needing info about assisted delivery

[Maria2007]

Hi everyone,

I'm Maria, 36 weeks pregnant today, this is my 1st baby... am trying to get some more info on the labour process, since from now on it could happen any time really. We're working with a wonderful doula who has helped us think through our options at a meeting last week. One of our decisions is to choose an epidural, since I'm panicky about the pain (mobile epidural is what's given at our hospital) & she not only accepted this, but helped us realise that there are many things you can do to work 'around' an epidural & still get some movement. I'm so happy she'll be there with us to assist with the movement-factor & help me avoid being in a lying down position, especially in the 2nd stage.

However, there is one question both me & my partner have, & it doesn't seem as if we can get adequate info anywhere. We're really worried of the possibility of assisted delivery (forceps/ventouse) & particularly its effects on the baby. We both hate the idea of baby's tiny head being squashed or damaged somehow. I know that with epidurals the risk of assisted delivery is somewhat higher. Would like to ask- does anyone know how much higher? And what- if anything- can be done to avoid this? Also: if worse comes to worse & forceps have to be used, is it preferable to have a c-section do you think, for the baby's safety, & if so, will we have a say in the matter?

Thanks so much in advance.
Maria

I have had two ventouse births, after very different labours: ds1 was a long labour with epidural, syntocin, episiotomy; ds2 a very fast one with no pain relief, where the ventouse was due to sudden and dramatic foetal distress. Both of them were fine afterwards - the long labour and possibly epidural did affect ds1 in some way, though (he was also 38 weeks and IMO not quite ready for the world) and that and bad advice conspired to make esablishing bf a struggle. With ds2 I didn't have an episiotomy, 'just' a second-degree tear. Of course I'm not 'glad' to have needed ventouse, but assisted delivery isn't always the absolute nightmare scenario it is often depicted as. I don't know about forceps, but my ventouse births were IMO infinitely preferable to an em CS.

HTH and good luck.

Hi Maria - I have not seen any research to quantify the increase in instrumental births, it depends on how late you have the epi, how mobile you are, babys position, size etc. But I would say its a significant increase.

Having an epi later in labour and staying mobile, using the birth ball walking around etc will reduce the chances a lot IMO. If you have the epi early, I find that most women will have 5-6 top ups, (usually 5-6 hours worth) before their legs get too heavy to mobilise safely, so I would wait and have the epi as late as you can, use mobilisation, TENS, massage etc to get you through. On your other thread, someone mentioned hypnobirthing, that is a good suggestion too.

If you need instrumental, it is usually the Doc who decides to use either ventouse or forceps, and it depends on their training whether they are happier using one or the other, how much caput (swelling) is on babys head (ventouse does not stick well to caput), and the position of babys head. Babys head is designed to get squashed, thats why there are lots of bones in a babys head, and even in the course of pushing baby out yourself, the baby will look a bit misshapen (for a first baby mostly) and this changes in a few hours.

As for choices - yes you can refuse an instrumental but a c/s at fully dilated carries significantly higher risk of damage to you as baby is so low in the pelvis. By that stage it is probably safer to have the instrumental, but ultimately the choice is yours - you have to give consent. Or more realistically, consent is usually implied, but you are perfectly within your rights to withhold consent and an instrumental therefore cannot be done, whereby a c/s becomes the only option.

Which hosp are you going to? (interested which hospitals do mobile epis)

HTH.

I had ventouse with my first baby, traumatic and dramatic after a long labour. Baby out, trauma over.

Ds2 was breech and elective csection.

Even though my experience of vaginal birth was not pleasant, I would rather have that again than a section. Its not an easy option.

If you get to the stage where forceps/ventouse is needed then the baby is probably in, if quite a way down the birth canal. In my case it was quicker and less risky to do the ventouse thing than take me into theater, give anasthetic or top up epidural, and perform e-csection which might involve having to push the baby back up the vagina in order to be taken out through your stomach. Thats what the consultant said were the options when it was me on the bench in front of her!

Listen, you need to chill. I know before my first baby I was all birth plans at the ready. But the more you try to PLAN, the more potential to get stressed on the day if things are not going to plan, or you dont' feel the way you want them to.
Don't assume you will need an epidural, you may do fine on the other pain releif. And please plesae don't stress about ventouse or forceps. If they are needed on the day its because its the best way to get your baby out and you will have to go with the flow.

I fully intended to have every type of pain releif available but ended up managing on yoga breathing (and I'm NOT lentil weavery at all!), and then gas and air.

Mint purple - I wasn't asked consent for the ventouse, I was just told that baby needed to be got out asap and that this was what they needed to do. Would I have witheld consent in the final stages of labour, for something they told me was the best thing to do? Would I bloody hell.

