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.)

Kristina, I don't find any of it upsetting. But I didn't really explain what I meant in my post either (fell asleep on the settee about five minutes later )

What I meant was, that you can't know what would have happened if forceps had been used - most likely you would have both been absolutely fine, as were we.

It's just the assumption that forceps=problems that bothers me,(and I don't mean in your post, I mean generally over MN) as clearly the vast majority of people escape from the experience unscathed.

Does anybody know what the different types of forceps are?

It seems to be the keilands type that scares everybody and gives forceps in general a bad name.

The type I had were Neville Jones(?) as far as I remember, and were fine. Much preferable to an emcs.

I'd be interested in knowing about the differences in types of forceps and their use though, if anybody reading this thread knows?

I don't know what type of forceps were used on me, but dd was born by forceps delivery - a couple of scratches on her soon disappeared and I didn't feel I took at all long to recover.

I was pushing for about an hour and dd wasn't apparently moving down at all - I wish in hindsight that I had asked to try different positions - we don't know why she got stuck and I had previously read about getting on all fours etc, but just didn't think of it at the time.

Needless to say, this is on my birthplan for next time - I want to avoid them, if poss, only really cos I don't want an epidural and want things to be as natural as possible. I fit had to happen again, based on previous experience, I wouldn't be scared of it.

Janice they are called Neville Barnes forceps and they are 'lift out' forceps I believe, not high ones like Keillands.

Just to say, i had a ventouse delivery (kiwi cup) after 90 mins of pushing in the birthing pool, on knees, legs in air and no progress. DD (and I) was absolutely fine. She was quite big 9lb 13oz, but they thought the main problem was that her head was turned slightly to the side. She had a bit of a cone head for a few days after, but really, it worked well for us. Good luck with it all.

Slanted - hopefully you won't need any of this advice, but I would have to disagree with Checkmate

I didn't have an epidural, but still ended up with a high forceps delivery. The labour wasn't progressing and after hours of pushing ds still hadn't arrived. I wish I'd had an epidural, as I felt I left myself exposed to a lot of pain. Basically if you end up needing forceps chances are you will have been through the mill - why would you want to do this with as little pain relief as possible?

I think I got slightly brainwashed by my NCT class in to thinking I could do it with, breathing, yoga, aromatherapy etc etc - fine if everything goes smoothly - not good if it doesn't.

Wrigleys forceps - the smallest - lift out forceps when head very low down in pelvis or the type used at a cs. Rarely used for vaginal birth as ventouse preferred method of delivery generally.

Andersons or Neville Barnes (same thing) - for mid pelvic cavity with no rotation/correction of malpresentation needed. Most commonly used forceps. Often used if ventouse slips.

Kiellands - longer than the other two types; straight to enable rotation and blades which slide on top of each other to correct 'asynclitism' where baby's head is tilted. When transvere, posterior or asynclictic the babies have not usually engaged fully and are higher in the pelvis. Many obstetricians will go straight for cs option.

HTH

I had Keillands (I think - must have been - high forceps, head turned to one side) with ds, he was 9 lb 15, back to back and as I say head was a bit askew. After 31 hours of labour I was very glad to have a registrar there who was competent to use them and to have avoided a cs, which I really didn't want (though wouldn't be so against one now, having heard lots of positive stories since). Yes we were both battered but to be honest, given his presentation and size, I don't see any way we weren't both going to be a bit battered. No marks on his face, and episiotomy healed nicely - much better than my 'graze' after a 5 hour intervention-free natural delivery with dd, that bloody killed!

Slanted. Be wary of the warnings against epidural. If you find you are not coping with the pain (hyperstimulation and back to back baby meant I wasn't) then epidural saved my sanity. In the owrds of a friend who also found she needed one "I went to a very dark place in the time I waited for the anaesthetist to administer it".

Epidural may well contribute to a cascade of intervention, but it can also lead to a culture where a woman feels she let herself or her baby down by "failing" to cope without one and thereby "causing" the intervention. That is really unhelpful in trying to promote good mental recovery and avoidance of PND.

If you cannot cope with the pain then have an epidural. There should be no shame or fear in that. It was the fact DD was completely wedged with her head sideways after trying to turn out of OP and getting stuck that caused the need for forceps not the epidural.

Slanted, you answer your own question with "could sometimes be too late to do so." When they resorted to forceps with my first child, the ob. told my mum that if forceps didn't work, we were in very, very big trouble as DS was too low down for a c-section.

When it came to it, all I wanted was for the baby to be out and ok - I didn't care how that happened. Having wanted no intervention at all (and having had no pain relief until the forceps), I was beyond the point of worrying about my birth plan. It was all fine in the end, thank goodness. The damage and recovery were dreadful (far worse than subsequent ELCS) - but, as I say, all I wanted was a healthy baby out of me, and that's what I had.

(Herethere - your story is just like mine! Epidural came about only because I needed forceps. Even I don't do forceps without anaesthetic).

There are three types of forceps. There are high/rotational/keilands forceps, straight/Neville Barnes forceps, or low/Wrigleys forceps. They never tell you this a antenatal classes for some reason

The second two can be used pretty much in comparison to ventouse. They are used to pull the baby out straight, just case the mum is abit tired or whatever. The first, keilands can be a problem and is the one that gets bad press. These require a epidural and episiotomy. They are required to turn the baby when they are in a high position and not decending. In my case DD was looking over her shoulder and needed to be turned. A CS was an option, but never offered to me as she was completely engaged, and I was fully dilated and it was deemed safer to get her out. CS when in full blown labour is not good.

If it helps my sister had two labours, both back to back and she hasn't ahd a stitch! It doesn't always follow that a back to back follows in intervention

Feeling a bit better now. I met with my midwife this morning, and she assured me that the hospital very rarely uses rotational forceps - in situations where they would be used, the obstetricians tend to go straight to CS.

She has suggested I meet with the consultant again to discuss my fear further, and is going to recommend that to reduce the risk of needing to use forceps it gets written into my notes that I should be low threshold for CS.

Hopefully, even if he stays posterior I'll be able to deliver him without intervention (good to hear that your sister's done it twice, Chesticles!) - I want to try for a while, at least. I am, though, more relaxed now that I know that the hospital is OK with trying to avoid forceps by moving early to CS if it looks as though things aren't going well.