Thoughts on forceps

[Sammi1986]

Hi all, I'm only 8+3 so it's a loooong way off yet, but I'm wondering how safe forceps really are?

They terrify me and I have always said I would refuse to have forceps if i needed an assisted birth because of the horror stories I have heard.

Are my fears genuine or unessasary? Is vacuum better or if it comes to it is a c-section better? Obviously I'm hoping I would never need anything.

I think I've been watching too many "one born every minute"!

Sorry.-,

On either side of her head and was a bit bruised on her head, but she is fine now. My recovery has been good too, i had a lot 2 pints of blood loss as the placenta had to be manually delivered and am on iron tablets, which has meant i am now formula feeding

This wasnt the birth experience i wanted and was asking for a section, but it was explained to me why forecps should be tried and seeing other mums on the post natel ward following a section im really glad i had the delivery i did and would do it all again if necessary

I know everyone is different, but ultimatly my birth plan was me and baby both safe and well and thats what we acheived

I've put on my birth plan - in bold and underlined - "NO FORCEPS". My best friend is a midwife in the country I'm originally from (Western Europe). I asked her opinion on forceps as I too was worried about them. She told me they don't use them anymore over there. Birth death rates are no higher (in fact lower) than in the UK - both for mother and baby.

I don't understand why they still use them in the UK if there's obviously other ways to get the baby out. A cynical part of me thinks it has to do with costs - you get a lot more scans where I'm from and if it becomes clear vaginal birth would be very difficult due to the size of the baby v pelvis, you get a caesarean. I'd much rather have a planned c-section (from which you recover quite easily) than a go through one of the horror stories you read on here re things going wrong in a forceps delivery (word often used is being "butchered").

Also re slow deliveries - in my home country they don't let you go over 24hr once your waters have broken (unless it's pre 37 weeks and then you're constantly monitored). They'd do a c-section rather than you being in pain and exhausted after hours and hours of labour.

I do rate the NHS but I'm afraid I very much disagree with certain aspects of it.

Just to add - they do use vacuum where I'm from - as not as damaging to the mother nor baby. I've also put on my birth plan that I'm absolutely fine with that.

But what do MWs/OBs in your country do if baby has descended too far and vacuum won't attach, MissHC? Or vacuum fails? Pull baby back up through the pelvis for a CS? What if you want to try a VB and they think your pelvis is too small? Or you want to continue trying after 24hours?

It sounds like a very prescriptive birthing culture which I guess is fine if you're used to it but it wouldn't (didn't) suit me.

NomDeClavier - I'm not a midwife so I don't know. I think they wouldn't let it get that far. You might think it's prescriptive but I don't know of anyone there with pelvic floor / incontinence issues after giving birth, whereas I know a few here in the UK.

Yes it's prescriptive in that they wouldn't let you try for more than 24 hours because of the much increased risk to the baby. Just to add - you also always give birth with a gynaecologist present and your antenatal care is done by a gynaecologist - for everyone, also low risk pregnancies. You can do water births etc and gynaes don't push for epidurals etc - a lot of people have a natural birth without pain relief. It's not like the US where it's massively medicalised.

And re gynaecologists - you choose your own gynae. You register at their practice, go to antenatal appointments there and they are called in for the birth (even if it's the middle of the night). If he/she's on holiday you will know the person who covers for them beforehand.

Because it's done that way you can choose a gynae who you feel most comfortable with and who you feel will support your choices.

It's more like going private here, only that you pay very little (about €100-150 depending on your insurer - you're obliged to have one but you can choose whichever one you want and yearly cost is about €30).

To be fair I don't know anyone with pelvic floor issues in France and they still use forceps. They do subsidise 6 sessions of physio after the birth though which helps.

I guess the entire system is built around you having a personal relationship with your ob/gyn who then actually knows you and can provide better care, similar to indy or one-one midwifed in the UK, and that kind of care has statistically better outcomes like a higher rate of non-instrumental deliveries anyway.

