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Ventouse or forceps

Ventouse or forceps

Pregnant woman in hospital bed covered by a sheet while healthcare professionals assist with birth In some cases your doctor may recommend assisting the birth of your baby by using either a ventouse or forceps. This may occur where the second stage of labour (the pushing stage) is longer than expected, where your baby’s head is not in the best position to come through the birth canal or if there are changes to his/her heartbeat meaning that birth needs to happen as soon as possible. A ventouse is a metal or plastic suction cup that is placed on your baby’s head. Forceps are curved metal tongs that are placed around your baby’s head. You will be offered pain relief for an assisted vaginal birth, with either local anaesthetic or an epidural. The birth will be managed by your doctor. Your midwife will be present to help and support you. Your doctor will gently pull using the ventouse or forceps whilst you push during your contractions. Sometimes several pulls are needed, or if one method doesn’t work, the other may be tried. You are more likely to need an episiotomy, particularly if forceps are used. In rare circumstances, if neither ventouse or forceps successfully deliver your baby, a caesarean birth might be recommended.
What’s involved in assisted birth?
Ventouse and forceps More on ventouse and forceps
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Episiotomy

Episiotomy

New born baby lies on the mother's chest while the umbilical cord is cut An episiotomy is a cut that is made (with your consent) to the perineum (the area between your vagina and your rectum) to assist in the birth of your baby. Your midwife or doctor may recommend this if:
  • your baby’s heartbeat suggests that he or she needs to be born as quickly as possible.
  • if you are having an assisted birth; or
  • if there is a high risk of a serious tear affecting your rectum. An episiotomy is repaired using dissolvable stitches and normally heals within a month of birth.
Episiotomy
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Oxytocin (known as synth or syntocinon)

Oxytocin (known as synto or syntocinon)

Close up of a woman's arm receiving oxytocin via cannula while connected to a fetal monitoring machineOxytocin is the naturally occurring hormone that causes your womb to have contractions. If your contractions slow down, or are not effective in causing the cervix to dilate, it may be recommended that you have a synthetic oxytocin drip which is given in small amounts directly into a vein via a cannula. Oxytocin makes contractions stronger and more regular. If you have an oxytocin drip, close monitoring of you and your baby (using continuous electronic fetal monitoring, sometimes called cardiotocograph or CTG) is recommended.
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Breaking your waters (amniotomy)

Breaking your waters (amniotomy)

Pregnant woman reclines on a hospital bed holding her bump Before, or during labour your waters will normally break at some point (although sometimes they don’t – and some babies are born in their amniotic sac). If your labour seems to have slowed down or there are concerns about your baby’s wellbeing, your midwife might recommend breaking your waters. This is done during a routine vaginal examination, it does not hurt your baby, and has been shown to sometimes reduce the length of labour. If you think your waters have broken it is important to call your maternity Triage/assessment unit straight away, particularly if you think you can see meconium, which is green or brown in colour. If you are less than 37 weeks pregnant this may be a sign of premature labour.
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Induction of labour: Frequently asked questions

Induction of labour: Frequently asked questions

Smiling pregnant woman holds her bump while talking to a midwife

Do I have to have an induction?

Your midwife/doctor will explain why induction has been recommended for you and your baby, including the risks and benefits of having it at the time advised, versus waiting. If you choose not to have the induction, or to postpone it, you may be offered additional monitoring to observe you and your baby’s wellbeing.

How long can induction take?

Induction can take anything from a few hours to a few days. Bring plenty of things to distract you, as there can be a lot of waiting whilst the medications start to work.

What if the induction does not work?

If the induction is unsuccessful your midwife and doctor will discuss your options with you. These options may include waiting, trying something else or a caesarean section.

Is induction painful?

Vaginal examinations may be uncomfortable but should not be painful. It is felt that induced labour (particularly with a oxytocin drip) can be more painful than natural labour. You can discuss your options for pain relief with your midwife at every stage of the induction process. National guidance includes offering an epidural for pain relief prior to commencing, oxytocin (the artificial hormone), to augment (increase) contractions.
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How is labour induced?

How is labour induced?

