Is it possible to totally refuse forceps?(133 Posts)
This is a musing rather than urgent Q, as not even pg yet! Am v organised
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>
Of course, you can refuse anything
Yes, you have an absolute right to decline any treatment offered to you.
However, I suppose there may be circumstances where it would be more detrimental to your health/your baby's health to go for CS rather than forceps - if the baby is low in your pelvis for example, it may well be more damaging to have to pull it up again for CS.
But even if this was the case, you would still be able to decline - you just might decide differently in those sorts of circumstances iyswim?
Yes, I did exactly that. Was taken to theatre for trial of forceps. Before she did anything the registrar said the the nurse, this will be a very high forceps. She looked v apprehensive. I said very loudly, I withdraw consent for forceps and she did a cs instead.
Btw, I am not a midwife/doctor, so this was just my musings!
I am totally with you on fear of forceps/episiotomy - just trying to think through what might be factored in when discussing forceps at hospital.
Yes it is....it is utterly your choice and your consent. I am an ex midwife, when I was expecting DS I wrote in capital letters on my notes "I will not consent to a forceps delivery".
In the end it wasn't needed as DS decided to be breech so I had a straightforward caesarean section instead.
Yes it is though like someone said up stream there may be circumstances where it is better for the baby. Best thing is to get as informed as possible, make sure your partner is equally informed & able to speak on your behalf, be willing to fight your corner but also flexible enough to consent if it is entirely necessary.
It depends on how far the baby is down the birth canal, if it's too far down then a cs is not an option really. I don't know what they/you could do if you refuse forceps (venouse only i guess?)
I think there are also circumstances where it would be better for you. If the baby has descended into the birth canal it would need to be moved back up to be born by CS which sounded more horrendous than forceps to me.....
I put that I would not consent to high or rotational forceps on my birth plan. The midwife said that was fine and they weren't really used at the hospital where I gave birth anyway.
I was going to refuse forceps but it wasn't required in the end. Dd was head down but head to the side, facing my hip. If she hasn't moved during labour it would have needed keillands forceps which I would not have allowed.
When I needed them, I was only glad that I was in the right place (a hospital in the Western World) with trained medical staff who knew what they were doing. If you need them, I can't imagine any circumstance where you would then choose to refuse them if it gives a chance of your baby getting out alive and well, now. Of course it's not a particularly nice thought but the circumstances where they are telling you that's what's needed, then there just isn't any question, IME
BackforGood, but she doesn't have to have them, even if the baby is in danger - she still has an absolute right to decline.
If the baby is low in birth canal and needs dragging back up for a c section there is a high risk of anoxic injury and damage to the baby as others have said above. I had failed forceps and then a c section. Baby managed to ping herself back up but a scary moment for all when we realised had to go for a cs. I think it's so hard as you can put a strong view across then things just happen during birth.
I do not give consent first ventouse or forcepts delivery, if the baby cannot be delivered naturally I will need a cesarean. that's what my plan said,
I think that's the key point though if the baby is in danger - why wouldn't you do whatever you could to ensure a safe delivery ?
I don't think you need to understand why someone would make a decision in order to support their right to make it. I'm sure most people would accept a forceps delivery if that was their only option to save the life of the baby, but that doesn't mean that they are under any obligation to do so.
Yes it is, I wrote 'no consent to forceps' on all my birthplans. I would have gone to CS if absolutely necessary. Ended up with 4 very easy births though so it was all unnecessary.
You can refuse anything but you may need to accept this may harm the baby. What if baby was low down and suddenly dropped his heart rate/ became distressed. If they could pull him out in a few minutes would to take the risk of waiting 10 mins to be prepared for theatre and a c section, with the risk of further damage as he was pushed up the birth canal?
Yes, I think it is.
However, if my spinal block had failed then forceps would have been the only option as I could not have had a general anaesthetic.
Thankfully the spinal worked and the forceps worked.
Although you can refuse them, if there are really dire circumstances (I had a punctured lung) then not many people will be looking at your birth plan - they will just trying to get you and baby through the process alive.
Jake did you really? That is v interesting! May I ask what moved you to do that?
BackFG the backstory is, our local hospital had a bit of fuck up recently where a woman was advised to go for a high forceps delivery. Will spare you gory details but she is now doubly incontinent and baby brain damaged. Hence, I'm not sure I'd listen to a dr there saying you need forceps!
