Instrumental Delivery

This term is used to describe a vaginal delivery that is assisted by the use of an instrument. It may also be referred to as an operative vaginal delivery. Between 5% – 20% of all births are instrumental or operative vaginal deliveries.

The instruments most commonly used are forceps or vacuum/suction devices. Many instrumental deliveries take place in a hospital delivery room but around 1 in 20 will take place in an operating theatre.  Both devices can also be used to assist a caesarean section delivery.

Forceps are metal instruments which are shaped like large spoons and cradle a baby’s head.  Vacuum or suction devices look like cups and are placed onto a baby’s head and a vacuum is created. Both devices help guide the baby through the birth canal during the contractions, while the pregnant woman continues to push.

A decision may be made with a pregnant woman for an instrumental delivery when the baby is not moving down the birth canal as expected, if the pregnant woman has a medical problem which may place her at risk of complications if she keeps pushing, or where a baby is showing signs that they are not receiving enough oxygen.

Instrumental or operative delivery does have risks which can cause harm to the baby, or the pregnant woman, although rarely serious harm is caused. However, an instrumental delivery can help expedite delivery and thereby avoid serious injury to a baby who is not receiving enough oxygen.

The risks to a pregnant woman include injury to the vagina and surrounding structures, problems with controlling passing urine and blood loss after delivery.

The risks to the baby include minor injuries to the face or scalp, bleeding (which can make them more vulnerable to jaundice), temporary weakness of the muscles of the face and, rarely, a skull fracture which can cause brain injury.

The risks need to be balanced against the risks of not delivering the baby promptly or by delivery by caesarean. The pregnant woman should be informed of any warning signs that her baby is not tolerating the stress of labour and of the risks associated with trying to expedite labour with vacuum or forceps so that she can participate in the decision-making process and provide informed consent to the plan.

An instrumental delivery is not always appropriate and should not be used in some circumstances such as:

• when a baby has not moved far enough down the birth canal;
• when a baby may be relatively too large to fit through the birth canal;
• when it is difficult to assess a baby’s position.

In these situations, attempting an instrumental delivery may cause injury or may delay the decision to proceed with a caesarean section which can in turn cause an unborn baby to be deprived of oxygen for a longer period and potentially suffer a brain injury. It is also not safe to continue to attempt to expedite delivery with an instrument after initial attempts have failed.

During labour, when it is not progressing as expected, the pregnant woman may feel that she was not fully informed of how her labour was managed by her health care team and that she was not given the opportunity to participate in the decisions made and provide informed consent, including any decisions to expedite labour with an instrumental delivery. If you experienced an instrumental delivery and your baby has suffered a brain injury, and you have concerns over how your labour was managed then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care you received and help answer your questions. We will provide you with the information and advice you need to make informed decisions about your child’s future and ensure your child’s rights are protected. Rest assured – the consultation is confidential and free of charge.