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!

@RoosterPie

Exactly me too. I knew about incontinence...but prolapse, chronic pain- maybe not being able to enjoy sex? I had no idea.

Midwife told me c sections could cause breathing problems for babies. Never told me how many babies get stuck on their way out of the birth canal. I should say vagina because it's not just a birth canal. It should be a place for love and it's horrible when it's too painful to enjoy a physical relationship. I'm so sorry you are in permanent pain. I'm keeping my fingers crossed mine goes, but who knows after all it's 5 months since I had my son.
I hope you have a healing birth.

Hi Kay!

I had a Keillands forceps delivery with DD1 which left me with a 3rd degree, almost 4th year, incontinence, pain, sex was impossible for well over a year (maybe partly due to DHs insensitivity and my fear). People didn't understand, I remember leaving the hospital holding that plastic rail thing on the walls with my finger nails and the midwives at the desk saying "see you in a year!" and feeling so upset.

Anyway, DD is 11 now and even though I said I couldn't go through it again I have 2 more lovely DDs (8 +2) - both born at home without tearing or issues which, for me, was very healing. I know others have chosen C-section but this was right for me.

For 18 months I cried every day because I felt butchered. What helped me was firstly talking to a midwife friend about what happened and she just explained in simple terms why my birth went the way it did (back to back slow labour, early waters breaking, syntocin, epidural and DD1 just wedged at an angle and stuck.

I had a debrief with the hospital, a consultant and I sat down for an hour. He went through my notes and was very candid. He said in his view I should have had a section but it wasn't possible at the stage they decided on forceps because she was too low and it was riskier to pull her back up again. That helped me. He sort of said "I would have suggested a csection at this point" in my notes.

He also told me that the person who performed the rotational forceps procedure hadn't done it before but they had done it on me under supervision. I struggled with that for a long time but made my peace with it eventually. I guess they all have to learn and there wasnt a suggestion that he did anything wrong.

I had surgery when DD1 was 7 months for incontinence, an injection of filler into what was left of my anal sphincter (they had missed some of the tear at the birth which caused me problems). Turns out that was experimental too and some of it migrated into my vagina causing me pain there. Same hospital. I couldn't cope anymore and we moved away from that city to be nearer family on the other side of the country. I got a new consultant who told me 7 months post birth was too early for any repair surgery because it takes the body about 2 years to recover from even a straight forward birth.

However, all these years on I am fine. No pain, no continence issues, normal sex life. And it hasnt taken 11 years to get there, it was gradual. Things are intense in the first year post birth even when birth is breezy so don't extrapolate how you feel now out for the rest of your life. I know that's hard because you feel so different to how you did before you had a baby but it does get better I promise.

Sorry for the huge reply. I'm always happy to listen or chat more if you need to x

hulla It sounds horrific but good you were able to have two better births and a fantastic outcome you are not having any issues now.
Your line about early waters breaking, back to back, syntocin, epidural was exactly my experience. Glad you are ok now.

I’m glad you’re better and got a debrief hulla - my experience was exactly the same in terms of the run up but had the mid cavity forceps.

TMI warning....

When having sex it feels like a poo will come out and even that his willy will come out of my anus🙈I have even wondered for a split second if he’s gone for anal (never done it) accidentally as the wall between my birth canal and rectum is so weak - anyone else?!?

Thanks Dixie, I think that's a really common cascade of events if back to back babies.

My 2nd 2 babies were both back to back but turned eventually - bit quicker that my first. I think it's just my shape and how they fit best. But the labours were quicker and they both rotated. I'm sure DD1 would have done the same but I was in slow labour for days and exhausted.

I found Katy Bowen's work on pelvic floor health wonderful, she very much recommends squatting which I did for years after DD2 was born and I felt like it helped, I can bounce on a trampoline without problem now . I'd recommend her blog, I'll try and find a link.

Sorry to hear you had such a traumatic experience. I really recommened the debrief. I also had a very traumatic birth and the debrief really helped me. I had an emergency c section after 40 hours of labour with a back to back baby. It was incredibly scary for my husband to watch. I had a severe pph and sepsis and I had a long hospital stay and difficult recovery. I dont know what would have been
best option in circumstances but a c section especially an emergency c section can be very risky.

I always wondered why I had a back to back baby. I’m very “straight up and down”-no childbearing hips here and my DD got stuck and I had pprom I think it’s called

@Siameasy errrrr....yup. With you there

@hulla thank you for taking the time to go through your experience. It sounds like we all had a similar labour experience, I didn't have the epidural. But did have early waters breaking, back labour and slow second stage labour at least.

@LeekPeachPlum that sounds horrific. You had a horrible experience. That must have been very scary for you and your family.