Of course if it really was the only only option, whatever. But I might put 'no Keillands/ high forceps' as an insurance policy.
Also very reassuring to hear how many women apparently do this. Am glad I am not
the only lunatic alone.
I requested no high forceps (keillands) on birth plan. To be honest if I had got to that stage I would prob have changed my mind as I was so desperate to meet baby and get her out. As it was I ended up with c sec as she wasn't descending.
Would personally not consent to forceps unless it was a last resort/life or death but would and have consented to ventouse with no consequences for my DC, not even a conehead: episiotomy once, not ideal but wanted DC out and safe and daresay me being cut was unpleasant but the healing certainly no worse and probably a hell of a lot easier than cs abdominal surgery (and frankly my pain tolerance is zilch)
Sarge may I ask, did you write that in your birth plan or just keep it stored in your head in case?
I am a bit jittery about this as my local hosp seems v high intervention: the two women I know personally who have given birth there have had 3 sections between them, and then this woman with the poor damaged baby is the only other one I know about (on the grapevine). Obviously not a statistically significant sample, but they seem very gung ho!
Just noticed that you mentioned a fear of having an episiotomy as well - I was on the brink of needing forceps when the midwife gave me an episiotomy, baby slithered out in 3 pushes (after 24 hours of labour) and everything healed up nicely with very little discomfort and no lasting damage. So for me, the episiotomy helped me avoid any further intervention and was well worth it.
I refused forceps with DS - they were already prepping me for CS as they were fairly sure forceps would fail, and I'd had forceps with DD. The Dr was but I'd heard her and the MW suggest that DS was transverse.
Anyway, after discussion with DH I agreed to one attempt with forceps in theatre, with spinal in place ready to go to CS, and they worked, with none of the damage I suffered first time round.
It would have been possible to go straight to CS though, the Dr wasn't 'happy' when I was refusing forceps but she didn't have any option but to accept my choice. I don't know what made me change my mind to this day - there was no pressure placed on me to try, even with the Drs face!
Even in very urgent situations a good PBS will explain the risks of all options. I never wanted forceps or episiotomy. However, when it came to it the risks of C-section were considerably greater than the forceps risk, so I took the forceps. We are both alive and well, but forceps was the least bad if a lot of very bad options. But then as a vet I am horribly aware that some positionings are very, very high risk whatever you do.
Yes, you can absolutely refuse any intervention you wish. But please make sure you are willing to accept the potential consequences, which have been pointed out very well by previous posters. Crucially, a C-section is not always a viable or safe alternative to a forceps delivery.
I've never had forceps so can't speak about these personally, but had a (recent!) delivery with ventouse and episiotomy (with just gas and air). Just to balance out the horror stories: my experience was that it was a extremely easy, barely felt a thing (on gas and air only), recovered quickly and fully, pelvic floor perfect from day one. And, most importantly, my baby was brought out safely and completely unscathed. Of course everyone is different, but when I see instrumentation being discussed as if it is the work of the devil, I feel the need to stick up for it
In your position, I would make it clear from the outset that you would very much prefer to avoid forceps if at all possible, and to go to ventouse or C-section if it is safe to do so . Sometimes it is a genuinely equal choice between two options. But I would not rule it out altogether. In my humble opinion, labour and delivery tend to work best if you keep an open mind.
Just seen that I said gas and air only twice Probably still under the residual influence of it...
DS1 was born with forceps, his heart rate dropped suddenly and thank God the consultant was with me and got him out as quick as humanly possible.
He was the Queens gyno consultant so I think I was in safe hands.
Personally, when I heard the MW saying the heart rate is dropping dangerously, we need to deliver this baby right now, I didn't think okay then I'll just wait here while you prep a theatre, find an anaesthetist, take me to theatre etc. I just wanted him out right then. Regardless of the episiotomy and million stitches.
I had "I will become very very distressed if forceps are mentioned, please try to explore any other avenues if it's looking like they will be required" written down - I didn't dare point-blank refuse (other forceps threads will tell the tale of why I didn't feel capable of doing so) but I wanted to make my strong aversion to them clear.
And can we quit the semi-judgemental "oooh but you'd put your fanjo on the line for your baby" comments that basically bash anyone as not a good altruistic mother for having wibbles about the infernal things please - they're actually very very hurtful for those who got upset or were coerced into a forceps procedure.
