Can you refuse forceps?

(33 Posts)
Hermya321 Thu 08-Jul-10 12:39:02

Hi,

I'm starting to think of my Birthplan and due to SPD issues I really don't want Forceps and would much rather have a c-section than have potential damage to my pelvis.

So really my question is this, can I refuse them? Or is there a point that you reach where there is no other choice but to use them?

Thank you.

Rubberplant Thu 08-Jul-10 14:31:37

At the end of labour I was asked to make a decision between forceps or an emergency c-section. I refused forceps and my baby was delivered by ventouse.

My understanding is that you can say you don't want forceps but sometimes the baby has descended so far that a c-section is difficult because the baby has to be pulled back up and out of you.

Loopymumsy Thu 08-Jul-10 14:34:55

Message withdrawn at poster's request.

ReasonableDoubt Thu 08-Jul-10 14:36:43

You can state in your birth plan that you don't want forceps and make the midwives in the labour suite aware of your wishes, but I guess when push comes to shove (no pun intended!) it is a call to be made at the time. Often, once forceps are being suggested, it is a 'no going back' situation. Ventouse might be another possibility, or c-section depending on how far down the birth canal the baby has reached.

Are your antenatal midwives aware of your SPD and is it in your notes? Make sure this is all covered off. Women with SPD are even more in need of an active birth, with standing/squatting/kneeling (to whatever extent you can manage) etc positions, rather than on your back with your legs wide open. And active births generally lead to less need for intervention (although nothing is guaranteed with labour, obviously!)

Is this your first birth?

Acanthus Thu 08-Jul-10 14:41:49

If they tell you that you need forceps you will likely be so exhausted that you would let them use a bulldozer if you thought it would help.

So put it in your birth plan if you are convinced that you know better than they do, you won't have time for an argument if it comes to it. State it clearly - I don't want forceps because of my SPD - I'd prefer an emergency c-section.

WildSeahorses Thu 08-Jul-10 15:49:58

From a strictly legal perspective, you can refuse any medical procedure (provided you have the mental capacity to make the decision, obviously).

I suppose that if you refused forceps, they would have to do a CS eventually (on the basis that they still have an obligation to care for you even if they disagree with your decision to refuse one form of treatment). Before you put a blanket ban, however, you might want to consider whether there are any circumstances in which you would be happy for forceps to be used.

FWIW I am of a similar mind to you re forceps (although no SPD issues) and my birthplan stated that I would only consent to an instrumental delivery if it was low cavity and non-rotational (i.e. a simple lift-out - I felt that a CS at that stage of labour would be riskier for the baby and also the risk of any damage to me would be lower). I don't know whether having SPD would mean this was significantly different for you - probably best to discuss with a doctor in advance and agree a plan of action with them so you don't have to make the decision while in labour.

Hermya321 Thu 08-Jul-10 16:34:46

It is my first birth so I'm a little clueless tbh. From what I've read, in order to use forceps they place you on your back in the lithotomy position. I'm concerned that this could result in them over extending my pelvis and causing some lasting damage.

Realistically I know that despite the best intentions in the world things can and do go wrong. I just wondered at what point does it become forceps or nothing.

Can they use Ventouse instead?

It is in my notes, I've got an appointment with my midwife next week so I'll make her aware.

Tangle Thu 08-Jul-10 16:44:23

I think you need to sit down and have a detailed discussion with your MW and/or ask for a referral to discuss it with a consultant.

There are pros and cons to any form of intervention and, depending on what happens, one option might be significantly safer. My understanding (although I'm by no means qualified or an expert) is that there are some situations where the choice between ventouse and forceps is down to the preference of the HCP but others where one or the other will be inapropriate.

Fear and worry release adrenaline, and adrenaline is an enemy to a straightforward birth - so please keep asking questions of whoever you need to until you find out what the options are and how they can work with you to minimise the risk of aggravating your SPD.

MrClaypole Thu 08-Jul-10 17:00:27

Hermya, at my antenatal classes, the midwives said that the Dr will almost always try a ventouse before using forceps.

I think that there's more chance of an instrumental delivery if baby in in certain positions - so look up optimal positioning to try and get baby in a good position. Having an epidural can also increase chances of instrumental delivery so might want to avoid one of those.

