Birth plan - forceps/ventuose/c-section question.

[BreeVDKamp]

I am currently thinking about my birth plan. If it gets to the point where the midwives are suggesting either forceps or ventuose, can I refuse and ask them to go straight to a c section? Or is it likely that by that point I wouldn't be able to have a c section? Why would that be? Baby too far down the birth canal?
I haven't read anything good about forceps or ventuose deliveries.... tears, prolapses, incontinence etc...... O_O I would much rather that if it looks like I'm going to need assistance, just skip straight to a c section. Is that naive and impossible?
Am hoping for an active birth, and an epidural and not being able to walk around really scares me, but I would take that over long term health problems from forceps!

(Also, I only just realised what a spinal block is. I thought it was a sort of cuboid anaesthetic device that attached to your spine for the duration, and was wondering how you could lie down with one of those in place. Then I read about a pudendal block - you can imagine my horror!! Then I realised it was 'block' as in, blocking out the pain! HA ... So much to learn...!)

Similar to others, DD was delivered in theatre with forceps, they were ready to go to c-section had it not worked as her heart rate was dropping. I had an epidural, which I said on my birth plan I didn't want, but by that stage I didn't care!

We were discharged 24 hours later. She was born around midday and I was up and wandering round by the evening. I recovered much faster than my two friends who had unassisted births a month before and a few months after, one of whom had to stay in hospital for a few days. DD had a slight mark on her forehead for a few weeks, but is completely perfect.

Hope that reassures you a little!

See for me, it really did matter how DS was delivered, even after the event. Still does now.

Anyway, shan't go into details because your labour will be different from everyone else and my story will not be a happy forceps one!

I just wanted to say that I wish I had thought more about what I was and wasn't prepared to accept and had passed that to birthing partners. I think you are very sensible to think about it in advance.

Make sure that your partner knows what to do if it reaches the point at which they are suggesting assistance. Obviously listen to the advice of the HCP. They will always be doing what they believe to be the best thing for you. If they say that you need to think about having some help, ask what all the options are.

I know many people who had forceps/ventouse in the room and it wasn't traumatic and didn't cause lasting damage. In fact, I know people who have had it in theatre and didn't have an especially rough time. You may be lucky, if it even gets to the stage where you may need help!

Just to give a balanced view to some of the responses on this thread, the recovery time for me (theatre, epidural, spinal, forceps, big bleed) was longer than anyone I know who had a c section.

Yes a c section is a serious medical procedure but for some people, forceps are too.

Thanks all, this thread is v helpful and interesting!

So how come sometimes it's too late to go to c-section once they've tried forceps/ventuose, but other times they tried forceps/ventuose and were able to do a c-section if it didn't work? Surely once they realise the baby's head is stuck on the way out and they need to use foceps, the head is too far down to then do a c-section (if I'm right that pushing the baby's head back up is unadvisable?).

Sorry, just really like to understand these things!

I had an epidural in my first birth - I probably could have managed without one, in hindsight, as I was 9cm (anaesthetist tried to persuade me not to), but I was so knackered from not having slept for 2 nights that I felt like I needed one in order to carry on. Now I realise that was probably transition!

Anyway, I ended up with a forceps delivery - not what I wanted, but my contractions were not coming close enough together for me deliver under my own steam (and DS was prem and therefore v small), and the epidural wouldn't have helped.
But it was fine - I had an episiotomy which healed very well. I wonder if me being up on my feet a lot just a couple of days after birth, going to and fro visiting DS in special care, helped me heal faster?

I'd much rather that than a c-section, but that is a personal thing. But forceps / episiotomy doesn't automatically equal total disaster, is what I'm trying to say...

Bree I think it gets to the point where it is far more dangerous to baby to push back up birth canal for c sec than use forceps etc.
Oh course it is technically possible- but they won't use it as an option unless last resort due to the dangers.

Yeah. But surely if the ventuose device thing or forceps can reach the baby's head, then surely it's already too far down to then do a c-section? So how come sometimes a c-section is possible and sometimes it's not?

I know I'm getting distracted from the original post now!!

Anyway! Glad to hear lots of positive forceps/ventuose stories, thanks all!! :)

When deciding whether to do ventouse/forceps or cs many factors are taken into account including the position of the baby (eg back to back, head in the transverse position etc) how well flexed the baby's head is and also how far down into the pelvis the baby is. It is often a combination of these factors that determine how the baby is delivered
(Eg there are three different types of forceps each with their own indication for use). What is sometimes an unknown factor is the pelvic anatomy and until the obstetrician actually tries to deliver the baby through the pelvis you just can't tell whether baby will go through. They will attempt a trial of instrumental delivery (ie in theatre prepped fully for cs) when one or more of the first things I listed is not optimal. It is never too late to do a cs after they have tried an instrumental. If they can't deliver with forceps/ventouse then obviously a cs is the only way a baby can delivered. As viva said previously this may involve pushing the baby up through the pelvis but this is a highly risky procedure: one which was criticised at a recent serious case review I read.

