Help with birth plan to avoid forceps

[Inaina]

Hello, I am almost 37w pregnant and my baby has been back to back for a while. Often b2b babies end up needing forceps delivery and I've read so many bad things about it I just don't want to take any risk, considering how safe C sections are nowadays.
So my plan is to try naturally, hoping he will turn during labour (seems most of them do), but if he doesn't, request a C-section instead of forceps. But I am not sure how realistic this is, i.e if the hospital staff will consider my wish; a C section when the baby is too down is riskier, so I need the midwife to tell me honestly when to stop hoping and safely move to C-section during labour, however every time i tried to discuss the plan with them they say 'we will see then' which worries they will let me progress until it is too late.
Wondering if anyone had a similar situation, whether planned or not, especially if they have been to UCLH hospital.
Thanks !

You need your birth partner on board, and understanding your preferences for every scenario. Unfortunately my midwives didn't always listen to me (especially with my first birth) but did listen to my husband. He must be able to advocate for you effectively.

I had consultants orders to avoid forceps so I was covered in that case, but he had to advocate for me strongly in other areas (pain relief, getting them to realise that I was in transition etc).

I had forceps which they tried and was successful but would have been c section had this not been the case. They’ll do whatever gets the baby out most quickly and safely, not sure how much say you’ll have.

Tbh I've always been advised by midwives and obstetricians that if I was going to be adamant that I wouldn't consent to instrumental delivery then the safest option is to opt for an elective c section. Because as you say sometimes 'in the moment' the safest thing IS instrumental delivery.

I don't think it's possible for a midwife to 'stop' you when pushing, because then you couldn't deliver the baby anyway? There's no way of knowing whether you will birth the baby without assistance until leaving it until the baby is far down enough to do so. There would be no point in starting to push at all if youre saying you don't want to push far enough to actually have any chance of birthing the baby, does that make sense?

I think you need to think long and hard about this really and either accept that in some circumstances you will consent to instrumental delivery, or you won't in which case I'd suggest elective cesarean would be the better choice.

Agree that you need your birth partner to advocate for you if you are not able to. I also wanted this but was ignored and when I finally got a midwife willing to listen, the consultant said it was too late. Don’t rely on writing it in your birth plan or your notes either.

you might find however it just really is too late, that an emergency happens and forceps or ventouse are the fastest way to get your baby out.

They used the ventouse cup with my daughter. Would that be a consideration? Maybe say you want that if it needs to be instrumental.

Hi OP, I just want to add a different experience to maybe put your mind at ease a little bit just incase. I had my baby girl last week and she ended up being a forceps delivery, it was my worst nightmare while pregnant and I was terrified when they said that was needed but it genuinely wasn’t anywhere near as bad as I expected. I was then on a ward overnight with 2 other ladies who had c sections and in comparison I was in a far better way than them, where they couldn’t get up to go to shower/toilet alone, lift baby, feed baby, I was totally mobile and genuinely really not in much pain at all. Now 6 days on I’m back to normal, going out on walks, pushing the pram, able to do everything I could before. X

Agree with others that if it's necessary, it's necessary. Three things that may help avoid - no epidural, don't allow waters to be broken early, stay active during labour. May not be possible of course. Best of luck!!

You can absolutely say no to forceps and have a CS instead. It might not be what is recommended at the time but it is still your choice.

The ventouse cup as another poster has mentioned is different to forceps (and generally “kinder”) but if you need forceps then a ventouse likely won’t work.

As another poster has mentioned, avoiding induction and epidural, and keeping mobile (UFO - Upright, forward, open) will all help!

Have you looked at spinning babies?

As someone who lost over a litre of blood from perineal trauma and basically had my bladder and bowels rearranged thanks to forceps- just ask to arrange an elective c section. There's no real possibility of consent once labour is going, especially if the hospital is under pressure, and, no offence to anyone who works for maternity services, but in my experience no-one really cares about ongoing health or quality of life as long as baby comes out in one piece.

