1 in 3 first time mother's need forceps or vaccum

[KayBM]

Just stumbled across leaflet on rcog site...it was published in April 2020, so too late for me! But it says 1 in 3 women who are first time mother's need forceps or vaccum. Pretty sure there should be a bit of discussion about this with midwife...

The leaflet also says that for women who don't want an assisted birth they should consider a caeserean.

Just wondering if any first time mother's out there have been told this? Do you think women should be told this? Anyone think this should be on the NHS site too?

Anyone else think that a natural birth is highly unlikely for a first time mother? I wonder what the induction rates and c section rates are for first time mother's too?

Completely agree Lisa. When you are in active labour esp towards the end it’s very difficult to assert much. I didn’t want to be examined. I was saying that and trying to assert me self but it wasn’t coming across and I didn’t have the mental energy or strength. A student midwife had a go first which was very painful. She couldn’t feel anything so the qualified midwife tried and still couldn’t feel anything - again painful. It was difficult as I wouldn’t keep still and I find examinations extremely intrusive and painful. They both tried again 15 mins later and I tried to keep as still as I could. There was no cervix and babies head was there. No wonder I was in pain, I was in transition and just wanted to be left alone.

@time2change2

I also know dozens of women who asked their gp for an induction when they got to 39 weeks because they wanted baby to come. No other reason.

How do you know their requests were ill informed?

And why are you painting women making their own choices as a bad thing?

Women making their own choices is not a bad thing, but making a choice when you don’t know proven risks and not being informed of those risks explicitly when discussing with a medical professional is a bad thing.
I know they were not medically needed because the women told me.

Oh gosh I also agree about being internally examined whilst in active/end stage labour.

By the time I got to hospital I'd had about half a dozen by various midwives and then the doctor insisted that she also needed to do one.

I was crying by this point saying please don't , I'm in agony and she actually got quite shitty with me!

@Time2change2 in my own experience I was desperate for baby to come before 40 weeks was up. I had a huge belly on a tiny frame, was massively uncomfortable and found it really difficult to do anything, including sleep.

I really didn't want to be induced, my mother had terrified me with stories of how painful it was and I didn't like the risks of intervention. Even so, I was tempted to ask my midwife for one.

@Time2change2

How do you know they were ill informed?

Maybe they had other reasons?

What would you suggest to 'inform' women from the outset? A long and depressing chat with a midwife where every statistic and worst case scenario is laid out before you? I'm pretty sure most pregnant women dont want to hear that.

@Szalinski it's awful isn't it, I had a student in the room and the senior midwife kept asking me to let the student have a go. I understand they need the experience but it got too much, especially since then the other midwife would have to check she had measured correctly. No thanks, I've had enough hands up my vagina today.

@wolfgirrl did you actually read your previous article you shared regarding evaluation and head/pelvis size?

As if you have you would have found it supported @Time2change2 argument about the evolution of the female human body to give birth

They found that female head size and pelvis size was linked, if you genetically have a larger head, then you would be more likely to have a larger pelvis to be able to birth a larger head.

Likewise many of the problems where found between the hunter gatherer and farmers, which was mostly considered to be linked to diet, high carbohydrate diets = larger babies.

"Pregnant women have adapted to nourish their foetus for as long as they can before it grows too large to feed internally. The female pelvis has adapted to be just the right size to allow this maximally-nourished foetus to travel through safely. And dietary changes in the last few thousand years have upset this fine balance, making childbirth risky – particularly for mothers who have a poor diet."

So this article supports the argument that the human body has evolved to give birth, the issues are human behaviours eg diet. Another factor they identified as potentially leading to a incompatible baby size is ceserians. In cultures were they're more common, its found that babies are becoming increasingly large and harder to birth.

Does not have to be depressing. Real facts about having an indcution early for non emergency medical reasons should be given before the medical professional agrees to the indcution. No I’m sure people won’t want to hear it but people don’t want to hear a lot of things about their health, it doesn’t mean it shouldn’t be given.
No, by and large the women I know who have opted for early sweeps and inductions had them because they wanted the baby out. No other reason

@time2change2

How do you know they weren't given the facts?

How do you know they didnt read them online themselves?

What facts would you want to be given to them?

Thanks all.

@LisaSimpsonsbff - not discouraging, good to be realistic. My hospital has been pretty good so far (no one tried to talk me out of a maternal request c section when I was considering one, for example) but I am usually quite an assertive person (aka a complete PITA!) which I appreciate may not be the case when I'm in agony!

I did know this statistic, and I also knew about fetal positioning as someone upthread mentions though I didn’t need 8 weeks of 10-12 hours’ exercise per day to make sure I gave the baby a good chance to get into the right position - but my two straightforward births were more luck than anything else I believe

I was given this information at an NCT class and then followed it up with my own research - I obviously found it useful so it’s a shame others have found it a shock to know after the event

They weren’t given the facts because all were clueless as to the increase of interventions and chain of interventions. In most cases it was the Gp or midwife suggesting the early interventions and promoting them.
I would like women to be told of the facts about risks of assisted delivery and csection associated with Early intervention (in non emergency medical cases)
I would also like to see women being made more aware that they can in lots of cases op for a less medical birth. I would like to see fear reduced around childbirth and I would like to see natural birthing and NCT style classes be available for everyone, not only those who can afford it

Who discusses induction with the GP? Round here it would be the midwife and/or consultant. I don’t know anyone for whom the GP has been involved in any antenatal care recently - it has all gone through maternity services

I wasn't told this. I was very fortunate to have had a natural birth with DD without complications.