Not sure how bad your SPD is, but remaining immobile and on your back gives more chance of intervention so have a look on here for tips on keeping active and birth positions.

Good luck!

LackaDAISYcal Thu 08-Jul-10 17:36:49

Hi hermya smile

For my third, a VBA2C, DS2 got a bit stuck and my SPD meant that I couldn't be mobile in order to help his position (I couldn't even lift my leg off the floor without screaming in agony). As this was a VBAC I was determined to have a natural delivery, so when it came to the option of forceps or CSection, I opted for the forceps. Ventouse was never offered as an option, possibly because he had had a scalp clip on?

I was given a spinal incase the forceps option failed though so it wasn't such a bad experience. The episiotomy didn't give me any bother afterwards, but the piles from pushing for almost three hours to no effect did!

In hindsight I would do it again though as the CS I had for my first DS after a long and difficult labour left me completely traumatised.

vanloadtovenice Thu 08-Jul-10 20:23:05

My registrar refused point blank to try ventouse before proceding to forceps. They have caused permanent damage, and I curse her often.

So, in my experience, they do what suits them, regardless of your wishes. At least in Winchester!

WildSeahorses Thu 08-Jul-10 21:54:33

I think that sometimes it isn't possible to use ventouse (e.g. too much caput/baby is too premature...). Also I've read that trying ventouse and then using forceps is far riskier than just using forceps straight away so if they think the ventouse is unlikely to work then they won't make an attenpt. Not sure if this was the case for you, Vanload?

bruffin Thu 08-Jul-10 22:35:45

venteuse doesn't always work, I had venteuse which failed, then forceps in theatre in case they failed,it was going to be emergency c section.

Make sure you go to the loo often too during labour. When i got to pushing stage( and had been labouring in pool, good position, all that jazz) baby's head just would not crown. Ended up with ventouse delivery (kiwi cup) which was fine. MW initially thought it was because DD's head was slightly in wrong position, but then, after the delivery, drew off two big buckets of wee with a catheter and said that might have had something to do with it blush!

zapostrophe Thu 08-Jul-10 22:43:51

Message withdrawn

PictureThis Thu 08-Jul-10 22:53:14

Hermya, it seems to me from reading your post that the actual concern is potential exacerbation of your SPD and potential damage to your pelvis from being in lithotomy. Both forceps and ventouse are performed in lithotomy so by stating you would prefer a ventouse to forceps wouldn't really solve your concerns.
How bad is your SPD? You may benefit from an obstetric review and assessment so that a plan of care can be made for your labour (ie LSCS instead of instrumental delivery).

KAEKAE Thu 08-Jul-10 23:01:41

My daughter was born by VBAC with assisted foreceps. I was asked and I said yes I just wanted a natural birth and she was slightly stuck and I wasn't progessing. I had failed forecepts and ventous with my first child and ended up with a csection and the section was hell. I had a rough time. I had no problems with the forceps and made a really speedy recovery unlike the first time and they enabled me to have my VBAC.

barkfox Thu 08-Jul-10 23:07:29

Without being alarmist or negative, I want to point out there is a risk of injury to babies who are born via forceps/ventouse, aka instrumental delivery.

It's hard to quantify, and well nigh impossible to predict - factors like how high the baby is in the birth canal, how they present, what forceps are used, and frankly how skilled the person wielding them is are all important.

I just think it's important to say this, as forceps do not necessarily equal 'maternal injury risk but guaranteed healthy baby.'

And I think we'd all rather have a healthy child than one who was 'damaged.'

Tangle Thu 08-Jul-10 23:34:52

barkfox - I think what you say is very true, but I think it needs to be considered against the backdrop that unless there was concern for the health of either the mother the baby or both they wouldn't be suggesting an instrumental delivery in the first place. Everything in life has risks. All we can do is to try and be as informed as possible to enable us to choose the risk/benefit profile that is most appropriate to us, as individuals, at the time.

My Mum was a midwife and when I was discussing birth with her she said sometimes they HAD to use forceps. It might be a choice between that and breaking one of the baby's bones shock to get it out.

