Refusing forceps

[LilBB]

When I had DD she was lying sideways for most of the labour so could not deliver naturally. Whilst we were waiting to see if she would move they explained what would happen if she didn't move. I already had an epidural so they would top that up. Move me to theatre, give me an episiotomy and try to turn DD with forceps but be ready to do a CS immediately if this failed. I decided if she didn't move there was no way I was potentially having to recover from forceps and CS so I would refuse forceps. She moved herself in the end an I delivered vaginally.

Anyway I'm now pregnant with DC2 and even though im only 12+6 I've been thinking about the birth a lot. I don't expect what happened with DD to happen again but I want to know where I stand with refusing forceps whatever the circumstance? Since DD I've seen a lot about how they aren't used as much and doctors dont have the experience to use them. I also know some countries have stopped using them. Has anyone done this? Will they tell me or will they just use them? Is it sensible to refuse them?

Are you saying you want to go straight to C section instead if forceps are suggested? If so I think that is fine but everyone concerned needs to be aware well in advance that is what you want to happen i.e in birth plan and probably need to ask midwife to make appointment for you with doctor to discuss this at hospital simultaneous with your 20 week scan.

I know if baby was sideways like DD I would not want them to try and turn it with forceps. From what I have read this is Keillands forceps and is the one that could possibly cause the most problems. I don't know in what other circumstances forceps are used and if it wise to refuse them. I think I will have to speak to my midwife at my next appointment.

Also do bear in mind that there are circumstances where the baby may be so low and 'nearly there' that the safest thing for both of you is forceps, as the alternative is basically attempting to shove the baby back up to do the section (sorry, very unscientific explanation), so you may want to discuss that too.

Just to second what you've been told here. Most forcep deliveries are done when baby is v low in the birth canal. So is generally v safe. The alternative (if you refuse) is ventouse (but I'd guess you'd refuse that too?) or section, but with the kind of rough treatment secondtime suggests. If you didn't have an epi in place (or one wasn't working too well) then it would be a crash section too.

I have had three babies either breech/transeverse/oblique til quite late and going into labour has never been an option with any of them. If I knew baby was not ceph presentation I would never agree to be in labour. I would insist on an elcs.

I would never agree to have the baby turned from transverse in utero. Far too risky, in my opinion.

Ah right. I can see how in situations they may be the best option. I just really don't want them to use them to turn baby if this was necessary. I think I may talk through with midwife my concerns.

The chances of needing an instrumental delivery with your second is slim and second babies are often born with not nearly so much effort on your part. However, I would say try and avoid the epidural and stay upright. Gravity makes all the difference to the type of birth you achieve.

I actually know someone who had a forceps birth for DS and DD. While normally the second time should be easier, I don't think that always happens at all.
Why not consider an ELCS on the basis of a previous traumatic birth? I have read about quite a few women(some on mumsnet) who have asked for a CS after a previous forceps birth. It would rid you of all the uncertainties that you have.
If not, if you would like to give a possible uncomplicated vaginal delivery a shot then my advice is as follows.
Develop a thick skin. Irrespective of how rude or patronising the staff gets, stick to your guns. Say you will not consent to forceps under any circumstances. They will try to make you feel like an idiot and might even talk down to you but just ignore it. Tell DP that even if you are too out of it at that moment he should insist on your behalf.
It is illegal for doctors to do anything to you without your consent. Yet, so many use forceps and ventouse on women without even asking them. So, you have to make it clear at the onset that nothing is to be done without asking you first.
From what I understand, many times forceps don't work and neither does ventouse. In those cases the woman is taken for a crash CS. So, in reality a CS can be performed at any stage. You might want to consider the fact that sometimes they have to push the baby up the birth canal in order to perform a CS. In such a scenario, an assisted VB might be better. Mostly when they say it is too late for a CS the head is so far down, that an assisted VB will harm you and the baby less than if the baby was pushed back up. Pushing the baby back up can give you internal injuries and grazes and actually damage your pelvic floor almost as much as an assisted birth.
The only surefire way to avoid an assisted birth is to have a planned CS.
You can however reduce the chances considerable by being firm with them and drilling it in their ears that you want a CS not forceps. To put your mind at rest, they cannot legally do anything without your permission. If you imply you are aware of it, they will be hesitant to force it on you.

The one type of forceps you can always refuse are the Keillands(sp?) forceps.
They are used to turn the baby in the birth canal and are banned in most countries other than the UK. Any time those are used the baby is high enough for a CS to be done safely. So if they bring those out- scream. Yell, throw things at them, do whatever it takes to get them away from you and your baby. Make it very clear that while you understand that low forceps can never be completely avoided, under no circumstances will you submit to the high rotational(or even medium) forceps. You can't always say no to low forceps(which aren't that harmful anyway) but you can absolutely refuse medium and particularly high forceps. Just stick to your guns about that. In a worst case scenario, tell them you wan tit in writing that if they use the high forceps they will take full responsibility for what happens. That ought to shut them up.
All the best:)

I had a forceps delivery with DD.

The one thing I put on my birth plan that DH had drummed into him was NO FORCEPS.

When it came to it, I wanted her out.

Remember too, that there are different kinds of forceps - Keillands forceps (which are used for turning babies) are the ones you are talking about which are being taken out of use in some countries. Neville Barnes forceps are generally what are thought of as forceps. These are used to assist the baby to come down the birth canal when pushing is either not working or baby needs to shift far quicker than the mother can push it out.

Flisspaps, I'm curious to know something. Had you refused the forceps, do you feel they would have given you a CS? Or was the attitude pretty much like "this is what we are going to do so get over it."? Its one thing that you agreed to have the procedure done but had you refused do you feel your decision would have been respected?

