When labor doesn't progress smoothly, some assistance
becomes necessary. Popular procedures involve the
use of instruments such as forceps or a vacuum extractor.
Common reasons for assisted delivery are -
• Fetal distress - heart beat slows down in
response to contractions
• Maternal distress - the mother is too tired
to push; has heart, muscular or respiratory complications
• Prolonged labor or prolonged second-stage
labor
• Baby's head is facing the wrong direction
or if baby's head is too large for the pelvis
Prerequisites
before the Procedures
• Cervix needs to be fully dilated and effaced
and the membranes ruptured; the fetal head has to
be engaged
• Prep time takes about 30-45 minutes; the
birth is over within 2-3 contractions
• An experienced physician should handle the
procedure. Choice of instrument used will depend
after a vaginal examination to determine which is
more appropriate
• An epidural or a local anesthetic will be
given to numb the perineal area
• A thin catheter will be inserted in the
bladder to empty it
• An episiotomy may be performed to enlarge
the vaginal opening
• All necessary preps for a C-section should
be made in case instrumental delivery fails
Forceps-assisted
Birth
• The instrument is shaped like a pair of
scissors which when hooked together look like salad
tongs. It may look scary but it is preferred if
your doctor deems it necessary or to avoid a C-section.
• Forceps are used to help turn the baby's
head if he is facing the wrong way
• One spoon goes in one at a time into the
vagina to cradle around the temples of the baby's
head. With the uterine contractions and the mother
pushing, your doctor gently pulls on the forceps
to help the baby through the canal.
• Forceps delivery will only be used if the
baby's head is properly engaged in the mother's
pelvis. A cesarean will be performed otherwise.
• Episiotomy may always be necessary but it
is performed in most instances to help with the
delivery
Vacuum-assisted Birth
• Also known as venthouse birth, it is an alternative
to forceps. A venthouse or vacuum extractor uses suction
to guide the baby out.
• A rubber or plastic cup is pressed against
the baby's head; the cup gets its suction through
a tube from a vacuum bottle attached to a small pump.
• With each push the obstetrician will gently
pull the cup and guide the baby out.
• Again, episiotomy may not always be necessary
with this procedure
Instrumental birth and
the Baby
• Baby is able to feel the blades of the forceps
or the vacuum cup as well as the force which is
applied during the contractions
• Pressure
will only be exerted when the mother is actively
pushing
• Venthouse delivery mostly leave a prominent
reddish purple colored bump on the back of baby's
head
• Forceps can sometimes leave two red marks
on baby's temples. Both bruises and bumps take about
a week to subside
• Sometimes bruising cause babies to become
irritable and even develop jaundice
• Immediate special care services are usually
arranged for babies who were already in distress
prior to the use of the instruments. The delivery
style has nothing to do with the need for special
care.
Instrumental
birth and the Mother
• The mother is likely to feel sore and bruised.
In case of stitches special care needs to be taken
to help in the healing.
• Some women may feel a sense of disappointment
but don't forget baby's safety necessitated the
use of instruments during delivery.
• Once an assisted delivery doesn't mean always
an assisted delivery. Similar assistance may not
be necessary with the second delivery because fatigue
experienced will be less this time round and fetal
distress may not even be a possibility because of
a shorter labor.
