Imagine you are in labour and you’ve been pushing for hours. The doctor brings up the idea of using forceps or a vacuum to deliver your baby. What should you expect?
#1 What is an instrumental delivery?
Instrumental delivery refers to Vacuum or Forceps assisted delivery of your baby. Instrumental delivery is an aid to facilitate natural birth. Your doctor will decide which instrument is more suitable for the delivery.
#2 Forceps Delivery
Your doctor will gently apply 2 forceps blades into your vagina around the baby’s head. The instruments look like curved spoon-shaped tongs, and are specially designed to fit the baby’s head. As you push with each contraction, your doctor will deliver the baby’s head using the forceps blades.
#3 Vacuum Delivery
Your doctor places a vacuum device on the baby’s scalp. The vacuum extractor looks like a cup. A vacuum force is then gently created using a pump. As you push with each contraction, your doctor will gently pull so that your baby’s head is delivered using the vacuum assistance. There are many forms of vacuum extractors available but the most commonly used one is the ‘Kiwi cup’.
#4 When do I need Instrumental Delivery?
There are many reasons why it may be advisable to have an assisted delivery during your labour.
You are too tired to push.
You have been pushing for too long (>1 hour).
The baby is in distress and an instrumental delivery would be most suitable for immediate delivery.
An episiotomy may be required when the vacuum or forceps is used.
#5 When should Instrumental Delivery be avoided?
There are some instances where an instrumental delivery should be avoided. C-section may be a better option.
The baby suffers from any rare conditions, such as bone mineralization defects or bleeding disorders, predisposing it to injuries or bleeding when delivered instrumentally.
The baby is premature (<34 weeks gestation) and avoiding a vacuum extraction will reduce more trauma to the scalp and brain. Forceps delivery may be preferred under these circumstances.
Factors to consider before an Instrumental Delivery is carried out
In addition to your cervix being fully dilated, your doctor will need to perform an internal examination to ensure that the membranes are ruptured and that the exact position of the baby’s head is known.
The baby’s head should have descended low enough into your pelvis to increase the chance of a safe delivery (engaged).
The uterine contractions must be optimal and if necessary, an oxytocin infusion can be started to ensure this. Your doctor may also apply gentle pressure (fundal pressure) onto your womb to aid in your pushing efforts.
Just before the application of the instrument, a catheter will be inserted into your bladder to drain out the urine and a local anaesthetic drug may be infiltrated into your perineal area to reduce your discomfort.
The more effectively the mother pushes during the contractions, the less the doctor will have to pull with the forceps or vacuum. This good cooperation and coordination between the mother and doctor increases the chance of a safe delivery.
Complications with an Instrumental Delivery
It has to be stressed that most of the assisted deliveries are uneventful and will be performed with you and your baby’s interests in mind. This will only be carried out if it is felt that you will be able to deliver safely through the vagina. However, some of the possible problems include:
Failure of the assisted delivery with one instrument — There may be several factors involved. Your doctor will make a re-assessment and decide if you need a Cesarean section or if an alternate instrument may be used instead.
Complications to the mother — Pain at and after delivery. Tears or trauma to the vaginal and back passage that may necessitate a repair in the operating theatre under anaesthesia.
Complications to the baby — Skull fractures or intra-cranial bleeding, potentially life threatening conditions, may rarely occur. Injuries to the facial nerve or eye may happen. During an instrumental delivery, a condition known as shoulder dystocia (whereby the baby’s shoulders may be stuck at the birth canal) can happen and is more commonly seen in bigger babies.
Instrumental Delivery aftercare
If an episiotomy was done, you will need some stitches. Occasionally, your doctor may insert an indwelling catheter to help “rest your bladder” for a day or two till your discomfort reduces.