Is it possible to totally refuse forceps?

[RevoltingPeasant]

This is a musing rather than urgent Q, as not even pg yet! Am v organised

The Birthrights thread got me thinking: can you refuse in advance one specific procedure, or is this just really not possible?

In an ideal world I'd want a homebirth but would transfer to hospital if any probs. However, once there, would it be possible to say I simply don't want forceps under any circs, and to go straight to CS if it's tending that way?

Or will an NHS hospital not have that flexibility?

I ask because I've seen some forceps horror stories, and that + episiotomy is my real fear during birth!

[Merlini]

You can refuse anything in labour I think but do bear in mind forceps may be the safest option for you both. I have had two forceps deliveries and despite being utterly terrified of them before I gave birth it was fine. Both deliveries have been intensely brutal and traumatic but the forceps were not the worst bit, babies both too low in birth canal for safe cs. I had the necessary episiotomy, which I think is equivalent to a 2nd degree tear and healed up fine after, no pelvic floor issues or anything. DD and DS also both fine. In my second labour the doctor used the forceps without a spinal and even that wasn't too awful.

I know many people have had awful experiences and completely understand why anyone would be scared of forceps but just wanted to say they are not always as bad as you might think.

[higgle]

My first labour was very slow and the obstetrician seemed tbe getting concerned. She did something I've not heard of before which was to give me a "good talking to" She told me that I needed to make much more effort, that giving birth wasn't callled labour for nothing and that if I didn't start t work as hard as if I was climbing Everest without a sherpa I would have to have an episiotmy and forceps delivery. By tht point I had felt totally exhausted but the pep talk did me a load of god and DS1 was born natuurally a while later. She told me afterwards that just saying enough to make me realise the implications of giving up was a technique she often used to avoid instrument deliveries, I was very pleased, even though I still needed stitches.+

[Flisspaps]

higgle those of us who did need forceps after putting everything we had into it should've just tried a bit harder then, eh, or perhaps we just needed a stern talking to?

The other thing about forceps is that they're often seen as a way to avoid surgery (CS) but many women who've had them end up having surgery later anyway to put right the damage done!

[fedupwithdeployment]

I had an episiotomy and forceps with DS1 who didn't want to come out. I wasn't keen on the idea, but frankly after almost 5 days in labour (not all established but I was knackered) and with a stuck DS, I agree with the poster who said she would have consented to the cleaner hoovering him out!

It went well and despite a bit of bruising, we were both fine. No long term damage. It was thoroughly unpleasant at the time mind you.

[PastaBeeandCheese]

I agree with flissflaps. That's quite an assumption......

[higgle]

Flisspaps - that is not what I meant at all, but her unconventional approach did work for me. DS 1 was born in a rather unconventional private hospital, so I was paying to be told off for being lazy! I just wondered whether some instrument deliveries might be avoided if midwives and obstetricians encouraged/supported/had a go a bit more - that's all.

[MajaBiene]

DS was injured by a forceps birth, so I don't think it is just a case of "whatever is quickest is best". He could have been born perfectly safely by CS.

I think for any subsequent births I will state forceps only if baby's health/life is at risk without them or there is no safe alternative.

[OneLittleToddleTerror]

higgle I found it quite insulting as well. It's got the implication that we are too 'posh to push' so we ended up with an instrumental birth? I'm mainly thinking the bit about labour being hardwork and the implication of otherwise. FWIW, I was in labour for 2.5 days, without any pain relief (except a couple of tablets of codeine), so I was definitely making the effort.

[RedToothBrush]

Told off for being lazy?

WTF!?!

Tell that to the wrong woman and you risk giving her all sort of psychological issues.

Its just not acceptable.

By all means use 'motivation', but that is not achieved by using language which puts down a woman or might damage her confidence, self esteem or worth or otherwise suggest she might be failing in someway.

It is nothing short of bullying to achieve results and there is every chance it won't work. Do not suggest acting like this is anything different, because it really isn't.

You do realise how many women are worried about coming across medics who lack empathy and act in that way, don't you?

Unbelievable.

[notimefors]

They tried to do a CS first with me but couldn't push DD back up so then went for foreceps as second choice.

The attempt to push her back up was far far worse than anything else pain-wise.

[wishfulthinking1]

Dc1 is due in 11 days - eeeek! Have read the thread with interest.

Just wanted to say that I'm sure higgle's post was well intentioned. It was about her own experience, one where clearly the medical professionals felt like she was able to give a bit more, she did, and it worked.

I imagine the dr doesn't try that particular 'pep talk' with all women. But uses it as a strategy on a case by case basis.

