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An assisted vaginal birth is when a ventouse (vacuum cup) or forceps is used to deliver your baby.

Forceps and ventouse help deliver babies safely. In Ireland, around 1 in 7 women have an assisted birth.

Your obstetrician will only use them if they feel it is the safest way for you to give birth.

An assisted birth is sometimes called an 'instrumental delivery'.

Why you might need an assisted birth

You might need an assisted birth if:

  • there are concerns about your baby’s health during the birth
  • your baby is not moving out of the birth canal as expected
  • you cannot push during the birth because of an underlying medical condition
  • you cannot push due to exhaustion, or the contractions become less intense

Your obstetrician or midwife will recommend an assisted birth if they have concerns about your baby’s health during the birth. For example, if your baby is getting tired or distressed. An assisted birth will speed up the delivery of your baby.

If your baby is lying with their back against your back you might need an assisted birth. This is sometimes called the occiptio-posterior position (OP position).

They will need to turn so they are looking downwards when coming out of the birth canal. Sometimes babies need a little help to rotate or turn into the correct position.

Occipito-anterior (OA) and occiput-posterior (OP) positions pregnancy
The occiptio-posterior position, with the baby's back to you, pictured right, may mean your baby needs an assisted birth. The position best for birth is called the occiptio-anterior position. This is with your baby's back facing out, pictured left.

Options other than assisted birth

The alternative to a recommended assisted birth is to have a caesarean section. But this can be a difficult surgery at this stage in labour. It can also increase the risk of harm to you and your baby.

What happens during an assisted birth

Your obstetrician or midwife will talk to you if they think you need an assisted birth.

They will usually explain:

  • the reasons why you need one
  • what instrument they will use
  • how the birth will happen

They should explain any risks to you and your baby. Never be afraid to ask questions. Your birth partner can ask questions if you are concentrating on focused breathing.

Consent

If the birth is in an operating theatre you will usually need to sign a consent form to have an assisted birth. If your baby needs to be born quickly you can give your consent verbally. The birth takes place in an operating theatre if there is a chance that you may need to have a caesarean birth.

Epidural

You will be offered an epidural for pain relief during an assisted birth. If you have already had an epidural during labour, the dose of medication can be 'topped up' before the birth.

You’ll usually be given a local anaesthetic. This numbs your vagina and your perineum (the area between your vagina and your anus).

Episiotomy

You may need to have an episiotomy (a surgical cut that is made in your perineum). This will make the opening at your vagina bigger. You may not need this, especially if you have had a baby before.

If you have an episiotomy or if you have a perineal tear, your midwife or obstetrician will stitch this after the birth.

After the birth, your baby may need to get checked by a paediatrician.

Instruments used during an assisted birth

Your obstetrician will use either a:

  • forceps, or
  • ventouse (vacuum cup)

Different kinds of forceps or ventouse (vacuum cups) may be used. Your obstetrician will choose which is most suitable for you and your baby's situation.

Why an assisted birth might be unsuccessful

A forceps or ventouse birth may not work. You may need to have a caesarean birth.

An assisted birth is less likely to be successful if your:

  • baby’s head is too high in the birth canal
  • baby is positioned with their back facing your back
  • BMI is high (especially if it is over 30)
  • baby is big

After an assisted birth

Your bleeding may be heavier than usual immediately after the birth. After that, you should have normal amounts of bleeding.

It is normal to have some pain after an assisted birth. You may feel bruised and sore. It may sting when you go to the toilet.

Your obstetrician can prescribe medication to help with any pain. Tell them if you are breastfeeding as some painkillers are not suitable. Your midwife will show you how to care for your perineum.

It can take time to recover emotionally. Talk to your midwife or obstetrician about any decisions made about the birth.

If you want to talk to someone about the birth in the weeks or months afterwards, talk to your GP. They can refer you to your obstetrician.

Your next pregnancy and birth

Having one assisted birth does not mean you will have another one again if you get pregnant.

Around 8 out of 10 women who have an assisted birth go on to have a normal birth the next time.

Related topics

Caesarean birth

Episiotomy

page last reviewed: 26/01/2021
next review due: 26/01/2024