Birth "plan" / consultants advice

[bumperella]

I have a medical condition which means I MAY have weak blood vessels in my brain (cerebral AVM's - the condition is called hereditary haemorrghagic tenegianctasia). Labour can make them more likely to rupture (the pushing strains them).
A cesarian is not a particularly safe option because I could have these dodgy blood vessels in the pelvis area, so could loose huge amounts of blood.

The upshot is that the consultant wants to make sure the active, pushing stage of labour is kept as short as possible, by giving me an epidural (I'm terrified of needles), and forceps ("as soon as the head is within reach"). Does this mean that I am gauranteed to need a huge episiotomy? The whole thing sounds horrific. I'm 23 weeks pregnant.

• Am I over-reacting?
• How horrific will an epi be?
• How barbaric are forceps used as early as possible?

I would rather people were brutally honest than I waited and found out at the time.

I have no health problems so planned a lovely active birth. But....v large baby in distress, unbearable pain = epidural and forceps and large episiotomy. Pre birth this would have been my worst nightmare BUT in labour the epidural was wonderful, you don't see any needles and I felt no pain when they put it in, the episiotomy healed quickly and fine and the forceps bit just helped baby out quick. When your baby is at risk you honestly don't care what they use to get him/her out! So believe me in labour the things you worry about disappear and are not as bad as you think. I was terrified of an epidural and it was fantastic! Good luck, you'll be fine.

Ps you will likely need an episiotomy if they use forceps but as I said it is not as bad as you think it will be,

Oh you will need a catheter in your hand for fluids if you have an epidural (expect you would have one in anyway given your health issues) so you will see a needle then but trust me, in labour you won't really notice it going in.

I think in your case the risks to you are too important to not take his advice. My understanding is that the horror stories you hear about forcep deliveries happen when they are done as a matter of emergency and therefore often "rushed" so episiotmy is messy etc etc. If it is planned, hopefully the obs performing the delivery will have lots of experience with assisted deliveries (this reduces the risk of complications - experienced phys) and they will take their time and be careful etc. I have no experience of forceps myself but I know of people who have had them with no lasting damage. And yes I believe an episiotomy is pretty much always necessary with forceps. But lots of people tear anyway, and some argue an episiotomy heals better as it is a neat incision. And you won't be in pain as you will have had the epidural. Hope it goes well for you. x

Well hold on, an epidural and related immobility is known to lengthen the pushing stage so I am much confused by his logic! And an episiotomy and forceps can bleed just as much (if not more) than a section wound. I would take a bit of time to think about a physiological labour and birth where you can let your body tell you to push or not, women who birth naturally do not have to do the forced pushing that comes with an epidural.
If this is not an option I would go for a section (where you will be in theatre, with 4 units of cross matched blood and the full team available) if they are so worried about haemhorrage.

I had epidural, high forceps and large episiotomy and the thought of it beforehand would have been the last thing I wanted but it was broadly fine. I certainly wouldn't call it barbaric, the episiotomy wasn't horrific - much neater scar and healed quicker than my tear 2nd time round. If you're scared of needles you might even find the epidural easier than blood tests or whatever as you can't see what they're doing. The forceps delivery left me feeling uncomfortable and a bit weak for a while but I had a really long labour too so that can't have helped.

The thing I wished I'd realised is they don't actually leave the needle in your back with the epidural, it's a very thin flexible plastic tube that stays in there, so I spent a couple of hours terrified of something that wasn't there!

Good luck!

i would take your consultants advice. There are some pretty heavy duty arteries in the pelvic area, so if they think its safer to deliver vaginally I would trust them. Dont worry about the epi, you wont even see or feel much at all.

Thanks all.
The consultants plan is to speed the whole process up AND minimise my pushing. Am not sure how this could happen without medical intervention! In fact, I don't get how this would happen pre-forceps-stage. I have to confess that I'm with reikizen in that I don't see how an epidural would speed the process up, - is there something they would give me that would increase contraction strength or something? The consultant did say that I wouldn't be able to cope without good pain relief. To be honest I was a bit shell-shocked so didn't ask all the questions I should ahve done, but am seeing her again.
The issue re: bleeding is where I could have these dodgy blood vessels. I don't have blood clotting issues or any other health problems or anything like that - I don't even have any real symptoms of the HHT (red dots on my skin and occasional nosebleeds), so I do find it difficult to accept the level of medical intervention which childbirth seems to entail for me. However, all the advice does point the same way and am sure the cnsultant really does know what she's doing.

Could you ask them next time how they are planning to speed things up? Yes there are things they can do, if you are induced and things are going slowly they often give a syntocinon (?sp) drip - tis a hormone to speed things up, but it is known to often make them more painful too, this may be what she was thinking of? (I had this too - slow induction - again not my plan but have to say the epidural made it all very manageable.) I guess they will also have bloods on hand anyway in case of post-partum haemorrhage and / or emergency section?

