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!

[expatinscotland]

I had mid-cavity forceps for DD1. Luckily it was a very senior consultant on and she had a good look and feel and decided that was the best course to get her out quickly as she needed to be delivered (she turned out to be face up and with her hand cupping her head above the ear). A CS in that case would have been much more dangerous for her.

[Bibs123]

I went to theatre for forceps as if that had not worked then they would have done a section. Fliss - where did i say you should blndly accept? and when did i say they should put up and shut up? I am merely saying that the average person does not have then training and skills of a consultant and we should be confident in their skills and knowledge. I don't think they are gods but they are better placed to make decisions in these situations than the.average woman.

[VinegarDrinker]

Schro it varies but in general any forceps or ventouse with a risk of failure (eg rotational delivery) will be done in theatre so an immediate CS can be performed if it fails or isn't possible. Those are the type of delivery where there is a genuine alternative, albeit one that may carry greater risks to Mum or baby.

I often read about countries that don't use forceps on here, but haven't worked in any and can't find any info via Google so can't really answer that. Ventouse and forceps can sometimes be used interchangeably but more often than not there is a clear indication that one would be more suitable and/or likely to work.

I'm intrigued about refusing McRoberts maneuver, that's a new one on me! I presume you know it's just lifting the knees to the chest, which you can do yourself if no epidural/spinal. It works very well IME and often avoids need for any other "intervention". It is also a bit of a necessity to make space in the pelvis to do the other maneuvers if it fails. So please do enlighten me about your reasons and alternative suggestions for managing a shoulder dystocia Starlight ?

[mercibucket]

Yes, it does sound horrific, pushing a baby back up, but I am unsure why medical experts are telling women it will be a very painful procedure, as if painkillers had never been invented. Do they mean it is very painful for the baby? Or is pain relief such as a general not possible? Just interested really

Bibs - you sound so different to me :) I literally can never imagine having that kind of confidence in any consultant without checking it out myself too

[Bibs123]

What would you.have done if your.baby was stuck at the shoulders starlight and why would you have refused mcroberts manouvre? Or forceps for that reason?

[SchroSawMargeryDaw]

Bibs That's where a lot of problems stem from though, Drs assuming that they know best in all cases and not listening to patient concerns, often ignoring anything said to them because they are the ones with the training so they must know best of course.

Vinegar What would happen if the forceps failed when not in theatre?

[StarlightMcKenzie]

McRM Isn't the only way to deal with SD. It's the most hands-on and active way though and I think HCPs prefer it because 'doing something' gives the impression of better control.

Refusing forceps and McR from the outset can give the woman two essential (imo) things. 1) More likelihood to be able to birth in the most optimal position from the outset to reduce the chances of NEEDING those two interventions and 2) More senior and experienced birth attendants.

[Bibs123]

I didn't have blind faith in anyone but in that situation I had to trust that the consulatant was sufficiently trained and knew alot more than me about the best action to take.

[VinegarDrinker]

Schro you'd have to move to theatre, which takes time. Fine if the baby's heart beat is normal, not great if not. Hence a lot of emphasis placed on how to decide which to do where (there are multiple factors - position of the baby, is it tilting its head at all, how high the head is, is it descending with pushing, how much swelling is there on the head etc etc)

[StarlightMcKenzie]

My first baby was born using fundal pressure and has autism I believe as a result.

I have suffered PTSD and he will suffer for his whole life - and I do not trust anyone touching me.

McR is not just raising your knees. It is being handled.

[SchroSawMargeryDaw]

Thanks Vinegar. :)

I have just often wondered when I keep seeing people mentioning being in theatre for forceps.

[Bibs123]

I did not say not to voice.concerns. or that doctors should ignore patients concerns. Why do people keep misquoting me? We are talking here about people refusing procedures before labour has even started.... I certainly voiced my concerns and did not let them do whatever they pleased but we should be able to listen to professionals too... there is a culture for women to think they know better and that is.not always the case. starlight what is the other way to deal with SD?

[SchroSawMargeryDaw]

I didn't mis-quote you. I'm just putting it out that we shouldn't just trust them because they are trained.

And they do quite often ignore patients concerns.

I knew why I was refusing that procedure and I told them why. I ended up with it anyway and need surgery to fix it for the exact reasons I told them I shouldn't have it.

