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.

Tangle

It is the research paper I've posted twice- clearly states the risks with forceps to the baby.

No offence meant, but IMHO, even without that research paper, the risks with forceps to the baby are quite obvious. You can look it up anywhere online, or ask any private doctor- the risks with forceps to the baby are:

1. Intracranial haemorrhage
2. Spinal cord injuries
3. Possible death
4. Cerebral palsy
5. Brachial plexus injuries
6. Facial nerve damage

Whereas, even with a CS performed at that stage, the risks to the baby would be transient breathing difficulties. There is no other known risk of a CS performed at full dilation. There is the fact that the baby will have to be pulled from the other side during a surgery, but it still causes less I juries than tugging him out with forceps.
When a study includes EMCS, they include several CS performed at full dilation, even those performed after failed instrumental attempts.
Even in those studies, forceps are associated with the highest morbidity.

Have you ever seen a forceps birth being performed? Its brutal.

A baby's head is so delicate and skull so "soft" that it changes shape in the first few months.
Grasping it with metal tongs can never be considered a good idea.

Dance - not trying to be difficult, but you've now posted quite a few papers, not all of which I am able to access in full. I haven't noticed any in particular that you have posted twice, and given the length of this thread it is not trivial to try and find all your posts and compare the URL's to see exactly which paper you are referring to so that I can establish whether or not I am even able to read it.

A study including EMCS may well include "several" CS performed at full dilation and after failed instrumental attempts - but "several" is a very loose term. If a hypothetical study had 500 women undergoing EMCS, to me the interpretation would be very different if 10 of those were at full dilation with a further 2 after failed instrumental attempts or if there were 250 at full dilation with a further 100 after failed instrumental attempts - yet many women would still describe 12 women as "several". Any study that is being considered to try and establish relatives risks of EMCS at this point in birth vs. the risks of instrumental delivery needs to segregate this subgroup of women, not just include them.

Again, I'm not trying to down play or disregard any possible injuries to mother or baby. Nor am I suggesting that grasping a baby's head with metal tongs is a "good idea". But from reading the articles that you have referenced (as far as I can) I still cannot see any conclusions supporting your position that an EMCS performed at the point in labour when an assisted birth would be recommended (i.e. when the head is already well descended through the mother's pelvis) has fewer risks than forceps or ventouse. They may not be a "good idea" but based on the information you have presented I cannot come to the conclusion that they are categorically and definitively never "the best idea from a choice of not great options".

Not fewer risks, but maybe different risks? I am not agreeing with Dance's interpretation of the links she has posted, as I haven't read them in detail (especially not the ones I can't access).

However, we are basically talking about comparing the risks of e.g.

bad tearing requiring a repair in theatre
some degree of anal involvement (perhaps temporary)
a painful recovery down below, and
a baby with facial bruising and scratching who refuses to breastfeed because they have a headache
cosmetic changes to your nether regions because of an extensive repair, and possible pain during intercourse, at least initially

with, e.g.

major abdominal surgery, possibly including slightly higher blood loss
a painful post-op wound infection requiring antibiotics
possibly missing out on skin-2-skin post birth because baby needs help breathing
initial breastfeeding difficulties
longer hospital stay
cosmetic changes to the abdomen, eg skin drooping over scar, extra stretch marks from retractors

I'm sure a list could also be written for ventouse, but I know less about that.

It's apples and oranges isn't it? I have made up these specific scenarios based on some things I know individuals have experienced after each procedure. I have deliberately included some things (like stretch marks) that a medic would probably consider completely irrelevant. The likelihood of each consequence varies. The impact of each consequence on any one individual also varies -some people don't mind at all, some heal better than others, some are traumatised. There are of course many other better and worse scenarios for each intervention, these are just plucked out of the air for illustration.

In terms of death, both mum and baby are highly likely to survive all these procedures, thankfully . What this thread is really about is long term consequences to each of a hypothetical procedure. Severely disabling injuries to the baby are also rare. I suspect the nub of the debate going on here is about the importance or not in parents weighing up risks that medics deem to be 'minor', e.g. a re-modelled pelvic floor that may or may not function fully as before, or minor bruising to a baby's head that might impact on its behaviour in the early weeks, especially in relation to breastfeeding -which can then itself have health consequences. The risk of a large number of potential specific 'minor' consequences may in some people's minds outweigh well-defined, but maybe less frequently occurring major risks for abdominal surgery such as e.g. serious blood clots.

