Forceps more likely to hurt mothers and babies than C-sections

Obstetric forceps

I’ve been writing recently about the moral panic surrounding C-sections.

A moral panic is a widespread fear, most often an irrational one, that someone or something is a threat to the values, safety, and interests of a community or society at large.

The handwringing about the high US C-section rate of 32% is a widespread fear, generally irrational that C-sections are a threat to the safety of women and babies.

More babies and mothers were injured by attempting to avoid C-section than by C-sections themselves.

The World Health Organization’s “optimal” C-section rate of less than 15% is Exhibit A in the moral panic. The WHO continues to cling to this fabricated figure despite:

Acknowledgement there is not and has never been any evidence that 15% is the optimal rate
Best studies to date demonstrate a minimal rate compatible with low perinatal and maternal mortality of 19%
International data that shows that C-section rates of over 42% are compatible with excellent outcomes

Exhibit B is the recommendation to reduce the C-section rate by promoting operative vaginal delivery (forceps and vacuum) instead. One of the reasons why the US C-section rate has increased is because operative vaginal delivery has fallen out of favor. The recommendation to revert to operative vaginal delivery makes no sense because the risk of severe perinatal injury and severe maternal injury are increased by operative vaginal delivery compared to C-section.

The 2017 paper Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery is yet more evidence of the harmful effect of operative vaginal birth.

What is operative vaginal delivery?

It is a procedure (using forceps or obstetric vacuum) used to deliver a baby during the pushing phase of labor. It is used for two main reasons: the baby doesn’t fit (dystocia) or fetal distress. The station of the baby’s head determines whether an operative vaginal delivery is midcavity, low or outlet.

…At midcavity station the leading part of the fetal skull is between 0 and 2 cm below the spines, at low cavity it is >2 cm below the ischial spines but not on the pelvic floor, and at outlet station the leading part of the fetal skull is on the pelvic floor and visible.12 Operative vaginal deliveries at midcavity require the greatest operator skill and experience; consequently, it is at midcavity station that the decision between operative vaginal delivery and caesarean delivery presents a serious challenge…

This study involves midcavity operative vaginal delivery and looks at severe perinatal and maternal morbidity.

Severe perinatal morbidity/mortality included convulsions, assisted ventilation by endotracheal intubation, 5-minute Apgar score <4, severe birth trauma (intracranial haemorrhage, skull fracture, severe injury to the central or peripheral nervous systems, long bone injury, subaponeurotic haemorrhage, and injury to liver or spleen), stillbirth and neonatal death. Severe maternal morbidity included severe postpartum haemorrhage (requiring transfusion), shock, sepsis, obstetric embolism, cardiac compli- cations and acute renal failure. Secondary outcomes included respiratory distress in the infant (including hya- line membrane disease, idiopathic respiratory distress syndrome, transient tachypnoea of the newborn and other neonatal respiratory distress), postpartum haemorrhage, as well as birth and obstetric trauma. Birth trauma included intracranial haemorrhage, injury to the central or peripheral nervous systems, injury to the scalp or the skeleton, and other birth injury. Obstetric trauma included severe perineal lacerations (third- and fourth-degree), cervical and high vaginal laceration, pelvic haematoma, obstetric injury to the pelvic organs, pelvic joints or ligaments, and other obstetric trauma.

They used an intention-to-treat analysis:

Women who had a failed operative vaginal delivery (and eventually delivered by caesarean) were included in the operative vaginal delivery group. This ensured a clinically appropriate comparison of the different modes of delivery using an intention-to-treat framework.

What did they find?

Among deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity/mortality compared with caesarean delivery (forceps ARR 2.11, 95% CI 1.46–3.07; vacuum ARR 2.71, 95% CI 1.49–3.15; sequential ARR 4.68, 95% CI 3.33–6.58). Rates of severe maternal morbidity/mortality were also higher following midcavity operative vaginal delivery (forceps ARR 1.57, 95% CI 1.05–2.36; vacuum ARR 2.29, 95% CI 1.57–3.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity/mortality following attempted midcavity vacuum (ARR 1.28, 95% CI 1.04–1.61) and in severe maternal morbidity following attempted midcavity forceps delivery (ARR 2.34, 95% CI 1.54–3.56).

The results are expressed in this table:

920A4F32-9FF5-46D4-8252-1D14EAC72B13

I graphed the overall results for severe perinatal and maternal morbidity:

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It’s easy to see that operative vaginal delivery increases the risk of both severe perinatal and severe maternal outcome. The greatest risk is sequential application: for example the vacuum is tried but doesn’t work and then forceps are tried.

The authors explain:

…[A]ttempted midcavity operative vaginal delivery was associated with an increased risk of severe perinatal morbidity/mortality compared with caesarean delivery. The magnitude of the increased risk varied by indication for delivery, being significantly larger in the dystocia group relative to the fetal distress group. This difference in the effect of attempted operative vaginal delivery by indication appears to reflect the greater fetal jeopardy associated with fetal distress and the consequent higher baseline rate of adverse outcomes even in the caesarean delivery group. We also found substantially greater risk of birth and obstetric trauma following operative vaginal delivery compared with caesarean delivery, with 2.8- to 8.5- fold higher rates depending on indication and instrument.

