Intervention: What thought disturbs you more.

[paradise lost]

Inertia you are perfectly within your rights to decline vaginal examinations, they are not necessary - checking labour doesn't make it happen betteror faster!

DD gave me a 2nd degree tear with her shoulder on the way out which i didn't have stitched (my choice) and it healed beautifully without any of the painful scar tissue some of the women i know who WERE stitched have. I know a woman who had a 3rd degree tear after her planned unassisted homebirth. She didn't have it stitched either, just kept her legs together for 10 days (tied her knees together loosely when she was asleep so she wouldn't part them too much) and she too healed up fine. Tears are generally not volunteered for but unless you tear through the rectal mucosa stitches are a choice.

Bx

[Inertia]

Hoobley - I was thinking in respect to episiotomy. My perinium has never failed me before, so I have enough faith that it can get through it just fine - but accepting a method that would voluntarily ask for manual perineal dissemination is a whole new ball game.

Oh, and Thank you for the information on examinations. That one is definitely going into the birth preferences. I'm happy enough for them to stand and watch from a distance!

[Tobily]

I would never choose a caesar over a vaginal birth even if there were instruments involved.

Instrument births don't always involve an episiotomy, although your risk of having one is certainly higher where instruments are used.

The midwives there told me that a lot of obs won't use forceps now and would have simply sent me for a c-section.

This is true I reckon. I have only seen one forceps birth which was in a public hospital, and it would have been a ceasar if she'd been with the private OB that she ditched a week beforehand. Forceps are most often used when the baby is still high - high enough to do a caesarean. The use of forceps is on the decline with obstetricians because they are opting for c/sections instead.

Ventouse most often comes out when the baby's head is on view (ie. baby is very low in the birth canal) and there is a desire to get things over with. Sometimes that's from the mother but most often it's from the caregiver. I have seen one situation where the baby's heartbeat was seriously bottoming out and not recovering and the ventouse was probably justified...but most of the time I see it used it's purely impatience.

The point of all that ramble being that it's rare that instrument use is a life and death scenario.

[Janie]

Mmmm, it's interesting re. the whole forceps/c-section thing. I had a four hour second stage, with a malpositioned and posterior baby. Ob let me go on my own (with midwife support, he was just in the background) for almost three hours before he got ansty. Even then he didn't rush into anything. Ventouse was eventually tried a number of times, but my bubba wasn't moving, he was seriously stuck! Eventually forceps were called for, and with them and some almighty pushes DS was born. The middies all said that any other Ob would have had me in theatre, that I was lucky to have him. I never thought before that that was because of anyone's reluctance to use forceps, but maybe that was what they meant. I think time-frame would have had something to do with it too.

Um, yeah, I would definitely prefer a birth without intervention, but I was glad the forceps were around for my DS's birth, and it was far from a traumatic experience, I loved every minute of it!

[Tobily]

Mmmm, it's interesting re. the whole forceps/c-section thing. I had a four hour second stage, with a malpositioned and posterior baby. Ob let me go on my own (with midwife support, he was just in the background) for almost three hours before he got ansty. Even then he didn't rush into anything. Ventouse was eventually tried a number of times, but my bubba wasn't moving, he was seriously stuck! Eventually forceps were called for, and with them and some almighty pushes DS was born. The middies all said that any other Ob would have had me in theatre, that I was lucky to have him. I never thought before that that was because of anyone's reluctance to use forceps, but maybe that was what they meant. I think time-frame would have had something to do with it too.

Absolutely Janie. A four hour second stage when it's known that the baby is posterior would be completely unheard of in alot of hospitals. Most OB's would tell you that you're not going to birth vaginally at that point and want to do something. Even with an anterior baby usually 1.5 to 2 hours (first baby) is where there will be pressure to intervene.

