| Q: |
What is an assisted delivery?
| | A: |
An assisted delivery is one that uses either forceps or a vacuum, or suction cup (see Helping your baby's birth),
to help extract the baby from the birth canal if the baby is not making
good progress or there are complications during the second stage of
labor in a vaginal delivery. You will still be helping deliver your baby
with your contractions, but the instrument used will be helping to
guide the baby out of the birth canal.
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| Q: |
How is an assisted delivery carried out?
| | A: |
Assisted deliveries are carried out using either forceps or
vacuum extraction by a doctor (or specially trained midwife). Forceps
are metal instruments specially shaped to fit around the baby's head,
whereas in the vacuum method, a vacuum is created by attaching a cuplike
fitting to the head and using a mechanism to create suction to help
draw your baby out.
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| Q: |
How do they decide whether to use vacuum or forceps? Will it be my choice?
| | A: |
Both forceps- and vacuum-assisted births are relatively safe
procedures and, although each has pros and cons, it's best to be guided
by the doctor, since the choice of instrument usually depends on the
position of the baby and the doctor's preference or experience, although
your opinion will be taken into consideration. Although forceps used to
be the most widely used instrument, vacuum has increased significantly
in popularity. Many consider vacuum easier to use and less likely to
cause damage and tearing to the mother. However, this method is also
more likely to cause swelling to the baby's head where the cup was
placed.
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| Q: |
What is a “prolonged second stage” and does this mean that the delivery will be assisted?
| | A: |
It is difficult to define a “prolonged second stage” since it
depends on certain factors, for example if it is your first baby, the
position and size of the baby, if you have an epidural, if the
contractions are effective and how often they are coming, how well you
are pushing, and if the pelvis is an adequate size. There is some
evidence to suggest that if the baby has progressed further into the
pelvis, and there is no sign of distress, then there is no need to put a
time limit on labor. However, it does tend to be the case that
hospitals have guidelines as to how long they will allow a woman to push
before deciding that intervention may be necessary. Usually, after
about 2–3 hours, doctors may decide to assist the delivery to reduce the
risk of fetal distress and of the mother becoming exhausted.
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| Q: |
I had a forceps delivery since in the end I was too tired to push. Is this likely to happen again?
| | A: |
An assisted delivery is more common during a first birth than in
subsequent ones. The first pregnancy and birth causes the pelvic
ligaments to stretch, which can make subsequent births easier, and the
uterus is often more efficient in contracting the second and subsequent
times around, which also means that labor is usually shorter. Often,
even if the baby's head is not in the best position for birth, for
example if the baby is in a posterior or transverse position, where the
back of the head is toward the mother's spine and lower back, it may be
delivered without assistance during a second delivery. Therefore, it is
likely, but by no means certain, that you will have a normal vaginal
delivery next time.
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| Q: |
Can I refuse to have forceps or vacuum extraction and what are the alternatives?
| | A: |
No one can go against your wishes if you do not want to have a
particular procedure. However, it's usually best to have a flexible
approach to labor. Although you may wish for certain things not to take
place, the doctor or midwife is likely to have a good reason for wanting
to perform a procedure and has you and your baby's best interests at
heart. If an assisted delivery is suggested, asking the midwife or
doctor to explain and support this decision can help you to come to
terms with it. Usually the only other alternative to an assisted
delivery would be a cesarean section; however, this may be difficult if
the baby has gone too far into the pelvis.
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| Q: |
Will I have an anesthetic before they use the forceps?
| | A: |
Appropriate pain relief, such as a local anesthetic injection, or
an epidural, will be given before the procedure. The doctor will then
help pull the baby out while the mother pushes. The forceps and vacuum
cup are removed after the head has been delivered, and the body is
delivered normally.
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| Q: |
What can go wrong at an assisted birth?
| | A: |
Forceps and vacuum can cause bruising, swelling, and marks on the
baby's head or face, although these usually resolve with no problems
within a few days. In rare cases, cuts and severe bruising on the baby
can occur. The pediatrician, a doctor who specializes in care of babies
and children, may prescribe a mild analgesic to ease any discomfort that
the baby may feel. There is also an increased risk of the baby
developing jaundice, where the baby looks yellow due to the presence of
the waste product bilirubin,
particularly in cases of severe bruising. The levels of bilirubin will
be checked if the doctor is concerned and the condition can be treated,
if necessary.
For the mother, the two
main concerns are that there is an increased risk of tearing or being
cut during the procedure—and hence an increased risk of more bleeding
(which can be managed)—and, rarely, damage may occur to the anal
sphincter or rectum.
If the situation
warrants an assisted delivery, the benefits of delivering babies by
these methods far outweigh the risks. If the procedure is not
successful, an emergency cesarean may be necessary.
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| Q: |
What is an episiotomy and why might this be done?
| | A: |
An episiotomy
is a cut along the muscle between the vagina and anus, known as the
perineum, to widen the area where the baby will be delivered
. This is done only when absolutely necessary and will not be
performed without your consent. There are several reasons why an
episiotomy may be recommended, including if the baby is in distress, to
speed up the delivery of the head; in cases of forceps or vacuum
deliveries; if the baby's head is too large to pass through the vagina;
if the perineum has not stretched sufficiently by the end of the second
stage of labor to allow the smooth passage of the baby's head through
the vagina; if there is a complication in the vaginal delivery of a
breech baby; or if the mother is finding it difficult to control her
pushing while the baby's head is crowning, which means she is more likely to tear significantly during the delivery.
Usually, local
anesthetic is injected into the muscular area first and the procedure is
performed at the strongest part of the contraction, since this
distracts you from what is being done and assists with a quick delivery.
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| Q: |
The thought of having a cut down there is terrifying. What can I do to prevent this?
| | A: |
Some studies have shown that massaging your perineum regularly
during pregnancy, using an unscented vegetable oil, can reduce the risk
of tearing since this helps to make the area more flexible and may consequently
help stretch the area as the head is being born. Wash your hands
thoroughly before massaging the perineum. Although an episiotomy may be a
worrying prospect, if you are advised to have one, this may prevent
uncontrolled tearing.
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| Q: |
Why might they do an emergency cesarean section?
| | A: |
Emergency cesareans are performed for several reasons. The baby
may be showing signs of being distressed as evidenced by certain
patterns displayed on the fetal monitor, in which case a cesarean may be
recommended. Rarely, the umbilical cord comes down before the baby, a
condition known as cord prolapse, and this is an emergency that requires
immediate delivery by cesarean.
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