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?

I said when I went in that an instrumental delivery was only to be done if it was a matter of life or death for baby in that moment, otherwise go to c-section. It was the only thing I was bothered about, I had no 'birth plan' as such.

By some miracle I managed to birth a nearly 10lb back to back baby, with an epidural (that worked amazingly, I couldn't feel a thing despite having an oxytocin drip)

Going by other people's experiences I was extremely lucky given the circumstances.

Here is the data if any one is interested. Table 3i.
digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2016-17
For first time mothers in uk 2016/17:
144,638 deliveries of which:
72,837 spontaneous
28,235 instrumental (7,773 low forceps, 8752 other forceps, 11,672 ventouse)
39,381 caesarian (11,280 elective, 28701 emergency)

So around 1 in 5 are instrumental.

figures

NHSfigures show that vaginal deliveriescostthe health service £1,985 each.Caesarean sections cost £3,781.

Thanks @weepingwillow22. That's very interesting. Excellent googling skills for this time in the morning!

Lol FourPlasticRings. I am an researcher when I am working. Currently bored on maternity leave and baby up early.

I went into labour naturally, baby was back to back and after reaching 10cm I was in absolute agony and baby HR was starting to concern them. They went through what they wanted to try (forceps) but said I could opt for a c section, but as baby was already part way down the birth canal it would be tricky. I said try forceps first, turns out DS had shoulder dystocia too. Thankfully everything went well, I was feeling a lot of pressure for a while but no pain, and was fully healed in a month or two; no damage to me or baby. I was given options and felt that the delivery was carried out expertly, I guess it depends which hospital.

That figure is terrifying, Im a worrier and read up on everything but never knew the figure for first time mums was so high.

When I was due DS I was dead set against having an instrumental which is why I was determined to not be induced, not have an epidural and to use our hospitals birth centre which had much lower instances of assisted births than the labour ward. DS did get stuck but they kept and eye on his heart rate and he was finally delivered after an hour of pushing. The midwife who did my check at home went over my notes with me and said they would have definitely intervened in the labour ward.

@Aria2015 my birth experience was 8 weeks ago and it’s like you were there. Back to back baby and in the last 20mins the room absolutely filled with people - cut, forceps and then huge blood loss and tearing.
I’m now being treated for not only the physical impacts but ptsd.
I had no idea these were the stats. I wasn’t told much about assisted delivery pre labour and when I asked my midwife and told her how scared I was and why she really played it down.

I’m very glad to hear the lady who talked of a totally different second labour experience!

To be honest I think I would have found these figures terrifying with my first. However I did find myself inside a very "natural birth is best" bubble and as such I quite convinced myself that my chances of such things were lower than average

I did NCT classes (this is going back 12 years) and I think we had an unusually good teacher - shortly afterwards she left NCT and set up her own company for birth classes which is still running. We learned about back to back babies and how to position oneself in late pregnancy to reduce the chances. We learned about each intervention and why it is usually used, I don't remember learning rates, but perhaps I have forgotten. Or they may have been intentionally left out due to not wanting to induce fear.

I knew I didn't want induction and was prepared to ask for wait and see if I went overdue. We learned about BRAIN which is an acronym designed to help you ask questions and be informed about what is happening.

I planned a home birth, because I was frightened by hospital and the possibility of an instrumental delivery. I also didn't fancy the sound of the delivery methods of the more hardcore pain relief. I knew there was a high chance I'd transfer in, which I did and I was happy with the birth overall, but it was long and exhausting. About 60 hours and I'd only had 2 hours' sleep before that contraction woke me up. But I did have a non instrumental birth. I wonder if DS1 was back to back but I never had a debrief, so I don't know.

With my second I was in Germany and with Hindsight my biggest mistake was not booking into the one hospital that I knew had gas and air, because I was keen to avoid a routine cannula ready for fast IV placement if they needed to, because again I was assuming that meant a more medical mindset. As it happened I had this anyway, because I tested positive for GBS.