In my experience (17 yrs of midwifery) the only 'failed instrumentals' are those done in theatre where there was a high chance that a cs would have been necessary anyway. I have only ever seen one attempted forceps in the delivery room proceed to a crash cs.

I have tried to put it as clearly as I can - hope it's not too waffley! A lot will boil down to the obs and their preference/training/experience. In the early part of my career I worked with lots of Australian obstetricians who were very skilled with the kiellands rotation forceps (very uncommon now) - they would also rarely use a ventouse. Conversely I have worked with obs who won't use forceps at all - horses for courses!

Better stop waffling! Hope that helps a bit.

First birth was hypnobirth, needed a little episiotomy at the end because my pushing was ineffective (couldn't engage the right muscles despite trying desperately to "poo") but DS1 came out and I healed amazingly despite being terrified of getting cut.

Second DS was a bit of a pre-natal worry so OBGYN had me hooked up to monitors as soon as I started dilating to monitor his questionable heart rate. I decided on an epidural in case he had prolonged decels and we had to do a crash section but in the end he was fine and came out with ventouse, only because he was compressing the cord. I only pushed 3 times and felt him move down very well even without OBGYN using the ventouse. Didn't tear or need an episiotomy second time.

I don't think it occured to me to be worried about the ventouse but I would have been if it had been forceps. But i've heard horror stories about forceps but not about ventouse.

In all honesty, having had one hypnobirth and one epidural and assisted labor, I can see the incredible benefits for both of them. The hypnobirth left me feeling totally exhilarated and high, the epidural birth (6am birth, labored through the night whilst I slept) was calm and quiet.

Please don't rule out or jump straight to a section for fear of forceps or ventouse, especially if you don't particularly want a section. I've had both episiotomy and ventouse and had fantastic labors, so it doesn't spell disaster!

For me, they wanted to do forceps because baby was coming down and then going back up. So each time he was returning to a place where they could have done c section. Presumably why they took me to theatre, in case the forceps just couldn't get him out either.

It wasn't as simple as baby going down and getting stuck. They had to go in high with the forceps.

On the other hand, friend only needed forceps for the last little bit because baby's shoulders were stuck. Another one was because baby was tired.

Completely depends on the situation, which unfortunately you can't predict! Sorry, not helpful!

I refused Kiellands forceps and had a c section last June. Recovery was incredibly quick, no regrets. In my case I had been 10cm for a while but baby was still very high and back to back. No pushing up required. I'd be interested to know at what stage it becomes necessary to do that.

Two ventouse here and one natural.
First ventouse with episiotomy. Second without. Both with epidurals.
Third with nothing at all - huge mistake and caused the most damage as it happens.
Ventouse used when it was clear I was not going to push them out. I asked for a section with dc1 and was told it was too late/not necessary. I think the baby being pushed back up would be my worst case scenario.
I was sore with the episiotomy but neither of the ventouse births were as bad as the last one.

By the time it got to the point where they were telling me that I would have to have a section if forceps didn't work, my son's heart rate was dropping and I wanted him out and safe no matter what (having previously been terrified of any intervention, particularly episiotomy which I agreed to in a flash when the time came!). I would always take into account the recommendations of the HCPs at the time as they are able to assess the situation with the benefit of experience and they prioritise the safety of mother and baby over personal preferences and any ideals one might be harbouring about how you would like your birth to be.

I don't know if I'd agree that health professionals always prioritise the health of mother and baby. In certain situations, eg distressed baby, there probably won't be time to discuss options and fast action is necessary. But this isn't the case all the time and there are many women who suffer after effects from an assisted delivery (also many who don't but how do you know which you'll be?).

In my case if I'd followed recommendations they would have tried to rotate an 11lbs 9ozs baby with a head off the centile chart using kiellands forceps (the most extreme kind). I shudder to think what might have happened to him and to me.

In the hope of being reassuring, DC1 was delivered by ventouse after an induction and epidural (my waters broke but contractions still hadn't started two days later...). Whilst it wasn't what I had expected (and it took a while to get over the shock) it really was fine. I did tear and needed a cut but both healed with no lasting issues. Obviously some people do have horrid experiences but I think a (straightforward, minor) cut/tear can sound much more scary in theory than in practice. Best of luck and hope all goes well for you.

Oh and just to add DC2 was a straightforward delivery with no instruments but I still had a minor tear - again, it has healed well.

