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.

Lovethesea... I had something similar to what you mentioned the the epesiotomy scar, turned out to be proud flesh ( I couldnt see it!) and the GP cauterized it. That particular part of my scar has not caused any problems since, and I no longer wipe any blood after opening my bowels. Just a thought

Hulla, a big hug for summoning the courage to complain. I hope you get some answers. I am the same age as you and found my experience bad enough tbh, but do not have the continence issues you have. Wishing you all the best, hoping you continue to recover. x

Sorry to hear you had a bad time. My dd1 was delivered by Keillands Forceps. It was a long time ago now,nearly 13 years,but I had to sign a form saying if it didn't work they were going to give me a c-section then we were rushed off to theatre.
Like Butterscotch it was a long time,many years, before I realised that most forceps deliveries are usually just done in the delivery room.

The Forceps did work and although I was very lucky and didn't have any permanent damage it was still very traumatic and it took years before I could even consider having a second child.

I wish you all the best for your recovery.

sillysow - thanks for mentioning that. After this elective I will see what needs addressing still and push for a referral if it doesn't sort itself. Helpful to know there could be another reason that is not being considered.

I think the medics aren't bothered because it's a minor thing bloodwise, but it would be nice not to be reminded of pain and feeling torn again just from a bowel movement! Too many memories.

I completely know what you mean about the reminder Lovethesea, it sometimes feels hard to move on mentally when you're left with physical reminders.

Thanks for the new responses and nice wishes.

The hospital called today and said they have spoken to the doctor who delivered DD and she is going to write a response which will be added to the overall reply to my complaint.

I should hear back from them in about a month so I will keep checking this thread and pop back when I hear from either hospital.

Glad to hear things are moving for you - albeit slowly. It will be interesting though probably very hard to read the doctors response. I know they often cover themselves chronically rather than admit error or fault.

I hope in your case they make an exception and just put all the accurate facts there on the table to be assessed.

I'll look out for your future threads.

I meant to add that she said the reason some hospitals don't use Keillands (preferring cs) is that Keillands requires a senior doctor and they don't want to do the on-call so they have a no-Keillands policy instead.

That sounds a bit strange to me. Don't they have a senior doctor at a cs? If not, that would imply that cs was the safer option and that I should definately have been asked if it was ok for a doctor in training to rotate dd.

She also said "that's why we do rotation which is when all the damage is caused".

I thought I'd mention it here as I don't expect it to be phrased like that in the letter.

That is odd isn't it? Are they trying to say that KF are better than CS but only if someone has great experience in it - and then how do you get that experience (if so risky) without endangering women and babies?

Everyone has to start somewhere and learn, and I can see that if they asked all the time if someone could try a proceedure for the first time on you they might never get anyone trained up ..... but it does make a CS sound so much 'simpler' to learn doesn't it?

I had heard that it is the turn of the rotational forceps that really screws up a woman's insides; my poor old bladder had already had DD stuck against it head sideways for 11 hours plus with constant contractions not budging her. A pair of giant salad tongs squeezing in too and then twisting away must have been the last straw for those nerves.

If it's a procedure which require a lot of skill to reduce the risk to mother and baby then I think the mother should be informed if the doctor performing the procedure doesn't have the skills to do it alone.

Not just informed, actually, but asked for consent. The risks of it going wrong might be small but the consequences can be huge - you, me and that poor baby in the DM article are evidence of that.

Yes, bladder damage is awful. The physio was horrified when I told her that I didn't go to the toilet all day because I didn't feel the urge and didn't know wee properly. I could only empty a bit. I found, by chance, that I could only fully empty my bladder if I had a tap running.

This seems to have improved now but I wouldn't say I get the urge to go very often.

Hulla - I don't think the doctors at a CS are always terribly senior. with DD2 I had 2 registrars, 1 junior, 1 senior, but a senior one can have as little as 5 years' experience (so not really very senior I think). Having had failed Keillands before (used by a consultant - no damage, thank God) I refused forceps second time around.

But then a cs is a very commonly performed procedure, so it is easy for doctors to get a lot of practice and I have heard that primary cs at least is a fairly easy operation.

As an aside, with DD2 I had a very strange experience. Junior registrar told me she was going to use forceps in the labour room. I said no because I hadn't had any drugs and in the time it took them to get the local anaesthetic ready a more senior reg came and took me into theatre. The baby was 1cm above the spines so it would not have been sensible to use forceps at all (my consultant told me afterwards that cs had been the only option) and anyway I was demanding a cs and saying my consultant had said I should have one instead of forceps if the baby was stuck as DD1 had been. Yet the junior registrar - who could have been nearly a senior registrar- thought she could whip the baby out in the labour room and told me that the baby was "just there". with hindsight I am quite shocked about that and wonder what damage could have been done to my baby.

That's shocking Haliborange. I imagine not all women would have insisted on a cs if another doctor was talking about forceps. Especially with your consultant saying afterwards it was the only option.

Actually, I say senior but the person supervising was a senior registrar - there wasn't a consultant present.

Yes, I think that's the thing with Keillands, its performed so infrequently that, one would imagine, it's hard to get the training and then keep your skills at a high level.

