What are assisted vaginal births?
Assisted vaginal births (sometimes referred to as a helping hand) are a way of expediting the birth of your baby if there are concerns during the pushing stage of your labour. The aim is to support your baby's journey along the birth canal and facilitate a vaginal delivery whilst maintaining your and your baby's safety.
These births involve the use of specialist medical instruments to help guide your baby through the birth canal and safely into the world. They account for about 1 in 8 of all births in the UK (or more like 1 in 3 if you are having your first baby). So when are these interventions deemed necessary and what are the options?
When a helping hand may be considered
Most labours and births are straightforward, but sometimes complications arise which need attention. The main reasons include:
Your baby not moving along the birth canal as would be expected
Concerns arising about your baby's wellbeing
You being unable to, or advised not to push
To reduce your chance of having an assisted delivery, there are a few steps which can be taken, including:
Having a supportive birthing partner and midwife
Adopting upright, or side lying positions (avoiding lying flat on your back)
Epiurals may increase your chance of needing assistance, if you have had one then waiting for a strong urge to push before commencing pushing can help to reduce the risk
The decision to assist your birth will be a joint one between your obstetrician, midwife and yourself. They'll explain what their concerns are and what your options are.
Assisted vaginal birth options
Assisted vaginal births use either ventouse (vacuum cup) or forceps to help guide your baby. Your obstetrician will decide which instrument is best for your situation; there are different types to choose from, for example if the baby needs to be turned into a more favourable position there are certain forceps to best facilitate this.
They'll take into account your gestation, the position of your baby and how high your baby's head is in the birth canal. Forceps tend to have a higher success rate, but ventouse deliveries tend to result in less vaginal tearing.
Forceps
Forceps are smooth, curved metal instruments which some have likened to salad servers. They are gently inserted inside the vagina to snugly fit around your baby's head. When you have a contraction the team will ask you to push whilst they pull and guide your baby out.
Ventouse
A ventouse is a vacuum cup made of plastic or metal which is applied to your baby's head using suction. You’ll be asked to push when you have a contraction and your healthcare professional will pull on the suction cup to facilitate the delivery.
What about pain relief?
For either option you'll be provided with pain relief eg epidural top, a spinal or a local anaesthetic injection in the vagina. You’ll also have your bladder emptied to make sure this isn't obstructing your baby’s passage. Your healthcare professional will examine you and see if an episiotomy is necessary (a small cut to enlarge the space in the vagina), as they are more likely deemed necessary for assisted vaginal deliveries.
Your team of healthcare professionals will be guiding you through step by step, they'll keep you updated on progress and if they think the plan of care needs to be adjusted; sometimes they will try one instrument and if this is not successful they will try the other. If they are unable to guide baby out they will suggest an emergency caesarean section.
After birth care
You’ll be carefully monitored and cared for after you’ve had your baby. With assisted vaginal births heavier bleeding is common, as is vaginal tears, episiotomies and sometimes problems passing urine. The midwifery team will make sure your bleeding is normal, any sutures are clean and that you’re able to pass urine before you're discharged.
Your baby will have a full baby check before they leave the hospital. It is quite common for babies delivered instrumentally to have some bruising for a few days. For ventouse births this will be a cup shaped mark on baby’s head (chignon) or bruise (cephalohaematoma) which usually disappears within 48hours. Forceps marks on babies faces are quite common and should also resolve within 48hours. Serious trauma or damage to babies' nerves are rare.
Remember that your healthcare team will be with you every step of the way explaining what’s happening during your labour, it’s always useful to have some prior knowledge though so that you feel more comfortable if any changes in your birth plan occur. If you have any concerns please talk to your healthcare professional to find out more about assisted vaginal deliveries.
