©Pregnancy bliss 2008

Assisted delivery: Forceps and Ventouse delivery

 

The second stage of labor is when the cervix is fully dilated and the baby is ready to be delivered. Labor, by its very nature, is a dynamic process. There are various factors that influence its progress and whether a spontaneous delivery, without external assistance, will be achieved or not.

 

The pushing is done in this stage. This is the active phase of labor. If the hallmark of the first stage is the pain that characterize the contractions, pushing to get the baby out is what happens in the second stage.

 

From time to time, all those monumental efforts are just not sufficient. Sometimes, it all becomes too much, so the mother descends into full-blown maternal distress. This will normally happen after a prolonged first stage, especially if pain control was sub-optimal. She is exhausted, she is in a lot of pain and she is called upon to perform a monumental and very intensive task. It can be a tall order. Help is then offered in the form of instrumental delivery. There is a whole variety of designs of forceps. There is also the ventouse, where a suction cup is used, as we shall explain shortly. The ventouse is also known as the ‘vacuum’. The latter is more of a descriptive term based on how it works.

 

Maternal distress is not the only indication for using instruments to facilitate delivery. The indication could be fetal distress in the second stage, an unfavorable position of the head for delivery, and a few other indications.

 

There are circumstances where instruments cannot be used, where the remaining option is caesarean delivery.

 

 

 

These instruments, in the right hands, are extremely safe and complications are very uncommon and usually transient. Debate flares up from time to time among the obstetrics fraternity about which is a better instrument, the ventouse or forceps. In the UK, historically, the forceps were the most commonly used instrument. Since the mid-1980s the ventouse has made significant inroads into most labor suites and statistics towards the end of the 1990s show that it is by far the most used instrument.

 

The general reasons for the take-over are more to do with the fact that it is regarded as kinder to the mother and probably easier to use even by relatively junior obstetricians. On the issue of safety, both the ventouse and forceps are extremely safe and the argument in comparison is largely an exercise in splitting hairs. Specific issues regarding these instruments are discussed here.

Continues next page

Forceps (above) and Ventouse or vacuum delivery (below) are the principal forms of assisted vaginal delivery