I can't help but wonder though if the signs of a poor position are there- why none of us got sections earlier? I certainly would rather have transferred to hospital earlier had I known. I think there's a lot of improvements required in maternity care by the sounds of it!

I wasn’t given a choice with DC1. He had shoulder dystocia which was discovered incredibly late, I’d got to pushing stage when they realised he was stuck and just couldn’t get out. His heart rate was thankfully strong throughout so they weren’t as worried but they only said a CS would be used as a back up if the forceps failed. I definitely don’t recall a conversation about forceps v c section, just remember them saying CS was last resort.

Found the forceps fairly traumatic, DS was born with a fairly large cut just below his eye and I always wonder what damage could have been done had they caught his actual eye. I had an extended episiotomy so they cut right into my butt cheek to get him out. The stitches split open a week or so PP too and got infected, absolute agony.

This was a decade ago so memory probably hazy but that is what I recall. I’m guessing they considered forceps safer because he was already in the birth canal (or at least his head was) with right shoulder stuck in pelvis. I’d personally have preferred a CS.

Hi OP, similar tale here, rotational forceps unexpectedly when I was taken to theatre and was sort of expecting a C section. 3rd degree tear and episiotomy.

I had a debrief within a couple of weeks as I was so distressed but I didn't find it helpful as my mind wasn't clear enough and I felt like it was simply a legal process, quite cold, as a means so that I wouldn't put in a formal complaint (long story I won't go into about what led me to having the forceps).

I had counselling when ttc DC2 with a counsellor who specialised in birth trauma (free through my work employee assistance). She helped me plan how to ask for a C section, and a second debrief which I did.

The second debrief was brilliant, much easier to understand why the forceps had safest option at the time (too far down birth canal), position of baby, why consultant had taken over pulling when first doctor couldn't get baby out etc.. Helped me make my peace with it. So perhaps slight delay not a bad thing for you?

I asked for section at my first midwife appointment. Saw consultant on same day as my second scan, there was absolutely no issue with a section once they'd explained the risks, signed off on that plan that day, so I could enjoy the rest of my pregnancy. Section was fine, had a lovely birth, totally different to my first. Recovery took a while and 3 years later I still have pain in my scar, tender to touch, can't have kids climb on me etc. But small price to pay, my vagina has never been the same from first birth, I have nerve damage so get pain sitting on hard surfaces and during sex and an orgasm (sorry tmi!) doesn't feel as good as it used to, so it has affected our sex life massively.

I did a bit of physio after birth, but didn't properly commit to it so maybe consider your options there and press for more support.

Hi OP, what an awful experience you had.

I had a long, back to back labour with a big baby. Ended up pushing for a long time and she was getting distressed. I had stated on my birth preferences I would rather proceed to a c section than have forceps, and they checked with me at the time. I was insistent I did not want forceps, and they respected that.

The c section was difficult as DD was partially in the birth canal. They had to sort of push her back up, and they struggled to get her out. She needed to be resuscitated when she was born, and was black & blue from the struggle. I recall having to grip the table as it was rocking so much with them trying to get her out.

They ended up having to do a different type of incision to get her out too. My recovery was rough at first - it was incredibly painful, and I couldn’t move at all for 2 days. We were in hospital for a week. It was an awful experience but thankfully I have no long term effects from it at all, so I do feel it was preferable to forceps.

Sorry you went through such a traumatic time OP. When you are in the blur of labour it's normal to just go with what the medical professionals tell you, so you shouldn't feel guilty. I had an emergency c section with my eldest due to a failed induction. At one point they were talking about forceps and I had to sign a form agreeing to an instrumental birth or a c section. I tried to say that I did not consent to an instrumental birth but I was basically told by the nurse I had to sign the form consenting to it for the safety of the baby. Luckily for me the consultant decided on a c section straightaway. But my point is even if you had protested against an instrumental birth you might have been railroaded into it anyway. Agree with pp a debrief might be useful with both the hospital and your homebirth team.-

@umnoway yes I wasn't presented with a choice. I was told what was going to happen and no one asked me how I felt. I was told they may have to put me under for a c section on the way to theatre. Unfortunately I wasn't well enough informed before giving birth and didn't understand the different types of forceps or whether a c section was safe to do at that point...

@Blacksideupanddownagain I'm with you on the vagina changes. Butchered is the word I see a bit on mumsnet...feels appropriate for me.
Yes I really am desperate for a debrief. It sounds like yours helped.

@Sipperskipper

if only I'd had that on my birth plan! But then my midwife asked me about forceps and I said there's not an alternative is there? She never answered so I always assumed that when baby was low, it was too late for c section. It does sound like a rough c section though! This is same midwife who congratulated my traumatised friend with a 3c tear on having a natural birth...if only we hadn't been due so close together, hearing that would have made me much more distrustful!

