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| |    Forceps & Vacuum-Assisted Birth by Elisa Ross, MD reviewed by Marjorie Greenfield, M.D. When are forceps or vacuum extractors needed? Occasionally, help is needed in order to complete a vaginal delivery. Your doctor may need to pull gently on the baby's head while you push. The use of vacuum or forceps to assist in delivery is referred to as assisted or operative vaginal delivery. While this type of delivery is not an option if a women's cervix is not fully dilated, assisted vaginal delivery is helpful when a baby has free access to the birth canal but is not progressing down the birth canal as expected. In some cases, a baby needs to be delivered more quickly than a mother could reasonably be expected to push it out. Usually this is because the baby has a slow heart beat. Another common reason for operative vaginal delivery is when the mother has been pushing for a long time and is getting exhausted. If a little extra power will make the difference, assisted vaginal delivery is an option. In cases where the cervix is not adequately dilated, a cesarean section is usually needed. How are forceps and a vacuum extractor used? Forceps are smooth metal instruments, shaped like long, narrow spoons, which are carefully applied to the sides of the baby's head. As the mother bears down, the doctor will guide the baby's head. When the head is visible, the forceps are slipped off, one at a time, and the mother is usually encouraged to complete the delivery on her own. A vacuum extractor is used for the same purpose. In this case a plastic cup is placed on the baby's head and attached to a suction device. Again, the baby moves down the birth canal using both sources of power, the mother's pushing and the pulling of the vacuum. When forceps or vacuum delivery is questionable There may be something about the situation, say, the position of the baby's head or the shape of the mother's pelvic bones, which makes the practitioner doubt the success of an intervention. In this case, it may not be offered, or offered only on a conditional basis. Usually, if three pulls of the vacuum, or a similar number of pulls of the forceps, do not result in the baby moving down the birth canal, the attempt at assisted vaginal delivery is stopped and cesarean birth is recommended. Individual situations may be treated differently. Should I choose vacuum or forceps? Each practitioner has a feeling about which instrument will help in each particular situation. If you have a strong preference, bring this up with your practitoner during your office visits. Each method has slightly different advantages, disadvantages and risks. Both have been shown, in scientific studies, to be safe and effective when properly used. There may be temporary red marks on the baby's cheeks from the forceps, or a bruise on the top of the head if vacuum is used. These usually go away in a few days. Both methods increase the chance that the mother's vagina may tear, or that episiotomy may be needed. However, many prefer this possibility to the certainty of a surgical incision from a cesarean.
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