Recovering after instrumental birth

Overview

Instrumental birth (also called assisted vaginal birth) is when a doctor or midwife uses a tool like a vacuum cup or forceps to help guide your baby out during the final stage of labour. Recovery after this type of birth focuses on healing from any tears, swelling, or soreness in the vaginal area, and getting your strength back.

Yes, about 1 in 8 births in the UK involve an instrumental delivery (also called an assisted vaginal birth).

It affects women who have given birth vaginally with the help of forceps or a vacuum cup. It can also involve a cut to the vaginal opening (episiotomy) or a tear that needs stitches.

Symptoms

Common symptoms

• Soreness or pain in the vaginal area (perineum)
• Bruising or swelling around the vagina or anus
• Stitches from an episiotomy (a small cut) or a tear
• Discomfort when sitting or walking
• Light bleeding (lochia) – this is normal and can last up to 6 weeks
• Trouble passing urine or bowel movements at first
• Feeling tired or emotional

Symptoms in children

• This section does not apply – instrumental birth is a delivery method for the mother, not a condition in children.

Symptoms in older adults

• This section does not apply – instrumental birth only happens during childbirth.

Causes

Main causes

• Instrumental birth is performed when labour is not progressing and the baby needs to be born quickly.
• Common reasons include: the baby showing signs of distress (like an abnormal heart rate), prolonged pushing stage, or the mother being too tired to push effectively.
• The tools used are: ventouse (vacuum cup) or forceps (like large spoons) to gently guide the baby out.

Risk factors

• Having a long or difficult labour
• Having epidural anaesthesia (which can weaken pushing effort)
• Baby being in an awkward position (e.g., facing backwards)
• Baby being larger than average
• Mother being very tired or having an underlying medical condition that affects pushing

When to see a doctor

See a doctor urgently if:

• If you have very heavy bleeding or large clots
• If you have severe pain that does not improve
• If you have a fever or chills

Book a routine appointment if:

• If your stitches are painful, red, or leaking fluid
• If you have ongoing trouble passing urine or stool
• If you feel very sad, anxious, or overwhelmed (this could be a sign of postpartum depression)

Diagnosis

Recovery after instrumental birth is not a diagnosis – it is a period of healing. Your healthcare provider will check your perineal area (the area between your vagina and anus) for tears, stitches, and healing. They will also ask about your symptoms.

Tests that may be done

• Your healthcare provider will look at your stitches and the surrounding area to check for infection or poor healing.
• They may check your temperature and pulse to rule out infection.
• They might ask about your pain, bleeding, and how you are managing with peeing and pooing.

What to expect at your appointment

You will be offered a check-up in the first week after birth, either at home or at a clinic. Your midwife or doctor will ask how you are feeling, look at your stitches, and give you advice on self-care. They will also check your emotional wellbeing.

Treatment

Treatment focuses on helping you heal and manage any discomfort. Most of the healing happens naturally with time. Your healthcare provider will give you advice on pain relief, wound care, and when you can resume normal activities.

Self-care at home

• Keep the area clean and dry – gently wash with warm water after using the toilet and pat dry.
• Change your sanitary pads regularly (at least every 4-6 hours) to prevent infection.
• Apply ice packs wrapped in a cloth to the perineum for 10-15 minutes several times a day to reduce swelling (do not put ice directly on the skin).
• Use a cushion or a soft pillow when sitting to relieve pressure on sore areas.
• Take pain relief as recommended by your midwife or doctor (common options are paracetamol or ibuprofen – always follow the instructions on the packet).
• Drink plenty of water and eat fibre-rich foods (like fruits, vegetables, and whole grains) to prevent constipation.
• Rest as much as you can – your body needs time to recover.

Medical treatments

Your healthcare provider may prescribe pain relief or recommend over-the-counter medications (like paracetamol or ibuprofen) to help with soreness. They may also prescribe stool softeners if you are constipated. If you have an infection, you may be given antibiotics. Always take any prescribed medicine as directed and finish the full course.

When is surgery considered?

Surgery is rarely needed after instrumental birth. However, if you have a severe tear or an episiotomy that does not heal properly, you may need a procedure called a perineal repair (stitches) under local anaesthetic. In rare cases, if bladder or bowel problems persist, further surgery might be discussed with a specialist.

Living with this condition

In the first weeks, take it easy. Ask for help with the baby and household tasks. Use a squirt bottle of warm water to clean the area after toileting. Wear loose, breathable cotton underwear. Do not lift anything heavy until your stitches have healed and you feel ready.

Lifestyle tips

• Avoid sexual intercourse until you feel comfortable and your healthcare provider confirms healing – usually at least 4-6 weeks.
• Do not use tampons or menstrual cups until bleeding has stopped (usually 4-6 weeks after birth).
• Start gentle walking as soon as you feel able – but do not overdo it.
• Avoid heavy exercise or lifting for the first few weeks.

Diet and exercise

Eat a balanced diet with plenty of fibre to prevent constipation. Drink plenty of water. Gentle walking is good for circulation and mood. Kegel exercises (pelvic floor exercises) can help strengthen the muscles that were stretched during birth – check with your midwife or a physiotherapist for guidance on when to start.

Mental health and emotional wellbeing

It is very common to feel emotional, tearful, or anxious after an instrumental birth. You may feel disappointed or worried about the experience. These feelings are normal, but if they last more than two weeks or make it hard to care for yourself or your baby, talk to your midwife or doctor. They can offer support and connect you with counselling services.

Prevention

Not always – sometimes instrumental birth is necessary for the safety of the mother or baby. However, you can reduce the risk of complications by staying healthy during pregnancy, attending all antenatal appointments, and discussing any concerns with your midwife or doctor. Having a clear birth plan may help you feel more prepared, but remember that plans can change.

Vaccines

This does not apply to recovering after instrumental birth.

Screening programmes

After giving birth, you will be offered a postnatal check-up at about 6 weeks. This is a good time to discuss any ongoing issues with your recovery.

Complications

If left untreated

• Infection in the perineal area (the area between the vagina and anus) – signs include redness, swelling, pus, or fever
• Poor healing of stitches – they may open up or become very painful
• Long-term pain or discomfort in the pelvic area
• Difficulty controlling urine (urinary incontinence) or stool (bowel incontinence)
• Pain during sexual intercourse

Long-term outlook

Most women recover fully from instrumental birth within a few weeks to a couple of months. With rest, good wound care, and gentle exercise, the vast majority have no long-term problems. If you do have ongoing issues, treatment is available and effective. Your healthcare provider is there to support you every step of the way.

Find support

International organisations

• World Health Organization (WHO) – Maternal health
• The International Childbirth Initiative (ICI)

Local organisations

• NHS – Your local maternity service or health visitor · UK
• The Association for Improvements in the Maternity Services (AIMS) · UK

Helplines

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