Forceps, Vacuums, C-Sections
Operative Vaginal Delivery: Push Comes to Pull
What it is: A procedure in which a doctor uses forceps (a tong-like steel instrument) or a vacuum (a suction cup) to gently pull the baby out by the head during a contraction. Between the two, doctors tend to opt for the technique they're most comfortable with and best matches the situation -- for example, forceps better rotate a baby or fit a preemie's head. The recent trend, though, is toward using vacuums, which are easier to maneuver and result in fewer injuries. A specially trained nurse-midwife may use a vacuum, but only doctors work with forceps.
Why it's done: "The baby isn't descending, or is having breathing difficulties and should be delivered quickly," says Dr. Hoskins, "or the mother can no longer push effectively because she's fatigued or contractions have slowed."
Slowed contractions can be an issue for many women. "My water had broken 15 hours earlier, and the doctor felt that labor was taking too long, so he went in with the vacuum," says Loya. "I'd had an epidural earlier but also got a local anesthetic; still, I was surprised by how much it hurt."
So is this type of pain par for the course? Unfortunately, yes. "You can't get the high level of anesthesia that you'd be able to for a c-section because we need you to push," says Dr. Flamm.
Possible problems: The device could injure the baby's head or face or fracture the skull, although serious injuries occur in less than 1 percent of cases, says Dr. Hoskins. Risk increases with repeated attempts, so three or four unsuccessful tugs mean a c-section. (As a safety measure, the vacuum pops off to prevent pulling too hard.) The mother's risks include vaginal tearing -- more common with forceps, which encircle the baby's head and are more likely to touch the mother (as opposed to the vacuum placed atop the baby's head).
Postnatal pointers: Do Kegel exercises to help tighten the vaginal muscles stretched by the instrument, suggests Dr. Hoskins. A specially designed donut-shaped cushion can also reduce pressure on the area when you're sitting.
C-Section: The Last Call
What it is: After topping off an existing epidural or numbing the region with a spinal block, a doctor cuts through the abdomen to reach the uterus, makes an incision, suctions out the amniotic fluid, and removes the baby. "The baby's usually out within five minutes, though sewing up can take up to an hour," says Dr. Flamm.
Why it's done: The top reason is stalled labor, but fetal stress may also call for c-section. "Sometimes a cesarean is the only option left, particularly when there has been no progress with forceps or vacuum," says Dr. Hartmann. Nurse-midwives have doctors on standby to do the surgery if needed.
Possible problems: About 5 percent of women have complications including wound infection, internal bleeding, or blood clots. Adhesions, also known as scar tissue, usually pose no problems; but repeated cesareans raise the risk that this scarring could affect nearby organs, such as the bowel and bladder, causing chronic pain, says Dr. Goldberg.
Postnatal pointers: The incision makes it difficult to lift, bend, and even breastfeed, so enlist as many helpful arms as you can, advises Dr. Flamm. Surgery also dulls reaction time, so don't drive for two weeks. Sometimes c-sections also have emotional repercussions. "Some moms feel they did something wrong because they didn't deliver vaginally, but that is not a failure," says Dr. Flamm. "Every childbirth is different, just as every baby is different."
So be sure you understand the interventions, express your opinion about options -- and accept that safety issues may trump personal preference. "I find that many mothers lack confidence in their bodies and in their ability to make good decisions," says Hanrahan. "The more informed you are, the better your birth experience will be because you'll understand everything that happened and why. After all, the ultimate goal is a healthy mom and a healthy baby."
Rachelle Vander Schaaf is a writer in Macungie, Pennsylvania.
Originally published in American Baby magazine, January 2006.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.