Again I had a long and painful labour, and wondered again (from reading other back to back stories) whether DS2 was back to back. But again nobody said anything. I also had an epidural here, which didn't work. That was something I'd never heard of happening before, and made me feel completely out of control and panicked. I felt like my only tool was gone and I didn't cope. I couldn't even talk about his birth for over a year and nothing really traumatic happened. No instrumental delivery. He did have a scalp monitor which I was upset about, but obviously had no lasting effect. Then lacked oxygen when he was born and had to go into SCBU for 24 hours.

I don't think the idea of requesting a low threshold c-s or asking for a c-s over instrumental delivery is something I've ever come across outside MN and only rarely on here. It seems like a sensible option - unfortunately the natural birth lot seem to consider a c section the lowest of the birth hierarchy whereas actually I reckon an instrumental delivery is probably worse!

I didn't know these figures when I was pregnant first time round, but off the top of my head, out of seven women I know well who gave birth for the first time in recent years, I was the only one who didn't have a forceps, vacuum, or c section delivery. And I think that's shocking.

If I had know those figures beforehand I would have been scared. And being pregnant with my second I'm very clear that I don't want either forceps or vacuum for my second labour. If I can't have an unassisted birth like I did first time round I would prefer a section. Each woman who had a forceps or vacuum delivery out of the seven had to be cut and stitched, and half of those suffered complications with either infections or the stitching done incorrectly leaving them in pain for a considerable amount of time afterwards (think a year plus).

Birth is traumatic and physically barbaric, and I'm still gobsmacked that woman are just expected 'to get on with it' if they suffer complications, have major c section surgery, or have life-long complications as a result of giving birth.

Part of me can understand that medical professionals don't tell women these stats so as not to scare them but I think overall women need to know. Informed is forewarned, and at least we would have the opportunity to mentally prepare ourselves for the possibility of such intervention rather than deal with the shock and trauma of the unexpected during what is already a very vulnerable time in our lives.

Thanks @weepingwillow22 🙂

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

That is admittedly only one source saying contrary regarding the difference in costs between both planned vaginal birth and planned c section. On the day it may be less expensive to have a planned vaginal birth, but the question is what about long term? Once negligence, repair operations, physio and so on are added in? Are there a number of studies on this?

I'm sure someone else will come up with another study with info!

@weepingwillow22

If we take your study info from 2016/17, we could say let's look at the women who are planning a normal vaginal birth (whatever normal is) . If I take out the planned c section group that leaves:
22.75% needing instruments
22.11% needing an emergency c section

So rounding it up about 44% need assistance and cannot give birth vaginally without either instruments or they need a c section. Of the other 56% that give birth spontaneously...how many have inductions etc, is that classed as natural?

A friend of my was induced, terrible labour and didn't need an emergency c section or instruments but believes the induction and strength of contractions caused her birth injuries. I don't think she would call that natural...but she had a vaginal birth.

The RCOG figure of 1in 3 needing instruments puts this at a higher percent than that in the study you mentioned. But then is this from more recent figures? We would like to hope so, seeing as though it's from the RCOG...I wonder what the overall stats were from 2019 ?

I think what is clear though is that a lot of women may not know the 1 in 3 figure regarding assisted birth.

Personally I am glad that an up to date leaflet has been put out about this...just hope that more information starts getting shared through antenatal info. I know I wouldn't have risked those odds had I known. Also if I had known about prolapse from forceps etc, I would not have risked it...but that is just me.

@Time2change2

www.bbc.com/earth/story/20161221-the-real-reasons-why-childbirth-is-so-painful-and-dangerous

Here is a really interesting and informative article which explores the link between women's pelvises narrowing over the last million years, and baby's head sizes becoming larger. Human childbirth is widely accepted to be more difficult and dangerous now than it was a million years ago. So evidently the body is not evolving to make the process of birth easier.

