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?

@user1477391263 and @Oblomov20

Yes it seems like there are a lot of factors leading to a lot of intervention.

@tangochutney

I agree and feel communication would help a lot of women. Some proper attention paid to mode of birth/ birth plans as a tool to think about choices, along with some more information to help women make those choices where there are some.

I agree and feel communication would help a lot of women. Some proper attention paid to mode of birth/ birth plans as a tool to think about choices, along with some more information to help women make those choices where there are some.

But we have all of this already. We have all the information we could wish to know at the click of a button, and a huge thing is made now of the birth 'experience' and planning how you want everything to be. Doulas, birth plans, antenatal classes etc.

At the end of the day, if you're in the late stages of labour and they need to get baby out quickly, what other choice is there?

It sucks but sometimes there isnt a choice to be made, unless you want to completely forego medical advice and put yourself in enormous danger.

The best thing we can do is teach aftercare for stitches/episiotomies, encourage women more to do their pelvic floor exercises, and how to identify injuries such as prolapses etc. Plus timely and thorough treatment for such issues.

The only way to avoid it would be for every woman to have an ELCS and even then, theres the possibility of haemmoraghe, infection etc.

Birth is what it is, it comes with risks and unfortunately there is just no way around that.

@Wolfgirrl

You were informed clearly. Some women may be told not to Google by medical professionals because it could be unreliable information. Some can't access antenatal classes or the classes they attend aren't very informative.

There are many reasons why women may be uninformed.

But I dont know what informing women would actually achieve?

@Wolfgirrl I disagree- doulas are great for those who can afford it but are out of reach for most. Birth plans are still routinely mocked and scoffed at in our culture that many women don’t realise how valuable they can be for supporting informed choice and they’re written off as silly and useless. 1 in 5 women giving birth have history of sexual assault yet many say the care they received didn’t take their past trauma into account and was distressing.

I found a very good article about asking for maternal request c-sections. Basically that the hospitals who take the approach of refusing point blank with no discussion don’t actually lower the c-section rate. A midwife explains that reassuring from the start that a woman is entitled to a c-section if she wishes and then working through what could help them aim for a vaginal birth was actually way more successful in lowering the number of maternal request sections-

The majority of women I saw had had a previous traumatic birth experience. Common themes were a lack of control, lack of communication from staff and a negative experience of induction. Therefore the plans we made together often stated no induction of labour, no rotational forceps, minimal examinations and diverting to a caesarean rather than trying other interventions if the birth wasn’t completely straightforward

85% of the women initially requesting an ELCS decided to opt for a vagina birth with this approach, yet so many hospitals still point blank refuse for no discussion. I think the article shows how important it is to really listen to women, take them seriously and discuss birth choices.

@tangochutney

I was talking specifically about instrumental deliveries.

I would like to politely disagree though, I think birth plans etc contribute to a sense of failure and disappointment in women for whom it doesnt go to plan, which is a lot.

I think keeping an open mind and taking the labour minute by minute is a much better approach.

When I was pregnant, my grandma asked if I had a birth plan. I said I hadn't bothered and she said, 'Waste of time, baby hasn't read it'.

She gave birth to 5 babies in the 1960s/70s, from chatting about it birth wasnt anticipated as a huge 'event' in itself, just a means to an end to have a baby.

She didnt sound traumatised about her births, nor did she sound pleased. It was a bit like talking about having your appendix out or something.

I wonder if this is a healthier approach, seeing it as a medical event rather than tying it into a woman's self worth by making it some kind of pass/fail exercise.

But a good birth plan IS about learning about the things that can happen in labour, what/why/how intervention may be needed and what options there are.

The midwife in the above article stated that helping women make birth plans, women who were traumatised and adamant on wanting a c-section, massively helped them. She also states that in a lot of cases you can have a ‘low tolerance’ for a section during labour and caters can take into account the women’s preference for c-section over instrumental should problems arise.

This was also the case for me planning a second birth after a traumatic first instrumental, a birth plan helped massively and came in useful when complications did arise in labour- I was more informed and more in control.

I think the problem is the massive misconception that birth plans ignore intervention and are about self-indulgent women having a ‘magical’ natural water birth with no thought for what could happen or go wrong.

I also disagree about women in the past- my grandmother still spoke of the trauma of a birth 50 years previously and you could tell it still effected her. Birth trauma association say they receive messages from women in their 70s who have a lot of unresolved trauma. You just couldn’t speak about it as openly in the past.

@tangochutney

I'm really sorry to hear about your traumatic birth.💐

Shame that these women you discuss have to go through a traumatic birth to access all this support. It would be nice for women to be informed before going through the trauma.

But a good birth plan IS about learning about the things that can happen in labour, what/why/how intervention may be needed and what options there are.

But what options are there? If baby isnt coming out unassisted, then the only routes are vacuum/forceps/c-section. Whichever route is needed will come with risks of tearing, haemmoraghing, infection etc. There simply isnt a risk or consequence-free way of giving birth.

The only informed option a woman could make would be whether to attempt a normal birth or have an ELCS. Beyond that, everything is in the heat of the moment and needs must.

