Kiellands forceps are they ever safer than C section

[KayBM]

Hi everyone,

Sorry for the long thread!
I had a rotational forceps (incl. Kiellands) delivery 5 months ago. It was traumatic. Fortunately me and my son are alive. It is taking some getting my head around, as I have a slight prolapse, but no incontinence fortunately, back not great either and pain down below. Got episiotomy and a second degree tear, but it could be a lot worse.

I know there has been some debate over Kiellands forceps, but I would like to know if anyone has any thoughts/ was told they were the best of a bad lot? Or any obstetricians on here who can give some info?

Long story short...arrived at hospital from home birth, by then been in second stage labour over 4 hours (to what they knew). Told initially they may have to do c section, then forceps, then c section. Was warned about episiotomy and incontinence from forceps...I looked alarmed at this and the anaesthetist said the doctor would be as careful as possible. Told if they had to do c section there was a greater risk of death and bladder/bowel damage as baby was low. Anaesthetist was in and out, had scan...baby looked wedged and to be honest nothing like a baby to me! Anaesthetist comes back says the doctor thinks it's better they do forceps if possible and if not a c section. I wasn't happy at this, and I'm pretty sure the anaesthetist could see I was upset. He knew I was worried about a greater risk of incontinence too. That said I was not given an option, and I had the impression that they really were not happy at having to potentially do any course of these two actions. I signed the form when asked, as I figured the c section could go a lot lot worse. I wasn't offered a choice, so without refusing and kicking up a real fuss I don't think I was going to get a section. More to the point, I wanted my baby to be safe too- I didn't want to be responsible for him getting hurt by being pushed back up for a c section. I wasn't aware of the types of forceps they would be using etc.

As I was wheeled into theatre I was told I might be put under general anesthesia for a c section if needed.

In theatre there were about 22 people, mostly looking very serious. Obstetrician examines me says we're not going to have to do a c section...some of the staff appeared to look relieved at this, I certainly wasn't!

The forceps were a bit brutal. It was difficult for the obstetrician to get my son out. He was born quiet, but tried to cry quite soon afterwards. It was pretty scary. I think he was lucky to be okay really after being wedged for so long...and he was born with a caul so he must have been extra lucky!

I ended up having a panic attack in theatre, the anaesthetist was telling me to breathe oxygen etc. I was asking when the obs would be done stitching as I was very stressed, but the anaesthetist told me that this needed to be done correctly. I was very carefully repaired.

Afterwards a midwife told me that my son's head was at a really funny angle, unbirthable and wedged. He was a big baby for me at 5 foot 3 and he was 8 pounds 8 ounces, I had an anterior placenta and I'm quite petite framed. By the time my son was born it had been nearly 24 hours since my waters had broken, so it was a long labour. So I think it was a bit of a disaster waiting to happen, however I had no information on my added risk factors from my midwife and when I asked her if it really would be ok having a home birth towards my due date ( I was getting jitters)...I was told that I would more than likely be fine.

So did anyone else have Kiellands forceps or rotational forceps and was convinced it was the best option? Any obstetricians got a view on this?

Are there some positions that make for a bad c section? I genuinely think my obstetrician seemed like a nice man, he did come round afterwards asking if I had any questions...but I was in that much of a daze that I just thanked him profusely. I was so glad my baby was ok.

By the way my thoughts go out to anyone else who's experienced a traumatic birth and any obstetricians/ medical staff dealing with these!

When lockdown over request a debrief. I consented to c section but had keilands. Back to back 9lb 6 baby. I requested through my gp and saw a specialist midwife. Took time with me went through my notes and explained. Very helpful. Gave me a card to get in touch if I ever had a second baby. Never did.

Sounds similar to my birth.. as @Dixiechickonhols says, request a debrief. My GP suggested I did this at my 6 week check as I was still quite traumatised but hasn't happened due to lockdown etc.

I constantly worry what I would do if we had another. Recovery was slow and awful (3b tear and catheter in for 2 weeks after delivery), but caesarean isn't a walk in the park either so o don't necessarily know whether forceps was the worst of the two options. I had signed the form and was in theatre with caesarean the plan b.

