Can someone talk to me about Keillands Forceps please?

[Hulla]

DD was delivered by Keillands last year which I found very traumatic. I suffered a tear which was only partially repaired and now suffer problems because of this (I am having ongoing treatment).

I had a debrief with a consultant at the hospital last month. He told me that the person who delivered dd was training (but had used Keillands before) and was under the supervision of a senior registrar.

He also mentioned that, despite being taken to theatre for dd to be rotated and delivered she was born OP. He says this means that either:

a. They got it wrong and she wasn't OP to start with

b. The doctor only rotated dd's head and not her whole body so that between contractions dd turned her head back and they delivered her "face to pubes" (his words).

He thinks my notes indicate it was the latter.

So I came away from the debrief feeling like I knew a bit more and it helped but now I can't stop thinking about this part of the story. If someone was improving their Keilland's technique on me under the supervision of a more senior doctor, should I have been made aware of that? Should I have been asked if that was ok?

And if they only rotated dd's neck and not her whole body is that not really risky? It just sounds so dangerous to me. I keep thinking about that thread on her a few weeks ago with the link to the DM article (I won't relink - it was pretty distressing).

DD is fine by the way but I have this sense of panic that she maybe came really close to not being ok.

Does anyone know enough about Keillands to help me make sense of this please? The consultant did say I could go back and speak to him but I think if I ask him the same questions I may not get completely honest answers.

Were you offered a csection as an alternative to Keillands? And did they inform you of all possible risks using Keillands? I am sorry that you are having continuing problems but, thank heavens, your DD is ok having read the DM article too. Seems that there needs to be much more information available about the use of these forceps.

Thanks for replying gailforce1. No, I wasn't offered an alternative. They told me the risks were "soft tissue damage and infection". I didn't know it carried a risk of tearing or I would not have agreed. I also think risk of soft tissue damage should have been changed to certainty as an episiotomy accompanies forceps and I didn't know about that either. I didn't know if Keillands carried any risk for the baby.

The thing that sticks with me gailforce1, is that the doctor who decided to take me to theatre for a trial of Keillands was the doctor that needed the training. I don't care what the hospital tell me now, I think I will always feel that she saw a training need which is why she didn't offer me a cs or tell me all of the risks. I know thats terribly cynical and perhaps unfair to her.

I had told the midwife repeatedly that I was terrified of tearing, it was my worst fear. This isn't recorded in my notes. I would have jumped at a cs over anything involving an episiotomy.

Hulla - I know that this must be a terribly difficult time for you and you may not feel up to doing it but if you can, make a complaint. If no complaints are received then the health authorities assume everything is fine. I have several friends who are NHS nurses who say how they wish that patients and/or their families would make complaints as it would back up what they are telling their managers. Managers simply tell them there have been no complaints so take no action!! I understand that the PALS service is good. If you dont feel up to it do you have a friend/relative to write it on your behalf. Your action now may help prevent other women going through this. IMO you should have been told that the Dr was training in this procedure, episiotomy, long term damage to you and the risks to your baby. Was your dp with you when the risks were explained and I wonder what he feels aoput it all now?

DH was ignored when they came to consent & talking about going to theatre. He feels really angry about it and has been on at me this morning to write a complaint (which prompted me to write this thread). He says I was "smashed off my head" when they asked me to sign consent and would have signed anything just to get it all over with.

I have written lots of complaint letters but never posted them. Some stick to the bare facts and others are full of "my marriage is ruined, I'm incontinent at 31!" type rantings. I feel scared to send them. I half expect them to reply saying "Childbirth is hard, what do you expect" or blame me.

You're right though, I have to. My mum was saying recently that I should use this experience to help others so to make sure I made a fuss.

Hulla - I do hope that you can find someone who can help you write this letter as I fully appreciate how hard it is going to be for you when you want to express your emotions. Perhaps you could do it in bullet points in chronilogical order and then, at the the end, a summary of how this has affected you (physically and emotionally), your dh, your marriage etc. Perhaps yuou could phone PALS tomorrow and chat to someone there. I think that it is important to say that you are not looking for financial compensation but at making the service safer and better informed for other users. I wish you luck and hope that this process may help you and your husband to move forward.

Thanks for this gf1, its been great to talk it through with someone.

