What is instrumental delivery?

Instrumental delivery involves the use of forceps or a suction device to assist with the delivery of your baby. Forceps are a tool much like a pair of salad spoons, used to guide the head of your baby. Vacuum-assisted delivery uses a suction device that attaches to your baby's head to help draw them out.

Instrumental delivery is usually recommended when:

  • Your baby's head is not facing in the right direction;
  • Your baby's heartbeat indicates there may be a problem;
  • You are pushing during labour, but childbirth is not progressing, or;
  • You have heart problems and your doctor thinks it wise to limit the amount of time you spend pushing.

Whenever instrumental delivery is recommended, a caesarean section is also usually an option, so it is a good idea to discuss your options with your doctor well before your due date, so you have a plan for what option you would prefer if the need arises.

Preparing for instrumental delivery

Instrumental delivery is not performed until your cervix is fully dilated and the membranes of the amniotic sac have ruptured (also known as the 'waters breaking').

Before an instrumental delivery is started, your doctor may try other methods to encourage delivery, such as adjusting your anaesthetic to enhance pushing, or injecting a synthetic hormone called oxytocin into your veins to stimulate stronger contractions.

Amniotic sac

The bag that develops in the uterus during pregnancy, in which the fetus develops.

Cervix

The lower part of the uterus, leading out into the vagina.

Contractions

1. The tightening and shortening of muscle fibres that occurs when muscles are used. 2. The regular tightening of the uterine muscles during labour and childbirth.

Hormone

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Membranes

A thin layer of tissue that lines the surfaces of organs or cells.

What happens during instrumental delivery?

If your doctor thinks an instrumental delivery is the best option, they will ask for your consent and if you have not already been given anaesthetic, you may be given an epidural anaesthetic.

Forceps delivery

Prior to delivery, a catheter is inserted into your bladder to empty it of urine. An incision might also be made between your vagina and anus to assist with the delivery of your baby, known as an episiotomy.

Forceps delivery. 

Vacuum-assisted delivery

During vacuum-assisted delivery, a suction cup is carefully placed on the middle of the back of the baby's head. The procedure will normally be abandoned if it takes more than three pulls or if the device detaches three times, as continued use under these circumstances increases the risk of complications.

Length of procedures

Forceps or vacuum-assisted delivery is usually abandoned if birth has not been achieved within 15 minutes of either procedure being started.

Risks involved

The risks involved with forceps delivery for the mother include:

Risks involved for the baby include:

  • Minor injuries to the head caused by the forceps;
  • Temporary weakness of the facial muscles;
  • Minor eye damage, and;
  • Rarely, skull fracture, bleeding in the skull and seizures.

In general, forceps delivery poses less risk to the baby than vacuum-assisted delivery, which is more likely to result in failed delivery, as well as eye and skull damage to the baby. However, forceps delivery poses a greater risk of causing faecal incontinence and damage to the mother's genital tract.

Bladder

An organ in the lower abdomen that stores urine for excretion.

Catheter

A thin, flexible tube inserted through a narrow opening into a body cavity for removing fluid.

Epidural anaesthetic

An anaesthetic injected into the epidural space of the spinal cord, especially used in childbirth.

Episiotomy

A surgical cut to the perineum (the area between the anus and vulva) during childbirth, to stop tearing of the posterior vagina wall. This is usually repaired after childbirth.

Fracture

A complete or incomplete break in a bone.

Genital tract

All of the organs involved in reproduction, from the ovaries to the vulva in females and from the testes to the penis in males.

Seizures

A sudden, involuntary contraction of muscle groups caused by abnormal electrical activity in the brain.

Urethra

The duct through which urine flows from the bladder to outside the body.

Uterus

The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Faecal incontinence

A lack of bowel control that results in leakage of stools. Also known as bowel incontinence.

Pelvic floor muscles

A group of deep muscles and ligaments at the bottom of the pelvis that support the organs that lie on it and control the anal, vaginal and urinary openings.

What happens after instrumental delivery?

After delivery, your baby will be closely monitored for signs of complications and you will be examined for any damage that may have been caused by the instruments used. If present, vaginal tears and incisions may be repaired with stitches.

If you experience pain when going the toilet, it may help to pour warm water over your vulva as you urinate, or press a pad against your wounds during a bowel movement.

Childbirth can result in a loss of bladder and/or bowel control, so you may need to wear sanitary pads in the months after giving birth. Pelvic floor exercises can help to strengthen your stretched and weakened pelvic floor muscles.

Bladder

An organ in the lower abdomen that stores urine for excretion.

Vulva

External female genitalia.

Bowel

The part of the digestive tract that comprises the small and large intestines.

Pelvic floor muscles

A group of deep muscles and ligaments at the bottom of the pelvis that support the organs that lie on it and control the anal, vaginal and urinary openings.