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?

Had ventouse for my first but I'm sure it was because it was induced Don't think my body was ready for it and with epidural on top I was just not pushing properly. Second one was soooo much better

For my first I had 2 nurses pushing on my belly with their forearms I'll tell you one thing: bring on the contraction pain!!!

I bet I have taken up a lot more time of medical professionals due to the way my birth went.

Yes, but that doesn't matter so much- it's the time limits on individual appointments that are a concern for HCPs dealing wit a routine pregnancy, rather than the number of appointments per se.

It's your opinion that it may scare women and not be helpful. I have mine, we've all got different opinions

Indeed, but I think it's fairly certain that some women would be scared if warned of the worst case scenarios for each birth type. Essentially, that baby has got to come out and there's no way of doing that without the body undergoing some trauma. The issue is that no one can say for certain for any specific woman which will be the most traumatic method with each specific pregnancy in either the long or short term.

I agree that the information should be signposted more, but I'd stop short of encouraging everyone to read it.

Essentially, that baby has got to come out and there's no way of doing that without the body undergoing some trauma. The issue is that no one can say for certain for any specific woman which will be the most traumatic method with each specific pregnancy in either the long or short term.

I also agree with this.

Even if you had all the facts, you cannot plan for every eventuality. And you are even less able to make a logical decision in labour. Your birth partner can have an idea of what you want, but again there are so many variables it would be impossible to remember them all.

@Wolfgirrl I agree which is why I didn't read/google a lot/research whatever you want to call it, did no classes and just went with the flow. On reflection my birth was pretty good.

Thank you for your views...clearly some women wouldn't want to know more and some would want more information antenatally. Some really interesting answers to questions. Some really awful stories to go along with this thread.

Speaking of antenatal research, having just asked my antenatal course instructor about rotational forceps (when they might be used and whether they increase the likelihood of vaginal prolapse or anal incontinence) I got the reply:

"The forceps discussion is probably too large to have over email. We did cover a lot of this in the session but there is so much information it’s easy to forget. [We didn't]
I think it’s important to remember that whatever mode of delivery or particular instrument is being used is because of the individual situation and what the obstetrician feels is the most suitable and safest at that time. Perhaps a discussion to have at your next midwife appointment?"

Tbh, having paid several hundred pounds for the course and been invited to ask questions, I'm not particularly impressed. But maybe I'm expecting too much.

I actually think I'm in some ways a textbook argument for not telling women - I would definitely have been desperate for a caesarean if I'd known the risk of instrumental birth was so high as it was a major fear of mine; as it was I had a straightforward vaginal birth and so almost certainly an easier recovery than if I had had a caesarean. But I still find the argument just so patronising. In what other areas of medicine are people actively kept away from information so that they don't get scared and so that they don't question the advice of the health care professionals?

I mean, when I had suspected cancer I suppose I'd have been happier and less anxious if they hadn't told me why they wanted to do exploratory surgery, and as it turned out I didn't have cancer so is that what they should have done? Just not really gone there on the scary bit on the grounds that ignorance is bliss?

I hadn't heard this statistic but it sounds about right when I compare to my friends/nct group. In my NCT group of 8, 3 had EMCS, 3 assisted and 2 normal delivery.

The cynical part of me thinks we arent given the info as more people would choose c-section.

But I still find the argument just so patronising.

Oh, it undoubtedly is. It's a touch circle to square.

The cynical part of me thinks we arent given the info as more people would choose c-section.

I think that's probably the long and the short of it tbh.

In what other areas of medicine are people actively kept away from information so that they don't get scared and so that they don't question the advice of the health care professionals?

Could not agree more.

In what other areas of medicine are people actively kept away from information so that they don't get scared and so that they don't question the advice of the health care professionals?

Contraception- they don't tell you that they're likely to refuse to remove the implant until they feel you've given it enough time to 'settle'. Some women are actually lied to and told their contraceptives can't cause the symptoms they're experiencing. No one ever told me there was a link between the pill and depression/anxiety.

Endometriosis- you're likely to have your pain dismissed as normal period pain or be told it's down to anxiety or stress. They won't tell you about endometriosis unless you already know about it in a lot of cases.

Antibiotics and other medicines in pregnancy- they'll tend to tell you it's safe even if there is evidence of negative effects, provided that they feel the need to take them outweighs the risk of not taking them. I had this happen the other day.

Medicines in breastfeeding- They'll tend to tell you that medicines are not safe even if they are.

And I think lots of other conditions. When you're being told to keep to your ten minute appointment length, it doesn't pay to have people asking more questions/exploring more options.

There's a book- This is Going to Hurt- by an ex OB/GYN in the NHS and he summarised it by drawing an analogy with the people who get to the front of a queue in a shop and proceed to hem and haw about what to pick. His view was that he'll offer his expert opinion and your choice is whether to take it or not. Not saying I agree with him, but we don't live in an ideal world. In the world we do live in, if you want to be properly informed about anything, you generally need to inform yourself.

