Some births need a little help. Here we explain what an assisted birth is, why ventouse or forceps might be needed, what happens and how you might feel.
Knowing what to expect and understanding why your doctor or midwife might recommend an assisted birth can help you feel more confident about the process. It’s especially good to know about this just in case you have a long, challenging labour, or if concerns about the baby crop up. Read on to find out more.
What is an assisted birth?
An assisted or instrumental birth is when ventouse or forceps are used in the later stages of labour to help a baby to be born.
"About one in eight babies in the UK are born with the help of these instruments." (RCOG, 2012, 2016; NHS, 2017)
You’re more likely to need an assisted birth if you’re giving birth vaginally for the first time.
What are ventouse and forceps?
A ventouse is a cup-shaped suction device that can be attached to your baby’s head to help them to be born. You might have heard it called a vacuum delivery (NHS, 2017).
Forceps are smooth, curved metal instruments that look like large tongs. They’re placed around the baby’s head to help pull the baby out.
Why might I need help with the birth of my baby?
Sometimes, when the second stage of labour is very long, an assisted birth is suggested because:
- the baby needs a little help to move out of the birth canal, particularly if they are lying in the back-to-back position
- there are concerns about you or your baby
- you are exhausted
- you are unable to push, perhaps after an epidural, or because you have a condition that prevents you from doing so.
(RCOG, 2012; NICE, 2014; NHS, 2017)
What are my other options?
If your doctor thinks an assisted birth is possible but could be difficult, you would be moved to an operating theatre in case you need a caesarean section (NICE, 2014). Usually, you’d be offered an assisted birth first because if it works this can help your baby out quicker than a caesarean. This is important if the baby is in trouble.
As with any medical intervention being offered, you can say ‘no’ to an assisted birth. Your doctor or midwife should first discuss why you need an assisted birth and their choice of instrument and gain your consent (RCOG, 2012). A caesarean birth involves major surgery, which carries risks and takes longer.
If the ventouse or forceps do not help your baby out, you will need a caesarean.
What happens during a forceps or ventouse assisted birth?
The midwife or obstetrician will examine you. If there are concerns about you or your baby’s health, you might need an emergency caesarean and be moved to an operating theatre. This way, if the forceps or ventouse is unsuccessful, a caesarean birth can happen soon after. For example, if the baby’s head needs to be turned, forceps or ventouse might not help so easily.
If you haven’t already had an epidural, you will be offered one, or a single spinal injection or local anaesthetic to numb the area around the vagina (RCOG, 2012). You’ll lay on your back and have your feet in stirrups. Your bladder will be emptied using a catheter.
You might have a cut (episiotomy) made at this point to make your vaginal opening bigger (RCOG, 2012; NICE, 2014). This isn’t routine but might be necessary (NHS, 2017). You’re less likely to experience vaginal tearing with ventouse than with forceps (RCOG, 2012).
In a ventouse delivery, the obstetrician or specially-trained midwife will attach a suction cup to your baby’s head. They’ll then gently pull when you have a contraction, to help your baby out. They might need to pull more than once (RCOG, 2012).
A ventouse is not suitable if you are less than 34 weeks pregnant. This is because the baby’s head is softer thus increasing the risk of your baby getting bruised, or having a brain haemorrhage or jaundice (RCOG, 2012).
If you have a forceps delivery, the doctor or midwife would gently place them around your baby’s head. Then on the next contraction you will be asked to push as your baby is carefully pulled. You’d normally need an episiotomy first (RCOG, 2012).
Ventouse or forceps delivery?
Ventouse and forceps are both safe and effective. If you do need assistance, your doctor would choose the most suitable instrument for you, your baby and your situation. Forceps are more successful in assisting the birth than ventouse. Yet ventouse is less likely to cause vaginal tearing (NHS, 2017).
Can I avoid an assisted birth?
An assisted birth can’t always be avoided but you can reduce the risk. Here’s how:
- If your pregnancy has been straightforward, try planning to give birth in a birth centre or at home. That means you are less likely to need forceps, ventouse or any other interventions.
- Continuous support from a birth partner other than your midwife can make a positive difference.
- Remain upright or on your sides and mobile to give you and your baby the best chance of a spontaneous birth.
- Avoid an epidural if possible, or if you do have an epidural, wait for a while after your cervix is fully dilated before beginning to push.
(Hodnett et al, 2010; Hollowell et al, 2011; RCOG, 2012; Hodnett et al, 2013; NCCWCH, 2014)
What can birth partners do?
It might be helpful to think about the support you can give your partner if she need forceps or ventouse assistance. This could mean offering reassurance if this is a change to your birth plan, or simply holding her hand during the birth (RCM, 2012).
Some partners have said they found it difficult watching forceps or ventouse being used. So consider where you might want to stand during the birth.
It’s also a good idea to discuss birth scenarios in advance so you’re clear on whether your partner would prefer you to stay with her or go with the baby if needed. For example, you could provide skin-to-skin care for the baby if your partner isn’t able to.
