Assisted birth fear

[bettybat]

Hi all - there was a great thread on forceps, but I have so many questions I didn't want to hijack it! Reading that thread just threw up more questions, so I thought I'd face my fear head on and go with the knowledge is power approach :)

I'm really frightened of forceps, and don't massively understand them - or ventouse. As in, choosing between the two or can you even?

I'm 4 months and a bit pregnant with my first, and focusing on having an active birth, using hypnobirthing and would like a water birth. But I have this nagging worry at the back of my mind - what if despite all my preparations, it just doesn't go like that? What if the baby gets stuck, or labour doesn't progress or whatever? I'm really aware that no amount of hypnobirthing will change things if my baby gets stuck and I'm just so fearful of assisted births.

I have tons of questions because I am really ignorant about the procedures, but my main fears are damage to my baby, and also...the pain of them being used on me. The thought of labour pain does not frighten me - maybe because it's my body doing it? But the thought of having pain inflicted upon me really freaks me out :(

So here goes - any advice or any information very gratefully received :)

How far in advance would the midwives be able to see the need for assistance?
Can you choose between forceps or ventouse?
Is there an opportunity for pain relief in the event of assisted birth, cutting - or if not, how do you manage?
Is it possible to opt for a CS if the midwife can see enough in advance that assistance is needed?

Basically my worst nightmare is needing assistance but not enough time for pain relief, and being cut and having the forceps inserted (oh god, I don't even know the actual details of forceps!), and my baby being yanked out and hurt.

I sincerely apologise if this projecting brings up any memories of a traumatic birth for anyone...I am normally very positive, and 95% of me is focused on things going well...but then these absolute nightmares creep in and I think it's the not knowing that's worst.

Hello Bettycongratulations on your pg!

I guess the first thing to say is - no matter how prepared/determined you are for a particular mode of delivery - it's all down to how it turns out on the day and many factors (too many to mention here) govern this. Particularly in the case of labour, less so I suppose for an elective c-section.

I have two girls: one born in 2009 with an assisted delivery (kiwi ventouse) and my second born almost 3 weeks ago via ELCS. I'll share my knowlede with you re. DD1.

About forceps and ventouse: you can't really choose between them. It depends on where abouts baby is in the birth canal. If they're low down (as in almost out) then ventouse it is. If they're higher up, there are a few different types of forceps that can be used: I don't know the specific names; I'm sure another Mumsnetter can inform you ofthe names (I think there are some called 'Neville Barnes') There are some that will grip baby if s/he's higher up. Kiellands forceps (I believe) rotate and descend baby. I think these are the ones that can cause most damage mum's cervix, perineum/pelvic floor. I have read on some post here that mum can refuse to consent to have Kiellands forceps and go straight to EMCS. You would need to research this further as I'm not 100% sure of the protocols.

Usually, assistance is given when labour is not progressing as it 'should', e.g. mum has been labouring for ages and is getting exhausted (not pushing strongly enough); baby is getting distressed (reduced heartbeat and/or passing meconium). They're not used willy-nilly. There has to be a good reason. For me, I'd been labouring for a long time, I hadn't slept or eaten for a long time and been pushing for 2 hours. I was knackered and wasn't pushing effectively. Also, DD1 passed meconium so I was given an episiotomy and she was delivered by ventouse.

I was given a regional anaesthetic in my perineum prior to being cut. I think this is standard procedure as I imagine as it is a minor surgical procedure it would be very painful without.

I think you can go for CS if you don't consent to forceps. Remember that this would need to be stated on your birth plan an expressed if the situation arose. Hospitals have procedures an protocols. They also have statistics that they need to fulfill and giving EMCS over a forceps delivery might not be what they automatically do.

For the recorrd, I was grateful for my firstborn's assisted delivery. I knew I didnt have it in me to push anymore, and I could have kissed the consultant who delivered her. One small, painless injection into my perineum and I was numbed. One last relatively small push and she was out, and her lovely little body placed on my tummy. I didn't feel being stitched together again. Don't e frightened by it.

Best of luck to you and I hope that you getthe birth you want xx

Oh, forgot to mention that you might be able to have the chance to discuss your birth fears with a professional. I know that women who have tokophobia (not suggesting that you do) and request CS are first given counselling in order to overcome their fears and aim for a VB.

OP, I understand that especially for a first delivery you can have these fears. But good for you for being 95% positive!

Remember though that if you were to choose not to have forceps in the event of an emergency, there are also risks to a c-section. A full dilatation section after a prolonged period of pushing has significant risks associated with it.
I had a mid cavity forceps delivery (there was a very tight nuchal cord which was preventing delivery plus non reassuring CTG and meconium) after pushing for a hour. I was so thankful that my baby and I were both healthy after it and happy to have avoided a full dilatation section!

Can I add that if you do a hypnobirthing course, the practitioner will take you thru a fear release session which I found really helpful.

