Upsetting visit with consultant today

[working9while5]

I am 14+2 on dc 2.

Last birth was Kielland's forceps delivery and I had MONTHS of trouble after it, lots of pelvic pain and back and hip pain which has flared up nastily in this pregnancy.

After scan today (which is bloody late!) I was sent to clinic and I had NO idea why. The doctor asked vague open questions about how I was feeling about birth etc and I had no idea what she was looking for, so I just told her about my pregnancy and birth...

Anyway, eventually I said that my family have a history of needing post-dates induction on all babies and I would rather avoid an induction again. I would be happy to do spontaneous natural labour if it happens but I don't want to go through the whole strapped-to-a-bed, foetal monitoring, syntocin drip etc type of birth.

This is where it all changed. I said something like I would be happier for lower levels of induction e.g. ARM, and she said "yes but that's what you had, you had the lowest type of induction we can give you, you were dilated when you came in". I said I thought I had a syntocin drip and she said yes, you did.. but it only took four hours to get going so it was "just like natural labour"(though I know from the day that my uterus hyperstimulated!). It suddenly became as though I was saying "this is how I felt it went" just for her to say "no, you are wrong".

She kept highlighting how "straightforward" my birth was, she must have used that word ten times in five minutes. It was a "straightforward" case of a back to back baby, it was a "straightforward" Kielland's forceps delivery with "very senior doctors in the room" etc. Dh said he had felt there was a lot of panic and she said "well yes, they did lose the heartbeat at one point which probably accounts for that, but there was nothing sinister, the baby just turned and they couldn't hear it any more". She also said "induction can't have been that bad as you managed to deliver vaginally".

I burst into tears of course. I felt like I was being told that I was a monumental wuss and blowing everything out of proportion when I didn't go in there even aware that that was what we would discuss and I just answered her questions openly and honestly. I just felt like she was telling me I was lying and/or thick or that I was looking for an elcs she wanted to talk me out of - which I wasn't! What was the point in ripping my experience to shreds and telling me how "straightforward" it all was? For her, yes, perhaps... but no, it wasn't to me and it didn't feel at all like that on the day. AT ALL. Nor for the frigging NINE MONTHS I was virtually immobile because of pain after it.. or through all the feeding difficulties my baby had because he was a screamy forceps bruised sleepy baby.

Is this normal? I am really feeling shaky and upset after it. And I am not having it that a Kielland's forceps delivery is as straightforward as you can get!

Thank you very much for your responses.

Designerbaby, it's great to read you had such a positive spontaneous second birth experience after a traumatic time first time round. Your position before it was pretty much the same as mine as mine is now. From what I understand from this consultant, the prostin leads to a longer labour than the drip would have done from me so you probably had a tougher time but yes, I feel the same way. I don't want a chemical induction, thanks very much. I am happy to put lots of work into hypnobirthing, looking at active birthing, water birth, I don't care I'll try it BUT no, I do not want a chemical kickstart that leads to me strapped to a bed with a monitor on, having hyperstimulation again and all of that if it can be avoided.

I think like many women, and to my own disgust, I become a bit of a "good girl" when faced with health professionals, even when in horrendous pain. This is a lot of my concern I suppose.. I don't want to be in a position where I am consenting to things because I haven't the strength to refuse, I want to have considered the options in a realistic sense e.g. I am open to lots of variation but with certain caveats.

I just find NHS professionals are sometimes very hard to trust.. and I say this as one myself. I know that most departments have certain "party lines" that are based on broad probabilities/cost effectiveness/"pathways" which are only tenuously based in evidence. In a lot of respects, the fact that only 2-3% of second births result in instrumental delivery/emcs is totally bloody irrelevant to how I plan for if I am one of that 2-3% because it is my life and my body and I don't want a negative experience and want to avoid that if at all possible (while recognising there are no guarantees).

