Assisted birth – why forceps or ventouse may be necessary

Assisted birth is when your baby is born with the help of medical instruments. Around one in eight women in the UK has an assisted birth using forceps or ventouse suction cup to encourage faster delivery.

In most cases, these methods are used when the labour has been long or is failing to progress. Assisted birth techniques are more commonly used in first-time labours.

When are assisted births most likely

Common situations that occur during labour and which might lead to assisted birth methods being needed are:

• The baby is suffering fetal distress and the heart rate is being affected
• The mother is too tired to push
• The baby is failing to progress through the pelvis
• Maternal medical reasons such as heart disease, which require speedier delivery
• The baby’s head needs turning

If your midwife recommends the use of either forceps or ventouse, they will explain the reasons to you at the time. There may be a period when you will be monitored and observed before a final decision is made. Both of these tools are regularly used and considered safe in the UK.

Forceps delivery

Forceps are stainless steel, tong-like implements having a handle at one end for the obstetrician and a curved cradle at the other to fir around the baby’s head. The head is gripped gently during a contraction and encouraged down the birth canal as you push.

If forceps are advised you will be given pain relief and examined internally to check that your baby is in the right position for birth. An episiotomy may be performed. This creates a larger opening in your vagina in order to be able to apply the forceps to your baby’s head. Throughout the process your legs will be placed in stirrups.

With each contraction the doctor will help the baby to move down the birth canal and be rotated, if necessary. This will be performed three times only. If your baby has not been born at this point, it is likely that a caesarean section will be advised.

Although considered safe, there are some small risks associated from using forceps to aid birth. These include:

• Tearing to the vagina
• Damage to the perineum (area between the vagina and the rectum)
• Short-term incontinence
• Redness and bruising to the side of baby’s face

Although intervention with forceps can cause short-term physical problems for a labouring mother, if a baby is in distress forceps are likely to be advised to speed up delivery and minimise associated risks.

Ventouse delivery

A suction cup is attached to the baby’s head. The air is sucked out of the cup using a hand-held pump or foot pump machine. During a contraction the baby is gently pulled down the birth canal.

Ventouse won’t be used in a baby earlier than 34 weeks, as the baby’s skull will be too soft, or if the baby is in the breech position or lying face first.

A midwife or obstetrician with specialist training in ventouse delivery will carry out the delivery. You will be given pain relief and your legs will be placed in stirrups whilst the procedure takes place. In some cases an episiotomy may be required. If the hospital uses a foot-controlled pump be prepared for it to be a little noisy too.

As your contraction begins the midwife or doctor will ask you to push and they will simultaneously pull gently on the ventouse cup. If your baby has not been born following three contractions then you may be offered forceps delivery.

Ventouse delivery is less likely to cause damage to your vagina and perineum, when compared to a forceps assisted birth, but there are some small risks to your baby, which include:

• Short term swelling to your baby’s head (cephalhaematoma)
• Retinal haemorrhage to your baby’s eye

Recovery following an assisted birth

Assisted labour is very unlikely to cause long term problems for a baby and any bruising or swelling caused by the use of forceps or ventouse will quickly reduce.

For a mother, there will be a period of recovery and some discomfort to the vagina may be experienced. You may also need to be fitted with a catheter for 24 hours afterwards.

Overall, you and you baby should quickly and comfortably recover.