If the baby gets stuck when its head is in your vagina or partially crowned, what do you want?

To avoid forceps, tell your HCPs at the birth that you dont want to end up in that situation. You have a medical reason for avoiding forceps then they should take this into account when managing your labour. If it is looking like forceps might be needed (slow progress, epidural) then they could move to do an EMCS sooner than they might with another patient.

I agree with the other poster that the best way of avoiding one is to get the baby into the best position and have as active and natural a birth as possible. A planned home birth greatly reduces the chance of forceps being used even if transferred to hospital.

barkfox Fri 09-Jul-10 00:06:26

tangle, for sure - I think though it's very difficult to be properly informed about the risk/benefit profile for forceps, in particular, as the risks seem to be less well documented, or discussed, than the risks of a CS, for example.

I would love nothing more than for women to be able to make well informed personal choices, and wasn't for a moment suggesting that instrumental deliveries are carried out for no reason.

hellymelly Fri 09-Jul-10 00:11:17

I was going to reply "barbecue tongs" because I had misread the heading as "can you reuse forceps?".Think I need to go to bed now.

My SIL had rather nasty pelvic floor damage from a forceps delivery (to be fair, it was an emergency and it was probably the right thing to do in the circs). It really coloured how I felt about them, though obviously in a real emergency I'd rather they were tried than not.

My second stage went on 'too long' (2 hrs 45 mins in all), which I suspect was down to the epidural I had. The obstetrician who appeared as if by magic at the 2 hour point kept pushing (ha!) for forceps. I said - why not ventouse? He said ventouse might be more gentle but carried a higher failure rate and he didn't want to distress the baby with two different instrumental attempts. I stuck out for trying the ventouse. After the episiotomy (which healed well, and fast, btw) DS flew out, and I think he really was on his way anyway. He had a minor swelling which went down very fast. I have an intact pelvic floor. smile

Ask (or get your partner to ask) what happens if you don't have forceps at that point? What would happen if you try ventouse instead? Would it help if you were able to be in a more upright position?

Hermya321 Fri 09-Jul-10 09:36:04

With regards to my preference for ventouse over forceps, I've never really heard any real horror stories about them being damaging to your pelvic floor and pelvis. So I had taken it that they were a nicer option than forceps (if in that situation), I may be wrong though blush. As I said though, I'm a but clueless. But I will be talking to my midwife.

But you have all been very helpful and I appreciate your replys (frantically writes notes).

This is why I'm so glad I discovered MN, where else would I be able to find out about this stuff without feeling like a bit of a clueless idiot. smile

Foreverastudent Ok that makes sense and is good to know, thank you.

Reshape I know similar people and I've heard a few horror stories as well. But thank you for sharing your story, it's really helpful.

Helly [Grin]

Picture It's not that bad at the moment, but I just want to be prepared and have a bit of knowledge about all the eventualities. I figure if stuff like this were to happen to me, then it would be a lot less tramatic mentally if I were aware of my options and able to make an informed decision at the time. I do plan on going to a midwife led birthing centre and they encourage active birth. I also have a doula coming with me as well to support me and my husband. I met up with her and she started talking about my birth plan, I've been going through it and trying to look at all options and this is my forceps section of the plan.

PictureThis Fri 09-Jul-10 09:47:21

I think you have absolutely the right attitude. Good luck with everything and hope it all goes well. (have you considered labour/birth in the pool?)

Lovethesea Fri 09-Jul-10 10:44:01

I had rotational forceps with DD as an emergency. She was descended past the spines so too low for an easy cs, and I had been fully dilated for 6 hours which apparantly also made a cs a worse option for her. Her head was stuck sideways on and she was unbirthable. Her heartrate crashed and I was rushed to theatre. It was one try of forceps then an emcs was planned. I have longterm damage, especially to my bladder which didn't function at all post birth and took months to get close to normal again.

But I am comforted knowing it was the safest exit for DD - safer than reversing her up the birth canal and ventouse wouldn't have been able to turn her given how wedged she was. She was short of oxygen but has no longterm damage which I am ever grateful for. DS arrived a month ago by elcs to prevent further damage to my pelvic floor/bladder and to prevent him getting wedged in like DD.