Close up of a medical drip Around 30% of women are recommended an induction of labour for various reasons. Depending on assessments done throughout your pregnancy, you may be offered an induction. To enable you to make a fully informed decision, your midwife or obstetrician will provide you with information regarding the risks and benefits of induction. They will discuss the different methods of induction and suggest which may be best based on your personal circumstances. Considering the different methods will enable you to advise your healthcare professional of your preference. When you come into the maternity unit for your induction, a midwife will undertake a full assessment of you and your baby. This will include electronic monitoring (CTG) of your baby’s heartbeat and any contractions that you may be having. Your midwife will assess your cervix by undertaking a vaginal examination. You will have plenty of time to ask any questions, and your midwife will take you through your options and what to expect in detail. Some people may need only one of the steps below, and others will need a combination to go into active labour (4cm dilated with strong, regular contractions). Induction may be a long process which can be frustrating, however the aim is to mimic the body’s natural process in the best way possible.

Step 1 – Preparing (“ripening”) your cervix

Many find that their cervix is not quite ‘ready’ for labour yet. In that case, a step is necessary to ‘ripen’ your cervix to prepare it for labour. The aim of this step is not to start active labour, but to open your cervix enough to break your waters, ready for active labour to be induced. The different induction of labour options are listed below. Your hospital may only offer one method, or they may give you a choice. Depending on your circumstances, you may be able to go home for a period of time during your induction. Some people may not experience any changes during ripening and for others, it may be enough to start active labour. You may need more than one ‘round’ before your waters can be broken, in which case you may be offered more than one method one after the other. The order they are offered may vary between hospitals.

Option 1 – Mechanical methods

There are two mechanical methods available, which do not contain any drugs (artificial hormone). They help to promote your body’s natural initiation of labour – they won’t start contractions artificially and side effects are less likely. Some hospitals may allow you to go home with these methods.

Dilapan-S

This is a thin dilator that absorbs fluid from your cervix to gradually expand in diameter, helping to dilate your cervix and change its consistency for labour. The dilators remain in place for 12-24 hours and help your body release natural hormones associated with labour. Most people experience minimal pain during the process, and it doesn’t extend outside of the vagina, so you will be encouraged to relax or to go about your usual daily activities to help prepare your body. More information about: Dilapan-S.

Balloon catheter

This is a small balloon which is inserted into the cervix and inflated with water. By putting pressure on the cervix, it encourages the release of your natural hormones and dilation. The balloon catheter remains in for 12-24 hours to stretch and soften the cervix in preparation for labour. The catheter tube will be taped to your leg during that time to keep it in place.

Option 2– Medicinal Methods

Prostaglandins are medicines that use an artificial hormone to help ripen the cervix. There are two options available; a gel or a pessary that are inserted just behind your cervix. The gel works over 6 hours, while the pessary is released slowly over 24 hours. If you and your baby are responding well, some units may allow you to return home during this time, however, as with all medicines, side effects are possible, so your doctors may prefer to keep you in for continued monitoring. Cramps and pain can be common with prostaglandin methods, and your midwife will be able to discuss pain relief options with you.

Step 2 – Breaking your waters

Amniotomy

Some people (particularly those who have had a baby before) may be told that their cervix is favourable for an amniotomy or ‘ARM’. This where your waters are broken artificially. A midwife will insert a small sterile hook into the vagina to make a hole in the bag of waters that surrounds your baby. After the waters are broken, labour may start on its own. Your waters will continue to drain from the vagina for the duration of your labour.

Step 3 – Helping with your contractions

Oxytocin drip

A hormone called oxytocin may be offered to those who do not progress into active labour. Oxytocin is given continuously in small amounts until your baby is born. It is given directly into a vein through a cannula inserted into your hand or arm. The oxytocin aims to stimulate contractions and progress your labour. A midwife will be caring for you and your baby closely throughout your labour.
Understanding induction of labour – a video developed by clinicians, women and a local hospital charity in North West London.
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Why might I be offered an induction of labour?

Why might I be offered an induction of labour?

Pregnant woman in discussion with healthcare professional
  • you are overdue or post-dates, meaning that your baby has not been born yet and you are at least 10-13 days past your due date. This is the most common reason for induction
  • your medical history suggests an earlier birth would be safer for you or your baby
  • there are concerns with the wellbeing of your baby, meaning that it would be safer for them to born sooner than to wait for labour to start naturally
  • your waters have broken and labour has not started naturally.