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

Just to add, I had an epidural because I was "failing to progress". It was when I had the epidural that I dilated fast and everything got going. This was true on all 3 occasions. The doc told me this was not unusual. So I don't see why anyone should assume that there's a correlation between epidurals and assisted delivery. For me, childbirth with an epidural was a really good experience. I could enjoy everything without the pain clouding the experience, and I was fine straight afterwards, and also mobile straight afterwards. I also think that I was much less tired, so much better able to cope with a newborn baby, because I'd had calm birth experiences with limited pain. Also, even if you can't walk around with the epidural, you can feel the contractions, feel the baby crowning, and feel to push.

Starlight - I had to push for about 80 minutes with ds1, ds2 was out in 10. Hope that's encouraging!

can echo googly's experience.. epidural brought my blood pressure down and defo helped speed hings along. Could push ok and ended up with assisted delivery cos tehy were concerned re meconium staining in water ..not cos of epdiural.. in fact was pushing ok. also agree it didnt hinder but helped me cope afterward and recovery/mobility was fine (tbh I've been more wobbly after big nights out!)

Wildseahorses - Its generally the idea of intervention that is refused rather than the instrumental or the c/s. I suppose if the docs are really concerned about a baby they would agree to doing a c/s rather than doing nothing but I dont recall this being the case. In my experience it is usually Somali women (although I have seen caucasians also) who are very against any intervention who will refuse anything, and often it is the husband who will refuse and the wife will agree with him.

The reason I mentioned it was we had this very scenario just a couple of weeks ago at work (the CTG was atrocious, thick mec etc) and eventually the baby was born spontaneously but in extremely poor condition.

Have to say I have been doing this job for a very long time and that it is pretty unusual though (hate it when I make myself sound like a fossil!).

Also agree with poppy and googlys experience - sometimes an epi can relax the pelvic floor and let labour move along pretty quickly!

Hi Maria2007, have been at work for past two days so no time to look at mn, sorry if I freaked you out. I have not worked on a labour ward for about 6 years so maybe my memory is incorrect about the figures. Also when I did work on a lw it was in a hospital with a high intervention rate so could have been unrepresentative.

However having been a community/ birth centre mw for the past six years (maty leave x 2 excluded) I would say that most women who are transfered to the labour ward from us who go on to have epidurals go on to have instrumental or cs deliveries, but then obviously the reasons they are transferred may mean that they are more likely to have difficult deliveries.

Mintpurple, you are lucky if you have an 80% normal birth rate of first time mums with epidurals, considering in my hosp the first time mum normal delivery rate altogether is only about 65% everyone included, then 80 - 85% with an epidural is amazing, how do you manage that?! I am going to try and find out some official figures for first time mums with epidurals now to see exactly what the % of them who have normal births is. I reckon I could find out the stats for my unit next time I am at work. I will look this time next week if I get time.

Maxbear - our normal birth rates are not great either, but if you take out all the elective c/s etc, and add in the % of emergency c/s it is about right.

I audit myself every year and last year had just over 200 births, around 10% em c/s, 15% instrumental giving an SVD rate of about 75%.

Unfortunately, I didnt filter them down by parity, but primips are probably 70-80%, (a lot of multips use our BC), and the vast majority of primips will have mobile epidurals.

These are my figures - and I get most of my women up and about, a lot of others have much worse figures

Hi everyone. I had a forceps delievery 18months ago. Information I've read tells me that it's very unlikely I'll need an assisted delivery the second time around. But I don't know if this is because labour will be easier or because I'll tear natually along the old scar line. Does anyone have any experience of this?

Apologies for jumping ahead ther, this is my first time on Mumsnet. I can relate to Marias anxiety as I was exactly the same last year. I'm a total control freak and I had everything planned out but I was very aware that I was likely to get extremely stressed if things didn't go to plan. I absolutely did not want an epidural unless it was necessary for the baby. I wanted a mobile delivery with maybe a little dia-morphin if I felt I really needed it. Of course these things are fairly unlikely to ever go to plan so I tried to remain open to suggestion from the midwives.
As it was 28 hours into labour and having been on the monitor for the whole time I happily accepted the offer of the epidural as my baby was stuck and I was exhausted. I had an episotomy and a forceps delievery at 32 hours.
Now this really isn't the hard luck story it might seem. As far as I am concerned I had a very sucessful labour (my baby came out ok and so did I)and the next time I go through it I'llkeep a completely open mind.
When you're in the middle of it you just find that you'll cope with whatever happens and you'll find a strength of spirit and character that you didn't know you had. I was numb up to my chest afterwards which worried me a little but it soon wore off and within a couple of hours I'd washed myslef, changed into my pj's and bf my baby.
My only concern now if what the next time will be like. Can you give birth naturally after an episotomy or will the old wound re-open.

I know loads of people who have had an episotomy with their first and went on to have more kids, sometimes with no further stitches.

I had an epidural which was topped up every 45 mins (amazing!) and had forceps and episotomy. Both myself and DD were fine afterwards.

Maria

A good experience of ventouse.....