I had PND for the first 2-3 months because feeding etc was horrendous.. I look at photos of my beautiful baby boy now at birth and realise he was just that, perfect, but I remember when the Bounty people took his photograph it physically hurt me to look at it because I felt so much guilt that he was so badly bruised. It seems like madness to me now of course, but it was horrible.. I just want a different experience this time round.

working9while5, that is not a straightforward birth first time!! I was induced, similar to you. I waited for 30 hours after my waters broke at 40+2. I wanted to wait longer, but they weren't keen, so I insisted on trying the pessary before syntocinon drip, particularly as my cervix was 'unfavourable' (high, closed, posterior) to see if this would 'ripen' it. No luck, Ended up starting the drip at 3am- stupid time to exhaust me further. 16 hours in, NO dilation, I was struggling with the pain massively. I had an epidural- I was told it was my only chance of natural delivery. I did end up having a natural delivery, and no forceps, but a third degree tear anyway. Like you say- hard recovery, no fun at all.

I am pregnant again now- a little further than you, I'm 21+5, with twins. I was under a consultant anyway for my third degree tear on my delivery last time. This time, they are saying I can absolutely have an elective CS if I choose. I was going to try for a normal delivery, and do the same as you- hypnobirthing etc and try not to ever have chemical induction again. However, now I have (TMI, sorry) vulval varices, there's always the risk of an assisted breech birth with twins, as one can turn even if both head down when twin 1 delivers, and the third degree tear history mean I'm leaning to cs. The doctors said if I'm desperate to I can try VB, but I think you're doing very well to be so laid back about it. I'd change consultant and seek some better advice. Straightforward!!! How ridiculous. No one has ever said anything like that to me (and I've seen a fair few people now with this being a twin pg), and I was probably more straightforward than you as not instrumental!!!!!

In differnt trusts PROM policies differ, but some let you go up to 72 hours post-rupture I was told.

dance this is the wrong thread for that.

working

had you considered

1. talking to supervisor of midwives. they may refer you a more sympathetic consultant who will agree a plan in the event of induction (if it happens) that takes account of your concerns. This one was doing nothing for you!
2. MLU/Home birth - if this consultant is banging on about how 'normal' your first birth was they hopefully won't recommend against that choice in the same sentence..this also significantly reduces the chances of another instrumental delivery. Of course, if you do go over +14..this may be harder to obtain.
3. doula/IM to support you and act as your advocate both at these appointments and in labour - usually associated again with reduced rates of intervention, and trauma.

i know exactly what you are saying about being all 'nice' with consultants - the thing is they should be being nice back, which isn't what this one did - they just ignored your very legitimate concerns! In labour women shouldn't have to advocate for themselves which is why it is important to be confident of having the right support.

Hi

Thanks for all the input again.

Edless, you raise good options there. I discussed with comm m/w today and I will be referred to Delivery Suite/Labour team to do a birth plan... I think this is first point of call. No MLU in this area sadly and dh would probably kill me if I suggested home birth, he is none too happy that I am not demanding an elcs as he found the birth quite traumatic too!

I think a doula/IM is a good additional thing to consider and I will look into them, too. They are pricey though, but on the other hand I must consider that we are shelling out easily as much for other things in our life that are not more important...

Dance, seriously quit it with the projection of your fears and beliefs on to other people.

You have a very strong preference for the type of birth you want - to the point of militancy - about having an ELCS. You shouldn't scaremonger others though. You consider vb barbaric in general, not to mention your views on forceps. We get it.

HOWEVER you are not 'giving women the facts' as you like to put it. You are giving women YOUR OPINION. You can't give an unbiased respond to this question due to the strength of your opinion.

Instead of projecting, give a range of possibilities INCLUDING reassurance and support for forceps and ventose and let the lady decide for herself rather than scaring the shit out of her even more.

There are a range of possibilities and complications for every type of birth and it is just plain wrong to go round scaring women for any type of birth and saying X is better than Y. I don't care what type of birth it is - whether it be having a baby standing on your head to relieve the pain or having it surgically removed in an field tent. Offer support and understanding and coping strategies. Don't give them even more to worry about.

Given that I too, share your preference for the type of birth I would want and have a lot of similar reasons behind it, if I'm saying the way you are expressing your feeling is offensive and over steps the marks, please seriously have a good think about the way you are coming across and what you are saying.

