Assisted birth (forceps or ventouse)

An assisted birth is when a health professional 'assists' or helps your baby out of your vagina during childbirth.

Your doctor may use a vacuum cup or forceps to assist with your baby's birth. Assisted birth is also known as an instrumental vaginal birth. It has previously been called assisted delivery.

1 in every 10 babies in Australia are born by assisted birth.

Video provided by Birth Trauma Australia.

There are many reasons for assisted birth, including when:

• 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 without assistance
• you are fatigued and can't push effectively during labour
• you have a medical problem that means you shouldn't push during labour
• your baby is not making their way through the birth canal as expected

It's a good idea to think about how you would like to give birth before your labour begins. Discuss your birth plan, and the possibility of assisted birth, with your doctor or midwife, as well as your birth partner.

It's important to know that birth does not always go to plan. Unexpected events can occur during labour and birth. Your doctor or midwife will consider what is happening during labour and what is best for you and your baby.

In Australia, your healthcare rights mean that you can ask questions and make decisions about your labour and birth. Here are some questions to ask if your doctor or midwife recommends an assisted birth:

• Why do you think I need an assisted birth?
• What is involved in an assisted birth?
• What are the risks and benefits of an assisted birth?
• What are the potential risks of not having an assisted birth?
• What if I prefer not to have an assisted birth?
• Are there any other options?

It's your choice whether or not to have an assisted birth.

You also have the right to complain about any aspect of your healthcare. Read more about your healthcare rights and obstetric violence.

An assisted birth is only done when you give informed consent. To give consent, you must be given enough information about your options to make the right decision for you and your health.

Before an assisted birth, your doctor or midwife will:

• explain the risks and benefits of assisted birth compared to the risks and benefits of giving birth without assistance
• discuss the advantages and disadvantages of each type of assisted birth
• discuss whether an episiotomy (cut in your perineum) is a good idea. This is used to make your vaginal opening larger and help stop severe tearing.
• do a physical examination to check your cervix is fully dilated
• make sure you have enough pain relief, like an epidural anaesthetic or local anaesthetic injection
• place a catheter (thin tube) into your bladder to help you release urine (wee) before giving birth

An assisted birth is usually done by an obstetrician, but other staff, including midwives, will be there to help. A paediatrician may also be there to check your baby after the birth.

Your doctor may recommend having your assisted birth in an operating theatre. This is suggested if they think you may need a caesarean birth (C-section).

Rural and remote areas

If you live in a rural or remote area, you may need to be transferred to a tertiary hospital (major hospital) for an assisted birth. All states and territories in Australia have Patient Assisted Travel Schemes (PATS) to help eligible patients with the costs of travel.

The eligibility rules and costs covered can vary, but PATS may help pay for:

• accommodation costs at your destination, including for your support person or carer
• travel expenses

Your doctor will use an instrument to gently pull the baby while you push. A vacuum cup (also known as a ventouse or vacuum extraction) or forceps can be used. There are advantages and disadvantages to each method.

Your doctor or midwife will recommend which method to use based on your baby's position:

• Low position — this is when your baby's head is positioned more than 2cm below the widest part of your pelvis. This is the easiest position for an assisted birth.
• High position — this is when your baby's head is positioned above the widest part of your pelvis. Assisted birth can be more difficult from this position. It may be recommended that your assisted birth is done in theatre in case a caesarean section is needed.

The recommended method of assisted birth will also depend on:

• the weight of your baby
• your body mass index (BMI)
• what pain relief is being used
• your stage of pregnancy
• how quickly your baby needs to be delivered

It's important to discuss with your doctor or obstetrician the options for assisted birth. You have the final say on which type of assisted birth is used.

Ventouse assisted birth

Your doctor will place a soft vacuum cup on your baby's head. The cup stays on with suction.

During a contraction, while you are pushing, your doctor will slowly pull on the cup. This will help your baby move through the birth canal and out through your vagina.

More than one pull may be needed.

If your baby has not been born after 3 pulls with the vacuum cup, your doctor may try again using forceps.

Forceps assisted birth

Forceps may be recommended if your baby is in a rotated position or if a ventouse-assisted birth was not successful.

Your doctor will place the forceps (2 smooth, spoon-shaped blades) over your baby's head.

Your doctor will gently pull on the forceps during a contraction and while you are pushing. This will help your baby move through the birth canal and out through your vagina.

More than one pull may be needed.

You may need a caesarean section to help with the birth. If you or your support person have concerns about what is happening, tell your healthcare team.

Most assisted births happen safely without any complications. If an assisted birth is recommended, it's because your doctor or midwife believes this is the safest option for you and your baby.

If you're not sure what to do, ask your doctor or midwife why they recommend assisted birth and what your options are.

Risks to you

After an assisted birth you may have:

• bruising or an injury to the skin around your vagina
• an injury to your pelvic floor, which may affect your bladder or bowel function
• a perineal tear (injury to the skin or muscle between your vagina and anus)

You may be given antibiotics after an assisted birth to prevent infection.

Risks to your baby

During an assisted birth your baby may have shoulder dystocia (when your baby's shoulder gets stuck during birth). This is a medical emergency, and your baby will need to be born quickly if this happens.

After an assisted birth your baby may have:

• bruising or haematoma (blood under the skin) on their scalp. This usually fades quickly.
• jaundice (yellow discolouration of the skin)

• weakness in their facial muscles due to a nerve injury. This will usually heal quickly on its own.

Your baby may have a severe injury to their head or spine after an assisted birth — this is very rare.

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 or midwife can give you information about each option.

As your labour progresses, you and your healthcare team can review your options again.

The time to recover from an assisted birth is different for everyone.

After an assisted birth, you may have:

• a change in your bladder or bowel function
• pain from an episiotomy or perineal tear
• bleeding from your vagina for a few days
• weakness of your pelvic floor muscles

A woman's health physiotherapist can show you exercises to help strengthen your pelvic floor.

Read more about:

• your body after having a baby
• scar healing and recovery after a perineal injury
• sex after having a baby

Emotional support

If you've had a difficult birth or complications after birth, try to discuss it with your doctor or midwife before leaving the hospital. You might find it helpful to talk about what happened.

Giving birth is an emotional time, especially if things didn't go as you had planned. If possible, ask for emotional support from family and friends.

If you have ongoing physical or emotional issues following birth, speak to your doctor or midwife. You can also contact an organisation such as Birth Trauma Australia.

Learn more about the emotional impacts of birth trauma and how you can recover.

See your doctor if you have problems that are not getting better, such as:

• pain in your vagina
• urinary incontinence (trouble controlling your bladder)
• trouble with your bowel function
• pain during sex

Talk to your doctor, midwife or obstetrician if you need support.

Visit the Birth Trauma Australia website for information and support, including peer-to-peer support.

ForWhen provides mental health support for expecting and new parents. Call 1300 24 23 22.

PANDA also provides advice and mental health support for new parents. You can call the PANDA National Helpline on 1300 726 306.

Continence Health Australia offers information and support to people with bowel and bladder problems. You can call the helpline on 1800 33 00 66.

Languages other than English

Factsheets on women's health, in languages other than English, are available on The Royal Women's Hospital website.

The Jean Hailes website offers women's reproductive health factsheets in multiple languages.