That instrumental delivery should be banned?

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I know it’s the DM but this is shocking:

www.dailymail.co.uk/health/article-6797199/As-doctors-midwives-finally-act-searing-expos-childbirths-shameful-secret.html

They say 10 percent of mums suffer from some sort of anal incontinence! Claims forceps are the biggest cause so why are they still used? AIBU to say they should be banned? Why couldn’t you just get a C-sec at that point?

As a midwife I don't even know where to start with this level of ignorance. Maybe go read some papers? Some rcts? Maybe anything but the dailymail..

It’s also an unpalatable truth that the skill of the operator depends on the amount of experience they have and there’s only one way to gain experience....

This is a good point, and I think I heard that’s why they are falling out of use in North America. OBGYNs are less confident that they can use them skillfully and opt for earlier CS instead.

Just looked up the stats. In 1990, 5% of US births used forceps; now it’s 0.5%. Very rare, considering some hospitals ban their use because of litigation fears. By contrast, CS rates are now over 30%.

I understand that CS presents an alternate set of risks. However, I do wonder if the full risks are being teased out, since so many health systems ignore the postnatal issues of women.

This is a very interesting letter from an OBGYN in response to an article decrying the decline in forceps usage in US-based hospitals. It covers a lot of what we’ve been talking about in this thread:

journals.lww.com/greenjournal/Citation/2016/12000/Obstetric_Forceps___A_Species_on_the_Brink_of.40.aspx

The writer basically says that there is no evidence that forceps are “indispensable” and says it’s “hopeless endeavor” to increase their usage in the USA—says there is a good reason for the decline.

www.ncbi.nlm.nih.gov/pubmed/27500345 (the article in question)

My ds was born by forceps after a failed ventouse. He was in distress (cord round his neck). I was exhausted after being in labour for days and finally given syntocin. I had an episiotomy which I didn't know about until the next day, when dh mentioned it.

Dd was a VB with no intervention, just a graze.

However I have a prolapse and significant injury, which means incontinence and issues with pooing. I have actually had surgery to fix this, but because dd has SN, which mean me having to continue carrying and manhandling her age 6, it hasn't been very successful. Ideally I would never lift anything heavy and the surgery would last 10 years.

I'd ban them. Ds' birth was terrifying. And I think unnecessary as his heart rate dropped earlier and they decided to "keep and eye" on him. A Csection then probably would have been fine and saved me from a lifetime of awful toileting.

I'm a runner who can't run without wetting myself or needing to poo at random points in a race, even slight jolts see me wet myself. I have to wee several times a night, meaning I'm knackered.

Me and dh may split up in the near future and while dh will be free to go and find a new partner, I will struggle I imagine to find someone who finds an incontinent woman attractive in any way.

As others have said once the baby is past a certain point then forceps can be the only option.
I do think that high rotational forceps should be banned though (and they are in many countries). DS was born by high rotational forceps and it was awful.

mrmakersfartyparty

Please do start though. We would be interested to hear. Look at the way it struck a chord with so many on this thread. Of course they shouldn’t be banned but do you think women are fully warned about this when being told that vaginal birth is better for them?

If I had had a section would I have this prolapse which blights my life? Would intents be suffering the issues she is?

Of course c-sections carry other risks but shouldn’t women be able to choose which risks are more acceptable to them?

I don’t think people are right who say you can’t do a section after forceps. I was prepped and told I would have a section if forceps didn’t work.

I think the focus on natural birth at all costs and a prejudice against c sections has led to this situation, where women are left with lifelong complications from birth. My NCT class was happily spreading nonsense about epidurals and c sections just four years ago. Not to mention the attitude of some midwives (eg investigation at hospital where babies dies because the midwives has attitude of vaginal birth at all costs). We see the same with breastfeeding- women are pressured into doing it with a dogmatic “natural is best” approach. There’s no thought given to the time it takes and difficulty for some and the consequences for women.

Dunno if instruments need to be banned but we need to be intervening earlier in many cases and c sectioning in some. And warning women properly about the risks.

I actually asked the midwife running my anti natal classes to discuss forceps vs c-sections to see pros and cons and she completely glossed over it saying it was rare anyway and once the baby was in a position for forceps a c-section wasn't possible. No mention of high rotational forceps.

So I was completely confused when I was in labour, they were prepping me for surgery and told me they'd try a couple of times with HR forceps and if that didn't work they'd proceed to c-section. I was too far gone by that point to coherently question anything.

If I'd been given proper information at my anti natal class I would have asked for c-section or at least my DH might have known enough to ask me if I was sure I was happy with HR forceps.

I think the focus on natural birth at all costs and a prejudice against c sections has led to this situation

I think it’s partly this and also cost rationing. A vaginal birth is cheaper, especially if they don’t care to fix what they’ve broken.

But as the letter I linked to earlier references, if you had to include costs of fixing prolapses and the like, perhaps the costs wouldn’t be so far apart?

As a poster said early on in the thread, I think they're an unacceptable risk and in many cases could be avoided. After reading many horror stories on here about VB, the scant disregard for the concept that a female body is anything but a birthing vessel, the facial trauma they bring and the attitudes and incompetence of many NHS staff, I'm terrified of giving birth now. I'd only want a section. Especially as I'm quite little and have been told by many people who've examined me for IUD insertion, smears and silver nitrate treatment that I'm very small. Everyone always ends up getting out smaller instruments than intended. I'm genuinely frightened of the state I could end up in and of being bullied. I don't think getting the pat on the head for having a vaginal birth at any cost is worth nerve damage, incontinence and trusting that the person who is going to stitch me back up would do it properly, let alone the risk to a baby.