[olivertheoctopus]

You can refuse what you want. I had an episiotomy with DS1 and never really noticed it so I wouldn't let that be your sole reason for not having forceps. DS1 was extracted with ventouse in the end.

[SchroSawMargeryDaw]

That should have said some of them do quite often ignore patients concerns.

[Bibs123]

Starlight they performed the McR manouvre on me as my baby became stuck. They push your legs to create more space in the pelvis to get baby out in an emergency, when they are stuck. What would you have done at that point?

[VinegarDrinker]

I beg to differ, Starlight, McRoberts is not anything to do with fundal pressure. I don't know how old your DC is but "fundal pressure" is not part of the correct or suggested shoulder dystocia management. Suprapubic pressure is - ie pressure on the shoulder through the mother's abdomen, but definitely not fundal pressure. You can perform McRoberts yourself, it may not be as effective but it doesn't necessarily have to involve anyone touching you, and if you had a subsequent shoulder dystocia I would strongly recommend you to do so.

What alternatives did you consider?

I seriously hope you have had a good opportunity not only for a debrief but to make a crystal clear plan for any subsequent deliveries with a senior Consultant, Supervisor of Midwives and quite possibly the legal team of the Trust looking after you. Not wanting to be touched at all is of course your prerogative and absolute right but if I was looking after you I'd want to be 100% sure that you were fully informed of all of the risks and benefits and potential scenarios.

[StarlightMcKenzie]

My ds is 6. They performed fundal pressure to get him out. No idea why. It isn't mentioned in my notes as having happened. I wasn't asked to consent. I was pinned to the bed in a MLU and a SHO jumped on my abdomen and I couldn't breath.

I KNOW that isn't the McRoberts but given that experience all subsequent labours stated clearly 'don't you fecking touch me EVER'.

[VinegarDrinker]

I understand why you would say that and as long as you are fine with the risks then obviously it's your call.

I wanted to clarify the McRoberts maneuver for the sake of anyone else reading this who may get the wrong impression.

[StarlightMcKenzie]

Vinegar, I was very well informed for my subsequent labours.

I began with preventative. Increasing my odds for a well-positioned baby.

Also, refusing intervention and drugs before the SD occurs means that you are better able to manage the SD yourself. I never did understand why you would be expected to go onto your back when all the research states that on all fours gets you the most space for baby-exit.

[StarlightMcKenzie]

Honestly, if all imo 'sane' attempts had been made to get the baby out and I was still struggling, I would have consented to either forceps (low) or McR. We are lucky to have these potentially life-saving procedures and interventions after all.

However, I will not agree to them in advance and risk them becoming an inevitable solution for poor care.

[VinegarDrinker]

You shouldn't be encouraged onto your back if you are already on all fours. But if you are on your back it makes sense to quickly do McRoberts and suprapubic pressure as this resolves the vast majority of shoulder dystocias without any need for further intervention and generally much quicker than it takes for a woman to get onto all fours. Anyway I am sure you have read plenty about it and you are well aware of the standard HELPERR mnemonic for management of shoulder dystocia (which includes as routine turning the woman/asking her to turn onto all fours).

[cakebaby]

Some types of forceps are not used in the US nor parts of Europe as medical professionals cannot secure insurance to use them, due to the huge potential for injury and damage to mother and child. So WTF are we doing using them in the UK? There is no way they are touching me with them, it is in my notes, DH has been primed and I will sue their ass if they ignore my instruction. They can add my legal action to the growing list they have already, having just paid out in excess of a 7 figure sum for causing life changing injury to a child.

[StarlightMcKenzie]

'I seriously hope you have had a good opportunity not only for a debrief'

I tried. They denied it had ever happened. Tried to blame my memory on the pethadine they had injected into me without consent.

Subsequent labours had no touching and no drugs. Not even gas and air. Though subsequent midwives were wonderful and respectful, I could never really trust them.

[StarlightMcKenzie]

Yes, thank you Vinegar. I was obsessive in my research before I could ever fall pregnant again. It is sad that I thought the risks were higher for my baby and me were higher by listening to my caregivers on the day than not.

I do have to say again, that the midwives attending my next two births were really very good and competent 'hands-off' hcps and whilst I didn't trust them much at the time, I would now trust them with my life and my baby's.