I haven't been on these forums in a while - I lost two pregnancies in a row and took a break from forums - but I am 21 weeks pregnant right now, and working on my birth plan, and I've got a question.
I met with a doula on Monday to decide whether I wanted to hire her (I do). We got started talking about the hospital where I'll be birthing, and apparently the hospital is great in a lot of ways, and has a very low cesarean rate. That's great! She did caution me, however, that some of the residents are pretty forcep-happy. I am really, really opposed to forcep delivery, unless there's bad fetal distress and there are simply no other options - in which case, obviously I want them to do whatever's necessary. The doula told me that was fine, but to bear in mind that some of them will really pressure you to have the forceps. She said a lot if her mothers feel like I do, and she says the usually put in their birth plan that they do not consent to forcep delivery and would rather have a cesarean birth if there is an emergency situation.
Now to me, this makes a certain amount of sense. I think I'd rather have them cutting into me than risking my infant head injury and my pelvic injury, but otoh, it is a major surgery, so that does make me nervous. Ultimately, which is, in your opinion, more dangerous and/or traumatic for the baby? What about for the mom? Which would you choose? Are there any studies or anything that you've seen ... when I google, it brings up a lot of UK sites (not sure why), mostly just mom forums.
I would not want a resident driving the forceps.
One reason c sections are increasing is because there are fewer instrumental deliveries, and one reason for that is that c-sections are easier to teach. In an instrumental delivery, you have to feel what's happening and keep a light touch - it's challenging, and the instructor can't always tell if it's going wrong. If you must have forceps, you want the most experienced practitioners available. Not a resident.
Atul Gawande wrote an article on obstetrics for the New Yorker in which he touches on the shift from vaginal operative delivery to c section. The whole thing is pretty interesting.
Basically, I sgree with your doula, with a side order of insist on max experience if they tell you you need vaginal operative delivery of any kind.
Keep in mind that C-sections are a major surgery, which greatly increases the risk due to infection (I think about 1 in 10 women with c-sections get infections), may preclude you from ever having a vaginal birth, and may cause more difficulties with breastfeeding and bonding. I think a forceps delivery would be traumatizing for both the baby and myself, but I would still chose that over a c-section. If you plan on being unmedicated and trying different positions, walking around, using gravity to your advantage I think the chances of needing forceps or vacuum assist decrease dramatically, its more of a necessity when women are half-paralyzed laying on their backs, which is the pysiologically the worst possible position for labor and birth.
Hopefully it won't come to that, but it is nice at least that the doula warned you so you have a better idea what to be prepared for.
Oread, the risk that I'd be worried about with instrumental delivery is brachial plexus injury, which can cause nerve damage, and permanent paralysis. Spinal cord injuries are sometimes an issue as well. There are occasional horror stories where an instrumental delivery goes wrong, and an infant dies. I disagree with your calculation concerning whether the risk of trauma at this level is preferable to the risk of infection.
I was certainly not either paralyzed from the waste down or lying flat on my back for my vacuum delivery. I did have an epidural, but I was mobile, able to move, and moving. We tried a lot of things. In retrospect, I wish that I hadn't been so scared of surgery, because it would have been easier and safer in my case, and VBAC is very available in my city.
You mention not being able to hold a baby after c/s - I spent the first two hours after my ventouse delivery hemmorhaging and getting stitches, and I assure you, my child was not in my arms at that time. My point is twofold: surgery isn't the only thing that keeps you from holding the baby, and, long-term, big picture, a temporary inability to hold the baby right after birth is small change. I think hospitals should generally promote contact between moms and babies wherever it's safely possible, but I don't think a temporary delay in that contact is a risk to be considered in the same way that a broken collarbone or Erb's Palsy is.
For whatever reason I had at the time, I consented to an unplanned c/s with my firstborn over the possibility of needing forceps if he came further down. I had labored at a birth center and he was big, and needed more time, and I needed support to know to give him time, and so on and so forth. Transferred after ineffectively, prematurely pushing at 9cm and in the throws of hard contractions, felt injury to him was more likely with forceps than in the cesarean, even though the c/s that goes very smoothly carries long term consequences (ie gut health).
At home amongst the redwoods with my husband and my son, born 7/5/11 Instant CNM, just add !
I personally know two people whose birth stories include the detail that they pushed just a few times and their doc used the vacuum and then baby was born. I wonder what was at work there. Is the vacuum the new "We need to get the baby out NOW" technique? I don't know a lot about this.
Erigeron, I pushed for five and a half hours, and the last hour of that was the OB trying to get through the consent process to use the damn vacuum, in between contractions, while I had a bad case of labor shakes and a fever of 102. Obviously, this was not a "get the baby out NOW!" situation. (Also, I can't for the life of me tell you what I signed or what she said.)
Ventouse delivery involves less force then forceps, and is considered less likely to cause injury. If it doesn't work, though, you need to be prepared with a step two, either forceps or c-section.
Sorry it's taken so long to get back to this. Thank you for sharing your thoughts on the subject. I met with my doula and we discussed it again, and I ended up going with "I do not convent to use of forceps during delivery; I would prefer to have a cesarean if it becomes medically necessary." I'm not positive I'll go with that exact wording, but I've got a while to figure it out. Thankfully, my doula has had many years' experience and has a good rapport with the people at this particular hospital, and she has had experience with women refusing forceps. While I am we'll aware that there are risks to cesarean deliveries as well, I'm ultimately more comfortable with that than with forceps, especially in the hands of a resident.
Thank you again!