'Would I have witheld consent in the final stages of labour, for something they told me was the best thing to do? Would I bloody hell.'

-LOL. I didnt mean that I would advocate that, at all, just that it was technically an option albeit not the best one!

In my years in labour ward, I have actually seen babies severely compromised and in a couple of cases die because the parents have refused consent to do an instrumental or a c/s (or even an episiotomy)!

Dear Maria, no direct answer to your question, just wanted to respond to your threads in general...

My impression is that you are worrying far to much about the birth and trying to take control in a way that is impossible when the day comes. Of course you are anxious, everybody is, and having a doula to help is probably the best thing you can do to assist labour.

Knowledge of caesarians/eppidurals/assisted delivery etc is great but on the day things will be out of your control to a large degree. You might just forget everything you have diligently studied over the last months! But your doula will be there to help ensure your wishes are respected.

What I do think is important (and may be asking the impossible?) is to maintain a POSITIVE attitude towards childbirth. It is not a terrible experience for all women but could be a joyous one. Why not aspire toward this as a goal? I would love to give birth again and do not fear the pain but any unforseen complications, which to me are the real worry.

Another critical thing for me personally is learning breathing exercises to control pain. MInd over matter basically. I am convinced it worked with me. I don´t think you´ve mentioned you´re doing this and it is a great way to maintain control over the situation.

One last thing, staying at home as long as possible whilst labouring has always worked for me. Something about a medical set up makes things worse. If I were brave enough to risk it I would have had my children at home!

Best of luck, try not to get over-anxious! This will only make things more difficult!

Hi again,

Mintpurple: I'll be having my baby at St Thomas (in London)... I have felt wonderful so far with my antenatal care there, and I'm very hopeful that all will be well & we'll be looked after.

NoPainNoGain / FlibbertyJibbet: You're right, I'm starting to realise that I'm very anxious about the labour & that I need to start building some confidence in the doctors, the midwives, our doula & the natural process of childbirth itself. I think a very large part of my fear has to do with the fact that I was hospitalized for one month in the 1st trimester of my pregnancy, due to serious complications of fertility treatment (rushed on 3 separate occasions to A&E in the middle of the night, so hospitalized 3 separate times). I went through lots of very bad pain at the time & felt completely out of control, although everyone at the hospital looked after me very well. I think that this is why I'm kind of freaking out with the idea of worst case scenarios, & trying to read up on them etc... However, as I told my partner earlier today, I'm now realizing that all this research & reading & asking is actually having the opposite effect. It's not reassuring me, it's making me more anxious. The reason is that there are always 'worst case scenarios' and there is no real control in labour. I will have to somehow trust that I'll be looked after & that I won't end up feeling horrible... and most importantly, that my baby will be ok, which is what's making me most anxious. On the plus side, I've had a completely uneventful pregnancy after the 1st trimester nightmare, so that should count as a plus, I hope...

Thanks again everyone & sorry for writing an essay!!
Maria

NoPainNoGain makes a good point. If you get too worked up about the details then it can make you more anxious. Of course some knowledge is desirable, then you can make informed choices. Don't underestimate the effect that being very anxious and uptight will have on your body's ability to deal with the pain. If you get very tense and 'fight against' the pain rather than accept it, then the pain feels worse. Breathing techniques are wonderful, as is water, and keeping mobile. I felt rather like you approaching my first birth - I didnt feel I was particularly 'good' with pain. However, i was very keen to avoid an epidural if possible because you're right, it does increase the risk of forceps/ventouse/other interventions which can have an effect on the baby. The horror stories abour seriously damaged babies are rare; though having said that I have two friends whose babies have facial marks from forceps deliveries. But there may be other less serious effects eg distressed baby if your labour doesnt progress well after an epidural (it can slow it down). And if you are one of the unfortunate few where there is a more serious consequence then it's no consolation that it's rare. I had a really supportive midwife and this was the key factor in my achieving a first birth on gas and air (and she was a big baby too!). So however you feel now, it is perfectly possible to have a good birth without having to be drugged up to the eyeballs!

Also want to second FindTheRiver.. For my first delivery I just didn´t listen to the benefits of water birth, thought it a bit airy fairy somehow, and didn´t like the idea of looking like the back of a bus in a pool at theat stage in life.

For my second, I thought it might reduce the chance of having stitches and gave it a go. I did have stitches again, but could walk after giving birth and had no discomfort whatsoever from the episiotomy. Give the water birth a go or at least stay in as long as you feel comfortable, maybe starting when labour is well established and becoming more like har work. I don´t know how exactly the water helps, but it does!

