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?

Giving birth to a live baby is far better, call me old fashioned, if you like.

Yeah because those are the choices in all cases - baby dies or use of forceps. A timely c-section is out of the question for some reason.

The baby's mother surviving to rear him is also better. call me old fashioned if you like.

I had high forceps on my first. The doctor missed the contraction and the forceps sat inside me until the next one. The immediate pph was no coincidence. I was "lucky" enough not to be rendered incontinent but nearly dying was fairly traumatic for me and my husband

I gave birth at a time the US in general and the big teaching hospital I gave birth in, in particular, were completely consumed with c-section rates. I'd love to see a similar concern with incontinence rates. I should have had a c-section. I did for subsequent pregnancies.

1st pregnancy, I had HG and was induced at 35 weeks + 3 days due to fetal distress and very minimal amount of waters, induction began on a Wednesday afternoon and I finally gave birth at almost midnight on the Saturday, baby's heartbeat was dropping with every contraction and not recovering in-between contractions, when it had dropped to 60bpm they tried ventouse, that failed so they tried forceps and that failed too, they started preparing me for an emergency CS but as the heartbeat had dropped to 38 BPM they decided to try ventouse again, they had begun to panic they didn't think they had time to get me to theatre other than me and DH there were 10 other people in the room, 2 Obstetricians, 2 midwives, 1Anaesthetist, 1Paediatric Consultant, 2 Paediatric nurses and 2 HCSW (who were preparing the re-sus trolley) thankfully that attempt at ventouse was successful but baby spent 10 days in NICU and SCBU, I had a 3rd degree tear and nerve damage, I was in hospital for a total of 15 days and I've suffered everyday since then from the birthing injuries. Shortly after my youngest was born (straight forward, very quick birth, 2nd degree tear) I began going through early menopause.

Why of COURSE women should suck up all manner of debilitating, life changing birth injuries, just as long as the baby is OK

I see that on these kind of threads all the time.

Outcomes for women matter too.

Also, I rather suspect that if men gave birth, modern medicine would have invented an alternative to forceps that ISN’T taken straight out of medieval times. They are barbaric.

(And no, I don’t mean ventouse).

I do wonder if forceps could be avoided if c sections were in the majority of cases performed earlier. I had a very long labour and wasn't really conscious for the last part, according to DP who kept questioning what was happening the midwives kept telling him all was fine even though the heart rate wasn't great and I wasn't dilating very quickly. Thankfully he is a farmer and has seen plenty of births and demanded they fetch a doctor and I have section. DS probably wouldn't have survived otherwise.
I am aware there are risks with c sections but I would rather have one healthy child and accept the risk of secondary infertility.

TinklyLittleLaugh

Probably nothing, I have a tilted pelvis and other than taking an x-ray, I doubt anyone would have known.

One thing that amazed me when I was pregnant with my first is that no one ever examined me to properly check if I was able to give birth naturally. No one looked at my pelvis or hips or indeed my vagina and I’m pretty small; I’m 5’2” quite slight, size 3 shoes.

In my case all was fine, but my similarly built, narrow hipped friend ended up with an emergency CS after a long labour and a big baby. Her paternal grandmother had actually died in childbirth, giving birth to her dad in the 1930s so possibly some family difficulty.

I do wonder if forceps could be avoided if c sections were in the majority of cases performed earlier.

Exactly. Or if elective sections were given to anyone who asked.

I'd be dead. Presume you're happy with a lot of dead mums and babies? Crack on then

Don't read the fucking DM.

I do wonder if forceps could be avoided if c sections were in the majority of cases performed earlier.

Well this is the salient point.

I accept that sometimes it can't be predicted, but we do actually know that eg back to back is less likely to result in an unassisted vaginal delivery than when baby is better positioned. Same with prolonged latent stage. There are at least some instrumental deliveries where it was obvious that the risk was climbing before the baby got into a position where instrumental became the safest option. There is nothing to prevent us from telling women about this.