And for mothers:

The increase in severe maternal morbidity following midcavity forceps delivery was primarily due to the increased rate of severe postpartum haemorrhage…

Third- and fourth-degree perineal laceration rates in our study were high following midcavity operative vaginal delivery. Similar high rates have been reported in other recent studies of operative vaginal delivery… With rates of obstetric anal sphincter injury as high as 23.0% following attempted midcavity forceps deliveries, it is imperative that the risks and relevant long-term quality-of-life implications for pelvic floor health of attempted midcavity operative vaginal delivery be discussed with women both in the antenatal period, as well as during labour (as currently done with regard to the surgical risks associated with caesarean delivery).

Every midcavity operative delivery was attempted in the express effort to avoid a C-section because of the purportedly harmful consequences of C-sections. Yet the “cure” turned out to be worse than the “disease.” More babies and mothers were injured by attempting to avoid C-section than by C-sections themselves.

The bottom line is that attempting to lower the C-section rate by substituting midcavity operative vaginal birth is bizarre because operative vaginal delivery is harmful.

There is nothing wrong with a high C-section rate. It is completely compatible with excellent perinatal and maternal outcomes. The current handwringing about C-section rates is the result of moral panic, generally irrational, and we should get over it.

  • Betty Gelsworh

    OT- sorry- but if any of you have time on your hands please join in this discussion on homebirth on popular UK forum mumsnet. All sorts of nitwittery on this thread and I am losing the will to argue. FWIW I am an admirer of Dr Amy and am also former attachment parent/ bf fanatic. I firmly believe hospitals are the safest place for babies to be born
    https://www.mumsnet.com/Talk/am_i_being_unreasonable/3199294-To-want-a-home-birth?pg=22&order=

  • Sue

    Question for any lurking radical-NCBers: does a forceps-assisted vaginal birth qualify for “natural”? What if the forceps are yielded by a midwife?

    Are the sparkly-points discounted if the baby is pulled through the birth canal, rather than pushed? Just asking.

    • Anna

      Ex cult member here. I can tell you that you dont get any NCB medal if you had any intervention, that includes IVs, scans, VEs, AROM – but, a forceps birth is still “better” than a c-sec. I saw a screen grab from a homebirth groups a few months ago and one of the high ups posted “cant stand it when women say thay had a natural birth but turns out they were induced or had augmentation or interventions”. In NCB all interventions are bad except chiro, herbal crap, homeopathics or rebozo. So basically if its quackery its okay.

      • Sue

        OK – so only “interventions” that don’t work are allowed.

        (Glad you found your way out of the cult!)

        • Anna

          The hard way.

      • EmbraceYourInnerCrone

        SO if it was used medically after 1850 it’s not allowed (actually forceps have been around since about the mid 1700’s), I think Queen Victoria used chloroform for her 9th birth in 1853…

  • mjd3

    It seems to me the distinction between low-forceps/vacuum and mid-forceps is really important! SOB, can you do a follow-up piece to provide some additional information for women to be able to discuss this with their OBs? Obviously if forceps are the only option and a c-section is impossible or more dangerous, most women would want that. But if forceps are being chosen as a way to avoid a c-section, that’s different!

  • Tbird

    Thank you so much for the kind words! I needed that validation today!! My mother has been especially judgmental lately about my parenting…

    • maidmarian555

      It is hard when your own mother isn’t nice. For me, it wasn’t until I had my own children that the penny really dropped and I realised that actually, her behaviour isn’t acceptable. Nor is it something I need to be exposing myself to all the time. I maintain contact with her but I minimise it to maybe one visit a month/6wks or so. That’s about my emotional limit, even though I know her criticisms are mostly bullshit, it’s still quite hurtful when she comments on my toddler’s behaviour (he’s not even 2 yet, he’s going to run around like a maniac if he feels like it) or the choices I make for my children. I’d recommend this arms-length approach if your mother continues to behave unkindly. You really don’t have to tolerate it if it’s upsetting you.

      • Tbird

        I feel the same way!! I try to keep her at an arm’s length but she is so invasive. She calls me everyday and is very nosey. Your mother sounds identical to mine! She says the same things about my toddler’s behavior, she’s 15 months! Of course they have tantrums, she can’t communicate yet!

        • maidmarian555

          It has taken me years to shove her back to this distance. I think if she went back to her old ways and tried to impose herself into my life more then I’d probably have to cut her off as it’s just too exhausting dealing with her nonsense and with two babies I just don’t have the energy for it anymore. She doesn’t view either me or my little brother as people. We are hers, we are her property, her stuff. She has no boundaries, when I was a teen, she’d insist on opening all my mail because she couldn’t cope with the idea that I might have something going on in my life that she wasn’t controlling. Eventually my Dad sort of put his foot down and told her she couldn’t do that any more as I was almost an adult so she’d bring my mail up and sit there until I opened it in front of her (if I said I would look at it later she’d literally scream in my face until I opened it. I never had any interesting mail, it was only ever bank statements or advertising circulars etc). I mostly moved out at 16 and spent a number of years sofa surfing out of a backpack as her behaviour was suffocating and unbearable.

          I’ve had to be very clear where the boundaries are. She has made a big fuss about that (and god knows what she says to her friends about what an awful person I am) but over time she’s stopped fighting. It’s honestly like having another baby to take care of sometimes.

          • Sue

            Kudos, maidmarian, for having emerged from such parenting with so much insight yourself!

