Planned use of either forceps or ventouse (sp?) any experience?

[BrianCoxIsEatingBrains]

Hi,

As the title says really, do you have any experience of having either forceps or ventouse planned into your birth plan? I had always assumed they were for emergencies and were a last resort (have only heard horror stories).

This is all very new to me. I am pg with DC2, due April. DD was born by planned c-section for medical reasons.

Having researched the medical reason behind me having a c-section (brain haemorrage 18 years ago), it would appear that advice has changed in the 9 years since DD's birth so I have asked for a natural birth, rather than a c-section.

It all hangs on my consultant discussing the pros and cons with a neuro surgeon, but at my hospital appointment today I was told that should the answer be 'yes' one of the options could be to monitor me closely as I labour and then take the final 'big' pushes/strains away by delivering by either forceps or ventouse.

Anybody got any experience of this? Anybody strongly advise me not to go down this route and take the c-section option?

I really would like to have a natural birth but will not put that desire above the risk of my health and babies safe delivery.

TIA.

I have had two CS's - both as emergencies but one was proper emergency and the other just for failure to progress - my VBAC attempt. Personally, I would not choose to labour with a planned forceps/ventouse. No way/no how. I would opt for an elective CS instead.

However if it was safe (enough - always some risks with birth) I would be happy to try for a spontaneous delivery. But forceps etc are usually only used as an addition to the mum pushing, they are not for dragging the baby out with.

Can you have a google of Keillands Forceps and check they wouldn't be using them? Would they be recommending an epidural? Can you be mobile? I assume they will be wanting you to have constant monitoring?

Bear in mind that epidural and CFM/reduced mobility can all reduce the chances of an unassisted delivery

Having said that, there are advantages to the baby of experiencing labour, but I would much rather have a CS than planned pelvic floor damage - an episiotomy is usually needed for instrumental delivery. Can you have an appointment with a supervisor of midwives who can go through the options and risks with you in more detail?

Hi,

thanks for your post Manifesting

I only spoke to the Dr today (was supposed to be consultant but is on holiday) so it is all "If and But and Maybe" at this stage. I get to speak to the consultant on 20th November, at which point I will know if she is willing to allow a natural birth, given my circumstances and the outcome of her discussion with the neuro surgeon.

I know nothing about forceps/ventouse other than reading things on forums and seeing a few births on One Born Every Minute. I will definitely have a look for that Keillands Forcep and take note to check they are not using them.

My main reason for a VBAC is to experience it, the desire to give birth and do it myself and then the recovery after being a lot quicker than the 6 weeks post c-section (although in reality, I was back on my feet around 2-3 weeks with DD)

However, if my attempt at natural birth is going to involve planned intervention which carries risks, I am not so sure of my eagerness to pursue!

Meant to add, once I speak to the consultant - I will then speak to the supervisor of midwives to see her take on it/advice etc,

thank you for your advice.

Its more suggestions than advice, I know. I get that they are probably worried about ?raised intercranial pressure during pushing, but I would wonder if they are possibly setting you up to fail with all the restrictions on the labour, then a big chance of ending up with a CS anyway.

VBAC is generally safer for the baby than CS, but when there are special circumstances the balancing the risks gets a bit more complex. FWIW, I laboured twice and it wasn't much fun but a planned elective is generally safer than an EMCS - maybe ask whether or not they feel the likelihood of you 'succeeding' to give birth vaginally is high? What are their stats - have other with similar situations ending up with an EMCS or any had a spontaneous VB without the forceps and no neuro problems?

Might be worth joining the UK VBAC HBAC yahoo group - there may be someone with experience that could give you suggestions. Or the NCT experiences line might be an option. I know a lady who does VBAC support - I could see if she knows anything that might be useful if you like?

Hi Brian- I'm in the same position as you, although my haemorrhage happened after my first pregnancy so I have given birth naturally. The advice given to me by the obstritirician is similar to yours. Monitor pushing and then suction if necessary. This seems to be the preferred option above the csection especially as I've given bith naturally before. I was actually very happy with this as I'd hate to have a c section. Now in retrospect I should push for more detail on the suction issue. Unfortunately im not seeing my neurosurgeon at the moment and this is a different hospital. It will be interesting to find out what you get from your consultant, how far along are you?
It's such a predicament really as you never know how well the birth may go.

