Instrumental delivery

Agreee with TC - at Tsan Yuk (went through that system too) they explain all the POSSIBLE situations of what could happen. Should warn you however, that at Queen Mary you probably will have episiotomy. I didn't want to, but they told me that it was pretty much their standard procedure. Believe me - it doesn't hurt (I had an all natural delivery- no epidural or anything) and you are in enough pain that a little snip down there doesn't hurt.


My friend had forceps/vacuum with her first when she delivered at Matilda. She didn't make it seem like a big deal - but i'm sure you'll hear from others in this post.

Have already posted this to the same questions in Moms and Dads - why did you post it twice???


First baby (in Australia) was delivered by forceps with an episiotomy in a traditional stirrups position - and a very interfering birth by the medics after spending 16 hours in labour. With gas, pethidine and epidural. The episiotomy took ages (weeks - months) to heal properly. I ended up having to have ultrasound to stimulate repair, got infections, and couldn't walk properly for about 2 weeks. The worst part of this delivery was the humilitation and loss of dignity I felt at the time - and still feel when I think of it. The doctor wasn't very nice. I felt I had been sexually assaulted by the end of it all, and left for dead.


2nd baby (Australia) I had in an upright position (kneeling against something) with no drugs or pain relief and an active labour and tore a little bit - but the doctor came very late after the delivery and had to inject the anasthetic after about an hour of the birth - the needle was worse than the birth. But the tear healed much faster and was much more comfortable than the previous episiotomy. (about a 12 hour labour - but only in hospital about 1 hour - 2nd stage - from 1st experience wasn't that interested in being in the hospital for a long time)


3rd baby was born at home (planned) (Australia) - again in an upright position after a very active labour - minimal tearing - called grazing. No stitiches required. The midwife massaged my perimeum on crowning. 7 hour labour.


4th baby was a home birth - a water birth (in HK)- again an upright position and an active labour - no tears or grazing - fabulous. Again the midwife massaged the perimeum on crowning. Wish I had done it this was for all the births I had. 6 hour labour.


My suggestion - be as active as you can in labour to make sure your baby is worked by gravity to be in the right position if you want to avoid the forceps and an episiotomy, and deliver in an upright position with gives your pelvis room to accomodate a moving baby to allow it to get in the right position for birth. Laying on your back is detrimental for birth - the pelvis has nowhere to move and so baby's get 'stuck' and require help to be born.


Also - your body will repair itself to be fully functional - the only concern i would have if your are stitched up too tight! not good for more baby's. Find a doctor and midwife that will let you body do what it is made for - that part of your body (The perimeum) is very stretchy as it is a muscle (part of your pelvic floor muscles) and has loads of blood flow to help it stretch more - massage of the perineum with an oil during crowning (by the midwife) also helps to reduce tearing and reason for episiotomies.


Some websites for you...


http://www.notjustskin.org/en/episiotomiesandtears.html

http://pregnancyandbaby.com/read/articles/132.htm

http://www.gentlebirth.org/archives/perinealProtection.html


If you have an epidural it will increase your chances of having to have an assisted delivery because you will have limited movement during the 2nd stage of labour. So if you can - avoid having one.

http://www.efn.org/~djz/birth/betterbirth/7bottom.html

Oh my god. No no no. Anyone will tell you that the first child is the most difficult with subseqent ones being more easy. Dimca I feel for you but the reason that the subsequent ones has probably nothing to do with the technique.


First of all, epidural was sent by God. I know of no one who has given birth with and without and epidural and subsequently elected to go without. Very little (if any risk) to the infant and saves mom alot of grief, again with relatively low risk. Certainly less that the amount of narcotic to acheive even close to the amount of pain relief.


Vacum delivery: Baby has a conehead. Will resolved in with minimal if any sequelae. Overall very safe.


Forceps: If done correctly, very little risk but more than vacum


Episitomy: If you must tear, a controlled tear is ALWAYS better. Just got lucky with the tear. Don't count on luck for your medical outcomes.


Natural birth in water: You're nuts. In all my years I've never seen a baby with a vacumn that had a serious consequence. Had the misfortune of taking care of a "vegetative" patient die a slow death that was born in water. He drowned.

By the way, I'm involve in critical care for childern. I don't care what you do your bodies (well maybe some), and have NO financial or any other interest in the OB part of it. All I care about are healthy kids.

Yeah being called nuts I don't agree - it was a safe delivery with a prepared and very experienced midwife in these things, and it is the best way to have a baby after all my experience. It all comes down to being aware, educated and sensible.



The reason first babies tend to be more difficult is the mother is able to be pushed around by medics as she doesn't really know what is happening. I was a doula for many women having their first babies (in and out of hospital) and they didn't suffer the same as I did because they had experienced women as their helpers (as opposed to a stressed out Dad - who was there as well) who were able to ensure she had the birth she wanted and to minimise interference by the medics. After my first baby I made sure that I had the father present, plus 2 other women folk, and the midwife present at the birth to make sure that I was helped the way I needed to be helped - at times they were bullies to make me get up and moving but in the end I had very little stress and the types of births that empowered me - call me a greenie or a hippy, nuts or whatever - but the first birth was so traumatic I never wanted to repeat that experience again.


I will emphasise - the delivery will have everything to do with how active you are and the position you deliver in. I have taught childbirth classes as a certified Childbirth Educator and seen the difference with real women taking different approaches during labour and delivery. In the end if you have tried everything and baby still needs help - then baby needs help - a healthy baby is the required ending, but the mother can take action to help baby as much as possible herself.


