Sometimes, birth doesn't unfold as straightforwardly as we might hope. Its unpredictable nature can challenge us. But fortunately, advancements in obstetric medicine provide safe methods to support mothers and babies when necessary.
There are various ways to prepare for and encourage a physiological birth, offering both yourself and your baby the best chance for a smoother and more comfortable experience. However, on occasion, mothers and babies may require a little extra assistance. In the UK, approximately 1 in 8 women undergoes an assisted vaginal birth, with a higher likelihood (1 in 3) for women giving birth for the first time.
What is an Assisted Vaginal Birth?
An assisted vaginal birth, also known as instrumental birth, is when an obstetrician uses special instruments (forceps or ventouse) to help baby to be born. This would only happen during the very last stage of labour when your cervix is fully dilated, and baby’s head has dropped down into your pelvis. Local anaesthetic is usually used to numb the vagina and the skin between the vagina and the anus (perineum) - if you have not already had an epidural.
What are forceps and how are they used?
Forceps look like two large spoons. They are inserted into the vagina and placed around the baby’s head. Forceps are used to apply gentle traction to help guide the baby’s head out of the birth canal while you keep pushing.
What’s a ventouse and how is it used?
The ventouse is a vacuum device that comprises of a suction cup with a handle attached. The suction cup is placed in the vagina and applied to the top of baby’s head. Gentle controlled traction is used to help guide baby out of the birth canal while you keep pushing.
Why you might be offered an Assisted Vaginal Birth?
There are various reasons why an assisted vaginal birth may be offered. The most common reasons are:
There are concerns about baby’s heart rate during labour.
Failure to progress during the 2nd stage of labour: you have been pushing for a long time, but baby’s head has stopped moving down the birth canal. This might be because baby is in an awkward position.
Baby is getting tired and there are concerns that they may be in distress
You are very tired from a long labour and require the extra help.
You have an underlying health condition (such as a very high blood pressure) and have been advised not to push.
The type of instrument that is used also depends on various factors, including the experience of the obstetrician and your individual situation.
What are the benefits of an Assisted Vaginal Birth?
You might want to consent to an assisted vaginal birth to avoid a C-section. Caesarean birth is a major surgery with risks in itself. If you are planning to have more children, avoiding a caesarean birth may help prevent some of the possible future complications of multiple caesarean births. Recovery from a vaginal birth generally is shorter than recovery from a C-section. Often, assisted vaginal birth can be done quicker than a caesarean birth.
However, as for all interventions in labour, you should be offered potential alternatives to an instrumental birth and you might want to discuss the possibility of having a c-section if you believe that this is a better alternative for you and your baby.
What are the risks associated to a ventouse or forceps birth for mums?
Episiotomy - surgical cut made at the opening of the vagina to give more room for baby to come out. The cut is then repaired with dissolvable stitches.
Vaginal tearing including increased risk of 3rd or 4th degree tears - vaginal tears that involve the muscle or wall of the anus or rectum (4 in every 100 women having a ventouse birth, and 8 to 12 in every 100 women having a forceps delivery compared to 3 in every 100 women having an unassisted vaginal birth.
Infection - estimated to affect around 15% after assisted delivery.
Blood clots - these can be prevented by moving around as much as possible after the birth, by wearing special anti-clot stockings, and by having injections of heparin, which makes the blood less likely to clot.
Urinary and anal incontinence - although leaking wee is not unusual after childbirth, it's more common after a ventouse or forceps delivery. You should be offered physiotherapy to help prevent this happening, including advice on pelvic floor exercises. Anal incontinence is more likely after 3rd or 4th degree tear.
What are the risks associated to a ventouse or forceps birth for babies?
A mark on baby’s head (chignon) being made by the ventouse cup – this usually disappears within 48 hours.
A bruise on baby’s head (12 in every 100 babies born by ventouse assisted delivery) – the bruise is usually nothing to worry about and should disappear with time.
Marks from forceps on baby’s face – these usually disappear within 48 hours.
Small cuts on your baby's face or scalp (1 in 10 babies born using assisted delivery) – these usually heal quickly.
Jaundice.
Bleeding inside the skull (low risk).
Problems with the nerves in the arm and face (low risk).
What can I do to try to avoid an Instrumental Birth?
Prepare your body: walking, swimming and yoga classes are a great way to do this.
See a physio, osteopath or physical therapist during pregnancy to check a potential pelvic alignment problem.
Be active and adopt upright positions during labour.
Familiarise yourself with movements and positions that aim to create more space in the pelvis (my courses include Biomechanics for birth information and resources). You can also find these techniques on the Spinning Babies’ website. Often, when labour stalls it’s because baby has got him/ herself in a difficult position and by providing more space, you are giving a chance for baby to rearrange themselves.
Avoid the use of epidural analgesia.
Choose a strong birth team. You might want to consider having an experienced doula by your side.
Follow your body’s cues during the 2nd stage. No coached pushing particularly if you don’t feel the urge to.
Avoid an artificial rupture of membranes if possible so baby has more space to rotate and be in a more optimal position.
In navigating the intricate journey of childbirth, the unpredictability of the process can sometimes necessitate additional support. While preparing for a physiological birth is invaluable, acknowledging the potential for an assisted vaginal birth becomes equally crucial. The use of forceps or ventouse, guided by advancements in obstetric medicine, can aid in ensuring the safety of both mothers and babies under specific circumstances. It's important to recognise that while assisted births carry potential benefits, they are not without risks. Understanding the reasons, alternatives, and potential complications empowers expectant mamas to make informed choices. By staying informed, maintaining an active role in the birthing process, and having a supportive birth team, you can prepare yourself to navigate the complexities of childbirth with confidence, ensuring the best possible outcome for you and your baby. The Poppy & Jack Complete Hypnobirthing Course has been meticulously crafted to provide you with empowering knowledge and essential tools. Designed not only to support the natural processes of birth physiology but also to deepen your understanding of available options and birth rights, this comprehensive course ensures that you can navigate any unexpected twists in your childbirth journey feeling well-informed and in control.
Photo by: Jessica Vi Photography