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.

SecondDietLucky,

Nope. My example doesn't miss it at all. I've explained it rather in detail. If you don't understand it, that's quite all right. I don't think it makes sense for me to argue over mathematics with you on a parenting website.

Shagmundfreud,

Who said anything about mild tearing and stress incontinence? I'm talking about severe perineal tears and long term urinary and fecal incontinence which may require further surgery to correct.

Someone I know has double incontinence. Wearing adult diapers and accidentally passing stool or urine during sex can affect your self esteem in a big way, I'm afraid.
Do you realise the kind of painful and invasive surgeries that are required to correct incontinence and uterine or rectal rolapse? They're far worse than a CS.

People have a tendency to dismiss incontinence and prolapse as 'minor', without realising how they can completely change your life.

I'm aware of the long term repercussions of c sections btw. I don't intend to have more than one or maybe two children, so the impact on future pregnancies is not a cause of concern for me.
Even if I was intending to have more children, I don't see the logic behind putting one baby at risk for intracranial haemorrhage and brachial plexus palsy for the sake of future, hypothetical children.

Lastly, your attempt at portraying me a someone with "my head in my pants" is unnecessary. Preferring a CS to preserve pelvic floor and sexual function doesn't make me some kind of nymphomaniac.
Nor an I "fixated on my genitals". By that logic, any woman concerned about severe perineal tearing is fixated on her genitals.

I've had abdominal surgery before, I know what it involves. It didn't bother me in the least and I'd be quite OK with the CS "wound". I tend to focus on long term benefits, not short term recovery.

I understand your example Dance. I'm afraid I just think it's wrong - that's different from not understanding.

If it was 9% of all women have a third degree tear or worse, the figure would be 90 women out of 1,000, not the 81 you have used as your example.

I totally agree that there's not much benefit in debating this further (though I do think it is an important issue given the heavy focus on statistics in your posts). But it might be worth noticing that you seem to be in a minority of one at the moment with your maths.

I don't much care if I'm the only one getting this, SecondTimeLucky,

With a masters in mathematics, I'm far too secure in my abilities in the subject area to care if certain faceless non-mathematicians on the Internet agree with me.

Dance - you give me an example of someone you know with double incontinence.

I raise you someone I know who had a bad case of placenta percreta in a pregnancy following c/s, who ended up with massive scarring, a hysterectomy and a colostomy because she needed extensive bowel surgery.

Severe perineal damage resulting in serious life-changing injuries are EXTREMELY rare. About as rare as hysterectomy, and severe bowel and bladder injury following c/s (which does happen by the way).

I think you are fixated on rare risks to the point that it's distorted your perception of normal childbirth.

"I don't see the logic behind putting one baby at risk for intracranial haemorrhage"

Honestly - when I read statements like this I could weep. Having a vaginal birth is not 'putting your baby at risk', any more than becoming pregnant is 'putting your life at risk'.

It's a life-sapping and depressing way of approaching parenthood.

Have the birth you can face having - in your case that's a c/s, but seriously, these sorts of discussions are so abstract and pointless. Birth is about as safe as it's ever going to be in developed countries, as long as you have good care. Obsessing over rare risks is about as psychologically healthy as refusing to leave the house in case you get run over by a run away bus.

Dance

Its ironic to speak of others here being faceless and for you to then make claims about your own background.

If your posts had been credible they would have stood on their own merits.

Shagmund,

I never said having a VB is putting the baby at risk for all those things. I'm referring to forceps and ventouse when compared with a CS. To me it would make no sense to refuse a CS and accept forceps, with the risks to a future pregnancy in mind. I see no point in putting one child at increased risk for a future, hypothetical baby.

Lastly, if you look at research papers, the incidence of a colostomy or permanent incontinence may be rare, but the incidence of incontinence requiring surgery or uterine prolapse or pelvic floor dysfunction post VB is not as rare as you would like to think.

I'm very aware of the possibility of a hysterectomy post CS. I'd much rather take that risk than take the risk of permanent or long term incontinence, uterine prolapse or pelvic floor dysfunction.

I'd just like to note we've still not been shown any figures on the incidence of brachial pexus palsy, cerebral palsy or spinal cord injuries following forceps, which DLTW continues to go on about as real risks. RCOG do not mention these, presumably because they are so vanishingly rare as a proportion of all forceps deliveries ? The midwives on this thread have never seen any of these things.

The other risk she keeps mentioning is intracranial haemorrhage, which RCOG lists as 5-15 cases per 10,000 forceps births. That is what most people consider rare, although RCOG calls it "uncommon".

Dance - I am happy to respectfully agree to disagree on the maths. However, I would agree with Cats about your claims on your qualifications.

