Instrumental delivery
Sometimes the best available option, with its own costs.
If you are fully dilated and pushing but the baby needs help, forceps or a vacuum can be used instead of a cesarean.
Risks per current guidance include severe tears involving the anal sphincter, roughly six times more common with forceps and about twice as common with vacuum compared with spontaneous birth. Newborn bleeding inside the skull occurs in roughly 1 in 650 to 850 operative vaginal deliveries. Scalp swelling from a vacuum is found in 28% of babies when it is applied for more than five minutes.
Set against that, the alternative in this situation is usually a cesarean performed with the baby's head deep in the pelvis, which is the most difficult cesarean there is.
Fair questions in the moment"Which instrument and why that one?" "What happens if this does not work?" "Are we doing this in the room or in the operating room?" The last one matters: a trial of instrumental delivery in the operating room means a cesarean can follow immediately if needed.
Where this comes from:
225. American College of Obstetricians and Gynecologists. Operative vaginal birth. ACOG Practice Bulletin No. 219. Obstet Gynecol. 2020;135(4):e149-e159.
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