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!

I had a forceps assisted delivery with my eldest (who’s now in her late teens), it was used after a failed attempt at a vacuum delivery (think that’s what the suction one is called).

I also had a slight prolapse afterwards, do your pelvic floor exercises religiously. And I was temporarily incontinent which was a massive shock as nobody had told me that would happen. Thankfully it only lasted a short while.

I did have awful nightmares and flashbacks that I was still in labour and trying to push my baby out for weeks afterwards. Was very traumatic.

My DC was born with her chord wrapped around her neck and she was blue when she came out and completely silent (I didn’t know this at the time), I was really distressed at not hearing my baby cry and a team of medical people suddenly rushing into the room. I was stitched up by the doctor who delivered the baby and he took ages also, but I think that meant he did a very careful and good job.

Recovery for me was hard, my stitches got infected, but worse was I then haemorrhaged a few days afterwards, as a part of the placenta was left inside me. I was blue lighted back to hospital.

That DC is thriving and now taller than me and I had more dc afterwards. And I’m not incontinent thankfully ( can’t reiterate enough do pelvic floor exercises).

In my case they opted for a forceps assisted delivery as I had been in labour too long, baby was far too low down.

I hope you’re recovery goes well, talk about your birth, maybe ask for your notes so you get a better idea of what happened.

Congratulations on your new baby xx

KayBM congratulations on the birth of your baby.

Your experience sounds horrific, much like the many stories here on this page. I experienced a traumatic birth too and required stitches in theatre. I remained in hospital for a week and, same as you, I was just so profusely grateful that DS was healthy that I didn't really understand the toll it had all taken on me! Thankfully my 3rd degree tear healed OK, but incontinence was always a great fear in the back of my mind.

We always wanted a second child and when the time came for hospital appointments to start, it was quickly apparent that I was deeply traumatised from the first time around.

My consultant organised for me to have a debrief with the Lead Midwife and she was just fantastically brilliant. We went through the notes almost minute by minute and she was explaining in detail what was happening with DS and what was happening with me at each stage. Then she explained why particular decisions were made at what point and the reason/impact these decisions had.

Finally, she discussed how the 2nd birth would differ from the first (both were an induction, first was very heavily medicalised and second wouldn't necessarily be, now they could offer wireless monitoring, etc, etc) and she also gave strategies that the midwives/doctors would use for the second birth in order to minimise the chance of repeating the tear (which they actually did, and I didn't tear as badly the 2nd time around).

It was totally worth it and really made a huge difference to my mindset! I'd definitely recommend that you pursue a debrief when you get the chance.

Good luck!

I have to know. It also makes me feel guilty to think I may have put my son more at risk

Just remember OP, you listened to what the medical experts advised you to do at the time. They were there on the day weighing up all the possible outcomes and risks, so you absolutely didn't put your son more at risk by choosing to listen to them. I hope a debrief, when you get it, can reassure you of this. I personally refused forceps in my birth and was made to feel (by the midwives) like I was endangering my baby by doing so. I stuck to my guns and the consultant who made the final call didn't try to sway me or make me feel like I was making a bad decision. Ultimately, if the Drs thought forceps were the best option in your case then there's a reason for that. C section also carries huge risks, particularly if baby was in a difficult position.

I requested my notes through a freedom of information request

Mentioned by a PP, if you decide to do this then make a 'subject access request' not a FOI request. FOI is releasing information to the world at large, unlike SAR where you release data to the person it's about. Just to make it clear to the hospital what you're asking for

Best of luck with everything

I’m sorry it sounds like a really stressful experience and I hope you can access a debriefing service once Covid has calmed down.

Doing a caesarean in this situation would likely be category 1 (meaning the baby has to be delivered very quickly). This increases all the risks of a caesarean, particularly the risk of bleeding very heavily or causing damage to other internal organs on entry. If your baby was very low then they may have needed a doctor/midwife to do a vaginal examination during the caesarean to dislodge baby’s head for the obstetrician to deliver them. This can be traumatic for the baby and also cause them to be shocked when they’re born. In addition to this, doctors are reluctant to perform a caesarean when another delivery method is available and looks likely to be successful, because putting a scar on the uterus can lead to complications in future pregnancies (stillbirth and uterine rupture) and the options you have in those pregnancies.

