Assisted birth

An Assisted Birth is one where forceps or ventouse are used to assist the birth of the baby.

Forceps have been used in childbirth for approximately 400 years, having been first invented by a man named Peter Chamberlen, then used more widely by doctors in the 18th century. Ventouse – also called vacuum assisted vaginal delivery – is a more recent phenomenon that was first used in Sweden, using a bicycle pump to create the necessary pressure to deliver the infant!!! Obviously this procedure has been much refined to provide controllable negative pressure, creating suction to help deliver the baby.

Today, both methods are still used to deliver a baby vaginally, when assistance is needed. In New Zealand both procedures are carried out by doctors, although in other parts of the world midwives also do ventouse deliveries.

What are forceps?

These are hand held instruments which look rather like a pair of large, metal salad servers which are used to help delivery of the baby’s head. They are placed around baby’s head by the doctor and then the baby is born by combined efforts of mum and the obstetrician.

What is a ventouse?

This is a rubber or metal cup which is placed over baby’s head and attached to a suction machine. The ventouse helps the baby’s head to be born, in conjunction with mum’s pushing efforts. The pressure of the suction is carefully controlled by a machine – it is gradually increased, prior to the doctor attempting to deliver the baby.

Why would I have an assisted birth?

The main reasons for having an assisted birth are

Fetal distress – the baby is not coping with the reduced blood supply from the placenta at the end of labour – baby’s reserves have run out.
Maternal exhaustion – despite attempted pushing the mother is too tired to continue pushing (it can be particularly hard work birthing your first child).
Failure to progress – the baby is not descending down the birth passage, despite mum’s efforts. Possibly it is too big or in a poor position for a straightforward birth.
High blood pressure – if mum has raised blood pressure or pre eclampsia the assisted birth may be planned to prevent this getting any worse
Prematurity – forceps may be used to prevent the premature infant’s head being squashed during a vaginal birth

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What does an assisted birth involve?

Firstly, the decision needs to be made between yourself, your partner and your health professionals that assisted delivery is the best option for you and your baby. As all procedures carry risks, it is important that you understand the reason for the forceps/ ventouse. The doctor will briefly explain any risks to you and obtain your verbal consent for the procedure. If you are going to the operating theatre for your delivery (sometimes the doctors request this because they suspect the forceps/ ventouse will not be successful and you may need a caesarean section), then you will be asked to sign a consent form for a caesarean section in case this is necessary.

If you wish to know more about the pre-operative preparation for caesarean section, please read our article on Caesarean Section- before, during and after.

You will be assisted into the lithotomy position (legs apart and supported by stirrups) and the doctor will carry out the following procedures:

Feeling your tummy to check that baby’s head is well down in your pelvis
Empty your bladder with a catheter
Check that your cervix is fully dilated and check which way baby is facing, by doing a vaginal examination
Apply the ventouse or forceps to baby’s head between contractions – if you do not have an epidural you will receive local anaesthetic for this.
When you have a contraction you will be encouraged to push, while the doctor applies traction, to deliver the baby’s head
If you have forceps (and sometimes with ventouse) you will need an episiotomy. This is an incision to make the vaginal opening larger, to allow the baby to pass through.
When baby’s head is born, the ventouse or forceps are removed and the shoulders are born with a push from you and gentle traction from the doctor.
If you had an assisted delivery due to fetal distress, the baby may need to go straight to the paediatrician (or baby doctor), who will be in the room with you, to see if baby needs help with breathing. Otherwise the baby will be placed on your tummy immediately after the birth.
You will always be advised to have the injection to deliver your placenta (syntometrine) as your body will be very tired after an assisted delivery.
If you have had an episiotomy or a tear you will require stitches, which will be done immediately by the doctor.

The staff will do everything possible to make this birth as gentle and special for you. Many women find it difficult to feel positive about the birth experience when there have been extra people present and they needed procedures they had not anticipated having. Other women are exhausted and grateful for the extra help, just relieved it is all over. It is important to acknowledge your own feelings and to talk to your health professionals to ensure that you understand the ‘whys and wherefores’ of what happened at your birth.

What are the risks and complications of forceps and ventouse?

Generally the ventouse is preferred to the forceps as it carries less risk of complications. Any interventions carry risk, therefore it is generally preferable for the woman to push her baby out un-aided, if possible.

Risk of bruising and internal injury to mum, particularly with forceps
Risk of tearing and extended tears
Risk of bladder or bowel injuries
Risk of psychological stress to mum, particularly if she has suffered sexual abuse in the past and finds the procedure traumatic.
For baby there is risk of head injury, nerve injury and marks or bruising on the head or face, due to the instruments used to help deliver them. This has to be balanced against the alternative of not assisting the delivery and the infant getting a poor blood supply for a long period.
If the procedures are not successful, you will need a caesarean section to deliver your baby.

Tips : What can I do to prevent an assisted birth?

Eat small amounts of high energy foods in early labour and drink well to keep hydrated throughout labour – in order to keep your energy up.
Maintain upright positions in labour: if you need to rest lie on your side, rather than your back. This promotes good positioning of your baby inside the womb and results in a quicker, easier birth.
Discuss with your midwife, prior to the birth, techniques to help you to push effectively in the second stage of labour; for example, waiting till baby’s head is well down, prior to pushing.
There have been suggestions that epidurals increase the need for an assisted birth, due to lessening of the urge to push, but this has never been proven. You need to balance your need for pain relief against the possible risk of complications from procedures in child birth.
Most importantly, keep yourself fit and healthy in pregnancy and remember that most women are very capable of birthing naturally if well supported and positive about the experience.