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 !

DD was B2B and I had a vaginal birth. It was long because she kept slipping back, but we got there in the end.

My mum started having severe pelvic issues after menopause all down to the forceps delivery she had when I was born in the 80s. She had zero issues in the intervening years, but the damage was done and became apparent many years on.

For this reason my Plan B (Plan A being intervention free vaginal delivery), was a C-section. Luckily my baby turned during delivery although I fully laboured in my back, which was relentless.

Ventouse instead of forceps if too late for C-section?

I had a back to back baby, really long labour, and several things I hadn’t wanted (pethedine, forceps, episiotomy) all happened. But I really didn’t care by that point. Pethedine brought me a sleep (ish) that took me from hardly at all dilated to 8 cm, after days of early labour. Then by the time it got to the forceps / episiotomy bit, I would practically have gone in with scissors myself. Couldn’t have cared less. Worked great, baby out safe, and I healed up fine.

Sorry OP, I think you’re being a little niave to think you can control exactly how your birth plan goes.

If you feel that strongly about no forceps and are willing to labour b2b until 8cm and be whisked in for an emergency section, I’d honestly just go for an elective section.

I would practically have gone in with scissors myself

This shouldn’t of made me laugh as much as it did, bless you @Talipesmum!

They won't check how dilated you are more frequently than every four hours so you're unlikely to hit the magic 8cm and know. Also things can change very fast - with my second I took five hours to get to 2cm, and 40 mins from 2cm to holding her!

It was somewhere else, but really not a horrendous experience. I did have an episiotomy yes, baby had a little mark on either side of her head where the forceps had been but both were completely gone within a few hours of delivery. Her heart rate was dropping during labour and it was the safest thing for us at the time so although I was scared I have no regrets and genuinely it was nowhere near the awful experience I imagined it would be. As I say I’m 6 days post birth now and for the last 3 days I’ve been out for walks with the pram, went out for lunch today, was walking around the ward in hospital once on the postnatal ward after delivery totally able to look after baby independently, go to the toilet etc and with the exception of the first 10 ish hours after delivery have only needed paracetamol & ibuprofen in terms of pain relief (and I am a proper wimp for pain, no pain threshold whatsoever) and haven’t had any pain relief at all for 2 days now purely as I just don’t feel I need it X

The thing is though, there are plenty of situations in which an obstetrician does not believe there is a high likelihood of a safe birth with a ventouse but believes there is with forceps. And you won't be able to convince an obstetrician to use a ventouse if they don't think it's going to be safe and effective.

Best way to avoid them is not to lie down in labour - so ball, walking about, all fours, and avoiding an epidural early on as they often make you lie down

OP, having a c section at fully dilated increases your risk of going into pre term birth with your next baby. I would maybe book an appointment with a consultant so they can give you all the benefits and risks of each option and you can make an informed choice.

There is no black and white, labour and birth can be very grey and in between so you need to be as informed as possible.

Everyone's experience on this thread will be different and you need to make the choice that's right for you, your baby and your family and also bear in mind your possible future family and impact on any future pregnancies because, despite what the previous poster says, we DO care about women and their future health.

@Bumblebeeinatree it's not as simple as that I'm afraid. Ventouse and forceps aren't used interchangeably. They have slightly different functions and can be used at slightly different times depending on the clinical picture at the time.

Yes, although unfortunately I did all those things in both my labours and still ended up with ventouse births both time.

I had a back to back Labour which was horrendous and ended with forceps (which actually wasn’t as horrendous as the contractions). My second baby was also back to back when I was due to be induced. The midwives gave me exercises to do to try to turn him - walking up and down stairs ideally sideways, bouncing on a birthing ball - these were before Labour. They had other ones I did in Labour. It worked and he turned and I had a natural delivery wirh him.

Your checked every 4 hours so depending how you dilate you could be passed 8cm.

I agree your best arranging a section as you have no idea until that moment if you need assistance or not.

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.
I had forceps with my first, had an epidural so pain wise it was fine but he needed out quick and I was already pushing.
A load of staff burst through the door and he was out in minutes. Cord round his neck so if it wasn't for the forceps I dread to think what would have happened.