I had a birth plan and was informed and open to idea of instrumental delivery should need arise, my baby's safety being paramount. No one told me at any point a shattered coccyx that still hurts 2.5 years later due to forceps delivery was a factor that I should consider in my birth plan / options! When baby needed to be induced due to reduced growth and then needed forceps due to reduced heartbeat I didn't take time to ask what alternative options were, in retrospect I could've had c section instead of forceps but when on no pain relief and baby's head coming out I didn't really think about it and just went with what doctor said. I guess my point is that as others have said u can be informed and open minded and you still can't control what happens :-/

There are sometimes emergencies where things can go wrong without being able to prevent them. This can happen by either planned c section or planned vaginal birth. However some women/ not all women would prefer to be informed and understand what is happening and why. This may help prevent psychological trauma and questions about why things happened. @tangochutney pointed to trauma and how this is often due to lack of communication.

@tangocutney
One hospital seems very proud to be using forceps to cut caesereans according to this report from 2017. I know you mentioned forceps being used to cut caesereans earlier. See link.

www.stgeorges.nhs.uk/newsitem/our-maternity-unit-outperforms-national-average/

OP I wish I had known this too. With the encouragement of my MWs I spent so much time researching water births and hypnobirthing and wanted as natural and drug-free a birth as possible.

In reality I ended up having an emergency c-section after DD’s HR plummeted during my induction. What made the experience more traumatic was that I was in no way mentally prepared for it.

@fibee

I'm really sorry to hear that you had a traumatic birth. Hope your dd is ok.
I hope you got lots of support too after on the ward.

Sorry I meant @fibeee

Really sorry about your traumatic birth. Hope your dd is doing well. And I hope you got well looked after by staff afterwards

@Wolfgirrl

So for me the options were ELCS or having a lower ‘threshold’ for a caesarean during labour. I went through my previous birth notes and when distress began they had done all sort of things to speed everything up- waters artificially breaking, drip inserted to make contractions stronger all in order to try and make forceps do-able. I was supported to have strictly no high rotational forceps policy in my plan and that basically if history had repeated itself then I didn’t want all the intervention to try and get things moving but just go straight to cesearean. They were amazing at honouring this and working around my preferences during labour. Not every woman would make the same choices of course :)

I get what you mean that ultimately if intervention is needed then there isn’t a safe way to have a straightforward birth- I just think women should be involved deciding which set of risks they’re happier with. And that discussion comes into it with induction and so on. I just found it more positive. As you say a lot more attention is paid to the birth experience and I think that’s so important if we want to pay attention to post-natal depression, birth trauma and mental health.

And hospitals do need to work to ensure intervention rates aren’t skyrocketing with no actual improvement- statistics can show that they can be very high somewhere but outcome rates aren’t any better than places with far lower rates. Obviously that indicates many women are going through procedures they don’t need or want which is very concerning, but it’s a very complex issue.

@tangochutney well written post and I agree for the most part. There is some scope for lower threshold caesarians to be agreed pre labour.

I just don't really understand why instrumentals are the enemy I suppose, and major surgery with long term repercussions in terms of future births is viewed as safer/preferable. I know several people who have had instrumental deliveries, and none of us have any incontinence or lasting issues. The only change for me is my episiotomy scar which can sometimes get a bit inflamed if I wear tight jeans etc, but episitomies are also given without instrumentals.

Another enormous benefit of instrumental deliveries is the high probability any subsequent births will be unassisted and straightforward. Anecdotally on MN, women that have a forceps delivery for their first baby seem to pop the second one out in about five minutes (not literally, but you get the gist!)

Obviously you get occasions when instrumental deliveries leave lasting damage, but so do 'straightforward' births and caesarians.

I'm really sorry for anyone who's gone through a traumatic birth. 💐

@Wolfgirrl
I'm really glad you are ok. I hate the thought of women struggling with issues.

@Wolfgirrl

Do you think the people you know who've had instrumental deliveries would tell you if they did have prolapses, couldn't have sex etc? I'm interested to know in whether you think that?
Even a family member skirts around the subject with me, and acts like I should find my problems shameful. They can't even bring themselves to say the word prolapse.

A gp I saw said that most women hide these issues, many from even those closest to them.

@tangochutney

I know this is not relevant to the OP...but did anyone say anything to you about breastfeeding after instrumental delivery? No one said anything to me...but my milk never came in properly. Someone said to me at the hospital when I had to go back that the trauma can affect it.

Should say no one said anything at time of the birth! ....

I have always believed that ASD DC1 (now an adult) has SEN because of his birth. He was back to back, long labour then told he was distressed and suddenly room filled with people and he was delivered by ventouse. His poor head was deformed for weeks and he cried ALL the time .I think he was in pain.

Not a great result for me either' Long term bladder damage, virtually no perineum so prolapse (though mild apparently(!) so no treatment other than kugels which just don't make a difference. I have given up running, jumping, gym, horse riding as a result. I have asked for the hospital records and they basically show nothing. He should have been a caesarian and judging by the comments on this thread so should all back to back babies.

If I had known then what I know now, I would have gone for a caesarian.

Wolfgirrl that’s the reason personal choice is important I guess- some women can’t understand why anyone would want to risk an instrumental whilst others just don’t get why anyone would voluntarily book a planned c-section with no medical need. The fact is we all have different preferences and needs. I was less willing to put up with more intervention for a vaginal birth and one reason was because it was my final baby, so repeat caesareans and their risks didn’t come into it for me. That’s another reason why it’s important not to have the ‘one size fits all’ approach some drs may take, one woman may be planning on 3 more kids whilst another is definitely done.

@KayBM No not specifically. I gave up quite quickly but that was more linked to the depression caused from the birth trauma and having very little drive or motivation with it. I’ve heard about harder bfing after sections but wasn’t sure if that was linked to recovery and mobility? If so it may be a reason that could also be linked to difficult bagjnal births and instrumental deliveries too?