          • maidmarian555

            Thank-you! It has taken a lot of work to get where I am now. I was sure for many years I would never be a parent myself as I was really worried about whether I had the necessary emotional tools to be a good mother, and I certainly didn’t want to visit an upbringing similar to the one I had on another human being. I am really grateful that life and circumstance has lead me to where I am now as I really enjoy being a mother (I also really trust my partner- he would absolutely not put up with me behaving the way my mother behaved with us and would call me out on any of that sort of nonsense within a heartbeat).

      • Cat

        “For me, it wasn’t until I had my own children that the penny really dropped and I realised that actually, her behaviour isn’t acceptable”

        It’s funny, isn’t it, how having your own children makes you question the way you were parented yourself? My mother isn’t all bad at all, but I had a moment of shocked recognition the first time I heard her snap “don’t be a wimp” at my 10 month old baby daughter when she cried because she’d fallen over attempting to cruise the furniture. Also, it was a bit of an eye-opener that, when I was struggling in the first few days with a newborn and an infected incision, she thought what I really really needed was for her to go and buy me a very expensive hair removal thingummy because my priority ought to be my slight increase in facial hair during pregnancy (and then she guilt-tripped me endlessly about the price when I didn’t use it, even though I hadn’t asked her to buy it and didn’t have time even to read the instructions). Families are weird.

        • maidmarian555

          Oh wow! That’s….inappropriate. To say the least (I mean jeez, like we don’t all know we look pretty rough right after having a baby. It’s supposed to be the one damn time in your life where you just focus on adjusting to living with your tiny, shouty, poopy new addition whilst inhaling chocolate biscuits and not actually worrying at all about your slightly dishevelled appearance).

          My mother used to tell us a ‘funny’ story about this one Christmas Eve where my parents got gifted some ornament and we found my baby brother having a good chomp on the polystyrene box, hiding behind the sofa. He was violently sick all Christmas Day. Haha, funny baby eating plastic right?! My bro and I were talking about it fairly recently and I realised, with some horror, that if that happened to my baby we’d have been in A&E faster than you could blink. My parents didn’t even take him to the GP. He ate a fucking plastic box and they did absolutely nothing. I seriously can’t fathom how they justified that inaction in their own heads.

  • Libby

    I’m pregnant now. My first child was 10 lbs with a nuchal hand and we are fortunate that labor and delivery was relatively gentle on us both.

    How can I discuss this with my doctor or my current pregnancy? Can I ask her about her experience and preferences with operative vaginal birth? Can I say if it gets to a point where the baby is stuck up high, I would prefer a c-section to a forceps or vacuum delivery? Or how much time is there usually to discuss options when there is an emergent stuck baby situation?

    • Sue

      Libby – you SHOULD be able to discuss these issues in advance. Much better to have it sorted out pre-emptively than in the heat of the moment. it would be good to come to an agree position with your provider about the relative risks and benefits of the available choices.

    • Sue

      Libby – you SHOULD be able to discuss these issues in advance. Much better to have it sorted out pre-emptively than in the heat of the moment. it would be good to come to an agree position with your provider about the relative risks and benefits of the available choices.

  • mabelcruet

    Incredibly biased article in the Daily Mail (this is a donotlink link so the Mail doesn’t get the views.

    https://donotlink.it/Y3ba

    • Gene

      I lost count of the number of times I rolled my eyes when reading that “article”.

  • AnnaPDE

    I’m glad there’s proper statistical evidence being collected and published on this, but really it’s a bit obvious…

    For example, that the dystocia outcomes are a lot worse for forceps/vacuum than for C-sections: No shit, Sherlock. The need for some kind of medical assistance arose in the first place because the pretty effective process that usually gets the baby through the mother’s pelvis failed and the baby got stuck. In other words, there’s already empirical proof that this kid does not fit through that passage even when some pretty strong directed forces are applied. Clearly, applying extra tools and forcing it through will have a good chance of damaging the kid, the passage, or both.

  • Gæst

    I’ve mentioned this before, but I was delivered via forceps decades ago. I don’t seem to have any long-term damage myself (but since my mother was put under GA and my father not allowed in the delivery room, I don’t think anyone knows what condition I was in at delivery), but my mother suffered a broken tailbone (and possibly other issues she never shared with me) and her OB told her after that it should have been a c-section delivery.

    • Mishimoo

      You are so lucky! My husband’s grandmother was a forceps delivery which appears to have contributed to issues with her mastoid processes. It may have also caused some brain damage – she has evidence of minor brain damage as well as suffering learning difficulties in school and afterwards.

      • Gæst

        I was bruised when I came out and that seems to be it – so yes, lucky indeed. My mother was less lucky.

    • Tigger_the_Wing

      I wish I’d had a GA when my second was delivered by forceps in 1982. Or any pain relief whatsoever. My husband was there for the whole thing – he was pinning my upper body to the bed whilst other people were restraining the rest of me, and he says he was deaf in one ear for a week as a result of the screaming. My son – who was bright blue – was rushed off to the special care unit. Apart from some mild learning difficulties (dyslexia) he’s fine.

      • Gæst

        I’m sorry that your delivery was so awful. My own kids were delivered by emergency c-section, but I had an epidural and didn’t have to feel it.

