Sometimes, despite everything that you have done to avoid one, and it is usually dependent on the shape of your pelvis, it is necessary to perform an assisted birth. Your baby could be showing signs of distress and it may be safer for you and him to have an assisted birth. Your baby’s head will probably be too low in your pelvis to make a Caesarean section a safe option. Also, a Caesarean section at full dilatation of your cervix carries a higher risk of infection and bleeding at this stage of your labour.
Forceps or ventouse is a decision taken by the midwife or obstetrician carrying out the procedure. A forceps birth is usually carried out when your baby’s head is still not visible when you push or there is a lot of swelling on the top of his head. If your baby has become distressed and needs to be born straightaway, your midwife or obstetrician will normally opt for a forceps birth as it is most likely to be successful and quicker than a ventouse.
Babies delivered by forceps can receive marks or bruises to the skin on the face and occasionally grazes where the forceps were applied, while babies delivered by ventouse may suffer headaches caused by a ‘chignon’ or swelling of their head.
A ventouse birth is no riskier for you than a normal birth, however a forceps birth will increase your risk of third degree tears and you will need an episiotomy. If a ventouse birth is attempted when your baby’s head is high the suction cup will usually displace and need to be reapplied. If this happens a few times your midwife or obstetrician will revert to forceps. Likewise if there is a lot of swelling on your baby’s head then they will be unable to apply the ventouse and forceps will need to be applied.
If you’ve had no pain relief you will be offered a spinal anaesthetic or a pudendal block. Both offer excellent pain relief with benefits and drawbacks. A Spinal anaesthetic requires you to give birth in theatre with an anaesthetist present. You will be numb from the waist down – this type of anaesthetic is used for Caesarean section so you will be in bed for at least six hours.
A pudendal block works in the same way as an anaesthetic you would be given by your dentist. It ‘blocks’ the nerve pathways to the lower part of your pelvis. You should feel no pain but you will feel pulling and pushing. The benefits of a pudendal block are you can give birth in your labour ward room and you can walk immediately afterwards.
In both cases the delivery is the same. Firstly, your legs are placed into lithotomy poles attached to the side of your bed. Your perineal area is cleaned and draped with sterile towels and a catheter is passed to drain your bladder then removed. Another vaginal examination is performed to confirm the position of your baby is in before forceps are applied one at a time. When the forceps are in place your midwife will either feel for contractions or encourage you to push when you have one. As you push your midwife or obstetrician will gently guide your baby’s head out and perform an episiotomy, a cut to the skin and muscle of the area between your vagina and anus, just before his head is born. The forceps are then removed and with your next contraction they will help you to deliver the rest of your baby. If needed your baby will be taken the resuscitation table and be assessed by a paediatrician, midwife or nurse, but it is more common for him to be placed on your stomach after he is born and to be assessed there. Following this your placenta will be delivered and your perineum sutured but it is unlikely that you’ll be aware of this as you welcome your baby into your family.
The cup of the ventouse that sits on your baby’s head is about the size of a tennis ball which has been cut in half and is smaller than his head. Because of this there is no need for pain relief unless you request some. You will be helped into lithotomy position and, as with a forceps birth your perineum will be cleaned and draped with sterile towels and your bladder emptied with a catheter. As you push, your midwife or obstetrician will gently guide your baby’s head out and once his head is born, remove the ventouse cup. Usually, there is no need to perform an episiotomy and baby is usually placed straight onto your stomach. As with forceps deliveries, if needed, he will be taken to the resuscitation table to be assessed. Once you have your baby in your arms your placenta will then be delivered and any tears repaired.
For some women there will be disappointment that they required a forceps or ventouse birth especially when they followed all the advice given to them. This should not be viewed as some sort of failure but a testament to your strength and endurance that you managed to give birth after such a difficult labour. You should tell yourself ‘I worked hard for that forceps birth’ and mean it.
If you used an epidural for pain relief recognise that it was the only option and you could well have required an assisted labour anyway. Labour and birth is a means to an end. We can strive to enjoy its amazing journey, but ultimately the way we give birth is predestined by the shape of our pelvis and the size of our babies.