I don't know if I'd agree that health professionals always prioritise the health of mother and baby.

They may not always turn out to be 100% correct (who does?!) but my point was that they won't be swayed by their expectations in the same way that a labouring mother might be, so they can be more objective about what they suggest.

I was scared of forceps too op but ended up having them. My labour progressed very quickly so no time for an epidural. My baby's heart rate started dipping and my contractions slowed down. The midwife and doctor were very calm so I didn't fully appreciate the seriousness of the situation at the time but when I was offered forceps I didn't hesitate - I just wanted her out as quickly as possible so that the labour was over!

Had an episiotomy (which I view now as being lucky because it was a clean cut as opposed to a tear) which has healed really well. I was up and hobbling round a few hours later.

I should also add that I didn't have to transfer to theatre and she was out within a matter of seconds.

I think it's a great thing that you are thinking about this. With DS1 I skipped the pages about c sections and forceps because I strongly believed that if I was well prepared, educated, in a mid-wife led unit, with a water birth in sight, I wouldn't need any intervention of any kind. My mum and both my sisters had given birth without epidurals so why would I?

I wish I had read all the information about forceps, ventouse, and c sections as I ended up in theatre, somehow I developed an infection during labour and had very high temperature and was delirious, kept on being sick and passing out. I went into episodes of bradycardia, very low blood pressure, my body went in shock. Had an attempt at ventouse delivery but ended up with am emergency c sections.

I feel a bit sorry for the posters who think that preparation will be some kind of insurance policy against a medicalised birth, it may be helpful, but it's not fool proof in any way.

For second birth, i had an attempt at a natural delivery again, but my body reacted the same way as DS2 and I refused ventouse, went straight for c section - this was discussed beforehand with consultant. I suppose that in some cases you can insist and discuss, but in other cases it's important to take into account what the professional suggest.

My birth was pretty much as mrspatrickdempsey described. Dd's head was transverse and I half been pushing for more than 2 hours after a long and stop/start labour. I was on a hefty dose of the drip by that point too. The consultant made the decision that there was no way she would come out on her own, so I was prepped for theatre and signed consent for cs beforehand.

In theatre, they tried a ventouse, which failed. At that point, forceps and an episiotomy were mentioned, I said very clearly that I didn't want them. The consultant agreed to go straight to the cs. What I don't know is if he was going along with my wishes or if he thought there was little chance of success with the forceps because of Dd's position anyway.

Dd had to get pushed back up in order for the cs to happen. I had had a spinal by then and didn't know, until a cheery midwife mentioned it! I've had no after effects from this, or from the cs.

OP - I did hypnobirthing and I firmly believe that it helped me. Obviously, it can't do much about a baby that gets stuck, but it definitely helped me cope. Until I got to theatre and had the spinal, I managed on tens and g&a. Overall, while none of it was exactly ideal, it wasn't a negative experience. I felt well cared for the whole time , nobody panicked and apart from a massive bruise where she had been head butting my pelvis, dd was fine.

I had this on my birth plan and was co-erced out of insisting on CS by a consultant and his team who were '90% confident' they'd get DD out that way. We were taken to theatre with spinal block in case the forceps failed.

They did get DD out with the Keillands forceps (I didn't even know their were different types until after they'd already been used on me). DD is still scarred on her face to this day (5 and a half years later) I suffered a terrible slow and painful recovery which included some faecal incontinence. The following day the consultant was introduced by a midwife who described him as 'the man who keeps our CS rate down'.

Fact is the advice provided to you will be provided by people with agendas which include the health of you and your baby but also their statistics and budget. Never assume it's all about you and the baby, I made that mistake.

If this is what you want ensure it is emphasised on the plan and that your birth partner knows and can advocate when you are not in a position to fight for this. I wish I had known this.

It is worth thinking about how you feel about different types of forceps. Keillands are different to low forceps and I would have refused them.

I've had an emcs and a vbac with forceps and they're both equally painful, debilitating and had equal healing time. I didn't mind the forceps because she was stuck and after an hour of pushing she was going no -where. Of the two births the vbac was far more positive and I wasn't really aware of the forceps use, thanks to a lovely spinal block and cheesy 80's radio music.

Oh, forgot to say I had ELCS for DD2 (hard fought but desperately wanted after my experience with DD1).

the procedure and recovery were an absolute walk in the park piece of cake compared to the Keillands forceps experience. On a scale of 1-10 where 10 is the worst my Keillands recovery was 8/10 and my ELCS was 2/10. Honestly, the calmest easiest most controlled procedure and a recovery where I got noticeably better every day and felt like myself almost straight away (it took 2 months after the Keillands). Honestly, I'd kill before being put through that again.