It is even harder to make these assessments where there isn't good data and a lot of it comes down to the specific situation you may or may not find yourself in at the time.

MoTeaVate

I think your mention of the risks associated with an instrumental birth are biased and misleading.

For the tenth time in this thread I'm repeating myself.

The risks to baby with forceps are-

Brachial plexus nerve palsy
Cerebral palsy
Spinal cord injuries
Intracranial haemorrhage
Facial nerve injuries
Possible death

The risks to mum include-

Anal incontinence (contrary to what you said, this is not always temporary)
Urinary incontinence
Obstetric fistula
Sexual dysfunction
Uterine prolapse
Rectal prolapse

Ironically, most of the above require surgery to fix.

It isn't just temporary pain in the perineal region, stress incontinence and cosmetic changes- the above complications are life altering.

Can you stop this now - the OP is due to give birth soon and has already said she's scared. If I'd have read all of this before DD was born I'd have been fucking terrified. Not quite the reassurance she's after.

I have found that it is pointless trying to say anything to DLTW regarding forceps ever being more appropriate in some situations than a CS. Those of you trying to reason - good luck.

As someone who had a forceps delivery after 2 hours of pushing, resulting in a 3rd degree tear I have all but given up on posting on threads where DLTW posts as I end up feeling irate - in many cases it's the right choice, the safest choice and the least damaging choice.

This thread too will now be hidden, before I explode with pregnant rage!

BrookeDavis

Pregnant women don't need empty reassurance. They need hard facts to enable informed choices.

We can make up stories and tell her forceps are perfectly safe and that all HCPs are good and trustworthy- but how will that help? It is far from the truth.

Yes, these facts are terrifying. But they're also the truth- are you saying we should keep research and facts from women in order to avoid scaring them?
That's not very empowering.

Flisspaps, I've told you earlier- you know full well that forceps are never the best course of action. You choose to justify them repeatedly because your child's birth involved them and perhaps it gives you peace of mind to tell yourself they are safe.

If 17 countries can manage deliveries without forceps, the answer is obvious-
They aren't necessary.

If you read my post you'll see it was an illustrative example, I didn't say it was the most likely or even how common. I also didn't say which list of consequences I thought was more serious, and I suspect different posters on this thread would have different views.

I could list out every single serious complications associated with c section like you have done for forceps, but I'm not sure what that would achieve ? My point is simply that there are risks to both procedures. They are different. In each case some risks are more likely, others are rarer. Some are more serious for mother or baby than others.

What's missing from any of your posts is any data on the percentages of UK deliveries separated by mode of delivery which have each adverse consequence. Without that data this becomes a bit of a thought experiment...

Some of the risks you have listed are potential risks of an unmedicated and non-instrumental vaginal delivery too. I accept, from what I have read elsewhere, that the risk of these things is increased with the use of forceps, but without numbers on the relative risks it is hard to compare, and actually potentially useless because anyone requiring an instrumental or surgical birth does not have the option of a spontaneous delivery.

Even with all that data, not everyone will reach the same conclusion as you, whether a parent or a clinician. That is the nature of individual assessment of risks.

I agree that information should not be hidden, and that giving blind reassurance is not necessarily the most informative response either. But there are ways of going about giving information, and to be honest your approach of "I'm right and you're all wrong" in the absence of adequate data to support your conclusions is unlikely to be well received.

MoTeaVate I agree entirely, particularly as DLTW has never had to make the forceps-or-not decision. There is presenting information in order to make an informed decision, and posting repeatedly and in an unbalanced way about one small set of risks in an almost obsessional fashion whilst actually having no experience of the reality of such a decision.

I cannot hide posts in my iPhone, therefore as expected.

LoveinaSnowyClimate - Sorry your thread has gone so mental. I started one in another topic area once under an old name which went a bit this way and stopped reading, so not sure if you are still following.

