Self-Advocacy Toolkit

Instrumental Deliveries: Ventouse & Forceps

If you are labouring in a medical setting, it’s important to be aware of different interventions you may be offered by the medical staff caring for you. It is also important to understand that it is always your choice whether or not you accept these offers, even if they are phrased in a way that feels like you have to agree to them.

Instrumental or Assisted Vaginal Deliveries: Ventouse & Forceps

  • What is an “Instrumental Delivery”, and when might it be suggested?

  • Ventouse vs. Forceps

  • What are the benefits? What are the risks?

  • YES, you can say NO!

  • Alternatives to Instrumental Delivery

What is an “Instrumental” or “Assisted Vaginal Delivery”, and when might it be suggested?

When birthing in a medical setting, such as a hospital Labour Ward, there are a lot of different metrics used by medical staff such as Midwives and Obstetricians to “track” how your labour is progressing - largely designed by a man in the 1950s and since proven to be inaccurate…! (Reed, 2011) The idea behind this is, of course, to keep a watchful eye on everything that could possibly go wrong (though often this does more harm than good), to keep you and your baby safe. The issue with this is that every woman’s body is different, and therefore every woman’s labour and birth will be different. Sometimes, labour progress can appear to slow in a “labour plateau” (Wickham, 2022), which doesn’t match up with the outdated tracking techniques most hospitals use (Reed, 2017). Often, this is what is physiologically normal for that woman and her baby! However, often when medical staff become uncomfortable and want to feel “in control”, or if the birthing dyad of mother and baby need some assistance, they may offer an instrumental delivery.

This is where medical staff use either a ventouse (also known as a kiwi, vacuum extraction, or suction cup) or forceps (metal salad-tong-esque devices) to guide and pull baby by the head through the birth canal, while the mother pushes during a contraction. This can speed up the delivery of the baby.

This is, unfortunately, very unlikely to be phrased as an offer.

You’re much more likely to be told “we need to get baby out now”, or “baby needs a little help”. This is usually due to perceived problems with the baby’s condition shown through electronic monitoring of the baby’s heart rate, called “continuous foetal monitoring” (evidence shows that actually, constant monitoring of baby’s heartrate has no impact on baby’s wellness at birth; more on this here.)

In a true emergency, instrumental delivery would not be offered; the next move is a c-section. If you’re being told you need to have a ventouse or forceps delivery, you’re absolutely able to ask why, use BRAIN, or just plain say no! I recommend to all expectant parents that they think about their choices in this situation ahead of going into labour.

Ventouse

A “ventouse” may also be known as a suction cup or a “kiwi”. It is a suction cup that is placed on the crown of baby’s head through the birth canal (the woman’s vagina). This creates a vacuum, sticking it to the baby’s head, which allows the obstetrician to pull on baby while the mother is contracting, to move the baby down the birth canal quicker than they would with pushing alone.

Forceps

Forceps are rather like large metal spoons-come-salad-tongs. The obstetrician places them within the birth canal (the woman’s vagina) on either side of the baby’s head. This allows the obstetrician to pull on baby while the mother is contracting, to move the baby down the birth canal quicker than they would with pushing alone.

Benefits

Women who have had an epidural may sometimes struggle to push baby out alone due to reduced mobility and/or not being able to feel the urge to push; assisted vaginal delivery provides a solution which avoids abdominal birth.

Coping with Pain in Labour

Instruments can help to turn baby if they are in a less-than-ideal position for birth; however, it is less likely to be successful if baby is back-to-back.

Changing Baby’s Position in Pregnancy & Labour

If there are concerns for your or baby’s health, and you wish to avoid an abdominal birth, assisted delivery may help you to avoid this.

vs

Risks

For You:

  • Perineal/Vaginal Tearing

  • Episiotomy

  • Prolapse

  • Pelvic Floor Injury

  • Urinary or Faecal Incontinence

For Baby:

  • damage to the soft tissues of baby’s head

  • damage to baby’s skull

  • bruising & swelling

  • laceration (cuts)

  • jaundice

  • intracranial hematoma (bleeding inside the skull)

  • shoulder dystocia

  • seizures

  • temporary facial palsy (nerve damage in the baby’s face that leads to muscle weakness and drooping)

  • other birth injuries (rare, but they do happen) including brain damage leading to cerebral palsy

YES, you can say NO!

Sometimes, an assisted vaginal delivery is going to be right for the birthing person. Sometimes, it’s not!

Example:

You’ve thought about it ahead of time, and have planned with your birth partner that ventouse and forceps are something you’d prefer to avoid. You’ve made your birth plan, but in the moment, you’re told “baby needs a little help”, and they’re preparing the forceps. Now is the time for you and your birth partner to self-advocate using BRAIN!

The Result:

You first try moving to another position that feels right to your instincts, to help baby into a better position. If, after 45 minutes, baby still hasn’t been born, you agree with your care providers that you’d prefer an abdominal birth over an assisted vaginal delivery.

Your situation is unique to you.

Your Body, Your Baby, Your Birth.