I hate my chat with registar about type of forceps used and the registrar told me but also said they don't use Kellards a our hospital however my mw has told me that one of the senior consultants would always use kellards over a cs! But that he is very skilled at the useage!
My consultant at 16 weeks offered me a elcs after last birth but the registrar was tryif to talk me into trying normal labour! I finally got consent agreed for my elcs after hubby had to stand up for me! I got of lightly apart from weak bladder and sneezing/laughing and feeling stitches for 6months I really feel for all of you that have on going problems.

Hulla - I think I have your bladder urges! Mine is far too insistent that it must be emptied NOW and if I ignore it it just goes ahead anyway. Somewhere between you and me is the happy middle ground ....

I still do not understand why Keillands forceps are still being used in the UK (though not by all hospitals) when their use is banned in the USA?
Can anyone enlighten me?

Hulla, the result of your procedure is awful. Well done for making the complaint.

I don't know where you are based but you need a second opinion with regard to possible future surgical options. One of the (very few) advantages of the choose and book system in the NHS now for referral is that you can see nearly anyone. Can I recommnd you ask to be referred (by your GP) to Mr Ed Kiff and Wythenshawe Hospital in south Manchester for a second opinion. He is a tertiary specialist in anal incontinence and involved with a lot newer procedures that just aren't available from other people. He is also really nice and non threatening ( I know some surgeons can be quite intimidating) I worked for him a few years ago and a large number of his patients are women with simillar experience to you. I met more than one woman who had been told that their only option was a colostomy in whom he restored full continence. At the very least it would be worth seeing him for an opinion. (if you do make sure your appointment is on a day when he personally will definitely be there and that you see him and not one of his team)

Good luck and best wishes.

Thank you so much, Ineedacoffee, I will look into that with gp. I have now been diagnosed with vaginismus so need to see my GP for some dilators [dread]. It would be great to talk to someone who might explain things more fully &, just this week, I was considering paying privately for that.

Good news, I think. DH and I have been accepted onto a psychosexual therapy course. The therapist thinks that we should be able to "fix" our problems fairly quickly. DH is dreading having to talk to a stranger about dd's birth & our sex life but I'm hoping he'll find it useful.

gailforce I have no idea. It doesn't seem right does it? I can't find out much about them being banned in the US so I'm having trouble understanding that one too.

Still no reply to the complaint but hopfully not long now!

That sounds a promising person to follow up Hulla! Hope it gets things moving soon - and that the therapy is healing for you and your DH.

I am 6 weeks away from my elcs now. Have made another appointment to see consultant and anaethetist before then to go over details. This time round I want all my queries answered BEFORE things happen to me (ie will it be a spinal, will catheter be put in after the spinal takes affect, pain relief post op, can the screen be lowered for the birth etc etc). I just no longer trust the system unless I take charge as much as possible.

I have received a response to my complaint letter. It's crap.

They say they uphold my complaint. They agree that consent was rubbish but say that in life threatening situations there isn't time to explain "statistics and the risks and benefits of Keillands versus a caesarian section". So why bother with half-informed consent? If it was that life threatening don't get me to sign a form saying "risk of soft tissue damage" just say "sorry, you and the baby are in danger. We're doing X".

Oh and there was no risk to dd because her apgar scores were good. Think they are confusing risk with side-effect.

I can't bear to read it again now but will have to write back I think.

So I feel as though I've wasted my time. I'll pop back when I can face thinking about this again.

Thanks for all the support.

So they admit you have a valid complaint. But they argue that you couldn't be given a choice on forceps/c-section as it was an emergency - but there was still time to sign a consent form but not to actually give real consent as it couldn't be explained?!

Surely that makes any form pointless and misleading? Better to just act in whatever way they think best medically? Isn't that what they do in A&E all the time with people who are conscious but in life/death situations? They don't all sign forms do they? Surely only for planned surgery not for emergency proceedures?

And they totally didn't get your point on risk did they? My DD's agpar scores were 6 then 9 after the forceps. I know she was in serious distress before them so I guess that means they worked to get her out safely .... but how can they say that twisting her head from OT to deliverable was risk free? It may have been safer than hauling her back up the birth canal for a c-section but it isn't risk free?

I am so sorry they are being so obtuse with it. I saw my 'consent form' in my notes a couple of weeks ago. My signature was almost illegible and I would have signed anything to get the pain to stop, but it wasn't for forceps or a c-section. It was for them to act and do a medical proceedure or something vague. Don't know why they bothered. DD was in distress, heartrate decelerating and not recovering, meconium in waters, stuck OT for over 11 hours, 4-6 hour second stage etc etc - of course I wasn't able to discuss options for forceps or c-section.

Surely that all argues for these things to be clinically decided at a higher level, not left to individuals on the day who may or may not have the training needed. Someone must be collating the research on the safer longterm outcomes for babies and mothers on forceps/c-section? Is no one looking at maternal health? If it is such an issue then could women not discuss it prior to labour and have it as part of a birth plan?

Is there anyone you can take the response to who can support you in going back to them again? Legal support even?

