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.

Bloody hell, I hadn't thought of that, Gail. Alarming to think babies' safety and women's bodies could be put at risk for the sake of stats. Are there any medical professionals on here who could comment on whether they have come under pressure to use forceps to keep CS rates down? TIA.

Hi Love, nothing new to add, but another "success" story, if you like.

I had my first baby earlier this year and also thought any kind of forceps/ventouse/cut would be a nightmare scenario. After 2 hours of pushing, meconium in water etc, a really great doc said "Look, we need to help you get this baby out asap". I said fine. I had an episiotomy, ventouse and a third degree tear. And do you know what? It was all totally fine.

It all happened so quickly and so professionally that you really will not be afraid, you will be in the hands of experts. You don't have to look at what's going on down there (nor should your DP/DH really!) and you don't have to feel it (you can have epidural or numbing block). You just have to breathe deeply and stay calm, and focus on the fact that if you end up in this scenario, you're going to have your baby out of you in about 30 seconds.

Yes, I felt a bit sore and battered for a few days afterwards, but you're on such a high with your baby that you don't care. And it heals fine. And there is lots of help and support from midwives and GPs to make sure you recover. Don't see this as a nightmare/worst case, just see it as a back up plan/safety net that is there if you need it and it REALLY isn't that bad.

Good luck

I haven't seen keillands forceps used for about ten years, but when I did they were used skillfully and safely and helped the mother to avoid a caesarean section. They can be safe used in the correct hands. However most hospitals will not use them anymore but would proceed to a cs instead.

As for hospitals going to great lenghts to keep section rates down this is not true. They try to keep section rates down by doing things like encouraging active births, greater consultant presence on the labour ward, robust guidelines about when to do them but they would rather do a cs than have a woman with a 3rd or fourth degree tear for example as this can lead to greater morbidity for the woman and potentially a greater cost to the hospital in terms of compensation. Doctors on the labour ward do not sit around wandering how they can get away without doing sections. The section rate in most of Britain is greater than 20% but there have been studies that suggest that the optimum cs rate is around 10 - 15% and that having a cs rate greater than this does not improve the rates of mums that have these problems.

Getting back to the op I have only come accross one woman who refused forceps, she had a section and ended up with an awful infection and the scar needed dressing for months. (although of course this wasn't related to not having forceps!) I wasn't actually there so don't know if she was pressured to have an instrumental, but I would imagine that she would have been strongly advised to accept an instrumental as it is much much safer to the baby to come out vaginally if it is that low down in the birth canal. Most women would find that it is not as bad as they think it would be.

Good Luck, Hope you don't need any instruments to help you give birth!

Maxbear your post is really interesting esp the point about 3rd/4th degree tears and compensation. Is it likely that a woman suffering 3rd/4th degree tears would be entitled to compensation?

As for hospital consultants keeping c section rates down there was a MNetter who posted saying that the ward sister stopped at the foot of her bed during ward round intorducing the medic as "this is the consulatant who keeps our c section rates down". If I remember correctly the patient had undergone a particularly brutal forceps delivery and was not happy to think that she had endured this to help the hospital statistics.

maxbear

There are statistics and valuable research that compares forceps with c sections and conclude that latter is far safer.

Secondly, WHO has altered the guidelines that state that the optimal CS rate is 10-15% . There is no longer an optimal rate- countries and hospitals can form there own policies regarding CS rates in accordance with the needs of the demographic.

Gailforce1 I don't know of any specific cases about compensation for third and fourth degree tears, but maternity payouts for birth injuries (mother and baby)represent a large amount of total payouts for nhs cases. I would guess that you wouldn't get compensation if it was sutured well and healed well but if there was suggestion of inappropriate care that let to the injury or subsequent inappropriate care then this might be different.

