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?

Funny that all of those things only affect women, isn't it, @FourPlasticRings?

Yep, I had noticed. Though there are also struggles elsewhere where the female pathology of an illness does not match the male- generally medics are trained to recognise how men present rather than women.

I had an episiotomy and a vacuum delivery with my first... I have to admit the Drs and midwives were amazing and I’ve healed very well... but if I was to ever have any more kids I’d opt for an c section. I could not go through the labour and birth I had again.

Does anyone know if you can talk through your birth with the hospital? Or am I best leaving it until I’m thinking of more children?

In all my midwives appt and my whole NCT classes, instrumental delivery was not mentioned and, as my sister had a very traumatic ventouse delivery with her first, I was looking out for it to be discussed.

I had a forceps/ episiotomy delivery. I was wheeled in to have an EMCS after a long labour was not progressing well. My stitches were also infected, so my first week post labour was terrible.

However, my second birth was without intervention or instruments and was fine.

The forceps were necessary. The lack of information was not.

I think women should be encouraged to research this for themselves
Many women are not able to do this. If you left school without o level/GCSE maths, then reading and comprehending statistics is going to be difficult. If you have poor literacy, then understanding the articles about forceps delivery and the terminology used is going to be difficult. If you have a limited knowledge of the human body or are unable to use a computer, you will find the information hard to find and comprehend.

According to literacy UK: "16.4% of adults in England, or 7.1 million people, can be described as having 'very poor literacy skills.' They can understand short straightforward texts on familiar topics accurately and independently, and obtain information from everyday sources, but reading information from unfamiliar sources, or on unfamiliar topics, could cause problems. This is also known as being functionally illiterate."
Someone needs to explain the risks and benefits to these women and others.

If this pandemic has taught me anything, it's that people are not good at reading scientific material and assessing risk.

Oh and please dont misunderstand, I do think women doing their own research is great and should be encouraged. However, it shouldnt be their responsibility to do so and they should also have the right to information from their midwife or other HCP if they ask - not to be fobbed off.

From my NCT group of 8 we had 3 c sections (all emergency), 3 normal deliveries and 2 instrumental deliveries.

The two women who had instrumental deliveries - one is now paying for private physio treatment due to ongoing incontinence issues 3 years later. The other had months of physio on the NHS for severe birth injury. She recently had a second baby and had to have a c section due to the damage caused the first time.

@UnderTheBus

That's awful. Really awful.

People on here have talked about the fact that hcps may not want more women having elective c sections...but I don't understand it. It seems to be a false economy, due to ongoing costs of physio, repairs, negligence claims etc.

I think a few things would have helped me...a general overview of statistics, brief explanation about instruments why they might be used, discussion about physical effects, which include prolapse, chronic pain, sexual dysfunction etc. Risks of vaginal birth Vs c section. The small but life threatening risks of c section i.e uterine rupture from scar, ectopic pregnancy etc, but also honest information about vaginal birth and effects. If I had had this information, I could have used it and either had a planned c section maybe just stuck to one child that way or I could have known enough to refuse forceps when baby was high. Equally if I had known about possible damage I could have done as much as possible to prevent it it would have helped me knowing what to out into Google...which probably would have brought up things like spinning babies, birth balls etc.

As it was...and this is what hurts me most about it all- I didn't even stand a chance of protecting myself from the damage. That's what is worse, if they don't want women having c sections fine...but don't tell them an episiotomy is fine, don't pretend vaginal birth is almost risk free. At least give us a chance to know what damage can be done so we can do our utmost to prevent it.

@UnderTheBus

A lot of women probably are not in a position to research... you're right. But equally if you don't know what you're researching for it's hard. You need a starting point.

I do think when you see hcps during pregnancy it's not wrong to expect them to give information when you speak to them.

@Underthebus

I only started to find this stuff out after birth from finding Mumsnet. I typed in heavy dragging feeling in vagina and something came up about prolapse on Mumsnet. First time I'd heard of this site.

I then asked a midwife about it postnatally and she said they talk bs on mumsnet.

It does seem that it is a postcode lottery regarding info.
At my NCT class we even had a pair of forceps to play with and a whole session on csection and instruments.

I was consultant led so had several honest conversations with medical staff about likely outcomes for a FTM over 40 with GD.

I suppose I was also well informed as being older I know loads of people who already had babies and some had lasting damage from birth. It’s why I almost went down the ELCS route. But decided not to and was fortunate to have no damage.