As for refusing induction unless 'medically neccessary', study in Sweden on pregnancy outcomes at 43 weeks had to be cancelled due to the high number of stillbirths:

www.google.com/amp/s/amp.theguardian.com/lifeandstyle/2019/oct/28/post-term-pregnancy-research-cancelled-babies-die-sweden

The study also concluded that early induction reduces the risk of needing a caesarean section.

Unless you are a doctor, it is not for you to say which interventions are or are not necessary. And you shouldn't be encouraging women to go against medical advice to hold out for the chance of a whale song birth.

And one of the only studies into the effect of hypnobirthing produced no significant results:

obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13433

Allocation to two‐third‐trimester group self‐hypnosis training sessions did not significantly reduce intra‐partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation.

@WingingIt101

I'm so sorry for what you're going through. 💐

@Chachang
I wish I'd been offered a c section...as it is I don't plan on any more children, especially now. So any benefits of delivering vaginally have gone as far as I'm concerned.

@FourPlasticRings

So a study from the USA from 20 years ago that said women are more likely to be given sedatives than pain relief equates to an NHS conspiracy not to listen to women and to disregard their feelings?

As for women receiving substandard care in some instances, the same can be said for men:

prostatecanceruk.org/about-us/news-and-views/2017/12/new-data-shows-men-wait-four-times-longer-to-be-diagnosed-with-prostate-cancer-than-women-with-breast-cancer

I accept women receive substandard medical care globally, but not in the UK.

What about the different types of forceps? I was born using Kiellan forceps, which are the highest risk, so I researched them. Sure enough my dc1 needed them when he was twisted. I had read about the risks relative to c-section and put it in my birth plan, but no one mentioned them.

It would be nice to have a fact sheet with all the different sorts of interventions and their relative risks. It is so hard to find the information yourself and most people haven’t got the skills to make an informed decision.

@Porridgestoat

I can't seem to tag you, I'm afraid. I will say upfront that I have a very obsessive personality which helps with doing stuff like this.

I used a few different resources. For DD1:

The exercises laid out on the Spinning Babies website:

https://spinningbabies.com/start/in-pregnancy/daily-activities/

I did all of them every single day.

The exercises laid out in the Fit for Pregnancy leaflet my midwife gave me:

https://pogp.csp.org.uk/system/files/publication_files/POGP-FFPregnancy%20%281%29.pdf

I had a birth ball and only ever sat on it in the third trimester. No couch or chair. I did exercises on the ball daily: _
_
https://thebirthball.com/pages/birthing-ball-exercisess_

I did a pregnancy yoga class weekly and then practised the breathing and visualisations from that daily. I used the NHS yoga video every day except the day I did the class: _
_
https://www.nhs.uk/conditions/nhs-fitness-studio/prenatal-and-postnatal-exercisee_//_

I did an aqua natal class weekly at my local pool. I swam for an hour two other days a week. _
_
I practised all the positions from Fit for Birth (another leaflet from my midwife) every day: _
_
https://pogp.csp.org.uk/system/files/publicationfiles/POGP-FFBirth%20%281%29.pdf

I knew this birth preparation would take a lot of time so that is why I was on leave from 32 weeks. I have no idea how you could do all this plus go to work.

I also did relaxation every evening before bed and squeezed in a nap every afternoon! 😴

https://www.nhs.uk/conditions/nhs-fitness-studio/bedtime-meditation/

With DD2 I was more restricted due to PGP and having DD1 at home. I did get her a mini 'birth ball' so she could 'join in'! 😀

I added Breastfeeding relaxation with DD2 in my preparation:

https://www.natalhypnotherapy.co.uk/shop/Testimonials-for-the-Breastfeeding-Companion.html

Ignore the link below. It doesn't seem to work and I can't seem to delete it.

https://pogp.csp.org.uk/system/files/publicationn_files/POGP-FFBirth%20%281%29.pdf

I had a Ventouse during my CS which I no idea what even a thing but apparently fairly common.

