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 had a forceps assisted birth with episiotomy the first time around and am now pregnant with my second. First labour was 30+ hours, made slower by epidural but I really couldn’t manage without it as I was in so much pain - my baby was back to back. His heart rate was all the place and I asked for a c section but as I was fully dilated the obstetrician wanted to try forceps first and thankfully he was out and safe around 15 minutes later. He was (only) 7lbs but I’m quite small and I just couldn’t seem to part with him. Ended up with an umbilical hernia also - probably from all the bloody pushing for a solid hour (to no avail). I’m glad I was pretty out of it on pethidine as I think I would have been traumatised by the experience. I’m hoping that my second labour is quicker and I’m hoping to rely on gas and air to get me through this time but I’m very open minded and will go with the flow and see what the situation requires when I’m in it. I was my
Mums 5th baby and she had pretty much the same experience with me as I did with my son, so it just goes to show that it doesn’t always get easier, sadly!

There is a currently huge fear around childbirth generally speaking in 1st world countries.

Probably because of websites like MN 🙄

I wasn't told this either. I had a forceps delivery, massive haemorrhage, could barely walk for the first few months and was so traumatised that I couldn't even consider having another child. Pretty sure it contributed to my anxiety and depression too. I would have definitely have requested a caesarean if I'd been in possession of all the facts. Any conversations I had prior to birth were all geared towards making me feel like I'd be an abject failure if I didn't breastfeed - and the impact that had is a whole other story.

During Labour I felt the NHS care was great but the after care was appalling. If you went through that kind of trauma at any other point in your life you'd be off your head on morphine with everyone looking after you. Instead they chuck you a couple of paracetamols (which you have to practically beg for) and attach a newborn to you.

Disingenously cut and pasted

Not at all- I simply cut and pasted the summary at the end of the page rather than the first bit.

It's also a limited study of one population that's very different from our own and contradicts many other studies. They paid no attention to when babies were weaned onto food either, which is ignoring a pretty big potentially confounding factor. It's not enough to say conclusively that breastfeeding increases allergy risk. However, even if it were, it still has no bearing whatsoever on the discussion at hand, so I've no idea why you brought it up in the first place.

sorry to hear of all these traumatic births. I hope for those of you left with ongoing problems, physically or mentally that you are getting the support and help needed. 💐

Wolf girl
Unnecessary intervention for example, sweeps, induction because the baby has not arrived by the ‘date’ doctors have given you for your baby to arrive. (I am not talking about induction for medical reasons or inductions over 42 weeks) examinations during labour for the sole reason of finding out how dilated you are, even against the wishes of the mother (as in my case). These are just a few

During Labour I felt the NHS care was great but the after care was appalling. If you went through that kind of trauma at any other point in your life you'd be off your head on morphine with everyone looking after you. Instead they chuck you a couple of paracetamols (which you have to practically beg for) and attach a newborn to you.

Completely agree with you & tbh I was shocked after my CS to get paracetamol & be sent home. After my appendix was removed I was in a week & on morphine for at least a day or 2.

I agree that this should be discussed with mothers but I disagree with your final sentence. If 1/3 need assistance then obviously 2/3 don't. I had a back to back vaginal delivery with my first with no assistance and know plenty of FTMs who didn't need it either. Sweeping statements such as your final sentence aren't particularly helpful or correct

My son was back to back. I had an absolutely traumatising labour which culminated in him being yanked out with forceps. I also started off in a stand-alone midwife unit and was rushed to hospital 45 mins away after pushing for 90 mins and when it became apparent that he was stuck. I actually wanted to die, the pain was so horrendous.

I have no doubt that the birth contributed to PND and the effects have been so profound that I have only recently been able to entertain the idea of having a second child 6 yrs later. I'm not even pregnant yet and I'm absolutely terrified.

I should also add that out of 8 women in our NCT group, only 1 had an unassisted birth.

@roarsome

You will see that I asked how common emergency c section or induction rates are as well. The instrumental rate is only telling us what women have instruments... it's not telling us about what other women end up having who plan a natural birth.

My friend was induced didn't need instruments or emergency c section but the contractions were strong and unrelenting...she believes that contributed to her significant birth injury. I don't think she would class being pumped full of chemicals as natural.

We could do with all the statistics which are reasonably current which show outcomes for those planning a vaginal birth and what percent don't have any interventions.

So many awful stories, particularly about back to back babies.

Just to allay some fears, my second was back to back, didn't even know until she came out..... 2 hour labour, gas and air, she just arrived, face up and arm first !!!! Second labour though, so that probably makes a difference.

I am appalled by the stats. An old midwife friend of mine sees this as a "failure" of midwifery. I feel (and this is just a feel, not scientific), that birth was become horribly medicalised, and therefore not the calm, natural experience it could be. As said above, so much fear and anxiety over birth. Of course you need interventions to prevent harm to mother and baby, and thank god we have it now, but it am just so worried for my girls that they will have an awfully low expectation of their birthing experience, when it shouldn't really be that way.