Having said all of that, rotational forceps are no walk in the park. They can cause pretty awful damage and are often a traumatic experience. It’s one of those parts of birth that is still unpredictable and unclear which route is best.

I hope that helps in understanding a bit of the thought process that goes behind it, but there isn’t a clear answer unfortunately and I think a debrief would be great.

Hi op

Will admit I've not RTFT as i have have no experience with forceps. So I'm not any help with the psychological side and whether it was the best course of action. I've had two births without forceps and I was still left with a double 2nd degree tear (on both) and a double prolapse.

Certainly not defending the use of forceps, on my birth plan it simply said no forceps. Just that some of the physical issues are a risk in any birth.

I hope you get the answers you seek.

There's too many posts on here for me to adequately reply too. But I am so grateful for all your comments.

I wish there was more information on this for pregnant women! I had to beg to get on an antenatal class and was 37 weeks and nothing was really covered about what could go wrong.

There are so many of you with so many difficult births and for those of you who did it again, my hat goes off to you! You must be very very brave. 💐 For all of you

@Spoons1987

Thank you for explaining that. My thinking at the time was there was likely to be a chance of trauma to the baby whatever way he came out. But I did think there was more bleeding risk with a c section and that if they were trying to get the baby out and struggling, that with a bleed say it could be catastrophic for me and the baby.

I'm not particularly bothered about other pregnancies...I thought it would probably just be the one anyway. You may ask why did I not have a planned section then? Well I didn't know about prolapse or chronic pain etc that could be caused from birth. Nor was I aware how many babies could get stuck.
Sounds naive but birth issues and postnatal health isn't discussed much and I think it's disgusting that it isn't. Not least of which because it might help women make informed choices.

Could the NHS cope if more women had planned caesareans...maybe not straight away. But I think women would still by and large choose vaginal birth. There would probably be a greater pressure on current practices however to minimise trauma. My friend who has had nearly a 4th degree tear was poorly coached by her midwife, were there more awareness about women's health she would have been more aware and looking up techniques herself to minimise trauma. To be honest my friend didn't know such a thing could happen! There would also be more pressure on labour management techniques to improve. It will never be foolproof but there would be more pressure for change and women wouldn't feel embarrassment about post birth bodies.

I had Keilland’s just over 30 years ago at the end of 32 hours on delivery suite. So out of it by then but still very traumatic for me and for my husband who has never forgotten the consultant sloshing in his white wellies in my blood at the end of the bed. Took ages for the ache to go. Had c section 2 years later which was absolutely a breeze both at the time and on recovery. After the forceps I was told how lucky I was that the doc had managed to deliver that way so I avoided a section, but after experiencing both I know which I would prefer. All these years later I still feel sad to have been denied the “natural” births I had hoped for.

OP I'm so sorry you had such a difficult time.
My ds was induced just before 40 weeks because he was small for dates.
I was given the pessary and put in an antenatal ward. After about 6 hours I was seen by a midwife and told her I was in quite a lot of pain but she didn't think I was in active labour so gave me some paracetamol. A couple of hours later I went to get her as I had the urge to push and when she examined me she found I was fully dilated so rushed me down to the labour ward.
I was the examined and they found my ds was back to back and in distress so advised forceps in surgery in case they failed and they had to go for a section.
Thankfully we lived quite near the hospital and my dh got there in time.
It was brutal and my dh was traumatised from watching it.
My stitches then ruptured a few days later and I was left to heal- slowly!

