Vacuum or forceps delivery

Vacuum or forceps delivery, otherwise known as operative or assisted vaginal birth, is when your gynaecologist assists your vaginal birth by using either a vacuum cup or forceps. 10% of women will need to have an assisted vaginal birth. It is more commonly done for first time mothers. As things may happen quickly in labour, it is advisable for you and your partner to discuss your feelings regarding an assisted vaginal birth before you labour, just in case the situation arises.

When is a vacuum or forceps delivery needed?

There are several reasons why an assisted vaginal birth is needed. Some of these include:

• Concerns about your baby’s well-being e.g. baby heartbeat dropping etc 
• You have been pushing for quite some time and baby is not yet delivered
• You are exhausted from pushing/ unable to push hard for very much longer 
• You have medical conditions and have been advised not to push for too long 

An assisted vaginal delivery does not mean that you do not have to push at all – although your gynaecologist can assist you, the majority of the work still lies in your efforts!

What is a vacuum delivery?

A vacuum cup is a soft plastic cup that is attached to your baby’s head through suction. You will need an episiotomy to open up the space for baby to come through. During your contraction, your gynaecologist will pull on the vacuum cup to help guide baby’s head through your birth canal as you push. This will take the course of several contractions, during which the cup may “pop” off. In such cases, your gynaecologist may have to re-apply the cup before pushing resumes. 

What is a forceps delivery?

Forceps are smooth metal instruments that curve and fit around your baby’s head. You will need an episiotomy to open up the space for baby to come through. During your contraction, your gynaecologist will pull on the forceps to help guide baby’s head through your birth canal as you push. This will take the course of several contractions.

What if it doesn’t work?

You will need an emergency caesarean section if neither the vacuum or forceps is effective in assisting you for delivery. At this point, the risks of the emergency caesarean section will be higher-than-usual with increased complexity as baby’s head is usually much lower in the birth canal.

Are there instances where assisted vaginal delivery has a lower chance of success?

It is less likely to work if:

• You are petite (your height is 1.6m and below)
• You are overweight (body mass index 30 and above)
• You are having a big baby 
• Your baby is looking upward to the ceiling (lying in occiput-posterior position) instead of looking down towards the floor – this means the diameter of his/her head that needs to pass through your birth canal is larger 
• Your baby’s head is not low in your birth canal
• You are not able to push hard enough 

What are the risks of vacuum or forceps delivery?

Majority of assisted vaginal deliveries do not result in complications; however due to its nature, there are risks associated. Some of these risks can be serious or frequently occurring and include:

Serious risks

Mother

Third- or fourth-degree tears (1-4 in 100 for vacuum and 8-12 in 100 for forceps)

Multiple vaginal tears (1 in 10 for vacuum and 1 in 5 for forceps)

-these will require additional repairs

Baby

Bleeding between the skull and brain surface (3-6 in 1000)

Bleeding in brain (5-15 in 10 000)

Injury to facial nerve (rare)

-your baby will need to be checked by a neonatologist

Frequent risks 

Mother 

Bleeding after delivery/ postpartum haemorrhage (1-4 in 10)

Vaginal tears (common)

Weak pelvic floor muscles leading to issues with passing urine or stools 

Baby

Cup or forceps mark on baby’s head/face (very common, usually resolves on its own)

Bruising underneath scalp (1 in 10)

Face or scalp lacerations (1 in 10)

Jaundice (1 in 10)

Bleeding in the back of the eyes (1 in 5)

-these usually resolves in a few weeks and your baby will need to be checked by a neonatologist 

What happens after I have had an assisted vaginal delivery?

You will have a urine catheter inserted temporarily to help drain your urine while you regain your strength. This can usually be removed later in the day or the following day.

You will be given regular painkillers as you may feel fairly sore. It may help to sit on doughnut cushions and do regular warm salt baths.

You will need to care for your episiotomy or vaginal tear repair.

You will be advised to move about to reduce the risk of blood clots forming in your legs.

What if I do not wish for a vacuum or forceps delivery?

If you are concerned about assisted vaginal delivery, you may opt to go directly for an emergency caesarean section.

I’ve had an assisted vaginal delivery. Does it mean I will need it for my next pregnancy?

Most women who needed an assisted vaginal delivery for their first childbirth do not require one in their next. You will need a reassessment by your gynaecologist on an individual basis.