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. 

OP I was in your position and completely understand where you're coming from. I was also very overdue (12 days) and under a lot of pressure to agree to an induction, which worried me due to increased risks of instrumental delivery. In the end I had an amazing straightforward water birth after 1 pessary, only took 3 hours - similar to @Plughole3.

I did find though that throughout the process things were presented to me (eg vaginal examinations, monitoring) as if they were mandatory, not requiring my consent. I had to really fight to refuse being strapped to a bed for monitoring because they didn't believe I was as far along as I was - turned out to be 9cm. So do read up on your options and know your rights.

I put on my birth plan that I did not consent to Keillands forceps. Proceed to c birth.

By the time they need to use forceps or ventouse it is too late for a c-section, it is when the head is coming out.

Forceps and ventouse are use as a last resource anyway, so putting that in any birth plan doesn't make much sense...

I wrote that in my birth plan, no forceps, and my midwife told me I had to be more open-minded, that nobody (including the doctors) want to use them and they are used only when scrictly necessary.

My DD was born via ventouse delivery (after they tried with forceps and didn't work) and I know they didn't have any other option. Trust the professionals.

A section can impact on fertility and future pregnancies..

What a load of bunkem!! Honestly. Do you not think reading some of the stories on here may lead to issues with future pregnancies? Like double incontinence... Bits down below torn to shreds!!

Given that some countries ban the use of forceps, they clearly aren't strictly speaking necessary. It might be be the best option in some situations, but clearly there are alternatives which don't involve either party dying etc.

Sections can impact future pregnancies though, the risks of placenta praevia and accreta are clear in the RCOG guidelines.

@TurnipCake true, but they're pretty low chances imo. I'm comfortable with those odds. It's important for people to have all the info definitely.

@piscis not necessarily - check out @AsMuchUseAsAMarzipanDildo post below, really helpful in understanding the different kinds of instrumental and when a c section is/isn't possible.

Sections can impact future pregnancies though, the risks of placenta praevia and accreta are clear in the RCOG guidelines.

The risks are fairly low, and a vaginal delivery can lead to further pregnancy complications if it goes wrong too.

YANBU. Had 2 forceps deliveries, one rotational and other "mid cavity" (think that means high-ish but uncertain. Both fucking traumatic. Scarring, numbness and pain in genitals and hip 8 years after the last. Both children had side effects at the time, seem ok now but older still has scarring and younger some developmental issues (not sure if related), so would have been better with CS. Know lots of people who had CS and none have side effects this much later. UK should do scans before labour. NICE had recommended against high/rotational forceps by the time my youngest was born so there is no excuse. Low forceps can be done by ventouse instead. Forceps are victorian torture instrument, not suited to modern childbirth.

I thought this was about a piano being delivered from the title....! Good luck with it all op

Nothing wrong with stating you would like to avoid them if at all possible. Just want to alert you to the fact that, ime, no-one pays the slightest attention to your birth plan unless you make a big fuss that they read it. God knows why the community midwives make such a big deal about writing them, the delivery staff pay them not the slightest mind. And to be fair, whatever happens happens. My birth bore not the slightest resemblance to my plan, and in some ways I wish I hadn't made one as then I might not have felt like such an abject failure.

My son would not be here if it was not for forceps. He was in distress (merconium waters) and was stuck in the birth canal. Ventouse failed, consultant was bleeped and the baby was born within 3 minutes. At that moment i didnt care what they did to me as long as baby was alive and the pain was over. Second baby was c section but they had to use suction to get her out.

I didn't say this to scare or patronise you but I would leave your options open because you don't know what will happen and what will be necessary. Obviously I wouldn t consent to these things unless necessary but when the risks of not using them are higher than the risks of using them they have their place.

Good luck, prepare yourself by all means but do be prepared to just go with it too.

I just googled Keilland's forceps - I would put on my birth plan that I don't consent to an instrumental delivery and all efforts need to be made to offer me a c-section if it looks like it is heading towards intervention. I'm not sure I'd be responsible for my actions if someone came at me with a pair of those things!

I think you may benefit from speaking with a specialist midwife linked to the hospital for an individualised care plan and maybe have a tour of your local unit?

No one is going to pay attention to a birth plan made in the community because they all say the same thing, "I want to move around in labour, I would prefer to avoid x, y and z unless medically indicated, my partner to announce the sex/cut the cord etc"

Because, if an instrumental delivery is something you're not going to consent to, the labour ward staff need to know early on. I looked after someone who did not want an instrumental delivery - and no one, including her midwife in the room knew about it until it was the middle of the night and she had been stuck at 9cm for most of the day. My colleague who CBA to section her during the day left her and left her until she eventually got to fully and it made for a very difficult section with a major haemorrhage.

Also worth bearing in mind that not everyone who goes to theatre for a trial of instrumental goes because of a high head/malpositioned head. Sometimes someone is in so much pain, they wouldn't tolerate delivery in the room without significant trauma and we take them to theatre for a nice spinal anaesthetic and the delivery is very straightforward.

I had forceps, the baby's heartbeat took a plunge and suddenly the room was filled with doctors and I could sense the urgency. In that moment all I wanted was the baby to be out safely. They cut me but I didn't tear and I had less 'damage' than some of my friends who had no intervention. It's hard because it's no ones preference, all you can do is discuss it with your midwife.

@TurnipCake great idea, thank you very much. Would I speak to my community midwife about arranging this or call antenatal at the hospital?

Yep I would contact your community midwife to see if they can refer you directly. If your local unit doesn't have a consultant midwife, then ask them to refer you to the antenatal clinic

No one even asked for my birth plan! I’d written all sorts of things in it as well but ultimately none of it was considered during my induction.