Birth with forceps or Ventouse assistance
Birth with forceps or ventouse
If your baby needs help to be born your team may offer you an assisted birth. An assisted vaginal birth is when a healthcare professional uses specially designed instruments to help you give birth to your baby. This information is for you if you wish to know more about assisted vaginal birth (also known as operative vaginal birth, assisted delivery, birth with forceps/ventouse or instrumental birth).
There can be many reasons for needing help with the birth of your baby. The main ones are:
- there are concerns about your baby’s wellbeing during your labour and birth
- your labour is not progressing as would usually be expected
- you are unable to, or have been advised not to, push during birth
- your baby is in a position that makes birth tricky
The idea of an assisted birth, sometimes known as an instrumental delivery, can be daunting, and your doctor will only offer it to you if they think it is needed
1 in 8 (10-15%) people will have an assisted vaginal birth. This rises to 1 in 3 for people having their first baby. You are less likely to need one if you have had a vaginal birth before.
Your doctor will check you over to make sure an assisted birth is best for you and your baby. With consent, this will include a vaginal examination.
If you have had an epidural, an anesthetist may check it is still working. If you have not had one, you should be offered a local anaesthetic to numb your vagina and the skin between there and your anus (the perineum). Or if trialling instrumental birth in theatre, your doctor may advise you to have an epidural or spinal block to help with pain.
If your healthcare professional expects your assisted vaginal birth to be straightforward, they will recommend that you give birth in the same room where you have been in labour. If they think that the assisted vaginal birth may be more complicated or that there is a chance that it might not work, you will be advised to give birth in theatre. This is so that you can have an immediate caesarean if necessary.
To reduce the chances of your anal sphincter (muscle that helps to control your poo) from tearing, your care provider may offer to give you an episiotomy (a cut between your vaginal opening and your anus)
There is no guaranteed way to avoid an assisted birth, but there are some things that may make having one less likely:
- having someone to support you during labour, especially someone you know (a birth partner) as well as a midwife or doctor
- having an uncomplicated pregnancy and giving birth in a midwife-led unit rather than a labour ward/delivery suite.
- not having an epidural (If you do choose an epidural change position and remain as mobile as possible throughout labour)
- not pushing too soon after your cervix is fully open. Your doctor or midwife will be able to give you advice about this
- staying in upright positions during labour or lying on your side after your cervix is fully open
Forceps and ventouse will only be recommended if they are thought to be the safest way to help you give birth. The reasons for recommending an assisted vaginal birth, the choice of instrument, and the procedure will be discussed with you at the time. If you are in labour and choose not to have an assisted vaginal birth, the alternatives are to wait for your baby to be born without assistance or to have an emergency caesarean. Your healthcare professional will discuss your options depending on your individual circumstances.
A caesarean in the late stage of labour is a more complex operation than a planned caesarean and, in some circumstances, may increase the risk of harm to both you and your baby.
Decision making in labour can be difficult which is why it is important to explore any concerns you may have with your healthcare professional before you go into labour.
If you are certain you would not want an assisted vaginal birth, one option is to choose a planned caesarean birth before you go into labour. If you are considering a planned caesarean, you should discuss this with your healthcare professional during your pregnancy. For more information, refer to the
Yes, your doctor will ask for the go ahead from you. They will also explain:
- Why they think you need an assisted birth
- The instrument they wany to use and why
- Any potential risk to you and your baby
After your baby is born, you should also have a chance to talk to your doctor or midwife about how the birth went, and why you needed help.
With your consent, your healthcare professional will examine your abdomen and perform an internal vaginal examination to confirm that an assisted vaginal birth is safe for you and your baby. You will usually be asked to sit with your legs supported and your bladder will be emptied by passing a small tube (catheter) into it.
Pain relief for the birth may be either a local anaesthetic injection inside the vagina or a regional anaesthetic injection into your back (an epidural or a spinal). For more information about pain relief see the website .
You are more likely to need a cut (episiotomy) to enlarge your vaginal opening and allow your baby to be born. A healthcare professional who specialises in the care of newborn babies may be there when you give birth in case your baby needs some extra help after birth. If your baby is well, you may choose to have an immediate skin to skin contact and/or delayed cord clamping. After your baby is born you may be offered antibiotics through a drip if this is required to reduce your risk of infection. Your doctor or midwife will discuss this with you.
A metal or plastic ventouse vacuum cup will be attached to your baby’s head using suction. The doctor will wait until you are having a contraction. Then, they will ask you to push while they guide your baby gently, to help with the birth. You may need to do this over a few contractions.
Forceps are smooth metal instruments that look like large spoons or tongs. They are curved to fit around your babies head. Some types of forceps can help turn your baby if they are in an awkward position.
The doctor will put the forceps around your babies head, wait until you have a contraction and get you to push while they gently guide. You may need to do this over a few contractions before your baby is born.
Ventouse and forceps are both safe and effective. Choice of instrument depends on factors including how well your epidural is working (if you have had one), the wellbeing of your baby and the position of your baby’s head. If you need an assisted vaginal birth at less than 36 weeks of pregnancy, forceps may be preferred over ventouse. This is because they involve less risk of injury to your baby’s head which is softer at this stage of pregnancy.