I think calling pals is a good idea actually, they may be able to help I guess.

I wonder how I can find out if dd was at risk. I couldnt sleep last night for thinking "what if she'd twisted dd's neck too far". I have to squeeze my eyes shut everytime I think about it just to get rid of the horrible image.

Sorry, rambling now. Thanks again!

'Were you offered a csection as an alternative to Keillands? '

I've never heard of any women being offered CS as an alternative to forceps.

I gave birth via H-F forceps at the same hospital where the baby in the DM article was born.

We were very fortunate in that it was during the day and DD1 was delivered by a very senior consultant herself with some students observing and neither DD1 nor I had any long-term problems.

a c section is not always an alternative , it depends on the position and descent of the baby and what needs correcting and if the baby is too low, then a c.section is not appropriate

Really? The consultant said he thought I should have been offered a cs but if he'd been there he'd have encouraged me to have forceps anyway.

It's so confusing. If I'd felt like it was the only option then I'd feel better about it, despite my ongoing problems.

Do either of you know if the fact that dd wasn't rotated properly (just her head) and was born OP was a risk to her? I have come to terms with my problems I think but this bit was new to me and has really scared me.

DD1 was OP. She also had her hand up by her head. She'd managed to descend far enough that she did not need rotational forceps.

Interesting that the consultant said that he would have encouraged you to have had forceps, he must be very confident that he could have used them and not caused you any long term damage either. Have you thought about getting a copy of your notes. There was a thread on here recently about this, who to ask and cost etc. Sorry I do not have the skills to link you to it!!
I am not a MW but from what I have read (including on MN) and particularly the DM article there are different types of forceps and it is the Keillands that are the "controversial ones" (if YSWIM).

I have my notes but they don't mean a great deal to me really (I missed that dd was OP when born). I don't know what to do with them now!

Yes, I guess that's the other thing that sticks in my mind. After dd was born, I was so ill that I moved back in with my mum 80-ish miles away for 3 months. A midwife from the local hospital came out to see me & dd a couple of times. She said "I haven't seen Keilland's used in 16 years. We don't use Keillands them at my hospital because of the damage they cause. If you'd been with us you'd have had a cs".

That always stayed with me.

I remember reading the Mumsnet book on pregnancy and birth. A section in the back on why you would not go through childbirth again and one MNer wrote that she would not have another vagianal birth because she had had a high forceps delivery with inadequate pain relief which left her with severe internal damage. When she complained to the hospital they said that they thought that they had given up using the type of forceps used on her years ago! Perhaps your complaint will force your hospital to rethink their use of Keillands and, if so, I hope that this would give you some satisfaction at knowing that you had helped to protect women in the future.

If it really does protect them gf. I have thought about this and what if there are some case where forceps should be used (like Lulu & expat say)?

That's what I find so confusing. One hospital says they don't use Keillands but would do a CS instead and others say you can't always perform a cs if baby is too low, Keillands are needed.

I need to make my peace with this don't I? I've been waffling on MN about it for the last 14 months or so. I am having therapy

Please please complain!!
Its time that the NHS bans the use of Keillands as they have done in the US.

Not sure whether you are in an upset stage or in the angry stage of this. But use whatever emotions you've got and get some of yourself back!
You are a powerful person and don't let anyone tell you otherwise!
You have the power to force changes and do good to benefit yourself and others.

I'm sure you aren't interested in money but you may also have a case of medical neglect so it may be worth a look as it may help you get answers. (if you have issues about sueing you could sue if you have a case and if you win then donate the money)

Have you contacted anyone to help you discuss everything that has happened? ie counseller - research the various types to ensure you get the type to suit you.

Thanks Vistana I have been through the upset stage and the angry stage but after my debrief I feel kind of exhausted. The consultant was so nice that I left feeling guilty for bothering them.

No, DH would like to start court proceedings but I am not sure I have the fight really. I am seeing a wonderful therapist who is really helping me to accept that the way I feel now is the right way to feel following trauma and for the first time in a year I think my marriage might survive this.

If I honestly thought I could bring about change for the better I would do more but I guess I don't feel confident saying Keillands should never be used. Although if the MW at my mum's local hospital is right and they no loner use them for then maybe I should just have more courage.