An assissted delivery isn't necessarily terrible. I had my DS here in Spain 4 months ago at 36+1 (spontaneous labour). He was OP and labour progressed very fast. He was in distress so they decided he had to come out asap. I hadn't had an epidural, although I wanted one as labour was progressing too fast. I was given an epi in the delivery room to enable the ventouse to be used and he was out in no time. I had a cut and a 2nd degree tear but apart from some tenderness afterwards it really was absolutely fine...sex life resumed (gently ) at 8 weeks post natal.
Until I had the epidural it was painful but much less than I expected, just as I felt I couldn't cope with a contraction it subsided. And this is all with a very stressful, speedy-stuck in traffic-will i have to give birth on the hard shoulder-kind of journey to hospital.
I was on such a high from the moment he popped out and remained so for days. Obviously I'd prefer to do it without intervention next time and not have the stitches but it really was fine although unexpectedly medicalised.
You need to trust your body and the doctors and remember you might not need intervention

HTH

Mintpurple - I'm an antenatal teacher. I have to say that the MAJORITY of my mums (almost all primips)who have an epidural also go on to have an assisted delivery. However - as they generally have had an epidural in response to the events of labour (very few elective epidurals) this may not be representative of the bigger picture for primips.

Wanted to say to Maria - I think one of the hardest things about becoming a parent is learning to live with the fear you have that something bad will happen to your child. It's something you really don't think about much before you get pregnant - you can't imagine how you'll feel, but the fear starts the MINUTE you get a positive pregnancy test, and it never goes away.

You will get used to it - you do, you learn to live with it, but it's something we all share.

So I'd really reiterate what everyone else says about trying to stop thinking about the birth and all the things that might go wrong. Just try to enjoy your baby inside you, look forward to meeting him or her and switch off from everything else!

second what fabsmum says...as much as poss enjoy what's left of your pregnancy...i really missed having that last month of relaxing, nesting, being on mat leave.

Dear Maria
Your post reminds me of how i was when i was nearing the due date. I wanted to know all the options/scenarios etc. and in the end i had a forceps delivery as baby got stuck and had the cord wrapped around his neck twice bless him...the forceps left a tiny mark on his head that cleared up within one day and if the doc hadn't used the forceps i don't know if baby would have arrived safely. Please try not to worry, the pain isn't nearly as bad as the fear of the pain. You will be surprised what you can cope with and i am a total wuss. I had tons of gas and air and eventually morphine and then eventually epidural because of needing the forceps and the epidural was the strangest thing coz you cannot feel anything. What scared me most was not knowing how painful it was going to get but the drugs do work they really do.
ok got to go as baby is crying
Good Luck you will be fine and you will be looked after in hospital.

DD is 13 days old. I had an assisted birth and can assure you its not that bad.

My labour was induced and ended up lasting 27 hours, going through all pain reliefs and ending with an epidural. When I eventually got to the pushing part they realised she was stuck (shoulder dystocia) and they mentioned an emergency c- section.
Was prepped ready and taken to theatre. The registrar knew i wanted to avoid that if possible so said he would try with the ventouse which he did. When she was on her way out the realised why she was stuck... she had her hand up by her face so then had to use forceps to pull her out quickly.

So i ended up with a full assisted delivery and was cut and had 3rd degree tear. Orginally birth plan was for a water birth with little pain relief. At the end of the day, i had what was needed to get baby out safely.
I personally would say assisted delivery is more prefferable than a c-section. I was out and about with DD at 4 days old which i couldnt have done with a section. A section is effectively major surgery.

effects on baby- DD had a sore head from the suction cap and a red ring on the top of her head which went in a few days and had a mark on her cheek for a day from the forceps. Nothing lasting. No cone head!

Hope ths helps

Hi Maria

You have prepared yourself very well for labour and birth, information-wise, and also have brilliant people backing you up/bein with you. You are at an execllent hospital who from what you say are looking after you very well.

Please try not to worry. It is normal to get a bit panicky, but remember that the successful birth rate in this country is incredibly high. For things to go badly wrong is very very rare.

The hospital people and you will be able to decide what pain relief etc you want when it happens. There will always be people who can give you both positive and negative stories of all of the various pain relief and intervention. You don't know until it's happening what you will want, and that is fine. Everyone with you has the job of looking after you and getting a healthy baby delivered with the least trauma for you.

Try to relax and trust your birth partners and the hospital, everything will be fine.

dear Maria,
Just a slightly different view about ventouse deliveries after MGMidget's post - DS1, for example, had a large lump on one side of his head post unassisted delivery and went on to develop a very mishapen head from lying with his head on one side -sadly we weren't as pro-active as MG (well done) in getting it sorted and although it is much better aged 3 he won't look good as a skinhead when he's older...in ds1's case the lump was because his head had been lying turned to one side and he got a little stuck. A ventouse would have sorted that easily and saved me nearly 3 hours of pushing and associated bad pelvic floor probs. SO I guess - you can't tell in advance what the "best" thing for you and the baby will be on the day, just see how things go. I wish you all the very best.

i had an epidural with both babies, and neither needed asstistance. Ds1 was pushed out in 10 mins and ds2 was in 15 mins. Even though i was numb from the epidural and lying on my back i could feel the senstaion of the contraction and knew when to push. Also the advice of my yoga teacher was ringing in my ears; imagine a coffee plunger and plunge the baby out!! It really did help!