    • I was failed forceps, 30ish years ago. I wouldn’t fit for some reason, but my mom was determined that c-sections were a failure so they kept trying to get me out the ‘normal’ way for hours. By the time she let them cut me out I had some nasty head-bruises and had to spent the night in a toaster oven lookin box cause they were afraid I might have inhaled meconium. I never really thought much about it till they started saying ADHD might be caused by fetal oxygen deprivation during birth. That makes me wonder if mom had consented to the section the FIRST time the docs said I wasn’t going to fit… would life have been easier?

    • Gene

      I was a forceps delivery. And 10 days in the hospital post partum stay, even for normal healthy deliveries. That was what was done in the UK at the time. I don’t know if my younger sibling was or not, but it was a different country. My first was a vacuum assist. Second and third weren’t.

      I spent a lot of time chatting with my OB about vacuum vs forceps vs section for my second. He was the hefty 5kg/11lb monster. My OB was in his 60s and was very well trained in instrument delivery. He thought forceps should be be taught, but given a choice, section was much safer. OBs trained now are often less comfortable with forceps for good reason. Section is safer for mom and baby.

  • mjd3

    Can you explain this clinically? Is there ever a point of no return, where you have to use forceps because a c-section isn’t an option yet? Would you literally only chose a midcavity forceps to avoid c-section, or is there ever any other reason? And low-cavity forceps are not discussed in this article, right?

    • Forceps deliveries are divided into three basic types: high, mid, and low. Today there is NO justification for high or mid — these antedate general anesthesia and antibiotics, befor C/S became feasible.. Much better for all concerned to go directly to C/S. Low, or outlet forceps, are done with the head on the perineum, when the mother is out of oomph to push any more, and really just needs a helping hand to get the vertex past the perineum. By that time, the head is so low that a C/S is almost impossible. (There are also a couple of kinds of special forceps used for special conditions, like Pipers for the aftercoming head in a breech, but since vaginal breech deliveries are rare these days, most doctors have little experience with them)

      • mjd3

        This article is about mid-forceps deliveries though, right? So why are they still being done (at least where a safe c-section is an option)?

        • Charybdis

          Because the CS rate MUST come down! For um, VERY IMPORTANT REASONS!!

          Toss in some fear-mongering about bonding and
          breastfeeding problems, add some angst about “microbiome” and garnish with a reference to WHO and their completely arbitrary, made-up “optimal” CS rate of 15%. Voila! The recipe for why forceps and vacuums are somehow “better than” a CS.

          • Mishimoo

            I think part of it is also the nostalgic nonsense – forceps were good enough in the olden days! There were no caesareans, everyone grew up tough and healthy, there was no sickness or obesity; people are all lazy and weak nowadays.

          • Lilly de Lure

            I’m just amazed they’ve stopped at forceps (which were after all invented by ebil doctors – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704058/) birth hooks were good enough for honest-to-goodness midwives down the centuries, why not for spoilt modern women?

          • sour_sadie

            Because that means we’d actually have bodily autonomy, more control. You know, something that only teh white menz can have, provided that they’re abled(developmentally, mentally, neurologically, invisibly physical, or physical).

          • Sue

            And nobody talked about the multitude of “women’s problems” openly – they just put up with them.

          • Mishimoo

            Exactly! Nan keeps saying “We never had things like this (depression, PTSD, autism, anxiety, teen pregnancy, lgbtqai people, etc) back in MY day.” and we just keep gently pushing back until she goes “Oh, except for…” and realises for herself that it just wasn’t talked about.

          • Anna

            Funny thing is if they got their way and c-sections were banned tomorrow and everyone had a nacheral homebirth they still wouldnt be happy because then they wouldnt be special anymore.

        • I actively worked in L&D between 1967-2001 in the US, UK, and Israel. [Between 2002 and 2012 I worked in an outpatient clinic before retirement] I never saw mid-forceps attempted even once; hardly ever even saw a Scanzoni maneuver to correct a persistent occipito-posterior position, instead of going for C/S. I was taught in the 60s that mid-forceps were obsolete even before there were epidurals and all C/Ss were done with GA.

          I can only think the practice continues where the facilities for C/S do not exist. But I’ve been in Israel since 1976, so I don’t know if there are any hospitals in the US which still think it’s preferable to do midforceps extractions.

          • StephanieA

            We have one doctor that still uses them, and will use them for persistent OP. He is truly a master at them, I’ve never seen anyone else as skilled with forceps. But I don’t know if skill has any bearing on whether a woman has pelvic floor issues after.

  • Tbird

    This makes me feel a little better about my birth experience. I have been made to feel by women in my life that I “failed” at giving birth and I “didn’t try hard enough”. I labored at home for 12 hours before coming to the hospital. I had excruciating back labor, not a single abdominal contraction, all vice-grip like grinding in my lower back. Contractions started at 5 minutes apart, but I had them every two minutes for 10 hours, no breaks in between.

    I got to the hospital after 12 hours only to be dilated to 3 cm. I caved and asked for an epidural. I was exhausted, it was 4:30 am and I had been walking around and on hands and knees all night.

