Assisted Delivery (Forceps and Ventouse)

Failing to push out the baby in a spontaneous manner once the pushing stage of labour has begun, is the most common reason to opt for assisted delivery. Generally, the gynaecologist will monitor up to two hours of pushing, but at times, after an hour or so, it becomes obvious that the baby will need external support to come out. This is when the doctor decides on carrying out an assisted delivery.

What is an Assisted Birth?

When the doctor decides to help the birth process by making use of instruments like forceps or ventouse (suction cup) and deliver the baby, an assisted delivery is said to be carried out. Assisted birth is also known as instrumental birth and is used only as a last resort. During delivery, an epidural is administered which reduces the pain but may also reduce the ability to push the baby out. It is in such circumstances that the woman will require assistance in delivering the baby.

Assisted birth, also known as operative vaginal birth, aims to replicate spontaneous delivery by extracting the fetus from the vagina without the help of maternal pushing. If the doctor has any concerns about the baby’s heart rate or its position, he/she will use this method to avoid any complications in the delivery.

What Are Forceps and Ventouse?

Ventouse

A ventouse is a vacuum extractor which is attached to the baby’s head by suction during assisted delivery. It consists of a rubber, plastic or metal cup that connects to a suction device through a tube. The cup is designed to fit snugly on the baby’s head without causing any injury or damage. Supported by the woman’s pushing and the contractions, the doctor pulls in a gentle manner to help her in delivering the baby. When the ventouse is used, the suction leaves a temporary mark, known as a ‘chignon’, on the baby’s head. If you are at less than 34 weeks of pregnancy, the ventouse is not used as the baby’s head is soft.

Forceps

These are metal instruments that resemble tongs or large spoons and are designed to fit around the baby’s head . During assisted delivery, these forceps are placed carefully around the baby’s head, and the handles are pulled together to grip the head properly. During contractions, the doctor gently pulls the baby outwards and delivers it safely. There are specific forceps available to help the baby turn to the ideal position for delivery. Though the forceps can leave a slight mark on the baby’s head or forehead, these are temporary and will disappear after some time.

Why you Could Need an Assisted Birth

You will need assisted delivery in case of following conditions:

1. If you have been pushing for long and this has caused extreme exhaustion.
2. If the baby is distressed during labour.
3. If you suffer from a medical condition like heart disease.
4. If your baby isn’t moving properly through your pelvis.
5. If the baby’s head is required to be turned so that he/she faces the right direction during delivery.
6. If during a breech position, the head is unable to come out

Can Assisted Childbirth be avoided?

Although avoiding assisted delivery may not always be possible, the risk of having one can be reduced through the following factors:

• Try and avoid an epidural.
• If an epidural is unavoidable, wait for an hour before you push so that you are completely dilated, and there is a natural urge to push.
• If your doctor allows it, try moving into a sitting position repeatedly during labour.
• Get help and support from your labour partner or the doctor while in labour.

What Normally happens before an Assisted Delivery?

While deciding upon conducting an assisted delivery, your doctor will check the position of the baby. If the baby’s position is right, he/she will then make a choice of the instrument to be used. Of course, you may not be in a position to discuss this with the doctor. Depending on your condition, you could be shifted to the operating room in case a C-section operation needs to be carried out. After putting your legs in supports on both sides of the bed, you will be shaved, and a catheter will be used to drain off your bladder. You could also be administered a localised pain relief injection.

What happens during a Forcep Induced birth?

During an assisted birth using forceps, you will be given a local anesthetic in the vagina as the first step. The doctor will make a cut so that the opening is widened and there is enough space to put the forceps around the baby’s head. After the forceps are delicately clamped around the baby’s head, the doctor will time his/her pull with your contraction so that the baby’s travel along the birth canal is facilitated. If the baby does not move satisfactorily enough after three pulls, the doctor will quickly move on to conducting a cesarean section and deliver your baby.

What happens during a Ventouse birth?

A ventouse is generally preferred by doctors for assisted delivery as they are less painful as compared to forceps. Since the suction cup sits firmly on a small area of the baby’s head, there are fewer chances of it causing perineal tearing to the mother. The doctor uses a foot-controlled pump to remove air from the cup so it is firmly fixed. The doctor will then pull the ventouse outwards during your contraction and will guide the baby out. If this doesn’t work, the doctor will opt for a C-section operation to avoid any risks.

Which is better- Forceps or Ventouse?

Your doctor may opt for either of the instruments depending on your condition as each has its own benefits and risks. A ventouse can lead to temporary swelling around the baby’s head and cause retinal hemorrhage to the baby but does little damage to your vaginal and surrounding areas. Forceps are more likely to do the job of helping the baby out as compared to the ventouse but can cause some bruising to the baby’s face. Its use during delivery can lead to external and internal damage to the vagina. It is your doctor’s choice to decide about the instrument to be used according to the prevailing circumstances.

What happens after an Instrumental Delivery?

Right after the delivery takes place, you will want to know the reasons why you had an assisted delivery. Your obstetrician is the best person to speak as he can give you the facts quite competently. You can ask and clarify all your doubts post the assisted delivery and how it will affect normal life for you and the baby. You may want to know the time taken to recover from the delivery. If there are any marks on the baby due to the instrumental delivery, be assured they will disappear within a few weeks. The doctor may prescribe the external application of ointments if the blisters are severe.

Risks associated with Forceps and Vacuum Delivery

Both vacuum-assisted and forceps-assisted delivery can cause a small amount of tear or injury to the tissues around the vagina, anus and perineum. Both these methods are also known to cause fecal or urinary incontinence because of the tiny injuries caused. Your doctor will give you a fair idea of these issues and prescribe the necessary medications to help you to tide over it.

Risk to your Baby

Although the use of forceps and ventouse is made to assist in facilitating a normal delivery, there are a few risks you should be aware of as a mother-to-be:

1. External Scalp Injuries

Assisted delivery using forceps or ventouse can cause external wounds to the baby’s head and forehead and a tiny bit of swelling too. While the swelling will subside in a few days, the injuries may need medical attention. There could be small cuts or abrasions, but these will be superficial and are not known to leave any permanent marks.

2. Hematoma

The formation of blood under the baby’s skin, known as hematoma is a common occurrence when vacuum-assisted deliveries are carried out. There are two types of hematoma which are cephalohematoma and sub-galeal hematoma. While cephalohematoma does not lead to any major complications, sub-galeal hematoma is rare but can be life-threatening in certain situations.

3. Intracranial Haemorrhage

The suction that is applied to the baby’s skull can cause internal bleeding due to damage to the veins. It is a rare condition but can lead to serious consequences like memory loss, speech impairment or loss of movement to the connected area. However, with modern equipment and better vacuum cup material, such a condition is quite rare.

4. Retinal Haemorrhage

Bleeding at the rear portion of the eyes is known as retinal hemorrhage and is a common occurrence in newborn babies. The baby’s head is subjected to a lot of pressure when it passes through the cervix and when the external pressure in the form of ventouse or forceps is applied, it can lead to retinal hemorrhage.

Assisted Delivery with the help of external devices like forceps and ventouse (vacuum pumps) is used by doctors when they anticipate issues with normal deliveries. Your doctor will know how and when to use them and will deliver your baby using them as support devices to create a safe passage.