To refuse forceps or ventouse delivery

[mummypig189]

Quick background-
Im pregnant with my third child, 2prev emcs both awkward positions
Would v much like to try for a vaginal birth this time but in case of emergency i would only like a c-sec, not an instrumental delivery.
Is this an unreasonable request to make when i see my consultant in 3weeks time?

As others have said YANBU to want to discuss it with your consultant. He/she will be able to explain why an instrumental delivery is sometimes the safest option and may be able to offer either an elective section or say that if possible they'll opt for a section rather than an instrumental.

YABU to point blank refuse an instrumental. You could potentially put your baby at risk by doing so there is a point where a section becomes very difficult/impossible. I would be careful how you word what you say to the consultant as well. If its documented in you notes that you "refuse", even if you change your mind at the time it will make the doctors think twice before proceeding, delaying urgent treatment.

Sorry if I sound unsympathetic but especially as you had such a short labor last time an emergancy section might not be an option. Maybe you should ask about an elective section?

I say do it, good luck!! My DS could not come out, it was like the story of the biggest turnip!! I was pushing, they were pulling. He could not come out. Eventually I had an EMCS, I had asked for a CS ages before. He was born with a black eye and ptosis as a result. If forceps had not been used he may not have had the damage.

Thanks. I have the option of having an elective section, just want to try for a natural birth but not 100% either way

I'm a midwife and I don't think it's overly unreasonable. Sometimes we take women to theatre for a "trial of forceps" which then would progress immediately to a c/section if it wasnt successful. In that scenario I think you would be well within your rights to request to for-go the trial and just have the Caesarian. Obviously though if your baby was in severe distress and the doctor could get the baby out quicker (and was confident he/she could do so) with forceps/vacuum then that would be the best choice.

I would suspect though, "they" would not want you to have a very long labour and would expect you to have very minimal intervention (ie. no induction) if you were to have a vaginal birth. You probably would not get into such a situation as they'd be watching you closely. (if that makes sense). Good luck and think positive thoughts.

The thing with a natural birth is you can only know what's happening when it's happening.

You can state your preferences but if it came down to delivering a healthy baby you could find your preferences go out the window.

If you pointblank refuse you could put your life and your baby's life at risk.

You have to be able to trust the midwives and Dr's to do what is best for you and your baby, including using forceps/ventouse if they believe it's necessary. If you can't trust them enough to go with whatever they recommend then it might be that natural isn't for you. That said the chances of you needing an assisted birth are fairly low, and with a natural you definitely get to a point where you don't care whether they use a towtruck - you just want the baby OUT!!! :)

Also sometimes forceps are needed at section.

Perhaps have a think about what aspect of instrumental delivery you have concerns about and talk to your consultant.

Lots of good luck with your birth and new baby.

thegoatswife -This is what happened to me in my first labour, they wanted to try a high head forceps delivery but i refused.
Can i ask, as i have never delivered vaginally would the second stage be just as long as it would be if it were my first IYKWIM ?

And is there a point i could get to where there is no going back? Instrumental or nothing?

Surely you would be better doing what is best for your baby.

If you get to the point where you need ventous or forceps its too late for a c section.

I didn't even have time for pethadine with DS2. I didn't feel in control, but I had a healthy baby at the end of it

YANBU to ask your consultant, but I think a little bit U to reject an instrumental delivery completely when it may be the most sensible option, depending how things go.

OP You never can tell, there are many reasons for a long second stage- pushing too soon without an urge to push; position of the baby, not actually being fully dilated, epidural, a very strong pelvic floor the list goes on. Each birth is different, as is each pregnancy as you'd know. (sorry I can't give you a direct yes or no).

With regards to point of no return, technically no there isn't one, but it is risky once the baby is well in your pelvis and it would not be something I'd guess they'd want to do, especially with your history of two c/sections.

The best thing you can do is educate yourself and go to that appointment knowledgable, informed and confident. Ask lots of questions, even if you have to repeat yourself a few times because they might have explained themselves in a way you don't understand. I really believe there is no such thing as a dumb question don't be afraid to ask. You might want to look at a doula and/or some vbac or nbac classes too.

Mummypig, I had similar experience as you. I was postdate with no signs of labour and they had to induce me. I was against it and wanted to go for CS instead as the rates of EmCS, instrumental delivery and poor outcome are high in induced labour compared to Elective CS/spontaneous labour. I discussed with Consultant beforehand and made her write in the notes, no difficult instrumental delivery.

As it happened, I was bleeding heavily in 2nd stage of induced labour with DD showing no signs of descent and her HEart rate dropped significantly when I was pushing. They decided to rush me to OT for high fore ceps delivery with a junior doctor asking me to sign the consent form. It seemed so rushed and panicky. I am so pleased I kept my cool despite the registrar pestering me to either sign the consent or push! I asked the consultant to be called and asked them to refer to my medical notes. Luckily I had seen the consultant who was on call before for 2nd opinion. They then took me for EmCs. I would have preferred vaginal birth if I had gone in labour naturally.

I definitely think you need to discuss with your Consultant and maybe have the option of CS open in case you don't go into spontaneous labour. I would go for Elective CS next time as the whole experience of DD's HR dipping was so scary.