This makes me so angry.

I wasn’t allowed in the birthing pool at the MLU because my bump was measuring so big. I should have been offered a c section then. Instead, I endured a 50 hour labour and was made to have an epidural halfway through because I was so exhausted.

Then I was put on a syntocinon drip and it still took hours before I was fully dialated. Then I was allowed to push for two hours before they took me into theatre for forceps delivery. DC ended up being 10lb 3oz! I had a 3rd degree tear and lost almost a pint of blood. Two years later I still had a rectocele, enterocele and urethrocele. I asked for help and was given nine months of physio on the NHS which basically did fuck all. In the end I had to go private (luckily I was covered with my work’s policy) and have surgery to repair everything.

I had an elective c section for my second birth and was fully recovered within two weeks.

I was the first out of my group of friends to have a baby. When they got pregnant, each time I told them: have a c section. I told them honestly about what had happened to me. I wish someone had been honest with me and I could have made an informed choice - instead of the airy fairy, whale song, homeopathy nonsense I was told in my NCT class (although, as an aside, I did get excellent breastfeeding advice there). All my friends took my advice and had very successful elective c sections. And thankfully none of them are now having to use their fingers to push the poo out of their anus through their collapsed vaginal wall 👍🏻

Wow! Thank you @stargirl1701 !

So any benefits of delivering vaginally have gone as far as I'm concerned.

If it helps, being delivered vaginally is associated with a lower risk of immune disorders in babies (allergies etc) because you basically cover them with bacteria on the way out. So there may still have been a benefit.

So a study from the USA from 20 years ago that said women are more likely to be given sedatives than pain relief equates to an NHS conspiracy not to listen to women and to disregard their feelings?

I didn't say there was a conspiracy, I said there was a nasty tendency. And there is.

www.google.com/amp/s/amp.theguardian.com/society/2017/sep/06/listen-to-women-uk-doctors-issued-with-first-guidance-on-endometriosis

www.bbc.com/future/article/20180518-the-inequality-in-how-women-are-treated-for-pain

www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562

@RUOKHon

I'm so sorry to hear about your experience. That sounds really terrible and traumatic.

I'm glad to hear you're informing your friends. Everyone just told me I would be fine, it is one day admittedly very painful but then it's over...

For me and countless other women it is not over...like you we have terrible birth injuries, or PTSD or our partners have PTSD. Women shocked by the pain and suffering they endure after, recovering from a vaginal birth which they may never recover from.

So glad you got surgery and got sorted! Hope it's all holding up well. If you would pm me with details I'd appreciate that as my physio diagnosed me with prolapse too. I know there are a lot of different surgery options. If you would give me a bit of info I'd be grateful, if you've got time.

I'm in Ireland and while we arent given the rates, the midwife read down through all the types of instruments during one of the appointments and i was sent home with a leaflet. At around 30 weeks then, was asked if I had written a birth plan and had any questions on the types of birth/labour.
Shocked to see from pp that they had used some instruments that pp didn't even know existed.
For me, I had an episiotomy and forceps with ds1, then I tore and needed the vacuum with ds2. Ds1 was nearly 10 pounds, ds2 was almost 11 pounds so I tried as much as I could but was glad for the instrumental assistance. That being said, if i wasnt informed on what the instruments were, I'm sure I would have had a different perspective.

@FourPlasticRings

Fingers crossed my baby doesn't get allergies then! 🙂

I hadn't heard about the allergy thing. Although it didn't work in my case I was born vaginally and riddled with allergies my brother was emcs and doesn't have anything - sneezes for the 8th time today 😑

@BuffaloCauliflower which? Consumer website has the details on each hospital

I narrowed down to the top 3 hospitals closest to me then googled the heck out of them as well

www.which.co.uk/reviews/birthing-options/article/where-to-give-birth