Agree entirely, Miaow. Well said [ smile]
I don't know anyone who would put their minnie before their baby though, and if the fastest way to get the baby out was with forceps why would anyone refuse? Genuine question.
coconutty You don't need to understand why anyone would refuse, the point is that it is perfectly legal and within a woman's rights to do so. Take a look at the ragged bits thread over in Health if you want to have a small insight into why some women may consider declining forceps during birth.
YABVU (I know it's not AIBU but still) to use the word 'minnie'
I am just so bored of Fanjo that I have reverted to Minnie.
Of course it's legal to refuse, but didn't realise it was such a big deal. I had DS when I was quite young and never had a birth plan - didn't realise that I even could tbh. Until I read this thread I had actually forgotten than he was a forceps baby. It was such a non issue. He did have a big red mark on his face when he was born from the forceps but that was the only negative thing I could say from my personal experience.
What peoniesplease said.
Op of you are worried about intervention rates at your hospital, the stats are available to check. Unhelpfully I can't remember where. I'm sorry you know people who had a bad experience, but please don't think that happens to everyone.
Any chance of a link to that thread? I can't find it. Thanks if you can do it.
As everyone else has said, it's your body, your choice. However do be aware that it is sometimes the quickest and safest option for the baby.
I had in my mind that I didn't really want forceps if possible .... Ended up with forceps + episiotomy in theatre after 2.5 hours pushing. Tbh if the cleaner had said they wanted to Hoover him out at that point I think I would have agreed!
Very pleased I did consent to forceps though, I had no nasty tears, no pelvic floor issues and a pretty damn quick recovery all things considered. And DS was absolutely fine, couple of small forceps marks that disappeared within a day.
I didn't put my vagina before my baby - but I got absolutely fucking terrified by how hostilely I was being yelled at to consent to forceps, panicked utterly at the idea of being stuck in the crippling SPD hell I'd been in permanently when they wanted to do a spinal and was desperately trying to get them to note and stick to my pain-free gap when they were going to spinal and forcep me... while they just yelled at me more and more making me more and more terrified... I had no choice but to consent, didn't consent to episiotomy - in fact I was explicitly told they wouldn't without asking me, didn't sign any consent forms so they proceeded on verbal consent... epi was done anyway and I ended up with a social services referral for being resistant during the birth. It completely and totally ruined my life if you must know - I ended up with severe PTSD, nightmares every single day, flashbacks, utter terror of health professionals - they basically ripped a huge chunk of "me" out along with the baby that time and I've never recovered from it. The 3c tear in contrast was a piece of piss. I was so utterly, totally terrified, I just wanted everything to stop - I wanted to be dead to make it all go away and them stop shouting at me to be honest - and because of how dreadfully it affected me, part of me still wishes I'd died in that delivery room.
Hence my reluctance to have them even entertained last time... I'd hardly call that an attempt at fanjo preservation - and my noting down that I'd become very distressed if they were mentioned because of how traumatised they'd left me with their behaviour at the previous birth.
Still want to lump me in with someone wanting to keep their vag nice and tight and shiny?
I think I've missed something, has someone suggested that you wanted to keep your vag nice and tight and shiny?
Having had a 3rd degree tear myself where the episiotomy extended, followed by a PPH and manual removal of placenta (all things that are risks of intervention including forceps), for me, forceps WERE an issue. And DS had marks on his face and facial palsy for several weeks from the forceps, had that not healed then I would probably have been left regretting my decision to change my mind and consent a second time.
I don't know anyone who would put their minnie before their baby though, and if the fastest way to get the baby out was with forceps why would anyone refuse?
I think ^ this has been construed as you suggesting some women woulld want to keep their 'vag nice and tight and shiny', rather than putting their physical and mental health and their baby first.
Oh okay, making much more sense now. Thanks fliss.
I honestly didn't realise that some people think that others don't want forceps to preserve their bits. That would be utterly ridiculous. As I said, I was clueless when I had my first, had never even seen forceps let alone knew what they were used for. DH said they looked like giant salad tongs.
Miaow it sounds like you have had a terrible experience, I hope you didn't have your second in the same hospital and I hope you complained afterwards about what happened to you.
You obviously can refuse, but I would do whatever it takes to get the baby out safely. I guess the best thing to do is educate yourself on the risks and alternatives.
