When would forceps be the only option?

[Slanted]

I'm trying to write my birth plan, and would appreciate it if anyone could tell me under which circumstances intervention with forceps or ventouse would become the only option.

I wish to avoid both, and would rather go straight to caesarean if possible, but I imagine that it could sometimes be too late to do so and the use of forceps/ventouse would be necessary? Is that the case, or is there always enough time to know that intervention will be required and to request a caesarean instead?

(I'm slightly confused about all this, as I do know of many cases where forceps have failed and there has still been time to go to caesarean.)

It can be too late for a CS to be the safest thing for the baby.

If forceps fails then a CS would be the next step, but that is then at higher risk to the baby then if the forceps had worked.

Shoulder dystocia - when the head is already born but the shoulders are wedged. Requires the 'McRoberts procedure' too, which is a certain way pressur is applied by the midwife while the doctor uses forceps.

The idea of ventouse/forceps/tearing/episiotomies terrified me when I was pregnant the first time, as I expect it does you. The reality however was ok. I experienced shoulder dystocia with DS1, the ventouse failed, so I had an episiotomy and they used forceps. Local anaesthetic used so not painful at all(apart from the contractions).

Healed within a couple of weeks, uncomfortable to sit but not painful, just swollen. Poor DS was battered and bruised though and struggled to bf for a few days, but we got there in the end.

When I had DS2 we took the decision to have an ELCS, which was wonderful and DS2 fed straightaway with no problems. My recovery was also very good, similar time for me as the episiotomy wound, but I know that it commonly takes longer to recover from an emergency CS.

Hope that helps and that you have a lovely straightforward labour and delivery!

DD was v stuck when I was trying to give birth. I pushed for 8hrs and no baby. They gave me a choice. They could try with a ventouse (too high for forceps) or proceed straight to cs. She was showing early signs of distress. I chose to try the ventouse because ideally I wanted to give birth vaginally and believed this better for both of us than a cs. In the event it didn't work and they tried one more intervention before moving to emcs (at which point dd was really upset by the whole thing).

I think there are too many scenarios for them to be fully detailed here. They will explain at the time the reasons for choices offered to you and you can make a decision then.

DD couldn't come out on her own and I had to choose between options. I wanted a vaginal birth if possible and to avoid major abdominal surgery, so I said yes to the ventouse attempts.

I had forceps after half an hour of pushing and failed ventouse because myBPp was so high, couldn't have an epidural due to a medical condition so it was either that or CS under GA

The recovery from the episiotomy was fine here too. Bit uncomfortable but not painful at all.

The emcs recovery was fine too (I was discharged after 12hrs and felt okay, if a bit shell shocked). Just to reassure you that it's not necessarily a long recovery period.

DD was very battered and bruised and had muscle damage in her neck. This was due to positioning and a long labour and protracted 2nd stage though, not caused by the ventouse. The ventouse did cause a small tear by her ear (she was coming out ear first which was the problem all along) but again it was her positioning.

I had in my birth plan that I wanted ventose over forceps if intervention was necessary (but if it could be avoided then it was to be, didn't happen).

After 10 minutes of pushing, DS was distressed and needed to be born quickly so forceps were used. I was told that if I didn't do it within 3 pushes it was going to be an EMCS, he came out on the second push. I know they prefer to try intervention before CS in some cases as it is safer for the baby once you are so far along in labour. Obviously in some cases the intervention doesn't work and they have no choice but to do an EMCS but the risks are higher which is why they will go for intervention first.

Intervention was necessary as they couldn't find DS's heartrate and he had to be born very quickly. He was fine btw as they got him out within minutes.

There are all sorts of unpredictable emergencies that might happen in birth, so you couldn't ask for a blanket ban on foreceps.

Are you frightened of the idea?

You could say "to be avoided if possible."

Thanks for the responses. It's reassuring to hear of babies with the use of forceps and being OK. (I've been reading too many horror stories . . )

I am frightened of the idea, yes. I've been having nightmares about it for a few weeks now, and have managed to work myself up into a bit of a state. I appreciate that this fixation with forceps may well be a way of dealing with more general anxieties related to giving birth, but I can't seem to get it out of my mind.

I did have a chat with my consultant about it the other day. She was sympathetic, but said there was no way of guaranteeing that forceps won't be used. She did, however, write in my notes that they are not to be used unless in exceptional circumstances.

I think I've been worrying partly because my baby is posterior, and that may increase the need for intervention? I'm only 33.5 weeks, so there's time for baby to rotate, but I'm concerned he won't, and my midwife told me that my anterior placenta makes it more likely that he will remain posterior.

Thanks again - it helps a lot to hear of others' experiences.

I know how you feel. I got a little obsessed with my fear of an episiotomy with my first pregnancy. I even talked to DH about requesting a caesarean but I knew I didn't really need one.

I did end up having an episiotomy for forceps to be used, and I didn't care at all when it had to happen, and it was honestly no major trouble afterwards!

I can't add anything on the forceps question, but have a look into optimal fetal positioning, which should help your baby to rotate.

I really really didn't want forceps either so I know where you are coming from. I knew of a horror story and it always put me off but when it came down to it, the safety of my baby was in question and I just didn't care (actually when they first mentioned forceps I did have a little moan and the bitch surgeon got quite snappy with me and said something, can't remember what it was now but I do know I wanted to kick her at the time ).