I just think you are being negative and destructive rather than giving what people come here for - help and support.

Working - I have steered clear of this thread, mostly because of the stuff NICE has just highlighted and not wanting to get into a fight. However, maybe I can add some stuff given your last comment...

I had a similar-ish experience with DD1. Not induced, but augmented in every way and then forceps. I haven't had major long term issues, but I have had some pelvic floor problems (although cannot be sure this wasn't also the long labour which preceded the intervention). I also had big fears about the second birth. Forceps was actually the least bad bit of the experience for me - because the registrar was lovely, and careful, and respectful. The treatment by midwives during much of the early stages was dismissive, upsetting and alienating.

I deliberately did not debrief with the hospital, because I was so scared it would be a dismissive or arse-covering exercise, and that it would dredge up bad feelings. It sounds like that was your experience .

However, we did hire a doula for DD2. It was the best money I have ever spent. She did amazing work with us preparing for the second labour. She really validated everything I felt and, importantly, she didn't assume. When people heard my birth story they always had an 'oh poor you, forceps, how nasty' attitude and, if anything that made me feel worse. Because forceps weren't the bad bit. Other bits were the nasty bits. She listened. She gave me stuff to read on birth trauma, we did various exercises to try and tap into how we both felt (stream-of-consciousness writing, etc. Sounds a bit wanky but was really useful).

DD2 was an amazingly positive homebirth, and a very healing experience. I have come to the conclusion that supporting a woman in labour is often not a one person job. I think you often need someone you love (and who loves you) plus someone who is an expert at supporting you. Especially if you had a shit time first time round. It's not about undermining your DH's role (which I know is a common fear) - it's about having someone who brings something totally different to the situation. If anything, I think a doula would be more useful in a hospital setting than at home - I won't go into long boring details, but when automatic protocols were invoked at one point in my birth, our doula was magnificent at reminding us what we had wanted, why and that it was our decision. I think that would be great in hospital, where you are more likely to encounter that type of thing.

I know doulas are expensive, but ours was worth every penny. If price is prohibitive, there are options like trainees or hardship funds which could help.

If you happen to be London, happy to pass on my doula's details...

OP, your consultant was either vile and insensitive, or was very misguidedly trying to reassure you (telling you that your experience was unexceptional enough in some way so that you shouldn't worry about it - as if that was how trauma works....)

NICEY, there's something strange about your attitude towards Dance, here and on other threads. Perhaps it would help if you said what YOU feel about things rather than policing her responses?

Of course it is true that you can hear good and bad about all birth experiences. As someone who was born by forceps and who has permanent facial nerve damage as a result (not disabling but disfiguring), I bite my lip through enough 'forceps leave nothing more than a bruise!' comments. But my experience is my experience. Telling that truth isn't scaremongering, no matter how much some people would like it not to be true.

Ditto the OP's experience.

Working, my Dh is very keen for me to have elcs. He thinks recovery will be miles better than my tear was. Is it an option you'd consider? You have ages yet, and i hope the horrible consultant experience doesn't linger too long. Thinking of you, x

NICEY, I'll second what fruity bread said. Instead of criticising my opinions why not post some of your own?

I stated that forceps are barbaric- I'll stand by it, it's my opinion.
When I stated that forceps are far riskier than a c section, that's not an opinion. It's a fact which I've supported with solid evidence.

If you think forceps are acceptable and better than a c section, I'm sure you can find some data to support your argument?

Lastly, telling women facts is not scaremongering.

By that logic, Flisspaps is scaremongering by going on about the higher mortality rate of a c section. Yet somehow, only when people bring up the risks of a VB are they accused of scaremongering.

Dance - I think that the issue is perhaps that you don't always engage with the actual topic that the OP has posted as much as you could? I think sometimes your strength of feeling draws you away from the topic at hand. This is totally understandable, but not always that helpful. We feel diametrically opposite about labour - for me a section would be a terrifying thought, and a section under general my worst nightmare. However, I support absolutely the right of women to choose - provided that enough resources are in place that it is a genuine choice (i.e. not women being forced to choose section because they are scared they won't receive proper care in labour, or being railroaded into VB or VBAC).

