there are concerns about the baby's heart rate
your baby is in an awkward position
you're too exhausted
Both ventouse and forceps are safe, and are only used when necessary for you and your baby. Assisted delivery is less common in women who have had a spontaneous vaginal birth before.
If the baby's head is in an awkward position, it will need turning (rotating) to allow the birth. A paediatrician may be present to check your baby's condition after the birth. A local anaesthetic is usually given to numb the vagina and perineum (the skin between the vagina and anus) if you haven't already had an epidural.
If your obstetrician has any concerns, you may be moved to an operating theatre so a caesarean section can be carried out if needed – for example, if the baby can't easily be delivered by forceps or ventouse. This is more likely if your baby's head needs to be turned.
Sometimes, as the baby is being born a cut (episiotomy) may be needed to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Depending on the circumstances, your baby can be delivered and placed on your tummy, and your birthing partner may still be able to cut the cord if they want to.
A ventouse (vacuum extractor) is an instrument that is attached to the baby's head by suction. A soft or hard plastic or metal cup is attached by a tube to a suction device. The cup fits firmly on to your baby's head.
During a contraction and with the help of your pushing, the obstetrician or midwife gently pulls to help deliver your baby.
The suction cup leaves a small swelling on your baby's head called a chignon. This disappears quickly. The cup may also leave a bruise on your baby's head called a cephalhaematoma.
A ventouse is not used if you're giving birth at less than 34 weeks pregnant because your baby's head is too soft. It is less likely to cause vaginal tearing than forceps.
Forceps are smooth metal instruments that look like large spoons or tongs. They're curved to fit around the baby's head. The forceps are carefully positioned around your baby's head and joined together at the handles. With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.
There are many different types of forceps. Some forceps are specifically designed to turn the baby to the right position to be born, such as if your baby is lying facing upwards (occipito-posterior position) or to one side (occipito-lateral position).
Forceps are more successful than ventouse in deliverying the baby, but a ventouse is less likely to cause vaginal tearing.
What are the risks of a ventouse or forceps birth?
Ventouse and forceps are safe ways to deliver a baby, but there are some risks that should be discussed with you. Your obstetrician or midwife should also discuss the reasons for having an assisted birth, the choice of instrument (forceps or ventouse), and the procedure for carrying out an assisted birth. The risks are listed here.
Vaginal tearing or episiotomy
This will be repaired with dissolvable stitches.
Third- or fourth-degree vaginal tear
There is a higher chance of having a vaginal tear that involves the muscle or wall of the anus or rectum (known as a third- or fourth-degree tear). This kind 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
Higher risk of blood clots
After an instrumental delivery, there is a higher chance of blood clots forming in the veins in your legs or pelvis. You can help prevent this by moving around as much as you can after the birth.
You may also be advised to wear special anti-clot stockings and have injections of heparin, which makes the blood less likely to clot.
Urinary incontinence (leaking urine) is not unusual after childbirth. Research suggests it affects around 30 out of 100 women. It is common after a ventouse or forceps delivery. You should be offered physiotherapy-directed ways of preventing this.
Anal incontinence (leaking flatus or faeces) can happen after birth, particularly if a third-or fourth-degree tear has occurred. As there is a higher risk of such tears after a forceps or ventouse delivery, anal incontinence is more likely to occur after instrumental delivery.
It is difficult to know exactly how common anal incontinence is, as there is no standard definition and because people who have it may be reluctant to say they do. In a review of studies looking at incontinence after childbirth, estimates of how common anal incontinence was ranged from 13% to 27%.
What are the risks to the baby?
The risks to your baby include:
a mark on your baby's head (chignon) being made by the ventouse cup – this usually disappears within 48 hours
a bruise on your baby's head (cephalohaematoma) – this happens to between 1 and 12 in 100 babies and disappears with time; it can cause a slight increase in jaundice in the first few days, but rarely causes any other problems
marks from forceps on your baby's face – these usually disappear within 48 hours
small cuts on your baby's face or scalp – these affect 1 in 10 babies born via assisted delivery and heal quickly
You will sometimes need a catheter (a small tube that drains your bladder) for up to 24 hours. You're more likely to need this if you have had an epidural as you may not have fully regained sensation in your bladder and therefore don't know when it's full.