If your baby needs help to be delivered in the second stage of labour, an obstetrician may recommend an assisted vaginal birth.
You may need an instrumental delivery if your baby is showing signs of distress or if you are completely exhausted. An instrumental delivery is only recommended when it is the best option for the delivering your baby.
If the baby is very low in the pelvis an instrumental delivery is often a much safer option for both of you than an emergency caesarean.
Around 13% of pregnant people will need an instrumental delivery.
What to expect
If an instrumental delivery is recommended, we will tell you about the benefits and risks to help you to make an informed decision. Please ask us if there is anything you don’t understand.
We can only do an instrumental delivery if your cervix (neck of the womb) is fully dilated. It will be done by an obstetrician, but your midwife will stay with you to support you and help with the delivery.
Either a ventouse (suction cup) or forceps will be used to gently pull the baby down the birth canal, while you push.
The obstetrician will decide which instrument to use and whether it’s safer to deliver your baby in the labour room or in theatre. This will also depend on your baby’s position, how low in the birth canal they are and how well they’re coping with labour.
We may advise you to have an episiotomy. This is a deliberate diagonal cut on the perineum, the area between your vagina and anus. An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily. It will be done under local anaesthetic.
Sometimes the obstetrician will change from using a ventouse to using forceps if they feel the delivery is still possible using a different instrument. We will explain this at the time or immediately afterwards.
If we cannot delivery your baby after using instruments, you will need an emergency Caesarean section.
Risks for baby
Your baby may have bruises and small grazes on their head or face after an instrumental delivery. These are usually superficial (just skin layer) and heal quickly. A neonatologist and midwife will check your baby to decide if any treatment is needed.
If your baby has a lot of bruising, they are more likely to develop jaundice in the few days after birth. We will keep an eye on this and give them treatment if it’s needed. Feeding your baby often after birth helps healing and reduces the risk of jaundice.
Some babies are unsettled after an instrumental delivery. If you’re worried at any time, please talk to your midwife.
Risks for you
There is a risk of tissue damage to your vagina or perineum (skin between the vagina and anus) from an episiotomy (vaginal cut) or a tear. This can lead to bleeding, pain and an increased risk of infection.
Episiotomies and tears are sutured (stitched) after birth, usually with dissolvable stitches. We will advise you on how to look after the area to reduce the risk of infection. We will also give you pain relief.
Recovery after an assisted delivery
We will discuss what happened with you and answer any questions you may have. Your baby will be checked by a neonatologist as soon as he or she is born. You may need a catheter (urine bag) for around 6 hours after the birth. You may need pain relief, but you should recover easily.
Your tear or episiotomy should take around 6 weeks to heal. It’s important to keep the area clean and dry to reduce the chances of infection. Your Community Midwife will visit you regularly for the first 10 days, or longer if needed, and will check that your perineum is healing well.
Please contact Triage or your GP as soon as possible if you have any signs of infection such as:
- red, swollen skin;
- discharge of pus or liquid from the cut;
- persistent pain;
- an unusual smell; and/or
- feeling generally unwell.