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 wouldn't rule out anything before the birth - you may feel completely different when it comes to it. By the time my DD was ready to make her appearance I would have agreed to anything to get her out as quickly as possible. I didn't need forceps/ventouse, but I'm sure I would have agreed to them if they had been suggested.

LoveinaColdClimate- I saw that you are planning on coming back to this thread, so I thought I'd add a couple of things.

By choosing to birth in a MLU you have already reduced your chances of forceps or ventouse considerably. A recent study showed that women who plan to homebirth or give birth in a MLU have far lower levels of this intervention than those who birth in a consultant led unit. (These figures included those women who transferred to a CLU, so it isn't just because they don't have them in the MLU). I don't think the study speculated on why, but my guess would be that, where a transfer is necessary to use these interventions, it makes midwives more like to exhaust other options rather than turning to them as an 'easy' solution.

Trying to avoid an epidural (or at least a full one, I imagine mobile epidurals would not have quite the same stats, if isolated figures are available anywhere) will also reduce your chances of an instrumental delivery. If you have a full epidural, you will be flat on your back or semi reclining to deliver. You are therefore working against gravity and pushing round the U-bed. Being vertical, squatting, etc all make pushing easier and instrumental delivery less likely to be needed.

If you do need an instrumental, I would be another anecdote of it not being too bad. My first birth was pretty grim overall, but mainly because of lack of compassion in the nursing care. The registrar who did the forceps was lovely and very gentle. DD1 had a tiny bruise on her face that faded with 24 hours. Now, anecdotes are not data, but that was my experience. It was clearly discussed with me what was being planned - the registrar actually said that he wanted the forceps and the ventouse prepped and he would decide at the last minute which to use. Basically I was still pushing whilst everything was being got ready and if I'd shifted her more he'd have just used the ventouse. As it was, he said he was worried he couldn't get a decent grip and didn't want me to go through three failed ventouse (they only try up to three times) and then forceps anyway.

I had what they call low forceps - not the keillands. Didn't feel a thing as was totally numb, one push and out came ds, not a single mark on him, no lasting harm to me either - stitches healed up same as everyone else's, felt fine and simply happy it was all over and we were both well. C section is not to be taken lightly, friends who had them were off their feet and uncomfortable for a lot longer. No point worrying about it, births are unpredictable and most interventions are for the best.

I felt the same way before I had my dd (4 weeks old today!)
I ended up with an EMCS after pushing for 3 hrs, they mentioned forceps to me but decided to go straight to cs as DD heartrate went abit low.
To be honest you will feel different if it comes to that situation, I just wante my baby out safely and no longer cared as long as she and I were safe
Hoenstly dont obsess about the birth because its nothing like you expect and theres a million ways it could go, you WILL get over it when your baby is here.
be positive - your life is about to change in the best most amazing way possible, the birth is just the beginning!

OP, there are just a couple of points I'd like to make.

1. It's a myth that instrumental deliveries involve shorter recoveries than c sections. It depends entirely on how badly you tear and how complicated the instrumental delivery was.

1. You CAN refuse ventouse and forceps. There is no guarantee that they will listen to you, but it's incorrect to say that a c section cannot be performed in place of ventouse and/or forceps. The reason being:

When forceps and/or ventouse fail, what do they do to get the baby out safely? C section. The baby is still as low down the birth canal, but a c section is performed. That is why they often prep you for surgery as well before attempting an instrumental birth. Secondly, sometimes attempting an instrumental only to have it fail and then moving on to a c section wastes valuable time in an emergency.

Unless the head is already out, it is never too late for a c section- they can still be performed, but many doctors prefer not to do it.

As for forceps being used in a c section- they cause less harm to the brain and spinal cord of the baby in a CS birth. You also have a reduced chance of anal incontinence.

The one thing you can and absolutely should refuse are Kiellands forceps. They are banned in USA and most of Europe. If they can manage without them, they're hardly a necessity. You can certainly opt for a c section in place of them.

I'd like to point out that if you refuse ventouse/forceps, even in an emergency, and they use it anyway, that's ASSAULT. You might want to bring this up with your HCP.

I had ventouse followed by forceps and it was more a case of them informing me what was happening than asking my permission. I believe this was because it was best for both of us as I'd been pushing for 4 hours (DS was affectionately known as enormobaby!).

Had a couple of stitches but didn't notice them as the pain of a bruised coccyx from having him sat there all that time still means I can't sit on a hard surface and it's 9 months later! So if they'd used the forceps earlier my recovery would have been pretty straightforward.

I'm all for them. He wouldn't have come out otherwise!

nomoreminibreaks

Just because they didn't ask for permission does not mean you can't refuse a procedure. If a doctor just walked in and said "I'm cutting off your nose", you do have the right to ask why and then refuse. The attitude that "doctors know best" is dangerous IMHO. They often do things in keeping with convenience or random hospital policy even if it isn't the best way to go.