Sorry that might not be very helpful but a debrief might at least make it clearer for you why certain things happened.

I had a c-section with my 9lbs back to back baby, after her heart rate kept spiking during contractions. I can’t comment on the forceps, but wanted to second the suggestion of asking for a debrief after lock down is lifted. A midwife will go through your notes with you and can help to explain the thought process behind the decisions that were made.

Very similar to my birth - she was back to back and distressed. I was prepped for an emergency c section but ended up with exactly your outcome - including the episiotomy and 2nd degree tear. Baby is 20 weeks so similar dates too! I never wrote a birth plan, I always said I wanted them to do whatever they needed to get her here safely - and they did - but it was traumatic. I ended up readmitted 13 days postpartum with sepsis from the episiotomy too, which wasn't fun!

I don't really know what the point I'm trying to make is.. Other than to say you're not alone. My partner was absolutely horrified to witness the forceps birth - at the time I was too terrified to care but they certainly don't look friendly.

Same here too. I had a horrid forceps birth with my son 8 years ago. I did get cbt for ptsd but didn’t have a debrief. I was traumatised for years. I was so scared of having to go through it all again that it took me 6 years to try for another baby. I was terrified and broke down to my midwife at first appointment. Fantastic support from there on. Referred to the consultant midwife who was amazing and supported my wish for a c section. We spent a lot of time talking about my first birth and why things had gone the way they had. My second birth didn’t go to plan either as my labour started before my c section date. I went in and still got my section. It was an amazing experience in comparison and it was healing to go through it. Some of the staff even remembered us from all those years ago.
it’s hard. It will take time. Both physically and emotionally.

My DD is 14 now. I found debrief very positive and helpful so do push for one. I had Flashbacks about birth until she was 5 or so. I was flat on back numb from neck down due to spinal (prepped for c section) but know DH at other end found it horrific to watch.

Wow...thank you all for your advice and thoughts. I had a debrief booked but it got cancelled due to Corona virus. Will chase up when over. Dixiechickonhols did the debrief help you feel like it was the right thing? I've seen other people on here say they've refused forceps, but when you're not medically trained and there's two of you to worry about it's not so simple! ELM8 I hope you do have another if that's what you want. I've been told a c section next time...seems like I might as well have had one this time. Plus I think you have to have sex to make a baby, not sure it's going to happen again! Thank you for your comments

Sideyeing I'm so sorry to hear about you getting sepsis and being readmitted. I keep reading these forceps are rare...yet you had them a similar time to me! My partner was traumatised too, I've said to him recently when he's said he can't believe I am still in so much pain...what did he think it would be like after metal tongs, and a full grown man pulling a baby out?! Lucky to have him though.

Hi OP sorry this happened to you, I had the Kiellands forceps 8 years ago and my outcome was worse than yours. I had a ‘worse than 4th degree tear’ was repaired under GA for more than 3 hours. My DS was 9 pounds 2 and back to back, he had klumpkes palsy and lasting neurological damage after a 52 hour labour. I had dual incontinence for 6 months which eventually resolved. My DS was born in a Central London teaching hospital and I was offered no ongoing care or support. I repaired myself with a Kegel8 machine but DH and I have not had a sex life since really. Maybe dtd once every two years. I was told on the day of my birth by the obstetrician to not have another child as the repairs would not hold for a subsequent pregnancy and I have listened to that advice. Mentally I was lucky and have not suffered as I totally accepted that the doctors did what they could for us and we were lucky to be alive. For me questioning their decisions or going for a debrief was pointless as it wouldn’t change the outcome. I love my DS but wish I had an NT child and I’m lucky my DH has stuck around. Good luck to you and lots of love

@queenunikitty

I am so so sorry to hear that. It sounds like your birth was incredibly mismanaged. I have no words really.

This sort of thing shouldn't be happening. I am much more fortunate than you, in terms of injuries and my son is well. I hope that things improve in maternity care so these things don't happen as often in the future. But that is not much consolation to those who are suffering now.