I had ds2 a few years later and it was a totally different experience- a few hours of labour then 6 minutes of pushing and he was out. It was a fantastic experience. I know you are not sure about having a second but just wanted you to know that things may be very different if you do x

I had a kiellands delivery nearly 18 years ago. Fortunately for me, I didn't realise until several years later that it could have been disastrous, and both baby and I were fine. I didn't have any more children, I didn't really want any more anyway, but I did have in the back of my mind that I wasn't very good at giving birth and it was better to quit while I was ahead.

I did my final year law degree dissertation on defensive medicine, focussing particularly on birth processes. On the back of the research at the time, the only stipulation I had in my birth plan 15 years later was no forceps. Statistically higher risk than all other forms of birth.

@rockofages

Yes I think we forget how traumatic it is for the men too. My partner had been married previously and both his other two children were born at home so it was a shock for him. Yes I think I would have preferred a section but in the moment I don't believe either option was without some considerable risk.

Congratulations on having another baby and a much easier recovery from the section

ChazP well done on being so informed. If I'd had that in my birth plan things might have gone very different. Having said that there's a chance they could have gone so much worse...we'll never know. Hope you had a calm birth.

There wasn't much on either of my birth plans for both DC.

Except, I DO NOT CONSENT TO KEILLANDS FORCEPS. PROCEED TO C SECTION.

When I had dd 13 years ago she was back to back and I was an older mum with gestational diabetes. After 6 hrs of being told it wouldn't be long the consultant was wheeled in and smiling told me he would use his 'special forceps' (keilland). Dd was born at 37 weeks weighing 8lbs 6 with big bruised rings on the side of her head.
I fortunately dont have incontinence but a prolapse makes it difficult to go to the loo. At no point did anyone ask if I was ok with this or anything explained.

Oh also to add- I was only 20 when I had my forceps delivery and when I did some more in-depth reading I found that a lot of the risks of incontinence etc were far lower for my age group than the main statistics you see.

I also had a very smooth, straightforward VB for my second baby with no stitches at all- this may not have been the case if I’d been attempting a vbac. So I do wonder if my age and the fact it was my first baby was taken into account when the decision was.

I do think women need to more information antenatally though and more involvement in the decision-making, like a lot of women on this thread the decision was pretty much made for me by other people.

Yes debrief helped me understand why. Overall she was just very kind and reassuring. Felt listened too not that I should be grateful we were both alive and ignore the trauma. Do think about DH too mine recalls a slops bucket of blood obviously I didn’t see that bit but must be traumatic for them to witness and be helpless. I was grateful I didn’t have section as DD had health issues and I could go with her for the tests and scans she needed in few days after her birth. Definitely recommend a debrief. Best wishes.

I'm pregnant with my second after kielland forceps with my first. I have only recently learnt that they are used as its quicker to get the baby out then a c section and there is risk to life. Essentially at that point the doctors don't care about the long term effects to your body. This is fine but my biggest grievance is the lack of support for women who have had this procedure. I ended up going privately for help as I was just fobbed off by the NHS. However now I am pregnant again when any health professional asks me about my first deliver they recoil in horror when I mention kiellands and tell me how brutal they are!

@maralb

That's interesting to hear. At the moment- I don't feel committed to say what I believe is right in that situation. I've read studies suggesting that these forceps are more traumatic. However, that's only what I have read since and I'm not medically trained.

We have nothing to be ashamed of body wise...we went with medical advice at the time and did what we thought was best. Be proud of yourself!

Yes every medical professional I have talked to recoils in horror.

I tell everyone I know about what happened and warn pregnant women, as nicely as possible that things don't necessarily work out as you want. I'm not trying to scaremonger but I don't want people to feel bad if it goes wrong. Also I think it would be great if women didn't feel any embarrassment about their post birth bodies. Easier said than done... psychologically it is hard. I don't know if you like me feel violated by the rather vulnerable nature of such a traumatic birth, forceps and an obs hand up you etc. The removal of my placenta was particularly awful...

You know it can be really hard to get support. I hope you're feeling a lot better about things and looking forward to meeting your second child.
Hope your upcoming birth goes much much better for you!

