Forceps or vacuum delivery
An assisted birth is when forceps or a ventouse suction cup are used to help deliver the baby.
Ventouse and forceps are safe and only used when necessary for you and your baby. Assisted delivery is less common in women who have had a spontaneous vaginal birth before.
What happens during a ventouse or forceps delivery?
Your obstetrician or midwife should discuss with you the reasons for having an assisted birth, the choice of instrument (forceps or ventouse), and the procedure for carrying it out. Your consent will be needed before the procedure can be carried out.
Find out more about consent to treatment.
If your obstetrician has any concerns, you may be moved to an operating theatre so a caesarean section can be carried out if needed – for example, if the baby can't easily be delivered by forceps or ventouse. This is more likely if your baby's head needs to be turned.
A cut (episiotomy) may be needed to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Depending on the circumstances, your baby can be delivered and placed on your tummy, and your birth partner may still be able to cut the cord if they want to.
A ventouse (vacuum extractor) is an instrument that's attached to the baby's head by suction. A soft or hard plastic or metal cup is attached by a tube to a suction device. The cup fits firmly on to your baby's head.
During a contraction and with the help of your pushing, the obstetrician or midwife gently pulls to help deliver your baby.
A ventouse isn't used if you're giving birth at less than 34 weeks pregnant because your baby's head is too soft. It's less likely to cause vaginal tearing than forceps.
Forceps are smooth metal instruments that look like large spoons or tongs. They're curved to fit around the baby's head. The forceps are carefully positioned around your baby's head and joined together at the handles.
With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.
There are different types of forceps. Some are specifically designed to turn the baby to the right position to be born, such as if your baby is lying facing upwards (occipito-posterior position) or to one side (occipito-lateral position).
Forceps are more successful than ventouse in delivering the baby, but a ventouse is less likely to cause vaginal tearing.
Why might I need ventouse or forceps?
An assisted delivery happens in about one in eight births, and can be because:
- there are concerns about the baby's heart rate
- the baby is in an awkward position
- you're too exhausted
If the baby's head is in an awkward position, it'll need turning to allow the birth. A children's doctor (paediatrician) may be present to check your baby's condition after the birth.
What are the risks of a ventouse or forceps birth?
Ventouse and forceps are safe ways to deliver a baby, but there are some risks that should be discussed with you.
Vaginal tearing or episiotomy
This will be repaired with dissolvable stitches.
Third- or fourth-degree vaginal tear
There's a higher chance of having a vaginal tear that involves the muscle or wall of the anus or rectum, known as a third- or fourth-degree tear.
This kind of tear affects:
- 1 in 100 women having a normal vaginal birth
- up to 4 in 100 having a ventouse delivery
- 8-12 in 100 having a forceps delivery
Higher risk of blood clots
After an instrumental delivery, there's a higher chance of blood clots forming in the veins in your legs or pelvis. You can help prevent this by moving around as much as you can after the birth.
You may also be advised to wear special anti-clot stockings and have injections of heparin, which makes the blood less likely to clot.
Urinary incontinence (leaking urine) isn't unusual after childbirth. Research suggests it affects around 30 out of 100 women. It's common after a ventouse or forceps delivery. You should be offered physiotherapy-directed ways of preventing this, including advice on pelvic floor exercises.
Anal incontinence (leaking wind or poo) can happen after birth, particularly if a third- or fourth-degree tear has occurred. As there's a higher risk of such tears after a forceps or ventouse delivery, anal incontinence is more likely to occur after instrumental delivery.
It's difficult to know exactly how common anal incontinence is, as there's no standard definition and people who have it may be reluctant to say they do.
In a review of studies looking at incontinence after childbirth, estimates of how common anal incontinence was ranged from 13-27%.
Are there any risks to the baby?
The risks to your baby include:
- a mark on your baby's head (chignon) being made by the ventouse cup – this usually disappears within 48 hours
- a bruise on your baby's head (cephalohaematoma) – this happens to between 1 and 12 in 100 babies and disappears with time; it can cause a slight increase in jaundice in the first few days, but rarely causes any other problems
- marks from forceps on your baby's face – these usually disappear within 48 hours
- small cuts on your baby's face or scalp – these affect 1 in 10 babies born via assisted delivery and heal quickly
You'll sometimes need a small tube that drains your bladder (a catheter) for up to 24 hours.
You're more likely to need this if you've had an epidural as you may not have fully regained sensation in your bladder and therefore don't know when it's full.
The Royal College of Obstretricians and Gynaecologists (RCOG) has further information on assisted delivery.
healthtalk.org has videos and written interviews of women talking about their experiences of vaginal birth, including forceps and ventouse.
Media review due: 20 March 2020
Page last reviewed: 29 April 2017
Next review due: 29 April 2020