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refusing forceps and general anaesthetic(39 Posts)
A doula can help advocate for your wishes.
In my experience when it comes to it you can't actually refuse / I tried to refuse consent for forceps but they told me there was no option to consent to section only - had to consent for trial of forceps then section.
As for the GA, have you thought about what would happen if you needed an EMCS?
idea of forceps is scary. The thing is though that they don't use them on a whim, they can and have been lifesaving. Forceps were used to safely deliver my DS when he got properly wedged (he was born with a condition that meant this head plates couldn't move together properly during birth) I was told afterwards that they were worried they wouldn't manage to get him out that way and that they would have to perform a c section and push him back up the birth canal to get him out. Forceps potentially saved my son's life and saved me from major surgery
When I was in labour DD turned and lifted her head when she was nearly out of the birth canal. She was totally and utterly stuck. If the doctors had gone for a C section, they would have needed to trail her all the way back up, which would have been extremely difficult. As it was, she was delivered successfully with forceps and one push, and no damage.
If you insist on no forceps, make sure you talk through scenarios like this one (which happened in an active labour, I was upright on a birthing stool) and any other situation where they might use forceps, and come up with alternatives. Get them written down. Make sure your birth partner is aware. Hopefully it won't come to it but you need to be very well prepared.
I was very anti forceps too. But when it came to it I was prepped for a c section when they discovered he was pretty much there- the alternative would be to push him back up which would have been riskier for him and done me more damage.
There are different types of forceps too - the ones that are banned in many countries are kieland forceps, I did refuse consent for these in my birth plan, as they are used when the baby is higher up and more damage can be caused - but also c section is a viable alternative at that point.
Also, refusing general- what do you think the alternative is? If the baby gets stuck they will only do a general if epidural/spinal fails- so in the nicest possible way not sure there's going to be an alternative?
I am not in any way trying to dismiss your feelings with my comment but here is my opinion.
I felt a lot like you during pregnancy, I felt it was all about the baby and I was just the incubator. When you are pregnant you have no idea of the way you will feel about your baby, they are just a concept rather than something tangible.
During dds birth my feelings changed. I knew I would do whatever it took to get her into the world safely. Then when she was born my whole world shifted. Suddenly all those concerns for myself disappeared completely. All I cared about was her, she was so so much more important than me.
All I'm trying to say is that if you want to write those things in your birth plan, go ahead, but when it comes to it you may find you feel differently.
In answer to your question about moving to c section in advance of baby descending too far, in theory yes that's a possibility. In practice I dilated from almost nothing to fully dilated in 10 mins so it wouldn't have made a difference, he just came very fast at the end.
I can fully appreciate your fears, I had them too, but in the end forceps meant my baby was delivered safely, I didn't suffer any more damage than a 'normal' delivery, and I didn't have major surgery to recover from.
First, congratulations on your pregnancy.
Second, I'm sorry to hear about your previous bad experiences - I can completely understand why that might influence your decisions in the future.
Third, while I think you're entirely sensible to be thinking about your birth plan and what might go "wrong", please be reassured that for very many of us things go "right". I can honestly say that my three labours were the best experiences of my life, and I would go through all three again today in a heartbeat. I have never felt as alive, or powerful, or female as when I gave birth. My body knew what to do. I was very lucky to have relatively quick labours which didn't need induction, interventions or pain relief other than G&A, and I wish the same for you.
Fourth, I would really recommend a book called "Stand And Deliver". The book is given over entirely to positive birth stories - even when the births didn't go according to plan. (There's also a useful hospital bag checklist at the end.) It's well worth buying or borrowing a copy if you can.
Fifth, and at the risk of sounding patronising, when I was in labour it was so very different to how I imagined it would be. I thought I'd be self-conscious about people seeing my boobs and bits, and worried about whether my pubic hair was trimmed , and embarrassed at the thought of puking or pooing in front of others. But once it came down to it, I really didn't give a stuff about any of that (as it happens I didn't poo or throw up, but I was completely naked on all three occasions). My biggest tip to anyone is don't expect it to be how you imagine - no matter what you're imagining! It will be different. Be prepared to 'go with the flow'.
Sixth, a doula would be a great investment if you can afford it. An experienced advocate (partners, no matter how lovely, be definition aren't experienced at birthing) who understands the options open to you and who is on your side could be invaluable.
Seventh, talk to your midwife about your condition that makes anaesthetics problematic. Of course you can refuse an epidural for pain relief purposes, but you do need to have a plan for if you need an EMCS. (I'm assuming that you wouldn't refuse the EMCS if it were needed, but of course that could be an option too - as long as you understand that refusing an EMCS could put you and/or your baby's life in danger.)
