Assisted birth

Why might I need help to delivery my baby?

There are several reasons you may need help, including if:

• your baby is not moving out of the birth canal as expected
• there are concerns about your baby’s wellbeing
• you can’t, or have been advised not to, push during birth.

The purpose of an assisted birth is to mimic a normal birth with minimum risk. Forceps or ventouse will only be used if they are the safest way to give birth for you and your baby.

How common is an assisted birth?

Assisted birth is quite common, although you’re much less likely to need help if you’ve had a vaginal birth before.

Will I be asked for consent?

Yes. Your doctor or midwife will ask for your permission to use forceps or ventouse to help deliver your baby. They will also explain:

• why they think you need an assisted birth
• what instrument they want to use
• the potential risks to you and your baby.

After your baby is born, you should also have a chance to talk to your doctor or midwife about why you needed an assisted birth.

Can I avoid an assisted birth?

Women who have someone supporting them during labour are less likely to need an assisted birth, particularly if the support comes from someone you know (a birth partner as well as a midwife.

Using upright positions or lying on your side and not having an epidural may also help. Find out more about movement and positions during labour.

If this is your first baby and you have an epidural, you may be able to reduce the need for an assisted birth by waiting until you have a strong urge to push or by delaying when you start pushing. The length of time that you delay pushing will depend on your individual situation and your wishes but is usually 1–2 hours after the cervix (neck of your womb) is fully open. Starting a hormone drip may also reduce the need for an assisted birth.

Try not to worry too much about this and how to do it. You can talk to your midwife about how to avoid an assisted birth before labour and a professional will be there to help you on the day.

What is a ventouse birth?

A ventouse (vacuum extractor) uses suction to attach a soft or hard plastic or metal cup on to your baby’s head. The doctor will wait until you are having a contraction and then ask you to push while they gently pull to help deliver your baby. They may need to pull more than once.

What is a forceps birth?

Forceps are smooth metal instruments that look like large spoons or tongs. They are curved to fit around your baby’s head. The doctor will carefully put them around your baby’s head, wait until you have a contraction and then ask you to push while they gently pull to help deliver your baby. They may need to pull more than once.

Which instrument will be used?

Ventouse and forceps are both safe and effective. Your doctor will choose the type of instrument most suitable for you, your baby and your situation.

There are many different types of ventouse and forceps, some of which are specifically designed to turn the baby around, if needed. Forceps are more successful in delivering the baby, but a ventouse is less likely to cause vaginal tearing.

The ventouse is not suitable if you are less than 34 weeks pregnant as the baby’s head is softer, which can increase the risk of bruising, brain haemorrhage and jaundice.

What happens during a forceps or ventouse assisted birth?

Your doctor will examine your stomach and do an internal examination to confirm that an assisted delivery is best for you. Your bladder will be emptied by passing a small tube (catheter) into it.

They may use a local anaesthetic injection inside the vagina (pudendal block) or a regional anaesthetic injection given into the space around the nerves in your back (an epidural) to block any pain.

If your baby’s head needs turning, you’ll probably be advised to have an epidural for pain relief during the birth.

Are assisted births always successful?           

Not always. If your doctor has tried using a ventouse or forceps and they do not think your baby can be born safely vaginally, they may recommend that you have an emergency caesarean. The word ‘emergency’ makes it sound last minute and rushed, but this is just a medical term.

Assisted vaginal birth is less likely to be successful if:

• you are overweight with a body mass index (BMI) over 30

• your baby is large

• your baby is lying with its back to your back

• your baby’s head is not low down in the birth canal.

What are the risks of having an assisted birth?

Bleeding

Bleeding after having a baby is normal. Immediately after an assisted birth, you may have some heavier bleeding. This should become like bleeding after a normal birth in the days afterwards.

Use sanitary towels, not tampons for the first 6 weeks after birth because tampons can increase your chance of getting an infection.

Tell your midwife or health visitor if you’re losing blood in large clots because you may need some treatment.

Vaginal tears or episiotomy

You may have a vaginal tear or an episiotomy. This is a cut made in the area between your vagina and anus, called the perineum. Even without the forceps or ventouse the perineum may tear during delivery. If you have a vaginal tear or episiotomy, this will be repaired with dissolvable stitches.

If you have an assisted birth, you’re more likely to have a third- or fourth-degree tear. This is a vaginal tear that involves the muscle or the wall of the anus or rectum.

This type of tear affects:

• 1 in 100 women having a normal vaginal birth
• up to 4 in 100 having a ventouse delivery
• 8–12 in 100 having a forceps delivery.
  

Bowel and bladder problems

Urinary incontinence (leaking wee) can happen after childbirth and it can be common after a ventouse or forceps delivery. You should be told about ways to prevent this, including advice on pelvic floor exercises.

Anal incontinence (leaking wind or poo) can happen after birth, particularly if you had a third- or fourth-degree tear.

If you have any concerns about incontinence, you can ask your GP to refer you to a women’s health physiotherapist.

Blood clots

Pregnancy increases the risk of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis) and this risk is higher after an assisted birth. You can help reduce this risk by staying as mobile as possible after you give birth. You may also be advised to wear special stockings and to have daily injections of heparin, which makes the blood less likely to clot.

Find out more about your body after birth.

Are there any risks for the baby?

If you have a ventouse delivery, the suction cup can:

• leave a mark on the baby’s head, which should disappear after a day or two
• commonly cause a bruise on a baby’s head called a cephalohaematoma – this occurs in between 1–12 in 100 babies who are born by the ventouse and disappears with time. It rarely causes any problems with babies except for a slight increase in jaundice in the first few days.

Forceps can:

• leave a mark on the baby’s face – this is very common and usually small, and usually disappears within 24–48 hours
• commonly leave small cuts on the baby’s face or scalp, which will heal quickly.

How will I feel after I leave hospital?

Much like after any birth, you may feel a little bruised and sore. Any stitches will heal within a few weeks and pain relief will help.

Will I need an assisted birth next time?

Not necessarily. Most women who have an assisted birth deliver their baby without help next time.