What is Instrumental Delivery?
Instrumental delivery or assisted birth is when your baby needs help to be born with instruments that attach to her head. It’s also called an instrumental, or operative vaginal birth. About one birth in eight is assisted.
Assisted births are often needed when labour has been long and tiring, as it can be about helping the mum as well as the baby. A long slow labour is more likely if you’re expecting your first baby. Based on statistics for England, about one in five first-time mums has an assisted birth compared with one in 14 mums who have had a baby before.
The option of assisted birth helps many first-time mums to achieve a vaginal birth, and puts them in a better position to have a straightforward birth for their next baby than if they’d had a caesarean.
What are forceps and ventouse?
Forceps and ventouse are the instruments used for an assisted birth.
Which instrument is used depends on how close you are to your due date, the position she is in, and how difficult your doctor thinks the birth is going to be.
Forceps look a bit like two stainless steel salad servers that fit together. There is a handle at one end, and the other end has two curves which cradle your baby’s head.
The ventouse (vacuum extractor), has a cup attached to a suction device, and a handle to pull on. The cup fits on top and towards the back of your baby’s head, and a vacuum is created within the cup. The cup is made of soft or semi-rigid plastic, or metal. The vacuum is created by a hand-held pump or a suction machine.
Ventouse is not recommended if:
- Your baby is less than 34 weeks, as her skull will be too soft to cope with the vacuum.
- You are having a breech birth.
- Your baby is lying face-first.
Why might I need an assisted birth?
Your midwife and doctor may recommend an assisted birth if:
- Your baby is distressed during the pushing stage of labour.
- You are exhausted and can’t push any more.
- Your baby isn’t making progress through your pelvis as would normally be expected.
- There’s a medical reason why you shouldn’t push for too long, such as if you suffer from heart disease.
- Your baby’s head needs gently turning, so she’s facing the right way to be born.
Can I avoid an assisted birth?
It’s not always possible to avoid an assisted birth, but you can reduce your risk when planning your baby’s birth and when you’re in labour.
If your pregnancy is going well, you should have the option to give birth at home or at a birth centre. Planning to have your baby in either of these places increases your chance of having a straightforward labour and birth, without instruments and other interventions.
Once you’re in labour, taking these steps will reduce your risk of needing instruments to help your baby to be born:
- Having continuous support from a birth partner or doula.
- Having an upright position during labour or lying on your side for the birth rather than on your back.
- Not having an epidural.
- If you’ve had an epidural, waiting for at least an hour after you are fully dilated (so that the head can descend further into the birth canal), or until you feel the urge to push, before trying to push your baby out. Using a hormone drip can help too.
What happens before an assisted birth?
Your doctor will explain why you need an assisted birth and what your options are. They will also observe your bump and examine you internally, to check your baby’s position and make sure that an assisted birth is the right thing to offer you.
Dr John will then decide which instrument to use and talk this through with you.
If your doctor thinks that an assisted birth is possible, but could be difficult, you will be moved to the operating theatre. This is in case a caesarean is needed. Assisted birth is less likely to be successful if:
- your body mass index (BMI) is over 30
- your baby is large
- your baby is lying back-to-back
- your baby’s head is not low down in the birth canal
Whether you’re in a delivery room or in theatre, your legs will be placed in stirrups or supports at either side of the bed, and the end of the bed will be removed.
You’ll need an empty bladder, so a thin tube (catheter) attached to a bag may be put in your bladder to empty it. This may be a bit uncomfortable.
You’ll be given pain relief, which may be an injection inside your vagina (a pudendal block), an epidural, or a spinal anaesthetic. Your baby’s heartbeat will be monitored throughout.
A paediatrician is likely to be called to the delivery room. This is normal for an instrumental birth, so try not to worry.
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