Slanted, I just wanted to try and reassure you with regards to your baby being posterior. 2 out of my 3dc were back to back and both times I did everything possible to get them into a good position. I spent most of the latter parts of my pregnancies on all fours and avoided sitting on sofas at all costs!!

In the end both babies turned at the end of the 1st stage of labour and the deliveries were fine (13.5hrs for dc1 and 1hr40mins for dc3). I have read that for some women and particularly if your placenta is anterior their baby is just more comfortable back to back. What I wanted to say was I spent a lot of time worrying about their position and whilst it is always helpful to do what you can to encourage them to turn it does not necessarily mean that your delivery won't go well. Good luck with the rest of your pregnancy and I hope you get the delivery that you want.

Id written in my birth plan for ventouse to be tried before forceps, if necessary. i'm glad i did as Ds came out with the ventouse and we were both much less damaged than by forceps. the doctor complained a lot ( as they usually do) but then it wasn't her baby / perineum

Kristina it might be a bit worrying to the OP for you to say "we were much less damaged than by forceps*

FWIW, my daughter was delivered by Keillands forceps and there was not a mark on her and my stitches healed without the slightest bit of pain or discomfort.

And don't forget forceps can be used in CS too, although it's more likely when it's elective and the baby hasn't descended.

well we were. I'm sorry if either you or the op find this upsetting.

that's great for you that you had such a positive experience

Slanted, write your birth plan as you would like it to be, just reserve the right to change it at any point if new information comes up that would change your mind.

I said I wanted natural, no drugs, no intervention unless necessary. Due to meconium in the water I was made to lie on my back at the hospital straight after my waters broke to be monitored. DD got head stuck in a funny position and went into distress. I should have known something was up as I was in so much pain I asked for pethidine (had been fine at home just walking and marching). They tried ventouse and forceps, but as she was so big they could not maneuver her in the birth canal and with heart rate dropping went for EMCS. She was fine had APGAR of 9. I was glad they tried ventouse and forceps as having had EMCS I realise that the recovery time can make things difficult in caring for a newborn.

My DD was delivered by Keillands forceps. Her face is permanently scarred. I took months to heal physically and I'm just getting there psychologically (15 months on). I was in far more pain, for longer, than my NCT friends who had cs'.

Keillands (high or rotational forceps) are used when the baby has not moved down the birth canal and is malpositioned so needs turning. They are the ones you hear horror stories about. I would NEVER consent to them again. The mw described me and DD as being battered.

IMO they are only used to keep the cs rates down (a mw at the hospital actually said this). They are not the same as a necessary use of forceps when the baby is stuck too low down for a cs.

If I were you I'd prohibit these on your birth plan.

herethereandeverywhere makes a good point - I think there are different levels of intervention with forceps. Although its great to hear that forceps don't always mean a bad experience, I certainly took longer to heal than friends who had c-sections. Its a very difficult area to keep clean and if an infection takes hold in a deep cut(as it did with me)you will really know about it. I had to have my epis repaired too, and have ended up with continence problems. I don't mean to terrify you, but it would be wrong to suggest that it is risk free procedure, however rare (I hope!) my experience was.

Another positive forceps story here - DD was born with the aid of forceps. She had slight bruising and I healed quickly - slightly uncomfortable for a couple of days but that's all. For every bad forceps story there will be a bad C-section story - and plenty more, untold, positive stories for both. Good luck.

Keilands are horrid things. You could put in your birth plan that you would prefer c-section to use of Keilands forceps.

Normal forceps come out when it's too late for c-section and the baby needs to come out pronto. By that stage, you would be happy to go with anything to get the baby out, especially if there is a shoulder dystocia.

DS born with forceps because I'd got to 10cm then his heartbeat suddenly got worrying so they had to get him out quickly.

Forceps were the one thing I really didn't want prior to labour but as has been said at that point I was willing to try anything to get him out quickly and him be okay.

It was fine, I was taking painkillers when I needed them for the first week, I healed well and quickly and soon couldn't feel it at all. DS had red marks either side of his head where the forceps had been but they quickly disappeared.

There are different sorts of forceps, high, medium and low, and different medical indications for each one. Which is appropriate depends on the presentation of the baby and how far it has descended in relation to the pelvis.

If the baby has passed the spines of the pelvis, then low lift out forceps are the only real option. If stuck higher up, then forceps may be indicated as the best/fastest way to get the baby moving, but if that fails then a CS can be performed instead.

I had in my birth plan that I'd prefer CS to high forceps (simply because I recoiled in horror at the thought of stitches in two places!) and this was accepted. Fortunately, it didn't come to that for me, so I don't know how that preference would actually be regarded on the day.

My midwife explained that it depended on where the baby was and it's position ie how far down it was and how it was presenting, as to whether forceps or ventouse was preferred.

I am afraid of forceps too, but less so since a friend of mine had them used with her las dc and they're both fine.

Slanted
After a horrible experience with forceps with DC1 (though no permanent damage to either of us), I had a birth afterthoughts debrief with a midwife. What I discovered then, was that it was likely to be the epidural I had which caused the need for the forceps in the end. I was not as clued up as you and had no idea of the link between epidural and then needing an instrument delivery.
Sine then I've had 3 other DC - all bigger than DC1 - with only gas and air. Had them easily; no instruments, no Dr's in room, no tearing or stitches.

So, if I were you, I would focus on you and your birth partner learning about techniques to deal with the contractions with as little pain relief as possible (hypnobirthing etc..)