Dancelikethewind I'd be interested to read research that seems to suggest that caesarean sections are far safer than forceps deliveries. Please post a link on that one if you can. Undoubtedly this is sometimes the case, especially if the operator is not skilled in using forceps, however when the fetus is that far down in the birth canal, trying to extract it at a casearean section can be very difficult and dangerous for the mother and the baby. The risk of the mother bleeding substantially at a caesarean section at full dilatation is so much higher than a caesarean section carried out at any other stage. Also having a forceps delivery for the first birth usually makes it much safer for subsequent births than having a caesarean section for the first birth although I can understand that that is not something that is usually at the forefront of peoples minds as they are having their first baby. Most women who have forceps deliveries do not have awful birth injuries, they usually have episiotomies that will often heal well, there are no guarantees about healing well with episiotomies or with section wounds though.

maxbear

Here are links that prove that anal incontinence, sexual dysfunction and colostomies are most common after forceps births. They were conducted in reputed hospitals so I'm assuming the surgeons conducting them were "skilled".

This link compares all modes of delivery and is a compilation of various research papers. It states that forceps are associated with the maximum risks to both mother and child.

This link clearly states that fecal incontinence is most common after forceps deliveries.

www.sciencedirect.com/science/article/pii/S0002937803011785

www.nejm.org/doi/full/10.1056/NEJM199312233292601

This link compares incontinence after forceps deliveries and CS. It also elaborates upon the risks and benefits to the baby.

www.cmaj.ca/content/170/5/813

This link states that intracranial haemorrhage in the baby is often a direct result of forceps being used-
onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1981.tb01211.x/abstract

your statement that most women having forceps deliveries don't have birth injuries is FALSE. Third and fourth degree tears are most common with forceps. Read the links above carefully for a full explanation of the extent of the damage forceps can do.
In general, when you compare forceps with CS, CS are safer. As far as future births are concerned, for women who don't plan to have more than one or two children that matter is irrelevant.

I have several more links which I can post if these don't satisfy you.

Dance - I don't often comment on these threads, so excuse me if I am joining a long running conversation.

You will make it easier for people if you actually add links to journals - double around the web address.

I'm interested in what you've posted, but it doesn't seem to relate directly to the issue. The cmaj link specifically says:

"Unfortunately, for women not having a breech birth, such as those pregnant with twins, women who have had a previous cesarean section, older women, those who are having their first baby, those with incontinence problems and women who are afraid of labour, we have little information on the true benefits and risks of planned elective cesarean section compared with planned vaginal birth. Randomized studies are underway involving women with twins and women who have had a previous low-segment cesarean section, but the findings will not be available for several years."

Also, I don't understand why you say is it is false that most women having forceps don't have birth injuries. Your links seem to be showing that some birth injuries are more common from forceps births - although that first link doesn't show a great difference between forceps and natural vaginal birth. It doesn't show that more than 50% of women having forceps suffer some form of birth injury - or have I missed a bit. Only if more than 50% of women having forceps suffer a birth injury is it a false statement?

There also seems to be increased morbidity for emergency sections - which would surely be the alternative at the point being discussed (as opposed to, say, going for an elective). By that measure, could you not argue that forceps is safer than an emergency section?

Most of what you've posted seems to be about the benefits of electives for women who want them? Which I'd totally agree with, by the way.

Ribena Berry,

You need to read the full articles, not just the few lines that pop up when the page opens, and I imagine that most if your queries will be answered.
Most birth injuries are more common after forceps- third and fourth degree tears, grazes, prolapse, incontinence, and for the baby intracranial haemorrhage, brachial plexus nerve damage, and spinal cord injuries.

There is clearly a link above that mentions that majority of the women who have forceps deliveries do have birth injuries.

PS I forgot to put in this link-
It's a comprehensive analysis of scientific data that compares various modes of delivery.

www.pregnancycare.eu/pregnancy/labour-and-delivery

It states that forceps are associated with maximum morbidity.

Ribena,

ONE link out of all those I'd posted, had a mere mention of electives. I haven't really posted any information about ELCS in this thread.

dance you are obviously very well informed on this topic. I hope you don't mind me asking what was your experience when you had your children?

Are your strong feelings as a result of a bad instrumental or positive EMCS iyswim?

Well, I have read the majority of the articles, though admittedly not every line and certainly not all the footnotes. The one I quoted from is titled "planned elective cesearean section: a reasonable choice for some women" and the article is against that background. It isn't a mere mention of electives, it is the focus of the article, with discussion of sections more generally included within that discussion.

