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. 

I've had 2 sections and because of the position of my youngest, they still had to use forceps to get him out even with a section. Although I'm assuming they went through my incision rather than the usual means.

I had a ventouse delivery with my first, who was induced. Reason was due to baby's position - she was presenting with the side of her head first and I had an epidural so just couldn't push her out effectively. She was 7.5 lbs. I had an episiotomy and a further tear and was rather sore for a while afterwards (took a good 6-8 weeks to heal). No problems with continence though.

I was adamant that I wouldn't consent to a forceps delivery though. I've worked in a maternity unit and there seemed to be a fair number of issues, either with the baby or the Mum. While my thoughts were based on absolutely no statistical evidence, it just felt too risky for me to be happy with it.

I had a very quick labour with DD, all going well but she got distressed, heart rate kept dropping while I was at the pushing stage, so they said she needed to be delivered right away. And suggested forceps delivery. I said no, I would rather have a C-section (like first time I gave birth). They said that there's no time, baby needs to come out very quickly, how about ventouse. I was OK with that, episiotomy + ventouse, and 5 minutes later my daughter was out and fine and healthy.

I think when time is of the essence it would be unwise to decline medical advice. A weak pelvic floor can be strengthened but brain damage is permanent. I had a ventouse second time round. It wasn’t a great experience but I fully recovered.

OP, you say: I'll listen carefully to every recommendation I'm given when I'm in that situation.

Just bear in mind that once you're in that situation, you might not be in a 'listening carefully' frame of mind. By the time I got to the failed ventouse/forceps stage, I'd been in back-to-back labour for about 48 hours. I had had no pain relief apart from a TENS machine (my choice). I was ambulanced to hospital, but fortunately have only fragments of memory of this. I kept losing consciousness in the delivery suite. My mum was present and gave consent for me because I couldn't consent or not consent to anything (I could trust her, thank God, where I unfortunately couldn't trust XH, who was insistent that they stick to my original birth plan, come what may). I had to sign the epidural consent form, but you don't have to sign properly - any random scrawl will do, so long as it's in your hand. I would encourage you to make sure you have someone in there with you who will make sure they do whatever they can to make sure you and your baby get out alive. You may not be in a position to give informed consent yourself.

Needless to say, this is a bad-case scenario. Most of them aren't like this. My ELCS was a dream by comparison, and my vaginal birth was the worst of all the people I know in RL. Most of them are ok. It's partly just a matter of luck.

I had no birth plan. My only plan was to give birth. Noone looked at the plan anyway. And I don't believe they use instruments for thr fun of it - they were looking for an aesthetist at the time to prep me for an ECS when DS1 changed his mind.

If you 100% don't want an instrumental birth I think your only option is to ask for an ELCS, so I'd start working on that if I were you. I was lucky in that I asked for one at my 36 week appointment and the consultant was open to the idea.

I recently had my baby abroad and ended up with an EMCS after he got stuck in the birth canal. He was far enough down that the dr could, and initially did consider using forceps to deliver but she was so concerned about significant injury to both me and my son that she went with a c-section instead.

So, it is possible to have a c-section if the baby if most of the way down - I’d imagine not all drs would be willing to do it though. Like others have said, it’s risky as the baby needs to be pushed back up during the c-section. In my case doing that caused a ruptured artery. I was fine once they found the source of the bleeding and pumped a couple of litres of blood into me, but the risks are there. You’re in good hands though, and medical staff are trained to deal with emergencies like that.

That said, I am happy personally to have had the c-section rather than an episiotomy and forceps. I was terrified of tearing and the potential for long-term injury so the C-section was the preferred choice for me, even with the risk and the bleeding. I’m scared to think what the drs idea of significant injury was had we gone ahead with the foreceps.

For those saying that instrumental delivery is only offered when baby is to low in birth canal or pelvis for a c section - not true.
Dd1 emergency c section due to brow presentation.
Dd2 - still not head engaged and high up (but something had to be done due to lengthy labour ) I was informed sternly that kiellands rotation was the way to go - I pleaded for a c section but was told that this instrumental delivery was the way to go... I had months of pain and still after a decade have side effects, scars, pain etc (and upon independant research, found that dd2 was still in a position where c section was viable ) and I was left feeling traumatised and effectively misled in a very vulnerable state.
Apologies for long and horrible post but I wanted to say that i dont think your wrong headed in refusing instrumental delivery.
Good luck

And I do agree with Betty. I don't even remember being asked about ventouse. I don't remember if I had to sign something or if DH did it. I also had SPD and my chief memory of that point is screaming in pain with the SPD as they tried to work out why DD's heart rate was plummeting. I wasn't tired (12 hour labour, and I was so relaxed I slept through most of it, woke up to suck on a bit of gas and air and back to sleep again) but at the crucial decision making point, I was in so much agony from the SPD that I think if they'd told me they wanted to do a live screening of the whole procedure on BBC1 Id have agreed. So I second the advice to have someone else in the room who knows your mindset but is also prepared to be flexible.

@Sistersofmercy101 Apologies for long and horrible post
Not at all, thank you for posting. for you, I'm so sorry - it's shit you were dismissed like that.

Well yes, but everyone has valid concerns about potential permanent damage as a result of instrumental delivery, but it's a risk with labour that you can't really get around. If an instrument is needed then it's needed, it's the way they're used that would create the issue and you really don't have control over that. You won't be able to calculate the risks and apply them to your exact situation because you won't know.

I'm not being mean OP so you don't need to be defensive but the more information you have can be detrimental, and the fact quoting and statistics show that you have a more in depth knowledge than you need. Knowing the facts, being told during labour that you need xyz and then thinking you have an option can only lead to massive anxiety at the time. Of course, be informed, but your knowledge and questions is going way past being informed and you're setting yourself up for a difficult time.