Mine was 8lb 8oz too and direct OP. They attempted Kiellands but were unable to rotate him so delivered him OP with Neville Barnes forceps instead. I had an episiotomy and a 3rd degree tear plus a postpartum haemorrhage and he was a bit shocked but we both recovered ok.

I did not want a CS instead of forceps as I knew his head was low and he was probably pretty wedged after several hours of pushing so CS would have been risky for both of us. I was glad the consultant was willing to go ahead with forceps.

@ceibatree

Glad everything worked out for you. Railroaded... I'm sure that happens a lot. Like you I was terrified about the baby too and it's hard when you're in that situation with very little knowledge to know whether you should be kicking up a fuss and refusing or what. I mean I didn't know if a c section was going to be life threatening under the circumstances or anything, sounds naive but I know there's a usually a big difference between planned and emergency ops. Thank you for your kind words! No one wants forceps I think

No forceps but ventouse and 3c tear here. I didn't feel like I had much choice - how can you really, unless you are a midwife yourself, you just have to trust them. It's hard. I've made my peace with what happened, by realising that there are inherent risks involved with giving birth. Women ought to be much better informed. It would make it much easier to come to terms with things that go wrong, rather than feeling somehow cheated of the problem free birth.
As a general point, 5 months is early and things can definitely still improve in terms of both pain and function. Do push for physio and further treatment though, if necessary, it can make a huge difference.

Just to say as well- I think we all deserve some flowers because it truly is terrifying when your baby gets stuck. There's no good way to get them out at that point maybe? and some of us, probably have different views on what we'd prefer. Thank you for sharing your stories and thoughts 💐

DS1 long labour, 2 hours of pushing, failed ventouse, EMCS. He was back to back. He ended up briefly in NICU for several hours of obs, I ended up on HDU with symptoms of pre-eclampsia.
The whole thing felt wildly out of control and comprehension. He was spontaneously born a little early, right in the pre-Christmas surge. I was labouring in agony in a waiting room for an hour just to get into labour ward, and had already had regular contractions for over 24 hours by then.

So DS2 was the lovely VBAC to set the record straight... all went pretty well until the MW began struggling with his heart rate, was it position? Was it uterine rupture? So the big red button was pressed and it was back to theatre for another EMCS... except it did end up being forceps as he was about the point of no return and back to back. He came out on about my final attempt at being allowed to push. No idea what forceps were used, but the poor thing had a very purple forehead the next day. I ended up with a 3rd degree tear and shitting in the shower for the next month. I did not leave the house, and the aggravtion to SPD that had already had me on crutches meant some days I had to crawl up the stairs.
(You can guess how excited I was about the prospect of lockdown and such happy memories of being stuck in )

I had a check-up 3 months later due to the tear and asked about forceps vs CS, given that CS was initially mentioned, and was told with DS's position, it would have been rough anyway. If I had a 3rd (which I have no plans to volunteer for because 2 is frankly enough palaver for life) I would have an open choice of ELCS or VBAC given my history and difficult experiences either way. I'd go ELCS these days although early on part of me might have been stupid to try 3rd time lucky at breathing a baby out. I absolutely would not volunteer to labour with SPD for a 3rd time.

@Worriedmum54321

That sounds really horrible. How are you doing? My friend had a 3c tear and didn't know it could happen- but thankfully she is ok. You're right we should be better informed. I do feel guilty though for signing a form for such a risky forceps procedure without knowing about the risks involved. Turning the baby with forceps doesn't sound good.
Really hope they did a good job with your repair after such a bad tear

BogRollBOGOF

You've had two rough births there. I guess the EMCS was rough. The vbac wasn't what you hope for clearly and very traumatic. If you do have another...it sounds like you'd have an elcs then? Hope you've recovered well from your tear

Congratulations on your baby. Sorry you had a horrible time. Hope you get your debrief and make peace with it.
I had a forceps delivery with DD2, DD1 was an emergency section. I didn't even know there were different kinds of forceps until now but she was back to back so presume rotational forceps.
It was hideous, had a huge episiotomy. Lost lots of blood, they lost my bloods but discharged me as I looked fine but when they found one they wanted me back in for a transfusion which I refused, took lots of iron tablets and ate steak and spinach to get my levels back up. Physically, I didn't feel back to normal for 12-18 months maybe. Give your body time, keep doing your kegels. Your body will heal in time and your memory of the trauma will fade. Birth can be horrendous and it's not talked about enough, I think mostly women want to forget and don't want to upset other women with their horrific birth stories. Both of mine were terrible! The outcome outweighs that though ultimately. Wishing you lots of luck with your recovery