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. 

Lotstothinkof speaks a lot of sense. I know a fair few women who had very set ideas of labour and what would happen. When things don't go to plan, it's upsetting for some and difficult to get over if things deviate from the birth plan. Really try to stay open-minded about this, the HC staff know the risks. Anything suggested in terms of treatment will only be done so because they've weighed up the benefits and risks, they have training and at the end of the day you have to trust them. Or what's the point of going into hospital at all? Labour is a wild ride. The most important thing when labour starts will be for you to focus on yourself and let everything else go. Losing focus and worrying about whether you'll be needing any form of intervention will just heighten your stress and may make labour more difficult.

My baby would have died without forceps. She was too far down the birth canal for a caesarean. It would have been too dangerous to pull her back.
I really didn't want forceps but have now learnt that you'll consent to whatever us needed when it comes down to it!

I was cut then ventouse,ds can a slightly pointed head for a couple hrs then fine

Honestly, when the time came, I didn't give a damn how they got my son out, I just wanted him out!

I had an elcs because I did not want an instrumental delivery and realise that if I did try to deliver vaginally, it is sometimes too late to have an elcs instead of an instrumental delivery. In other words, after a certain point of no return the baby must come out through the birth canal, instrumental or not. It would no longer be my choice.

Hence elcs. I am delighted with the outcome of the elcs and ease of recovery.

The senior midwife who was there to counsel me on the risks admitted she would have chosen an elcs in my situation.

I dont know a single birth plan go to plan. Just dont rule everything out. Your and baby safety is most important

Really try to stay open-minded about this, the HC staff know the risks. Anything suggested in terms of treatment will only be done so because they've weighed up the benefits and risks, they have training and at the end of the day you have to trust them. Or what's the point of going into hospital at all?

Have you read all the heart breaking birth injury stories on mn. I bet almost every single one of them had a HC on site. Sure they don't make mistakes

Honestly, you’ll do much better if you let go of some of your expectations.

The most common reason for forceps is failure to progress with baby being quite low and out of energy/showing signs of distress. At that stage would you really want to delay with all the preparation necessary for a section?

It’s enough to say that if there is time, no immediate risk to the baby, and there is no technical contra-indication you would prefer a c-section to an instrumental vaginal birth.

Don’t get more specific or hung up than that and be prepared to go with the flow.

If it helps, forceps isn’t always as bad as you hear...as with most things you hear of/read about worst case scenarios. I had a forceps with episiotomy with my first when things weren’t progressing. I have spoken to lots of people who had the same and don’t feel it was any big deal. My second was a rapid SVD with superficial tearing. There was very little difference between my recoveries. In fact I have asked for an episiotomy again for my third as I found the healing of a clean straight wound quicker and easier than the multidirectional ragged but superficial tearing I had second time.

Good luck.

I’m another one who thinks you’d be mad not to consent to an instrumental delivery if that’s what you need. Trust the midwives and doctors - they will do what is necessary to deliver your baby safely.
I was like you - wanted C section above all else. Ended up with ventouse which took seconds. My baby was born not breathing. God knows what would have happened if I hadn’t consented

I don't believe I have any control over the birth at all - nowhere have I said I do, nor do I have any rigid ideas. I'm actually pretty chilled out and positive about the birth, but that doesn't mean I don't have a valid concern about potential permanent damage as a result of instrumental delivery, or am somehow silly/untrusting of the professionals for wanting to know as much as possible about the situations it's necessary in, the trade offs and alternatives etc.

I trust the HCPs' judgement up to a respectful, sensible point - that doesn't mean blindly. I'll listen carefully to every recommendation I'm given when I'm in that situation.

OP I was induced with my first which I didn’t want & was terrified about epidural, forceps, EMCS etc & scoured the internet for positive induction outcomes. All I had was one pessary & that was it, super fast delivery & only about 3 stitches, so it can happen.

I've had two very positive ventouse deliveries, very different labours, both for fetal distress very close to birth. Had an episiotomy with the first and a second degree tear (stitched - tbh that was the worst bit of the whole birth) with the second and healed really well each time - was up and about a lot quicker than I would have been with CS. Babies fine both times. They were out quickly and Apgar was 8 or 9, rising to 10.

I think a blanket non-consent is tricky. If I'd not consented in my births, I don't know what would have happened - things had progressed too far to make CS viable, AIUI. I guess I would have delivered OK, but my babies might have been in a considerably worse state (it turned out that ds2 had the cord wrapped twice round his neck), and that's something I'm very glad didn't happen.

You do know there may not be a choice right - if baby gets stuck in the birth canal?

Don't get me wrong I would not want forceps but it's better than the alternative.

I have to admit that I didn't really have a "birth plan". My plan was to simply get the baby here by any means the medical team with me thought was for the best for us both. I never really gave it a thought before I was actually in labour as I wanted to enjoy my pregnancy and thought I would just scare myself if I started researching things.