What are the effects of a forceps or ventouse delivery on babies?
Some parents-to-be worry their baby may be harmed during an assisted birth. But any effects are likely to be short term, resolving within 24 to 48 hours (RCOG, 2012).
Forceps can cause bruising, marks or cuts on a baby’s head, while a ventouse may temporarily affect the shape of a baby’s head (RCOG, 2012). The suction cup used for ventouse delivery might also mark a baby’s head or cause a bruise that disappears in time (NHS, 2017). Small cuts on a baby’s face and head may occur but generally fade quickly (RCOG, 2012).
If you are worried about any after-effects, talk to your health visitor or GP.
How will I be affected?
It’s normal to feel bruised and sore after birth, particularly if you had an assisted birth.
Help and support is available, so do seek medical advice if you experience any difficulties or complications. Your midwife or GP can talk through your options with you.
As you’re more likely to have an episiotomy during an assisted birth, stitches and swelling or tearing may make going to the toilet painful (RCOG, 2015). You’ll probably need to up your intake of fibre (RCOG, 2015). You could also take a stool softener to make it easier to open your bowels. See our article about episiotomy care and recovery for more details.
Four in 100 women who have a ventouse birth will have a third or fourth degree tear (into the tissue surrounding the anus). That compares with eight to 12 women in 100 who have a forceps birth will have a third or fourth degree tear (RCOG, 2012).
Third or fourth degree tears would need to be repaired in an operating theatre and it is normal to feel pain for two or three weeks afterwards (RCOG, 2015). You’ll be offered pain-relief and a course of antibiotics after the operation, and will need to keep the area clean (RCOG, 2015). See our article about perineal tears for more details.
Most women will recover from an assisted birth within a few weeks. But some might experience complications, such as severe vaginal tearing, blood clots and urinary or anal incontinence (RCOG, 2012). If you have any medical concerns talk to your midwife, health visitor or GP.
How will I feel?
Sometimes, an assisted birth can leave new parents feeling as if the situation was taken out of their hands. Difficult birth experiences like an assisted birth can affect women’s psychological health with around one third of women in the western world evaluating their childbirth experience as traumatic (Ayers et al, 2006).
If this is how you feel, it can help to chat to the doctor or midwife before you leave hospital. You could ask about what happened and why it was necessary (RCOG, 2012).
Some women and their partners might also want to talk about the emotional impact after they have gone home (RCOG, 2012). If you did an NCT antenatal course, you could get in touch with your antenatal teacher to talk this through.
Most hospitals have a ‘birth reflections’ service. This service gives you the chance to discuss the events with a midwife and resolve unanswered questions (Ayers et al, 2006).
Will I need an assisted birth if I have another baby?
It’s unlikely you will need an assisted birth with subsequent babies. Most women (80%) who have an assisted vaginal birth give birth spontaneously next time around (RCOG, 2012).
This page was last reviewed in September 2018.
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Ayers, S, Claypool J, Eagle A. (2006) What happens after a difficult birth? Postnatal debriefing services. British Journal of Midwifery 14(3):157-161. Available from: http://openaccess.city.ac.uk/2023/6/What_happens_after_a_difficult_birth.pdf [Accessed 1st October 2018]
Hodnett ED, Downe S, Walsh D, Weston J. (2010) Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev.(8):CD000012. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000012.pub4… [Accessed 1st October 2018]
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. (2013) Continuous support for women during childbirth. Cochrane Database Syst Rev.(7):CD003766. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003766.pub5/pdf [Accessed 1st October 2018]
Hollowell J, Rowe R, Townend J, Knight M, Li Y, Linsell L, et al. (2011) The Birthplace national prospective cohort study: perinatal and maternal outcomes by planned place of birth Birthplace in England research programme. Final report part 4. NIHR Service Delivery and Organisation programme; NHS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK311289/ [Accessed 1st October 2018]
NHS. (2017) NHS Maternity statistics 2016-2017 Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2016-17 [Accessed 1st October 2018]
NICE. (2014) Intrapartum care for healthy women and babies. Clinical guideline 190. Available from: https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#general-principles-for-transfer-of-care [Accessed 1st October 2018]
RCM (Royal College of Midwives). (2012) Evidence based guidelines for midwifery-led care in labour: supporting and involving women’s birth companions. Available from: https://www.rcm.org.uk/sites/default/files/Supporting%20and%20Involving%20Women's%20Birth%20Companions.pdf [Accessed 1st October 2018]
RCOG (Royal College of Obstetricians and Gynaecologists). (2012) Information for you: an assisted vaginal birth (ventouse of forceps). Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-an-assisted-vaginal-birth-ventouse-or-forceps.pdf [Accessed 1st October 2018]
RCOG. (2015) A third or fourth degree tear during birth. Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf [Accessed 1st October 2018]
RCOG. (2016) Patterns of maternity care in English NHS trusts. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/maternity-indicators-2013-14_report2.pdf [Accessed 1st October 2018]