    My labor was augmented with pitocin at around 9 am with AROM. I got to 10cm around 4 pm and pushed for about an hour and a half. I pushed, head would become visible but baby “sucked back up” between pushes. No
    matter what I did. Baby was posterior. OB tried to manually rotate baby, didn’t work. OB didn’t mention forceps or vacuum, I’m thinking it wouldn’t have worked anyway. “Rested” with a peanut ball and oxygen for half an hour, pushed another hour but due to meconium and baby’s heart rate all over the place, they called for a c-section. The OB didn’t communicate any of this to me during labor. I have often felt the feelings of failure and guilt associated with c-sections, and even been shamed by my mother who said “I don’t understand why you couldn’t just push her out”. At least I neither me or the baby ended up with injuries from forceps or vacuum. Baby did have a three day NICU stay due to respiratory and jaundice issues.

    • Sarah

      Mine kept sucking up between pushes too, also posterior and horribly painful labour in back. Wonder if it’s characteristic of posterior?

      • StephanieA

        It definitely is. Both my kids were posterior, and that back labor is no joke.

      • Mishimoo

        My youngest did a bit – he had the umbilical cord around his neck and broad shoulders resulting in shoulder dystocia – but the older two didn’t (one of which also had nuchal cord). Back labour and persistent occiput posterior position for all of them.

    • fiftyfifty1

      The fact that the baby’s head would come down with your pushes shows that there was nothing wrong with your pushing. The fact that it would “suck back up” between your pushes shows that the baby was caught up there. You can tell your mom that you “couldn’t just push her out” because her body was hung up. It’s like asking a dog chained to a tree why it can’t “just run out of the yard”, sheesh. Mom shaming is the most painful of all, no?

      • Tbird

        Thank you so much for your kind words! It’s very true, there is so much mom shaming. Everyone I talk to tells me “well you shouldn’t have gotten an epidural so early” or “you should have avoided reclining when you were pregnant” or I don’t think anyone did anything wrong, the OB was wonderful, the nurses were fantastic. It’s just hard to hear as a new mother that you failed at the very beginning! So much pressure on women to have these unmedictaed vaginal births. My own mother had four c-sections and no vaginal births, one would think she would be more sympathetic.

        • fiftyfifty1

          Ugh, I am so sick of that myth that reclining causes OP presentation. It has zero truth and yet, somehow, it is the myth that won’t die.

          At least the early epidural myth seems to be dying a little (at least where I live) now that there are multiple studies proving it is not true.

          • Tbird

            Exactly!! It’s ridiculous! All the spinning babies BS drives me crazy! I know plenty of women who were completely inactive during their pregnancy and got early epidurals and had easy vaginal deliveries, it’s ridiculous! It all seems like old wives’ tales trump reason.

          • StephanieA

            Ha that was me my first pregnancy! I was so lazy, was put on ‘light’ bed rest at the very end, and got an epidural at 3 cm. Had a super easy delivery. It truly is just luck, and all the pieces have to fit together perfectly (baby’s head and mom’s anatomy) for a successful vaginal birth. I also have OP babies and my doctor said it’s probably because of my pelvic shape. Not much you can do about that.

          • Empress of the Iguana People
          • Charybdis

            Just don’t ask what they make baby powder out of….

          • mizzleslondon

            Arghh, so pleased to read this. I was a total gym rat during pregnancy and still had an OP baby who wouldn’t turn (and a forceps delivery in theatre – fun). I really felt for ages that it was somehow my fault (in fact that’s what led me to this blog in the first place).

          • Tbird

            Same! I still struggle with feelings of “what if?”. What if I waited longer for an epidural and stayed upright during labor or on hands and knees? What if I stayed home longer? What if I pushed harder at the beginning? What if I just didn’t push hard enough? It sucks. I don’t glorify vaginal births but I didn’t want a c-section for my first. And now I think I’m probably a bad candidate for vbac. I’m not opposed to RCS at all. I just don’t like being in the hospital and I don’t want to stay that long again.

          • mizzleslondon

            I know, your brain just focuses on all these pointless counterfactuals doesn’t it? I had a nasty haemorrhage (2 litres – not as much as some poor devils but I am petite and it was enough to make me very anaemic) and struggled with breastfeeding as a result (I think – I might just have been rubbish at breastfeeding but the anaemia can’t have helped). And so I kept thinking that all of that was my fault: if only I’d gone with the midwife’s suggestion of an aromatherapy bath rather than an epidural, if only I’d not yelled ‘Fuck the birth plan’ at her, etc. It took me a long time and this blog in particular to get a different perspective on it all.

          • kilda

            I actually kind of love that you yelled “fuck the birth plan” at her. 🙂

          • KeeperOfTheBooks

            I’m giggling like a 6th grader at “Fuck the birth plan.” 😀

          • Tbird

            Yeah seriously! All these old wives’ tales that are not substantiated by any eveidence at all. I know plenty of women that got epidurals really early in labor and had easy least vaginal deliveries. Everything is always the mother’s “fault”.

        • ukay

          Everyone should just shut up. You had a difficult labor and your child had to go to NICU. My experience was similar, but my baby was not posterior, no meconium and by sheer luck avoided VE. I do not understand what people want. Your baby had clear signs of distress and they still have an opinion about the necessity of a c-section. I am glad c-sections exist and you both are safe.

          • Tbird

            Yeah exactly. I would rather have the c-section than wait and potentially have a tragic outcome.