For me this was a water birth with gas and air and the only reason that happened was that I was lucky enough in my midwife led centre that the room with a pool was available and the midwife suggested it.
However had she been stuck and they decided on a forceps I would have gone along with this as I don't believe they would do it if it was not necessary for us both to be here safely.
Had they suggested abandoning the midwife centre for the hospital or a c-section I again would have done anything they advised.

I definitely wouldnt put that you don’t consent.
They don’t use ventouse or forceps for the fun of it. They use them when the babies get stuck and are very nearly out so if they had to do the emergency c-section it would likely mean pushing the head back up while getting them out of the stomach. This act happened to a friend of mine.. she had one dr pushing the baby up with his hand up her vagina and another trying to pull the baby out.

I had ventouse as my sons head got stuck and if it was that or c-section it’s always going to be that. (I’ve had both).

You can say you would like to do everything possible to avoid any instrumental help unless necessary but I think hats usually he case. I would say avoid an epidural if possible.. I read a lot of studies about how it slows down labour and statistically ends up with instrumental delivers a lot more and this is exactly what happened to me, I was labouring great and progressing well until I had an epidural and it slowed to half the pace and it all went down hill from there.

@peoplearemean yep, it's been explained in more depth earlier on on the thread. Not that it's impossible, but much riskier as opposed to when the baby is higher in the canal.

My birth plan didn't even come out of my bag for my first.

My daughter would be dead without forceps. You don't get time to just whip off for a c section.

Yes I did have birth damage from that (not great) but I'd rather than than no daughter.

Oh. and birth no2 was a c section. trust me. You don't want one of those.

Oh and this birth plan of yours. No one actually reads them! I personally would save yourself the effort.

Without a ventouse my DS would have died - he got stuck very low down when he flexed up instead of tucking his chin into his chest - all hell broke loose in the delivery room with consultant, trainee consultant,mid wives etc and I just want him out - birth plan out of the window - only on gas and air - was cut and out he came - he was fine - I was a mess down below for a while but healed well and next 3 babies all normal deliveries, Just be flexible OP because you just don't know how it will actually go. Good Luck.

My son is 24, I had written out the perfect (in my mind birth plan!!)
well that went up in smoke!
We lived in a rural area, my water broke, I had to be flown to mainland on an ambulance plane, my labour was 20 hours from when my waters broke.
I had a reaction to morphine, the cord was round my sons neck, the epidural only worked on one side as if the turned me his heart rate dropped - due to the cord!!!
i ended up in theatre for a forceps delivery, on my own as my husband wasnt allowed in...
So my 'perfect plan' went out the window and he would have died if they hadnt used the forceps.
sometimes you have to take the advice of those whose job it is to save you and your baby's life x

@PickAChew it's not really about having a physical birth plan to wave around (as obviously you may be a bit busy! ) I gather the real point of making birth plans is so women know their options and can express a preference for things, e.g. yes to gas and air no to epidural etc etc, should they have one.

My first was ecms with GA and it took me months to recover though there were no complications with the operation itself and DD was fine. To this day (19 years later) I still have uncomfortable lack of sensitivity and rolled fat along the scar line. With my second, my absolute number one priority was to avoid another section, I was so worried about going through that recovery again with a newborn and a toddler. Happily DD2 was a trouble-free pretty quick delivery. Whenever I read about elective sections I wonder how on earth? But as I think this thread has shown, every birth experience is different and you just can't predict or prescribe

Another one here who might not have dc without forceps. Dc was 50 percentile baby with 97 percentile head.
Labour was very slow but normal, then got stuck & lost the heart beat. Theatre was a 4 minute trolley dash across the grounds at that time of the early hours - rural hospital, so it was forceps or nothing.
Dc was fine, delivered in 90 seconds, unmarked and came out pink and yelling. I had some damage but am now good as new.
I’d say “as last resort if necessary” and hope the maternity theatre is open.
Congratulations and good luck.

I have only read a couple of pages but like some pps on here, my eldest was crowning. Easy labour, no indications of problems, started to crown and they told me I'd be holding my baby within 10 minutes.
Forty five minutes later and she'd gone nowhere and it was like one of those films. We went from me, DH and relaxed midwife to what felt like a cast of thousands. (I'm very hazy on details because I was high as a kite on gas and air at this point). Essentially, she had tried to stick one hand over her head which had lead to her getting well and truly stuck. Plus, the cord was round her neck. She started to get distressed, and they used ventouse to get her out ASAP. Wouldn't have been time for surgery really. But we didn't know any of that and there was no way until we were in the situation as it unfolded of predicting it.
State preferences but that's all you can do. Sometimes the situation overtakes you and you have to run with what is best in that moment. (And yes, I tore. Having the stitches was fine, the next couple of days were painful, but I had a healthy baby which ultimately was what I was most interested in).