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.
There are several reasons why an assisted vaginal birth is needed. Some of these include:
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!
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.
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.
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.
It is less likely to work if:
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
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.
If you are concerned about assisted vaginal delivery, you may opt to go directly for an emergency caesarean section.
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.
