Women

Assisted delivery When is this necessary?

An assisted delivery, using forceps or a vacuum extraction, may be carried out for one or more of the following reasons:

  • The mother is exhausted from a long labor and has insufficient energy to push.

  • The baby is showing signs of distress during the second stage of labor.

  • The baby's head is in a slightly wrong position—if you are in the second stage of labor, forceps or vacuum can often be used to turn the head around and deliver the baby.

  • Forceps are sometimes used to protect the delicate head of a premature baby during birth.

  • Forceps are sometimes used to deliver the head of a breech baby.

  • If the baby is particularly large—this can be the case when the mother has had gestational diabetes.

Episiotomy cuts

An episiotomy is an incision, or cut, made with scissors or scalpel into the area called the perineum, which is the piece of tissue between the vagina and the anus. This area stretches and thins during the birth to allow for the baby's head to be born with ease. An episiotomy is performed only in an emergency situation. An example of this is if the baby needs to be born quickly, or sometimes during an assisted delivery, for example with forceps (see Forceps delivery), to prevent uncontrolled tearing. Before the procedure is performed, a local anesthetic is gently injected into the muscle to reduce the discomfort or pain during the procedure. An episiotomy will need stitching afterward, and this is usually done by the midwife or doctor who has been involved in your delivery or by the obstetrician involved in the birth. Although episiotomies used to be routine around 10 to 15 years ago, they are now performed only when really necessary. You should be informed why one is being recommended and give your verbal consent before the procedure is done.

Medio-lateral Cut:

The incision may be done at an angle, moving away from the vagina and into the surrounding muscle.

NOTE

The decision to assist a vaginal delivery may prevent the need to perform an emergency cesarean section

Helping your baby's birth All about assisted deliveries

A delivery may be assisted using either vacuum extraction which involves a small suction cap (metal or plastic) placed on the back of your baby's head and very gently pulled, or forceps, metal tongs that guide the baby out.

Q: Why might this be necessary?
A: There are several reasons why the obstetrician, and in some units the midwife, will advise this type of birth. Generally an assisted delivery is performed because the mother is too tired to continue pushing after a prolonged second stage of labor, and the vacuum suction cap or forceps can help accelerate the baby's progress through the birth canal. An assisted delivery may also be necessary if your blood pressure has risen suddenly, or if there are signs of fetal distress. You will be given either an epidural or local anesthetic before the procedure is performed.
Q: Is it safe?
A: This is a safe way for your baby to be born, although there is a very small chance that your baby may bleed under his scalp and may need to go to the neonatal unit to be cared for and monitored after the birth. After vacuum extraction, most babies will have a little bump where the soft cup has been attached to the head, and the baby's head may look slightly elongated. Babies delivered by forceps may have marks on the sides of the head where the tongs were. However, any swelling or marks should disappear within a few days.
Q: Will I need an episiotomy?
A: An episiotomy—a cut made between your vagina and rectum to make more space for your baby to be born in order to prevent tearing—is sometimes done if you have an assisted delivery, and is more likely with a forceps delivery (see Episiotomy).
Vacuum extraction:

A suction cup is attached to the baby's head. This creates a vacuum, which is then used to help draw the baby down the birth canal.

Forceps delivery:

The curved metal tongs are placed gently on either side of the baby's head and then, in time with the contractions, they help to guide the baby down.

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