There does seem to be some degree of heritability in labour. Types of labour - fast, long, etc do seem to run in families. Likewise positioning. I don't have official stats on that, but midwives I have talked to believe it to be true. It would kind of make sense since things like pelvis shape, build, stretchiness (sorry, don't know medical term!) of ligaments, how much a pelvis moves in labour are all likely to be inherited to some degree - just like many other physical characteristics.

As others have said though, if your mum had induced births, a lot of the consequences may have stemmed from induction. Likewise some degree of heritability does not mean inevitability.

What I would say though, is that maybe it is worth thinking in your final preparations about how you would cope if (big if) you had a labour like your mother's. I didn't with DD1 and turned out very similar (long, OP). I think if I'd invested a bit more time in researching positioning techniques (e.g. the spinning babies website), coping with a long latent stage, etc I might have had more 'tools' at my disposal when my labour did progress like hers and have had a better chance at a less upsetting outcome from a similar starting point, IYSWIM. Plus, the known is always less scary that the threat looming over you.

[Disclaimer: the forceps wasn't the bad bit of my delivery. Don't want to freak you out more than this thread probably already has! I just didn't have very nice midwives who were a bit dismissive about the degree of pain I was in because I wasn't very dilated. My big top tip is to brief your birth partner to kick up the mother of all fusses if you are not being cared for by a midwife with a good bedside manner!].

Flisspaps

Instead of asking me for data to prove that forceps are more dangerous than a CS, does anyone have any information that proves they are safer?

I don't see what you're all supporting? A tool that is banned in 17 nations, a tool that is not even used in the better hospitals of developing nations, a tool known to have high risks. Why?

But 'more dangerous' and 'safer' are rather meaningless terms when the risks are different.

Forceps are not banned in this country. They are a standard obstetric tool. If you wish to persuade people in this country they are less than desirable then you need to speak in that context. You also need not to claim that things you link to contain info they do not or support things they do not (I have now read your links I can access and agree with Tangle's excellent summary above). In particular, to get a comparison of the relevant risks for the discussion the OP started, you need to compare data on forceps, ventouse and emergency c-sections, NOT elective pre-labour c sections.

Are all forceps really banned in 17 countries? Googling this revealed little.

By asking you for more info, what is it you think I'm supporting ?

My dear, I am speaking in that context. I am clearly implying that if so many other countries can manage to deliver babies without even considering forceps, there is no situation in which they are the only resort. If it were so, they wouldn't be relegated to obstetric history in so many hospitals the world over.

Lastly, the articles I posted DO go on to compare EMCS and forceps. If you cannot purchase and access them, it's really not my problem.

Here you are-
This article talks about the increased rate of injuries for mother and child in forcep and vaccuum deliveries.

journals.lww.com/greenjournal/Abstract/2004/03000/Immediate_Maternal_and_Neonatal_Effects_of_Forceps.18.aspx

I have not disputed the info provided in that article. It adds no new information, and certainly not the info several of us have asked for.

Do yo realise your tone is patronising and rude?

Do you know what, there has been one benefit of this thread, which is that I've now uncovered some v useful information .

This is the Royal College of Obstetricians and Gynaecologists guide to obtaining consent for ventouse and forceps from July 2010 and very helpfully it provides fully referenced quantified information about risks to both the mother and baby for each of these procedures.

Serious risks listed:
Maternal

• third- and fourth-degree perineal tear, 1?4 in 100 with vacuum-assisted delivery (common) and 8?12 in 100 with forceps delivery (very common)
• extensive or significant vaginal/vulval tear, 1 in 10 with vacuum 1 and in 5 with forceps

Fetal

• subgaleal haematoma, 3?6 in 1000 (uncommon)
• intracranial haemorrhage, 5?15 in 10 000 (uncommon)
• facial nerve palsy (rare 1/1000-1/10,000)

Frequent risks listed:
Maternal

• postpartum haemorrhage, 1?4 in 10 (very common)
• vaginal tear/abrasion (very common) *anal sphincter dysfunction/voiding dysfunction.

Fetal

• forceps marks on face (very common -up to 1/10)
• chignon/cup marking on the scalp (practically all cases of vacuum-assisted delivery) (very common)
• cephalhaematoma 1?12 in 100 (common)
• facial or scalp lacerations, 1 in 10 (common)
• neonatal jaundice /hyperbilirubinaemia, 5?15 in 100 (common)
• retinal haemorrhage 17?38 in 100 (very common).

