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Assisted delivery - suction or forceps

Before you have an assisted delivery it is important to know all you can about it.
 
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
 
 

What is the problem?

You need help to deliver your baby through your birth canal. This could be for many reasons, including:
 
  • you become exhausted during a long labour
  • your baby becomes distressed
  • your baby’s head is not in the correct position for delivery.
 

What is an assisted delivery?

An assisted delivery is the delivery of your baby, through your vagina, with the help of forceps or a suction cup. Assisted deliveries are usually done to speed up the baby's birth. It may also be called an instrumental delivery. Depending on the instrument used, other names for this procedure are a forceps delivery and Ventouse, vacuum or suction delivery.
 
Occasionally, we use an assisted delivery to slow down a birth, as in a vaginal breech delivery. In these cases we may use forceps to control the baby's head, as it comes down the birth canal.
 
The doctor will feel inside your vagina to find out how far on in labour you are and where your baby's head is in relation to your birth canal. By doing this we know exactly where on your baby's head we are placing the instrument. We then decide on the best instrument to use. This helps avoid injury to you and your baby and makes successful delivery more likely.
 

What is a forceps delivery?

Forceps are specially designed instruments made of two separate blades of metal, which look like spoons with a handle at the end. The two pieces fix together in the middle, and are opened and closed with a scissor action. The doctor places the blades into your vagina separately on either side of your baby’s head. They grip your baby's head on both sides. We gently pull on your baby’s head using the forceps, while you push.
 
We use different types of forceps depending on the position and location of your baby. For instance, there are traction forceps for pulling and rotational forceps for turning the baby.
Assisted delivery

What is a suction delivery?

A suction delivery is also called a vacuum extraction or Ventouse delivery. The small bell-shaped suction cup is made of metal or soft materials. The cup connects to a small, portable electrical suction machine or hand pump. This is used to create a vacuum that makes the cup stick to your baby's head. The doctor pulls on the cup to help deliver your baby. We use different types of suction cup depending on the position of your baby.
 

Which is better - forceps or suction delivery?

In some situations there is little difference in which instrument is used. Often, the doctor will choose the instrument they are most skilled with. In other cases, the instrument depends on the reason for you needing an assisted delivery. However, there are advantages and disadvantages to both types of instrument.
 

Forceps deliveries are:

 
  • less likely to cause scalp injuries to the baby
  • less likely to cause bleeding to the baby’s eye, called a retinal haemorrhage
  • more likely to be successful.
 

Suction deliveries are:

 
  • easier on the mother, causing less discomfort, pain and injury, and so require less pain relief
  • less likely to cause injury to the baby's face.
 
Generally, forceps deliveries are more successful than suction. Statistics show that 75-94% of suction deliveries are successful, while forceps deliveries have a higher success rate of 90-98%.
 

What has gone wrong?

You may need an instrumental delivery if your baby is having problems or if you are having difficulty with the labour.
 
The various causes of these problems are separated into problems with the baby or the mother.
 

Problems with the baby

 
  • Wrong position of baby’s head - The first of the three stages of labour lasts until your cervix is fully dilated. Your cervix dilates because the contractions of your uterus push your baby’s head against it. Your contractions also turn your baby so that the baby’s head is in a good position for delivery. The correct position for the baby’s head during labour is called occipito-anterior or OA for short. This is when the back of the baby’s head, called the vertex, is towards the front of your pelvis. In this position the smallest width passes through your birth canal.
Assisted delivery 2
If your baby’s head is in any other position the delivery will take longer and be more difficult. Other common abnormal positions of the baby’s head could be:
 
  • OP - occipito-posterior; when the back of the baby’s head is towards the back of its mother.
  • OT - occipito-transverse, when the back of the baby’s head is towards the side of its mother’s pelvis.
Assisted delivery 3
  • Fetal distress - This is when not enough oxygen reaches your baby. Changes in the baby’s heart rate may be seen on a fetal monitor. Changes in heart rate may be enough to diagnose fetal distress or we may confirm it by testing a sample of the baby’s blood, called a fetal blood sample or FBS. If we confirm fetal distress we need to deliver the baby straight away. This can be by assisted delivery if your cervix is fully dilated.
 

Problems with the mother

If you cannot push hard enough during labour and this causes a delay in the birth you may need an assisted delivery. There are various causes for difficulties with pushing, including:
 
  • Exhaustion - If you are exhausted during a long labour, you may not have the strength or desire to push properly. This is particularly true if you do not have enough pain relief, if your pulse rate and temperature are high, and if you are dehydrated because you have not had enough fluids to drink.
  • Medical conditions - If you have a medical condition affecting your blood pressure, heart or breathing, pushing may make it worse. We use an assisted delivery to reduce the time you need to push.
 

The aim

The aim is to safely deliver your baby and make sure you come to no harm.
 

The benefits

You should safely and quickly return to normal health.  You and your baby will avoid undue trauma or distress.
 

Are there any alternatives?

If your labour is taking a long time because your contractions are weak we may give you a drug called oxytocin to improve them. Oxytocin speeds up contractions and increases their strength. This may help you deliver your baby naturally without the need for instruments.
 
If your baby's head is in the wrong position the doctor may be able to move it into the correct position for delivery with their hands.
 
Eventually, the doctor may decide that a Caesarean section, where your abdomen and womb are cut open to deliver your baby, is the safest method of delivery for you. You may also prefer to have a Caesarean section rather than an assisted delivery after the doctor has discussed the risks and benefits of each technique.
 

What if you do nothing?  

If you are having a long labour but are well, not too tired and your baby seems fine, we may wait a bit longer to see if you can deliver the baby on your own. You may want to try to push for a bit longer.
 
If this is the case, your midwife or doctor will agree a time limit and then assess things after that. However, it is important to discuss all the options carefully with your obstetrician.
 

Who should have an assisted delivery?

We only decide to help with a delivery using instruments after assessing the pregnancy, the progress of the labour, the condition of the baby and the condition of the mother. There are no hard and fast rules as every woman, pregnancy and labour is different. Therefore, each doctor will manage every woman's labour on an individual basis.
 
Author: Dr Chineze Otigbah MRCOG. Consultant obstetrician and gynaecologist.
© Dumas Ltd 2006
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