Being informed is the most important thing. In certain cases you really do have to weigh up the risks I had a tear and have ongoing problems due to the forceps delivery I was told these risks. However, in my case c-section had a considerably increased risk of anoxic brain injury or death to baby. So on balance in my mind I would rather take the risk and then accept the damage to myself rather than risk DD.
Thanks revolting for explaining
Do remember though, that people will complain when they've had a bad experience, but there will be loads more women who were very glad of the intervention, who you won't hear from, because they were perfectly happy with their care.
This is an interesting thread as I remember one fairly recently that said it was impossible to refuse consent, as they make you sign for a trial of forceps before c section. This is heartening to know there are choices available. The only hope is that there is enough time to be informed of the specific risks in any given scenario so you can make an informed decision - ie if forceps are considered likely to fail, then c section should be presented as the preferable choice. If c section would take too long, then that should also be made clear.
I think that my concern is that so much is made of the drive to try and avoid c sections that you may not be presented with the risks in a balanced way, ie you will be encouraged to try forceps even if not likely to work. Having watched OBEM and read plenty of threads on both sides of the debate on here, there is a certain endemic mistrust of the motivations of HCPs. Obviously not all HCPs will have stats at the forefront of their mind in these circumstances, but there is certainly an implication that some do.
How would you be able to tell in an emotionally distressing scenario whether your HCP genuinely had yours and baby's health at forefront, or whether they had half an eye on stats? I think that is a challenge, and one of the things that makes childbirth such a terrifying prospect to many women - especially with tales of shortstaffed midwives who you may not have been able to make a connection with and therefore trust up to that point.
Twitchy, in fairness a forceps delivery is generally considered to be worse than ventouse. I also had a ventouse delivery and, like you, didn't find it to be too bad. In fact I only needed two stitches. The stuff that led to me needing it was hard, but the delivery itself was ok. I've never had a forceps birth myself so can't directly compare, admittedly, but not sure it's a good idea to compare it with ventouse. It seems to be rather more traumatic.
Interesting to hear that BraveLilBear but I'm not sure how anyone could be made to sign for a trial of forceps as a condition of a CS. You'd just write that you consented to one and not the other.
I had an episiotomy, and trust me, by that time, all you want for the baby is to come out. All I had in my mind was, oh no, my baby is stuck in the birth canal. It actually didn't hurt, but I have been in labour for over 2 days.
And want to add to others that there are cases where the baby is too far down in the birth canal for a safe c-section. I had a horror story from my doctor friend about this. She was in delivery as a trainee with a woman where the baby was stuck for the c-section. They had many doctors and nurses in there all trying to pull the baby out from the top. I can't remember how long she said it took, but it was a long time. The baby had to be taken to SCBU afterwards. (She didn't say if they failed a forcep/ventouse, but I'm guessing it is).
You can refuse anything in labour I think but do bear in mind forceps may be the safest option for you both. I have had two forceps deliveries and despite being utterly terrified of them before I gave birth it was fine. Both deliveries have been intensely brutal and traumatic but the forceps were not the worst bit, babies both too low in birth canal for safe cs. I had the necessary episiotomy, which I think is equivalent to a 2nd degree tear and healed up fine after, no pelvic floor issues or anything. DD and DS also both fine. In my second labour the doctor used the forceps without a spinal and even that wasn't too awful.
I know many people have had awful experiences and completely understand why anyone would be scared of forceps but just wanted to say they are not always as bad as you might think.
My first labour was very slow and the obstetrician seemed tbe getting concerned. She did something I've not heard of before which was to give me a "good talking to" She told me that I needed to make much more effort, that giving birth wasn't callled labour for nothing and that if I didn't start t work as hard as if I was climbing Everest without a sherpa I would have to have an episiotmy and forceps delivery. By tht point I had felt totally exhausted but the pep talk did me a load of god and DS1 was born natuurally a while later. She told me afterwards that just saying enough to make me realise the implications of giving up was a technique she often used to avoid instrument deliveries, I was very pleased, even though I still needed stitches.+
higgle those of us who did need forceps after putting everything we had into it should've just tried a bit harder then, eh, or perhaps we just needed a stern talking to?
The other thing about forceps is that they're often seen as a way to avoid surgery (CS) but many women who've had them end up having surgery later anyway to put right the damage done!
I had an episiotomy and forceps with DS1 who didn't want to come out. I wasn't keen on the idea, but frankly after almost 5 days in labour (not all established but I was knackered) and with a stuck DS, I agree with the poster who said she would have consented to the cleaner hoovering him out!
