Assisted delivery is defined as the condition when your baby is not delivered naturally but with the help or assistance of instruments. This is also termed as operative or instrumental vaginal delivery. According to statistics, one birth in every 8 hospital births is assisted birth. Mostly forceps or a vacuum device are used to help your baby through the birth canal, and is done only if your doctor in the delivery room thinks it is essential.
What Instruments Are Used For Assisted Vaginal Birth?
Ventouse and forceps are the two assisted delivery instruments.
The use of ventouse and forceps depends upon the following:
- How close you are to the due date
- Position of the baby
- Doctor’s comfort or assessment
- Forceps: The forceps are a pair of stainless steel instrument that somewhat look like salad servers that fit together. There are two curves for holding baby’s cranium or head at one end and a handle at the other end
- Ventouse: The ventouse is also called the vacuum extractor. It has a cup fixed to a suction device and a grip handle for holding and pulling. The cup fits on the top of your baby’s head and with the aid of vacuum created inside the cup the baby is pulled out. The ventouse cup is made of semi rigid or soft plastic
When Is Assisted Vaginal Birth Recommended?
Generally the need for assisted birth arises when the labor is prolonged and tiring particularly in the first delivery. This is in the interest of the mother as well as the baby. Assisted birth becomes essential under following circumstances:
- Maternal exhaustion due to prolonged labor
- Baby is distressed due to prolonged labor
- Non-descent of baby or baby is not making any progress in your pelvis as normally expected
- Any medical problem that restricts you from pushing down too much
- The baby’s head needs gentle turning so as to be able to be born in the head-down way
What Are The Limitations Of An Assisted Vaginal Birth?
Assisted delivery is usually unsuccessful if any of the following conditions are present:
- The maternal body mass index (BMI) is above 30
- The baby is oversized or healthy
- The baby lies back-to-back
- The head of the baby has not descended in to the vaginal or birth canal
In such case C-section is the ideal choice. Your doctor will discuss the same with you with patience
What Complications Can Arise With An Assisted Delivery?
Even the normal vaginal un-assisted deliveries are associated with some amount of risks and assisted deliveries are no exception as far as risk or complications are concerned.
There are risks or complications involved with assisted delivery. Some of the important ones are listed here:
- Superficial Scalp Markings: One of the most common outcomes of use of vacuum extractor or ventouse are the superficial scalp markings the swelling on the top of scalp is due to the application of vacuum cup and the pressure exerted by it. The swelling caused by ventouse is in the form of a cone called the chignon and its formation is vital for successful ventouse application.
The swelling usually subsides in 7 to 10 days and the bruising caused, if any, is superficial and heal rapidly
- Hematoma: This is another common condition seen with vacuum application in assisted deliveries. Hematoma is a collection of blood beneath the skin caused by bleeding. It can be of two types-cephalohematoma and subgaleal hematoma. Cepahlohematoma is caused when bleeding or hemorrhage is limited to a particular space in the fibrous skull covering. The prevalence of cephalohematoma is around 6 to 8 percent in newborn babies with vacuum extraction. It does not require any active intervention and recovers on its own in a week or two. Subgaleal hematoma is a serious condition where blood collects under the scalp and is a serious complication of ventouse
- Neonatal Jaundice: Some doctors believe that babies born with the assistance of vacuum extractor are vulnerable to neonatal jaundice however; the veracity of this statement is yet to be proved scientifically. Read more about it here
- Intracranial Hemorrhage: A rare complication of assisted deliveries is intracranial hemorrhage. The vacuum and traction pull applied on the head of the baby may result in the injury of veins and blood vessels. This can lead to accumulation of blood around the brain of the baby
- Retinal hemorrhage: Sometimes bleeding occurs at the back of the eyes around the retina. This is called the retinal bleeding or hemorrhage. This condition can be associated with normal vaginal deliveries too and is not specifically related to vacuum assisted births. It is not a fatal or serious condition and it resolves quickly
Are Forceps Better Or A Ventouse Is Better?
Both these instruments used in assisted vaginal deliveries have their pros and cons. Where ventouse can cause some degree of temporary swelling in your baby’s head, it is less likely to cause a significant damage to your perineum and vagina, reducing your chances of having an episiotomy. However, forceps help your baby to be born easily, where a ventouse may not be as successful. The choice of the instrument used to birth your baby will depend on your doctor’s assessment and the baby’s position. Try to put your faith in your doctor and refrain from over analyzing the situation. The application of ventouse is not advised under following conditions:
- The baby is less than 34 weeks of gestation because the baby’s skull is very soft to withstand the pressure of vacuum
- The baby is in breech position
- The baby is in face presentation
In the end it can be stated that the success of the assisted deliveries depend largely upon the proficiency of the caregiver and the condition of the baby. Maternal counseling is also very important.