I had forceps with my baby, he was distressed at the time and so they needed to get him out ASAP. If worst comes to worst and you need an instrumental delivery, you won't care at the time you will be more bothered about your baby. I was fine, didn't feel a thing really (too busy concentrating on baby and what I had to do to get him out. They will use local anaesthetic and give you pain relief to cover you for a while after the birth. Not sure if my post is helpful, just speaking from my experience but I really think you will just do what you have to do at the time. I also had a fear of forceps and thought I would prefer a section to forceps but my sister had a section a week before I delivered ds and she has had a much longer recovery. Good luck and enjoy your pregnancy

Thank you all for your replies :)

So I guess...in the long run it's better to go through the relative quickness of the forceps rather than the prolonged recovery from an ELCS...

It's the unpredictability of it, I think! I want someone to say, this is exactly what it will be like but I also completely understand no one can!

Can the midwives see ahead of time how things might progress? I suppose I've answered my own question - not if I've been pushing and pushing, and baby is stuck.

Thank you Lunarlyte for the info on kinds of forceps...understanding a little better, I think it is the Keillands kind I have more fear of. If the baby is lower down in the birth canal, that doesn't seem so bad.

I'm sure someone else more knowledgeable will comment, but I'm not sure Kiellands forceps are used in the uk anymore (a cs being seen as preferable in terms of minimising risk to mother and baby).

i am sorry you are anxious - I think with every kind of birth you will get a wide range of experiences.

FWIW, I had an elcs for my 1st dc, due to tokophobia (and I didn't have counselling beforehand, a perinatal psychiatrist thought this wouldn't be effective and recommended that I have an elcs).

The op and recovery were very easy, and my recovery was a damn sight easier than other 1st time mums who had assisted deliveries. Of course, cs is a complex set of risks, short and longterm, and furthermore, they are risks that matter less to some mothers than others.

I mention this because I think it is misleading for women to say 'oh, forceps so much better than a cs....'. It really varies from birh to birth.

Obviously what you really want is a crystal ball - we all do and unfortunately they are in short supply. Practice and experience also seems to vary widely from hospital to hospital - there are posts here where women feel they were 'rushed' to cs and others where women feel they were left to labour too long and a cs would have been preferable. It really varies hugely.

It may be worth discussing with your mw how seriously birth plans are taken at your hospital/mlu. It is possible to express strong preferences in a birth plan but if for example your hospital has a very high instrumental birth rate and a very low cs rate, there's probably a policy reason for that, and they may not be sympathetic to your preferences.

Ps this doc explains when and why instrumental delivery should be considered, if it helps - less subjective, anyway -

www.patient.co.uk/doctor/Delay-in-Second-Stage-of-Labour-and-Use-of-Forceps.htm

I can sympathise as I am a bit of a control freak (not saying you are but that's definitely me!) and I didn't like the idea of things happening outside my control in my first labour.

I have to say though that after hours of contractions and a baby getting stuck (my experience) I really couldn't have cared less what went on down there as long as they got her out... I was in a lot of pain anyways so having more epidural and then an episiotomy and ventouse delivery didn't even register much at the time!!

I won't lie, it was very painful afterwards but no more so I believe that naturally tearing quite badly... which I understand often happens.

I think if you focus on all the what if's you'll drive yourself crazy. However, I will add that due to my first birth experiences I am opting for an elcs this time round (booked for 5 weeks time) as I don't like the feeling of being in pain (in labour generally) and I'd rather have the recovery pain afterwards than the pain beforehand! But that's very subjective. Many would disagree!

Good luck.

I wouldn't worry about it at this stage, you never know how your labour will turn out. I should have had a low risk labour, but it ended up being really long and exhausting, then I couldn't push effectively enough so DS's heart rate dropped and he needed to come out quickly. He was too far down for a CS so it had to be forceps. I was given a local anaesthetic but it still really really hurt (maybe it hadn't taken effect properly). There are risks associated with forceps and with CS, but they are probably roughly equal (just guessing though), and the recovery time after CS is longer.
Anyway, it is much more likely that you won't have any problems at all, but if anything doesn't go according to plan the midwives will explain the options to you and do everything they can to keep you at ease.

I don't want to tell you not to worry, as I think my experience was a particularly good one, but I had a ventouse delivery and really didn't feel a thing.
I wanted a similar birth to you- homebirth, hypnobirthing. I was terrified of instrumental delivery too, I totally understand the fear of pain being inflicted on you, it does seem different to contractions.
I did fine until issues with an incompetent midwife led to us going to hospital, I arrived fully dilated but my contractions were dying off and after 4 hours of pushing I needed a ventouse. I had no pain relief, just a local in my perineum, but it didn't hurt at all. The midwife laughed because I asked if she'd started yet when she'd already finished! I had a big tear too, something I had been so scared of as I imagined it would be soooo painful, but I didn't even feel it.

