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?

@TastingTheRainbow and @FourPlasticRings

Thank you. Yes 66 percent don't have instruments...that is 2 out of 3. But I wonder out of those how many are induced, emergency c sections etc?

A friend of mine was on a drip...continuous contractions, very strong ending in 3c tear. I wish she'd had an easier time.

@Tootletum of course you can have an opinion that differs. That’s all I’m doing, it’s all any of us are doing - discussing differing opinions.

What changes for us if we know the risks is we can elect to have a planned caesarean, like I am in a couple of weeks, and like I would probably have done if I had been given honest answers to my questions. And then I wouldn’t be incontinent and in pain and in need of prolapse surgery. I feel misled and I do disagree with you I’m afraid that the NHS is upfront about the risks. I agree with OP they push natural birth.

I’m sorry you had a difficult time bonding with your baby. I did too so can empathise and it’s horrible.

@KayBM

pubmed.ncbi.nlm.nih.gov/30063899/

This is quite helpful on how many people have uncomplicated births. It’s between 33-40% in this study, which puts instruments at just over 20%.

@RoosterPie

The info is all on the NHS webpage on forceps and ventouse. It includes all the stats including likelihood of damage to mum and baby,such as tears, blood clots, incontinence etc.

I had no idea of the increased risk as a FTM and had forceps and episiotomy. In my case the umbilical cord was wrapped around my baby twice so no amount of pushing was ever going to get her out. Even with foreceps I was dragged halfway down the table when they tried to get her out and I tore internally. I was traumatised from the birth and said if I ever had another baby I would opt for a c section. However the stats for my hospital for that month showed only 6% of births were assisted and 40% were FTM so I don't think it's that common. I know two friends who had forceps and episiotomy and one was a VBAC.

@stargirl1701 I'd be very interested to know what exercises you did to encourage the optimal positioning. And was it really 10 - 12 hours a day?! Seems a lot!

I have read up a lot and dithered about maybe having an ELCS as I was aware that first timers are at increased risk of needing intervention (I'm a firm, due in a couple of months). Currently I'm planning to try for a vaginal birth but if anything becomes apparent in early labour that would increase the risk of intervention even more (back to back, needing induction etc) then ask for a c section asap. We'll see how it goes I guess🤞

Wow, I had no idea. I do know someone who had ventouse but assumed they were in the minority as it along with forceps have never been mentioned throughout my pregnancies. DD1 was back to back, ended up with a second degree tear but sounds like I got off lightly

One hospital by me does lots of Ventouse and pretty much no keilands. The one a few miles away does hardly any ventouse and lots of forceps/keilands. My best friend’s mum is a midwife abroad and they never use forceps - similar section rates. There feels lots wrong with the variability in our birth experiences and the fact that stats suggest different venues could give different outcomes. I can’t help but see a link between the male dominated team running the unit with high forceps rates.

This page @Wolfgirrl or is there another one? This is what came up when I searched for nhs forceps delivery.

www.nhs.uk/conditions/pregnancy-and-baby/ventouse-forceps-delivery/

@RoosterPie

I'll have a look. You see 33 percent worse case scenario doesn't seem good to me. With induction, drips like my friend had and emergency c sections it's not that simple as just planning a natural birth

When I went to my antenatal class...I got virtually no information. Just textbook vaginal birth, hardly anything on instruments, c sections, induction

Yes that one Rooster.

This will be partly because so many early interventions are used as standard now. Doctors are asking if you want a sweep from 37 weeks. If you are 39 weeks they talk about induction which many people start to think is a good idea because they are fed up of being pregnant (and some are in pain or a lot of discomfort) and just want the baby to come. The gp readily goes along with induction.
Any FTM who are due to give birth soon- please think about having as few interventions as possible. You do not need a sweep. Do not interfere with the cervix. Let the body do it’s job. Do not book an induction unless absolute totally medically necessary. Even then question and wait as long as is safe. Let your body go into labour naturally. If your baby is back to back, research all you can about helping it to turn before birth. Women should be told that sitting on a sofa or office chair during late pregnancy for long periods day after day can make baby back to back. Humans are not meant to be sat down for long amounts of time every day but often with office working (esp with first babies and no other small kids around) this happens.
Read up on hypnobirthing and learn to lesson fear around childbirth. Learn natural methods for birthing and go into it with a positive mindset. Get support during labour. Try to think of interventions and medical assistance as a last resort. These are the things which will bring those figures down but unfortunately It’s going the opposite way in the UK

@Glendaruel have a look into the history of making women lie on their back rather than more natural positions like all fours. It’s the medicalisation of birth that lead to it and its largely for the doctor’s benefit than the woman’s. Rather than the issue being midwives encouraging women out of lying down, more likely is women wanting to be in other positions but being told they have to lie down

@RoosterPie

There's a gynaecologist who says forceps are the biggest risk factor for prolapse. I didn't know this.

