Really, really hate the idea of forceps or ventouse... please share your thoughts on declining them and proceeding to C section instead

[LoveInAColdClimate]

I think I'm probably being a bit silly. I really, really hate the idea of either forceps or a ventouse delivery, to the point where I am considering putting on my birth plan that in the event that either is necessary, I would prefer a C section. I'm not even sure why I loathe the idea so much that I'm prepared to opt for major surgery instead. Has anyone refused forceps/ventouse? If so, why? How did the hospital react? Were you pressured to agree? Has anyone had them and found it not really that bad? Am I worrying unecessarily (and possibly focusing my fear of the birth into this one area)?

Will the hospital always discuss their use with you before doing it? A gradutate of my active birth class was convinced that forceps had been used on her without consent, but she did say she was so out of it that she might have consented without really realising.

TIA.

I wanted to proceed direct to CS in the event that I needed an instrumental delivery - it was in my birth plan. I effectively wasn't allowed, was told the consultant was confident there was a high chance he'd get her out etc. etc. I needed Keillands (rotational or high) forceps so DD WASN"T too low down for CS, and she wasn't in distress. I was prepped and given a spinal for a cs beforehand in case the forceps didn't work out and DD was delivered in theatre (so nothing to do with not having the correct staff/theatre available). In fact the following day the midwife at the end of my bed when the consultant did his rounds introduced him as "the man who keeps our cs rates down". I had an horrendous recovery from the delivery, faecal incontinence, wound broke down and took 2 months to heal during which time the pain was unbearable. My dd's face is scarred and it's becoming more noticeable as time goes on (now 2 years old).

I'm interested to know why the leaflet I was given about birth/delivery I was given during my pregnancy (which I could read, digest and ask questions about at my leisure) mentioned "red marks that will fade" as the only notable side effect of a forceps delivery and yet the consent form I signed when exhausted, wracked with pain before the spinal was put in and frightened that my birth plan was being deviated from listed "lacerations, nerve damage and paralysis" (amongst other things) as possible side effects.

I have managed to secure a cs for my next delivery (I'm 28 weeks with DD2) after having a break down and some counselling for PTSD.

viva

I don't think that's what you were saying.

You calculated 7%, whereas the 9% and 90% are mathematically independent statistics.

Keep in mind, as I explained that these do not have to apply to every sample size. It's great if your hospital has a lower rate of third degree tears, but that is a small sample size compared to the whole of UK.

catsareevil

How can you be so sure? How can you say that a high or mid forceps birth is safer than a CS?

The risks with a CS, even at full dilation would be breathing difficulties for the baby and infection, blood clots and uterine scars for the mother.

Whereas with forceps the risks include brachial plexus nerve injuries, spinal cord injuries, intracranial heammorrheage for the baby and fecal incontinence and pelvic floor dysfunction for the mother.

Unless the fetal heart rate is extremely worrying and the baby is on the verge of crowning, how can anyone be so sure that a forceps birth is safer?

It isn't always about how frequent a complication is, the severity of the complication is also very important.

Take the case of herethereandeverywhere- she could have easily had a CS.

At any point where you're being prepped for a CS anyway, you can ask for one to be performed directly instead of wasting time attempting an instrumental birth.

I wrote no forceps in my birth plan. My sister, sil and best friend ALL had to have recontrsuctive surgery after forceps. My sister had no more children aftre that birth ( her first) and my bf and SIL had to have cs

When baby got stuck the consulatnt complained about being " forced" to use ventouse instead as it " wouldnt work" . But it did. I still had a lot of stiches, pain and bruising but No 3rd degree tear. So im v glad they tried that first and im convinced they would not have done so otherwise

I refused forceps when giving birth to DD2. I'm glad I did as I went on to give birth to her vaginally with no intervention. Good luck.

loveinacoldclimate, Can anyone tell me how I ended up with a unnoticed 4th degree tear and it told the DR 23 mins to use an assisted delivery to get my baby out .... and in the same hosptial were I had my dd another baby died using forceps!!!! why was I not told I could get up with a colostomy bag!!!!!! im ranging wtf happened anyone with any experience on this my consultant made me feel it was my fault!!! well I thought the pain I had was normal ie broken burning glass feeling with a knife grinding up and down below now im having a stoma next sections are less risky !!!!!!! refuse forceps at all costs ..... all the best.

But is 9% of tears, 90% of women have tears so it is 9% of 90% even though they're independent statistics.

