C section or Kielland's forceps?

[lunalovegood84]

I gave birth 3 weeks ago - the brief version of the story is 14 days overdue, induction of labour, got to fully dilated easily. Baby was back to back, high up in my pelvis and moving down only slowly. I was in established first stage labour for 20 hours, the last few in excruciating pain.

I was told by the registrar that I would need baby rotated and assisted to deliver using Kielland’s rotational forceps, the most ”extreme" type of forceps. I refused consent and insisted on a c section, which went well and recovery has been straightforward.

I've been mulling it over since, whether I made the right decision or not. I had read about Kielland's forceps, but I hadn't made up my mind in advance about the level of intervention I would accept. On the whole I'm happy with my decision, especially as baby turned out to be 11 lbs 9 ozs so natural birth would likely have been very difficult. It just feels strange to have had to make a choice like that against medical advice and while off my head on gas and air!

Anyway I'd like to hear other people's opinions on which choice they would make in a similar position : Kielland's forceps or emcs?

DD1 was delivered by Keillands forceps. She is scarred on her face. I had faecal incontinence for months after the birth a huge episiotomy which broke down so I had an open wound for months. The pain was horrific for months. I had wanted to avoid instrumental delivery and go straight to csection (it was on my birth plan) but I was coerced out of it.

DD2 was an ELCS and a doddle to recover from. Much easier to go to the loo and sit for hours feeding baby when your undercarriage hasn't been messed up beyond recognition.

You made an absolutely genius decision, totally the right one. Well done you!

DD1 was back to back and a Keillands delivery. She's beautiful and very healthy. I had the top consultant perform the delivery though. The episiotomy I had with DD1 healed much better than the tear I had with DD2's super quick absolutely drug free natual birth.

I was shivering on the operating table with fright during the whole delivery because of the dread of it not working and forcing a c-section. I had no idea of any disadvantages or bad history relating to Keillands though.

We all have different views om childbirth and you absolutely made the best choice for you.

I had a respected consultant at St Thomas's London doing mine. (According to a midwife there) he is known as 'the man who keeps our CS rates down'. I would guarantee it was the statistics he was more worried about in my case. I'd also (stupidly) said in my birth notes that I was happy for students to be in the room to observe. This just meant he has someone to show off to. The coersion used before I consented was basically saying 'Consultant says he's over 90% sure he'll get her out with them' (slightly glossing over the damage he'd do in the process). I wasn't even told the type of forceps to be used or that she'd need rotating. I've learnt all of that after the event.

She was back to back and in deep transverse arrest. There was a moment during the delivery where the consultant said 'Colleague X please come here [to the business end] as I think I have a shoulder problem'. He did manage to release it. But he pulled so hard that they had to hold me onto the table whilst he had his foot against it for leverage. Absolutely brutal, I would never have consented if I'd have been fully informed. THIS NHS PAGE is what I had read previously about forceps. I can guarantee the obstetrician did NOT 'pull gently' and the mark is still on my daughter's face after 5 years so it did not 'disappear quickly'. The trauma of that birth still haunts me 5 years on. Believe me OP you made the right decision.

Forceps of any description was the one thing I said I wouldn't do during childbirth so I would have also opted for the section (although I'm very pro-section anyway!)

Also just to add to the reassurance above, I've had two sections and no overhang either. Aside from my scar, which is still red (section six months ago) you can't tell by looking at my stomach that I've had c-sections.

CS over Kiellands without question; and both of mine were born with Neville Barnes forceps.

I didn't realise you could refuse forceps in favour of c section? It that definite?

Lazaretto, I'm sure when my eldest was a bit stuck they were saying she was too far down for a CS. She was born vaginally with no help in the end, but I got the impression me refusing an assisted delivery wasn't an option.

Lazaretto - it depends on the position of the baby. Keillands are high/rotational forceps so the baby won't have descended much before intervention is needed.

You can - of course - refuse ANY procedure but in circumstances where baby is nearly at the exit then it would make far less sense to refuse as s/he'd have to be forced back up the birth canal for a CS.

Makes sense, thank you both :)

Best decision. I had a keillands delivery 20 years ago. My baby was born with the cord around his neck 4 times and barely breathing. I had internal damage which was repaired when he was 4. The Labour was long and the delivery traumatic. He’s almost 20 and severely autistic. I do wonder if the labour and delivery was to blame.

You absolutely made the right decision! I made it explicitly clear on my birth plan and repeated it to each midwife I saw during my 24hrs of labour with a back to back baby. NO K forceps!! One of the midwives assured me that they never use K forceps at the hospital - I was relieved to hear this but to be honest I didn't want forceps of any kind unless absolute necessary. Ended up in theatre EMCS, after they decided baby was too high up still to attempt any kind of forceps.

From what I have heard about those medieval instruments, all that doctor was trying to do was save money.
The damage they can cause to women is barbaric, considering there is still an option of c section at this point because the baby is high up, I believe women should at least be given a choice, if not actively recommended c section.

You have probably made the one of the best decisions you will ever make in your life. I also would be grateful that the doctor listened to you, as many women from not so long ago (possibly even still today) have their rights and wishes ignored in labour.

Congratulations on your new born

I had keillands forceps.

The thing that makes me so angry is that I had no idea about what they actually were. I was simply told ‘we’re taking you down to theatre for forceps ok? If that doesn’t work we will do a c-section. I was pretty much just told what was going to happen and it was all very rushed.

Like A LOT of pregnant women it was never explained to me in antenatal appointments that this type of scenario may happen and that I had a choice. It wasn’t explained about different types of forceps and the risks of k forceps to women and babies. A lot of the information provided to women is patronising crap about ‘metal tongs’ used to gently help guide the baby out without any info on CHOICE and RISKS and different types of forceps. It’s infuriating.

I’m really happy to see the replies here though with women who have clearly informed themselves beforehand but I honestly think every single day women are just
told they are ‘having forceps’ during labour and don’t actually know what they are ‘consenting’ to until after the event.

100% agree ^^
It seems obstetrics is the only area of healthcare where withholding information is seen as a way to obtain ‘consent’ and persuade women to do something they probably wouldn’t do otherwise.
Montgomery v Lancashire is an interesting read re these issues and sadly I don’t think obstetric care has came all that far in terms of consent and informing women.
Basically if you don’t inform yourself about some of the risks, they won’t tell you.
Sadly for those not intelligent or educated enough, or those women who are just trusting that the hospitals have their best interests at heart, rather than targets and cost cutting, they are unlikely, in my opinion to get all of the information they need to give informed consent.
It’s another huge legal case waiting to happen.

Yep I think consent is a really big problem in childbirth. I understand that sometimes it can be tricky in all kinds of medical emergencies to obtain informed consent, but in childbirth it extends out way beyond the ‘absolute urgent emergencies’ situations to standard ‘normal’ births and procedures. I think forceps deliveries are an example of that. They don’t willingly explain the risks and benefits of one vs a c-section. There is also narrative pushed that v birth is always easier in terms of recovery than a section, even including complicated and instrumental deliveries.

Also the fact that many women don’t actually realise their rights to accept and decline procedures. The language around childbirth perpetuates the myth that once you’re pregnant your body pretty much ‘belongs’ to healthcare staff. I’ve seen threads where women say they didn’t know you were ‘allowed’ to decline vaginal exams in labour :(

Well obviously it’s impossible to know - clearly some people on this thread had ok experiences with KFs - but FWIW I think you made the right decision. As you say, they’re banned in a lot of countries.

Some of the stories on here are making me spit with rage at the misogyny and arrogance and negligence of it all.