Dance - pregnancy often buggers up your pelvic floor no matter what the mode of birth. Also, bowel and bladder damage can (and sometimes does) happen during surgery. That's why the midwives check every single c/s mother to make sure bowel sounds have returned before they discharge them from hospital. They don't do this for mothers who have had a v/b as it is not deemed necessary. Go back to the RCOG website and look at the consent information on the risks of c/s.

DreamingofawhiteChristmas - you might want to start your own thread .This one has gone a bit , err, off piste. Most of the complications being discussed here are rare or very rare.

I don't know much about twins, but I do know that an elective section is generally rather nicer than an emergency (so stories or stats of those aren't that relevant). You are not contracting for one! You're also not knackered from hours of labour. The complication rates are low and, given that this will be babies 2 & 3, unless you are planning a huge family I doubt you are too worried about having many subsequent sections. I have a couple of friends who've recently had planned sections for no. 2 and both have said it was a lovely, calm, experience.

If you decide to have a VB (or at least plan one barring any complications - I do realise it's more difficult with twins), there are people on here who can point you in the right direction for resources on that with specific focus on twins. Lots of people on here will be supportive.

Good luck, and congratulations.

Sorry, I know I vanished but I wanted to have a relaxing Christmas during which I did not think about the birth. Thank you for all your advice, albeit that I now don't know which of the available exit routes alarm me most. I am going back to natal hypnotherapy, denial, and a vague hope that the baby may stay breech and make the decision for me . Thanks again for all your time.

MVT,

This link mentioned high cervical spinal cord injuries as a risk of rotational forceps deliveries:

www.sciencedirect.com/science/article/pii/S0029784495800220

This article talks about how forceps are associated with the highest risk of intracranial heamorrheage.

onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1981.tb01211.x/abstract

I don't know if this article is free, but if you are able to access the full article, please do. It talks about the real risks of forceps candidly.

DanceLikeTheWind

Note the conclusion:

High cervical spinal cord injury in neonates is a rare but specific complication of forceps rotation

Please note the word rare. There can be rare complications with caesareans too - so it's a matter of being as well informed as you can be and making a choice.

Some would argue that prevention is better than cure and that a better choice for mother and baby would be to try to avoid interventions. The recent Birthplace Study shows that you are significantly more likely to give birth without intervensions with a homebirth or in a midwife lead unit than in a consultant unit, without compromising the safety of the baby.

LaVolcan,

Let it be rare. There's still no guarantee for anyone that their baby won't be one of the rare, unfortunate few.

Midwife led units can be an option for women who want it. It isn't an option for me, because I don't consider them qualified enough. I'd prefer an OB, I trust them more. I feel that the midwives' preoccupation with VB does more harm than good in some cases.

This might be something to consider - if something goes wrong at a midwife led unit and you need to be transferred to a hospital, you may have a higher chance of an instrumental birth. Because by the time you get there, baby might be too low and they may insist on trying an operative birth first.

In a hospital, they may consider a CS well in advance by anticipating complications.

Yet again more misinterpretation of research...

"This might be something to consider - if something goes wrong at a midwife led unit and you need to be transferred to a hospital, you may have a higher chance of an instrumental birth. Because by the time you get there, baby might be too low and they may insist on trying an operative birth first."

So better to avoid midwife units in case you actually make progress towards delivering the baby?

An operative birth is not a disaster. That is your own personal viewpoint. Your views as expressed on this thread are unsupported by the literature and by professional opinion.

Why do you think that an instrumental delivery is usually the first choice when the baby is low enough to allow it? Do you think that when the baby is low down all the doctors and midwives secretly believe that a CS would be better for the mother and baby but do a forceps anyway? When clearly there are some other situations when a CS would be the first choice, and it is performed.

But how often are rotational forceps used and what does "rare" mean in terms of quantifiable risk? 15 case studies without any useable stats is pretty meaningless really.

What evidence is there that planning to give birth in a midwife-led unit increases your risk of an instrumental delivery? Or indeed that obstetric-led care decreases it? I was under the impression that in most delivery units the majority of women in the UK receive midwife-led care too, but perhaps I'm wrong.

I'm once again at the opinions you are expressing.

Loveinasnowyclimate perhaps with the exception of praying for a breech baby , your plan actually sounds like a v good one .

I declined a high rotational forceps, for them not to get consent is assault. I also declined an episiotomy but then I was a complete pain in the arse in labour (in only a way a midwife can be ).

I had high rotational forceps. I recovered after nine months, no long-lasting damage. Would decline again though as feel risk of injury to me and/or baby is unacceptably high. Kiellands forceps are banned in many countries, cs in none. That says it all for me...

catsareevil

My dislike for midwives is not based on research, that's just my personal experience with them. I'm not saying that. Midwife led unit increases the risk if an instrumental birth, I'm just saying that in my case it might and yes, for me that is a disaster. For you, evidently, a CS is a disaster. So what?

