# Forceps or Vacuum-Assisted Delivery

Source: https://www.pregnancypowerhour.com/birth/forceps-vacuum
Last updated: 2026-07-15

> Instrumental delivery, using forceps or a vacuum, is an intervention sometimes used during the second stage of labor to assist birth when delivery needs to happen promptly.

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](/birth/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](/birth/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.

## When it's recommended

Your care provider might recommend an instrumental delivery if your labor is progressing slowly in the second stage, if there are concerns about your baby's well-being (fetal distress), or if you are experiencing significant exhaustion and are unable to push effectively. These situations mean that a timely birth is in the best interest of both you and your baby. This conversation typically happens in the moment, as the need arises, emphasizing the importance of understanding your options beforehand.

## Brittany's doula perspective

As a doula, my focus is always on supporting your autonomy and helping you make informed decisions, especially when unexpected turns arise during labor. When instrumental delivery becomes a consideration, it's a moment to pause and engage in a clear conversation with your care team. Even in a situation that feels urgent, you get to ask questions and understand the 'why' behind the recommendation. This is about working collaboratively with your provider to ensure the safest and most positive outcome for you and your baby. While a swift decision might be necessary, knowing what to ask can bring a sense of clarity and confidence. Preparing for birth, perhaps through exploring resources on [Early Labor](/birth/early-labor), can help you feel more grounded even if your birth plan shifts. Remember, every birth is unique, and sometimes interventions are a necessary part of a safe and supported birth experience. This doesn't diminish your efforts or your capacity. It's simply one option to help bring your baby earthside when extra support is beneficial. For parents hoping for an [Unmedicated Birth](/birth/unmedicated-birth), the introduction of an instrumental delivery can feel like a significant shift, and processing those feelings is a valid part of the experience.