Forceps and vacuum delivery: why it's offered, what happens and how you recover

Forceps and vacuum delivery, also called assisted or instrumental delivery, is when your doctor uses forceps or a suction cup to help your baby out as you push. KKH says it happens in about 10% of all deliveries. It's offered near the end of labour, when helping your baby out is the safest option. KKH stresses that most assisted births are uneventful, and a few things you do in labour may lower your chance of needing one.

How to prepare for an assisted birth, step by step

1. Ask your doctor at your antenatal visits when they'd use forceps or a vacuum. KKH says the safest way for you to deliver is discussed then, so add your questions to your birth plan.
2. Bring a birth partner who'll stay with you. The RCOG, the UK's college of obstetricians, says support all through labour makes an assisted birth less likely.
3. Stay upright or lie on your side once your cervix is fully open. The RCOG says this can cut the need for help, and our labour positions guide shows what works on a drip or an epidural.
4. Let your baby move down before you push, if your team agrees. SGH says this passive phase usually lasts one to two hours and may lower the rate of instrument births.
5. Ask why, which instrument, and what happens if it doesn't work. A Families for Life guide by KKH doctors says you'll sign a consent form once the decision is made.
6. Relax while the instrument goes in, then push with each contraction. The same guide says the better you push, the less the doctor has to pull.
7. Ask to talk the birth through before you go home. The RCOG says you should get that chance, ideally with someone who was there.
8. Care for your stitches and bladder, then start on your pelvic floor. Our guides to episiotomy and tears and pelvic floor recovery take it from there.

Why your doctor may suggest forceps or a vacuum

KKH lists four main reasons. Your baby's well-being is a concern. You're too tired to push after a long labour or long pushing. Your baby's head isn't in the best position, for example facing your tummy instead of your back. Or you've been told not to push, such as with a serious heart condition.

SGH adds a long second stage, when you've been pushing for more than an hour. Our guide on how to push during labour explains how that stage usually goes. If you're deciding on pain relief, our epidural guide covers how an epidural affects pushing.

Your cervix has to be fully open, at 10 cm, before either instrument is used, the KKH doctors' guide says. Your doctor picks the instrument, and the RCOG says the choice depends on your baby's position, how your baby is coping and how well your epidural is working.

What happens during a forceps or vacuum delivery

First, the doctor examines you inside to find the exact position of your baby's head. A thin tube called a catheter drains your bladder. The KKH doctors' guide says you may also get a local anaesthetic in the area between your vagina and anus. You may need an episiotomy, a small cut that widens the opening.

With forceps, the doctor fits two blades around your baby's head. With a vacuum, a round plastic cup is held on your baby's head by suction. The doctor then pulls gently as you push with each contraction. The RCOG says this can take several contractions, and a vacuum cup can come off with a pop and be put back on.

The RCOG says a newborn specialist may be in the room in case your baby needs help. If the first instrument doesn't work, KKH says your doctor will decide between the other instrument and a caesarean. Once your baby is out, KKH places them on your chest for skin-to-skin, and you get a hot drink and biscuits. Our guide to the delivery room covers the rest of that first hour.

Forceps vs vacuum: how they compare

The RCOG says both are safe and effective. The differences show up in the marks they leave and the tears they cause.

A deep tear here means a third- or fourth-degree tear, which reaches the muscles of the anus or rectum. The RCOG puts it at 3 in 100 women across all vaginal births.

What it means for your baby

The RCOG says most babies born this way are well, with no long-term problems. The marks in the table fade on their own. A vacuum cup can also leave a bruise under the scalp called a cephalohaematoma. The RCOG says it affects 1 to 12 in 100 babies and goes with time. The RCOG adds that small cuts on the face or scalp happen in about 1 in 10 assisted births and heal quickly.

Jaundice, a yellow tinge to the skin and eyes, affects 5 to 15 in 100 babies after an assisted birth, the RCOG says. Our newborn jaundice guide covers what to watch for at home. For a cone-shaped or uneven head, see our newborn head shape guide.

KKH names the uncommon, serious problems plainly: a skull fracture, bleeding into the brain in five to 15 in 10,000 babies, and injuries to nerves or other organs. SGH lists damage to the facial nerves among them. KKH adds that shoulder dystocia can happen, where a shoulder gets stuck above your pubic bone after the head is out.