I find it quite hilarious that you say my views are unsupported. I'm the only one who has posted research on this thread. You insist that I've misinterpreted research, whereas I'm just quoting directly from it.

It is a well known fact that an assisted VB is far more risky than a spontaneous VB or a planned CS. Whether it is more risky than a CS in labour depends on individual preference and risk assessment. To me it is, to you it isn't.

MVT,

The surprising fact is that most studies have rather small sample sizes. Not much to do about it really. But if 27 babies had intracranial heamorrheage, and ALL were the result of forceps, that says a lot to me personally.

You are right that in the UK, on the NHS, most women have midwife led care. Despite that the overall assisted delivery rate is around 15% I believe.

My dislike for midwives is not based on research, that's just my personal experience with them.

I didnt say it was, my reference to research was the selected links to various abstracts that you keep digging out and posting.

I'm not saying that. Midwife led unit increases the risk if an instrumental birth, I'm just saying that in my case it might and yes, for me that is a disaster. For you, evidently, a CS is a disaster. So what?

I dont think a CS is a disaster. For most people an assisted VB isnt either.

I find it quite hilarious that you say my views are unsupported. I'm the only one who has posted research on this thread. You insist that I've misinterpreted research, whereas I'm just quoting directly from it.

You are not the only one who has posted research. You are the only one who has posted little snippets that you think support your case and shown ignorance of quite important aspects, for example, that you didnt know that intracranial heamorhage could be associated with CS, and even when you were told that it was, couldnt find that evidence. Eventually you managed to have found something which told me that I was 'partly correct'
Do you want to give us the link to the paper that you found that helped to change your mind on this?

It is a well known fact that an assisted VB is far more risky than a spontaneous VB or a planned CS. Whether it is more risky than a CS in labour depends on individual preference and risk assessment. To me it is, to you it isn't.

I agree that an assisted VB is more risky than an uncomplicated VB.

Whether it is more risky than a CS in labour depends on individual preference and risk assessment. To me it is, to you it isn't.

That risk assessment has to be informed by evidence. For me the relative risk is altered by how far the labour has progressed.

I'm slightly irritated by myself for taking the bait on this. You have shown a bizarre approach to mathmatics and to the critical analysis of research. You have also seemed completely disinterested in the fact that people who obviously do know what they are talking about have questioned your knowledge. So I dont know if you are for real on this or not. If you are then this book is an excellent starting point, if you are genuinely interested.

Dances. You are not the only person who has posted links to research on this thread, I have as well.

Dances -your point about 27 babies and intracranial haemorrhage suggests to me you lack an understanding of the different types of research study and the meaning of and interpretation of their findings. I cannot properly assess that study's methodology and findings, as I cannot access the full text. I suggest you get hold of and read the book that Cats suggests.

What I think I find most odd about this thread, is that you are only prepared to accept evidence that supports your narrow viewpoint. Speaking personally, on my last birth plan I wrote that I would not consent to forceps and that if induction was though necessary I would want a discussion with a consultant about the option of an elective caesarian. So you see, for myself, I am not keen on some options either. However, that is because my decisions are influenced by my personal experiences, obstetric history and reading and prioritising of the various risks and their likelihood and impact. Just because I hold these views for myself does not mean I think all forceps are evil, nor that the decisions I would make are the right ones for everyone. It certainly does not cloud my ability to interpret research findings and critique studies, even where they do not support my views, and it does not mean I try to railroad everyone I encounter into agreeing with me, insulting or patronising them if they don't.

Your behaviour is very odd.

"Midwife led unit increases the risk if an instrumental birth, I'm just saying that in my case it might and yes, for me that is a disaster"

Look Dance - all the evidence we've got points to healthy women having easier, healthier births when they're cared for by midwives in a non-medicalised environment.

So -
shorter and less painful labours
Lower rates of forceps and ventouse
Lower rates of emergency caesarean section
Higher rates of satisfaction with their care

As for an instrumental birth being a 'disaster' for you - well if you did have one the overwhelming likelihood is that you and your baby would be ABSOLUTELY FINE afterwards, like most women and babies are.

But in any case I don't think it makes sense to try to have a rational discussion about this issue with you. I suspect your fear of forceps comes from a dark and irrational place inside you, rather than arising from a logical assessment of the comparative risks and benefits of different modes of birth. And I think you'll argue about this subject until you're blue in the face to try to justify your very deep and personal choices on clinical grounds.

You don't have to you know. It's fine to say that a vaginal birth is simply not for you.