I will ask about syntocinon, thanks! I thought I vaguely remembered having read something... somwhere... and it could well be this that I'm thinking of.

Can anyone tell me about how long would an episiotomy take to heal /how painful afterwards?
lucybrad - I x-posted with you, but your explanation that there are major pelvic arteries this explains to me why excessive bleeding after c-section makes it less safe - thanks. I would prefer to have a pelvic bleed than a brain one, but it sounds like neither will happen!

I had an epidural and forceps delivery about 11 days ago as the baby had a big head and I'd been in labour for ages.

The epidural was heaven. I hate anyone touching my spine but by that point it was such a relief. Just breath deeply throughout and think of other things.

A consultant delivered the baby using forceps once it was low - this was actually a relief after all the pushing and he hardly had to go in at all as I'd done so much pushing already. It was more just a little help at the end. Look away when the forceps appear would be my advice, and when you feel the baby's head and body emerge soon afterwards you won't mind at all.

I had a second-degree tear which he stitched really well - he was giving a lesson at the same time (teaching hospital) and so did it all very carefully and by the books. It's now healing well, just follow all the advice they give you for looking after the stitches and take all the pain relief. So don't assume you'll have an episiotomy.

My biggest fears were forceps, tearing and epidurals. I got all three but because he was so experienced it turned out OK. Good luck!

I had an epidural, epi and Keillands Forceps delivery.

Epidural - didn't exactly enjoy getting it done, but it was absolutely nothing compared to the contractions. Plus the effect was heavenly within less than ten minutes.

Episiotomy - didn't even know it had been done, as the spinal block was total. Healed perfectly, no pain, you would never know it had been done (apparently )

Forceps - again, felt nothing due to the spinal block. There was not a single mark on my daughter from them either, so I am not concerned by their use in the way that a lot of people are.

Hope that helped

Thanks all. I was really freaked out at how "medical" it was all going to be, with various folk doing unmentionably grim things to my nether regions! I am really reassured now.
I will ask consultant about epidurals slowing down labour and syntocinon. It's the red-faced-bursting-bloodvessels straining which she's wanting to avoid, and am guessing that if I can't feel when to push then this will be avoided - but does that make any sense?

With a rare medical condition like this, I don't think you ought to be taking 'advice' or reassurances from a parenting message board. Don't get me wrong, I am a die-hard, long time poster of MN - under my Christmas name (since 04) but most posters cannot be of any useful help to you, me included.

If I were you, I would get in touch with AIMS, www.aims.org.uk for further qualified, independent and supportive of you evidence based information.

the mention of things like syntocinon really worries me. From how I know syntocinon works, it will put a strain on your blood pressure which may increase you likelihood of some of the same things that supposedly they are trying to avoid.

Episiotomy and forceps, I dunno. I may be speaking out my arse end here but from what I have read, the approach the transition is the most intense physically and mentally and therefore more likely to put a strain on your blood pressure, and the so called pushing stage not so bad at all, especially if a woman is encouraged to give birth in positions that suit her ie, not lying down which coincidentally seems the most preferred in hospitals.

A friend of mine who gave birth in Norway last month had acupuncture, given by the midwives. I should think that is a fab way for keeping a woman's blood pressure down as the later stages of labour approaches. Also, consider natal hypnotherapy which is self hypnosis.

You may think those two proposals are all airy fairy and lentil weaving but irregardless of what your philosophies are, please please please visit the AIMS website and give them a call as your situation is very unique.

If you have the money consider an independent midwife or experienced doula who can also advocate on your behalf with the hospital.

having an epidural will lower your blood pressure significantly.

Really I wanted to find out what it was like to have an epidural, forceps, episiotomy, etc, rather than to find out wether people thought I should have them. I totally agree re: medical advice off internet, though I have found the information on (eg) syntocin very useful. Also I'm really glad to hear that episiotomies etc are not as barbaric as they sound - I think sometimes personal experience stories really help as the medical facts don't really tell you much in the way of pain and horror !

Thanks for the link to AIMS, I will definitely have a look at that later, it seems like it could be exactly what I need!

As an aside, the risk isn't high blood pressure as such, the risk is bursting a malformed blood vessel which COULD happen by excess "straining" (horrible expression!). There's no particular concern with high blood pressure and HHT, so taking a drug that increased blood pressure would really be an issue from that perspective.

with my second there was no need to strain or even push. She was out without even pushing.

ergonomically birthing positions have a lot to say for themselves.

have you read any books which look at birth as a normal physiological process? if not one may inform you of some of the questions you may need to ask anyone, not just your consultant.