Any extra procedures which may become necessary during the procedure:

• Episiotomy (5?6 in 10 for vacuum assisted delivery, 9 in 10 for forceps)
• Manoeuvres for shoulder dystocia
• Caesarean section
• Blood transfusion
• Repair of perineal tear
• Manual rotation prior to forceps or vacuum-assisted delivery.

Here is the RCOG consent guide for caesarian section from Oct 2009.

It states that complication rates for all caesarean sections are very common. Women who are obese, who have significant pathology, who have had previous surgery or who have pre-existing medical conditions must understand that the quoted risks for serious or frequent complications will be increased. Complication rates from caesarean section performed during labour have overall complication rates greater than during a planned procedure (24 women in every 100 compared with 16 women in every 100). 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).

Serious risks listed

Maternal

• emergency hysterectomy, seven to eight women in every 1000 (uncommon)
• need for further surgery at a later date, including curettage, five women in every 1000 (uncommon)
• admission to intensive care unit (highly dependent on reason for caesarean section), nine women in every 1000 (uncommon)
• thromboembolic disease, 4?16 women in every 10 000 (rare)
• bladder injury, one woman in every 1000 (rare)
• ureteric injury, three women in every 10 000 (rare)
• death, approximately one woman in every 12 000 (very rare).

Future pregnancies:

• increased risk of uterine rupture during subsequent pregnancies/deliveries, two to seven women in every 1000 (uncommon)
• increased risk of antepartum stillbirth, one to four woman in every 1000 (uncommon)
• increased risk in subsequent pregnancies of placenta praevia and placenta accreta, four to eight women in every 1000 (uncommon).

Frequent risks listed:
Maternal

• persistent wound and abdominal discomfort in the first few months after surgery, nine women in every 100 (common)
• increased risk of repeat caesarean section when vaginal delivery attempted in subsequent pregnancies, one woman in every four (very common)
• readmission to hospital, five women in every 100 (common)
• haemorrhage, five woman in every 1000 (uncommon)
• infection, six women in every 100 (common).

Fetal

• lacerations, one to two babies in every 100 (common).

Any extra procedures which may become necessary during the procedure:

• Hysterectomy
• Blood transfusion
• Repair of damage to bowel, bladder or blood vessels

There is also the full forceps and ventouse guideline and the full NICE caesarian section guideline

Dance - in your first (?) post on this thread, and in many posts subsequent to that, you claimed to have provided the data that "proved" forceps are more dangerous than a CS. You have been asked to clarify your interpretation as others are struggling to come to the same conclusions on the basis of the references you linked to.

You have chosen not to do so.

Why should I spend my time trying to find research to support an argument that, to me, is not really under debate? You are the one that made very broad, very sweeping and very strong statements - if you still believe in them then you need to support and justify them. Telling those who have asked you to clarify your position (and to re-iterate, I don't think anyone has said forceps = good, CS = bad - they've said that there are scenario's where it may not be so cut and dried and that the risks are not directly comparable) to go off and find information to prove the other side of the argument makes it look (to me at least) that your argument is weak and you cannot defend your position.

Claiming that research papers that most of us are unable to access without spending money have all the answers we are asking for - when the publicly available abstracts suggest otherwise - is, again, not making your arguments look convincing. Neither is falling back on patronising comments.

You state that forceps are banned in 17 nations. I've just done a quick google and, like MTV, can't find a single link in the first three pages that mentions all forceps being banned in any country - never mind 17 of them. Again, if this is the case please provide a link to support this statement as I am unable to find reference to this information in anything other than anonymous and unreferenced posts on message boards.

[I did come across one website - not a research article - that stated high cavity forceps were "banned" (their quotes, not sure how to interpret them from the context!), but this relates to a subset of forceps not all forceps - and you seem to argue that all forceps are equally dangerous.]

Lastly, you make the observation "Pregnant women don't need empty reassurance. They need hard facts to enable informed choices."

