Some babies need a little help to be born.  You may need an assisted delivery if your baby gets into a difficult position, shows signs of distress, or if you and your baby get very tired.

What is an assisted delivery?

It’s an umbrella term for medical techniques used to speed up the delivery of your baby in the last stage of labour when your cervix is fully dilated.

These methods use instruments to help you give birth naturally but with minimum risk to you and your baby. These include:

Ventouse

This is the French word for suction cap – a cap is put on the baby’s head and attached to a vacuum pump and the power of the vacuum is used to help ease your baby down the birth canal. You’ll be asked to push with your contraction and the same time the suction will help pull the baby down. They can’t be used before 34 weeks as the baby’s head is too soft.

Forceps

These are large metal instruments which look like giant salad servers or tongs (they sound worse than they actually are!). They are curved to fit around your baby’s head to protect it and you’ll be asked to push with a contraction as the obstetrician eases the baby down the birth canal (don’t worry the obstetrician will work with the power of your contraction).

Why might I need an assisted delivery?

• Your baby is in distress (her heart rate has fallen)
• You’ve had a long labour and are too tired to push the baby out
• Your contractions aren’t strong enough to push your baby out
• The baby is not moving out of the birth canal or is in an awkward position (e.g.; back to back).

What pain relief will I need for an assisted delivery?

You will be given a local anaesthetic injection inside the vagina or an epidural (a regional anaesthetic injection into the space around the nerves in your back).

What else happens before an assisted delivery?

1. Episiotomy: To create more room for manoeuvre your midwife may make a small cut in your perineum (the area between your vagina and anus) to widen the opening of the vagina (this will be stitched after the birth).This is more likely before a forceps delivery than a ventouse.
2. Catheter: Your bladder needs to be emptied by a small tube called a catheter
3. Examination: Your obstetrician should check you beforehand to see if it’s possible to deliver your baby vaginally or whether you might need a caesarean section instead (where your baby is delivered through a surgical cut in your abdomen).
4. Stirrups: Your feet are usually put in stirrups to keep your legs out the way and give your obstetrician unobstructed access.

What if assisted deliveries don’t work?

This is usually because the baby is still too far up in or in an awkward position and in these cases you will be given a caesarean section.

Forceps v Ventouse ?

The Royal College of Obstetricians and Gynaecologists say both are safe and effective when used by an experienced obstetrician – and your obstetrician will choose which method is most appropriate for you.

Because forceps can cause more tearing than ventouse, the latter will often be used first and if that is unsuccessful the obstetrician will then try forceps.

Forceps are more likely to be used for deliveries where the baby is in an awkward position such as back to back or breech.

Forceps are more effective: A recent review (2010) of many research studies conducted for the Cochrane Library – an international collaboration which evaluates the effectiveness of different medical treatments - found forceps were more effective at delivering a baby, but women who had forceps deliveries were more likely to suffer from vaginal tears and incontinence.

Ventouse is less likely to cause vaginal tearing, but is not suitable for babies less than 34 weeks gestation because their heads are softer.

Will my baby be harmed by an assisted delivery?

In the vast majority of cases – no. The whole point of an assisted delivery is a speedier safer delivery for your baby.

• Forceps risks: Sometimes however, forceps use may cause your baby to suffer some temporary facial nerve damage or a broken collar bone – however these complications are unusual. In even rarer cases babies can suffer brain and spinal cord damage.
• Ventouse risks: Caps can cause a mark on your baby’s head called a chignon or a bruise called a cephalohaematoma- but don’t worry both will disappear in time. Babies delivered by ventouse may also have a lightly elongated ‘cone ‘shaped head – but again this is temporary and will disappear in the first few days.

How will I feel afterwards?

You may have internal bruising from forceps and need stitches if you’ve had an episiotomy or vaginal tear, these will feel sore but will heal within a few weeks. Ask your midwife on the postnatal ward for pain relief if you are in any discomfort.

A mum says...

‘I’d been pushing for 35 minutes in the second stage of labour when I was just overwhelmed by tiredness as my contractions had started 24 hours before. I just couldn’t seem to push hard enough. Eventually the midwife suggested ventouse and I was extremely relieved to have some help. It wasn’t painful as I had a painkilling injection and Natasha was born after 10 minutes.’  Ellen Smith , mum to Natasha, three months