Forceps or CS?

[ChicaT]

I have a heart condition and have been told that I won't be allowed to push for more than 20 mins when giving birth...this is my first baby, he's quite large, and I don't think there is any way I'll be able to push him out in 20 mins! They would then use forceps to remove him, which while it can cause internal tearing to me and bruising to him, I'm still being told is preferable to a CS due to elevated blood clot risk. I would be put on epidural very early on which can slow labour down, and as I would have been on it for such a long time by the time it comes to push, I may not be able to push at all! I've also been offered a CS if I want one. What are your experiences with forceps? Hideous? Do-able? Would you go VB it if you knew in advance forceps would be used? TBH a CS is seeming a lot simpler and calmer!

[ChicaT]

Oh Miaow I'm so sorry that sounds like an absolutely awful experience. I think a lot of the medical profession can forget that we are humans, real people, they just see the medical condition. They don't have to make a traumatic experience worse than it is by not caring - I haven't experienced birth yet but I did witness medics treating my mum, who had terminal cancer, with terrible lack of respect and compassion. Hideous

[ChicaT]

Goodness so many responses! Thank you everyone for your honesty, advice and support. In answer to some of your questions - I'm on Clexane 40ml daily but as you have to stop taking it 12-24 hours before birth, at the time of the birth when blood clot risk is highest it won't be have any effect during the birth itself. It's not possible to take Clexane during vb or cs birth because of the risk of losing too much blood. I wouldn't be allowed to push for more than 20 mins, and would be given the epidural so early to reduce stress from pain, and to reduce strain on my heart. I have a very good consultant, and I'm going private so no NHS funding issues come in to play, my consultant is just pro-vb, although she is perfectly happy for me to have a cs, it's entirely my choice. The issue is clotting - pregnancy raises your blood clot risk by 6 (i.e. all of us are 6 times more likely to have a clot while pregnant) a CS raises the risk by 10 and the highest blood clot risk would be with an EMCS where it raises to 13 or 14. My consultant has explained the risks of both options to me quite clearly, but is still in favour of vb with forceps - her equipment of choice as I think she has many successful forceps deliveries - over what is a major operation. I'm pretty decided on a cs now, especially after so many of you have confirmed what I thought - that the damage from forceps /episiotomies etc can be pretty severe to both mum and baby, though mostly and more long-lasting to mum, and that it's difficult to push under epidural. And I have an L-shaped coccyx from an old snowboarding accident, just waiting to block a vb baby! So when you add a potential re-broken coccyx to the mix...

I had a CVA (stroke) a few years ago which is how the heart condition was discovered, so I'm keen to avoid another clot, but i still think I'd rather have the controlled risk of the cs despite the blood clot risk rather than unknown potential damage to me and baby. Given the upheaval the stroke caused, a calm under-control cs birth appeals...especially as a home water birth with no intervention or drugs is so not on the cards! It is still strange and scary to volunteer for a major op, but I'm hoping once I have our little boy in my arms none of it will matter anyway.

[Loislane78]

I have blood clotting issues and took Clexane injections throughout pg and afterwards. Plenty of people have Clexane/fragmin after a CS so I'd be asking the consultant about this.

[amyboo]

I would never have forceps. They're not used at all in the hospital where I give birth (in Russels, Belgium). I'd opt for ELCS every time. Had one for DS1 (footling breech) and it was fine.

[samarcanda]

Sorry, Don t agree, if you actually ask for hard data (we did because it was part of the legal case against the hospital for the way my cousin was treated) you will realize that the risks associated to an elcs for mother and baby are tiny compared to the ones of a forceps birth... What I find SHOCKING and i try to advocate against is that these risks are played down by almost everyone in the NHs and the risks of c sections are played up so women are not properly informed ... This allows hospitals to save loads of money without being challenged at the expense of patients. There are certainly some cases where using forceps is the safest option because labour is too far along and risky to have a c section, but these are only a ver small part. In reality forceps are used to avoid the hassle and cost of surgery.... And of course there will be positive experience and negative ones for everything...

[ByTheWay1]

samarcanda - I could equally scare you with pictures of scarred babies cut by the surgeon's knife - there are benefits and risks to both.

I personally recovered much more quickly from a forceps delivery than from a CS, some will find the opposite. Most forceps deliveries actually turn out just fine, as do most CS deliveries..... and as someone has mentioned forceps can also be used during a CS delivery.

[oscarwilde]

I've had an emcs and a vbac with forceps, minimal 2nd degree tears to perineum and she was out in one push (with forceps - quite a bit of pushing before then). In my experience the recovery from a CS was faster by quite some way. About 6 versus 12 weeks to feel "normal" and my pelvic floor is still weak. Reading the postings above it seems to be quite conclusively in favour of ELCS.
I was lucky enough to be able to consult a friend who is an obstetrics consultant and the opinion there was that multiple CS's are low risk in their eyes if you are having a normal pregnancy. By your 3rd+CS a consultant will be operating / overseeing due to risk of adhesions but before then you will in all likelihood be treated as low risk.
My friend also noted to me that there are lower instances of geriatric incontinence and other issues in later life in countries with a high instance of CS delivery. I was going for an ELCS but my DC2 had other ideas so vbac with forceps it was.

[Narked]

Big difference between taking a baby out of a c-section incision and a vagina.

[DontmindifIdo]

Samarcanda - you know if the baby is in a funny position, they will use forceps to get the baby out during a c section as well...

But generally OP, I'd go ELCS.

[MolotovCocktail]

With the greatest respect Samarcanda, I don't think that 'scaring' women about forceps delivers is the most useful strategy when the OP is trying to make this significant decision.

Let's face it, the things that could go wrong with CS (and labour generally, for that matter) are very scary. I was 'scared' by my OB at our initial consulatation of the things than can go awry with CS. It wasn't helpful at all.

What was helpful was looking at the likely outcomes of ELCS and VB - in the OP's instance, VB with forceps.

Now is not the time for scaremongering. I agree with you that I would prefer an ELCS over a forceps VB, but that's only because I'm aware of the risks and benefits of both and prefer the outcomes of ELCS.

[samarcanda]

C section ABSOLUTELY! I m a strong advocate against this horrendous practice of using forceps to save money that the NHs still persists on using ... No other developed country does this from the 80s! My cousin was seriously brain damaged by a bad forceps delivery, on a wheelchair all his life! Since then I ve tried to scare away from it as many people as I can..sorry but I d rather sound horrible than being complacent. The risk of clothing is so much lower and better managed with blood thinners than the risk of a bad forceps delivery.... Also to put you completely off, try googling an image of it...

[louschmoo]

Read this with interest as I just had an appointment with consultant to discuss my impending VBAC. I was pretty keen to refuse forceps outright and move straight to CS in event of difficulties. After discussion we've agreed that I will consider low/outlet forceps, but not high forceps. I feel fairly happy with this, although am hoping it doesn't come to that and that baby just glides out!

[MadeinBelfast]

I could have written your post OP. I had fantastic medical support on a high dependency unit in the labour ward with extremely competent midwives. After being induced I was left for 12 hours for the head to descend as far as possible and then after 20 minutes pushing a consultant carried out a forceps delivery. We were both absolutely fine and I would have no qualms about trying it this way again. Obviously every birth is different but get as much advice as possible and then choose what seems to be the best option for you. Good luck!

[Flisspaps]

ByTheWay1 The potential risks of forceps were NEVER explained to me in either case - and both times there was more than enough time to do so. Everything I know about forceps has come from MN!

[ByTheWay1]

But Ushy do they explain the risks of bladder cut (more common than you think with ELCS !), cuts to the baby, wound infection, future fertility and placental problems, adhesions, rupture etc for CS birth?? You can also "be lucky" with a CS and not suffer much damage.. there are risks to both.

[Ushy]

ELCS every time:-) You can be lucky with a forceps and not have much damage but the reverse is also true and the potential risks like bowel incontinence, prolapse, damage to the baby's head etc I felt were never properly explained.

[atrcts]

I had forceps delivery and it was brutal. I was shoved so hard up the bed that they had to pull me back down to continue!

Baby came out with purple rings on his eyes and was cut and bruised for weeks after. He was desperate to suck constantly and I think he must've had one heck of a headache poor little mite. I took him to a baby cranial chiropractor to help realign his spine.

It twisted my pelvis so much that it hurt to stand and took 2 years to heal. I also needed Physio to help tone up the anal sphincter and although it improved, it's never been the same since.

I have a medical condition (multiple sclerosis) which studies show increase the likelihood of an assisted delivery. For this reason, and because of the MS fatigue, I want a c section next time. I'd rather repair for 6 week than 2 years!

Someone else said you have to push with forceps and that's true. I couldn't sit down for weeks after birth and had to use a rubber ring! Also had to have cautery to the episiotomy scar at 8 weeks as that had failed to heal (due to the terrible swelling which healed so slowly).

I'm not saying everyone experiences the same trauma but you can never know with forceps and with a heart condition, I am surprised you'd be offered anything other than a section.

[Narked]

CS would be safer for you and the baby unless there are specific clotting risks related to your heart condition.

[DontmindifIdo]

I had a forceps delivery with DS. If I knew for definate I'd be doing that again, it would be CS, no question. Have been told I could have an ELCS this time round if I want, I'm still debating it but only because I'm intending to put 'no forceps' all over my notes.

Let me put it this way, only 1 woman I know who had a forceps delivery didn't have any complications afterwards caused by it (about 15 woman I know had forceps), of those who had CSs, I don't know any who had complications (around 20 woman I know who've had them, both emergancy and planned).

[JollyRedGiant]

I had a hurried forceps delivery. With no lasting damage. I had a graze afterwards which took a few weeks to heal though. I imagine it was significantly less painful than a CS recovery! I'm 5'1 with size 10 hips and had an 8lb 3 baby.

That's not to say forceps would go as smoothly for anyone else - you hear lots of horror stories.

The impact of a CS on breastfeeding was something that concerned me. Not that there is a great deal of conclusive scientific research into the effect on BF rates, especially when the section is planned. It was just an irrational concern I had.

[MarshmallowFarm]

ELCS any day of the week - I had a forceps delivery and it took me 5 years to recover physically. DD had terrible colic and now has SEN, both of which some paedeatricians have suggested may have been exacerbated by the forceps.

Good luck!

[ByTheWay1]

I had a partial failed epidural which made a CS very agonisingly traumatic to start with! recovery time was long and 3 days in hospital and I felt generally sore and slow for a month or so after.

Second was a VBAC - I had forceps due to just being so tired, small episiotomy, no tearing, up and out of hospital that day, felt bruised for 2 or 3 days - much better experience for me.

Both babies BF well. CS DD has allergies/chest infections, forceps DD does not - I will always wonder if it is due to method of birth as there is no history of allergies/chest trouble in either family.

[MildDrPepperAddiction]

I've had both forceps (with third degree tear) and emcs. Neither are nice, but I think the cs was less traumatic for me and definitely so for the baby.

Good luck with your decision.

[VinegarDrinker]

I had a positive forceps delivery with episiotomy. Pretty quick recovery and no problems having sex etc.

You need to consider how many children you will want in total as part of your decision making. 3rd Caesareans onwards can be fine but can be very tricky with a much higher risk of complications.