You seem very defensive about this, and I'm really not trying to have a fight with you. I'm genuinely interested in your post, but I'm trying to understand the information you have posted. I have a friend who is thinking of having an elective for her first if her consultant will agree (she knows about the new NICE guidelines, which is helpful). I'm very supportive, but it is has piqued my interest in why people might make these decisions and the risks and benefits (not to be clear,that I would ever try to put her off. It is her decision. This is just my own interest). Could you direct me to where the mention is that the majority of women who have forceps have birth injuries? You talk about birth injuries being more common, which I'm not disagreeing with, but is rather different to more women suffering them.

Sorry, that last phrase should be most women.

p.p.s. Second sorry, when I talked about morbidity in my first post that was a typo. I meant to say 'mortality' (which is low in all cases, but percentage wise much higher in the emergency sections).

Reading those articles again and not while BF'ing DD at 2am the key statistic for me is
83.5% of women would choose vaginal delivery again. This surely flies in the face of every other figure in that article?

If I had sexual disfunction, incontinence and a damaged baby then surely I wouldn't include myself in the 83.5%?

As I and many other posters have outlined to love a VB can be a positive and uplifting experience despite forceps. In terms of injury I think the reality is most first time mums will have a tear of sorts regardless of instrument use. They are mended by experts and heal quickly and the pain subsides rapidly.

My first dc was an emergency cs and I definitely wouldn't recommend that.

With DC2 I was 8cm when I got to the hospital. When I had my trace done they found she was in distress and I got whisked to labour ward. I was then taken to theatre for another emcs. Once there they found I was fully dilated and used ventouse to turn her head and forceps to pull her out.

It sounds horrendous, but it was done under a spinal and I felt nothing. In fact I felt amazing. And the aftermath of these procedures was 500% better than the emcs for me. I was up and about as soon as my spinal wore off. I had way more energy. I could walk pain-free. I could roll over in bed pain-free. I could get out of bed pain-free. I had an episiotomy but really it was insignificant in comparison to the emcs internal stitching. And so much more short-lived. I had loose waterworks for a while until everything settled down again but again, this is nothing compared to my previous experience of trying to get myself back into any kind of shape with cut abdominals.

I would recommend it wholeheartedly. DC2 had a bit of facial bruising over one eye from the forceps but arrived safe and healthy and is full of beans with no apparent ill effects 2 years later.

Pastabee,

It states that 85% of the women who didn't end up with instrumental deliveries and crash CS would opt for VB again. Read carefully;)

Nobody is denying that an uncomplicated VB is best. I'm simply stating that when compared to other modes of delivery, forceps are associated with maximum morbidity for both mother and child- the data I've posted backs that up.This wasn't about VB, it was about forceps.

If you are convinced they are safe, despite research that proves otherwise, you are at liberty to consent to them.

If you found forceps to be an uplifting experience, that's very good for you. Unfortunately, there are women who end up with fecal incontinence, fourth degree tears, sexual dysfunction, uterine and rectal prolapse and obstetric fistulas. Their babies often end up with intracranial haemorrhage, brachial plexus nerve injury, and spinal cord injuries. These are plain facts stated in numerous research papers.

Windywoos,

Are you aware that every global medical guideline states that ventouse and forceps should not be used together? It is only in the UK that they are ever used together.
Something to think about before 'wholeheartedly recommending' it.

I'd also advise you not to compare two modes of delivery based solely on recovery.
It's wiser to compare risks and possible long term damage. The risks to your baby and your pelvic floor are far greater with an instrumental birth than a CS.

ooh wasn't expecting a lecture!

My VBAC was extensively researched on my part, and I took into account of all documentation and risks before deciding to refuse induction and go past dates for DC2 to avoid a cs. I also scared myself witless with stories and stats on intervention on here, but still decided that, in order of preference, a VB with intervention was better than a cs in my mind. And everyone has to weigh up the stats on risks to baby, pelvic floor, recovery and, along with their perceived ability to cope with procedures make an informed decision which is right for them.

