Birt5h plan - no instrumental delivery, please help!

[breastfeedingquestion]

I had a forceps/failed ventouse delivery with my last baby and want to avoid instruments at all costs with my next.

I've read up on all the advice re: positioning keeping mobile etc etc to avoid instruments but I want to how best to guarantee that the hospital goes straight to c-section rather than instruments if it comes to it.

Will they allow a trial of labour then go to section without instruments? Or can this not be guaranteed?

Have a meeting with my consultant shortly but sort of want to know what's realistic or jnot before I go into it as if it's still likely that they'd have to use instruements (baby too far down the birth canal) I'd rather go in to my app fighting for ELCS.

Thanks!

I think you just put in your birth plan that you'd rather have a c-section that an instrumental delivery.

Key to natural delivery is good foetal positioning and keeping mobile in labour (ie no epidural) - being in a midwife lead unit, and also in a birth pool. I had on my birth plan that I would refuse to lie on a bed at any point and that I did not want CFM.

2nd births are usually easier than first births anyway so not reason to think you would need instrument delivery again.

I think the problem is that once the baby has left the uterus and is in the birth canal a c-section is no longer possible. Might be worth discussing that if induction other intervention looks likely then you want CS because any intervention is likely to lead to intrument delivery (esp epidural as hard to push with one).

See this is my mian concern - i'm fairly sure I'd want another epidural, going on my experience. I have done a hypnobirthing course this time but it really doesn't fill me with confidence that I wouldn't be begging for an epidural at 5cm again.

Can I put in my birth plan that if I want an epidural I want a c-s instead?

Having an epidural doesn't mean an intrumental, just makes it more likely. I think you might have difficulties in practice with saying you wanted a section if you wanted an epidural - you won't be an emergency/priority for a section at that point, and theatre may well be full. You could therefore find yourself haveing to choose between having the epidural and continuing to labour normally, or waiting for x hours until theatre comes free for a section. Couldn't you say, as you have suggested, that you would rather have a section than an instrumental delivery.

They can't use intruments unless you consent. If you haven't, and the baby needs to come out, they're going to do a section if they possibly can, not just leave you there!

Can I ask why you want to avoid an instrumental delivery? Having had a CS and a ventouse delivery, IME the latter was certainly much easier to recover from - and that was with an episiotomy and stitches.

I'm not sure whether they'd agree to that (ie wanting cs rather than epidural) perhaps discuss in advance - but you might not need an epidural - I did hypnobirthing course with DS and although i wasn't in hypnosis for the birth I managed really well on G&A and tens before I got into the pool quite late on (strongly recommended you hire tens) and didn't even ask for epidural - remember telling midwife I wasn't sure why anyone would even want one as it wasn't that bad - this was down to lack of fear etc from hypnobirting couse. I wrote on my birth plan that I did not want an epidural even if I asked for one and they were to distract me etc.

I had the mindset that I wanted to stay in the lovely MLU and have natural birth with lovely midwifes etc and have a water birth etc therefore an epidural was just not an option. I had a lovely birth, delivered DS myself in the pool without a tear.

they can't use intruments unless you consent, but they can't do a CS unless the baby is in the uterus. so if the baby is distressed and stuck in the birth canal I don't think there is that much choice?

Sparky - certainly, I'm incontinent as a result of my forceps delivery.

Hmm, perhaps I should just go for the ELCS, have already been offered one but was wondering if I should attempt another VB. AM thinking no now though!

Mummu I hired a tens last time, it was ok but no match for the pain. If that's one of your better suggestions then I#m thinking def c-s! Thank you though, glad it worked for you.

Oh, poor you. Have you had physio? Can you make sure you have it lined up for after the next birth (no matter which route out the baby takes!)

I had forceps a year ago and have some minor issues in that respect (sneezing mostly!). I'll never know if it was due to the forceps or not, but DD was low and in distress, so no much choice..

In that case entirely understandable! My ELCS if you go down that route was a really positive experience - had skin to skin straight away and breastfed without too many problems!

Have you got a friendly midwife you can discuss your concerns with?

That's good to hear thanks sparky.

My cons has agreed to ELCS but I think he thinks i could still have a good vb exp. I couldn't give a ratsarse about having a good vb experienced, never been remotely interested but I thought I should at least entertain it for a bit.

In that case (incontinence) perhaps better to go for ELCS - even with natural no instruments delivery can be damage down there.

re: tens machine - I think it worked well as it was in conjunction with G&A and the hypnobirthing relaxation. Also my labour was pretty quick - DS born within 2 hours of arrival at hopsital even though I apparently wasn't in established labour when I arrived, I suspect if if had gone on and on I might have felt differently.

I have had 2 natural deliveries (tore with DD) no instruments, and despite doing pelvic floors after both births etc still very slightly leaking when sneezing or coughing late in this pregnancy. I think pregnancy/vaginal birth contributes even without instruments.

I had high forceps and have incontinence problems. I am 30 weeks pregnant now and am going for elcs because I know that in certain cases they would need to use forceps again as the best option for the baby - if like DD they have come past the spines but are wedged sideways on. Pulling back up the canal from a c-section is far more risky apparantly though that was the next step for me if forceps hadn't got her out.

I didn't have an epi or morphine, I was mobile and fit and did all I could to avoid any intervention but it went wrong badly for me. This time I want the planned control of a section to reduce the chances of either a fast birth with tears - and possible worse incontinence or double incontinence. Or of forceps doing more harm to my bladder again.