I do always do my own research as I work in academia so second nature to me-but I appreciate not everyone is like that.

It should be more consistent for sure. But I don’t think instrumental delivery is always bad, but women should understand the risks and benefits of everything. I knew the risks and benefits of all the drugs and interventions and my DH was aware of what I would and would not consent to and my birth plan reflected this.

@Megan2018

Yes. It seems like a postcode lottery with what's on offer. I attended an NHS antenatal class after much ado, was 37 weeks...nothing that would have really helped me was covered. Forceps were 'rare,' they usually do vaccum... that's about all that was said.

People on here have talked about the fact that hcps may not want more women having elective c sections...but I don't understand it. It seems to be a false economy, due to ongoing costs of physio, repairs, negligence claims etc.

Depends how many women who undergo them require such things. It's not a foregone conclusion that instrumental delivery = long term damage, and it's definitely not a foregone conclusion that vaginal birth = long term damage. Plus one c section often begets others due to the dangers of VBAC. And they get riskier and more time consuming with each subsequent section. I daresay someone somewhere has done the sums and decided it's cheaper to push instrumental over c section.

Also, you can only have a c section if a theatre is free. If you're in the throes of labour and it'll take a few hours to arrange a theatre (and even then there's no guarantee, as an emergency involving fetal distress might arise at any point), I can see the argument for going for the instrumental. They should present the option though, even if that option is, 'There are no free theatres at the moment and we can't tell you when one will be free, but we could wait for one and do a c section instead. However, if the baby moves lower down in the interim a c section may be impossible/more dangerous anyway'.

Not read all of this but to add my own experience, my first birth was a very large baby (2 weeks over due) she was back to back I had to be induced and I thank god I didn't dilate because I know it would have ended up with forceps. I had a c section and opted for an elective with my second. My sister had a forceps delivery and has essentially been left incontinent and has had hideous reconstructive surgeries and still isn't right. I strongly believe women who face forceps should be given the option of c section delivery if at all possible.

i daresay someone somewhere has done the sums and decided it's cheaper to push instrumental over c section

I am certain I’ve seen someone link to this on another similar thread. all I can find is this but it’s about indemnity and compensation not other procedures.

www.itv.com/news/2019-04-18/caesareans-cheaper-than-natural-deliveries-once-negligence-claims-taken-into-account/

@Irishgirl55, you can have a birth debrief any time, and you can discuss future births in the debrief. My daughter is six months old and I just had mine (by phone, because of Covid). I had failed ventouse, forceps, a 3b tear and a PPH. It looks like I was having a placental abruption. We discussed future births and the consultant said she’s supporting me in my choice to have a C section next.

I think information that would be helpful wouldn't be overloading women with information about forceps etc, but information on how to mitigate or treat injuries that most women sustain at birth, instrumental or otherwise.

My stitches were very sore for quite some days, the hospital had advised me to only use water to clean them but it just wasnt getting any better. My midwife came for a routine visit and advised me to put a few drops of lavender oil and a camomile teabag in the bath and the effect was like magic!

Perineal massage, pelvic floor exercises, how to care for a caesarean wound, how to know something is wrong, when to see somebody about incontinence etc all might help.

Similar stats here in our NCT group of 6: one planned C section, one EMCS after failed forceps, one ventouse, one failed ventouse and forceps, one “natural” but with an episiotomy and some incontinence afterwards, and just one straightforward “natural”.

@FourPlasticRings

There are different risks to both, that's the point. I think it's important not to focus on one type of birth or the other- but honest evidenced based information. There are studies out there that hcps could reference to discuss risks. I'm just asking if people think we should have more information? If women had it, they could make better plans, choose the risks and benefits they feel are right for them.

This is anecdotal, but two interesting points from my limited experience:
The ventouse was definitely not gentle. It caused my 3b tear even before the forceps were involved. Two doctors were pulling me back on the operating table while the registrar was pulling with the ventouse. I’d have been yanked clean off the table otherwise.
We were all hammered in NCT with stories about epidurals delaying things. It took me 18 hours to dilate to 1cm. DD was back to back and I was screaming the place down in agony begging for the epidural. When I finally had it, I went from 1 cm to 10 and pushing in less than 5 hours. My body just relaxed and was able to do what it needed to do.

