Forceps and ventouse

Until very recently, most British hospitals used forceps far more frequently than ventouse, but the balance between the two methods is now shifting and if you have a preference for one over the other, you may be able to choose.

Forceps

Before they can be put round the baby’s head, the doctor needs to enlarge the opening from the vagina by cutting through the back wall into the perineum (the tissue between the back of the vagina and the rectum). If you have an epidural in place, you won’t feel the cut. If you haven’t, your midwife or doctor will inject some local anaesthetic into the perineum before making the cut.

The forceps come in two sections and the doctor gently places the first blade round the side of your baby’s head, and then the second blade round the other side. There is a mechanism to fix the forceps once they have been correctly placed so that they don’t slip. You are asked to push with your next contraction and the doctor pulls. You deliver the baby together.

After the birth

As soon as your baby is born, the forceps will be removed and the paediatrician will check the baby over. As long as your baby is in good health, he will be brought back to you immediately.

Risks to the baby

In general, babies born by forceps are fine. However there are, inevitably, some risks attached to bringing babies into the world in this way:

• The baby’s face may be bruised by the forceps
• Occasionally, there is some damage to the baby’s facial nerves. This is generally temporary and corrects itself within a few days
• Very rarely, the baby will suffer from a broken collar bone as a result of forceps delivery
• Parents sometimes say that babies born by forceps are demanding and difficult to comfort. Cranial osteopaths claim that a lot of their work is done with babies whose skull bones appear to have become misaligned as a result of forceps birth

Ventouse

It takes about seven minutes to apply enough suction to ensure that the cap is firmly attached. The doctor then pulls on the ventouse while the mother pushes in order to help the baby to be born.

After the birth

The procedure is the same as for forceps. The cap is removed from the baby’s head and, once the baby has been given the all clear by the paediatrician, he is quickly given back to his mother.

Risks

• The cap may not stick properly to the baby’s head and will need to be applied again, thus delaying delivery of the baby
• Sometimes, the cap keeps coming off and finally the baby has to be delivered by forceps
• Some babies develop a cephalhaematoma after a ventouse delivery. This is a blood blister which appears on one side or other of the midline of the baby’s skull. It affects only the scalp tissues and has nothing to do with the baby’s brain. The blister can take six to eight weeks to be reabsorbed.

Forceps

• The mother will require effective pain relief before the delivery is carried out
• The mother will have to have an episiotomy (a cut into the back of the vagina)
• There is a risk of damage to the mother’s vagina and bladder
• The baby may be bruised or may suffer minor nerve damage

Ventouse

• Pain relief may not be necessary as this is a less invasive procedure than forceps
• It may be possible to apply the cup to the baby’s head without cutting the vagina
• There is less risk of damage to the mother’s vagina and bladder
• The baby may have a cephalhaematoma (blood blister)
• In some cases (for instance where a baby is stuck and needs to be rotated inside the mother) ventouse may not be possible, and forceps will have to be used

Research suggests that for women, a ventouse delivery is a much gentler option than forceps. For babies, it doesn’t seem to make much difference - both forceps and ventouse deliveries carry small risks.