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?

Thats interesting, BagofHolly. Although as I posted earlier, I think the ones used during a CS are far less harmful. Also, the process is a lot different I imagine, from trying to pull a baby out from a birth canal. I could be wrong.
All the best nunnie:) I really do think that if you make it clear straight away and tell DP to argue your case in case you aren't in a state to do so, you'll be fine.

I wasn't given a choice. One minute the doctor was having a little look around and rummage. The next thing i know the ventouse came off DS's head and they had moved onto forceps. No one told me a thing, didn't ask consent for anything, just cut me and started to use various instruments on me and poor DS.

SleepDeprivedGrumpyBum, thats awful. And very illegal. I hope you and dc are OK?

The only thing Ive written in my birthplan is NO forceps unless absolutely and urgently necessary. At my last midwife appt (saw a stand-in, not my own) she smirked at this then patronisingly insisted that forceps were a one of the "realities" of birth. Everyones, apparently. I never want to see that silly cow again.

That is exctly what happened to me, dd1 stuck back to back, prepped and rushed off to theatre for a try with forceps and section if it didn't work. The forceps did work and dd1 arrived safely but I was a bit traumatised by the whole scenario, they used the keillands forceps as she was high up and needed turned, I spent months afterwards wishing I'd insisted on a section but I didn't know any better as it was my first baby.

Fast forward to dd2 I told the consultant in no uncertain terms that if the same thing happened again I didn't want forceps and I wanted to go straight to c-section and I wrote it in my birth plan and had dh primed to stick up for me at all times. Luckily it didn't come to anything as I managed to deliver dd2 vaginally. I did find dd2's labour much easier than dd1's whether or not it was because I knew what to expect, my body had done it before or what I don't know but do discuss this with your midwife/consultant and don't let them fob you off.

What strikes me as very odd is how many people have said, both in real life and on here in other threads, that when they stated before their first birth that they didn't want forceps they were fobbed off but if they had forceps in their first birth and didn't want them in their second birth they were listened to. I don't mean to sound paranoid but it's almost as if the midwives/doctors know that once you've experienced forceps and know how awful they are that they should believe you that you won't allow them to be used, whereas they think in a first birth you can be bullied and cajoled and convinced that they're not really that bad.

To be fair to my midwife, when she saw "No Forceps" in my birth plan she discussed it with me rather than fobbing me off. When it became clear that I knew what forceps were, that I knew the different types and why they were used, it seemed like she was at a loss as to how to convince me they were "fine". In the end she reluctantly agreed with me that I should try to avoid them but half-heartedly said they might be unavoidable. When I sort of sneered at that she basically gave a look as if to say "that's what I'm supposed to say." The low-cavity forceps aren't great but they sometimes are necessary and the damage to the mother won't be huge. But Keillands forceps are barbaric. It makes me sick that HCPs think using an instrument that can permanently damage a person's body is acceptable. In other spheres of medicine such an instrument would have been phased out years ago in favour of something less damaging (ie a c-section) but with birth there's very much a "suck it up" attitude, as if permanent vaginal damage isn't important.

writer - I have no experience of forceps (and thank the dear Lord, judging by what's been written here). I had a VB with no interventions, but have very bad birth injuries and need extensive reconstructive surgery. For a variety of reasons I should have had an ELCS. Anyway. The point I wanted to make is that I agree that all that seems to matter to the NHS is that babies are born vaginally, as long as it is safe for the baby. The NHS does not seem to care one jot about the damage to the mother's body and the health implications (which can be life long) of that damage. As long as a CS does not show up on their stats and the costs don't have to come out of obs/gynae budgets, then that's just fine. The fact that patching up the damage will end up costing more than just doing a CS in the first place doesn't seem to register.

cardamomginger what an excellent post! I think that you have got to the root of the issue - COST! I think that the cost of all future treatment that women need following birth injury should come from obs budget not gynae. And I would include any counselling/psychiatric care needed. Perhaps this would concentrate the minds of those in charge of budgets and get away from the attitude of VB at any physical cost to the Mother.

