Around 1 in 8 births in the UK will be an assisted delivery, although this is less likely for women who have had a vaginal birth before.
Sometimes things don’t go to plan and your baby will need some help to be born safely. This might be because:
The baby is not moving through the birth canal despite lots of pushing
You are too exhausted to continue pushing
Your baby’s heart rate isn’t responding well to the contractions
There are concerns about your baby and they need to be born quickly
Your baby is becoming tired
You have a medical condition where you are advised not to push
Staying upright, having a supportive birth partner and not having an epidural can reduce your chances of needing an assisted delivery. However, the benefits of an epidural in terms of pain relief and your energy levels may outweigh the risks, and you should discuss any concerns with the team.
The obstetrician on the labour ward will talk to you and explain why your baby needs help to be born, and what will happen during the delivery. Your consent will be taken, and any questions you have can be answered before any procedures and intervention are performed.
There are two methods of assisted delivery: forceps and ventouse. Your obstetrician will advise you on which is the safest and best type of delivery for you and your baby. You will be given a local anaesthetic before these procedures to reduce pain. You will usually be taken to theatre for these procedures, so that you are in the right place if you need to have an emergency caesarean.
Ventouse is a suction cup that is applied to your baby’s head. The obstetrician will assist the birth of the baby by gently pulling while you push with your contractions. In most cases this will require a few contractions to birth your baby.
Forceps are curved shaped tongs. They are placed around baby’s head to help assist with the birth. The obstetrician will gently pull the baby while you push with the contraction. This usually requires a few contractions to birth your baby.
In order to deliver your baby safely, it may be necessary to perform an episiotomy. This is cut made between the vagina and rectum, which includes cutting through the skin and muscle.
The midwife/obstetrician will recommend that you have an episiotomy if your baby needs to be born quickly, if you are advised to have an assisted delivery with forceps/ventous), or to reduce trauma to your rectum if you are likely to tear.
Episiotomies are not done routinely – they will only be suggested if the midwife or doctor feels they are necessary, and they will get your consent. You will be offered an injection to numb your perineum prior to the procedure. If you have an epidural, you won’t need any additional anaesthetic as this will stop you feeling any pain.
If your baby is not born within a few contractions despite this assistance, the obstetrician may feel it is safer to proceed with an emergency caesarean. The obstetrician will discuss your plan of care with you, talk through your options and explain the risks involved. They will ask for your verbal consent and, if time allows, they will ask for your written consent for a caesarean.
The suction cup will usually leave a mark on your baby’s head but this usually fades quickly. It may also bruise your baby’s head (cephalohaematoma). This can slightly increase the risk of your baby getting jaundice, but it usually doesn’t cause a problem. Forceps will generally leave marks on your baby’s head, but they usually disappear within 48 hrs. Occasionally small cuts can happen to your baby’s face or head, but these will heal quickly.
Mums sometimes feel a sense of failure if they are not able to push their babies out without assistance. It’s important to remember that labour is different for every mum and baby, and it is not a personal failure if your baby needs some help to be born. The most important thing is that your baby is born safely, and it’s also important to consider your recovery and your long-term health.