Forceps and ventouse delivery is sometimes referred to as assisted or instrumental birth.
Both types of intrumental delivery can only be used in the second stage of labour, that is when the cervix has fully dilated and can no longer be felt on an internal examination. This means the baby’s head has already started to leave the womb and is in the process of coming through the vagina.
Both forceps and ventouse delivery methods help pull down the baby to increase and double the effect of maternal pushing efforts in the second stage.
The decision to intervene is not taken lightly, but there are important reasons to do so.
Some babies get distressed in labour. This can be detected by changes in the pattern of the baby’s heart rate. Meconium poo in the amniotic fluid is also an indication of fetal distress. If the baby is distressed this is a major reason to speed things along.
There may also be need for assistance if the pushing effort alone is not effective enough to safely deliver the baby. Pushing effort can be diminished if an epidural is so effective that the body’s natural urge to push down cannot be felt, so this is a common reason for assisted delivery.
Certain medical conditions, like heart problems for example, might mean that it is not recommended to push for too long.
It is more common to have an forceps or ventouse birth if it is your first baby.
A ventouse is often used to swiftly and safely aid delivery. The doctor first does a vaginal examination to check the exact position of the baby. The ventouse suction cap is then applied to the crown of the baby’s head.
The ventouse instrument can either be a small disposable device called a Kiwi Cup, or a silicone or metal ventouse cap attached to a suction machine. Suction is gently increased or pumped up, and the doctor will apply steady traction whilst the mother pushes down hard with each contraction. It usually only takes a few contractions until the baby’s head is delivered.
Ventouse delivery should not harm the baby, but he will have a soft swelling or chignon on his head for a day or two. Baby’s head will begin to reshape within a few hours. Sometimes there is slight bruising but this will quickly resolve.
Here we have the before and after images of the same baby. The top picture shows the baby within an hour or so of a ventouse birth. The tell tale chignon bruise visible where the suction cap was applied to the baby's head.
Below is the same baby five days later with the chignon bruising mark barely visible.
An alternative to ventouse is to use a pair of forceps to apply traction to the baby’s head. Forceps are made from stainless steel and look rather like a large pair of salad servers or tongs!
They are carefully placed one at a time on either side of the baby’s head and again the doctor will apply traction as the mother bears down. Sometimes forceps leave red marks on the baby’s face but these fade in a day or two.
Extra pain relief is usually given if an epidural is not already functioning well. This may be gas and air or a pudendal block or even a spinal analgesia.
Babies can only be delivered in this way if the doctor is happy that it is safe to do so. Sometimes women are taken to the operating theatre and prepared for caesarean section before trying an assisted delivery. This way if the instrumental attempt fails the obstetric team can proceed straight to delivery by c-section without delay.
It is more likely that perineal stitches will required after a forceps and ventouse delivery. Sometimes a cut known as an episiotomy is needed to make the passage of the baby through the vagina happen more quickly, particularly if the baby is showing signs of fetal distress.
For those who who have the stomach for it! Some graphic diagrams of how forceps are used shown at this Wikipedia page!
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