Couple of Qs; induction option and forcep use

[Mames123]

Hi,

Just looking for some advice/experiences from others, due first this weekend, apologies for length!

I was seen by my MW this week, I asked what the state of play is RE inductions if I go over (zero signs of baby making an exit this far & family has a history of running to 42 wks) at this time of year, she informed that I would be allowed to run up to 23rd Dec it's fully dependent on how many inductions and CS are booked in already and that I won't find out until post ANC date on 16th leaving such a small window to 23rd, can you refuse induction and request monitoring instead and insist after 25th? I know from friends and family experience of induction they don't tend to work for a day or so and I dread being in hospital over Xmas due to induction.

I am aware that there are dangers either way and I'm in pain with SPD and poor sleep.

Also, refusing forceps, has anyone successfully managed to refuse their use for a first time pregnancy? 2 friends children have been left with physical damage/learning difficulties due to use of forceps and I can't bear the thought. Also don't want to go through the process of labouring, tried with forceps and then rushed for CS having to recover from both ways.

Thanks

I wrote on my birth plan that I didn't want forceps for similar reasons to your own. Baby got stuck and the very grumpy doctor agreee to try ventous saying it was a waste of time . I'm glad i asked because it worked. Baby wasn't damaged and I was not as badly injured as with forceps.

Sorry to hear you are having such a difficult pregnancy .

I dont really know about induction dates, I think all hospitals differ. I was allowed 12 days over, but it varies.
But re. forceps, I know that if you chose an epidural, you are more likely going to need an assisted birth such as forceps or episiotomy. It can end up being a cascade of intervention as you are numb and not in full control of your body and how it is labouring.
I avoided an epidural for that reason. If you can go with the pain, feel it and breathe through it. Yoga breathing and positive thought helped, then you will be more likely to manage the second stage (pushing) without intervention.

That's absolute balls, secret loads of women have epidurals without forceps!

Look into lying on your side, which you can do with an epidural, as long as you are turned every 30 min or so, it reduces intervention. Also remember that you can just say no! I pushed for 2 and a half hours (without an epidural!), they wanted to cut me. I said no. My husband said no. We were firm. Baby came just fine without.

I was damaged (physically and psychologically) from the use of forceps following an induction with my first and only child 5 years ago.

No comment on your post but just wish someone would have told me that I had the right to say no to them

I've never used a chat thread so apologies I'm not sure how to tag your names into the reply . Thanks for those that have already responded.
I am going to attempt using only TENS, breathing and gas & air if possible, the thought of the epidural also terrifies me with the additional intervention often part of it. It just seems that regardless of wishes and it being your birth experience, they seem to disregard pleas to refuse forceps, my area allows you to run 12 days over in Scotland. I understand they want to do "what's best for baby" but there's also staffing and budget issues which I'm sure effect some decisions. I have a couple of friends who months after forceps deliveries, were still feeling the effects of them. It's just interesting seeing where first timers tend to stand with inductions and sections.

Hi isthat, not quite balls, maybe I phrased it badly. You are definitely more likely to need a forceps if you have had an epidural. Of course, lots of women who have epidurals dont need a forceps, but not many non-epidutal births require a forceps.

To look at it another way, you are more likely to need forceps if you are having the very difficult sort of birth that leads to you requesting an epidural. In my case it wasn't the epidural that led to the forceps, it was the positioning of DS which led to both the epidural and the forceps.

Epidural are medically known to have a much higher rate of intervention births - it's absolutely NOT balls it's fact. Most hospitals share the statistics on this. It's well known.

I refused forceps but they used them anyway.

My son wasn't damaged but I was. I have, by the skin of my teeth, dodged a bladder prolapse. I'm 'at risk' of one and have done a ton of Physio. I'm in not too bad shape 14 months on,but forceps can be o credibly damaging on a mother too.

But, if baby has begun to descend then a section is extremely difficult as the baby has to be pushed back up vaginally (v damaging) and so forceps at that point carries less risk than an emergency section....

So it's hard to rule them out altogether. I was epidural free in the pool. Baby got stuck on exit. I was dragged to land, spinal, episiotomy and forceps delivery.

You are allowed to refuse induction and go for monitoring instead. You should be offered a scan to check your placenta is OK and then they will monitor baby's heartbeat every second day.

I ended up with forceps and it was OK. Hoping to avoid this time though. I wasn't induced, went for the monitoring instead.

The birth of my DS two years ago was a classic cascade of intervention - induction, epidural, forceps in theatre. We were both fine and I was up and walking without much issue as soon as the spinal wore off (to the horror of the midwives). HOWEVER, I wouldn't do it that way again - I would 100% ask for monitoring if post dates and if I give birth again it will hopefully be a home birth unless any medical reason not to.