What I find particularly scary in the UK is that there's no requirement for there to be a consultant there, so a fairly junior doctor could be using forceps and while when used properly low or lift out forceps are perfectly safe you don't have a guarantee, especially at night, that the person using them will be experienced. That said if it came down to a choice between 'we can get the baby out using forceps' and 'we can't do anything' I'd rather have the possibility of forceps.

No I see your point. I totally agree that IF forceps it used, it should only be used by an experienced consultant.

I think I'll probably still agree with forceps if there really is no other way to get the baby out, but by putting it in bold on my birth plan I hope to at least get the message across to them that I'm REALLY not keen on it (also for the reason you mentioned re consultant)

I ended up with a forceps assisted delivery with full epidural after it became clear that my (earlier epidural) pushing was not going to get baby out quick enough. As she had shown signs of distress during contractions it was the best solution for me. My only real request throughout the labour had been to avoid a c-section, which the mw, registrars & anaesthetist respected. I had an episiotomy and my pelvic floor is slowly recovering with regular exercise. The only really annoying side effect has been issues with my bowel movements & flatulence which I have read will improve, again with exercise & time.

I'm nearly 8 weeks post birth and my lo has had no visible side effects from the forceps (only very mild bruising for a day or so after), and is a very happy alert baby. She had maximum apgar scores too, so all well on that front.

Congratulations on your pregnancy, and good luck!

I made it clear in my birth plan that I would not consent to forceps. I said that should there be any signs during labour that I might later need them that I should be transferred for a c/section.

I also stated that on no account should anyone ever touch me after my blood pressure had been taken, including for Shoulder Dystocia.

No internals, no manoeuvring, no helping on bed/in pool/ - anything.

Boy did the SD thing get their attention and consequently I had very experienced midwives in attendance.

It was my understanding that the uses of forceps is medically referred to as a "trial of forceps" and in the case of high, rotational forceps, protocol is that only 3 contractions worth of attempts are 'allowed' and then they jack it in for a cs if there's no progress?

Obviously a baby further down the birth canal is a different issue as you don't have the ease of switching to a cs in the same way. I was spinal blocked and in theatre with a very high up baby (only her head was through my cervix) so clearly they were thinking it could easily end up in a cs.

I have to say that I was very pleased I'd had the forceps rather than the cs when it came to having DC2 as obviously everything had been 'travelled along' before and he shot out in 2 pushes (!) but I suspect it's maybe used as an option too quickly in some cases, when a bit of more creative midwifery could work round some cases of a lack of progress (and I do NOT mean being trapped on your back while some grumpy midwife makes you repeatedly hold your breath and push for far longer than felt natural).

I went down the hb route to avoid any unecessary fiddling using hypno & pool. 2nd stage took ages but baby ok so midwife sat me on the loo to get help from gravity and release pelvic floor.

If hb not your thing do your utmost to get into a mlu and stay there! The birthplace research stats show that is as safe for baby as labour ward and much better outcomes for mum. Sadly not all mums have access to one - hope you do!

Oh yes and try to avoid an epidurL as lying down makes it damn tricky to avoid needing help. Stay upright or on all fours - which wis why water for support is good....

I was also terrified of having a forceps delivery so I used hypnobirthing, had only gas and air and laboured upright but baby went back to back and I just couldn't push her out.

I asked for a section but they said forceps attempt was preferable, so I went to theatre and had a spinal block. Baby also had shoulder dystocia but was out in 3 pushes. She had a conehead for a few hours and a mark on her cheek that took a few days to disappear and was absolutely fine.

Other than being very sore for a couple of days (and one dreadful incident the day after the birth with some antibiotics which disagreed with me ); 11 weeks later I haven't had any problems.

It really wasn't as bad as I thought it would be at all. My baby was born safely and we were both fine. My recovery was much quicker than if I'd had a section so I was glad in the end, and I wouldn't be so worried about having them in future. Obviously every delivery is different but wanted to reassure you that even if you don't have the birth you imagined it can still be positive. Good luck!