I couldn't agree more. I am deeply concerned that you are posting information as though they were "hard facts" even though they contradict the current guidelines from NICE and the RCOG, as linked just above by MTV. When you are asked to substantiate your "hard facts" you are unwilling or unable to do so. To me, this is no longer giving women "hard facts to enable informed choices" - this is pushing a personal agenda in a manner likely to scare a woman (possibly into demanding a course of action against medical advice that puts her and her baby at increased risk), NOT supporting informed choice by discussing risks and options.

If you still believe your initial assertions then support them with data freely available in the public domain - be that reviews or abstracts or full research papers.

If you do not feel you can defend your initial assertions with the vigour with which you made them then have the good grace to say so and either retract them or reframe them as personal opinion / with appropriate caveats.

Flissflaps / Tangle I couldn't agree more with everything you say.

I said I wouldn't do this, but honestly the more I see Dance post on the subject the more alarmed and distressing I find it. I find her whole attitude irresponsible and frightening. She doesn't get the impact her words have on people. I actually think what she's doing is very dangerous, right down to the point that she tries to give herself authority on the subject by saying she comes from a family of health care providers as she has done.

I think it displays a complete and utter lack of understanding of what the purpose of this forum is for and why women use it. To get support and a source of quality information - some of which CAN be anecdotal - provided it is framed as exactly that - some of which CAN be links to studies - provided it is questioned appropriately and with cavets.

TBH without that, imho, it is no better than likes of crackpots who try and sell extreme diets of fruit and veg to cancer sufferers as an alternative to traditional chemotherapy etc. Dangerous, Dangerous, Dangerous.

It is all very well to have an opinion, but when it crosses the line into scaring the shit out of people and trying to make out it has more weight and authority than health professionals it worries me.

When you are going against NICE guidelines, then you need to do so in a way that isn't as biased and offers a range of arguments in a calm, unemotive and rational way, which doesn't include words like 'barbaric'.

This is nothing more than scaremongering and insensitive scaremongering at that. I feel powerless to try and make the point on here and I feel worried about the impact her posts have on already frightened women. She's basically trying to almost emotionally blackmail or terrify women into opting for a c-section when that might not be the best thing for them. I feel quite bullied by the strength of force she is pushing this with actually and I'm in the boat of wanting a c-section anyway.

Its just troubling and I don't know how the hell to get that message across, especially in a way that isn't causing a confrontation or a personal attack. I do think though, that SOMETHING has to be said about what she's doing and why she's doing it as a warning to any readers who may get worried about this.

From experience I know how easy it is to get sucked into google searching for studies that support your opinion. The thing is, you also have to force yourself to do the opposite and force yourself to question, question, question and cavet, cavet, cavet when you do so. Its very very easy to fall into the trap of 'being well informed' but completely failing to inform yourself of the opposite side of the coin. If you don't do that, you aren't well informed at all though you can appear to be on forums like this. You do need to do your best to try and take a step backward on stuff like this and avoid pushing it too forcefully on other people.

Opening people's eyes to alternative ideas is a good thing, if done with thought and consideration. In this case, I question whether that is actually being done.

Tangle

Not once have I said all forceps are equally dangerous. Kiellands forceps are the worst, followed by Simpsons. These are high forceps deliveries banned in many countries, but not UK.

I also clearly mentioned that in the modern, better equipped hospitals of 17 nations (such as Sweden, Italy, China, Japan, Korea, India, USA, Germany, to name a few) forceps are not used or even mentioned.
There may not be a legal ban on them, but due to a high rate of litigation against obstetricians performing forceps deliveries, they have been abandoned by most hospitals. If you look for blanket bans online, you may not find it.

Are you going to blindly trust NICE? Up until a year ago they thought women with tokophobia should be giving birth vaginally. RCOG and NICE are known to reveal exactly how much they feel is appropriate.

Why have they not mentioned the following risks of forceps?

Brachial plexus palsy
Spinal cord injuries
Possible death

Why haven't they mentioned that incontinence is most common after forceps deliveries as are obstetric fistulas and pelvic floor dysfunction?

Majority of the risks of a CS are listed by them as uncommon, but the serious risks of forceps are much more common, if you compare the statistics in brackets.

I don't see what you're trying to say Tangle? That forceps are perfectly safe and should continue to be used ? That women should not have the right to refuse forceps and ask for CS instead?