Most women on this site have yet to face the reality of the consequences of their VB as many problems will not emerge until the menopause and afterwards. By which time it is far too late for any compensation.

(Card I hope that you are making progress BTW, remembering a post from earlier in the year).

WriterofDreams,Cardomomginger and gailforce1, be very careful. Some people on this forum are rather touchy about the NHS. Say something against it and they pounce on you.
For what its worth I agree with you 100%. The NHS, particularly the maternity sector care mainly about cutting costs. Every time Keillands forceps are used the baby is high enough in the birth canal for a ceasarean to be performed. Yet, they take advantage of women in labor and use forceps.
As the WriterofDreams said, for some reason it is considered wrong for expectant mothers to worry about permanent vaginal damage. It seems to imply that because we are having a baby we should stop caring about ourselves completely. Every time I have brought up the fact that I would never consent to forceps and would prefer a ceasarean to minimize vaginal damage I have been made to feel like a selfish, stupid bitch. I cannot understand why the NHS does not ban Keillands forceps? They have been banned in america and the EU for a reason. Yet we continue to use them here.
We are just supposed to "grow up" and accept the fact that our bodies will never be the same again. It absolutely does not have to be like that. At least 60% of women who suffer permanent damage, do so because of inexperienced staff, overworked and careless midwives and poor, insensitive care.
Some women on here however, find that very hard to accept for some reason and continue to defend the NHS and love to glorify the experience of natural childbirth. I have nothing against either. If it works out well for someone, thats lovely. I just wish people would stop looking at it all through rose tinted glasses.

The word forceps turns my stomach. But my LO was turned then delivered by Keillands forceps as a last ditch attempt to avoid a crash CS. It was the best option for us: no bruising or damage at all to baby, very very small episiotomy for me, home the next day and no need for painkillers when the spinal and suppository wore off. It's not ideal, it's not what I wanted, but for me having a section would have been worse and in this case it would have been under GA and I would have been severely messed up emotionally by that.

My daughter was also lying in an awkward position, and there were concerns about her movements and heart rate. I was 15 days overdue and had been in labour since 1am Friday morning - she was delivered on the Monday afternoon.
I was adamant throughout my pregnancy that i would not have forceps, but when it came down to it i practically snatched the consent form off from the Dr.

She was delivered by Keillands forceps. She had some bruising, but i think i came off worse!

She's my first child, so i have no idea how the 'aftermath' of the forceps delivery compares to a 'normal' vaginal birth, but i was in considerable pain for weeks, and suffered from urinary incontinence. 19 weeks on, and things appear to be ok now...continues furiously doing pelvic floor exercises

Hi,

Forcepts made be incontient due to a 4th degree left unnoticed that is and im havin a colostomy bag in sept and the surgeon is going to try and do a spincter repair this is not good this surgery is 50% success rate and the repair will fail in time if it successful I did not want a section after my last one it took 7 weeks for me to recover as in walking I wished I had one now though.

my first baby was born using forceps (simpsons) and no4 was keilands forceps,which i didnt know where dangerous and was on so much gas,as i was in agony due to an old back injury,i was unaware he was using them,but i was told after i had the best doctor to do the job..n02 and no3 i had them without forceps.

JUst looking at some stats for the UK and it seems to say (according to HESOnline) that for 2009-2001 : Forceps low 17,271 ; Forceps other
14,637 ; Spontaneous 26,966 ; Caesarean ? other / emergency 79,460

Not sure what falls in to the "forceps other" category - but it must be a lot!..

Seems a bit sad that according to the states are as likely to have a forceps birth as a spontaneous one, and 3x more like to have a caesarean than a spontanteous birth.

Maybe im reading it wrong, the link is here:
www.hesonline.nhs.uk/Ease/servlet/AttachmentRetriever?site_id=1937&file_name=d:\efmfiles\1937\Accessing\DataTables\Annual maternity release 2010\MatExpNotes0910.pdf&shortname=MatExpNotes0910.pdf&uid=8942

Becca that's terrible. The stand I saw I commented my birth plan would just have two words weitten across the whole page no forceps she said I don't blame you. This of course was stressed to dh when I got hone that I'm not overracting even the mw agrees.