I understand where you're at with debrief...but it would help me because I keep reading how you should refuse forceps on the other threads and insist on c section. So I have to know. It also makes me feel guilty to think I may have put my son more at risk 😕 unintentionally. Good on your DH for honouring his vows...💐 For you too. Hold your head up high, without us women there would be no human race! I'm a bit terrible because everyone knows about my prolapse etc...I am even thinking of looking into setting up a website to increase awareness and give support, because I had no clue.

It's not the same but my best friend has had a baby and had an almost 4th degree tear. She will require a c section in the future. She saw her midwife at home, told her about the tear and how she'd had a bad time. She got no sympathy and was congratulated on the fact that she'd had a natural birth. She was not impressed ...

Kay, I'm so sorry to hear this is still happening and what you went through. You post took my straight back to my first labour over 16 years ago which was a keillands rotation, especially the bit about all the people in theatre. I'm Also 5ft 3 and petite, and my baby was back to back with her chin presenting first. Her neck could have broken. I too had ptsd and felt very angry and upset about that feeling you describe of not having any proper choice or informed consent because you're so tired and out of it. Moving city shortly after the birth meant no direct debrief, but a midwife in the new city got the notes and went through them with me and later counselling both helped. When I had my second baby, I asked for and was granted an elective section at the booking appointment. It took several years before I'd even consider a second though!
At the time I wished they'd just done a section, but with hindsight can see that there are a lot of factors for the midwives and obstetricians to weigh up, and their goal is to have a mum and baby in the best possible state, and that's why they rush in and do things that are distressing at the time. Allow yourself to grieve the Labour you thought you'd have, have the debrief and ask for any further counselling you need.
Good luck

No matter how much we sanitise it, giving birth can be brutal and dangerous for mother and baby. Congratulations on your baby and I agree that a debrief would be useful.I'm struck by how long you had remained at home for so maybe it would be useful to have the midwife at the debrief.

First of all and congratulations. And I agree with others that you should be asking for a debrief.

Same experience for me. I was in too much of a state to be making any kind of decisions during labour. I was prepped for a C Section. Baby was born in theatre with dozens of people dressed in green. DH was no use because he fainted sometime in the middle of it all. She didn't cry for ages afterwards. It was horrendous. We were both ok thank God.

It was the 1990's but I still remember it vividly. Looking back I believe I had a form of PTSD because I had flashbacks and bad dreams. I had no idea how many things could go wrong with Keilands Rotation and I've only really understood how bad it could have been for me and baby since reading about it on Mumsnet. I was black and blue for months. I had to have a catheter for a while afterwards because my bladder wouldn't work properly. I have irritable bladder now and I think the forceps were to blame.

I remember being terrified when I found out I was pregnant with DC2 and I spent the whole of my second labour in the bath at home in denial. I literally left it to the last minute before I went into hospital. She was born about 2 minutes after we got there and she literally flew out, I didn't even push. I can't even begin to tell you how different it was. In fact, I honestly think having DC2 was a kind of a cure for me - the flashbacks went away and I stopped having nightmares.

In hindsight I should have asked to speak to someone about it.
OP, if you can get someone to talk it all through with you then you should. I think it would have helped me and I have lots of questions I will never have the answer to. Not sure if a C Section would have been better or not for me. A planned one maybe but not an emergency - I don't think there was much option because my baby was well and truly stuck and they needed to get her out fast. And moving on not having a previous C Section meant I was able to have a very normal easy delivery for number 2 which massively helped me to recover mentally iyswim. I asked if I could have a planned section but was refused so it's good to know that things have moved on a bit since then.

I have a lot of mixed feelings about my forceps delivery and I do wonder sometimes why they are banned in other countries and whether hospitals force them sometimes because anything other than a c-section is seen as preferable over here.

Saying that I do have an acquaintance who is an obstetrician and for one of her births had keillands forceps which failed and she then had a c section- if an obstetrician herself was happy to put her body through them rather than straight to c-section then they can’t be completely terrible surely.

Hi Kay, it’s not common but when a baby is wedged down into the pelvis forceps can be the safest option. A caesarean in that situation also involves risk to mother and baby. Sometimes during a caesarean forceps are needed anyway for babies who are in difficult positions.

