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. 

Hi OP I have not read the entire thread, I just want to say that there are not really threads on MN of mums saying "Yes, straightforward birth/CS without complications" as it is somewhat redundant. Naturally we will be posting and discussing and self-serving for the births and deliveries with issues. My point as that the majority of births do not have major kind standing problems for the mother afterwards.

In my case I am 5' 5" and on the small size for build, I have never had gestational diabetes or any problems except anemia during pregnancies but all my babies were huge. My first was almost 9lb, second almost 10lb and my son was almost 11lb!! Amazingly I had vaginal births each time with an epidural.

My first was a very long labor and the baby was in distress as the cord was wrapped around her neck so the doc had to disentangle her while in the birth cabal and she was born with the help of forceps. Neither she or I had any long-term damage. Even with these huge babies I have not had tears or incontinence that was permanent. Had a tear with my first tgat healed fine and after my 3rd once I got back to exercise lost the baby weight and did normal weight training (i.e. nothing special specifically for pulling together my undercarriage) I have no pee leakage while jumping or running, which I did a bit after my third.

All women have their own stories, but the majority do not have major complications. The main focus is healthy mum and baby.

"Self-serving"!!! I meant to say self-selecting.

Haven't read it all but! If it weren't for forceps I wouldn't be here. My dm laboured for 38 hours and then I got stuck in the birth canal. Quick hoick with forceps and out. Other than a bit of a red mark, I was (I modestly add) bloody gorgeous.

Just from another perspective... It's highly likely that if you get to the point where instrumental delivery is suggested/necessary and you don't have an epidural in place already, it wouldn't be an EMCS, it would be a crash section - where you would be put under general anaesthetic instead... something to think about I guess.

I tried to refuse consent to forceps (which bruised DS, meant he couldn’t breastfeed for 3 days, required stitching me for an hour in surgery afterwards and left me with a posterior and anterior prolapse) however it was calmly explained to me (as I was banging on about C sections), I was at risk of bleeding to death if I insisted on a section. DH quite rightly asked me (with an ashen face) to please take the forceps.

My birth plan just consisted of I refuse forceps and the reasons why ( I was doubly incontentent during pregnancy and I have suffered lifelong issues from my birth). I did speak to a doctor about during early labour whilst I was in for monitoring and the only time it would be an issue was if the baby was a long way down and we agreed to cross that bridge later.
As it happened I had a very long augmented labour and I was apparently (I don't remember) very tired, in agony as epidural wasn't working well, baby was starting to be distressing and my partner said enough she can't cope anymore and it was off for a c section. I'm told the midwives and doctors did read my birth plan and without it they probably would have wanted to leave me longer before going for the csection.
The c section was a doddle compared to the preceding labour

It’s fine to have a plan but when everything is kicking off be prepared to forget it and put your trust in the professionals.

I wouldn't be worried about putting that in your birth plan, OP. A good maternity unit looks at your birth plan as an indication of your preferences and concerns - you're not dictating to professionals how to do their job.

If the rare situation did arise that instrumental delivery was the only way to deliver your baby safely they would discuss it with you and explain why - it is actually possible to have a discussion while in labour! (And generally, you'll likely realise that you just want what's best and safest for your baby and yourself at the time.)

In reality, there is usually more than just one safe way to deliver a baby so please don't worry - feel free to put your concerns and wishes down.

I had a non-progressing labour and was put on syntocinon drip to try and help but baby got distressed whenever they tried to increase it and after 24hours they said c-section was likely. I really really didn’t want a cs especially as I’d done 24 hours of labour so asked to wait a bit longer (baby was not distressed without the syntocinon).
Anyway to cut a long story short I ended up with failed ventouse and a forceps delivery with episiotomy, extended tear and haemorrhage.

I wish I had said yes to the c-section . I had unbearable pain for many months after and struggled bonding and feeding my baby (tbh I think I was depressed).
I still have some pain many years later.

A weak pelvic floor can be strengthened

A detached pelvic floor (i.e. ripped off the bone) cannot be reattached. It isn't as simple as "do your pelvic floor exercises". The issues forceps cause goes much, much further than a weak pelvic floor.

I am due in a few weeks and have put that I would prefer a section to an instrumental delivery if it came to it. I did my birthplan with my community midwife who said if the likelihood of instrumental delivery was needed as I plan to give birth in MLU if there was distress I would have already been transferred to the labour ward and should be early enough to go with the section option. Having read lots of opinions this is what I believe would be the best outcome for all involved. I understand a birthplan is a wish list of a perfect birth and that most don't go that way but what's the point of being asked to think about it if everyone is going to shoot you down for your considered opinions. The reason you do it before labour is so that you are informed so that you can make more informed decisions at the point of no return.

