Not consenting to instrumental delivery?

[pandarific]

I'm pregnant with my first, and mulling over what to put in my birth plan about consenting to forceps or ventouse.

I'm not anxious about labour as such, I'm low risk and giving birth in a hospital with one of the best consultant led maternity units in the south east, and my community midwife and the NHS class has been excellent so far versus some of the things I've read on here, they've really been brilliant! but there is one thing I'd like some more info on, if any HCPs here can help?

My first priority is delivering my baby safely with no injury to them, however I am concerned about consenting to forceps and ventouse, having read some of the stats around birth injury - and it's not an insignificant risk, if I've read correctly that the likelihood of having an instrumental delivery with a first baby is 8-12%? I'd much rather a c-section than a 3rd or 4th degree tear, prolapse, or ongoing issues with incontinence - I know CS is major abdominal surgery but the inability to drive after is not an issue and the other risks seem quite low to me. I really think I'm okay with that possibility.

WIBU to put in my birth plan that I don't consent to instrumental delivery? My understanding is that then, if I was unlucky and the baby did get stuck and the baby was in distress, the next move would be to EMCS? I know I could leave it out of my birth plan and simply decide in the moment, but I am worried that a) I might be too out of it to be able to process info that I'm given and make an informed decision b) might the discussions and deciding cause a delay in getting the baby out safely versus a quicker decision to EMCS if I just had 'do not consent to instrumental delivery' in my birth plan/made them aware of it up front?

I'm sure I'm missing lots of detail and not considering the full picture, so if anyone has any advice / stats etc they could link me to I'd be really grateful. 

After a c-section isn't not just driving, it's picking up things, including your baby.

Well that’s a lie. I was holding my baby after my cesarean.

Sorry, I read that as “it’s not picking your baby up” as if the hospital don’t allow you to. Yes it’s individual when it will be less painful to hold the baby.

I really didn't want forceps and put in my birth plan that I wanted to avoid them if I could. Guess what, DS was in distress, they couldn't even find his heart rate and it was a case of 'forceps and this baby needs to come out NOW.' Not sure what the outcome would have been without them or with the delay in getting to theatre and an EMCS.

Yes I tore, badly. 3b tear and had to go to theatre to be stiched. Was in there for over an hour. Recovery was painful. I also had to go to the toilet very quickly when I needed to go, I couldn't have waited. That lasted for a couple of years. But I healed well they said and the toilet urgency went away. Safety of my baby was far more important when it came down to it. When they first said they were using forceps (they didn't actually ask), I kind of moaned as I knew I didn't want them and asked for a ventose, but the doctor was quite abrupt with me and said she had to get him out, legs were already up and she was already doing the episiotomy at the time.

I had keilands rotational forceps with my first due to her being stuck.

Have to say the recovery was fine. Yes a was a bit sore but nothing too bad! Baby was fine. Little red mark on her face but that was all.

Another ventouse here.
We were in theatre ready to knock me out for emergency section but he came out with ventouse (baby in distress with very low heartbeat, and mother knackered after 42 hours Labour).
I had a tear I knew nothing about and have no issues with 20years later.
He struggled a bit and eventually He had cranial osteopathy which solved it astonishingly well.
Still preferred it to a section.

If you get into the situation where you need an episiotomy or forceps, you will want them. Getting baby out safe is priority and yes, there are horror stories but they are rare. Try not to worry yourself. It's amazing how quick you will heal after birth, no matter how much or little intervention you will need.

Reading this is quite helpful because it has made me think that maybe forceps were the only option for ds1 to be delivered safely. I’ve spent 15 years wishing I had said no and had a c section instead!

I won’t lie, I believe forceps have damaged me permanently. I suffered a prolapsed womb shortly after birth and if I hadn’t had to have a hysterectomy for other health issues, I strongly suspect I would have faced corrective surgery. As it is I have since suffered a ‘vault prolapse’ for which I had surgery and now have a large rectocele which I won’t have more surgery for. I attribute all of my issues to my forceps delivery and a subsequent large ds2.

I wrote ‘I do not want a forceps under any circumstances, please give me a c section if there is any risk to the baby at all’

I’m had nothing else written on the piece of paper. I was open to anything but did not want a forceps and felt very strongly about it.

As a failed ventouse, failed forceps, emergency section mother, I'd say you'll try whatever you have to at the time.

Just to note: the baby I refer to is a gorgeous healthy 18yo about to receive fabulous a level results.

I'd try not to overthink it beforehand but go into it knowing what your options might be given whether circumstance birth throws at you.

Good luck op and let us know how you get on

I don't know about forceps/ventouse being only used when necessary in every** situation - a few people above have said it's been suggested when baby wasn't in distress but it was taking taking too long in the doctors opinion, and then they managed without. Appreciate in the main it's true though.

This is all very useful, thanks everyone. I'm not up for an elective CS as I'm actually pretty happy to try delivering vaginally - I just have a concern about permanent birth injuries due to instrumental, so wanted more info on the ins and outs of that particular situation.

I may err on the side of making HCPs aware of my wishes to avoid instrumental delivery unless as a very last resort on arrival on the ward - and keep the flat 'no' to Kelliland / high rotational forceps. As I understand if those are used when the baby's high in the birth canal and they're the most likely to do permanent damage so a EMCS rather than those would be preferable for me.