        • Empress of the Iguana People

          Babies get in some weird positions. My daughter’s head was just a smidge askew when she came out. She’s fine, but it could definitely be worse. My mother had 4 vaginal births (or 6, depending on whether you count the trips separately or together) but had no qualms about her c-section with the twins when the ob recommended it. (the triplets were born before ultrasound, the first two stillborn and the third live and noisy. Said 3rd born is the one who also survived Stage IV cancer for over a decade now. Bless her, she’s a freak of nature. 🙂 The twins were born 18 years later)

          • Tbird

            Yeah exactly! As I could possibly know what position the baby was in! Or as if I could do anything to change the position!

      • Sarah

        Is that what it means? I didn’t know that.

    • Casual Verbosity

      First of all, I’m so sorry you went through all of that. A long and painful labour is difficult enough without adding unwarranted shame to the mix. Secondly, I just want to remind you that you didn’t “cave” by asking for an epidural; you made a sane and rational decision to relieve your pain as is your right as a human being. Finally, I hope very much that your mother has profoundly apologised for that hurtful comment she made. Those comments are hard enough to hear from anyone, but it’s even worse coming from someone like one’s mother, because we expect them to be on our side.
      If you stick around the Skeptical Ob blog, you’ll be able to find a lot of articles that will tell you exactly why choosing an epidural and having a c-section do not make you a failure. I’m not sure if you’re still struggling with feelings about your birth, but if you are, please consider speaking to a professional. They might be able to help you deal with these difficult feelings.

      • Tbird

        Thank you! That’s so kind of you, truly! You got the nail on the head with your points! I love this blog. I have read it pretty much everyday since my baby has been born. It gives me so much peace of mind. It’s very reassuring and helps me process some of the crap I’ve gotten from other women. It’s been invaluable!

    • mabelcruet

      I hope your mother has apologised for that appalling comment. Given that your baby had a 3 day NICU stay, its highly likely that had you hung on much longer trying to ‘just push her out’, your baby wouldn’t be here right now. A decision was made, by you and your doctor, that was in both your and your baby’s best interests, and your mothers role and say in this is precisely zero.

      • Tbird

        Thank you! Nope my mother never apologized. She also tells me if I opt for a reaper c-section instead of a vbac next time I’m “lazy”.

        • BeatriceC

          Your mother is….something. I don’t know. She sounds a lot like my mother, tbh. This is not a compliment. If you opt for a RCS you’d be making a very good, solid choice that’s the best one for you, if that’s what you want.

          • Tbird

            Thank you! She is very passive aggressive and can be very very tone deaf! Thank you for your support!

          • Sarah

            I know exactly what thing her mother is…

        • Gæst

          Gee, I guess I was lazy when I had my appendix removed surgically. I could have just let my body fight the infection naturally, after all. Sure, it might have killed me, but it wouldn’t have been lazy!

          • Tbird

            Seriously!! I couldn’t believe she said that to me! Especially considering she had FOUR c-sections! Her flack of empathy is astounding!

        • Sue

          Tbird – if you opt for another c-section next time, please let this community support you and handle your mother!

          • Tbird

            Thank you! I’m really so speechless over eveyone’s Kind responses on this thread, thank you!

          • Mishimoo

            Anyone who criticises you for having a caesarean here will be shouted down by the rest. A fair chunk of us have crappy, unsupportive parents so we completely understand. You absolutely did the right thing, and you didn’t deserve to be treated like that. Especially not by your own mother!

          • Tbird

            Thank you so much! It’s so crazy to me that she gives me shit about it. It’s not like she’s one of these “holier-than-thou” women that had an unmediated vaginal birth and like to rub it in peoples’ faces. She had c-sections herself! Thank you for your support!

        • ukay

          Why does she think she has a say in that? Is she your doctor, a professional with in depth knowledge of childbirth? I do not know you but I suspect even if you had a picture-perfect vbac she would find something wrong with you.
          She should be grateful that you and the baby are unharmed.

          I am sorry she treats you like that. But what she says is wrong, you failed at nothing. And believe me when I say you also did not miss out on anything.

          • Tbird

            My mother takes pleasure in criticizing me. You’re right, even if I have a “perfect vbac” she will still find something to criticize. One would think she would feel grateful that not only is her grandchild unharmed after the experience but also her own daughter. What a concept!

        • Inform her that you and your OB will decide thebest course of action, and it’s your baby and the doctor’s the expert. Then, stop listening to your mother.

          • Tbird

            Yep!! Whenever she says stuff now I just say “thank you for your opinion” and change the subject.

        • Charybdis

          This is when you tell her that thanks to your first (?)/previous childbirth experience, you have opted for an elective CS. That scenario removes nearly all of the “what if” variables that can complicate a vaginal birth. You can plan for the birth, arrange childcare for your first, line up support personnel for the hospital stay, you won’t be exhausted after laboring for XXX hours and pushing for YYY hours, no chance of tearing, things like nuchal cords, short cords, prolapsed cords, etc. aren’t crisis situations, etc.

          So what if SHE thinks it is “lazy”? Embrace that shit like it’s your long-lost lover. “Why would I put myself through that sort of ordeal when there is a perfectly good, perfectly acceptable alternate choice called a CS available?” Sucks the wind out of the criticizer’s sails pretty quickly.

          And which is it? Is it “lazy” to have a CS or is it “the worst outcome ever! It’s MAJOR SURGERY, don’tcha know! Awful recovery! Much harder on your body”! It can’t be both…

          • Tbird

            Yes exactly!! Yes this was my first baby/delivery. My biggest regret is letting her be in the delivery room. If I could have a do-over it would just be me and my husband.