I didn't need any help with my back to back labour. It was painful and slow, but I only had gas and air, nothing else.

My DD was back to back, ended in forceps and a large PPH. The forceps themselves weren’t awful, the contractions were incredibly intense and I found recovery from the episiotomy hard. I am pregnant again now and am considering electing for a c section this time. The risk is if baby is too far down the birth canal but just a bit stuck, they will likely just want to get baby out as soon as possible so at that point it’s too late to refuse forceps and request a c section.

I had emergency forceps delivery.
I went from 2cm to 10cm in 20 mins and they didn’t tell me at the time but my babies heart rate was dipping with contractions.
I too was terrified I’d read the horror stories but once I was on the table and had had the epidural and wasn’t in pain my brain let me process it calmly - the doctor who came in to do the delivery at 1am was reassuring and calm and within a couple of minutes my daughter arrived. Yes she had some red marks on her face from the forceps but they had gone within a few hours. I had a couple of internal stitches and my recovery was super quick

DD1 was b2b and no one realised until I'd been in labour for aaages. Ended up with a spinal block, episiotomy and forceps in theatre.

DD2 was an elective c-section, due to placenta previa.

The c-section was a much calmer experience (but I don't know how different it would be going into it after already labouring), but recovery from the forceps birth was much easier.

Surely chances are the baby could turn last minute anyway? My baby was in a perfect position the whole way through and then went back to back while I was in labour 🙄

thanks ! can i ask, if you remember at which stage it turned? they say most turn in labour but can't figure out if is in the active labour or mostly once 10cm dilated. did you do anything in labour to help? or did the medical staff?

@Inaina

I stayed on all 4s or lent over the bed. They kept asking me to move my hips/body into different positions to help him move. I vaguely remember feeling him almost clonk out of position, and then he came very quickly after that.
But the back labour pain/pressure I felt in my back/bum was intense and didn't stop between contractions like I was promised in antenatal classes. I think it was worse than the contractions themselves.

I didn't have any interventions or medication at all during labour, which is how I wanted it.

It was my first so I don't have much to compare with (& I won't be having another).

I was also B2B when I was born with forceps. With my mum now suffering the consequences several decades later.

My eldest was back to back and we didn't know until labour and when I was admitted into hospital. I will be honest, it was a very long and drawn out labour, started on the Friday afternoon and he wasn't born until early hours of Monday morning. I managed to get to fully dilated, but by that time we had both just had enough, I was exhausted and his heart rate was dropping and coming back up again.
In the end I needed an emergency c section anyway.
Not saying this will happen to you but anyone who's baby has been back to back during labour will tell you it is not pleasant at all (not that labour is in general).

My second labour I opted for a planned c section and whilst it wasn't perfect, it was better for so many reasons.

OP are you concerned about a forceps delivery for yourself (e.g. damage to the perineum) or concerned about forceps for your baby? I ask because my EMCS delivery of my back to back baby also resulted in a forceps delivery as he was well and truly stuck and had to be pulled back out through the sunroof!

My first baby only turned back to back during labour despite me labouring at home, being upright etc. Labour was very long and my DS went into distress so we had to have an EMCS.

My second baby was a ventouse delivery, again due to distress. I didn't have any pain relief and didn't have an episiotomy. There were no complications for either me or my DS. From my experience the CS was far more invasive and more difficult to recover from.

I also had a fear of forceps so I feel you.

My baby turned when I was about 10cm, just before I started pushing. The midwife had me lie on my side with a peanut ball between my legs to open up my pelvis and encourage him to turn.

No instruments required, very successful delivery (although I did have a second degree tear and a minor PPH).

I think there's a lot of scaremongering about childbirth, both of vaginal and c-section deliveries. We all get through it though, and most of us even do it again. I wouldn't have a c-section just in case your delivery could have complications. I also know someone who had a c-section and the doctor still had to use forceps to get the baby out!

Back to back labour is hard so keep your mind open about pain relief if you decide to go for it, I got no breaks between contractions. I found the TENS machine helped for a lot of it but also asked for an epidural as I progressed (which I hadn't planned for).