Assisted delivery (forceps or ventouse)
- Assisted birth is when forceps or a vacuum cup is used to help birth your baby vaginally.
- Around 1 in 5 babies are born by assisted delivery.
- Most women who have an assisted delivery will need an episiotomy.
- It’s a good idea to talk to your doctor or midwife about your birth options and preferences including assisted delivery during pregnancy.
What is an assisted birth?
An assisted birth, also known as an instrumental birth, means that your doctor or midwife ‘assists’ or helps your baby out of your vagina during birth. Your doctor or midwife may use instruments such as a vacuum cup or forceps to assist at your baby’s birth.
Video provided by the Australasian Birth Trauma Association.
Why might I need assistance to give birth?
There are many situations in which you might need help to birth your baby. In fact, around 1 in 5 babies are born by assisted delivery in Australia.
Some common reasons for assisted delivery include:
- your baby is unwell and needs to be born quickly
- your baby is in a position that makes it difficult for them to be born
- your baby is bigger
- you are unable to push effectively, or you have a medical problem that means you shouldn’t push during labour
How do I decide whether to have an assisted birth?
It’s a good idea to think about your how you would like to give birth before your labour begins, and to discuss this with your doctor or midwife, as well as your birth partner. It’s also important to know that birth does not always go to plan, and you may need to deal with unexpected events during your labour and birth.
Here are some questions you may wish to ask if your doctor or midwife recommends an assisted birth:
- Why have I been recommended an assisted birth?
- What is involved in an assisted birth?
- What are the potential risks and benefits of an assisted birth?
- What are the potential risks of a not having an assisted birth?
- What are my options if I prefer not to have an assisted birth?
It’s your choice whether to have any intervention during your labour and birth. Many women find it helpful to discuss their options with their doctor or midwife and other support people.
How is an assisted birth done?
Before the birth
An assisted birth is usually done by an obstetrician, but other medical staff, including midwives, will be there to assist. A paediatrician may also be in the room to make sure your baby is healthy after the birth.
An assisted birth can only happen if your cervix is fully dilated (to 10cm) and if you baby is low enough in your pelvis.
In some cases, your doctor may choose to do the assisted birth in an operating theatre. This is especially true if they think there is a chance you may need to have a caesarean, for example if your babies head is still quite high in your pelvis.
Your doctor will make sure you have enough pain relief. This may include an epidural anaesthetic, or a local anaesthetic injected around the birth canal.
Your doctor or midwife will insert a catheter in your bladder to make sure it is empty before the birth, so your baby has enough room to move through the birth canal.
An episiotomy (cut of the perineum) is usually required to make the vaginal opening larger.
During the birth
Your doctor will do a vaginal examination to check your cervix and your baby’s position in the birth canal.
Your doctor may choose to use a vacuum cup (also known as a ventouse or vacuum-extraction) or forceps to assist your birth. Both of these methods are safe and effective, but each has advantages and disadvantages. Your doctor will choose a method depending on your individual circumstance including your baby’s position, how low your baby is in your pelvis and the type of pain relief you have.
During a vacuum-assisted birth, your doctor will place a soft cup on your baby’s scalp (head). During a contraction and while you are pushing, your doctor will pull on the cup to help your baby move through the birth canal.
During a forceps birth, your doctor will place 2 smooth spoon-shaped instruments over your baby’s head. As with a vacuum-assisted birth, your doctor will gently pull on the forceps during a contraction and while you are pushing to help your baby move through the birth canal.
It may take more than one pull using either forceps or a vacuum cup to birth your baby. If your baby has not been born after a few pulls, generally 3 pulls is considered the upper limit, it may be safest for your baby to be born via a caesarean section. If at any point you or your support person are concerned, it’s important to raise this with your healthcare team.
What are the risks of an assisted birth?
Most assisted births happen safely without any complications, but sometimes complications do happen.
Some women might have bruising or an injury to the skin around the vagina, or injury to the pelvic floor muscles. Rarely, an assisted birth can resultis a more severe tear or damage to the bladder or bowel function.
After a vacuum-assisted birth, your baby may have bruising (haematoma) over the area of their scalp where the cup was attached. After a forceps birth, your baby may have marks or bruising on their face or scalp from the forceps, which fade quickly. Rarely, an assisted birth may injure a nerve in your baby’s face, which usually heals quickly on its own.
The risk of shoulder dystocia is greater during an assisted birth. This happens when the baby’s shoulders do not come out straight away after the head is born.
If your doctor or midwife recommends an assisted birth, it is because they believe the risks of not helping your baby’s birth are higher than helping your baby’s birth.
If you aren’t sure whether to have an assisted birth, it’s a good idea to ask your doctor or midwife about the reasons that they recommend one and what an alternative option may be.
What are the alternatives to an assisted birth?
If you choose not to have an assisted birth, you can keep trying to birth your baby on your own, or you can have a caesarean birth. Your doctor and midwife can give you more information about the benefits and risks of each option.
How long does it take to recover from an assisted birth?
It can take time to recover from any type of birth so it’s important to rest and take care of yourself.
After an assisted birth, you may have discomfort from an episiotomy or vaginal tear and weakened pelvic floor muscles in the first few days or weeks. You will likely have stitches in your perineum, they will dissolve in 1 to 2 weeks but it can take several weeks or months to fully recover.
If you have any ongoing problems with pain or a heavy dragging feeling in your vagina, urine leaking or trouble with your bowel function, or if sex is painful, it’s a good idea to see your doctor for advice. Your doctor may refer you to a women’s health physiotherapist to help you recover.
You can read more about your body after having a baby here.
If you have had a difficult birth or complications after birth, it’s a good idea to talk to your healthcare provider in the immediate recovery period whilst you are still in hospital. Although, for some new parents these feeling may not arise immediately. If you are concerned or having ongoing physical or psychological issues in the weeks or months following birth, seeking help early is recommended.
What resources and support are available?
There are several organisation that you can talk to for advice and support:
Speak to a maternal child health nurse
Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.
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Last reviewed: January 2022