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?

Doula here!

Yes, there is so much about birth that isn't widely known, which is why I recommend to all my clients that they research as much as they can about the things that are important to them.

There are lots of things we can do to influence how a birth will go but ultimately we can't control it (even an elective csection can have unplanned side effects).

Here are some of the things you can do:

• Exercise, stay active during pregnancy and labour.
• Eat well, stay hydrated during pregnancy and labour (you need the energy!)
• Empower yourself through education (take an independent childbirth education class, research, read books etc)
• Stay at home and labour there as long as you can
• Remember that due dates are guess dates really - the majority of babies come 'late', ie after 40 wks
• Hire a doula! Having a consistent support person with you (aside from your partner) is proven to reduce the need for intervention, increase your chances of a vaginal birth, and increase your chances of having a positive birth experience.

I was clear that I would refuse instruments and go straight to c section if there was a problem

Well that was naive and foolish @Tootletum because often it won’t be apparent there’s a problem until the baby is too far descended for a caesarean to be a safe option.

There is also a thing called medical consent. I was induced and ‘consented’. They are meant to tell you about risks of procedures when they consent you. The whole “you could have found out if you wanted to” is disparaging and offensive. I went to NHS ante natal classes and read the NHS literature. And yes I expected that to be honest about the risks to me so I could make an informed choice.

@Wolfgirrl I agree we consent to a certain level of risk but I do think we should have an informed choice as to what risks we prioritise. I might have planned a section if I had known what forceps could do to me long term.

@Wolfgirrl actually if you are very toned with tight tummy muscles that can work against you...

Yoga isn't what is recommended for optimal fetal
Movement.

Even if a woman does everything they can some will
Need assistance or c-section. Lots of women still die due to childbirth daily - it's a risky business!

I never went into spontaneous labour, longest I waited was 14+3 and the thick meconium meant with subsequent I only waited to 42 weeks. I was fortunate - induced, included ARM and epidural yet unassisted delivery.

@cuddlypenguins

So glad you escaped an instrumental delivery...phew!

That's the thing as well, since finding Mumsnet after giving birth unfortunately...I have read people saying they have given birth before an instrumental delivery is needed despite a doctor saying it is...so it makes you think doesn't it? Maybe if women were better informed they could say could we wait a bit see what happens if baby still seems ok?

I was told about forceps and the cup vacuum thing at the class I went to. I felt like the midwife explained them both well.

I was told that they might consider the vacuum for my son because his heart rate was playing sillybuggers every time I had a contraction and he was slow to arrive. I ended up not needing it though.

@babychange12 where did you find those statistics for hospitals near you? I’d be interested to look myself

@RoosterPie why so rude? I see nothing naive and foolish about not wanting instruments if avoidable. I'm quite aware that there isn't always a choice, and yes obviously once the baby is in the birth canal it could be distressed and needs to be born. I wanted that in my birth plan so that midwives could ask me whether I wanted to carry on if there was a risk of instruments, which they were perfectly happy with. I had discussed it with my midwife and she had agreed it was reasonable. Since I've had three kids without any major issues, I'm not sure what I've done that was so naive and foolish.

I had an epidural for my first and had a decent nap in the middle of labour. They had to wake me up to have DD. I really didn’t care how she came out after that and I had a bit of help. However I was calm, no pain and everything was easy. Same for DD2. Just a shorter labour and no epidural top up. No intervention at all. We are all different and I would take sleeping during labour over any worries about intervention. However I’m not a worrier and my birth plan just said “epidural”. Birth plans don’t go to plan!

Should first time mums be given full info? Probably yes but I’m not sure if it would make any difference to the actual birth.

The thing is all my pregnancy I had a gut feeling my son’s movements weren’t right (but they were whenever they were checked) and so pushed my consultant to induce me at 40 weeks. I have a clotting disorder that isn’t recognised by the NHS yet and so it was a battle to do this despite me only being a few months off the age when they would have induced automaticallt. They agreed eventually but put down MH issues as the reason and were quite snotty about it.

The induction worked quickly and within 5 hours I was fully dilated but the babies movements and heartbeat kept faltering so they didn’t want to risk my pushing. By the time I was ready to push my son’s heartbeat was failing and I was rushed into theatre where I pushed as the consultant pulled the baby out. I was later told the pattern of the birth fit micro-clotting in the placenta / cord and I was very lucky not to have a stillbirth. Thankfully my son was okay but I had a PPH and needed to be in hospital for a week.