It went well and despite a bit of bruising, we were both fine. No long term damage. It was thoroughly unpleasant at the time mind you.
I agree with flissflaps. That's quite an assumption......
Flisspaps - that is not what I meant at all, but her unconventional approach did work for me. DS 1 was born in a rather unconventional private hospital, so I was paying to be told off for being lazy! I just wondered whether some instrument deliveries might be avoided if midwives and obstetricians encouraged/supported/had a go a bit more - that's all.
DS was injured by a forceps birth, so I don't think it is just a case of "whatever is quickest is best". He could have been born perfectly safely by CS.
I think for any subsequent births I will state forceps only if baby's health/life is at risk without them or there is no safe alternative.
higgle I found it quite insulting as well. It's got the implication that we are too 'posh to push' so we ended up with an instrumental birth? I'm mainly thinking the bit about labour being hardwork and the implication of otherwise. FWIW, I was in labour for 2.5 days, without any pain relief (except a couple of tablets of codeine), so I was definitely making the effort.
Told off for being lazy?
Tell that to the wrong woman and you risk giving her all sort of psychological issues.
Its just not acceptable.
By all means use 'motivation', but that is not achieved by using language which puts down a woman or might damage her confidence, self esteem or worth or otherwise suggest she might be failing in someway.
It is nothing short of bullying to achieve results and there is every chance it won't work. Do not suggest acting like this is anything different, because it really isn't.
You do realise how many women are worried about coming across medics who lack empathy and act in that way, don't you?
They tried to do a CS first with me but couldn't push DD back up so then went for foreceps as second choice.
The attempt to push her back up was far far worse than anything else pain-wise.
Dc1 is due in 11 days - eeeek! Have read the thread with interest.
Just wanted to say that I'm sure higgle's post was well intentioned. It was about her own experience, one where clearly the medical professionals felt like she was able to give a bit more, she did, and it worked.
I imagine the dr doesn't try that particular 'pep talk' with all women. But uses it as a strategy on a case by case basis.
No-one was implying that if you had a instrumental delivery then you were lazy- at least that's certainly not how I interpreted it.
A "pep talk" is certainly not the best way to go with many women. I had this from unkind and unsympathetic midwives in both of my deliveries. In both I've had a very short first stage (1hr in first labour, 40 mins in second) and hideous protracted 2nd stage (4hrs first time and 2.5hrs second time). Both persistent OP babies finally delivered still back to back, with DS I had no pain relief at all other than some fentanyl just as they made the cut. DD was 4 weeks early and badly stuck. She had to be rotated by hand and that was no fun. I had a lot of "pep talks" about how I wasn't trying, despite being out of my mind with pain and terror. When I went to a birth afterthoughts meeting recently and saw what the MW had written in black and white (poor maternal effort, ineffective pushing etc etc) it was very difficult. My feelings of shame and failure are nearly overwhelming. DS2 is due in 7 weeks, am trying very hard to stay positive but remain very distrustful of MWs in general and still very deeply ashamed of myself. Having got through two forceps deliveries so far though at least am not particularly scared of them this time.
No amount of 'pep talking' would have prevented DS being born with forceps. he was stuck due to me being small and him being big.
It's not a case of me being lazy or not trying hard enough, actually feel that is a really incendiary
OP, if you are concerned about intervention rates at your local hospital, you know you have a right to choose a different hospital don't you (if there is another one in your area)
Have just noticed you are not even PG yet.
So maybe you didn't know that you will be (or should be) offered a choice of hospitals (or other locations such as midwife-led units) to deliver in. You can compare stats about them (e.g. numbers of complaints) on NHS Choices- www.nhs/uk
It also gives you the percentage of unassisted vaginal deliveries at each hospital.
Sorry for multiple posts!
higgle your second post does nothing to explain or ease the way you came across in your first post.
In short, no, having a go at women probably won't make a difference to the number of forceps births, but it probably will increase the number of women left feeling like failures about it.
Back I think it's more that I'm not sure I trust the drs at that hospital. It's not so much about the woman 'complaining' if you see what I mean - her baby has permanent disabilities now and I believe she's suing the PCT - it's more that the dr who was left to deal with her was v junior. This is all friend-of-a-friend stuff but apparently she gave birth at 3am and there were no consultants around, and no one to supervise the relatively inexperienced person who decided she needed that procedure.
