Instrumental delivery, also known as operative vaginal delivery, involves the use of specialized tools—either forceps or a vacuum extractor—to gently guide your baby through the birth canal during the second stage of labor. This option is considered when a prompt delivery is needed, often as an alternative to a Cesarean Birth in specific circumstances.
What it is
Instrumental delivery refers to the use of either forceps or a vacuum extractor to assist in the birth of your baby. Forceps are a pair of smooth, tong-like instruments that are carefully placed around the baby's head to provide gentle traction and rotation. A vacuum extractor involves a soft cup attached to the baby's head with suction, also used to assist with descent and rotation. Both methods aim to help your baby navigate the final stages of the birth process when additional assistance is needed.
What the evidence says
Evidence suggests that forceps and vacuum extraction are used for approximately 3% of births in the United States. The most common reasons for considering this intervention include a prolonged second stage of labor, signs of fetal distress, or significant maternal exhaustion. It's important to understand that instrumental delivery is often considered when a vaginal birth is still possible but requires a little extra help, providing an alternative to a Cesarean Birth during the second stage. Research indicates that while both methods are generally safe, there are some associated risks. Perineal trauma can be higher with forceps, and there's a slightly increased chance of shoulder dystocia or neonatal hematoma/abrasion with vacuum extraction. The skill and experience of your care provider are significant factors in the safe and effective use of these instruments. In the US, vacuum extraction (often with a kiwi cup) is more commonly used than forceps, though forceps are still frequently used in the UK and Europe. It's also worth noting that an epidural is typically required for forceps delivery to ensure comfort, while a vacuum extraction can sometimes be performed without one.
