Instrumental delivery refers to the use of the Vacuum or Forceps instrument to assist the delivery of your baby. Instrumental delivery is actually an aid to facilitate natural birth. Your cervix needs to be fully dilated (10 cm) before either instrument can be used. Your doctor will decide which instrument is more suitable for you and the baby.
Your doctor will gently apply two sterile instruments (forceps blades) into your vagina around the baby’s head. The instruments look like curved spoon-shaped tongs, and are specially designed to fit comfortably around the baby’s head. As you push during each uterine contraction, your doctor will deliver the baby’s head using the forceps blade
Your doctor places an instrument called a vacuum extractor on the baby’s scalp. The vacuum extractor looks like a cup. A vacuum is then gently created using a pump. As you push with each uterine contraction, your doctor will gently pull so that your baby’s head is delivered using the vacuum extractor. There are many forms of vacuum extractors available but the most commonly used one is the ‘Kiwi cup’.
There are also a number of reasons why it may be necessary for you to have an assisted delivery (forceps/vacuum delivery) during your second stage of labour (i.e. when the cervix is fully opened). You are too tired to push effectively to deliver your baby. You have been pushing for too long (usually >1 hour). This avoids the obstetrical complications from prolonged pushing such as excessive bleeding from a ‘tired womb’ after delivery or a deterioration of your baby’s condition. The baby’s condition has deteriorated and an instrumental delivery would be the most suitable for an immediate delivery. This is usually shown on the cardiotocograph (CTG) that monitors your baby’s heartbeat. An episiotomy may be required when the vacuum or forceps is used.
It has to be stressed that most of the assisted deliveries are uneventful and will be performed with you and your baby’s interests in mind. This will only be carried out if it is felt that you will be able to deliver safely through the vagina.
Failure of the assisted delivery with one instrument — There may be several factors involved. Your doctor will make a re-assessment and decide if you need a cesarean section or if an alternate instrument may be used instead. Complications to the mother — Pain at and after delivery. Tears or trauma to the vaginal and back passage that may necessitate a repair in the operating theater under anesthesia. Complications to the baby — Skull fractures or intra-cranial bleeding, potentially life threatening conditions, may rarely occur. Injuries to the facial nerve or eye may happen. During an instrumental delivery, a condition known as shoulder dystocia (whereby the baby’s shoulders may be stuck at the birth canal) can happen and is more commonly seen in bigger babies.
Dr Pradnya Randive MBBS, MS(OBGY), DPH (Mum) is an Obstetrician Gynaecologist, Laparoscopist & Fertility Specialist, She is the Director of Aadityacare Maternity Hospital, Bhandup, Mumbai.