My baby got her shoulder stuck. I don't know what the readings were saying but it was total panic to get her out ASAP. She was floppy, blue and without a heartbeat (but fine now thankfully ). It was several minutes before she cried, during which I aged ten years. Due to the rugby scrum delivery (ventouse x 100) she had a bump on her head that was half as big as her head and the delivery staff were all a bit quivery, telling me 'That was a bad one!'. In retrospect, given that she was a big baby (over 9lb), I would have asked for a C section rather than take the risk she would be so hard to get out. It's when you get to the end of a hairy ventouse delivery that an ECS seems the only sane thing to do! (although not without its own risks of course). But for a big baby, perhaps there's more to be said for it. My stuck shoulder drama could have ended tragically.

Is it the episiotomy or the delivery that concerns you? My eldest was forceps delivery in the end - but I asked them to avoid an episiotomy if possible, and they managed to with only second degree tears, which healed no problem. Might be worth asking if that's an option if you do come to need it (which it's not that likely - although possible!).

Oh sorry, what I also meant to say was: there was no chance of a ECS when the stuck shoulder problem became apparent (or if there had been, it would have been one of those no-anaesthetic horror stories you read about). By that stage it was clear that there was basically no time left. When a baby is in distress, you've got a bottle with a few marbles inside, each representing a minute. If your preference takes longer than the number of marbles in the bottle, it's not viable. They know that and in the heat of the moment, you will totally get that too.

i had instrumental delivery with dd3. she had shoulder dysocia. it was too late for a ceasarian. it saved her life and her arm function. i learned that with childbirth genuinely you cant know every possibility. i had 2 normal births beforehand.

Yabu. Dd was delivered via ventouse 8 weeks ago. Her heart rate was up and down during labour and I was starting to be prepped for emcs. It stabilised again then dipped again. Doctor asked me if I’d be ok with an episiotomy and ventouse. In that moment I didn’t care how she was delivered, I just said do what you have to do to get her here safely. She had a sore head for 2 days but recovered well.

Thank you pandarific you're very kind.
There are different types of forceps deliveries and Kiellands rotation is regarded as the 'most extreme ' (quoting a medical text) - and one where a c section is still viable due to baby still being high up / not engaged therefore if I knew then what I know now - I'd have had it in my birth plan!
Wishing you well .

I would chill.. it’s your first snd I understand your anxiety.. when the time comes the right decisions will come forward for our health and that of your baby. I was advised by my midwives that they prefer a preference list rather than a do and don’t list. I think everyone would rather avoid that but if it means baby safety you will choose it in the moment. Make clear that you are advised and can make decisions o n the way and your prefeeence is for a natural birth. I had two natural births the first of them could have been assisted as it was so long but I kept grinning and going.... fingers crossed you get the experience you want I refused to be induced which I think helped me

@LotsToThinkOf I get what you're saying but I disagree I'm setting myself up for a difficult time by asking about and fully understanding a potential part of childbirth I have concerns about. It's a pretty in-depth medical thing this, and I'm not medical, so I'm getting my head around it - that's all. I'm not panicking, not obsessing, just learning. I trust the HCPs and I've got lots of good advice on here; it's all good imo.

Got to go to bed now, thanks everyone for sharing your experiences. Night all!

it's good that times have changed since I had my DC

There was no account taken of my birthplan by the (midwife-led) delivery team. They just let me labour in a delivery ward without any pain relief whatsoever for the first 9 hours of labour until I got into a delivery room and was able to avail myself of blessed (blessed!) gas and air. That stuff is wonderful.

My experience of midwife led delivery units is NOT wonderful TBH. Think they should all be closed down. I'm very glad that you are in a consultant led ward and should have proper medical care.

NB The final indignity was when a midwife attempted to falsify my medical records. She tried to write in that I'd been in labour for 90 minutes. DH who is a solicitor was right on top of that straight away. He pointed out that I had been in labour (without pain relief for 9 hours and that I was fully dilated when I was finally awarded a delivery room). It can be very very good having a lawyer for a husband.

I'm afraid you have to watch the delivery team like hawks.

I'm sure that as you have a consultant led team you should be fine. But make sure that whoever is with you is calm rational and level headed and be very clear about your preferences. Your birth partner needs to be your advocate and your supporter. And your birth partner needs to be able to shout if there are obvious signs of medical negligence. The UK is not a good country for maternity provision.

My eldest wouldnt be here if it wasnt for forceps. Cord round her neck no heart beat and after 13 hrs in del suite and a low blood pressure and passing out it was instruments or we would both be dead. No time for emcs. In my plan i stated only to be used in emergancy and only forceps i didnt want the vontuse. I had a few (alot)stiches but no other problem. I wish the midwife had listened to me on my 2nd. I begged for an episotomy -she refused, i begged for forceps she refused and used her hands..baby was blue and needed full resus... and i spent 3 hrs in surgery fixing the damage she had done! Dont rule it our but state you would prefer natural if possible. My 1st dd had a small bruise on her cheek and eye but it soon went.

I refused an episiotomy and a ventouse delivery with my dd, I truly believe they were trying to rush my delivery so the dr could finish his shift. He was really shitty with me even before that, but the MW was lovely.
As it was the reason she was slow to come out was her arm was up by her face, I had a tear and needed stitches, they healed with no issues. Oh and the shitty dr offered me a ‘husband stitch’ thinking he was being funny, I told him to piss off
He was the reason I had home births with ds1 and ds2