Introduction
Operative vaginal delivery uses forceps or a vacuum extractor (ventouse) to deliver the baby in the second stage. It is done in about 10–15% of births.
Indications
- Fetal: suspected fetal compromise in the second stage.
- Maternal: prolonged second stage, exhaustion, need to avoid pushing (heart disease, severe hypertension, cerebral aneurysm, myasthenia).
- Forceps also for the after-coming head of a breech.
Prerequisites (all must be met)
- Cervix fully dilated and membranes ruptured.
- Head engaged: no more than one-fifth palpable abdominally, station at or below the ischial spines.
- Position of the head known exactly.
- Adequate pelvis, no obvious disproportion.
- Bladder emptied, adequate analgesia (epidural or pudendal block), consent.
- An experienced operator and a plan to abandon (move to caesarean) if it fails.
Classification by station
- Outlet: scalp visible at the introitus; low: station +2 or below; mid: head engaged but above +2. Instruments are not used for a high (unengaged) head.
Safety rules
- Abandon if there is no descent with each pull or no delivery after 3 pulls (vacuum) or if the cup detaches repeatedly.
- Avoid sequential use of instruments if possible (more fetal injury).
- Mediolateral episiotomy is advised with forceps; examine for tears; consider a single dose of antibiotic.
- Inform the neonatal team; document fully.
No instrument without a fully dilated cervix and an engaged head whose position you know.