Actually this is what I meant! The only way to avoid them completely is to have a CS. Women can vehemently oppose intervention, but when the time comes exhaustion, bullying, and fear can make them agree to almost anything. Many regret it later.

Yes.

But then a c/s had been suggested earlier anyway (lack of progress for several hours before a sudden change in dilation!) and the operating theatre was free when the Obs came in to do the forceps - if they hadn't worked then theatre was ready for me to go into. Refusal of forceps wouldn't really have left them with any other option but c/s.

Certainly they couldn't force me (or anyone) to consent to forceps anyway, and had I not consented and they had attempted to use them then DH would have been at the end of the bed blocking their way like a shot - he made sure I was absolutely certain before they got near me.

X-post.

There wasn't a hint of bullying or pressure from the staff, but from reading other posts I feel quite lucky. They were all very calm, and the suggestion of forceps was made after about 90 minutes of pushing, it was a further 30 minutes before DD was born so there were 30 minutes for me to make my feelings known and to prepare for c/s had I refused.

I don't regret the forceps as they got DD out. I DO regret not sticking to my guns over non-induction and expectant management, but that's a whole other thread.

I was offered forceps or a CS. I went for the CS. As it was dd got distressed and they had me knocked out and in theatre pronto, before they had a chance to do the epidural.

Flisspaps and Portofimo, thats how it should be actually. The option to refuse forceps must be given to every mother. I begin to boil with anger when I read about women who were denied a CS and bullied or scared into forceps.

DD2 was back to back and i was stuck at 7 cm dilated for 4 hours. I was rushed into theatre for a section but she was too low down to section. I refused forcep, which they tried to get DH to get me to change my mind but we were both adamant that they weren't coming near me with forceps - it was in my birthing plan. They gave me a drip to speed things up, and i ended up having a natural birth.

My niece was born using forceps and she had flesh hanging off her skull and face, she ended up having to have her skull broken and reconstructed due to a crushed skull thanks to the forceps.

What's to say that forceps won't be needed during the caesarian section. I have seen many a baby with trauma from forceps used during a section. The risks of Caesarian are great and should not be underestimated, nor taken lightly. I am a great believer in listening to mothers and letting them choice the best option for them.

michglas, I am horrified. So sorry about your niece. Dear god why don't they ban the bloody things?
Sorry to be nosey but may I ask why they didn't push the baby back up for a CS? Letting you continue with the labor when DD was stuck doesn't sound very sensible!

"I am a great believer in listening to mothers and letting them choice the best option for them."
That says it all really. I would run a mile from forceps and others from a CS. Its a question of choosing your risks.
BTW, forceps are very rarely used during a CS. If I opted for a CS there would at least be a huge chance of the baby not needing forceps. Secondly, the ones used during a CS are not the kind that can cause long term injures. They can also avoid using them completely if they increase the length of the cut on the mother's abdomen. I would rather they cut me more than touch my baby with forceps.

Just to clarify, the baby isn't ever pushed back up the canal. That's not really possible to do. Pressing on the baby's head and forcing it back through the pelvis could cause serious injury and besides it just wouldn't be feasible for physician to get their hand in to do such a thing.

Once the baby is past the pelvis then he or she begins crowning and at that point the baby usually gets stuck due to shoulder dystocia which can be rectified by changing the mothers position and manual rotation, usually. Sometimes forceps or a ventouse is used. However, even in this situation a CS is possible as the baby is still partially in the uterus. Rather than pushing the baby back up the surgeon would pull the baby carefully out of the pelvis from the other end.

As another poster pointed out, forceps are often used in a CS although in that situation the overall damage is less as the surgeon is better able to see what he or she is doing and there is no damage to the mother's pelvic floor.

I for one would never consent to forceps.

WriterofDreams, that was very informative. Although I remember reading a post by someone who said her baby was pushed back up the birth canal before a CS. Several others have also mentioned this. So could it be that it was actually something else like manual rotation that they mistook for the baby being pushed back up? I was always under the impression that that was how it was done.

Well I should have said the baby shouldn't ever be pushed back up the canal. Pushing back up is called the Zavanelli manoeuvre and is considered highly dangerous. It might be done as a very very last ditch thing but only in extreme cases. It's just not possible to do it safely.

If the baby is not beyond the pelvis it's not really necessary to push it back up as it can be removed safely from the uterus, sometimes with the help of forceps.

Pushing a head back up when it is still in the vagina is completely different to the Zavanelli manoeuvre which is replacing the head after it has been born.
Its only needed when the heads really low or got itself impacted on the pelvis and usually the attending midwife will do it, not the surgeon.
OP, you say you gave birth vaginally but was this assisted or under your own steam? It highly unlikely you have an assisted birth the 2nd time.

Replacing a head after it has been born is very risky and is rarely done. Thats what I was talking about actually. Thats when it is too late for a CS.
However if the head has not been born and it hasn't gone past the crowning phase then a CS is an option. The baby can be gently pushed back up the birth canal. Sometimes that is not even required. The baby can just be pulled out by the surgeon from the other end during the CS. Once the head is out and the shoulders aren't coming out, it is called shoulder dystocia. It is one of the most unfortunate things to have to go through. It can cause the baby to have cerebral palsy, and can cause terrible damage to the mother's pelvic floor.

The only way to avoid these nasty surprises is to a) not give birth or b) have a planned CS both of which are not an appealing option to most women.

My obstetrician said forceps are more common in cs than vb! My first child was born with a big red mark above his eye from forceps and he was cephalic, ELCS. he was fine, and the mark disappeared.

I have put this on my birth plan for VBAC but not sure I will have the strength to argue on the day but hoping I will.