Mine was an informed decision. I didn't anticipate the need for both ventouse and forceps. I wasn't aware that they are not used in combination anywhere except the UK. I trusted my obsteatrician and the outcome was great for me and for my daughter. I would do it again in preference to a CS which, I feel, contributed to PND for me.

OP asked if anyone had had them and found it not really that bad. I was answering her question.

Sorry, I must be really thick but I read "we found that 83.5% of women with vaginal delivery would chose the same mode again" and didn't think the women with vontouse were separated from that?

I'd be really interested to hear your birth experience as obviously it must have differed from mine greatly and I am very sorry for you if this is the case.

Windywoos,

If after researching thoroughly, you came to the conclusion the combined ventouse and forceps are safer for you and your baby than a repeat CS, that's your prerogative. Everyone has the right to make their own decisions, and I'm glad you did too.

For the OP's benefit, and for the benefit of less informed first time mums who may be lurking, I felt compelled to point out that despite your preference and experience, research states otherwise.

Pasta bee,

I'll request you to read the entire article, not just the first four lines of the synopsis. The statistics you insist on mentioning repeatedly are for straightforward VB.

Women who had forceps or ventouse or crash CS, really didn't want to experience it again.;) I'll post more links which include surveys of birth experiences since you seem to be very interested in this.

Lastly, I find it funny that you have assumed I had a traumatic birth experience. Every woman who points out the risks associated with certain procedures is not automatically crazed, irrational and traumatised.

My research didn't include combined ventouse and forceps, but when the time came the surgical team made the decision that it was a good option and I trusted their judgement. I am thankful for it.

By all means quote figures, but please don't infer that these procedures inevitably result in damage to mother and baby, which, by your tone I feel you are doing. They wouldn't be allowed if so. There are plenty of other women like me who have had positive experiences.

OP, I hope that you manage to wade through this and make a decision which is right for you. The chances are, if your mother had uncomplicated births that yours will be too. If complications arise you can indicate your preferences. I found in invaluable to read a balance of experiences on MN before I made my decisions, aided by the stats and an appointment with the consultant midwife who was extremely helpful.

Oh god, my mother had appalling births with both babies! Induced, incredibly long, forceps, unwell babies... Does that make a difference, windywoos? Somehow I had not considered that it could be hereditary...

AFAIK sometimes yes, sometimes no. A lot can depend on the lie of the baby at the time. It's something that midwives tended to ask me a lot. My mum and I were very similar. This is something that I don't have stats on.

If it concerns you, speak to your midwife. If you are not reassured, ask to speak to a consultant midwife (they usually do appointments after 30 weeks IME). The best thing you can do for yourself is to be informed and make your own decisions and be in control. Hospitals cannot do anything that you don't consent to, even if they can give the impression that certain procedures are 'policy'. If you have discussed your fears beforehand and have written a birth plan with your midwife then it should be respected. I found that feeling of control very important second time around, as I felt bullied into things first time around. That said, in the heat of the moment decisions regarding intervention may have to be made quickly. Sometimes HPs explain what they are doing rather than ask if it is ok, assuming that you will want what is best for your baby and according to their research and experience they feel that x mode of intervention is better then y for you and your baby so they will go with x. If you explicitly state that you do not want something, then that is something which they must take notice of. Nominate your birth partner to make decisions on your behalf based on your views, in the light of the advice they are getting at the time, if you are feeling out of it.

Hello OP

I haven't read all the thread - apologies - I am on my way out.
To put it crudely I would not want to be in the situation where they push the baby back up in order to do a c-section. In my head that would be worse.

Have had ventouse twice - preferred that to forceps - helped push as they vacuumed and neither child ended up with a conehead.

First time just really awful I won't lie - the episiotomy and whole birth was just grim.
Second time tbh I was gratedful for the ventouse as baby not budging - had a 37cm head - and I knew with ventouse the baby would be out quicker. So perversely I calmed down when ventouse was mentioned and we got her out that way.

You will endure whatever it takes to try and provide a safe birth. And you will get through it sweetie. You will. But often the way things go - you cannot predict and it is out your hands so you go for what is safest for your child. I wish you all the best, lots of luck and an un-mumsnet hug x