Instrumental Delivery
Dr. Liew Fah Onn
M.B.,B.S. (Mal), M.R.C.O.G. (U.K.)
L.L.B. (Hons) (London)
Certificate in Legal Practice (Mal)
Senior Consultant Obstetrician & Gynecologist
Head of Dept. of Obstetrics & Gynecology
Assunta Hospital, Petaling Jaya, Selangor
What is an Instrumental delivery?
An instrumental delivery, or also called assisted birth or operative vaginal birth, is one where a pair of forceps or ventouse is used when your baby needs help to be born.
What are forceps?
The instruments looked like a pair of metal salad servers that are placed around baby’s head by the Obstetrician.
What is a ventouse (or vacuum extractor)?
This is a plastic or metal cup-shaped device which is placed over the crown of baby’s head and attached to a suction machine.
When might I need an instrumental delivery?
- Fetal distress
- Maternal tiredness
- Failure of baby in descending the birth passage, despite maternal efforts
- High blood pressure or heart disease
- Prematurity
- Forceps may be used at vaginal birth of a breech baby”s head, or during Caesarean Section
How can I reduce my chances of an instrumental delivery?
- keep yourself fit and healthy in pregnancy
- continuous support during labour from a birth partner
- upright positions during labour
- lie on your side, rather than your back
- “bearing down” at midwife’s instruction
- epidural anaesthetic had not been proven to increase the risk
Most women are able to give birth naturally with a fully support spouse and a positive attitude.
What happens at an instrumental delivery?
- Your Obstetrician will examine you internally. He will explain why you need an assisted birth and get your verbal consent.
- Your legs will be placed on supports at each side of the bed. The foot end of the bed will be removed.
- A thin tube called a catheter may be used to empty your bladder.
- You will be given a numbing injection at the vagina if you are not using epidural anaesthetic.
- A Paediatrician may be present.
- When your baby’s head is out, the ventouse or forceps are removed. Next the body will be delivered next with a push from you and gentle traction from your Obstetrician.
What happens during a forceps birth?
- Your Obstetrician will make a cut (episiotomy) along the numbed part of your vagina to allow the forceps to be placed safely around each side of your baby”s head.
- During a contraction, your Obstetrician will gently pull while you bear down.
- If your baby is not born after three pulls, then the forceps will be abandoned and a Caesarean Section will be performed immediately.
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What happens during a ventouse birth?
- Your Obstetrician may make a cut (episiotomy) along the numbed part of your vagina to allow the ventouse cup to be placed safely and securely fitted on top of your baby”s head.
- The cup is attached to a vacuum pump.
- During a contraction, your Obstetrician will gently pull on the cup while you bear down.
- If your baby is not born after three pulls, then the ventouse will be abandoned.
- Your Obstetrician may then use forceps before resorting to Caesarean Section.
What are the maternal risks and complications with instrumental delivery?
- bruising to vagina
- tearing of perineal skin and vagina
- injury to perineal muscles
- very rarely, bladder or bowel injury
- psychological stress to you and your spouse
- caesarean section if instrumental delivery fails
What are the baby’s risks and complications with instrumental delivery?
- head injury
- nerve injury
- marks or bruising on the head or face
The majority of this injury is temporary and has no long lasting effects.