When it all went mad and hundreds of staff rushed in I was given something to sign, I didn't know what it was really, I was in too much pain - later I saw it was consent for 'medical proceedures' so that covered them for whatever they deemed necessary. I really could contest that signature though - it's illegible! grin

Tangle Fri 09-Jul-10 10:47:11

One of the things they gave us at NCT classes was to "remember to use your BRAINS" whenever an intervention is suggested in labour - there are very VERY few true obstetric emergencies when there isn't time to run through the following:

What are the Benefits?
What are the Risks?
What are the Alternatives?
What does your Intuition say?
What happens if you do Nothing for now?
Smile!

These phrases by Mary Cronk are also great to have in your backpocket - mainly antenatally but also during labour if necessary. I found I didn't really use them (apart from once, to tell the MW to get her arm off my back during the 2nd stage), but knowing that I could helped me feel in control of the situation.

You sound like you're doing everything you can to put yourself in a strong position - fingers crossed all your hard work pays off

virgomummy Fri 09-Jul-10 11:15:43

I was told that if I put something in my birth plan, ie 'I do not want an epidural', I couldn't change my mind later and was advised to say 'I would prefer to avoid an epidural if at all possible'.
I don't know if this is a nationwide or local thing, or if the midwife was just talking bollocks! Agree with having a word with your midwife but maybe you could say you want to avoid them in your birth plan so you're covered if they do become necessary. Maybe your midwife will tell you that you can change your mind later on.
(PS I had forceps, no damage to me or dd, apart from episiotomy of course!)

japhrimel Fri 09-Jul-10 12:11:52

Pretty sure that a birth plan is a plan of how you would like things to go and you should be able to change your mind at any point. Some people might say for example that they do not want an epidural, but change their mind after hours of back-to-back labour and that's fine. They can't hold you to something you wrote down! Having it written in yor birth plan also won't mean that they won't offer something.

If the issue is SPD, then ventouse or forceps won't make much of a difference. I would try and get some info on how much damage it can actually do to you though. I'm hypermobile anyway so I think my SPD is a bit different to normal so I'm not much help on that issue - I can't actually damage myself so much (my ligaments are extra stretchy naturally and I'm accustomed to dealing with dislocated hips), although it also means I have problems earlier!

Some people I've seen mention having SPD problems after birth have actually had hip problems instead, which should've been sorted to not be a long-term issue anyway (there's no need to go through life with a subluxated hip, believe me!). I'm not sure how many people actually have ongoing SPD issues (rather than PGP) from stretching the front pelvic ligaments and them not recovering. Even in that case, I would've thought physio could help.

If to gets to a ventouse/forceps issue, you can ask for an epidural so that you don't have to deal with the pain of the SP joint being pulled apart. You can say you'd prefer an EMCS too, but in either case it may be that it's not really an option. The "remember to use your BRAINS" thing is brilliant!

Fontella Fri 09-Jul-10 12:21:08

I had failed forceps and failed ventouse and ended up having an emergency C-section. The forceps were definitely tried before the ventouse.

Son was born with damage to his head which turned out to be permanent. He's now 17 and has a sizeable indentation on the front of head on one side, just above the forehead. It's covered by hair now of course, but it's still there.

hermya- i had terrible spd in first pregnancy, had to finish work at 27 weeks etc, awful.

i was at the point during labour where altho they mention to u that u have the choice ,really there was no choice the cord was round her neck more than once and it was more dangerous to attempt anything else.

so i ended up with rotational forceps- i have been told they will not give u elcs for spd as it effects so many women etc.

i felt the same as u last time, i agree with the other posters that putting it in ur birth plan is great idea and say many times, that given the choice u would prefer other options.so then mayb they could use something earlier if nessary (sorry spelling!) smile

LittleSilver Sun 11-Jul-10 20:19:00

virgo that's absolute tosh. Consent is an ongoing process. Did a real HCP actually say that?

porcamiseria Mon 12-Jul-10 09:27:04

cant you opt for ventouse, I had it and had no damage (othewr than a very sore chuff for 3 weeks)

I get it BUT your priority is to get baby out safely at the end of the day

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