Birth injury series - assisted or instrumental delivery

3 July 2015

Babies cannot always be delivered through the birth canal without assistance from medical staff and sometimes medical instruments or tools will be needed to help the baby to come out. Forceps or ventouse can be used to achieve delivery in the second stage of labour, when the baby is ready to be born and the cervix (vaginal opening) is fully dilated.

An instrumental delivery may be needed after a very long labour or when the mother is too exhausted to be able to push her baby out during contractions in the second stage. A spinal epidural can also result in the mother not being able to “push” when required.

Sometimes the baby will have been identified as becoming distressed (with an abnormal heart rate), or the head is in an unusual position. When any of these events arise delivery may need to be achieved quickly to ensure the safety of mother and child. A caesarean section may not always be possible or the safest option at this stage and an instrumental delivery may be needed.

Which instrument is used depends on a number of factors including the baby’s age, the position in which the baby is lying and how difficult the doctor thinks the birth will be. An episiotomy or cut of the mother’s perineum (the area between the vaginal opening and the anus) may sometimes be required just before the ventouse or forceps are applied, but not always. This is to enlarge the vaginal opening to assist the delivery.


This is an instrument which uses a suction cup and suction device. The cup (which is usually made of soft or semi rigid plastic) attaches to the baby’s head. The cup fits on to the top and towards the back of the baby’s head and as the contractions come the suction device can help to pull the baby gently out.

A ventouse delivery is not recommended if the baby is less than 34 weeks (as the skull will be too soft to cope with the vacuum), if the birth is breech (with the baby’s bottom or feet first in the pelvis), or if the baby is lying face first).


This is a curved tong like instrument (a bit like stainless steel salad servers) which is positioned and closed carefully around the baby’s head, usually after an episiotomy is performed. The baby can then be gently turned/rotated into the correct position and delivered safely. Again, as contractions happen, the baby can be gently delivered from the mother.

The doctor will aim for the baby to move down and be delivered within three contractions. If birth is not achieved within three contractions and pulls of the forceps then the forceps delivery will be stopped and a caesarean section may be needed.

These procedures will usually be possible in the delivery room, but if the doctor thinks that the assisted birth may still be difficult, or there are other complications then a mother may be moved to an operating theatre.

It is very important that the appropriate level of force is used during an instrumental delivery to ensure that the baby’s head and neck are not damaged by the instrument. Care also needs to be taken to ensure the mother does not sustain unnecessary injuries. If a ventouse delivery is tried first and is unsuccessful then it may be possible to also try forceps but using different instruments, one after the other, may also increase the risk of injury to the mother and baby.

Babies born with the help of ventouse will frequently be left with a temporary swelling of the head, and with forceps redness and bruising can also occur to the face. This does not usually result in any form of permanent injury. Spinal injuries can also be caused if forceps are used incorrectly.

However, facial, skull and nerve damage can occur when inappropriate force is used and inter-cranial haemorrhage (bleeding in the brain) can arise. A ventouse delivery can also result in bleeding inside the eye (retinal haemorrhage).

Too much force, or poorly applied instruments, can result in a child suffering permanent brain damage and/or cerebral palsy.

This article first appeared in At Home Magazine. 

Further information

For more information, please visit our page on Cerebral Palsy and Birth Injury. You may also be interested in reading some of our other blogs on this topic, including; 

Kingsley Napley is experienced in acting in clinical negligence claims relating birth injuries. If you would like advice, please contact the Clinical Negligence and Personal Injury team on 020 7814 1200 or by emailing us at

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