Un assisted delivery consists of using obstetric instruments to speed up and facilitate theexpulsion of the baby by natural means. This is the case for around 15% of births in France. There are three types of obstetric instruments:

• la obstetric suction cup (also called vacuum extractor): it consists of a metal or silicone cup of different diameters, connected to a device allowing vacuum suction of the cup.
• le forceps : these are two large metal “spoons” joined together and articulated in the middle. Thus forming a clamp, the forceps is intended to grip the baby’s head during childbirth to facilitate its expulsion, while the baby is still in the mother’s birth canal.
• the spatulas : these are also two metal spoons to facilitate the descent of the baby, but each is independent of each other.

The obstetrician uses an assisted delivery when the cervix is fully dilated, the bag of water is ruptured, that the baby presents itself through the head and the latter is engaged in the pelvis, but when a rapid extraction is necessary:

• le heartbeat changes in the baby (abnormal fetal heart rhythm)
• the baby is not making enough progress
• the mother’s efforts to expel the baby are not enough
• the mother is exhausted
• the expulsion of the baby takes more than 30 minutes, while the pushing efforts are intense
• the baby does not appear in a physiological position (torsion, etc.) and must be “reoriented”

aThe obstetric suction cup

The obstetrician places the suction cup at the level of the baby’s occipital bone (also called the occiput; the posterior and lower part of the head). This allows a gentle suction as the mother pushes to expel the baby. The application time should be less than 20 minutes.

Using the suction cup can cause a bruise to appear on the baby’s scalp or a lump, which will disappear spontaneously in just a few days. 

The forceps

After lubrication, each spoon is placed on either side of the baby’s head, on his temples, while the baby is still in the mother’s birth canal. With each contraction and push, the obstetrician performs pulling movements to help lower the baby.

Note that a episiotomy (= incision of the perineum) facilitates the entry of the forceps.

Marks usually appear on the baby’s temples but they resolve spontaneously within a few days. In the mother, the use of forceps increases the risk of tearing the cervix, lesions in the vulva or vagina, as well as perineal tear (this is why episiotomy is most often necessary).

Spatulas

The obstetrician places the two handles of the spatulas against the vaginal walls and the soft parts of the pelvic region. The maternal tissues are separated and the control of the descent of the baby is thus facilitated. Spatulas are also used to orient the baby’s head in the correct direction.

Note that the use of these obstetric instruments takes place under epidural anesthesia.

If the use of obstetric instruments is not enough to expel the baby, if there is a risk for the mother and / or the baby, the medical team can perform a cesarean section to ensure the rapid exit of the baby.