Lots of people here saying that "birth plans are useless, any intervention offered will be essential/no-alternative so what's the point?"
I agree that a lot of birth plan stuff is pointless. HOWEVER, I think an exception should be made for the whole forceps/cesarean thing.
I've seen a few people here arguing that if forceps are ever proposed to a woman in labor, then it means that there is no alternative, it's too late for a cesarean and so on. I have to say, this is complete bollocks.
Forceps are used in the UK for various stages of "head engagement" (if I may put it that way):
- There are high forceps deliveries (unusual, but not unheard of--basically, Kielland's forceps are typically used for this, I believe).
- Then there are mid forceps deliveries.
- Finally, there are outlet forceps deliveries, when the birth of the baby is already well underway.
High forceps/Kielland's are actually banned in many countries, but I regret to say that they are still used in some cases in the UK. You absolutely CAN have a cesarean at this stage--if a hospital is using this technique, it is because they are making the choice to do so.
Similarly, it is perfectly possible to avoid a mid-forceps delivery by going straight to a cesarean. It is absolutely not "too late" for a cesarean.
An outlets forceps delivery is the least invasive kind. By this stage in the labor, it's basically too late for a cesarean--but to be honest, many of these could probably be substituted for ventouse, as is actually the case in many countries.
As a non-UK resident, I'm just giving a bit of international perspective on this, but honestly, I am startled at how common forceps deliveries are in the UK. In a lot of developed countries, forceps deliveries are now rare, because the high/mid forceps type presentations mostly just go straight to a cesarean, and the "outlet forceps" presentations (least invasive) are usually done by ventouse instead.
It is perfectly possible to insist on refusing forceps and going straight to a cesarean in most cases, and if I was going to have any kind of birth plan, that is actually the one thing that I would absolutely insist on.
A high percentage of forceps deliveries result in third-degree tears and/or levator ani muscle injuries, often leaving women with significant sex/continence problems, which cannot always be corrected with surgery--I have heard that the majority of women who have had a forceps delivery have permanent and significant LAM damage. That is before we even talk about the injuries that can be done to babies.
I don't know why the NHS is so keen on forceps compared with other countries. I suspect it's a mixture of a) pressure to keep the cesarean rate down for political reasons b) forceps are cheaper than cesareans in most cases and women can be booted out of hospital quicker c) the medical profession feels a need to ensure that medical practitioners "keep their hand in" by getting regular practice with forceps.
Forceps operations are notoriously difficult to teach to students and medical residents; experienced OBGYNs find it very very hard to describe exactly what they are doing or give concrete instructions. There is, I understand, concern that if doctors don't practice with forceps, they won't become expert in using them, which will mean that the medical profession will lose the ability to use forceps in those cases where they genuinely are unavoidable. I "get" this. On the other hand, I have to say that (selfishly) I would not be prepared to allow my own body to be used as a training tool.