injuries, spinal cord injuries and paralysis in babies. For mum, they are associated with an increased risk of third and fourth degree tears, anal sphincter damage, incontinence, pelvic organ prolapse and PPH. The question should be: Why would you consent to forceps? Especially nowadays, when they are recommend forceps when c-sections are also possible, just to save money.

zirca Fri 05-Apr-13 23:14:09

I refused Keilland forceps. They said DC's heartbeat was erratic and wasn't coping with labour. So I stopped pushing, and heartbeat stabilised. I then pushed, stopping if the heartbeat faltered. That went ok so they left me to get on with it. DC unstuck themselves and got most of the way out, then we needed low forceps and episiotomy for the final bit. That was fine and not an issue. I didn't want Keilland forceps because of the risk of brain damage etc for the baby.

Also - with DS he was crowning, and got pushed back up and out the sunroof.

For both my births I absolutely refused to consent to forceps, and that was in my birth plans. My DM and DH were told they were not to be used and I would rather a section.

DS ended up a section, but couldn't have been delivered any other way anyway.

Dd was a lovely vbac with no intervention

tilder Mon 01-Apr-13 22:49:19

Starlight I'm glad your subsequent Labour's went much better.

Cakebaby, that is entirely your prerogative. Personally I have found for my three labours that things go best when everyone is working as a team. You seem to have quite a confrontational/litigious view on things, if you have worries or concerns please talk to your mw beforehand.

Bibs123 Mon 01-Apr-13 22:47:43

cake baby - forceps are used as a last resort usually when mother has been pushing for a long period and baby has become stuck. It could be very dangerous to pull baby back up through the birth canal to perform a section so there is only one way out. A forceps could get the baby out but you would refuse that? so that means you would leave the baby stuck and at risk of death or brain damage because forceps could cause damage to your child? Not forgetting the extra risks that come with a section to mother and baby.

Yes, thank you Vinegar. I was obsessive in my research before I could ever fall pregnant again. It is sad that I thought the risks were higher for my baby and me were higher by listening to my caregivers on the day than not.

I do have to say again, that the midwives attending my next two births were really very good and competent 'hands-off' hcps and whilst I didn't trust them much at the time, I would now trust them with my life and my baby's.

'I seriously hope you have had a good opportunity not only for a debrief'

I tried. They denied it had ever happened. Tried to blame my memory on the pethadine they had injected into me without consent.

Subsequent labours had no touching and no drugs. Not even gas and air. Though subsequent midwives were wonderful and respectful, I could never really trust them.

cakebaby Mon 01-Apr-13 22:30:31

Some types of forceps are not used in the US nor parts of Europe as medical professionals cannot secure insurance to use them, due to the huge potential for injury and damage to mother and child. So WTF are we doing using them in the UK? There is no way they are touching me with them, it is in my notes, DH has been primed and I will sue their ass if they ignore my instruction. They can add my legal action to the growing list they have already, having just paid out in excess of a 7 figure sum for causing life changing injury to a child.

VinegarDrinker Mon 01-Apr-13 22:30:30

You shouldn't be encouraged onto your back if you are already on all fours. But if you are on your back it makes sense to quickly do McRoberts and suprapubic pressure as this resolves the vast majority of shoulder dystocias without any need for further intervention and generally much quicker than it takes for a woman to get onto all fours. Anyway I am sure you have read plenty about it and you are well aware of the standard HELPERR mnemonic for management of shoulder dystocia (which includes as routine turning the woman/asking her to turn onto all fours).

Honestly, if all imo 'sane' attempts had been made to get the baby out and I was still struggling, I would have consented to either forceps (low) or McR. We are lucky to have these potentially life-saving procedures and interventions after all.

However, I will not agree to them in advance and risk them becoming an inevitable solution for poor care.

Vinegar, I was very well informed for my subsequent labours.

I began with preventative. Increasing my odds for a well-positioned baby.

Also, refusing intervention and drugs before the SD occurs means that you are better able to manage the SD yourself. I never did understand why you would be expected to go onto your back when all the research states that on all fours gets you the most space for baby-exit.

VinegarDrinker Mon 01-Apr-13 22:22:19

I understand why you would say that and as long as you are fine with the risks then obviously it's your call.

I wanted to clarify the McRoberts maneuver for the sake of anyone else reading this who may get the wrong impression.

My ds is 6. They performed fundal pressure to get him out. No idea why. It isn't mentioned in my notes as having happened. I wasn't asked to consent. I was pinned to the bed in a MLU and a SHO jumped on my abdomen and I couldn't breath.

I KNOW that isn't the McRoberts but given that experience all subsequent labours stated clearly 'don't you fecking touch me EVER'.

VinegarDrinker Mon 01-Apr-13 22:13:29

I beg to differ, Starlight, McRoberts is not anything to do with fundal pressure. I don't know how old your DC is but "fundal pressure" is not part of the correct or suggested shoulder dystocia management. Suprapubic pressure is - ie pressure on the shoulder through the mother's abdomen, but definitely not fundal pressure. You can perform McRoberts yourself, it may not be as effective but it doesn't necessarily have to involve anyone touching you, and if you had a subsequent shoulder dystocia I would strongly recommend you to do so.

What alternatives did you consider?

I seriously hope you have had a good opportunity not only for a debrief but to make a crystal clear plan for any subsequent deliveries with a senior Consultant, Supervisor of Midwives and quite possibly the legal team of the Trust looking after you. Not wanting to be touched at all is of course your prerogative and absolute right but if I was looking after you I'd want to be 100% sure that you were fully informed of all of the risks and benefits and potential scenarios.

Bibs123 Mon 01-Apr-13 22:12:57

Starlight they performed the McR manouvre on me as my baby became stuck. They push your legs to create more space in the pelvis to get baby out in an emergency, when they are stuck. What would you have done at that point?

That should have said some of them do quite often ignore patients concerns.

olivertheoctopus Mon 01-Apr-13 22:08:02

You can refuse what you want. I had an episiotomy with DS1 and never really noticed it so I wouldn't let that be your sole reason for not having forceps. DS1 was extracted with ventouse in the end.

I didn't mis-quote you. I'm just putting it out that we shouldn't just trust them because they are trained.

And they do quite often ignore patients concerns.

I knew why I was refusing that procedure and I told them why. I ended up with it anyway and need surgery to fix it for the exact reasons I told them I shouldn't have it.

Bibs123 Mon 01-Apr-13 22:03:54

I did not say not to voice.concerns. or that doctors should ignore patients concerns. Why do people keep misquoting me? We are talking here about people refusing procedures before labour has even started.... I certainly voiced my concerns and did not let them do whatever they pleased but we should be able to listen to professionals too... there is a culture for women to think they know better and that is.not always the case. starlight what is the other way to deal with SD?

Thanks Vinegar. smile

I have just often wondered when I keep seeing people mentioning being in theatre for forceps.

My first baby was born using fundal pressure and has autism I believe as a result.

I have suffered PTSD and he will suffer for his whole life - and I do not trust anyone touching me.

McR is not just raising your knees. It is being handled.

VinegarDrinker Mon 01-Apr-13 21:55:35

Schro you'd have to move to theatre, which takes time. Fine if the baby's heart beat is normal, not great if not. Hence a lot of emphasis placed on how to decide which to do where (there are multiple factors - position of the baby, is it tilting its head at all, how high the head is, is it descending with pushing, how much swelling is there on the head etc etc)

Bibs123 Mon 01-Apr-13 21:55:28

I didn't have blind faith in anyone but in that situation I had to trust that the consulatant was sufficiently trained and knew alot more than me about the best action to take.

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