Sorry to say this to you but there are times when to refuse a GA would prove fatal for mum, baby or both.
Don't be too set on what you do or don't want in your birth plan, births are entirely unpredictable, and you must be prepared to be flexible.
My apologies - I misunderstood your comment about 50% of anaesthetics failing to mean you were anti-epidural and CS.
I haven't had forceps, I have had a CS. My birth plan indicated that I was ok with forceps but not Keilland forceps. I would have preferred to avoid a section but I was told my baby would be unlikely to survive a VB. My recovery took much longer than people I know who have had instrumental deliveries.
I'm not sure what you would achieve by refusing anaesthetic. A GA section is usually a last resort, because the epidural or spinal has failed, or because the situation is so urgent that there is no time to site one. It isn't like there is some more pleasant alternative, and it is pretty rare anyway.
Agree it might not be poss to avoid GA - if there is an emergency then there may be no time to sort an epidural.
You're right to think about what you would like to happen ideally, but try not to be too black and white about it. There are so many variables at play during labour. I had been scared off any instruments by my NCT teacher, but when it came to it I bloody needed the help to deliver ds. He had a ventouse delivery and we're both fine. I narrowly avoided an emcs and I'm glad I did - for me, instrumental delivery was the lesser of two evils. I would have been knocked out for the emcs but I am confident the docs we're doing what was best for ds. He was stuck, and in that situation you really do need to act quickly.
Whilst in labour I suffered from a near fatal condition called Eclampsia, it was very sudden and resulted in me having seizures during the pushing stage of labour.
I was immediately put under a general anaesthetic and my son was born (very poorly but alive)
If I had not had that general anaesthetic we most certainly would both have died.
I understand your concerns, but I wouldn't be knee jerk and start saying you don't want this or that.
In my case I was not in a position to have changed my mind should I have had requested no general anaesthetic and this would have left the doctors in a very difficult position.
GA's make up 1% of births, they are very rare.
I don't like the thought of them, but I am facing one again with this baby as I do not have an epidural space (spinal fusion)
I'm just saying don't rule anything out - one person's bad experience doesn't account for everyone.
Yes they want baby to be safe, but they want you to be safe too.
If you have problems with anaesthetics it is worth mentioning this to your midwife and asking if you can meet with an anaesthetist in the hospital you plan to give birth in before your due date.
Obviously the majority of births go really smoothly with no major complications but rarely things go so wrong so quickly that the only way to save the mother and/or baby is to do an emergency section under general anaesthetic. (This may not even be during the delivery but due to the mother having a big bleed once the baby is out).
If you meet with an anesthetist, a formal anaesthetic plan could be made which could include an early epidural, they could look at your back to make sure an epidural would not be too tricky for you (and if it looks like it could be difficult, make sure they know about it beforehand so if you come in at 2am they call someone senior in early), they could also document in your notes exactly what problems you have with anaesthetics so if you did happen to need a general anaesthetic in a hurry (for example, my friend was at home, she thought her waters had gone, looked down and was sitting in a pool of blood - she was waking up from her anaesthetic with her gorgeous baby in her arms within 20 minutes of arriving at the hospital!) they would know exactly what drugs work and don't work for you.
When I worked (briefly and never in obstetrics) in anaesthetics there was a list of mums with potential anaesthetic issues that was handed over to each anaesthetic doc coming on call as these ladies reached their due dates.
As for forceps, you can certainly say you'd prefer not to have them used and that you'd prefer to have a section considered early but on occasion the baby is stuck but too far down for a section, is getting stressed out and forceps are the best option, this is something to have a proper discussion with your midwife about.
I was petrified of forceps after a story after one of the mums from my NCT Class delivered at 35 weeks with them; I'd have preferred have a C section to them. When it came to it, DD's heart rate kept dipping with every contraction and they said I could either push her out in an hour or she be out in 5 with forceps and I made the decision to go with them - it's the best decision I have made.
They look scary, yes, but I had 2 stitches, no tear and it wasn't anywhere near as bad as I thought it would be. Have in your mind that you don't want them but be open to the fact that it may be what's best for your baby and in the moment, that's all that matters.
Firstly in response to Borttagen I think you were lied to, badly misled. In a healthcare setting they CANNOT do anything you don't consent to, so you were within your right to refuse forceps and insist on going straight for a CS. I'm not saying that would necessarily be the correct choice, but you are entitled to accept or decline intervention, and anybody doing anything you don't consent to is assaulting you.