Speaking of antenatal classes - I was a bit that mine didn't even mention maternal request c sections.

Well that page doesn’t say anything about 49% of forceps deliveries resulting in permanent and irreparable damage to the pelvic floor. It doesn’t say 1 in 3 first time mothers have instruments - and the link at the bottom is to the brand new leaflet which OP has linked to. It wasn’t there when I gave birth in April 2018. It doesn’t say your episiotomy may never heal. It doesn’t say you have a higher chance that you never enjoy sex again.

I don’t think it presents the full picture of risk at all.

There's a gynaecologist who says forceps are the biggest risk factor for prolapse

Not just one gynaecologist - there are studies showing this as well.

Also missing from the NHS instruments page incidentally.

"Around sixty percent of first time mothers have uncomplicated vaginal deliveries."

Are all these mothers followed up 1 month, 6 months, 12 months down the line to check they have recovered with no underlying damage? I've known a couple of friends give birth with no problems to later discover there's a nasty problem a month or so later. What should have been a straightforward healing process was nothing of the sort and was the start of lots of treatment.

I assumed forceps and ventouse were old fashioned and weren’t used anymore. I hadn’t heard of anyone needing them and don’t remember ever having any discussions about them at any of my midwife/gp appointments but then I felt I was let down a few times with my first birth, despite two previous mcs. I went to my 36 week midwife appointment and saw a new midwife, when I asked if the one I had been seeing was off I was told she’d gone to work in Africa, also had to cancel a bf workshop because I was snowed in and was told it wasn’t that important anyway. Never did work out how to bf my first dc. Other things too I felt I wasn’t informed of but that’s for other threads.

I did end up with them attempting the ventouse but I think I screamed when it came near me so ds was delivered with forceps. It was all very rushed so no explanation of anything, I was just told your baby needs to come out. I was always under the impression it was a natural delivery or cs, as nothing else was ever mentioned. I remember it all feeling like I wasn’t really involved in it at the very end. Not a pleasant experience at all and I did end up with pnd, although I didn’t realise that until I had second dc 4 years later.

Are all these mothers followed up 1 month, 6 months, 12 months down the line to check they have recovered with no underlying damage? I've known a couple of friends give birth with no problems to later discover there's a nasty problem a month or so later. What should have been a straightforward healing process was nothing of the sort and was the start of lots of treatment.

You could check? It's a long document, linked upthread, and I've no desire to read the methodology section! Regardless, it doesn't matter for the argument at hand, which is about instrumental deliveries and the OP's assertion that it's 'highly unlikely' for a first time mum to escape them. Which is patently wrong as 60% of women don't have them.

I'm not at all surprised by this figure. It definitely tallies up with the experience of people I know. I had a horrific forceps delivery with my first, ending in permanent damage. It would take a very strong first time mum to demand a csection under these circumstances. I felt like the whole thing was taken out of my hands. By contrast, my second birth was 5 hours with no intervention at all.

I hadn't a clue about forceps deliveries when I had DC1 in the 90s, and I'd done antenatal classes, read lots of books and thought I was well informed.

I had an epidural, couldn't feel to push, and then DC started showing signs of distress. Next thing I knew, my legs were being hoisted into stirrups and DC was being helped out with forceps. It was all a bit of a shock, but DC was fine and so was I, with no lasting damage.

I do wish I'd known more beforehand, though.

Just to add I do think the position that the woman takes whilst giving birth is massively important. DD1 had to have the heart rate clip on her head and I was forced into stirrups. It went against everything that my body was telling me I needed to do any actually contractions started to stall. All in all a quick labour at 3 and a half hours but certainly hindered by the culture of forcing women onto their backs. My top advice would be to resume some sort of more upright position.

I'v just had a look over the NHS web link, can't believe how casually it mentions the chance of lack term damage such as incontinence.

@fourplasticrings

I did not say it is highly unlikely that a first time mum would escape instruments. What I said was 1 in 3 women giving birth has instruments.

What are the other 2 in 3 having? Are they being induced or having c section?

That is why I am uncertain as to how likely a natural uncomplicated birth is? If the 1 in 3 having instruments statistic has been kept hidden for so long? What about the other statistics of women who don't have instruments? Are these being induced etc?

It's not as simple as planning a natural birth because clearly there are many complications... I am interested in all the stats.

I wonder out of those how many are induced, emergency c sections etc

I imagine emergency cs don't count in the 59%- as you say, if they were just counting all non-instrumentals you'd get 66%ish, so I imagine those have been removed from the stats. As for induction, probably quite a lot (and I'd wager many/most of the instrumentals and emergency cs- look up the cascade of interventions in childbirth), but it's the end outcome they're measuring so it's not terribly relevant in that regard.