Mmm, I do understand your wanting to try for a vaginal delivery if possible. However, I personally would only be keen on that route if the neurosurgeon said it was absolutely safe for you to deliver that way, pushing and all. I think if they talk about instrumental delivery as definitely being needed, they are saying there is a potential concern about you pushing and raised intracranial pressure, and I do not think it is possible to give birth with no pushing whatsoever. I am not as well qualified in that as your obstetrician, but I'm a GP with a diploma in obstetrics and have worked in obs in both the UK and New Zealand. Instrumental deliveries are for helping baby out when pushing isn't quite enough, or for cases where baby is starting to show signs of distress and needs getting out more quickly. In those cases a fair amount of pushing has already gone on, so baby should be well down the birth canal and just need a 'helping hand' to come out. That is an entirely different scenario to baby higher up in the birth canal, as the only way they can be brought out vaginally is by Kielland's forceps. Other types of forceps or ventouse can only be used when baby is lower down and closer to coming out - it is called assisted delivery because these instruments are designed to be used along with, not instead of, pushing. I personally would run a mile from the suggestion of planned forceps, which are not the pleasantest of things. Maybe see what your neurologist has to say before making any decisions though. Sorry if that hasn't helped you at all or has complicated your thoughts further... x

As cashewnuts said above, if the specialists advise monitoring pushing and possible use of suction to assist, I think that is a very different scenario to pushing not being safe and having a planned forceps delivery.

mummy2benji you know when you ask a question and then the metaphorical can of worms erupts everywhere.... Yep, that's what I feel happened to me today ha!

Thanks for all your replies and Cashewnuts I think you are the only other person I have spoken to who has had a haemorrage (so much easier to spell aneurysm though!) I am 16 weeks - due April.

I know that the easiest option (ie planning wise) is a section, I just have this thought that natural birth would be my preferred option. I will not, under any circumstances, go against medical advice though should I be told that VBAC is a riskier option.

Planned forceps or ventouse is definitely making me think, as has been mentioned, that they are not necessarily confident I will deliver safely. I do not like the idea of the baby being pulled out either.

Thank you for all your ideas/thoughts/advice - it is good to talk it through.

I will go and look for the VBAC group, another friend mentioned a Midwife group on Yahoo that should be able to give advice. I just want to know what is happening or what my definite options are, before I go ahead and ask questions/delve deeper (back to can of worms )

x

mummy2benji I may have misunderstood the Dr in relation to the actual use of the forceps or suction during labour - it was a lot of info to take in, but also a lot of ifs and buts so my head was spinning a bit [doh]

I had an instrumental delivery - my baby was stuck. Unfortunately she was stuck very high up, and the resulting damage to me and the baby wasn't pretty. Everything is fine now (but it was a close run thing with me). If I knew that an instrumental delivery was on the cards, I would take a CS in a heartbeat.

My second was a "natural" birth; it was exhausting and almost ended up with yet another stuck baby, and even then I had quite a bit of tearing that took a good while to heal. It wasn't the be all and end all by any stretch of the imagination.

I personally would take a perfect easy vaginal delivery with no tearing or damage as my first choice, but I would take a lovely calm planned CS as a very close second. And it looks as though neither of us is capable of a perfect easy vaginal delivery! :)

A friend had a no-pushing delivery by forceps because she'd previously had a detached retina. She had a huge episiotomy and was in pain for months. I don't know why she wasn't offered a CS but she won't have another baby.

Bear in mind that if they insist on that you will have to be in a sub-optimal position for second stage labour, but I doubt they would let you be upright in case assistance were needed. Squatting would let gravity give a helping hand.

My first DD was born by C section due to breech presentation. I have just (13 days ago) had DD by way of VBAC ending with forceps and episiotomy.

