When is assisted vaginal delivery (using forceps or vacuum) used?

Assisted vaginal delivery using forceps or a vacuum device is performed in specific situations during labor and vaginal birth when assistance is needed to help guide the baby out of the birth canal. These situations include concerns regarding the fetal heart rate, when pushing has continued for an extended period without progress in the baby's descent, maternal exhaustion, or a medical condition that prevents the mother from pushing effectively and safely [2].

Assisted delivery is a procedure aimed at avoiding the need for a cesarean section, which is major surgery that carries its own risks, such as severe bleeding and infection. Recovery from a vaginal delivery is often shorter than recovery from a cesarean section, and an assisted delivery can sometimes be performed more quickly than a cesarean section [2].

Indications for Assisted Delivery

The primary reasons a doctor might consider an assisted delivery include:

• Concerns regarding fetal heart rate: If fetal monitoring shows abnormal changes in the heart rate, which may indicate the fetus is not receiving enough oxygen [1].
• Failure to progress in labor: When the mother has been pushing for a long time, but the baby's head has not moved sufficiently through the birth canal, or when contractions weaken and the cervix does not dilate adequately [1].
• Maternal exhaustion: If the mother is very tired from a prolonged labor and is unable to push effectively [2].
• Certain maternal medical conditions: Some health conditions, such as heart disease, may limit the mother's ability to push safely and effectively [2].

Types of Assisted Delivery

There are two main types of assisted delivery:

• Forceps-assisted delivery: Forceps, which resemble two large spoons, are inserted into the vagina and placed around the baby's head. The forceps are used to apply gentle traction to help guide the baby's head out of the birth canal while the mother continues to push [2].
• Vacuum-assisted delivery: A suction cup attached to a handle is placed on the baby's head inside the vagina. Gentle, controlled traction is applied to help guide the baby out of the birth canal while the mother continues to push [2].

Potential Risks and Considerations

Before recommending an assisted delivery, the doctor considers several factors, such as the estimated fetal weight, the position of the baby in the birth canal, and whether the mother's pelvis size appears sufficient for a vaginal delivery. The cervix must be fully dilated and the baby's head must have descended into the pelvis before an assisted delivery can be initiated [2].

Although an assisted delivery can be beneficial, it carries some risks for both the mother and the baby. For the mother, it may increase the risk of injury to the vaginal, perineal, and anal tissues, and in rare cases, can lead to urinary or fecal incontinence. For the baby, there is a risk of injuries to the scalp, head, and eyes, intracranial hemorrhage, and issues with the nerves of the arm and face [2]. However, the overall rate of injury to the baby resulting from an assisted delivery is low [2].

Recovery After Assisted Delivery

After an assisted delivery, the mother may experience pain and bruising in the perineal area and may find walking or sitting difficult for a while. If a perineal tear occurred, it may require stitches. Over-the-counter pain relief, the application of ice packs, sitz baths, and the use of anesthetic sprays or creams can help alleviate pain and swelling. For additional information on managing birth complications, you may visit Childbirth Problems: Complications, Signs, and Medical Interventions (Arabic).

Medical references

• Childbirth Problems
• Assisted Vaginal Delivery