Day of instrumental birth

Overview

Instrumental birth is when a doctor uses a special tool, like forceps (tongs) or a vacuum cup, to help deliver a baby during vaginal childbirth. It is done when the baby needs a little extra help to be born or when the mother is too tired to push.

About one in eight births in the UK involve an instrumental delivery. It is a routine procedure in maternity care.

Instrumental birth can affect any pregnant woman who needs help during the pushing stage of labour. It is more common in first-time mothers, those with an epidural, or when the baby is larger than average.

Symptoms

Common symptoms

• Strong contractions and the urge to push
• Feeling of pressure in the pelvis
• Pain or discomfort in the lower back and abdomen

Symptoms in children

• This topic does not apply to children. Instrumental birth is for the mother during delivery.

Symptoms in older adults

• This topic does not apply to older adults. Instrumental birth only occurs during childbirth.

Causes

Main causes

• The baby is in a difficult position (e.g., facing the wrong way)
• The mother is exhausted and cannot push effectively
• The baby's heart rate shows signs of distress and needs to be born quickly

Risk factors

• Having an epidural for pain relief
• Long labour (especially the pushing stage)
• Large baby (over 4 kg or 8.8 lbs)
• First-time mother
• Induced labour

When to see a doctor

See a doctor urgently if:

• If you have severe pain or heavy bleeding after the birth
• If you feel faint or dizzy
• If you have a high temperature or chills

Book a routine appointment if:

• Attend all postnatal check-ups with your midwife or doctor
• If you have any concerns about your recovery or your baby's health

Diagnosis

During labour, your midwife or doctor will assess your progress. If the second stage (pushing) is taking too long or if the baby shows signs of distress, they may decide that instrumental delivery is needed. They will check the baby's position and your cervix.

Tests that may be done

• Continuous monitoring of the baby's heart rate (CTG)
• Internal examination to check the baby's position and how far down they are
• Assessment of your contractions and your ability to push

What to expect at your appointment

You will be asked for your consent. The doctor will explain what they are going to do. You may be given extra pain relief, such as an epidural or spinal block. The procedure is done during a contraction. You may feel pressure but usually not sharp pain.

Treatment

The doctor uses forceps or a vacuum cup to gently guide the baby out during a contraction. You will be asked to push at the same time. The whole process usually takes just a few minutes.

Self-care at home

• Use breathing techniques to stay calm during contractions
• Rest between contractions when possible
• Follow your midwife's guidance on positions to help the baby move down

Medical treatments

Pain relief options include an epidural, spinal block, or local anaesthetic. If needed, the doctor may make a small cut (episiotomy) to help the baby come out. The doctor will monitor the baby's heart rate continuously. If the instrumental delivery does not work, a caesarean section may be necessary.

When is surgery considered?

If the instrumental birth is not successful or if there is an emergency, a caesarean section (C-section) may be performed.

Living with this condition

Most women recover well within a few days. You may have some soreness around the vagina or perineum (the area between the vagina and anus). It is important to rest and ask for help with household tasks and looking after your baby.

Lifestyle tips

• Avoid heavy lifting or strenuous exercise for at least a week
• Take pain relief as recommended by your doctor (paracetamol or ibuprofen are common over-the-counter options – always check with your pharmacist or doctor first)
• Use a cold pack or warm bath to soothe soreness

Diet and exercise

Eat a balanced diet with plenty of fibre to prevent constipation, which can strain the perineum. Gentle walking is fine, but avoid running or gym workouts until your doctor says it is safe.

Mental health and emotional wellbeing

Some women feel upset, disappointed, or anxious after an instrumental birth. These feelings are common. Talk to your midwife, partner or a trusted friend. If you feel very low, tearful, or unable to bond with your baby, please contact your healthcare provider. If you are in crisis or need urgent mental health support, contact your local crisis team or call your country's emergency number (e.g., 999 in the UK).

Prevention

Not all instrumental births can be prevented. However, staying active in labour (changing positions, walking) and having continuous support from a partner or doula may reduce the chance. Your healthcare team will only recommend instrumental delivery if it is necessary for your or your baby's safety.

Vaccines

Vaccines are not related to preventing instrumental birth.

Screening programmes

Routine antenatal checks and ultrasounds help identify factors like baby's size or position that may increase the need for instrumental delivery. Your midwife will discuss these with you.

Complications

If left untreated

• If instrumental birth is needed and not done, the labour may be prolonged, leading to exhaustion or infection
• The baby could experience distress or lack of oxygen
• Severe tears to the vagina or perineum may occur if the birth is not assisted

Long-term outlook

Instrumental birth is a safe and effective way to help babies be born when they need a little extra help. Most mothers recover well and have healthy babies. Complications are rare. With good care and support, you can expect to feel better within a few weeks.

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