I had an assisted delivery. Extended labour and I was getting exhausted and contractions weak so couldn't push baby out. She was far down enough to have a kiwi-ventouse delivery - which is about the size of the bottom of a tea-cup. A bit of effort on the consultant's part and she came out. Had a very slight bump to head initially - but birthing process itself is quite traumatic for the baby and head anyway - and bump went away completely in the first few days.
I think they tried the minimum intervention first as baby wasn't in discernable distress, and it worked and absolutely no harm done. Was a relief to get her out safely ultimately, so I have no regrets.
i think at the time I would have accepted any means of extracting her as long as there was no risk to her.

The thought of ventouse/forceps before I went into labour was completely alien to me. I had no knowledge of the kiwi-ventouse, but now I think it's a great intermediate method.

I had an epidural at about 5/6cm dilation, with just one top up. I could still move my legs, and I was able to get up immeadiatly after delivery.

I could also still feel my contractions which was really helpful in the pushing stage.

No assistance, forceps etc, and no tearing or stitches.

The pushing process took about 1/2 an hour, and the midwife suggested an episiotomy, but I continued to push on my own.

So ime, fewer top ups can help prevent the need for assistance.I was not completely pain free but it worth it in order to avoid stitches or assistance.

HTH

Maria, just to give you a boost, I had baby at St Thomas' and really thought it was excellent.

Be prepared, be open-minded and BREATHE.

HI,
I had a horribly long first labour, stuck at 5 cms for lord knows how long, total time in labour 36 hours - wouldn't recommend it !

I only avoided c-section because as I was about to be taken to theater an emergancy came in and since our baby was fine (just me having problems) we had to wait. Then, they decided to examine me again just before they took me down and I'd suddenly jumped to 10cm, so it was agreed we could "give it a go". I'd initally started as a home birth so that gives you an idea of what our pain relief/birth plan was like but had an epidural when I went into hospital after about 18 hours mainly as I was so knackered. I actually got to have 3hrs sleep Things still didn't progress and I was taken to theater preped and ready for a c-section but with the consultants agreement to try ventouse.
I'd been very determined with them about avoiding a c-section if at all possible and I'm sure that affected how they dealt with me. The ventouse was tried 5 or 6 times and then eventually I was delivered by forceps. I'd always thought that both options were a sort of gentle helping hand but my very small slight consultant looked like she had her foot up on the end of the bed and was taking part in a tug-o-war

Despite everything our son only had a couple of bruises and a squished ear from the forceps and a giant haematoma (swollen blood filled bruise) on the top of his head from bouncing up and down on my pelvic bone for hours when he was stuck, but otherwise absolutely fine.....and the most peaceful and contented baby you could wish for, and generally still is at 3.5.

2nd time round, tried for home birth again, ended up with emergancy c-section, very late stage (I was pushing when I got to hospital) as no2 was suddenly discovered to be breach after a blissful and essentially pain releif free labour (last 20 mins on gas and air).

IMO I wouldn't opt for an epidural again as hated not being able to get up - spent most of my 2nd labour standing/crouching and that was great. Also hated that sense of being dislocated from the process and having to watch a monitor to know when my contractions were coming and therefore when to push. Also, swelled up like a ballon after the birth with water retention, put down to so long immobile during labour.

BUT would rather have epidural and instrumental delivery that c-section, especially if, like my daughter, baby has to be yanked back......consultant said "I just had to grab what I could" and this resulted in me having my uterus tear and a much more protracted/complicated c-section. C-section is definately not an easy option.

Finally, both my births have been completely different to how I would have wanted them but the outcome - 2 wonderful and beautiful babies - is the best result you can hope for, and not everyone is that lucky so listen to your body and the advice you are getting at the time and make your decision as best you can and if it has to be instrumental delivery or c-section so be it.

That's just my opinion of course

My baby (now nearly 3 and perfectly normal!) was born after induction, epi, syntocin, ventouse and forceps. He did look a bit mashed up when he came out. Black eye and squashed head. I took him to the OCC (a charity osteopathy clinic in London) and they really sorted him out. Can't recommend them enough. I took him there from 6 days old.

I had a mobile epidural with my son (first child) and it was very sucessful. I had a relatively natural birth. Admitally I don't know anyone else in RL who has bee as lucky as me except my mother. Who had an epidural twice in the 1970s and no complications either time.

There is a small chance of the needle going in the wrong place which can cause the worst headache in the world. I also have a friend who has terrible spinal problems caused by the epidural. You have to be confident that you can stay 100% still while in total utter agony if you are going to have an epidural.

I agree with the others that its best to keep an open mind. I had a wonderful birth plan. I thought I could use nothing but gas and air and tens. I quickly found that the gas and air made me throw up and tens was useless. After 28 hours I was really tired and just needed a break from the pain.

I think it has to be remembered that giving birth is just one day of your life. Coping with child for the next 18 years is toughter.