Having worked in a unit with mobile epidurals for several years I would say that they are not all that they are cracked up to be. Some women can still walk with them, some can go on their hands and knees, many think that they will be able to and then collapse in a heap when their legs can't take their weight. It is much easier to move around the bed than with a traditional epidural but in my opinion not safe to stand or be on all fours for most women who have had more than one top up. As a midwife looking after a first time mum in the second stage of labour with an epidural I would very much hope for a normal delivery and do every thing that I could to help the woman to have one. However realistically most women (first time vag delivery) with epidurals, mobile or not end up with ventouse or forceps deliverys I would guess at about 85% - 90% of first time mums and prob 15 - 20% of mums who have had previous vaginal deliveries. If it matters that much to you then try to avoid an epidural. You might well find that you are ok without one, I find that women who are expecting it to be painful and request an epidural before labour even begins are often more realistic about it and often get on ok. Hope it goes well for you.

Maxbear: I'm sorry, I'm not sure I understand. You're saying that of those 1st time mothers who use epidurals, 85-90% end up with forceps/ventouse? Surely that can't be right! What you're basically saying then is that in your opinion, offering an epidural to a first-time mother means that almost certainly she is also choosing an instrumental delivery. Is that what you're saying or am I not understanding something here? I happen to have lots of friends who have had epidurals in their first birth & didn't have to resort to instrumental delivery. So I have to say the numbers you quote have freaked me out a bit.

Maria - I work in a big London teaching hosp - not Tommies, but our epidurals certainly dont have a big impact on needing instrumental delivery. We probably have about 70% epidurals in primips, and of these, approx 15 - 20% will have ventouse or forceps, for multips, about 5% will need instrumental, so Maxbears figures are not representative of all hospitals.

In fact Im extremely sceptical of these figures (sorry Maxbear!), having worked in many different hospitals, and never having seen stats like these. If these figures are correct Maxbear, your hospital has some serious problems, unless your patients only have an epi if it looks like they will need an assisted delivery?

Thanks Mintpurple for that info. I mean, I'm starting to understand (from what everyone has written here) that things are more or less out of control during labour, & that the main thing is to trust midwife/doctor & the hospital itself. However, the figures Maxbear quoted seem really over the top to me... not that I'm an expert, but it just seems that if those were the figures women would be told about it very clearly.

things are not necessarily out of control in labour. it is not all or nothing. your doula will help guide you too.

if you are more worried about assisted delivery, then it might be wiser to consider pain relief other than an epidural.

you can use:

nothing

mobilisation , vocalisation, visualisation

TENS

hypnobirthing and / or breathing excercises

water

aromatherapy and / or massage

gas & air

pethidine or diamorphine

epidural

or combinations of some of them! there are plenty of other options before an epidural

also, an epidural will make your birth take a different route, yuo will require more monitorting and you will be more restricted. also, mobile epidurals vary in availibility and in how mobile you really are!

also, bear in mind epidurals do not always work. i don;t wish to worry you BUT for some women the epidural only works partially. it can also have side effects. yes, they can be fantastic but it is always a good idea to know the risks and benefits of anything you are going to use in labour. weigh up the pros and cons

you are not slung right into the middle of terrible agonising pain.. your body will build up and your own endorphins will increase to help with the pain.

also, it is not like any other pain, it is positve and productive and not negative.

Lulumama- thanks again for your message :-)
What I meant about being 'out of control' is that the main thing, for me, at the moment is trusting my doula, the midwife & the process (and my body) & not agonizing about this or that scenario. I say that because in the last few days I've been going a bit mad thinking of this or that eventuality, while in reality no-one can really predict how things will go. Our doula, as I've written above, has been great in explaining all pros & cons of epidural, & also showing us different positions that I can use (& she can help with), working around an epidural, if that is in the end what I do use.

i see sounds like you do have it all under control!

I don't wish to worry you but..