Yes, he would have come out without those interventions. If you pushed for four hours, they had enough time to realise the baby was too big and offer a CS. Had the ventouse and forceps failed, they would have proceeded to a CS.

Lastly, if they had used forceps earlier there is no guarantee that the recovery would have been easier. They are known to cause third/fourth degree tears which also involve a fairly long recovery.

Before I had my DS (in October), I felt exactly the same way as you, Love, and put a note in my birth plan that I didn't consent to use of forceps unless absolutely no alternative and didn't consent to use of Kiellands forceps at all. I was absolutely petrified of a forceps delivery.

Then during pregnancy we went to see an obstetrician privately for scans and she explained the situation outlined by many above where the baby can be so far down the birth canal that an EMCS isn't an easy option. She said a full dilation CS, as she termed it, was a high risk medical procedure, compared to a simple lift-out forceps delivery. THe conversation I had with her sent shivers down my spine as I thought 'what a horrible situation to be in during your delivery - stuck between the devil and the deep blue sea, a difficult EMCS or a forceps delivery. I hope that doesn't happen to me'.

Needless to say, that's exactly what happened to me! It was my previously imagined nightmare come true where DS was too far down for a simple CS but not turned fully for a normal vaginal delivery. I debated back and forth with the head consultant regarding use of forceps and questioned whether it was the right choice and had a guarantee from her that Kiellands wouldn't be required, but in the end just wanted DS out. Looking back, I don't regret anything as the forceps was just a simple lift-out, no rotation as DS turned just at the last minute, and he was born without a mark on him. My episiotomy was 'extensive' according to the GP at my postnatal check-up but it's healing OK, no infection or excessive pain, and I think I would have torn anyway as DS was above average for head size - at least with the forceps delivery it meant I had an epidural so full anaesthesia in the area and I didn't feel a thing which wouldn't have been the case for a natural tear... so I'm just throwing in my penn'orth to let you know that sometimes your worst fears do come true and they're never as bad as you think. Don't underestimate your own strength and worry too much! You'll be fine.

PS Also absolutely no incontinence at all, of either kind, which was one of my biggest fears about a forceps delivery as I knew they were associated with a higher risk of incontinence, especially faecal incontinence. I was TERRIFIED of some kind of total pelvic floor collapse like that happening but everything was fine, despite long labour, forceps and epis.

Giving birth is a huge deal and I think it helps to know that it's normal to feel some anxiety. (quite a lot actually)

I think you are projecting your anxiety onto the possibility of intervention just as some women worry whether they'll get to the hospital on time, or whether their partner will make it to the birth or whether the baby will be healthy.

Ventouse/forceps/c-section/episiotomy - they are scary words. But in the care of someone you trust, they are tools to assist a birth.

The key is to trust your dr/midwife. Talk to them about your concerns, it can help a lot.

With my first child I felt totally intimidated by the maternity staff and didn't ask, just did what I was told. No intervention but miserable experience because no trust.

Second baby was c-section and forceps (he was wedged in so tight) but I was fine with it all as I had total trust in the dr.

All the best, your lovely baby is nearly here

believe me you really wont care at the time you will just want you baby out this comes from me im a wimpI had the cut and vontusse and it was fine he is fine best not think t happens at the timell and after you been pushinng 3 hours you will be happy for the help to get hm out and the cut you dont even feel it and stiches not bad at all i promise i dont know why woman make chilbirth out to be so bad and painful i had no pain relief and i was scared about it after horrid stories but really its not bad at all as long as baby okxx

oh by the way i tryed ask for caesarian wouldnt let me and glad i didnt cause after the birth im up and about and fine be brave xx

I had forceps as my DD had her hand up by her head (saluting!) so was causing problems getting her out. I was knackered, she wAs knackered, so when they suggested forceps I was like 'yes please'

Once the decision was made, it was action stations and all very quick. I had an episiotomy which was fine (I had an epidural) and they said they they really didn't need the forceps to pull her out, more just guide her and then she came out with one push.

Ti be honest, it all happens so fast you really aren't aware if what is happening, andvecause my legs were up in the stirrups, I couldn't actually see what was going on. All I know that from me agreeing to it, it seemed like a milli-second and she was out on only chest.

You have all helped so much - thank you. I am now wondering about writing on my plan that I do not want Keilands used unless there is absolutely no choice, and briefing DH well (in case I am totally out of it) to discuss with the doctor the chances of low forceps/ventouse actually working, with a view to declining if they think the chances are minimal and I will probably end up with a C section anyway. Does that sound fairly sane?

You have all made me feel much stronger and less terrified - thank you.