Coco I don't think it's trivial to think about your own long-term health in birth, and also, there is an obvious risk to baby from forceps. Of course it might be the best option, and if I genuinely thought that I'd probably give in, but like others I think the drs probably are thinking about £££ as well as the mother's long-term health.
Pendulum thanks - yes, this is hardly an immediate problem for me - though I'm hoping it will be soon
The thing is, I want to try a home birth so would only transfer to hospital in case of problems, which is why I think I'd need to go to my nearest as I imagine it'd be a high-pressure, blue-light type of deal.
I've had forceps twice. Venutose failed both times. Too late for C-section. Without forceps both my babies would have died. I could have withdrawn consent, but I preferred an alive baby rather than the opposite.
banana, I think what I was asking was really, is it possible to say no forceps beforehand so it doesn't get to that point, where it's too late for a CS, as they are looking to do sth before then. Rather than, would you let your baby die rather than have forceps, which would be a pretty insane position!
Anyhow, thanks for opinions, all.
banana in all honesty the answer to that question is no. Well, as stated earlier you can, of course, refuse, but as for the obstetricians and MWs being able to predict before the event that you may need an instrumental delivery, I'm afraid not.
There are some clues eg long first stage often means long second (pushing) stage, but if HCPs were to jump in and do a Caesarean for every one with a long first stage the CS rate would be astronomical. It is also very difficult to predict which babies will suddenly get distressed in second stage.
The only way of guaranteeing you wouldn't be recommended an instrumental delivery would be to have a CS prior to labour or in early labour.
Of course you could consent to ventouse but not forceps but it may not always work.
You have to be aware that there are many, many different situations in which forceps are recommended. In some there are totally reasonable safe quick alternatives, in some the alternatives would be considerably more risky for you and/or the baby.
Sorry for what seems like a negative post but I don't want you to get the wrong impression.
Sorry, that was to Revolting not banana in answer to the question " * really, is it possible to say no forceps beforehand so it doesn't get to that point, where it's too late for a CS, as they are looking to do sth before then* "
Revolting often forceps are used when a birth had been progressing in a normal manner and goes straightforward at the very, very end. So no often there aren't any signs earlier that you should stop and do a c-section.
Yes in my case there were some pointers, but I think these are very rare. My DD was breech till 37.5 when she some how managed to turn, she then failed to engage at any point prior to or during labour. The only time she actually engaged was when she was completely stuck in a lateral oblique presentation too low for a c-section. Once born she was little for her dates and had clearly had too much room to party in there hence all the activities. With hindsight yes I probably should have had a planned section, but this scenario is very, very rare.
Sorry meant to say the birth goes pear shaped at the very very end.
RevoltingPeasant is there a birth centre or a midwife led unit around you? They might be a good choice for you when you become a first time mum. Tbh, after what you said, I wouldn't trust that hospital either. I think from all the posts here, you can see there are many who had foreceps and haven't had any problems. Also that sometimes an instrumental birth is needed and the best option. But I think the main issue is trust. That you have to trust the HCP knows what they are doing, and that they know what is the best options for you and the baby. And it doens't seem to be the case in that particular hospital. If you need a hospital birth, I would seriously consider an alternative. (Or the birth centre or midwife led unit).
I am currently 32 weeks pregnant with DC2. After a horrendous birth with DC1 involving forceps which left permanent damage to me and DC1 in a terrible state I will not consent to the use of them unless it really is life or death. I would rather a CS than put myself through that or my unborn child through that again.
Wish I hadn't posted now, just sharing my experience with no spin or criticism of anyone else. The very experienced famale obstetrician at The Garden ( subsequently Lizzie and john) told me she often used this approach when the mother seemed tired and despondent. It was a bit like a bootcamp instructor getting you to the end of the class. They were beginning to be getting a bit cncerend about DS and there was no obstruction or question of difficult presentation, I'd just been in labour for nearly 19 hours.
I had just assumed I'd have a regular straightforward delivery and it didn't cross my mind I'd be stuck there for so long, tired and in pain ( of my chosing) It brought home to me the reality of what would happen if I didn't get on with it and I was pleased she did. That is my experience and my experience only. This lady has probably retired now but was lauded in her field and had lots of grateful patients, the fact that with my telling off I was able to be the first to look into my son's eyes is something I am very happy about.
Some countries don't use forceps at all though do they? So there must be some alternatives.