Thanks ! Yes I tried all the spinning babies advice, swimming, moving, birth ball, even cleaning carpets to be more on all 4s :)). Will keep trying, but so far no luck :(

I had failed forceps and an emergency c section for a b2b birth. They used a fetal cushion to push baby back up

Was this at UCLH or another place? This sounds re-assuring compared to what I've heard, did you not have an episiotomy? And no marks or anything to the baby?

Id book yourself in for a C-Section right now. If you wait you might not get one and back to back labour is horrific, ive been through it and know. Once it starts there will be no control over what interventions you have most likely

I was hoping more for like a 8cm mark to move to c section, not getting to the pushing stage. but maybe I am being too naive

Don't be on your back!! Heaviest part of baby is the back side, so you want to be forwards leaning from now on as much as possible, avoid sitting at a desk if you can? Lots of scrubbing floors on hands and knees, downwards dog etc! No slouching backwards on the sofa in the evening..have you looked up the Miles circuit? Plenty of vids on YouTube. Rebozo techniques can help with a suitably informed practitioner too.

Just a note to say I ended up with forceps, it wasn’t what I wanted but what was needed at the time and in the moment I just wanted to deliver my baby safely.

Agree with PP about opting for elective to avoid potential for forceps completely if you are that against it as you may end up too far along for a c-section in the moment and forceps may end up being the safest option at the time.

Good luck OP, I hope everything goes well, my DC is one so I remember these feelings well leading up to the birth.

I can’t help much with advice but I had forceps with my first and it was fine. 100% would rather had that than a c-sec. I had a fully ‘natural’ delivery with my 2nd with no pain relief and it was much worse!

What would be the point in labouring I til 8cm though? As you say, you wouldn't even be pushing then, so it wouldn't be possible to predict whether you are going to birth without intervention or not when you haven't even started pushing. Do you see what I mean? So there would be no point in putting yourself through a labour to get to 8cm and then request a section. The section would also be higher risks if you waited until then compared to having a planned one.

It was firmly in all three of my birth plans. NO FORCEPS. And to be fair it only came up in the last one but the surgeon was a dick who refused to look at notes.

I’d honestly book a section.

After a really bad forceps experience I wanted to avoid forceps again at any cost and booked ELCS.

The recovery was remarkably better for me and I never looked back.

I do know that trying to switch from forceps to CS isn't always safe for baby when it reaches a certain point, so if you really feel that strongly about it, don't chance it.

The other thing a midwife told me was to ask for the statistics of forceps being successful. Apparently asking for numbers makes them not want to put it to the test if there's a chance it won't go well, so they go to CS to be safe. But I'm guessing even that can't be used too late on in the game.

My second baby was back to back, very fast labour which was under 3 hours from start to finish. The pain was horrific, but when got to the pushing stage baby was out in 2 pushes. They hasn't realised baby was back to back. We were both in shock for a while after. I'd ask for an elective c section.

I was the same as you something about forceps just made me go noooooo and cross my legs throughout pregnancy!

Not that I would of said no of course intent getting baby out safely but my hospital offered the cup first anyway with an episiotomy which actually wasn’t as bad as I had thought it would of been! And no marks no baby!

And like the other poster I was in a much better position than my friends who had C- sections but it really is horses for course all we wanted baby here safely!!

My first was back to back and nobody had realised, I didn't need forceps but did end up with a 3rd degree tear.
My second was also back to back throughout my pregnancy, I opted for a section and honestly it was a lovely experience compared to first time round, recovery was a breeze and I'd do it all again in a heartbeat.
I think in your situation I'd opt for a planned section rather than leaving it to chance and then needing an emergency one anyway but if you do choose to go naturally make sure your birth partner knows what your wishes are in every situation and make sure they can advocate for you as you likely won't be able to for yourself by that point. Keep as mobile as possible throughout labour and do not push on your back, the worst way to birth of baby is back to back. Good luck with whatever you decide op!

I think it's so hard on a forum as everyone has such different experiences. I had forceps delivery with DC1 as they needed to get her out quick, relatively pain free with nothing more than paracetamol and would do that 10 times over then give birth to DC2 again who wasn't an instrumental delivery 😅

I agree with PP that deciding for a CS at 8cm may not be feasible. I'd perhaps either go for a ELCS or accept there may have to be some intervention if necessary 😃

Good luck OP!