[paradise lost]

Bec, with DD she went into distress 1 push before she was born, and i was lucky i was that close that i didn't end up with any intervention TBH. Labour progressed beautifully, everything was perfect. Waters were broken at 9cm (but even if i hadn't agreed to that, realistically they would have broken very soon after), third stage began 10 mins later (2 contractions, but there weren't monitoring her, so not sure what HR was doing in that time). My DD had an extremely long cord (infact, the longest they had seen in a very long time), which was wrapped incredibly tightly around her neck, twice. They couldn't get it off her neck, and said to me that i needed to get her out that push. (i also felt them using the doppler i think??) Luckily i mis-heard them, and thought they were telling me "common, you can get her out this push", because i didn't freak out (well, any more than normal), and she was ok. She pooed all over me straight away, and was born very gray and looked like she was dead.

I was lucky she had the waters cushioning her, because i believe i would have (and probably rightly), ended up with a c/s for feotal distress. And if i didn't get her out that push they would have done an episiotomy and whatever else they needed to, to get her out quickly.

But her head was already born right, or how could they see the cord? And if her head was already born then none of the 3 listed interventions would have been of use, see what i mean?

Your waters DID protect her until they were ruptured for you, and probably that is what they are there for (those small number of babies who need the extra protection for labour) and perhaps if they hadn't been broken she would have had no issues whatever - think of the number of women who have a c/s after AROM because baby is in severe distress - clearly birth works better when not messed with for the majority. Many women's waters break as the head descends and rotates through the pelvis just before birth, and it's possible that they are designed to do so (mine broke 15 hours before DD was born, but i'm sure the 5 stretch and sweeps i had had over the previous 10 days contributed and i know better for next time).

I'm not dismissing your experience, i just don't see how intrumental or surgical assistance would have helped at all. The only thing that could have been done differently is not to have the AROM and that's a lessening of intervention, not an increase.

Bx

[Yael]

If the head is out and not the shoulders, and i couldn't have got her out they would have given me an epi. My friend had the same experience, and even with an epi they couldn't get the baby out, and they used the vacuum to help tug her out.

If they were monitoring me after my waters broke, and she was in distress then, then i would have ended up with probably a late c/s.

Yes my waters were broken, and it was also 15 mins before she was born, so although it is technically an intervention, they were probably just about to break anyway. At which point the same thing (i.e. late distress) would have happened anyway. I declined the offer for them to be broken at 6cm (and my obs respected my choice), as i felt that it was an unnecessary intervention, and in the future i would make the same choice with subsequent births, that the waters are there to protect the baby for a reason.

The point of my story is to point out that even without obvious signs of something going wrong, things can change at the last minute, and this does lead to surigcal intervention when necessary. And i would have been happy for them to do an epi if my daughter needed it, becuase i trust my care provider that he would only do these things if necessary.

[OceanPrincess]

... becuase i trust my care provider that he would only do these things if necessary.

Hear hear

[Ca Plane Pour Moi]

I had a ventouse without an episiotomy. But then I had another one with because DS was posterior. TBH, the ventouse was quite easy and fairly pain-free for me. Trying to turn DS was NOT easy or pain-free LOL. I'd go for... actually, I'd go for kicking the Obs in the head before letting them anywhere near me, but ventouse would be my option I guess if I didn't have the machine-gun to hand.

As for "don't let them"... that implies you have a choice which cannot be overridden because someone else says so. I very much hope no-one overrides your choice, Inertia, but having the plan is a GOOD thing because at least that has more of a chance of being the first option someone decides to try, telling you about it when it's almost done, if not a few hours later.

[Toomanytoomany]

I'd go for... actually, I'd go for kicking the Obs in the head before letting them anywhere near me, but ventouse would be my option I guess if I didn't have the machine-gun to hand.

This made me laugh quite a bit.

[widdly]

I would go straight for the c-section.

For me, I tore and got stitched up and that really traumatised me for quite a while, so rather than have the trauma of forceps or ventouse I would go straight for the c-section and keep my vagina in tact.

[Glamourcide]

I am *petrified* of episiotomy... don't ask me why, I just am. Like, phobic. During DD's birth, the old hag midwife I had (oh, she was a right ol' cow... don't get me started) leaned in close as I was struggling to gather enough strength to push again, and threatened to 'cut me' if I didn't 'stop whingeing and do what you're told'. I was so frightened that she would just go ahead and cut me without my permission that I shut up and just about tore myself to shreds trying to get DD out - there was nothing wrong with her, the monitoring equipment had slipped and they weren't getting a proper reading of her heartbeat so the old cow assumed she was in distress and kept hurrying me.
Thankfully I gave myself enough time to stretch naturally, I didn't tear or have any problems and it has just made me more determined to avoid an epi unless it is literally a matter of life and death.