I just don't understand how forceps ever came into use. After giving birth vaginally (without intervention), one of the things that struck me was how my pelvis moved apart just enough to allow DD's head to come through and no more. There wouldn't be any more space to put anything else in!

After reading all of this "No Forceps" has been added to my birth plan, in red ink and underlined just to show I'm serious . DH has been instructed that no matter how out of it I am he is to stand up for me and not to act as the persuader. I'd rather have a section if it comes down to it.

I'm sticking to my guns this time on interventions. With DS they refused to let me go in the pool because I'd had bleeding in the pregnancy. Then they told me that the Doppler wasn't giving them a satisfactory reading so they wanted to do a CTG "for just a little while" and I was still allowed to walk around albeit on a leash of wires. This turned into "just lay on the bed for a but while we finish the CTG". The consultant decided that I been in labour too long and he wanted a clip on DS's head, this involved breaking my waters - something I didn't want. My labour was 36hrs from start to finish but only the last 9hrs was spent in hospital in established labour (4cm+) so I don't know where the too long came from. I told them I didn't want my waters broken or a clip. The consultant came in and told me how DS could get distressed and die if they didn't watch him closely, then they got DH to pressure me, DH somehow got the idea I was going to die and talked me into it. Waters were broken when I was 10cm, clip was put on, and I was able to get down to pushing. Was made to lie on my back with my feet in stirrups and DS was OP so it was dire. Three hours of pushing later, with the consultant in and out every five minutes, I was told DS was 100% stuck and there was no way I could deliver him myself. The consultant wanted a ventousse, I was again pressured and shown no consent forms, he had wanted the ventousse after an hour of pushing but because DS had the clip I was able to prove he was in no distress and there was no need for it but after the three hours it was "no longer a matter of if he gets distressed but when" along with the news that he was stuck. The consultant ran off to get his toys and on the next contraction I pushed DS out myself. So much for stuck and about to become distressed.

I honestly think they're too quick to intervene sometimes and that once you've reached a certain time limit then they want to get the baby out (and mum out of the way). I think that the consultant being in my face contributed to such a long second stage because it was stressing me, that and the awful position they had me in. If anyone even suggest stirrups this time I'll shove the sodding things up their nose.

?The NHS, particularly the maternity sector care mainly about cutting costs. Every time Keillands forceps are used the baby is high enough in the birth canal for a ceasarean to be performed.?

But it?s not ?the NHS? making decisions as to the management of a difficult labour ? it?s an individual obstetrician, who, (I assume), would be making a clinical decision as to the best way to deliver with the least risk to both the mother and baby. I?m not a huge fan of some obstetricians but I doubt many of them knowingly and cynically inflict avoidable damage simply to save the NHS money. I mean ? we?ve got a 27% c/s rate in the UK. Doctors in this country don?t exactly shy away from doing surgical births usually do they?

I really don?t think the evidence on the balance of harm is clear cut: (from an NCT Evidence Based Briefing on Assisted Vaginal Birth)

?A dilemma encountered by about 4% of women and their obstetricians is how to keep maternal and neonatal morbidity to a minimum when given a choice between difficult assisted vaginal birth and a caesarean at full dilatation. On the one hand, caesarean sections performed in the second stage of labour are not infrequently traumatic and are associated with significant morbidity and mortality. And a successful, assisted vaginal birth may increase the likelihood of an uncomplicated normal birth in a subsequent pregnancy.
However on the other hand, there have been reports of maternal and neonatal morbidity after assisted vaginal birth, compared with caesarean, for midcavity arrest (albeit with inconsistent reports). This inconsistency may relate to the retrospective design of such studies and the methodological biases inherent in them. A prospective cohort study of 393 women requiring operative delivery in theatre at full dilatation at term, for a singleton, live, cephalic baby was carried out for one year. Of these, 102 had a caesarean section with no attempt at an instrumental vaginal birth. Vaginal birth was successful in 184 of the 291 attempted vaginal deliveries. Women giving birth by caesarean section were more likely to have a major haemorrhage (>1000 mls) than those giving birth vaginally. There was a high rate of third degree tears (8%) in those giving birth vaginally, but there was a comparable morbidity of an extension of the uterine incision into the cervix, vagina or broad ligament (24%) in those giving birth by caesarean (both those having caesarean alone (22%)and when caesarean was carried out after an attempted assisted vaginal birth (26%). Babies born by caesarean were more likely to require admission for intensive care but less likely to have received trauma than babies who had an attempted vaginal birth, whether successful or not. Overall, neonatal morbidity was low, but a few babies in each group had serious complications (serious trauma, 8 vs.3; sepsis, 6 vs. 13; and jaundice, 10 vs. 12 after assisted vaginal andcaesarean birth respectively). Women in this study were less likely to proceed to a caesarean or to havea major haemorrhage if they were treated by a senior obstetrician."