Hulla, am and at their response. Sounds like they're trying to fob you off. Will have a think about how best to respond to this, let me know if you want me to help with your response once you feel ready to look at it again xx

I'm really sorry that you've been fobbed off and didn;t get the answers you are looking for. I forget (I haven't reread the thread in a while) was it the hospital you complained to or the NHS trust? It might be worth going higher, you need to get a satisfactory answer and /or apology for your own peace of mind. Its not your fault that these terrible injuries have been inflicted on you and you have the right to some answers and as much help to get over it as the NHS can provide, however I'm not sure how to go about getting the closure (terrible expression I know but applicable here) that you need. Perhaps the people at Birth Trauma Association can advise?

I hope the psychosexual therapy course is beneficial.

I'm getting on fine though pelvic floor is really suffering now that I'm 34 weeks and stupidly huge. However have date for c-section - they had no qualms about me having one just glaced at notes and said rotational forceps, 3rd degree tear, twins - its the sunroof option for you!

Thank you ladies! All not far from your due date and still helping me out!

I wrote a long post yesterday but the laptop died and I couldn't face typing it again.

Snail - I'd be very grateful. If I write an emotional, angry rambling would you temper it with some calm, clinician-speak?

Lovethesea & Ginger - You both sound so positive and looking forward to the birth of your dc - as you should be! It's really lovely! Not long to go now. Lol @ sunroof!

I have come to the conclusion that I can't avoid calling the bta any longer. For all the therapy and counselling, I'm not really over this. DH is hating psychosexual therapy - we've started with a sex ban which isn't a lot different to how life was anyway but he doesn't like being told by a stranger.

We have to do a sensual exercise together this weekend which we have to go shopping for tonight. I'm kind of looking forward to it actually which is progress in itself!

As for the hospital, I am so worn down. I will try and post some snippets from the reply tonight (sensual exercise permitting!). I am so angry at them just glossing over the fact that I'm left with such a raft of problems because they missed the tear. I have even googled solicitors today, wanting to scare the hospital really. But I don't have the strength to go down that road. I think it would tip me over the edge if a solicitor read my notes and said "actually, they did nothing wrong".

Of course I'll do my best to help Hulla, will put on my best calm clinician head (pregnancy hormones permitting )

Enjoy your sensual exercise

Hope the sensual exercise is a good chance for intimacy for you both. I wonder who would specialise in good legal aid for medical incompetence? Maybe there is an experienced firm that would be very gentle with looking through such emotive and jargon notes to decide on any case?

I can understand not wanting to face the possibility of being told it isn't 'that bad' or 'their fault' though. One to think through in your own time. You could always ask CAB if they can recommend a firm that is good with medical cases but not ambulance chasers? Might be a long shot but at least you might end up knowing a firm that would have a free chat with you over whether you would have a case IF you ever felt that would suit you.

I'm afraid I don't know law firms at all, but maybe someone else can advise a good one local to you. What a route to have to consider though. Is there a compensation scheme for medical injury? I presume they would have to be proved liable? Maybe the patient information groups might know more?

Just thinking out loud here so ignore if not relevant!

I have spoken to two ante-natal medics this week who asked why I was having an elcs this time - I only got as far as 'rotational forceps' and they immediately cut in with 'say no more'.

Some snippets:

"you were asked by Dr X to complete a consent form prior to the procedure being carried out and again Dr X's communication seems to have been inadequate. Obtaining consent at this very difficult time is challenging as being able to take the time to fully inform patients of all the potential complications is difficult as time is usually in short supply due to the risks at this stage of labour. However, I am sorry that the information you were given was not more comprehensive as clearly while she has documented the risk of soft tissue damage you clearly were not aware that an episiotomy would definately be performed and that there was a risk of sphincter damage with the subsequent potential complication of incontinence later. You are quite right in stating that the risks are low as this is a rare complication but certainly not unheard of and had you known all of this you may not have consented to this form of forceps delivery."

"Dr X performed the keillands forceps delivery under direct supervision as this is a requirement of the guideline we have in place for instrumental deliveries. Dr X is a very experienced Doctor at Registrar level, it is normal to continue to learn more complicated procedures that are still supervised but I can assure you that she had performed many keillands forceps deliveries and if the supervising doctor had had any concerns he would have intervened. It is best practice to inform patients that this supervision is taking place and again this will be discussed with the medical staff to ensure that lessons are learnt and other patients are better informed."

I am left incontinent, how much do you think they felt that warranted in a response letter? This much: "hopefully...you are now having the appropriate treatment".

It's 4 pages long and I'm not sure the bits I've picked out even sound that bad. I think it just feels like a totally underwhelming response to the totally overwhelming situation they've caused.

Had a good cry on the phone to a birth crisis person yesterday. I have also decided not to continue my colorectal treatment at this hospital. The idea of letting them operate on me again is terrifying me and I'd rather go back on the waiting list for SNS when we move house next month.

We're relocating about 70 miles from here. I need a new start and to get out of this city and all the bad memories. I can't ever go back to that hospital - definately never to have more children.

Sensual exercise went out of the window - we had another row instead