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?

Wasn’t told any of this! It’s a disgrace how little pregnant women are informed about the Long term (life changing) risks that come with natural delivery. 4 years on and I’m still not able to come to terms with my changed pelvic floor, it’s terrible. I didn’t have an epidural or forceps /vacuum though- just a bit headed baby and Pushed for far too long .Second time round I had a c section and it was nowhere near as bad my first birth (3rd degree tear)
I don’t know why Nct /midwives focus so much on the negative side of c sections. One of the (many) urgogyne surgeons that I’ve seen post birth told me that he thinks there should be a consent form for natural births. He said he sees all the unfortunate women that are left in bits after bad vaginal deliveries. Everyone seems to think male doctors that offer c Sections are just doing it to make their own lives easier but they’re actually saving so many women’s pelvic floors from irreversible trauma.
There should be some form of decision making tree in how you give birth. Things like baby head size versus your own size (I’m petit ) plays a role. I was asked my shoe size in a follow up clinic and was told there’s a link between that and bad tearing. This annoyed me as my feet have always been a size 4 , they came with me to every appointment and it was never asked until it’s too late.
Ugh sorry just this topic winds me up so much . Wish I could do something more Than ranting on mumsnet

@Immaback

I'm so sorry to hear this. I hope you are getting the treatment you need. If you don't mind I'll pm you when I get chance, I am having some issues too.
@PMHull
Has an article on caesereanbirth.org about a leading doctor who says it is wrong to talk to women about pelvic floor damage, despite studies being there showing this is the case.

I think the fact is there are risks to both types of birth, to both mum and baby and we are not being informed of these antenatally.

Forceps and vaccum are other interventions, surgical interventions that have there own risks too. These need to be disclosed as well.

Also to PP who mentioned the Adam Kay book- he also mentioned how 60% of female ob/gynae drs actually opt for a c-section without any medical need and used that as justification for why he is happy to talk through the real risks of vaginal delivery if a woman requests a caesarean even though he isn’t ‘supposed to’.

It’s obviously worth mentioning that most midwives won’t opt for a c-section and prefer to aim for a vaginal birth but it does seem that if most female obs have the choice and do actually opt for a c-section then there’s no reason to deny any other woman who has done her research and feels happier with those risks to her body.

This is shocking.

Agree about written information about the most common scenarios way, way before birth.

I dug out RCOG guidance on VBAC vs C section after a v distressing VBAC attempt where, like with this, I was pressured into a VBAC and was not informed about factors for my situation that made the odds of a successful VBAC low.

@Dozer

Can I ask where you have found this information?

My 1st baby ended in an EMCS after he turned his head and wasn't progressing down. My doctor was very very good and simply said "I could try forceps but it'll potentially cause lots of damage so I'll go straight to a c section"

However, we are TTC #2 and already I'm thinking about whether to go for an elective section because I found even my EMCS a positive experience, or whether to go for a VBAC, and it would be interesting to read some information

@Immback

That's really interesting! I ended up with an EMCS but I do have small feet (5) in comparison to my height (5'6")

Also to PP who mentioned the Adam Kay book- he also mentioned how 60% of female ob/gynae drs actually opt for a c-section without any medical need and used that as justification for why he is happy to talk through the real risks of vaginal delivery if a woman requests a caesarean even though he isn’t ‘supposed to’.

I think he said one in three rather than two in three, but I'd have to dig out the book to check. Also, at that point in the book he was talking to a woman who wanted an elective and said he does think it's unfair to deny it so he told her so ask him why some women have cesareans. He told her the magic combination of words he needed to hear so she could parrot it back to him and then book her in. I can't remember him saying he was happy to talk through the risks with them though- I got the impression he wasn't allowed to actually give them the information, which was why he had to do it in that roundabout way.

I’m pretty sure it was 60%! Although that is shockingly high so may be wrong and it’s been a while.
I’m sure he wrote something along the lines of ‘it isn’t fair’ in relation to it. I don’t know, what I took from it was that he definitely favoured the right to choose.

Surprised he never had women come to him who were already armed with the facts though- why exactly did that patient come to him wanting one but without a particular reason lol.

I think she was scared. She kept giving increasingly desperate reasons that he wasn't allowed to accept- one of which was 'Aaahbaht fime too poshtapush?'

Tbh, from the NICE guidelines the request alone is enough. He did say something about it not seeming fair to refuse it given that so many female OBGYNs opt for it.

