Forceps seem to be used a LOT in One Born Every Minute

[lucysullivan]

I can't get over how often forceps are used on mothers in Channel 4's One Born Every Minute, every week some poor soul seems to be subjected to them and on tonight's programme forceps were used for 2 births. I've read on here the horrendous damage that forceps can do and know that in some hospitals they are not used at all for precisely this reason.

I've specifically requested in my birth plan for this baby that I will not consent to forceps. Worried though at the extensive use of forceps in British hospitals today, the women I've watched in the documentary don't seem to be told about the risks associated with them, to their health or their babys. Whereas I will be screaming for a c section if forceps are mentioned.

Does anyone else worry about the use of forceps? I'm starting to get very worried that despite me saying I will not consent to forceps I will be told it's either that or I'll be putting my baby at risk, so made guilty if I kick up a fuss about not consenting.

Sorry Milly I have no idea what you're trying to say or if you're even talking to me.

I'm just asking violethill to clarify what she said about the MLU she gave birth in having GP's on call to do forceps, wasn't asking you a question at all.

I've found that accessing information about risks associated with instrumental births is very hard.

Info about the facts and risks of C-sections is much easier to come by (although there is MUCH misleading rumour and myth about them, with a lot of people preferring to generalise risk rather than take a more detailed and accurate view).

According to this, from the NCT - www.nctpregnancyandbabycare.com/press-office/press-releases/view/144

• CS rates in England in 2007/8 stood at 24.6%, and instrumental births (forceps/ventouse) at 12.1%. Forceps use stood at 5% (and had risen over the previous 3 years).

It seems to me that if more than 10 percent of women are having instrumental deliveries, then some clear info about risks and choices, where possible, should be available. Understanding that there may be situations where low forceps only are an option, versus other situations where there may be a choice between forceps and CS would be useful. Maybe this could be something which helps inform a birth plan. Also info about short term and long term trauma to babies, and post natal maternal welfare (issues like incontinence, perineal surgical repair, etc).

I'm UK based, so tend to stick to NHS/NICE info,and so far I've found very little that helps. This, from NICE, is very dense reading - www.gserve.nice.org.uk/nicemedia/pdf/IntrapartumCareSeptember2007mainguideline.pdf

They're guidelines for Intrapartum care, including recommendations for dealing with complications at each stage. For those interested - p.240 onwards discusses research on ventouse versus forceps. There's also a very small section comparing instrumental births with C-sections - which contains the following:- "Limited evidence showed women with CS were more likely to lose more blood, and stay in hospital longer, while babies born with CS were more likely to be admitted to a neonatal unit, but LESS LIKELY TO HAVE TRAUMA, compared with assisted vaginal birth." [caps are mine]

NHS patient info leaflets describe risks to babies delivered via forceps as follows - "Forceps can leave small marks on your baby's face, but these will disappear with time." Well, I'm 38 now, and the nerve damage that left me with ptosis when I was delivered via forceps hasn't gone yet! And there's no mention of maternal risk or wellbeing, implying it's virtually risk free.

That's a long post. The short version is that we talk a lot about informed maternal choice, when in fact getting information about some areas seems to be very hard. I think getting a detailed picture is virtually impossible - personally, I think we're so stuck in a groove of 'CS BAD, GET CS RATES DOWN' now that other birth risks are being overlooked or downplayed.

Barkfox - excellent post, so much info. perhaps you could take your NHS leaflet to your GP and ask what the NHS are going to do to put your nerve damage right as you have given it 38 years and think that you have given it enough time!!(if only I am sure you are thinking). The information on this leflet is quite clearly incorrect - I wonder who you could comlain to as it is totally misleading. I googled the Independent Complaints Advocacy Services (ICAS) who assist with complaints against the NHS and wonder if they would take this up?

i had an epidural and forceps were used, i had no idea they were about to use them and nobody asked for my consent, they had already done an episiotomy before i'd noticed what was going on! That said my baby was in some distress and she was born healthy. Also i have recovered well. But there was definately no informed consent for the proceedure.

As a midwife I ofetn see women who had forceps or ventouse first time round and have a straight forward birth second time round. The vast majority of mums have suffered no ongoing problems, nor have their babies. CS has associated problems of it's own which then impacts on the next pregnancy.
Sometimes forceps are needed to deliver a baby's head at CS, especially is the head is high.
I agree that the risks associated with assisted vaginal delivery need to be explained much more to women in a meaningful way. I am not sure that at the moment women who are making the decision not to consemt to forceps under any circumtances are doing that with a full knowledge of the consequences.
In my career, I have seen more catastrophic consequences of CS than forceps but bearing in mind that these experiences are in the minority. Health porfessionals base their propsed eecison on how to deliver a baby using the safest means for mother and baby, not based on statistics to reduce CS.