One of my friends had an awful birth with forceps and PPH who should have had a section as she was left to labour too long, not in all cases is instrumental the best option.

As others have said, no-one even looked at my birth plan.
Dd was a ventouse delivery with a episiotomy (which I hadn't to add I was not even asked about). Heart rate dropped after 27 hours of labour and she was small, so was a case of just getting her out quickly in the end.
All healed within a month or so, she has a red mark on the back of her head, but more likely that is a generic birth mark than a result of her delivery.

• hasten not hadn't

I was imagining you refusing to sign for a Yodel man a delivery of a sax and double bass!!

Anyway, my advice is that you assert clearly that they are an absolute last resort to your Midwife or consultant or whatever doc is involved in your labour. Have your dp ready to advocate for you if the situation arises also so that he can properly make the stop and consider if there is a little more time to try pushing or not. But ultimately, and I don’t say this lightly, you NEED to rely on their judgment as to whether it’s time for that last resort or not. It will be down to luck whether you have doctors who really do try their utmost to avoid using the ventouse or foreceps.

I think you would be stupid and dangerous to outright refuse to consent if they are telling you that you absolutely need them.

My first was ventouse and my second forceps. I had injuries with both. Ventouse took several years to get back to ‘normal’ Forceps was probably about a year.
After the event I would definitely choose instrumental delivery and damage to myself over my children’s safe delivery, but I appreciate when I was pregnant I thought labour injuries were best to be avoided.

I don’t remember being asked for consent. My babies were in distress and I was off my tits on morphine. A c section would have taken too long.

Good luck, it’s really scary waiting to give birth. I kept reminding myself that women choose to do it more than once so it must be worth it. It totally is xx

I think it all depends on the birth and baby too. I had forceps with my first as she got stuck and only needed an episiotomy (which required only 2 stitches) where as for my second I had a water birth and had a 3rd degree tear.
All the best with what ever you choose 😊

The only way you can guarantee that is with an ELCS. It'll be harder short term recovery but at least you'll know what you're getting.

Try not to worry OP, I can understand it’s natural to focus on the birth, especially as a first time mum when you don’t know what to expect.

Birth is not something you can plan for, with my first DS I wrote a birth plan, biggest waste of my time ever I would say.

For me birth was a lot easier than I imagined it would be. But there are so many factors involved including the position of the baby, length of labour, the time of day or night labour starts.

Your health and safe delivery of your baby is the most important thing, so be open to anything that may help you. Good luck OP.

I wrote a brief birth plan with my first and then realised no one even looked at it. It's good to be informed but the truth is you have no idea how labour will go, and you have no idea how you will feel. I've had fast quick deliveries and 1 long very painful delivery where I'd have agreed to them cutting my foot off if asked as I just wanted it over.
Question things if they are suggested but I wouldn't bother getting too get up about a birth plan as birth rarely goes to any plan (other than baby will come out) and they seem to set people up for disappointment.

Having read most of these posts, I am startled by the prevalence of the attitude that women 'will' and 'must' do 'whatever it takes' to get their babies out. Yes, obviously, a safe delivery of a live and healthy baby is going to be the priority, but it doesn't override informed consent. If a woman's birth plan states that she will not consent to forceps, it is incumbent on the HCPs to do what they can to get her down for a c-section before the baby is so far down the birth canal that forceps are the only safe option. They cannot ignore your birth plan, or assume consent to a procedure that you do not want.

you're not dictating to professionals how to do their job.

Like this, for example. Actually, yes, I am dictating. I have to consent to medical procedures

Peng, I’m not sure it’s helpful to encourage a woman to withhold consent on the assumption that a HCP can know before it’s too late that instruments would be needed. Nothing can or should be done without a patients consent but that doesn’t mean it’s wise to encourage not giving consent.

What I mean is, people are trying to encourage her to give consent for very good reasons, not trying to say that her consent doesn’t matter.

Hideandgo

I am not 'encouraging' not giving consent. I am stating a fact: her consent is needed. We don't need to patronise her.

people are trying to encourage her to give consent for very good reasons, not trying to say that her consent doesn’t matter.

She should do what she wants to do. It is her body, her choice.