The OP in this case was asking whether her consultant's behaviour was reasonable and seeking validation for her feelings. Some of your post was helpful - because obviously forceps is not a normal, straightforward birth, and the consultant should have acknowledged that. However, you seem to come onto every thread and talk about how barbaric and awful forceps are (including a thread specifically asking for good forceps stories). There is a time and a place for that, but I'm not sure that the OP needed to be bombarded with statistics about all the awful things that could have happened with forceps complications. She was looking for support for her post forceps situation - not help making a choice on whether to consent to them for the first time.

You have also been fairly choosy in the studies you linked to. I am running round after toddlers and don't have time to trawl pub med, but there are many studies which do not show risks in stillbirth until post 42 weeks, hence the policies in many trusts to induce around this time.

Finally, it is not a fact that forceps are more risky than a section. It is a fact if you take certain criteria. I think you have taken the criteria of birth injuries to mother or baby. That is totally fair enough, but if you take the criterion of maternal death, section is (I understand) more risky. So it might be a fact, but it could be a slightly unintentionally misleading one if you haven't made your parameters clear.

"I stated that forceps are barbaric- I'll stand by it, it's my opinion."

Perhaps you ought to listen to women who've had a forceps delivery.

I've had one. It wasn't fun but it wasn't traumatic.

Most women don't find the use of forceps traumatising, as long as they have adequate pain relief, are treated kindly and their baby is well afterwards.

"I bite my lip through enough 'forceps leave nothing more than a bruise!'"

I have never seen a comment like this on mumsnet, so you must be imagining it. Forceps can cause serious nerve damage to babies. But they usually don't. Serious side affects associated with the use of forceps in the UK are rare.

And having been on the receiving end of a forceps delivery, and having witnessed c/s births from the business end, I really can't see how forceps is more brutal than a c/s. Seriously - have you ever watched film of an actual c/s? Have you seen the way the surgeon puts his or her hands into the incision and PULLS the mothers muscle apart? It's absolutely brutal and would result in instant death if there wasn't a mass of expertise and equipment on hand to prevent it. But it's a life-saving operation for many women and usually results in a healthy mum and baby. Seriously - there is no such thing as surgery or instrument use which doesn't look brutal to the onlooker.

By the sound of it I had a similar experience to Secondtimelucky - augmentation, Keillands forceps, and the Registrar doing it opined that 'It was all completely natural'!

I too had very healing homebirth with my second - a completely different and genuinely natural experience with no drugs whatever.

The registrar was very nice, and very competent and didn't leave me with any short or long term problems, but I am still bemused by his idea of 'natural.'

Shagmundfreud,

I wish I could post a video of what a Kiellands forceps delivery looks like. Or even Neville Barnes. It's most certainly barbaric.

A c section is like any other surgery- it's not medieval.

Secondly, c sections are not barbaric for the baby- forceps certainly are. A couple positive experiences with forceps prove nothing. They are in general an unnecessary, and outdated tool.

Lastly, I have listened to women who have had forceps deliveries;) I personally know some of them very well. One of them has fecal incontinence, one couldn't have sex for two years, one of them has a baby who cannot move her arm due to injuries to the spine, one of them went through the trauma of her baby having a brain haemorrhage at birth.

And btw, most studies that claim higher mortality rates with sections include high risk, emergency sections as well. Many of them are conducted after failed operative deliveries or when the situation is already dire. Some women with heart disease or diabetes have planned sections. That might explain the higher mortality rate.

Dance - I have tried my level best not to get sucked into one of your exchanges but I think I have just failed.

How dare you describe forceps as "certainly" barbaric for the baby. You simply cannot see that your own incredibly strong views are a perception of the world. You are entitled to that view, I would defend to the end your right to hold it, but it is not the only view, it is not the only way and it does not excuse this type of comment.

Forceps can be traumatic to babies. They can cause complications. They can cause injuries to babies. You know people with some of the most serious complications and that is incredibly sad. You take the view that the risk of complications is too great, and that is your right as a competent adult to assess. That does not mean that all forceps births are "certainly" barbaric to the babies involved. To say so is incredibly rude and disrespectful to the many women who have given birth to babies involving use of forceps - you are basically accusing them of permitting barbaric treatment of their own baby.

