Assisted delivery (forceps or ventouse)

What is an assisted birth?

An assisted birth is when a health professional 'assists' or helps your baby out of your vagina during childbirth.

Your doctor may use a vacuum cup or forceps to assist with your baby's birth. Assisted birth is also known as an instrumental birth, or operative vaginal delivery.

Video provided by the Australasian Birth Trauma Association.

Why might I need assistance to give birth?

There are quite a few situations in which you might need help to birth your baby. In fact, around 1 in 10 babies are born by assisted delivery in Australia.

Some common reasons for assisted delivery include:

• your baby is unwell or in distress and needs to be born quickly
• your baby is in a position that makes it difficult for them to be born
• you are becoming exhausted and are unable to continue pushing
• you have a medical problem that means you shouldn't push during labour

How do I decide whether to have an assisted birth?

It's a good idea to think about how you would like to give birth before your labour begins. Discuss your birth plan with your doctor or midwife, as well as your birth partner. Learn about assisted delivery as part of planning ahead.

It's important to know that birth does not always go to plan. There can be unexpected events during your labour and birth. On the day, your doctor or midwife will consider what is happening during labour and what is best for you and your baby.

Here are some questions to ask if your doctor or midwife recommends an assisted birth:

• Why do you think I need an assisted birth?
• What is involved in an assisted birth?
• What are the risks and benefits of an assisted birth?
• What are the potential risks of a not having an assisted birth?
• What if I prefer not to have an assisted birth?
• Are there any other options?

It's your choice whether to have any intervention during your labour and birth. You can discuss your options with your support person.

What is done to prepare for an assisted birth?

The steps will be explained to you so that you can give informed consent.

An assisted birth is usually done by an obstetrician, but other staff, including midwives, will be there to help. A paediatrician may also be there, to check your baby after the birth.

An assisted birth will only be done if your cervix is fully dilated (to 10cm) and if your baby is low enough in your pelvis. Your doctor will examine you thoroughly to check.

Your doctor may choose to do the assisted birth in an operating theatre. For example, if they think you may end up needing to have a caesarean birth (C-section).

Your doctor will make sure you have enough pain relief. This may include an epidural anaesthetic, or local anaesthetic injections.

Your bladder needs to be empty before the birth. The doctor or midwife will insert a thin tube called a catheter into your bladder to release the urine (wee).

Your legs will be placed in supports or stirrups.

An episiotomy (cut in your perineum) is usually recommended to make your vaginal opening larger and prevent severe tearing.

How is an assisted delivery done?

A vacuum cup (also known as a ventouse or vacuum-extraction) or forceps can be used to assist your birth. There are advantages and disadvantages to each method.

Your doctor will choose which instrument to use based on:

• the position or rotation of your baby
• how low your baby is in your pelvis
• the type of pain relief being used

Ventouse assisted birth

Your doctor will place a soft vacuum cup on your baby's head. The cup stays on with suction.

During a contraction and while you are pushing, your doctor will slowly pull on the cup. This will help your baby move through the birth canal and out through your vagina.

More than one pull may be needed.

Forceps assisted birth

Your doctor will place the forceps over your baby's head. Forceps look a bit like salad server tongs, with 2 smooth, spoon-shaped blades.

Your doctor will gently pull on the forceps during a contraction and while you are pushing. This will help your baby move through the birth canal and out through your vagina.

More than one pull may be needed.

If your baby has not been born after 3 pulls with the vacuum cup or forceps, your doctor will need to use a different method. If the ventose was used first, they may try again using the forceps.

Or you may need a caesarean section to help complete the birth. If at any point you or your support person are concerned, tell your healthcare team.

You may be given antibiotics after an assisted birth to prevent infection.

What are the risks of an assisted birth?

Most assisted births happen safely without any complications, but sometimes complications do happen.

If an assisted birth is recommended, it is because your doctor or midwife believes the risks of not helping your baby's birth are greater than any risks of the assisted birth.

If you aren't sure what to do, ask your doctor or midwife about the reasons that they recommend assisted birth and what the alternatives are.

Risks to you

After an assisted birth you may have:

• bruising or an injury to the skin around your vagina
• an injury to your pelvic floor that may affect your bladder or bowel function

If you experience any ongoing symptoms, such as pelvic pain or bladder and bowel problems, you should see your doctor. You may also consider seeing a women's health physiotherapist.

Risks to the baby

After a vacuum-assisted birth your baby may have bruising or haematoma (blood under the skin) on the area of their scalp where the suction cup was attached.

After a forceps birth, your baby may have marks or bruising on their face or scalp from the forceps. These fade quickly.

Rarely, an assisted birth may injure a nerve in your baby's face. This will usually heal quickly on its own.

There's a risk of shoulder dystocia during an assisted birth. This is when your baby's shoulders get stuck and do not come out straight away after the head is born.

Very rarely there could be a more serious injury to your baby's head or spine.

What are the alternatives to an assisted birth?

If you choose not to have an assisted birth, you can keep trying to birth your baby on your own, or you can have a caesarean birth. Your doctor or midwife can give you information about the benefits and risks of each option.

As labour continues or the situation changes, you and your healthcare team can look at the options again.

How long does it take to recover from an assisted birth?

It can take time to recover from any type of birth. It's important to rest and take care of yourself after giving birth.

After an assisted birth, you may have:

• a change to your bladder or bowel function for a few days
• pain and discomfort from an episiotomy or vaginal tear
• stitches in your perineum
• weakness of your pelvic floor muscles

It can take a few weeks for a full recovery. A physiotherapist can help with care of your pelvic floor.

You can have sex again when you feel comfortable. It is quite normal for it to be a few weeks or even months before you are ready to have sex after an assisted birth.

See your doctor for advice if you have problems that are not getting better, such as:

• pain
• discomfort in your vagina
• urine leaking
• trouble with your bowel function
• painful sex

You can read more about your body after having a baby here.

Emotional support

If you've had a difficult birth or complications after birth, talk to your doctor or midwife before leaving the hospital. You might find it helpful to 'debrief' and talk over what happened.

Giving birth is an emotional time, especially if things didn't go as you had planned.

If you have ongoing physical or psychological issues in the weeks or months following birth, seek help through your doctor or midwife. You could also contact an organisation such as the Australasian Birth Trauma Association.

Resources and support

Talk to your doctor, midwife or obstetrician if you need support.

Visit the Australasian Birth Trauma Association website for information and support, including peer-to-peer support.

ForWhen provides mental health support for expecting and new parents — call 1300 24 23 22.

PANDA also provides advice and mental health support for new parents. You can call the PANDA National Helpline (Monday to Saturday) on 1300 726 306.

Factsheets on women's health in your language are available at The Royal Women's Hospital website.