NICEy,

What exactly am I doing that is "irresponsible"? Is it irresponsible to elaborate upon the risks of forceps and inform women that they can in fact refuse the procedure?

Nothing I have said is concocted. If you cannot purchase the articles I posted, I'm sure you can still verify the risks of forceps from any doctor or website.

NICEySigh

I agree with your comments above about the way in which DLTW posts, so much so that I have in fact previously reported comments made by her to MNHQ as I feel that they are unhelpful, dangerous and somewhat unhealthily obsessional.

I do think that someone could be put in a position where they need forceps and a delay in delivery could result in a serious danger to their baby (lack of oxygen for example) but refuses on the basis of what DLTW has posted repeatedly and demands a CS which will take longer to set up and perform.

I am unbelievably angry right now, and no, DLTW it is not because I am trying to justify the use of forceps in my case with hindsight, but because you post in a manner which scares and frightens women unnecessarily when what they need is unbiased advice which helps them make an informed decision should they need to, at a time when there isn't time to explain all of the risks and advantages of a particular mode of delivery.

And now as I have been able to access a computer, I can and will hide this thread, which is no bad thing as my BP must be through the bloody roof again, hardly ideal at 25w pregnant.

To those of you who continue to try and reason with DLTW - good luck!

To the OP - honestly, don't be frightened or scared. Most of us who have had forceps have somehow lived to tell the tale, and have healthy and happy children who have suffered no ill effects :)

Flisspaps

If the forceps fail a CS is performed. That wastes even more time. Demanding a CS, particularly if an epidural is already in place is not the worst thing.

Many women are first prepped for a CS (with an epidural top up, and catheter) anyway and taken to theatre before attempting an instrumental. So how is it wasting extra time?

LoveInAColdClimate,

I've read most of the thread with interest. I want to mainly answer your OP though.

People on the thread are right that forceps/ventouse do raise the risk of various birth injuries both to yourself and the baby. However in 7 years working in a large obstetric unit out of the following list that Dances posted

Brachial plexus nerve palsy
Cerebral palsy
Spinal cord injuries
Intracranial haemorrhage
Facial nerve injuries
Possible death

I haven't seen a single one from an instrumental delivery. Its all very well saying there is a raised risk of the above (which I would agree with) but if you don't quantify it then its all rather meaningless.

MoTeaVate wrote a better post earlier this morning which had some figures from the RCOG attached to the risks. I'd also like to add that some of the things where there is a raised risk such as a PPH may not be due to the actual forceps or ventouse but could be due to the fact that a longer labour increases the risk of a PPH, a larger baby or a baby in an awkward position that has taken longer to birth is more likely to have nerve damage or low APGAR scores due to the birth itself as well as the instruments. I've certainly seen babies born with a normal vaginal birth who have had nerve damage. I've seen babies born by LSCS with nerve damage.

Problems like this are rare. There can certainly be times where if the Dr wants to do an instrumental but you'd prefer a section then there would be enough time and baby would be in a position where its safe to do this. There will be other situations though where either there isn't enough time or baby is too low and an instrumental really would be safer. It is definetly true that sometimes babies can be so low down that they need to be pushed up for a section - I have had to push babies back up for sections before and there are risks attached to doing this.

If its a simple case of "failure to progress" and a long second stage then you can certainly try putting your foot down and asking for a section. However if the Drs are worried about baby's heartrate and want to do an instrumental they can have baby out by ventouse or forceps in a few minutes, it would take longer to get you to theatre, get all the staff there, get you prepped either by spinal or GA and get scrubbed and get the baby out. And if baby's heartrate is plodding along at 60pbm I'd rather take the risk of incontence problems down the line and get baby out.

Try and do what you can to avoid the need for an instrumental. Avoiding an epidural and remaining mobile and upright in labour are the best things you can do. Try and stay positive and not worried, the majority of babies are born in good health and with no long term health problems to mum or baby. Good luck.

And Flisspaps, merely because you don't consider a forceps delivery harmful, is not a guarantee that nobody else will suffer ill-effects.

Most women live to tell the tale, but it is a tale of incontinence, sexual dysfunction or brachial plexus palsy. Just surviving the process is not enough.