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.

Oh goodness Hulla this thread, and from it a search of that heartbreaking Daily Mail article has touched a nerve with me, I couldn't not respond.
I'm 'the woman' who got the c-section instead of the Keilland forceps. You are quite right in some instances it's a very close thing so the birth could be either by forceps, or just inches different and it has to be a c/s. They took me into theatre to try to use the forceps first, I too was the one who signed the consent, I remember the pen sort of sliding down the page I was so tired, and like you say it's not made clear which type of forceps they are going to try, but it must have been that sort. Thankfully however DS had the good sense to be just that little bit out of reach.
You see it was the same hospital as the poor woman in the DM article and my DS was born just two months later, and like her DD he was transverse, but his position wasn't diagnosed until theatre. And while I'm not much bigger than the lady in the article, he was a couple of ounces heavier than her DD. I am so THANKFUL that he was out of reach - and this is despite the fact that I had a major haemorrhage - a common side-effect of a c-section and ended up in high dependency. My injuries were more acute at the time - but overall left far fewer traces. I've been mulling getting my notes too, as I'm finding it really hard to understand how I could labour for 19 hours and push for 1 and a half and not have anyone realise my baby had turned into such an undeliverable position. We had an amazing midwife and trainee at the start, but after a shift change, both me and my partner where made to feel like I had let down my (final, pretty disinterested) midwife when my textbook drug-free birth pool labour 'didn't deliver', but it turns out she kind of let me down, by telling me I needed to try harder, and keeping make me try to deliver a baby in an impossible position.
Sorry for the epic ramble.
Anyway Good luck to you and I hope you take whatever steps you can to find peace on this.

'I am so THANKFUL that he was out of reach -'

I also gave birth at that hospital (ERI) via H-F forceps and, other than a postpartum infection treated by IV antibiotics, had no long-lasting effects.

I went on to a deliver a second, healthy baby there with no drugs at all about 20 minutes after arrival.

And a third, healthy baby at Paisley via ventouse delivery (cord round his neck, over 2lbs. heavier than my others and I'm not a big person).

Every day, I'm thankful that she was delivered by a senior consultant. I don't know what her name is, but the midwife told me we were 'lucky' she was on shift that day.

She had a look and I didn't need to be moved to theatre. She asked if I wouldn't mind a few students she hand-selected to observe only, and I was okay with that.

Thankfully, she was born just fine and I healed well (actually, it was my 2nd, 'normal' delivery that I wound up with a small fistula, which thankfully closed on its own with physio help).

But she was a bit lower down than your baby, I believe.

OP i feel for you I really do I have my consultants appoint on 9/4 when I find out what type of forceps were used on me! I was also in theatre, waters broke Wed didn't have dd till Sat!
Like you and others I just wanted it all over with! At my 16 week appointment my consultant offered me a planned section, but at the time I was convinced I would go down the Hypno birth route but as time goes along I'm more swaying to an ELCS...
I think my dd had KF as it was theatre (for a long time after i didn't know that forceps were normally done in delivery room) I had two failed attempts and ventouse, the forceps were the "last attempt"....never in my NCT classes were the risks of ventouse or forceps discussed they bangged on about c-sections being evil but i think recovery would have been a lot quicker and less painful! It took a good 6months for me not to feel my stitches if I moved funny and my pf is shot, my bladder is so weak but until being pregnant again I hadn't put it down to the forceps birth...i just blammed myself for not doing enough PF exercises!!!

Good luck and I'll defo be interested in how you get on, good luck xxx

OP I am so sorry about what happened to you and echo others chorusing at you to complain, complain complain. Copy to PALS and your health authority as well maybe? I'd be tempted to go down the legal route as well.

I also just wanted to comment about people saying that their DH hadn't been consulted. Well, he can't give consent on your behalf, no matter how "out of it" you are. It's a quite common misconception that next of kins can consent on behalf of their loved ones but it is completely false.

Just a bit of advice on writing your complaint. Try to keep it factual and avoid long peices on your own emotions you don't want any of the very important points about your 'care' to be lost and informed consent being appropriatly taken is a huge safety issue. Keep one short paragraph on emotional issues. Lay out in a point by point basis and set out goals and wishes for what you would like to see happen as a result of your complaint. I cannot stress enough how important it is to sound calm and collected think of it as giving evidence. It might also be usefull for yourself and your husband to complain seaeratly to keep all sides of the problems encountered to the point..

