Operative (Assisted) Vaginal Delivery

During a vaginal delivery, it may be necessary for the medical team to manually assist a mother give birth to her baby. This can be done either by way of forceps or vacuum extraction. However, if the appropriate steps are not taken to reduce the risks, a new mother could find herself with a number of complications – in particular, anal sphincter injury and faecal incontinence.

What is Operative Vaginal Delivery?

Operative vaginal delivery, sometimes known as an 'assisted birth', is when special instruments are used to help deliver a baby. This does not occur as a matter of routine, for a midwife or obstetrician will only deem an assisted birth necessary if:-

The baby needs to be delivered quickly – usually because either mother or baby are in distress;
The baby is not moving out of the birth canal;
The baby is stuck behind the mother's pubic bone;
A prolonged second stage of labour.

Used in the final stages of delivery, operative vaginal delivery is meant to replicate the natural spontaneity of birth. Thus after a woman has been given adequate pain relief and her bladder emptied, the medical team will wait until a contraction before using instruments to gently assist the baby from the vagina.

There are two instruments that may be employed during operative vaginal delivery, during which either one or both can be used:-

1. Forceps
Forceps consist of two metal tongs that are curved to fit around the baby's head. When a woman has a contraction, the obstetrician will gently pull the handle of the forceps, easing the baby out. The type of forceps used will be determined by the baby's position.

2. Vacuum Extraction (Ventouse)
A vacuum extractor or ventouse uses suction as a means of assistance. A cup (which can either be hard or soft, metal or plastic) is attached to the top of the baby's head. This cup is connected to a suction device, which once switched on will again gently pull the baby from the vagina.

Reducing the Risks of Operative Vaginal Delivery

The main risk of operative vaginal delivery is a perineal tear, which can potentially be very extensive. Indeed, operative vaginal delivery is known to be a significant factor in the number of birth-related sphincter anal injuries. This in turn will lead to faecal incontinence in up to 50% of women.

Midline episiotomy was once thought to reduce the risk of perineal trauma during birth. Thus it was common for a woman to be deliberately cut before an assisted birth was performed. However, this method has been reviewed, and it is now believed a standard episiotomy can have a detrimental affect as it can actually increase the chance of vaginal tears.

Alternatively, it is now widely accepted that instead a 'mediolateral episiotomy' should be carried out, in which the cut made diagonally rather than straight down. Research shows that this type of episiotomy reduces the chance of perineal tears during both vacuum extraction and forceps delivery, helping to protect a woman from the risks of operative vaginal delivery.

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