I found out from my notes that during my emergency c section Wrigley’s forceps were used to get baby out.

Hello. Almost 20 years ago my DD was delivered by forceps. I had already been in labour for 48 hours plus and was exhausted, I was prepped for a c-section and taken to the operating theatre where my 7 lb 4 oz baby was delivered by forceps. It was frightening and painful and I had a severe post partum bleed that left me needing blood transfusions and impacted on my health for many weeks after. However my baby was born healthy and well and I was extremely fortunate despite a long healing process not to have had a single long term complication. That is the best outcome possible and the alternatives are unthinkable. My baby was born safely. It must be terrible for anyone who has suffered as a consequence of instrumental delivery and I truly feel for them however I really do not think that the use of instruments is anything other than the safest way to deliver a baby in a potentially risky situation. C-sections are also risky and sometimes not the the best option in delivering a baby as swiftly as possible.

Maybe the problem is the use of forceps in unskilled hands. Although I think they are an instrument of torture and should only be used when absolutely no other alternative available.

User I think that you are right. I was extremely lucky that the consultant on duty to deliver my daughter was an extremely experienced one and was very well regarded. If I had been in the same situation the next night and he was not on duty I may have had a very different outcome! I appreciate that his skill is the reason after an extremely traumatic birth that I have had not a single long term consequence to my health!

Is there any science behind the measuring of women, shoe size etc? I'm wondering as me, my aunt and all four of my cousins who have given birth have all had c sections for each delivery. All very petite, size 2 or 3 feet. I'm the only one who didn't labour but everyone else had sections after labouring for too long. I'm actually relieved that I needed a section the first time before I went into labour and I got an ELCS next time. None of the family babies were big either. My mother (a taller and more robust build, shall we say) is the only woman in the whole family who has had vaginal births and they involved forceps.

Then again, millions of very small framed Asian women have vaginal births with no issue, so it's probably psuedo science.

I found out from my notes that during my emergency c section Wrigley’s forceps were used to get baby out.

Yes that's not unusual for an emergency cesarean when the baby's head has descended deep into the pelvis. It's quite different to delivering vaginally with forceps, because they don't go through the vaginal opening, so less risk of damage.

I had a quick look and found this, which did find a link between shoe size and Caesarean rates - it's pretty old and C-section rates were lower then. I'm not at work at the moment so can't read the full article, either. In terms of body size, what is a known fact is it's actually very large (obese) women who are at much higher risk of complex labours - but the trouble is the risk of surgery is also higher for them.

For what it's worth, midwives did tell me that they could 'predict' good labours - but I think that was mostly to make me feel good/confident because I fell into their categories: I'm tall, medium framed, slim and was very active in pregnancy (which they kept saying was the best sign of all)! They did seem quite certain that labour would be smooth for me - and it was, relatively - but I don't think you can base policy on whether a midwife thinks you look like you're 'right' for birth! I do wonder if there would be actual ways to tell - especially more scans late in pregnancy, as happens in many other countries.

www.ncbi.nlm.nih.gov/m/pubmed/4084467/

This study found the exact opposite to the one I just posted - no relationship with shoe size but some with height:

www.ncbi.nlm.nih.gov/m/pubmed/3139180/?i=4&from=/4084467/relate

You can have a section after forceps zsazsa, and people do have them after failed forceps, it's just not a very safe option. If the baby has descended low enough for instrumental, instrumental is usually better. But this is why the discussion about why we're so much more likely than other countries to leave it until the stage where instrumental is the safest option needs to be asked. Especially as EMCS following failed forceps is one of the risks of that approach.

Thanks to my DH’s side of the family the babies are all big. A recent new baby was 9lb 9oz despite mum being 8 st when she became pregnant. I am currently trying to persuade a family member to have an elected C section which she can have because of health issues. I don’t think young women are fully informed of the risks involved in childbirth and the consequences for your long term health should the birth go wrong. I don’t wish to cause alarm but I do think everyone should be aware that potentially there could be problems.

roomba but most of the small framed Asian women would have equally small framed husbands :)
Although anecdotally I know a handful of Filipina women (DHs family are from there) with white partners and they all had straightforward births (though I think they were all in their 20s)

All the women in my family are small too (probably all around 5’3, size 4 feet) and I can’t think of any relative that’s had a c-section, so I think if there is a link it’s probably a bit more complicated than small = finds it hard to give birth. Although actually I think the older generation all had episiotomies (routine in 80s and 90s Italy) but me and my cousins have all had ok births touches wood and crosses self

Isn’t it down to hip size?

My first birth was a high rotational forceps delivery. I had an epidural but it was still painful, thankfully the consultant was a marvel, stitched me back together immediately following delivery and advised C section for any subsequent deliveries.

I haven't had any problems with incontinence, pain etc and I'm very grateful but this was as a consequence of the skill of the consultant and I may not have been so fortunate in other hands.

I do believe C section to be preferable to instrumental deliveries wherever possible. Having had 4 c sections which were an absolute breeze when compared to 36 hours of established labour and forceps.

Incidentally, the only colicky baby I had was the one delivered by forceps, I think he was in quite a bit of discomfort too, poor thing.

A very well written post, wheredowego, and should be required reading for some of the contributors on this thread.