Instrumental delivery

• Your baby's head is not facing in the right direction;
• Your baby's heartbeat indicates there may be a problem;
• You are pushing during labor, but childbirth is not progressing, or;
• You have heart problems and your doctor thinks it wise to limit the amount of time you spend pushing.

Whenever instrumental delivery is recommended, a caesarean section is also usually an option, so it is a good idea to discuss your options with your doctor well before your due date, so you have a plan for what option you would prefer if the need arises.

Preparing for instrumental delivery

Instrumental delivery is not performed until your cervix is fully dilated and the membranes of the amniotic sac have ruptured (also known as the 'waters breaking').

Before an instrumental delivery is started, your doctor may try other methods to encourage delivery, such as adjusting your anesthetic to enhance pushing, or injecting a synthetic hormone called oxytocin into your veins to stimulate stronger contractions.

What happens during instrumental delivery?

If your doctor thinks an instrumental delivery is the best option, they will ask for your consent and if you have not already been given anesthetic, you may be given an epidural anesthetic.

Forceps delivery

Prior to delivery, a catheter is inserted into your bladder to empty it of urine. An incision might also be made between your vagina and anus to assist with the delivery of your baby, known as an episiotomy.

 

Vacuum-assisted delivery

During vacuum-assisted delivery, a suction cup is carefully placed on the middle of the back of the baby's head. The procedure will normally be abandoned if it takes more than three pulls or if the device detaches three times, as continued use under these circumstances increases the risk of complications.

Length of procedures

Forceps or vacuum-assisted delivery is usually abandoned if birth has not been achieved within 15 minutes of either procedure being started.

Risks involved

The risks involved with forceps delivery for the mother include:

• Breakage of the uterus wall, allowing the baby to enter the abdominal cavity;
• Pain between the vagina and anus;
• Tearing of the lower genital tract;
• Injury to the bladder or urethra;
• Ongoing problems with urination, and;
• Weakened pelvic floor muscles.

Risks involved for the baby include:

• Minor injuries to the head caused by the forceps;
• Temporary weakness of the facial muscles;
• Minor eye damage, and;
• Rarely, skull fracture, bleeding in the skull and seizures.

In general, forceps delivery poses less risk to the baby than vacuum-assisted delivery, which is more likely to result in failed delivery, as well as eye and skull damage to the baby. However, forceps delivery poses a greater risk of causing fecal incontinence and damage to the mother's genital tract.

What happens after instrumental delivery?

After delivery, your baby will be closely monitored for signs of complications and you will be examined for any damage that may have been caused by the instruments used. If present, vaginal tears and incisions may be repaired with stitches.

If you experience pain when going the toilet, it may help to pour warm water over your vulva as you urinate, or press a pad against your wounds during a bowel movement.

Childbirth can result in a loss of bladder and/or bowel control, so you may need to wear sanitary pads in the months after giving birth. Pelvic floor exercises can help to strengthen your stretched and weakened pelvic floor muscles.