My birth plan said everything should be natural (home birth, no drugs, etc, etc). Ventouse and forceps saved DS's life, and mine (he was too low for an EMCS). I suffered from PTSD and PND, but that wasn't due to the instruments - it was the whole situation (was in ICU afterwards, had a massive allergic reaction, was incontinent and so on). DS had bruising on his face, but was otherwise fine. If I'd been a bit less insistent on trying for an all-natural birth, I'd have had an EMCS, and that would probably have been better. I would just keep an open mind.

Subsequent deliveries were ELCS.

I thought this was about a piano being delivered to your house whilst the neighbours were away

I felt the same before I had my first but once labour gets going, it all goes out the window. I think it's really important to keep an open mind. If it's a total deal breaker, opt for a planned section.

They're are so many variables in labour that you just can't plan for. I've been booked in for two home births but ended up with instrumental deliveries.

Both babies were distressed in labour. First was due to an infection. Second was cord compression. Once your attached to that monitor, you won't take your eyes off it. When you see the heart rate dropping you'll consent to getting the baby out the quickest way possible.

My first was rotational forceps and the second was ventouse. I've had no lasting issues thankfully. It's not anyone's first option tbh but has a good outcome. The risks of PPH when fully dilated are really and serious to both baby and you.

In my experience, birth plans aren't the focus of the situation, if there's time then they'll be read but other than that no one really looks. That's not meant in a snippy way, it's just that the professionals delivering the baby will be focused on the situation.

Focusing too much on staying in control is detrimental, we can't control this particular situation and, to some extent, we just have to go with the flow.if you make bold statements such not consenting then if you have to change your mind during labour it can then make you feel like you've 'failed' somehow - irrational and untrue, but it happens to so many women. Express your preferences by all means, but avoid ruling things out. You don't want to have such an enxiety ridden decision to make whilst you're in labour, so coming to terms with it beforehand will help you.

It's not helpful to know the percentage rates of everything, it really isn't. I don't mean this in an awful way but the percentages exist because of how things happened naturally not through choice. I don't think you're HC providers are being helpful by leading you to believe that you have that level of control. At the end of it, the midwives and drs will make the decision to keep everyone safe, refusing consent really seems like you don't trust their judgement.

Ds1 was delivered by emcs after a failed ventouse. They wanted to try forceps, but I wouldn’t let them. They explained it would mean a c/s, which I agreed to.

We did antenatal classes & they explained that we might be told ‘we are going to...’ & that we would need to say no if we didn’t want it or it would be marked as explained & consented to in our notes. That was true. This is about 15 yearsago though.

My hips were damaged by forceps when I was being yanked out of my Mother and she couldn't have more children after me. So I wouldn't consent to forceps with my baby and told my husband if I was unconscious not to consent to it either. Told him to have them cut her out if needed.

Ventouse is not that bad honestly. C section recovery far worse!

The risks of a c section go up astronomically once baby's head is fully in the birth canal. And at that point forceps are much, much safer for baby.

I had absolutely no forceps as the only thing on my birth plan. I begged and begged for a section, yet got forceps.

My recovery was horrific.

Never, ever again.

LotsToThinkOf

After my delivery, I absolutely do not trust their judgement. Their judgement through the the entire of my labour was wrong and it was only by the grace of God DS and o made it through alive, and I would not call the first 18months of motherhood living, all as a result of their absolutely appalling judgements.

You can't know how it's going to go and forceps or ventouse delivery aren't the only way you get nasty tears. I had a third degree tear, and an episiotomy without either, had to be stitched back together in theatre and there was an impressive amount of stitches.

Healed up with no problems though. Apparently I had a really good surgeon.

I had an episiotomy and forceps 4 months ago, it was also my first baby and I recovered completely after a few weeks. As pps have said, when they tell you it's either that or you could lose your baby you will let them do anything. At the time I terrified and begged for a c-section but it was too late and could have been dangerously as my DD was too low. Please don't worry, it will be what it will be. You may well have a perfectly normal birth.

Their “judgement” nearly killed my mum.

She laboured for 28 hours with no progression so they broke her waters. She asked for a cesarean and they said no. I was back to back, and she had a 3rd degree tear. Then they noticed the placenta was incomplete but didn’t do anything about it and a week later she haemorrhaged at home, and had to be blue lighted back to hospital, for emergency surgery that ripped through her stitches.

She never had any more children.

So no, sometimes you do have to ask for and insist on what you want. Mum to this day wishes she’d had a cesarean.

CS doesn’t necessarily protect you from prolapse or incontinence, pregnancy alone does damage plus other factors.

They used a ventouse during my semi elective CS which apparently is pretty common.

My first was ventouse with episiotomy. It's fine healed well and I was just grateful to get him out of after long time pushing

Yanbu. Of course the priority is delivering a healthy baby but I do sometimes think the mother's long-term health takes a backseat in the decision making process.
Fwiw, I would not consent to instrumental delivery, nor would I consent to induction again. And I know plenty of people who have had c sections and most of them were at the pushing stage when it occured so they obviosuly can do it then. Yanbu to educate and research these things for yourself. I know women permanently damaged by childbirth and, while sometimes it is sadly unavoidable, there are certainly options that need to be explored and considered.