If you do end up with stitches then 2 bits of advice which were indispensable to me:

(1) Arnica tablets. They reduce the bruising like you would not believe. My MW was gobsmacked by the difference in a couple of days!

(2) Keep your maternity pads in the freezer. They don't 'freeze' but are deliciously cool when you first wear them, nice on your bits for a the first couple of mins!!

Good luck. I'm sure you will be absolutely fine!!! The thought of giving birth can be terrifying, but you'll be surprised how in control, calm and zoned you are when it comes to it.

Thanks, SleepyFergus. I have some arnica tablets all ready to go into my hospital bag - and fab tip about the freezer! I am working on the calm and collected part .

Loveinacoldclimate

Remember that when forceps and/or ventouse don't work, they do a c section.

Contrary to what anyone may tell you, it's never really "too late" for a CS unless you're crowning or very close to it.

If you stick to your guns, they may listen and do a c section instead of ventouse/forceps. Try explaining your concerns to a consultant and have him/her put on your notes that you understand the risks and will be refusing an assisted VB at all costs. This way, if the staff on call is trying to bully you into an assisted birth, you can tell them to have a look at your notes.

Oh and there is no situation where Kiellands are the only choice. 25 countries deliver babies without them, I'm sure the doctors here can manage.

You should just put on your notes that you refuse Kiellands under ALL CIRCUMSTANCES. They bloody well do a CS instead.

I think it is worth while checking whether they use keillands at your hospital. I put on my notes that I didn't want them used and at the 36 week 'birth plan' appointment the midwife explained they are not used where I gave birth.

While they are not banned in the uk presumably every team of drs have to make a decision about how comfortable they are using them.

As you know from my birth story I agree with the use of low forceps in the right circumstances. I trusted the medical staff advising me. They showed me DD's trace and explained why she had to be born quickly. Forceps were the quickest way to get her out especially given I hadn't had an epidural so would have had to wait for a spinal block and be transferred to theatre.

Having said that and having had a positive experience with low forceps I wouldn't have wanted keillands. IMO if the baby is positioned in a way that indicates their use a CS is still a more straightforward option so your plan makes sense to me.

I would put on my birth plan that I would want to go to CS at first sign of any problem not use it as a last resort. I would also be happy to sign a consent form for a CS when I was admitted so that there would be no delays.
Unfortunately I have heard about babies who have suffered terrible injuries, including a severed spinal cord, from forceps delivery. Women also need to remember that there can be long term issues for them.
A friend's Mother has just had extensive surgery becuse of a forceps delivery and is looking at 6 months plus recovery time on top of 18 months of double incontinence prior to the operation. She has found this debilitating to say the least and has aged greatly. She has missed out on precious time with her grandchildren and has had to give up her volunteering. As she says "if I could go back in time and have a c section.."

Hi Loveinacoldclimate - interesting thread for me as I was in a similar position.

Be assertive on your birth plan and make your preferences known to your birth partner - so (s)he can make sure that they are followed even if you are tired or high weak from the drugs.

I pushed for 1.5hr and then the consultant decided to follow the protocol to the letter and not let me push anymore (even though baby and I were fine) and use forceps even though I said I didn't want forceps. Ended up with a 4th degree tear from which I'm 99% recovered. I felt I wasn't listened to TBH and my birth plan wasn't worth the paper it was written on.

Looking back I would have preferred a CS as with the tear and stitches I was unable to do so much for the first month anyway (walk up the stairs carrying DD, walk more than 200 yards, sit up carrying DD). I couldn't even get up from the car for a few days!

All is well now and I'm looking forward to trying for baby2 but will go for the recommended CS as I feel this was too close a shave for me.

Thanks for comments re Kiellands - I will check whether my hospital even uses them before I panic myself!

So sorry to hear your/your friend's mother's stories, MissY and gailforce - how awful. Gailforce - were the injuries to babies just from Keillands or is there a risk with low forceps as well? TIA.

I can't speak for Gailforce, but there was a story about a severed spinal cord in the press a while back (Daily Mail I think). It is sufficiently rare that this may be the case being referred to. It is awfully sad if it is the same story - it appeared to be medical negligence .

Thanks, SecondElf. How incredibly sad - and dreadful for the medical professionals involved as well as the poor baby and family.

Secondelf - yes I read about that case and it was Keillands. However, yesterday I was reading a thread on MN where a consultant told a MN who complained about the brusing on her DC from forceps that she should consider her baby lucky that his spinal cord had not been severed as that had happened to another baby.
HCP are being pressurised to keep CS rates down so will try all other alternatives even, it seems, if there is some "collateral" (sp) damage to Mother or baby. They are not judged on how many 4th degree tears they inflict and future treatment for birth injuries does not come out of maternity budgets!