Sorry for typos - typing too fast.

Hiya foxinsocks

As has been said before Kiellands forceps are banned in the USA - so if they have decided that they are too dangerous to use there why are they still being used in this country?

Milly - forceps were occasionally used in the MLU where I delivered. They would not called an ambulance unless a transfer to hospital was needed. I have no idea of the specific qualfications and experience of the GPs on call - I mean obviously they were qualified doctors, but other than that I don't know -I didn't ask!!

Are you implying that a MLU might be using unqualfied people to use forceps on labouring women?! I hardly think so!!!

P.S. It doesn't seem at all unlikely to me that some GPs would have obstetric training. Doctors (and midwives) have varying levels of qualification and experience - eg some midwives are now trained for procedures such as assisting with a ventouse delivery.

It's simply nonsense to state that a MLU 'would have called an ambulance' - I was there, the doctor was gowned up holding the forceps as my first labour had gone on a long time, and they thought I might need them. Thank god the brilliant midwife supported me to push out the baby unaided about 5 minutes before the doctor would have gone in with the forceps.

mears, I hear what you are saying -

This unsettles me, though - a friend who gave birth to her 1st about 5 weeks ago, and who had a very protracted labour ending in a crash CS has a birth de-briefing afterwards.

As they went through her notes, one of the things she questioned was why she had been left for so long when it was clear she had 'stalled', and the syntocin drip she was on was having no effect. BY the time her baby's heartrate dropped dramatically, and a crash CS was ordered, she hadn't dilated any further for about 7 hours (and in fact had started 'going backwards'!)

She felt it was a decision that could have been made earlier, and she would have preferred that. The midwife doing the debriefing agreed it looked like something could have been done a lot sooner - and said, off the record, that the hospital was under such pressure to get its CS rates down, this 'may' have been a factor.

Anecdotal, I know, but very recent. After the birth, my friend described how when she was utterly exhausted and 'out of it', there was 'panic' as her baby's heartrate dropped, and she remembers talk of forceps and CS, and someone asking her if SHE wanted to go for forceps. She had no idea at all what this meant, not having researched it all beforehand - things were decided when a new consultant arrived and said firmly that while they could try forceps, he strongly recommended they went straight to CS.

Having read up about 'trial by forceps' after the birth, she says she is very grateful no one 'had a go' with forceps, as the baby was still very high. Not least because according to NICE, the babies who are most likely to be injured are the ones who have several failed attempts at instrumental delivery before going to CS.

I should say in the interests of fairness that she seemed to have had quite a bad care experience overall - she's not a very assertive person, and neither is her husband, and when she says she was screaming in pain, and asking if she should have an epidural, or something else, (begging for help and asking what to do, basically) the midwives told her they couldn't 'tell' her what to do as if it 'went wrong', she could sue them!

Needless to say, she's come away from the whole experience very disillusioned with how care decisions are made (and is making a complaint, as there were other issues with her birth which went badly).

PS gailforce1, you know, its never occurred to me to do anything legal about my nerve damage!

I would imagine it's too long ago now? - and I guess given the fact it's purely cosmetic (i.e my vision's never been affected, I've just got a wonky eye and droopy eyelid), it's just been 'one of those things.'

That is interesting, though. I wonder how much our expectations for what constitutes a good outcome from a birth, for mothers and babies, have actually changed over time. I mentioned this on another thread, but anecdotally I knew of women my grandmother's generation who were described as 'never right' after birth, and definitely had big incontinence issues, and who never 'went hear' their husbands afterwards. I think were a bit less likely to be tolerant of those things these days.

Similarly, I know the line with me at birth was 'yes, her head is quite squashed and bent, but she's alive and functioning!' (and there's a lot of sense to that of course). I think in 1972, it's possible that people were more accepting of 'cosmetic' damage than they might be today. I know my dad was so shocked by how mangled I looked, he just breathed a sigh of relief everytime I hit a developmental milestone and didn't care that people kept asking if I had a 'bad eye.'

Dunno, just thoughts.

Violet I am saying there is no way a GP would have used forceps, neither would a midwife. I'm sure they meant they would have called the necessary dr with the right experience, not a general practitioner who rarely steps foot in a hospital.

I would suggest the Dr you had should not have been a GP and if he was I'd be asking some serious questions about what the hell they were playing at.

