Assisted Birth

All mothers hope for a flawless, natural birth for their baby. In most cases, the process occurs spontaneously without the need for the doctor to intervene. Under some circumstances, the doctor may need to “assist” to speed up the delivery process. Your doctor will decide at the time of delivery whether assisted birth is necessary for your safety or that of your baby.

The vacuum cup and forceps are instruments a doctor uses during an assisted birth. As with any birth, there is always a risk of complications when the doctor uses these tools to assist. However, the doctor should make the decision for assisted birth only when the risks of not doing so are greater.  For example:

  • The baby isn’t moving through the birth canal
  • There is a perceived risk to the baby that requires a faster birth
  • You can’t push anymore due to the effects of pain medication, physical limitations, or due to the advice of your doctor to stop

Ventouse Vacuum vs Forceps

Both the Ventouse Vacuum and Forceps instruments are considered safe and effective for use in assisted birth. The doctor determines the best instrument to use in each case based on a number of factors. To some degree, the doctor will base their choice on their personal preference and which method they have the greatest experience in using. Other factors the doctor considers include the position of the baby and the type of pain relief available to you.

- How a Ventouse Vacuum Cap Works

The Ventouse cup is placed on the baby’s head while inside the birth canal. When you experience a contraction and start to push, the doctor pulls gently on the cup to assist its progression through the birth canal. Multiple pulls may be needed to deliver the baby.

- How a Forceps Delivery Works

Forceps have the appearance of two spoons facing each other. These “spoons” are shaped to fit around the baby’s head. The forceps lightly grasp the baby’s head and protect it during the delivery. Similar to the vacuum cap, the forceps allow the doctor to help pull the baby out of the birth canal while you push during a contraction. The doctor may need to make multiple pulls to deliver the baby.

What to Expect During Birth

Once early labour begins, your cervix begins to dilate. Early labour, during which the cervix dilates to 3cm, is often the slowest phase of the process. As labour progresses, the pains become more intense and closer together. This is why women are often advised not to go to the hospital until their labour pains are three to four minutes apart and last for 45 to 60 seconds. If you have complications or it isn’t your first birth, your doctor may advise you to come to the hospital sooner.

Once you arrive, the doctor will examine you and measure the progress of your cervix. Once it reaches 10cm, you are ready to start the delivery process.  

During the exam, the doctor will determine the position of the baby and make a decision about the need for an assisted birth. Once they explain the type of birth and the instrument they will use, they will request your verbal consent. Doctors often perform assisted births in an operating theatre. This can save valuable time if surgery is required.

You will receive pain relief to make the assisted birth a more comfortable process for you. The doctor may give you either local anaesthetic, epidural, or spinal anaesthetic. In addition, the doctor usually orders an intravenous drip (IV) to deliver fluids and medications. Your legs are placed in supports to give the doctor easy access to the baby.

A member of the medical team will empty your bladder with a long, thin tube called a catheter. The catheter usually remains in place for a little while after the birth. If you end up requiring a caesarean delivery, you may keep the catheter overnight to keep you from having to get up and go to the bathroom after surgery.  

The doctor will make a final check of the baby’s position. A midwife assists the doctor by monitoring the baby’s heart rate, timing contractions, and determining when it’s time to push. The doctor, midwife, and you work together as a team to make the assisted birth a successful one.

The Episiotomy

Doctors often make a cut in the perineum, the tissue between the vagina and anus, to alleviate pressure and prevent tearing tissue as the baby is born. A surgical episiotomy heals better than the tears caused during birth.

Depending on the circumstances of the birth or the common practice of your doctor, a doctor or midwife may examine the baby as soon as it is born. This is often the common practice for any birth performed in the operating theatre.

Recovering from Assisted Birth

In many ways, both the delivery process and recovery following an assisted birth are the same as with an unassisted delivery. The most significant difference is the use of the vacuum cap or forceps and any problems that may have occurred directly from their use.

The doctor will probably encourage you to walk with assistance soon after birth. If you receive an epidural for pain relief, it will take somewhat longer before you can walk. Movement helps prevent the formation of blood clots in your legs.

