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?

my health visitor was only interested in my baby.
the post natal midwife didn't even check my scars, neither did the gp at the 6 week check up.
a leaflet about exercises and a hard sell of the implant lecture about contraception was all there was for me, the mother, after a traumatic instrumental delivery.

That woman should not have been pushing for 3 hours that is terrible.

I wanted to put no forceps on my birth plan but then I thought it was pointless because let's face it by the time they are needed it's often too late for a section and they are trying to save your baby.

I also wonder though what they use in Denmark instead.

It is not an easy alternagive to a vaginal delivery or instrumental. It is MAJOR ABDOMINAL SURGERY

No, I have never said that. I had an EMCS and the recovery was painful. It’s hard to take care of an infant after major surgery, and would have liked to have had VB—but not at any cost (as it turned out, my OBGYN simply doesn’t do instrumental delivery).

There are different risks involved to CS; it just seems to me that the risks of forceps delivery is not well known among the populace, nor well studied, nor explained to patients (and issues are dismissed, often enough).

But clearly some OBGYNs know, and perhaps is why forceps usage is becoming a rarity in many other developed countries.

That saddens me to hear that you weren’t able to talk about your birth experiences with your health visitors. We are meant to be there for both your baby AND you! This could be down to lack of continuity, lack of rapport, time constraints and many other political issues I won’t delve into. But I’m sorry you’re made to feel this way, it’s sad.

There are many complications following instrumental deliveries; I am not denying this. However it pains me when people imply that the alternative is easier. Someone asked what long standing complications there are from a C/S. There are many, and many I have come across, especially when having another baby. However I won’t delve into that on here. I am conscious there are pregnant women and I do not want to get into scare mongering; but they’re easily found on the internet and well evidenced.

As for me not calling a C/S major abdominal surgery. It absolutely is, and I will not change my stance on that or the evidence.
When you’ve watched hundreds be performed in many different scenarios, you soon see how complex the uterus and abdominal muscles are. The anatomy is very complex, as can be the recovery.

And just because you may have covered well after an EMCS - does not mean all do.

I’ve seen many different scenarios over the years.
I’ve also seen a lot of substandard care which horrifies me. However I can’t unfortunately change peoples practice, only focus on making mine the best it can be and offering the best care I can provide.

We have all been let down by maternity, or health care services, (I was with both my children- and have recently had surgery to correct a problem from birth which was 10 years ago). So I am not by any means underestimating birth trauma from instruments. I am merely saying; let’s not jazz up the alternative, because a C/S has huge risks, also side the anaesthetic.

I wish you all well in your birth adventures and hope that your maternity care and aftercare is good enough to make you feel heard and valued and able to talk freely with no fear of stigma or judgment.

Take care all.

The thing is most of us are very aware of c-section risks. They are all over the antenatal leaflets and information booklets we receive, and very much drummed into us. Instrumental birth risks need to be spoken about as well. Sometimes there is a choice during birth where either is an option and a woman should have the information to make an informed choice. You often get midwives and OBs themselves on these type of threads stating they wouldn’t consent to keillands in a lot of scenarios or would opt for an elective c-section if they were at a higher risk of a difficult VB.
I would be interested to see statistics of women with long term damage or problems from childbirth and whether it’s mostly c-sections rather than instrumental and vaginal birth.

Agreed on the awareness past. Definitely a lack of informed choice. Maybe I’m just venting, because of the demographic I work in and how C/S are minimised and how women opt for them over vaginal deliveries believing it’s an easier alternative.

I didn't talk to anyone about my issues for along time. Its not about whether I felt able to talk to HV. I also didn't tell anyone the pain and distress going for my first poo after forceps/ventouse. And how I lay in the bathroom crying, not knowing what to do.

Strangely enough it's not easy to bring up the subject of shitting yourself with anyone, even a medical professional. Or having your poo get stuck and having to use your fingers to get it out. It's mortifying.

But it's all OK, because my baby is alive. Given the options I sometimes wish he had survived but I hadn't. Because it really isn't any kind of life.

