Things to consider about having a forceps or vacuum birth

Many women worry during pregnancy about having a forceps or vacuum birth. Forceps and vacuum births are vaginal births with the assistance of your doctor, who uses an instrument to guide the birth of your baby while you are pushing.

You may hear your midwife or doctor using the term ‘instrumental birth’ or ‘assisted birth’ — these are terms used to describe either a forceps or vacuum birth. Assisted births are more common for a woman birthing for the first time, compared to a woman having a later birth.

Why might a forceps or vacuum birth be necessary?

Firstly, your cervix (the neck of the womb) must be 10cms open (no cervix remaining) for you to birth your baby vaginally. A forceps or vacuum birth might be advised if:

• There are concerns with your baby’s heart rate.
• You have become exhausted from trying very hard to push your baby down your birth canal for a long time. (This will happen more often if you are lying in bed for the pushing stage. It’s much better to get up and push in a squatting position for a while, even if you have decided to birth lying down).

Your midwife and chosen birth partner will be present with you throughout the birth of your baby. The doctor will help you to birth your baby and usually there will be a paediatrician (baby doctor) in the room with you also.

The decision to use a forceps or a vacuum instrument is dependent on different circumstances, including the position of your baby, how high up or low down in the birth canal your baby is, and what way your baby is facing.

Can I have pain relief?

You may want to use Entonox (nitrous oxide and oxygen, or ‘laughing gas’) for pain relief. The doctor will offer you a local anaesthetic injection to numb your vagina and perineum (area between your vagina and anus) or a pudendal nerve block may be suggested (a temporary nerve block that will give quick pain relief to the vaginal and perineal area). If you have an effective epidural, this will continue.

A hot compress may also be used on your perineum as your baby’s head is crowning (when the widest part of your baby’s head is birthing) to reduce any risk of a tear. If you have been using this while you were pushing and found it helpful, ask the midwife to keep doing this for you.

Your doctor may suggest doing an episiotomy (a cut at an angle in the perineum). This may only be done if the doctor is concerned that a natural tear may be deeper. Again, this will be a choice that you may or may not want. An episiotomy is advisable if there is a concern with your baby’s heart rate.

Could using forceps or vacuum harm my baby?

The paediatrician will check your baby after the birth. Lots of women worry whether this type of birth may harm their baby. The reason that this type of birth may be suggested is to reduce any potential harm to your baby by prolonging birth, or if there are concerns with your baby’s heart rate.

Your baby may experience some slight bruising or skin lacerations (little marks or cuts) from the instruments. Once the paediatrician has assessed your baby after the birth, your baby will then be placed skin-to-skin with you.

How can I reduce my chances of an instrumental birth?

In 2017, a review of studies combining information from over 9,000 women showed that keeping upright and changing position will help to move your baby down in your pelvis (Gupta et al, 2017). This will increase your likelihood of birthing your baby without the assistance of instruments.

Remember to keep active, upright and moving as much as you can during labour and birth. In particular, any activity that moves your hips up and down is good, such as walking up and down stairs, dancing and/or resting alternate knees on a chair during each contraction.