Obstetrics: forceps and aspirator

What is Obstetrics?

In about eight percent of all cases, a baby in Germany needs help at birth (Hopp). Obstetrics (sometimes referred to as vaginal-operative delivery) use instruments (either forceps or, significantly more commonly, suction cups) that are applied to your baby's head so that it can be pulled out.

What are forceps and suction cup?

Forceps are sometimes described as ""stainless steel salad servers"" or ""big sugar tongs"". They go over into two overlapping parts and have curved ends to hold your baby's head. There are many different types of forceps.

The suction cup or vacuum extractor consists of a bowl connected to a small vacuum pump and a handle for pulling. The bowl is adjusted on top of your baby's head and back of the head.

There are several types of suction cups:

  • soft plastic cups that will not easily cause injury to your baby's head, but will slip off more easily
  • semi-rigid plastic cups that have the greatest success rate
  • Metal cups that do not Slipping off easily like the soft bowls, but more likely to injure your baby's scalp (Enkin et al 2000: 399-400; Johanson and Menon ; 2000)

Which bowl is used may depend on your baby's location and how difficult is your doctor's assessment of birth (Johanson and Menon , O'Mahony et al 2005).

Why do I need midwifery?

Your midwife and doctor will consider giving birth with forceps or a suction cup if:
  • your baby is in need during pressing
  • you are tired and unable to squeeze
  • Your baby is not progressing through your pelvis
  • There is a medical reason why you should not press too long (for example, if you have a heart condition) (RCOG 2005: 3).

Forceps may also be used in vaginal breech birth (RCOG 2005: 4; RCOG 2006: 7). Your baby's body is born. When head trouble occurs, forceps are used as birth aids (Baker 2006: 265).

Is it possible to avoid midwifery?

It is not always possible to avoid obstetrics, but the following factors can help reduce the risk. These are:
  • You have constant support from a birthing partner or midwife during labor
  • You remain upright during labor
  • You avoid epidural anesthesia
  • If you have received epidural anesthesia, you should consult with Wait at least one hour for the squeezing to fully open the cervix or until you feel the urge to squeeze (RCOG 2005: 2).

What happens before obstetrics?

Your doctor will explain why he thinks you need midwifery. He examines you internally and determines if your baby is in a good position for midwifery, and then decides which instrument to use.

If your doctor thinks that obstetric care is possible but could be difficult, it may be decided to have a caesarean section. You need to put your legs in stirrups or a bracket on both sides of your bed. The end of the bed is removed and your legs are covered with sterile towels.

A thin tube (catheter) connected to a pouch is likely to be led into your bladder to empty it. (This procedure can be a little uncomfortable) (RCOG 2007). You get a painkiller, maybe an injection into the vagina, or an epidural or spinal anesthetic.

A pediatrician may be called to the delivery room. This is common in such cases. So do not worry.

What happens during a birth of a pacifier?

Many physicians prefer a suction cup or a vacuum extraction device because it is less painful for you during and after birth (Fitzpatrick et al 2003, Johanson and Menon , Enkin et al 2000: 400) as a forceps delivery. The risk of damaging your bladder or bowel function is lower than with forceps. You probably need an episiotomy (RCOG 2007).

The bowl of the suction cup is placed near the top of your baby's head and not around it, so less space is needed for the instrument.

A doctor or specially trained midwife puts the bowl of the suction cup on the head of your baby inside the vagina. Then the air is sucked out with a vacuum pump controlled by hands or feet. This can be loud, so be prepared.

If the shell is fixed, your doctor will ask you to squeeze the next pain. He pulls on the shell to help your baby out. If your baby does not move forward every time you pull, or is not born after the third woe / third pull, then the suction cup should no longer be used (RCOG 2005: 7).

If the cup did not work, an experienced physician may try a forceps delivery before deciding to have a caesarean section (RCOG 2005: 8). However, using different instruments may increase the risk of injury to your baby (RCOG 2005: 8).