Your birth sounds very similar to my first OP. It is incredibly traumatic, made worse by the fact you're supposed to simply be greatful for the outcome and get on with it. My DH still shakes with rage talking about it four years later. Please don't beat yourself up about not refusing forceps. When you're in the zone it's incredibly difficult to do so and nigh on impossible when it's your first baby.

My poor DD still has the forceps scar on her forehead after a failed ventouse. I requested my notes through a freedom of information request and got a midwife friend to go through them with me. This helped a little but also just made me angry.

What really "healed" me was having DD2. Everything went as it should (of course this was pure luck and and I'm not recommending another baby will "heal" you!) and I felt empowered as opposed to helpless and traumatized.

for you. Be kind to yourself

My second child was forceps, I was incontinent for 6m and suffer PTSD p(diagnosed during 3rd pregnancy).

I was fully dilated and pushing for 6 hours. My midwife kept shouting at me, calling me lazy, the registrar and anaesthetist followed her lead. For 6 agonising hours, during which I begged for help, they told me that I was killing my baby as he was too far down the birth canal. They refused to do a cesarean as the baby wasn't distressed.

I have never, ever felt pain like it. The midwife slapped me when I wouldn't move on to my back mid contraction. The fetal heart rate monitor had come off and they were furious. I was staring at a screw hole on the bed, trying to ride the pain.

They didn't ask for consent, angrily wheeled me in to a small theatre room. They gave me several spinal block injections, which only worked on one side, but they didn't believe me. So the 2 nurses held up a screen and the anaesthetist pinched me aggressively with tweezers, which I felt. So after more injections, I was finally numb and the registrar held up the huge salad tongs. Horrific flashbacks of that moment even now 10 years later.

The registrar pulled so hard that I was pulled down the table. I had to be pulled back up. In the end after about 5 contractions I felt a pop inside and he came out.

The registrar immediately apologised, he was back to back, 10lb and they hadn't known that. Despite being in the hospital for over 24 hours, they hadn't felt his fontanelle or scanned to check position. I know that because after the 4 hour stitch up, the anaesthetist took the midwife and registrar in to a side room and shouted at them about it.

I just kept repeating that he was alive, because I wasn't expecting him to be after 6 hours of being told he was dying because of me. Whilst they were all in the side room I was left with the 2 nurses, 1 male, 1 female. I was traumatised and in shock. The male nurse then appraised the stitch up job, stuck his finger in me and waggled it around and said to his colleague that it had been a neat job. They laughed. I was crying still but didn't say anything.

The episiotomy cut was huge, it took ages to heal. The stitches went all the way up inside too. I didn't know where I was weeing from for ages and still get stabby pains down there.

I asked to review this hell, but they lost my notes. Given how angry the anaesthetist was I don't know how innocent this was.

3rd baby fell out. 10lb, 1 hour. I am sure that I will have ongoing issues as I get older. I don't think that I will ever get over that, so I know what you mean xxxx

DS has scars on his cheek from the forceps being the wrong way around, and a port wine stain on one side in the shape of the forceps, although I have been advised that they are not connected.

Hi 11KayBM,
Congratulations on your new baby. I'm sorry to hear that the delivery was a difficult one. As previous posters have recommended, a debrief when you can would be good. In time you will recover both physically and emotionally.

I never did a debrief and wish now that I had. I just wanted to share my experience of a late stage c-section to raise awareness of one of the complications. My DS seemed to be stuck due to an awkward head angle, I was almost fully dilated, feeling the urge to push when he became distressed and they performed an urgent c-section. As he was in the birth canal there was some difficulty getting him out, they had to work to get him breathing properly, and I had a torn incision. However the delivery was sucessful and we were both fine.

With my 2nd pregnancy, I very unexpectedly had a miscarriage at 17 weeks. I was feeling a bit tired but nothing too out of the ordinary, I remember saying to my DH that I felt heavy in my pelvic area so I took a nap, of course in hindsight these were symptoms, but I didn't know what I was looking for then. When I woke up my waters broke, my cervix had begun to open and I lost all my amniotic fluid, there was no way to save my DD. After some investigations the consultant diagnosed me with an incompetent cervix, caused almost definitely by damage to my cervix from the c-section for my DS. I'm just sharing to say there are risks with all types of deliveries. All the best to you and your family.