On your other point, and FWIW, just to show the other side, I have seen videos of both sections and forceps. The section looks far more terrifying to me. Muscle being ripped apart, internal bits and pieces being pushed out of the way. All open surgery looks brutal to me. I am forever grateful that I had forceps instead of surgery.

On sections, I am well aware you think that the best way to birth is a planned section. As I have said many times, I respect your right to that view. But for the majority of women that is not their preference and a c-section will either be for a complication, breech, or an emergency section for some reason. For that reason, when comparing section and instrumental for most women, including emergency sections is valid. It only becomes a different matter if women are thinking of an elective, rather than looking at instrumental vs section.

I suppose it's one of those things that are different for different people.

Sadly, I do believe Kielland's forceps are a bit barbaric and I do think they had quite a negative impact on both me and my son. Ds was quite badly burned with two black eyes and his scream in those first few weeks was high-pitched and incessant. The midwives even told me that babies with his kind of delivery are often in a lot of pain and he had huge trouble feeding and couldn't be set down. He is a baby that, thankfully, did not have long term issues related to the forceps use other than a small scar on his right eye.. but as a poster has mentioned up thread, some people are not so lucky.

In a Kielland's delivery. the forceps are clamped around the infant's head in the pelvis and the head is rotated. With skilful application, I have no doubt that it saves lives and for that reason, and the fact that very often there is no choice as the baby is too far descended to permit another option usually, I have no regrets that I permitted their use. But that doesn't mean that they weren't barbaric in their own way and tragically, babies have died through their use and suffered permanent disability. For this reason, their use is banned in several countries, suggesting that some people, at least, have found evidence to suggest that they are barbaric.

The thing is, is any of this relevant to my thread really? I had a forceps delivery that I certainly find remembering without crying with some difficulty (will be meeting with a Pregnancy Support midwife to discuss it soon) and that caused physical trauma to both me and my son. Yet I am not looking for an elcs and despite my experience, if faced with forceps again I would be cautious about putting a blanket ban on them as I wouldn't want to deny my baby the safest route out of me at that moment even if it were barbaric.

Fruitybread, I think you have the truth of it here: "OP, your consultant was either vile and insensitive, or was very misguidedly trying to reassure you (telling you that your experience was unexceptional enough in some way so that you shouldn't worry about it - as if that was how trauma works....)"

In fact, it did the opposite as it made me feel that I was an idiot for having feelings about it!

Working, sounds to me like your consultant was insensitive to your experience so you should perhaps try to see someone else for a second opinion. Obstetricians tend to see the real extremes of birth and pregnancy so their idea 'straightforward' will be vastly different to the average person's. Nonetheless, they shouldn't impose that skewed experience onto patients and dismiss valid fears, like yours.

Sounds to me like you would benefit from speaking to a better medical professional for a second opinion, someone who has a good bedside manner and is more sympathetic. Could you contact the Birth Trauma Association maybe for some advice? You could also try seeing an ob/gyn privately if it's not too expensive. There is a private clinic in my city where you can see an obstetrician for extra scans and monitoring and it was about £150 per session. The obstetrician we saw was fantastic and really put our minds to rest before DS's delivery, discussing delivery options, risks etc

She was, incidentally, all in favour of forceps and said they were 'a wonderful instrument' (!!) that have saved lives in her experience and she also explained that in an emergency situation, a forceps delivery can sometimes be quicker and lower risk than an emergency C-section.

working, yes - I have seen that response to mothers who've been traumatised before (the 'oh, gosh, it wasn't really anything unusual' response) - I think it can be kindly intended, although very wrong and insensitive. It seems to make traumatised mothers feel as though they have no right to their feelings, or that someone else's external evaluation should override them. It's all basically down to a failure to listen and understand.

shagmund - no, I'm not 'imagining' anything, thank you. "I have never seen a comment like this on mumsnet, so you must be imagining it." Gosh. How very arrogant. YOUR views do NOT dictate what anyone else's experiences are. You sound like the OP's consultant.