I had a ventouse delivery for my son and he had a terrible lump on his head afterwards. Studiously ignored by the paed who did his check up on the ward afterwards and who said his bruising 'wasn't bad'. I didn't know what to expect so took him at his word. However, weeks later he still had a lump and a stiff neck (possibly also caused by the ventouse delivery?). Developed plagiocephaly from preference to lie on one side so we had months of repositioning and physio to try and sort out his neck (diagnosed as 'torticollis') and get his head back in shape. It worked to some extent but eventually we put him in a cranial remoulding helmet to complete the job. One of the GPs at my local surgery saw him when he was a few weeks old and commented on the lump as being 'cranial moulding' and said it would become less noticeable by the time he was two. How grim! He's still got a bit of a lump but hopefully the helmet treatment (expensive and not paid for by the NHS) will result in a nice round head! Now I know we've been unlucky but I have to say I will fight hard to resist an instrumental delivery if I have another baby. That's not to say I would rule it out but I will question why they have decided it is necessary before they go ahead. That's something your doula could do for you if the time comes and you're concerned. Notably, I know about 15 women through NCT who gave birth around the same time as me and they all had a ventouse delivery or C-section. Not a 'natural' birth among us and it does seem that ventouse is becoming regarded as the norm by the medical profession so perhaps they are a bit biased towards instruments. I'm sure sometimes its necessary but it may be worth making them justify their decision so that you know that whatever happens it was the right decision. And by the way, they didn't seek my consent for a ventouse delivery - in fact I had my ankles grabbed and strapped into stirrups whilst I was crying about it so if you are going to question the decision you need to be assertive about telling them you want to justify it first. My son was born with an agpar score of 10, no need for the special care baby unit and his only problem was the damage to his head from the ventouse - makes me wonder why it was necessary. My husband told me that someone had come into the room saying they needed to free up a bed urgently so that was a possible motivation for the sudden decision.

Sorry mintpurple, I misunderstood you!

I had this vision of me, in stirrups, monitors all over me, as I was when ventouse was being applied. So they'd say 'oh I think a cesarean' and I'd refuse consent....and....what? Get up and go for a coffee?

Maria2007. Things are not 'out of control' during labour. Labour is unpredictable so the professionals adapt and do what is necessary for each individual birth. If you go with the flow you won't get stressed and feel out of control, you will feel 'ok this is what is happening at the birth I'm doing today'.

Pleeeeeeaaaaaaase stop stressing. many many women have straightforward births and enjoy the occasion and feel empowered etc etc. If you post for info about ventouse/forceps the only women who can reply are the ones that happened to. I make a policy of never going into details of my first childs birth when asked by anyone who hasn't given birth yet. Cos I don't want to frighten them . I simply say that birth isn't nice but you just have to get on with it on the day. Its not like you can get up and leave the room if you don't like whats going on!

Just try to relax and enjoy the last few weeks of your pregancy. Whatever happens on the 'birth day' will happen and when its over (ok a few weeks later in my case) you will look at your baby and know that you would do it all again for them in an instant.

Maria - it is worth checking with the hospital whether a mobile epi really is genuinely mobile.

I had one at QC and, after it was given, the anaesthetist told me I was not to get up unless I had 2 people to hold me up at all times. Not sure if this was just a continuation with their apparent obsession with keeping me on the bed but it was very unwelcome news after he had done the epi.

I had forceps as well. My daughter was high up and out of position so it would have been quite a complicated delivery. All I can tell you is that the consultant seemed incredibly calm and in control and at the first sign that maybe the forceps wouldn't work she decided to go for a CS instead. There was not a scratch on my baby. So I know people get a bit worried about forceps, but my experience was fine notwithstanding that they didn't work. And my Dr did not give me an episiotomy to get the forceps in (although she probably would have had to, had she been able to deliver the baby vaginally) so that was a result as far as I was concerned.

Maria, I'd say that "mobile" epidurals aren't really "mobile". You can kind of feel your legs, but not really enough to go for a walk. I've had 3 epidurals, which were very nice, and no one ever came near me with a ventouse thank God. It took an hour to push dc1 out, but he was fine and so was I. In some countries, for example Switzerland, about 90% of mothers have epidurals. I don't know what the % of assisted deliveries is, but none of my friends/baby group contacts had forceps or ventouse, so it can't possibly be anywhere near 80%.

Please remember that the point of childbirth is to go home with a baby, not as some kind of special experience in itself. If you do end up with an emergency c-section or something it's not really a big deal so long as you and dc are OK afterwards.

I had an epidural and no assistance/forceps/ventouse whatsoever. Also i was fully mobile within minutes. It was a fantastic experience. If anyone says anything negative about epidurals or focuses excessively on 'problems', just smile in a beatific manner and tell them 'I'm sorry, negative thoughts are bad for my baby!'

Message withdrawn

Message withdrawn

Mintpurple, you mentioned earlier that you had seen babies "severely compromised and in a couple of cases die because the parents have refused consent to do an instrumental or a c/s". I'm intersted to know, if you are very concerned about having an instrumental delivery, can you refuse consent to forceps/ventouse but ask that they carry out a c/s in such circumstances instead? Would that approach allow you to avoid the instrumental delivery while getting the baby out sufficiently quickly? Or am I missing something?