Instrumental Delivery (Vacuum and Forceps): What Expecting Mothers Should Know

In short: Forceps or a vacuum cup are used to complete a vaginal birth when the mother is exhausted, the second stage is prolonged or the baby’s heartbeat weakens. A normal second stage lasts up to two hours in a first birth (3 hours with an epidural) and one hour in later births (2 hours with an epidural). The cervix must be fully open and the baby’s head low. Forceps cause more tears in the mother; the vacuum causes more injuries to the baby’s scalp.

Forceps and vacuum devices are important, well-established tools in obstetrics. They are used to gently assist natural birth during the second stage of labor, helping speed up delivery when there is a medical reason to do so for the wellbeing of the mother or baby.

When might your doctor recommend forceps or vacuum during natural childbirth?

• Reasons related to the mother’s health:
• Heart failure (stage III or IV)
• The mother’s fatigue and inability to push for a longer period during childbirth
• The mother has neurological/muscular problems that reduce her ability to push
• Some diseases that require avoiding high internal pressure in the body, such as heart disease and cerebrovascular disease
• Prolonged second stage of labor
• Reasons related to the health of the fetus:
• Weak fetal pulse during natural birth and the need to speed up the birth to expel the fetus as quickly as possible (fetal distress)
• Fetal scalp blood sampling revealing that fetal blood PH is less than 7.2
• thick meconium together with an abnormal fetal heart-rate pattern (suspected fetal compromise)

Does epidural analgesia increase the rate of instrumental delivery?

Yes

How are forceps/vacuum births classified?

Classification is based on the level of the fetal head (station) in the birth canal:

• The middle of the birth canal
• At the lower portion of the birth canal
• At the outlet of the birth canal

How long does the second stage of labor usually last?

For women who have previously given birth (multipara): birth is usually expected within about 2 hours of active pushing, and it may be a little longer with an epidural as long as the mother and baby are well and progress continues.

For primiparas: birth is usually expected within about 3 hours of active pushing, and it may be longer with an epidural as long as the mother and baby are well and progress continues.

What are the prerequisites for safe forceps/vacuum delivery?

• Full cervical dilatation
• Ruptured membranes
• The level of the fetus’s head must be at least at the ischial spines (zero station).
• The position of the fetus’s head must be known
• The mother’s pelvic examination shows that the birth canal is wide and adequate
• The mother’s consent to the procedure
• There must be sufficient local anesthesia/analgesia
• The mother’s bladder must be completely empty
• Aseptic technique
• The doctor must have sufficient experience to use forceps/vacuum
• There should be an operating room nearby in case the delivery with forceps/vacuum fails and there is a need to perform an emergency caesarean section.
• There should be no severe swelling in the fetus’ scalp (caput) or severe overlap of the bones of its skull

What are the harms of forceps compared to suction?

Forceps cause more tears and wounds (maternal trauma) in the mother’s birth canal than vacuum

What are the disadvantages of vacuum compared to forceps?

Vacuum leads to more fetal trauma

Is episiotomy always needed in instrumental delivery?

This is based on the doctor’s individualized assessment, but studies have shown that cutting an episiotomy when using forceps/vacuum reduces tearing of the anus (obstetric anal sphincter injury)

Should antibiotics be given when using forceps/vacuum during childbirth?

A single preventive dose of intravenous amoxicillin–clavulanic acid (co-amoxiclav) is recommended after the birth, as it has been shown to halve the risk of infection (an alternative is used if you are allergic to penicillin).

What is the most important aspect of postpartum care after using forceps/vacuum?

• Evaluating the patient’s need for anticoagulation
• Ensure that the bladder is not injured and that the patient empties her bladder completely and without any difficulty.
• Providing psychological care for the woman, as the use of forceps/vacuum during natural birth may negatively affect her psychology and make her afraid of natural childbirth. A detailed explanation must also be provided to both spouses after the birth about what happened and why we needed to use instrumental delivery.

If you have questions about your delivery options or want to discuss your birth plan, Dr. Najeeb Layyous and his team are here to guide you with clear, compassionate care.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist