Deliveries that are performed with a vacuum extractor or forceps are referred to as “operative deliveries.” They account for approximately 10-15 percent of all vaginal births. Although they used to be somewhat routine, operative deliveries today are reserved for specific clinical reasons. Some of the scenarios in which a provider may want to perform an operative delivery include:
Concern for the baby’s heart rate.
To shorten the amount of time a woman is pushing (if she has been pushing a long time or is too tired to continue).
If the mother has a medical condition where she should not push, such as certain types of heart problems.
Both a vacuum and forceps delivery use external force to help guide the baby out of the vagina, but they differ in how they achieve that goal. In a vacuum delivery, a vacuum cup is applied directly to the top of the baby’s head and suction is used to assist with delivery. During a forceps delivery, forceps are placed alongside the baby’s cheekbones and the doctor pulls (usually while the mother pushes) to assist delivery.
Different risks and benefits exist when it comes to either form of delivery. Vacuum deliveries, while usually associated with less severe vaginal tearing and maternal blood loss, are often associated with more swelling on the baby’s head (this is reversible) and can cause lacerations on the scalp, bleeding under the baby’s skin or the skull, or bleeding behind the eyes. This bleeding can then lead to jaundice in the baby or other complications. Forceps are known to cause more extensive vaginal tearing, which may lead to blood loss or issues for the mother, such as incontinence. While forceps delivery can lead to bruising on the baby’s face or any of the injuries listed with the vacuum, they may be less than when compared with the vacuum.
If your doctor suggests an operative delivery, you should be counseled about the risks, benefits, and the reason it needs to be done. The alternatives may include continuing to push unassisted or proceeding with a C-section if there is enough concern that delivery needs to happen immediately. When it comes to what type of operative delivery is offered, while it is acceptable to make a request, the most important factor is which type your physician is comfortable using. Training on forceps and vacuum varies greatly in the United States, so your doctor most likely has a device he or she feels most confident using.
If an operative delivery is not successful, your provider will then likely want to proceed with a C-section.
Reviewed by Dr. Jen Lincoln, November 2018
- American College of Obstetricians/Gynecologists Practice Bulletin #17
- Operative Vaginal Delivery.
O’Mahony F, Hofmeyr GJ, Menon V
- Choice of instruments for assisted vaginal delivery
- Cochrane Database of Systematic Reviews 2010, Issue 11
- No.: CD005455
- DOI: 10.1002/14651858.CD005455.pub2.
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