I've pushed babies heads up before in order that a c-sec can be done, very safe and totally different to zavanelli manuover. I also teach doctors how to safely get a baby out that's got a shoulder dystocia and I've never heard of a forceps or ventouse been used in this situation. I certainly don't teach it.

I'd decline a keilands, well there is maybe one dr I'd let do it on me but no one else. I'd rather have a low forceps than a section if I'd got that far.

I had Neville barnes forcepts with ds1, he had some bruising but other wise fine, when it came down to it the most important thing was that he was born as quickly as possible, the forcepts were a quicker option than cs, had an emcs with ds3 and would rather have forcepts any day of the week

DS was delivered using Keillands forceps.

This was prior to my MN days and I naively hadn't heard of them before. After 2 days of labour and at the pushing stage he was still transverse and his heartrate had dipped. I was told they would first try the forceps and if that failed they would perform a CS. I wasn't offered a choice and wasn't aware I had one. I signed the consent form while completely drained and in agony with no idea what I was agreeing to.

Thankfully he came out fine with the forceps but he was very battered and bruised and it took him several days to get over it. (Several weeks for me what with the episiotomy and forceps).

In hindsight I would have just asked to go straight for the CS if that was what they'd have resorted to anyway. I've since heard all the horror stories regarding Kiellands and it's so awful to think of what could have gone wrong. I feel so lucky that we both fully recovered and also that the consultant knew what she was doing!

I know that next time I will ask for a CS if the same situation arrises. But I do realise that sometimes an instrumental delivery is the best option. I guess you can't really make a definite decision until you know fully what the situation is and what all the options are at that time.

Never mind being stuck in the vagina, a painful clip stabbed in your head would make anyone distressed

The long term consequences of the use of forceps seems to be overlooked.

A friend's mum who is fit, active and slim has suddenly become incontinent of urine. After weeks of waiting, housebound, she has now been told by a specialist urogynae consultant that the use of forceps during the delivery of her last child has caused her incontinence all these years later.
She is now on a waiting list for a major op which will not take place until the new year leaving her in pain, housebound and now on anti depressants.

I get a bit tetchy about all these anti-forceps threads tbh.

They don't recommend them for fun, the obstetricians/midwives are well aware of the possibilities with or without them and make a choice.

They can be (and often are) the difference between happy family and the Worst Case Scenario.

I was a (N-B) forceps baby. If I hadn't been, if DM had wavered and considered and faffed, not only would I not have survived but neither would she (or DB - he's younger).

Sure, if you feel strongly about it, put it in your birth plan. But be flexible - it might be the safest thing for you and your baby in extremis.

And yes, forceps are fairly often used in c-sections. Are you all going to vet the rest of the surgical instruments used too?

I live in uk am 7 months pregnant with my first.Am from Italy .In my country instrumental birth is practically ban nobody use ventous or forcipes anymore for more than 40 years now since end of 70tees begging of 80tees .There are few reasons why: they made the mother bleed far more they made the recovery longer.They can damage the baby brain seriously and scalp and face or any other parts .Personaly i consider them medioeval torture instruments.Then i discovered that in uk are still in use and not just in few cases. So my mw send me to an appointment to talk about this.But if they cant guarantee me that nobody even mention those in my presence and they dont listen WHEN i scream NO at them i will plan to give birth in my country