In my case forceps were a last attempt to avoid a c-section. If it came to that again I'd say forget it - go straight to the c-section.
As others have said yes you can but it does depend what's best at the time. If I had refused forceps/they had failed I would have needed a really brutal c section where DS would have been pulled from the section and pushed back up birth canal at the same time very distressing for him and dangerous so I'm always grateful for the forceps delivery he had it could have been much much worse.
the thing is Higgle in your situation there was no need for an instrumental delivery so they did the right thing. In most cases an instumental delivery is needed becauase the baby is stuck - I was pushing for 3 hours, I wasn't being lazy, I didn't need a pep talk, DS was just stuck because of was back to back, hadn't turned and his head was at a funny angle. I was never going to get him out on my own. I had a ventouse which worked really well for us.
OP I would rather avoid forceps too, had that on my birth plan. I notice that you also mention you are also scared of an episiotomy, I had one becasue of the ventouse and can reassure you that it was fine. Local anasthetic so didn't feel it being done (as an added bonus you don't feel the dreaded crowning!) and also didn't feel it being stitched. It healed really fast with no issues at all - I didn't even need pain killers after the birth.
Correct, he wasn't stuck I was just dog tired and wasn't having strong cntractis anymore. i onl mentioned it as obstetrician said they wuld nothave let it go on for so long in NHS hospital and I'd have had an intervention at an earlier stage. i think at that time you had to be transferred to another hospital if you needed a CS so they tried very hard to avoid them.
I had a birth plan just like your intended one for dc2. It was a homebirth, and I had a mild prolapse from the first birth so there was no way I was consenting to instrumental delivery for the second. My plan said homebirth, and at the first sign of lack of progress or malpresentation, please go straight to c-section. No instrumental delivery.
In the end I had a very straightforward homebirth so it didn't matter, but no eyebrows were raised regarding the plan. I think having the prolapse meant that they were understanding of my reasons, at least.
Thinking about it myname my experience was exactly the way you described yours, so though I would love to avoid forceps this time around I don't know if I would be able too or if there was any alternative. the experience left me traumatised as I had lost so much blood needed a transfusion, didn't see DS for nearly 4 hours and was kept in hospital for a week but not sure I am fair in blaming this on the forceps as they were probably the thing that saved us....
Yep myname my DS so so wedged DH said they almost pulled me off the table trying to get him out! (I was a bit out of it at the time, I'll take his work for it!)
I did, when my midwife asked about my birthplam I said I only wanted to write in capitals letters across the page NO FORCEPS, she replied that she didn't blame me!
I surprise that statistically there must be women who don't 'try' hard enough
Yes you can. I have a clotting disorder and it was possible that my baby would have the same one.
So I was told in no uncertain circumstances that forceps or ventouse we to be used for mine and baby's health.
They said if failure to progress they would prefer to push baby back up!! And do CS.
Just make it really really clear what you will and will not do. It was easy for me. I didn't have a choice, but they did say that pushing baby back up would be very VERY painful if that did happen!
thing1 thanks for that. Yeah, that's kind of how I feel. I really want a natural home birth but if it doesn't happen I'd rather be in a controlled environment.
I forget the PP who mentioned looking on the internet for stats on the hospital, but I did, so thanks and the hosp I am talking about has below national avg for CS but above for instrumental delivery, which makes me think they go for instrumentals over CS, possibly on cost grounds. It also has a higher number of complaints than other hospitals in the area and is rated as the least well performing in the area on one site.
Thanks, all. I know birth is a big adventure and what happens, happens, but this has at least helped me clarify thoughts. Now I just need to get pg - easy!!!
Bluefish when I saw the cons this time to go over previous birth she said that instrumental deliveries were much less likely second time round even if you've had one before. Fingers crossed!
I had forceps and episiotomy, i was begging for a c section but they managedto talk sense into me as a section carries alot more risk to mum and babyand a much longer recovery. People should not refuse procedures unless properly educated about it, we are in the hands of trained professionals with years of training behind them who know more than we could ever know. I am glad i trusted my fantastic consultant as I was back to normal within 2 weeks. people can be a little arrogant to thinm they know better than a hospital consulatant about matters they are trained in.
I had it in my notes, no forceps and no episiotomy.
They will ask you if the time comes though and you are not usually thinking the way you were when you wrote it and could give a completely different answer.
