FAQ - Instrumental Vaginal Delivery

Instrumental Vaginal Delivery

Though most of the patients deliver vaginally normally, few (2% to 5%) may require assistance to complete the process of delivery from below. This is done in the interest of the mother & her baby. This also avoids caesarean section in a few cases. There are basically 3 ways in which pt. can be assisted to deliver vaginally.

(1) Fundal Pressure : Criticised by few, it is one way to help the patient when she is about to deliver. Here manual pressure is given on the top of the uterus while uterus is contracting so that the patient is helped to push her baby down. It is a very gentle push, not brutal but at the same time can be very effective.

(2) Forceps : Here a pair of blades called forceps are applied around the baby’s head very gently & carefully when it is low down near introitus. Then during uterine contraction (next pain) baby is pulled down. Such 2-4 pulls may be required for a successful delivery from below. It is preformed under local anaesthesia. It is a minor but very skillful operation.

Risk : Rarely it may give rise to trauma to baby’s head / brain. Sometimes baby may take slightly longer time to cry. In mother it can give rise to extension of cut given on perineum. Rarely little extra blood -loss may take place, very rarely mouth of the uterus may be torn.

 (3) Ventouse : A 4 to 6 cm. diameter small cup (plastic or metallic) is applied on the baby’s head Little amount of negative pressure is created in the cup with the help of a machine. & then pull is given in downward direction during uterine contraction. This pulls down baby’s head with least complication to mother or baby.

Risk : Small swelling on the baby’s head may develope. Very rarely bleeding in the baby’s brain may occur. Risk to the mother is rarely laceration of the the mouth of uterus. Above three procedures are all minor. All of these require small cut on the mother’s perineum called episiotomy which facilitates delivery from below.

Why one has to undertake one of these procedures to complete vaginal delivery ? a) Here doctor’s intention is to deliver the baby from below. Labour has advanced quite a lot. Mouth of the uterus is completely open. Suddenly baby’s heart activity becomes irregular or heart rate increases / decreases suddenly. This indicates that baby is suffocating inside the uterus due to lack of oxygen / nutrients. Especially when the water around the baby becomes greenish - yellow in colour which is because the baby passes meconium i.e. stools in the uterine cavity. This can be very dangerous & can create lot of problems & complications to the baby. b) It can also be performed on those mothers who are exhausted a lot during delivery. They require help / assistance from below to push down the baby. (c) In few cases passage for the delivery is small & bit narrow (minor CPD). But otherwise the labour process has advanced quite a lot & little help in one of the above forms may deliver patient from below successfully. But always remember that these are the efforts on the part of the doctor to deliver patient from below with minimal risk to mother & baby. These efforts / techniques may fail sometimes & patient may require caesarean section.

 

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