Assisted Vaginal Birth

An assisted vaginal birth is where a doctor uses specially designed instruments - forceps or ventouse (suction) - to help deliver your baby during the last part of labour. An information guide from the Royal College of Obstetricians & Gynaecologists can be found here

Forceps and ventouse will only be used to help you birth your baby if they are the safest method of delivery for you and your baby. The reasons for having an assisted birth, the choice of instrument and the procedure of assisted birth should be explained to you by your obstetrician or midwife. The risks to you and your baby of an assisted birth will be discussed with you and your consent will be obtained. Ventouse and forceps are both safe and effective. There are many different types of forceps, some of which are specifically designed to turn your baby round, for example if your baby has its back to your back in the late stage of labour.

Forceps are more successful in delivering your baby, but a ventouse is less likely to cause vaginal tearing.

The ventouse is not suitable if you are at less than 34 weeks of pregnancy because your baby’s head is softer.

There are many reasons why you might need help with the birth of your baby. The main ones are:

  • Your baby is not moving out of the birth canal as would normally be expected
  • There are concerns about your baby’s wellbeing during the second stage of birth
  • You are unable to, or have been advised not to, push during birth.

The purpose of an assisted vaginal birth is to mimic a normal i.e. vaginal birth with minimum risk to you and your baby. To do this, an obstetrician uses instruments - ventouse or forceps - to help your baby birth.

Ventouse  - (Vacuum extractor) is an instrument that uses suction to attach a soft or hard plastic or metal cup on to your baby’s head. The obstetrician will wait until you are having a contraction and then ask you to push while he/she gently pulls to help you to give birth to your baby. More than one pull is often required but usually no more than three are attempted. 

Forceps - Smooth metal instruments that look like large spoons or tongs. They are curved to fit around your baby’s head. The forceps are carefully positioned around your baby’s head. The obstetrician will wait until you are having a contraction and then ask you to push while he/she gently pulls to help you to birth your baby. More than one pull is often required but usually no more than three are attempted. We sometimes recommend this procedure is performed in theatre as the obstetrician may decide that the baby will not come this way and a caesarian would be safer.

What does an assisted vaginal birth mean for me?

Bleeding - it is normal to have bleeding after the birth of a baby. Immediately after an assisted vaginal birth, heavier bleeding is more common. The bleeding in the days afterwards should be similar to a normal birth. We would recommend the use of a drug to manage the third stage of labour (delivery of placenta).

Vaginal tears/episiotomy - a 3rd or 4th degree tear (a vaginal tear which involves the muscle and/or the wall of the anus or rectum) affects one in 100 women who have a normal vaginal birth. It is more common following a ventouse delivery, affecting up to four in 100 women (4%). It is also more common following a forceps delivery. For this reason an episiotomy is often performed to try to prevent this. This will be repaired with dissolvable stitches.

Pain relief - most women experience some discomfort after they have given birth. If you suffer from discomfort, you should be offered regular pain relief. Regular paracetamol and ibuprofen is recommended and could be stocked up for when you go home.

Bowel and bladder care - problems with moving your bowels or passing urine are common immediately after birth, but the majority of women have no symptoms later on. It is important to measure the amount of urine you pass for this first time after giving birth so that the midwife can measure it to ensure you are passing a normal amount and not retaining any urine.

Reducing the risk of blood clots - being pregnant increases the risk of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis). The risk increases after an assisted birth. You can help by being as mobile as you can after delivery. You may be advised to wear special stockings and have daily injections of heparin, which makes the blood less likely to clot, but only if it is necessary.

What does an assisted vaginal birth mean for my baby?

The suction cup used for a ventouse delivery often causes a mark on a baby’s head. This is called a chignon (pronounced sheen-yon) and usually disappears within 24–48 hours. The suction cup may also commonly cause a bruise on a baby’s head called a cephalohaematoma. This disappears with time; it rarely causes any problems with babies except for a slight increase in jaundice in the first few days.

Forceps marks on your baby’s face are very common and usually small, and usually disappear within 24–48 hours. Small cuts on your baby’s face or scalp are also common and heal quickly.

How can I reduce the need for an assisted vaginal birth?

Women who have continuous support during labour are less likely to need an assisted vaginal birth, particularly if the support comes from someone you know as well as your midwife. You should have someone you know and trust with you during labour if you can.

Using upright positions or lying on your side as well as avoiding epidural pain relief can also reduce the need for an assisted birth.

If this is your first baby and you have an epidural, the need for an assisted birth can be reduced by waiting until you have a strong urge to push or by delaying when you start pushing. The length of time that you delay pushing will depend on your individual situation and your wishes, but is usually one – two hours after the cervix (neck of your womb) is fully open. Your midwife will guide you at the time. Starting a hormone drip may also reduce the need for an assisted vaginal birth.

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