Herethereandeverywhere

I really feel for you having read your post and totally agree with you, that women are like lambs to the slaughter when it comes to birth, you didn't say that, but that you don't trust medical staff.

They/we sit there in the most vulnerable position we will probably ever be in, thinking they are looking at us as individuals, and care about us!

WRONG.

I think birth plans are a total con.

I really hope you kicked up a stink, how could any consultant not listen to a woman's request after your horrendous ordeal.

I hope he was made to feel ashamed and indeed the person who had the temerity to introduce him to you as the man who keeps section rates down.

OP

Where would you rather be cut, down below, or in the womb/stomach?
After my first birth, which by the way was normal, no stitches, I had a real problem going to the loo, I was so sore, it became very distressing, its really important to me to be able to go to the loo!

After my section, I was dreading catheter more than anything for this reason, and it was FINE!

I preferred the section.

My DD was vacuum delivered and she had a pointed head for 2 days.

Sorry that I haven't been replying ladies, I had some bleeding and cramping so it's been a scary few days! Had the scan this morning and all is good!

But back to the topic, I'm just trying to learn as much as possible before it gets to that point. My partner is also wary of forceps which makes me want to know all I can - he works in the ICU and doesn't often worry about medical procedures!

I was terrified of the prospect of forceps, and aimed for a water birth (first choice) or at least active birth (second choice). Nothing significant happened tho after my waters broke so I ended up on the drip, with constant monitoring.

After 15 minutes of pushing, I remember the mw saying 'you'll start to feel it stinging soon...' but then after getting me to change positions several times it was clear there was a problem when more and more people arrived in the room.

DS had got stuck due to his chin being up and not down - ie he was trying to come through the birth canal with the biggest part of his head first.

Ended up rather quickly in theatre for a trial of ventouse/forceps with emcs on cards. I was very lucky to have a consultant (which everyone was very excited by) and after he quickly ruled out ventouse went for the forceps.i still don't know which kind- my notes had midcavity in some places and low cavity in others - plus episiotomy and it worked.

I don't think they use high forceps in many trusts any more.

I had a spinal block which was great as the pain of him being stuck was excruciating.

He still has marks in front of his ears (born 8 weeks ago) but tthey have faded and hopefully will fade altogether. I am not yet fully healed but hope to get closer when I see the gp tomo for the 8 week check.

Two things worth saying I think- as traumatic as it was, I was ultimately relieved to not need a cs (whereas in pg I'd said I would rather go straight to cs). Second, if the time comes its more about informed consent than decision making- I vividly recall being handed one sheet to consent to the procedure, another to consent to spinal whilst in excruciating pain and having had pethidine and g&a. It's incredibly stressful. Despite that I still felt that if I wanted to put my foot down and ask for a section I could have.

I had a high forceps delivery with my first. He was born with a haematoma on his head which took a while to go down.

The doctor wanted to do a CS but I'd been so brainwashed by the NCT classes, about the negatives of a CS that I said only as a last resort.

I now wonder if a CS would have been better?

The two people I know who had forceps had a very bad experience and want an elected section. Both told medics they didn't want them but felt pressurised into it. If you really decide against forceps I think you would have to be as forthright as to say you refuse to give consent.

I mean want a elcs with next child.

From the experience of myself and people I know, forceps can be very unpleasant at the time they are used, but the general recovery from a forceps birth is generally quicker and better than an emcs.

Of course there will be exceptions to this - all I know is that it took me six weeks to even be able to walk properly after my emcs, whereas two close friends had nasty forceps births but were up and about very quickly afterwards.

I always thought I didn't want forceps anywhere near me or my baby but after he tried to turn and got stuck his heart rate dropped and the obstetrician explained he didn't have time to try the ventouse. I ended up with a pph, third degree tear and an extended episiotomy. My little boy had bruising to his head that went after a couple of days and that was it. Luckily I recovered very quickly and didn't have any ongoing issues as a result. It wasn't an ideal situation but I believe it was being delivered by forceps that saved his life.

CS over forceps every time. Much safer for the baby.

Would your friends tell you about faecal incontinence or prolapse?