I don't know why I'm arguing this seeing as I know through many years of expereince that the figure is no way as high as 9%. I honestly don't care what the RCOG figures say, I've found other research and stats that say less than 2.5% which is a figure I would agree is much more accurate.

viva

LMAO!

You clearly don't have a mathematics background! 90% of women tear. OK? That's one separate statistic. BUT out of every 100 women who tear up to 9 have a third or fourth degree tear. There is no 7% or 9% of 90% involved anywhere. It's simple mathematics.

Secondly, statistics aren't about what you agree with- they are what they are.

I've explained to you three times- percentages will vary in different sample sizes and demographics. RCOG said up to 9%- they are acknowledging that in some sample spaces like your unit, it may be much lower. But in others it is obviously higher. I don't care if you're a midwife- you possibly cannot know about every hospital in the UK.

Your 2.5% figures may not match with some other unit where maybe 4% experience third degree tears. But that figure is still valid for a particular sample space.

You've forgotten probability and statistics.

I don't think you have to be quite so cheerily vindictive towards me.

I don't see why you can't understand that 9% of tears is different to 9% of total women. If 90% of women tear and 9% of those are third degree tears then it is not 9% of all vaginal births that have a third degree tear. That seems very simple to me and I fail to see why you can't understand it.

No maths isn't my strong point, though I do have a science degree with an SPSS module as well as a midwifery degree so I'm not totally thick when it comes to stats.

I've never said I know every hospital in the UK, though I have worked in three seperate units and none of them have been anywhere near as high as 9% for third degree tears. I also fail to see why there would be a huge difference between hospitals. You can't even say that one hospital might have poor Drs who are doing forceps badly as they move hospital every 12 months.

I do know that statistics aren't about what I agree with, why are you only happy to quote the 9% figure that you've found and you're not interested in other bodies that are saying between 0.5% and 2.5%. Or do these lower figures not sit with what you believe in?

You're coming across as quite rude.

Dancelikethewind

It has repeatedly been pointed out on this thread that at the point where a forceps ventouse is being considered then that is safer for the baby then a CS. Yes a CS can be performed, and will be if needed, but that is a higher risk option.

You have picked out a fairly random set of risks for each procedure in a way that seems to minimise the risks of a CS and maximise those of a forceps, for example you have listed intracranial hemorrhage as a risk of foceps, which is it, but in fact the very highest risk of intracranial hemorrhage is when a CS is performed when the baby was far enough down to attempt a forceps of ventouse.

I agree entirely with you that the severity of the complication is an important consideration.

There might be some people who in retrospect having had a forceps might have been better of with a CS, just as there might be people who have a CS where in retrospect a forceps would have been better. It isnt possible to 100% guarantee that any path is a risk free one, its about using the evidence + peoples individual priorities to select the best choice.

Dancelikethewind - so we get the message that you think a CS is wonderful! Personally I don't - I had a keillands forceps with my first and am mighty glad that I was spared a CS - and no, I didn't have an episiotomy or 3rd or 4th degree tear and don't suffer from incontinence. In the right hands they can be done successfully.

Unlike you, I don't think that tearing is a matter of luck and can't be prevented. Give me a midwife like laluna each time - having helped 700 plus women with their births with only one third degree tear surely is as much a reflection of her midwifery skills as 'luck'? A good midwife is worth her weight in gold. I am angry that we have such a shortage, but that is a subject for a different thread.

Thank you Lavolcan, your words are very kind. I was offended at Dance's 'feather in your cap' comment. God, I really do not do my job for my benefit - working nights, 14 hr days, weekends, bank hols (early shift today) etc.

I appreciate that you have understood the meaning of my posts - that experience is just as valid a contribution to our knowledge base as formal research.

Thank you.

viva

You don't seem to understand that 90% is a different, independent statistic. Out of every hundred women who do tear, up to 9 may have a third degree tear. It is not 9% of 90%.

catsareevil

My question is this: other than the time factor (it takes a bit longer to prep the woman for a CS than an operative VB ) what are the added risks of a CS performed at a point where forceps may also be an option? The inherent risks of each procedure stay the same. If I had a choice between transient breathing difficulties and potential intracranial haemorrhage and cerebral palsy for my baby, I'd pick the former.
I don't know how you are saying that intracranial haemorrhage is a risk of a CS, because I searched Google Scholar and Science Direct high and low and I could find any link between the two.

