Assisted Vaginal Births
Assisted Vaginal Births
Jay Goldberg (Obstetrician/Gynecologist, Cedars-Sinai Medical Center) gives expert video advice on: What is an "assisted vaginal birth"?; What is an "episiotomy"?; What is a "forceps-assisted birth"? and more...
What is an "assisted vaginal birth"?
Assisted vaginal birth is necessitated when you become completely dilated and proceed to push, and for various reasons, whether it be maternal exhaustion, where you can't push anymore, or not adequately; fetal distress, where the baby is ready to come out, but mom's pushing efforts aren't allowing for that final delivery, and the baby is distressed; or sometimes other complications that your physician would discuss with you. During assisted vaginal birth the doctor assists in the vaginal delivery, either by using forceps or by using a vacuum extractor.
What is an "episiotomy"?
An episiotomy is an incision made by the physician in the perineum, or the area between the vagina and the anus, that will allow for more room. The episiotomy allows for the baby to have a little bit more room to pass through the vaginal canal. You need to discuss this with your physician as to whether or not episiotomy is commonplace in their practice or it's something that they don't do routinely. Most physicians don't do it routinely. They do it if the baby's in distress and they feel that that will expedite the delivery, or if the vaginal opening is so small that a tear is inevitable and a tear may be worse than the actual episiotomy.
What is a "forceps-assisted birth"?
A forceps assisted delivery is a delivery in which a physician will use a device called a forceps that will allow for guidance of the foetal head through the vaginal canal. Forceps aren't used as commonly nowadays, and graduating residents aren't trained in using them as frequently. You can have some physicians who are a little bit older that may feel very comfortable using them, and there are situations in which they can be used, but most deliveries nowadays will be assisted by a vacuum delivery.
What is a "vacuum-assisted birth"?
A vacuum-assisted birth is a delivery in which a small suction cup is placed on to the top of the baby's head and suction is applied to this instrument. Traction is also used as well as with maternal pushing efforts. Mom has to push just as hard as she was pushing before if not harder. The doctor can sometimes guide the baby under the pubic bone and allow for delivery. Most often, adequate application has to be performed and the device has to be used accurately, but with application of this pressure the baby can be brought under the pelvic bone and delivered successfully. If the instrument pops off it may be because the instrument wasn't applied appropriately, so it can be reapplied. If it pops off a second time then most times it is not recommended to apply it the third time. You have to trust your physician to a certain extent and if your physician feels that it popped off twice but it wasn't applied adequately then maybe a third time is okay. However, beyond a third time it's starting to become excessive and you have to wonder if it's popping off because the baby is just not fitting; it's not adequate to fit through the vaginal canal. Then, if the baby is not stressed you can resume pushing with hopes of getting the baby out, or you will have to consider another method of delivery such as a caesarean section.