So sorry to hear of the damage you are dealing with daily Hulla. I've read the general health thread a lot over the past year and been so thankful that I escaped worse damage than I got from DD's birth.

I had high keillands rotational forceps too with DD 16 months ago. My mw erred and thought that DD was in a good position when she actually had her head side on and could not descend depsite me being fully dilated. It was a traumatic intense 11 hour labour with no pain relief for the last couple of hours (to 'help' me push) which ended in the rush to theatre for emergency forceps under spinal while being prepped for a c-section. DD had got distressed and her heartrate was no longer recovering.

I have a lot of bladder and pelvic floor damage. I was seeing the physio for 10 months and still have urge incontinence problems (especially while I am pregnant again now). I also had to see the gynae consultant again at 6 months for possible unhealed internal scarring that made any internal touch very painful, and the urogynae for my bladder up to 7 months post natal.

I also signed something for the c-section when I would have signed anything. I didn't know they were going to try forceps and at that time would have agreed to anything for DD's sake.

My consultant told me a couple of weeks ago that DD had descended a little past the spines and I was fully dilated. She said in those circumstances it was safer to use forceps to turn and deliver than to c-section and take her back up again. Obviously with her head side on DD would never descend any further so without some intervention she would have eventually died.

I have also been struggling for 16 months on why they didn't just do an emcs because friends who had those did not have such tough recoveries and longterm issues as I have. It has helped me a lot this past fortnight knowing it was safer for DD to use the forceps - though I know other consultants might disagree and I think it depends on the skill of the user a lot.

I know they are reluctant to c-section because of other risks - maybe to future fertility etc - but I also feel strongly that rotational forceps should be debated more rigourously. I have read of so much damage from rotational forceps, often to bladders like mine (it just had no sensation and no control for weeks and then huge urge incontinence issues for months and will never fully recover. I sponser Tena.).

I am going for an elective this time round after a careful review of research. I want to prevent further bladder and pelvic floor damage. I am scared of needing forceps again if my body is suited to babies having their heads side on. I am scared of tearing badly if labour goes quickly as I think it was trying to do last time.

I would rather deal with a controlled surgical proceedure and recovery than the gamble on a nice birth with the potential for disasterous lifelong consequences.

I would echo the others - put in a complaint in a way that will make them address the issue on the balance of risks of a c-section v.forceps.

Do you know if your baby had descended past the spines? Were you fully dilated? It sounds like you need more information on how that affected the balance of risks for your baby and yourself.

I am seeing maternity psychology now as my current consulatant has referred me. I am still strongly affected by DD's birth and the damage - and obviously facing another birth is really pushing all the fears to the front. I wish you and your family great peace as you deal with all this.

Hey expat,

Sounds like that consultant you had was god! Am fairly sure given my wee small hours emcs that she would not have been on duty then, but a more junior bod might have been, so another reason I'm thankful. Although I'll never forget waking up all on my own in high dependency, (yes they still send DPs off even if you end up there!) gasping for air, without a clue what's happened or where my baby was.
You're quite right DS was higher up, in my hospital letter to the GP about my birth it said he was above the spines - so 19 hours of labour and he actually ended up higher than he was two days earlier when he was 3/5 engaged. I do know I was fully dilated and my labour had been going at a nice pace until the end. I wonder if he turned transverse when they did ARM near the end, or alternatively when the midwife was getting me to stand up then slam downwards into a crouch at speed to try to get DS to budge. I do remember coming round from the G&A haze briefly at that time, and appealing to the midwife that I didn't have any urge to push, but just got told to keep at it. Either way they never found out til he was pulled out by the surgeon so given they only use those forceps 170 times a year out of 6,000 deliveries, I'm glad someone wielding forceps wasn't the one to discover that surprise! God knows what they might have latched onto instead of his head! You give me hope that i might have a natural birth next time though so thanks for that, although my GP flagged up what she said was an unusual line in my letter, stating that I would need to have a consultant appointment on the mode of delivery of any future baby. She reckoned it could have been pelvic disproportion and would mean more c-sections in the future. Although listening to Hulle's tale I guess I should maybe be thankful for that, even if it means I'll never manage that water birth eating hand woven lentils to whale music. And H - sorry again for the thread hijack.