I am currently trying to persuade a family member to have an elected C section which she can have because of health issues.

If a family member did this to me I would tell them to sod off.

Why do people feel it's ok to infantilise women when it comes to childbirth? And tell them what they should want, rather than letting them make their own decisions?

When I was pregnant with my first, I even had my DH's (male!) best friend telling me I should get a c section. But I don't think it's any better when women tell other women what birth they should want.

I've read up on all the risks and I still know I'd always prefer a VB if possible, and I'd prefer forceps to a c section. But that's me. Just because that's what I want doesn't mean that another woman shouldn't read exactly the same information as me and decide she's more comfortable with a c section.

@Redorangeyellowgreen have you given birth before? Have you read the accounts on here? The risk of damage with forceps is quite high, I don't know a single friend who had instrumental delivery without damage that makes them in some way incontinent/effects sex life. Those aren't reported in the risk factors. They only consider death or full double incontinence. The thousands of women wetting themselves, unable to have sex pain-free or having they cervix hang out of their vagina are usually not included on those stats.

I'm not sure though that anyone is saying the alternative of CS is easier, just that on balance of the risks (risks of CS) and the risks of forceps( anal incontinence etc) a CS can be preferable and there should be choice in that matter and a delivery ought not to get to a stage (especially in a case like mine where it seemed clear from early on that baby was not in a good position for normal delivery) where a high forceps is the best available option. Would I prefer scar tissue on the abdomen rather than the vagina/anus - yes. PPH - I had a large PPH in any case with forceps (1.3litres). Recovery time - I had a LOT of stitches(the registrar said she'd helpfully reinforced some areas with stitching) , was in hospital for 3 days to monitor whether transfusion was needed and could hardly move. My friends who had EMCS were out before me. I was automatically give strong pain meds when I understand a CS at St Thomas's usually only gets paracetamol/ibuprofen. It's not a question of thinking CS is a walk in the park filled with butterflies and I don't think the prevailing attitude of 'CS is MAJOR surgery' is helpful. Of course it's major surgery but I equally consider being stitched up for 2hours major surgery!!

Gosh this thread is making me realise that I'm not really over the traumatic birth.

And yes to PP - in recovery the first thing I asked was what went wrong and wanted the registrar to explain and all everyone kept saying was You had a healthy baby.

I also agree that CS shouldn’t be put forward as the ‘easier option’ however the reverse shouldn’t happen either.

I was certainly made to feel that my high rotational forceps delivery was the ‘easy option’ compared to a c-section and that I was ‘lucky’ to have avoided one.

It’s about balancing out the risks of both options in an honest manner- and that of course includes being open and honest about the real risks of c-section (separately for planned and emergency of course) compared with instrumental delivery including keillands.

redyelloworange

That’s totally valid. There is no right or wrong way to give birth, and preferring to have a VB and take the risk of an instrumental to the risks of a CS is perfectly reasonable and something a lot of women would decide. The converse is also true but women aren’t really able to make this decision in an informed way because the risks of VB are downplayed.

I was a birth partner for a friend who had a planned CS and was present for the consent. Increased miscarriage risk, complications such as praevia etc for future pregnancies is a big deal. A lot of it was wound infections etc - I had an infected episiotomy, is that any nicer? Big risks such as hysterectomy and death etc but those are very rare so she was told.

It’s not that I’m saying there aren’t big risks with a CS - these are hammered home. There are also big risks with a VB, especially instrumental, which people often don’t know till they give birth and the risks materialise. That isn’t unacceptable.

There is no simple way to get a baby out and it is simplistic and does a disservice to women to say VB is better. It’s different. Women should be able to choose which they prefer to take instead of having the wool pulled over their eyes about VB.

@intentsandporpoises yes I have given birth thanks. And have the scars to prove it. Actually the account of my own birth is pretty awful, it certainly wasn't textbook by any means.