The consultant I initially saw refused to see me after the birth and so it was the one who operated on me who spoke to me. He admitted that had I not demanded an induction my baby might have died.

Now all of this could have been prevented , and I could have had a natural delivery, if when I first saw this consultant (while I was pregnant) ishe had just prescribed me a higher dose of LMW heparin and aspirin or similar. But to save money (probably only a few hundred pounds) there they instead wasted thousands extra on my assisted delivery.

I had a fairly positive birth experience but it’s this waste of money that really gets me.So no I don’t believe first time mums have to have an assisted delivery - if they received excellent care from the start then a lot can be prevented.

Interesting reading for ftm to be!! One thing that struck me was it said it's more likely to be needed if you're lying on your back, so better to be sitting or on side. I am a little naive as not done it all yet, but can't help but note, the large amount of women in giving birth programmes on telly that are on their back. How much encouragement is given to sit up and move?? Have you found this useful?

I didn’t know this and didn’t really consider a tricky delivery with instruments, for some naive reason I thought I would either give birth with no/ little intervention or end up with a CS. Even after being consented for theatre for instrumental delivery or CS if required I still didn’t really comprehend that it may not be as simple as turning the baby to allow the delivery to progress. Ended up with nasty 3rd degree tear, plus episiotomy and further intervention for a retained placenta. If I had known the risk I would have opted for CS once delivery wasn’t going to be straightforward.
A little more education to allow for informed consent and decision making is definitely needed.

@KayBM The stats say 1 in 3 need assistance so that means 2 in 3 don’t, around 66%. @FourPlasticRings was agreeing with your stats!

@Tootletum

Your post said this:

Erm this is a strange thread. Anyone can read anything they like on the internet, it ask their midwife, who I seem to remember was quite clear about the stats because I asked. No one is "not told", they can find out if they ask. Lots of people would rather not fill their mind with negativity. I was clear that I would refuse instruments and go straight to c section if there was a problem

It read to me, and still does, as though those of us who did not know these stats are to blame for not asking. You on the other hand knew because you were cleverer than us and asked and would have avoided instruments by moving to a section.

I’m sorry if my post was rude but I found yours very rude. People who had instruments without being aware of the stats are not to blame for “not asking”. The point is many of us did ask and the risks are played down. Those of us who had instruments are not to blame because we didn’t say we wanted to move to a section rather than have instruments - the option of a section wasn’t available in my case, or many others (at least not without undue risk to the baby of being pushed back up through birth canal).

If it is the case you avoided instruments in your births I am pleased but this was luck, not because of anything you did right or we did wrong. It was naive to think you could avoid them by asking to move to a section “if there was a problem” because for reasons outside of your control it may not have been possible to have a section in lieu of forceps.

I’m pleased fortune was on your side In this regard but please don’t think it was anything but luck, rather than because you asked better questions or had a better birth plan than the rest of us, and that us talking about it is “erm... strange”.

@Glendaruel - I had a walking epidural and was sitting up for the birrh: i dilated quickly but unfortunately my baby’s heart failed so I was rushed into theatre.

@Wolfgirrl

Well for a start I'd have done a lot more research. Although I asked my midwife about some things and did not get proper answers. But I trusted in the professionals.

I did ask my midwife if there was any alternative to forceps, though I thought they were relatively rare. I went to an antenatal class and they said it was usually vaccum used. My midwife basically implied there was no alternative to forceps...however if you look Kiellands forceps up you will see that they are simply an alternative to a c section with very similar outcomes. I'd never heard of them before.

When they said my baby was low and they needed to do forceps if possible and a c section if not, I thought the baby was really low and that a c section was too complicated. As it is a c section would have been an option, but because I had no information on this- even after asking my midwife for advice, I could not say I absolutely refuse.

I didn't want my baby to get hurt. So instead I had a traumatic and risky delivery for both of us, leaving me permanently injured. Which I had no idea of the dangers of till afterwards.

So for a start a bit more information from my midwife would have been good...

If I'd had the information I would have requested a planned c section and if I couldn't have got one... I would have put low threshold EMCS on my plan and asked what position my baby was in. Instead I spent hours pushing and being told by my midwives that I wasn't trying hard enough...when he was never going to come out.

