Assisted Birth

Labour can be tough, but you are not on your own. Most women in child birth are attended to by medical professionals, and they are there for encourage

08:15 09 June 2009

Labour can be tough, but you are not on your own! Most women in child birth are attended to by medical professionals, and they are there for encouragement and to help your baby into the world. This article also appears on www.bbc.co.uk/parenting/having_a_baby

You will get help

The three main ways for the medical team to help your baby into the world are by using:

• forceps
• ventouse, sometimes known as vacuum extraction
• caesarean section. (See our feature on Caesarean section.)

Forceps and ventouse are sometimes known as 'instrumental delivery' as they use tools to assist the delivery of your baby. They are used in the second stage of labour, where the baby is part way down the birth canal (vagina) but for whatever reason can't get any further, is progressing too slowly, or if the baby needs to be born quickly. See our feature Stages of labour for more details.

They might be used:

• if you are exhausted by contractions or the length of your labour, and you are unable to push anymore
• if your contractions have slowed or if they have stopped being effective
• if your baby is showing signs of distress, which means he is not getting enough oxygen. Distress is detected by your babies heart rate slowing down, or sometimes, if he passes meconium (his first bowel movement). The midwife or doctor may also take a sample of blood from your baby's scalp, and have it tested to check if your baby's oxygen levels are low.
• if your baby is in a difficult position to make a quick exit - he could be face-up, for instance, which means the widest part of his head is coming first
• if your baby is breech (feet or bottom first); using instruments might give more control over the birth of the head
• if you have a small or differently-shaped pelvis that can't open wide enough
• if your baby is pre-term, or ill, or very small, which could mean he needs to be born soon so he can be given special or intensive care.

What happens?

Ventouse or vacuum extraction - this is a silicone cup fixed to a suction pump. The cup goes over the baby's head, and stays in place with suction. The mum pushes with each contraction while the doctor pulls on the ventouse. This can cause a swelling on the baby's head but this will disappear in the first few days.

Forceps - these are two spoon-like instruments which fit together and which are placed on each side of the baby's head. Again, the mum and doctor co-ordinate their pushing and pulling to help the baby come out. The baby may have a mark on either side of his head, or even bruising, where the forceps have been. These marks fade in a short time.

Your role

"...try changing your position in labour..."

You'll be asked to lie flat on your back, and your legs are then raised and supported at the ankles in stirrups. You'll then be given a local anaesthetic (unless you already have an epidural in place). You will probably be given an episiotomy (a cut made to enlarge the opening of your vagina so the baby can be delivered safely), so there is room for the insertion of the forceps or ventouse cup. This will be stitched up after the birth.

After effects

You and your baby may feel a bit bruised and sore afterwards. Recovery from an assisted birth can take longer than an unassisted birth. There is some evidence that ventouse is less damaging for you than forceps, but forceps may be less distressing to your baby than ventouse.

The vast majority of mums and babies make a full recovery from forceps or ventouse.

Avoiding forceps and ventouse

Try changing your position in labour - an all-fours position, or supported squatting, can help move things along better than lying flat.