Assisted vaginal birth (ventouse or forceps)

An assisted birth means using an instrument to help deliver your baby. There can be many reasons for needing help with the birth of your baby.

The main ones are:

• There are concerns about your baby’s wellbeing during labour
• Your labour is not progressing as would usually be expected
• You are unable to, or have been advised not to push during delivery

Your obstetrician or the midwife will use a ventouse or forceps to guide your baby during your contractions.

The ventouse extractor is a suction device that attaches to your baby’s head and connects to either a small machine that generates suction or to a palm pump which allows the obstetrician or the advanced midwifery practitioner to guide your baby’s head out.

Forceps are smooth metal instruments that look like large spoons or tongs. Your obstetrician will place the forceps on either side of your baby’s head and will pull gently as you push hard with your contractions.

Do I have a choice between ventouse and forceps?

Ventouse and forceps are both usually safe and effective. The choice of which of these are used
depends on many factors, including how well your epidural is working (if you have had one), the wellbeing of your baby, the gestational age and the position of your baby’s head.

Your obstetrician or advanced midwifery practitioner will recommend the method most suitable for your individual situation. If one instrument has been chosen and is not effective, they may then either recommend using the other instrument to help you have a vaginal birth or offer a caesarean, depending on your individual circumstances.

If you are in labour and choose not to have an assisted vaginal birth, the alternatives are to wait for your baby to be born without assistance or to have an emergency caesarean section. Your obstetrician or advanced midwifery practitioner will discuss your options depending on your individual circumstances.

Are there any complications?

An assisted vaginal delivery is usually safe for you and your baby. The majority of babies born this way are well at birth and do not have any long-term problems. However, complications can happen such as:

• Pain around the stitches: it usually settles quickly
• Bleeding: if the bleeding is heavy, you may need additional machines or a blood transfusion
• Tears: minor tears are common and are easily closed with stitches. Major tears are less common, and some may require repair in theatre if the anal sphincter (muscle controlling the back passage) is involved. An episiotomy (a cut on the perineal skin and vagina) is often required to assist with delivery and to help reduce the risk of uncontrolled tearing
• Damage to your back passage: caused when a major tear or episiotomy extends to your anal muscle itself. Your obstetrician will suture it in the theatre to correct the damage
• Healing problems: sometimes an episiotomy or tear will open but this usually does not need any treatment and still heals well. Your community midwife will provide support and advice on taking care of the wound while you are healing
• Difficulty passing urine: you may need a catheter for few days
• Infection: usually one dose of antibiotics is given to prevent infection
• Increase risk of venous thromboembolisms: According to your risk score, injections may be given to prevent developing blood clots
• The experience of birth can sometimes be distressing and for some women there is a risk of post-traumatic stress disorder. If this occurs, your midwife will direct you to places where you can receive help
• The ventouse suction cup can leave a temporary swelling on your baby’s head that will disappear over the next few days but it may also leave a bruise on your baby’s head, called a cephalohaematoma, which will disappear with time (up to six to eight weeks)
• The forceps may leave small marks, bruising or scratching, which is quite common. These usually heal or disappear within a day or two. Rarely, forceps may compress your baby’s facial nerve, causing one side of their mouth to droop (palsy). This is usually only temporary.
• Serious complications, including fractures and bleeding in baby’s brain, are uncommon and will be discussed with you by the attending obstetrician.
• Babies are usually quite comfortable and continue as normal

Most people recover well after their assisted vaginal birth. You can begin to have sex again when you feel that it’s the right time for you.
Having an assisted vaginal birth does not mean you will necessarily have one in your next pregnancy. Most women who have an assisted vaginal birth deliver spontaneously next time.