Hulla - I'll say again I am not a MW but my understanding is that there are many types of forceps that are used depending on where the baby is in the birth canal. It is the type of forceps ie the Keillands that were used on you that the controversy is about. i would echo Vistana, please complain, it may be that your Health Authority do not know that Keillands are still being used.
I wonder if you have thought about contacting the Birth Trauma Association (sorry i cant link you) as there have been some very good reports by MNetters who have contacted them. Wonder if they might help you with your complaints letter? Please let us know what you decide to do and know that you have our support.

Thank you so much, it really means a lot. I am going to type a complaint letter now and send it with a copy to Patient Relations.

I will post back here with an update it you like?

I have thought about contacting BTA, gf. I even almost did it once but I get scared that they'll say it was my fault for agreeing to syntocin, epidural, not staying at home longer...Maybe I'll do it as I'm in a seize the day kind of mood now...

Hulla - no one is going to say that it is your fault. You were in the care of HCPs who should have been acting in the best interests of you and your baby. I feel sure that the BTA will give you loads of support you just need to get in touch.
Dont forget to keep copies of any letters you write and please keep us updated and I am sure we will give you lots of support. Best wishes for your "seize the day" actions!

Hulla, just wanted to wish you the best of luck with your complaint - I really hope you get some clarity, and also a bit of peace in the longterm.

I remember there was a fair bit of confusion about forceps v CS on the other thread (about that awful DM story). I think that as lulumaam says, there are circumstances where a CS isn't an option (e.g. baby very low in birth canal) - but it seems to me that there are often cases where a baby is stuck 'high', and that's where the 'forceps v VS' choice exists.

It also seems to me that whereas the many risks of a CS are widely known and repeated, the risks for a forceps birth to mother and baby are massively understated.

I've never used the BTA, but I know people who have and found it very helpful. I wonder if they might be able to shed some more light on the whole issue of forceps use (circumstances, risk, choices).

Anyway, I'm very sorry you've had such an awful experience, and I actually think you've done a lot of work to help yourself deal with it already, so well done for being that active and positive!

Yeah, it's the type of forceps. Keilland's are rotational forceps.

I volunteer for the BTA and if anyone said to you that it was in anyway your fault, i'd be horrified. it is a totally non judgemental association, and the volunteers have all had birth trauma to some degree, so will be v understanding

Hulla - PLEASE contact BTA.

They are not the slightest bit judgemental about anything - I had an epidural and forceps and they have been wonderfully supportive and helped me to arrange a consultants app to discuss c-section this time round.

When I moaned to them about by m/w trying to push me into a home birth this time round they were very supportive of the fact that there is no hierachy and a drug-free natural birth is no more of a 'correct' birth experience than any other type.

Also re: BTA. They were also extremely supportive in talking me through the approach and route I needed to take to get to see a consultant and what to do if I wanted a second opinion.

They said to me if the first consultant didn't take me seriously to come back to them and someone there would know what to advise next. For the first time I did not feel totally alone in all of this, it made a huge difference to me.

Hi Hulla, I recognise you from the injuries thread in general health. I too had keilands forceps with DD1 and although don't have as severe problems as you I've been left with incontinence problems.

Similar to you I had my keilands forceps performed by a trainee, but there was the head consultant (I remember the midwife saying - this is the top guy in the department) who placed the forceps and then talked her (the trainee) through the whole procedure including the repair afterwards.

What I didn't understand until much later is the different types of forceps. Noone ever explained to me that keilands are a lot more risky than straightforward lift out forceps/ventouse. They did explain (to me in my drugged up state) that the forceps would have to be preformed in theatre and that if they didn't work they would do a section. Likewise my DH wasn't really consulted and I was so doped up that I could have signed anything (I would love to see my signature - it must be a scrawl)

I'm back at the same hospital and they have offered me an elective section this time which I'm taking. In my opinion its less traumatic and since its twins there is a high chance they would have to reposition one of the twins with forceps and I don't want to go through that again!

I think keilands are necessary in some circumstances but like breech births are so rarely performed these days that inexperience is making them very dangerous. If I were you I would be questioning the degree of supervision of the trainee, as I'm sure thats the main reason mine turned out ok (ish). Good luck.