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 put on my birth plan that I only consented to an instrumental delivery when the baby is so far down the birth canal that a CS would be difficult / impossible. If there was any possibility to safely have a CS I refused consent for instrumental delivery.

Really hope it doesn't come to that and you have a straightforward labour.

The only thing I wrote on my both plans (4 of them) was that I wasn't planning anything and would take things as they came.

I didn’t have a birth plan.

I also wouldn’t have given a fuck at the time and just wanted him out NOW

Honestly op, have an open mind and trust the professionals. My midwife was lovely and I would have done anything she said at that point.

My little boy was delivered by forceps via Caesarean section as they couldn't get him out
To be honest just ask if they only resort to instruments if absolutely necessary - but doctors need to be on control and get your baby delivered safely if that means instruments then so be it
Good luck

You can't predict the future. Birth plans go out the window when in labour. From experience having forceps is what saved my child's life and glad it prevented a c section x

You can absolutely refuse an instrumental. I did - the risks were too high for me, and it was around the time of a lot of horror stories. They still transferred me to theatre with the intention of a trial of forceps according to my notes, but DS was too high and in a properly shitty position. If they had went ahead regardless, it would have been assault.

You do NOT have to consent to anything you don’t want to. Make sure you have a good advocate that can be strong for you in case you are swept along to agree.

Birth plans do go out of the window. It’s so unpredictable for all involved.
You have to trust the professionals and not plan too much, to be honest.

I had episiotomy and ended up with a ventouse as well. As soon as they handed me DS, I had no idea what else was going on I was just elated and I love. The placenta fell out (so it seemed) they stitched up my cut, but it was all over in my mind.

DS had a cone head for about 2 to 3 months, which we blamed on the ventouse. I did take him to a cranial osteopath and she was lovely, didn’t do much, as you can’t on very tiny ones. But it seemed to disappear on its own. He was always my perfect boy from that first second!

I have had one ventouse delivery and one crash section under general anesthetic and my recovery from the ventouse was 100x easier than the c/s. I was like you and terrified of the forceps horror stories I had read, I had it drilled into DP that if any problems arose with DC2 he was to remember that I wanted cs over forceps. As it turned out there was no time for discussing anything, I was whisked to theatre and put under and DS was delivered within 12 minutes.

Sometimes when giving birth bad stuff happens very quickly and can’t be anticipated. If the head is too low for a safe LSCS and there is severe fetal distress an instrumental delivery will be the fastest option. There will be urgency and worry and more people called to attend (paeds etc) and everyone will be listening to the concerningly low heart rate on the CTG. Everyone will be wanting your baby to be born vigorous and not pale, not breathing or not moving and in need of breathing suppprt. Your baby being born alive and in as good a condition as possible will take immediate priority over later potential issues related to instrumentation.

If this makes you uncomfortable then you should request an LSCS.

I hope your delivery goes well
Nothing useful to add other than what PP's have already said. Nobody wants forceps intervention but if it saves the baby's (and possibly yours) then you may need it. Consider a Caesarian and discuss options thoroughly with your MW now. Good luck

Your baby being born alive and in as good a condition as possible will take immediate priority over later potential issues related to instrumentation.

If she consents. She doesn't have to.

I was also low risk with my first. The very long labour turned into shoulder dystocia and I needed emergency forceps to save his life. I wouldn’t say no to anything that will allow your baby to arrive safely.

No one actual looked at my birth preference. In my antenatal and post baby friends no one elses was either. They were, or partners, were to tell the midwife what was wanted in terms of the tub, delayed clamping and pain relief.

I had birth injuries, still affecting nearly 2 years later. My gp is very good and i am having physio for it and a potential operation. My baby was in extreme distress, when you hear that all thoughts of injuries go out the window. I tore ligaments trying to change positionings and in the end the ventouse and forceps were done. I had tearing and cutting so was a bit ravaged down there.

The main thing is that your birthing partner knows and will support in getting it for you. I would not focus to much on firm wants and dont wants, it can then make things ferl even more out of control.

Op here. People keep saying no one looked at their birth plan. I know this is common - the point of a birth plan is for women to have thought about their preferences and be informed. To be clear, it's not being cut / an episiotomy which I have a concern about, it's the permanent serious damage to the mother which can happen with instrumentals.

I put on my birth plan that I only consented to an instrumental delivery when the baby is so far down the birth canal that a CS would be difficult / impossible. If there was any possibility to safely have a CS I refused consent for instrumental delivery.