I ended up with both, I actually begged for them as had already been begging for an already promised c-section and was getting no where.
Btw, can anyone tell me why I keep reading about people going to theatre for forceps?
Bibs That's not always the case, just because you aren't sure about the best option for you, does not mean that others don't for their own circumstances.
I always thought we were unusual in doing high forceps deliveries? Anyway, I put down a big 'no' to that on my form
And as an aside, sorry to be naïve, but why would pushing the baby up be v painful? Can't they do generals, or at least epidurals?
People should not refuse procedures unless properly educated about it
And I don't think we should blindly accept procedures we're not properly educated about either. Doctors are not some sort of God.
people can be a little arrogant to thinm they know better than a hospital consulatant about matters they are trained in
People could also be construed as arrogant in suggesting that perhaps women should put up, shut up, and do just let the doctors do as they please regardless of what the woman wants.
Flisspaps Completely agree with everything you have just said.
Not only did I make sure that the midwives understood no forceps, but I made it clear I would not consent to the mcroberts maneuver for shoulder dystocia either.
Merci, pulling the baby back up is bad for the baby. It puts pressure on the neck as the baby is designed to move down the canal head first.
With dd2 I was pushing for about 2 hours to actually deliver her, I did two pushes laid on the bed because the midwives wanted me there and then moved to kneeling against the bed despite their protests. It seemed to go on forever but thankfully they didn't mention forceps. I just had a big headed baby that took forever to move, but if I had stayed on the bed I think she would have required help.
I had mid-cavity forceps for DD1. Luckily it was a very senior consultant on and she had a good look and feel and decided that was the best course to get her out quickly as she needed to be delivered (she turned out to be face up and with her hand cupping her head above the ear). A CS in that case would have been much more dangerous for her.
I went to theatre for forceps as if that had not worked then they would have done a section. Fliss - where did i say you should blndly accept? and when did i say they should put up and shut up? I am merely saying that the average person does not have then training and skills of a consultant and we should be confident in their skills and knowledge. I don't think they are gods but they are better placed to make decisions in these situations than the.average woman.
Schro it varies but in general any forceps or ventouse with a risk of failure (eg rotational delivery) will be done in theatre so an immediate CS can be performed if it fails or isn't possible. Those are the type of delivery where there is a genuine alternative, albeit one that may carry greater risks to Mum or baby.
I often read about countries that don't use forceps on here, but haven't worked in any and can't find any info via Google so can't really answer that. Ventouse and forceps can sometimes be used interchangeably but more often than not there is a clear indication that one would be more suitable and/or likely to work.
I'm intrigued about refusing McRoberts maneuver, that's a new one on me! I presume you know it's just lifting the knees to the chest, which you can do yourself if no epidural/spinal. It works very well IME and often avoids need for any other "intervention". It is also a bit of a necessity to make space in the pelvis to do the other maneuvers if it fails. So please do enlighten me about your reasons and alternative suggestions for managing a shoulder dystocia Starlight ?
Yes, it does sound horrific, pushing a baby back up, but I am unsure why medical experts are telling women it will be a very painful procedure, as if painkillers had never been invented. Do they mean it is very painful for the baby? Or is pain relief such as a general not possible? Just interested really
Bibs - you sound so different to me I literally can never imagine having that kind of confidence in any consultant without checking it out myself too
What would you.have done if your.baby was stuck at the shoulders starlight and why would you have refused mcroberts manouvre? Or forceps for that reason?
Bibs That's where a lot of problems stem from though, Drs assuming that they know best in all cases and not listening to patient concerns, often ignoring anything said to them because they are the ones with the training so they must know best of course.
Vinegar What would happen if the forceps failed when not in theatre?
McRM Isn't the only way to deal with SD. It's the most hands-on and active way though and I think HCPs prefer it because 'doing something' gives the impression of better control.
Refusing forceps and McR from the outset can give the woman two essential (imo) things. 1) More likelihood to be able to birth in the most optimal position from the outset to reduce the chances of NEEDING those two interventions and 2) More senior and experienced birth attendants.
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.
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)
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.
I have just often wondered when I keep seeing people mentioning being in theatre for forceps.
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?
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.
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.
That should have said some of them do quite often ignore patients concerns.
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?
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.
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'.
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.
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.
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.
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).
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.
'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.
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.
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.
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.
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
Also - with DS he was crowning, and got pushed back up and out the sunroof.
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.
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.
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.
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