Forceps or vacuum delivery (assisted birth)

If your baby needs help to be born your obstetrician or doctor may offer you an assisted birth. They will use special tools to help you deliver your baby through your vagina. They will either use a ventouse (a suction cup) or forceps (metal tongs).

Why might I need help to deliver my baby?

There are many reasons you may need help. Perhaps:

• Your baby is tired, in distress or there are worries about their heart rate.
• Your labour is not progressing as it should.
• You cannot push or have been told not to push, for example if you have very high blood pressure.
• Your baby is in a position that makes birth tricky.

During a premature vaginal delivery, forceps can also help protect your baby’s head on their way out.

The idea of an assisted birth, sometimes known as an instrumental delivery, can be daunting, but it is safe. Your doctor will only offer it to you if they think it is needed.

How common is an assisted birth?

1 in 8 people will have an assisted vaginal birth. This rises to 1 in 3 for people having their first baby. You are less likely to need one if you have had a vaginal birth before.  

Will I be asked for consent?

Yes, your doctor will ask for the go-ahead from you. 

They will also explain:

• why they think you need an assisted birth
• the instrument they want to use, and why
• any potential risks to you and your baby.

After your baby is born, you should also have a chance to talk to your doctor or midwife about how the birth went, and why you needed help. 

What happens before an assisted birth? 

Your doctor will check you over to make sure an assisted birth is best for you and your baby. This will include a vaginal examination, with your consent.

If you have had an epidural, an anaesthetist may check it is still working. If you have not had one, you should be given a local anaesthetic to numb your vagina and the skin between there and your anus (the perineum). Or, your doctor may advise you to have an epidural or spinal block to help with pain.

You may be able to stay in the room you have been in so far. But if there are any worries that your assisted birth could become complicated, or that you might go on to need a c-section, your team will suggest you move to an operating theatre. This may sound scary, but it means you and your baby can get the right treatment as soon as you need it. 

Your team will pop a small tube (catheter) into your bladder to empty it. You are unlikely to feel this as you will have had an epidural or local anaesthetic.  

It is likely that you will be given an episiotomy (a cut between your vaginal opening and your anus) before your assisted birth. This sounds worrying but it will reduce the chances of you tearing. Your healthcare team will ensure your epidural is topped up or you have had enough local anaesthetic.

Find out more about episiotomy and tears during an assisted birth.

What happens during a ventouse birth?

A metal or plastic ventouse vacuum cup will be attached to your baby’s head using suction. The doctor will wait until you are having a contraction. Then, they will ask you to push while they pull gently, to help deliver your baby. You may need to do this over a few contractions.

What happens during a forceps birth?

Forceps are smooth metal instruments that look like large spoons or tongs. They are curved to fit around your baby’s head. Some types of forceps can help turn your baby if they are in an awkward position. 

Your doctor will put the forceps around your baby’s head, wait until you have a contraction, and get you to push while they gently pull. You may need to do this over a few contractions before your baby is born.

Which instrument will be used?

Your healthcare team will use the instrument that's best suited to you and your baby. If you are less than 36 weeks pregnant you would need to have forceps rather than ventouse. That’s because they are less likely to injure your baby’s head. 

Can I avoid an assisted birth? 

There is no guaranteed way to avoid an assisted birth, but there are some things that may make having one less likely: 

• having someone to support you during labour, especially someone you know (a birth partner) as well as a midwife or doctor
• having an uncomplicated pregnancy and giving birth in a midwife-led unit rather than a labour ward
• not having an epidural
• not pushing too soon after your cervix is fully open. Your doctor or midwife will be able to give you advice about this
• staying in upright positions during labour or lying on your side after your cervix is fully open. 

Find out more about movement and positions during labour.

Are assisted births always successful?      

Assisted births do not always work. If your healthcare team has tried an instrumental delivery and they do not think your baby can be born safely in that way, they may suggest you have an emergency c-section. 

The word ‘emergency’ makes it sound scary, but this just means it has not been booked in advance.

Assisted birth is less likely to work if: 

• your body mass index (BMI) is over 30 by the time you go into labour
• you are less than 161cm in height 
• your baby is large, or predicted to be more than 4kg
• your baby is lying with their back to your back
• your baby’s head is not low down in the birth canal. 

What are the risks of having an assisted birth? 

Forceps and ventouse are safe and work well, but there are some risks to be aware of. 

Bleeding 

Bleeding after having a baby is normal, but you may have heavier bleeding straight after an assisted birth. This should slow down in the days that follow.

Use super-absorbent sanitary pads or maternity towels, rather than tampons, for the first 6 weeks after birth. Tampons can increase your chance of getting an infection.

Tell your midwife or health visitor straight away if you are losing blood in large clots. You may need further treatment.

Episiotomy and tears

You will probably be offered an episiotomy before an assisted birth, which will be repaired with dissolvable stitches. It's to help reduce the chances of tearing. 

This is because you are more likely to have a third- or fourth-degree tear during an assisted birth. 

A third- or fourth-degree tear is a vaginal tear that also includes the muscle or the wall of the anus or rectum. It affects:

• around 1 in 8 people having a forceps delivery
• around 1 in 25 people having a ventouse delivery
• around 1 in 33 people having a normal vaginal birth.

If you do end up having a third- or fourth-degree tear make sure you get referred to a perineal clinic for a follow-up. Ask about this before you leave hospital. Your follow-up appointment should take place around 6 weeks after you give birth. 

Find out more about perineal tears and episiotomy. 

Bowel and bladder problems

Urinary incontinence (leaking wee) is common after childbirth. An assisted birth can make it more likely. Your midwife or GP should refer you for physio to help treat this. They will also give you advice on pelvic floor exercises. 

Anal incontinence (leaking wind or poo) is also more likely after an assisted birth, even more so if you had a third- or fourth-degree tear. 

Do not suffer in silence, if you have bowel or bladder problems after the birth. Try not to feel embarrassed. It can be upsetting, but it is very normal. 

Speak to your GP and ask them to refer you to a specialist physio. In some parts of the UK, you can refer yourself to a physiotherapist without having to speak to your GP first.

Blood clots 

Pregnancy increases the chance of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis). This risk is higher after an assisted birth.  

It can help if you are able to stay mobile after you give birth. You may also be advised to wear special stockings and to have daily injections of heparin, which makes your blood less likely to clot. 

Find out more about your body after birth.

Are there any risks for my baby?

You will only be offered an assisted birth if it is the safest option for you and your baby. Serious trauma or injury to babies during this procedure is rare. However, there are a few minor risks involved. 

Ventouse can:

• leave a mark on your baby’s head, which should disappear after a day or two
• cause a bruise on your baby’s head, called a cephalohaematoma, which occurs in up to 1 in 8 babies, is usually harmless and should fade with time.

Forceps can:

• leave marks on your baby’s face, which should go within a couple of days
• leave small cuts on your baby’s face or scalp, which should heal quickly.

Other problems include:

• slightly higher risk of jaundice, which is when your baby's skin and eyes look yellow
• bleeding in the brain, which affects less than 1 in 700 babies.

How will I feel after I leave hospital? 

Much like after any birth, you may feel bruised and sore. Any stitches will heal within a few weeks and taking pain relief will help.

Will I need an assisted birth next time? 

Perhaps, but it’s likely you will not. Up to 9 in 10 people who have an assisted birth give birth to their baby without help the next time.