Which is better - forceps or vacuum delivery?What is an instrumental delivery?Instrumental delivery refers to the use of the Vacuum or Forceps instrument to assist the delivery of your baby. Instrumental delivery is actually an aid to facilitate natural birth. Your cervix needs to be fully dilated (10 cm) before either instrument can be used. Your doctor will decide which instrument is more suitable for you and the baby.How is a forceps delivery conducted?Your doctor will gently apply two sterile instruments (forceps blades) into your vagina around the baby’s head. The instruments look like curved spoon-shaped tongs, and are specially designed to fit comfortably around the baby’s head. As you push during each uterine contraction, your doctor will deliver the baby’s head using the forceps blades.How is a vacuum delivery conducted?Your doctor places an instrument called a vacuum extractor on the baby’s scalp. The vacuum extractor looks like a cup. A vacuum is then gently created using a pump. As you push with each uterine contraction, your doctor will gently pull so that your baby’s head is delivered using the vacuum extractor. There are many forms of vacuum extractors available but the most commonly used one is the ‘Kiwi cup’.When will I need an instrumental (forceps/vacuum) delivery?There are also a number of reasons why it may be necessary for you to have an assisted delivery (forceps/vacuum delivery) during your second stage of labour (i.e. when the cervix is fully opened).
An episiotomy may be required when the vacuum or forceps is used.When should an instrumental delivery be avoided?There are actually very few instances where an instrumental delivery should be avoided. The following is a list of clinical scenarios where a cesarean section may be a better option:
What are some of the factors to be considered just before an instrumental delivery is carried out?There are certain prerequisites that must be present before an instrumental delivery can be carried out.
What are the complications with an instrumental delivery?It has to be stressed that most of the assisted deliveries are uneventful and will be performed with you and your baby’s interests in mind. This will only be carried out if it is felt that you will be able to deliver safely through the vagina.However, some of the possible problems include:
Aftercare following instrumental deliveryIf an episiotomy was done, you will need some stitches. (read the article on Pushing and delivery: Is an episiotomy needed?).Occasionally, your doctor may insert an indwelling catheter to help “rest your bladder” for a day or two till your discomfort reduces.Frequently asked questions (FAQs)Q: Which is better? Forceps or vacuum delivery?Although these instruments may be used under similar conditions, your obstetrician will choose the instrument most appropriate to the clinical circumstance and personal preference.Q: Should I opt for a cesarean section instead?It has to be stressed that most of the assisted deliveries are uneventful and will be performed with you and your baby’s interests in mind. This will only be carried out if it is felt that you can deliver vaginally safely. A cesarean section performed under these circumstances may be riskier at a late stage of labour.Q: What will I need to do during an instrumental delivery?It is important to follow the doctor’s instructions closely during instrumental delivery. You should relax and not bear down when the instrument is inserted into your vagina and applied to the baby’s head. Similarly, you should push well when asked to do so. This is when you are experiencing a contraction. During a contraction, when you are pushing, your doctor will assist you with the forceps or vacuum to deliver the baby’s head.Sometimes, if your doctor attempts an assisted delivery and the baby cannot be delivered safely, you will need an emergency cesarean section.You would also be required to sign on the appropriate consent forms once the decision for an instrumental delivery is made.Explore more
By Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John,KK Women's and Children's HospitalSources:The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.