No-one was implying that if you had a instrumental delivery then you were lazy- at least that's certainly not how I interpreted it.

[Merlini]

A "pep talk" is certainly not the best way to go with many women. I had this from unkind and unsympathetic midwives in both of my deliveries. In both I've had a very short first stage (1hr in first labour, 40 mins in second) and hideous protracted 2nd stage (4hrs first time and 2.5hrs second time). Both persistent OP babies finally delivered still back to back, with DS I had no pain relief at all other than some fentanyl just as they made the cut. DD was 4 weeks early and badly stuck. She had to be rotated by hand and that was no fun. I had a lot of "pep talks" about how I wasn't trying, despite being out of my mind with pain and terror. When I went to a birth afterthoughts meeting recently and saw what the MW had written in black and white (poor maternal effort, ineffective pushing etc etc) it was very difficult. My feelings of shame and failure are nearly overwhelming. DS2 is due in 7 weeks, am trying very hard to stay positive but remain very distrustful of MWs in general and still very deeply ashamed of myself. Having got through two forceps deliveries so far though at least am not particularly scared of them this time.

[Pendulum]

OP, if you are concerned about intervention rates at your local hospital, you know you have a right to choose a different hospital don't you (if there is another one in your area)

[Pendulum]

Have just noticed you are not even PG yet.

So maybe you didn't know that you will be (or should be) offered a choice of hospitals (or other locations such as midwife-led units) to deliver in. You can compare stats about them (e.g. numbers of complaints) on NHS Choices- www.nhs/uk

[Pendulum]

Sorry www.nhs.uk/

[Pendulum]

It also gives you the percentage of unassisted vaginal deliveries at each hospital.

Sorry for multiple posts!

[Flisspaps]

higgle your second post does nothing to explain or ease the way you came across in your first post.

In short, no, having a go at women probably won't make a difference to the number of forceps births, but it probably will increase the number of women left feeling like failures about it.

[RevoltingPeasant]

Back I think it's more that I'm not sure I trust the drs at that hospital. It's not so much about the woman 'complaining' if you see what I mean - her baby has permanent disabilities now and I believe she's suing the PCT - it's more that the dr who was left to deal with her was v junior. This is all friend-of-a-friend stuff but apparently she gave birth at 3am and there were no consultants around, and no one to supervise the relatively inexperienced person who decided she needed that procedure.

Coco I don't think it's trivial to think about your own long-term health in birth, and also, there is an obvious risk to baby from forceps. Of course it might be the best option, and if I genuinely thought that I'd probably give in, but like others I think the drs probably are thinking about £££ as well as the mother's long-term health.

[RevoltingPeasant]

Pendulum thanks - yes, this is hardly an immediate problem for me - though I'm hoping it will be soon :)

The thing is, I want to try a home birth so would only transfer to hospital in case of problems, which is why I think I'd need to go to my nearest as I imagine it'd be a high-pressure, blue-light type of deal.

[banana87]

I've had forceps twice. Venutose failed both times. Too late for C-section. Without forceps both my babies would have died. I could have withdrawn consent, but I preferred an alive baby rather than the opposite.

[RevoltingPeasant]

banana, I think what I was asking was really, is it possible to say no forceps beforehand so it doesn't get to that point, where it's too late for a CS, as they are looking to do sth before then. Rather than, would you let your baby die rather than have forceps, which would be a pretty insane position!

Anyhow, thanks for opinions, all.

[VinegarDrinker]

banana in all honesty the answer to that question is no. Well, as stated earlier you can, of course, refuse, but as for the obstetricians and MWs being able to predict before the event that you may need an instrumental delivery, I'm afraid not.

There are some clues eg long first stage often means long second (pushing) stage, but if HCPs were to jump in and do a Caesarean for every one with a long first stage the CS rate would be astronomical. It is also very difficult to predict which babies will suddenly get distressed in second stage.

The only way of guaranteeing you wouldn't be recommended an instrumental delivery would be to have a CS prior to labour or in early labour.

Of course you could consent to ventouse but not forceps but it may not always work.

You have to be aware that there are many, many different situations in which forceps are recommended. In some there are totally reasonable safe quick alternatives, in some the alternatives would be considerably more risky for you and/or the baby.

Sorry for what seems like a negative post but I don't want you to get the wrong impression.

[VinegarDrinker]

Sorry, that was to Revolting not banana in answer to the question " really, is it possible to say no forceps beforehand so it doesn't get to that point, where it's too late for a CS, as they are looking to do sth before then "