Assisting Nature: Operative Vaginal Delivery

If the baby’s head is low enough in the birth canal and your practitioner feels that the baby needs to be delivered immediately or that you can’t deliver the baby vaginally without some added help, she may recommend the use of forceps or a vacuum extractor to assist. Using either of these instruments is called an operative vaginal delivery. Such a delivery may be appropriate to use when

• You’ve pushed for a long time, and you’re too tired to continue pushing hard enough to deliver.

• You’ve pushed for some time, and your practitioner thinks you won’t deliver vaginally unless you have this type of help.

• The baby’s heart rate pattern indicates a need to deliver the baby quickly.

• The baby’s position is making it very difficult for you to push it out on your own.

The figure shows forceps, two smooth, curved, spatula-like instruments that are placed on the sides of the baby’s head to help guide it through the outer part of the birth canal. The vacuum extractor is a suction cup that is placed on the top of the baby’s head, to which suction is applied to allow your practitioner to gently pull the baby through the birth canal.

Credit: Kathryn Born, MA

Both techniques are safe for you and the baby if the baby is far enough down in the birth canal and the instruments are used appropriately. In fact, these techniques can often help women avoid cesarean delivery (but not always). The decision to use forceps or a vacuum extractor often depends on your practitioner’s judgment and experience and the baby’s position and station.

If you haven’t had an epidural, you may need extra local anesthesia for a forceps or vacuum delivery, and most practitioners perform an episiotomy to make extra room. After the forceps or vacuum is applied, the practitioner asks you to continue to push until the head emerges. The forceps or vacuum extractor is then removed, and the rest of the baby is delivered with your pushing.

If forceps are used, very often the baby is born with marks on her head where the forceps were applied. If this happens to your baby, remember that it’s quite typical, and the marks disappear within a few days. A vacuum extractor may cause the baby to be born with a round, raised area on the top of the head where the extractor was applied. This mark, too, goes away in a few days.