Why can't she say no to instruments being used.

I am sorry but if op says no it is no, they can not force a women in labour to accept medical treatment.

because it depends on how the labour is going, the medical people know better than we do and I would always go with what they say..

Thanks so much for all the replies very much appreciated x

mchappypants you're entirely right. Of course OP can say no. But a flat refusal in all situations may cause her or her baby harm. There is a point at which a section becomes very difficult and may delay the birth. What I was saying was of course she can express her preferences but disregarding medical advice could be a very bad idea.

My first daughter was ventouse delivery. She probably wouldn't be here if she hadn't been and neither would I. I was pre eclamptic and was declining. They had to get her out fast. I wasn't about to argue and I'm a nurse. I knew my body was 'shutting down'. I wouldn't start quibbling with the obstetrician they don't opt for ventouse or forceps on a whim you know.
It kind of irritates me that women watch a few birth programmes or one born every minute and think they are equipped to be in charge of every moment of the birth. In a medical emergency you are not.

I had a similar dilemma.
DD1 - stuck in pelvis - ventouse and forceps. Broken coccyx, episiotomy anus to vagina, stitches did not dissolve - ulcerated. Could not sit (or poo without suppositories) for three weeks. Grim.
DD2 - stuck in pelvis - EMCS. Wow!
DD3 - ELCS. Double wow!
Midwife looked at my notes and said it's likely that my pelvis is an odd shape.
For me, the elective was the better option. It was almost serene.
They even scan your back for the optimum spinal site!

I'm sure the ventouse is responsible for DS1s LDs.

C-section all the way. Far safer.

If you get to the point where you need ventous or forceps its too late for a c section.

Not necessarily true. With DD1, I went to theatre for a ventouse which failed, then had an EMCS. They didn't need to push her back up, she just wasn't descending far or fast enough with the pushes.

DD2 was a VBAC delivery, I was so happy to have done it without another CS, especially since all the way through, right up until just before she came out, it felt to me like things we're going the same way as with DD1.

However, DD2 was back-to-back and I had a bad 3rd degree tear. The short term recovery was much better than for the CS, but long term was worse.

With a VBAC, they don't let you push for too long (they told me 45 minutes, I think, depending on progress).

I don't really know what to suggest for you. If you had 2 bad position babies, is it more likely that you're not the usual shape inside and might have a 3rd the same?

I absolutely understand the desire for a "normal" birth, but I think in your position I'd worry about things all going wrong again. But if you do go down that road, I'm not sure you can rule instruments out completely, I think in some cases, they are the safest option for both Mum and baby.

Dd wasback to back and got stuck. They tried to deliver by forceps which failed so had to shove her back up (so dignified!) and do a C-section. I was definitely asked if I wanted to try the forceps and could have skipped that step. (But I was desperate to avoid the c-section so didn't.)

So there are definitely times that you do have a choice so it is worth making that choice clear.

One thing is that they put the epidural in a coup,e of hours before the c-section - mainly so that I would stay still as they needed to put a drip of oxy-whatsit in. But they also said it meant it would reduce the chance of a crash section if dd got into distress.

Anyway the point is that it meant that when it was time to make the forceps vs c-section decisions I hadn't been in pain for a good couple of hours and was tired but calm. So I could articulate my views clearly and was obviously rational. When we were making the epidural decision they were very worried I wasn't able to make the decision as I couldn't really speak.

It was almost funny. They were trying to explain to me about the 1 in 80 risk of complications and asking me if I understood what 1 in 80 meant and I was thinking 1 in 80 is 0.0125 or 1.25%. But I could actually say that so they thought I had no clue!

Anyway the point I am trying to make is that an epidural could be a good idea for you.

Yanbu sobs that she didn't get a cs but had a forceps birth

ventouses don't cause learning difficulties. What an irresponsible scaremongering stupid thing to say.

I had a horrendous (dry, back to back, fast progression) labour, no urge to push, ds's head well and truly wedged in birth canal. I was pre-eclamptic, ds was getting distressed. Was taken to theatre for trial of forceps with understanding would be emcs if unsuccessful so had full spinal anaesthetic.

Ended up with keillands forceps, I was horrified at the idea of forceps, but the doctor explained that pushing ds back up into the uterus would be more traumatic and dangerous for us both and at that point tbh it was fast becoming an emergency situation, so it became more about what was necessary rather than my personal preference.

I can honestly say I was terrified in theatre but didn't feel anything, ds was out in 3 mins. I had an episiotomy which was stitched there and then and which has healed up fine. My recovery (physically) was quicker than my friend that had an emergency section. Had some issues with my pelvic floor to begin with but 8 weeks on its all resolving itself.

Suppose what I'm trying to say is that instrumental delivery isn't the worst thing in the world, I found my labour massively traumatic but the delivery itself was ok, and if you'd have asked me beforehand, keillands forceps would have been my worst nightmare scenario.

YANBU to have and express a preference, but in an emergency it might not be possible to get what you want? Would elcs be an option for you?

Good luck & I hope everything goes smoothly for you.