Recovery was simple too- everyone warned me it would be painful for weeks, but I only took paracetamol for a day, and after that it was fine. Everything felt a bit tender and bruised, but I could sit down fine and was out shopping after 4 days.

There's lots of information out there- I find the more I know about something the more at ease I feel. I hate to feel out of control and to not know whats going on, so I did tonnes of research about every possible outcome- I know this would freak lots of people out, but it worked for me.

Just to clarify a point from above, Kiellands forceps are still used in the UK. Not all obstetricians are trained to use them but many still do.

I was really frightened of having forceps or ventouse, and then ended up with... a forceps delivery. I had been in labour for a long time, pushing for a long time, there were signs of foetal distress so off we went to theatre, they said they were going to give it a short try with forceps but failing that I was going to have an CS. I was frightened at the time, more for baby than for me, but it was very calm, they took me in, gave me the spinal block, told me when to push (that was weird because I couldn't feel a thing, but I found that if I imagined that I was pushing, apparently I was pushing. I couldn't see anything, then they said 'here she is!'. She didn't look that fantastic and she took a minute to cry, but perked up once she was on the table and they were checking her over. I didn't get to cuddle her or anything until I was in recovery because she needed a wee bit of oxygen but they told me she was fine, and she was.

The only thing that was bad about my forceps delivery is that I did lose a lot of blood in recovery room, which was a bit scary, it was one of those situations where baby is whisked away (she was with my DH though) and suddenly the cubicle fills with people who are all very intent on fixing something wrong. This doesn't happen to everyone though and it wasn't a panic, it just needed dealt with.

Not going to lie, my undercarriage was a bit of a mess but I think some of that was from pushing for ever and ever, I had piles... they did a good job with my epi. It was better by 6 weeks post-natal and I think it was better for me that I didn't want to go running all around town.

I would recommend doing natal hypnotherapy CDs beforehand because I found it helped me cope with situations that I wasn't expecting.

Just to add a couple of things:

I have been told in the past on here that Keillands forceps would always be used in theatre and with relevant pain medication (spinal block, epidural). If that is correct, saying you don't want Keillands forceps isn't going to make much difference on timing getting the baby out - you are effectively prepped for section anyway.

I had a forceps delivery for no.1. I do still have some pelvic floor issues (very minor), but otherwise it was ok. I think in my case needing forceps was directly related to the pressure to augment my 'slow' progress. ARM stopped my contractions, which meant I needed syntocinon, which meant I wanted an epidural, which meant I was flat on my back and my DD didn't turn from her OP position and got wedged and distressed. Honestly, the best thing you can do to limit the chances of instrumental is finding ways to be active and avoid being flat on your back.

Hi there, i think the fact that you have a positive attitude and are swotting up on hypno birthing etc will stand you in good stead but just be prepared to expect the unexpected. I had two easy pregnancies, did yoga throughout and read up on hypno birthing for the second. However, ended up with two emergency c sections. I was determined for a vbac but it wasn't to be. I agree with a previous post in that when the time comes, all you want is your baby in your arms and are grateful for any way he comes out! Enjoy the rest of your pregnancy and i hope all your fears are put to bed!

Again, ladies, thank you so much. It really does help hearing all of your experiences - from the reassurances of some having had pain relief, to those of you who didn't have time and yet you were all brave warriors and got through it anyway.

Honestly, I am sat reading these at work and biting sobs back!

I think I do believe on a rational level that if/when the time comes, I will just want to get my baby out and I will get through bad pain. I just don't want to be scared, and I'm so ready to get down with the contractions and pushing my baby out - this new worry has emerged and side swiped me a little.

I do need to do more research - like some of you, being informed makes me feel better. I think it's mostly fear of the unknown.

I haven't got much to add as you've had some great responses, but just wanted to say that you are doing absolutely the right thing in researching the alternatives.

I'd planned for a homebirth, pool set up and ready to go. When things didn't progress as expected I had a complete meltdown. I just couldn't give up on the idea of a homebirth and deal with what was actually happening. Ended up being induced, then episiotomy and ventouse - they basically came at me with all the contraptions they wave at you at antenatal classes, which i'd smugly thought weren't coming my way. Not the best experience but we both came out of it relatively intact, and my goo covered conehead baby was the most beautiful thing i'd ever seen. Like others have said, I was oblivious about what was going on back down at the business end.

I think if i'd spent time seriously considered the what ifs (instead i spent a ridiculous amount of time deciding what to do with my placenta - didn't even see it in the end!) i'd have been much better prepared for what actually happened - i have never felt so out of control in my life. While you can't control every aspect, if you can adapt (relatively) calmly to changing circumstances if things don't go quite the way you hoped you will be doing yourself a huge favour. In short, i think you are doing the best thing you can in planning positively for the birth you want, but preparing yourself for the possibility that those plans can change. Good luck with it all.