Sigh. Read the thread march. Fucking up women’s bodies and dead babies. No one is saying it is either/or; there is a big space for changes in practice.

Once again, many countries apparently do not use forceps, yet have a lower baby mortality rate than we do.

*How do other countries manage it? Does this ever need to happen to women, and if it does are we acceptably managing it.

The whole culture of lack of choice and treatment of women in labour needs questioning.*

Absolutely agree with this.
There is this worrying culture of expecting women to put up and shut up, and not question anything that happened during their birth. Accept that a horrific forceps delivery which left you with no sex life and incontinence was the only way you would have ever delivered a live baby and be thankful to those who did it to you.

It’s not as simple as that and you do have to question hospital guidelines and whether what happened to you was the only way and if it was really made with your best interests in mind rather than statistics or cost or just because that particular hospital does things a certain way that wouldn’t really line up with your own birth preferences. For example, years ago routine episiotomy used to be a thing for every single woman. We can’t just blindly not question anything and not want to improve outcome beyond ‘live mum, live baby’- it should go far beyond that.

Why of COURSE women should suck up all manner of debilitating, life changing birth injuries, just as long as the baby is OK

Well, quite. It’s been said more than once on this thread alone...

Because most women want their baby delivered safely by any mean necessary. I know id rather shit myself for the rest of my life and have a healthy baby

I am suffering the lifelong effects of delivering DC1 by Keilland's forceps (anal incontinence, which has lessened over time and some sort of prolapse, I can't poo unless I manually push on my perineum, every time I need to go, every day). DC1 is also facially scarred. Almost 10 years after her birth I am still absolutely RAGING at the system which subjected me to this butchery.

I also feel somewhat guilty. I have birth in a London teaching hospital like Littlefluffyclouds... I considered suing but didn't (I actually posted on here and was chastised for thinking of doing that to our beloved NHS) but perhaps more women doing that might have saved people like Lfc. If it was St Thomas's, and an arrogant shit of a consultant, I'm especially sorry Lfc ....

Several things spring to mind:

1. MORE INFORMATION

- Full disclosure on the risk of VB in the same way as the risks of CS are hammered home

• I had no idea there were different kinds of forceps, so no idea that in some circumstances a CS is still possible and sometimes preferable. Earlier in the thread a midwife actually posted she'd like to see less use of Keilland's forceps yet I was persuaded by the consultant at the time to have them despite my birthplan saying I wanted to go straight to CS.

- stats on chances of instrumental delivery broken down by 1st and subsequent births (the non-first birth stats bring down the overall stats quite nicely...)

• clear stats on chance of damage (urine and faecal incontinence, prolapse) for VB instrumental and non-instrumental (ideally by type of forceps too)
• stats on need for instruments or CS if being induced (I was induced despite the midwife knowing my baby was lying back to back. I had been in the waiting room for 8 hours by then to they got to work regardless)

1. MATERNAL CHOICE

With proper information as set out above, if women want to go down the 'any chance of a VB is best for me' route then crack on. I only consented to my instrumental birth because I felt coerced into it. Knowing what I know now I wish to God I had kicked and screamed for a CS.

1. CHANGING THE NARRATIVE AROUND BIRTH

Connected to honest sharing of decent statistics, we need to move away from 'VB good and CS bad' and 'live baby = be grateful and be quiet'. We need much more honest sharing of the risks of VB. Women also need to respect each others choices and, importantly, validate our experiences. We need much more honest sharing of what bearing children does to women's bodies. I naively assumed that I'd be back to normal with some Kegels (that's what the token NHS leaflet implied).

1. MORE SPENDING ON BIRTH AND MATERNITY CARE

We can only really have a choice if we can afford all the options.

1. BETTER RESEARCH

What has changed in the last 50 years? Almost nothing in terms of practices. Imagine if scans could accurately predict size and ease of delivery (I was 5'2, size 8 and unsurprisingly my malpositioned 8'9" 1st baby got stuck...)