You can refuse induction and be monitored- they won't be keen because of the increased risk of placental failure and slight increase in stillbirth rate beyond 42 weeks but it's your choice.
No forceps is trickier - at the point of needing forceps you'd be fully dilated and baby deeply descended so at that stage a full dilation & pull the baby back up c-section is much more challenging for the obstetrician and risky than forceps.

Epidurals are associated with higher rates of instrumental delivery, but that doesn't actually mean you're more likely to end up with one if you have an epidural. It could also be that the factors making a woman more likely to end up with an epidural are also the factors making a woman more likely to have an instrumental, iyswim. The appropriate comparison would be with women who request but aren't given epidurals.

In answer to your question OP, provided you are considered competent, you can refuse any medical procedure you don't want. You don't even need to give a reason. And making a decision that might be considered medically inadvisable is NOT enough to make you non-competent.

secret and others, it is true that epidurals have higher rates of intervention. It doesn't make intervention inevitable, though. Thanks for clarifying the wording to make that clear. Lying on your back is one of the reasons epidurals tend to more interventions, so avoiding that is helpful.

They might pressure you to agree to forceps, but you really can refuse. My SIL did, for instance. If they go ahead, it's assault. I think the trick is making sure they know you'll stand up to them.

It's worth mentioning that induction with hormones (rather than pessaries) generally makes labour more painful, causing more women to opt for epidurals. And also that many kinds of delivery have lasting effects. I had a third degree tear after no interventions ten weeks ago, it's still painful, because it was, you know, a third degree tear!

I think not been able to,push as effectively as can often be the case with epidurals is a major factor in there been an increase in the chances of an instrumental birth.

OP, yes you can decline IOL and ask for monitoring instead.

Be aware that there are some circumstances where forceps are safer. The baby may be too low for a lscs, too high for a ventouse. You can decline a forceps but trying to push a baby back up so a lscs can be done isn't a good option.

Another whose life and baby were saved by forceps but who also wished these forceps had never come near her.

There are clearly two schools of thoughts regarding epidurals. The Birth Trauma association has a document called Epidurals for pain relief in labour by Felicity Reynolds that articulates what others have said here about what triggers the need for an epidural being the likely cause of the use of instruments rather the epidural in itself being the problem.

Otherwise yes, you can refuse any intervention if you wish. It has to do with your right to autonomy. The best book on this question is Why human rights in childbirth matter by Rebecca Schiller.
This may not apply in Northern Ireland but should in the rest of the UK.

Hope it all goes well!

You have to give consent for any type of medical procedure including forceps but it may be that you are heavily pressurised given fears for your baby and those may be legitimate. You could request to go straight to cs if that's the only other option but it can be a more difficult procedure if the baby is already partly down the birth canal and may need a general anaesthetic if you don't already have an epidural in.

At my local hospital they seem to offer u an epidural if they are about to try a forceps delivery? I wonder if all hospitals do this? So if u looked at the stats in my local hospital you would see a correlation between forceps and epidurals but correlation is not always causation. In many of those cases the epidural was driven by the need to not feel the forceps (ouch!) and was only given once the decision to do forceps had already been made. Is this the norm or do they sometimes do forceps without an epidural? That sounds hideous if they do

I was induced. I had an epidural. I wrote NO FORCEPS on my birth plan due to spd. I did not want my legs in stirrups under any circumstances and made it clear stirrups were not to be used. I pushed my baby out in 2 hours and 20 minutes. Of course if forceps had been needed in a dire emergency I would have consented, but by making it clear I didn't want them they didn't push them on me for a slow second stage.

Oh, and I gave birth on my side!

"Lying on your back is one of the reasons epidurals tend to more interventions, so avoiding that is helpful"

BUMPES trial here isn't showing higher rates of assistance needed for supine mothers with epidurals compared with non-supine mothers with epidurals.

I had epidural with both of my children and no forceps or anything like that. Both pushed out fine and a few stitches with dc1 and no stitches with dc2. Dc2 was induced at 36+6 due to pre eclampsia. Please don't assume the worst. I would personally get induced when they advise.

Not all women birth the same. A lot of the reason for forceps are because the baby gets stuck/ mother gets to tired at end to push enough.

Good luck

A very long time ago (her ds is at uni now) my friend refused induction and had her 13lb ds at 45 weeks, so you can refuse induction for as long as you like, but make sure you understand the risks.

The same as everyone else re: forceps, you can refuse them up to a point, but the baby has to come out and there does reach a point when there is nothing else to be done but use forceps, I had asked for no forceps but ds was almost crowning but stuck (cord around his neck multiple times) they tried ventouse but it failed, so forceps it was. Tbh I had been in labour for so long and pushing for what felt like eons, if they had backed a truck into theatre and tied him to the tow bar I would have been all for it

I think it is a really good idea to understand your options and have an idea of what you would like to happen, but then when it comes down to it be prepared to go with the flow, birth is unpredictable.