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Assisted Vaginal Delivery

An assisted vaginal delivery is a delivery that is achieved with the help of either forceps or vacuum. Using these devices, an obstetrician can pull gently on the baby in conjunction with the mother’s pushing efforts to help make a vaginal delivery happen.

Assisted vaginal deliveries do not happen often. Most of the time mothers will push out their babies without help. There are a number of reasons why an assisted vaginal delivery might be needed:

  1. Most often they are done because there is reason to be concerned about the wellbeing of the baby. If delivery by the mother’s own pushing efforts is not imminent and there is great enough concern (usually because the baby’s heart rate pattern is abnormal) an obstetrician might recommend an assisted vaginal delivery in order to get the baby out faster so that we can be sure it is ok, and if it is not ok we can provide the needed help to the baby sooner.
  2. Sometimes the positioning of the baby makes it much more difficult to push the baby out.
  3. There are some rare conditions that make pushing efforts by the mother dangerous for her.
  4. Sometimes moms just get exhausted! Pushing a baby out is hard work. Occasionally at the end of a long labour, and after pushing for a long time, a mother might find that she is physically unable or unwilling to push any more. We do our absolute best to encourage mothers to persevere and keep pushing if we are not concerned about the baby’s wellbeing, as this is the safest way to do it. However, every now and then a little extra help is needed to get the job done.

Assisted vaginal deliveries have some associated risks to take into consideration for both mother and baby.

The vast majority of babies who are delivered by forceps or vacuum do very well. With a vacuum assisted delivery there is often a bruise on the baby’s head that resolves in the first few days. With a forceps assisted delivery there is sometimes a mark on the face or some drooping on one side of the face because of compression of the facial nerve. These usually resolve on their own in the first few days as well. There are however some rare but serious complications of both vacuum and forceps to consider. Serious or life threatening bleeding around the brain and skull can occur in about 8 per 10,000 assisted deliveries. This can also occur in a normal vaginal delivery without any assistance, however the rate is about 3 per 10,000.

For mothers, the risks are mainly related to vaginal tearing associated with delivery. This can occur with any vaginal delivery, but is higher with assisted vaginal delivery, especially forceps. Sometimes an episiotomy is made in combination with a forceps delivery to help make space for the extra width of the instrument.

There is also a risk that the assisted vaginal delivery will not be successful.

The alternatives to having an assisted vaginal delivery are to keep pushing without assistance (in situations where we are not concerned about the baby’s wellbeing) or to proceed to a c-section.