Re the tearing - when your body tears it will only tear as much as it needs to and in the line of least resistance (thinnest part) - the episiotomys tend to be across the fattest section of the muscle and always longer than required. There is always the possiblity of tearing and an episiotomy. More to the point - when baby is crowning - if you have a good midwife they will help to control the exit and the pushing so you don't tear -and again mum has to have some control in resisting the urge to push (overpowering as that is) to ensure she doesn't 'burst'.


It does all sound a bit overwhelming and very scary when you actually haven't done it - but it is all OK and your body is made for having babies.

I do emphasize what I said in the previos post. I have no doubt that unless you are using an epidural, you would be more comfortable with midwives. In addition, the maternal psychological comfort would be greatly enhanced by midwives.


As for infant safety/health, is concern, at home deliveries is not a good idea. Sure if everything goes right, and in the majority of the times thats the case, things are fine. But if there are problems.. the mortality rate for the infants skyrockets. Like I said, I have very little concern for the mom, but I have the utmost concern for the infant and I'm betting that most of the moms feel the same way.

As I said - homebirth comes down to being educated, and most of all sensible with an experienced midwife - who will make the call to go to hospital if required. But this thread was not to harp or argue the safety of homebirth - we will have to agree to disagree on our different points of view - I just know that having two homebirths myself and having attended about 20 others as a helper (in HK and Australia) - not once did we have problems that could not be managed by the experienced midwife. And at all times, all parties were ready to move onto hospital if, and when required to ensure a healthy baby at the end. Scutdog1 have you had more than one baby?


I had an epidural for the first baby and elected to go without pain relief for the next three - using hot towels, water, loads of support, and positioning for pain relief - yeah it hurts, but not having a dopey baby and being able to walk and recover quicker from the birth - it is worth it and very possible. (also not having to deal with chronic back pain from the insertion for years afterward).


Some people think of me as an extreme birther! ;-)

Mosy - C section should not be an option to avoid the instrument delivery. There are other risks in a C section, and baby's actually do benefit from a vaginal delivery. An emergency C section should be used when there is no other option for removing the baby safely, if it was an easier option with less risk, they would do them instead of the forceps/vacuum cup. Have a look at this website which gives you more information about C sections overall - and other birthing information.


http://www.childbirth.org/section/section.html


The antenatal class needs to inform you of all the possibilities that may occur in childbirth so you can be an informed consumer. Do loads of reading and come up with ideas that might be possible - be flexible as things change throughout your pregnancy and labour!

Well done Mrs Miggins, but I do need to say that the episiotomy is not usually a painful thing at the time because there is so much going on, and that part of your body is burning like hell anyway - the forceps or vacuum will also not be more painful as again there is so much going on - it is the recovery from both which can be complicated - not always.


And I agree the scariest part is the lead up to having your first baby - which is why first mums sometimes end up with more than they want - because they are stressed out, confused, worried, it is all a new experience and one that you don't repeat too often in your life - (thank goodness ;-))


The best thing to do is to be informed, be flexible and relax as much as you can.


Sheila Kitzinger is also an excellent read - had 5 babies herself (home and water births) in the UK and is woman centred in her approach without being preachy - she has published loads of books her website is http://www.sheilakitzinger.com/


If you can, also take with you a woman friend who knows what your needs are, and also has knowledge/ experience of having babies - it makes a load of difference to your ability to relax.

I had my last 2 babies at the POW and was also told that episiotomies were standard in HK. I told them that as they were my 4th and 5th babies I really didn't feel it would be necessary. The doctor then admitted that the rule was mainly for their local mums. I made a birth plan which was looked at and used. No episiotomy, no flat on your back with legs in stirrups, (which is also common for local mums)and midwife delivery. I had an epidural with the 1st which wore off after an hour but left me with really bad back pain, wouldn't have one again although I'm sure they've improved in the last 17 years. I had number 2 in Germany where they did an episiotomy (without permission and without telling us), admit I didn't feel it at the time, but the stitches and aftercare was awful, ironically he was the smallest of my kids. 2 of them I had gas and air, 2 with nothing. The best thing do to is be armed with as much info as possible, draw up a birth plan but be aware that things can change on the day. Try and have someone with you who knows your wishes and will fight your corner if you feel unable to do so.

Well, I didn't want to mention it but I'll come clean.


I'm not a father, I'm not an OB, I don't have the personal experience that you have.


What I am is an expert in the field of very sick kids. Specifically, I am what they care a pediatric intensivist. Sort of like a neonatologist but differnt in that I take care of the kids that get discharge from the NICU. I provide the acute care (not routine) of all the birth disasters. I have the experience of not 1 OB's disaster but many hundreds.

I had to speak out to what I saw was the unnecessary sufferings of kids. Seen too many, would be so glad if I never saw one again.

I would also like to add something. Many doctors have a tendency to agree with patients' views because they know that if they don't, the patients will usually find someone that will. This includes OB's. Not to say anyone's opinion is based upon that but just food for thought.


I however have a financial incentive to have MORE disasters. I don't have to appease anyone because patients almost never choose me. My referrals come from other doctors (pediatricians, ER doctors etc) who ask for my help during a crisis. During these crisis, parents usually have very little choice (you can't shop around when your child is dying). At work, they often compare me to Dr. House (a US TV character). I am frank and often undiplomatic but if I didn't know what I was doing, I would starve (or least be out of a job).

Thanks for your honesty Scutdog1...I do appreciate where you are coming from with regards to sick kids - but in all thing with regards to birthing - the baby is the priority when it comes down to it - however it would be nice if the mother could have as pleasant a time of the whole ordeal as possible - without feeling as if she doesn't exist except for the birthing canal...which is how many women feel after they have had baby's.


The homebirthing (and waterbirthing) choice that women make is to reclaim their dignity and person throughout this celebration of bringing a baby into the world. And this needs to be approached sensibly as with any birthing practise.