That's probably along the lines of what I'm going to put. I DO trust the HCPs, and as I've said in almost every post of mine, I'll be taking their advice at the time with open ears (and DH primed in the case I'm too out of it) - if the team have been as great as my care has been so far and they are telling me 'one more push with an episiotomy and a ventouse and he'll be here, we don't think it'll take much' then great, let's do it. But it's situation dependent and I'd rather they know up front I have concerns about the potential of instrumental so it can be part of the conversation from the get go. I think that's sensible.

@Pengggwn Thank you!

If you’re in the UK...There are usually 2 types of instrumental. “In the room” or “trial in theatre”. If it’s “in the room”, it’ll be very straightforward for the obstetrician to do. If it’s a “trial in theatre” it’s likely that baby is still quite high or in a tricky position. Personally (a midwife) I’d have one in the room and a “trial” if either baby was in immediate distress or I was bleeding (as it is quicker than a caesarean). If it was for prolonged pushing and no immediate threat to life then I wouldn’t have a “trial”.

However, bear in mind (as others have said), a caesarean is not necessarily straightforward at the pushing stage either. They may still need to use forceps abdominally to deliver baby’s head.

Also bear in mind that prolapse is a risk of pregnancy. Even with a caesarean, 9 months of carrying several kilos on your pelvic floor with hormones relaxing your muscles, may still cause pelvic organ prolapse.

As an aside, I also often see women asking for ventouse and not forceps. I always say that the best instrument is the one the dr feels most competent with and also to bear in mind that if your baby has a lot of swelling on their head (as they often do if you’re pushing for a long time), ventouse is less likely to be successful and more likely to cause trauma to their scalp.

As an extra aside...we do not do unnecessary episiotomies. I have genuinely never seen one done that wasn’t because baby was in distress or for an instrumental birth.

I have a prolapse, it's anterior and worthy of surgery. I had no interventions, no instuments and no pushing stage longer than 8 minutes. There are some things you just can not control.
I would not ever choose an instrumental delivery, who would? Being informed is good though as you and your birth partner (if you have one) can then question any suggestions made.

Ah yes that’s a good point, my second was an ELCS (after my first was vaginal, forceps) - they used forceps to get him out too! Didn’t find out until afterwards. Forgot about that. I was so surprised as had never heard of forceps during a c section. So yes, forceps for both babies and consented to neither!

When I had my 2nd I was asked about my birth plan as I had nothing written down my plan was gowith the flow but to avoid a c section if I could

I had an episiotomy and a ventouse delivery. It barely left a mark on her head when she was born, just a little suction mark gone in 24hours.

You are reading too much scaremongering. Statistics do not help you or your baby. If the head is well advanced it might be too late for a section.
If a baby gets distressed and is in trouble a ventouse or forceps can surprising be the gentlest answer. Sometimes it is just a little lift out. Please dont tie your health professionals hands behind their backs. Of course you would prefer a natural delivery, and surprise surprise your health professionals would to. A forceps is done to save the baby, Focus on that one fact. Before they were invented babies DIED

@AsMuchUseAsAMarzipanDildo If you’re in the UK...There are usually 2 types of instrumental. “In the room” or “trial in theatre”. If it’s “in the room”, it’ll be very straightforward for the obstetrician to do. If it’s a “trial in theatre” it’s likely that baby is still quite high or in a tricky position. Personally (a midwife) I’d have one in the room and a “trial” if either baby was in immediate distress or I was bleeding (as it is quicker than a caesarean). If it was for prolonged pushing and no immediate threat to life then I wouldn’t have a “trial”.

THANK YOU so much, that's precisely the kind of info I was hoping for and incredibly useful. brilliant!

I have had three babies - first long time pushing but got baby out myself, second loooong time pushing and baby was stuck - I had vontouse, my doctor was brilliant and didn’t even cut me, I didn’t even tear. Baby was fine but had a cone shaped head for shout 12 hours.

Third I put no forceps unless absolutely nessecary as I don’t think a c section that late is any better. Luckily this was the easiest birth and baby came out v quickly and easily.

Personally I wouldn’t dismiss it completely - they aren’t pleasant, but you can be like me and escape from it just fine with no major trauma.

I think being clear what you do and do not consent to, is important in a birth plan. Just allow enough wriggle room, should a true emergency arrive.

I had my baby via elcs, but had a vaginal birth plan just in case I went into labour early and they couldn't section me for whatever reason.

I stated very clearly that I did not consent to instrumental delivery save for where it was necessary to save the life of either of us, and no reasonable alternative existed.

Consent is paramount, and it's shocking the amount of people here that had procedures done without being asked to consent. It's your body and your decision.