I feel I am weakened already by the forceps birth with episiotomy, tears and much scar tissue. My physio also said that the action of the birth itself, the baby's head stretching through the pelvic floor, doesn't help with later continence. I don't want to risk more damage there though I also know I 'could' have a lovely time with minimal damage.

Maybe consider longterm v.shortterm. Many incontinence issues worsen post menopause as the hormones in your body change - they way my bladder is weaker again now I am pregnant. Read up and make sure the incontinence is not dismissed as a minor issue, it can be hugely life changing for some people.

Good luck with whatever you opt to try! I can see great reasons for both so go with your gut feeling once you have got the info you want.

my dear you cant request a CS instead of instrumental. I dont want you to think you can, they may well refuse! unless you are private. EMCS are a huge cost to the NHS and they wont do it unless they have to

Try and have the natural birth you want, and if you do have to have INSTRUMENTS ITS NOT THE END OF THE WORLD

I am 20 weeks and have decided to chill out. as if they induce me, I will need an epidural. and if I have an epi, I might need ventouse, and if that happens, my chiff will kill for 4 weeks, c'est la vie

and here is hoping none of this happens

sorry did not read all, OK all sorted. happy ELCS, I thought you meant mid labour....

I had what you wanted - I delivered DD2 in a birthing centre attached to a regular delivery ward. I had a meeting with the senior midwife and she wrote and signed my birth plan, which was that I would not have an instrumental delivery unless my baby was well descended and in severe distress. I didn't want to endanger my baby (obviously!) and I knew that pushing the baby back up far enough to do a CS in those circumstances would risk damage to us both.

Basically that was the whole plan - natural delivery, but if anything went wrong, I would have a CS.

I think that this was very dependent on that excellent midwife though. We went through the notes from my previous horrible delivery and she was very understanding and sensible. Without someone like her I don't know if it would work, because it would be dependent on who was on shift at the time.

In your case - with the continence problems as well, I would probably go for an elective CS. Even with a supportive DH and MW, and a great birth plan, it was still very scary to go into labour and trust to the Gods.

Hi breastfeedingquestion.

I also had forceps/failed ventouse with DD1.

I went for an ELCS with DD2 as there was no way, if I tried a VB, that it could be guaranteed I could avoid a second instrumental delivery. My experience was that a certain amount of assertiveness was needed to get the ELCS; and I'm not sure I would have been able to do that if I was in labour at the time of asking.

My ELCS was great - such a wonderful birth experience compared to first time round. Held DD2 straight away, bf fine. I was lucky in that I have family near by so could arrange not to be alone for the first 6 weeks afterwards (necessary, as lifting toddler was not an option for that time!).

So, to answer your question, my experience was that they would not allow a trial of labour then go to section without instruments.

Good luck with your choice.

porca you don't have to have an epidural if you're induced.

Thanks all, ELCS it is!

There is no way on earth I would entertain any birth that may involve an instrumental delivery and it sounds like my question has been answered.

Porca, sorry, not sure where you got the impression I hoping to "have the natural birth I want" that must have been before you read the thread properly too!

Meant to say - recovery not a huge issue for me. DH is taking 3 weeks off then my Mum has offered to come for as long I need her once DH goes back to work.

Glad that you have your cunning plan. Hope we both have nice smooth births this time- and no further longterm damage to manage too!

My recovery was so horrific last time I feel I am all prepared for the surgery this time already. At least this time I won't be expecting a possible nice birth in scented water and no stitches needed!

Good luck too lovethesea.

At least these stitches will be on my belly and I won't have to sit on them or try to keep them clean when I go to the toilet this time

I know of a lady, not well enough to get many details but she basically stopped contracting at 7cm's and then insisted on a caesarian instead of forceps but I do think you have to be quite assertive and make sure you're feeling are clear before it becomes an emergency situation.

Breastfeeding questionnincould have written your post!

for dd I had forceps delivery in theatre after they tried ventouse twice! Had signed paper work frlor c-section etc... I don't believe the side effects of the forceps were discussed etc....I could feel my stitches a food 6 months after if breaking in the car/if I sat funny and caught one bum cheek felt the pull etc...
Anyway was referred to a consultant at 16 weeks for more info as my cmw didn't know if 2 cord vessel was herediary and I had this with dd.
Anyway also about my concerns about previous birth and really keen to avoid instrumental birth! So I'd gone to the appointment set on hypnobirth as an option to get a better birth experience also dd was back to back but they didn't realise sor say till inwas 10cm dialated! I was at the hospital by the time i was 2 cm dialated crying in pain and scared that I wasn't going to make it cos of the pain! Nobody said to me it was back to back labour I think if someone had I would have probably relaxed a lot more!
Anyway at my consultants appointment he offered me a elcs pretty much straight away, at the time i said to him i wasn't keen on a section and henwrote that in my notes....hebsaid to me that thinks can change I'll see you at 36 weeks we can discuss/youncan decide for sure then!
Roll on today to my 36 week appointment and I saw the registrar who was very much pushing for a vb! I discussed it with her and got her to agree to an elcs after being quite assertive my hinny had to pipe up and stand up for me as well!
She agreed eventually but had to check with the consultant who agreed immediately!
So I've been booked in for section at 39 weeks and if my waters gp or lanoir starts i phone the hospital an they will do it as emergenct howwver i habe agreed if it happens early that i will do a trial of labour! I'm trying to be open minded about it all but like you he bought is
another instrumental delivery makes me feel sick!
Good lick whatever you decode x

Hubby not hinny! Sorry typing on phone!