Helping Your Body Heal

Bleeding

Bleeding after childbirth for several days after and, for some women, for several weeks is normal. Bleeding should minimise over a period of a few days. During the first day after the birth, the colour of blood should be between fresh red and brown-red and quite heavy. Don’t be surprised if you pass some fairly large blood clots but do show them to your midwife.

During the period of two to six days after birth, the blood should become darker in red or brown and subside in flow. Any clots you pass now should be smaller in size. Over the next several weeks, the bleeding continues to subside. Bleeding may only occur at the end of breastfeeding or after activity. Address any concerns about bleeding with your midwife.

If you don’t have a caesarean, the catheter will usually be removed within a day. Bowel movements often take longer to return to normal. If you fail to have a bowel movement after a certain period, your doctor can give you a laxative to help.  

The doctor uses dissolving stitches to repair episiotomies or tears in the vagina. These stitches dissolve over time once the wounds heal. Apply ice packs and get plenty of rest to enhance healing and speed recovery.

Pain

Everyone is different when it comes to pain. Most women will experience some degree of discomfort after birth. Getting the appropriate pain relief to make you comfortable is important for a healthy recovery. Tell your midwife if you have pain or need medication for nausea.

Pelvic Floor Care

Pregnancy and birth put a lot of pressure on the pelvic floor muscles. The steps you take to strengthen your pelvic floor after delivery can aid in preventing long-term complications like prolapse of the bladder, bowel, or uterus and incontinence. A physiotherapist guides you on the types of exercises you need to do and the correct way to do them.  These exercises offer a great deal of benefit following a caesarean or assisted birth.

Sexual Function

You can resume normal sexual function when it is comfortable for you. This may take weeks or even months before you are ready to resume sexual activity.

Feelings of Guilt or Sadness

Assisted births typically go smoothly without any long-term effects on the mother or baby. Still, some new mothers have lasting feelings resulting from an assisted birth. Discuss the event with your doctor or midwife before you leave the hospital. Make sure you understand the reasons the doctor opted for an assisted birth. If problems continue after you go home, feel free to schedule visits later on. An assisted birth isn’t the result of something you did or didn’t do. It is a choice that your doctor makes to ensure the safety of you and your baby.

Complications and Risks

Any birth carries a risk of complications. A doctor makes the decision for assisted birth when the risks to the mother or baby are even greater by waiting for the birth to occur naturally. There is also a risk that the assisted birth doesn’t work and you will still require a caesarean.

You may have abrasions and bruising in the vaginal area but no more so than with a spontaneous birth. Damage can also occur to the pelvic floor and, more rarely, lead to problems with the bladder or bowels.

Potential Risks of Assisted Births on Babies

Often, mothers are more concerned about the impact assisted birth has on the baby. Sometimes the instruments leave bruises on the baby’s scalp or face. Injuries to the baby’s facial nerves are very rare and they usually heal quickly when they do occur.

Even more rarely, haematoma (the collection of blood under the skin) occurs with the use of Ventouse suction. This also resolves with time and doesn’t have a short-term or long-term effect on the baby’s brain.

Shoulder dystocia refers to a birth in which the baby’s head is born but the shoulders do not come out. When this condition occurs, the doctor must take steps to help deliver the shoulders. It is difficult to predict when the condition will occur, making it a sudden and frightening occurrence. Although shoulder dystocia can occur any time a large baby with a large body is born, it is more likely to happen during an assisted birth.

A fracture of the baby’s skull or brain haemorrhage is extremely rare. It is much more likely if the assisted birth is not successful and a caesarean is required.

Spinal cord injury is also extremely rare.

Caesarean Section

The doctor may opt not to try assisted birth if the baby’s head is deep in the birth canal. Depending on the circumstances, they may attempt the assisted birth unsuccessfully before performing surgery.

The decision to attempt an assisted birth is made at the moment of delivery. It is based on the baby’s position and whether the potential for success makes it a better choice than surgery. If the doctor determines assisted birth is too dangerous, a caesarean is the alternative.

The more support you have throughout your pregnancy and labour, the less risk there is of requiring an assisted birth. In addition to the support you receive from your midwife, you may want to have someone you trust to help you reduce the likelihood that you will need an assisted birth.