Articles

Key takeaways

• An assisted vaginal birth uses special instruments to help deliver your baby.
• About 1 in 8 births are assisted, rising to 1 in 3 for first-time mothers.
• Reasons include concerns about your baby, slow labour, or difficulty pushing.
• Forceps or a vacuum cup can be used, depending on your situation.

Understanding assisted vaginal birth

An assisted vaginal birth is when a healthcare professional uses specially designed instruments to help you give birth to your baby. This is also known as an instrumental delivery.

About 1 in 8 people will have an assisted vaginal birth. This number rises to 1 in 3 for first-time mums.

There are several reasons why an assisted birth might be recommended. These include concerns about your baby's well-being during birth. Your labour might not be progressing as expected.

You may also be unable to push. This might be advised if you have very high blood pressure.

The tools: forceps and vacuum cups

Two main instruments are used in an assisted birth: forceps and a ventouse (vacuum cup).

Forceps

Forceps are smooth, curved metal instruments. They look like large spoons or tongs. They are designed to fit carefully around your baby's head.

Your healthcare professional will wait until you have a contraction. Then, they will ask you to push while they gently pull with the forceps to help deliver your baby. This may happen over several contractions.

Ventouse (vacuum cup)

A ventouse uses suction to attach a plastic or metal cup onto your baby's head. This cup is connected by a tube to a suction device.

During a contraction, your healthcare professional will ask you to push while they gently pull. This helps to deliver your baby.

The cup can sometimes detach, making a popping sound. If this happens, the cup may need to be re-applied to your baby's head.

Choosing between instruments

Both ventouse and forceps are safe and effective. The choice of instrument depends on several factors. These include how well your epidural is working, your baby's well-being, and the position of your baby's head.

If you need an assisted vaginal birth before 36 weeks of pregnancy, forceps may be preferred. This is because they involve less risk of injury to your baby's head, which is softer at this stage. Your healthcare professional will recommend the most suitable method for your individual situation.

If one instrument is chosen and is not effective, your healthcare professional may recommend using the other. They may also offer a caesarean section, depending on your circumstances.

What to expect during the procedure

Before an assisted birth, your healthcare professional will examine your abdomen. They will also perform an internal examination to confirm it is safe for you and your baby. This will be done with your consent.

You will usually be asked to sit with your legs supported. Your bladder may be emptied by passing a small tube (catheter) into it.

Pain relief

Pain relief for the birth may be a local anaesthetic injection inside the vagina. It could also be a regional anaesthetic injection into your back (an epidural or spinal). If you have already had an epidural, an anaesthetist will check it is still working.

During the procedure

You will probably be helped to lie down on your back. Your legs will be raised in stirrups.

A doctor or nurse who specialises in newborn babies (a paediatrician or neonatal nurse) may be present. This is in case your baby needs extra help after birth.

During a forceps delivery, the forceps are carefully positioned around your baby's head. They are then joined together at the handles. With each contraction, you push as the doctor gently pulls to help deliver your baby.

For a ventouse delivery, the cup is inserted and attaches to your baby's head by suction. As you feel each contraction, you push as the doctor pulls.

Benefits, risks, and recovery

An assisted delivery helps deliver your baby quickly. It is often performed when there are concerns for their safety or when labour is not progressing.

Risks for the mother

• Heavier bleeding – Bleeding after birth is normal, but it can be heavier after an assisted birth. Use super-absorbent sanitary pads or maternity towels for the first 6 weeks, and avoid tampons as they can increase your risk of infection.
• Episiotomy and tears – Before an assisted birth, you will likely be offered a cut to the area between your vagina and anus (an episiotomy). This helps reduce the chance of tearing.
• Third- or fourth-degree tears – You are more likely to have a third- or fourth-degree tear, which involves the muscle or wall of the anus or rectum. This affects around 1 in 8 people with a forceps delivery and 1 in 25 with a ventouse delivery.
• Bowel and bladder problems – Leaking urine (urinary incontinence) is common after childbirth, and an assisted birth can make it more likely. Leaking wind or poo (anal incontinence) is also more likely, especially with a third- or fourth-degree tear.
• Blood clots – There is a higher chance of a blood clot (deep vein thrombosis, or DVT) forming in your legs or pelvis after an assisted birth. Moving around and following medical advice on stockings or injections can help prevent this.

Risks for the baby

• Marks on the head – A mark on your baby's head (chignon) from the ventouse cup usually disappears within 48 hours. A bruise on your baby's head (cephalohaematoma) can also happen but usually disappears with time.
• Marks or cuts on the face – Marks from forceps on your baby's face usually disappear within 48 hours. Small cuts on your baby's face or scalp affect about 1 in 10 babies and heal quickly.
• Jaundice – There is a slightly higher risk of a condition that makes your baby's skin and eyes look yellow (jaundice). This usually passes in a few days.
• Bleeding inside the skull – Very rarely, a baby may have a small bleed inside their skull. This affects less than 1 in 700 babies.

Recovery

After an assisted birth, you may feel bruised and sore. This is similar to any birth. Any stitches will heal within a few weeks, and pain relief can help.

You may sometimes need a small tube (catheter) to drain your bladder for up to 24 hours. This is more likely if you had an epidural, as you may not have fully regained sensation in your bladder.