GPs used to have obstetric training in some areas to assist in MLUs. Not sure how many there are now though. They certainly have to keep up to dat with training.
Midwives are now trained in ventouse and forceps (I am currently training) but only under very specific circumstances.
There are a wide range of circumstances where women need assistance and therefore a wide range of risks/complications.
One of the main areas where a lot of work has been done is trying to increase 'normality' to avoid instrumental delivery or CS.
Sometimes though, women just have not got the ability to deliver their baby and really need help for that final part where we can all see it but she just can't get it round that bend and out. These assistaed deliveries are miles away from the ones that are done because the baby's head is in a poor position and not yet visible.
There is a piece of work needing to be done there to try and put that into figures for women and health professionals.
Mumsnet is a brilliant forum but it is not representative of the population as a whole for experiences. I think it can engender fear for others when women speak of their awful experiences. However I truly think that this site offers great support when women find each other and can support each other. It is a catch 22.

Good post Mears.

ROFL MillyMolly.

It doesn't seem a strange concept to me that a GP could have obstetric training.

Thanks for your concern, but I really honestly don't think out local MLU makes a habit of inviting inexperienced people in to masquerade with a pair of forceps.

ah x post there mears.

Thanks for clarifying that from a professional viewpoint. Even as a non-medical person, I know enough to realise that there are some medical procedures which some GPs and midwives are trained in. Surprises me that some people can post making factually incorrect claims.

Avoiding intervention is aim of promoting normality. The focus in Scotland is Keeping Childbirth Natural and Dynamic

KCND

Sometimes interventions are done because women request it such as induction of labour without clinical need. That in itself can cause the cascade that can result in a forceps delivery.

It is all very complicated.

procedures which some GPs and midwives are trained in

And forceps isn't one them.
Not many surgeons would feel confident using them.

Some GPs ARE trained in forceps

From what mears says, some midwives ARE trained in forceps. She says she is doing the training currently.

Or are you suggesting she's lying?

Currently training simply isn't enough though mears is it ?
Not when you are putting a metal instrument around a baby's skull and squeezing and pulling it's whole weight.
I'd be sticking to the obs and gyne surgeon personally, most of the damage reported is done by inexperience rather than any other factor if you check out the information online about cases reported.

millymollymoo - I don't think mears suggested she would be carrying out a procedure until she's finished training!

Personally I would avoid a large hospital like the plague for a straightforward birth. Most women don't need a gynae surgeon to enable them to have a baby.

Anyway, you haven't responded to the point that your posts are factually incorrect. Some GPS are trained in forceps and assist if needed in MLUs. Fact. Fortunately they aren't often needed because you are more likely to avoid interventions in the first place.

I personally know 3 GP's and DH has worked in that field for 15 years, I cannot imagine for a moment anyone of them would deliver a baby with forceps on the simple basis that they haven't stepped foot in a hospital unless it was to have their own babies in years.
Maybe out in the wilderness where a hospital is an hour away they might be trained in obstetrics, as all dr's are during their initial training, but the three I know would call for an ambulance for every emergency situation you can think of from childbirth to a heart attack simply because there are more qualified people who are up to date and have day to day experience in the field.

MillyMollyMoo - I wasn't talking about the 3 GPs you know.

I was making the statement that some GPs do have up to date training in forceps, and do assist in MLUs, and do set foot in hospitals regularly.

The MLU I delivered in wasn't in the wilderness either, it's in a small market town, about 30 minutes from a big hospital. Also, my birth wasn't an 'emergency' situation; it was a straightforward, though very long, first labour, which I managed naturally, but as it was so long, there was a possibility I might have needed forceps in the last minutes. Luckily I didn't. Actually, I don't believe it was down to luck, I believe it was because I was being delivered by an excellent, experienced and supportive midwife, I had been helped to keep mobile throughout, and I had avoided drugs - all factors which contribute to a natural birth. The midwife told me afterwards that had I been in the hospital, I'd probably have been pushed towards intervention a couple of hours earlier.

The outcome - a healthy baby who was delivered straight onto my chest, and a mum who climbed off the delivery bed without being numbed up or attached to dozens of tubes.

A normal pregnancy and labour does not necessitate obstetric surgeons, ambulances, or heavy duty drugs.

I don't think the 3 I know are terribly unusual in their profession.
We'll have to agree to disagree, since ALL MLU locally are all next door to the main hospital it would be a strange day indeed when a GP was called out as instead to the highly qualified obstetrician.
And frankly I wouldn't want a man or woman who spends 99.9% of their time attending to bunions to suddenly start brandishing a pair of forceps. I imagine they would feel the same way.