Many women worry about an assisted delivery. Is it harmful? When is it useful?

Tanuja is excited but a little edgy. She is in the last weeks of her pregnancy. She has just read an article in the paper that says that assisted delivery rates are on the rise. The article has left her confused. What are assisted deliveries? Are they to be avoided? If she has one, will it harm her baby? Are caesarean sections a better option?

What is an assisted delivery?

Assisted deliveries, also known as instrumental deliveries, are done to cut short the labour process and help ease the baby out. When done properly and at the right time, they reduce the need for a caesarean section.

The obstetrician may use a forceps or vacuum cup to help the mother deliver the baby. These instruments are attached to the baby's head so that it can be gently eased out with the least trauma to the mother and baby. Instrumental delivery might be required when

the woman is having a difficult time pushing the baby out through her birth canal

the woman may have become too tired and exhausted to continue pushing

the woman has had an epidural and may not have the urge to push

the woman should not push too long because of a medical condition (e.g. heart disease)

the baby may need to be delivered quickly because it is showing signs of being in distress

the second twin might require assistance in delivery

What are forceps?

Forceps are stainless steel instruments that are placed gently on either side of the baby's head and are used to cradle the head. Holding the baby with the instrument, the obstetrician will apply traction and lift the baby out of the birth canal.

What is a vacuum-assisted birth?

The vacuum cup is attached by a flexible rubber tube to a small vacuum pump. The cup, which fits on top of the baby's head, may be made of metal or silicone plastic. The soft cups are less likely to cause damage to your baby's head, and are more commonly used nowadays. The obstetrician applies gentle traction on the tube attached to the cup, and lifts the baby out of the birth canal.

After your baby is born

Even after a normal vaginal delivery, the baby's head may be a little elongated and conical. This happens because the baby has to mould itself to the shape of the birth canal. In babies born with the help of a forceps or a vacuum extractor, the head may be a little more conical or there may be a prominent bulge where the vacuum cup was applied. This will usually subside in a few days.

Are instrumental deliveries harmful to the baby?

Some women are worried that a forceps delivery or a vacuum extraction can harm the baby. This is not true. When a child is born with cerebral palsy or mental retardation, the parents are sometimes quick to blame the use of instruments. In reality, instrumental deliveries cannot result in a baby being born with mental retardation or cerebral palsy.

Medical literature has clearly shown the opposite. Studies from even 25 years ago have compared intelligence levels of children born with or without forceps. They have shown that delivery by forceps did not result in neurological disability or cerebral palsy. Another study actually showed that children born by forceps had higher intelligence scores than those delivered spontaneously or by caesarean section! Yet another study has also shown no relationship to the development of epilepsy in the child. Sometimes a baby may have a mark on the face due to the application of the forceps. This will usually disappear in a few days. A properly done instrumental delivery will not harm the baby.

Should caesareans be done instead of forceps delivery?

A competent obstetrician will know when to apply a forceps and will decide on a caesarean when it looks like that forceps delivery might be difficult. In fact, using a forceps or vacuum cup will decrease the rate of caesarean sections. It is a misconception that caesarean deliveries will guarantee safety for mother and child. Caesareans do not guarantee that the baby will be normal or healthy. Caesareans are major surgeries with their own problems and should be resorted to only when absolutely necessary.