@Time2change2

Yes but how?

Who would tell them? And when?

Anyone else think that a natural birth is highly unlikely for a first time mother

But 1 in 3 doesn’t make it “highly unlikely”.

There are countries where safe medical intervention is not guaranteed to be available. The human race wouldn’t have survived if it was highly unlikely that a first time mother would not need intervention, since it would result in death

I thought the rise in CS was due to forceps having been avoided as much as possible.

Ventouse doesn’t seem as drastic.

I am glad that as a first timer I laboured at home, in pool, and only went into hospital when it was clear we would need ventouse assistance. (Back to back).

I was involved in all decision making, calm throughout. I don’t regard that birth as ‘non natural’. It was assisted natural. All birth is natural until we birth babies from test tubes, but it might be assisted to a tester or lesser extent.

www.spph.ubc.ca/mid-pelvic-forceps-vacuum-deliveries-associated-with-higher-rates-of-trauma-for-mothers-and-babies/
a link to an article about midforceps deliveries for anyone interested. Some countries don't use forceps from what I have been told since. I believe they either do c section or if baby is very low, they do vaccum.

If women knew their chances of forceps they might be able to ask questions about when forceps are used and decline a midforceps delivery for example. If they want to do so. This is why being informed can be useful for patients.

@Tootletum I agree with everything you've said!
It's all out there. I even chose a different hospital because they had lower intervention rates.

Working full time, hearing nothing of the consequences of vaginal delivery and tight lipped medical professionals meant I was not informed. I went to a class, looked for information, digested my pregnancy pack and I talked to my midwife and I had no clue about a lot of things. Clearly instead of working full time with two jobs and paying taxes in part to pay for the NHS I should have been taking time off and studying a course on midwifery so I knew what and how likely things were to go wrong. Never mind that women are paying into the service and not getting support and information. If I had only found Mumsnet before...

I'm not bragging about doing two jobs but I didn't realise I was meant to be doing the job of medical professionals too. You don't always get answers to questions either.

NHS professionals work to the clock and do not have time to explain these things to everyone in a way that would make them understand. And not everyone who undergoes an instrumental delivery sustains long term damage- you'd have to look at the statistics for that really, to make the case for warning everyone off them. You could campaign for the information to be included in antenatal courses I suppose, but generally fear is counter productive in childbirth and can actually slow things down, so there's a fine line to walk between ensuring women are informed when necessary and not scaring them unnecessarily at a time when many are already more anxious than usual. I'd agree that they tend to do things to women without asking properly in labour, but I'm not sure what the solution to avoiding that that is.

I agree with every word of that statement @fourplasticrings

I think women should be encouraged to research this for themselves. I looked at these rates by hospital. I can't remember what figures were for my hospital, not quite that high, but I had an induction, an epidural and a ventouse delivery, with an episiotomy and a third degree tear.

I would have been horrified if I had known that in advance, and would have chosen a c-section instead, but I'm v glad I didn't have a section, even requiring follow up intervention after the tear. My daughter has a host of allergies and food issues: there is a reasonable likelihood these would have been worse if I'd had a c-section. I had no pain after my tear, and have had great support afterwards, I know women who have struggled much more after c-sections.

I think the main thing is, women aren't given a clear picture but lots really don't want it. And its almost impossible to know what the reality is. Many women with on paper 'better' births than me fared worse, many with 'worse' births recovered very quickly.

As someone said above, I also think that people don't take on board the difference being fit makes. I had two friends who gave birth at the same time as me who had remarkably easy labours: both first time mothers, both essentially went on hikes the week before they delivered. They were mid/late-thirties, but very fit and healthy, before and through pregnancy. I have a normal BMI but spent most of the last trimester curled up with Netflix.

There's lots of information people have, but chose not to act on, and lots people could find out easily, but chose not to investigate. Given how much experiences can vary, I think women should be encouraged to explore their options and how different things will effect different women but I'm not sure a statistic like that without context would be helpful for most women.

www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/

They could give leaflets like this article suggests they were considering doing...I read everything in my pack, they could answer questions when asked, they could tell you info in antenatal classes and it could be on the NHS site with figures for interventions for first time mothers. Like @RoosterPie I didn't know the dangers of prolapse which studies correlate with vaginal birth but especially forceps. If women just had a quick chat about it and there was a realistic depiction of what the dangers were it would make a lot of them take up doing research.

This is what I was told in terms of recovery...you might leak a little urine to start with most women do, common after c section or vaginal birth, you will be a bit sore to start with but this will pass in a few weeks.

Not the reality at all.

If women knew more- practices would have to improve, because women would more than likely be clamouring for better treatment. There might be more use of less traumatic techniques like the fetal pillow, manual rotation etc which I have heard of on Mumsnet since.

@FourPlasticRings
I bet I have taken up a lot more time of medical professionals due to the way my birth went. It's your opinion that it may scare women and not be helpful. I have mine, we've all got different opinions. I'm not downplaying any mode of birth by the way.

I should say practices would probably improve...

@worriedmama1980

Sorry to hear about your daughter's allergies. 💐 It's a good suggestion that women could be pointed to do their own research.