Childbirth is a life-changing event that sometimes needs a little help. Assisted deliveries are quite common. About one in eight babies are born this way in the UK, and it’s more likely to happen if you’re a first-time mum. An assisted delivery involves your medical team guiding your baby into the world with medical instruments such as forceps or a ventouse cup. While you won’t be planning one, it is important to be informed.

What happens during an assisted delivery?

This procedure can only be performed by your obstetrician, so your midwife will call one if they’re not there already. You’ll have a vaginal and abdominal examination to check your baby’s position. You may be moved to an operating theatre as a precaution, if this is safer for you and baby. In the unlikely event an assisted delivery does not work or becomes complicated, the theatre is the simply best place for a casarean section to happen quickly. If you haven’t had an epidural so far, you maybe offered this or another form of anaesthetic. A catheter will be inserted to help empty your bladder. Your legs will be put into supports to give the baby as much room as possible.

The two instruments generally used are a forceps or a ventouse cup. Forceps are more commonly used in the UK. These look like smooth metal salad spoons or tongs. They are inserted into the vagina and locked in place so your baby’s head doesn’t get crushed. A ventouse is a small, round cup that is attached to the baby’s head by creating a vacuum. A ventouse birth is sometimes called a vacuum extraction. The doctor can use both instruments to guide the baby out, rotate the head and gain traction. Your pushing will help, too! All going well, your baby will be delivered onto your chest and your partner may be able to cut the cord. Afterwards, you’ll usually be put on an antibiotic drip to prevent infection.

Why might I need an assisted delivery?

Any reason for this kind of delivery will be explained to you before intervention happens and your consent is required. Common examples of reasons for instrumental birth include your baby getting distressed and/or lying in an awkward position, needing some help for delivery. A pushing stage that lasts a very long time or some health conditions that means a mumtobe can’t push too hard for an extended period are other reasons.

Can I avoid needing an assisted delivery?

Interestingly, women who have someone they know (such as a birthing partner) supporting them during labour are less likely to need an assisted birth. So your significant other is making it more avoidable by staying with you!

You are less likely to need one if you’ve given birth vaginally before and/or if your pregnancy is low-risk and uncomplicated. Assisted deliveries also happen less when you give birth in a mid-wife led centre, though you would be more likely choose one of those if your pregnancy is low-risk and uncomplicated anyway. Staying upright can help, as can lying on your side after your cervix is fully dilated. There is a common worry that using an epidural makes assisted delivery more likely but, as we mentioned in the previous sessionon pain management with medication, this is considered less likely with modern forms of the local anaesthetic and if you wait until your cervix is fully dilated to start pushing.

If you really feel strongly about avoiding assisted delivery, an elective caesarean guarantees that you won’t have one - but remember this comes with its own risks.

Can I choose whether the birth is by ventouse or forceps?

We understand that you might have a preference for how assistance is given and it’s a good idea to put this in your birth plan. Forceps are more successful in delivering the baby, for example, but a ventouse is less likely to cause vaginal tearing. However, a ventouse cap can cause bruising to baby’s headwhich is a commonfear for many mums.

However, your doctor will discuss what typpe of instrumental delivery is most appropriate based on your labour’s progress, your baby and you. Sokeep an open mind and listening carefully when the reasons for the doctor’s recommendation are explained to you. He/she will have done both kinds of delivery hundreds of times and their experience can only benefit you and your baby.

If the method first attempted does not work, you may be given the option of trying the other or having a caesarean section. In the unlikely event that neither forceps nor a ventouse cup works, you will be offered a caesarean section or to wait to give birth without intervention.

What are the risks involved in assisted delivery?

Risks to you include an increased risk of perineal and vaginal tearing, so you may be offered an episiotomy at the time of delivery to reduce this risk. You’ll be at greater risk of blood clots in your pelvis and legs. This can be reduced by moving around soon after the birth, if you can. You’ll also have an increased risk of vaginal and anal incontinence. These can be treated with postpartum physiotherapy.

The overall rate of injuries to babies is low. The ventouse cup might make a mark or bruise on your head that fades soon after birth. Some babies have jaundice or small cuts on the face or scalp that heal quickly. Forcep marks on your baby’s face disappear within a day or two.

Will I need an episiotomy?

Your perineum has to stretch significantly when your baby is crowning. An episiotomy is a small cut made by your doctor in the perineum and vaginal wall to make room. This is sometimes done to prevent a severe perineal tear. You may need one with an assisted birth. It is not always the case and your consent will be required. According to the NHS, up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.

What will my recovery from assisted birth be like?

Your hospital stay will usually be longer than after a vaginal birth. Post-birth symptoms usually include bleeding (though no more than you’d have after vaginal birth), bruising, swelling and pain, including pain from stitches for your tears and episiotomy. Your midwife will give you advice on avoiding infection and constipation as well as safe methods of pain relief, depending on whether you are breastfeeding. It could take up to a month for the stitches to heal.

What if I refuse an assisted delivery?

If you refuse, you will usually be offered a caesarean delivery or if it’s safe, have the option to wait until your baby is born spontaneously.

How might assisted delivery affect a future birth?

Most women who have an assisted vaginal birth deliver spontaneously next time around. Women who have an episiotomy are somewhat more likely to have an episiotomy and perineal tears after a subsequent birth.

What do I need to know about assisted delivery?

Unii has all the information to help you make informed choices.