Hi your experience sounds really upsetting. I had forceps for a back to back baby but they were the mid-cavity ones plus episiotomy second degrees so probably not as bad?
However I’m afraid my pelvic floor still isn’t right (I strongly suspect a rectocele but was told there’s nothing wrong just need to do Kegels) and DD is 5.
At 6 months I wasn’t confident about my bowel continence and even when I went back to work at a year it was a case of if I need to go to the loo (no.2) I must go RIGHT NOW there was no warning. It was terrible.

I was a nearly 12lb first baby... my mum ended up with episiotomies and 4th degree tear. I had to be turned, as was also stuck, ended up with forceps (not sure what kind), concerns over oxygen deprivation (luckily seem to be OK!) and big scar on my cheek / tissue damage. Fixed face when I was older, plastic surgery. Mum ended up needing re-stitched 20 odd years later as well as they'd not stitched her up properly.

My own first was measuring 7 wks ahead in growth scans, came a week early and still 10lbs plus, we clearly just breed big 'uns (I'm not that big myself fairly average!). I opted for a c-section after taking a lot of time to read up on it and taking my own individual risks into account (also have compromised pelvis, joint issues etc). Found out when first saw my DD they'd used forceps during c-section!!! Accepted it had obviously been needed but was horrified as I'd never even considered they were an option with a section and my own experience with them was traumatic.

Every birth is unique, every option to get little one out carries risks for both of you. It's really you and your consultant who can assess your personalised risk, generalising option A versus option B isn't possible as so many factors involved. What's right for one person may be totally wrong for another. Never let anyone make you feel pressurised into taking an option you're not comfortable with (unless it's emergency situation in which case you're obviously given medical advice to follow).

Due my second beginning of August... another planned section for me.

So sorry to hear of all of your scary birth stories. Hope you are being given good aftercare and support and not just left with the old 'this is normal and you should just accept how you've been left' approach...

OP, I'm sorry you had such a terrible experience.

The impression I got when I was obsessively reading about worst-case scenarios and birth blogs, way back when, was that if you had the luxury of time to prepare and choose, like six months, you should pick a caesarean. However, when births go wrong, there isn't always going to be time to perform a c-section.

When my second child was born, his heart-rate was dipping, and the implication in the room was that it would be episiotomy and so on if he wasn't out in the next few pushes. There absolutely wouldn't have been time to shove him back up for a caesarean.

I hope you can get a personal birth debrief of what actually happened in your situation and what, if anything, could have been done to change it.

DD2 was so well wedged that the only way to get her out was forceps. I had signed the consent form for a section. The doctor said that in his opinion, a section would have been far more likely to result in her death and my having a PPH - I'm a very matter of fact person, so I asked why and not to worry about upsetting me 'because the position she was in made it likely I'd have pulled her head off trying to get her out'.

She was 9lb 10oz.

Their worry was probably compounded by the knowledge that you were coming in from a home birth and, as told to me when I was booked in for a section for DD1 (breech, 7lb 11oz and I was very slightly built), their greatest fear is dealing with somebody who has come in during second stage, the baby is too far down for section but too stuck for delivery and the placenta covers exactly where they need to make an incision.

Having said all of that, rotational forceps are no walk in the park

Possibly the greatest understatement ever made on MN!

OP, I had mid cavity forceps and am left in permanent pain. I am having a caesarean this time and having had the risks explained to me at length by my obstetrician, I am astonished anyone prefers the risk profile of a VB. like you, I had no idea of the risks of a VB and just accepted the advice from professionals that it is better.

@Siameasy
Please try to get referred to a women's physio if you think it would help. I think there's a lot they can do. But unfortunately prolapse is something that's got to be managed rather than cured. My physio said it's hard to know what will happen in terms of progression etc.

@lynzpynz
well done on doing your research and planning sections which were obviously right for you. Big babies indeed!

Your poor mum! I wish mine had been a bit more upfront with me about things, I'd have probably had a planned c section myself.

Yes I have seen since that they use forceps in c sections sometimes. I think even in planned sections babies can be a bit wedged.