A while ago I said that I would write the whole, toe curling stories of how my children came to be born. Two long labours and two trips to theatre is the short answer. I’ll save the longer account for another day though because I’m not sure the world is quite ready yet for the sheer volume of bodily fluids contained within the tale of those 55 hours.
For now, I just want to write down a little bit about something which happened in both my labours which I still think about sometimes. That is the use of forceps. More specifically, Kielland’s forceps.
Yeah that one was a mystery to me too. I had no idea, pre-pregnancy, that there were different types of forceps, let alone the controversy surrounding Kielland’s in particular. I did my reading while I was pregnant though, to fill all that time which would have otherwise been spent drinking and eating pate. I learnt about caesarean sections and about ventouse. I learnt about diamorphine and epidurals, shoulder dystocia and fourth degree tears. I learnt about hypnobirthing and I learnt why you would need to use a sieve in a birthing pool. One of the common themes though in all my hours reading parenting websites was the revilement levelled at Kielland’s forceps.
So for those of you lucky enough not to know, Kielland’s forceps are used to turn babies who haven’t descended into the euphemistically named birth canal, due to being in the wrong orientation. Here’s how they work. You’re on your back in the theatre, legs stuck in hanging straps like great big hams. Hopefully by this point, you’ve got a spinal block or an epidural going to town on your spinal column and you’ve ceased to exist from the waist down. The forceps are big although I couldn’t see them at the time thanks to the massive hillock of belly blocking my eye line. The obstetrician goes in with a hand first and has a good old furtle around. And when I say hand, I mean hand. This is no gentle two fingered midwife exam. This is a gloved fist up the fanny. They need to know exactly where the baby’s head is to safety position the forceps. Then it’s time for the tongs. One half first then the other, either side of the baby’s head, locked together in the middle once they’re in place. In between contractions, the obstetrician will give a little twist to the handle of the forceps, gently turning with very minimal pressure until the head is in a better orientation. Once this is done, they will take a pair of scissors1 to your undercarriage to make a bit more room and with the next contraction, they will use the forceps to pull the baby out. If you’re feeling brave, there are many videos of this on YouTube although I found myself making an involuntary “eeeeeee!” noise while I was watching some of them and I’ve got a pretty strong stomach. Once the head’s out, the forceps come off and the rest should follow like a slimy, slithery dream. Oof! A baby!
So what’s the problem? Arguably, giving birth lying down on a nice comfy bed, pain-free with someone else putting in all the effort sounds preferable, no? Well not quite. I’ve yet to see a discussion around Kielland’s forceps without an associated horror story. I understand that they seem medieval and of course no one sets out to have an assisted birth. But so often when curious first timers ask on message boards or at childbirth groups for opinions on forceps they simply get told that they must not choose this as an option. They should push for a caesarean section instead, they should question the motives of the doctors, forceps are barbaric, they will be left with lifelong damage and by the way, did you not know that Kielland’s forceps are actually banned in the USA? Which tells you nothing about forceps but quite a lot about the American litigation culture. (Actually it’s not even strictly true but seems to have propagated its way around the internet quite effectively anyway)
Scaremongering helps no one. I’m not denying that Kielland’s forceps can sometimes cause injuries, to mothers and babies. But childbirth, of all varieties, causes injuries too. Caesarean sections when the cervix is fully dilated are complicated and often more traumatic than those performed at an earlier stage. Any woman, damaged in any way by any part of childbirth deserves to get the help they need. To suggest that perhaps, giving consent to the use of forceps (or indeed any other intervention) could have exacerbated an injury, or caused complications is unhelpful, to put it mildly. It also downplays the level of skill and training required not only to use Kielland’s forceps but the experience required to make that decision in the first place. Of course, consent is everything and I wouldn’t want to suggest for a second that we return to a time when labouring women were expected to keep their trap shut and do what they were told. But in that moment when you’re deciding, with the input of your obstetrician, your next move to somehow evict this baby from your insides, remember that they’re the ones with the knowledge, skills and expertise. You don’t get to wield the tongs unless you know what you’re doing2. Remember too, that the doctors and midwives want the same thing you do – a living mother and baby with the least amount of trauma.
I have trouble generally with the idea that choosing a perfectly valid intervention during labour is ‘wrong’. Leaving the hospital at 8cm dilated and going to Alton Towers – wrong. Consenting to the use of forceps and being ok with that – not wrong. It all feeds into the idea of a perfect birth and unrealistic expectations on what you should expect. It’s absolutely possibly to have a calm, straightforward, intervention-free birth and I can understand why that is preferable to the kind I had. But it’s not a competition and if it doesn’t pan out like you expected, that’s ok. So just to be clear then, here are two things not to say to a woman who’s still in the recovery period of a forceps delivery; first, don’t tell her that a Caesarean would have been better, you don’t know that and anyway it’s a bit bloody late now and second, don’t even start with your ideas on birth preparation. If you practised visualisation and breathing techniques and then went on to have the perfect birth, then I’m pleased for you but it won’t work for everyone. Those are exactly the kinds of misinformed ideas that leave people feeling crappy about their choices.
Can you tell that I may have heard some of this before? When people asked what kind of labour I had, I described it for them, sometimes in great detail. Some people looked horrified and clamped their legs together in empathy. That’s fine, I appreciated the empathy and it’s ok to feel a bit squeamish about it; childbirth is brutal. Some people shared their own experiences of forceps, of sections, of labours too fast for even a whiff of gas and air. All fine, it’s good to (over)share. It was the small proportion of people who reacted as though a terrible tragedy had befallen me who left me with a lingering, suppressed rage. I am not bereaved, I am not traumatised, I don’t need any pity.
I rationalised the use of forceps in exactly the way that any woman who doesn’t quite get the birth she hoped for rationalises their labour experience. So I didn’t get to gently squeeze out a baby in a nice relaxing bath? So what, we’re all alive. After the same thing happened with my second child it became obvious (to me, anyway) that I must have a gnarled and misshapen pelvis trapping my babies and refusing to allow them into the optimal position. I was never going to push either of them out myself because they were stuck fast and getting my babies manually extracted while I have a nice lie down is just the way I roll.
- I was surprised when I found out that episiotomies were cut with scissors and not a scalpel. Possibly because it made me think of those strange people who use scissors to cut up bacon.
- Sadly, almost every tragic story I’ve ever seen relating to Kielland’s has happened because they were used by someone lacking the correct training and supervision. This doesn’t make forceps inherently bad but if ever there was a time for someone be absolutely sure they know what they’re doing, then this is it. The issue isn’t the use of forceps; it’s the use of forceps without the appropriate skill to back it up. Oh. I think I’ve just solved the problem.