Your healthcare professional will recommend the method most suitable for your individual situation. If you have any concerns around the use of ventouse or forceps you should discuss this with your healthcare professional at any time during your pregnancy or labour.
If one instrument has been chosen and is not effective, your healthcare professional may then either recommend using the other instrument to help you have a vaginal birth or offer a caesarean, depending on your individual circumstances. If neither instrument is effective in helping you give birth, your healthcare professional may recommend an emergency caesarean birth.
Assisted births do not always work, if they are unsure is an assisted birth will work this will be discussed with you. If your healthcare team has tried an instrumental birth and they do not think your baby can be born safely in that way, they will suggest you have a caesarean birth.
Assisted birth is less likely to work if:
- your body mass index (BMI) is over 30 by the time you go into labour
- you are less than 161cm in height
- your baby is large, or predicted to be more than 4kg
- your baby is lying with their back to your back
- your baby’s head is not low down in the Vagina/birth canal.
You may need to stay in hospital for longer than originally expected after the birth of your baby.
- Placenta / Third stage of labour
It is advised to have an injection to help ‘active management’ for the birth of your placenta due to an increased risk or bleeding after an assisted vaginal birth.
- Bleeding
It is normal to have vaginal bleeding after you have given birth. Straight after an assisted vaginal birth, heavier bleeding is more common. The bleeding in the days afterwards should be similar to an unassisted vaginal birth.
- Vaginal tears/ episiotomy
Birth with ventouse and with forceps does mean a higher chance of needing to have an episiotomy or having a vaginal tear. If you have either a vaginal tear or an episiotomy, this will be repaired straight after birth with dissolvable stitches.
A third- or fourth-degree tear (a tear which involves the muscle and/or the wall of the anus or rectum) affects 3 in 100 women (3%) who have a vaginal birth. It is more common following a ventouse birth, affecting up to 4 in 100 women (4%) and following a forceps birth, affecting between 8 and 12 women in every 100 (8–12%).
- Pain relief
Most women have some discomfort or pain after they have given birth. You will be offered regular pain relief after an assisted vaginal birth. You may also be offered a rectal pessary for pain relief following you assisted birth to help with the immediate pain.
- Bladder care
If you have had an assisted vaginal birth, you are more likely to have difficulty passing urine after birth (Common for up to 6 weeks). If you have had an epidural, you may not be able to feel your bladder getting full and may need a catheter to help empty your bladder for a few hours until your epidural wears off. It is important that you empty your bladder completely after birth to reduce the risk of longer-term problems with passing urine. Your healthcare professional may ask you to pass urine in a jug so they can measure the amount. If they think that you haven’t been able to fully empty your bladder, they may use either an ultrasound or a catheter to check. Leaking urine is common in late pregnancy and after birth. Physiotherapy may help to treat symptoms of urinary incontinence. If you have any concerns, you should discuss these with your healthcare professional who can refer you to further support. Please also see Pelvic Health - Maternity or
- Blood clots
Pregnancy increases the chance of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis). This risk is higher after an assisted birth especially if your baby was higher up in your pelvis at the time of the assisted birth.
It can help if you are able to stay mobile after you give birth. You may also be advised to wear special stockings and to have daily injections of heparin, which makes your blood less likely to clot.
You will only be offered an assisted birth if it is the safest option for you and your baby. Serious trauma or injury to babies during this procedure is rare. However, there are a few minor risks involved.
Ventouse can:
- leave a mark on your baby’s head, which should disappear after a day or two
- cause a bruise on your baby’s head, called a cephalohematoma, which occurs in up to 1 in 8 babies, is usually harmless and should fade with time.
Forceps can:
- leave marks on your baby’s face, which should go within a couple of days
- leave small cuts on your baby’s face or scalp, which should heal quickly.
Other problems include:
- slightly higher risk of jaundice, which is when your baby's skin and eyes look yellow
- bleeding in the brain, which affects less than 1 in 700 babies.
Yes. Before you go home from hospital, you should be given the chance to talk about the birth of your baby with one of your healthcare professionals, ideally someone who was there when your baby was born. They will be able to answer any questions you may have.
Most women recover well after their assisted vaginal birth. After any birth, including an assisted vaginal birth, you may have some pain. The stitches and swelling may make it painful when you go to the toilet to pass urine or open your bowels. It is important to keep your wound area clean to avoid any complications or infections. Cleanse front to back, pat dry with a towel and change your pad regularly.
Regular pain relief will help and starting pelvic floor exercises when you are able will aid in healing. You can begin to have sex again when you feel that it’s the right time for you. The experience of birth can sometimes be distressing and for some women there is a risk of post-traumatic stress disorder (PTSD). Following an assisted vaginal birth, if you or your partner feel you are developing anxiety, have low mood or feel that you need additional support, you should talk to your healthcare professional. Alternatively please see here for more information including how to refer for services: Perinatal mental health :: Avon and Wiltshire Mental Health Partnership NHS Trust
Emotional & Mental Wellbeing - Maternity
Having an assisted vaginal birth does not mean you will need one in your next pregnancy. Most women (up to 9 in 10) who have an assisted vaginal birth have a vaginal birth next time round without needing assistance.
BRAIN /Making decisions about your care