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Instrumental delivery (vacuum and forceps)
Forceps and vacuum are considered important tools in obstetrics, they are used as assistive tools during natural birth (in the second stage of birth) to speed up the birth process due to the presence of maternal/fetal indications.
What are the indications for using forceps/vacuum during natural childbirth?
** Reasons related to the mother’s health:
- Heart failure (stage III or IV)
- The mother’s fatigue and inability to push for a longer period during childbirth
- The mother has neurological/muscular problems that reduce her ability to push
- Some diseases that require avoiding high internal pressure in the body, such as heart disease and cerebrovascular disease
- Prolonged second stage of labor
** Reasons related to the health of the fetus:
- Weak fetal pulse during natural birth and the need to speed up the birth to expel the fetus as quickly as possible (fetal distress)
- Fetal scalp blood sampling revealing that fetal blood PH is less than 7.2
- thick meconium
Does epidural analgesia increase the rate of instrumental delivery?
Yes
How are forceps/vacuum births classified?
Classification is based on the level of the fetal head (station) in the birth canal:
- The middle of the birth canal
- At the lower portion of the birth canal
- At the outlet of the birth canal
How long does the second stage of labor usually last?
For women who have previously given birth (multipara): one hour in the absence of an epidural analgesia and two hours in the presence of epidural analgesia.
For primiparas: 2 hours if there is no epidural analgesia and 3 hours if there is epidural analgesia
What are the prerequisites for safe forceps/vacuum delivery?
- Full cervical dilatation
- Ruptured membranes
- The level of the fetus’s head must be at least at the ischial spines (zero station).
- The position of the fetus’s head must be known
- The mother’s pelvic examination shows that the birth canal is wide and adequate
- The mother’s consent to the procedure
- There must be sufficient local anesthesia/analgesia
- The mother's bladder must be completely empty
- Aseptic technique
- The doctor must have sufficient experience to use forceps/vacuum
- There should be an operating room nearby in case the delivery with forceps/vacuum fails and there is a need to perform an emergency caesarean section.
- There should be no severe swelling in the fetus’ scalp (caput) or severe overlap of the bones of its skull
What are the harms of forceps compared to suction?
Forceps cause more tears and wounds (maternal trauma) in the mother's birth canal than vacuum
What are the disadvantages of vacuum compared to forceps?
vacuum leads to more fetal trauma
Is episiotomy always needed in instrumental delivery?
This is based the doctor’s individualized assessment, but studies have shown that cutting an episiotomy when using forceps/vacuum reduces tearing of the anus (obstetric anal sphincter injury)
Should antibiotics be given when using forceps/vacuum during childbirth?
A single dose of amoxicillin is given intravenously
What is the most important aspect of postpartum care after using forceps/vacuum?
- Evaluating the patient’s need for anticoagulation
- Ensure that the bladder is not injured and that the patient empties her bladder completely and without any difficulty.
- Providing psychological care for the woman, as the use of forceps/vacuum during natural birth may negatively affect her psychology and make her afraid of natural childbirth. A detailed explanation must also be provided to both spouses after the birth about what happened and why we needed to use instrumental delivery.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