As part of International Women's Day the Royal College of Obs & Gyn hosted a talk and panel discussion around this topic. I watched it streamed live and was interesting. I'll see if I can find a link.
It mentioned the NICE Guidelines and work done on relative cost of VB and CS. So CS is about £700-odd expensive until you factor in cost of incontinence (I think only urine incontinence) when it becomes about £70-odd more expensive for a CS. However, the cost of litigation for botched births was never included and revised figures are apparently being prepared which make CS look great value for the NHS..... something like 50% of NHS litigation payments, over £700m per year, are for botched births.Better Maternity care would bring this down but the inherent risk of serious damage to mother and baby is largely from CS, not VB.

I think we need to strive for more than 'both alive'. Of course everyone would take whatever birth injury if their baby was safe, but it doesn't mean we should accept that this is the best things can be.

Dodgy but 'maimed or dead baby' or 'shitting yourselves for the rest of your life' shouldn't be the only options available - they aren't in other developed countries (many pp have already pointed this out).

And whilst I would, of course, never prefer injury or death for my DC1, if I'd have known how I would be affected by my VB ahead of time I'd have chosen to not have kids.

However, I prefer to state that my choice should have been 'maimed by Keillands forceps' or 'CS with associated risks' in which case I'd have chosen the latter.

If it gets your baby out safely into the world I wouldn't care about the imcontience as long as my baby was safe and healthy

I'm pretty sure that if you shit yourself on a daily basis for the rest of your life, you very much will care about it. Regardless of healthy baby.

Keillands are not really used now. I've seen them use once in 8 years of working as a midwife and then only one consultant could use them. There are some scenarios where a vaginal birth is pushed at all costs, and then this results in trauma which would have been prevented, however often as I midwife I'll call the drs to say things aren't progressing, baby isn't in a great position and the drs are the ones saying keep going. It's not always the midwives fault!

I had forceps with my first, with no pain relief, and ended up with a third degree year and pph. I was stitched back together in theatre with a long awaited for spinal. I had physio for six weeks after and was discouraged from a debrief by the physiotherapist. I listened to her and, being very fragile, decided to leave it.

Back to the birth: Having been labouring for 24 hours and vomitting, I was hooked up to a drip for the last 6 hours of labour. I told the midwife I felt I needed to pee, but couldn't 'go'. This was dismissed as 'there's so much going on down there it can feel like that.'

I was pushed for over an hour against a very full bladder. Eventually exhausted, midwife suggested a forceps delivery and I agreed thinking I'd get an epidural hollow laugh.

The first thing the doctor did was empty my bladder. There was at least one full bag of urine. Glamorous thing childbirth.

Next he inserted the forceps, one arm at a time, and clicked it together. He was surprised I screamed in agony as it was inserted, and asked me if that had hurt. At that point in the proceedings I couldn't even swear at him.

DD was pulled out of me squashed wrinkled but essentially fine. I was carted off to be put back together.

I genuinely believe things could have been different if the midwife had listed to me about needing to pee in the first place.

Second time round I had the most wonderful elective section.

So you'd be fine shitting yourself every day and/or shitting through your vagina and not being able to work and provide for your child but hey, it's okay if your body was butchered to the point you can't work anymore . SMH.

I'm not incontinent anymore (for about 5 years I'd periodically shit myself)....
but I can't shit without manually using my hand. Every day. Almost 10 years after the birth that did the damage.
Believe me I care about it.
I haven't even mentioned mental health impact but it's had a significant, ongoing effect on my MH.

It's just my opinion omg wow

Oh, I can't link to the RCOG thing from International Women's Day but it's on their Facebook page, on 6th March, headed as follows:
^"Our first session is: "Birth plans and caesareans"
Prompted by her own birth experiences Clare Goggin will share details of the research she undertook to connect with women and healthcare professionals to explore ways in which caesarean birth can become more woman-centred.
Maria Booker is Programmes Director at Birthrights, the human rights in maternity care charity. Maria will speak about Birthrights work to uphold women's rights to choose the birth that is right for them."^

It was the Birthrights speaker who quoted the cost stats.