Has anyone read about the Montgomery case? The woman’s circumstances meant she had 1 in 10 chance of shoulder dystocia (not sure right spelling?) her doctor knew this but purposefully did not tell her because they didn’t want her to choose an elective section. She had a vaginal birth and shoulder dystocia and consequently a disabled child. The court ruled that patients should be informed of risks in order to make an informed decision.

I think it’s unfair to say that women should just research it all themselves- a decent doctor can Use their skills/knowledge to give women balanced information that is relevant to their own personal situation, and support her in making a decision that she feels is best.

Can I pop in here again, I've noticed the discourse here is very much about avoiding instrumentals due to vaginal trauma. I totally get that and there is a lot of research about this that there are higher chances of vaginal trauma (PFDs, more severe tearing, SUI etc) from instrumental deliveries than vaginal births overall. However most of those studies show that absolute risk remains small and even the increases in risk are pretty small if I remember correctly (it's been a while since I properly looked into this as my DC is almost 2 and we aren't trying for another yet). I definitely agree better info and stats should be presented to women in pregnancy but I think if you really really want to massively reduce your chances of pelvic floor related issues your only option is an elective section, and I feel everybody probably does already know that? I don't think it's very realistic to go into a vaginal birth with ideas of avoiding instrumentals other than high and/or rotational forceps which I agree is different from a standard instrumental. It seems to me that people have to make a choice that they don't want to take the risk and have an elective, or they will take the risk that they may need an instrumental, and even if they don't, they run a risk of pelvic floor damage anyway. I was only 'allowed' to push for about half an hour in the end due to foetal distress and this was compounded by the fact that DC was query small for gestational age (turned out she wasn't!). Especially as she was fine, sometimes I agonize and think I should have refused and I may well have pushed her out myself given longer to do so, with it being a first birth, and she probably would have been fine. The problem is as a FTM I was highly likely to tear that way anyway and there's no way to know it wouldnt have been even more trauma than what I had from the ventouse. I do think we have to be mindful that it's not just instrumentals equals significant risk of pelvic floor injury, as really it's vaginal birth equals significant risk of pelvic floor injury.

@MeadowHay

Did your midwife tell you that you would likely have birth injuries? I didn't even know what a prolapse was when I making my birth choices. I didn't know about women's postnatal problems. Only periods, menopause that kind of thing. Did you get much information?

I was definitely told that most FTMs tear and that episiotomy is most common in FTMs and basically routine if you have an instrumental. I wasn't told any breakdown of the actual incidence of each type of tear other than the stars for 3rd and 4the degree tear incidence, which is relatively very small. I had a decent conversation with her about it as I had very high levels of anxiety about birth, particularly tearing and perineal trauma, so she tried to put my mind at rest. I don't know if she would have talked about it at all if I hadn't raised it - probably not? Plus I had already done some of my own research and already knew a little bit about prolapse etc, so was in a very privileged position in that regard as a few members of my family are HCPs (not midwifery or in one/gynae at all though), and I am degree educated etc. Not saying that to sound like an arsehole just obviously it was easier for me to become better informed than it would be for many other women.

@KayBM

Did your friends not talk about this? Birth injury has been a topic amongst my friends for the last 10-15 years! Not a goady question, just generally surprised that it’s not something you were familiar with.

Not everyone had any injuries by any means, but tears, episiotomy, sections, prolapse, continence issues are all things widely discussed un my group. I am the last to have a baby so benefitted from the good and bad stories.

@Megan2018

No. I did know some women with children but they'd never shared that. My mother only told me about her mother's prolapse after I gave birth, and an aunty talked about it after I had given birth. It's had an impact on how I feel about my relationships with people unfortunately.

My friend who had a baby just before me, she had a 3c tear. She thought tears were just skin. My midwife did talk about episiotomy, but just said it wasn't anything to worry about. She said it would only be done if necessary. So I didn't even realise I had a choice on having one or not. My midwife told me I'd be a bit sore to start with then back to normal in a few weeks. When I asked her about whether it was safe to give birth at home, and whether it was a good idea just in case though rare something went wrong she said she thought I'd be in the best place there. She was a bit annoyed with me so I thought I must be worrying over nothing.

I did see a gp about pregnancy once, but they were really dismissive and my midwife seemed really nice so I just accepted everything. I didn't know any better because I didn't know, and I wouldn't have known what to Google anyway. I did read everything in my pregnancy pack though and went to an antenatal class.