@Baaaahhhhh

Who knows? It's terrible that so much trauma is happening

We could do with all the statistics which are reasonably current which show outcomes for those planning a vaginal birth and what percent don't have any interventions.

Didn't weepingwillow give us those a few pages back? She said:

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.

@FourPlasticRings

Well that study is in conflict with what the most current up to date stats are from the RCOG leaflet published in April this year.

It also lumps elective sections in the stats. If we look at women planning a normal vaginal birth without intervention, we can't include those with planned caesereans.

It also does not give induction stats. The study you point to is from 2016/17. It gives an instrumental rate of 21.75 %.

The RCOG leaflet states 1 in 3 which is 33%. That is current info. The study is from 2016/17 .... Therefore emergency c sections and induction rates may well have gone up too.

@FourPlasticRings

The thing which is concerning is that women like myself do not seem to know the likelihood of their chances of a normal vaginal birth without intervention.

@Time2change2 has pointed out that there seems to be a lot of intervention.

@FourPlasticRings - do you mind saying what your understanding of the risks of an episiotomy are? I've heard that tears heal better, but also that an episiotomy reduces the risk of a really bad tear (which I guess would be less likely to heal well?) so I'm a bit confused as to whether to actively try to avoid one or not confused

Sorry, only just spotted this @PorridgeStoat

Well, there's some conflicting information around this. My conclusion from reading around it was that it's generally better to tear because it's a jagged edge that knits together better and because a lot of the third degree tears I've heard about have started with an episiotomy. I think if the tear is starting in a downward direction you're possibly better off with the episiotomy because they try to get the cut off to a different angle so it doesn't go straight through to the bowel.

To avoid tearing, you want to give birth on all fours with someone applying firm pressure on your perineum using a warm flannel during the end stages (despite knowing this, neither of the above happened for me- my birth partner was useless). Don't push unless you can feel a contraction and don't feel rushed. There is a normal lull in activity during birth to allow for a bit of respite, but many HCPs will interpret this as failure to progress- mine threatened episiotomy, so I pushed without a contraction through fear and then tore. Again, I knew all of this beforehand but felt unable to speak up during. You can also do perineal massage in the weeks leading up to birth.

Thank you for this thread. I too had no idea about this either.

Last year, our NCT teacher only said an epidural would make instruments more likely, but that was it.

I had an ELCS, my body just isn’t very reliable after various medical things, and I remember saying to MW and then consultant that, personally, I don’t feel I’ll manage labour unassisted because of my history. My point was that I then didn’t want the risk to me or baby that comes from instruments. I also referred to some stuff I got from MN about the types of instruments we use here vs in Europe, basically ours are more severe (I now can’t remember much about this, but it was all legit and backed up by proper medical docs). Both MW and consultant laughed those worries off as instruments are “very rare”. This was last year. I pressed for ELCS anyway and all was well.

Of the 8 FTMs in my NCT class, only 1 had an unassisted VB. The other 6 (so, minus my ELCS) had instruments and/or EMCS. All still recovering and there is a general sense of not being informed enough.

My hospital published quite detailed stats on birth, I knew that I had a 44% chance of Interventions based on age alone.

It was greater than that because of having GD as the consultant explained to me that the threshold is lower, so they would more rapidly move to CS if I didn’t progress.

As it was my induction was abandoned as I reacted to the pessary. My waters went spontaneously and I had a quick birth.

It also lumps elective sections in the stats. If we look at women planning a normal vaginal birth without intervention, we can't include those with planned caesereans.

But you can see the individual numbers. So:

144,638 deliveries of which:
72,837 spontaneous (this would mean roughly 50% induced/c section compared to 50% starting themselves).
28,235 instrumental (7,773 low forceps, 8752 other forceps, 11,672 ventouse)
39,381 caesarian (11,280 elective, 28701 emergency) This tells you how many were elective, so they're not exactly lumped in.

Or a home birth. I chose home birth first time. Couldnt happen, so pushed for cesarean when I was in hospital and it was going pear shaped.

(Just remember op that also means 2 in 3 don't have assisted! ). If I were you I'd try for vaginal and if it's not going well then push for c section before you have it as a horrible emergency anyway. That's what I did.

Also please look up hypnobirthing. That alone can help avoid it all..

When I was labouring I must have gone into a naturally 'hypnobirthing' state as the midwife asked me if I'd done classes, I hadn't but it was just the way I dealt with the situation. I look back now and I'm amazed at how I behaved really, I didn't outwardly panic, I barely made a sound. I was very much in my own head.

It didn't make a blind bit of difference! I still needed an instrumental delivery! The panic set in when I was in the ambulance and that panicked feeling didn't leave me for about three years.

EveryoneLoves- thank you! I have been trying to say this up thread but have been accused of promoting whale music and reeling nonsense

I am sorry @Szalinski 😢 May I ask what happened that you were in an ambulance? Was that during active labour?