What happens with a forceps delivery?

Your doctor will make a perineal incision to enlarge the opening so that the forceps can be placed on either side of your baby's head.

When the forceps are placed, your doctor gently pulls during a pains to help your baby slip through the birth canal and into the world.If your baby does not move every time she pulls or is not born after several labor pains, doctors will decide if and when a caesarean section is needed.

Pincer births are more painful and unpleasant. Therefore, you are more likely to require local anesthesia for a forceps delivery than for a suction cup birth (Johanson and Menon ). Forceps have a greater success rate than suction cups, but the risk of injury to your pelvic floor or perineum is greater for a forceps delivery than for a suction cup birth (Johanson and Menon ).

An experienced medical professional is unlikely to hurt you during this procedure and will be able to use the instrument that is right for your particular case (RCOG 2005: 5-8).

Understanding the Process of Birth

If you had obstetrics, you should understand the reasons why it was necessary (RCOG 2005: 9-10). Ideally, discuss this with your doctor or midwife who was there. Otherwise it might happen that you are worried about the next child. Eight out of ten women who have had obstetric care will have a normal birth the next time (RCOG 2005: 10). If you have just had midwifery, read our postpartum article for more information.

Sources

Hopp, Hartmut, Clinic for Obstetrics of the Charité / Berlin, www. Academus. de / cme [accessed May 2011]

Baker PN. ed. 2006.

Obstetrics by ten teachers. 18th edition. London: Hodder Arnold. Enkin M, Keirse MJNC, Neilson J, et al. 2000.

A guide to effective care in pregnancy and childbirth. 3rd edition. Oxford: Oxford University Press. www. childbirth connection. org [accessed May 2011] Fitzpatrick M, Behan M, O'Connell PR, et al. 2003. Randomized clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery.

BJOG 110 (4): 424-9. Johanson RB, Menon V. . Vacuum extraction versus forceps for assisted vaginal delivery.

Cochrane Database of Systematic Reviews Issue 2. Art. : CD000224. www. mrw. inter science. wiley. com [accessed May 2011] Johanson R, Menon V. 2000. Soft versus rigid vacuum extractor cups for assisted vaginal delivery.

Cochrane Database of Systematic Reviews Issue 2. Art. : CD000446. www. mrw. inter science. wiley. com [called in May 2011] Johanson RB, Heycock E, Carter J, et al . Maternal and child health after assisted vaginal delivery: five-year follow up of a randomized controlled comparing forceps and ventouse.

Br J Obstet Gynaecol 106 (6): 544-9. Macleod M, Strachan B, Bahl R, et al. 2008. A prospective cohort study of maternal and neonatal morbidity in relation to episiotomy at operative vaginal delivery.

BJOG 115 (13): 1688-94. Midir. 2008a. Fashion of delivery and events around the second stage of labor.

MIDIRS Informed Choice - for professionals 16. Midir. 2008b. Health and care after childbirth.

MIDIRS Informed Choice - for professionals 15. O'Mahony F, Hofmeyr GJ, Menon V. 2005. Instruments for assisted vaginal delivery. (Protocol)

Cochrane Database of Systematic Reviews Issue 3. Art. : CD005455. www. mrw. inter science. wiley. com [accessed in May 2011] RCOG. 2005.

Operative vaginal delivery. Royal College of Obstetricians and Gynecologists. Green-Top Guideline, 26th London: RCOG press. www. rcog. org. uk [pdf file; called in May 2011]

RCOG. 2006.

The management of breech presentation. Royal College of Obstetricians and Gynecologists. Green Top Guideline, 20b. London: RCOG press. www. rcog. org. uk [pdf file; called in May 2011] RCOG. 2007.

An assisted birth (operative vaginal delivery): information for you. Royal College of Obstetricians and Gynecologists www. rcog. org. uk [accessed in May 2011] Show sources Hide sources

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