Caesarean vs. forceps/ventouse...

[WildSeahorses]

I suppose this is really a question for midwives/doctors, although all responses welcome! I am currently writing up a birth plan and, because I'm concerned about the potential damage (to both mother and baby) that can be caused by instrumental deliveries, I am considering stating that forceps or ventouse may not be used under any circumstances (I am quite happy to have a CS in an emergency situation and this is made clear in the plan - I'm not trying to refuse medical assistance generally, this is a specific concern). I assume that it would always be possible to do a CS, on the basis that if the forceps didn't work then you would have to have a CS in order to get the baby out (although I realise that an emergency CS at full dilation would likely entail a more difficult recovery than an ELCS would).

What I wanted to check was whether there were any circumstances in which it would be much riskier for the baby to have a CS than to have forceps (I have been researching this and, although I realise that the baby would have to be pushed back up a bit, I haven't found anything that indicates a specific risk to the baby). Does anyone have any thoughts on this?

Thanks!

The medical folks will probably say its riskier for you to have a CS than an instrumental delivery. I'm just guessing, but probably increased risk of haemorage etc. But I think it would be safer for the baby. That's just my opinion though and based on no specialist knowledge. I have had an emergency CS and a ventouse and both were hideous to be honest. They were both about as bad as each other in terms of me recovering. But as for the babies, my DD1 who was ventouse was really beaten up by it and quite a screamy unsettled baby, possibly as a result. I would agree with you and would prefer CS over an instrumental delivery.

Not a midwife or doctor. But mum who had failed ventouse, then forceps followed by emergency c-section. What did work well was that they gave me a spine block/epidural immediately I became distressed so if the ventouse/c-section didn't work they could get me straight into surgery and operate.

At the time I was trusting the doctor and midwife to make the best choices to ensure our survival.

I am putting it on my birth plan that I would prefer a cs to an instrumental delivery, mostly because I already suffer with some bladder problems and a very mild prolapse since my first (natural, non-instrumental) birth and I think it'd make it a lot worse. Rock and a hard place...

I said this to the doctor as I am keen to avoid an instrumental delivery. His response was that if they are at the stage of proposing ventouse/forceps it would be best to avoid a csection as the baby would be further down the birth canal and the csection would pose greater risks. I suppose what I was trying to get him to agree to was carrying out a csection earlier, I don't want to get to the stage ventouse/forceps stage.

The dollshouse, did your doctor say what the risks actually were?

The other thing is, allowing for circumstances. I was in the position of having pushed for 6hrs and no baby, the wait for an anaesthetist was going to be a long one (he was very busy with a crash cs), dd wasn't distressed really but her heartrate was becoming more variable during contractions and the options were to try ventouse, wait for anaesthetist for em cs or risk crash cs if dd became properly distressed. I opted for ventouse (figuring dd was becoming unsettled and I'd been in labour for 2 days with 6 days of pushing and wanted it over). So in that situation, it wasn't clear cut, the options were presented, the staff gave their recommendations and the decision made.

The ventouse didn't work, tore the skin on dd's scalp and she had some muscle damage in her neck (but that may have been her position and the fact that she'd been stuck for so long). They also attempted a manual rotation which is something else that they occasionally try. They attempted to turn her and push her back up the birth canal. That didn't work either and eventually I had an em cs.

What's best for you is also a consideration.

My physical recovery from the em cs (with an episiotomy too) was surprisingly easy. Was discharged after 12hrs and in no pain at all.

My (excellent) consultant was very clear that if my baby got stuck having descended beyond a certain point the only sensible (i.e. safest) option would be an instrumental delivery because otherwise the baby would have to be pushed back up and that might not be good for the baby. I therefore don't think putting a blanket ban on something is the right way to go.

In the event my baby got stuck quite high up. The first doctor got it wrong, announced the baby had descended and wanted to try forceps in the delivery room with no drugs. While I was resisting that suggestion (screaming really) the second doctor marched in and bore me off to theatre where he quickly realised a CS was the only option (not least because the epidural would not go in and a mid-cavity forceps delivery without one would be cruel and unusual). Phew.

I've had forceps (which failed) and now 2 emcs and to be honest I would take a simple instrumental lift-out over a CS any day of the week. Having said that, the thought of a more complicated forceps delivery makes me shudder - purely because of the potential size of episiotomy. Like most other things to do with childbirth, I suspect there are pros and cons of this which have to be weighed up in the circumstances on the day.

When I had the ventouse attempt, dd was still very high up, not past the ischial spines. She was too far up for forceps, would have been very risky to me if they'd tried them apparently.

No he didn't state exactly what the risks were WSH He basically gave the same reasons that MrsHappy's consultant gave.