I don't think having given birth makes me any more qualified to comment on other women's choices though and I still maintain that telling other women they should give birth in a certain way is wrong. There's no right way and birth is just risky however you do it.

grubbyhipsterbeard agree with most of your post but not sure if I've misunderstood your last bit. To be clear, I didn't say VB is better. It's what I would personally always choose if it's possible, but like you I think it's for other women to make their own choices. The key is making sure they have correct facts on which to base that choice.

Interestingly I actually think I was very aware of the risks of VB before I had one (as well as c sections), partly from the antenatal classes I did at the hospital and partly from reading far too much Mumsnet when I was pregnant. But I appreciate that might just be my own experience and there are clearly plenty of women here who weren't.

The area where I really felt things were overly romanticised and where I definitly did not have all the facts was breastfeeding. But that's a whole other thread...!

I agree with you RedYellow and if someone was trying to pressure me either way I'd be unhappy. There should be more informed choice - and actual choice as in the ability to choose without needing to kick up a drink and threaten litigation (which is what I'm imagining one would have to do at the moment) , in the delivery room. For example, my partner recently sustained an injury which there were 2 options to treat - conservative or surgical. Funnily enough the specific risks of that surgery were presented but not so much the 'general risks of surgery' and no influence was given one way or the other, it was entirely his decision, they had prebooked a surgical slot should he wish to go for that option. I do not feel that is how CS is presented at all. In any event I was denied the ability to choose for delivery - I had expected to be brought consent papers for both straight to CS and forceps and was only brought trial of forceps. By that time I just didn't have it in me to argue. Anyway, I am going to retire from this thread as it has triggered all sorts of emotions I didn't really know existed in me!!!

redorangeyellow

Sorry didn’t mean to imply you said VB was better - just went off on a tangent! I’m sorry you had a traumatic birth

And yes, breastfeeding, not quite what I had anticipated!!!

I also agree that I was very aware of the risks of vb, some of my first words to the registrar when discussing theatre were that I didn't want to be left incontinent and I was basically shushed and told it was a very very low risk in a silly woman, we have to get your baby out style.

Oh god yes, breastfeeding!!!!!!!

because a C/S has huge risks, also side the anaesthetic.

Not true. It has risks. They are not huge. A c section displaces risk onto the mother in proportion to the baby so there is in fact a lower chance of the baby being born with complications or dying (a quarter of the risk of death, and virtually zero risk of hypoxia related damage) www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf

When you look at cs stats you need to look at types of cs. A crash EMCS for example will have an over representation of women with complications and injuries. What we need to look at here is scheduled elective risks. Even within that population, there are differences. First cs? Fourth? Scheduled elcs for placenta previa vs maternal choice?

When you look at the maternal injury statistics, from a Scandinavian country with no forceps (sweden, only used under exceptional circumstances in surgery and very rare) what you actually see is that the rate of maternal long term injury is similar to VB. the worst outcomes are for those who have had a VB and CS delivery. Measured outcomes were hernias, anal and urinary incontinence, prolapse and adhesions

That’s for a country with a MUCH lower birth injury rate than us and who don’t use forceps.

In terms of maternal injury, instrumental birth is VASTLY more damaging (and the RCOGs own figures back this up, if you look at their green top guidelines.)

NICE have also costed out the lifetime extra cost of elcs. That is, the money it costs upfront (theatre, staff, beds etc) and the cost of repair of physical damage later on which is not borne by obs and gyn but by different departments. That extra cost is either 83 or 87 quid.

Many countries do not use forceps in routine delivery. at all. So the idea that they’re essential is untrue. The UK needs to look at best practice in other European countries which have vastly better outcomes than us and it needs to put money and political will into ante and postnatal care because it is an absolute bloody disgrace.

Picture: Swedish VB vs CS long term outcomes.