Having a csection isn't the end of the world by far, poppet, if you have to have one.

There are loads of threads on here about elective csections and they seem to go a lot more smoothly.

Thanks everyone for your messages of support, I really am so touched.

Well, I have written my complaint. Thank you for the tips, I used bullet points to stop me waffling and took your advice wonka to just keep emotions to one paragraph at the end.

I sent it via email patient relations so that it didn't sit in my bag for months, unposted. I feel so much better for sending it. I hope I get some answers. I feel really positive that I have finally done something.

PR got back to me yesterday to say they've logged it as an official complaint.

Sorry for the short post and if I haven't answered anyone's comments. I am rushing to work but will log back in later.

I am still getting the courage up to call BTA too.

Obviously, I meant to wave to you Ginger!

yey Hula!

profers celebratory biscuit

Well done Hulla!

I have thought of putting in something in writing about better ante-natal prep for possible forceps damage etc. Maybe after my psychology sessions are done. I would have coped a lot better if I had known that bladder issues are common, that the forceps might have been best for DD anyway and how recovery might be very slow and painful and never complete.

The shock was huge for me after all the rubbish ante-natal classes I took (hospital and NCT) - contractions building up and having pain free bits in between - nope, just straight into 2 to 3 mins apart and agony. I know it was DD's unusual position and they don't want to scare anyone, but it doesn't help those left feeling freakishly damaged after it all ends too.

I had Kiellands delivery, I begged them not to do a c section as i was afraid of an operation but I didn't really know the implications of this type of high forceps delivery.

Also I wasn't really in my right mind at the time, not a good time to make a life changing decision after hours of pain and gas...

As far as I understand if you are having high cavity forceps such as Kiellands, the baby would also be high up enough for a c section.

I'm scared of another vaginal delivery but also afraid of operations.
Both my babies have got stuck so i don't know if I'll ever manage a natural birh.

What is the extent of your physical problems now, if you don't mind me asking?

No problem framey, I tore all the way into my internal anal sphincter. Unfortunately they only repaired up to my external sphincter so I have been left incontinent of faeces & flatus (wind).

The vaginal repair was done too tight so sex is painful. My gynae would have liked to have repaired my vagina but my colorectal surgeon thinks it's too risky & may make my incontinence worse.

My surgeon says my next procedure is my last hope before a colostomy bag. He thinks I've probably only got 10 years "good years" left (good includes an episode of incontinence in front of a friend whilst out shopping - hate to see what bad leaves me like). I'm 31.

I've asked my mums local hospital why they don't use Keillands. Waiting for pals to call me back.

Hulla - Firstly well done on doing your complaint letter and will be following the thread to see how it progresses.
I can only admire the way you are coping with these horrendous health issues that you have been left with. I do wonder if, for peace of mind, you have had a second opinion as it seems to be a very stark choice between being feacally continent for 10 years and having a sex life which, if I have read your thread correctly, seem to be your choices.
Did you have a chance to contact the BTA, I feel sure that you will find a lot of support there and perhaps they will be able to offer advice with your complaint. Very best wishes.

Sorry for brief replies - I'm posting from my phone. I will come back this evening & reply properly.

I'm sorry to hear that Hulla.

My Kiellands delivery was performed with a 'generous' episiotomy that ran down to the top of my leg.

I've had problems over the last 11 months which I am not really ready to talk about on here though I have been reading the other threads on health.

How did they tear you? wasn't there an episiotomy done first?

sorry to ask personal questions.

Oh and by the way, that thread about the Daily Mail article really upset me too.

I asked to have it removed as it linked to an upsetting image.
I couldn't sleep after reading that.

In my case I had an episiotomy but it tore further as they got DD out with keillands. All my other tears and lacerations were done by the forceps coming down with DD - plenty of internal and external damage.

I am so thankful I had the spinal in by then - I cannot imagine those who have had forceps without pain relief.

Yes, mine was the same lovethesea. I had an episiotomy which extended but I also had some tearing to my labia (not in notes oddly but I have scaring and a funny concertina bit of skin at the join with the top of my thigh.