My episiotomy is slightly infected and I'm on my second course of antibiotics. Whilst this is a bit miserable and I'm fed up with not being able to sit comfortably, this recovery is far less difficult than the C section recovery. It's easy to forget previous recoveries but every time I pick up my toddler or do anything involving my stomach muscles I realise that not having abdominal surgery is definitely a good thing, notwithstanding that the episiotomy has also been painful and debilitating - but nowhere near as much, just in a different way. I also spent half the time in hospital post natally with the VBAC than the C section.

I can't comment on any of the medical aspects of your situation but just wanted to let you know that, for me, the forceps delivery was nowhere near as bad as I imagined forceps deliveries would be and the recovery is preferable to my C section recovery.

My 5th child was a ventouse, and tbh, it hurt like fuck but I could get up and walk after, she was ok (bit of a lump on her head for a few days) I was not confined to bed, so for that reason I would choose that over a CS. It was needed as she wasn't coming out, turns out the cord was round her neck a couple of times. She is fine now, a bit of a handful but fine :)

Yes this has raised lots of questions. My consultant obstetrician was very confident in the plan he gave me. I didnt push much in my first birth. I was induced and apart from the horrific contractions the baby flew out. Based on that I think he's more confident that things will be easer this time around but again you never know. The idea of having a section, the surgery and being numb from the epidural gives me nightmares n I never want to lose feeling of any part of my body again.
I better act fast and do more research but I don't want to get too stressed aboutit. I think because I haven't had the experience of intense pushing it was an easy plan to swallow.

SoozleQ and topknob - gd to hear of your experiences. I think you get good and bad stories from all types of intervention.

Cashewnuts have to say, in favour of c-section, my planned one was delightful (seriously) but it was planned and no-stress. The recovery was a pain in the bum as in my mind I felt great after 2 weeks but the reality of my body healing meant light duties for 6 weeks. Also the post birth trapped wind is horrendous (they don't warn you about it, I thought I was dying drama queen )

It is good to hear the pros and cons of going with an assisted delivery (is that the right phrase?) I do not want to go into it blind. I want to hear good and bad stories so thank you to all who have given the not-so-rosy side

So much to think about!

SozzleQ congratulations!

I think if I had to rely on complete intervention I'd go for a csection. But the fact that I've experienced one birth of no pushing although assisted by induction made me more confident. My muscles are definitely a lot loser now! I just have an issue with the operation itself, as I was paralysed initially by the haemorrhage and don't want to lose feeling even if t for a short while. Of course if medical advice was to go for it then I would. Ithnk I'll also write to my neurosurgeon and have a list of questions for the obstritrician in a few weeks. I think once you see your consultant you can really go through the options in details, mine gave me a lot of confidence.

I "needed" an epidural for my instrumental delivery. Of course, it wasn't that it couldn't be done without, but the fact that I had to be on my back (back-to-back baby) and the fact that they had to do an awful lot of rummaging to even get up far enough meant that it would have been very difficult for me without.

I also lost a lot of blood and had a recovery that was more difficult than that of a friend who had an emergency CS at the same time. Sitting, walking, or even standing for any length of time were all really quite painful.

It would have helped to have had a baby that wasn't in a lot of pain and crying constantly. :( I wish I'd known about cranial osteopathy at the time.

It's all a balancing act and I would have loved to have had a crystal ball, but I suppose that we just weigh up the odds and go with what we feel most comfortable with.

Poor you and poor baby sounds like it was very tough. I suppose we can never tell what will happen at birth. A crystal ball would be useful.

I had forceps and vacuum with first birth followed by 2 natural births - if they said they were coming near me with forceps/vacuum again I'd insist on c section - sorry.

Have a look into breathing the baby out - basically where you let your body do the pushing (there was a thread recently in childbirth topic about it). It didn't work for me but DS was in a difficult position, however lots of women seem to have success with it.

I had to have an episiotomy however didn't have an instrumental delivery, and it wasn't as bad as I thought it would have been. Personally (and I've never been in your situation) I would be tempted to see if I could try to labour, and if things weren't going to plan immediately go for a c section instead. I would never consent to Keilland's forceps however they are used when the baby is still very high up and a c section would still definitely be an option.

There is nothing bad, wrong, anything at all negative about having a c section, but I personally would have been gutted to not have experienced a VB so I can understand why you want to :)