I would much, much prefer vacuum over anything else, provided it could be done without an epi. Forceps I would take if necessary, again, but I'd still prefer a vacuum extraction over forceps - I watched a few assisted-birth videos before having DD and vacuum looked like a much gentler, less traumatic option than reefing the poor kid out by its head with big tongs...

C-sec would be an absolute last resort for me, but as others have said, a lot more doctors these days don't offer the option of forceps or vacuum and will just send you for a c-sec as they 'know what they're doing' and don't have much experience with forceps etc. In fact, when I was discussing birth options with my midwives before DD's birth, and I mentioned vacuum, I was told flat-out that 'we don't even *have* vacuum equipment in this town - it's forceps or c-sec if you can't do it yourself'.

[Snacks]

I really dislike the foetal monitor so can I opt for a doppler or other form of intermittent monitoring?

Of course. They will probably insist on fetal monitoring only if they have already intervened previously (i.e. synto drip or epidural). With Natty, I was only monitored with a doppler intermittently. (In the pushing stage, they would monitor her briefly between contractions which was still bloody annoying but much better than the fixed monitor!)

[Inertia]

Of course. They will probably insist on fetal monitoring only if they have already intervened previously (i.e. synto drip or epidural).

Oh good. I don't have to worry about the epidural - the chances of them getting a needle within 5kms of my spine is non-existent. And I will happily tell them I am not responsible for the my phobia driven defensiveness if they even try it (which the pathologist today did not help at all. I *really* miss the path from Nepean). I do manage to keep myself still enough to get a canula for synto drip, but they only have my permission to use it in the third stage to prevent repeat PPH. I wont even let them attach the bag until after I have delivered the placenta.

Its really coming together now!

Goth: That mw sounds like a right cow. Only had 1 like that when I had Sam. I remember the conversation going something like this.

MW: Don't push yet, you're not ready
Me: I'm not bearing down yet. I've done this before too you know.
MW: Well I have delivered hundreds of babies.
Me: and here I was thinking I was doing all the work.

She was just getting impatient because she had already written the DoB on the baby tags and it was half past 11. No faith whatsoever in us at all. *sigh* If she had the slightest clue on how much of that contraction I didn't push for... They wouldn't go away without some form of push - and that seems to be about the norm for me - so something must be happening that requires a little push.

[BekZ]

OMG I really haven't thought about assisted deliveries. I have been fortune enough to birth my 2 girls without any assistance. Makes me think that I need to read a bit more so that I have informed choices

[Toomanytoomany]

OMG I really haven't thought about assisted deliveries. I have been fortune enough to birth my 2 girls without any assistance. Makes me think that I need to read a bit more so that I have informed choices

I must admit I've been very complacent. I've had five very easy deliveries, and always assumed they would be so. Now that I'm heading towards some high risk areas (age, multiparity) I'm considering those issues much more carefully.

[Junglemum]

I had a private OB in a private hospital and had a forceps delivery. No episiotomy, 3 stiches.

There was no option of ventouse as she was too high. It was either forceps or emergency c/s. If i wasn't 10cm i would have been heading to theatre. I was so glad to be able to have forceps, to me it was a much better option than C/S.

I think it is great to have preferences, but sometimes a particular situation will not allow for a choice. I am fortunate in the same way Yael is, i totally trust my care provider and know he is on the same page as me.

But my answer to the original question..... IF i had a choice. Vac or foerceps first. C/S absolute last resort.

BTW- That midwife sounds like a cow, do like your comeback though!

[Jas]

I'd opt for vac, forceps and the cs and before all that I would be politely be telling them to go stick their time constrains and only opt for any of these options if it was a TRUE EMERGENCY!!! And in the case of a TRUE EMERGENCY I would opt for all and any of the above!!