So sorry for what you went through. Can see you had a very specific birth presentation. That said, I honestly believe this is a women’s rights issue. Can believe women are left to labour more than 12 hours nowadays and think it should always be c section over instrumental delivery. My understanding is that some countries have massively reduced their use.

Definitely get a debrief and insist on an elective csection if you have a second baby.

There are several issues here.

I'm not sure why you were allowed to remain in the second stage of labour for 4hrs before coming into hospital. This in itself needs reviewing at your debrief.

The other thing I would add is that having a C-Section when fully dilated increases your risk of recurrent second trimester loss or preterm birth for your subsequent pregnancies due to cervical trauma or damage. Just Google 'fully dilated C section' and have a read.

Your obstetrician will have weighed up the risks v the benefits carefully before choosing how to proceed.

You should definitely ask for a debrief so you can discuss these issues. It may help with getting some closure.

Hello.
Just offering solidarity. Birth can be brutal. My first was back-to-back and born via ventouse in the end. I was shocked at the pain and brutality. My scar took 8 months to heal. I had my second 21 months later. I was terrified of birth and had debrief wholst pregnant, but found that scary and not really helpful, except to show me I did nothing wrong.
The 2nd birth was very straightforward and fast but again, I was shocked and overwhelmed by the pain. My midwife claimed a straightforward birth would heal my fear, but it didn't.
I was terrified of birth when pregnant with my third. Unfortunately she was back-to-back again, but I was in a birthing centre and there was no time for a hospital tranfer. I ended up giving birth with only gas and air and a 3rd degree tear. Transferred after the birth and stitched in hospital. Ruined pelvic floor.
I will never put myself through it again. I wish people talked about how gruesome and unnatural birth can be. I hate hearing that 'your body knows what to do'. Mine didn't. I never got an urge to push in any of my births.
Time heals. A debrief might help. Remember there are options if you ever have another, such as an elective CS. Be kind to yourself. My third was a nightmare birth, but I am confident I was well looked after, and I was extremely grateful for my life and my baby's life. Maybe a debrief might help you to understand the decisions made, and make peace with them.
Best of luck.

I am sorry that your birth experience has left your feeling traumatized, I would agree that a debrief is so important.

I have 2 children, the first was born using forceps and had post birth complications. The second birth. I won't go into other than to say the debrief enabled me to reflect from a different perspective as it was very traumatic and at the time I hated the midwives, they were brutal with me both mentally and physically. But the situation was scary, I was scared, they were scared but we both wanted the same outcome a healthy baby! I was fortunate in that my baby was eventually delivered and he recovered after 6 months of physio, however when I was discharged all the midwives knew was that no bones had broken but it was unclear if the paralysis was permanent. The debrief also gave me the opportunity to ask why they hadn't just done a c-section, but I now understand why and the additional risks that would have posed, particularly to a baby who has progressed well down the birth canal. I also found out what other options were available and feel lucky compared to some women despite the brutality of my childs birth!

I would add that I do have long term damage caused by the birth, these sadly can not be resolved.

However, my sister had a c-section and her pelvic floor is much worse than mine. I also know that I did recover much quicker both physically and mentally than my sister following both deliveries.

I hope you get the debrief, to help you move forward positively and I am sorry that so many of us have such a rough time

OP that sounds horrific. All my DCs were back to back with heads tipped back ( I have an oddly shaped pelvis) and all were born safely with not even a minor tear. In all cases I had one to one care from experienced home birth midwives and a very good hospital / consultant as back up. For DC1 we transferred to hospital 18h in so I could have an epidural to stop me wanting to push, giving DC1 a chance to rotate. If that hadn’t worked, I would have had a C section. Remaining DCs were water births at home.

Not had the forceps but did have a c section that went wrong. C section was due to baby being breech and nearly 4 years later it still pops into my head whether I should of pushed for a vaginal breech delivery. I think it's natural to have these what if moments when something traumatic has happened but we will never know if the other option would of been better. Hope the debrief helps.