Giving birth after a previous instrumental 'delivery'

If you experienced an instrumental birth for your first baby, is it likely to happen again?

Around one in three women will have an instrumental birth (Forceps or Ventouse) with their first baby.

Good news!

Of the women that experienced an ‘instrumental delivery’ in their first birth and who go on to plan for a second vaginal birth, there is a very high likelihood that they will now have an unassisted vaginal birth.

91% of those who had ventouse, 88% of those who had a low forceps, 82% of those who had a high forceps birth for their first, will have a straightforward vaginal birth second time. Now sure which you had? It should be written in your maternity notes- you can either ask your midwife to check, or you can request your notes directly from the hospital (you don’t have to be pregnant to do so).

Whilst these statistics are hopefully encouraging in themselves, there are some questions worth asking and considerations worth making, if having an unassisted birth is important to you this time.

Is there anything in your first birth that contributed or directly led to the need for instrumental assistance?

This might be something like induction of labour, augmentation (speeding up) of labour, epidural or restricted mobility (eg being made to lay in a bed/push on your back).

Are these things avoidable second time?

What choices could you make or what else could you reach for to avoid these things being needed this time?

Did baby’s position have an impact on the need for ventouse/forceps?

You might not know whether or not it did- if your labour was very long or took a long time to ‘get going’, if you felt lots of pelvic or back pain, you weren’t getting ‘rest breaks’ between your contractions or your contractions had ‘double peaks’, you felt an ‘early’ urge to push or your midwife/dr mentioned anything about ‘back to back’ or baby’s head ‘being at an angle’- these would all be indicative of a ‘tricky’ position. Have a listen to our podcast episode on 'Labour Dystocia’ if any of this rings true for your first birth story!

Was there anything obvious that may have cause the malposition?

Sometimes imbalances in the pelvis can impact the baby’s passage through it. Imbalances might be recognisable by having a history of back/pelvic/hip/leg pain; may affect dancers or athletes and can certainly be caused by previous injury (a fall/ broken ankle etc). Seeing an osteopath or chiropractor in pregnancy can help realign pelvic imbalances and improve a baby’s position in utero.

Consider where you give birth to your baby.

Giving birth at home, out of the hospital environment, considerably reduces the chance of an instrumental birth being needed- with no increased risk for baby. Certainly worth exploring!

Think about the picture holistically.

How are you feeling emotionally following your first birth? Do you have unanswered questions or would you like to chat through your experience? Could you do with support advocating for yourself this time? Or better antenatal education?

We are here to help support you to have a positive birth experience for your second baby. Get in touch to see how we can help!

References

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.2000.tb11094.x