        • Empress of the Iguana People

          Bah, she sounds like a damned fool.

          • Tbird

            Yep! She really is.

    • maidmarian555

      I was in hospital for three days before my emergency c-section. I had contractions the whole time, they tried different methods to induce me, I only got to 2-3cm despite all the repeated efforts. I ended up having an epidural (and I’m bloody glad I did as I was lucid when things started going really pear-shaped and could understand what was being said to me regarding risks etc.) I’ve had comments since from a handful of delightful people about my body ‘failing’ and whatnot but with almost two years of hindsight what I can say with absolute certainty is that I failed at nothing. The people in charge of my care *failed me and my son*. They prioritised vagina birth over our welfare and dragged things out way longer than they needed to just to make sure that they’d tried literally everything in the pursuit of that type of birth rather than ensuring we were both got through the experience as fit and well as possible.

      I’m sorry about how you feel right now. I know how that feels. Seriously, you didn’t fail. You followed the recommendations of the experts who were supposed to be putting you and your baby first. They failed you by leaving you feeling like you had any control over how things turned out. You did not. But you are still here and you got through it. Anyone telling you that you’re anything less than amazing for making it through such a harrowing experience is wrong. (My mother is also difficult and makes unkind comments- she talks about how she had successful vagina births, ignoring the fact I have permanent scarring on my head from the forceps used during mine. I am 37yrs old and they are still there).

      • Tbird

        Oh wow! Thank you for sharing your story. I just believe in trusting the recommendations of the physician providing care. I had a c-section and my baby was ultimately safe because of it. Seems absurd to me that people respond to me as if I got duped in some way because I had a c-section. It’s insane.

        I’m so sorry your mother makes those comments to you. It’s really out of line.

        • Empress of the Iguana People

          My sister was in labor all day. She finally ended up with a c-section and in hind sight it was -very- necessary. No one even knew she had Stage IV Ovarian cancer until she gave birth and her uterus and the umbilical cord were riddled with it. Its freaking amazing that her body managed to grow her healthy boy. Nearly eleven years later, and their survival is still a wonder and a delight.
          Anyone who says she failed or caved in for pain meds is going to hear it from me!!

          • Tbird

            Oh wow that’s so scary!! I’m so happy both survived and are doing well! Three cheers for modern medicine!

    • Cartman36

      Please don’t feel like you “caved” by asking for an epidural. Birth is literally the only time that we pretend pain relief is too “risky” and that there is a benefit to not getting it. If someone needs surgery but isn’t healthy enough to survive the anesthesia, we don’t strap them down and tell them to breathe through the pain.

      • Tbird

        Thank you! I didn’t feel like I caved, it felt empowering to say “I’m done suffering needlessly”. But others will tell me I’m weak or “couldn’t handle it”. You make a great point about other surgeries, it’s so true!

    • EmbraceYourInnerCrone

      You didn’t cave , you needed pain relief. You probably wouldn’t want to go through a root canal or passing a kidney stone with out pain relief so why would anyone expect you to go through labor without pain relief. If someone wants to do any of those things with out pain relief thats Ok but it’s not the only or most “valid” choice.

      As far as “just wait” or “just push the baby out” do people not realize the labor especially prolonged labor is stressful and exhausting for the baby as well as the mother? Sounds like your OB should have probably communicated with you much better and maybe done a C-section earlier

      • Tbird

        Exactly! Someone just grabbed to me recently about having an I medicated labor which was only 8 hours. She seems to miss the point that I was in labor three times longer than that. I did I medicated labor forn12 hours so I actually outlasted her. And my contractions were at their longest five minutes apart from the beginning. I had been awake from 7 am and baby was not delivered until Wednesday at 7pm. The lack of sleep alone combined with prolonged labor was exhausting.

        That’s my only issue with the doctor. I don’t think she did anything wrong or unnecessary, but she didn’t tell me what was happening when it was happening. She told me everything at my six week follow up appt which was upsetting because I was scared and stressed in the moment partially because I didn’t know what was happening. My husband said I started bleeding profusely during pushing and baby’s heart rate was all over the place.

    • Heidi

      Oh I’m so sorry people are implying any sort of failure on your part. You didn’t fail your baby. We don’t have any true control with how a labor progresses. Asking for an epidural isn’t caving. I think my epidural allowed me to actually push, instead of writhing in pain and throwing up.

      This might sound crass, but sometimes people can’t push out a turd. Why would we be guaranteed that we can push out a baby? I don’t imagine someone would shame someone needing a laxative or surgery for bowel obstruction and say, “I just don’t know why you couldn’t push your poo out?”

      • Tbird

        Exactly! I don’t get all the anti-epidural comments from people. And yeah no one would shame someone for having issues with their bowels or some other bodily function. It’s crazy what people will say to New mothers.

    • Doubtingdebbie

      I’m no expert at all, but I have read coronial findings that point to the presence of meconium leading to fatal outcomes for baby. You absolutely did the right thing – fell your mum to bugger off.