More information might mean more c section requests, but it could also help women to optimise their chances of a normal vaginal birth with minimal intervention. At least those women have a better chance then at not being badly injured and are less likely to end up with PTSD because they thought interventions were rare.

@PorridgeStoat
I included a link to a study on midforceps deliveries upthread versus c section. Might be worth a look if you're worried. @RoosterPie
Mentioned levator avulsion and forceps, if you Google that you might get more info.

I think if baby is really low and they use forceps, there's a lot less trauma to mum. If you Google Kiellands to reduce c section rates you will probably find a lot of information.

What is meant by mid pelvis just out of interest? I had Rhodes forceps but have no idea what that means

I had forceps delivery after induction that in retrospect wasn't needed and I was left alone either no pain relief until fully dilated. In absolute agony they gave me gas and air and said baby was distressed and needed to come out so I signed paperwork for c section and forceps. DD came out with forceps and thank GPD is ok but I have broken coccus that still hurts 2.5 years later. No one tells you that is a risk until it happens! Very traumatic.

@KayBM thank you, that's helpful.

During an early obstetrician appointment he mentioned that there were some circumstances where choosing a c section over forceps could cause more trauma as the baby would have to be "pushed back up". I don't think he was bullshitting or anything, but I'd really like to understand how they judge which would be best (I've now been re categorised as low risk so don't think I'll see an obstetrician again until d day).

@Wolfgirrl

0 station to plus 2 station.
Had a look at Rhodes forceps doesn't say where in pelvis they're used from what I have just looked up. Was there anything in your notes regarding station?

@Wolfgirrl
I wasn't able to give informed consent... I find that really upsetting. I didn't even meet the doctor beforehand, just the anaesthetist. Didn't realise that was unusual till afterwards and talking to other women. . My oh jokes that my kidneys might drop out one day, along with my womb and everything else... I found the birth really frightening not just for me but for baby, it looked really brutal even from where I was. I had thought from looking on NHS site that the baby was pulled gently. It didn't look gentle to me. Q

Funny that all of those things only affect women, isn't it, @FourPlasticRings? I just don't agree that it's the same for any medical condition. Whenever I've had an issue that wasn't reproductive I've been given much more candid and full information. In the suspected cancer situation I mentioned upthread it was quite a borderline decision whether to do anything - as it turns out, I had half a healthy thyroid removed - and, while I was given a strong recommendation (to have the surgery) I was talked through why that was and the respective pros and cons in great detail.

The only times I've been made to feel like I shouldn't worry my pretty little head about the medicine stuff was during my investigations for recurrent miscarriage and then during pregnancy. The consultant told me that I was probably too anxious because I was 'over educated!'

@lydiangel83

Sounds brutal! ☹️

I just consulted dr google who says rhodes are mid cavity forceps like Neville barns?

I dont remember seeing anything about stations in my notes, they took them off me so 🤷‍♀️ maybe I'll never know!

I'm planning to ttc number 2 soonish and this time I'm going to ask for an epidural to be done the moment the drip goes in (due to medical condition will always be induced at 38 weeks or earlier). I'm also going to ask for gas and air, which I didnt ask for last time and I'm not quite sure why.

Sorry for your experience, I really hope you can make peace with it

Women should definitely be supported to be the decision-makers and have control in pregnancy/birth- ‘My body, my choice’ springs to mind, women should always have say in what happens to their body, same as in any other situation medical or otherwise.

Find it incredibly patronising when people argue that ‘women can’t cope with the facts’ so must be somehow protected from them. We are competent adults.

I also think well thought-out birth plans are invaluable for women to have more control and knowledge. I had the ‘go with the flow’ (basically ‘do as you’re told’) approach with my first and massively regretted it.

Second baby I had a better time with more knowledge and a flexible birth plan and it made me question why women are often so encouraged not to put any thought into a process that will change their mind/body forever and even mocked or chastised for wanting to have input/say into what is done to their own bodies.

@FourPlasticRings exactly all of those affect women! I’ve read that studies show medical students attitudes to consent change considerably specifically after doing an obs/gynae rotation. Medicine can be extremely paternalistic and patriarchal with women not listened to, taken seriously or trusted to make their own decisions.

I don’t think a person deciding what to pick in a shop can really be likened to a woman making important decisions about long-term impacts on her body that will affect her for the rest of her life. Part of being a decent obstetrician is seeing that the woman herself actually matters as a human being too, it’s not just about removing a healthy baby from her.

@Wolfgirrl

Fingers crossed with TTC!

I'll have to try make some sort of peace with it. Getting evaluated by my physio again might make me feel better, and a birth debrief. At least by starting this thread I might have helped some other expectant mums raising awareness of intervention figure from rcog and other posters have also given out advice re birth.

With my first, in our NCT group of 6 we had 1 EMCS, 2 forceps, 1 ventouse, 1 "natural" but highly traumatic and 1 "natural" without complications. The stats are dreadful.