Despite the scary look of forceps and vacuum extractors, these instruments -- which are used to assist vaginal deliveries about 10-15 percent of the time -- pose no greater risk to your health or your baby's well-being than a cesarean delivery. Some births go much more smoothly because these instruments help things along. Talk to your provider about circumstances where she might use these instruments, and have her explain them in detail now so that you won't feel nervous if she needs one of these tools during your delivery.
Reasons for use. Typically, forceps or vacuum extraction is used if there is a prolonged second stage of labor -- perhaps 2-3 hours of pushing with little progress due to maternal exhaustion. These tools might also be required if the baby is about to come out but her heart rate drops and she needs to make a quick exit. Neither instrument is used unless your cervix is fully dilated with the baby's head positioned no more than 2 inches above your vaginal opening.
Choosing the instrument.
Whether your practitioner chooses forceps or vacuum extraction will probably depend on her training. Both have been around a long time. Forceps have been used in assisted births since the 16th century. They resemble a large pair of curved salad tongs. The most primitive form of vacuum extractor -- a device that even today looks like a plunger -- was first used in 1705. Now that the instruments have soft, synthetic rubber cups instead of the metal cups originally used, vacuum extractors have become increasingly popular in the United States.
If your practitioner opts to use forceps, you will be anesthetized around the perineal area and have your bladder emptied with a catheter. Each side of the forceps must slide into your birth canal around the baby's head. Forceps can help remove the baby; they are also used to rotate the baby's head to a better position for delivery. You may need an episiotomy to make more room.
If your practitioner opts for a vacuum extraction, you may also get perineal anesthesia and have your bladder emptied. Then the cup is placed on the crown of the baby's head. Pressure is generated by your provider using a handheld pump or by a nurse pumping from an external source. Traction is applied only during contractions, and you will be encouraged to continue bearing down as much as possible. Vacuum extraction is usually abandoned if the suction cup slips off more than 3 time, or if the procedure lasts more than 20 minutes. In that case, your provider will perform a cesarean delivery. You are less likely to need an episiotomy with the vacuum because the cup does not take up space in the vagina.
Originally published in You & Your Baby: Pregnancy.
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