  • mabelcruet

    n=1, but I’ve done more autopsies on babies who died due to ventouse/kiwi or forceps injury than babies injured by section (although I’ve autopsied those who died because the section wasn’t done quickly enough). The range of injuries is horrific-subgaleal haemorrhage (basically, the loose attachment of skin to bone means a baby can exsanguinate its entire blood volume into its scalp), comminuted and depressed skull fracture, laceration of the cervical spinal cord, occipital diastasis with lacerated venous sinus and embolised brain tissue seen in the pulmonary vessels. Personally, as a never pregnant and never likely to be pregnant woman, I would run screaming in the opposite direction if anyone came at me with forceps. But I probably see a very biased picture.

    • StephanieA

      The vacuum is dangerous too, because of pop offs. Most types have a recommended limit of 2-3 pop offs, but some doctors will try more. It’s scary.

      • mabelcruet

        There are guidelines as to how many attempts are supposed to be made before instrumental delivery becomes operative delivery (The Royal College of Obstetrics and Gynaecology in the UK produces them, as does the USA equivalent), but with the cases I’ve had there is a fairly common thread of multiple tries with the suction cap and then multiple forceps goes, and then finally emergency section. Obviously, I only see the babies who don’t make it so there might be loads of perfectly healthy kids out there who had multiple attempts made before delivering and everything was fine, but the clinical histories are quite repetitive on the ones I get (or got, now I’m retired).

    • Kelly

      I don’t understand all those words but I understand enough to understand the kind of damage that can be done. No thank you, I will gladly have a c-section.

    • Sarah

      My first was delivered with a vacuum after PROM and nearly two days early labour. I’d heard all about forceps before then and was pleased to be able to avoid them, but I’m sure I had no idea what vacuum even was (despite having been to an NCT class when they must have mentioned it, they did forceps). She was very far down and only two pulls were needed, so it wasn’t too bad as ventouse goes, but I hadn’t really thought about it going wrong until now. Left me pushing far too long, nigh on three hours. Back to back as well. I begin to seriously wonder if that ought to have been a failure to progress section earlier.

    • mjd3

      *shudder* When I was pregnant, I absolutely did not want forceps near me. I didn’t want a c-section, but I wanted forceps even less.

    • Tigger_the_Wing

      I would very much have liked to have run in the opposite direction, but all I could do was the screaming part.

  • Sarah

    Have the WHO reintroduced the 15% nonsense then? I thought they’d quietly got rid of it and still hadn’t brought it back- has that changed? I know they still scaremonger but I hadn’t seen anything recent spell out the optimum rate.

    • Casual Verbosity

      As far as I’m aware they never brought it back, but they also don’t go out of their way to correct all the major public bodies that still cite it in their policies, thus they’re essentially still endorsing it, albeit tacitly.
      That being said, if someone has heard otherwise, I will stand corrected.

      • Sarah

        That was my understanding, but I too stand corrected if otherwise.

  • The Kids Aren’t AltRight

    Is a C-section always an alternative to forceps? I mean, is there a point in labor where it is too late for a C-section so forceps are the only option?

    • Casual Verbosity

      If you’re at the stage of foetal distress and it’s a case of “HOLY SHIT GET THAT BABY OUT RIGHT NOW!” then there may not be time for a c-section, but generally there’s a bit of a build-up to that point, during which a c-section would hopefully be discussed with the mother.

    • fiftyfifty1

      No, an outlet forceps birth can be a life saver. For instance if the baby is “right there”, but goes into severe distress. You don’t have time for a section, and at that point a section is more dangerous (pushing the baby all the way up backwards), but baby NEEDS to come out. Rarely this will happen without warning. Happened to me once in training. Baby had previously been doing well, was very low, then went into severe distress that did not clear at all between 2 contractions. I was reaching for the emergency button to call in the back-up OB, when she came in all on her own (she had been sitting in the nursing station keeping an eye on all the strips remotely, as supervising OBs tend to do), and calmly did a quick and efficient outlet forceps.

      • Krista

        This happened to me with my second child. Just as pushing started, the monitors showed my daughter went into sudden and unexpected distress. She was already coming out and vacuum assisted was faster at that point. A few pushes with the vacuum assisting and she was out. It was later determined that there was a true knot in the umbilical chord which pulled tight with pushing. I didn’t care about avoiding a c-section but I really think that in my particular case the vacuum was the best option and I don’t see how we could have gotten her out any faster otherwise.

    • Tigger_the_Wing

      The delivering midwife only believed that my second baby was breech when his feet came out. Of course, the rest of him rapidly followed – except for his head. At that point, an emergency forceps delivery was the only option.

      I would imagine that, thirty-six years later, it is very unlikely that anyone will be in the position I was then. At the very least, I would expect that a portable ultrasound machine would be available to check the baby’s position before it’s too late.

  • StephanieA

    My third is due in August, and I’ve already decided to refuse forceps or vacuum if it comes to that. I’ll also make sure my husband knows so he can advocate for me. My boys have both been OP, first needed to be manually turned by the doctor and the second turned on his own. There’s a good chance this one will be OP as well, and if he can’t/won’t turn I would rather have the section than risk damaging my pelvic floor more, not to mention the risks to the baby. It’s hard because sections are so demonized, and I know everyone will look down on me for refusing a vacuum/forceps (almost no one refuses).

    • Kelly

      We won’t. You don’t have to tell anyone why you had a c-section either. All that matters is that in the long run, you did what is right for you and your baby. Also, I would choose the same as you if that makes you feel any better. I have had three easy vaginal births and a c-section makes me nervous because I have never gone through it, but I would still gladly choose a c-section.