An assisted birth (also known as an instrumental delivery) is when forceps or a ventouse suction cup are used to help deliver the baby.

Ventouse and forceps are safe and only used when necessary for you and your baby. Assisted delivery is less common in women who've had a spontaneous vaginal birth before.

Your obstetrician or midwife should discuss with you the reasons for having an assisted birth, the choice of instrument and how it will be carried out. Your consent will be needed before the procedure can be carried out.

Find out more about consent to treatment.

You'll usually have a local anaesthetic to numb your vagina and the skin between your vagina and anus (perineum) if you have not already had an epidural.

If your obstetrician has any concerns, you may be moved to an operating theatre so a caesarean section can be carried out if needed.

It is likely a cut (episiotomy) will be needed to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Depending on the circumstances, your baby can be delivered and placed on your tummy, and your birth partner may still be able to cut the cord if they want to.

Ventouse

A ventouse (vacuum cup) is attached to the baby's head by suction. A soft or hard plastic or metal cup is attached by a tube to a suction device. The cup fits firmly on to your baby's head.

During a contraction and with the help of your pushing, the obstetrician or midwife gently pulls to help deliver your baby.

If you need an assisted birth and you are giving birth at less than 36 weeks pregnant, then forceps may be recommended over ventouse. This is because forceps are less likely to cause damage to your baby's head, which is softer at this point in your pregnancy.

Forceps

Forceps are smooth metal instruments that look like large spoons or tongs. They're curved to fit around the baby's head. The forceps are carefully positioned around your baby's head and joined together at the handles.

With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.

There are different types of forceps. Some are specifically designed to turn the baby to the right position to be born, such as if your baby is lying facing upwards (occipito-posterior position) or to one side (occipito-lateral position).

An assisted delivery is used in about 1 in 8 births, and may be needed if:

• you have been advised not to try to push out your baby because of an underlying health condition (such as having very high blood pressure)
• there are concerns about your baby's heart rate
• your baby is in an awkward position
• your baby is getting tired and there are concerns that they may be in distress
• you're having a vaginal delivery of a premature baby – forceps can help protect your baby's head from your perineum
• you require an epidural for pain relief during labour

A children's doctor (paediatrician) is usually present to check your baby's condition after the birth. After the birth you may be given antibiotics through a drip to reduce your risk of getting an infection.

Ventouse and forceps are safe ways to deliver a baby, but there are some risks that should be discussed with you.

Vaginal tearing or episiotomy

This will be repaired with dissolvable stitches.

3rd or 4th degree vaginal tear

There's a higher chance of having a vaginal tear that involves the muscle or wall of the anus or rectum, known as a 3rd- or 4th-degree tear.

This kind of tear affects an estimated:

• 3 in every 100 women having a vaginal birth
• 4 in every 100 women having a ventouse delivery
• 8 to 12 in every 100 women having a forceps delivery

Higher risk of blood clots

After an assisted birth, there's a higher chance of blood clots forming in the veins in your legs or pelvis. You can help prevent this by moving around as much as you can after the birth.

You may also be advised to wear special anti-clot stockings and have injections of heparin, which makes the blood less likely to clot.

Urinary incontinence

Urinary incontinence (leaking pee) is not unusual after childbirth. It's more common after a ventouse or forceps delivery. You should be offered physiotherapy to help prevent this happening, including advice on pelvic floor exercises.

Anal incontinence

Anal incontinence (involuntary farting or leaking poo) can happen after birth, particularly if there's been a 3rd or 4th degree tear. Because there's a higher risk of these tears happening with an assisted delivery, anal incontinence is more likely.

The risks to your baby include: 

• a mark on your baby's head (chignon) being made by the ventouse cup – this usually disappears within 48 hours
• a bruise on your baby's head (cephalohaematoma) – this can happen during a ventouse assisted delivery, but the bruise is usually nothing to worry about and should disappear with time
• marks from forceps on your baby's face – these usually disappear within 48 hours
• small cuts on your baby's face or scalp – these affect 1 in 10 babies born using assisted delivery and heal quickly
• yellowing of your baby's skin and eyes – this is known as jaundice, and should pass in a few days

You'll sometimes need a small tube that drains your bladder (a catheter) for up to 24 hours.

You're more likely to need this if you've had an epidural as you may not have fully regained sensation in your bladder and therefore do not know when it's full. 

The Royal College of Obstretricians and Gynaecologists (RCOG) has further information about assisted delivery.

Find out more about what happens in labour and pain relief in labour.