To sleepy2kp there's a few different things I think it's important you should know. First of all, it is a good idea to access information to think about a birth plan, although 12 weeks is exceptionally early to be doing it. The important thing is to get balanced, reasonable information, rather than skewed. It's horrible that your friend had a bad experience, but how about all those people that didn't have a bad experience, there's plenty of those that exist too. Don't let information bias get in the way of facts.
If you need any interventions in your pregnancy you will have to work alongside Doctors. Obviously we don't know about your past history, but you're going to have to work on the trust issue with Doctors. I've had bad experiences in the past too, but there are many many times more good doctors than bad.
If you are going to decline anything, you need to be correctly informed about it, just the same as you would if you provided your informed consent. It's therefore a good idea to actually talk to a Doctor about forceps, including risks, benefits and alternatives. Try to remain open minded in that conversation and don't view it as "emotional blackmail to make you agree". Stating that something could potentially save your babies life IS emotive, but it's not emotional blackmail, it's just truth. Your no DOES mean no, but make sure you know what it is you're saying no to. I know you said you have done a lot reading, but the reasons you state you want to decline don't come across as particularly well researched. As a PP stated, I think it's a particular type of forceps that may be banned rather than ALL types.
Forceps themselves aren't necessarily dangerous, but they are in the wrong hands. Could it be a consideration that you would only consents experienced Doctor, such as a consultant, using them.
I also think you should have received an anaesthetic referral, so if you haven't you should request this from your midwife. This will mean that before you are in labour you can speak to an anaesthetist and discuss your previous issues with anaesthetic, see why they happened and again, discuss alternatives and make a plan for labour. For example, if during your pregnancy you remain low risk you'd do x in labour, but if you're high risk you might consider an early epidural (like you alluded to), so there's plenty of time to right any issues should they arise.
Birth plans are really more about getting you to think who you'd like there, what atmosphere you'd like etc, what pain relief you want to try. A birth plan that says I really want a room with dim lights, x music (that you supply yourself) and have access to a bath or shower is a much more helpful birth plan that says I don't want a CS unless I need one, I don't want forceps unless I need them, I don't want an epidural unless I need one etc. it's sort of a given that you wouldn't really be advised to have anything deviating from the normal unless it was determined that you did need one. I wouldn't think it would be necessary to even state in a birth plan that "it's ok to ask but respect my wishes if I say no" because again, that's exactly what they have to do, it doesn't really need to be stated.
A much better way to write it would be something along the lines of "I'm very keen to avoid an instrumental delivery, so I would appreciate help ensuring I have an active labour and would like suggestions for labouring and birth positions that ensure optimal fetal positioning" - that helps your midwife much more, because she will know you will be open and receptive to advice about active birth. Exactly the same if you write "I am concerned that I have had previous severe anaesthetic complications so I would like an early epidural to avoid potential emergency anaesthetic complications" - that kind of plan helps a midwife know you've made a conscious informed decision and maybe she shouldn't offer to run you a bath because you aren't interested in keeping things intervention free. Think about writing a birth plan as all the things you do want, that are in your control.
Please don't feel anything I've written to you is meant to be critical at all. I just don't want you to close doors on options but then have nothing to fall back on. If you're adamant you don't want something you are fully in your rights to decline, but if there's no other alternative the only other option is that they do nothing.
And here's hoping that none if this will ever be necessary anyway, and you have an easy pregnancy and a textbook birth where no interventions are required!
Forceps are used very rarely and generally when the baby is well descended in to the birth canal but stuck. I had similar fears and in the end had a ventouse delivery and shoulder dystocia which was pretty scary. It was all handled brilliantly and I recovered very well. When you are in the thick of it and if your baby is stuck and needs to come out you will consent to almost anything to allow a safe delivery
I had a GA with my first, it was an EMCS as my son was back to back and his chin was right up meaning he was stuck mid labour. Then the epidural failed twice in theatre so there was no choice but to do it under a general. When you're in that situation, I can guarantee you will do whatever it takes to get your baby out safely and ultimately; alive. That's all that matters.
If I was you I'd write in your birth plan that you'd rather avoid these 2 things but will have them if an emergency situation arises. Anything can happen and unfortunately, some of the time, there's no time to mess around for hours, it's done to save your baby!
Can I ask something since this seems to be an appropriate place to do it?
If you're at the stage where they're looking at using forceps, will they even be able to do a section at this stage? Surely the baby will be really far down the birth canal so how could they section you at this point?
Yes they can, I was 10cm dilated and pushing when I had seizures, there was no way they would have got baby out safely with my unconscious.
I have no idea how as I was asleep!
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