Childbirth is a hugely emotive subject and its bringing up all sorts of feelings for all i’m sure. But what I will say ladies; is to those of you who are still suffering, please do seek help if you feel you want to explore this further.
My birth affected my attachment with my first born and it wasn’t until I had therapy I gained more understanding and helped me with my attachment process with my son. The therapy was not so much fixated on the birth trauma itself, but more on my lack of empowerment and changed my mindset.
It helped me, so please if you feel you need help, try and seek it. It was also a key driver for me to train to become a midwife, so I could make positive changes for the women I cared for.

Childbirth at times becomes a conveyor belt because of lack of staff and time constraints. What an awful thing to say of me, I’m sure you’ll be thinking. But it is true and I hate it. Which is why I’ve expanded with my profession now and left a hospital setting for not being able to give the care women deserved. But please let it be known that most midwives are aware of the shoddy care and the constraints and try their hardest to advocate for you and empower you.
I for one have closed the door to my patient with a smile and then left the room to tear the doctor a new arsehole when I felt a women’s choice was taken away and she was not informed or empowered when it came to decision making.

But as I have previously said, with the way the NHS currently is, I do still believe there are a place for instruments; until there is an alternative option. Although hearing some posters say they wish they weren’t here and their child was because their life is so impacted now, is awful. This is time for change, but with such little resources it isn’t possible at the moment.

until there is an alternative option

There is an alternative option. Forceps are not used in Sweden or Denmark. Ventouse is used, sparingly. They manage. What do they do? That’s what we need to do.

I was left completely traumatic after my forceps delivery. I was in labour for 36 hours. Lying on my back attached to a monitor. I should have had a CS. To add insult to injury I was then seeed up by a butcher and surrounded by students.
Needless to say I didn’t bond with baby and didn’t even want to hold him. I felt like I’d been abused.
My next 2 were born at home. Perfect!

And what are the comparable rates of CS between Sweden and the other countries using forceps?

DD1 was forceps. I was given no choice and because I quibbled at all about the idea (I had SPD and had been housebound for a lot of the pregnancy it was that bad) and wanted to make sure they'd handle my pelvis safely under a spinal block to use them... they did a social services referral on me as a "resistant patient."

Left with permanent damage to my SPD - still unable to walk any great distance now, in constant pain in my pelvis and hip - despite physio and umpteen different exercise plans. Also an absolutely massive tear/cut down there as well - which I did recover well physically from but mentally I've never quite resolved those issues really. Also left with PTSD from how appallingly I was treated by the staff throughout - it may sound daft but I could fairly easily compartmentalise the "awful stuff physically" going on as necessary evils... but the "treated worse than a slab of annoying inconvenient tissue between the doctors and a baby" aspect I couldn't cope well with at all.

By all accounts I should have been fairly certain of being able to have an elective section with DD2 (a product of the one single shag I've ever managed to have since DD1's birth ironically enough... you wait 6 years for one successful pregnancy and then one craply attempted bonk for a second one) - but my appointment with the "specialist midwife" who dealt with women who'd suffered birth trauma, tokophobia or just previously complicated deliveries resulting in injuries literally took the form of "why are you here... if you think you're going to be getting a c-section this time around you're kidding yourself because we won't let you have one." To be honest, if I spoke to a child I was teaching in the same tone and manner she'd spoken to me in - I would have been facing a disciplinary - and I teach 5/6 year olds... not grown women! (I guess we have some common ground since I seem to spend half my working days saying no to people as well though...) I don't think that kind of situation is acceptable and I think pushing for that kind of situation to be resolved (pardon the choice of phrasing) and targeting a reduction in the number and severity of forceps births would be a better way forward than going for an outright ban.

As it was - I wasn't even specifically seeing the ruddy woman to request a section! I wanted to clarify some concerns I had regarding possible post-natal care following the previous awful experience in a different hospital in the same NHS trust and beg to be given priority for my care NOT to be transferred back there again if they were starting to fill up when DD2 deigned to make her appearance - but she started the whole appointment with her "silly woman wants a c-section - sod off" opening gambit!

As it turned out DD2 - sub 15 minute labour, just about got my jeans off in time - she's still an impatient little sod hurling herself into things and bulldozing them down to this day!