FWIW - here is a link to NHS advice on forceps and ventouse delivery. www.nhs.uk/Planners/pregnancycareplanner/Pages/Instrumentaldelivery.aspx. I quote - "Forceps can leave small marks on your baby's face but these will disappear quite quickly." That's ALL they have to say on the subject of infant trauma.

Well, golly gee. I guess I must be just imagining my forty odd years of facial nerve damage from my forceps birth.

shagmund - as a poster, you do cut your cloth according to the thread. I know on another recent thread you posted about how you experienced urinal and faecal incontinence after your forceps birth. If you didn't find that personally distressing, fine, I believe you. But it's worth mentioning, surely?

And - "And having been on the receiving end of a forceps delivery, and having witnessed c/s births from the business end, I really can't see how forceps is more brutal than a c/s."

shagmund - you don't have to. I had a planned CS, recovered very quickly and painlessly, and was able to enjoy and exclusively BF my DS when friends who had forceps deliveries at around the same time had longer stays in hospital, agonising episiotomies and infections, and incontinence issues that left them distressed and housebound. Some transient, a few ongoing.

Everyone one of us is an individual with individual experiences and emotions. But pulling the wool over womens' eyes when it comes to birth and birth choices is infantilising, patronising, disempowering and ultimately dangerous.

I find it very odd that you were sent to see the consultant without requesting it. I might be totally paranoid but it looks to me like they were trying to head you off before you had a chance to request a meeting yourself, almost as though they expected you to complain about your first birth and request a CS so the consultant decided to drum into you how "straightforward" your first birth was to discourage you from doing anything. Have you seen your notes from the birth? If I were you I would request them right away. You might not want to but in your position I would be kicking up a massive stink about this - it completely sounds like bullying to me and I would be absolutely livid about it.

Just to add, is there any reason for you to be seeing a consultant at all? If your pregnancy is low risk then there should be no need to see a doctor, especially not this early, which makes me even more suspicious. Sounds like an arse-covering exercise to me.

Fruity, I just find her approach militant and damaging to getting a balanced and fair choice for all women wanting c-sections or a vb. My cup of tea isn't someone else but I think we all have a choice. I don't anywhichway should be pushed to anyone. I find her approach very biased and very damaging and destructive to women who want to have a c-section as its just too confrontational. I just think its actually counter productive.

That said I equally find Shag's views on the flip side, just as bad.

Its not their point of view I have a problem with but the use of language. Words like 'barbaric' do not have a place in this subject. They are emotive and smack of judgment and smack of trying to put down women for not choosing 'the right way' and somehow have conatations of 'failure' about them.

Put simply. I favour BALANCE rather than shoving views down others throats and I find the use of language particularly distasteful. I really wish people would think more about how they use certain phrases.

I'll just avoid Dance from now on, as although we seem to have a lot in common, I just find her very upsetting tbh and destructive. Instead of supportive, which actually is what I feel people in our boat need, since theres already a battle against attitudes.

You aren't fighting for choice, if you are telling everyone else their way is wrong imo.

Secondtimelucky,

How dare I?! Because to me grabbing a baby's delicate head with a pair of metal tongs is barbaric. Using an instrument that can cause injuries to the brain and spinal cord of the child is barbaric. Using an instrument that can cause complete pelvic floor dysfunction and have a lifelong impact on a woman's sex life and health is barbaric. That is my view, and I'm allowed to have one.

Yes, a c section can look barbaric, but the damage it can cause is not as serious. It's less traumatic for the baby when compared to an instrumental birth. How hard is that to understand?

The risk of death in either case is far too low for it to be a deciding factor for me.
If I compare the long term risks of forceps and a c section, the latter is far preferable. If someone chooses forceps over a c section, that's her decision, but she should at least be aware of the fact that all things considered they are NOT safer for the baby and can cause her to develop complete pelvic floor dysfunction.

CailinDana, I won't lie. I did wonder... it seemed very strange to me... I am definitely low risk on the risk assessment my community m/w did.