Alternative perspectives
Vacuum and forceps assisted births account for 10-15% of all births in
England and a small number of cases are complicated by significant
morbidity and mortality. For most women and babies, it is a balance
between the risks and benefits of not intervening, of using an
instrument, or performing a second stage caesarean section. There are
short- and long-term potential complications and implications for future
births. Not surprisingly there are individuals who hold strong views
about AVB, and some believe that forceps should be abolished entirely.
This was reflected in one submission during the consultation phase from
a patient advocacy organisation who suggested that planned caesarean
section should be recommended to women as a means of avoiding AVB. The
co-author group together with the Guidelines committee, felt that the
point they were making was about avoiding labour, rather than avoiding
AVB, and was better addressed by the RCOG guidance “Choosing to
have a Caesarean section ”. We did, however, make specific
recommendations on the importance of antenatal education, intrapartum
counselling, shared decision-making, informed consent, and postnatal
review. There was an entire section on the importance of the Montgomery
ruling.