Your recovery and your next birth

KKH says an assisted birth raises your risk of a third- or fourth-degree tear, trouble passing urine and infection, and SGH lists bleeding after the birth too. The RCOG says heavier bleeding is more common straight after. In the days that follow, it should be similar to any vaginal birth.

Occasionally, the KKH doctors' guide says, a catheter stays in for a day or two to rest your bladder. The RCOG says to empty your bladder fully after the birth, so tell your nurse if you can't. Get up and move as much as you can, since the RCOG says an assisted birth raises the risk of blood clots. KKH says a perineal tear usually heals in two to three weeks. Our peri bottle and sitz bath guide covers soothing sore stitches.

Leaking urine is more likely after an assisted birth. SGH's Postnatal Assessment Service sees the women most at risk, including those who needed help at delivery, especially with forceps. Ask your gynae about pelvic floor physiotherapy at your follow-up.

The birth may stay on your mind for a while. The RCOG says to talk to your healthcare team if you feel anxious, low or in need of support. Our postnatal depression guide lists where to get help in Singapore.

One assisted birth doesn't mean another. The RCOG says up to 9 in 10 women have a vaginal birth next time without help. If you're sure you don't want forceps or a vacuum, the RCOG says a planned caesarean before labour is one option to discuss in pregnancy. Our C-section vs normal delivery guide weighs the two.

When to see a doctor

• Pus-like or foul-smelling discharge from your vagina, KKH says.
• Bleeding from your stitches, or perineal pain that's severe or getting worse (KKH).
• Bleeding that suddenly turns heavy after it had been easing (KKH).
• You can't pass urine or can't empty your bladder. KKH lists trouble passing urine as a known risk after an assisted birth.
• Leaking urine that isn't improving. SGH's Postnatal Assessment Service sees women after assisted births.
• Anxiety, low mood or a feeling that you need support, which the RCOG says to raise with your healthcare team.
• Your baby's skin or eyes look yellow. The RCOG lists jaundice among the less common effects.

Before you leave hospital, KKH gives you a postnatal follow-up appointment at its Women's Specialist Clinic, a GP or a polyclinic. KKH says your postnatal review may be around six weeks after delivery.

For urgent problems after the birth, KKH's Urgent O&G Centre is a 24-hour walk-in centre at Basement 1 of Women's Tower, and it sees post-pregnancy conditions. KKH says to go there or to your nearest emergency department for heavy vaginal bleeding or significant abdominal pain. If you delivered elsewhere, call that hospital or your gynae's clinic. In an emergency, call 995, SCDF's emergency line. Our postnatal recovery guide has the full list of warning signs.

Frequently asked questions

How common is assisted delivery in Singapore?

KKH says an assisted vaginal delivery happens in about 10% of all deliveries. It adds that up to 30% of women in labour need either an emergency caesarean or an assisted delivery. The RCOG says it's much less common if you've had a vaginal birth before.

What are the vacuum delivery risks to baby?

The usual effect is a swelling on the head called a chignon, which KKH says is usually gone after 24 hours, and sometimes grazes on the scalp. The RCOG says a bruise under the scalp affects 1 to 12 in 100 babies and clears with time. KKH says bleeding into the brain is uncommon, at five to 15 in 10,000 babies after an assisted birth.

How long does forceps delivery recovery take?

KKH says a perineal tear usually heals in two to three weeks, and the average hospital stay after a vaginal birth is 24 to 36 hours. The RCOG notes you may stay longer than planned after an assisted birth. Your postnatal review is the time to raise leaking, pain or worries about the birth.

Is instrumental delivery the same as ventouse delivery?

Not quite. Instrumental delivery covers both forceps and vacuum births. Ventouse is another name for the vacuum cup, used by SGH and UK hospitals, so a ventouse delivery is one kind of instrumental delivery.

Can I refuse forceps or a vacuum and ask for a caesarean?

You'll be asked for your consent first, so you can say no. The RCOG says the other choices in labour are to wait or to have an emergency caesarean. It adds that a caesarean late in labour is a more complex operation than a planned one. The KKH doctors' guide says it may be riskier at that stage. If you feel strongly, raise it with your gynae during pregnancy.