I'm a first time mom and I was in slow labour for 4 days...I was open minded about my birth plan eg happy for any pain relief...my little boy was back to back and the pain was terrible...I had to ask for gas & air in the birthing pool to which the midwife said well it won't help u...I got offered no pain relief what so ever...each time I went to the MLU at our hospital I told them I couldn't wee...eventually they placed a catheter and drained jugs of brown wee out...for days I couldn't sit down/lie down/eat etc...in the end the labour wasn't progressing and I had to have an episiotomy and forceps...for weeks after I had infection after infection which required 2 lots of antibiotics...It wasn't a traumatic birth but to this day I still think about it and wonder why I didn't get offered any more pain relief xxx

millie2007 here is the rcog guidance on birth after C section. It sets out factors that make successful VBAC more/less likely. For example, having got further along in a natural birth the first time, and going into labour spontaneously are good.

www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/

Wish I’d seen it during and at the end of my pregnancy with DC2! All fine, but went through needless pain and distress.

@Wolfgirrl

Saw this today and thought it relevant to the sub-discussion we had about the problems women have accessing appropriate medical care in comparison with men:

www.theguardian.com/society/2020/may/24/why-does-medicine-treat-women-like-men?CMP=fb_gu&utm_medium=Social&utm_source=Facebook&fbclid=IwAR0bMdg_cV4x0n7sDEKOh5Rz4bF7q2LQY6PocATjgflxXI_a85BOsAlqnw4#Echobox=1590318274

@FourPlasticRings

Interesting article...

Interesting article but the general idea cannot be applied to this scenario as there are no equivalent to forceps/vacuum in male health for obvious reasons.

True, but it does show that there is a bias in medicine that means women in general are treated less well.

We know that lying down in labour increases the risk of an instrumental delivery. Well it turns out that the lying down was originally a man's fault....

www.iflscience.com/health-and-medicine/theres-a-really-creepy-reason-why-women-mainly-give-birth-lying-down-/

Would be interested to see the comparison of instrumental interventions between countries.

Someone has already mentioned the US. In France labour and birth is also extremely medicalised. In the Netherlands, however, where I had my first child in 2018, there is a great emphasis on natural birth (indeed I had nothing except a TENS machine and was very happy with the whole process) and on the use of midwife-led units. So I would be very interested to see what the Dutch stats are on instrumental interventions.

Am slow to the party here and haven't read the full thread, but Ina May Gaskin's book has a very interesting discussion about medicalisation of childbirth and how to maximize chances of labouring without needing interventions. She also praises the Netherlands for their maternity services 👍

I get mixed messages from forums like this.

On one hand, posters are objecting to the fact birth is still fairly barbaric and painful even in 2020;

And on the other, posters are objecting to the fact interventions etc are needed and advocating 'natural' birth without epidurals etc.

What would the ideal approach from doctors be?

@Wolfgirrl i know what you mean, it’s tricky. I think it’s a balancing act really. Epidurals should be freely available and any woman should be able to quickly and easily access one, but simultaneously women who wish to go without one should have their decision respected and be supported to try and ‘achieve’ this and have access to other pain relief.

I think with intervention rates- it’s always important to look at why unnecessary intervention may be happening to women who do not want it. I do get frustrated however when I see certain groups on social media who strongly advocate for any woman to be supported in birthing a home if she makes that choice, but are then firmly against maternal request caesarean. In my mind both these can relate to positive birth, autonomy, choice and centering women in decision-making.

I think it's a British thing.

In most developed countries, forceps are now far rarer than in the UK. Cases which would have been a high or mid forceps delivery, are mostly now delivered by c section instead. Cases which would have been a low/outlet forceps delivery, are mostly handled with the vacuum.

I don't know why the NHS seems to have such a love for the salad tongs. Probably cheaper.

It probably also does not help that UK women are not much encouraged to monitor or modify weight gain during pregnancy. A high % of UK mums gain too much weight. This greatly increases the risk of an instrumental delivery.

@Wolfgirrl

I get mixed messages from forums like this.

On one hand, posters are objecting to the fact birth is still fairly barbaric and painful even in 2020;

And on the other, posters are objecting to the fact interventions etc are needed and advocating 'natural' birth without epidurals etc.

What would the ideal approach from doctors be?

I get the impression that most women (please feel free to correct me) fall into 2 camps A) Those that want to do it completely 'natural' with no instruments, inductions or other interventions B) Those that want a planned caesarian and for it to be over as easily and painlessly as possible

I don't know of anyone who has aimed for an instrumental birth.

1 in 3?
That's disgraceful. What is going so wrong here? This is NOT good.

@weepingwillow22 I think it’s too simplistic to say all women fall into those 2 camps, although it’s worth noting the births with highest satisfaction rates from women tend to be either low-intervention straightforward natural births or planned c-sections.

Some women are happy to take the risk of instrumental birth to attempt a vaginal birth. Some would rather forceps are used in an emergency to try and avoid a section for various reasons, whereas other would rather have a c-section straight away. I think the key is better communication and choice. It’s like when you see articles along the lines of ‘Doctors told to attempt forcep deliveries more in order to bring down c-section rate’ is anybody telling/asking the women whether they are happy with this or not?