LaVolcan
I'm glad you aren't incontinent and the forceps worked for you. Keep in mind that if you had become incontinent (as some women do- some on mums net have experienced double incontinence after Kiellands forceps) you wouldn't have been so glad to have been "spared" a CS. Most women have no way of knowing if the person using forceps on them us experienced enough or not. There have been many cases in the news where unbeknown to the woman, inexperienced doctors have used forceps on them causing irreparable damage.

I will stand by what I said- no midwife can completely prevent a third degree tear. This is a natural process- you cannot control and predict it beyond a point. It isn't about how hard someone works, it's just a fact.

What I said was that at the point that a forceps or ventouse is an option then the highest risk of intracranial heamorhage for the baby is if a CS is needed.

I'm surprised that you are not aware of this, having the interest that you do in this topic.

viva

I'd like to clarify that I have no problem at all with the research you quoted and the statistics in it.

In fact you were the one expressing concerns with the RCOG statistics because they don't sit with what you believe in. You feel the rate should be lower, so you dismissed the RCOG statistics as flawed.

I'm sure certain hospitals may even have a zero percent rate of third degree tears. Anything is possible!

That's what I was trying to explain to you actually- different sample spaces will give different results.

catsareevil

You are partly correct. A CS will increase the risk of intracranial haemorrhage only if an operative delivery is attempted first and fails. Hence mush eddy on that if you're being prepped for a CS anyway, it may be safer to go for one directly instead of attempting an instrumental birth.
A CS (emergency or planned) on it's own will not cause intracranial haemorrhage- at ANY point in labour.

Intracranial heamorrheage is a risk associated mainly with forceps.

OK, I meant 'Hence my suggestion" don't know how that came out as gibberish- sorry about that!

Dancelikethewind

You are still incorrect, and still giving potentially dangerous advice.

The inherent risks of a c-section do not remain the same. Referring back to the RCOG stats I posted a couple of days ago, at the point at which forceps or ventouse would be an option, the risks of any complications from a c-section are approximately double the average risks for a c-section:

"Complication rates are higher at 9?10 cm dilatation when compared with 0?1 cm (33 women in every 100 compared with 17 women in every 100)."

If forceps are needed during a c-section because the baby is well descended then intracranial haemorrhage must be a risk then too. I have not searched for stats.

Sorry, the stat I gave is not the average rate, it is the rate for 0-1cm dilated. The overall complication rate for an in-labout caesarian is 1 in 24, whereas for a pre-labour caesarian it's 1 in 16.

Some of that must be due to whatever situation has precipitated the caesarian.

Hi
I don't have any scientific information or lots of experience to share like some others but Just want to tell my story briefly.

I was the same feared forceps, tears, cuts etc the idea of that level of intervention made me horrified at the idea of childbirth for years, I gave birth on Thursday last week by forceps delivery and now have a perfect liitle 4 day old boy. I had had an epidural and felt no pain I didn't notice the cut or even see the forceps. It was recommended due to his unstable heartrate and the fact I developed a temperature and so they thought I could have an infection from the point of them recommending it and him coming out was about 12 minutes. I'm healing well from the stitches (again done under the epidural and pain free) in little pain and he was Mark free. I appreciate I may be lucky and am just so grateful he was out quickly and safely I don't mind how he was delivered afterall

"You don't seem to understand that 90% is a different, independent statistic. Out of every hundred women who do tear, up to 9 may have a third degree tear. It is not 9% of 90%.
"

Yes, of course its a different statistic and I've never said otherwise. You seem to fail to grasp though that the two can be related to each other. Maybe you dont understand it enough. Earlier on you said that 9% of women will have a third degree tear. That is incorrect and seemed to be based on your misunderstanding of the figures.. 9% of tears according to the RCOG are third degree, who also say that 90% of women will have a tear. You can relate the two together to then work out what percent of women will have a third degree tear (according to rcog). I don't see why you can't grasp that.

I am no dismissing the RCOG stats. But I have found conflicting stats from reputable sources. As a professional who practises evidence based practice it would be remiss of me not to question conflicting information like this. Very remiss. I've been taught to critique research as part of my second degree. I'd need to see the piece of research that the RCOG get their figsures from.

Oh and I've just come back from a shift on a busy postnatal ward where there wasn't a single third degree tear.

I worked today too and no third degree tears on our postnatal ward either!