I was asked at the hospital why on earth I had taken such a big risk having a home birth. I'd no idea the danger I'd put me and baby in ☹️

I'm really thankful that I read this statistic on Mumsnet during my pregnancy and that significantly swayed my decision for an ELCS. I've never heard anywhere else that the risks were so high. Just based on average general knowledge gleaned from school/media/social media etc I would have guessed it was 1 in 10 who may need intervention. 1 in 3 plus the a 44% risk of vaginal injury (prolapse, tears, lasting problems) was simply too high for me.

I myself was a ventouse delivery with episiotomy which my mum only mentioned in passing many years later. I feel that a natural birth is really pushed onto women by expectation, even by others who have suffered from it. The proof is that we assume every pregnant woman is going to give birth naturally (eg asking about the due date, asking them whether they're excited, whether they have their hospital bags packed etc). When people asked me I flatly told them my c-section date which definitely took the surprise out of things :P

Do you have the statistics to prove that @FourPlasticRings?

<a class="break-all" href="https://www.google.com/url?sa=t&source=web&rct=j&url=www.cqc.org.uk/sites/default/files/20151215b_mat15_statistical_release.pdf&ved=2ahUKEwiYy9_imMjpAhVhqHEKHW_5BG8QFjACegQIBBAB&usg=AOvVaw34ANjTVsTl22Qj-TahRr2I" rel="nofollow" target="_blank">www.google.com/url?sa=t&source=web&rct=j&url=www.cqc.org.uk/sites/default/files/20151215b_mat15_statistical_release.pdf&ved=2ahUKEwiYy9_imMjpAhVhqHEKHW_5BG8QFjACegQIBBAB&usg=AOvVaw34ANjTVsTl22Qj-TahRr2I

It's a PDF, if you start at the back and work forwards you come across it relatively quickly. It's a study, so doesn't cover every woman, but it was 59% two years and 60% another.

In my NCT group of 8 couples, 2 of us ended with emergency sections and 5 of us had interventions. I'm surprised it's not higher! I had forceps in theatre and was pretty traumatised afterwards. My bladder is not quite the same! Had an elective section with no 2 and wish I'd gone for that the first time. Both my babies were small and a bit early.

I dont think @Tootletum was rude at all? Just putting across a different viewpoint, which is what forums are for surely?

I agree if I'm being honest - if midwives suddenly started unleashing loads of scary statistics on first time mums, the mums would complain about being scaremongered. So they cant win really. It isnt a state secret, the information is there.

Second being early due to elective c section.

Your statement is obviously untrue though- for it to be 'highly unlikely' that women could have a natural birth, that'd be what- 5% or fewer managing it? Clearly that's not the case.

@RoosterPie ok well whatever, I didn't mean to cause offence. I was saying that a)it's not hard to find out, and b) I don't know what it changes if you do know, other than cause huge anxiety. I regret feretting out the 50 million ways it can go wrong, I cried for most of my pregnancy at the thought of the birth, I was unable to frame things positively and take positive steps to feel i had some control over the process. I did that in other births (although yes, before you say it, the difference is always hindsight with any subsequent birth), and was really surprised that I liked the Ina May Gaskin book. Just because it was a natural birth didn't make it wonderful, I struggled hugely to bond with my baby.
I just didn't like the OPs aggro about how this is all some plot to withhold information for the sake of pushing natural births, I don't think that is the case. Why can't I have an opinion that differs?

I was a first born with the help of forceps and have a sizeable dent on one side of my head as a result.

Ds1 was emcs but i went for vbac with Dc2 and 3 and both were born with the help of ventouse and episiotomy as they both were in distress and both got stuck on the way out. Ds2 sustained an injury that he recovered from and ds3 was fine but I remember screaming when the midwife ‘helped’ him out.

Never had dc4 but it would’ve been an elective section if we had.

@Wolfgirrl I don’t think I was rude in my post. I gave my viewpoint in response to her. I read her post as suggesting fault on the part of us who weren’t aware - which is upsetting when you are living with distressing birth injuries and did in fact ask questions but were fobbed off and told forceps are safe for you, and a vaginal birth will have a better recovery etc.

There is an issue with the NHS downplaying risks of vaginal birth, there are so many women who have this experience so I disagree with you (and Tootle) that it’s women’s own fault for not asking. We do ask. We don’t always get honest replies.

Wow, I had no idea the figure was so high, that's insane!

I ended up with vacuum, episiotomy and 3b tear and haemorrhage. But then again my induction at 39 weeks didn't exactly go as planned either. Was told it probably wouldn't work and but in reality I overstimulated, and had a 1.5hour labour in total.

Already decided next baby will be an ELCS