Framey, the article was awful wasn't it? My heart broke for that couple. I made the mistake of re-reading the article in the DM at work. It seems the way they rotated that baby was the same thing they did with DD (head only) so I now know what the risks to dd were. I felt so upset I had to leave work early.

Gail I completely forgot to mention the other complication to our sex life. My first "repair" about 8 months ago was to have collagen injected into my back passage (thats as painful as it sounds!) to tighten things up a bit. Unfortunately it didn't work like that, the collagen moved and a 1.5cm x 1.5cm lump of it solidified in my vagina.

My gynae (at a different hospital) want to cut it out because it causes me pain every day and make sex so painful unless I'm drunk. My colorectal surgeon has said if it has to come out he'll take it out the way it went in. I'd rather cope with the pain.

The good news though, is that my body should absorb the collagen over the next few years. I am trying to find ways around it for the sake of my sex life. We'd like to try for dc2 this year but I'd like to have some kind of normality before then rather than us just ttc.

lovethesea how are you now?

I haven't called BTA yet. I will. I just don't know when. It's a bit easier typing all of this than saying it.

Hulla - It seems so hard on you to have to undergo further painful procedures which are not producing positive results for you. I would be concerned that your gynae and colorectal surgeon have different ideas on how to take this forward but surely something has to be done if you are in daily pain? Have they said how these symptoms will be effected by pregnancy? I assume your next delivery will be by cs?
If you dont want to phone the BTA what about emailing them a copy of your complaint letter? I am sure you will find them very supportive.
If you feel able to please consider sending/e mailing a copy of your complaint letter to the Care Quality Commission. They monitor standards of care in all care settings including the NHS. Their address is CQC, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA email [email protected].
Also The Patients Association monitor patients experiences within the NHS and can be contacted at PO Box 935, Harrow, Middx HAY 3YJ. You would just send a copy of your complaint letter and a short covering letter asking for their comments. Unless these organisations receive comments from patients then they cannot do their jobs and try to improve standards. I do hope that you feel that you can do this. Very best wishes.

I'm pregnant at the moment, 29 weeks, so bit painful on occasion below (no attempts at sex at all since I've been pregnant so it's just sitting or stretching that's sore at time). There's an odd scarred bit of skin near the entrance of the vagina that seems very sensitive and joins onto the episiotomy scar that's also sensitive but not painful now.

I've an external pile/fissure/scarring/damaged bit of skin on the perineum that is painful a lot now and bleeds a little when I open my bowels (no one quite knows what it is but it's manageable so I normally can ignore it).

Bladder is tetchy - often have to rush to the loo suddenly and without the tena pad on I'd be doing a lot more washing. Usually it's a little leak but I do a lot of grimacing and muscle tightening and then sometimes it just goes completely.

Other bits are just pregnancy stuff - carpal tunnel, aches and bit of spd. It's a bit of a miracle I am pregnant again to be honest - we had only had sex a few times since DD's birth and only once near ovulation when I got pregnant. I am worried about how it will all settle after this baby but the elective will hopefully stop the symptoms getting worse - though not guaranteed.

I know it could've been a lot worse. Longterm the bladder will probably be difficult, more after the menopause too. I am also worried about leaking during sex in the future but we'll see.

Hope you get some answers and some healing very soon.

Firstly well done for complaining.Hope you get a reply soon.

My DD was back to back. Im not very sure on details as I didnt even know she was back to back untill going through my notes at my booking in appointment for Number 2! The MW was shocked I never knew.

She wasnt coming so eventually I was told I needed a section. I really didnt want that so they said they would try forceps first. Im not even sure they knew her position till in theatre. But was preped for a section in case.
Anyway it seemed she was turned with Vontouse, but failed using that to get her out so used forceps in the end. She appeared with her hand up by her face. DH said all the staff looked very worried when she was coming out.He had visions of her coming out not breathing or something but think it was seeing her hand up and the mess she had made of me.
I had an episotomy and still had a third degree tear, but thankfully no lasting damamge, although never quite the same as before.

I remember reading that DM article thinking im glad they used vontouse but has made me at worried this time (33weeks) as theres so much they never told me before.